Background and Aim: Distal radius fractures are the most frequent upper extremity fractures in the whole population. The incidence of distal radius fractures is 195.2/100,000, and the rate is increasing. It can occur with low-energy trauma in the elderly associated with osteoporosis. The purpose of this study is to compare the two different treatment groups (1. Sedation analgesia, 2. Supracondylar radial nerve block) in terms of reduction in Visual Analogue Scale (VAS) score, the length of hospital stay, complications, side effects, patient-physician satisfaction, and the ease of application. Materials and Methods: Patients diagnosed with distal radius fracture were enrolled prospectively, to whom the study's exclusion criteria do not apply. The patients included in the study were randomly separated into two groups. Ketofol was administered to the sedation and analgesia group's patients at a dose of 0.5 mg/kg (ketamine 0.5 mg/kg, propofol 0.5 mg/kg) intravenously, and supracondylar radial nerve block was performed on the other group's patients under ultrasound guidance. Results: There were 20 patients (6 male, 14 female) in the sedation and analgesia group and 21 patients (11 male, 10 female) in the supracondylar radial nerve block group. There was no significant difference between the groups regarding patient-physician satisfaction and complications. The length of hospital stay was significantly shorter in the supracondylar radial nerve block group (49.25 ± 4.05) compared with the sedation and analgesia group (125 ± 5.85) (p < 0.01). The mean reduction VAS score in the block group was observed to be lower than the admission VAS score (p < 0.01). Conclusion: Consequently, ultrasound-guided supracondylar radial nerve block would be a valuable alternative to procedural sedation analgesia and could become routine clinical practice in treating distal radius fractures.

BACKGROUNDThis study was designed to compare the effects of resuscitation with cold and warm fluid on survival time, rate and volume of hemorrhage, hemodynamics, hypothermia, coagulopathy, acid-base balance, hematocrit, lactate, and base deficit during uncontrolled hemorrhagic shock (HS) model in rats.METHODSHS model was created with splenic vascular and parenchymal injury in 29 rats under ketamine and xylazine anesthesia. Thirty minutes after the hemorrhage, the rats were randomized to receive 14.5 mL/kg 0.9% sodium chloride solution at either 24ºC (Group 1; n=9) or 4ºC (Group 2; n=10) for 20 minutes. Groups 1 and 2 were compared with group that did not receive fluid (Group 3; n=10). Statistical data were represented as mean±SD. SPSS for Windows, Version 15.0 (SPSS, Inc., Chicago, IL, USA) software, Bonferroni-adjusted Mann-Whitney U test and Kaplan-Meier procedure were used to perform statistical data analysis. P value of ≤0.05 was considered statistically significant.RESULTSCold fluid resuscitation decreased survival time due to increased rate and volume of hemorrhage, acidosis, hypothermia, lactate, and base deficit and decreased blood pressure and hematocrit.CONCLUSIONThere is a great need for further experimental and clinical trials on fluid resuscitation in trauma in order to define which fluid should be administered, temperature of the fluid, quantity to be delivered, and duration.

Survival rates for burn injuries have been increasing, thanks to the progress of modern medicine, and rehabilitation activities have gained more significance. Burn rehabilitation begins with the admission of patients to the hospital and may require a long time. Good nursing care and a multidisciplinary approach are of primary importance during the acute phase of burn cases, whereas rehabilitation activities constitute a major part of the treatment following the healing of wounds. Positioning, exercises, splinting and pain control are the primary rehabilitation activities that need to be planned by a multidisciplinary team. The rehabilitation program should be designed in line with each individual case, and the treatment modelities should be reviewed in the follow-up period. This paper presents burn rehabilitation practices in the light of the current literature.

