Ali Kemal Erenler

Workplace violence in emergency department and its effects on emergency staff

Workplace violence (WPV) is a growing problem for healthcare providers, particularly for those in the Emergency department (ED), with its increasing frequency and severity. Characteristics of WPV are similar in different parts of the World with different sociocultural and economic status. As this problem remains unsolved, its unwanted effects on mental and physical health of staff become more problematic. The most common psychological affects are reduced job satisfaction and fear. When the reasons of WPV are investigated; lack of preventive policies, educational inadequacy, unwillingness to report assaults as a result of a consideration of violence as a routine by the staff and unmet expectations of patients and their family may be listed. In the short-term, increasing the number of security personnel, flagging the names of the patients with a potential of aggression in the computer system and reducing length of stay in the ED are measures to implement immediately. In the long-term, governments must focus on this subject and develop necessary policies including educational programmes in order to reduce WP, before it is too late for another ED worker.

Heart-type fatty acid-binding protein as a potential biomarker of acute carbon monoxide poisoning☆☆☆

BACKGROUND The aim of this study was to investigate the role of serum heart-type fatty acid-binding protein (H-FABP) in the evaluation of patients with carbon monoxide (CO) poisoning. METHODS Forty patients with acute CO poisoning admitted to the emergency department and 15 healthy adults as the control group were included in the study. Serum H-FABP levels of patients were studied on admission and at the 6th, 12th, and 18th hours. Patients were divided into 3 groups according to clinical severity as mild, moderate, and severe. Patients were also divided into 2 groups according to treatment with hyperbaric oxygen (HBO) or normobaric oxygen. RESULTS Serum H-FABP levels of the patients were higher than those of the control group. There was a negative correlation between H-FABP levels and Glasgow Coma Scale score on admission. Heart-type fatty acid-binding protein levels were significantly higher in patients in the severe compared with mild group. Heart-type fatty acid-binding protein levels in patients treated with HBO were significantly higher than in those treated with normobaric oxygen. The cutoff value of serum H-FABP as an indicator for HBO treatment was determined as 1.5 ng/mL or higher, with a sensitivity of 85.7% and specificity of 69.7%. Serial measurement revealed that H-FABP level peaked at the sixth hour and reduced over time but remained higher than in the control group at the 18th hour. CONCLUSION Heart-type fatty acid-binding protein may be a promising novel biomarker in the evaluation of clinical severity and in the selection of patients for HBO therapy in acute CO poisoning.

Isolated unilateral oculomotor nerve palsy due to head trauma.

Unilateral oculomotor nerve palsy is a rare and challenging condition for both emergency department (ED) physicians and neurosurgeons. In this report, we present you a case of head trauma with oculomotor nerve palsy whose initial neuroimaging findings were normal. A 50-year-old female presented to our ED due to head trauma secondary to fall from height. On her physical examination, ptosis, minimal lateral deviation, and dilated pupilla unresponsive to the light were determined in the left eye. A computed tomography and magnetic resonance imaging were performed and both were found to be normal. Patient was consulted with an ophthalmologist and any sign of direct trauma to the eye was not determined. Then, the patient was consulted with a neurosurgeon and hospitalized. In some rare instances, minor traumas to the head may result in isolated oculomotor nerve palsy without accompanying findings. Neurosurgeons and ED physicians must be careful about this rare condition.

Reasons for Overcrowding in the Emergency Department: Experiences and Suggestions of an Education and Research Hospital

SUMMARY Objectives In this study, we aimed to determine the causes of overcrowding in the Emergency Department (ED) and make recommendations to help reduce length of stay (LOS) of patients in the ED. Methods We analyzed the medical data of patients admitted to our ER in a one-year period. Demographic characteristics, LOS, revisit frequency, and consultation status of the patients were determined. Results A total of 163,951 patients were admitted to our ED between January 1, 2013, and December 31, 2013. In this period 1,210 patients revisited the ED within 24 hours. A total of 38,579 patients had their treatment in the observation room (OR) of the ED and mean LOS was found to be 164.1 minutes. Cardiology was the most frequently consulted specialty. Mean arrival time of the consultants in ED was 64 minutes. Conclusions Similar to EDs in other parts of the world, prolonged length of stay in the ED, delayed laboratory and imaging tests, delay of consultants, and lack of sufficient inpatient beds are the most important causes of overcrowding in the ED. Some drastic measures must be taken to minimize errors and increase satisfaction ratio.

Characteristics of patients admitted to the emergency department due to tick bite

Crimean-Congo haemorrhagic fever (CCHF) is a tick-borne disease endemic in Turkey since 2002. Çorum is one of the leading five cities in Turkey in which CCHF disease is seen most. We studied characteristics of the patients with tick bites in our emergency department (ED) and determined the fatality rate of the disease in city of Çorum for the first time. We retrospectively analysed the characteristics of the patients admitted to our ED from the medical files of 21,680 patients in a 5-year period. The number of patients with definite diagnosis and who have died was determined. Our results demonstrated that the fatality rate of CCHF in Çorum is 6.78%. Among 21,680 patients, blood samples of 970 patients were sent to an advanced centre in Ankara for polymerase chain reaction (PCR) testing. Results of 560 patients were reported to be PCR (+) and 38 of them have died.

A Case of Respiratory Failure Due to Poison Hemlock Poisoning Presented to an Emergency Department

Poison hemlock (Conium maculatum) is one of the most poisonous plants in the world. Accidental ingestion of the plant could result in central nervous system depression, respiratory failure and even death. Airway and breathing management followed by fluid resuscitation is the mainstay of treatment. Poison hemlock poisoning is an important differential diagnosis for patients with impaired consciousness and respiratory failure after plant ingestion in areas of natural habitat for the plant. Early and proper diagnosis is vital for patients with poison hemlock poisoning. In this report, we present a case of life-threatening poisoning due to taking the poison hemlock mistaken for Helichrysum arenarium.

