SPINAL IMMOBILIZATION

Amerika Birleşik Devletleri'nde 200.000'den fazla kişinin spinal yaralanmalı olduğu ve her yıl 10.000 yeni olgunun görüldüğü bildirilmektedir. Bu hastaların yaklaşık 4.200'ünün hastaneye varmadan önce öldükleri tahmin edilmektedir. Yaralanmaları önlemeye yönelik eğitim, hastane öncesi uygun değerlendirme, stabilizasyon ve transport ile spinal travmalara bağlı mortalite ve morbidite azaltılabilir. Spinal travmaların en sık nedeni motorlu araç kazalarıdır. Diğer nedenleri düşmeler, penetran yaralanmalar ve spor yaralanmalarıdır. Spinal travma sıklıkla omurganın fizyolojik hareket sınırından daha fazla zorlanması ile oluşur. Spinal travmaya sıklıkla neden olan spesifik yaralanma mekanizmaları aksiyel yüklenme, aşırı fleksiyon, hiperekstensiyon, hiperrotasyon, aşırı lateral eğilme ve distraksiyondur. Spinal travmayı düşündüren semptom ve bulgular; ağrı, hareketle ağrı, duyarlılık, deformite, spinal alanda kesi, morluk, paralizi, parestezi ve güçsüzlüktür. Spinal yaralanmalar sprain, strain, fraktür, dislokasyon ve kord yaralanması olarak sıralanabilir. Spinal kord primer ya da sekonder yaralanabilir. Spinal kord lezyonları komplet ve inkomplet olarak sınıflanır. Spesifik spinal yaralanma türüne bakmazsızın olası spinal kord yaralanmasını düşündüren semptom ve bulguları olan tüm hastalarda klinik muayene bulguları ve radyolojik görüntüleme yöntemleri ile spinal kord yaralanması dışlanıncaya dek omurga stabilizasyonu sağlanmalıdır. More than 200.000 wounded of spinal injury are presently living in the United States, and more than 10.000 new cases occur per year. Of these patients, an predictable roughly 4200 will die before admission to a hospital. Education in injury prevention, prehospital assessment, and proper immobilization and transportation of these patients can decrease morbidity and mortality. Most spinal cord injuries result from motor vehicle accidents, followed by falls, penerating injuries and sport injuries. Spinal injury most commonly results from the spine being forced further than its physiological limits of motion. The specific mechanisms of injury that frequently cause spinal trauma are axial loading; extremes of flexion, hyperextension, or hyperrotation, excessive lateral bending and distraction. Spinal cord injury, includes the following signs and symtoms; pain, tenderness, painful movement, deformity, cuts, bruises over spinal area, paralysis, paresthesias and weakness. Spinal injury may be classified as sprains, strains, fractures, dislocations, and cord injuries. The spinal cord may sustain primary or secondary injury. Lesions of the spinal cord are classified as complete or imcomplete. Regarless of the specific injury, all patients with suspected spinal trauma and signs and symtoms of spinal cord injury should be immobilized, and unnecessary movement should be avoided until injury to the spine or spinal cord can be excluded by clinical examination and radiography

ANALYSIS OF ADULT PATIENTS WITH PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA IN THE EMERGENCY DEPARTMENT: A CASE SERIES

