The journal of Tepecik Education and Research Hospital, 2018
Objective: It is unclear whether esophagogastroduodenoscopy (EGD) should be performed early on in... more Objective: It is unclear whether esophagogastroduodenoscopy (EGD) should be performed early on in patients receiving caustic substances. In this study, the relationship between white blood cell (WBC) counts and patients with early EGD and upper gastrointestinal system injuries was investigated. Method: Patients who applied for urgent care because of caustic substance ingestion between January 2011 and December 2014 were retrospectively investigated. The esophageal, gastric and duodenal injuries were graded according to the method of Zargar. Zargar grade 0 and 1 injuries were defined as low scores and others were defined as high scores (Grade 2a to 3b injuries). The WBC counts in these patients have been studied. Results: 173 of 242 patients were excluded from the research. Our research was conducted with 69 patients. The most common caustic agent ingested was alkaline (66.7%). The number and severity of duodenal injuries was less than those of esophagus and stomach. Sensitivity and specificity values for patients with WBC count ≥11.95 K/μL were found to be 64% and 91%, respectively. Conclusion: Higher white blood cell counts in patients with caustic exposure can be an important predictor of the severity of injury and the need for early esophagogastroduodenoscopy.
The journal of Tepecik Education and Research Hospital, 2020
Covid-19 salgınında acil servisler, hastane ve toplum temelli bakımın ön saflarında yer almaktadı... more Covid-19 salgınında acil servisler, hastane ve toplum temelli bakımın ön saflarında yer almaktadır. Hem COVID-19 şüpheli vakaların belirlenmesi ve yönetimi hem de diğer tıbbi acillerin tanı ve tedavi sürecinin devam ettirilmesinde kritik bir öneme sahiptirler. Bu nedenle, acil servislerin değişen gereksinimleri karşılamak için yeniden organize edilmesi zorunluluk haline gelmektedir. Bu makalemizde, COVİD-19 pandemi sürecinde acil servis organizasyonu ve hasta yönetim süreçlerine odaklanmayı amaçladık.
Hydatid disease is a parasitic infection caused by Echinococcus granulosus characterised by cyst ... more Hydatid disease is a parasitic infection caused by Echinococcus granulosus characterised by cyst formation in various organs. The liver is the most commonly involved organ. Hydatid disease is endemic in many parts of the world and its prevalence is also high in the Mediterranean region including Turkey. Uncomplicated liver cysts may stay asymptomatic for a long time. Hydatid cysts can rupture either spontaneously or following trauma. Anaphylaxis is an acute, life-threatening medical emergency with many potential triggers. The rupture of hydatid cysts caused by sports trauma is very rare and can lead to anaphylactic reactions and fatal anaphylaxis. We described a patient who was previously unknown to have hydatid disease being treated in the emergency setting following a sports trauma.
... İletişim Dr. Özge Duman ATİLLA Tepecik Eğitim ve Araştırma Hastanesi, Acil Tıp Kliniği, Yeniş... more ... İletişim Dr. Özge Duman ATİLLA Tepecik Eğitim ve Araştırma Hastanesi, Acil Tıp Kliniği, Yenişehir, İzmir, Turkey. ... Adv Ther 2005;22:44-8. 6. Rodoplu U, Arnold JL, Tokyay R, Ersoy G, Cetiner S, Yücel T. Mass-casualty terrorist bombings in Istanbul, Turkey, Novem-ber 2003 ...
Objectives: Dizziness is a common symptom among emergency department (ED) patients and is often a... more Objectives: Dizziness is a common symptom among emergency department (ED) patients and is often associated with benign processes. The aim of this study was to investigate the incidence of severe central neurological pathologies in isolated dizziness cases and the diagnostic efficiency of neuroimaging studies. Methods: All applications for isolated dizziness to an academic ED between January 1, 2011, and December 31, 2017 were retrospectively reviewed. The frequency of these admissions, the demographic data of the patients, the results of cranial computed tomography (CT) and diffusion-weighted magnetic resonance imaging (DW-MRI) studies, and the central neurological causes of isolated dizziness were recorded. Results: The percentage of patients with isolated dizziness among all ED admissions was 2.5% (29,510/1,190,857). The median age of these patients was 52 years (interquartile range: 38 to 66) and 58% were female. During the study period, the rate of neuroimaging studies for isolated dizziness increased year by year, and a total of 6406 (21.7%) cranial CTs and 2896 (9.8%) DW-MRIs were performed. The diagnostic yield of neuroimaging studies was 0.6% for cranial CT and 3.9% for DW-MRI. Central neurological disorders were detected in 143 (0.48%) patients with isolated dizziness. The most common causes were posterior circulation ischemic strokes (47.5%), other ischemic strokes (18.9%), vertebrobasilar insufficiency (10.5%), and transient ischemic attack (8.4%). Conclusions: Isolated dizziness is rarely associated with central neurological pathologies. Neuroimaging studies, especially cranial CT, have low diagnostic yield in isolated dizziness and should therefore not be routine in the evaluation process.
