Coffee bean sign, whirl sign and bird’s beak sign in the diagnosis of sigmoid volvulus

The patient, a 28-year-old man who had presented to our Emergency Department (ED) with constant abdominal pain and distension for one day, had no previous medical or surgical history. He denied that he had any nausea, vomiting, diarrhea or constipation. At admission, his physical examination revealed hypertension (TA: 152/97 mmHg) and a distended abdomen with generalised tenderness and hypoactive bowel sounds. There was no fever, abdominal guarding, rebound or rigidity. Laboratory results were within normal limits. A plain radiograph of the abdomen revealed a “coffee bean” sign. We also observed an impressive picture of a typical “whirl” sign and a “bird’s beak” sign on an emergent abdominal computed tomography (CT) scan. Also, his CT scan revealed marked distension and a twisted loop of sigmoid colon. Sigmoid volvulus (SV) was diagnosed rapidly with these characteristic radiological signs. Subsequently, with flexible sigmoidoscopy, the patient was successfully decompressed and detorsioned. SV is potentially life-threatening and requires emergency intervention. It is the third leading cause of colon obstruction in adults after cancer and diverticulitis. The primary emergency therapy for uncomplicated SV is endoscopic detorsion and decompression. Emergency physicians in particular should be aware of the typical radiographic CT signs, “coffee bean,” “whirl” and “bird’s beak,” which are indicative of SV and which will allow them to easily diagnose this condition in cases of acute abdominal obstruction. If emergency physicians delay diagnosis, the patients might require emergency surgical intervention

A girl with a torticollis without trauma: Grisel’s syndrome

A 7 year-old girl patient was referred from pediatric emergency department (ED) to our emergency department due to cervical pain and neck stiffness. On her physical examination, torticollis was found in the neck. There was no history of trauma. Physical examination showed no focal neurological deficits. On further anamnestic evaluation the patient's parents revealed that she had presented to paediatric ED due to throat and neck pain and put on antibiotics therapy for 5 days. A computed tomography (CT) scan of the patient's neck was performed. A cervical lymphadenopathy associated with atlanto-axial subluxation shadow. The atlas was rotated on one articular process with 3-5 mm anterior displacement, compatible with Type II subluxation. Non-traumatic or inflammatory atlanto-axial subluxation is known as Grisel's syndrome. The subluxation was stabilized with external stabilization (rigid cervical collar). Skeletal muscle relaxants, antibiotics and nonsteroidal anti-inflammatory medications with bed rest were given for further treatment. Early diagnosis of Grisel's syndrome is of crucial importance due to the neurological deficits suc as recurrence or permanent neck deformity. CT, magnetic resonance imaging (MRI) or other imaging tests are required to demonstrate fractures and displaced bone fragments (ie., atlanto-axial subluxation). The primary treatment of early detected Grisel's syndrome is conservative including antibiotic therapy, bed rest, muscle relaxants, external fixation and anti-inflammatory therapy

Phenytoin intoxication with no symptoms correlated with serum drug level: a case study

In high-dose intake of phenytoin, which is used frequently to treatepilepsy, nystagmus, diplopia, nausea-vomiting, lethargy, confusion, seizure, and coma can be observed. In recent studies on phenytoin intoxication, in which seizure and coma were observed in drug levels greater than 50 ug/mL. The serum phenytoin level of apatient, who consumed approximately 100 pcs of 100 mg phenytoin tablets in an effort to commit suicide, and who had no pathological finding in her neurologic examination, was 124 ug/mL. High drug level and the absence of toxic effect (or the absence of toxic effect correlated with the drug level) indicates that cytochrome P450 is functioning, but there can be a mutation in the MDR1 gene. In our case study, we report on phenytoin intoxication in a patient having a high level of phenytoin but no symptoms correlated with serum drug level, as supported by the findings in the literature.Pan African Medical Journal 2015; 2

Temporal and clinical distribution of 112 emergency call system use of geriatric patients during novel coronavirus pandemic process

