Browsing by Author "Bulut, Mehtap"

Now showing 1 - 20 of 25

A case report of ammonium sulfate inhalation
(Aves, 2011-12-01) Köksal, Özlem; KÖKSAL, ÖZLEM; Almacıoğlu, Meral Leman; ÖZDEMİR, FATMA; Aydın, Şule Akköse; AYDIN, ŞULE; Bulut, Mehtap; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; AAK-8332-2020; AAX-5571-2021; HHN-5686-2022
Ammonium sulfate is widely used in agriculture and the leather trade in many countries. Although it is reported to have potential effects on respiratory, gastrointestinal systems and the skin, there are a few case reports and toxicological studies about ammonium sulfate intoxication after ingestion and there is no case about ammonium sulfate inhalation. Thus, we report the clinical and laboratory findings of a patient who inhaled ammonium sulfate gas due to a work accident and was brought to our emergency department directly from the factory. When he arrived, loss of consciousness, cyanosis, tachypnea and metabolic acidosis were observed and convulsions were reported before arrival at the emergency department. After intubation and mechanical ventilator support in the emergency department, he was admitted to the intensive care unit, was given a T tube - mechanic ventilator support and was discharged in a healthy condition on the 8th day of admission. Ammonium sulfate intoxication should be suspected for the patients which brought from the leather industry or an agricultural environment, who inhaled bad or dense odored material, and had loss of consciousness, convulsions, acidosis and respiratory failure.
Acil servise başvuran hastaların memnuniyetini etkileyen faktörler
(Uludağ Üniversitesi, 2008) Akkaya, Esra Gültekin; Bulut, Mehtap; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.
Bu çalışmanın amacı Uludağ Üniversitesi Tıp Fakültesi (UÜTF) Hastanesi Acil Servisine başvuran hastaların memnuniyet düzeyini değerlendirmek, hasta memnuniyetini etkileyen faktörleri saptamak ve gelecekte bu konuda yapılması planlanan iyileştirmelere yardımcı olmaktır.1 Mayıs-30 Haziran 2008 tarihleri arasında UÜTF Hastanesi Acil Servisine başvuran 18 yaş üzerindeki, araştırmaya katılmayı gönüllü olarak kabul eden hastalar çalışmaya alındı. Bilinç bozukluğu, iletişimi engelleyecek herhangi bir hastalığı, acil ameliyat gerekliliği olan ve aydınlatılmış onam alınamayan hastalar araştırma dışında bırakıldı. Araştırmaya alınan hastaların verileri araştırmacı tarafından hazırlanan anket formu kullanılarak toplandı. Anket formunda hastalara acil servis doktorları, hemşireleri, personeli, bilgilendirilmesi, tetkiklerin sonlanma süreleri, hastanenin fiziksel koşulları ve teknik donanımı gibi konularda memnuniyet düzeyleri soruldu.Araştırma süresince acil servise toplam 5865 hasta başvurmuş olup çalışmaya 600 hasta alındı. Yaşları 19-87 arasında olup, yaş ortalaması 40.7±16.6 olarak saptanan hastaların %51.2'si erkeklerden oluşmaktadır. %6.7'si triyaj 1, %24'ü triyaj 2 ve %69.3'ü triyaj 3 olarak tespit edilen hastaların %76.2'si herhangi bir nedenle beklemek durumunda kalmadan acil servisten taburcu edilmişlerdir. Yatışı yapılan 64 hastadan %45.3'ü yatış için acil serviste beklemiştir. Acil servis doktorlarının ve hemşirelerinin tıbbi bakım tecrübesinden memnun olma düzeyi sırasıyla %94.5 ve %91 olarak saptanmıştır. Acil serviste görevli doktor ve hemşirelerin davranışları ve tıbbi bakım tecrübeleri, hastanın tüm süreç boyunca bilgilendirilmesi ile acil servisteki bekleme süresi hasta memnuniyetinde önemli faktörlerdendir. Bu veriler ışığında, kurumun sürekliliğinin sağlanabilmesinin ancak hasta memnuniyetini misyon olarak kabul eden hastane idarecileri ve çalışanları ile mümkün olabileceği inancındayız.
Acil servise epigastrik ağrı yakınmasıyla başvuran hastalarda helicobacter pylori sıklığı ve tanıda kalitatif serum Ig G testinin yeri
(Uludağ Üniversitesi, 2004-02-25) Bulut, Mehtap; Armağan, Erol; Kıyıcı, Murat; Balcı, Veysel; Atar, Nurşen; Gürel, Selim; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Gastroenteroloji Bilim Dalı.