BACKGROUND:The analysis of autopsy reports plays an important role in the evaluation of trauma care quality. The objective of this study was to determine the rate of preventable deaths and medical errors in regard to the autopsy reports as an indicator of trauma care quality in traumatic deaths.METHODS:A retrospective review of traumatic autopsy reports kept between 2011 and 2012 in Eskişehir, Turkey was conducted. Demographic data of the cases, injury type, injury mechanism, injury location, ISS values, and cause and place of death were recorded. Deaths were judged in three groups including preventable deaths, potentially preventable deaths and non-preventable deaths. In the definiton of preventability, the criteria of American College of Surgeons Committee on Trauma were used. A commission composed of two forensic medicine specialists and one emergency medicine specialist reviewed preventability and defined medical errors.RESULTS:A total of five hundred and ninety-two autopsy reports were examined in the study period. Trauma was defined as the cause in 65.2% (n=386) of the cases. 81.9% (n=316) of the cases were observed to have suffered blunt injury and 18.1% (n=70) penetrating injury. Death occurred at the scene of trauma in 56.7% (n=219) of the cases, in the pre-hospital period in 11.7% (n=45), and in hospital in 31.6% (n=122). In preventability analysis, it was decided that 4.1% (n=16) of the cases had the properties of being preventable, 14.5% (n=56) potentially preventable and 81.3% (n=314) non-preventable. Suboptimal care was determined in 65.3% (n=47) of the total cases, delayed intervention in 58.3% (n=42), error in the medical method decision in 8.3% (n=6), delayed or wrong diagnosis in 1.4% (n=1), and inappropriate or incorrect medical application in 1.4% (n=1).CONCLUSION:High rates of preventable deaths in the pre-hospital period, in cases of penetrating injuries, and particularly in cases of chest trauma were evaluated as noteworthy findings. Integrated working of pre-hospital emergency healthcare services with trauma centres would enable the development of trauma care and reduce the rates of preventable deaths.

Serum neuron-specific enolase (NSE) and S-100β levels are considered novel biochemical markers of neuronal cell injury. In this study, the initial and post-treatment levels of NSE and S-100β were compared in carbon monoxide (CO) poisoning patients, who received normorbaric oxygen (NBO) or hyperbaric oxygen (HBO) therapy. Forty consecutive patients with acute CO poisoning were enrolled in this prospective, observational study. According to their clinical symptoms and observations, twenty patients were treated with NBO, and the other twenty with HBO. Serum S-100β and NSE levels were measured both at time of admission and 6 h later (post-treatment). Serum NSE and S-100β values decreased significantly in both of the therapeutic modalities. The initial and post-treatment values of NSE and S-100β in NBO or HBO patients were comparable. A clear negative correlation was observed between the decrease of NSE and S-100β levels and initial blood carboxyhemoglobin levels. In conclusion, the present results suggested the use of serum S-100β and NSE levels as indicators for brain injury. Due to the significant increase of their values with oxygen therapy, they may also be useful as prognostic follow-up markers. However, the current findings reflected no difference between the efficacy of NBO or HBO therapy.

Aim: Peripheral vascular injuries are usually associated with fatal injuries. Early diagnosis and intervention are so vital for improving a favorable outcome for traumatic vascular injuries. As a preventable cause of death, we aimed to evaluate peripheral vascular injuries in overall deaths in ten year period, 2003-2012. Material and Method: A retrospective evaluation was made of 2845 death cases which had post-mortem examination and autopsy from the 10-year period of 2003-2012 in Eskisehir, Turkey. The mean age of the cases included in the study was 32.5 +/- 7.9 years with the highest rate of cases occurring in the 30-39 years age group. Males constituted 89.2% of the victims. The most frequent manner of death was homicide 83.8%. The femoral artery was the most commonly injured vessel 29 cases (78.4%). In this study it was identified that, 33 patients (89.3%) died before any medical intervention could be performed. Discussion: Our study shows that, peripheral vascular injuries most commonly caused by sharp objects. The injuries have a low mortality rate when early intervention is made. Autopsies are conducted is very important to explain not only the cause of death but also the treatment process, which would clear the cases of any potential malpractice or negligence claims.

