Organofosfat zehirlenmelerinde pralidoksimin farklı doz uygulama şekillerinin etkinliği ve yan etkilerinin klinik karşılaştırılması

TEZ5895Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2006.Kaynakça (s.45-48) var.vii, 50 s. ; 29 cm.Organophosphate is commonly used as insecticides in agriculture in all over the world. Organophosphate poisoning also occurs in Turkey. Pralidoxime is a kind of oxime that is used in the treatment of organophosphate poisoning. The aim of this study is to compare effectiveness of pralidoxime treatment in different doses in organophosphate poisoning.Organofosfatlar dünyada özelikle tarımsal faaliyetlerin fazla olduğu ülkelerde yaygın olarak kullanılan böcek öldürücü maddelerdir. Organofosfatlı bilesikler ile olusan zehirlenmeler bir tarım ülkesi olan Türkiye'de yaygındır. Pralidoksim gibi oksimler organofosfatlar ile olusan zehirlenmelerin tedavisinde kullanılır. Bu çalısmanın amacı, organofosfatlı bilesikler ile olusan zehirlenmelerin tedavisinde pralidoksimin etkinliğini farklı dozlarda tedavi uygulamaları yaparak karsılastırmak ve sonuçlarını ortaya koymaktır.Bu çalışma Ç.Ü. Bilimsel Araştırma Projeleri Birimi Tarafından Desteklenmiştir. Proje No

Factors affecting the prognosis in acute ınsecticide ıntoxications containing organic phosphorus

Amaç: Bu çalışmanın amacı, organik fosforlu insektisitlerle zehirlenen hasta- yonların hastanın tedavi süresine etkisini araştırmaktır. Gereç ve Yöntemler: Bu çalışmaya üçüncü basamak bir üniversite acil servi- sinde Mart 2004-Eylül 2005 tarihleri arasında organik fosforlu insektisit (OPi) zehirlenme tanısı konulan hastalar alındı. Bulgular: Çalışmaya 34 hasta alındı. Hastalardan 7’sine solunum yetmezliği nedeni ile mekanik ventilasyon uygulandı. Solunum yetmezliği olan hastalarda glaskow koma skalası (GKS)300 U/L (normal değerin üst sınırının 3 kat fazlası) bulun- du. Bu hastalarda toplam kullanılan atropin dozu ve hastanede kalış süreleri diğer hastalardan daha yüksek bulundu. Sonuç: Özelikle solunum yetmezliği gelişen ve hiperamilazemisi olan hasta- ların klinik tabloları daha ağır, atropin ihtiyaçları daha yüksek ve hastanede kalış süreleri uzundur. Bu dönemde GKS entübasyon ihtiyacını saptamak için kullanışlı bir yöntemdir.Objective: The goal of the study was to investigate the complications en- countered during the follow up and treatment of the patients intoxicated with insecticides that contain organic phosphorus and assess the effects of these complications on the treatment periods of these patients. Material and Methods: Patients who presented to the tertiary care emer- gency department with the diagnosis of intoxication with insecticides con- taining organic phosphorus (OPi) between March 2004-September 2005 were included into the study. Results: Thirty four patients were included into the study. Seven of them un- derwent mechanical ventilation due to respiratory failure. The Glasgow Coma Scale (GCS) score was found to be 300 U/L. The total dose of atropine used in these patients and the duration of hospital stay were found to be higher than in the other patients. Conclusion: The clinical presentation and course of the patients especially with respiratory failure and hyperamylasemia are observed to be more seri- ous, their atropine needs are greater r and they have longer hospital stays. GCS is a useful parameter in determining the need for intubation

