Kamil Kayayurt

Paramedic-performed Focused Assessment with Sonography in Trauma (FAST) in the emergency department.

BACKGROUND Our objective was to evaluate the accuracy of paramedic-performed Focused Assessment with Sonography in Trauma (PFAST) for detection of free fluid in patients admitted to the Emergency Department (ED) following trauma. METHODS After four hours of didactic and four hours of hands-on training, four paramedics prospectively evaluated trauma patients. Our gold standard was the official radiologist reports of ultrasonography and computerized abdominal tomography (CAT). The sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio of PFAST were calculated and analyzed using SPSS 15.0 with ?2 testing. RESULTS One hundred and twenty-seven patients were evaluated by the paramedics. Fourteen patients had positive free fluid in the abdomen. Of these, 11 were corroborated by radiology reports and CAT (true positives), and three were found to be negative (false positives). In 113 cases, PFAST was negative for free fluid. Of these, 111 were determined not to have free fluid (true negatives), whereas free fluid was detected by CAT in 2 (false negatives). The sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio of PFAST were 84.62, 97.37, 32.15, 0.16, and 203.50, respectively. CONCLUSION Our study shows that paramedics can perform FAST in hospital Eds with a high degree of accuracy.

Pneumomediastinum Associated with Pneumopericardium and Epidural Pneumatosis

Spontaneous pneumomediastinum is a relatively rare benign condition. It may rarely be associated with one or combination of pneumothorax, epidural pneumatosis, pneumopericardium, or subcutaneous emphysema. We present a unique case with four of the radiological findings in a 9-year-old male child who presented to our emergency department with his parents with complaints of unproductive cough, dyspnea, and swelling on chest wall. Bilateral subcutaneous emphysema was palpated on anterior chest wall from sternum to midaxillary regions. His anteroposterior and lateral chest radiogram revealed subcutaneous emphysema and pneumomediastinum. His thorax computed tomography to rule out life-threatening conditions revealed bilateral subcutaneous, mediastinal, pericardial, and epidural emphysema without pneumothorax. He was transferred to pediatric intensive care unit for close monitorization and conservative treatment. He was followed-up by chest radiographs. He was relieved from symptoms and signs around the fifth day and he was discharged at the seventh day. Diagnosis of pneumomediastinum is often made based on physical findings and plain radiographs. It may not be as catastrophic as it is seen. Close cardiopulmonary monitorization is mandatory for complications and accompanying conditions. Most patients with uncomplicated spontaneous pneumomediastinum respond well to oxygen and conservative management without any specific treatment.

Incidental finding in a headache patient: intracranial lipoma.

A 60 year old female, with a history of atrial fibrillation who was on warfarin therapy, presented to our emergency department with chief complaint of the most severe headache that she ever had. Her vital signs, systemic and neurological examinations were normal. She had emergency computed tomography (CT) of the brain with suspicion of intracranial hemorrhage that revealed a lesion in fat dansity in the lateral ventricle and interhemispheric fissure (Figure a). Her international normalized ratio was 3,2. She underwent cranial magnetic resonance imaging (MRI) that revealed a hyperintense lesion in T1 and T2 sequances in the lateral ventricles, pericallosal area and interhemispheric fissure that did not show contrast enhancement (Figure b and c). After the symptomatic relief by analgesics she was discharged from the emergency department for out-patient follow-up. Figure Image (a) shows cranial computed tomography. There is a homogenously hypodense lesion measuring 33 mm × 30 mm in the lateral and third ventricles with about −101 to −110 Hounsefield unit. Image (b) and (c) show magnetic resonance ... Intracranial lipomas are rare and benign congenital malformations accounting for 0,1% to 0,46% of all intracranial tumors.1 Since half of all cases are asymptomatic, they are usually an incidental finding during neuroimaging studies. Headache is the most common symptom in adults if it becomes symptomatic.2 The deep interhemispheric fissure, especially the corpus callosum, is the most common localization of intracranial lipomas.1 Intracranial lipomas are often associated with other malformations of the central nervous system, such as callosal agenesis or hypogenesis, spina bifida or a cranium bifidum.1,3 Noncontrast cranial CT and brain MRI allow definitive diagnosis. The appearance of the corpus callosum lipoma on the cranial CT scan is quite typical, with the low attenuation seen only in adipose tissue, which ranges from −40 to −100 hounsfield units.4,5 In the brain MRI the lesion presents characteristics of fatty tissue, with a hyperintense signal in both T1 and T2-weighted studies.6 Most lipomas are treated conservatively and rarely requires neurosurgical treatment because of their benign nature.1 Our patient did not have any accompanying lesion and was discharged to follow-up as an out-patient.

