A rare consequence of trauma: Chylothorax

Chylothorax is defined as the lymphatic fluid accumulation in the pleural space due to the obstruction or injuries in the ductus thoracicus. The incidence of chylothorax due to blunt and penetrating traumas is low at a rate of 0.2-3%. This case presentation intends to evoke chylothorax as a rare cause of pleural effusion due to injuries. A 27-day-old infant was brought to the emergency department with the complaint of a sudden respiratory distress developing after falling off the couch. The respiratory rate was 62, the pulse rate was 174, and the oxygen saturation rate was 68%. In the physical examination, the respiratory sounds were diminished bilaterally. The patient was intubated. As the saturation levels did not improve after intubation, a needle aspiration was performed bilaterally in the anterior axillary line with a prediagnosis of massive haemothorax. A yellowish fluid was aspirated from the pleural space bilaterally. Chest tubes were inserted bilaterally to treat respiratory distress due to mass effect of chylothorax. Massive chylothorax cases may result in serious complications leading to respiratory distress and cardiac dysfunction. An early diagnosis and appropriate treatment can be life-saving in these patient

Primary Preventable Cause of Door-in to Door-out Time Delay in ST-elavation Miyocard Infarction: Physician Decision Time

Aim: Door-in to door-out (DIDO) time is defined as the process of primary percutaneous coronary intervention after the first medical contact. In patients with ST-segment elevation myocardial infarction, this period commonly causes delays in the patient’s treatment. Our aim is to determine the preventable component among the components that make up the DIDO time. Materials and Methods: The study included 86 patients with ST-segment elevation myocardial infarction who were referred from non-percutaneous coronary intervention-capable hospitals to our percutaneous coronary intervention center. In this study, the DIDO time for transferred patients was divided into three determining components: the door-to-electrocardiography time, physician decision time (PDT), and time to referral. Results: The DIDO time was >30 min in 91.9% of 86 patients referred for primary percutaneous coronary intervention from non- percutaneous coronary intervention-capable hospitals. The mean DIDO time was 85 (3-233) minutes. The main component prolonging the DIDO time in all groups was the “PDT”, defined for the first time in this study, with a median of 49 (1-186) minutes. Conclusion: Thanks to the data we have uncovered, a time recommendation should be developed for each stage of the transfer comprising the DIDO components. Developing standard recommendations can help define and reinforce time standards to ultimately reduce DIDO times and improve patient care

Detection Rate of Fractures by Triage Nurses Applying the Ottawa Foot Rule

WOS: 000446896600009Aim: The purpose of this study was to investigate the detection rate of fractures by triage nurses by applying the Ottawa foot rule. Materials and Methods: This is a prospective observational validation study that was designed in a training and research hospital between January and December 2013 on 98 patients with isolated foot injury. After triage nurses were provided training on the Ottawa foot rule for 4 hours, they evaluated patients with foot trauma by applying the rule. Foot radiographs were obtained from all trauma patients who were evaluated in the triage. Radiographs were evaluated by an emergency medicine specialist and fractures were determined. Results: Data collection procedures included the evaluation of 90 out of 98 patients who demonstrated one or more qualities of the Ottawa foot rule according to the trained nurses. The fracture prediction rate of the triage nurses using the Ottawa foot rule was found to be 14.4%. The sensitivity of the "the inability to take four steps in the Emergency Department" was 100% and the specificity was 41.6%. Of all patients, 69.2% with fractures were aged = 55 years. Conclusion: This study revealed that triage nurses could successfully perform the Ottawa foot rule after a brief training. According to the Ottawa foot rule applied by the triage nurses, the "inability to take four steps in the Emergency Department" rule was found to be the most significant

Detection of rhabdomyolysis in patients admitted to emergency department due to drug overdose as a suicide attempt: A propective original clinical study [İntihar Amaçli İlaç Alimi Nedeni ile Acil Servise Başvuran Hastalarda Rabdomiyolizin Araştmlmasi: Prospektif Orijinal Klinik çalişma]