Tizanidine poisoning (owing to two cases

Tizanidin santral etkili bir kas gevşeticidir. İlaç bir imidazol türevidir ve diğer kas gevşeticilerden yapısal olarak farklıdır. Tizanidin kullanımına bağlı olarak doza bağımlı veya dozdan bağımsız bir çok yan etki bildirilmiştir. Tizanidinin yüksek dozda kullanımına bağlı zehirlenmeler nadiren görülmektedir. Literatürde yüksek dozda tizanidin alımını bildiren bir yayın vardır. Biz bu yazıda intihar amacı ile yüksek dozda tizanidin alan iki olguyu sundukTizanidie is centrally acting muscle relaxant. The drug is an imidazole derivative structurally unrelated to other muscle relaxants. Many adverse effects, depended or undepended, to dose were reported in the literature due to tizanidin usage. Poisoning due to overdosage of tizanidine is seems uncommonly. In the literature there is only one case reporting the tizanidine overdosage. In this paper we reported two cases of tizanidine poisoning for suicidal purpose

Effect of vitamin d levels on lipid, glucose, vitamin b12 and c-reactive protein in acute ischemic stroke

Aim: Stroke ranks second among the causes of death world wideand related disability and death rates are high. Recent studies have shown that vitamin D deficiency is higher in patients with ischemic stroke compared to other patients and vitamin D deficiency has emerged as a new risk factor. The aims of the study are to investigate the relation between levels of vitamin D in patients diagnosed with acute ischemic stroke with levels of vitamin B12, glucose, HbA1c, blood urea nitrogen (BUN), creatinine, C-reactive protein (CRP) and lipids, and to determine the effect of vitamin D deficiency on other factors that increase the risk of acute ischemic stroke. Materials and Methods: Two thousand seven hundred thirty-four patients diagnosed with acute ischemic stroke were included in the study. Results of laboratory tests for levels of vitamin D, vitamin B12, HDL cholesterol, LDL cholesterol, VLDL cholesterol, triglycerides, glucose, HbA1c, BUN, creatinine and CRP were recorded. Results: As for correlation between vitamin D and other parameters, positive correlations between vitamin D and age, vitamin B12, BUN and creatinine, and negative correlations between vitamin D and triglycerides, LDL cholesterol, VLDL cholesterol, glucose, HbA1c and CRP were identified. Vitamin D and HDL cholesterol showed no correlation in normal HDL values, but there was positive correlation in patients with HDL cholesterol levels 40 mg/dL. Conclusion: Vitamin D levels in patients that suffered ischemic stroke were significantly correlated with lipid metabolism, glucose metabolism, inflammation, kidney function and vitamin B12 levels.No sponso

Emergency medicine admissions of pediatric intoxicated cases

Objective: In this study, we aimed to analyze the demographic features and mortality rates of pediatric patients admitted to the emergency department and diagnosed with intoxication. Material and Methods: Patients admitted to the pediatric emergency department and diagnosed with intoxication between December 01, 2009 and Decem- ber 31, 2010 were included in the study. Patients were evaluated through the examination of registration forms and hospitalization files. The characteristics, including age, sex, admission type to the emergency department, treatment before admission, time passed before admission, consciousness level at the time of admission, cause of poisoning, toxic agent, treatment administered after admission, outcome, and mortality rates, were recorded. Results: In our study, 1029 cases were included; 66.47% of the patients were female, and the female/male ratio was found to be 1.98/1. Poisoning was most fre- quently seen in the group of 13-18-year-old patients (56.17%). Patients were admitted mostly in the spring. The most frequent cause of poisoning was adminis- tration of drugs (81.8%), among which paracetamol was the most common and antidepressants were the second most common drugs. Suicide rate was 56.07%, and 54 patients (5.2%) had attempted suicide for the second time. Also, 85.71% of the patients were admitted to the emergency room within the first 2 hours. Conclusion: In order to minimize the rate of poisoning cases, preventive measures, education of the family, more secure storage of drugs, more prudent production of drugs in boxes by pharmaceutical companies, and prevention of childhood poisoning by regional epidemiological studies should be promoted.(JAEM 2014; 13: 67-70)Objective: In this study, we aimed to analyze the demographic features and mortality rates of pediatric patients admitted to the emergency department and diagnosed with intoxication. Material and Methods: Patients admitted to the pediatric emergency department and diagnosed with intoxication between December 01, 2009 and Decem- ber 31, 2010 were included in the study. Patients were evaluated through the examination of registration forms and hospitalization files. The characteristics, including age, sex, admission type to the emergency department, treatment before admission, time passed before admission, consciousness level at the time of admission, cause of poisoning, toxic agent, treatment administered after admission, outcome, and mortality rates, were recorded. Results: In our study, 1029 cases were included; 66.47% of the patients were female, and the female/male ratio was found to be 1.98/1. Poisoning was most fre- quently seen in the group of 13-18-year-old patients (56.17%). Patients were admitted mostly in the spring. The most frequent cause of poisoning was adminis- tration of drugs (81.8%), among which paracetamol was the most common and antidepressants were the second most common drugs. Suicide rate was 56.07%, and 54 patients (5.2%) had attempted suicide for the second time. Also, 85.71% of the patients were admitted to the emergency room within the first 2 hours. Conclusion: In order to minimize the rate of poisoning cases, preventive measures, education of the family, more secure storage of drugs, more prudent production of drugs in boxes by pharmaceutical companies, and prevention of childhood poisoning by regional epidemiological studies should be promoted.(JAEM 2014; 13: 67-70