Do we routinely need cranial computed tomography for mild head injuries in Turkey

The objectives of this study were to determine the role of clinical parameters in detecting intracranial injury and to find out whether cranial computed tomography (CT) is routinely needed for mild head injury (MHI) in Turkey. This retrospective study was conducted by reviewing the records of patients with MHI who underwent cranial CT in our emergency department. We carried out multiple logistic regression analysis, and odds ratios with 95% confidence intervals were calculated by using SPSS 15.0. This study included 923 patients. Positive cranial CT findings were determined in 17 patients (1.8%) and six of them (0.6%) underwent surgery. Statistically significant correlations were found among headache, presence of clinical findings of skull fracture, focal neurological deficit and positive cranial CT findings. Although the incidence of the intracranial lesions, especially those requiring surgery, is low in MHI, the liberal use of CT scanning in MHI seems to be justified in countries such as Turkey.

A Case of Ramsay Hunt Syndrome with Atypical Presentation

SUMMARY Ramsay Hunt syndrome is a rare complication of herpes zoster which results from the reactivation of the latent varicella-zoster virus in the geniculate ganglion. Although facial nerve is the most common affected nerve in Ramsay Hunt syndrome, other cranial and cervical nerves can also be affected. We present an atypical case of Ramsay Hunt syndrome in a 42-year-old male, with cervical nerve involvement. As spontaneous recovery rate in Ramsay Hunt syndrome is low, early diagnosis and treatment plays a key role in full recovery of paralysis.

Acute Dystonic Reaction Associated with Cefuroxime Axetil in a ChildRunning Title: Acute Dystonic Reaction

Dystonia is an extra-pyramidal motor function disorder characterized by intermittent spasmodic or sustained involuntary muscle contractions of the face, neck, trunk, pelvis and extremities causing repetitive movements and postural abnormalities. A 10-year-old male child was presented to the emergency department with complaint of regular rhythmic spasms on the head. He was diagnosed as dystonic reaction induced by cefuroxime axetil. After cessation of the therapy and administration of 2.5 mg of biperiden intravenously, the spasms were stopped. Our aim is to make up an awareness of this adverse drug reaction when prescribing such antibiotic in children.

Comparison of ultrasonographic methods as a marker of blood loss

patients whenever the symptoms are apparently only gastrointestinal and to give additional weightage for hiccup. Recent literature [2] suggests that diabetes is closely linked to heart disease, and it is a risk factor for acute myocardial infarction (MI) an equivalent to known coronary artery disease. Chowta and colleagues [3] had observed atypical symptoms such as epigastric pain or abdominal distress in 50% of patients with inferior-wall MI presented to them. Also, painless infarction was demonstrated in those patients with inferior-wall MI [4]. The hiccups were seen much more often in patients with inferior MI [5] compared with infarctions of other territory. It may be explained by the anatomical fact that the vagal fibers of cardiac plexus are within the inferoposterior myocardium and the phrenic nerve, which provide motor fibers to the diaphragm and sensory branches to the pleura and pericardium. The irritation from the infarct area or ischemia may result in stimulation of these fibers and cause hiccups. In view of that, treating physicians shall consider extension of infarction to inferior wall if a patient with an otherwise stable MI develops hiccup. Missed MI remains one of the greatest sources of litigation against EP. Med America mutual malpractice cases suggest that EP must maintain high index of suspicion for acute coronary syndrome and always recognize the possibility of an atypical presentation.