Çalışmamızın amacı acil servise epigastrik ağrı ile başvuran hastalarda H. pylori sıklığını saptamada Rapid H. pylori cassette testi ile üreaz testinin sensitivite ve spesifisitesini karşılaştırmaktır. Bu çalışma, ocak 2000 ile şubat 2001 tarihleri arasında prospektif olarak yapıldı. Hastalardan alınan 2-3 cc kanın santrifüj edilmesiyle hazırlanan serum, Rapid H. pylori cassette testi için kullanıldı. Sonra hastalara endoskopi yapıldı ve ayrıca H. Pylori üreaz testine bakıldı. Toplam olgu sayısı 47 olup (21 erkek, 26 kadın) yaş ortalaması 38.5 (16-71) yıl idi. Endoskopi ile 19 hastaya gastrit, 10 hastaya peptik ülser tanısı kondu H. pyloriyi saptamada üreaz testi ile Rapid H. pylori testi arasında istatistiksel olarak anlamlı bir fark saptanmadı. Üreaz testi ile karşılaştırıldığında Rapid H. pylori testinin spesifisite, sensitivitesi sırasıyla %81.4 ve %95 olarak saptandı. Non-invazif bir yöntem olan ve kolaylıkla uygulanabilen serum Rapid H. pylori cassette testinin spesifisite ve sensitivitesi invazif H. pylori üreaz testi ile karşılaştırıldığında kabul edilebilir sonuçlar ortaya koymuştur. Bu nedenle endoskopi yapma imkanı olmadığı durumlarda bu testin kullanılması önerilebilir.
Acil serviste hastaların uzun bekleme sürelerine etki eden faktörler
(Uludağ Üniversitesi, 2009) Durmuş, Oya; Bulut, Mehtap; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.
Bu çalışmanın amacı Uludağ Üniversitesi Tıp Fakültesi (UÜTF) Hastanesi Acil Servisinde hastaların uzun bekleme sürelerine etki eden faktörleri belirlemektir.Bu çalışmaya 13.02.2009?01.04.2009 tarihleri arasında UÜTF Hastanesi Acil Servisine başvuran 18 yaş üzerindeki yetişkin hastalardan ve 18 yaş altındaki çocuk travma hastalarından 3000'ü alındı. Hastaların doktor görüş süresi, kalış süresi, yatış süresi, yatış için bekleme süresi ve acil serviste takip süresi araştırıldı. Ayrıca hastalar bekleme nedenlerine göre 4 gruba ayrılarak incelendi; Grup 1 (Acil servis kaynaklı nedenlerle bekleyen hastalar), Grup 2 (Acil servis ve hastane kaynaklı nedenlerle bekleyen hastalar), Grup 3 (Hastane kaynaklı nedenlerle bekleyen hastalar) ve Grup 4 (Doğrudan acil ve hastane ile ilgili olmayan nedenlerle bekleyen hastalar).Çalışmamızda başvuruların en yoğun olduğu saatler 16:00-24:00 saatleri arası olarak saptandı. 3000 hastanın acil serviste ortalama kalış süresi 146,7±160,2 dakika olarak tespit edildi. Konsültasyon istenen hastalardaki kalış süresinin, konsültasyon istenmemiş hastalardaki kalış süresinden daha uzun olduğu saptandı. Hastanemizde uygun yatak olmadığından hastaların %41,1'inin 2 saat altında, %13,4'ünün 8 saat üzerinde beklediği bulundu. Grup 2'deki hastaların kalış sürelerinin (206,7±145,2 dakika) Grup 1'deki hastaların kalış sürelerinden (95,5±73,9 dakika) daha uzun olduğu, Grup 3'deki hastaların kalış sürelerinin (470,7±364,7 dakika) Grup 1'deki hastaların kalış sürelerinden daha uzun olduğu saptandı.Sonuç olarak, hastaların acil servisimizdeki uzun bekleme sürelerinin en önemli nedeni hastanemizdeki yetersiz yatak kapasitesidir. Bu sorunu çözmek esas olarak hastane yöneticilerinin görevidir.
Acil Serviste Yapılan Kan Transfüzyonları Acil Servis İşleyişini Etkiliyor mu?
(Bursa Uludağ Üniversitesi, 2020-06-03) Yüksel, Melih; Kaya, Halil; Atmaca, Suna Eraybar; Aygün, Hüseyin; Bulut, Mehtap
Bu çalışmanın amacı acil serviste yapılan kan ve kan ürünleri transfüzyonlarının acil servis işleyişini etkileyip etkilemediğini araştırmaktır. 01.08.2019 ile 31.12.2019 tarihleri arasında Sağlık Bilimleri Üniversitesi Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi Acil Servisi’nde kan ve kan ürünü transfüzyonu yapılan hastalar çalışmaya dahil edildi. Çalışmaya alınan hastaların yaş, cinsiyet, yapılan transfüzyon türü ve sayısı, kan grubu, kan bekleme süresi, transfüzyon işlem süresi ve acil servisteki toplam kalış süresi değişkenleri kaydedildi. Toplam 227 hasta çalışmaya dahil edildi. Hastaların %54,6’sı erkek olup ortalama yaş 63,86±17,81, ortalama hemoglobin (Hg) düzeyi 7,12±2,42 g/dL, ortalama kan bekleme süresi 6,44±3,02 saat, ortalama transfüzyon işlem süresi 3,54±3,45 saat, ortalama toplam acil serviste kalış süresi 10,13 ±4,00 saat olarak saptandı. Hastaların %74,0’ ünde anemi tanısı mevcut idi. Oneway Anova testi ile yapılan analizde acil serviste toplam kalış süresi ile hasta tanıları arasında anlamlı fark olduğu görüldü (F=4,235; p=0.001). Post hoc tukey testi ile farkın koagülasyon bozuklukları ile anemi (p=0.001) ve koagülasyon bozuklukları ile gastrointestinal sistem kanamalarından (p=0.013) kaynaklandığı saptandı. Acil endikasyonu olmayan kan ve kan ürünleri transfüzyonlarının acil servislerde yapılması acil servis yoğunluğuna ve hastaların bekleme sürelerinin uzamasına neden olmaktadır. Dolayısıyla bu işlemlerin acil servislerde yapılması acil servis işleyişini olumsuz yönde etkilemektedir.