OBJECTIVE:Acute ankle sprains are one of the most common injuries in emergency departments. Immobilization is widely accepted as the basic treatment modality for acute ankle sprains; however, immobilization method remains controversial. In this study, we aimed to compare two treatment modalities: splint and elastic bandage for the management of acute ankle sprains.METHODS:This prospective study was conducted in the emergency department. Fifty-one consecutive patients who were admitted to the emergency department owing to the complaint of ankle sprain and who were treated with an elastic bandage or a splint were included in the study. After bone injury was ruled out, treatment choice was left to the on-shift physicians' discretion. The extent of edema was evaluated before and after the treatment by using a small, graduated container filled with warm water. Volume differences were calculated by immersing both lower extremities in a container filled to a constant level. Pain was evaluated using the visual analogue scale.RESULTS:There were 25 patients in the elastic bandage group and 26 patients in the splint group. VAS scores of these groups before and after the treatment were similar. Although edema size before and after the treatment were similar between the groups, edema size reduction was significantly more in the elastic bandage group [p=0,025].CONCLUSIONS:This study showed that treatment of acute ankle sprains with an elastic bandage was more effective than splint in reducing edema. Therefore, an elastic bandage could be preferred over a splint for the treatment of acute ankle sprains.

Introduction: The number of geriatric patients presenting to the emergency department increases every year. In addition, it is known that the mental status of geriatric patients may deteriorate as they age. In the emergency department, one of the main premises of patient management is anamnesis. However, impairments in mental status of geriatric patients decrease the reliability of anamnesis. In this study, we aimed to determine the mental status of elderly patients who presented to the emergency department, the relationship between mental status and patients' complaints, and last diagnoses and mortality.Materials and Methods: The study was planned to be prospective. The mental status of geriatric patients who presented to the emergency department was evaluated with a six-question screening test. Complaints, final diagnosis information, hospitalization department, duration of hospitalization, judicial status and mortality information were recorded. Consistency between patients' complaints and symptoms determined in physician examination was evaluated. Symptom-finding consistency levels based on mental status were compared. Kappa tests for consistency assessments and chi-square test for intergroup comparisons were used.Findings: The match between patient complaints and final diagnosis of 755 patients was evaluated by two independent specialist physicians. As a result of the six-question screening test, a mismatch between patient complaint and final diagnosis was found in 16.2% of 204 patients with abnormal screening tests (n=33) compared to 0.4% of 551 patients, who had a normal screening test (n=2). Mortality was found to be 9.8% in patients with abnormal test results while it was found to be 2.0% in patients with normal screening tests.Conclusion: Mental status variance determined in elderly patients appears to be a risk factor in terms of mortality. Complaints in geriatric patients having mental status variance can be deceptive in terms of pointing to the current disease. Exploring this relationship in detail with further studies should be considered, in order to make a significant contribution to the service provided to this patient group.

BACKGROUND:Military personnel deployed abroad could be exposed to more risk factors that adversely affect quality of life. In this study, we examined psychiatric symptoms and quality of life in Turkish Armed Forces deployed to Afghanistan.METHOD:A total of 289 Turkish military personnel working in Afghanistan enrolled in this study. They completed two surveys containing questions about socio-demographic characteristics. Data were collected and analyzed from 258 of the participants.RESULTS:The general symptom scores (GSI) were above 1 in 20.8 Percent (n=54) of the participants. The lowest SF-36 scores by the sub-groups were mental health (59.14 ± 18.56) and vitality (59.25 ± 21.17). The highest score was in the physical function subscale (84.42 ± 19.53). All Quality of Life Questionnaire Short Form (SF-36)subscale scores were lower in the GSI above 1 group than the GSI below 1 group. In the GSI above 1 group: education level and depression affected SF-36 physical functioning; paranoid ideation and somatization affected SF-36 role limitations due to physical health; age and somatization affected SF-36 pain; age affected SF-36 general health; phobic anxiety affected SF-36 vitality; age, tenure of occupation, tenure abroad; and phobic anxiety affected SF-36 mental health.CONCLUSIONS:The negative effects of psychiatric symptoms on the quality of life were similar to those in the general population and in specific disease groups. These results should be considered when evaluating the mental health of military personnel deployed abroad.

