Serpil Yaylaci

Are YouTube videos accurate and reliable on basic life support and cardiopulmonary resuscitation

The objective of this study is to investigate reliability and accuracy of the information on YouTube videos related to CPR and BLS in accord with 2010 CPR guidelines.

Agreement between axillary, tympanic, and mid-forehead body temperature measurements in adult emergency department patients.

Objective To assess the agreement between noncontact infrared thermometer (noncontact) with infrared tympanic thermometer (tympanic) and electronic axillary thermometer (axillary) in an adult emergency department population. Materials and methods This is a single-center, cross-sectional, prospective trial carried out in a Joint Commission accredited private hospital in Turkiye. All consecutive patients above 16 years were included in the study. The agreements between three methods were analyzed by Bland–Altman analysis with MedCalc 11.0.4 statistical software. Results Body temperatures were measured on 400 patients (48% were men, mean 35.9±17.3°C). Mean noncontact, tympanic, and axillary measurements (±SD) were 37.22±1.03, 36.72±0.95, and 36.91±0.96°C, respectively, whereas Intraclass Correlation Coefficient of all measurements was 0.892 (95% confidence interval 0.821–0.929). Binary comparisons between body temperature measurements produced mean differences &Dgr; axillary−tympanic, &Dgr; axillary−noncontact, and &Dgr; tympanic−noncontact as 0.5±0.63, 0.2±0.71, and 0.31±0.61°C, respectively. However, the agreement limits for axillary and noncontact was between −1.2 and 1.6°C; −1.74 and 0.74°C for tympanic and noncontact, and −1.52 and 0.9°C for tympanic and noncontact. Conclusion There is a lack of agreement between body temperature measurements by noncontact, tympanic, and axillary in the adult emergency department population. The easy application may lead noncontact to be the preferable method for healthcare providers but large agreement limits should be considered.

Effect of harmless acute pancreatitis score, red cell distribution width and neutrophil/lymphocyte ratio on the mortality of patients with nontraumatic acute pancreatitis at the emergency department.

BACKGROUND Harmless acute pancreatitis score (HAPS), neutrophile/lymphocyte ratio and red blood cell distribution width (RDW) are used to determine the early prognosis of patients diagnosed with nontraumatic acute pancreatitis in the emergency department (ED). METHODS Patients diagnosed with acute pancreatitis (K 85.9) in the ED according to the ICD10 coding during one year were included in the study. Patients with chronic pancreatitis and those who had missing data in their files were excluded from the study. Patients who did not have computed tomography (CT) in the ED were not included in the study. RESULTS Ultimately, 322 patients were included in the study. The median age of the patients was 53.1 (IQR=36-64). Of the patients, 68.1% (n=226) had etiological causes of the biliary tract. The mortality rate of these patients within the first 48 hours was 4.3% (n=14). In the logistic regression analysis performed by using Balthazar classification, HAPS score, RDW, neutrophile/lymphocyte ratio, age, diabetes mellitus and systolic blood pressure, the only independent variable in determining mortality was assigned as Balthazar classification (OR: 15; 95% CI: 3.5 to 64.4). CONCLUSIONS HAPS, neutrophile/lymphocyte ratio and RDW were not effective in determining the mortality of nontraumatic acute pancreatitis cases within the first 48 hours. The only independent variable for determining the mortality was Balthazar classification.

A strategy to optimize CT use in children with mild blunt head trauma utilizing clinical risk stratification; Could we improve CT use in children with mild head injury?

AIM The purpose of our study was to investigate the impact of clinical risk classification on optimization of the rationale of CT scanning in children with mild blunt head trauma. Exposed effective radiation dose values of CT scanning were also evaluated. METHODS Children with isolated pediatric mild head trauma admitted in a single center over a 5-year period (n=3102, >2 years and <16 years of age) were retrospectively reviewed. The study group comprised 806 patients with a mean age of 7.4±2.1 years (range, 2-15 years). The patients were categorized into low and high risk groups with regard to presence of predefined signs and symptoms. Effective radiation dose values were calculated. RESULTS Incidences of the pathologic CT findings related to trauma were significantly different between low (n=10) 1.9% and high (n=90) 29.8% risk groups. Certain predefined signs and symptoms (e.g., vomiting, suspected skull fracture and loss of consciousness) were related significantly with pathologic CT findings attributed to trauma. Estimated mean effective dose values were 3.91±0.38mSv for 2-6 year old (n=557), and 3.33±0.12mSv for 7-16 year old patients (n=349). CONCLUSION The pediatric victims of mild head trauma patients within high risk group and those with vomiting, suspected skull fracture and loss of consciousness should undergo head CT scanning. The manufacturer settings on the CT scanners for children should be revised to alleviate untoward radiation exposure.

