Fatih Tanrıverdi

The lucky patient who aspirated a needle

Foreign body aspiration is seen frequently in pediatric and geriatric patients, but it can also be seen in adults. Needle aspiration is a common problem in our country. Foreign body aspiration can lead to complete airway obstruction, asphyxia and death but sometimes symptoms may not be evident during the early period of aspiration and patients may present with complications afterwards. Early diagnosis is important in foreign body aspiration for prevention of mortality and complications. Suspicion aroused by patient history is the first step towards a diagnosis. Plain radiography and tomography may be used for imaging. Bronchoscopy is performed for diagnosis if there is uncertainty after imaging and may also be used for the treatment of diagnosed cases. In this article, we present a foreign body aspiration case that presented with difficulty and pain while swallowing, subsequently found to be the result of a needle that was stuck between the oropharynx and epiglottis.

Tissue adhesives to secure peripheral intravenous catheters: A randomized controlled trial in patients over 65 years

Introduction Peripheral venous catheterization is one of the most used medical procedures in hospitals worldwide. Recent researches state that using intravascular devices is a risk factor for both local and systemic complications. In this study, we aimed to test that addition of tissue adhesive to the insertion site of peripheral intravenous catheters (PIVC) in the emergency department (ED) would reduce the device failure rate at 6u202fh and 24u202fh following insertion. Material and methods We designed a single-site, two-arm, randomized, controlled trial. We inserted 115 PIVCs into 115 adult patients. Results PIVC device failure for the 6th hour follow up was 15.4% in the tissue adhesive group (95% CI: 4.1–26.7) vs. 25.6% with standard care group (95% CI: 11.9–39.3). There was no statistically significant difference between two groups (pu202f=u202f0.33). The number of patients for 24u202fh follow-up was not enough and the obtained data could not be included in the study. Discussion In this study, the routine use of tissue adhesives in addition to standard care to reduce PIVC failure for patients 65 years or older in ED was not supported due to not clear benefits and cost effectivity. Conclusion Even though the routine use of tissue adhesives is not recommended according to the study results, it may be reasonable to use tissue adhesives for long term hospitalization expected patients to protect from related complications due to current literature.

Acute Renal Failure and Thiol-Disulfide Homeostasis

Aims: Investigating the thiol-disulphide balance in the patients with acute renal failure and evaluating the potential of using tGFR (thiol based GFR) index as a new parameter, alternative to the parameter called estimated Glomerular Filtration Rate (eGFR).Study design: The serum thiol-disulphide levels in the predialysis and postdialysis blood samples of 42 patients diagnosed with acute renal failure in the emergency department and hemodialyzed right after were measured through the novel method. Methods: The acute renal failure was detected through the clinical and laboratory findings, and a hemodialysis procedure was performed. The obtained results were statistically evaluated. While eGFR (ml/min/1.73 m2) values were being calculated, MDRD (Modification of Diet in Renal Disease) formula was used. To calculate tGFR as an alternative to eGFR, tGFR=(SH/creatinine) xk formula was used.Results: Disulphides/native thiol and Disulphides/total thiol rates in the patient population were found to be significantly lower after the hemodialysis when compared with those before the hemodialysis process (p<0.001). A significantly negative relationship was found between the creatinine values and the native and total thiol values (r=-0.732; r=-0.739; p<0.001 respectively). There was also a significantly negative relationship between the urea values and the native and total thiol values (r=-0.722; r=-0.739; p<0.001 respectively). Quite a significant relationship was also found between eGFR values and tGFR values (r=0.98; p<0.001).Conclusion: The thiol-disulphide balance in the patients with acute renal failure weakened, in addition to which the balance in question shifted towards the direction of disulphide. Native thiol and total thiol levels are associated with the severity of the disease. There is the potential of using tGFR index as an alternative to eGFR for the emergency department patients (ER-patients) whose age, gender and race cannot be identified.