A case report of fatal oral ingestion of resorcinol
(Wiley-Blackwell, 2006-11) Bulut, Mehtap; Türkmen, Nursel; Fedakar, Recep; Aydın, Şule Akköse; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Adli Tıp Anabilim Dalı.; AAH-6287-2021; 35783913800; 8715251700; 8725968900; 6603347542
Resorcinol is a pharmaceutical agent used topically in dermatological treatments for acne, eczema, psoriasis and related skin conditions. Although there are a few studies that indicate chronic toxic effects of resorcinol on humans after topical application, information on the effects of resorcinol in acute poisoning after oral ingestion is limited. Thus, we wish to report the clinical and laboratory findings of a patient who was admitted to our emergency department (ED) after inadvertent oral ingestion of resorcinol and later died, as well as the patient's autopsy findings. The major clinical and laboratory findings were unconsciousness, respiratory failure that required mechanical ventilation, generalized tonic-clonic seizures, leukocytosis and severe metabolic acidosis. In the blood sample taken at the autopsy, a high level of methemoglobin was found. In the serum, resorcinol was revealed by gas chromatography-mass spectrometry. It can be concluded that the basic approach to patients with resorcinol poisoning should include initial stabilization of the patient by supporting the airway, respiration and circulation, and treating complications such as seizures or metabolic acidosis in the ED, as soon as possible after oral ingestion.
Childhood falls: Characteristics, outcome, and comparison of the injury severity score and new injury severity score
(BMJ Publishing Group, 2006) Bulut, Mehtap; Köksal, Özlem; Korkmaz, Ayhan; Turan, M.; Özgüc, Halil Bülent; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; 0000-0003-2271-5659; AAK-8332-2020
Objectives: The aim of this study was to determine the general characteristics of childhood falls, factors affecting on mortality, and to compare the Injury Severity Score (ISS) and the New Injury Severity Score (NISS) as predictors of mortality and length of hospital stay in childhood falls. Methods: We retrospectively analysed over a period of 8 years children aged younger than 14 years who had sustained falls and who were admitted to our emergency department. Data on the patients' age, sex, type of fall, height fallen, arrival type, type of injuries, scoring systems, and outcome were investigated retrospectively. The ISS and NISS were calculated for each patient. Comparisons between ISS and NISS for prediction of mortality were made by receiver operating characteristic (ROC) curve and Hosmer-Lemeshow (HL) goodness of fit statistics. Results: In total, there were 2061 paediatric trauma patients. Falls comprised 36 (n = 749) of these admissions. There were 479 male and 270 female patients. The mean (SD) age was 5.01 (3.48) years, and height fallen was 3.8 (3) metres. Over half (56.6%) of patients were referred by other centres. The most common type of fall was from balconies (38.5%), and head trauma was the most common injury (50%). The overall mortality rate was 3.6%. The cut off value for both the ISS and NISS in predicting mortality was 22 ( sensitivity 90.5%, specificity 95.4% for ISS; sensitivity 100%, specificity 88.7% for NISS) (p > 0.05). Significant factors affecting mortality in logistic regression analysis were Glasgow Coma Scale (GCS) < 9, ISS > 22, and NISS > 22. There were no significant differences in ROC between three scoring systems. The HL statistic showed poorer calibration (p = 0.02 v p = 0.37, respectively) of the NISS compared with the ISS. Conclusions: In our series, the head was the most frequent site of injury, and the most common type of fall was from balconies. Scores on the GCS, NISS, and ISS are significantly associated with mortality. The performance of the NISS and ISS in predicting mortality in childhood falls was similar.
