Ibrahim Turkcuer

Intravenous paracetamol versus morphine for renal colic in the emergency department: a randomised double-blind controlled trial

Objective To determine the analgesic efficacy and safety of intravenous single-dose paracetamol versus morphine in patients presenting to the emergency department with renal colic. Methods A randomised double-blind study was performed to compare the efficacy of intravenous paracetamol (1u2005g) and 0.1u2005mg/kg morphine in patients with renal colic. The efficacy of the study drugs was measured by a visual analogue scale and a verbal rating scale at baseline and after 15 and 30u2005min. The adverse effects and need for rescue medication (1u2005μg/kg intravenous fentanyl) were also recorded at the end of the study. Results 133 patients were eligible for enrolment in the study, with 73 patients included in the final analysis (38 in the paracetamol group and 35 in the morphine group). The mean±SD age of the subjects was 30.2±8.6u2005years and 51 (70%) were men. The mean reduction in scores at 30u2005min after study drug administration was 63.7u2005mm (95% CI 57 to 71) for paracetamol and 56.6u2005mm (95% CI 48 to 65) for morphine. The difference between pain reduction scores for the two groups at 30u2005min was 7.1u2005mm (95% CI −18 to 4), demonstrating no statistical or clinical significance. Two adverse events (5.3%) were recorded in the paracetamol group and five (14.3%) in the morphine group (difference 9%, 95% CI −7% to 26%). Conclusion Intravenous paracetamol is effective in treating patients presenting with renal colic to the emergency department. Clinical trials registration no ClinicalTrials.gov ID number NCT01318187.

A study of depression and anxiety among doctors working in emergency units in Denizli, Turkey

Background: Major work has been carried out on the psychological well-being of emergency room doctors in the US, Canada and in other developed countries, but little has been published regarding the same in the countries in economic transition. Objective: To determine the level of, and the factors related to, depression and anxiety among doctors working in emergency units in Denizli, Turkey. Methods: This cross-sectional study was conducted in May 2004, using a sample of 192 doctors employed in emergency units in Pamukkale University Hospital, the City Hospital, the Social Security Hospital, private hospitals, citywide primary healthcare centres and 112 emergency services in Denizli, Turkey. Data were obtained using a self-administered questionnaire, including questions on sociodemographic characteristics and two instruments determining the level of depressive symptoms and anxiety. Logistic regression was the method chosen for multivariate statistical analysis. Results: The mean (standard deviation (SD)) depression score was 10.6 (6.5) and the frequency (%) of depression was 29 (15.1). Not having any hobby and having high anxiety scores were salient factors among doctors experiencing depressive symptomatology in bivariate comparisons. Logistic regression analysis showed that not having any hobby (pu200a=u200a0.07) and having increased anxiety scores (p<0.001) were positive contributors to depression scores. The mean (SD) anxiety score was 8.7 (8.2) and the frequency (%) of anxiety was 28 (14.6). Being a woman, having a low monthly income and having high depression scores contributed considerably to the anxiety of doctors in bivariate comparisons. Low monthly income (<1000 v 1000–2000 YTL) (pu200a=u200a0.03), the number of years spent in emergency units (pu200a=u200a0.03) and having high depression scores (p<0.001) were the factors that contributed significantly to the anxiety of doctors in the multivariate regression analysis. Conclusion: The considerable amount of depression and anxiety found among doctors in this study should trigger further work. Studies using more powerful designs would help to illuminate the factors leading to depression and anxiety, which result in attrition among doctors from emergency units.

Intravenous paracetamol versus dexketoprofen in acute migraine attack in the emergency department: a randomised clinical trial.

Objective Migraine is a common form of headache that is a major burden for patients who often seek emergency care. The goal of this study was to compare the effectiveness of intravenous non-steroidal anti-inflammatory medication (dexketoprofen) with paracetamol (acetaminophen) in the treatment of an acute migraine attack. Materials and methods This prospective, randomised, double blind, controlled study was conducted in a tertiary care emergency unit. Study patients were randomised into two groups to receive either 50u2005mg of dexketoprofen trometamol or 1000u2005mg of paracetamol intravenously by rapid infusion in 150u2005mL of normal saline. Pain reduction was measured at baseline, and after 15 and 30 min, using a Visual Analogue Scale (VAS)) as the primary outcome. VAS is a measurement tool ranging from 0 (no pain) to 100u2005mm (worst pain). Results 200 patients were included in the final analysis. Mean (SD) age of the study subjects was 30.1±11 years and 81% (n=162) were women. Median reduction in VAS score at 30 min was 56 (IQR 30–78.5) for the paracetamol group and 55 (IQR 34–75) for the dexketoprofen group, with a difference of 1u2005mm (95% CI −7 to 10) between the two groups. Conclusions Intravenous paracetamol and dexketoprofen appear to produce equivalent pain relief for migraine in the emergency department. ClinicalTrials.gov No NCT01730326.

