Meltem Akkaş

Occurrence of pneumomediastinum due to dental procedures.

The occurrence of pneumomediastinum and massive subcutaneous emphysema due to dental procedures is quite rare. We present a case of pneumomediastinum and massive subcutaneous emphysema that occurred during third molar tooth extraction with air-turbine handpiece.

Elektrik çarpması yaralanması olan hastalarda kardiyak monitörizasyon

BACKGROUND The necessity of admitting patients exposed to electrocution injuries for monitoring and observation in the emergency department (ED) remains controversial. METHODS We evaluated the medical records of 102 patients (86 male, 16 female; median age 29.5; range 18 to 68 years) admitted to the adult ED with electrocution injuries over the past 20 years. RESULTS Only 9 deaths were reported: 3 as a result of contact with low-voltage electricity and 6 after contact with high-voltage electricity. With the exception of a case of sepsis, all deaths were related to early rhythm abnormalities immediately following the incident. The ECG findings of surviving patients in the study group were as follows: 70 normal, 8 sinus tachycardia, 3 sinus bradycardia, 4 ST-T wave changes, and 1 ventricular extrasystole. ECG recordings of 7 patients could not be found. 72 cases had been followed up with repeat ECG recordings. There were no observed ECG changes requiring any medical or electrical therapies in the surviving patients. CONCLUSION Cardiac rhythm abnormalities related to electrocution injuries are usually observed at the time of the incident. If the patients overall clinical condition is good and they have a normal ECG at the time of admission to the ED, the probability of observing any delayed serious dysrhythmia is unlikely.

Patient population and factors determining length of stay in adult ED of a Turkish University Medical Center

This study is designed to analyze retrospectively patients who present to adult emergency department (ED) from January 1, 2002, to February 28, 2002. Age, sex, presentation time to ED, length of stay in emergency service, consultations, the number of patients who need to be hospitalized and also the number of hospitalized patients, diagnosis categories, and discharge instructions are analyzed. It is found that patients in most admissions are at 21 to 25 years of age. At night, the number of visits is decreased. Hospitalizations could be done to only about half of patients who in fact should be hospitalized. There is a correlation between the length of stay of patients in emergency service and the number of consultations per patient. There is also a correlation between patient complexity and length of stay in emergency service. The ED overcrowding rises with increased visits and patients staying in ED who should be hospitalized.

Independent Factors for Prediction of Poor Outcomes in Patients with Febrile Neutropenia

Background Febrile neutropenia (FN) is a life-threatening condition that requires urgent management in the emergency department (ED). Recent progress in the treatment of neutropenic fever has underscored the importance of risk stratification. In this study, we aimed to determine independent factors for prediction of poor outcomes in patients with FN. Material/Methods We retrospectively evaluated 200 chemotherapy-induced febrile neutropenic patients who visited the ED. Upon arrival at the ED, clinical data, including sex, age, vital signs, underlying systemic diseases, laboratory test results, estimated GFR, blood cultures, CRP, radiologic examinations, and Multinational Association of Supportive Care in Cancer (MASCC) score of all febrile neutropenic patients were obtained. Outcomes were categorized as “poor” if serious complications during hospitalization, including death, occurred. Results The platelet count <50 000 cells/mm3 (OR 3.90, 95% CI 1.62–9.43), pulmonary infiltration (OR 3.45, 95% CI 1.48–8.07), hypoproteinemia <6 g/dl (OR 3.30, 95% CI 1.27–8.56), respiratory rate >24/min (OR 8.75, 95% CI 2.18–35.13), and MASCC score <21 (OR 9.20, 95% CI 3.98–21.26) were determined as independent risk factors for the prediction of death. The platelet count <50 000 cells/mm3 (OR 3.93, 95% CI 1.42–10.92), serum CRP >50 mg/dl (OR 3.80, 95% CI 1.68–8.61), hypoproteinemia (OR 7.81, 95% CI 3.43–17.78), eGFR ≤90 ML/min/1.73 m2 (OR 3.06, 95% CI 1.13–8.26), and MASCC score <21 (OR 3.45, 95% CI 1.53–7.79) were determined as independent risk factors for the prediction of poor clinical outcomes of FN patients. Platelet count, protein level, respiratory rate, pulmonary infiltration, CRP, MASCC score, and eGFR were shown to have a significant association with outcome. Conclusions The results of our study may help emergency medicine physicians to prevent serious complications with proper use of simple independent risk factors besides MASCC score.

Could Vital Signs Predict Carbon Monoxide Intoxication

OBJECTIVE: This retrospective study examined the correlation between carboxyhaemoglobin (COHb) levels and vital signs in patients with carbon monoxide (CO) intoxication. METHODS: Over a 10-year period, patients > 16 years of age who presented to the emergency department due to CO intoxication were included. Age, gender, comorbidities, month/year of presentation, presenting symptoms, vital signs, blood pH, COHb level, treatment and outcome were recorded. RESULTS: In total, 476 patients were included. The mean ± SD age was 36.22 ± 13.65 years; 96.4% of the patients had a normal Glasgow Coma Scale score, 91.0% had normal blood pressure and 80.0% had a normal heart rate. COHb levels were stratified into three groups: < 10% (n = 39), 10 – 20% (n = 106) and > 20% (n = 205); levels could not be obtained in the remaining 126 patients. In patients with COHb levels > 20%, 34 (16.6%) had alkalosis and nine (4.4%) had acidosis. Among patients with COHb levels > 20%, 140 (68.3%) had normal vital signs. CONCLUSIONS: Vital signs cannot be used as a prognostic marker of CO intoxication and, therefore, patients must be monitored closely.

