The Perspective of Emergency Department Professionals on Patients Rights

WOS: 000363103000005Objective: Patient rights are a sub-heading of human rights and are one of the fundamental rights of human beings gained from birth. the aim of this study was to evaluate knowledge and attitudes of all personnel working in emergency departments of second healthcare hospitals of Rize province towards patient rights, which is an important aspect of the quality of healthcare and patient satisfaction. Methods: the study was conducted in July-August 2009 in the emergency departments of the second healthcare hospitals of Rize province by participation of 390 professionals 235 (60.2%) of them were volunteer to fill a survey performed in the basis of Patient Rights Directive. the obtained data were analyzed with the SPSS for Windows 17.0 software program; statistical analytic methods were used such as average, frequency, standard deviation and k-square, p<0.05 was accepted as statistically significant. Results: A total of 62.1% (n=146) of the study participants were males and 35.7% (n=84) were included in the 26-30 years age group. Regarding the period of working 34.5% (n=82) of the subjects were working for 13-36 months in the emergency department and 72.3% (n=170) of them was found to be willingly working in this department. When questioned about their first encounter with the patient rights 48.9% (n=115) of them answered as in-service training. When asked about the first to come to mind regarding patient rights 40.4% (n=95) of the subjects answered as equality of access to services Conclusion: Patient rights should be defended by patients, hospital staff and hospital management to allow the provision of quality health services to ensure a better environment for patients

Incidental Finding in a Headache Patient: Intracranial Lipoma

[West J Emerg Med. 2014;15(4):361-362.

Pneumomediastinum Associated with Pneumopericardium and Epidural Pneumatosis

Spontaneous pneumomediastinum is a relatively rare benign condition. It may rarely be associated with one or combination of pneumothorax, epidural pneumatosis, pneumopericardium, or subcutaneous emphysema. We present a unique case with four of the radiological findings in a 9-year-old male child who presented to our emergency department with his parents with complaints of unproductive cough, dyspnea, and swelling on chest wall. Bilateral subcutaneous emphysema was palpated on anterior chest wall from sternum to midaxillary regions. His anteroposterior and lateral chest radiogram revealed subcutaneous emphysema and pneumomediastinum. His thorax computed tomography to rule out life-threatening conditions revealed bilateral subcutaneous, mediastinal, pericardial, and epidural emphysema without pneumothorax. He was transferred to pediatric intensive care unit for close monitorization and conservative treatment. He was followed-up by chest radiographs. He was relieved from symptoms and signs around the fifth day and he was discharged at the seventh day. Diagnosis of pneumomediastinum is often made based on physical findings and plain radiographs. It may not be as catastrophic as it is seen. Close cardiopulmonary monitorization is mandatory for complications and accompanying conditions. Most patients with uncomplicated spontaneous pneumomediastinum respond well to oxygen and conservative management without any specific treatment

A Case of Ramsay Hunt Syndrome with Atypical Presentation

SUMMARY: Ramsay Hunt syndrome is a rare complication of herpes zoster which results from the reactivation of the latent varicella-zoster virus in the geniculate ganglion. Although facial nerve is the most common affected nerve in Ramsay Hunt syndrome, other cranial and cervical nerves can also be affected. We present an atypical case of Ramsay Hunt syndrome in a 42-year-old male, with cervical nerve involvement. As spontaneous recovery rate in Ramsay Hunt syndrome is low, early diagnosis and treatment plays a key role in full recovery of paralysis. ÖZET: Ramsay Hunt sendromu, varisella-zoster virüsün latent olarak kaldığı genikulat ganglionda aktifleşmesiyle oluşan herpes zosterin nadir bir komplikasyonudur. Ramsay Hunt sendromunda fasiyal sinir en sık etkilenen sinir olmasına rağmen diğer kraniyal sinirler ve servikal sinirler de tutulabilir. Bu yazıda, 42 yaşındaki erkek hastada servikal tutulumun da eşlik ettiği atipik bir Ramsay Hunt sedromu olgusu sunuldu. Ramsay Hunt sedromunda spontan iyileşme oranları düşük olduğundan bu hastaların tanılarının erken dönemde konması ve tedavilerinin hemen başlanması paralizinin tam olarak iyileşmesinde kilit role sahiptir. Key words: Facial palsy, Ramsay Hunt syndrome, varicella-zoster virus, Anahtar sözcükler: Fasiyal paralizi, Ramsay Hunt sendromu, varisella-zoster virü

Incidental Finding in a Headache Patient: Intracranial Lipoma

[West J Emerg Med. 2014;15(4):361-362.

