Gastrointestinal bleeding is a significant cause of morbidity and mortality among emergency unit patients. Several scoring systems are verified for predicting hospitalization and mortality such as Glasgow Blatchford Bleeding Score (GBS), AIMS65 score, Rockall score (RS), and International Bleeding Risk Score (INBS; ABC score). The aim of this study is to evaluate the efficacy and predictive value of these scoring systems. Adult emergency unit patients with gastrointestinal bleeding were retrospectively enrolled. The age, gender, complaints at admission, vitals and examination results, laboratory findings, outcomes, blood transfusion status, and endoscopic interventions were all reported, and GBS, AIMS65, RS, and INBS (ABC) scores were calculated individually for all enrollies. A total of 311 patients were included. The median age of participants was 70 years (IQR (25–75

INTRODUCTION:The elderly population is unique and the prognostic scoring systems developed for the adult population need to be validated. We evaluated the predictive value of frequently used scoring systems on mortality in critically ill elderly sepsis patients. METHODOLOGY:In this single-center, observational, prospective study, critically ill elderly sepsis patients were evaluated. Sequential organ failure evaluation score (SOFA), acute physiology and chronic health evaluation score-II (APACHE-II), logistic organ dysfunction score (LODS), multiple organ dysfunction score (MODS), and simplified acute physiology score-II (SAPS-II) were calculated. The participants were followed up for 28 days for in-hospital mortality. Prognostic scoring systems, demographic characteristics, comorbid conditions, and baseline laboratory findings were compared between "survivor" and "non-survivor" groups. RESULTS:202 patients with a mean age of 79 (interquartile range, IQR: 11) years were included, and 51% (n = 103) were female. The overall mortality was 41% (n = 83). SOFA, APACHE-II, LODS, MODS, and SAPS-II scores were significantly higher in the non-survivor group (p < 0.001), and higher scores were correlated with higher mortality. The receiver operator characteristics (ROC) - area under curve (AUC) values were 0.802, 0.784, 0.735, 0.702 and 0.780 for SOFA, APACHE-II, LODS, MODS, and SAPS-II, respectively. All prognostic scoring models had a significant discriminative ability on the prediction of mortality among critically ill elderly sepsis patients (p < 0.001). CONCLUSIONS:This study showed that SOFA, APACHE-II, LODS, MODS, and SAPS-II scores are significantly associated with 28-day mortality in critically ill elderly sepsis patients, and can be successfully used for predicting mortality.

Doğru zamanda, doğru bilgiyi kullanmaya ve bizi hızlı karar vermeye zorlayan bir mesleğimiz var. Bilgi birikimimizi doğru kaynaklardan arttırmalı ve doğru bilgiyi gerek mesleki gerekse de bilimsel gelişim için daima paylaşmalıyız. Merak edip okudukça, sorunları ve eksikleri fark edip, yeni araştırmaların geliştirilmesi bizim elimizde. Her gün binlerce makalenin yayınlandığı bu ortamda doğru derlenmiş kaynaklara olan ihtiyaç da artmaktadır. Bu kitabın amacı da gerektiği kadar değinilmeyen bu konuya, bir nebze de olsa ışık tutmak ve dikkat çekmektir.

Objectives: To compare the efficacies of various chest compression procedures performed on a stretcher during dynamic transport of patients with in-hospital cardiac arrest. Methods: This prospective and randomized cross-over study used manikins. Practitioners were asked to perform chest compressions on a manikin placed on a moving stretcher for 2 minutes. Cardiopulmonary resuscitation (CPR) procedures were included the following 3 types: i) CPR-walking (CPR-W) ii) CPR-straddling (CPR-S), and iii) CPR-mechanical chest compression device (CPR-MCCD). Demographic data of the participants, CPR quality indicators, the time between the start command and first compression, level of difficulty, and the distance covered by the stretcher for the duration of each application were recorded. Results: Thirty-two physicians (9 female, 23 male), participated in this study. The CPR-MCCD procedure was the most effective for all parameters, except the time between the start command and first compression. On the other hand, the compression rate at optimal depth, CPR success score, distance covered, and level of difficulty parameters were significantly favored in the CPR-S group, when compared to the CPR-W group (p<0.001, all comparisons). Conclusions: It is possible to perform high-quality chest compressions during patient transport using the CPR-MCCD method. The CPR-S method allowed practitioners to perform higher-quality chest compressions compared to CPR-W.