Objectives: Diagnosis of subarachnoid hemorrhage (SAH) in patients presenting with headache is ch... more Objectives: Diagnosis of subarachnoid hemorrhage (SAH) in patients presenting with headache is challenging and there has been any biomarker studied for excluding of SAH in those patients. We aim to determine the sensitivity of leukocytosis or left shift to exclude the diagnosis of SAH in ED patients presenting with headache. Method: Adult patients with headache who received a computed tomography (CT) with the diagnosis of SAH and had a complete blood count (CBC) represent the case group, headache patients with normal CT and had a CBC represent the control group. The white blood cell (WBC) count and percentage of polymorphonuclear cells (PMNs%) taken during admission and within the first 6 and 12 h of admission were recorded. Results: A hundred ninety seven patients with SAH and 197 patients without SAH were enrolled in to study. Sensitivity, specificity, NPV and PPV of leukocytosis or increase in PMNs% (left shift) in the diagnosis of SAH was 89.8% (84.5e93.5, 95% CI), 46.7% (39.6e53.9, 95% CI), 82.1% (73.5e88.4, 95% CI) and 62.8% (56.8e68.4, 95% CI) respectively on initial emergency department (ED) admission. Conclusion: CBC should be considered as a noninvasive test for the exclusion of SAH in ED patients with 6 h observation.
The diagnostic and prognostic value of the optic nerve sheath diameter on CT for diagnosis sponta... more The diagnostic and prognostic value of the optic nerve sheath diameter on CT for diagnosis spontaneous subarachnoid hemorrhage.
Objectives: Tetanus is a vaccine-preventable infectious disease. It is caused by the bacterium Cl... more Objectives: Tetanus is a vaccine-preventable infectious disease. It is caused by the bacterium Clostridium tetani. The aim of this study was to investigate tetanus immunity among adult trauma patients. Material and methods: This study was performed with 267 trauma patients who were admitted to the emergency department of Tepecik Training and Research Hospital in Izmir City, Turkey over a six month period. After obtaining a written informed consent from each patient, a questionnaire concerning demographic information and tetanus vaccination history was filled in by the physician. Patients' blood samples (4e5 cc) were drawn into a test tube while creating an intravenous (IV) access prior to making any attempt for therapy. And the tetanus antibody level (IgG) was measured using the enzyme-linked immunosorbent assay method. Tetanus antibody levels 0.1 IU/mL were considered protective. Results: Among 267 patients, 192 and 75 of the cases (71.9% and 28.1%) were male and female, respectively. The median age of the patients was 39 (IQRs ¼ 28e52). Seventy-five percent of the patients (n ¼ 201) had protective immunity rates for tetanus. Discussion and conclusion: In our study, which was conducted among adults, it was found that the protective ratio of tetanus immunity decreased with age with an additional, significant decline in elderly patients.
Abstract Outbreak of mushroom poisoning is uncommon in Izmir, Turkey. We report an outbreak of mu... more Abstract Outbreak of mushroom poisoning is uncommon in Izmir, Turkey. We report an outbreak of mushroom poisoning with Omphalotus olearius in Syrian refugees. Nineteen patients (median age: 7.8 year; age range: 2–52 years; 16 female, 3 male) were admitted to the adult and pediatric emergency departments of Tepecik Training and Research Hospital, Izmir, due to vomiting and abdominal pain within 2 h after eating mushrooms. Transaminase levels were moderately elevated only in one patient. The symptoms disappeared in 8 h after admission. We present 19 Syrian refugees poisoning with O. olearius mushroom because of its rarity. In our opinion, this outbreak was a good example that how refugees can change the disease profile in emergency practice.
