Yahya Ayhan Acar

Can mainstream end-tidal carbon dioxide measurement accurately predict the arterial carbon dioxide level of patients with acute dyspnea in ED.

OBJECTIVE This study was designed to determine whether the mainstream end-tidal carbon dioxide (ETCO2) measurement can accurately predict the partial arterial carbon dioxide (Paco2) level of patients presented to emergency department (ED) with acute dyspnea. METHODS This prospective, observational study was conducted at a university hospital ED, which serves more than 110 000 patients annually. Nonintubated adult patients presented with acute dyspnea who required arterial blood gas analysis were recruited in the study for a 6-month period between January and July 2010. Patients were asked to breathe through an airway adapter attached to the mainstream capnometer. Arterial blood gas samples were obtained simultaneously. RESULTS We included 162 patients during the study period. The mean ETCO2 level was 39.47 ± 10.84 mm Hg (minimum, 19 mm Hg; maximum, 82 mm Hg), and mean Paco2 level was 38.95 ± 12.27 mm Hg (minimum, 16 mm Hg; maximum, 94 mm Hg). There was a positive, strong, statistically significant correlation between ETCO2 and Paco2 (r = 0.911, P < .001). The Bland-Altman plot shows the mean bias ± SD between ETCO2 and Paco2 as 0.5 ± 5 mm Hg (95% confidence interval, -1.3165-0.2680) and the limits of agreement as -10.5 and +9.5 mm Hg. Eighty percent (n = 129) of the ETCO2 measurements were between the range of ±5 mm Hg. CONCLUSION Mainstream ETCO2 measurement accurately predicts the arterial Paco2 of patients presented to ED with acute dyspnea. Further studies comparing mainstream and sidestream methods in these patients are required.

A life-threatening complication of warfarin therapy in ED: diffuse alveolar hemorrhage.

Warfarin have some serious adverse effects, and bleeding is one of the most serious and frequent of them. In this case report, we present the diffuse alveolar hemorrhage case as a rare and life-threatening complication of warfarin.

Acute Psychotic Symptoms due to Benzydamine Hydrochloride Abuse with Alcohol

Benzydamine hydrochloride is a locally acting nonsteroidal anti-inflammatory drug. Benzydamine hydrochloride overdose can cause stimulation of central nervous system, hallucinations, and psychosis. We presented a young man with psychotic symptoms due to benzydamine hydrochloride abuse. He received a total dose of 1000 mg benzydamine hydrochloride with alcohol for its hallucinative effects. Misuse of benzydamine hydrochloride must be considered in differential diagnosis of first-episode psychosis and physicians should consider possibility of abuse in prescribing.

Hypertriglyceridemia induced pancreatitis (chylomicronemia syndrome) treated with supportive care.

Hypertriglyceridemia is a rare cause of pancreatitis. In treatment pancreatic rest, lifestyle changes, medications (fibrates, n-3 polyunsaturated fatty acids, and nicotinic acid) are essential. Many experimental treatment modalities have been reported as insulin and heparin infusion and plasmapheresis. In this study we present the hypertriglyceridemia-induced pancreatitis treated with supportive care.

Transpulmonary hypothermia with cooled oxygen inhalation

We read the article of Kumar et al. titled “Transpulmonary ypothermia: a novel method of rapid brain cooling through augented heat extraction from the lungs” in article in press section f your journal.1 In this experimental study, Kumar et al. reported hat they had managed to reach to the target brain temperature 32 ◦C) in 90 min using cooled helium–oxygen mixture (heliox) and erfluorocarbon aerosol in a pig model. In this correspondence we imed to share our preliminary results, and discuss which gas or as combination should be used in transpulmonary hypothermia nd if there is a side effect of this technique to any organ or system. In this preliminary study we tested the idea which is hypothsized and published by us previously that whether just cooled xygen inhalation can maintain hypothermia in a short period of ime.2 In preliminary study we obtained ethical approval from thical committee of Bagcilar Education and Training Hospital. ix rats were given general anesthesia with ketamine–xylazine 50–10 mg/kg) combination and ventilated with 100% oxygen 10 L/min) which is standardized at the temperature of 14 ± 2 ◦C. ooling the oxygen was enabled by a novel device which was develped especially for this study and temperature standardized by eat sensors. We were able to continue hypothermia below 34 ◦C or 1-h without additional hypothermia technique. Then the cooled xygen inhalation was stopped and rats were rewarmed to initial ectal temperature levels in room temperature without any addiional rewarming technique. Our preliminary results showed that it s possible to reach to the targeted rectal temperature (34 ◦C) with ust cooled 100% oxygen inhalation in 22 ± 4 min. In histopathologic xamination, trachea, lungs, kidneys, brain, and liver did not show ny pathologic changes. Just serum amylase levels were elevated ut other routine biochemical parameters were in normal ranges. We wonder whether Kumar et al. have tried cooled 100% oxyen inhalation in any phase of their study, and whether they have tudied biochemical parameters.

