Aim: This study aims to analyze the demographic characteristics of patients transported by ambulance to the emergency department (ED), their preliminary diagnoses during the pre-hospital phase, and their initial diagnoses and hospital outcomes after evaluation in the hospital. Material and Methods: This was a prospective, cross-sectional descriptive study. Data were obtained from the emergency medicine physician's patient forms in the hospital information system. The analysis included patients' demographic characteristics, admission times, and status at the ED. Results: A total of 633 patients who met the inclusion criteria were examined in this study. The demographic breakdown included 56.5% male (n=358) and 43.5% female patients (n=275), with ages ranging from 1 to 110 years and a mean age of 53.10 +/- 24.59 years. Approximately one-third of the cases were geriatric patients. Nearly half of the patient admissions to the ED occurred between 16:00 and 24:00. Trauma was the predominant reason for ambulance transports, with most cases originating from the patients' homes. The majority were discharged as outpatients from the ED. Despite geriatric patients constituting a significant portion of ambulance transports, their admissions to the ED were evenly distributed throughout the 24-hour cycle. Ambulances were primarily used for trauma and neurological disorders. Admissions after midnight were significantly lower than those before midnight. Although diagnostic concordance between ambulance and ED was generally high, it was lowest among the elderly (over 85 years of age). Additionally, the level of diagnostic agreement was consistent across different EMS teams, regardless of whether they were physicians, paramedics, or EMTs. Discussion: Pre-hospital diagnoses made by EMS personnel may be less accurate for older patients.

Background/Purpose: G protein-coupled receptor kinase (GRK4) is associated with essential hypertension (EHT). GRK4 regulates sodium balance in the proximal tubules of the kidney. In this study, the possible roles of A142V and A486V polymorphisms in the development of hypertension were investigated in a Turkish population. Methods: Genomic DNA was obtained from white blood cells using the standard DNA isolation kit (Roche). Genotypes of variants of GRK4 were determined by Polymerase chain reaction (PCR) - Restriction fragment length polymorphism (RFLP) analysis. Results: In this study, GRKA142V and A486V polymorphisms were found to be associated with EHT in the Turkish population (P

Objective: There are scales to decide hospitalization or follow up in patients presenting to the emergency department after suicide attempt. Modified SAD PERSONS scale (MSPS) is the scaling system for adult suicide generated using the initials of 10 major demographic risk factor in the literature. The aim of our study is to investigate the reliability of the MSPS patients who are evaluated in the emergency department after suicide attempt for deciding admission or discharging of patients in our population. Material-Method: Patients admitted to our emergency department with suicide attempts was evaluated by MSPS. All patients were evaluated by MSPS also consulted to a psychiatrist concurrently. MSPS suggestions are compared with psychiatry decisions. All data were inputted into SPSS analyzed statistically. Results: There were 205 patients totaly and 147of them were female. Psychiatrics decide hospitalization for 95% of patients MSPS score higher than 8. 131 patients MSPS score less than 6 are evaluated by psyhiatrics and 5 (3.8%) of them were decided for hospitalization. MSPS has sensitivity 90%, specificity 84%, positive predictive value 67%, negative predictive value 96% for deciding hospitalization when compared with psychiatric evaluation. Conclusion: Giving the decision of discharging or hospitalization of patients presenting in the emergency department after suicide attempt is a serious dilemmas for doctors working in the emergency department. There is a need for objective evaluation of such patients of in the emergency department. Although MSPS does not meet all of the requirements but can be used in the emergency department.

Gerçek bilgi, bilimsel araştırma ile elde edilir. Bilginin en üst düzeyi, bilimsel problemleri keşfetme/çözme becerisidir. Önemli bir bilimsel çalışma aynı zamanda bir takım çalışmasıdır ve başarının ön koşuludur. Bilimsel ve profesyonel çalışma öncelikle bir eğitim aracıdır ve içeriği farklı yollarla sunulabilir. Bilim, eğitim sisteminde bir bağlantı anahtarı, ulusların kültürü ve insanlığın gerçek bilgi kaynağını yansıtır. Bilim insanı bir çok durumda oldukça çalışkan, ne yaptığına odaklanmış kişidir. Kişi bilimsel çalışma dünyasına girdiğinde sıra dışı efor harcamayı ve günlük yaşantısından ödün vermeyi kabul etmiş demektir. Plagiarizm; “bir kişinin eserinde başka kişilerin ifade, buluş veya düşüncelerini kaynak göstermeksizin kendisine aitmiş gibi kullanması” olarak tanımlanmaktadır. Türkçe’de tam karşılığı olmasa da “eser hırsızlığı”, “intihal”, “aşırma”, “aşırmacılık”, “bilgi hırsızlığı” gibi karşılıklarla anlamlandırılmaya çalışılmıştır.

