Poisoning and suicide in emergency department [Âcilde zehirlenme olgulari ve özkiyim]

Suicide is defined as to prefer death in death-life dilemma. Poisoning is being faced by any agent that impacts functions of human bodies negatively. The most frequently reason is drug ingestion. Poisoning after suicide attempts are frequently seen in emergency departments. In such patients determining the factors that contribute suicide attempt and their prevention will decrease death after suicide attempts as well as increasing life quality. According to our department data; the most common factors influencing suicide behavior, were the relationship problems in the young age groups and financial problems in middle age groups. Most of our patients were young and single females. The patients have psychiatric diagnosis, mostly depression, in their medical history. Mostly poisoning cases preferred multiple drug ingestion as the method of suicide. All patients have admitted and treated in Emergency Observation Unit and then discharged. All patients who attempted suicide were consulted with psychiatry clinic in emergency department. Suicide behavior is an alternative solution as well as the way of expressing oneself when there is no solution to the problems faced. The problems experienced between people and financial problems seem like the most important reason in these attempts. The way to help and protect these people from repeated suicide attempts is referring all patients to psychiatric clinic after discharging from at emergency department

The evaluation of geriatric patients with headache admitted to the emergency unit [Aci·l servi·se başagrisi yakinmasi i·le başvuran yaşli hastalarin degerlendi·ri·lmesi·]

Introduction: Neurological problems are common in the elderly, especially in the emergency unit. Headache is one of them, and it can be the first and sometimes the only symptom of a serious disease. We aimed to retrospectively examine the patients admitted to the emergency room with a complaint of headache only, and to collect data for epidemiological studies. Materials and Method: Age and gender besides the type and cause of headache, rate of hospitalization and distribution of patients admitted to the Emergency Room with a complaint of headache were examined from their records. Results: Eighty-four patients out of 3851, accepted to the Cukurova University Faculty of Medicine, Department of Emergency between January 2006 and December 2007, had a complaint of headache. Forty nine (58.3%) of the cases were female while 35 (41.6%) of them were male. The onset was acute in 66 cases and subacute in 18 cases. The most common causes of headache were hypertensive attacks and cerebrovascular diseases. Fifty-one (60.1%) cases were hospitalized while 29 (34.5%) were sent home with a prescription, and four (4.7%) patients refused hospitalization. Conclusion: In the elderly population, headache is predominant in females and mainly develops secondary to another disease. Thus, patients complaining of a headache should be investigated etiologically

The role of patient-controlled apparatus for sedation in the emergency department

PubMedID: 16358163Aim: Hand trauma is a fairly common cause of emergency unit admissions. Various analgesic and sedative agents are used to decrease pain and anxiety during minor surgical procedures for hand trauma patients and provide more comfortable conditions for the surgeon. The aim of this study was to investigate the potential role of patient-controlled sedation (PCS) during surgical procedures done under local anesthesia for hand trauma in the emergency department. Materials and methods: Forty ASA I-II (Assignment of the American Society of Anesthesiologists) patients who visited the emergency unit with hand trauma were randomized to 2 groups of 20 patients each. The control group received 1 µg/kg of fentanyl (IV) and 0.028 mg/kg of midazolam (IV). Additional 1 mg doses of midazolam were given by the anesthesiologist to keep the sedation level between 3 and 4. In the PCS group, the midazolam was administered after programming the apparatus. The settings were as follows: loading dose: 0.028 mg/kg, bolus dose 1 mg, lock-out period: 5 min and basal infusion rate: 0. The loading dose was given before local anesthesia. All patients received prilocaine hydrochloride (Citanest 2%, 10 mL) for local anesthesia. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), oxygen saturation (SpO2) and respiration rate (RR) were measured before intervention and at 2, 3, 5, 10, 15, 20 and 30 minutes. Results: There were no differences in the demographic characteristics, operation and discharge times in the two groups (p>0.05). No cardiovascular or respiratory instability was observed in any patient, and SpO2 remained over 95% for all. The SBP, DBP, HR and SpO2 did not differ significantly (p>0.05). Although the sedation levels of all patients were satisfactory, the sedation levels of the control group were significantly lower at 5 and 15 minutes (p<0.05). The total midazolam dose was 4.3+1.1 in the control group and 4.0+0.8 in the PCS group. The patient satisfaction rate was 95% in the PCS group and 80% in the control group (p>0.05). Conclusions: The two regimens did not differ with respect to hemodynamic changes, sedation levels and patient satisfaction. Therefore, PCS may be an acceptable alternative for surgical procedures performed using local anesthesia. © The Mount Sinai Journal of Medicine

