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A 4 year retrospective analysis of our patients with mushroom poisoning
(Sage, 2013-03) Köksal, Özlem; Armaǧan, Erol; İnal, Taylan; Ayyıldız, Talat; Öner, Nuran; Tıp Fakültesi; Acil Tıp Ana Bilim Dalı; 0000-0003-2271-5659; AAH-8846-2021; AAK-8332-2020; 23389880200; 6506464232; 55695563500; 6603155277; 55695552500
Objective: This study presented the demographic, clinical and laboratory data for the patients who presented to our emergency department (ED) with mushroom poisoning. Methods: We retrospectively examined the data for adult patients with mushroom poisoning that presented to the ED of Uludag University, Faculty of Medicine between 1 January 2007 and 31 December 2010. Results: A total of 53 patients were enrolled in the study. The mean age was 46.58 +/- 15.47. 52.8% of the patients were female, while 47.2% were male. These patients were typically admitted in the autumn. The most commonly seen symptoms were gastrointestinal such as nausea and vomiting. The time to symptom onset was <6 hours for 30.2% of the patients and >6 hours in 69.8% of the patients. While 73.5% of the patients received gastric lavage, activated charcoal and intravenous fluid therapy, 15.1% received penicillin, N-acetylcysteine and intravenous fluid therapy. For the remaining patients (11.4%) silibinin, dialysis and plasmapheresis were administered. While 35.8% of the patients were hospitalised, 64.2% were discharged from the ED. The median duration of stay in the ED was 6 hours (range: 1-27 hours); the median duration of stay among inpatients was 6 days (range: 1-36 days). Three of the hospitalised patients died, and two underwent hepatic transplantation. Conclusions: Mushroom poisoning remains an important issue that is encountered in rural areas during the rainy autumn season in our region. The condition may be fatal, but can be prevented by early and appropriate treatment.
Aci̇l servi̇ste i̇nme tanısı almış 65 yaş üzeri̇ hastaların retrospekti̇f kli̇ni̇k ve görüntüleme özelli̇kleri̇nin deǧerlendi̇ri̇lmesi̇
(Güneş Kitabevi, 2013) İnal, Taylan; Armaǧan, Erol; Köse, Ataman; Köksal, Özlem; Özdemír, Fatma; Akköse, Şule; Balcı, Arif Kadri; Demir, Aylin Bircan; Tıp Fakültesi; Nöroloji Ana Bilim Dalı; 0000-0003-2271-5659; AAH-8846-2021; AAK-8332-2020; L-7334-2015; AAM-7896-2020; 55695563500; 6506464232; 15755792500; 23389880200; 7006765911; 6603347542; 57225396135; 57217395786
Introduction: Elderly population in the World has been increasing gradually. In terms of emergency service, the elderly constitute a special group. We aimed to study the demographic, clinical, and imaging findings in patients who are 65 years and older presented to Emergency Department. Materials and Method: By obtaining the data of the patients with stroke diagnosis, who are 65 and older and who applied to Emergency Department between 01.01.2011 and 29.02.2012, demographic, clinical, and imaging findings were investigated and then compared among 65-74, 75-84 ve >85 age groups in this study. Results: According to the study results, among the age groups of 65-74, 75-84 and >= 85, significant difference was not found out between gender, complaints for application, duration of complaints, and comorbidities. Similarly, among physical examination findings such as consciousness, eye movements, visual fields, facial nerve examinations, lower and upper extremity motor functions, ataxia, negligence, aphasia, dysarthria, and NIHSS scores, statistically significant difference was not established. Besides, no significant difference was found among diagnoses, Cranial Computed Tomography and magnetic resonance imaging findings. Following the statistical analyses, the parameters revealing significant differences among age groups were conscious status, sense examinations, infarct in Cranial Computed Tomography, and bleeding sides. Conclusion: As a result of our study, we have seen that etiology of stroke may alter along with advancing age, however; in terms of clinical characteristics and patient results in hospitalization, discharge and mortality statistically significant differences were not observed.