Objective: To determine the timing of first aid training in the medical school curriculum and the training method with the 8-hour first aid training given to the first-grade students of the faculty of medicine.Method: The study was conducted prospectively with 168 first year medical students at Faculty of Medicine, Maltepe University in October 2019. An 8-hour course plan consisting of theoretical and practical applications was prepared. Theoretical courses included cardiopulmonary resuscitation, basic life supports, epileptic seizures, heatstroke, aspiration, and drowning issues, while practical applications included cardiopulmonary resuscitation techniques, basic life support scenarios, Heimlich’s Maneuver and the coma position. Students were sent a link consisting of 17 questions created with Google forms at the beginning and the end of the course. Learned knowledge was measured with the posttest, and pre-and post-training results were compared.Results: A significant increase was found in the rate of correct answers compared to the pre-training period. Even the rate of correct post-test answers increased significantly in all questions; the increase in the questions related to the subjects supported by practical applications was more remarkable. It was found that more incorrect answers were given to questions about environmental injuries.Conclusions: It is possible to improve the public recognition of first aid, even with one day of theoretical and practical training. Thus, adding first aid practical courses to the first-year medical school curriculum and raising awareness at an earlier age will play an essential role in medical education.

INTRODUCTION: To determine head CT scan necessity in pediatric head trauma patients and to compare the decisions of Emergency medicine physicians (EMP) and PECARN scale suggestions on head CT scan necessity. METHODS: Our study was conducted retrospectively in our third stage hospital between January 2014 and December 2014. Patients under the age of 13 with head injury because of fall were included. Registry of all patients was analyzed and PECARN scale was applied to each patient's data retrospectively. Suggestions of PECARN scale were noted. Head CT scans were reported by radiologist. EMP's decision and PECARN scale suggestions were compared. Patients whom should had CT scan by PECARN scale suggestions but had no imaging were contacted and questioned about any other reasons to seek medical care. RESULTS: PECARN suggestion and EMP's decisions of CT necessity compared. Concordance analysis of two results are determined as 76.6% (Kappa coefficient: 0.766). EMP's decisions had 88.76% sensitivity, 91.09% specificity, 78.22% positive predictive value, 95.74% negative predictive value and 90.48% accuracy. DISCUSSION AND CONCLUSION: In assessment of children with minor head injury EMP decision and PECARN scale were found coherent and sufficient. Instead of early decision of CT scan, observation of patient can reduce radiation exposure, but cost effectivity of this approach should be evaluated by further studies.

Aim: Carbon monoxide (CO) is a colorless, odorless gas and tasteless. CO poisoning (COP) is one of the most frequently encountered inhalation poisonings. The most common cause of morbidity in COP is delayed neurological sequelae (DNS). DNS is the occurrence of neuropsychiatric findings within 2-240 days after discharge of patients with COP and there are no definitive diagnostic criteria. The aim of our study is; to determine the risk factors and incidence of DNS. Method: Our study is a retrospective, observational study. Patients with the diagnosis of COP in the emergency department between 2015 and 2016 were included in the study. Patients age, gender, findings in the initial physical examination (PE) and neurological examination (NE), blood carboxyhemoglobin (COHb) level, relation between hyperbaric oxygen (HBO) treatment and DNS were assessed. Results: Total of 72 patients were included in the study. Mean age was 33.43 +/- 20.89. It was determined that pathological findings in the initial NE are a significant predictive factor for DNS (Odds ratio 18.600, p:0.004). Significant relation between NE and HBO treatment was present (p:00.1). There was no statistically significant relationship between initial COHb level and receiving HBO treatment (p:0.9). Median COHb level of patients with DNS was 30 (min:10, max: 43), median COHb level of patients without DNS was 25 (min:10, max:44) and there was no statistically significant relationship between the two groups according to COHb levels (p:0.7). Conclusion: Pathological findings in the initial neurological examination had a predictive value for delayed neurological sequelae in patients with carbon monoxide poisoning. (C) 2019 Elsevier Inc. All rights reserved.

