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Acid-base disorders in the emergency department: Incidence, etiologies and outcomes
(Aves, 2014-03-01) Köse, Ataman; Armağan, Erol; Öner, Nuran; Köksal, Özlem; Mert, Dilek Kostak; Özdemir, Fatma; Aydın, Şule Akköse; ARMAĞAN, EROL; KÖKSAL, ÖZLEM; Mert, Dilek Kostak; ÖZDEMİR, FATMA; AYDIN, ŞULE; Tıp Fakültesi; Acil Tıp Bölümü; AAK-8332-2020; AAH-8846-2021; AAI-2164-2021; L-7334-2015
Objective: Acid-base disorders (ABDs) are usually correlated with high rates of morbidity and mortality. The objective of this study was to analyze the causes, outcomes, types and incidences of ABDs in patients presenting at the emergency department (ED).Material and Methods: We prospectively analyzed data from patients who presented between January 2011 and May 2011. Data on age, gender, chief complaint, and diagnosis in the ED were collected for ABD cases.Results: Of the 736 cases with an ABD, 173 patients (23.5%) had simple ABD and 563 patients (76.5%) had mixed ABD. The most common ABD was a mixed metabolic acidosis and respiratory alkalosis (MACRAL) (n=408, 55.4%). All ABD types were most commonly observed in patients over 65 years of age. Dyspnea was the most common complaint among ABD patients who presented at the ED (44.4%). In cases of ABD, pneumonia was the most common diagnosis (16.3%). Of the ABD cases, 379 patients (51.6%) were discharged, while 318 patients (43.2%) were hospitalized. Death was more commonly observed in cases with mixed metabolic and respiratory acidosis (MRAC) (n=6) and MACRAL (n=11).Conclusion: ABDs are quite common in patients presenting at the ED, especially among patients in a critical condition (71%). Mixed MACRAL was the most commonly noted ABD. Dyspnea and pneumonia were the most common diagnoses in ABD patients. Mortality was more common in cases with a mixed MRAC and MACRAL. This knowledge may provide important information concerning the diagnosis, treatment and early prognosis of patients.
Association of clinical characteristics with decision making in patients with severe lower extremity trauma
(Mre Press, 2021-01-01) Durak, Vahide Aslıhan; Ermutlu, Cenk; Atıcı, Teoman; DURAK, VAHİDE ASLIHAN; ERMUTLU, CENK; ATICI, TEOMAN; Tıp Fakültesi; Ortopedi Bölümü ve Travmatoloji; 0000-0003-0836-7862; 0000-0002-3396-3407; AAE-9483-2021; AEQ-5464-2022; A-5095-2018
Severe lower limb trauma represents a challenge for both the emergency department physicians and the surgeons. These injuries are associated with significant incidence of limb loss and it is not uncommon for the treating physician to make the hard decision between limb salvage, amputation or stump closure for a patient in critical condition. Our aim was to evaluate the epidemiology of traumatic lower extremity amputations and to analyze the factors which may have effect on patient resuscitation, limb salvage and efficient patient management. Patients who were admitted to our institution's emergency department for traumatic lower extremity amputation over an 8 years' period (2012 to 2020) were retrospectively analyzed. Patient files with the possibility of severe lower limb trauma and mangled extremity were retrieved and analyzed using ICD codes recorded/registered during the emergency department admission. Mean time from emergency admission to transfer to operating theater was 184,5 minutes. Replantation of the amputate was performed in 4 patients (19%). 25% of the amputations at the ankle level (1 out of 4) and 37.5% of the transtibial amputates (3 out of 8) were replanted. A multidisciplinary approach is necessary in every aspect of patient management; however, this does not justify a delay in treatment. Time spent during conclusion of necessary consultations does not have negative effects on patient outcome as long as patient is closely monitored and resuscitated in the emergency department.
Bedside sonography in emergency departments in turkey
(Sage Publications, 2008-05-01) Girişgin, Sadık A.; Cander, Başar; Yürümez, Yusuf; Coşkun, Figen; İkizceli, İbrahim; Akköse, Şule; AYDIN, ŞULE; Tıp Fakültesi; Acil Tıp Bölümü; JRG-1971-2023
Emergency departments in Turkey have been steadily improving their services since emergency medicine began as a specialty over 12 years ago, but bedside ultrasound (US) has not been implemented widely. In order to learn the extent of ultrasound usage and training opportunities, a 27-question survey was distributed to emergency medicine-trained physicians working in emergency departments at ten university hospitals (the busiest one in each geographical region, plus three others), which are referral centres covering over half of the country's population.Eight of the ten EM departments had an ultrasound machine in their ED (for a mean of 3.7 years), but the machines were used and controlled by the Department of EM in only four of the centres. While EM physicians knew how to perform US in seven centres, they routinely performed US themselves in only five. Of the 173 EM staff in the centres surveyed, 57 performed bedside US, and 28 possessed an US course certificate. All respondents wanted their EM residents to have formal US training, but such a rotation was present in only five centres. Bedside US was being performed in the following clinical situations: trauma (n=7), abdominal pain (n=7), renal colic (n=5), chest pain (n=3), assist to invasive procedures (n=3), locating subcutaneous foreign bodies (n=3), and dyspnea (n=1). Five departments had no form or system for documenting their US findings, and if finding anything suspicious, always sent the patients to radiology to have the US repeated. The mean duration from request-to-radiology-for-US to report-in-EM-physician's-hands was 47 minutes.Bedside US is performed by EM physicians in only half of the academic centers we surveyed. Documentation is absent in many, thus the quality or impact of this practice would be difficult, if not impossible, to determine. Formal educational programs are desired by all, but have yet to be implemented in half of the centres. Given the many benefits to patients of bedside US, diligent efforts still need to be made to improve this service in academic emergency departments in Turkey.
