Does determination of drug level in intoxicated patients offer an advantage in diagnosis, treatment, and reducing complications?

Objective: To investigate the effect of determining the drug type and level on emergency management in patients presenting with intoxication, and to identify the factors behind associated mortality. Methods: The retrospective, observational, cross-sectional and single -centre study was conducted at a large tertiary care teaching hospital in Istanbul, Turkey, between September and November 2016 using the hospital's toxicology registry. Data was extracted for patients who had presented to the emergency department from January 1, 2011, to February 28, 2013, and were found to have toxic doses of single active ingredients in the plasma. The patients were evaluated in terms of age, gender, demographic characteristics, time from ingestion to presentation, reason for drug ingestion, type of drug ingested, time elapsed before the emergency service was called, treatment given, drug level, hospitalisation and mortality. Data was analysed using SPSS 11.5. Results: Of the 224 patients, 145(64.8%) were women. The overall mean age was 30.8 +/- 15.4 years. Drug ingestion was more common in women aged 18-30 years (p<0.0001). Besides, 215(96%) patients had ingested drugs with the intent to commit suicide. The minimum education level of 163(72.8%) patients was high school. The most frequently ingested drug was paracetamol 90(40.2%). Overall mortality was 4(1.8%) and all of them were brought to the emergency department after a delay of more than five hours (p<0.0001). Conclusion: Drug type and quantity were found to be of great importance in taking timely decisions while attending to patients with intoxication in an emergency setting. Delay in presentation was associated with mortality.WOS:0005463942000052-s2.0-85084626195PubMed: 3240073

An unusual complication of cardiopulmonary resuscitation: Stomach perforation

Saritas, Ayhan/0000-0002-4302-1093; Saritas, Ayhan/0000-0002-4302-1093; Kandis, Hayati/0000-0001-9151-6050; afacan, mustafa ahmet/0000-0003-1045-0681WOS: 000343312600054PubMed: 24666745Stomach perforation is an unusual complication of cardiopulmonary resuscitation. It generally occurs while providing an advanced airway. Stomach perforation may develop as a consequence of chest compressions in a patient with stomach distention caused by long periods of bag-valve mask ventilation. We presented this case to emphasize that stomach perforation may develop during cardiopulmonary resuscitation, and early diagnosis and surgical treatment may be lifesaving

An unusual complication of posterior packing in epistaxis

WOS: 000434665900014PubMed ID: 30374485Endonasal or transnasal procedures are sometimes necessary in patients with head trauma. Before these procedures, the integrity of the skull base must be considered to avoid penetration of the cranial vault. A 54-year-old man was taken to a district hospital following a car accident. After the initial assessment and emergency treatment, he was transferred to our emergency clinic for further examination. The patient had massive nasal bleeding, though a Foley catheter had been inserted to control posterior bleeding. Computed tomography (CT) revealed that the catheter was not positioned correctly and was in the cranial vault. Several fractures of the maxillofacial and cranial bones and cervical vertebrae were detected on CT. He also had right hemothorax and bilateral brain contusions. Endonasal insertion of catheters or tubes in trauma patients without a complete assessment of the skull base can cause serious complications

Are Violence Related Cases Overtaking Motor Vehicle Accidents In Forensic Emergency Medicine?

