Gülsüm Kavalcı

Intravenous paracetamol reduced the use of opioids, extubation time, and opioid-related adverse effects after major surgery in intensive care unit ☆

BACKGROUND This study assessed the analgesic efficacy, side effects, and time to extubation of intravenous paracetamol when administered as an adjuvant to intravenous meperidine after major surgery in intensive care unit (ICU). MATERIAL Patients were randomized postoperatively into 2 groups in ICU. Patients received either 100 mL of serum saline intravenous (IV) every 6 hours and IV meperidine (n = 20 group M) or IV paracetamol 1 g every 6 hours and IV meperidine (n = 20, group MP) into a peripheral vein for 24 hours. Behavioral Pain Scale (BPS) is used until extubation, and visual analog score (VAS) is used after extubation. When BPS and VAS values were more than 4, meperidine, 1 mg/kg IV, was administered and noted in 2 groups. Pain scores, total meperidine consumption, time to extubation, sedation scores, and side effects are 24-hour postoperatively noted. RESULTS Behavioral Pain Scale and VAS scores are significantly lower in group paracetamol-meperidine at 24 hours (P < .05). In group MP, postoperative meperidine consumption (76.75 ± 18.2 mg vs. 198 ± 66.4 mg) and extubation time (64.3 ± 40.6 min vs. 204.5 ± 112.7 min) were lower than in group M (P < .01). In addition to, postoperative nausea-vomiting and sedation scores were significantly lower in group MP when compared with group M (P < .05). CONCLUSION We have demonstrated important clinical benefits by the addition of 4 g/d of paracetamol to meperidine after major surgery. This benefit has been shown in a range of patients under routine clinical conditions and therefore has important practical consequences in ICU. These data suggest that intravenous paracetamol is a useful component of the multimodal analgesia model, especially after major surgery.

Comparison of the Canadian CT head rule and the new orleans criteria in patients with minor head injury

AimThe aim of the study was to compare the New Orleans Criteria and the New Orleans Criteria according to their diagnostic performance in patients with mild head injury.MethodsThe study was designed and conducted prospectively after obtaining ethics committee approval. Data was collected prospectively for patients presenting to the ED with Minor Head Injury. After clinical assessment, a standard CT scan of the head was performed in patients having at least one of the risk factors stated in one of the two clinical decision rules.Patients with positive traumatic head injury according to BT results defined as Group 1 and those who had no intracranial injury defined as Group 2. Statistical analysis was performed with SPSS 11.00 for Windows. ROC analyze was performed to determine the effectiveness of detecting intracranial injury with both decision rules. p < 0.05 was considered statistically significant.Results175 patients enrolled the study. Male to female ratio was 1.5. The mean age of the patients was 45 ± 21,3 in group 1 and 49 ± 20,6 in group 2. The most common mechanism of trauma was falling. The sensitivity and specificity of CCHR were respectively 76.4% and 41.7%, whereas sensitivity and specificity of NOC were 88.2% and 6.9%.ConclusionThe CCHR has higher specificity, PPV and NPV for important clinical outcomes than does the NOC.

An Analyses of Bicycle Accidents in Ankara: Analyses of 5 Years

Aim: Bicycles are used for transportation, exercise and recreation. In this study we aimed to investigate the epidemiological, clinical and economic aspects of bicycle injuries. Material and Method: We included in the study who admitted to the Emergency Department with a bicycle accident between January 2008 and July 2012. Patient age and sex, accident pattern, presence of personal protective measures, injured body part, Glasgow Coma Scale (GCS) score, Revised Trauma Score (RTS), radiological findings, requested consultations, duration of hospital stay, season of injury, and average cost rates were recorded. The study population was divided into 2 age groups as 0-14 years and over 14 years. Results: A patients were 238 (81.2%) male and their mean age was 31.5±14.1 years. Fifty-five (18.8%) patients were female and their mean age was 34.5±15.9 years. Males had significantly higher rate of bicycle injury (p<0.001). The most common injuries occured to lower and upper extremities. Inspection of hospital bills revealed that median patient cost was

Retrospective Analysis of Indication of Bone Scintigraphy Performed in Our Clinic

175. Discussion: In this study bicycle accidents were more common occured in males and during summer months. The most common injuries was in the lower extremities.