Violence toward health care workers in emergency departments in Denizli, Turkey

This study sought to determine the frequency and types of violence that occurred during the previous year against health care workers in emergency departments in Denizli, Turkey, and to discern the views of workers on the prevention of such aggressive behavior. This study was conducted from March 1 to April 15, 2003, and included a group of 79 health care workers from the emergency departments of 3 hospitals in Denizli, namely, the Hospital of Pamukkale University Medical Faculty, the City Hospital of Denizli, and the Hospital of the Social Insurance Foundation. Data were collected from a self-administered questionnaire. In all, 88.6% of participants had been subjected to or had witnessed verbal violence, and 49.4% of them had been subjected to or had witnessed physical violence during the previous year. The most frequent reason (31.4%) for violence was abuse of alcohol and drugs by perpetrators. The second most frequent reason (24.7%) was the long waiting times typical of emergency departments. The most common type of violence was loud shouting; swearing, threatening, and hitting were the next most frequent violent behaviors. In all, 36.1 % of subjects who had experienced violence reported that they developed psychological problems after the incident. Most participants commented on the insufficiency of currently available security systems within emergency departments and on the need for further training about violence. All health care personnel within emergency departments should be aware of the risk of violence and should be prepared for unpredictable conditions and events; in addition, security systems should be updated so that violence within emergency departments can be prevented.

Analysis of clinical and demographic characteristics of patients presenting with renal colic in the emergency department

BackgroundRenal colic (RC), is one of the most severe pain patterns which is most commonly diagnosed and managed in the emergency department (ED). This study is designed to evaluate the characteristics of adult patients presenting with pain and diagnosed with RC in the ED, length of stay in the ED and hospital and factors affecting these variables.MethodsAll consecutive adult patients who presented with side pain, flank pain, abdominal or groin pain and consequently diagnosed with urolithiasis or RC were analyzed retrospectively. Sociodemographic data, times of admission into and discharge from the ED, adjunctive complaints, results of laboratory investigations, findings on examination, treatment and drugs administered were noted.ResultsA total of 235 patients with a diagnostic code of urolithiasis were enrolled. Physicians were more likely to order radiological and laboratory investigations for female patients and those without hematuria in urinalysis. The peak incidence of patients diagnosed with RC (p = 0.001) was noted in August, while the winter had the lowest frequency of relevant admissions. The peak frequency was between 06:00 and 08:00. Women stayed longer in the ED (p = 0.001). Absence of hematuria in urinalysis was associated with increased length of stay (p = 0.007).ConclusionAlthough RC is a common ED presentation for which the emergency physician has no guidelines in terms of diagnosis and management, there is no exact pattern to guide ordering investigations. Patients with atypical presentations stay longer in the ED and are likely to undergo additional tests in management.

Hospital cost analysis of management of patients with renal colic in the emergency department

Acute severe colicky pain in the flank region is termed as renal colic (RC), which is commonly diagnosed and treated in the emergency department (ED). The present study is designed to investigate the hospital costs of patients with RC admitted to the ED and factors affecting the figures. Retrospective analysis includes all patients diagnosed with RC following physical examination and X-ray, ultrasound, computed tomography together with laboratory investigations in the university-based ED between February 2007 and February 2009. The study included 574 patients eligible for the predefined criteria. Mean total hospital cost in patients admitted to the ED due to RC was calculated to be 55.77 Euro. The greatest contribution to the total cost was made by radiological investigations in the ED (40.5%) followed by treatment costs (19.7%). Size and location of the stone and stay times in the ED were the independent variables affecting the costs. The costs were higher as the stones were bigger and as they were more distal in the ureter. Renal stones were associated with the lowest hospital costs. Radiological investigations are the greatest contributors in the ED costs in patients with RC. Effective measures need to be undertaken to reduce resultant costs. Preventive measures as well as diagnostic and therapeutic procedures should be standardized in the ED in accordance with technological advances and also cost-effectiveness when appropriate.

Therapeutic plasma exchange in amitriptyline intoxication: Case report and review of the literature

Severe amitriptyline poisoning results in cardiac and neurological toxicity and continues to be a leading cause of significant morbidity and mortality both in children and adults. We present a case of severe amitriptyline poisoning successfully treated with plasma exchange. Due to high plasma protein binding property of amitriptyline, plasma exchange therapy should be considered in cases of severe amitriptyline intoxication as a life saving therapeutic modality.

