The evaluation of pediatric forensic cases presented to emergency department

Introduction: Pediatric age group serves as a preparation stage for the rest of the life. This age group has specific psychological, physiological and social conditions. This present study examined pediatric forensic cases aged between 0–18. Obtained parameters determined characteristics of pediatric age group foren- sic cases.  Methods: 1624 pediatric forensic cases aged between 0–18 who were admitted to the emergency de- partment at a tertiary healthcare service between the dates 31 October 2014 and 31 October 2016 were evaluated retrospectively. The cases were evaluated in terms of age, gender, nationality, admission time and season, reasons for presentation, radiological imaging techniques, consultation, intervention, treatment ward, clinical outcome and application of cardiopulmonary resuscitation.  Results: Age average of the patients was 9,2 ± 6,2. Adolescent age group (49, 4%) was the most frequent- ly admitted after traumatization. 61% of the patients constituted male patients. An association between age and gender was not detected. The most frequent reasons for admissions were assault (28,7%) and drug intoxication (22,4%). Assault, drug intoxication, traffic accidents, substance intake, penetrating stab wounds, falling down from the height and animal bites were frequently seen in adolescents whereas sim- ple falling, corrosive substance ingestion and burn were highly seen in infants. Assault, penetrating stab wounds and gunshot injuries were detected to be frequent in males; drug and substance use was seen to be frequent in females. The patients (57%) were seen to be admitted to the emergency between the hours 1600–2400. 46.4% of the patients underwent radiological imaging. Trauma patients were seen to undergo radiological imaging more frequently. A consultation was required for 42.4% of the patients. The discharge rate of the patients from the emergency was 66.9%. Patients discharged from the emergency were seen to undergo radiography and computed tomography directly. This was found to be significantly high.  Conclusions: Pediatric forensic cases are seen in adolescence and school-age children more frequently. The most frequent forensic cases were assaults and intoxications. Forensic cases are more frequently seen in males. Assaults are more frequent in males whereas intoxications are more frequent in females. Most of theforensiccasesaredischargedfromtheemergencydepartment. Patientsdischargedfromtheemergency undergo radiological imaging at higher rates compared to the other patients. 

Ingestion of caustic substances by adults

WOS: 000240407200187

Mortality Predictors in Patients Diagnosed with COVID-19 in the Emergency Department: ECG, Laboratory and CT

Background and Objectives: The aim of this study was to investigate parameters that can be used to predict mortality in patients diagnosed with COVID-19 in the emergency department (ED). Materials and Methods: Patients diagnosed with COVID-19 in the ED were included in this prospective study. The patients were divided into two groups. The surviving patients were included in Group 1 (survivors), and the patients who died were included in Group 2 (non-survivors). The electrocardiogram (ECG), laboratory results and chest computerized tomography (CCT) findings of the two groups were compared. The CCT images were classified according to the findings as normal, mild, moderate and severe. Results: Of the 419 patients included in the study, 347 (83%) survived (survivor) and 72 (17%) died (non-survivor). The heart rate and respiratory rate were found to be higher, and the peripheral oxygen saturation (SpO2) and diastolic blood pressure (DBP) were found to be lower in the non-survivor patients. QRS and corrected QT interval (QTc) were measured as longer in the non-survivor patients. In the CCT images, 79.2% of the non-survivor patients had severe findings, while 11.5% of the survivor patients had severe findings. WBC, neutrophil, NLR, lactate, D-dimer, fibrinogen, C- Reactive Protein (CRP), urea, creatinine, creatine kinase-MB (CK-MB) and hs-Troponin I levels were found to be higher and partial pressure of carbon dioxide (PCO2), base excess (BE), bicarbonate (HCO3), lymphocyte eosinophil levels were found to be lower in non-survivor patients. The highest AUC was calculated at the SpO2 level and the eosinophil level. Conclusions: COVID-19 is a fatal disease whose mortality risk can be estimated when the clinical, laboratory and imaging studies of the patients are evaluated together in the ED. SpO2 that is measured before starting oxygen therapy, the eosinophil levels and the CT findings are all important predictors of mortality risk