Acute Dystonic Reaction Due to High Dose Risperidon Intake

DOI: 10.4328/JCAM.2051 Received: 11.09.2013 Accepted: 28.09.2013 Printed: 01.05.2015 J Clin Anal Med 2015;6(3): 324-6 Corresponding Author: Füsun Aydoğan, Mustafa Kemal Üniversitesi Tıp Fakültesi, Nükleer Tıp A.D. Hatay, Türkiye. T.: +905056579710 E-Mail: drfusunay@yahoo.com Özet Amaç: Kemik sintigrafisi sık kullanılan radyonüklid görüntüleme yöntemlerindendir ve birçok hastalığın tanı ve takibinde başarıyla kullanılmaktadır. Çalışmamızın amacı kliniğimizde yapılan kemik sintigrafisi çekimlerinin endikasyonlarını ve çekim protokollerini belirlemektir. Gereç ve Yöntem: Çalışmaya Aralık 2011 ve Haziran 2013 tarihleri arasında kliniğimizde kemik sintigrafisi çekimi yapılan 252 hasta (132 erkek, 120 kadın) dahil edildi. Hastaların yaş ortalaması 50.1±20.2 idi (yaş aralığı 6-84). Sintigrafik protokoller hastalığın çeşidine göre geç statik tüm vücut görüntüleme ve üç fazlı kemik sintigrafisi olmak üzere iki şekilde yapıldı. Çekim endikasyonları ve sintigrafik protokoller tesbit edildi. Bulgular: 102 hastaya (% 40,5) metastatik kemik hastalıklarının tanı ve takibi amacıyla, 57 hastaya (% 22,6) ortopedik uygulamalar amacıyla, 29 hastaya (% 11,5) primer kemik tümörlerinin tanı ve takibi amacıyla, 17 hastaya (% 6,7) osteomyelit tanısı amacıyla, 12 hastaya (% 4,8) protez enfeksiyonu ve gevşemesi ayrıcı tanısının yapılması amacıyla, 14 hastaya (% 5,6) greft canlılığının araştırılması amacıyla, 9 hastaya (% 3,6) romatoid artrit-sakroileit gibi romatolojik hastalıklar nedeniyle, 4 hastaya (% 1,6) osteoporoz-vertebralarda patolojik kırık araştırılması amacıyla, 2 hastaya (% 0,8) metabolik kemik hastalığı nedeniyle, 5 hastaya (% 1,98) otitis eksterna tanısı amacıyla ve 1 hastaya (% 0,4) sedimantasyon-CRP yüksekliği gibi nedenlerden dolayı malignite şüphesi nedeniyle kemik sintigrafisi çekimi yapıldı. Hastaların 136’sına (% 54) geç statik tüm vücut görüntüleme, 116’sına (% 46) ise üç fazlı görüntüleme protokolü uygulandı. Tartışma: Kemik sintigrafisinin en sık kullanıldığı alan metastatik kemik hastalıklarının tanı ve takibidir. Bunu ortopedik uygulamalar, primer kemik tümörlerinin tanı-takibi ve osteomyelit tanısı gibi nedenler takip etmektedir.

Epidemiological and Cost Analysis of Self-Poisoning Cases in Ankara, Turkey

Acute dystonic reaction is an extrapyramidal side effect, caused by atypical antipsychotic drugs, that usually occurs suddenly. It may occur during antipsychotic treatment with pharmacological doses or after the patient takes an overdose. It is characterized by involuntary, continuous or spasmodic muscular contractions usually on the head or the neck region. Laryngeal muscle spasm may produce respiratory distress and asphyxia. Laryngeal dystonia is a very rare and life-threatening condition. The differential diagnosis is a challenging problem that should be treated immediately. Herein, we report a patient who presented with acute dystonic reaction on the head and the neck region due to high dose risperidon intake. (Yoğun Bakım Derg 2013; 4: 25-7)