Clinical value of D-dimer and other coagulation markers in differantial diagnosis of hemorrhagic and ischemic stroke
(Galenos Yayıncılık, 2009-12-01) Aydın, Şule Akköse; Köksal, Özlem; Bulut, Mehtap; Özuçelik, Doğaç Niyazi; Özdemir, Fatma; AYDIN, ŞULE; KÖKSAL, ÖZLEM; Bulut, Mehtap; ÖZDEMİR, FATMA; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tip Ana Bilim Dalı; HHN-5686-2022; AAX-5571-2021; AAK-8332-2020; JCE-0651-2023; ITH-9225-2023
PURPOSE: This study aims to determine the clinical value of some laboratory markers(D-dimer, Fibrinogen, etc levels) as alternatives to expensive and sometimes unavailable advanced radiographic techniques, in differentiation and early diagnosis of hemorrhagic and ischemic stroke which require distinct diagnosis, monitoring and treatment methods.MATERIALS AND METHODS: The study includes 100 adult patients who applied to Emergency Department of Uludag University with clinical symptoms of stroke. At presentation on all of the patients and D-dimer, fibrinogen and other laboratory tests were studied. For differentiation of hemorrhagic and ischemic stroke, computerized tomography(CT) and magnetic resonance imaging(MRI) were taken. CT and MRI detections were assessed by radiology specialists blindly.FINDINGS: Of 100 patients included in the study, 53% were women and 47% were men. In 28% of the patients, ischemic stroke, in 21%, hemorrhagic stroke and in 48%, transient ischemic attack (TIA) was detected, while remaining 3% were assessed as normal. Average age of patients with ischemic stroke was found higher than that of patients with hemorrhagic stroke. No significant difference was observed when patients were grouped by sexes. Coagulation markers, D-dimer and aPTT were significantly different between hemorrhagic stroke and TIA groups while no significant difference was observed between ischemic and hemorrhagic stroke groups.RESULTS: Ischemic and hemorrhagic strokes cause homeostatic anomalies besides the brain damage accompanying. In our study, a difference between hemorrhagic stroke and TIA groups was observed, while no difference was found between ischemic and hemorrhagic stroke groups regarding coagulation markers.
The comparison of modified early warning score with rapid emergency medicine score: A prospective multicentre observational cohort study on medical and surgical patients presenting to emergency department
(BMJ Publishing Group, 2014-06) Bulut, Mehtap; Çebiççi, Hüseyin; Sak, Ahmet; Durmuş, Oya; Top, Ahmet Ali; Kaya, Sinan; Uz, Kamil; Sığırlı, Deniz; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; AAA-7472-2021; 24482063400
Objective There are a few scoring systems in emergency departments (ED) to establish critically ill patients quickly and properly and to predict hospitalisation. We aim to compare the efficacy of Modified Early Warning Score (MEWS) and Rapid Emergency Medicine Score (REMS) on in-hospital mortality, and as predictor of hospitalisation in general medical and surgical patients admitted to ED. Methods This is a prospective, multicentre and observational cohort study. The study included general medical and surgical patients admitted to the EDs of three education and research hospitals during a period of 6 months. The primary outcome of the study is the admission of the patient to a ward/an intensive care unit (ICU)/high dependency unit (HDU) and in-hospital mortality. Receiver operating characteristics (ROC) curve analysis was performed to evaluate and compare the performances of two scores. Results Total patients were 2000 (51.95% male, 48.05% female). The mean age was 61.41 +/- 18.92. Median MEWS and REMS values of the patients admitted to the ICU/HDU from ED were 1 and 6, respectively; and there was a significant difference in terms of REMS values, compared with patients discharged from ED. REMS (area under the curve (AUC): 0.642) was found to have a better predictive strength than MEWS (AUC: 0.568) in discriminating in-patients and discharged patients. Additionally, REMS (0.707) was superior to MEWS (AUC 0.630) in terms of predicting in-hospital mortality of patients presenting to ED. Conclusions The efficiency of REMS was found to be superior to MEWS as a predictor of in-hospital mortality and hospitalisation in medical and surgical patients admitted to ED.
Comparison of trauma scoring systems for predicting mortality in firearm injuries
(Ulusal Travma ve Acil Cerrahi Derneği, 2009-11) Köksal, Özlem; Özdemir, Fatma Ayça Edis; Bulut, Mehtap; Aydın, Şule; Almacıoğlu, Meral Leman; Özgüç, Halil; Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; 0000-0003-2271-5659; AAX-5571-2021; AAK-8332-2020; 23389880200; 7006765911; 56233163200; 6603347542; 35784090800; 6603867989
Prediction of mortality in trauma patients is an important part of trauma care. Trauma Scoring systems are the current methods used for prediction of mortality. We aimed to evaluate and compare the performances of Injury Severity Score (ISS) and New Injury Severity Score (NISS) in firearm injuries. Records of 135 firearm-injured patients who applied to Uludag University Emergency Department between January 2001 and December 2005 were analyzed retrospectively. All patients' data, including age, gender, cause of injury, initial vital signs, injury region, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), mortality, operation data, and final diagnosis, were collected, and ISS, NISS and Trauma and Injury Severity Score (TRISS) were calculated. Mortality rate was 12.6%. The patients' mean GCS, RTS, ISS, NISS, and TRISS scores were 13.41+/-0.31, 10.65+/-0.26, 17.04+/-1.20, 21.94+/-1.45, and 9.52+/-2.37, respectively. The patients were divided into two groups as ISS=NISS (53.3%) and ISS ISS and NISS both performed well in mortality prediction of firearm injuries. NISS demonstrated no superiority to ISS for prediction of mortality in these patients.