Evaluation of dynamic thiol/disulfide homeostasis in adult patients with community-acquired pneumonia

Background: Community-acquired pneumonia is an important cause of mortality and morbidity in all age groups. Oxidant and antioxidant mechanisms play an important role in the pathogenesis and mortality of community-acquired pneumonia. Objectives: In this study, the role of thiol/disulfide homeostasis in the diagnosis and prognosis of community-acquired pneumonia was investigated. Methods: This was a prospective, controlled, observational study involving 73 community-acquired pneumonia patients and 68 healthy volunteers. Results: The native thiol and total thiol, which are thiol/disulfide homeostasis components, were significantly lower in the community-acquired pneumonia group. It was also found that the native thiol was lower in the high-risk community-acquired pneumonia group and that the native thiol and total thiol were associated with the Pneumonia Severity Index, CRB65 (confusion, respiratory rate, blood pressure, ⩾65u2009years old), and CURB65 (confusion, uremia, respiratory rate, blood pressure, ⩾65u2009years old) scores. The thiol compound levels were also associated with the C-reactive protein and procalcitonin levels. However, there was no significant difference between the survivors and non-survivors in terms of the thiol/disulfide homeostasis parameters. Conclusion: This study demonstrated the important role that oxidative stress plays in the pathogenesis of community-acquired pneumonia. The thiol/disulfide homeostasis biomarkers especially the native thiol and index-1 levels were significantly lower in patients with community-acquired pneumonia. Further studies are needed to investigate the diagnostic and prognostic value of thiol/disulfide homeostasis parameters in community-acquired pneumonia.

The Evaluation of Neutrophil/Lymphocyte Rates and Monocyte Counts in Patients with Acute Coronary Syndrome

Amac: Akut koroner sendromlar, dunyada ve ulkemizde tum olum sebepleri icerisinde en ust sirada yer almaktadir. Bu calismada tam kan sayimi parametrelerinin akut koroner sendromlarin klinik seyrinde prediktif acidan degerli olup olmadigini arastirmak amaclanmistir. Materyal ve Metot: Calisma, yillik hasta sayisi 150.000 olan bir Egitim ve Arastirma Hastanesi Acil Tip Klinigi’nde 01.02.2017-31.07.2017 tarihleri arasinda tek merkezli prospektif olarak gerceklestirildi. Calisma icin Lokal Klinik Arastirmalar Etik Kurulu’ndan etik onayi alindi. Hastalarin demografik ozellikleri, tam kan parametreleri, notrofil / lenfosit orani (NLR), GRACE risk skorlari kayit altina alindi. Hastalarin hastanede kalis sureleri, hastane ici mortaliteleri ve 6 aylik mortaliteleri takip edildi. Bulgular: Calismadaki hastalarin %77,27’ u erkek, %22,73’ si kadindi. Yas ortalamasi 61±12 idi. Tum gruplar icerisinde NLR degerleri (p=0,009), monosit sayilari (p<0,001) arasinda hastane ici mortalite acisindan anlamli fark saptandi. NLR degerleri (p=0,045), monosit sayilari (p=0,026) arasinda da 6 aylik mortalite acisindan anlamli fark saptandi. Hastane ici mortalite acisindan NLR duzeyi dusuk grup ile diger gruplar arasinda anlamli fark saptanmistir (p=0,006), Bu calismada NLR alt gruplari arasinda 6 aylik mortalite acisindan anlamli fark saptanmamistir (p=0,131). GRACE skoru ve NLR arasinda zayif (p<0,001; rho=0,393) korelasyon saptandi. Sonuc: Akut koroner sendrom nedeniyle acil servislerde takip edilen hastalarda tam kan parametreleri ve NLR gibi parametreler klinik karar verme surecinde ve hastalarin prognozunu ve mortalitelerini ongormede yardimci olabilir.