Geriatric patient admissions to the emergency service

Objective: In this study, we aimed to analyze the demographic features of patients older than 65 years admitted to the emergency department. Material and Methods: All patients who were over 65 years old and admitted to a tertiary care emergency department were included in this retrospective study. Information, including admission dates (month, season), age, sex, admission type, diagnosis, duration of hospitalization, and outcome in the emergency department of the patients, was evaluated. The obtained data were analyzed with student t-test and chi-square test by using SPSS 17.0 software. Results: Of 238,222 patients admitted to the emergency department, 8793 (3.6%) were over 65 years old; 58% of the patients were female and 42% were male. The rate of chronic obstructive pulmonary disease (COPD) among respiratory problems in males and the rate of hypertension among cardiac problems in females were found to be significantly high. The highest admission rate was in the autumn months (32.6%). The most common reason for admission to the emergency department was cardiac problems (21.7%). This was followed by neurological problems, trauma, respiratory system problems, and urinary tract infections, respectively. The highest mortality rate was 45% in the general intensive care unit. The most frequent cause for mortality was cardiac problems. Conclusion: Cardiac problems were the most common cause of admissions to the emergency department, hospitalization, and mortality in geriatric patients. Future studies for determining the admission rate and most frequently observed illnesses of geriatric patients might be helpful in developing special care areas and special scanning tests for geriatric patients. (JAEM 2014; 13: 53-7)Objective: In this study, we aimed to analyze the demographic features of patients older than 65 years admitted to the emergency department. Material and Methods: All patients who were over 65 years old and admitted to a tertiary care emergency department were included in this retrospective study. Information, including admission dates (month, season), age, sex, admission type, diagnosis, duration of hospitalization, and outcome in the emergency department of the patients, was evaluated. The obtained data were analyzed with student t-test and chi-square test by using SPSS 17.0 software. Results: Of 238,222 patients admitted to the emergency department, 8793 (3.6%) were over 65 years old; 58% of the patients were female and 42% were male. The rate of chronic obstructive pulmonary disease (COPD) among respiratory problems in males and the rate of hypertension among cardiac problems in females were found to be significantly high. The highest admission rate was in the autumn months (32.6%). The most common reason for admission to the emergency department was cardiac problems (21.7%). This was followed by neurological problems, trauma, respiratory system problems, and urinary tract infections, respectively. The highest mortality rate was 45% in the general intensive care unit. The most frequent cause for mortality was cardiac problems. Conclusion: Cardiac problems were the most common cause of admissions to the emergency department, hospitalization, and mortality in geriatric patients. Future studies for determining the admission rate and most frequently observed illnesses of geriatric patients might be helpful in developing special care areas and special scanning tests for geriatric patients. (JAEM 2014; 13: 53-7

