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The significance of routine thoracic computed tomography in patients with blunt chest trauma

PURPOSE The purpose of this study is to investigate whether the use of thoracic computed tomography (TCT) as part of nonselective computed tomography (CT) guidelines is superior to selective CT during the diagnosis of blunt chest trauma. SUBJECTS AND METHODS This study was planned as a prospective cohort study, and it was conducted at the emergency department between 2013 and 2014. A total of 260 adult patients who did not meet the exclusion criteria were enrolled in the study. All patients were evaluated by an emergency physician, and their primary surveys were completed based on the Advanced Trauma Life Support (ATLS) principles. Based on the initial findings and ATLS recommendations, patients in whom thoracic CT was indicated were determined (selective CT group). Routine CTs were then performed on all patients. RESULTS Thoracic injuries were found in 97 (37.3%) patients following routine TCT. In 53 (20%) patients, thoracic injuries were found by selective CT. Routine TCT was able to detect chest injury in 44 (16%) patients for whom selective TCT would not otherwise be ordered based on the EP evaluation (nonselective TCT group). Five (2%) patients in this nonselective TCT group required tube thoracostomy, while there was no additional treatment provided for thoracic injuries in the remaining 39 (15%). CONCLUSION In conclusion, we found that the nonselective TCT method was superior to the selective TCT method in detecting thoracic injuries in patients with blunt trauma. Furthermore, we were able to demonstrate that the nonselective TCT method can change the course of patient management albeit at low rates.

Analyses of demographical and injury characteristics of adult and pediatric patients injured in Syrian civil war

Purpose: Aimed to analyze demographical data and injury characteristics of patients who were injured in the Syrian Civil War (SCW) and to define differences in injury characteristics between adult and pediatric patients. Methodology: Patients who were injured in the SCW and transferred to our emergency department were retrospectively analyzed in this study during the 15‐month period between July 2013 and October 2014. Results: During the study period, 1591 patients who were the victims of the SCW and admitted to our emergency department due to war injury enrolled in the study. Of these patients, 285 were children (18%). The median of the injury severity score was 16 (interquartile range [IQR]: 9–25) in all patients. The most frequent mechanism of injury was blunt trauma (899 cases, 55%), and the most frequently‐injured region of the body was the head (676 cases, 42.5%). Head injury rates among the childrens group were higher than those of the adult group (P < .001). In contrast, injury rates for the abdomen and extremities in the childrens group were lower than those in the adult group (P < .001, P < .001). Conclusion: The majority of patients were adults, and the most frequent mechanism of injury was blunt trauma. Similarly, the children were substantially affected by war. Although the injury severity score values and mortality rates of the child and adult groups were similar, it was determined that the number of head injuries was higher, but the number of abdomen and extremity injuries was lower in the childrens group than in the adult group.

Aşırı Miktarda Kayısı ve Muz Tüketimi Sonrası Ciddi Hiperkalemi: İki Olgu Sunumu ve Literatürün Gözden Geçirilmesi

Hyperkalemia is well-known sequela of consumption of diet rich in potassium. It has also been reported in patients who consume large amount of fruits or fruit juice. Disorders of plasma potassium can have profound effects, especially on cardiac function. A potentially life threatening hyperkalemia is described in two female patients who consumed excessive amount of apricot and banana. Despite emergent treatment for hyperkalemia was initiated, serum potassium levels remained high. Therefore hemodialysis was chosen as definitive treatment for these patients. Upon reviewing their food intake and medication history, their relatives stated patients have consumed excessive amount of apricot and banana for the past 10 days. Hidden source of potassium intake, such as apricot and banana, should not be overlooked, especially in patients presenting with catastrophic cardiac and neuromuscular effects.

