Person: KÖKSAL, ÖZLEM
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KÖKSAL
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ÖZLEM
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Publication 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; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Bölümü; AAK-8332-2020; AAH-8846-2021; AAI-2164-2021; L-7334-2015Objective: 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.Publication Is there a relationship between the diameter of the inferior vena cava and hemodynamic parameters in critically ill patients?(Medknow Publications, 2015-11-01) Aydın, Şule A.; Özdemir, Fatma; Taşkın, G.; Ocakoğlu, Gökhan; Yıldırım, H.; Köksal, Özlem; AYDIN, ŞULE; ÖZDEMİR, FATMA; Taşkın, G.; OCAKOĞLU, GÖKHAN; KÖKSAL, ÖZLEM; Uludağ Üniversitesi/Tıp Fakültesi/Acil Servis Bölümü; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı; 0000-0002-1114-6051; AAH-5180-2021; AAK-8332-2020; HLG-6346-2023; AAI-2164-2021; IOY-2055-2023; GHW-4797-2022Introduction: The early detection of critically ill patients together with the rapid initiation of effective treatment in emergency departments(ED) increase the survival rates.Aim: This study investigated whether a correlation exists between haemodynamic parameters of critically ill patients and the diameter of the inferior vena cava (IVC).Materials and Methods: A cross-sectional study was performed included patients aged >= 18 years with an unstable haemodynamic and/or respiratory status who were referred to the ED for non-traumatic issues. IVC diameters were measured by ultrasound (US) and then central venous pressures (CVP) were measured. Anteroposterior (AP) and mediolateral (ML) diameters of the IVC, both in the inspirium (IAP, IML) and expirium (EAP, EML), were measured by US.Results: 102 patients were evaluated with a median age of 59. The relationship between the diameters of IVC and CVP was evaluated and significant correlation was found in IAP, EAP according to CVP values (p<0.001). ROC analyses were performed and significant relationship was found between the EAP diameter with haemoglobin (Hmg), haemotocrit (Hct), and central venous oxygen saturation (ScvO2) and also significant correlation was detected between the IAP diameter and white blood cell (WBC).Discussion: We detected significant correlation between the CVP and the IVC diameter in our study compatible with recent studies besides, significant correlation was found between the diameter of the IVC and CVP values as well as between the EAP diameter and Hmg, Hct, ScvO2 levels.Conclusion: Measurement of IVC diameters, especially EAP may be useful at the monitoring of critically ill patients in ED.Publication Comparison of ice and lidocaine-prilocaine cream mixture in the reduction of pain during peripheral intravenous cannulation in emergency department patients(Galenos Yayıncılık, 2013-03-01) Aygün, Hüseyin; Armağan, Erol; Özdemir, Fatma; Köse, Ataman; Selimoğlu, Kerem; Köksal, Özlem; Aydın, Şule Akköse; Aygün, Hüseyin; ARMAĞAN, EROL; ÖZDEMİR, FATMA; Köse, Ataman; Selimoğlu, Kerem; KÖKSAL, ÖZLEM; AYDIN, ŞULE; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; 0000-0003-3635-7282; AAK-8332-2020; AAI-2164-2021; AAH-8846-2021; AAM-7896-2020; JKT-3402-2023; JPE-0854-2023; CDS-3299-2022Objective: We aimed to compare the efficacies of ice, lidocaine-prilocaine mixture cream and the classical method in reduction of the pain observed during intravenous cannulation, which is the most frequently performed procedure in emergency departments and to define the most effective method.Material and Methods: One hundred-twenty patients who applied to the emergency department of Uludag University Faculty of Medicine were included in this presented study. Cannulations were performed after one minute application of ice package in the ice group. Patients who applied to emergency only for blood transfusion were chosen for the lidocaine-prilocaine group and their cannulations were performed at the 60th minute of cream mixture application. Finally, no applications before cannulation were used for the control group. All cannulations were performed from antecubital region and 18 G cannula were used. Visual analog scale ( VAS) and patient satisfaction were scored.Results: VAS scores for ice, lidocaine-prilocaine and control groups are 2.8 +/- 1.7, 4.1 +/- 1.8, 4.4 +/- 1.9, respectively. VAS score in the ice group was significantly lower than both lidocaine-prilocaine and control groups. In addition, there was no statistically significant difference between lidocaine-prilocaine and control groups.Conclusion: Ice application method before intravenous cannulation, in addition to its advantages such as being inexpensive, easy to obtain and apply, is more effective than lidocaine-prilocaine cream.Publication General characteristics of patients with electrolyte imbalance admitted to emergency department(Zhejiang Univ Sch Medicine, 2013-06-01) Balcı, Arif Kadri; ARMAĞAN, EROL; Köksal, Özlem; KÖKSAL, ÖZLEM; Köse, Ataman; ÖZDEMİR, FATMA; Özdemir, Fatma; Öner, Nuran; İnal, Taylan; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; AAH-8846-2021; ABD-7228-2021; AAK-8332-2020; L-7334-2015; AAM-7896-2020BACKGROUND: Fluid and electrolyte balance is a key concept to understand for maintaining homeostasis, and for a successful treatment of many metabolic disorders. There are various regulating mechanisms for the equilibrium of electrolytes in organisms. Disorders of these mechanisms result in electrolyte imbalances that may be life-threatening clinical conditions. In this study we defined the electrolyte imbalance characteristics of patients admitted to our emergency department.METHODS: This study was conducted in the Emergency Department (ED) of Uludag University Faculty of Medicine, and included 996 patients over 18 years of age. All patients had electrolyte imbalance, with various etiologies other than traumatic origin. Demographic and clinical parameters were collected after obtaining informed consent from the patients. The ethical committee of the university approved this study.RESULTS: The mean age of the patients was 59.28 16.79, and 55% of the patients were male. The common symptoms of the patients were dyspnea (14.7%), fever (13.7%), and systemic deterioration (11.9%); but the most and least frequent electrolyte imbalances were hyponatremia and hypermagnesemia, respectively. Most frequent findings in physical examination were confusion (14%), edema (10%) and rates (9%); and most frequent pathological findings in ECG were tachycardia in 24%, and atrial fibrillation in 7% of the patients. Most frequent comorbidity was malignancy (39%). Most frequent diagnoses in the patients were sepsis (11%), pneumonia (9%), and acute renal failure (7%).CONCLUSIONS: Electrolyte imbalances are of particular importance in the treatment of ED patients. Therefore, ED physicians must be acknowledged of their fluid-electrolyte balance dynamics and general characteristics.Publication Is routine pregnancy test necessary in women of reproductive age admitted to the emergency department?(Zhejiang Univ Sch Medicine, 2013-09-01) Köksal, Özlem; KÖKSAL, ÖZLEM; Özdemir, Fatma; ÖZDEMİR, FATMA; Armağan, Erol; ARMAĞAN, EROL; Öner, Nuran; Sert, Pınar Çınar; Sığırlı, Deniz; SIĞIRLI, DENİZ; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistk Anabilim Dalı.; AAH-8846-2021; AAK-8332-2020; AAA-7472-2021BACKGROUND: This study aimed to determine the necessity of pregnancy test in women of reproductive age admitted to emergency department (ED) in routine practice.METHODS: We retrospectively reviewed the records of patients who presented to the ED between January 1, 2006 and December 31, 2010 and received a pregnancy test.RESULTS: The median age of 1 586 patients enrolled into the study was 27 years. Of these patients, 19.55% had a positive result of pregnancy test. The most common complaint at admission was abdominal pain in 60.15% of the patients, and pregnancy test was prescribed. 15.83% of the patients with abdominal pain had a positive result of pregnancy test. Of the patients, 30.64% had nausea-vomiting at admission, and 11.52% had a positive result of pregnancy test. When other complaints were considered, the most commonly observed complaints were non-specific symptoms such as dizziness, malaise and respiratory problems. Of the patients, 70.93% were not remembering the date of last menstruation, and 9.51% showed a positive result of pregnancy test. Urinary tract infection (UTI) was commonly diagnosed with an incidence of 17.65%, which was followed by nonspecific abdominal pain (NSAP) (16.77%) and gastrointestinal disorders such