Cardiac Monitoring in Patients with Electrocution Injury

BACKGROUND The necessity of admitting patients exposed to electrocution injuries for monitoring and observation in the emergency department (ED) remains controversial. METHODS We evaluated the medical records of 102 patients (86 male, 16 female; median age 29.5; range 18 to 68 years) admitted to the adult ED with electrocution injuries over the past 20 years. RESULTS Only 9 deaths were reported: 3 as a result of contact with low-voltage electricity and 6 after contact with high-voltage electricity. With the exception of a case of sepsis, all deaths were related to early rhythm abnormalities immediately following the incident. The ECG findings of surviving patients in the study group were as follows: 70 normal, 8 sinus tachycardia, 3 sinus bradycardia, 4 ST-T wave changes, and 1 ventricular extrasystole. ECG recordings of 7 patients could not be found. 72 cases had been followed up with repeat ECG recordings. There were no observed ECG changes requiring any medical or electrical therapies in the surviving patients. CONCLUSION Cardiac rhythm abnormalities related to electrocution injuries are usually observed at the time of the incident. If the patient's overall clinical condition is good and they have a normal ECG at the time of admission to the ED, the probability of observing any delayed serious dysrhythmia is unlikely.WoSScopu

Emergency Admissions Due To Swallowed Foreign Bodies In Adults

AIM: To study a retrospective analysis of patients who presented to the emergency departments (ED) with complaints related to foreign body ingestions. METHODS: Patients older than 16 years of age who presented to the ED between January 1st and December 31st of 2010 with complaints related to swallowed foreign bodies were identified from electronic health records and patient charts. RESULTS: A total of 100 patients presented with a complaint of foreign body ingestion during the study period. Overall, an X-ray was performed on 75 patients, and a fiberoptic evaluation was performed on 45 patients. A foreign body was detected in 46 (46%) patients. The diagnostic yield of the X-ray was 27 (36%) out of 75 patients, while the diagnostic yield of the fiberoptic evaluations was 21 (47%) out of 45 patients. The detected foreign bodies were mostly located in the esophagus (17 out of 46 foreign bodies detected). When the types of ingested foreign bodies were evaluated, 52 (52%) patients reported ingesting food, and 19 (19%) patients reported swallowing pins. An X-ray was performed on 33 patients with accidental food ingestions but yielded a positive result in only two cases. In 12 out of 21 patients with accidental food ingestion who underwent fiberoptic evaluation, the foreign material was detected and removed. CONCLUSION: Plain radiography is helpful in the localization of radiopaque swollen foreign bodies, while fiberoptic methods are useful as both diagnostic and therapeutic tools, regardless of radiopacity. (C) 2013 Baishideng. All rights reserved

Predictors of poor outcome in gastrointestinal bleeding in emergency department

AIM: To determine the prognostic risk factors of gastrointestinal bleeding in emergency department cases. METHODS: The trial was a retrospective single-center study involving 600 patients over 18-years-old and carried out with approval by the Institutional Ethics Committee. Patient data included demographic characteristics, symptoms at admission, past medical history, vital signs, laboratory results, endoscopy and colonoscopy results, length of hospital stay, need of intensive care unit (ICU) admission, and mortality. Mortality rate was the principal endpoint of the study, while duration of hospital stay, required interventional treatment, and admission to the ICU were secondary endpoints. RESULTS: The mean age of patients was 61.92-years old. Among the 600 total patients, 363 (60.5%) underwent upper gastrointestinal endoscopy and the most frequent diagnoses were duodenal ulcer (19.2%) and gastric ulcer (12.8%). One-hundred-and-fifteen (19.2%) patients required endoscopic treatment, 20 (3.3%) required surgical treatment, and 5 (0.8%) required angiographic embolization. The mean length of hospital stay was 5.21 +/- 5.85 d. The mortality rate was 6.3%. The ICU admission rate was 5.3%. Patients with syncope, higher blood glucose levels, and coronary artery disease had significantly higher ICU admission rates (P = 0.029, P = 0.043, and P = 0.002, respectively). Patients with low thrombocyte levels, high creatinine, high international normalized ratio, and high serum transaminase levels had significantly longer hospital stay (P = 0.02, P = 0.001, P = 0.019, and P = 0.005, respectively). Patients who died had significantly higher serum blood urea nitrogen and creatinine levels (P = 0.016 and P = 0.038), and significantly lower mean blood pressure and oxygen saturation (P = 0.004 and P = 0.049). Malignancy and low Glasgow coma scale (GCS) were independent predictive factors of mortality. CONCLUSION: Prognostic factors for gastrointestinal bleeding in emergency room cases are malignancy, hypotension on admission, low GCS, and impaired kidney function.WoSScopu

Recommendations for trauma and emergency general surgery practice during COVID-19 pandemic