Emergency department overcrowding in Turkey: Reasons, facts and solutions
(Nepal Medical Association, 2014-07) Çakır, Oya Durmuş; Çevik, Şebnem Eren; Bulut, Mehtap; Güneyses, Özlem; Akköse, Şule; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; AAI-2164-2021; 6603347542
Introduction: The purpose of this study was to determine the factors affecting the long waiting times of the patients in a university hospital. Methods: This study included 3000 of the adults above 18 years and pediatric trauma patients under 18 years who applied to emergency department between February 2009 and April 2009. The examination period of the physician, length of stay, length of hospitalization, waiting times for hospitalization and follow up times in the emergency department were recorded. Moreover, the patients were divided into four groups according to the reasons for waiting. Results: In our study, the time period between 4 pm-12 pm was determined as the busiest time for the applications. Average length of stay in the emergency department for 3000 patients was 146.7 +/- 160.2 minutes. The length of stay for the patients consulted was longer than the length of stay for the ones who were not consulted. Because of the fact that our hospital did not have appropriate bed capacity, 41.1% of the patients waited less than two hours, 13.4% of the patients waited more than 8 hours. It was also found that the waiting times of the Group two patients (206,7 +/- 145,2 minutes) was longer than Group one (95,5 +/- 73,9 minutes) patients and the waiting times of Group three patients (470,7 +/- 364,7 minutes) was longer than Group one patients. Conclusions: In conclusion, cooperation of the managers, relevant departments and a multidisciplinary approach are necessary to achieve the goals to reduce overcrowding in the emergency departments.
Emergency management of multiple trauma patients in a level i trauma center: "Time" as a quality assurance
(Acil Tıp Hekimleri, 2008-09-01) Cebicci, H.; Bulut, Mehtap; Aydın, Almina S.; Özdemir, F.; Bulut, Mehtap; Aydın, Almina S.; ÖZDEMİR, FATİH; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Bölümü; 0000-0002-5806-562X; ACJ-4022-2022; AAX-5571-2021; JGQ-9107-2023
Background: We aimed to find out the present level of trauma care in our ED by evaluating time to determine standards of our trauma care and compare these standards with advanced trauma centers.Methods: Between January 2002 and May 2002, 104 multiple trauma patients (age > 15) bearing criterias for trauma team activation in advanced trauma life support (ATLS) protocols were randomly included in the study. Time needed to perform the routine trauma x-rays (lateral cervical vertabra, AP chest, AP pelvis radiographies), abdominal ultrasonography (USG), laboratory tests, if indicated cranial computerized tomography (CCT) and the length of stay (LOS) in the ED were recorded.Results: Patients who needed emergency surgery were taken to the operation room within 30 minutes compatible with objective time of advanced trauma centers. The x-rays, abdominal USG, laboratory tests of all patients and CCT if required were performed within mean 47 +/- 20 minutes, 56 +/- 27 minutes, 91 +/- 23,5 minutes and 98 +/- 30 minutes, respectively. The average LOS in the ED was 162 +/- 87 minutes.Conclusion: As a result, total ED stay of a multiple trauma patient in our ED was found to be significantly longer when compared to that of advanced centers. In constant quality improvement, assessment of structural features and the methods used, on the basis of lost time is a parameter that is important but not sufficient.
Evaluation of the modified MEDS, MEWS score and Charlson comorbidity index in patients with community acquired sepsis in the emergency department
(Springer, 2013-04) Çıldır, Ergün; Bulut, Mehtap; Akalın, Halis; Kocabaş, Egemen; Ocakoğlu, Gökhan; Akköse, Şule; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları Anabilim Dalı.; AAU-8952-2020; AAH-5180-2021; AAX-5571-2021; AAI-2164-2021; 56053023600; 35783913800; 57207553671; 55317360100; 15832295800; 6603347542
Sepsis is one of the most important causes of morbidity and mortality in patients presenting to the emergency department. SIRS criteria that define sepsis are not specific and do not reflect the severity of infection. We aimed to evaluate the ability of the modified mortality in emergency department sepsis (MEDS) score, the modified early warning score (MEWS) and the Charlson comorbidity index (CCI) to predict prognosis in patients who are diagnosed in sepsis. We prospectively investigated the value of the CCI, MEWS and modified MEDS Score in the prediction of 28-day mortality in patients presenting to the emergency department who were diagnosed with sepsis. 230 patients were enrolled in the study. In these patients, the 5-day mortality was 17 % (n = 40) and the 28-day mortality was 32.2 % (n = 74). A significant difference was found between surviving patients and those who died in terms of their modified MEDS, MEWS and Charlson scores for both 5-day mortality (p < 0.001, p = 0.013 and p = 0.006, respectively) and 28-day mortality (p < 0.001, p = 0.008 and p < 0.001, respectively). The area under the curve (AUC) for the modified MEDS score in terms of 28-day mortality was 0.77. The MEDS score had a greater prognostic value compared to the MEWS and CCI scores. The performance of modified MEDS score was better than that of other scoring systems, in our study. Therefore, we believe that the modified MEDS score can be reliably used for the prediction of mortality in sepsis.