Transient vocal cord paralysis following central venous hemodialysis catheter insertion

In this article, we present a case of recurrent laryngeal nerve palsy not caused by nerve injury but due to local anesthetic infiltration that was applied prior to central venous catheterization. A 47-year-old female patient was admitted to emergency room with fatigue and nausea and was diagnosed with acute renal failure. Right jugular venous catheterization was performed for emergency hemodialysis with Seldinger technique using middle approach. Within minutes and immediately after the procedure the patient complained of hoarseness and shortness of breath, and she had stridor in her physical exam. Awake flexible fibreoptic laryngoscopy revealed unilateral right-sided vocal cord paralysis with no edema. The patient was asked to remain nil per os and observed in ER with nasal oxygen. At the 3rd hour of follow-up without any other intervention, her symptoms resolved. Due to its proximity to the internal jugular vein injury to the recurrent laryngeal nerve while attempting to insert a central venous line can occur, particularly with difficult and repeated attempts. Local anesthesia led temporary ipsilateral vocal cord paralysis in patients undergoing carotid endarterectomy is described in literature. We think temporary vocal cord palsy in our case was due to local anesthetic infiltration rather than nerve injury, since it resolved spontaneously within only hours. Expectant treatment is a good choice ensuring the patients airway is safe. Emergency physicians should be aware of this rare complication and its right management.

Septic Pulmonary Embolism in a Patient Who Was an Intravenous Drug Addict

Introduction: Septic pulmonary embolism (SPE) is a pulmonary infarction and infection that is caused by pulmonary embolization from an infected fibrin thrombus that occludes the pulmonary arteries. SPE is a rare subtype of pulmonary embolism clinically characterized by fever, respiratory distress, and pulmonary infiltrates seen on radiological imaging. In the chest computed tomography of SPE, multiple air cysts; wedge-shaped opacities in the periphery of the lungs; multiple diffuse, small opacities mimicking bronchopneumonia; bilateral nodules; and cavitary nodules in the lungs can be seen. Case Report: A 34-week-old male patient presented to our emergency department with complaints of chest and back pain, shortness of breath, and coughing up bloody sputum. The patient was addicted to heroin for 10 years and was a smoker for 15 years. In his chest x-ray, multiple diffuse opacities were present in both lungs. Thoracic computed tomography revealed multiple hyperdense nodular lesions in both lung parenchyma. Since these findings were consistent with SPE, the patient was hospitalized in the intensive care unit for further treatment. Conclusion: The initial clinical and radiological features are often not specific to the disorder, and therefore, it is difficult to make the diagnosis. In patients with predisposing factors, if symptoms and radiological findings are compatible with SPE, the diagnosis should be kept in mind. In this article, we present the case of a 34-year-old male patient who was an intravenous drug addict and was diagnosed with SPE.

Motorlu Taşıt Kazalarında Kan Alkol Seviyelerinin Yaralanma Ciddiyeti ve Maliyet Üzerine Etkileri

Introduction and Aim Being one of the major problems in the world and in Turkey, traffic accidents require being accurately examined and solved . The purpose of this study is to reveal the effects of blood alcohol level on the severity of injury and death as a result of motor vehicle accident traumas and to review and command on the social importance of this issue.Materials and Methods Four hundred forty-five patients who were admitted to Ataturk Training and Research Hospital Emergency Department between January 2010 and December 2011, after motor vehicle accidents are enrolled in the study. Patients’ ages, gender, blood alcohol levels and vehicle types were recorded retrospectively. Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) were detected for each patient according to trauma regions and severity. The patients were divided into two groups according to the blood alcohol levels (<0,5 promile and ≥0,5 promile). Results The blood alcohol levels were <0,5 promile in 341 patients (76,6%) and ≥0,5 promile in 104 patients (23,4%). There was no statistically significant difference between the groups in terms of age (p=0,754), but statistically significant difference was detected in terms of Injury Severity Score (ISS), observation time in the emergency department and cost (p<0,001). Conclusion The severity of injuries in traffic accidents and the costs of treatment to patients increase parallel to the increase in the levels of alcohol in the blood.