as gastritis and peptic ulcer (6.87%). Of the patients, 88.40% were discharged from ED, and 11.60% were hospitalized.CONCLUSION: Pregnancy test should be given to women of reproductive age as a routine practice in ED in developing countries like Turkey.Publication Clinical probability and risk analysis of patients with suspected pulmonary embolism(Zhejiang Univ Press, 2014-12-01) Yetgin, Gülden Özeren; Aydın, Şule Akköse; Köksal, Özlem; Özdemir, Fatma; Mert, Dilek Kostak; Torun, Gökhan; AYDIN, ŞULE; KÖKSAL, ÖZLEM; ÖZDEMİR, FATMA; Mert, Dilek Kostak; Torun, Gökhan; AAI-2164-2021; AAA-2367-2020; AAK-8332-2020BACKGROUND: Pulmonary embolism (PE) is one of the most frequent diseases that could be missed in overcrowded emergency departments as in Turkey. Early and accurate diagnosis could decrease the mortality rate and this standard algorithm should be defined. This study is to find the accurate, fast, non-invasive, cost-effective, easy-to-access diagnostic tests, clinical scoring systems and the patients who should be tested for clinical diagnosis of PE in emergency department.METHODS: One hundred and forty patients admitted to the emergency department with the final diagnosis of PE regarding to anamnesis, physical examination and risk factors, were included in this prospective, cross-sectional study. The patients with a diagnosis of pulmonary embolism, acute coronary syndrome or infection and chronic obstructive pulmonary disease (COPD) were excluded from the study. The demographics, risk factors, radiological findings, vital signs, symptoms, physicallaboratory findings, diagnostic tests and clinical scoring systems of patients (Wells and Geneva) were noted. The diagnostic criteria for pulmonary emboli were: filling defect in the pulmonary artery lumen on spiral computed tomographic angiography and perfusion defect on perfusion scintigraphy.RESULTS: Totally, 90 (64%) of the patients had PE. Age, hypotension, having deep vein thrombosis were the risk factors, and oxygen saturation, shock index, BNP, troponin and fibrinogen levels as for the biochemical parameters were significantly different between the PE (+) and PE (-) groups (P<0.05). The Wells scoring system was more successful than the other scoring systems.CONCLUSION: Biochemical parameters, clinical findings, and scoring systems, when used altogether, can contribute to the diagnosis of PE.Publication Snakebite cases admitted to uludag university faculty of medicine emergency department and current management of snake bite(Aves, 2009-03-01) ÖZDEMİR, FATMA; Eren, Sebnem; Özdemir, Fatma; Köksal, Özlem; KÖKSAL, ÖZLEM; Durmuş, Oya; Esen, Mehmet; Akköse, Şule Aydın; AYDIN, ŞULE; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; 0000-0003-2180-6946; HHN-5686-2022; AAK-8332-2020; AAX-5571-2021Background: The purpose of this study is to analyse the characteristics of snakebite cases' epidemiology, clinic, treatment and prognosis and to investigate the current first aid and treatment methods.Methods: The snakebite cases admitted to our emergency department (ED) between 01.01.1995-31.12.2004 were investigated retrospectively. Demographic data, procedures and biochemical tests in the ED, prognosis of the hospitalized patients, the treatment given in the hospital and the complications were recorded.Results: The average age of the totally 48 (M/F: 27/21) patients was 40.4 year. 11 cases were discharged, 21 cases were transferred to other hospitals and 16 of them were hospitalized. Majority of the patients admitted in spring and summer. Among the 24 patients whom files had been obtained, 12 patients' snakebite was on the lower extremity, and 12 patients' was on the upper extremity. Antivenom was applied to 17 of these 24 patients. Systemic symptoms were seen in 6 patients. As an abnormal biochemical test only leucocytosis was seen in 7 patients. Faciotomy was applied to 25% of the patients with the diagnosis of compartment syndrome. The average hospitalization time was 4.2 day and there were no deaths and no extremity amputation among these patients.Conclusion: Most of the snakebites occur in the spring and summer season. Poisonous snakebites can cause severe systemic and local complications like compartment syndrome. ED approach includes close following of the vital signs, basic laboratory tests, tetanus