Z Girifl: Bu çal›flmada, acil servisten hastaneye yat›r›lan ve deliryum tespit edilen geriatrik h... more Z Girifl: Bu çal›flmada, acil servisten hastaneye yat›r›lan ve deliryum tespit edilen geriatrik has-talarda hastane içi mortalite, hastanede kal›fl süreleri ve deliryum geliflmesine yatk›nl›k yaratan ba-¤›ms›z faktörlerin tespit edilmesi amaçlanm›flt›r. Gereç ve Yöntem: Acil servise baflvuran ve hastaneye yat›r›lan 65 yafl üstü hastalar çal›flma-ya kabul edildi. ‹lk baflvuru s›ras›nda hastalarda deliryum varl›¤›n› saptamak amac›yla Konfuzyon De¤erlendirme Metodu k›salt›lm›fl versiyonu kullan›ld›. Hastalar›n klinik sonlan›mlar› ve birincil t›b-bi tan›lar› hastanenin elektronik kay›tlar›ndan takip edildi. Bulgular: Çal›flmaya 693 hasta kabul edildi. Deliryum prevalans› %7.1 (n=49) olarak saptan-d›. Hastane içi mortalite deliryum tespit edilen hastalarda deliryum tespit edilmeyenlere göre da-ha yüksek saptand› (s›ras›yla 28.6% ve 9%, p<0.001, OR= 4.041, 95% GA= 2.056-7.945). Delir-yum tespit edilen hastalarda ortalama hastanede kal›fl süresinin deliryum tespit edilmeyenlerden daha u...
Ranitidin, peptik ülser ve gastroözefageal reflü tedavisinde yaygın olarak kullanılan selektif hi... more Ranitidin, peptik ülser ve gastroözefageal reflü tedavisinde yaygın olarak kullanılan selektif histamin 2 reseptör antagonistidir. Midede asit salgısını azaltarak etki göstermektedir. Bununla birlikte selektif histamin 2 reseptör antagonistleri, histamin 1 reseptör antagonistleri ile kombine olarak, kronik ürtiker, anafilaksi ve anjiyoödem tedavisinde de kullanılmaktadır. Histamin 2 reseptör antagonistlerinin kullanımında nadiren de olsa baş ağrısı, halsizlik, baş dönmesi, kabızlık, ishal, bradikardi, döküntü, jinekomasti ve anafilaksi gibi yan etkiler görülebilir. Bu yazıda, ranitidin kullanımına bağlı anafilaksi gelişen bir olgu literatür eşliğinde sunuldu.
Objectives-Missing delirium in the emergency department (ED) has been described as a medical erro... more Objectives-Missing delirium in the emergency department (ED) has been described as a medical error, yet this diagnosis is frequently unrecognized by emergency physicians. Identifying a subset of patients at high risk for delirium may improve delirium screening compliance by emergency physicians. We sought 1) to determine how often delirium is missed in the ED and how often these missed cases are detected by admitting hospital physicians at the time of admission, 2) to identify delirium risk factors in older ED patients, and 3) to characterize delirium by psychomotor subtypes in the ED setting. Methods-This cross-sectional study was a convenience sample of patients conducted at a tertiary care, academic ED. English speaking patients who were 65 years and older and present in the ED for less than 12 hours at the time of enrollment were included. Patients were excluded if they refused consent, were previously enrolled, had severe dementia, were unarousable to verbal stimuli for all delirium assessments, or had incomplete data. Delirium status was determined by using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) administered by trained research assistants. Recognition of delirium by emergency and hospital physicians was determined from the medical record, blinded to CAM-ICU status. Multivariable logistic regression was used to identify independent delirium risk factors. The Richmond Agitation and Sedation Scale was used to classify delirium by its psychomotor subtypes.