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; 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 pediatric cardiopulmonary arrest cases in emergency service
(Acil Tıp Hekimleri, 2015-06-01) Pozam, Suna Eraybar; Aydın, Sule Akköse; AYDIN, ŞULE; Tıp Fakültesi; Acil Tıp Bölümü; 0000-0003-4306-9262; AAI-2164-2021
Aim: There are limited studies that evaluate etiological factors for out-of-hospital cardiopulmonary arrest cases in the pediatric age group. This study aims to investigate pediatric cardiopulmonary arrest cases that are encountered less frequently in emergency medicine practice.Materials and Methods: The data of patients with cardiopulmonary arrest aged 0-15 years who were admitted to the emergency service of Balikesir Ataturk Government Hospital between April 1, 2013 and April 1, 2014 were prospectively investigated. Cardiopulmonary arrest was defined as the patient being pulseless, apneic, and requiring chest compressions. Demographical characteristics, trauma exposure, initial cardiac rhythm, and results of intensive care follow-up of the patients were recorded.Results: Fifty children were evaluated in our study. The mean age was 5.3 years (range: 0-15); 52% (n=26) patients were male. Initial rhythms were 84% asystolic, 14% pulses electrical activity, 2% ventriculer fibrtilation. In 60% (n=30) patients, cardiac arrest evolves because of trauma, and the most common trauma mechanism was high falls. In all, 10% (n=5) of the study population considered exitus after undergoing cardiopulmonary resucitation procedures, and 95% had spontaneous circulation and their treatment continued in the pediatric intensive care unit.Conclusion: Pediatric cardiopulmonary arrest cases are associated with high mortality and morbidity rates. In our country, we believe that in emergency medicine practice, pediatric arrest cases remain in the background as we more frequently encounter adult patients; these discrepancies need to be resolved.
Rhinocerebral mucormycosis case in the emergency room
(Acil Tıp Hekimleri, 2021-12-01) Aslan, Şahin; Omar, Issa; Durak, Vahide Aslıhan; Çıkrıklar, Halil Ibrahim; Özdemir, Fatma; ASLAN, ŞAHİN; OMAR, ISSA MALONGO; DURAK, VAHİDE ASLIHAN; ÇIKRIKLAR, HALİL İBRAHİM; ÖZDEMİR, FATMA; Tıp Fakültesi; Acil Tıp Bölümü; 0000-0003-0836-7862; EMD-3139-2022; JRF-5591-2023
Introduction: Rhinocerebral mucormycosis is a rare disease, which causes serious and life-threatening fungal infections.The disease usually develops in immunocompromised individuals and usually begins by mimicking cellulite, especially in the face area, and shows a very rapid course.Case Report: A 75-year-old male patient previously admitted to an external center with 3-4 days complaints of headache, numbness in the right half of his face and closure of his left eye was brought to our emergency department for further investigation.The cranial magnetic resonance imaging (MRI) revealed suspected opportunistic fungal infection or malignancy in the ethmoidal and sphenoidal sinuses.The patient was hospitalized with the diagnosis of opportunistic fungal infection after consultations to relevant clinics. Biopsy revealed polypes and mucocele like cystic tissues. The patient, followed-up and treated with rhinocerebral mucormicosis, was transferred to intensive care unit after deterioration of his general condition.After approximately 45 days of follow-up and treatment, the patient was lost due to multiple organ failure.Conclusion: Rhinocerebral mucormycosis is an emergency that requires a multidisciplinary approach. Presence of one or more of the non-traumatic orbital apex syndrome findings should alert emergency physicians. In this and similar infections with high mortality rates, early diagnosis and treatment may lead to good results.
Serum pNF-H levels in the first six hours after experimental mild traumatic brain injury in rats
(Verduci Publisher, 2022-01-01) Karesioğlu, E.; Çıkrıklar, H. I.; Durak, V. A.; Aydın, B.; Ardıç, A.; Armağan, E.; KARESİOĞLU, EMİNE; ÇIKRIKLAR, HALİL İBRAHİM; DURAK, VAHİDE ASLIHAN; AYDİN, BİRNUR; Ardıç, Aslıgül; Armağan, Ersin; Tıp Fakültesi; Acil Tıp Bölümü; 0000-0003-0836-7862; 0000-0002-8193-474X; HEI-9103-2022; AAH-8714-2021; AAE-9483-2021; ADT-6417-2022; EKH-5913-2022; CBW-8706-2022
OBJECTIVE: Mild traumatic brain injury (mTBI) cases with a normal CT scanning account for the vast majority of all TBI patients. The aim of this study was to investigate the course of serum Phosphorylated Neurofilament Heavy Chain (pNF-H) levels in the first six hours after trauma in rats in experimental mTBI.MATERIALS AND METHODS: In this experi-mental animal study, 32 female Sprague-Dawley rats were enrolled equally (n=8) into 3 experimen-tal groups and 1 control group. In experimental groups, animals were exposed to a mTBI with a free fall of 50-gram metal disc from a height of 80 cm. We compared serum pNF-H levels at the 2nd, 4th, and 6th hours after traumatic brain injury in the experimental groups with the control group.RESULTS: Serum pNF-H levels at the 2nd and 4th hours after traumatic brain injury were sta-tistically significantly higher than the control group. Serum pNF-H levels gradually decreased at the 4th and 6th hours compared to the 2nd hour and decreased to a similar level to the control group at the 6th hour after injury.CONCLUSIONS: A high serum pNF-H value, could be used in the diagnosis and management of mTBI patients.

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