Demographic Evaluation of The Patients Admitted with Oral Intake of Corrosive Substances

Amaç: Bu çalısmada, oral koroziv madde alımı ile acil servise basvuran hastaların demografik özelliklerinin, mortalite ve morbidite oranlarının açığa çıkarılmasını amaçladık. Materyal ve Metod: Oral koroziv madde alımı nedeniyle 01.01.2009 ile 31.12.2010 tarihleri arasında başvuran vakalar geriye dönük incelendi. Hastaların yaşı, cinsiyeti, mesleği, alınan koroziv maddenin cinsi, alım nedeni (kazara, özkıyım), acile başvuru sekli, alım ile acile ilk başvuru arasında geçen süre, başvuru sırasındaki şikâyetleri kaydedildi. Endoskopisi yapılan ve yapılmayan hastaların tanı ve tedavi süreçleri, hastanede yatış süresi ve hasta sonlanım şekli ile ilgili veriler kaydedildi. Tanı sürecinde endoskopi bulguları Di Costanzo Evreleme Sistemi'ne göre sınıflandırıldı. Bulgular: Çalışmaya 59 hasta (30 kadın, 29 erkek) dahil edildi. Olguların yaş ortalaması 38.67±18.56 idi. Koroziv madde alımının % 74.58'i kazara, % 25.42'si özkıyım amaçlı idi. Alınan korozivlerin % 55,93'ü sodyum hipoklorit idi. Hastaların % 95'ine ilk 24 saat içinde endoskopi uygulaması yapıldığı görüldü. Endoskopi sonrası en sık rastlanan hasarlanma evre 2a (% 31) idi. Acil servise başvuran hastaların % 57.6'sı hastaneye yatırıldı. Yoğun bakımda takip edilen bir hasta eksitus oldu. Sonuç: Koroziv madde alımları morbidite ve mortaliteye yol açabilen zehirlenmelerdir. Zehirlenmelerin en aza indirilmesi için toplumun eğitilmesi, ambalajsız temizlik maddesi satışının yasaklanması, temizlik maddelerinin açıkta bırakılmaması ve başka kaplarda saklanmaması gerekmektedirPurpose: In this study, we aimed to reveal mortality and morbidity rates and demographic characteristics of patients admitted to the emergency room with corrosive substance ingestion. Material and Methods: The cases admitted with oral intake of corrosive substances to between 01.01.2009 and 31.12.2010 were retrospectively reviewed. Patients’ age, gender, occupation, type of the corrosive substance, reason of administring the substance (accident, suicide), the application form to the emergency room, the time between the first reference to the emergency room with the admission time, the complaints at the time of admission were recorded. Patients' data with and without endoscopy about their diagnosis and treatment processes, their staying time at the hospital and their outcome of the hospital were recorded. During the process of diagnosis endoscopic findings were classified according to Di Costanzo Staging System. Results: 59 patients (30 female, 29 male) were included in the study. Mean age of the patients’ was 38.67 ± 18.56. 74.58 % of the corrosive substance intake were accidentally, and 25.42 % were suicide. 55,93 % of the corrosive intake was sodium hypochlorite. It was seen that 95 % of the patients were made endoscopy within first 24 hours. The most common damage was stage 2a (31 %). 57.6 % patients admitted to the emergency room were hospitalized. One patient in intensive care unit, died. Conclusion: Corrosive substance poisoning can lead to serious morbidity and mortality. In order to minimize the poisonings, society should be educated, the sale of unpackaged corrosive substances should be prohibited, corrosive substances should not be left exposed and not stored in other container