Acute poisoning in adults in the years 1996-2001 treated in the Uludag University Hospital, Marmara region, Turkey
(Taylor & Francis, 2005) Akkose, Sule Aydin; Bulut, Mehmet Turker; Armagan, Emrah; Cebicci, Huseyin; Fedakar, Recep; Tıp Fakültesi; Acil Tıp Ana Bilim Dalı; 0000-0002-8987-6484; AAH-6287-2021
Background. Acute poisonings are frequent causes of admission to emergency departments and these cases may have hazardous outcomes. Methods. In the present study, medical records of 1818 poisoned patients admitted to Uludag University Medical School's Emergency Department between January 1996 and December 2001 were investigated. The age, sex, outcomes of the patients, and type of poisoning are described. Results. The mean age for females (63% of the patients) was 27 years, whilst the mean age of male patients was 31 years. The major types of poisonings were ingestions of medications (59.6%), mushrooms (3.3%), corrosives (2.5%), organophosphates (3.2%), and methyl alcohol (0.4%). Carbon monoxide accounted for 6.9% of intoxications. Approximately 65% of the patients survived, while the methyl alcohol and corrosive ingestions led to the highest fatality averages (100% and 14.8%, respectively). Conclusions. The demographic and diagnostic features of acute poisoning cases treated in our hospital are similar to those reported in the literature. Adults and women are in a high-risk group for acute poisonings and medicine poisoning, which is the most common type of poisoning.
Analysis of appropriate tetanus prophylaxis in an emergency department
(Türk Travma ve Acil Cerrahi Dergisi, 2013-07) Şimşek, Gözde; Armaǧan, Erol; Köksal, Özlem; Heper, Yasemin; Pozam, Suna Eraybar; Durak, Vahide Aslıhan; Tıp Fakültesi; Acil Tıp Ana Bilim Dalı; 0000-0003-4306-9262; 0000-0003-2271-5659; HIK-0672-2022; AAE-9483-2021; AAK-8332-2020; CAF-5149-2022; AAH-8846-2021; AAH-6506-2021; Y-3674-2018; 57225727701; 6506464232; 23389880200; 56191003300; 55791934000; 55792633100
BACKGROUND In this study, our aim was to identify the validity of the prophylaxis indications for patients who received tetanus prophylaxis, determine the ratio of high-risk wounds to the number of patients with immunity, and to evaluate the tetanus immunity of specific age groups. METHODS Patients who applied to the Emergency Department (ED) between September 2009 and May 2010 and who were considered for tetanus prophylaxis by his/her primary care physician were included in the study. RESULTS A total of 320 patients were evaluated. The average age of the patients was 40.87 +/- 15.83 years. A total of 73.1% of the patients were male and 26.8% were female. A total of 40.3% of the patients knew their vaccination history, while 59.7% had no recollection of their vaccination history. 14.7% of the patients had received their last dose within 5 years and 48.1% within 5-10 years; 37.2% of the patients declared that more 10 years had passed since their last vaccination. In 75% of the patients, the tetanus immunoglobulin (Ig)G level was identified as >= 0.1 IU/ml, while 25% of the patients had levels <0.1 IU/ml. The number of patients with protective levels was lower among those who were illiterate or who had only a primary school education, and this difference was statistically significant (p<0.001). CONCLUSION The vaccination histories can be misleading. Certain equipment can be used at the bedside to determine a patient's tetanus immunization status.