Retrospective Analysis of Patients admitted to Emergency Dental Clinic of a Secondary Care Public Hospital in Turkey

Background: This study aims to evaluate dental emergency visits in a public hospital as the number of dental emergency visits has recently increased. Materials and methods: This was a retrospective observational study. This study was approved by the local ethical committee and data were recorded from the dental emergency service record book between January 1, 2012, and December 31, 2013. Results: In total, 1,477 (4.01%) patients were admitted to emergency dentist services. Mean age was 24.59 ± 11.07 (min– max: 2–76) and 978 (66.2%) patients were between 19 and 35 years old. The most common diagnosis was pulpitis or periapical abscess (n = 1033, 69.9%) and the most common practice was the prescription of antibiotics and/or analgesics (n = 885, 59.9%). Conclusion: The latest increase in the number of dental emergency visits is a burden, and emergency physicians must be capable of differentiating the real emergencies from common uncomplicated complaints.

Transpulmonary Hypothermia with Cooled Oxygen Inhalation Shows Promising Results as a Novel Hypothermia Technique

Background: Therapeutic hypothermia was showed to improve neurologic outcome but current therapeutic hypothermia techniques have limitations. Novel techniques such as transpulmonary hypothermia with cooled oxygen inhalation may be beneficial. Aims: To evaluate the performance of transthoracic hypothermia with cooled medical oxygen inhalation as a therapeutic hypothermia method. Study Design: Animal experimentation. Methods: A total of 36 adult male Wistar-Hannover rats were used in this research. Rats were randomised into four groups: group 1, Cooled oxygen group; group 2, IV cold fluid group; group 3, Surface cooling group; group 4, control group. No hypothermia method was applied in the control group. Hypothermia techniques were administered in the other three groups until the targeted core temperature was maintained. The target temperature was continued for one hour at 32-34 °C. After that, rats were heated up with hot blankets. Once the rectal temperature reached 38 °C, rats were euthanised. The main outcomes were the rate of temperature decrease (°C per minute) (S) and the time required to reach the target body temperature (T). Results: All rats survived the study protocol. When compared to the control group, T and S values were better in the cooled medical oxygen inhalation group (p<0.001). The IV cold fluid group had lower S values and higher T values compared to the cooled oxygen group (p<0.001, and p=0.003, respectively). There was no meaningful pathology in the histological samples in any group. Conclusion: As an easy-to-use and inexpensive method, cooled oxygen inhalation may be a beneficial hypothermia technique.

Systematic Analysis of Theses in the Field of Emergency Medicine in Turkey.

SUMMARY Objectives The aim of this study is to systematically evaluate the theses in the field of emergency medicine in Turkey and to determine whether they were published as a scientific paper. Methods This is a retrospective observational study. Theses in the field of emergency medicine between 1998 and 2013 were browsed from the internet database of National Thesis Center (Council of Higher Education). Study type, both if it was in the field of emergency, or if it was published and the journals scope of published studies were assessed and recorded in the study chart. Results 579 theses were included in the study. 27.1% of them were published and 14.9% of them were published in SCI/SCI-E journals. Advisors of theses were emergency medicine specialists in 67.6% of theses and 493 (85.1%) of them were in the field of emergency medicine. 77.4% of theses were observational and 20.9% were experimental study. Most of the experimental studies (72.7%, n=88) were animal studies. Conclusions It was concluded that very few theses in the field of emergency medicine were published in journals that were indexed in SCI/SCI-E.

Warfarin doz aşımına bağlı oluşan kanamalar

li komplikasyonlar nedeniyle acil servisten yogun bakima yatirilan olgularin analizi. Turk J Emerg Med 2011;11:9-12 2. Denizbasi A, Unluer EE, Guneysel O, et al. Complications of

Evaluating the Diagnostic Value of Three Early Cardiac Markers (Myoglobin, IMA and Copeptin) in STEMI patients

1Van Asker Hastanesi, Acil Servisi, Van; 2Bağcılar Eğitim ve Araştırma Hastanesi, Acil Servisi, İstanbul; 3Etimesgut Asker Hastanesi, Acil Servisi, Ankara; 4Dr. İ. Şevki Atasagun Nevşehir Devlet Hastanesi, Biyokimya Bölümü, Nevşehir; 5Gülhane Askeri Tıp Akademisi, Acil Tıp Anabillim Dalı, Ankara Erdem ÇEVİK,1 Banu KARAKUŞ YILMAZ,2 Yahya Ayhan ACAR,3 Aylin HAKLIGÖR,4 Orhan ÇINAR5 Bazı Erken Kardiyak Belirteçlerin (Miyoglobin, İMA ve Copeptin) Tanısal Performansının STYME Hastalarında Değerlendirilmesi