Filiz Baloglu Kaya

Elevated lactate level and shock index in nontraumatic hypotensive patients presenting to the emergency department.

Background The aim of our study was to evaluate the effect of lactate level (LL) and shock index (SI) on the outcome in nontraumatic hypotensive patients in the emergency department, and also to show the significance of the combined usage of these two parameters. Methods This is a prospective, observational study. Elevated and normal LL (ELL and NLL), elevated and normal SI (ESI and NSI), and a combination of these two parameters (lactate–SI group 1: ELL and ESI, lactate–SI group 2: ELL or ESI, and lactate–SI group 3: NLL and NSI) were evaluated for primary (mortality) and secondary outcome measures. Results A total of 131 patients who fulfilled the inclusion criteria were analysed. Of the patients with ELL, 34.78% were mechanically ventilated (P<0.001), 31.88% received vasoactive drugs (P<0.001), and 68.1% were hospitalized (P<0.01). The mortality rate among patients with ELL was 50.72% (P<0.001). Of the patients with ESI, 39.42% died (P<0.01). Use of mechanical ventilation in the emergency department was higher in lactate–SI group 1 [36.1%, P<0.0001, sensitivity: 100.0%, negative predictive value (NPV): 100.0%]. Vasoactive drug use was higher in lactate–SI group 1 (32.8%, P<0.0001, sensitivity: 100.0%, NPV: 100.0%). Lactate–SI group 1 showed a higher hospitalization rate (67.8%, P>0.05). In-hospital mortality in lactate–SI group 1 was higher (54.1%, P<0.0001, sensitivity: 100.0%, NPV: 100.0%). Conclusion The combination of both parameters is effective in predicting these outcome measures with higher sensitivities and NPVs. Further studies on the subject are required.

An Analysis of Patients That Underwent Computed Tomography Pulmonary Angiography with the Prediagnosis of Pulmonary Embolism in the Emergency Department

Introduction. The purpose of this study is to analyze the frequency of other diagnoses and findings in patients that were diagnosed with or not diagnosed with PE following the CTPA in the ED and to analyze the relationship between diagnosis and D-dimer. Instrument and Method. This study involves all patients that presented to the ED that underwent CTPA with the prediagnosis of PE. The items considered in this study were their reason for presenting to the ED and pretest clinical risks for PE, D-dimer, and CTPA results. Findings. Of the 696 cases, the most common cause was shortness of breath (59.3%). The CTPA showed that 145 (20.83%) patients were suffering from PE. Among the remaining cases, 464 (66.66%) patients had pathological findings other than PE and 87 (12.5%) patients were reported as normal. The most common pathological results other than PE found in CTPA were atelectasis in 244 (39.9%) and ground glass in 165 (23.7%), as well as nonpulmonary results in 70 (10.05%) patients. The differences in D-dimer results of patients diagnosed with PE, patients diagnosed with another pathology, and patients with normal CTPA results were statistically significant (P < 0.001). Conclusion. CTPA scanning, performed on the basis of assessment scoring, helps in discovering other fatal pathologies in addition to PE.

An Evaluation of Complications in Ultrasound-Guided Central Venous Catheter Insertion in the Emergency Department

SUMMARY Objectives In emergency departments, emergency physicians frequently have to perform central venous access. In cases where peripheral venous access is not possible, central venous access is required for dialysis, fulfillment of urgent fluid need, or central venous pressure measurement. This study was carried out to evaluate the emergence of complications in the process of and in the 15 days following the insertion of central venous catheter under ultrasound guidance in the emergency department. Methods For this study, patients who presented to the emergency department over a period of eight months with an urgent need for central catheter were examined prospectively. Age, gender, and accompanying diseases of patients as well as the type, time, duration, and indication of the venous access were recorded. Furthermore, the amount of experience of the physician was taken into consideration. Results In the emergency department, physicians performed ultrasound-guided central venous catheter insertion for 74 patients (40 men and 34 women). For access, internal jugular vein was used in 65 (87.8%) patients, and femoral vein was used in 9 (12.2%) patients. The reason for access was urgent dialysis need in 55 (74.3%), CVP measurement in 3 (4.1%), fluid support due to severe hypovolemia in 6 (8.1%), and difficulty of peripheral venous access in 10 (13.5%) patients. None of the patients developed complications in the process of or after the insertion. Patients did not have infections related to the catheter in 15 days following the insertion. Conclusions Central venous access is frequently required in emergency departments. The risk of complication is little if any in ultrasonographyguided access carried out under appropriate conditions.