Analysis of the necessity of routine tests in trauma patients in the emergency department
(Türk Travma ve Acil Cerrahi Derneği, 2012-01) Köksal, Özlem; Çevik, Şebnem Eren; Aydın, Şule Akköse; Özdemir, Fatma; Tıp Fakültesi; Acil Tıp Ana Bilim Dalı; 0000-0003-2271-5659; 0000-0001-7602-8104; AAK-8332-2020; 23389880200; 54894485300; 15757217900; 7006765911
BACKGROUND: The necessity of routine tests as regarded in the Advanced Trauma Life Support protocols has become controversial in recent years. The aim of this study was to analyze the necessity of routine tests in trauma patients. METHODS: This was a prospective study. A total of 103 blunt trauma patients aged between 15 and 65 years who presented to the emergency department with major trauma, Glasgow Coma Scale of 15 and Revised Trauma Score of 12 were admitted to the study. RESULTS: The average age of the patients (30.1% female, 69.9% male) was 35 +/- 12.97 years. A total of 72.8% of the patients presented for motor vehicle crashes, 12.6% for pedestrian injury and 14.6% for fall from a height. All of the routine tests were evaluated separately. With the exception of cervical examination-lateral cervical X-ray results and pelvic examination-complete blood count and urinalysis test results, significant relations were determined between the reason for requiring a test and the results of the other tests (complete blood count, lateral cervical X-ray and abdominal ultrasonography). CONCLUSION: According to our study, biochemical tests, anterior-posterior chest X-ray and anterior-posterior pelvic X-ray can be ordered as targeted tests. Conducting targeted tests will reduce costs and workload.
Analysis of the outcomes of cardiopulmonary resuscitation in an emergency department
(Taylor & Francis, 2005-12) Özcan, Vedat; Demircan, Celaleddin; Engindeniz, Zülfi; Turanoğlu, Gülay; Özdemir, Fatma; Ocak, Özgür; Cebicci, Hüseyin; Akgöz, Semra; Tıp Fakültesi; Acil Tıp Ana Bilim Dalı; 0000-0003-1874-5097; 0000-0002-8987-6484; AAN-2617-2021; 9939161400; 55399735400; 6507354145; 6505738648; 7006765911; 9940943800; 8203353000; 14061863400
Objective - The aim of this study is to analyse the factors affecting emergency department (ED) cardiopulmonary resuscitation (CPR) outcome. Methods - A standard CPR protocol was performed in all patients and certain pre and post-resuscitation parameters including age, sex, initial arrest rhythm, primary underlying disease, initiation time of advanced cardiac life support, duration of return of spontaneous circulation were recorded. Patients were followed up to determine rates of successful CPR, survival and one-year survival. Results - From December 1999 to May 2001, 80 consecutive adult patients in whom a standard CPR was performed in the ED were prospectively included in the study. The overall rate for successful CPR, survival and one-year survival were found to be 58.8% (47/80), 15% (12/80) and 10% (8/80), respectively. Survival and one-year survival rates were better in patients with an initial arrest rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) than both pulseless electrical activity (pEA) and asystole; survival and one-year survival rates were better in patients with a primary underlying disease of cardiac origin than non-cardiac origin. Acute myocardial infarction had the best prognosis among conditions causing arrest. Presence of sudden death was found to have a better survival and one-year survival rate. Conclusion - Initial cardiac rhythm of VF/pVT, cardiac origin as the primary disease causing cardiopulmonary arrest and presence of sudden death were found to be good prognostic factors in CPR.
Aspirin resistance in patients presenting to the emergency department
(Carbone Editore, 2013) Köse, Ataman; Köksala, Özlem; Armağan, Erol; Sığırlı, Deniz; Özdemir, Fatma; Akköse, Sule; Tıp Fakültesi; Biyoistatistik Bölümü; 0000-0003-2271-5659; AAM-7896-2020; AAK-8332-2020; AAA-7472-2021; AAH-8846-2021; L-7334-2015; 55792812100; 55792424600; 55792577900; 55792509300; 57214275466; 55792876000
Introduction: The effect of aspirin is not the same for all patients and some patients can be resistant. Few emergency department (ED) studies have prospectively determined the rate of aspirin resistance in patients presenting to the ED and the most of them consider only specific group of patients. We aimed to evaluate the relation between clinical and laboratory parameters with aspirin resistance in patients presenting to the ED Methods: Using the bed-side point-of-care VerifyNow Aspirin assay (Accumetrics, San Diego, Calif), we sought to determine the rate of aspirin resistance in patients presenting to the ED with any complaint. Results: A total of 97 patients were included in this study. Aspirin resistance was found in 29 (29.9%) of them. There were not any significant differences in age, sex, drug usage, platelet count, ECG changes, heart rate, systolic, or diastolic blood pressure measures between the aspirin-resistant and aspirin-sensitive patients. In addition, patients' aspirin sensitivity and aspirin resistance did not differ significantly with regard to clinic results and diagnoses in the ED. However, patients with renal failure had significantly more aspirin resistance than other patients (p=0.007). Besides, the relationship between aspirin intake <30 time, pulse pressure and aspirin resistance were found out significant. Conclusion: To the best of our knowledge, this second current report of aspirin resistance in patients presenting to the ED pointed-out its presence in 29.9% of patients. In aspirin resistance, renal failure, pulse pressure and aspirin intake time were determined as important factors.