What do we miss without contrast in patients with flank pain

Flank pain is a common complaint in the emergency department, and the most frequent cause of flank pain is urolithiasis. Spontaneous renal artery dissection and renal artery thrombosis are rare causes of abdominal pain which can result in renal parenchymal injury. They are mostly difficult to diagnose and treat in the emergency setting. The present report describes 2 patients admitted to the emergency department because of acute flank pain who were diagnosed with renal infarction.

Work-related injuries among emergency medical technicians in western Turkey

OBJECTIVES Emergency medical technicians (EMTs) and paramedics are at serious risk for work-related injuries (WRIs) during work hours. Both EMTs and paramedics have higher WRI rates, according to the literature data. This study was designed to investigate causes and characteristics of WRIs involving EMTs and paramedics staffed in Western Turkey. METHODS All health care personnel staffed in Emergency Medical Services (EMS) in the city were interviewed face-to-face in their off-duty hours to inform them about the study. Excluded from the study were those who declined to participate in the study, those who were not on duty during the two-month study period, and those who had been working in the EMS for less than one year. The subjects were asked to answer multiple-choice questions. RESULTS A total of 163 personnel (117 EMTs and 46 paramedics) comprised the study sample. Eighty-three personnel (50.9%) were female and mean age was 29.7 years (SD=8.4 years). The most common mechanisms of WRI, as reported by the personnel, were motor vehicle accidents (MVAs; 31.9%), needlestick injuries (16.0%), ocular exposure to bodily fluids (15.4%), and sharp injuries (9.8%), respectively. Needlestick injuries commonly occurred during intravenous line procedures (59.4%) and inside the cruising ambulance (n=20; 62.5%). Working inside the cruising ambulance was the most commonly accused cause of the WRI (41.3%). CONCLUSION Paramedic personnel and EMTs are under high risk of WRI. Motor vehicle accidents and needlestick injuries were the most common causes of WRI. Strict measures need to be taken to restructure the interior design to protect personnel from all kinds of WRIs. Yilmaz A , Serinken M , Dal O , Yaylacı S , Karcioglu O . Work-related injuries among emergency medical technicians in Western Turkey. Prehosp Disaster Med. 2016;31(5):505-508.

Self-Cannibalism: The Man Who Eats Himself

Self-mutilation is a general term for a variety of forms of intentional self-harm without the wish to die. Although there have been many reports of self-mutilation injuries in the literature, none have reported self-cannibalism after self-mutilation. In this article we present a patient with self-cannibalism following self-mutilation. A 34-year-old male patient was brought to the emergency department from the prison with a laceration on the right leg. Physical examination revealed a well-demarcated rectangular soft tissue defect on his right thigh. The prison authorities stated that the prisoner had cut his thigh with a knife and had eaten the flesh.

MİNÖR TRAVMAYA İKİNCİL GELİŞEN SOL KAROTİD VE BİLATERAL VERTEBRAL ARTER DİSEKSİYONU OLGUSU

Servikal arter diseksiyonu, genc hastalarda nonateroskelerotik inmenin en sik nedenidir. Bu hastalar siklikla bas ve boyun agrisi sikayeti ile basvururlar. En sik rastlanan neden minor travmadir. Servikal arter diseksiyonu hem anterior hem posterior sistemi etkileyebilir, sonrasinda kalici veya gecici norolojik bulgulara neden olabilir. Bu yazida 34 yasinda, bas ve boyun agrisi sikayeti ile basvuran ve yapilan radyolojik incelemeler sonucu bilateral vertebral arter ve sol internal karotid arter olmak uzere ekstrakranyal uc damarda diseksiyon saptanan olgu sunulmaktadir. Acil hekimleri acisindan periyodik bas agrisi oykusu olan genc olgularda hastanin daha once yasadigi agrinin basvuru sirasindaki agri ile benzer ozellikte olup olmadiginin ve major/minor travma oykusunun sorgulanmasi; servikal arter diseksiyonu on tanisinin akla gelmesi ve gerekli radyolojik incelemelerin planlanmasi acisindan kritik oneme sahiptir.