The epidemiology and cost analysis of patients presented to Emergency Department following traffic accidents

Background Traffic accidents are ranked first as the cause of personal injury throughout the world. The high number of traffic accidents yielding injuries and fatalities makes them of great importance to Emergency Departments. Material/Methods Patients admitted to Hacettepe University Faculty of Medicine Adult Emergency Department due to traffic accidents were investigated epidemiologically. Differences between groups were evaluated by Kruskall-Wallis, Mann-Whitney, and Wilcoxon tests. A value of p<0.05 was accepted as statistically significant. Results We included 2003 patients over 16 years of age. The mean age was 39.6±16.1 and 55% were males. Admissions by ambulance and due to motor vehicle accidents were the most common. In 2004 the rate of traffic accidents (15.3%) was higher than the other years, the most common month was May (10.8%), and the most common time period was 6 pm to 12 am (midnight). About half of the patients (51.5%) were admitted in the first 30 minutes. Life-threatening condition was present in 9.6% of the patients. Head trauma was the most common type of trauma, with the rate of 18.3%. Mortality rate was 81.8%. The average length of hospital stay was 403 minutes (6.7 hours) and the average cost per patient was 983±4364 TL. Conclusions Further studies are needed to compare the cost found in this study with the mean cost for Turkey. However, the most important step to reduce the direct and indirect costs due to traffic accidents is the prevention of these accidents.

25-OH-Vitamin D and procalcitonin levels after correction of acute hyperglycemia

Background Hyperglycemia is a common complication of diabetes melitis (DM) and in the absence of metabolic decompensation is a common finding in the Emergency Department (ED). We aimed to evaluate the 25 OH Vit D [25(OH)D] and procalcitonin (PCT) levels during hyperglycemia and after normalization of blood glucose. Material/Methods The study included 88 patients over the age of 18 years who presented with acute hyperglycemia at the Hacettepe University Department of Emergency Medicine. Euglycemia was obtained within 6–12 hours and serum samples were taken from patients on admission and 6 hours after normalization of blood glucose. Along with plasma glucose, plasma 25(OH)D and PCT levels were measured using ELISA. Results There were 88 (45 males) patients, with a median age of 60.0±13.9 years. Serum 25(OH)D levels increased in all patients after normalization of blood glucose, and serum PCT levels decreased in the whole group. This decrease was independent of type of diabetes or presence of infection. Conclusions We demonstrated an increase in 25(OH)D after normalization of blood glucose, and a decrease in PCT in patients with hyperglycemia. This effect was independent of the type of diabetes and presence of infection. Further studies are needed to evaluate the faster link between metabolic abnormalities, vitamin D, PCT, and inflammation.

Tracheal rupture as a result of coughing

ABSTRACT Tracheal rupture is mostly traumatic or iatrogenic. A few cases of spontaneous tracheal rupture have been reported in literatüre and all of them have been described posterior membraneous wall which is the weakest portion of trachea. In most of such cases, predisposing factors that weaken the tracheal structure were present. We presented the first case of spontaneous anterolateral tracheal rupture as a result of coughing that caused no respiratory distress and that spontaneously recovered without any complications. A 24 year old male presented to the emergency department with sore throat. After eating chicken shawarma, the patient felt a lump in his throat and coughed. After coughing, a tearing like and severe pain developed at his necks front region radiating to his shoulders and back. On past medical history, the patient had no known diseases and had no history of use of medications. Physical examination findings were unremarkable except for neck tenderness. Pneumomediastinum, free air within the cervical fascias and a 4mm tracheal mural defect on the left anterolateral side at the level superior to the manubrium was observed in computerised tomography scan of neck and chest. The patient had no shortness of breath and therefore urgent surgery was not considered. Increase in free air was not seen in the control x‐rays 6 hours later. The patient with a foriegn nationality left the emergency at his own will. He was contacted one month later via telephone. The patient said that his neck pain subsided and had no other complaints.

Inferior mesenteric vein pylephlebitis due to sigmoid diverticulitis

A 55-year-old man was admitted to the emergency department, with high fever. Physical examination revealed a soft abdomen without any signs of peritoneal irritation and bowel sounds were normal. Laboratory tests revealed elevation of white cell count (11.5×103/mm3) and C reactive protein. Contrast-enhanced CT showed sigmoid colon diverticulosis and increasing stranding of fat tissue adjacent to the sigmoid colon, in keeping with diverticulitis (figure 1). In addition, complete thrombosis of the inferior mesenteric vein …