Subcutaneous facial emphysema is a well-known consequence of oral and maxillofacial traumatic injury.In some rare cases, the subcutaneous air collection could spread through the retropharyngeal and paralatero-cervical spaces, reaching the mediastinum.A 55-year-old man was presented to the emergency room after a blast injury caused by a blown truck tire while trying to change tires.The chest radiograph demonstrated suspected pneumomediastinum or pneumothorax.A computed tomography scan of the neck and thorax revealed widespread surgical emphysema along the thoracic wall, extending through the mediastinum.The patient was monitored in the Thoracic Surgery Department after surgery and managed with conservative methods.He had no complications on clinical follow-up following hospital discharge.The development of pneumomediastinum after oral or maxillofacial trauma is rare.Nevertheless, given the mortal complications that may develop, clinicians should keep pneumomediastinum in mind in the differential diagnosis.

BACKGROUND:Early prediction of return of spontaneous circulation (ROSC) for cardiac arrest (CA) patients is a major challenge. Different biomarkers have been studied as an early predictor for ROSC, but a consensus has not been achieved in this regard. This study's goal was to investigate the value of the carboxyhaemoglobin (COHb) and methaemoglobin (MetHb) levels as a predictive marker for ROSC and prognostic marker for patients who achieve ROSC.METHODS:A total of 241 adult patients (109 female, 132 male) diagnosed as non-traumatic CA were included in the study. The patients were divided into two groups based on whether they achieved ROSC. The ROSC group was divided into two sub-groups: survivors and non-survivors. Complete blood count parameters, routine biochemistry measurements, coagulation parameters, and blood gas analysis, and cardiac markers values were compared between the groups.RESULTS:COHb levels were significantly lower in the non-ROSC group than in the ROSC group (P = .002). Urea, creatinine, potassium and cTn (cardiac troponin) levels in the non-ROSC group were significantly higher than in the ROSC group (P < .001, .001, .014, and .005, respectively). COHb levels were significantly lower in the non-survivor group than in the survivor group (P = .022). Urea, creatinine, potassium, lactate dehydrogenase, and cTn levels were significantly higher in the non-survivor group than the survivor group (P = .001, .005, .001, .010 and .008, respectively). There was no significant difference between the ROSC and non-ROSC groups and survivor group and non-survivor groups in terms of MetHb levels (P = .769 and .668, respectively). Moreover, CPR duration is significantly shorter in the survivor group than the non-survivor group (P ˂ .001).CONCLUSION:COHb levels in the blood gas analysis at the time of admission could be used as a predictive marker for ROSC and prognostic marker for the patients who achieved ROSC.

Introduction: Early prediction of return of spontaneous circulation (ROSC) for cardiac arrest (CA) patients is a major challenge. This study’s goal was to investigate the value of the carboxyhemoglobin (COHb) and methemoglobin (MetHb) levels as a predictive marker for ROSC and prognostic marker for patients who achieve ROSC. Methods: A total of 241 adult patients (109 female, 132 male) diagnosed as non-traumatic CA were included in the study. The patients were divided into two groups based on whether they achieved ROSC. Complete blood count parameters, routine biochemistry measurements, coagulation parameters, and blood gas analysis, and cardiac markers values were compared between the groups. Results: COHb levels were significantly lower in the non-ROSC group (0.71 ± 0.57%) than in the ROSC group (0.95 ± 0.76%) and in the non-survival group (0.78 ± 0.53%) compared to the survivor group (1.45 ± 1.31%) (p =0.002, 0.022 respectively). There was no significant difference between the ROSC and non-ROSC groups and survivor group and non-survivor groups in terms of MetHb levels (p = 0.769 and 0.668, respectively). Conclusions: COHb levels in the blood gas analysis at the time of admission could be used as a predictive marker for ROSC and prognostic marker for the patients who achieved ROSC.