Role of ischemia-modified albumin in clinical practice

Abstract Difficulty in establishing a diagnosis of acute coronary syndrome (ACS) in the clinical setting has led researchers to investigate novel markers that show increased blood levels before the myocardial necrosis occurs. In ischemic conditions, some modifications occur in the amino acids located on the N-terminus of the human albumin molecule. Ischemia-modified albumin (IMA) is a marker formed after damage in the N-terminal region of albumin. The altered N-terminus can no longer bind transition metals, such as cobalt. The causes of the increases in IMA have been shown to be endothelial or extracellular hypoxia, acidosis, and free oxygen radicals. IMA, an early marker of ischemic disorders, is also a candidate marker for the detection of ACS. An assay measuring IMA might represent a promising marker for the identification of patients with myocardial ischemia. The aim of this study was to evaluate the clinical utility of IMA in the assessment of ACS as well as other medical disorders in light of the recent literature.

Subarachnoid hemorrhage and pneumocephalus due to epidural anesthesia

Epidural analgesia is an extremely effective and popular treatment for pain during labor. Subarachnoid hemorrhage and pneumocephaly is a serious but rare complication of puncture of the dura mater in epidural anesthesia. To best of our knowledge, intracranial subarachnoid hemorrhage together with pneumocephaly hasn’t been reported as a complication after the lumbar puncture so far. Our purpose is to increase awareness for serious complications such as subarachnoid hemorrhage and pneumocephaly following regional procedures (See Fig.). Our case was a 32-years old woman. The patient presented to emergency department with severe headache 3 days after delivery with epidural anesthesia. On CT scan, pneumocephaly and subarachnoid hemorrhage were detected. Our case was discharged to home on the day 20 after presentation, although there are life-threatening complications related to epidural and/or spinal anesthesia. Clinicians should be aware that serious complications such as pneumocephaly or subarachnoid hemorrhage may present in patients presenting with headache following epidural anesthesia and these patients should be assessed by CT imaging in case of clinical suspicion.

Investigation of mindin levels in hypertensive patients with left ventricular hypertrophy and QRS fragmentation on electrocardiography

Abstract Purpose: Mindin was associated with diabetic nephropathy, podocyte injury, colitis, allergic asthma, liver ischaemia and reperpusion injury and ischaemic brain injury. On the other hand, it was reported as a protective factor against obesity, cardiac hypertrophy, fibrosis and remodelling. Fragmented QRS complexes (fQRS) are markers of altered ventricular depolarisation owing to a prior myocardial scar and fibrosis. In this study, we aimed to investigate mindin levels in hypertensive patients with left ventricular hypertrophy and fQRS on electrocardiography. Methods: This observational case-control study enrolled 70 (36 female) hypertensive patients with fQRS and 38 (23 female) hypertensive control patients. All patients were evaluated by transthoracic echocardiography. Mindin levels were measured by the enzyme-linked immunosorbent assay (ELISA). Clinical, echocardiographic and laboratory data were compared between patient and control groups. Results: There was no significant difference between patient and control groups in terms of clinical, echocardiographic and routine laboratory parameters. The mindin levels were significantly higher in the patient group than controls (11.3 (7.21–19.31) vs 4.15 (2.86–6.34); p < .001). Multiple logistic regression analyses defined increased mindin levels as an independent predictor for the presence of fQRS (Odds ratio: 1.733; p = .034). Mindin levels >6.74 predicted the presence of fQRS with a sensitifity of 84.3% and specificity of 79.9% on receiver operating characteristic (ROC) curve analysis (The area under the curve:0.889; Confidence Interval: 0.827–0.951; p < .001). Conclusion: Mindin expressin is upregulated in hypertensive patients with fQRS complexes. In contrary to previous studies, increased mindin levels may be associated with myocardial fibrosis.

Butyrylcholinesterase as an additional marker in the diagnostic network of acute myocardial infarction

Abstract Background: Acute coronary syndrome defines a broad spectrum of complaints from angina to irreversible myocardial damage. There is an ongoing need for a biomarker to predict and diagnose acute myocardial infarction (AMI) in the early stage. In this study, our aim was to reveal early diagnostic value of butyrylcholinesterase (BChE) in discrimination of healthy subjects and patients with AMI. Methods: Eighty-five patients admitted to our hospital due to AMI and 45 healthy subjects were involved in the study. Patients and controls were compared according to BChE, lipid profiles and biochemical parameters. Results: The serum BChE activity was significantly lower in patients with AMI than in the controls (p<0.001). After correlation analysis, while a negative correlation was determined between the serum BChE concentrations and AMI presence (r=–0.363, p<0.001); a positive correlation was determined between the serum BChE and cholesterol (r=0.443, p<0.001), HDL (r=0.243, p=0.006) and LDL (r=0.369, p<0.001) levels. The data indicate that BChE is associated with AMI and a subsequent receiver operating characteristic curve (ROC) analysis revealed that BChE, as an independent indicator, may differentiate AMI patients from controls. A cut-off point set at ≤7.15 kIU/L, BChE showed a sensitivity of 51.2% and a specificity of 84.4% (AUC=0.719, p<0.001). Conclusions: Low BChE level was significantly associated with AMI when compared to healthy subjects. Even though it has low sensitivity, plasma levels of BChE might represent an additional marker in the diagnostic network of AMI.