A case report of fatal oral ingestion of resorcinol
(Wiley-Blackwell, 2006-11) Bulut, Mehtap; Türkmen, Nursel; Fedakar, Recep; Aydın, Şule Akköse; Tıp Fakültesi; Adli Tıp Ana Bilim 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.
Characteristics of patients transferred by air: A descriptive epidemiologic study
(TÜBİTAK, 2012-10) Köse, Beril; Akpınar, Ayca Açıkalın; Köse, Ataman; Köksal, Özlem; Aydın, Şule; Armağan, Erol; Tıp Fakültesi; Acil Tıp Ana Bilim Dalı; 0000-0003-2271-5659; AAK-8332-2020; AAH-8846-2021; L-7334-2015; AAM-7896-2020; 15755792500; 23389880200; 6603347542; 6506464232
Aim: To analyze the characteristics of patients transferred by air ambulance in the eastern Anatolia region of Turkey. Materials and methods: We retrospectively evaluated the records of patients transferred by air ambulance between January 2010 and December 2010. Demographics and medical data of the patients, geographic conditions, and flight duration data were all analyzed. Results: A total of 241 patients were included in the study, of whom 51% were men and 49% were women. The majority of the patients were between 0 and 1 year old (40.2%). In the adult patients, the most commonly seen diagnoses were trauma (31.6%), obstetric problems (24.7%), cerebrovascular events (12.4%), and myocardial infarction (9%). It was determined that in terms of medical disciplines the patients were most commonly transferred to the clinics of pediatrics (45.2%), neurosurgery (9.1%), gynecology (9.1%), cardiology (6.2%), neurology (5%), and general surgery (5%). The total flight time was 115.3 +/- 4.7 min and the patients were most commonly transferred to a university hospital. Conclusion: The decision to use an air ambulance may be made based on the distance, the length of the transfer and transportation, the resources of the health institutions located in the relevant region, and the environmental and climatic conditions. However, the association between the likelihood of survival, the therapeutic benefits of the patient, and the cost should be analyzed.
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; Tıp Fakültesi; Genel Cerrahi Ana Bilim 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.
Comparison of the efficacies of topical anaesthetics in the reduction of the pain during peripheral intravenous cannulation: A randomised trial
(Sage Publications, 2012-05) Armaǧan, Erol; Kocabaş, Egemen; Köksal, Özlem; Şimşek, Gözde; Bal, Haldun; Tıp Fakültesi; Acil Tıp Ana Bilim Dalı; 0000-0003-2271-5659; AAH-8846-2021; AAK-8332-2020; 6506464232; 55317360100; 23389880200; 57225727701; 57198099466
Objective: This study aimed to compare the efficacies of two different topical anesthetic agents and placebo in the reduction of the pain observed during intravenous (IV) cannulation. Methods: Study enrolled a total of 129 healthy male donors and IV cannulation was performed to antecubital region. The donors were assigned into three groups. Prilocaine-lidocaine mixture cream (E), lidocaine spray (X) and Placebo cream (P) were given to patients. After the administration the donors were waited for approximately 45 minutes. The pain experienced by the donors after the insertion of 16 gauge cannula in arms was recorded as "pain experienced at minute 0, 5 and 15" on 100 mm visual analog scale (VAS). Results: In the first group, there was no significant difference between mean VAS scores recorded after the administration of prilocainelidocaine mixture cream and lidocaine spray before IV cannulation. Mean VAS value was 9.1 mm with prilocaine-lidocaine mixture cream and 9.3 mm with lidocaine spray. In the second group, we detected significant difference between mean VAS scores recorded after the administration of lidocaine spray and placebo cream. Mean VAS value was 9.8 mm with lidocaine spray and 24.3 mm with placebo (p<0.05). In the third group, we found statistically significant difference between VAS scores recorded after the administration of prilocaine-lidocaine mixture cream and placebo cream. Mean VAS value was 8.8 mm with prilocaine-lidocaine mixture cream and 33.0 mm with placebo cream (p<0.05). Conclusion: Although both agents administrated before IV cannulation were superior to placebo in adult patients in this study, we can state that these drugs were not superior to each other and showed similar efficacy.