Amaç: Acil serviste erişkin paroksismal supraventriküler taşikardili (PSVT) hastaların demografik ve klinik özelliklerini ve normal sinüs ritmine (NSR) dönüşü etkileyen etkenleri belirlemektir. Yöntem: Bu retrospektif, tanımlayıcı çalışmada iki yıl içinde acil serviste SVT tanısı alan hastalar incelendi. Hastaların dosyalarından, yaş, cinsiyet, acile başvuru yakınmaları, vital bulguları, başvuru zamanı, tedavi girişimleri, NSR'e dönüş, komplikasyonlara ilişkin bilgiler tarandı. Analizde, ki-kare ve t-testi Fisher-Exact ve Mann-Whitney U testleri kullanıldı. Bulgular: Acil serviste PSVT tanısı alan toplam 104 hasta (55 kadın, %52,9) çalışmaya alındı. Hastaların yaş ortalaması 49 (aralık; 18-86) idi. En sık başvuru yakınması çarpıntı idi (%89,4). Diğer yakınmalar göğüs ağrısı ve huzursuzluk (%20,2), halsizlik (%6,8) ve istirahat dispnesi (%5,8) idi. Vital bulguları; kan basıncı ortalaması 127/88 mmHg, nabız ortalaması 176 atım/dakika, oksijen saturasyonu ortalama %96 idi. Vital bulgu bozuklukları; takipne (n=28, %28,9), hipertansiyon (n=6, %5,8) ve hipotansiyon (n=5, %4,8) idi. Acil servise en sık başvuru saati 16.00-24.00 arasında (n=44, %42,3) idi. Saat 08.00-16.00 arasında 39 (%37,5) olgu ve 24.00-08.00 arasında 21 (%20,2) olgu başvurmuştu. NSR'e dönüş zamanı kaydedilmiş 33 hastanın ortalaması 37,7 dakika idi. NSR'e dönen 90 hastanın dönüş anında kan basıncı ortalaması 116/75 mmHg idi. Sonuç: PSVT olguları acil servise benign semptomlar ve stabil vital bulgularla başvurmaktadır. Antiaritmik ilaç uygulamadan önce Valsalva manevrası yapılan hastalarda karotis sinüs masajı yapılan hastalara göre NSR'e dönüş oranının daha yüksek olduğu görülmüştür. İlk kez PSVT atağı ile başvuran ve Valsalva manevrası yapılmayan hastalarda NSR'e dönüş oranı daha düşük olmuştur. Objective: To describe demographic characteristics and clinical presentation of patients with paroxysmal supraventricular tachycardia (PSVT) and factors affecting conversion to the sinus rhythm in the emergency department (ED). Methods: All consecutive adult patients who were diagnosed to have SVT in the ED within two-year period were enrolled in this retrospective, descriptive study. The charts were reviewed regarding the age, complaints on admission, vital signs, time of admission, time taken to convert to normal sinus rhythm (NSR), complications and mode of disposition.The data were analyzed using chi-square, t-test, Fisher's exact test and Mann-Whitney U test. Results: A hundred and four cases (55 females, 52.9%) diagnosed to have SVT were enrolled. The mean age was 49 (range 18-86). Palpitation was the most common complaint reported by the patients (89.4%), followed by chest discomfort and pain (20.2%), faintness (6.8%) and resting dyspnea (5.8%). Abnormalities of vital signs included tachypnea (23.0%), hypotension (4.8%), and hypertension (5.8%). Mean blood pressure values were 127/ 88 mmHg, mean pulse was 176 bpm and mean SaO2 was 96%. The distribution of the cases' presentation to the ED was as follows: 44 cases between 16.00 and 24.00 hours (42.3%) 39 cases between 08.00 and 16.00 hours (37.5%) and 21 cases between 24.00 and 08.00 hours (20.2%). The number of patients successfully converted to NSR was 33 (%31.7). Mean time taken to conversion was 37.7 minutes. Mean blood pressures of the 90 patients who were successfully converted to sinus rhythm was 116/75 mmHg. Conclusion: Cases with PSVT may present into the ED with a broad range of symptoms that are associated with stable vital signs and clinical appearance. Patients subjected to Valsalva maneuver before receiving antiarrhythmic medications had a higher percentage of conversion to NSR than others. Conversion rate was lower in those with first attack of PSVT and those who had not undergone Valsalva maneuver than in other

Assessment of physicians employed in emergency medical services about their level of knowledge on basic life support, advanced cardiac life support and medicolegal responsibilities 112 Acil saǧlik hizmetleri'nde görevli doktorlarin temel yaşam desteǧi, ileri kardiyak yaşam desteǧi ve doktorun adli sorumluluklari konularindaki bilgi düzeylerinin deǧerlendirilmesi