prophylaxis, diagnosis of compartment syndrome and systemic complications. Patients should be examined in terms of antibiotherapy and antivenin.Publication The combination of scoring systems and lactate for predicting short-term mortality in geriatric patients with dyspnea(Springer, 2023-06-19) Ardıç, Anıl; Köksal, Özlem; Durak, Vahide Aslıhan; Dilektaşlı, Aslı Görek; Özkaya, Güven; KÖKSAL, ÖZLEM; DURAK, VAHİDE ASLIHAN; GÖREK DİLEKTAŞLI, ASLI; ÖZKAYA, GÜVEN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Hastalıkları Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı; 0000-0003-0836-7862; 0000-0003-0297-846X; 0000-0003-2271-5659; AAK-8332-2020; AAE-9483-2021; CNP-1063-2022; IVU-2672-2023BackgroundDyspnea is one of the most common causes for admission to the emergency department. Lactate (L), which can be used as a prognostic marker, was first studied by Broder and Weil and it was shown that a level > 4 mmol/l is associated with a poor prognosis. There are also scoring systems to assess the severity of illness of patients presenting to the emergency department such as the National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS) and VitalPAC Early Warning Score (ViEWS).ObjectivesIn this study, we aimed to investigate the combination of risk scoring systems and lactate in predicting short-term mortality in patients over 65 years of age with the complaint of nontraumatic dyspnea.Materials and methodsThe population of the study consisted of adult patients aged 65 and over who presented to Bursa Uludag University Medical Faculty Emergency Department with dyspnea. Admission NEWS, MEWS, REMS, ViEWS scores and their combined forms with added lactate levels at first admission, and 7-, 14-, and 28-day survival were recorded.ResultsWe found that the modified composite scores with lactate value, and the NEWS, MEWS, REMS, and ViEWS scores could predict the 28-day mortality. Ranking the scores and lactate value predicting 28-day mortality according to the area under the curve (AUC) value revealed that the 28-day mortality was best predicted by the NEWS + lactate with 64.97% sensitivity and 77.53% specificity (p < 0.001). We have shown that increasing lactate levels, NEWS, MEWS, REMS, ViEWS scores and their modified composite scores with lactate above suggested thresholds are independent risk factors for increased mortality in multivariable Cox regression analysis.ConclusionsIn cases with dyspnea, lactate value, NEWS, MEWS, REMS, ViEWS, NEWS-L MEWS-L, REMS-L, and ViEWS-L scores can be used to predict early mortality. Risk scores modified with lactate value were found to be more successful in predicting 28-day mortality.Publication 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-5686-2022Ammonium 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.Publication Management of fever; comparison of the effectiveness of metamizole and paracetamol in patients with suspected swine flu (h1n1)(Aves, 2011-12-01) Armağan, Erol; ARMAĞAN, EROL; Aydın, Sule Akkose; AYDIN, ŞULE; Köksal, Özlem; KÖKSAL, ÖZLEM; Kocabaş, Egemen; Küfeciler, Tarkan; Balcı, Arif Kadri; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; AAH-8846-2021Objective: The study was performed to compare the effects of metamizol and paracetamol administered intravenously (IV), int adult patients with suspected swine flu (H1N1) presenting at the emergency department (ED) with feverMaterials and Methods: The study is a prospective randomized study made at the Uludag University Medical School ED between the dates of December 01-31.12.2009. 125 suspected H1N1 patients with fever were included in the study. Patients were randomized in turn and medications (1000 mg paracetamol/metamizole in 100 cc serum physiologic) were applied in the form of a 20-minute infusion by IV. Body temperatures are recorded before and after 15 and 30 minutes of drug applicationResults: The patients' mean age was 27.2 +/- 10.2. There were 63 patients in the metamizole and 62 patients in the paracetamol group. Body temperature decrease was significant with both drugs of application, however, in the group administered paracetamol the temperature decrease was more significant (p < 0.05).Conclusion: Although both paracetamol and metamizole are effective in fever management, in patients with suspected H1N1, paracetamol is the drug of choice.