Age and Dialysis Adequacy in Maintenance Hemodialysis Patients

Background: Poisoning is a global public health problem. Self-poisoning has potentially serious consequences. Follow-up studies have found that 3-10% of self-harm patients eventually succeed. Objectives: This study was designed to investigate the epidemiological, clinical and economical aspects of deliberate self-poisoning patients admitted to Yenimahalle State Hospital Intensive Care Unit. Patients and Methods: The study was carried out retrospectively in Ankara Yenimahalle State Hospital. It included Seventy-one patients over 16 years of age who were admitted to the hospital due to poisoning during 2012. Exposed poisons were classified into one of three categories; pharmaceuticals, pesticides, and alcohols. Cost account was based on the medical invoices at patient discharge. Data were compared using Student’s T test and chi-square test. A P value of less than 0.05 was considered significant. Results: The female/male ratio was 2.55. The mean age of the 71 poisoned patients was 28.92 ± 11.51 years. Most of the poisoning agents were pharmaceuticals (68 cases). Among the pharmaceuticals, antidepressants were involved most often, followed by analgesics. There was no statistically significant difference between pharmaceutical agents in terms of hospital cost (P > 0.05). The mean length of hospital stay was 6.4 ± 4.3 days. There was a statistically significant difference between the lengths of stay of patients in terms of hospital cost (P < 0.05). Conclusions: The patient cost increased as the length of stay increased due to the policy of bundle pricing.

A vivid example of angioedema

Aim: The issue of optimal dialysis dose and frequency has been a central topic in the delivery of dialysis treatment. We aimed to consider the effects of age on some hemodialysis parameters specially dialysis adequacy by urea reduction rate (URR) and to compare these parameters between diabetics and non diabetic HD(hemodialysis) patients. Material and Method: Patients with end-stage renal disease (ESRD), undergoing maintenance hemodialysis treatment were considered. The urea reduction rate and body mass index were calculated. Results: The total patients were 60 (F=21 M=39), consisting of 44 non diabetic hemodialysis patients (F=15 M=29), and 16 diabetic hemodialysis patients (F=6 M=10). A significant difference of dialysis adequacy between non-diabetics and diabetics was observed with lower values in diabetic group and a significant difference of dialysis adequacy and creatinine was observed in patients, with ages below and more than 50 years old with lower values in older patients. A significant negative correlation of age with dialysis adequacy in total hemodialysis patients and a significant negative correlation of age with serum creatinine were observed. Discussion: The negative effect of age on dialysis adequacy needs more attention to this aspect to reduce the dialysis complications which is frequently observed in older patients.

Organophosphate Poisoning Due to a Wheat Bagel

Case reportA 68-year-old hypertensive woman, who had been using25 mg of carvedilol daily for the past 5 years, woke up withedema of the tongue and dyspnea. At the admission to therural hospital, 5 mg of hydrocortisone and 5 mg of dex-chlorpheniramine were given intravenously, and the patientwas sent to our department. It was learned from relatives ofthe patient that she had been given sublingual captopril inanother hospital where she had been treated the day beforefor hypertension. Additionally, it was reported that thepatient hadalsosufferedfromtongueedema intheprioryearafter using the same medication, sublingual captopril. Onphysical examination, she was alert, with vital signs: bloodpressure 130/80 mmHg, pulse rate 94 beats per minute,respiration rate 14 breathes per minute (Fig. 1). Inspiratorystridor was heard on auscultation, and the patient was notable to speak. She was breathing supplemental oxygen,placed on a cardiac monitor, and intravenous lines wereestablished. Therapy was commenced with 0.3 mg of a1:10,000 epinephrine subcutaneously, 40 mg methylpred-nisolone, 50 mg diphenhydramine administered intra-venously. Over the following 10 min, subcutaneous 0.3 mgof a 1:10,000 epinephrine was repeated a single time. Thetongue of the patient decreased in size and she became ableto speak. The patient stayed in the observation unit for 24 hand was discharged without any further problems.DiscussionAngiotensin-converting enzyme (ACE) inhibitors are fre-quently used in the treatment of hypertension. Side effectprofiles vary from minor allergic reactions to anaphylactic