BACKGROUND The aim of this study is to reveal the relationship between end-tidal CO2 (EtCO2) valu... more BACKGROUND The aim of this study is to reveal the relationship between end-tidal CO2 (EtCO2) values with infarct volume and early prognosis in patients diagnosed with acute ischemic stroke in the emergency department. MATERIALS AND METHODS This prospective cross-sectional study was conducted in a tertiary hospital. The demographics, characteristics, EtCO2, volume of the stroke area on diffusion-weighted magnetic resonance imaging and the modified Rankin Scale (mRS) of the patients were recorded. The values calculated at admission and at discharge were labeled as "mRS-1" and "mRS-2", respectively, and the mRS-2 measurement was used as a prognostic indicator. The "good" and the "poor" functional outcomes were defined as mRS ≤2 and mRS >2, respectively. Correlations between levels of EtCO2 and infarct volume, mRS were calculated. RESULTS In total, 44 patients were included in the study. The median age of the patients was 69 years (interquartile range; 16; min-max: 35 to 88 y) and 68.2% of them were male. In the univariate logistic regression models of the mRS-2 [0 to 2 (0) and 3 to 6 (1)], all variables were not statistically significant to predict mRS-2 group. There were statistically significant differences in EtCO2 values between mRS-1 (P=0.03) and mRS-2 (P=0.04). A negative moderate correlation was found between EtCO2 and mRS-2 (r=-0.410; P=0.006). The correlation between EtCO2 and infarct volume was not statistically significant (r=-0.256; P=0.093). CONCLUSIONS This study highlights the importance of capnography follow-up of patients with acute ischemic stroke. In patients with acute ischemic stroke, the EtCO2 value measured at the time of admission is lower in the group with high mRS at both admission and discharge.
Kırk bir yaşındaki erkek, acil servise ambulansla 2 metre yükseklikten dengesini kaybedip sol aya... more Kırk bir yaşındaki erkek, acil servise ambulansla 2 metre yükseklikten dengesini kaybedip sol ayağının üstüne düşme nedeniyle getirildi. Fizik muayenede sol ayağın yumuşak doku ödemiyle birlikte dorsal ve medial yöne doğru deforme olduğu (Şekil 1) ve sol ayakta dor-salis ...
Common carotid artery (CCA) dissection is a rare emergency condition. Early diagnosis of these ca... more Common carotid artery (CCA) dissection is a rare emergency condition. Early diagnosis of these cases is important to prevent the ischemic emergencies. We presented a CCA dissection case, who was admitted to the hospital after taken out from under rubble with satisfactory outcome.
We report the first case from Turkey of a dermonecrotic wound associated with possible Loxosceles... more We report the first case from Turkey of a dermonecrotic wound associated with possible Loxosceles spider bite and offer the complete clinical course that resulted in a permanent scar. Emergency physicians in western Turkey should be aware of Loxosceles spider bites as a cause of necrotizing wounds.
The journal of Tepecik Education and Research Hospital, 2018
Objective: It is unclear whether esophagogastroduodenoscopy (EGD) should be performed early on in... more Objective: It is unclear whether esophagogastroduodenoscopy (EGD) should be performed early on in patients receiving caustic substances. In this study, the relationship between white blood cell (WBC) counts and patients with early EGD and upper gastrointestinal system injuries was investigated. Method: Patients who applied for urgent care because of caustic substance ingestion between January 2011 and December 2014 were retrospectively investigated. The esophageal, gastric and duodenal injuries were graded according to the method of Zargar. Zargar grade 0 and 1 injuries were defined as low scores and others were defined as high scores (Grade 2a to 3b injuries). The WBC counts in these patients have been studied. Results: 173 of 242 patients were excluded from the research. Our research was conducted with 69 patients. The most common caustic agent ingested was alkaline (66.7%). The number and severity of duodenal injuries was less than those of esophagus and stomach. Sensitivity and specificity values for patients with WBC count ≥11.95 K/μL were found to be 64% and 91%, respectively. Conclusion: Higher white blood cell counts in patients with caustic exposure can be an important predictor of the severity of injury and the need for early esophagogastroduodenoscopy.
The journal of Tepecik Education and Research Hospital, 2020
Covid-19 salgınında acil servisler, hastane ve toplum temelli bakımın ön saflarında yer almaktadı... more Covid-19 salgınında acil servisler, hastane ve toplum temelli bakımın ön saflarında yer almaktadır. Hem COVID-19 şüpheli vakaların belirlenmesi ve yönetimi hem de diğer tıbbi acillerin tanı ve tedavi sürecinin devam ettirilmesinde kritik bir öneme sahiptirler. Bu nedenle, acil servislerin değişen gereksinimleri karşılamak için yeniden organize edilmesi zorunluluk haline gelmektedir. Bu makalemizde, COVİD-19 pandemi sürecinde acil servis organizasyonu ve hasta yönetim süreçlerine odaklanmayı amaçladık.