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; Tıp Fakültesi; Acil Tıp Ana Bilim 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.
Compliance with protocols in transferring emergency patients to a tertiary care centre
(Elsevier, 2004-09) Armağan, Erol; Gültekin, Murat Al; Engindeniz, Zülfi; Tokyay, Rifat; Tıp Fakültesi; Genel Cerrahi Ana Bilim Dalı; 0000-0003-1874-5097; AAH-8846-2021; AAN-2617-2021; 6506464232; 6504053848; 6507354145; 7003296847
Study objectives: We evaluated compliance with standard patient transfer protocols in a pre- and post-interventional, study among patients transferred from other hospitals to our tertiary care university hospital. Methods: In the first phase, transfer information was recorded on the arrival in 174 consecutive patients transferred to our emergency department (ED) over a 2-month period in 1999. Emergency caregivers throughout the province then received education about proper transfer procedures. This training was provided through monthly citywide co-ordination and co-operation meetings among the physicians of the emergency medical services (EMS) and the emergency departments of the hospitals in the city and the nearby counties. Fifteen months after the beginning of these educational efforts, the second observational phase was implemented. Over a period of 2 months in early 2001, information was recorded from 180 consecutive patients transferred to our ED. Presence of patient medical records, Laboratory results, and X-rays; clearly delineated reason for transfer; prior notification of transfer; and appropriate care during transport from the initial facility were the parameters compared in the pre- and post-intervention periods. Results: Patients in phase-II were found to have had more appropriate care in some respects, such as presence of cervical collar and proper airway management, during transport from the initial facility than patients in phased (P < 0.05). However, other parameters were not significantly different between the two phases. Conclusion: We have concluded that our monthly meetings and conferences have made a positive impact on compliance with some of the standard transfer protocols. We must however, continue our efforts to increase compliance with other aspects of standard patient transfer guidelines.
Conditions that mimic stroke in elderly patients admitted to the emergency department
(Elsevier, 2013-05-26) İnal, Taylan; Köse, Ataman; Armaǧan, Erol; Kıyak, Ramazan; Demir, Aylin Bircan; Tıp Fakültesi; Acil Tıp Ana Bilim Dalı; 0000-0001-6739-8605; AAM-7896-2020; V-7170-2017; L-7334-2015; AAH-8846-2021; 15755792500; 6506464232; 55948964800; 57217395786
Background: Stroke is the most common neurologic cause for patient admission to the emergency department (ED) and the risk of stroke increases with age. This study aimed to determine the clinical and demographical characteristics of stroke-mimicking patients 65 years or older who were admitted to the ED for stroke. Methods: After the retrospective file examination, patients 65 years and older who were admitted to the ED with an established final diagnosis of stroke as a result of history, physical examination, imaging, and required consultations were included in the study. Results: After scanning 671 records of patients 65 years or older, 87.3% (n = 586) were diagnosed with stroke and 12.7% (n = 85) received different diagnoses mimicking stroke. Of these 85 patients, 91.8% (n = 78) and 8.2% (n = 7) were prediagnosed with ischemic stroke and transient ischemic attack, respectively, by the ED physicians. After complete evaluations and consultations, the patients with stroke were typically diagnosed with vertebrobasilar insufficiency (n = 16, 18.8%). Of the patients, 76.5% (n = 65) were discharged after treatment and follow-up in the ED, and 21.1% (n = 18) were hospitalized. Conclusions: In older patients, stroke-mimicking conditions can cause signs and symptoms indistinguishable from true stroke, representing about 12.7% of elderly patients admitted to an ED with these diagnoses.
