Yusuf Yürümez

Electrocardiographic Findings of Acute Organophosphate Poisoning

In this study, we evaluated 85 patients who presented to our Emergency Department with organophosphate (OP) poisoning and discuss their associated electrocardiographic (ECG) abnormalities. Over a period of 3 years, 85 patients with OP poisoning were included in this retrospective study. ECG analysis included the rate, rhythm, ST-T abnormalities, conduction defects, and measurement of PR and QT intervals. The mean age was 32.2 +/- 14.9 years. Sixty percent of the patients were female. The mean corrected QT interval (QTc interval) was 0.435 +/- 0.052 s. Prolongation of the QTc interval (55.5%) was the most common ECG abnormality, followed by sinus tachycardia (31.8%). Elevation of the ST segment and low amplitude T waves were seen in 15 cases (17.6%). Patients with OP poisoning might reveal ECG abnormalities such as QTc interval prolongation or non-specific ST-T changes. QTc interval prolongation cannot be used as a unique predictive factor in determining short-term prognosis in OP poisoning. We found no clear relation between OP poisoning-related malignant ventricular dysrhythmia and QTc interval.

Bleeding due to a medicinal leech bite

This paper reports a case of prolonged bleeding following application of leeches to treat chronic pain. The paper discusses the characteristics of the wounds and possible complication of prolonged bleeding following medicinal leech application. The principles of treatment are also described.

Adult burn injuries in an Emergency Department in Central Anatolia, Turkey: a 5-year analysis

PURPOSE Burn injuries require a multidisciplinary approach. Emergency Departments can play vital roles in the treatment of burns. The purpose of this study is to investigate the epidemiological and clinical characteristics of the adult burn patients admitted to our Emergency Department and to determine the frequency of the patients who were treated on an outpatient basis and discharged from the Emergency Department. PROCEDURE A retrospective review of 314 adult burn patients who presented to the Emergency Medicine Department of Erciyes University Hospital from January 1996 to December 2000. FINDINGS Sixty-four percent of the patients were male. Mean age was 32.9+/-14.7. Ninety-nine patients (32%) had moderate to major burns. The highest numbers of patients were in the 21-30 age group. Flame burns comprised the majority of presentations and admissions (48 and 69%, respectively). Thirteen patients had associated injuries (4%). Eighty-seven patients (28%) were hospitalized, 21 of these died. Death occurred mostly from respiratory failure and sepsis. Domestic accidents were the leading mechanism (63%). CONCLUSION Burns were mostly due to accidents arising from carelessness, ignorance, hazardous traditions and improperly manufactured products. These can be prevented through mass education programs countrywide. Because almost all burn patients present to Emergency Departments first and not all hospitals can employ burn specialists, the patients with minor burns can be treated on an outpatient basis and the treatment of severe burns can be effectively initiated by emergency physicians.

Bedside Sonography in Emergency Departments in Turkey

Emergency departments in Turkey have been steadily improving their services since emergency medicine began as a specialty over 12 years ago, but bedside ultrasound (US) has not been implemented widely. In order to learn the extent of ultrasound usage and training opportunities, a 27-question survey was distributed to emergency medicine-trained physicians working in emergency departments at ten university hospitals (the busiest one in each geographical region, plus three others), which are referral centres covering over half of the countrys population. Eight of the ten EM departments had an ultrasound machine in their ED (for a mean of 3·7 years), but the machines were used and controlled by the Department of EM in only four of the centres. While EM physicians knew how to perform US in seven centres, they routinely performed US themselves in only five. Of the 173 EM staff in the centres surveyed, 57 performed bedside US, and 28 possessed an US course certificate. All respondents wanted their EM residents to have formal US training, but such a rotation was present in only five centres. Bedside US was being performed in the following clinical situations: trauma (n=7), abdominal pain (n=7), renal colic (n=5), chest pain (n=3), assist to invasive procedures (n=3), locating subcutaneous foreign bodies (n=3), and dyspnea (n=1). Five departments had no form or system for documenting their US findings, and if finding anything suspicious, always sent the patients to radiology to have the US repeated. The mean duration from request-to-radiology-for-US to report-in-EM-physicians-hands was 47 minutes. Bedside US is performed by EM physicians in only half of the academic centers we surveyed. Documentation is absent in many, thus the quality or impact of this practice would be difficult, if not impossible, to determine. Formal educational programs are desired by all, but have yet to be implemented in half of the centres. Given the many benefits to patients of bedside US, diligent efforts still need to be made to improve this service in academic emergency departments in Turkey.

Afyonkarahisar ilindeki Atesli Silah Yaralanmalanna Baglı Olümlerin Degerlendirllmesi

Amac: Bu calismada; Afyonkarahisar ilindeki atesli silah yaralanmasina bagli olumler analiz edilerek, atesli silah yaralanmasina bagli olumlerin sosyodemografik ve klinik ozelliklerinin degerlendirilmesi ve yapilan benzer calismalar ile karsilastirilarak tartisilmasi amaclandi. Gerec ve Yontem: Afyonkarahisar il merkezinde, 1997— 2004 yillari arasindaki sekiz yillik donemde olumu adli sorusturmaya konu olan 923 olgudan, olumun atesli silah yaralanmasi sonucu meydana geldigi belirlenen 90 olgunun kesif, olu muayene tutanaklari ile otopsi raporlari incelenmistir. Bulgular: Toplam 923 adli olum olgusunun 90’1 (%9.7) atesli silah yaralanmasina bagli olum olgusu idi. 90 olgunun 79’u (%87.8) erkek ve olgularin yas ortalamasi 33.453: (en kucuk: 9- en buyuk: 69) idi. Olgularin en sik 26 olgu (%28.9) ile 21-30 yas grubunda goruldugu belir— lendi. 56 olgunun (%62.2) cinayet orijinli oldugu ve bun— larin 51’inin (%91.1) erkek oldugu belirlendi. 32 olgu (%35.5) intihar orjiiili olup, bunlarin 26’si (% 81.2) erkek idi. En sik kullanilan silah tipinin 48 olgu (%53.3) ile yivli silah (tabanca) oldugu belirlendi. Olgularin dis muayenesinde tespit edilen oldurucu atesli silah yaralarinin, en sik bas-boyun (%51.1) bolgesinde oldugu saptandi. Olgularin 70’inde (%77.8) olumun olay yerinde meydana geldigi belirlendi. Toplam 78 olguda (%86.7) otopsi yapildigi tespit edildi. Sonuc: Atesli silah yaralanmalarinin halen basta gelen olum nedenleri arasinda oldugu, yaralanmalarin daha cok cinayet orjinli oldugu ve en fazla genc erkek nufusun etkilendigi gorulmustur

Myocardial contusion and multiple pseudocysts at lung without rib fracture.

For reprint information contact: Hidir Esme, MD Tel: 90 533 647 1729 Fax: 90 272 217 2029 Email: hesme@aku.edu.tr Department of Thoracic Surgery, Faculty of Medicine, Afyon Kocatepe University, Pembe Hastane, Afyon 03200, Turkey. An 8-year-old boy was admitted to the emergency department because of run over on his chest by a trailer of tractor. Chest X-Ray revealed Figure 1. Opacities and cavitary lesions in right lower lung zone without rib fracture.