Factors affecting mortality and morbidity after traumatic diaphragmatic injury
(Springer, 2007-12) Özgüç, Halil; Akköse, Şule; Şen, Gürol; Bulut, Mehtap; Kaya, Ekrem; Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Bilimler Bölümü.; 0000-0002-9562-4195; AAG-7319-2021; AAX-5571-2021; 6603867989; 6603347542; 23013375200; 56233163200; 7004568109
Purpose. We review our 11-year experience of treating diaphragmatic injury (DI), to identify the factors determining mortality and morbidity. Methods. We analyzed the effects of demographic characteristics, type of injury (blunt or penetrating), number of injured organs, injury severity score (ISS), revised trauma score (RTS), Glasgow coma score, and intensive care unit and hospital stay, on complications and mortality, in 51 patients treated for DI between January 1995 and December 2005. Results. Twenty-six (51%) patients suffered blunt injury and 25 (49%) suffered penetrating injury. The left diaphragm was injured in 40 (78%) patients, the right in 10 (19%), and both sides in 1 (2%). Only three (5.8%) patients had no concomitant injury. The diagnosis was made by the findings of laparotomy on 34 patients (65%), preoperative chest X-ray on 13 (25%), computed tomography on 2 (3.9%), and laparoscopy on 2 (3.9%). Complications developed in 23 (44%) patients and overall mortality was 19.6% (10/51). An ISS > 13 was found to be an independent prognostic factor for morbidity, whereas an RTS <= 11, age >= 48 years, and a major postoperative complication were independent prognostic factors for mortality. Conclusion. Establishing a preoperative diagnosis of DI is still problematic. Aggressive treatment and close monitoring of patients with an ISS > 13, an RTS <= 11, an age >= 48 years, or a postoperative complication may decrease morbidity and mortality.
Factors affecting mortality in patients with thorax trauma
(Türk Ulusal Travma ve Acil Cerrahi Dergisi, 2011) Emircan, Şadiye; Bulut, Mehtap; Özgüç, Halil; Akköse, Şule Aydın; Özdemir, Fatma; Köksal, Özlem; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; 0000-0003-2271-5659; AAK-8332-2020; 6603867989; 15757217900; 7006765911; 23389880200
BACKGROUND The purpose of this study was to define the epidemiologic properties and correlation of physiological and anatomical risk factors with the mortality rate among patients with thorax trauma and to ensure early prediction of severe trauma. METHODS Files of 371 cases were retrospectively examined. Their initial state in the emergency department was analyzed in terms of mortality development. Age, gender, trauma mechanism, systolic blood pressure and respiration type on admission, accompanying injuries, thorax pathology, trauma scores, and treatment approaches in exitus and surviving cases were compared. Survival probabilities and unexpected mortality rates were computed using the Trauma Revised Score-Injury Severity Score (TRISS). RESULTS Age, hypotension, pathologic respiration, blunt injury, accompanying injury, abdominal trauma, high Injury Severity Score (ISS), and low Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and TRISS were the factors affecting mortality, and presence of blunt injuries, TRISS <85, ISS >22 and GCS <13 were found to be independent prognostic factors. The strongest factor indicating mortality was TRISS. Thirty-four of 307 cases with survival probability of over 50% died. CONCLUSION In the presence of factors affecting mortality, patients with thorax trauma should be evaluated as being in a high-risk group and treatment strategies must be aggressive. Case analysis based on the TRISS model would further reveal the mistakes and may improve patient care.
Fatal descending necrotising mediastinitis
(BMJ Publishing Group, 2004-01-01) Bulut, Mehtap; Balcı, Veysel; Akköse, Şule; Armağan, Erol; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; AAX-5571-2021; AAH-8846-2021; 56233163200; 6507877217; 6603347542; 6506464232
Descending necrotising mediastinitis rarely develops and this variety of mediastinitis is a highly lethal disease. A case is reported of descending necrotising mediastinitis caused by an odontogenic infection. The importance is emphasised of prompt diagnosis and aggressive surgical mediastinal drainage for the survival of these patients. Most acute mediastinal infections result from oesophageal perforation, either secondary to oesophagoscopy or tumour erosion. Mediastinitis occasionally develops as descending necrotising mediastinitis originating from the complications of cervical or odontogenic infections. Descending necrotising mediastinitis usually has a fulminant course, leading commonly to sepsis and death.