Effects of different resuscitation fluids on tissue blood flow and oxidant injury in experimental rhabdomyolysis
(Lippincott Williams & Wilkins, 2005-11) Özgüç, Halil Bülent; Kahveci, Nevzat; Akköse, Şule; Serdar, Zehra; Balci, Veysel; Ocak, Özgür; Tıp Fakültesi; Biyokimya Ana Bilim Dalı; 0000-0003-0841-8201; AAG-7070-2021; 6603867989; 6602597846; 6603347542; 57222002284; 6507877217; 9940943800
Objective: This study was performed to evaluate the effects of 0.9% saline (SAL), 0.9% saline+sodium bicarbonate+mannitol (SAUBIC/MAN), and hypertonic saline-dextran (HSD) on hemodynamic variables, tissue blood flow, and oxidant injuries in experimental traumatic rhabdomyolysis (TR) in rats subjected allogeneic muscle extract infusion. Design: Prospective, randomized, experimental. Setting: Physiology experiment laboratory. Subjects: Male Sprague-Dawley rats, weighing 250-300 g. Interventions: All groups (n=8 each) underwent femoral artery and vein catheterization. The animals in the TR, SAL, SAUBIC/MAN, and HSD groups received an infusion of 2 mL of autologous muscle extract for 60 mins. After autologous muscle extract infusion, the SAL and HSD groups received 30 mL/kg 0.9% saline for 30 mins or 4 mL/kg HSD for 5 mins, respectively. The SAUBIC/MAN group received 30 mL/kg 0.9% saline for 30 mins plus a bolus of 1 g/kg mannitol and a bolus of 2 mEq/kg sodium bicarbonate diluted in 1 mL of saline. At 2 hrs of autologous muscle extract infusion, erythrocyte flows in liver and kidney were measured by using a laser Doppler flowmeter. Then, blood samples and kidney and liver biopsies were taken to measure levels of glutathione and malondialdehyde. Measurements and Main Results: TR caused decreases in mean arterial pressure, tissue blood flow, and tissue glutathione and an increase in malondialdehyde. Rats in the HSD group had significant metabolic acidosis. SAL resuscitation did not correct tissue blood flow and prevent oxidant injury. HSD increased tissue blood flow, mean arterial pressure, and liver and kidney glutathione and decreased serum, liver, and kidney malondialdehyde. SAUBIC/MAN resuscitation corrected all oxidant damage variables but did not increase tissue blood flow. SAUBIC/MAN preserved serum malondialdehyde and liver glutathione better than the HSD did. Conclusions: HSD prevented oxidant injury and restored tissue blood flow but increased metabolic acidosis that followed autologous muscle extract infusion. SAUBIC/MAN seems to be more effective than HSD in decreasing oxidant injury. Further research on the effects of the solute overload and metabolic acidosis due to HSD resuscitation on renal function in experimental rhabdomyolysis is warranted.
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; Tıp Fakültesi; Acil Tıp Ana Bilim 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.