The relationship of trauma severity and mortality with cardiac enzymes and cytokines at multiple trauma patients [Çoklu travmalı olgularda kalp enzimleri ve sitokinler ile travma şiddeti ve mortalitenin ilişkisi]

PubMedID: 23138993BACKGROUND In this study, we aimed to determine the effects of trauma severity on cardiac involvement through evaluating the trauma severity score together with diagnostic tests in multiple trauma patients. A trauma score was determined using various trauma severity scales. METHODS After obtaining the approval of the ethics committee of the faculty, this prospective study was performed through evaluating 100 multiple trauma patients, aged over 15 years, who applied to our Emergency Department (ED). After determining the trauma severity score using instruments such as the Injury Severity Score (ISS), Glasgow Coma Scale (GCS), and Revised Trauma Score (RTS), the cardiac condition was evaluated using biochemical and radiological diagnostic tests. RESULTS During the study period, 100 patients were evaluated (78 male, 22 female; mean age: 33.2±15.4; range 15 to 70 years). It was determined that 92 (92%) were blunt trauma cases, and 77 (77%) of them were due to traffic accidents. The majority of cases showed electrocardiogram (ECG) abnormalities (63%) and sinus tachycardia (36%). Abnormal echocardiogram (ECHO) findings, mostly accompanied by ventricular defects (n=24), were determined in 31 of the cases. Nineteen cases with high trauma severity score resulted in death, and 14 of all deaths were secondary to traffic accidents. Trauma scores were found to show a significant difference between the two groups. CONCLUSION The ISS trauma scale was determined to be the most effective in terms of indicating heart involvement in patients with multiple traumas. Close follow-up and cardiac monitoring should be applied to patients with high trauma severity scores considering possible cardiac rhythm changes and hemodynamic disturbances due to cardiac involvement

A comparison of effectiveness of sodium bicarbonete in patients intoxicated by tricyclic antidepressants and Anticholinergic drugs other than tricyclic antidepressants which affected the heart [Kalp etkilenmesine sebep olan trisiklik antidepresan i·laçlar ve trisiklik antidepresan dışı diger antikolinerjik i·laçlar ile zehirlenmeye maruz kalan hastalarda sodyum bikarbonat tedavisinin etkinliginin karşılaştırılması]

Objective: Anticholinergic drug poisoning is among the life threatening poisonings frequently seen in emergency services. These drugs have serious side effects on heart like heart rate alterations, arrhythmias and conduction delays. The purpo-se of our study is to determine whether the other negative impacts of intoxication with tricyclic antidepressants (TCA) and antic-holinergic drugs other than TCAs on heart are similar in nature in patients with QTc ?45, and to compare the effectiveness of the standard NaHCO3 treatment on prolongation of QTc as well as QRS complex widening in patients intoxicated by anticholinergic drugs. Material and Methods: This prospective case-control study was planned to enroll patients who admitted to emergency ser-vice of Çukurova University Medical Faculty between June 06, 2005 and November 30, 2006 due to poisoning with TCA or anti-cholinergic drugs other than TCAs, and having a QTc interval ?0.45 on the electrocardiogram (ECG) taken at the time of admission. The patients were managed with a 2 mEq/kg dose of NaHCO3 treatment. In both groups, changes in QTc and QRS distances, car-diac biochemical parameters and systolic blood pressure and heart rate changes were compared with respect to time and the gro-ups. Biochemical parameters related to possible complications due to the given treatment were examined. Results: The patients' demographic, clinical, electrocardiographic and laboratory findings were recorded and analyzed. A total of 58 patients, 30 of whom were poisoned with TCA agents, and 28 were poisoned with other drugs with anticholinergic effects were enrolled in the study. All patients had prolonged QTc and tachycardia and in 64.9% of the patients (n=37) QRS was ?0.1. When we compared the QRS and QTc values at admission and at the sixtieth minute of the therapy, we observed a statistically significant decrease in both gro-ups. Hopwever this reduction did not differ significantly between the groups. No significant changes were observed in systolic blo-od pressures or cardiac biochemical parameters of the patients of during the time between admission and discharge. Treatment and follow-up of all patients were performed in the emergency observation unit. No mortality occurred among patients in both gro-ups. Conclusion: The fact that NaHCO3 treatment completely improved signs and symptoms and no treatment-related complica-tions like hypertension, metabolic alcalosis, hypernatremia, hypokalemia, hypocalcemia developed, we suppose that standard 2 meq/kg NaHCO3 treatment is valid, effective and reliable in anticholinergic drug poisonings. Copyright © 2012 by Türkiye Klinikleri