Hastaneler arası hasta sevklerinin akademik bir acil servis perspektifinden değerlendirilmesi: retrospektif, gözlemsel bir araştırma
(2024-05-06) Dal, Evren; Eraybar, Suna; Kurtoğlu, Burak; Bulut, Mehtap
Araştırmamızın amacı, acil servise sevk ile kabul edilen hastaların sevk nedenleri, konulan tanılar ve klinik ya da yoğun bakım ihtiyaçları üzerinde bir karşılaştırma yaparak sevk gerekliliğinin uygunluğunu değerlendirmektir. Bu değerlendirme, sevk uygunluğunu analiz ederek etkin hasta yönetimi ve yoğunluğun etkili bir şekilde yönetilmesi konusunda stratejiler geliştirmeyi hedeflemektedir. Hastanemiz acil servisinde 01.07.2022-31.07.2023 tarihleri arasında sevk ile kabul edilen 4365 hastaya ait veriler geriye dönük olarak değerlendirildi. Hastaların ilk değerlendirme sonrası belirtilen sevk gereksinimi, tıbbi durumları, hastaların değerlendiren hekim tarafından istenen konsültasyonları, klinik ya da yoğun bakım yatış gereksinimi, acil serviste kalış süresi ve acil servis ve hastane içi mortalite durumu değerlendirildi. Hastaların sevk gereksinimi, hastayı değerlendiren acil tıp uzmanı tarafından talep edilen konsültasyonlar ve hastanın yatış ya da taburculuk durumuna göre karşılaştırılaştırıldı. Sevk sayısının %81,1 oranında en sık ilçe devlet hastanesinden olduğu ve sevk tanıları içinde en fazla iskemik kalp hastalıkları (%4,9) olduğu tespit edildi. Nakil sebepleri içinde en yüksek oranda gözlenen uzman hekim ihtiyacıdır Geliş tanısı (sevk tanısı) ile acil tanısı arasındaki uyumluluk oranı %48,5’ tir. Yan dal konsültasyon oranı ise %17,6 olarak bulundu. Sevk edilen hastaların acil serviste yaklaşık yarısı (%47,7) yoğun bakım ünitesine yatış ile sonlanmıştır. Hastaneler arası nakiller, her bir aşamasında özel bir analiz gerektiren, hastaların etkili ve gerektiği şekilde tedavi almalarını sağlamak için kritik bir öneme sahiptir. Hastanemize yapılan sevk tanıları içinde en fazla iskemik kalp hastalıkları, travma ve intoksiksyonların yer aldığı görüldü. Nakil sebepleri içinde en yüksek oranda gözlenen sebep uzman hekim ihtiyacıdır. Koordineli bir sağlık hizmeti sunumu için perifer hastanelerde uzman hekim ihtiyacının ve hastane kapasitelerinin gözden geçirilmesi belirleyici olabilir.
Major travmalı hastalara hastane öncesi yaklaşımda acil hekimliği sertifika programı temel eğitim modülünün etkisi
(Uludağ Üniversitesi, 2008) Turan, Mustafa; Bulut, Mehtap; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.
Bu araştırma, Acil Hekimliği Sertifika Programı Temel Eğitim Modülü'ne katılan Acil Sağlık Hizmetleri (ASH) ekiplerinin major travmalı hastalara hastane öncesi yaklaşımında eğitim öncesi ve sonrasında farklılık olup olmadığını saptamak amacıyla yapıldı.1 Ocak 2005- 30 Haziran 2005 (6 ay) ile 1 Kasım 2005- 30 Nisan 2006 (6 ay) tarihleri arasında ASH ekiplerinin hastane öncesi dönemde müdahale ettikleri 18 yaş ve üstü yetişkin, Hastane öncesi indeks (PHI) skoru 4 ve üstünde olan major travmalı hastalar çalışmaya alındı. Hastaların sosyodemografik özellikleri, travma mekanizması, yaralanma bölgeleri, Glasgow Koma Skoru (GKS), Düzeltilmiş Travma Skoru (RTS), Yaralanma Şiddet Skoru (ISS) ve PHI skorları, yapılan müdahaleler ve sonuçlanma durumları kaydedildi.Toplam 163 hastanın (Eğitim öncesi: 93, eğitim sonrası: 70) 130'u erkek olup ortalama yaş 37.63±18.42 yıl idi. Eğitim öncesi hastaların % 80.6'sı künt travma olup, eğitim sonrası bu oran %67.1 idi. Her iki grupta en fazla görülen yaralanma bölgesi baş (sırasıyla %63.4, %54.2) ve torakstı (%23.7, %28.6). Travma skorları açısından iki grup arasında anlamlı bir farklılık saptanmadı. Eğitim sonrası vakaya varış süresi, müdahale süresi ve nakil süresi eğitim öncesine göre daha kısa idi, ancak istatistiksel olarak anlamlı bir farklılık yoktu. Eğitim sonrası servikal ve torakal immobilizasyon, oksijen tedavisi uygulama ve damar yolu açma oranlarında istatistiksel olarak anlamlı bir farklılık saptanmaz iken sadece entübasyon uygulama oranında (%12.5'tan %35'e) anlamlı bir değişiklik tespit edildi. Eğitim sonrası (%25.7) ve eğitim öncesi (%28) mortalite oranları arasında anlamlı bir değişiklik yoktu.Sonuç olarak, Temel Eğitim Modülü hastane öncesi major travmalı hastaya yaklaşım açısından yetersiz olup, güncel bilgiler doğrultusunda yeniden gözden geçirilmeli ve hastane öncesi teorik ve pratik uygulamalarla desteklenmelidir.