Fragmented QRS; as a new sign on ECG for pre-diagnosis of non-ST elevation myocardial infarction

Aim: The aim of this study is to evaluate the predictive value of fragmented QRS (fQRS) wave to detect non-ST elevation myocardial infarction (Non-STEMI).Material and Methods: The study included patients who were diagnosed with Non-STEMI in emergency department and underwent percutaneous coronary intervention in the cardiology clinic. Coronary artery circulation is anatomically divided as the left anterior descending coronary artery (LAD) (V1-V5), the left Circumflex (LCx) (I, aVL and V5,V6) and the right coronary artery (RCA) (II, III and aVF).Results: Our study included 191 patients. Significant fQRS was detected in 139 (%73) patients and ST/T was detected in 79 (%41) patients. The sensitivity, specificity, of fQRS in the inferior leads to predict RCA lesionwas 76%, 46%, respectively. The sensitivity, specificity, of ST/T in the inferior leads to “predict RCA lesion was 12%, 93%, respectively. The sensitivity, specificity of fQRS in the lateral leads to predict LCx lesion were 44% and 83%, respectively. The sensitivity, specificity of ST/T in the lateral leads to predict LCx lesion were 34%, 74%, respectively. The sensitivity, specificity of fQRS in the anterior leads to predict left LAD lesion were 34% and 82%, respectively. The sensitivity, specificity of ST/T in the anterior leads to predict LAD lesion were 38%, and 81%, respectively.Conclusion: We have compared to fQRS and ST/T on ECG; fQRS has higher sensitivity than ST/T to predict culprit coronary artery lesion. Therefore, evaluation of fQRS in addition to ST/T on ECG may be more valuable in pre-diagnosis of Non-STEMI

Comparison of Single-Dose Pralidoxime and Pralidoxime Infusions for the Treatment of Organophosphate Poisoning

WOS: 000305320400025Objective: Organic phosphates (OP) bind covalently to acetylcholinesterase (AChE) and acetylcholine (Ach) accumulates in the synaptic cleft. Administering oximes before aging process causes breakage of the covalent bond between OP-AChE, and allows reactivation of AChE. Pralidoxime (PAM) is the most commonly used oxime. The purpose of this study is to determine the best PAM regimen for the length of hospitalization, the need for mechanical ventilation and reduction of the duration of mechanical ventilation in patients presenting with OP poisoning. Material and Methods: Thirty four patients included in this study were organized according to the order of enrollment, randomized and divided into two groups. Seventeen patients in the group I were given a single dose of 2 g/20 min PAM infusion (bolus dose), while 17 patients in group II were administered a dose of 2 g/20 min followed by 6 g/24 hours PAM infusion (bolus and infusion). Clinical signs and symptoms as well as the serum butyrylcholinesterase (BCHE) levels were used to verify the patients' diagnoses. Results: There were no significant differences between the groups. Conclusion: We suggest that PAM bolus plus infusion therapy does not have any advantage over a single dose of bolus PAM therapy the in treatment of OP poisoning

