Gökhan Aksel

The significance of routine thoracic computed tomography in patients with blunt chest trauma

PURPOSE The purpose of this study is to investigate whether the use of thoracic computed tomography (TCT) as part of nonselective computed tomography (CT) guidelines is superior to selective CT during the diagnosis of blunt chest trauma. SUBJECTS AND METHODS This study was planned as a prospective cohort study, and it was conducted at the emergency department between 2013 and 2014. A total of 260 adult patients who did not meet the exclusion criteria were enrolled in the study. All patients were evaluated by an emergency physician, and their primary surveys were completed based on the Advanced Trauma Life Support (ATLS) principles. Based on the initial findings and ATLS recommendations, patients in whom thoracic CT was indicated were determined (selective CT group). Routine CTs were then performed on all patients. RESULTS Thoracic injuries were found in 97 (37.3%) patients following routine TCT. In 53 (20%) patients, thoracic injuries were found by selective CT. Routine TCT was able to detect chest injury in 44 (16%) patients for whom selective TCT would not otherwise be ordered based on the EP evaluation (nonselective TCT group). Five (2%) patients in this nonselective TCT group required tube thoracostomy, while there was no additional treatment provided for thoracic injuries in the remaining 39 (15%). CONCLUSION In conclusion, we found that the nonselective TCT method was superior to the selective TCT method in detecting thoracic injuries in patients with blunt trauma. Furthermore, we were able to demonstrate that the nonselective TCT method can change the course of patient management albeit at low rates.

Rising Threat; Bonsai

SUMMARY Objectives In recent years, and especially in the past few months, the number of synthetic cannabinoid (bonsai) users has increased in our country. The aim of this study was to draw attention to the consumption of bonsai among young people and reveal the demographic and basic clinical characteristics of these users. Methods This was a retrospective study conducted at the Ümraniye Training and Research Hospital. All of the adult patients (≥18 year old) with synthetic cannabinoid intoxication who presented to the Emergency Department throughout the two years of the study (July 1st 2012–June 30th 2014) were enrolled. The frequencies were given as the median and inter-quartile range). Results 197 patients were included in this study, with 190 male patients (96.4%) and 7 (3.6%) female patients. Two of the four hospitalized patients were exitus, 52 left on their own will and a total of 141 patients were discharged after 6-12 hours of observation in the ED. Conclusions The use of synthetic cannabinoids (bonsai) in the recent years, especially in the summer months of 2014 was investigated in this study. Although these patients can have a benign clinical course, the process can also be fatal. It should especially be noted that patients with depressed respiration, low GCS scores and high PaCO2 values are at higher risk for mortality and the necessity of early intubation should be kept in mind.

Intravenous Lipid Emulsion Therapy for Acute Synthetic Cannabinoid Intoxication: Clinical Experience in Four Cases

There is no specific antidote for intoxication with synthetic cannabinoids. In this case series, we considered the efficiency of intravenous lipid emulsion therapy in four cases, who presented to emergency department with synthetic cannabinoid (bonzai) intoxication. The first patient had a GCS of 3 and a left bundle branch block on electrocardiography. The electrocardiography revealed sinus rhythm with normal QRS width after the treatment. The second patient had bradycardia, hypotension, and a GCS of 14. After intravenous lipid emulsion therapy, the bradycardia resolved, and the patients GCS improved to 15. The third patient presented with a GCS of 8, and had hypotension and bradycardia. After the treatment, not only did the bradycardia resolve, but also the GCS improved to 15. The fourth patient, whose electrocardiography revealed accelerated junctional rhythm, had a GCS of 13. The patients rhythm was sinus after the treatment. Cardiovascular recovery was seen in all four cases, and neurological recovery was also seen in three of them. Based on the fact that intravenous lipid emulsion is beneficial in patients intoxicated with lipophilic drugs, unstable patients presenting to the emergency department with acute synthetic cannabinoid intoxication may be candidates for intravenous lipid emulsion treatment.