THE DIAGNOSIS OF PULMONARY EMBOLISM IN PATIENTS WITH NORMAL D-DIMER LEVELS

Kalkan, Asim/0000-0002-5800-0201;WOS: 000375337700027Introduction: the combination of clinical probability assessment and the D-dimer test has been recommended to avoid unnecessary diagnostic testing in pulmonary thromboembolism (PTE). However, in clinical practice, patients are occasionally diagnosed with PTE despite normal D-dieter levels. in the present study, we reviewed the characteristics of cases in an emergency department (ED) in which a diagnosis of PTE was made despite normal D-dimer test results. Materials and methods: the hospital records of 107 patients who were admitted to the ED of a teaching hospital and diagnosed with PTE between January 2011 and December 2013 were reviewed retrospectively. We acquired data for 11 patients (10.2%) in whom D-dimer measurements obtained by an automated latex turbidimetric quantitative method were below 500 ng/ml (0-450). Results: of the 11 patients, 72.7% (8/11) were female, and mean age was 71. +/- 57.9 (61-84) years. the most common symptom was dyspnea (54.5%, n=6). the mean delay between onset of symptoms and admission to the ED was 10.6 (3-30) days, and follow-ups were performed for patients in other health facilities for various causes of dyspnea. When risk factors were analyzed with the Wells score, 18.2% (2/11) of patients had low probability of PTE, whereas 72.7% (8/11) had intermediate, and 9% (1/11) had high probability. According to the revised Geneva score, 18.2% (2/11) of patients were found to have low probability, and 81.8% (9/11) had intermediate probability. the Pulmonary Embolism Severity Index score classified 18.2% (2/11) of the patients in the low risk group, and the European Society of Cardiology classification classified 81.8% (9/11) in the low risk group. Conclusion: in patients with nonspecific symptoms of PTE, the delay between onset of symptoms and admission to the ED is important. the risk factors of the patients and their pre-test probabilities should be considered along with D-dieter test results

How much should we observe patients with mad honey poisoning?

WOS: 000396830900014The aim of this study was to understand better the pathophysiology of this intoxication by evaluating the effect of mad honey ingestion on Inferior Vena Cava (IVC) diameters and IVC Collapsibility Index (IVC-CI) and develop an objective algorithm for the duration of fluid replacement and observation. the patients with the medical history of mad honey ingestion and admitted to the emergency service due to the signs of mad honey poisoning were analysed. Their data concerning age, gender, admission symptoms and the time of onset of these symptoms, the vital signs during admission, the administered treatment, the post-treatment recovery time and vital signs were all recorded. the inferior vena cava diameter and the IVC collapsibility index were assessed by ultrasonography. of 29 patients included in the study, 79.31% were male, the average age was 52.76 +/- 17.52 years, and the most common cause of admission was dizziness. While 0.9% saline solution was administered to all patients, in 82.75% intravenous atropine was started. Significant differences were determined between the vital signs, the inferior vena cava diameters, and the collapsibility indexes of the pre and post treatment periods. the ingestion of mad honey should be questioned in the medical history in patients who were admitted to the emergency services due to hypotension, bradycardia, and syncope. the assessment of the vital signs and the measurement of the inferior vena cava diameters of the patients should be the parts of the follow-up. the monitoring of the responses to the administered atropine and/or normal saline solutions should be made by the ultrasonographic assessment of the inferior vena cava diameter and the IVC Collapsibility Index (IVC-CI), in addition to monitoring the vital signs

Heart Attack in the Course of Lithium Overdose

Kalkan, Asim/0000-0002-5800-0201;WOS: 000392223900001PubMed: 27703795Introduction: Lithium overdose can be associated with cardiac toxicity, especially in those with underlying heart disease. Toxic levels of serum lithium are associated with cardiotoxic effects ranging from simple ECG disorders to dysrhythmias, cardiomyopathy and even acute myocardial infarction (AMI). This report describes a patient with AMI accompanied by high blood levels of lithium. Case Presentation: A 62-year-old woman was admitted to the emergency department due to weakness and acute chest pain. Her ECG revealed ST elevation in leads DI, aVL and V5-6, with a ventricular rate of 80 bpm. Blood chemistry and complete blood count were within normal limits. the patient's blood lithium level was measured as 2.3 mmol/L (N: 0.5-0.8 mmol/L), and her troponin I level was 0.892 ng/mL (N: 0-0.01 ng/mL). Coronary angiography produced normal findings, concurrent with the resolution of electrocardiographic abnormalities following elimination of lithium. the clinical course in the intensive care unit was uneventful and the patient was discharged on the seventh day. Conclusions: Lithium intoxication should be considered in the differential diagnosis, especially in elderly patients on lithium therapy who are admitted to the emergency department with chest pain