Objective: The main causes of thromboembolic events are atherosclerosis, vascular endothelial injury, and hypercoagulability. Coagulation is activated through two basic mechanisms, including intrinsic and extrinsic pathways, leading to thrombin production as a result of a series of enzymatic reactions. The intrinsic pathway is evaluated with activated partial thromboplastin time (aPTT) and extrinsic pathway with prothrombin time (PT). This study aimed to investigate the relationship between thromboembolic diseases and coagulation parameters. Material and Methods: Patients diagnosed with acute ischemic stroke (AIS) (n=216), acute coronary syndrome (ACS) (n=25), pulmonary thromboembolism (PTE) (n=15), and patients without an emergency pathology (n=71) (Control Group) in the emergency department were retrospectively reviewed in the period from 01 November 2016 to 31 March 2019. Results: The aPTT (25.61±5.93 sec), PT (12.05±2.26 sec), and INR (1.04±0.19) values of the AIS group were statistically significantly lower compared to values of the control group (p = ˂0.001, ˂0.001 and ˂0.001 respectively). Similarly, the aPTT (27.15±8.97 sec), PT (12.26±2.75 sec), and INR (1.03±0.25) values of the ACS group were statistically significantly lower compared to those of the control group (p=0.012, 0.030, and 0.001, respectively). There was no statistically significant difference between the PTE group and control group in terms of aPTT, PT, and INR values (p= 0.133, 0.758, and 0.711, respectively). Conclusion: Shortened aPTT levels in cases without a history of anticoagulant use at the time of admission can be considered to be a predictive and effective tool for clinicians in arterial embolic events (AIS and ACS).

Introduction: Arrhythmias are one of the most common causes of mortality in patients with acute ischemic stroke (AIS). This study aimed to investigate the relationships of arrhythmia susceptibility markers (QT, QTc, Tpe, Tpe-D, Tpe/QT, and Tpe/QTc) with the localization and volume of the ischemic area, the National Institutes of Health Stroke Scale (NIHSS) scores, and troponin levels in AIS. Methods: Patients diagnosed with AIS in the emergency department in the period from 01 November 2016 to 31 March 2019 were retrospectively reviewed. Patients admitted to the emergency department with no pathological ECG findings were included. The measurements of QT, QTc, Tpe, Tpe-D, Tpe/QTc, and Tpe/QT were performed under a digital microscope. The NIHSS scores, troponin values, and the ischemic area volume based on the diffusion-weighted magnetic resonance imaging findings at the time of admission were found. Results: A total of 135 patients, comprising 70 AIS patients and 65 individuals as controls, were included in the study. The male/female ratio was 73/62 and the mean age was 68.51 +/- 10.80 years. All of the ECG parameters in the AIS group and the control group were statistically significantly different between the groups except Tpe-D (p=0.454) (For QT, QTc, Tpe, Tpe/QTc, and Tpe/QT; p=0.003, 0.022, <0.001, 0.001, 0.001; respectively). QT, QTc, Tpe, Tpe/QTc, and Tpe/QT values were not significantly different between the groups with a NIHSS score of <= 5 and >5 (p=0.480, 0.688, 0.663, 0.512, 0.333, respectively). Conclusions: Arrhythmia susceptibility markers including QT, QTc, Tpe, the values of Tpe-D, Tpe/QT, and Tpe/QTc are different in AIS patients compared to the individuals in the control group; therefore, these parameters can be included among the other parameters of close cardiac monitoring.