Acil Servise Başvuran Erişkin Travma Olgularının Analizi

Amaç: Travma acil servise en yaygın başvuru nedenlerinden birisidir. Bu çalışmada, acil servisimize başvuran erişkin travma hastalarının demografik özellikleri, etyolojileri, mortalite ve morbidite oranlarının belirlenmesi amaçlanmıştır. Materyal ve Metod: Acil servise 01 Mart 2011 ile 31 Ağustos 2011 tarihleri arasında travma ile başvuran 18 yaş üzeri hastalar çalışmaya dahil edilmiştir. Hasta muayene kartları, yatış dosyaları ve hastane otomasyon sistemine ICD 10 kodları ile girilen kayıtlar incelenmiştir. Bilgilerine eksiksiz ulaşılamayan hastalar çalışma dışı bırakılmıştır. Bulgular: Çalışma süresi boyunca 110495 hastanın acil servise başvurduğu ve bunların 13585'inin (%12,29) travmaya bağlı başvuru olduğu belirlenmiştir. Basit ekstremite travması (%38,28) ve düşmenin (%31,7) en yaygın etyolojik nedenler olduğu, hastaların %99,71'inin Glaskow Koma Skalası skorunun 13 ile 15 arasında olduğu tespit edilmiştir. Travmalı hastaların %9,6'sına Bilgisayarlı Tomografi (BT) çekildiği, bunların %84,5'inin normal olduğu ve en sık Beyin BT çekildiği belirlenmiştir. Hastaların sadece %6'sının hastaneye yatırıldığı, %0,9'unun ise eksitus olduğu görülmüştür. Bayanlarda yüksekten düşmenin, erkeklerde ise trafik kazalarının en sık ölüm nedeni olduğu saptanmıştır. Sonuç: Acil servise basit travma ile başvuran hastaların büyük çoğunluğunun ayrıntılı hikaye ve dikkatli fizik muayene sayesinde taburcu edilebileceği belirlenmiştir. Gereksiz tıbbi tetkikler, zaman kaybı ve para israfı azaltılmalıdır. Bu yolla ağır hastalara daha fazla zaman ve işgücü ayrılabilir.Purpose: Trauma is one of the most common reason of admissions to emergency departments. In this study, it was aimed to determine the demographic characteristics, etiology, morbidity and mortality rates and prognosis of adult trauma patients admitted to our emergency department (ED). Materials and Methods: Patients over the age of 18 years, who admitted to ED between 01 March 2011 and 31 August 2011 were included in this retrospective study. Patient examination cards, hospitalization files and records entered with ICD 10 codes to hospital automation system were analyzed. Patients with inaccessible data were excluded from the study. Results: During the study period, total number of 110495 patients admitted to ED, and 13585 (12,29%) of them admitted with trauma. Simple extremity injuries (38,28%) and falls (31,7%) were most common etiological factors. Glasgow coma scales of 99,71% of the patients were between 13 and 15. Of the patients with trauma, 9,6% had a Computed Tomography (CT) scan, and 84,5% of CT scans were evaluated as normal, and cranial CT was the most requested one. Only 6% of the patients were hospitalized, and 0,9% of the trauma patients died. Falls from height in females and traffic accidents in males were the leading causes of death. Conclusion: Most of the patients with simple traumas admitted to ED can be discharged from the hospital with a complete history and careful examination. The rate of unnecessary medical tests, loss of time and waste money should be reduced, and the time and labor allocated to severe patients can be increased by this way

