Atakan Yilmaz

Intravenous paracetamol versus dexketoprofen in acute migraine attack in the emergency department: a randomised clinical trial.

Objective Migraine is a common form of headache that is a major burden for patients who often seek emergency care. The goal of this study was to compare the effectiveness of intravenous non-steroidal anti-inflammatory medication (dexketoprofen) with paracetamol (acetaminophen) in the treatment of an acute migraine attack. Materials and methods This prospective, randomised, double blind, controlled study was conducted in a tertiary care emergency unit. Study patients were randomised into two groups to receive either 50 mg of dexketoprofen trometamol or 1000 mg of paracetamol intravenously by rapid infusion in 150 mL of normal saline. Pain reduction was measured at baseline, and after 15 and 30 min, using a Visual Analogue Scale (VAS)) as the primary outcome. VAS is a measurement tool ranging from 0 (no pain) to 100 mm (worst pain). Results 200 patients were included in the final analysis. Mean (SD) age of the study subjects was 30.1±11 years and 81% (n=162) were women. Median reduction in VAS score at 30 min was 56 (IQR 30–78.5) for the paracetamol group and 55 (IQR 34–75) for the dexketoprofen group, with a difference of 1 mm (95% CI −7 to 10) between the two groups. Conclusions Intravenous paracetamol and dexketoprofen appear to produce equivalent pain relief for migraine in the emergency department. ClinicalTrials.gov No NCT01730326.

Are YouTube videos accurate and reliable on basic life support and cardiopulmonary resuscitation

The objective of this study is to investigate reliability and accuracy of the information on YouTube videos related to CPR and BLS in accord with 2010 CPR guidelines.

Causes and characteristics of work-related eye injuries in western Turkey

Objectives: To analyze descriptive data and characteristics of work-related eye injuries (WREI) admitted into the emergency department (ED) and obtain information to utilize in planning measures to prevent WREI. Materials and Methods: This prospective study recruited patients with WREI admitted to the center in the two-year study period. Only the casualties occurred at the workplace and while working constituted the sample. The data were collected via face-to-face contact in the ED. Results: Males comprised the majority of the sample (95.3%, n = 778) and mean age of the patients was 28.1 ± 6.5 (range: 15-54) with the biggest percentage in between 25 and 34 years of age (46.2%, n = 377). Most patients were working in the metal and machinery sectors (66.4%, n = 542). Nearly half of the patients had less than 1 year of experience (50.4%, n = 411). The most common mechanism of WREI was noted to be exposures to welding light (26.9%, n = 219), followed by drilling/cutting injuries (21.1%, n = 172). “Carelessness” and “hurrying up” were the most commonly reported causes of WREIs among ‘worker-related causes’ (21.4% and 16.1%, respectively). Lack of protective measures ranked the highest among workplace-related causes (18.7%, n = 207). Conclusions: Programs to increase awareness on workplace safety and sound preventive strategies for both parties-employers and employees are to be pursued. Occupational safety efforts should include training on workplace eye safety and campaigns to raise knowledgeability on this disease among workers.

Pulmonary thromboembolism due to paliperidone: report of 2 cases

Venous thromboembolism (VTE) is serious medical condition, which might be caused by psychotropic medications. Previously, antipsychotic-induced VTE due to olanzapine, risperidone, clozapine, and amisulpiride was reported. In this report, we present 2 cases of paliperidone-induced VTE.

A strategy to optimize CT use in children with mild blunt head trauma utilizing clinical risk stratification; Could we improve CT use in children with mild head injury?

AIM The purpose of our study was to investigate the impact of clinical risk classification on optimization of the rationale of CT scanning in children with mild blunt head trauma. Exposed effective radiation dose values of CT scanning were also evaluated. METHODS Children with isolated pediatric mild head trauma admitted in a single center over a 5-year period (n=3102, >2 years and <16 years of age) were retrospectively reviewed. The study group comprised 806 patients with a mean age of 7.4±2.1 years (range, 2-15 years). The patients were categorized into low and high risk groups with regard to presence of predefined signs and symptoms. Effective radiation dose values were calculated. RESULTS Incidences of the pathologic CT findings related to trauma were significantly different between low (n=10) 1.9% and high (n=90) 29.8% risk groups. Certain predefined signs and symptoms (e.g., vomiting, suspected skull fracture and loss of consciousness) were related significantly with pathologic CT findings attributed to trauma. Estimated mean effective dose values were 3.91±0.38mSv for 2-6 year old (n=557), and 3.33±0.12mSv for 7-16 year old patients (n=349). CONCLUSION The pediatric victims of mild head trauma patients within high risk group and those with vomiting, suspected skull fracture and loss of consciousness should undergo head CT scanning. The manufacturer settings on the CT scanners for children should be revised to alleviate untoward radiation exposure.

A Comparison of Dexmedetomidine, Moxonidine and Alpha-Methyldopa Effects on Acute, Lethal Cocaine Toxicity.