Analyses of demographical and injury characteristics of adult and pediatric patients injured in Syrian civil war

Purpose: Aimed to analyze demographical data and injury characteristics of patients who were injured in the Syrian Civil War (SCW) and to define differences in injury characteristics between adult and pediatric patients. Methodology: Patients who were injured in the SCW and transferred to our emergency department were retrospectively analyzed in this study during the 15‐month period between July 2013 and October 2014. Results: During the study period, 1591 patients who were the victims of the SCW and admitted to our emergency department due to war injury enrolled in the study. Of these patients, 285 were children (18%). The median of the injury severity score was 16 (interquartile range [IQR]: 9–25) in all patients. The most frequent mechanism of injury was blunt trauma (899 cases, 55%), and the most frequently‐injured region of the body was the head (676 cases, 42.5%). Head injury rates among the childrens group were higher than those of the adult group (P < .001). In contrast, injury rates for the abdomen and extremities in the childrens group were lower than those in the adult group (P < .001, P < .001). Conclusion: The majority of patients were adults, and the most frequent mechanism of injury was blunt trauma. Similarly, the children were substantially affected by war. Although the injury severity score values and mortality rates of the child and adult groups were similar, it was determined that the number of head injuries was higher, but the number of abdomen and extremity injuries was lower in the childrens group than in the adult group.

Serum tau protein level for neurological injuries in carbon monoxide poisoning

Abstract Introduction. Carbon monoxide (CO) poisoning causes hypoxia that results tissue injury, especially in the brain and heart. Delayed neurologic sequela is one of the most serious complications that may occur up to 40% of severe CO poisoning cases. Objective. The aim of the study was to determine an association between the serum tau protein and severe neurologic symptoms/signs upon presentation. Methods. Seventy-eight patients with CO poisoning were evaluated in this cross-sectional study. The patients were divided into two groups, Group 1: those with loss of consciousness (LOC)/syncope, seizure, coma, altered mental status (n = 19), and Group 2; without LOC (n = 59). Serum tau protein levels were studied on admission. Results. Mean age of the patients was 37.3 ± 15.4 and 53.6% were male. Headache was the most common presenting symptom observed among 67 patients (86%). The median serum tau protein level was 76.54 pg/mL (35.56–152.65) within group 1, 64.04 pg/mL (23.85–193.64) in patients within group 2 (p = 0.039), respectively. The median serum tau protein levels were 79.80 pg/mL (35.56–193.64) in patients who received HBO therapy and 65.79 pg/mL (23.85–167.29) in patients who did not receive HBO therapy (p = 0.032). The value of area under the curve was 0.642 for detecting CO poisoning with severe neurological symptoms. Conclusion. Although tau protein levels were significantly higher in patients with severe neurological symptoms; the difference did not reach a clinical significance. Further studies are needed in order to reveal the validity of tau protein for detecting neurological injuries in patients with CO toxicity.

Social media, FOAMed in medical education and knowledge sharing: Local experiences with international perspective

Social media, through the Internet and other web-based technologies, have become a means of communication and knowledge-sharing. In this article, we provide details about the social media traffic of various scientific activities, the organizations of which we have played an active role in. We also provide information in our native language through our FOAMed website, which has been published for about 30 months, with us acting as editors. We are comparing these local and limited ventures with examples from the world and aim to remind that social media sources play a very important role in sharing knowledge in medical training and encouraging local initiatives, like ours, with limited resources.

Predictors of Inhospital Mortality in Geriatric Patients Presenting to the Emergency Department With Ischemic Stroke

Aim: To determine the most important predictors of inhospital mortality that could be assessed in geriatric patients presenting with ischemic stroke at admission to the emergency department(ED). Methods: A retrospective cohort study was carried out in geriatric patients with ischemic stroke who were diagnosed in the ED. The primary outcome measure was determined as all-cause inhospital mortality after 30 days of ischemic cerebrovascular event. Results: During the study period, 247 (35.7%) patients died in the hospital and 445 (64.3%) patients survived the 30-day period. The median age of the patients was 78 (72-83). Higher National Institutes of Health Stroke Scale (NIHSS) scores (odds ratio [OR]: 2.085; 95% confidence interval [CI]: 1.835-2.370), increased creatinine levels (OR: 2.002; 95% CI: 1.235-3.243), increased platelet levels (OR:1.006; 95% CI: 1.002-1.010), and hyperglycemia (OR: 2.610; 95% CI: 1.023-6.660) were found as independent predictors of inhospital mortality. Conclusion: In evaluating geriatric patients with ischemic stroke, laboratory values including platelet count, creatinine levels, hyperglycemia, and NIHSS scores should be considered to predict inhospital mortality in the ED.