Objective: To evaluate the success, degree of difficulty and completion time of endotracheal intubation without removing the endotracheal tube in the event of an oesophageal intubation. Methods: The prospective, randomised crossover study was conducted at Gulhane Training and Research Hospital, Ankara, Turkey, from July 1, 2018, to August 31, 2018, and used a manikin model. Endotracheal intubation was performed using Miller, Macintosh blades and a video laryngoscope. The procedures were randomised into two groups, with group E+ being subjected to it while an endotracheal tube ETT was placed in the oesophagus (E+) simulating the oesophageal intubation, and control group E-getting the standard procedure without the endotracheal tube in the oesophagus. All methods were evaluated for their success, completion time, and degree of difficulty. Data was analysed using SPSS 22. Results: There were 120 manikins, with 60(50%) in each of the two groups. The mean completion time with Miller in E+ group was 19.05 +/- 9.65 and for E-it was 17.55 +/- 11.95 seconds. With Macintosh, E+ had a mean completion time of 19.85 +/- 12.66 seconds and E-had 16.75 +/- 8.66. With video laryngoscope, E+ group had a mean completion time of 16.75 +/- 8.66 seconds, while E- had it 14.60 +/- 8.17. No significant difference was found in the paired group comparisons in terms of the degree of task difficulty (p>0.05). Conclusion: In case of inadvertent oesophageal intubation condition, leaving the tube in the oesophagus and performing subsequent endotracheal intubation attempts was not found to decrease the rate of success regardless of the laryngoscope type.

Objectives: The aim of the study was to determine the soft tissue thickness overlying the dorsal tubercle and the relationship with adjacent anatomical structures in the distal radius for using this area as an alternative intraosseous route. Methods: Contrast-enhanced MR images of 56 adult patients (28 females, 28 males) without any wrist pathology were evaluated. The shape of dorsal tubercle and its relations with neighboring tendons and vessels with a diameter larger than 2 mm was identified on the axial T1-weighted sections. The soft tissue thickness above the most protruding point of the dorsal tubercle, the distance of the dorsal tubercle to closest tendon on the radial and ulnar sides, as well as its distance to the bone edges on the ulnar and radial sides, and the cortical bone thickness of the radius was evaluated. Results: The dorsal tubercle had sharp edges in 40 cases (71.4%), blunt in 12 cases (21.4%), and hump in 4 (%7.1) cases. Branches of dorsal venous plexus were found on its surface in 11 cases, extensor pollicis longus tendon only was found superficial to the dorsal tubercle in 7 cases while both extensor pollicis longus and dorsal venous branches were found in 2 cases. Conclusion: Dorsal tubercle of the distal radius can be considered as an important alternative route for IO infusions since it can be easily accessed without having a risk of injury to important structures, and can provide effective flow.

Hypertriglyceridemia-induced pancreatitis (HTIP) is the third most common cause of pancreatitis. Hypertriglyceridemia shows familial transition and pregnancy increases the risk of HTIP. The treatment of HTIP is initiated with supportive treatment and continues with specific treatments including plasmapheresis, insulin, heparin infusion, and hemofiltration. The current study reports monozygotic twins who are pregnant at the same time having concurrent HTIP attack.

Aim: We investigated complete blood count parameters as inflammatory biomarkers and compared these to serum creatinine values as early diagnostic criteria of ongoing contrast-induced nephropathy. Contrast-induced nephropathy is an important cause of acute kidney injury. Early diagnosis can reduce morbidity and mortality. There is no clear predictor parameter for the early diagnosis of contrast-induced nephropathy.Material and Methods: Patients who underwent contrast-enhanced computed tomography examination were included in this retrospective study. Contrast-induced nephropathy was defined as 25%, a higher increment or a 0.5 mg/dL elevation above the baseline serum creatinine levels within 72 hours. Patients were divided into contrast-induced nephropathy and non-contrast-induced nephropathy groups. The complete blood count parameters obtained before and within the first 24 hours after contrast-enhanced computed tomography were compared between groups. Results: The post-contrast-enhanced computed tomography neutrophil-to-lymphocyte ratio values were significantly higher in the contrast-induced nephropathy group compared to the non-contrast-induced nephropathy group (11.85±1.56 vs 7.29±0.49; p = 0.000). Comparison of the post-contrast-enhanced computed tomography values of the platelet-to-lymphocyte ratio, mean platelet volume-to-platelet count ratio, and lymphocyte to monocyte ratio revealed no statistically significant differences between the groups (p = 0.283, 0.128, and 0.792 respectively).Conclusions: An increased neutrophil-to-lymphocyte ratio level after a contrast-enhanced computed tomography procedure is associated with the development of contrast-induced nephropathy. The use of the neutrophil-to-lymphocyte ratio in the emergency department as a predictive parameter can significantly improve the diagnostic process, favorably acting on the prognosis of patients developing contrast-induced nephropathy.