112 emergency call system is crucial for geriatric patients because the safe and secure transport of these patients can decrease mortality and morbidity. The present study was a temporal and clinical evaluation of cases with COVID-19 and non-COVID-19 older than 65 years of age during the pandemic. Of the 10948 cases accepted diagnosed with novel coronavirus between March 11 and May 1, 2020, 51.6% (n=5650) were female, 48.4% (n=5298) were male and the median age was 75.0 (70.0-81.0) years. The patients were compared concerning age, gender, month distribution, symptoms, comorbidity, computed tomography results, hospitalization, and discharge criteria. Concerning symptoms, the findings showed that 50.0% (n=5476) had high fever, 50.3% (n=5504) had cough, 59.5% (n=6509) had shortness of breath. Atypical complaints were found in 21.3% (n=2337) of the patients. Concerning comorbidity, 10.3% (n=1126) had hypertension, 5.8% (n=633) had diabetes mellitus, 7.2% (n=784) had chronic obstructive pulmonary disease and 0.9% (n=95) had cerebrovascular disease. The findings showed that 26.0% of the cases were hospitalized, while 74.0% (n=8098) were discharged. In 112 call center calls, being more careful and alert in the anamnesis of the geriatric patient group defined as important concerning the atypical course and potential risk factors and in the use of protective equipment is important for safe and secure transport of patients and since this will decrease mortality and morbidity. [Med-Science 2022; 11(2.000): 613-6

First response of emergency health care system and logistics support in an earthquake

BACKGROUND: An earthquake is an event that differs from any other disaster because it requires a multidisciplinary approach and affects all the people in the region where it occurs. The presented research aims to present healthcare, search and rescue, logistics and support to the magnitude 6.6 Elazığ earthquake by literaturę sight. This research also provides analysis of local and nearby support provided by Disaster and Emergency Management Authority (DEMA) (AFAD), 112 Emergency Health Services and National Medical Rescue Team (NMRT) (UMKE), equipment, timely manner and staff in the earthquake of Elazıg on 24.01.2020.   MATERIAL AND METHODS: A total of 1942 people, including 120 NMRT Teams (821 NMRT staff) and 276 staff 112 Ambulance teams, were assigned for medical rescue.   RESULTS: Victims: 12 injured and 5 exitus, who were triaged by 112 and NMRT teams, were pulled from the wreckage and transported to the hospitals within the first 30 minutes.   CONCLUSION: As in the Elazığ earthquake, the coordinated and cooperative work of all search and rescue and first aid teams of the region appeared to be one of the most important factors in reducing the mortality and morbidity of earthquake victims and maintaining life comfort

A fatal dermatosis in the emergency department: toxic epidermal necrolysis

Toxic Epidermal Necrolysis (TEN) is acute life-threatening mucocutaneous reactions, which are mainly induced by drugs. The annual incidence is 0.51.2 cases per million population and the mortality rate is 2030%. The genetic background associated with drug hypersensitivity is very important in the development of TEN. Antimicrobials and anticonvulsants are most commonly associated with the development of TEN. TEN is a disease which acutely starts and has prodromes such as cough lasting 1-3 days, throat ache, burning eyes, arthralgia before the disease. Intraoral erosion is a constant result. Sepsis and respiratory insufficiency were the most important complications in TEN. The main therapy are drugs used by the patient were stopped, systemic corticosteroid and supportive treatment. The aim of our study is recognized of TEN by emergency physicians. [Med-Science 2016; 5(4.000): 1027-9

The role and significance of 112 emergency health services in treatment and guidance in mass food poisoning cases

INTRODUCTION: 112 emergency health services send the same types of cases to different hospitals and receive the first information, have a comprehensive knowledge on these cases and inform all the hospitals simultaneously.   AIM: In this study, our aim is to share with the literature through anticholinergic food poisoning cases that it is possible to prevent delays in examination and treatment and to prevent information pollution when 112 emergency health services.   MATERIAL AND METHODS: We retrospectively reviewed 213 mass food poisoning cases which occurred between December 1 and 7, 2019 and which were taken to 14 hospitals with 112 emergency health services. File information of 69 of these cases were reached; in addition to demographic characteristics such as age and gender, physical examination findings such as blood pressure, pulse, skin-eye and consciousness states, laboratory values, hospitalization times, in which units the cases were followed and the duration of admission to the hospital after meals were noted.   RESULTS: Of the 69 cases, 42 were found to have skin findings, 37 were found to have mydriasis and 12 were found to have agitation and/or confusion. The duration of admission to hospital after meal was found as 6.5 (4.5–10.0) hours. 60 (87.0%) of the patients were followed in the emergency room, 4 (5.8%) were followed in the internal medicine service and 5 (7.2%) were followed in the intensive care.   CONCLUSIONS: When the crisis team of 112 emergency health services is alert, they can categorize the event, prevent the chaos in the emergency service of hospitals with correct triage and thus with the process of understanding the event, examination and treatment process becomes more executable