Hydatid disease is a parasitic infection caused by Echinococcus granulosus characterised by cyst ... more Hydatid disease is a parasitic infection caused by Echinococcus granulosus characterised by cyst formation in various organs. The liver is the most commonly involved organ. Hydatid disease is endemic in many parts of the world and its prevalence is also high in the Mediterranean region including Turkey. Uncomplicated liver cysts may stay asymptomatic for a long time. Hydatid cysts can rupture either spontaneously or following trauma. Anaphylaxis is an acute, life-threatening medical emergency with many potential triggers. The rupture of hydatid cysts caused by sports trauma is very rare and can lead to anaphylactic reactions and fatal anaphylaxis. We described a patient who was previously unknown to have hydatid disease being treated in the emergency setting following a sports trauma.
... İletişim Dr. Özge Duman ATİLLA Tepecik Eğitim ve Araştırma Hastanesi, Acil Tıp Kliniği, Yeniş... more ... İletişim Dr. Özge Duman ATİLLA Tepecik Eğitim ve Araştırma Hastanesi, Acil Tıp Kliniği, Yenişehir, İzmir, Turkey. ... Adv Ther 2005;22:44-8. 6. Rodoplu U, Arnold JL, Tokyay R, Ersoy G, Cetiner S, Yücel T. Mass-casualty terrorist bombings in Istanbul, Turkey, Novem-ber 2003 ...
Objectives: Dizziness is a common symptom among emergency department (ED) patients and is often a... more Objectives: Dizziness is a common symptom among emergency department (ED) patients and is often associated with benign processes. The aim of this study was to investigate the incidence of severe central neurological pathologies in isolated dizziness cases and the diagnostic efficiency of neuroimaging studies. Methods: All applications for isolated dizziness to an academic ED between January 1, 2011, and December 31, 2017 were retrospectively reviewed. The frequency of these admissions, the demographic data of the patients, the results of cranial computed tomography (CT) and diffusion-weighted magnetic resonance imaging (DW-MRI) studies, and the central neurological causes of isolated dizziness were recorded. Results: The percentage of patients with isolated dizziness among all ED admissions was 2.5% (29,510/1,190,857). The median age of these patients was 52 years (interquartile range: 38 to 66) and 58% were female. During the study period, the rate of neuroimaging studies for isolated dizziness increased year by year, and a total of 6406 (21.7%) cranial CTs and 2896 (9.8%) DW-MRIs were performed. The diagnostic yield of neuroimaging studies was 0.6% for cranial CT and 3.9% for DW-MRI. Central neurological disorders were detected in 143 (0.48%) patients with isolated dizziness. The most common causes were posterior circulation ischemic strokes (47.5%), other ischemic strokes (18.9%), vertebrobasilar insufficiency (10.5%), and transient ischemic attack (8.4%). Conclusions: Isolated dizziness is rarely associated with central neurological pathologies. Neuroimaging studies, especially cranial CT, have low diagnostic yield in isolated dizziness and should therefore not be routine in the evaluation process.
Objectives: Diagnosis of subarachnoid hemorrhage (SAH) in patients presenting with headache is ch... more Objectives: Diagnosis of subarachnoid hemorrhage (SAH) in patients presenting with headache is challenging and there has been any biomarker studied for excluding of SAH in those patients. We aim to determine the sensitivity of leukocytosis or left shift to exclude the diagnosis of SAH in ED patients presenting with headache. Method: Adult patients with headache who received a computed tomography (CT) with the diagnosis of SAH and had a complete blood count (CBC) represent the case group, headache patients with normal CT and had a CBC represent the control group. The white blood cell (WBC) count and percentage of polymorphonuclear cells (PMNs%) taken during admission and within the first 6 and 12 h of admission were recorded. Results: A hundred ninety seven patients with SAH and 197 patients without SAH were enrolled in to study. Sensitivity, specificity, NPV and PPV of leukocytosis or increase in PMNs% (left shift) in the diagnosis of SAH was 89.8% (84.5e93.5, 95% CI), 46.7% (39.6e53.9, 95% CI), 82.1% (73.5e88.4, 95% CI) and 62.8% (56.8e68.4, 95% CI) respectively on initial emergency department (ED) admission. Conclusion: CBC should be considered as a noninvasive test for the exclusion of SAH in ED patients with 6 h observation.
The diagnostic and prognostic value of the optic nerve sheath diameter on CT for diagnosis sponta... more The diagnostic and prognostic value of the optic nerve sheath diameter on CT for diagnosis spontaneous subarachnoid hemorrhage.