BACKGROUND: We aimed to determine the level of knowledge of Emergency Medical Services (EMS) physicians on Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) and medicolegal responsibilities in conjunction with related factors. METHODS: Fifty-three physicians (43 male, 10 females; mean age 39 years; range 28 to 50 years) employed in EMS were required to respond a questionnaire consisting of demographic data and educational background. They also answered 25 multiple-choice questions about BLS, ACLS and medicolegal responsibilities of physicians in a face-to-face manner. The data were analyzed using Mann-Whitney U-test and Kruskal-Wallis Analysis of Variance test. RESULTS: Mean level of knowledge was 45.4 on a hundred-point scale. Attendance to courses covering emergency aid and working as an ambulance physician for more than one year were associated with higher levels of knowledge (p=0.012; p=0.015). CONCLUSION: In-service training should be undertaken to raise the level of knowledge of the physicians employed in rural EMS and to improve the quality of field care

First aid: Level of knowledge of relatives and bystanders in emergency situations

Bystanders who are able to provide immediate first aid to patients who require emergency care can make a big difference in the outcome. Thus, first-aid training should be made available to as many people as possible. The aims of this study were to assess the level of first-aid knowledge among bystanders in emergency situations and to identify factors that affected this level of knowledge. At Dokuz Eylul University Emergency Service between February 1 and February 15, 2002, 318 bystanders were given a questionnaire. The first part of the questionnaire was concerned with demographic characteristics and factors that would affect first-aid knowledge level. The second part consisted of 16 multiple choice questions about first aid. Bystanders answered an average of 7.16 +/- 3.14 questions correctly. Bystanders who had graduated from a university, were health care personnel, had taken a first-aid course, had a first-aid certificate, or had a driver's license were considered to be more successful

Acute Subdural Hemorrhage While Traveling by Bus: A Risk Factor in the Elderly?

A 71-year-old man was delivered to our emergency department by an intercity bus. About 4 hours into a journey, he had complained of a headache to his wife. After one more hour, she noted a change in his level of alertness and notified the bus driver. A computed tomography scan of the head showed a subdural hemorrhage

What Does High Incidence of Sharp Injury Reports Indicate?

Aim: The aim of this study was to evaluate needlestick and sharps injuries in our hospital for the last six years and the effects of education on the prevention of exposure to sharp instruments. Methods: We retrospectively evaluated sharp injuries occurred in our hospital between January 2007 and January 2013. Results: It was found that 229 sharp injuries were sustained within six years. During this period, 1.386 health-care workers received education and training on sharps injury prevention. Conclusion: We concluded that education and training of healthcare workers will increase sharps injury reporting rates and raise awareness and reduce the risk of sharps injuries. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 98-102

AHP MODEL FOR TRANSITION FROM IPv4 TO IPv6

OZTURK, Yusuf/0000-0003-2762-5265; Ozturk, Yusuf/0000-0003-2762-5265; KIZILKAYA AYDOGAN, Emel/0000-0003-0927-6698WOS: 000295217600023In this study, one of multi criterion decision making methods, Analytic Hierarchy Process (AHP), was used to decide the best transition mechanism from IPv4 to IPv6 based on "National IPv6 Protocol Infrastructure Design and Transition" Project. The contributions of this study are summarized as being the first study in the field, establishing the parameters for this transition, defining criteria sets to this field for the first time and applying AHP to this problem. In addition to those, questionnaires were prepared and applied to define the best transition strategies. The results were then obtained from Super Decisions 1.6.0 software package for achieving suitable transition mechanisms. It is expected that this study will help and contribute to the state organizations to decide suitable transition mechanisms to IPv6, to use the country resources more effective, to shorten the transition time and finally to present systematic and scientific approach to this transition