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Öğe Changes in Advanced Cardiac Life Support Applications in Adult Patient During COVID-19 Pandemia](Dokuz Eylul University, 2023) Doruker, N.Ç.; Korkmaz, F.D.; Akarca, F.K.The Coronavirus Disease-2019 (COVID-19), which was first seen in Wuhan, China and later declared a pandemic by the World Health Organization on March 11, 2020, spread all over the world in a short time. COVID-19 infection is currently the most important public health problem in the world. COVID-19 infection emerges as a systemic disease, not just a respiratory system disease. Cardiac involvement is one of them, and it gives clinical findings in a wide range from myocardial infarction to cardiac arrest. COVID-19 infection patients are at risk for cardiac arrest and the mortality rate of these patients is also high. The most important intervention in cardiac arrest is advanced cardiac life support, which includes a range of treatments and clinical applications, applied to save lives and provide emergency care. In advanced cardiac life support, aerosol emission occurs during many applications such as chest compression, positive pressure ventilation and airway support. Healthcare workers at risk for infection during advanced cardiac life support are even more at risk for COVID-19 infection patients. In this case, an adequate, effective and safe advanced cardiac life support will provide both an increase in survival rates and protection of healthcare workers from infection. This review includes current guideline recommendations for the provision of effective and safe advanced cardiac life support in adult patients with probable or confirmed COVID-19 infection. © 2023, Dokuz Eylul University. All rights reserved.Öğe COVID-19 Infection, Vaccination, and Antibody Levels: Investigating Correlations through a Cohort Study(Multidisciplinary Digital Publishing Institute (MDPI), 2023) Kayalı, G.A.; Durmaz, S.; Şahin, I.N.; Akkul, B.; Durusoy, R.; Akarca, F.K.; Ulukaya, S.Aim: The objective of this study was to explore the potential correlation between COVID-19 infection or vaccination and levels of anti-nucleocapsid (anti-N) and anti-spike (anti-S) antibodies. Methods: Among 6050 healthcare workers at the Ege University Hospital, a cohort study with 162 participants divided into three arms with 54 participants each was conducted. The three groups were selected as follows: those diagnosed with COVID-19 and not vaccinated (group 1), those diagnosed with COVID-19 and subsequently vaccinated with CoronaVac (group 2), and those not diagnosed with COVID-19 but vaccinated with two doses of CoronaVac (group 3). Antibody levels measured at the sixth month of follow-up were defined as the primary outcome. Results: At the sixth month, all serum samples tested positive for anti-S. Anti-S levels were found to be significantly higher in group 2 than in the other groups (p < 0.001). There were no differences in antibody levels between groups 1 and 3 (p = 0.080). Average antibody levels were found to be lower in office workers and males. Anti-N antibodies were found to be positive in 85.1% of subjects at the sixth month. In group 2, anti-N antibodies were detected in all samples at the sixth month. Anti-N antibody levels were not significantly different between groups 1 and 2 (p = 0.165). Groups 1 and 2 had significantly higher antibody levels than group 3 (p < 0.001). Conclusions: Vaccination or infection provide protection for at least 6 months. Those who have previously been diagnosed with COVID-19 do not need to be vaccinated in the early period before their antibody levels decrease. © 2023 by the authors.Öğe Effectiveness of ultrasonography performed at the emergency department for pediatric elbow trauma cases(Elsevier Ltd, 2023) Korgan, M.B.; Altunci, Y.A.; Uz, İ.; Akarca, F.K.Background: Two-way direct radiography is the first-choice imaging method for pediatric patients presenting to the emergency department with elbow trauma. Although, unlike radiography, ultrasonography (US) is not used routinely, studies show that US can be used in the diagnosis of fractures in pediatric patients. Methods: In this single-center prospective observational study, patients under the age of 18 who presented to the emergency department after sustaining elbow trauma constituted the population of the study. Findings of the posterior fat pad sign using bedside US and the result obtained by seven-point assessment of the bone cortex were compared with the final diagnosis. Results: Of the 128 patients enrolled in the study, 6 patients were excluded due to various reasons. Seventy (57.4%) patients were male, and median age was 7.7 years. On examining the final diagnosis of the patients at the emergency department, fracture diagnosis was observed in 39 patients (32%). It was determined that fracture diagnosis for 94.9% of the patients included in