Fatma Ozdemir

Hipotermi ve varfarin uygulanan şiddetli femoral arter kanamalı sıçan modelinde kitosan lineer polimer’in (Celox®) hemostatik etkinliği

BACKGROUND In this study, the hemostatic efficacy of Celox® in rats under hypothermia or warfarin treatment was investigated. METHODS A total of forty-eight Sprague-Dawley female rats weighing 200-350 g were used in the study. Six experimental study groups were designed, as follows: Group 1: Normothermia + compression; Group 2: normothermia + Celox®; Group 3: hypothermia + compression; Group 4: hypothermia + Celox®; Group 5: normothermia + warfarin + compression; and Group 6: normothermia + warfarin + Celox®. RESULTS Celox® provided effective hemorrhage control in all three tested groups. There was a statistically significant difference between compression and Celox® implementation in all groups in terms of hemostasis (p-values for the normothermia, hypothermia and warfarin groups were p<0.05, p<0.01 and p<0.01, respectively). Furthermore, the compression numbers were significantly lower in all of the groups that received Celox ® than in those in which compression alone was applied (p-values for the normothermia, hypothermia and warfarin groups were p<0.01, p<0.01 and p<0.001, respectively). CONCLUSION Celox® provides effective hemorrhage control under conditions of normothermia, hypothermia and use of the oral anticoagulant agent warfarin.

General characteristics of patients with electrolyte imbalance admitted to emergency department

BACKGROUND: Fluid and electrolyte balance is a key concept to understand for maintaining homeostasis, and for a successful treatment of many metabolic disorders. There are various regulating mechanisms for the equilibrium of electrolytes in organisms. Disorders of these mechanisms result in electrolyte imbalances that may be life-threatening clinical conditions. In this study we defined the electrolyte imbalance characteristics of patients admitted to our emergency department. METHODS: This study was conducted in the Emergency Department (ED) of Uludag University Faculty of Medicine, and included 996 patients over 18 years of age. All patients had electrolyte imbalance, with various etiologies other than traumatic origin. Demographic and clinical parameters were collected after obtaining informed consent from the patients. The ethical committee of the university approved this study. RESULTS: The mean age of the patients was 59.28±16.79, and 55% of the patients were male. The common symptoms of the patients were dyspnea (14.7%), fever (13.7%), and systemic deterioration (11.9%); but the most and least frequent electrolyte imbalances were hyponatremia and hypermagnesemia, respectively. Most frequent findings in physical examination were confusion (14%), edema (10%) and rales (9%); and most frequent pathological findings in ECG were tachycardia in 24%, and atrial fibrillation in 7% of the patients. Most frequent comorbidity was malignancy (39%). Most frequent diagnoses in the patients were sepsis (11%), pneumonia (9%), and acute renal failure (7%). CONCLUSIONS: Electrolyte imbalances are of particular importance in the treatment of ED patients. Therefore, ED physicians must be acknowledged of their fluid-electrolyte balance dynamics and general characteristics.

Clinical probability and risk analysis of patients with suspected pulmonary embolism.

BACKGROUND Pulmonary embolism (PE) is one of the most frequent diseases that could be missed in overcrowded emergency departments as in Turkey. Early and accurate diagnosis could decrease the mortality rate and this standard algorithm should be defined. This study is to find the accurate, fast, non-invasive, cost-effective, easy-to-access diagnostic tests, clinical scoring systems and the patients who should be tested for clinical diagnosis of PE in emergency department. METHODS One hundred and forty patients admitted to the emergency department with the final diagnosis of PE regarding to anamnesis, physical examination and risk factors, were included in this prospective, cross-sectional study. The patients with a diagnosis of pulmonary embolism, acute coronary syndrome or infection and chronic obstructive pulmonary disease (COPD) were excluded from the study. The demographics, risk factors, radiological findings, vital signs, symptoms, physical-laboratory findings, diagnostic tests and clinical scoring systems of patients (Wells and Geneva) were noted. The diagnostic criteria for pulmonary emboli were: filling defect in the pulmonary artery lumen on spiral computed tomographic angiography and perfusion defect on perfusion scintigraphy. RESULTS Totally, 90 (64%) of the patients had PE. Age, hypotension, having deep vein thrombosis were the risk factors, and oxygen saturation, shock index, BNP, troponin and fibrinogen levels as for the biochemical parameters were significantly different between the PE (+) and PE (-) groups (P<0.05). The Wells scoring system was more successful than the other scoring systems. CONCLUSION Biochemical parameters, clinical findings, and scoring systems, when used altogether, can contribute to the diagnosis of PE.

