Selahattin Kiyan

Current status of emergency residency training programs in Turkey: after 14 years of experience.

Objective Emergency residency training programs, which have been developing in Turkey over the last 14 years, have been improving emergency health services by training each year a significant number of emergency medicine specialists. Sufficient data about these emergency residency training programs is not currently available. The purpose of this study is to determine (i) the structure of emergency residency training programs and (ii) trainer and resident views concerning these programs. Methods The data in this cross-sectional study was gathered by means of questionnaires. Three different forms of questionnaires were used for residents, trainers, and heads of departments. Results This study covers 20 emergency medicine departments and 261 physicians. It was determined that written rotational objectives have been indicated in 17 of the emergency medicine departments and log books are used in 16 departments. Although 60% of resident views on ‘practical skills’, 23% on ‘the contribution of rotations to the training’, and 44% on ‘the level of residency training programs’ were rated as ‘sufficient’, trainers indicated ‘sufficiency’ on these subjects as 78, 37, and 77%, respectively. Regarding theoretical and practical skills, residents and trainers, respectively rated as ‘sufficient’ following subjects: cardiovascular 74, 91%; neurology 68, 86%; resuscitation 83, 98%; trauma 76, 87%; orthopedics 56, 75%; pediatrics 16, 27%; and toxicology 63, 82%. Conclusion Most of the departments have developed the basic components for resident education. Residents and trainers frequently had different views on their own level of knowledge, practical skills, and the content of their training.

A rare diagnosis in emergency department: Spontaneous spinal epidural hematoma

We report a case of a 32-year-old man who presented to the emergency department (ED) with a sudden onset of paraplegia due to spontaneous spinal epidural hematoma. Although the patient had a poor neurological condition on presentation, he was successfully operated and discharged without any neurological sequel. Spontaneous spinal epidural hematoma is a rarely seen clinical entity, especially in the ED. Magnetic resonance imaging is the best choice for early diagnosis, and urgent surgical decompression is essential to prevent serious neurological deficits.

The effect of the use of ultrasound in the success of peripheral venous catheterisation

The aim of this study was to investigate the effect of ultrasound-guided peripheral venous catheterisation in patients where difficulty was experienced in peripheral venous catheterisation. The study was conducted in the emergency department at a university hospital in İzmir Turkey. After obtaining institutional review board approval and written informed consent, 60 patients with a history or suspicion of difficult cannulation were enrolled with 30 patients in traditional and 30 in ultrasound group. In the ultrasound group, peripheral intravenous catheterisation was performed using a portable ultrasound device with 13.5 MHz ultrasound probe and 20 gauge intravenous catheter. The success rate of peripheral venous catheterisation was 30% in the control group and 70% in the treatment group. The success rate was significantly higher among the treatment group. The mean intensity of felt pain was 6.00 ± 1.98 in the control group and 4.77 ± 1.74 in the treatment group. The mean intensity of felt pain was significantly lower in the treatment group. The state of chronic disease affected the success rate in patients in the treatment group.

Acute coronary syndrome mimicked by acute cholecystitis.

Various aetiologies have been reported that cause severe trauma segment and T‐wave abnormalities that are not related to acute coronary syndromes. However, the reports of transient ECG abnormalities associated with acute cholecystitis are limited in the literature. We describe a 42‐year‐old man presented with abdominal pain and hypertensive episode that developed dynamic ECG changes mimicking acute coronary syndrome and was diagnosed acute cholecystitis eventually. Emergency physicians should keep in mind dynamic T‐wave changes mimicking acute myocardial ischaemia in patients with acute cholecystitis.

The Effects of Oral Antibiotics on Infection Prophylaxis in Traumatic Wounds

BACKGROUND The objective of this study is to examine the effectiveness of oral antibiotics in the prevention of infection development in traumatic wounds. METHODS Forty Wistar albino rats were divided into five groups of eight animals. After the crushed wound model was made on the back of the rats, wounds were closed with a simple suture and Staphylococcus aureus ATCC 29213 strain was used to create infection. All rats apart from the controls were given oral gavage with antibiotics, including cephalexin, amoxicillin-clavulanate, clarithromycin (CAM), or levofloxacin for 5 days. Wounds were evaluated qualitatively and quantitatively on 5th day approximately 18 h after the last treatment. RESULTS In the quantitative evaluation, no infection was observed in the treatment groups with amoxicillin-clavulanate, CAM, cephalexin, or levofloxacin. There was no significant difference on the numbers of bacteria found in the wounds among the groups. In terms of quantitative inflammation findings, no hyperemia or pus was detected in the groups that were given medication. Furthermore, no statistically significant difference was found among the groups in terms of induration. CONCLUSION Oral prophylactic antibiotics have been found to be effective in the prevention of wound infection in the traumatic crushed wound model infected with S. aureus in rats.