Intrapleural and Intraperitoneal Free Fluid in Calcium Channel Blocker Overdose

Aim: Toxicity findings affecting many systems, particularly the cardiovascular system, are observed in calcium channel blocker (CCB) overdose. Here, we aimed to present the incidence of CCB overdose patients with intraperitoneal and intrapleural free fluids detected by abdominal ultrasonography (USG). Materials and Methods: CCB overdose patients admitted to the emergency room in a 2-year period were prospectively included. All patients with CCB overdose were evaluated by bedside abdominal USG in terms of the presence of pleural and peritoneal fluid. Results: A total of 14 patients with CCB poisoning were included in our study. Six (42.8%) patients had taken verapamil, 7 (50%) patients amlodipine, and 1 (7.2%) patient nifedipine. The mean age of the patients was 27.2±15.9 years (range: 18–65 years). The median time from drug intake to arrival at the hospital was 3.0 h (IQR: 1.75–5). Nine (64.28%) of these patients were detected to have intraperitoneal and intrapleural free fluid by bedside USG. The mean arterial pressure of patients with intraabdominal and intrapleural fluid was lower than that of patients without the detected fluid, i.e., 56.8 (IQR: 54.8–61.8) vs. 65.6 (IQR: 64.2–66.8), respectively (p<0.001). Conclusion: Besides the cardiovascular findings, intraperitoneal and intrapleural free fluid is also a common feature in CCB overdose. Bedside USG may help to identify these patients. (Eurasian J Emerg Med 2016; 15: 82-5)Aim: Toxicity findings affecting many systems, particularly the cardiovascular system, are observed in calcium channel blocker (CCB) overdose. Here, we aimed to present the incidence of CCB overdose patients with intraperitoneal and intrapleural free fluids detected by abdominal ultrasonography (USG). Materials and Methods: CCB overdose patients admitted to the emergency room in a 2-year period were prospectively included. All patients with CCB overdose were evaluated by bedside abdominal USG in terms of the presence of pleural and peritoneal fluid. Results: A total of 14 patients with CCB poisoning were included in our study. Six (42.8%) patients had taken verapamil, 7 (50%) patients amlodipine, and 1 (7.2%) patient nifedipine. The mean age of the patients was 27.2±15.9 years (range: 18–65 years). The median time from drug intake to arrival at the hospital was 3.0 h (IQR: 1.75–5). Nine (64.28%) of these patients were detected to have intraperitoneal and intrapleural free fluid by bedside USG. The mean arterial pressure of patients with intraabdominal and intrapleural fluid was lower than that of patients without the detected fluid, i.e., 56.8 (IQR: 54.8–61.8) vs. 65.6 (IQR: 64.2–66.8), respectively (p<0.001). Conclusion: Besides the cardiovascular findings, intraperitoneal and intrapleural free fluid is also a common feature in CCB overdose. Bedside USG may help to identify these patients. (Eurasian J Emerg Med 2016; 15: 82-5

Thrombolytic therapy delay is independent predictor of mortality in acute pulmonary embolism at emergency service.

AbstractAcute pulmonary embolism (PE) carries a high risk of morbidity and mortality. Delays in diagnosis or therapy may result in sudden, fatal deterioration; therefore, rapid diagnosis and an appropriate therapeutic approach are needed. We aimed to investigate the effect of delaying thrombolytic administration on the mortality rate in a suspected PE. We retrospectively analyzed 49 consecutive patients who were aged 18 years or older and received thrombolysis for a high-risk PE without a major contraindication. All patients were classified according to the time of onset of the thrombolytic therapy. Patients experiencing cardiopulmonary arrest were analyzed from the time of admission to thrombolytic administration with 10-minute cutoff values. Data were analyzed by a regression analysis and a receiver operating characteristic (ROC) analysis for significant and independent associated risk factors and in-hospital mortality. Mortality was seen in 17 of the 49 cases. Thirteen of these had received thrombolytic therapy 1 hour after their emergency department (ED) admission. Among all cases, the mortality rate was 35%. The ROC analysis indicated that a > 97-second delayed thrombolytic administration time was associated with mortality with 53% sensitivity and 91% specificity (area under the curve, 0.803; 95% confidence interval, 0.668–0.938). In the logistic regression, a 5-minute delay in thrombolytic therapy (beta = 1.342; 95% confidence interval, 1.818–2.231; p = 0.001) was associated with in-hospital mortality in the multivariable model. No major bleeding complications were seen in PE survivors. We conclude that early onset thrombolytic therapy in the ED for high-risk and hemodynamically worsening patients appears safe and life-saving