Objectives: Tetanus is a vaccine-preventable infectious disease. It is caused by the bacterium Cl... more Objectives: Tetanus is a vaccine-preventable infectious disease. It is caused by the bacterium Clostridium tetani. The aim of this study was to investigate tetanus immunity among adult trauma patients. Material and methods: This study was performed with 267 trauma patients who were admitted to the emergency department of Tepecik Training and Research Hospital in Izmir City, Turkey over a six month period. After obtaining a written informed consent from each patient, a questionnaire concerning demographic information and tetanus vaccination history was filled in by the physician. Patients' blood samples (4e5 cc) were drawn into a test tube while creating an intravenous (IV) access prior to making any attempt for therapy. And the tetanus antibody level (IgG) was measured using the enzyme-linked immunosorbent assay method. Tetanus antibody levels 0.1 IU/mL were considered protective. Results: Among 267 patients, 192 and 75 of the cases (71.9% and 28.1%) were male and female, respectively. The median age of the patients was 39 (IQRs ¼ 28e52). Seventy-five percent of the patients (n ¼ 201) had protective immunity rates for tetanus. Discussion and conclusion: In our study, which was conducted among adults, it was found that the protective ratio of tetanus immunity decreased with age with an additional, significant decline in elderly patients.
Abstract Outbreak of mushroom poisoning is uncommon in Izmir, Turkey. We report an outbreak of mu... more Abstract Outbreak of mushroom poisoning is uncommon in Izmir, Turkey. We report an outbreak of mushroom poisoning with Omphalotus olearius in Syrian refugees. Nineteen patients (median age: 7.8 year; age range: 2–52 years; 16 female, 3 male) were admitted to the adult and pediatric emergency departments of Tepecik Training and Research Hospital, Izmir, due to vomiting and abdominal pain within 2 h after eating mushrooms. Transaminase levels were moderately elevated only in one patient. The symptoms disappeared in 8 h after admission. We present 19 Syrian refugees poisoning with O. olearius mushroom because of its rarity. In our opinion, this outbreak was a good example that how refugees can change the disease profile in emergency practice.
Z Girifl: Bu çal›flmada, acil servisten hastaneye yat›r›lan ve deliryum tespit edilen geriatrik h... more Z Girifl: Bu çal›flmada, acil servisten hastaneye yat›r›lan ve deliryum tespit edilen geriatrik has-talarda hastane içi mortalite, hastanede kal›fl süreleri ve deliryum geliflmesine yatk›nl›k yaratan ba-¤›ms›z faktörlerin tespit edilmesi amaçlanm›flt›r. Gereç ve Yöntem: Acil servise baflvuran ve hastaneye yat›r›lan 65 yafl üstü hastalar çal›flma-ya kabul edildi. ‹lk baflvuru s›ras›nda hastalarda deliryum varl›¤›n› saptamak amac›yla Konfuzyon De¤erlendirme Metodu k›salt›lm›fl versiyonu kullan›ld›. Hastalar›n klinik sonlan›mlar› ve birincil t›b-bi tan›lar› hastanenin elektronik kay›tlar›ndan takip edildi. Bulgular: Çal›flmaya 693 hasta kabul edildi. Deliryum prevalans› %7.1 (n=49) olarak saptan-d›. Hastane içi mortalite deliryum tespit edilen hastalarda deliryum tespit edilmeyenlere göre da-ha yüksek saptand› (s›ras›yla 28.6% ve 9%, p<0.001, OR= 4.041, 95% GA= 2.056-7.945). Delir-yum tespit edilen hastalarda ortalama hastanede kal›fl süresinin deliryum tespit edilmeyenlerden daha u...
Ranitidin, peptik ülser ve gastroözefageal reflü tedavisinde yaygın olarak kullanılan selektif hi... more Ranitidin, peptik ülser ve gastroözefageal reflü tedavisinde yaygın olarak kullanılan selektif histamin 2 reseptör antagonistidir. Midede asit salgısını azaltarak etki göstermektedir. Bununla birlikte selektif histamin 2 reseptör antagonistleri, histamin 1 reseptör antagonistleri ile kombine olarak, kronik ürtiker, anafilaksi ve anjiyoödem tedavisinde de kullanılmaktadır. Histamin 2 reseptör antagonistlerinin kullanımında nadiren de olsa baş ağrısı, halsizlik, baş dönmesi, kabızlık, ishal, bradikardi, döküntü, jinekomasti ve anafilaksi gibi yan etkiler görülebilir. Bu yazıda, ranitidin kullanımına bağlı anafilaksi gelişen bir olgu literatür eşliğinde sunuldu.