Amaç: Her yıl bir milyondan fazla insan kendine zarar verme, başkası ta- rafından uygulanan şiddet ya da toplu şiddet uygulamalarıyla ha- yatlarını kaybetmekte veya sakat kalmaktadır. Daha önce acil ser- vislerde yapılan çalışmaların tü- münde, motorlu taşıt kazalarının (MTK) en büyük adli vaka grubunu oluşturduğu gösterilmişti. Bu ça- lışmada acil servislerdeki şiddet ile ilgili adli vakaların, MTK vaka- larından daha fazla olduğunu ve acil servislerde daha fazla iş yü- küne neden olduğunu göstermek amaçlanmıştır. Yöntemler: Bu çalışma 1 Ocak 2011 - 31 Ara- lık 2012 tarihleri arasında hasta- nemiz acil servisindeki kayıtlar incelenerek retrospektif olarak yapıldı. Eş zamanlı olarak litera- türü analiz edildi ve Türkiyenin farklı bölgelerinde toplam 54000 olgu içeren 7 ayrı çalışmanın ve- rileri karşılaştırıldı. Adli vakalar Motorlu taşıt kazaları, Şiddet vakaları ve Diğer olarak üç grup altında incelendi. Hastaneye başvuran tüm adli vakalar çalış- maya dahil edildi. Veriler topla- nırken hastane ve polis resmi ka- yıtları kullanıldı. Bulgular: Toplam 3838 adli olgu incelen- di. Vakaların %70,3ü erkek, %29,7si kadındı. Ortalama yaş 32,515,52 (min. 0, max. 94) bulundu. Vakaların çoğunu genç erkekler oluşturuyordu. Şiddet %45,6 ile ilk sırada yer alırken (darp %29, bıçaklan- ma %7, ilaç zehirlenmesi %8, ateşli silah %1, cinsel saldırı %0,1), motorlu taşıt kazaları % 37,9 ile ikinci sırada ve diğer grup %16,5 ile üçüncü sıra- daydı. Sonuç: Şiddet, 15-44 yaş arasındaki in- sanlar için dünyada en önde ge- len ölüm sebeplerindendir. Acil servislere başvuran adli vaka- larda motorlu taşıt kazaları daha çok mortalite ve morbiditeye sahip olmasına rağmen, şiddet ve şiddetten kaynaklanan adli vakalar daha sık görülmektedir. Bunun yanında şiddete bağlı adli vakaların acil servislerde çok daha fazla iş yüküne ve ekono- mik kayba sebep olduğu gerçeği de dikkatleri çekmelidir.Objective: Each year, more than a million people lose their lives, and many become disabled, as a result of self-inflicted, interpersonal or col- lective violence. In all the previous studies conducted in the emer- gency departments, it has been shown that motor vehicle acci- dents (MVA) compose the largest forensic case group. In this study, we aimed to show that violence related cases exceed the MVA cases and cause more work bur- den on the emergency physicians. Methods This study was conducted retro- spectively using the hospital re- cords between January, 2011 and December, 2012. At the same time we analyzed literature and com- pared seven different studies in- volving 54000 cases from different parts of Turkiye. We evaluated the forensic cases under three cat- egories as MVA, Violence and Others. All forensic cases who applied to the emergency depart- ment were included in the study. The data was collected from hos- pital and official police records Results: A total of 3838 medical legal cases were examined, 70.3% were male 29.7% were female. Mean age was found as 32.5 ± 15.52 (min 0, max 94). The ma- jority of the patients were young men: Violence with 45.6% ac- counted for the largest group of forensic cases [assault 29.1%, stabbing 7.4%, drug intoxica- tions 8.1%, and gunshot 1.0%, sexual assault 0.1%] followed by MVA, 37.9% and Others 16.5%. Conclusion: Violence is among the leading causes of death worldwide for peo- ple aged 1544 years. Although MVA results in higher morbid- ity and mortality in forensic emer- gency medicine, Violence and vio- lence related cases are much more frequent. Additionally attention should be drawn to the fact that violence related cases cause more work burden and economic losses in the emergency department

Can argyrophilic nucleolar organizing region-associated protein amount be used for the detection of cardiac damage?

KARA, ISMAIL HAMDI/0000-0003-2022-1882; KARA, ISMAIL HAMDI/0000-0003-2022-1882; Bayramoglu, Atif/0000-0003-3053-1956; afacan, mustafa ahmet/0000-0003-1045-0681WOS: 000369657300014PubMed: 25813961Introduction: Carbon monoxide (CO) is a colorless, tasteless, odorless, nonirritant gas and CO poisoning affects all organ systems. Aim: We aimed to detect any possible effects of CO exposure on the argyrophilic nucleolar organizing region (AgNOR)-associated protein synthesis of heart cells and whether there is any relationship between AgNOR protein amount and both carboxyhemoglobin (COHb) level and histopathological evaluation methods used for the detection of damage in heart tissue after CO exposure. Materials and Methods: The rats were divided into four groups (control, 1000, 3000, and 5000 ppm), each containing six rats. After CO intoxication, COHb levels were measured and the animals were killed on the 7th day. AgNOR staining was performed in the heart tissue. One hundred nuclei per rat were evaluated, and total AgNOR area/nuclear area and mean AgNOR number were analyzed for each nucleus. The CO exposure groups had significantly higher AgNOR values than the control group (p < 0.0001). According to cardiomyopathy (CMY) scoring methods, the differences between groups 3 and 4 and groups 1 and 2 were significant (p < 0.05). A significant positive correlation between AgNOR values and both CMY and COHb levels were detected. Conclusion: The detection of AgNOR protein amount may give information about the CMY levels and be used to detect the CO intoxication levels instead of COHb in later periods