Analysis of acute stroke patients admitted to the emergency department

Aim: In this study we investigated the demographics and medical characteristics of acute stroke patients who applied to emergency department (ED) and were admitted to neurology department (ND).Material and Methods: This study was conducted in a tertiary hospital. The patients’ medical records were reviewed; age, gender, diagnosis, comorbid diseases, previously anticoagulant treatment, brain computerized tomography reports, brain magnetic resonance imaging reports, hospitalized unit, length of hospital stay, vitamin B12 levels, electrocardiography recordings, and the outcome of patients.Results: In the including time of the study, 523 patients were hospitalized to the ND from ED. The patients with cerebrovascular diseases (CVD) were 68.7% (n357) of the hospitalized patients. The patients with acute ischemic stroke (AIS) were 74.8 % (n267) of the patients with CVD. In AIS, the most common comorbid disease was hypertension, followed by atrial fibrillation (AF). The rate of AF was 31% in AIS. AF was newly diagnosed in 46% (38 patients) of patients with AIS, and these patients had no anticoagulation therapy. Vitamin B12 levels were found to be low in 58 (21.7%) of AIS patients.Conclusion: A large number of patients with undiagnosed AF are diagnosed following AIS. Therefore, it is important that these patients should be followed closely for AF and its management, and it is also important to treat vitamin B12 deficiency to prevent stroke development

Evaluation of Head Trauma Cases in the Emergency Department

Aim: In this study, we aimed to determine the epidemiological characteristics, morbidity and mortality rates of patients admitted to the emergency department with head trauma. Material and Methods: In this study, ambulatory and hospitalized patients over the age of 18 brought to the Emergency Department because of head trauma between 01.12.2009 - 31.12.2010 were analyzed retrospectively. Patient data were recorded to standard data entry form. SPSS 17.0 package program was used for statistical analysis of data. The statistical significance level of all tests was p <0.05. Results: 5200 patients were included in this study. The average age of the patients was 39.97 &#177; 16.66 years. 4682'si patients (90 %) were discharged from the emergency department. The most common reason for admission to the emergency department was falls (41.81 %) in the discharged patients. 518 (10 %) patients were hospitalized. Gender of these patients was 110 female (21:24%) and 408 male (78.76%). 256 patients (48.35%) were injured as a result of a traffic accident. 201(38.8%) of the cerebral CT were reported as normal and 89 (17.2%) of the cerebral CT were reported as traumatic subarachnoid hemorrhage (SAH) in hospitalized patients. The fracture of lumbar spine (12 %) was detected as an additional pathological disease in patients. 75 patients hospitalized because of head trauma (14.5%) had died (1.44 % of all patients). Cervical spine fracture was the most common (14 patients, 18.68 %) additional pathology in patients who died. Thoracic trauma was detected as the second most common (13 patients, 17.33 %) additional pathology. Conclusion: Most of the patients admitted to the emergency department with head injury had a minor trauma. Patients can be discharged from the emergency department after a thorough physical examination and simple medical intervention. Most of the head injury patients admitted to hospital were male. The most common reason of the patients with head injury admitted to hospital was traffic accident. The most common finding of cerebral CT was SAH. Even though traffic accidents are the most common causes of death, gunshot wounds have higher death rate. This study will help emergency physicians to approach with head trauma patients and contribute to their clinical experiences. Our country-specific emergency trauma protocols can be created after more detailed studies. [Cukurova Med J 2013; 38(1.000): 63-71

Effect of Focused Bedside Ultrasonography in Hypotensive Patients on the Clinical Decision of Emergency Physicians

We assessed the effect of focused point of care ultrasound (POCUS) used for critical nontraumatic hypotensive patients presenting to the emergency department of our hospital on the clinical decisions of the physicians and whether it led to the modification of the treatment modality. This prospective clinical study was conducted at the Emergency Department of Antalya Training and Research Hospital. Nontraumatic patients aged 18 and older who presented to our emergency department and whose systolic blood pressure was 1 were included in the study. While the most probable preliminary diagnosis established by the physician before POCUS was consistent with the definitive diagnosis in 60.6% (n=109) of 180 patients included in the study, it was consistent with the definitive diagnosis in 85.0% (n=153) of the patients after POCUS (p<0.001). POCUS performed for critical hypotensive patients presenting to the emergency department is an appropriate diagnostic tool that can be used to enable the physicians to make the accurate preliminary diagnosis and start the appropriate treatment in a short time

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

Purpose: 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&#146; 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&#146; was 38.67 &#177; 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 containers. [Cukurova Med J 2014; 39(2.000): 271-279