Medical experience of a university hospital in Turkey after the 1999 Marmara earthquake
(BMJ Publishing Group, 2005-07-01) Tokyay, Rifat; Bulut, Mehtap; Fedakar, Recep; Akköse, Şule; Akgöz, Semra; Özgüç, Halil; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Adli Tıp Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; AAH-6287-2021
Objectives: This study aimed to provide an overview of morbidity and mortality among patients admitted to the Hospital of the Medicine Faculty of Uludag University, Bursa, Turkey, after the 1999 Marmara earthquake. Methods: Retrospective analysis of the medical records of 645 earthquake victims. Patients' demographic data, diagnosis, dispositions, and prognosis were reviewed. Results: A total of 330 patients with earthquake related injuries and illness admitted to our hospital were included and divided into three main groups: crush syndrome (n=110), vital organ injuries (n=57), and non-traumatic but earthquake related illness (n=55). Seventy seven per cent of patients were hospitalised during the first three days after the earthquake. The rate of mortality associated with the crush syndrome, vital organ injury, and non-traumatic medical problems was 21% (23/110), 17.5% (10/57), and 9% (5/55), respectively. The overall mortality rate was 8% (50/645). Conclusions: In the first 24-48 hours after a major earthquake, hospital emergency departments are flooded with large numbers of patients. Among this patient load, those patients with crush syndrome or vital organ injuries are particularly at risk. Proper triage and prompt treatment of these seriously injured earthquake victims may decrease morbidity and mortality. It is hoped that this review of the challenges met after the Marmara earthquake and the lessons learned will be of use to emergency department physicians as well as hospital emergency planners in preparing for future natural disasters.
Relationships between markers of inflammation, severity of injury, and clinical outcomes in hemorrhagic shock
(Advances in Therapy, 2007) Akköse, Şule; Özgürer, Aylan; Bulut, Mehtap; Köksal, Özlem; Özdemir, Fatma; Özgüç, Halil Bülent; Uludağ Üniversitesi/Tıp Fakültesi.; 0000-0003-2271-5659; 0000-0002-5682-0943; AAK-1697-2021; AAK-8332-2020; 14042171200; 56233163200; 23389880200; 7006765911; 6603867989
This study was performed to investigate the relationships between markers of inflammation in serum (interleukin-6 [IL-6], interleukin-10 [IL-10], and granulocyte elastase [GE]), severity of injury, and clinical outcomes, and to evaluate the predictive value of these markers for major complications and mortality. This study, which was conducted between August 2003 and May 2005, examined patients older than 16 y who were admitted to the Emergency Unit of the Uludag University Medical School within 12 h after trauma, and who had traumatic hemorrhagic shock (THS) at admission. Three groups were established: the THS group (n=20), the pure hemorrhagic shock (PHS) group (n=20), and the healthy control group (n=20). Demographic data were recorded for all subjects, and blood samples were taken for lactate, base excess, GE, IL-6, and IL-1 0 measurements. The Glasgow Coma Score, the Revised Trauma Score, the Injury Severity Score, the New Injury Severity Score, and the Trauma Score-Injury Severity Score were calculated; complications and final clinical outcomes were monitored. A total of 35 men and 25 women were included in the study; mean patient age was 41 +/- 17 y. In the THS group, scores were as follows: Revised Trauma Score, 10.2 +/- 2.2; Trauma Score-Injury Severity Score, 0.86 +/- 0.2; Injury Severity Score, 24.8 +/- 9.0; and New Injury Severity Score, 32.7 +/- 9.0. IL-6, IL-10, lactate, and base excess levels in the THS group were significantly higher than those in the PHS and healthy control groups. The serum GE level of the THS group was significantly higher than that of the healthy control group, but it did not differ significantly from that of the PHS group. Complications such as sepsis, acute respiratory distress syndrome, and multiple organ failure occurred in 50% of the THS group and in 20% of the PHS group. Mortality was 30% in the THS group and 10% in the PHS group. In the THS group, no significant differences were noted between markers of inflammation and trauma scores of patients who died and those who survived. The investigators concluded that although the levels of markers of inflammation increased in THS patients, they were inadequate for predicting mortality and the development of complications such as acute respiratory distress syndrome, multiple organ failure, and sepsis. A larger study based on the use of serial marker measurements is warranted.