Objective: Drug-induced rhabdomyolysis is the most common cause of disorders leading to acquired muscular inflammation. The aim of this study is to investigate rhabdomyolysis frequency in patients admitted to the emergency room (ER) due to one or different types of multiple drug ingestion with suicidal intentions. Material and Methods: This prospective clinical study was performed between June 2013 and November 2013 in Dr. Lütfi Kirdar Kartal Training and Research Hospital’s ER, which had a daily admittance average of 800-1000 patients. The study included 103 patients. Creatinephosphokinase in the blood and myoglobin in the urine examined at the 3rd, 6th, 12th and 24th hours of admission to the ER. Results: Of the patients, 77 (74.8%) were female and 26 (25.2%) were male. Mean age was 28.8±9.5 years. Male subjects ingested a greater variety and a greater number of drugs than female subjects (p<0.05). Creatine phosphokinase level was found to be higher in the patients who took a higher number of drugs. Creatine phosphokinase was higher than 171 (U/L) in 15 patients (14.6%). Myoglobinuria was detected in 7.8% of all patients. No rhabdomyolysis was observed in patients who were admitted to the hospital within the first 3 hours of ingestion. The most commonly used agent for suicide attempt was non-steroidal antiinflammatory drugs (NSAIDs) (36.9%), paracetamol (31.1%) and antidepressants (30.1%). Conclusion: It was found that patients with delayed admission to the ER had a higher incidence of rhabdomyolysis. Antidepressants were the third leading agents used for suicidal intentions following NSAIDs and paracetamol. © 2019 by Türkiye Klinikleri

Response of Treatment in Patients with Primary Headaches and Hypertension: A Prospective Observational Pilot Study

Amaç: Bu çalışmanın amacı, kan basıncı yüksekliğinin eşlik ettiği primer baş ağrılı hastalarda tedavi önceliğinin belirlenmesine katkıda bulunmaktır. Çalışmamızda baş ağrısına yönelik uygulanan tedavi sonrası baş ağrısındaki gerileme ile ortalama arteriyel basınçtaki değişim arasında ilişki olup olmadığını karşılaştırdık.Gereç ve Yöntem: Bu prospektif gözlemsel çalışma hipertansiyonun eşlik ettiği primer tip baş ağrısı şikayeti ile acil servise başvuran 101 hasta ile yapıldı. Tüm hastaların tedavi sonrası baş ağrılarındaki düşme düzeyleri, ortalama arteriyel basınç ve ortalama arteriyel basınçtaki düşme yüzdeleri hesaplandı. Bulgular: Tedavi sonrası 25 (%24,8) hastanın ağrısı 3 alt düzeye, 43 (%42,6) hastanın ağrısı 2 alt düzeye, 23 (%22,8) hastanın ağrısı 1 alt düzeye düşmüştü. Başvuru anında hastaların ortalama arteriyel basınç değerlerinin ortalaması 118,58±12,65 iken baş ağrısına yönelik tedavi sonrası 30. dakikada hastaların ortalama arteriyel basınç değerlerinin ortalaması 98,41±13,43'e gerilemişti. Baş ağrısına yönelik verilen tedavi sonrasında baş ağrısında değişme olmayan ve bir alt düzeye gerileyen hastaların ortalama arteriyel basınç oranında anlamlı düşme olmazken (p>0,05), baş ağrısı iki ve üç alt düzeye gerileyen hastalarda ortalama arteriyel basınç oranlarında anlamlı düşme oldu (p0.05) drop in the mean arterial pressure value of the patients with one level decrease in headache severity after treatment.Conclusion: This study showed that when a primary headache, which is often associated with high blood pressure, was treated instead of treating high blood pressure as a secondary cause of headache, blood pressure decreased spontaneousl

Acute bilateral vision loss in emergency department: A case report

Stroke occurs due to the interruption of blood flow to the brain and it is divided into ischemic and hemorrhagic. In the ischemic strokes, while the most commonly affected vessel is median cerebral artery (MCA), it is particularly affected bilateral posterior cerebral artery (PCA) is very rare condition. In this study, a case of sudden loss of vision and bilateral occipital infarct associated with bilateral vertebral system pathology and methylene tetrahydrofolate reductase (MTHFR) gene mutation were reported. A 62-year-old man was admitted with sudden loss of vision complaint starting 10 h before applying to emergency department. The patient was oriented and cooperative. On neurological examination, there was complete loss of vision in the right eye and only a response to light in the left eye. On the brain computerized tomography (CT), ischemic lesions were observed in the bilateral occipital areas and on magnetic resonance imaging (MRI), there were foci showing diffusion limitation in cortico-subcortical areas of bilateral parieto-occipital region. On the detailed examination at the clinic, MTHFR (a1298c) gene mutation was detected. Bilateral occipital infarction is rare and its diagnosis can be difficult because of its atypical symptoms. Therefore, occipital infarction should be suspected when the only sign is isolated vision loss in patients with risk factor for thromboembolism in their history and detailed visual-neurological examination of these patients should be performed. © 2016 The Emergency Medicine Association of Turkey

The Knowledge Levels of Emergency Physicians: Whom to Care About? Physicians or Patients?