Injury, hospitalization, and operation rates are low in aerial sports

Objectivess Aerial sports can cause serious injuries. The rate of injuries is nevertheless reasonably low, contrary to popular belief. This study aimed to evaluate the rate and severity of injuries to ASI patients presented to our Emergency Department (ED). Material and methods The study was held at a university medical center. The patients who were presented or transferred to the ED in a four year period were retrospectively reviewed. Results 73.2% of patients were male. The mean age of patients was 28.6. The distribution of injury rates by activity was as follows: 1.46% in parachuting, 0.35% in paragliding, and 0.04% in hang-gliding. 75.6% of patients were trainees. In 82.9% of patients, the injury occurred during the practical session of training. The most common injury is soft tissue and ligamentous (ST/L) injury (41.5%). 25 patients (61%) had isolated lower extremity injuries (13 of them had fractures). Other isolated injuries were head trauma in 2 (4.9%) and vertebral fractures in 3 (7.3%) patients. 4 (9.8%) patients were diagnosed with multiple injuries. The overall rate of hospitalization was 0.07% (0.16% in parachuting, 0.08% in paragliding, and 0.03% in hang-gliding). The need for operation in overall activities was 0.04% (0.08% in parachuting, 0.03% in paragliding, and 0.03% in hang-gliding). The mortality rate was found to be zero in the region. Conclusion Aerial sports are considered dangerous sports activities, but the injury, hospitalization, and operation rates are low.

METOKLOPRAMİD KULLANIMINA BAĞLI GELİŞEN AKUT DİSTONİ / ACUTE DYSTONIA DUE TO USE OF METOCLOPRAMIDE

OZET: Kolonun primer Non-Hodgkin lenfomasi gastrointestinal traktin nadir bir tumorudur ve tum kolonik malignensilerin %0.2-%1.2’sini olusturur. Kolonda en sik tutulan yer ileocekal bolge, sonra sirayla cekum, sigmoid ve rektumdur. Altmis iki yasindaki erkek olguda, kolonda primer kolon lenfoma bulgulari sunulacaktir. Olguda rektumda simetrik duvar kalinlasmasi ve mezenterde patolojik lenf nodlari mevcuttu. Bilgisayarli tomografi hastaligin yayilimini degerlendirmede gereklidir. ANAHTAR KELIMELER: kolon, primer kolon lenfomasi, bilgisayarli tomografi RARE TUMOUR IN RECTUM: PRIMARY LENFOBLASTIC LYMPHOMA CT FINDINGS ABSTRACT: Primary Non-Hodgkin’s lymphoma of the colon is a rare tumour of the gastrointestinal tract that compromises 0.2%-1.2% of all colonic malignancies. The most frequently involved colonic site at diagnosis is the ileocaecal region (approximately half of the cases), followed by the caecum, the sigmoid and the rectum. In 62 -year-old male patient, the primary colonic lymphoma findings are discussed. In the case symmetric wall thickening in the rectum and the mesentery pathologic lymph nodes were present. Computerized tomography is required to assess the extent of the dissease. KEYWORDS: colon, primary colon lymphoma, computerized tomography

A Rare Cause of Acute Abdominal Pain: Splenic Infarct (Case Series)

SUMMARY Splenic infarcts are rare cases. It may not be noticed in the emergency department because the clinical picture is likely to mimic various acute abdominal pains. The splenic infarct is often the result of systemic thromboembolism associated with cardiovascular disorders. The aim of this study is to present an evaluation of the patients that presented to the emergency department (ED) with abdominal pain and were diagnosed with splenic infarct.

A Rare Cause of Acute Abdominal Pain: Spelnic Infarct (Case Series)

SUMMARY Splenic infarcts are rare cases. It may not be noticed in the emergency department because the clinical picture is likely to mimic various acute abdominal pains. The splenic infarct is often the result of systemic thromboembolism associated with cardiovascular disorders. The aim of this study is to present an evaluation of the patients that presented to the emergency department (ED) with abdominal pain and were diagnosed with splenic infarct.

The Cause of Abdominal Pain after Dialysis

A 56-year-old woman presented to the emergency department with a sudden onset of nausea, vomiting, abdominal pain, and distension. Her symptoms started after dialysis and progressively worsened. Upon admission, a physical examination revealed a heart rate 96 beats/min, a blood pressure of 70/40 mmHg, left quadrant tenderness, rebound, and rigidity. Her hemoglobin level was 4.4 gr/dL and her platelet count was normal. Activated prothrombin time was high and the INR was 7.69. A computed tomographic scan without contrast was performed (Figure 1). (see page 39 for diagnosis).