COVID-19 is a new disease, based on currently available limited information, older adults and people of any age who have severe underlying medical conditions may be at higher risk for severe illness from COVID-19. People of all age groups are also at risk. Healthcare providers have always been the professionals most exposed to the risk of contracting to any kind of infection due to the nature of their profession. Elective interventions have been postponed to give care of patients with COVID-19. However, some interventions cannot be delayed, such as trauma surgery, acute abdomen, and emergency endoscopies. To maintain the sustainability of the healthcare system, the protection of healthcare providers should be the top priority. On the other hand, patients, who need emergency healthcare, should also be provided with appropriate treatment. Healthcare professionals should choose a treatment method appropriately in the circumstances to protect themselves and their patients as much as possible. This paper aims to summarize how a surgeon may act appropriately when an intervention is inevitable during the COVID-19 pandemic

Aşırı Kalabalık Aciller İçin Şikayet Temelli Bir Model: Beş-Düzeyli Hacettepe Acil Triyaj Sistemi

BACKGROUND To compare ESI Five-Level Triage System with 5-Level Hacettepe Emergency Triage System (HETS), which was developed for Overcrowded EDs in our country. METHODS Over a period of six days, patients were assessed by a different ED staff everyday using HETS, then re-evaluated blindly by an emergency. physician using HETS. Then patients were evaluated blindly for a third time by an independent, ESI-using emergency physician. RESULTS Of the patients in the study, 133 were men, 175 were women and the average age was 44.41 +/- 18.033. Inter-rater agreement was 97.40% (Kappa=0.963) between HETS and HETS-Blind, 74.35% (Kappa=0.646) between HETS and ESI-Blind, 74.67% (Kappa=0.652) between HETS-Blind and ESI-Blind. Inter-observer agreement between the second emergency physician performing HETS-Blind and the first emergency physician, resident, or nurse was very good (Kappa=1.0). Intern doctor, non-medical secretary and paramedic were found to have almost very good agreement (Kappa=0.971; 0.935; 0.864, respectively). An overtriage of 7.25% and undertriage of 1.08% were found in HETS. CONCLUSION Complaint-based HEST developed for overcrowded EDs is a triage system with a very good agreement between observations and observers, low undertriage and overtriage ratios, and easy application by all staff from a non-medical secretary to the emergency physician.WoSScopu

Changing Attitudes Of Medical Students Regarding Organ Donation From A University Medical School In Turkey

PubMedWo

General Approach To Penetrating Abdominal Traumas Of Turkish General Surgeons: Survey Of Practice

BACKGROUND: In patients with penetrating abdominal traumas (PATs), selective non-operative management (SNOM) has been widely accepted. This study was designed to investigate the practice trends among Turkish surgeons regarding SNOM. MEHTOHDS: The study was conducted as an online survey. Participants' demographic characteristics and their management trends and opinions regarding patients with PATs and SNOM were studied. Data were recorded using MS Excel (R) and analyzed. RESULTS: A total of 180 surgeons participated in the survey. SNOM approach rate in patients with stab injuries (SI) was 64%, whereas in patients with gunshot injuries (GSI), this rate was 52%. However, more than 90% of the surgeons declared that additional diagnostic studies were required before selecting SNOM approach in both SI and GSI. In addition, most of the surgeons who did not use SNOM in practice reported that they did not want to risk the patients' lives or their careers. DISCUSSION: Although our surgeons have constructive opinions and tendencies regarding contemporary approaches in the management of PATs, it is seen that nearly half of them prefer not to perform SNOM in practice for various reasons. We believe that approval of trauma and emergency surgery disciplines as subspecialties and funding- centralized trauma centers might correct this deficiency.WoSScopusTr-Dizi

General approach to penetrating abdomen traumas of Turkish General Surgeons: Survey of practice

BACKGROUND: In patients with penetrating abdominal traumas (PATs), selective non-operative management (SNOM) has been widely accepted. This study was designed to investigate the practice trends among Turkish surgeons regarding SNOM. MEHTOHDS: The study was conducted as an online survey. Participants' demographic characteristics and their management trends and opinions regarding patients with PATs and SNOM were studied. Data were recorded using MS Excel (R) and analyzed. RESULTS: A total of 180 surgeons participated in the survey. SNOM approach rate in patients with stab injuries (SI) was 64%, whereas in patients with gunshot injuries (GSI), this rate was 52%. However, more than 90% of the surgeons declared that additional diagnostic studies were required before selecting SNOM approach in both SI and GSI. In addition, most of the surgeons who did not use SNOM in practice reported that they did not want to risk the patients' lives or their careers. DISCUSSION: Although our surgeons have constructive opinions and tendencies regarding contemporary approaches in the management of PATs, it is seen that nearly half of them prefer not to perform SNOM in practice for various reasons. We believe that approval of trauma and emergency surgery disciplines as subspecialties and funding- centralized trauma centers might correct this deficiency.WoSScopusTr-Dizi