The role of whole-body computed tomography in determining risky patient group with regard to polytrauma patients in the emergency department:

Backround: High rates in trauma-related mortality pose a major health problem and increase every day. Early diagnosis and treatment can be lifesavers for this patient group in the emergency departments, which serve as the first place to admit trauma patients in a hospital. Objectives: We aim to determine high-risk criteria to indicate trauma patients getting the most use from whole-body tomography in patients with multiple traumas and reduce unnecessary computed tomography. Methods: We examined retrospectively all electronic files and computed tomography results of patients, who had been admitted to emergency department due to trauma, and who had undergone whole-body computed tomography. Results: We found that possibility of multiple injuries increased by 5.9 times in patients requiring mechanical ventilation. Possibility of multiple injuries in patients with free fluid in the Focused Assessment with Sonography for Trauma increased by 5.6 times. We also observed that possibility of multiple injuries in patients with Glasgow Coma Score < 13 increased by 4.3 times. Possibility of multiple injuries in hypoxic patients increased by 3.2 times. Possibility of multiple injuries in patients with a pulse ≥ 120/min increased by 1.8 times. Possibility of multiple injuries in patients with shock index ≥ 0.9 increased by 1.7 times. Conclusion: High-risk group in terms of multiple traumas involves mechanical ventilation need in trauma patients, positive Focused Assessment with Sonography for Trauma, Glasgow Coma Score being under 13, hypoxia, tachycardia, positive shock index, and extravehicular traffic accidents. Whole-body computed tomography should be performed in this patient group.

Comparison of Conventional Radiography and Digital Computerized Radiography in Patients Presenting to Emergency Department

SUMMARY Objectives To compare the differences between conventional radiography and digital computerized radiography (CR) in patients presenting to the emergency department. Methods The study enrolled consecutive patients presenting to the emergency department who needed chest radiography. Quality score of the radiogram was assessed with visual analogue score (VAS-100 mm), measured in terms of millimeters and recorded at the end of study. Examination time, interpretation time, total time, and cost of radiograms were calculated. Results There were significant differences between conventional radiography and digital CR groups in terms of location unit (Care Unit, Trauma, Resuscitation), hour of presentation, diagnosis group, examination time, interpretation time, and examination quality. Examination times for conventional radiography and digital CR were 45.2 and 34.2 minutes, respectively. Interpretation times for conventional radiography and digital CR were 25.2 and 39.7 minutes, respectively. Mean radiography quality scores for conventional radiography and digital CR were 69.1 mm and 82.0 mm. Digital CR had a 1.05 TL cheaper cost per radiogram compared to conventional radiography. Conclusions Since interpretation of digital radiograms is performed via terminals inside the emergency department, the patient has to be left in order to interpret the digital radiograms, which prolongs interpretation times. We think that interpretation of digital radiograms with the help of a mobile device would eliminate these difficulties. Although the initial cost of setup of digital CR and PACS service is high at the emergency department, we think that Digital CR is more cost-effective than conventional radiography for emergency departments in the long-term.

Acute Hepatitis Associated with Thymus Vulgaris Oil Ingestion; Case Report

SUMMARY Many plants traditionally used in folkloric medicine can cause poisoning. Typically known as “thyme”, “Thymus Vulgaris” continues to be one of the most commonly used folkloric herbs in Turkey. Here, we report a case of toxic hepatitis due to the ingestion of concentrated thyme oil. The patient was reported to have ingested a total of 25 ml of thyme oil which was routinely sold in the local market. The total dose was taken in two consecutive days in different amount. The pa tient then developed nausea, vomiting and diarrhea, and he was subsequently admitted to the emergency unit, with high transaminase levels. He was placed on observation unit for two days. His elevated aminotransferase levels and symptoms gradually decreased during the observation period. Thyme, which is known to be a nonpoisonous plant, is one of the most commonly used herbs; however, plants similar to thyme are not necessarily as harmless as they seem to be.