Objective: Emergency physicians, with their life-saving roles in critical diseases’ initial evaluation, are essential for patient safety within the health system. The aim of the study is to evaluate whether the practitioners working in the ER and expert physicians (in disciplines other than emergency medicine) consider themselves competent regarding the frequent life-threatening diseases that are encountered and the accuracy of their notions.Material and Methods: A survey of 20 questions was given to ER physicians working in hospitals. Results: Of the physicians that took the survey, 82.7% considered their knowledge regarding the initial treatment of a patient admitted to the ER as sufficient or very sufficient; 65.3% of the physicians stated that four or less symptoms that would raise suspicion in an EKG of patients admitted to the ER with myocardial infarction, while 34.7% stated that there may be five or more symptoms. Additionally, 53.8% of the physicians consider themselves competent/very competent in recognizing bleeding and ischemia in brain tomography. Furthermore, 81.6% of the physicians considered their ability to apply initial treatment to a patient with diabetic ketoacidosis as sufficient or very sufficient, while the percentage of physicians who stated that the fluid deficit of a patient with diabetic ketoacidosis is 5 L or more was 55.4% Conclusion: With this study, we found evidence indicating a serious lack of knowledge among practitioners treating patients in the ER and expert physicians not related to emergency medicine regarding crucial matters related to patients admitted to the ERObjective: Emergency physicians, with their life-saving roles in critical diseases’ initial evaluation, are essential for patient safety within the health system. The aim of the study is to evaluate whether the practitioners working in the ER and expert physicians (in disciplines other than emergency medicine) consider themselves competent regarding the frequent life-threatening diseases that are encountered and the accuracy of their notions.Material and Methods: A survey of 20 questions was given to ER physicians working in hospitals. Results: Of the physicians that took the survey, 82.7% considered their knowledge regarding the initial treatment of a patient admitted to the ER as sufficient or very sufficient; 65.3% of the physicians stated that four or less symptoms that would raise suspicion in an EKG of patients admitted to the ER with myocardial infarction, while 34.7% stated that there may be five or more symptoms. Additionally, 53.8% of the physicians consider themselves competent/very competent in recognizing bleeding and ischemia in brain tomography. Furthermore, 81.6% of the physicians considered their ability to apply initial treatment to a patient with diabetic ketoacidosis as sufficient or very sufficient, while the percentage of physicians who stated that the fluid deficit of a patient with diabetic ketoacidosis is 5 L or more was 55.4% Conclusion: With this study, we found evidence indicating a serious lack of knowledge among practitioners treating patients in the ER and expert physicians not related to emergency medicine regarding crucial matters related to patients admitted to the E

Does Simple Face Mask or Diffuser Mask Matter in the First Hour Treatment of Carbon Monoxide Intoxication? A Prospective Randomized Clinical Study

Aim: In patients who do not have any indication for hyperbaric oxygen (O2) treatment, the main treatment to eliminate carbon monoxide (CO) is by giving O2 using a face mask. In the absence of a non-rebreathing face mask, a diffuser mask (DMG) or simple face mask (SMG) is an option that can be used for treatment. There are insufficient data about the acute efficacy of these masks. To study the ability of DMG and SMG in lowering carboxyhemoglobin (COHb) levels after the first hour of O2 treatment in patients with CO intoxication. Materials and Methods: This was a prospective randomized clinical study conducted in patients aged ?16 years old who were diagnosed with CO intoxi-cation. They were randomly given 15 L/min O2 (from hospital central O2 supplies) treatment with DMG (n=29) or SMG (n=52). Partial pressure of O2 (PaO2), carbon dioxide, and COHb levels and saturation of O2 were measured before and after 1 h of treatment. Results: A total of 81 (42 female and 39 male) patients with a mean age of 39.1±14.7 years were included in the study. There were no differences with regard to age, gender, body mass index, comorbidity, source of CO, initial symptoms, and initial COHb levels before treatment. After the first hour of treatment, DMG had lower mean COHb (mg/dL) levels (9.6±5.0 vs. 12.8±6.2, p=0.0203) and higher mean PaO2 levels (224.4±56.5 vs. 183.4±63.7, p=0.0046) than SMG. Conclusion: Diffuser mask (DMG) appears to be better than simple face mask (SMG) in the first hour of treatment of CO intoxication