Causes and characteristics of work-related eye injuries in western Turkey

Objectives: To analyze descriptive data and characteristics of work-related eye injuries (WREI) admitted into the emergency department (ED) and obtain information to utilize in planning measures to prevent WREI. Materials and Methods: This prospective study recruited patients with WREI admitted to the center in the two-year study period. Only the casualties occurred at the workplace and while working constituted the sample. The data were collected via face-to-face contact in the ED. Results: Males comprised the majority of the sample (95.3%, n = 778) and mean age of the patients was 28.1 ± 6.5 (range: 15-54) with the biggest percentage in between 25 and 34 years of age (46.2%, n = 377). Most patients were working in the metal and machinery sectors (66.4%, n = 542). Nearly half of the patients had less than 1 year of experience (50.4%, n = 411). The most common mechanism of WREI was noted to be exposures to welding light (26.9%, n = 219), followed by drilling/cutting injuries (21.1%, n = 172). “Carelessness” and “hurrying up” were the most commonly reported causes of WREIs among ‘worker-related causes’ (21.4% and 16.1%, respectively). Lack of protective measures ranked the highest among workplace-related causes (18.7%, n = 207). Conclusions: Programs to increase awareness on workplace safety and sound preventive strategies for both parties-employers and employees are to be pursued. Occupational safety efforts should include training on workplace eye safety and campaigns to raise knowledgeability on this disease among workers.

Direct medical costs and working days lost due to non-fatal occupational injuries in Denizli, Turkey

Occupational accidents are avoidable and cause a great impact on productivity and on the economy, as well as great suffering. Death tolls are four to five times higher in developing countries than in developed countries. Every year, millions of workers suffer injuries and thousands experience deaths in developing regions . Little data can be found in the literature regarding OI in developing countries and their costs along with average working days lost (Brazil 2, , Poland, Malaysia, Lebanon, Taiwan, Nicaragua, China ). Employment statistics for March 2007 state that the sectors with the most intensive employment figures in Turkey are services, agriculture, industry and construction. The Social Security Institution (SSK) is the biggest state-run institution established to manage the social security issues of Turkish workers. Unregistered workers constitute up to 46.2% of the total working population in March 2007. SSK databases cite that 73,923 OI occurred in 2005. These were highest in the metal and machinery sector, 10,283 incidents (13.9%), followed by the construction sector with 6,483 (8.7%) and coal mining with 6,011 (8%). The male-to-female ratio of OI in Turkey is 21.1 with the highest rate of women injured in the textile industry. The weighted average age of victims is 29 for women and 31 for men . Populated by 850,000 people, Denizli is one of the outstanding industrialized cities of western Turkey and has a high rate of OI. The predominance of the textile industry in the city affects the male-to-female OI ratio (7.7 vs 21.1 in Turkey) . More than 1,500 admissions due to OI are recorded in the health facilities annually in Denizli . Three big hospitals operate in the city, including one Universitybased research hospital. This hospital received approximately one third of all OI recorded to have occurred in the city. The University hospital has 24-h coverage regarding advanced interventions for OI such as reimplantation and microsurgery, which the other two hospitals do not have. Medical costs of OI represent a neglected area of research in Turkey. Furthermore, health institutions lack reliable and regularly updated medical registries with respect to OI. The present study aimed to clarify the current situation of OI in the middle-sized industrialized city of Denizli in west Turkey.

Evaluation of the outcome of out-of-hospital cardiac arrest resuscitation efforts in Denizli, Turkey.

The objective of this study was to evaluate the outcomes and associated factors for short-term success and long-term survival rates of resuscitated non-traumatic out-of-hospital cardiac arrest (OHCAs) in Denizli, Turkey. All non-traumatic OHCA patients from the Emergency Departments of the Pamukkale University and City Hospitals between the dates of January 1, 2004 and March 1, 2005 were included in this study. A successful outcome was defined as the return of spontaneous circulation or breathing, or evidence of a palpable pulse or a measurable blood pressure. Information on post-resuscitation long-term survival up to 9 months also was obtained by telephone. A total of 222 adults experiencing OHCAs were resuscitated. The number of successful outcomes was 85 (38.3%); 25 (11.2%) were discharged alive; and 21 (9.4%) were alive at the 9-month follow-up. The predicted mean arrest time was 11.7 min (95% confidence interval 10.27-13.2). Type of transportation to the Emergency Department (ambulance, 32.1% vs. private vehicle, 44.5%; p = 0.057), place of arrest (home, 32.6% vs. other, 44.0%; p = 0.08), first rhythm at the scene (asystole, 22.9% vs. ventricular fibrillation-pulseless ventricular tachycardia, 48.0%, vs. pulseless electrical activity, 12.5%; p = 0.056), and advanced cardiac life support starting time (the first 8 min, 46.8% vs. later than 8 min, 32.0%; p = 0.025) had an effect on outcome. Intensive public education for diagnosis and appropriate reporting of OHCA, the importance of bystander cardiopulmonary resuscitation, and the use of automated external defibrillators have an impact on the potential to increase the number of survivors.