Occipital Infarcts Presenting with Isolated Temporal Vision Loss: A Report of Two Cases and Review of the Literature

Erişkinlerde en sık 3. ölüm nedeni olmakla birlikte, serebrovasküler hastalık en sık iş göremezlik sebebidir. Görme alanı defektleri oksipital lob enfarktlarının en önemli nörolojik sekelidir. İnme, homonim hemianopsilerin en sık sebebi olmakla birlikte inmeli hastalarda homonim hemianopsi %10 dolayında görünmektedir. Şaşırtıcı olarak bu hastaların büyük bir kısmı görme alanı problemlerinin farkında değildirler ve halen araç kullanmaya devam ederler. Literatürde temporal hemianopsi ile ilgili sadece yer yer olgu sunumu yapılmıştır. Bu yazıda, oksipital lob enfarktı sonucu izole temporal hemianopsiyle başvuran 47 ve 65 yaşında iki erkek hasta sunuldu.

Acil Servise Başvuran Doğurganlık Yaş Grubu Kadınlardan İstenilen β-HCG Testinin Pozitifliğinin Araştırılması

Amac: Bu calismayla acil servise basvuran dogurganlik yas grubu (15-49 yas) kadinlardan istenilen β-HCG testinin pozitifliginin arastirilmasi amaclanmistir. Gerec ve Yontem: Arastirmanin orneklemini 01-30.04.2014 tarihleri arasinda herhangi bir hastalik nedeniyle Ankara Egitim ve Arastirma Hastanesi Acil Tip Klinigi Eriskin Acil Servisine basvuran, gebe olmayan ve tetkikleri icerisinde β-HCG istemi olan 15-49 yas arasindaki tum kadinlar olusturmustur. Calisma retrospektif tipte bir arastirmadir. Veri kaynagi olarak olgularin yas, saglik guvencesi, tani, tedavi sonucu ve β-HCG sonucunun yer aldigi onceden hazirlanan veri formu kullanilmistir. Bulgular SPSS 15.0 programi kullanilarak degerlendirilmistir. Bulgular: Arastirmamizda olgularin %46.8’inin 20-29 yas araliginda bulundugu, %95.8’inin saglik guvencesinin bulundugu, %98.6’sinin dahili sikayetlerle basvurdugu, %53.5’inin karin agrisi on tanisiyla tedavi edildigi ve %94’unun taburcu oldugu saptanmistir. Acil servise bir ay icerisinde basvuran dogurganlik cagindaki toplam 8208 kadin hastanin %11.6’sindan β-HCG tetkiki istenmis ve bunlarin sadece %4.6’sinin pozitif olarak sonuclandigi belirlenmistir. Sonuc: β-HCG’nin acil servislerde daha secici hasta gruplarinda kullanilabilmesi ve maliyetin azaltilabilmesi icin; fizik muayeneden elde edilecek bulgular ile ayrintili ve etkin anamnez alinmasinin bu istem sayisinin azalmasina yapabilecegi katkinin daha genis katilimli prospektif calismalarla degerlendirilmesi gerektigi dusunulmektedir. Anahtar Kelimeler: Acil Servis, anamnez, kadin, karin agrisi, β-HCG

Anaphylaxis after intravenous infusion of dexketoprofen trometamol.

Dexketoprofen trometamol (DT), a nonsteroidal anti-inflammatory drug, is a highly water-soluble salt and active enantiomer of rac-ketoprofen. Its parenteral form is commonly used for acute pain management in emergency departments of our country. Side effects such as diarrhea, indigestion, nausea, stomach pain, and vomiting may be seen after the use of DT. Anaphylactic shock (AS) secondary to infusion of DT is very rare and, to our knowledge, it is the first case report describing this side effect. This case report was presented to emphasize that AS may be seen after the use of DT.

Greater weever fish: A case of poisoning with sea creatures far away from the sea.

SUMMARY Trachinus Draco, known as greater weever fish, probably seen more frequently than has been reported. However, only a few clinical cases have been reported in the literature that describes Trachinus species envenomation. Here, we presented a case poisoned by a weever fish and tried to describe the signs/symptoms and treatment modalities of the weever fish envenomation and also tried to emphasize poisonings that could be far from the sea with dead sea creatures. OZET