Background The present study evaluates the success and efficacy of endotracheal intubation (ETI) using a modified intubation stylet and a magnet system to direct the stylet into the trachea. The system was developed by the researchers in an attempt to increase the success and efficacy of ETI. Methods ETI procedures were performed on an airway management manikin by emergency medical technicians with at least four years of experience in ETI. The technicians used a stylet modified with an iron ball affixed to the tip and a neodymium magnet, designed specifically for the study. The intention was to guide the endotracheal tube into the trachea at the level of the thyroid and cricoid cartilages on the manikin with the aid of the modified stylet and the magnetic force of the neodymium magnet. The success rate, completion time, and degree of difficulty of two procedures were compared: magnetic endotracheal intubation (METI) and classic ETI (CETI). Results The success rate was 100% in both groups. The mean completion times for the METI and CETI procedures were 18.31 ± 2.46 s and 20.01 ± 1.95 s, respectively. There were significant differences in completion time and degree of difficulty between the METI and CETI procedures (both p=0.001). Conclusions We found the use of a neodymium magnet and modified stylet to be an effective method to guide the endotracheal tube into the trachea. The present study may provide a basis for future studies.

Background: The North Atlantic treaty organization (NATO)-led international security and assistance force (ISAF) conducted training, development, and humanitarian activities in addition to security operations during its 13 years in Afghanistan. Objectives: The aim of this study was to present the emergency department experiences of Kabul Ataturk Role II military hospital. Materials and Methods: We performed a retrospective observational study of emergency department admissions at Kabul Ataturk Role II Military hospital during a 12-month period from August 2012 through July 2013. Results: During the 12-month study period, 4348 patients were admitted to our emergency department. Admissions were evaluated as two groups according to trauma exposure of the patients and we detected that the Afghan civilian group had a higher number of admissions with stab wounds and burn injuries compared to the other groups. Moreover, our study results presents higher rates of surgical, orthopedic, and mixed treatments on the Afghan civilian group compared with other groups of patients. Conclusions: Humanitarian care facilities, including medical assistance, are still vital for the Afghan society. Participation of women and/or Muslim caregivers may enhance accessibility, particularly for Afghan women. We believe that the availability of emergency medicine facilities in a hospital setting at a reachable location for Afghan civilians is an effective and profitable choice for medical services. In terms of emergency medicine, the department should be prepared for orthopedic traumas, combat injuries including mine and gunshot wounds, and burn injuries.

DOI: 10.4328/JCAM.1406 Received: 16.11.2012 Accepted: 04.12.2012 Publihed Online: 04.12.2012 Corresponding Author: Omer Ersen, Maresal Cakmak Military Hospital Palandoken, Erzurum, Turkey. T.: +905335275181 E-Mail: merschenn@yahoo.com Ozet Trapezium kiriklari nadir kiriklardir ve tum karpal kemik kiriklarinin %3-5’ini olustururlar. Bunlarin yaklasik %20’si vertikal sagittal split kiriklardir ve izole olarak cok nadir gorulurler. Literaturde bildirilen trapezium kiriklari cok azdir. Normal basparmak fonksiyonunun kazanilabilmesi icin acik trapezium kiriklarinda yaralanmis yapilarin tam restorasyonu saglanmalidir. Aksi takdirde hareket kisitliligi, agri ve kuvvetsizlige bagli fonksiyon kayiplari gorulebilir. Bu vaka takdiminde distal radiustan elde edilen lokal kemik grefti ile defektif trapezium kiriginin tedavisi sonucu normal basparmak fonksiyonu elde edilmesi sunulmustur.