Whole body computed tomography in multi trauma patients: Review of the current literature

Many authors adopt the Selected Computed Tomography (SCT) approach of the Advanced Trauma Life Support (ATLS) for the management of multiple trauma patients. In the SCT approach, the initial physical examination is followed by conventional radiography (cervical X-ray, chest X-ray, pelvic X-ray and Focused Abdominal Sonography in Trauma (FAST)), and the computed tomography (CT) of the specific body regions if indicated. An alternative to this traditional approach is the Whole-body Computed Tomography (WBCT) protocol, which became widespread all over the world in the last two decades to minimize the rate of missed injuries and decrease the mortality rate. According to the literature, the WBCT approach is superior to the traditional SCT approach in the time of imaging, diagnostic accuracy, and mortality rates. Conversely, WBCT increases the cancer risk due to additional irradiation. Therefore, it is recommended that the WBCT protocol should be reserved for only severe multi-trauma patients. However, further studies to define severe patients, and clinical decision criteria for WBCT are needed.

Ruptured superior gluteal artery pseudoaneurysm with hemorrhagic shock: Case report

Pseudoaneurysm of the superior gluteal artery (SGA) is very rare and the most common causes are blunt or penetrating pelvic traumas. Although pseudoaneurysm can be asymptomatic at the time of initial trauma, it can be symptomatic weeks, months, even years after initial trauma. We present a case of a ruptured superior gluteal artery pseudoaneurysm with hemorrhagic shock twenty days after a bomb injury in the Syria civil war. In addition, we review the anatomy of the SGA, clinical presentation and pitfalls of pseudoaneurysm, and imaging and treatment options.

Spontaneous Subclavian Artery Transection After Sneezing

Giris: Spontan subklavyen arter yaralanmalari nadir rastlanir. Hapsirma sonrasi spontan subklavyen arter transeksiyonunu gelisen bir olguyu sunmayi amacladik. Olgu Sunumu: 18 yasinda erkek hasta acil servise hapsirma sonrasi sag omuz agrisi sikayeti ile basvurdu. Hastanin vital bulgulari ve fizik muayenesi normaldi. Akciger grafisinde mediasten genisligi 7 cm idi. Hasta taburcu edildi. Hasta taburculugundan bes saat sonra acil servise nefes darligi ve gogus agrisi sikayeti ile basvurdu. Hipotansif ve tasikardik olan hastanin sag brakial ve radial nabizlar palpe edilemedi. Masif hemotoraks tespit edildi. Tup torakostomi yapildi, hemodimisinin hizla bozulmasi uzerine acil torakotomi yapilan hastada kanama kontrolu esnasinda kardiyak arrest gelisti. Postmortem yapilan eksplorasyonda sag subklavyen arterin arcus aorta birlesme noktasindan sirkuler olarak tam kat yirtilmaya bagli olarak tamamen ayrildigi (komplet transeksiyon) goruldu. Sonuc: Hapsirma, spontan arter diseksiyonunu tetikleyen minor travmalar arasinda yer almaktadir. 6 cm ve uzerindeki mediasten genisligi uc kat artmis mortalite ile iliskili bulunmustur. Acil servise ozellikle ani hareket sonrasi baslayan gogus, sirt, omuz ve kol agrisi gibi yakinmalarla basvuran ve akciger grafisinde ≥6 cm mediastinal genislik tespit edilen hastalarda ileri goruntuleme yapilmasinin bu olgudaki gibi nadir ancak mortalitesi yuksek hastaliklarin taninmasinda faydali olabilecegini dusunmekteyiz.