Is routine pregnancy test necessary in women of reproductive age admitted to the emergency department

BACKGROUND: This study aimed to determine the necessity of pregnancy test in women of reproductive age admitted to emergency department (ED) in routine practice. METHODS: We retrospectively reviewed the records of patients who presented to the ED between January 1, 2006 and December 31, 2010 and received a pregnancy test. RESULTS: The median age of 1 586 patients enrolled into the study was 27 years. Of these patients, 19.55% had a positive result of pregnancy test. The most common complaint at admission was abdominal pain in 60.15% of the patients, and pregnancy test was prescribed. 15.83% of the patients with abdominal pain had a positive result of pregnancy test. Of the patients, 30.64% had nausea-vomiting at admission, and 11.52% had a positive result of pregnancy test. When other complaints were considered, the most commonly observed complaints were non-specific symptoms such as dizziness, malaise and respiratory problems. Of the patients, 70.93% were not remembering the date of last menstruation, and 9.51% showed a positive result of pregnancy test. Urinary tract infection (UTI) was commonly diagnosed with an incidence of 17.65%, which was followed by non-specific abdominal pain (NSAP) (16.77%) and gastrointestinal disorders such as gastritis and peptic ulcer (6.87%). Of the patients, 88.40% were discharged from ED, and 11.60% were hospitalized. CONCLUSION: Pregnancy test should be given to women of reproductive age as a routine practice in ED in developing countries like Turkey.

Discharge of emergency patients to the clinical wards or intensive care units: An assessment of complications and possible shortcomings

OBJECTIVE We aimed to evaluate the most common complications and possible shortcomings in the emergency patients who were admitted to the clinical wards or intensive care units. MATERIALS AND METHODS 1000 patients were included in this study. The patientss complication rates were compared with the clinical diagnosis, age groups, the section of the emergency department initially managed the patients, the time of the shift (daytime or night), the accompanying medical staff and specific type of patient populations. Also the interventions of the complications were recorded. RESULTS 37.5% of the patients who were included in the study were female and 62.5% were male. The median age of the patients was 54.2 year (min:1 max:92). The vital signs that were recorded prior to transport of the patients did not interfere with the complication rates (p>0.05). Complication rates in the night were found to be higher as more admissions took place during the night shift (p<0.05). The complication rates were found higher in patients who were admitted to coronary care unit. The most frequent complication was the dislocation of the intravenous catheter. Replacing the dislocated intravenous catheter was the most frequently noted intervention. However, initiating inotropic agents to the hypotensive patients was done more frequently in the admitted clinical departments. CONCLUSION The overall complication rate was low in this series of patients. The majority of them can be prevented by having in house guidelines.

Paraquat intoxication: a case report

Paraquat, a widely used herbicide, causes high morbidity and mortality in people when taken accidentally or for suicidal intent. In this study our aim is to present the treatment and follow up of a 23 years old young lady after a history of suicide attempt in the emergency department after taking large amount of paraquat. The patient was initially asymptomatic and in follow up care gastrointestinal, renal and liver toxicity developed. Patients with severe paraquat poisoning may be asymptomatic after ingestion, but may deteriorate rapidly within a few hours. Therefore, in the case of taking high dose paraquat, the patient needs long term follow up for liver, kidney and lung effects even if he is asymptomatic.