Handlebar Trauma Causing Small Bowel Hernia with Jejunal Perforation

An 11-year-old boy was admitted to emergency department with abdominal pain, bilious vomiting and rectal bleeding one day after falling from bicycle. He stated that he landed directly onto the handlebar through his left lower quadrant of the abdomen. Physical examination revealed a soft tissue bulge, tenderness and defense in the left lower quadrant without any head or skeletal injury. His abdomen was soft with no evidence of peritoneal irritation. The patient’s vital signs, radiographs and blood tests (hemoglobin, 14.4 g/dl; hematocrit, 43.0%; wight blood cell count, 6×103/mm3; C-reactive protein, 10 mg/dl; Sodium (Na), 130 mmol/L) were within normal limits. Ultrasound demonstrated intra-abdominal fluid and herniation of a small bowel loop through the abdominal wall at left lower quadrant. Computed tomography (CT) of the abdomen revealed the herniation of jejunal loop through a defect in the left lower abdominal wall just lateral to the rectus muscle, segmental ileus due to the herniated bowel segment, intraperitoneal fluid and pneumoperitoneum (Figure). Based on these findings, the patient was referred to pediatric surgery service with the diagnosis of intestinal perforation and abdominal wall hernia. Surgical exploration of the injured area demonstrated the disruption of all layers of the abdominal wall, and perforation of the jejunum at 110 cm distal to Trietz ligament. The postoperative period was uneventful. Figure A Axial computed tomography demonstrates the anterior abdominal wall defect and the herniated small bowel segment (arrow) with segmental ileus presented as dilatation of small bowel (*). B. Pneumoperitoneum (arrows) and free peritoneal fluid around the ... Abdominal wall hernia and related visceral organ injuries should be considered following blunt abdominal trauma. In our case, high velocity impact by handlebar was able to disrupt abdominal muscle and fascia. In most handlebar hernias, the defect is in the lower abdominal wall and can be associated with intra-abdominal injury.1,2 Injuries to the small bowel may occur secondary to high impact blunt trauma in a variety of deceleration mechanisms such as high-speed motor vehicle crashes, handlebar injuries, and falls.3 Diagnosis is often delayed because there is usually no associated major blood loss. The small intestine is the most common site of perforation, and peritoneal irritation may not be evident initially. Plain radiograph is also unreliable in diagnosis.4 CT is useful to differentiate hernia and its content, to define the anatomy of disrupted abdominal wall layers, and to detect associated injuries accurately and surgery is the eventual management of these patients.

Carotid Artery Dissection with Minor Trauma And Minor Symptoms

Introduction: Traumatic carotid artery dissection is a rare but signifi cant cause of ischemic stroke in young population. The delay in the diagnosis may lead to life long morbidity or even death. Symptoms may be delayed to several weeks. We are presenting a case with right internal carotid artery dissection after a low velocity motor vehicle accident with minor nonspecific symptoms. Case: 31 year old woman came to the emergency room on foot, two hours after having a low velocity motor vehicle accident. She did not have any specific complaint. She described hyperextension-flexion in jury and there was no direct trauma to head and neck. She had mild tenderness over right cervical paravertebral muscles. Systemic and neurological examination was normal. Cranial and Cervical CT scans were normal. CT angiography revealed dissection of the right internal carotid artery. No complication was observed after anticoagulation. Discussion/Conclusion: Carotid artery dissection may not always fulfill the screening criteria for blunt cerebrovascular injury. Emergency physicians should be suspicious about the vascular pathologies for all head and neck injuries. The most important clue is the injury mechanism. Detailed history must be obtained and patients should be asked in terms of transient symptoms.