Evaluation of prognostic value of MEDS, MEWS, and CURB-65 criteria and sepsis I and sepsis III criteria in patients with community-acquired infection in emergency department
(Sage Publications, 2019-04-29) Beğenen, Maruf; Durak, Vahide Aslıhan; Akalın, Emin Halis; Armağan, Erol; Tıp Fakültesi; Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Ana Bilim Dalı; 0000-0003-0836-7862; 0000-0001-7530-1279; 0000-0002-4641-9873; AAH-8846-2021; AAU-8952-2020; AAE-9483-2021; 55792633100; 57207553671; 6506464232
Background: Early and effective treatment of patients with sepsis requires early recognition in emergency department and understanding the severity of the disease. Many studies have been conducted for this purpose, and many of scoring systems have been developed that provide early recognition of these patients and show their severity. Objectives: The aim of this study is to evaluate the efficacy of the scoring systems used to determine the mortality of patients with infections admitted in emergency department. Methods: In all, 400 patients who admitted to Uludag University Hospital Emergency Department were prospectively included in this study. In addition to Systemic Inflammatory Response Syndrome score, Quick SOFA score, Mortality in Emergency Department Sepsis score, Modified Early Warning Score, and Charlson Comorbidity Index score in all patients, CURB-65 score was calculated in the patients diagnosed with pneumonia. It has been aimed to determine the power of these scores' predictive mortality rates and their superiority to each other. Results: It was found that Mortality in Emergency Department Sepsis score and Quick SOFA score could be used with similar efficacy (respectively p = 0.761 and p = 0.073) in determining early mortality in emergency department (5th and 14th days) and that MEDS score was more effective (p < 0.001) in predicting the 28th-day mortality. While these recommendations were valid in patients diagnosed with pneumonia, it was determined that CURB-65 score could also be used to estimate 5th-, 14th-, and 28th-day mortalities (respectively, for the 5th day, p = 0.894 and p = 0.256; for the 14th day, p = 0.425 and p = 0.098; and for the 28th day, p = 0.095 and p = 0.158). The power of Systemic Inflammatory Response Syndrome score, previously used to identify sepsis, in predicting mortality was detected to be lower. Conclusion: Mortality in Emergency Department Sepsis score and Quick SOFA score could be used with similar efficacy in determining early mortality in emergency department. However, if you want to predict 28th-day mortality rate, it can be better to use Mortality in Emergency Department Sepsis score or CURB-65 (in patients diagnosed with pneumonia).
Evaluation of the effect of the sublingually administered nifedipine and captopril via transcranial Doppler ultrasonography during hypertensive crisis
(Taylor and Francis, 2003) Gemici, Kani; Baran, İbrahim; Bakar, Mustafa; Demircan, Celalettin; Özdemir, Bülent; Cordan, Jale; Tıp Fakültesi; Acil Tıp Ana Bilim Dalı; 0000-0002-7528-3557; P-5653-2014; X-8540-2019; 6602927677; 35572557400; 26643051200; 6507741676; 7004168959; 6602518666
Objective: This study was designed to show the effects of sublingually administered nifedipine and captopril on middle cerebral arterial blood flow during hypertensive crisis in the emergency department. Methods and results: Transcranial Doppler ultrasonography (TCD) was performed on the patients fulfilling the criteria (15 patients given captopril, 13 patients given nifedipine, mean (+/-SD) age 56 +/- 11 and 54 +/- 10 years, respectively). Then, patients were randomized into sublingually administered captopril or nifedipine groups and after the drug administration, TCD was repeated. Initial systolic and diastolic blood pressures were 200 +/- 21/125 +/- 21 mmHg in the captopril group and 199 +/- 17/123 +/- 20 mmHg in the nifedipine group. There was no significant difference between antihypertensive effects of the drugs after initiation of treatment. Before the treatment with captopril, middle cerebral artery (MCA) flow velocities (Vm) and pulsatility index (PI) were 76.74 +/- 6.38 cm/s and 1.18 +/- 0.09, respectively. The values after the treatment with captopril were 78.21 +/- 15.24 cm/s (p < 0.05) and 0.92 +/- 0.08 (p < 0.001), respectively. Before the treatment with nifedipine, Vm and PIS were 64.73 +/- 5.11 cm/s and 1.14 +/- 0.18, respectively. After the treatment with nifedipine, Vm was 60.04 +/- 5.36 cm/s (p < 0.01) and PI was 1.21 +/- 0.09 (p < 0.01). Conclusion: After treatment with captopril, PIs were decreased to normal limits but in the group treated with nifedipine, PIs increased to more pathological values. These results showed that we should reconsider the use of nifedipine in the emergency departments as an antihypertensive agent in hypertensive attack treatment.
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; Tıp Fakültesi; Acil Tıp Ana Bilim 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 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; Tıp Fakültesi; Genel Cerrahi Ana Bilim 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.

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