Objectives-Missing delirium in the emergency department (ED) has been described as a medical erro... more Objectives-Missing delirium in the emergency department (ED) has been described as a medical error, yet this diagnosis is frequently unrecognized by emergency physicians. Identifying a subset of patients at high risk for delirium may improve delirium screening compliance by emergency physicians. We sought 1) to determine how often delirium is missed in the ED and how often these missed cases are detected by admitting hospital physicians at the time of admission, 2) to identify delirium risk factors in older ED patients, and 3) to characterize delirium by psychomotor subtypes in the ED setting. Methods-This cross-sectional study was a convenience sample of patients conducted at a tertiary care, academic ED. English speaking patients who were 65 years and older and present in the ED for less than 12 hours at the time of enrollment were included. Patients were excluded if they refused consent, were previously enrolled, had severe dementia, were unarousable to verbal stimuli for all delirium assessments, or had incomplete data. Delirium status was determined by using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) administered by trained research assistants. Recognition of delirium by emergency and hospital physicians was determined from the medical record, blinded to CAM-ICU status. Multivariable logistic regression was used to identify independent delirium risk factors. The Richmond Agitation and Sedation Scale was used to classify delirium by its psychomotor subtypes.
BACKGROUND The aim of this study is to reveal the relationship between end-tidal CO2 (EtCO2) valu... more BACKGROUND The aim of this study is to reveal the relationship between end-tidal CO2 (EtCO2) values with infarct volume and early prognosis in patients diagnosed with acute ischemic stroke in the emergency department. MATERIALS AND METHODS This prospective cross-sectional study was conducted in a tertiary hospital. The demographics, characteristics, EtCO2, volume of the stroke area on diffusion-weighted magnetic resonance imaging and the modified Rankin Scale (mRS) of the patients were recorded. The values calculated at admission and at discharge were labeled as "mRS-1" and "mRS-2", respectively, and the mRS-2 measurement was used as a prognostic indicator. The "good" and the "poor" functional outcomes were defined as mRS ≤2 and mRS >2, respectively. Correlations between levels of EtCO2 and infarct volume, mRS were calculated. RESULTS In total, 44 patients were included in the study. The median age of the patients was 69 years (interquartile range; 16; min-max: 35 to 88 y) and 68.2% of them were male. In the univariate logistic regression models of the mRS-2 [0 to 2 (0) and 3 to 6 (1)], all variables were not statistically significant to predict mRS-2 group. There were statistically significant differences in EtCO2 values between mRS-1 (P=0.03) and mRS-2 (P=0.04). A negative moderate correlation was found between EtCO2 and mRS-2 (r=-0.410; P=0.006). The correlation between EtCO2 and infarct volume was not statistically significant (r=-0.256; P=0.093). CONCLUSIONS This study highlights the importance of capnography follow-up of patients with acute ischemic stroke. In patients with acute ischemic stroke, the EtCO2 value measured at the time of admission is lower in the group with high mRS at both admission and discharge.
Kırk bir yaşındaki erkek, acil servise ambulansla 2 metre yükseklikten dengesini kaybedip sol aya... more Kırk bir yaşındaki erkek, acil servise ambulansla 2 metre yükseklikten dengesini kaybedip sol ayağının üstüne düşme nedeniyle getirildi. Fizik muayenede sol ayağın yumuşak doku ödemiyle birlikte dorsal ve medial yöne doğru deforme olduğu (Şekil 1) ve sol ayakta dor-salis ...
Common carotid artery (CCA) dissection is a rare emergency condition. Early diagnosis of these ca... more Common carotid artery (CCA) dissection is a rare emergency condition. Early diagnosis of these cases is important to prevent the ischemic emergencies. We presented a CCA dissection case, who was admitted to the hospital after taken out from under rubble with satisfactory outcome.
We report the first case from Turkey of a dermonecrotic wound associated with possible Loxosceles... more We report the first case from Turkey of a dermonecrotic wound associated with possible Loxosceles spider bite and offer the complete clinical course that resulted in a permanent scar. Emergency physicians in western Turkey should be aware of Loxosceles spider bites as a cause of necrotizing wounds.
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