the study could be achieved using US (in the presence of at least the fat pad sign and/or direct findings of fracture based on the seven-point assessment). Conclusion: US should be considered as a diagnostic tool in cases of pediatric elbow traumas owing to its high sensitivity and negative predictive value. US, which is reproducible, ionizing radiation-free, and can be performed at the bedside, can considerably reduce unnecessary radiography in low-risk patients when evaluated along with physical examination findings among patients in the pediatric age group presenting with elbow trauma. We believe that the result of our study will contribute to patient care practices. © 2023 Elsevier LtdÖğe Pediatric cardiac arrest in the emergency department: Outcome is related to the time of admission(Professional Medical Publications, 2019) Yurtseven, A.; Turan, C.; Akarca, F.K.; Saz, E.U.Objectives: Nights and weekends represent a potentially high-risk time for pediatric cardiac arrest (CA) patients in emergency departments. Data regarding night or weekend arrest and its impact on outcomes is controversial. The purpose of this study was to determine the relationship between cardiopulmonary resuscitation during the various emergency department shifts and survival to discharge. Methods: We conducted a retrospective, observational study of patients who had visited our Emergency Department for CAs from January 2014 to December 2016. Medical records and patient characteristics of 67 children with CA were retrieved from patient admission files. Results: The mean age was 54.7±7.3 months and 59% were male. Rates of survival to discharge 35% (11/31) within working hours’ vs. out of working hours 3% (1/36). Among the CAs presenting to the emergency department, the survival rates were higher for working hours than for non-working hours (OR: 37.6 (2.62-539.7), p: 008). The rate of return of spontaneous circulation within working hours was higher than that of non-working hours (71% vs.19%) (p<0.001). Patients who received chest compression for more than 10 minutes had the lowest survival rate (2%) (p<0.001), whereas better outcome was associated with in-hospital CA, younger age (less than 12 months) and respiratory failure. Conclusion: Survival rates from pediatric CAs were significantly lower during non-working hours. Poor outcome was associated with prolonged cardiopulmonary resuscitation, out of hospital CA and older age. © 2019, Professional Medical Publications. All rights reserved.Öğe Point-of-care emergency ultrasonography in non-traumatic cardiac arrest and near-arrest emergency patients; A pilot trial(Via Medica, 2020) Gulalp, B.; Evrin, T.; Akarca, F.K.; Unal, A.Y.; Sabak, M.; Ozel, B.A.; Yesilagac, H.Introduction: In this study, we evaluated the applicability and interpretation of point- of- care emergency ultrasound (POCEUS) performed by an emergency physician (EP) in non-traumatic adult cardiac arrest and near-arrest patients at presentation to the Emergency Department (ED). Methods: POCEUS was performed in 5 steps on 73 adults to assess; 1. Qualitative global cardiac function, cardiac chambers and presence of pericardial effusion; 2. Presence of pleural sliding, B-lines, A-lines or consolidation on anterior-superior; 3. Presence of an abdominal aorta aneurysm and pelvic free fluid; 4. Presence of pleural effusion, consolidation, free fluid on lateral-inferior; 5. Qualitative width and collapsibility of the inferior vena cava. A fulfilled checklist and real-time images of ultrasonography were sent by WhatsApp to the head of the study to generate the evidence and collect the data. The process of patient care, in-hospital diagnosis and survival were retrieved from digital hospital records. This prospective multicenter sample study was conducted from November 16, 2015, to January 5, 2016. Results: The most common findings of POCEUS were performed and interpreted to have a first prediction of patients' acute clinic problem by EPs were compatible with global systolic dysfunction (n = 16, 22.9%), pulmonary edema (n = 17, 23.3%), pulmonary embolus (n = 6, 8.2%), distributive/hypovolemic shock (n = 12, 16.4%), cardiac tamponade or pericardial effusion (n = 5, 6.8%), and pneumonia (n = 31, 42.5%) at presentation. The kappa correlation coefficient value of the POCEUS at presentation versus the final, traditional clinical diagnosis of the admitted ward, was 0.773 (95% CI, 0.747-0.892; p = 0.064, McNemar). Conclusions: POCEUS performed by an EP at presentation had a good agreement between in qualitative prediction of the first differential diagnosis in life-threatened patients and the last diagnosis obtained during hospitalization. Furthermore, this study showed the requirement of evidence in comparison of measurements to the qualitative manner and new descriptive processes in POCEUS for unexplained situations and questions. © 2020 Via Medica.