Background/aim: Urticaria is a vascular skin reaction characterized with papules and plaques. Neopterin is accepted as an immunologic marker and an indicator of activation of the immune system. Homocysteine and asymmetric dimethylarginine (ADMA) are the markers of increased vascular resistance. Alteration in vascular resistance has a role in the pathogenesis of urticaria. We aimed to investigate whether there is a relationship between urticaria and neopterin, homocysteine, or ADMA.Materials and methods: The study is designed as a prospective descriptive study and patients with a diagnosis of urticaria in the emergency department were included in the study. Demographic data and characteristics of the disease were recorded. Neopterin, homocysteine, and ADMA levels were measured both during and after urticaria attacks. All data were statistically analyzed.Results: The differences between neopterin levels measured during and after urticaria attacks were statistically significant (P < 0.001). The differences between homocysteine and ADMA levels measured during and after urticaria attacks were not statistically significant (P > 0.05).Conclusion: Our results indicate that neopterin levels in patients with urticaria attacks are increased and the level of neopterin is also a useful parameter in acute urticaria. Further studies should clarify whether homocysteine levels contribute to diagnosis of acute urticaria. However, no relation was found between ADMA and urticaria.

Objectives: Dislocation of the shoulder joint is one of the most common dislocations. The reduction procedure is a painful procedure. In this study, 2 different treatment groups were compared for pain control during shoulder dislocation reduction. It was aimed to evaluate the differences between the groups in reduction, success, length of hospital stay, complications, side effects, patient-physician satisfaction, and ease of application.Methods: The study was planned to be prospective and randomized. As procedural sedation analgesia (SA), titration of ketamine 1 to 2 mg/kg was administered intravenously to group 1. Suprascapular nerve block (SNB) was applied under ultrasound guidance (USG) to group 2. Conformity to normal distribution of variables was examined with the Kolmogorov-Smirnov test. The chi(2) test and Fisher test were used to evaluate differences between the groups in categorical variables and the Mann-Whitney U test, and a value of P < .05 was accepted as statistically significant.Results: The study comprised a total of 41 patients; 20 in the group 1 and 21 in the group 2. No statistically significant difference was determined between the groups in terms of age (P = .916), sex (P = .972), reduction success (P = .540), and patient-physician satisfaction (P = .198). The time spent in the emergency department (ED) by patients in the SA group was signficantly longer compared with the SNB group. No side effects were observed in the SNB group.Conclusions: Suprascapular nerve block, which can be easily applied under USG in the ED, can be evaluated as a good alternative to SA in the reduction of shoulder dislocations. (c) 2014 Elsevier Inc. All rights reserved.

BACKGROUND We aimed in this study to investigate the relationship between Injury Severity Score (ISS) and transfusion strategies required during medical intervention in patients wounded by high kinetic energy (HKE) gunshot, and to analyze end-mode mortality. METHODS The medical data of patients were included in the study. We evaluated whether there was any significant correlation in terms of demographic characteristics, HKE weapon type, ISSs, and transfusion strategy options and transfusion requirements. RESULTS Causes of mortality in cases resulting in mortality during hospitalization were evaluated. One hundred and eight consecutive patients were included in the study. All patients except one were male, with an average age of 25 years. 64.8% of them were injured by long-barreled firearms, whereas 35.2% were injured by explosives. Average ISS was 13.9. ISS values for the patients with and without transfusion were 16 (5-48) and 9 (3-36), respectively. Causes of mortality were evaluated in terms of systemic inflammatory response syndrome (SIRS), sepsis, and multiorgan dysfunction syndrome (MODS). DISCUSSION It was determined that there was a significant correlation between increase in ISS values in cases with HKE weapon wounds and their transfusion requirements, whereas this requirement was independent of the ISS value in cases with explosive wounds.

GEREÇ VE YÖNTEM: Olgulara ait tıbbi veriler çalışmaya dahil edildi. Olguların demografik özellikleri, yüksek kinetik enerjili silah türü, yaralanma şiddet skorları (Injury Severity Score, ISS), transfüzyon strateji seçenekleri, transfüzyon gereksinimi olan ve olmayan olguların ISS değerleri açısından anlamlı bir korelasyon olup olmadığı analiz edildi. Hospitalizasyon sürecinde mortalite ile sonuçlanan olgulara ait nedenler ait değerlendirildi.