Background: The treatment of cocaine toxicity is an important subject for emergency physicians. We investigated the effects of dexmedetomidine, moxonidine and alpha-methyldopa on acute cocaine toxicity in mice. Objectives: The aim of this study was to evaluate the effects of dexmedetomidine, moxonidine and alpha-methyldopa in a mouse model of acute cocaine toxicity. Materials and Methods: We performed an experiment consisting of four groups (n = 25 each). The first group received normal saline solution, the second group received 40 µg/kg of dexmedetomidine, the third group received 0.1 mg/kg of moxonidine and the fourth group received 200 mg/kg of alpha-methyldopa, all of which were intraperitoneally administered 10 minutes before cocaine hydrochloride (105 mg/kg). All animals were observed for seizures (popcorn jumping, tonic-clonic activity, or a loss of the righting reflex) and lethality over the 30 minutes following cocaine treatment. Results: The ratio of animals with convulsions was lower in all treated groups when compared to the control (P < 0.001). Furthermore, 68% (n = 17) of animals in the dexmedetomidine group, 84% (n = 21) of the alpha-methyldopa group, 92% (n = 23) of the moxonidine group and 100% (n = 25) of the control group showed evidence of seizure activity (P = 0.009). Cocaine-induced lethality was observed in 12% (n = 3) of the dexmedetomidine group, 48% (n = 12) of the alpha-methyldopa group, 52% (n = 13) of the moxonidine group, and 72% (n = 18) of the control group (P < 0.001). All treatments prolonged the time to seizure, which was longest in the dexmedetomidine group (P > 0.05). In addition, the time to lethality was also longer in the same group (P < 0.001). Conclusions: The present study provides the first experimental evidence in support of dexmedetomidine treatment for cocaine-induced seizures. Premedication with dexmedetomidine reduces seizure activity in a mouse model of acute cocaine toxicity. In addition, while dexmedetomidine may be effective, moxonidine and alpha-methyldopa did not effectively prevent cocaine-induced lethality.

Work-related injuries among emergency medical technicians in western Turkey

OBJECTIVES Emergency medical technicians (EMTs) and paramedics are at serious risk for work-related injuries (WRIs) during work hours. Both EMTs and paramedics have higher WRI rates, according to the literature data. This study was designed to investigate causes and characteristics of WRIs involving EMTs and paramedics staffed in Western Turkey. METHODS All health care personnel staffed in Emergency Medical Services (EMS) in the city were interviewed face-to-face in their off-duty hours to inform them about the study. Excluded from the study were those who declined to participate in the study, those who were not on duty during the two-month study period, and those who had been working in the EMS for less than one year. The subjects were asked to answer multiple-choice questions. RESULTS A total of 163 personnel (117 EMTs and 46 paramedics) comprised the study sample. Eighty-three personnel (50.9%) were female and mean age was 29.7 years (SD=8.4 years). The most common mechanisms of WRI, as reported by the personnel, were motor vehicle accidents (MVAs; 31.9%), needlestick injuries (16.0%), ocular exposure to bodily fluids (15.4%), and sharp injuries (9.8%), respectively. Needlestick injuries commonly occurred during intravenous line procedures (59.4%) and inside the cruising ambulance (n=20; 62.5%). Working inside the cruising ambulance was the most commonly accused cause of the WRI (41.3%). CONCLUSION Paramedic personnel and EMTs are under high risk of WRI. Motor vehicle accidents and needlestick injuries were the most common causes of WRI. Strict measures need to be taken to restructure the interior design to protect personnel from all kinds of WRIs. Yilmaz A , Serinken M , Dal O , Yaylacı S , Karcioglu O . Work-related injuries among emergency medical technicians in Western Turkey. Prehosp Disaster Med. 2016;31(5):505-508.

Self-Cannibalism: The Man Who Eats Himself

Self-mutilation is a general term for a variety of forms of intentional self-harm without the wish to die. Although there have been many reports of self-mutilation injuries in the literature, none have reported self-cannibalism after self-mutilation. In this article we present a patient with self-cannibalism following self-mutilation. A 34-year-old male patient was brought to the emergency department from the prison with a laceration on the right leg. Physical examination revealed a well-demarcated rectangular soft tissue defect on his right thigh. The prison authorities stated that the prisoner had cut his thigh with a knife and had eaten the flesh.

Intravenous paracetamol versus dexketoprofen in acute musculoskeletal trauma in the emergency department: A randomised clinical trial

Introduction: Musculoskeletal system traumas are among the most common presentations in the emergency departments. In the treatment of traumatic musculoskeletal pain, paracetamol and non‐steroidal anti‐inflammatory analgesics (NSAID) are frequently used. Our aim in this study is to compare the efficacy of intravenous dexketoprofen and paracetamol in the treatment of traumatic musculoskeletal pain. Methods: This prospective, randomised, double blind, controlled study was conducted in a tertiary care emergency unit. The participating patients were randomised into two groups to receive either 50 mg of dexketoprofen or 1000 mg of paracetamol intravenously by rapid infusion in 150 mL of normal saline. Visual analogue scale (VAS), Numeric Rating Scala (NRS) and Verbal Rating Scale (VRS) was employed for pain measurement at baseline, after 15, after 30 and after 60 mins. Results: 200 patients were included in the final analysis. The median age of the paracetamol group was 34 (24–48), while that of the dexketoprofen group was 35 (23–50), and 63% (n = 126) of them consisted of men. Paracetamol and dexketoprofen administration reduced VAS pain scores over time (p = 0.0001). Median reduction in VAS score at 60 min was 55 (IQR 30–65) for the paracetamol group and 50(IQR 30.25–60) for the dexketoprofen group. There was no statistically significant difference between the paracetamol and dexketoprofen groups in terms of VAS reductions (p = 0.613). Conclusion: Intravenous paracetamol and dexketoprofen seem to produce equivalent pain relief for acute musculoskeletal trauma in the emergency department. CLINICALTRIALS.GOV NO: NCT03428503