OZET Giris ve amac: Kunt servikal travma hastalarinda klinik olarak anlamli yaralanmalari tanimlamak icin gelistirilen ilk karar kurali National Emergency X-Radiography (NEXUS). NEXUS calismasinda, negatif prediktif deger(NPV)% 99,8 olarak belirlenmistir. Kanada Servikal Omurga Kurallarinin (KSOK) duyarliligi % 99.4, ozgulluk % 45.1 ve NPV % 100 olarak bildirilmistir. Bu calismanin amaci, servikal yaralanma riski olan Turk hasta populasyonu icin NEXUS ve KSOK’'nin guvenilirligini ve yararliligini belirlemektir. Gerec ve yontem: Bu prospektif gozlemsel calismaya, 1 Ocak 2012 - 1 Nisan 2012 tarihleri arasinda, akut travma geciren ve ambulansla ya da kendi imkanlariyla hastaneye basvuran, servikal travmaya yol acabilecek bir mekanizma ile yaralanan 16 yasin uzerindeki, gebe olmayan, stabil, bilincli hastalari kapsayan 225 hasta dahil edilmistir. Bu hastalar daha sonra NEXUS ve CCR gecerliligi icin degerlendirildi. Veriler guncel istatistik programinda analiz edildi. Bulgular: 225 hastanin 7’sinde servikal patoloji tespit edilmistir. Patolojik goruntuleme bulgusu varligini belirleme acisindan NEXUS’un duyarliligi %93(%95 GA 83-97) ve ozgullugu %1,3(%95 GA 0,2-5,1) olarak bulunurken, KSOK’nin duyarliligi %100 (%95 GA %56-100) ve ozgullugu %3,2 (%95 GA %1,4-6,7) olarak tespit edildi. Sonuc: KSOK ve NEXUS dusuk risk kriterlerinin acil serviste servikal patolojilerin dislanmasinda faydali oldugu, KSOK’nin, NEXUS dusuk risk kriterleri ile karsilastirildiginda daha guvenilir ve yararli oldugu tespit edilmistir. Anahtar Sozcukler: NEXUS; Kanada servikal omurga kurallari; Servikal travma ABSTRACT Background: The first decision rule developed to identify clinically significant injuries in blunt cervical trauma patients is National Emergency X-Radiography Utilisation Study (NEXUS). In the NEXUS study, the negative predictive value (NPV) has been determined as 99.8%. Sensitivity of Canadian Cervical Spine Rules (CCR) was reported as 99.4%, specificity as 45.1% and NPV was reported as 100%. The objective of this study is to determine the reliability and utility of NEXUS and CCR for Turkish patient population that has a risk of cervical injury. Methods: This prospective observational study included 225 patients, all stable, conscious patients over 16 years of age who had acute trauma and were brought to the hospital with ambulances or using their own means and who had been injured by a mechanism that may cause cervical trauma, and without exclusion criteria. The patients included in the study were then evaluated for NEXUS and CCR validity. Results: When CCR was evaluated as a whole, it was determined that all pathological cases were identified using these rules. In terms of identifying the presence of pathological imaging finding the sensitivity of CCR was 100% (95% CI % 56-100) and specificity was 3.2% (95% CI 1.4-6.7%). NEXUS's sensitivity was calculated as 93% (95% CI 83-97) and specificity as 1.3%(95% CI 0.2-5.1). Conclusion: CCR and the NEXUS were determined to be useful in the emergency department for the exclusion of cervical pathologies. CCR were more reliable and useful when compared with the NEXUS. Keywords: NEXUS; Canadian rules; Cervical trauma

Background: Gastrointestinal bleeding is a commonly seen multidisciplinary clinical condition in emergency departments which has high treatment cost and mortality in company with hospital admission. Risk evaluation before endoscopy is based on clinical and laboratory findings at patient’s emergency visit. Objective: The purpose of this study is to investigate the efficacy of “Glasgow-Blatchford scale + lactate levels” to predict the mortality of patients detected with gastrointestinal bleeding in the emergency department. Methods: A total of 107 patients with preliminary diagnosis of upper gastrointestinal bleeding included in the study after approval of the ethics committee were prospectively evaluated. Glasgow-Blatchford scale scores were calculated and venous blood lactate levels were assessed. Need for blood transfusion in the follow-up, the amount of transfusion, and mortality in the next 6 months were evaluated. Results: A statistically significant difference was found in mortality rates between the lactate and Glasgow-Blatchford scale cohorts in our study (p = 0.001 and p < 0.01, respectively). The mortality rate was significantly higher in the lactate(+) GBS(+) cases compared to the lactate(–) GBS(+), lactate(+) GBS(–), and lactate(–) GBS(–) cases compared to the bilateral comparisons (p = 0.004, p = 0.001, p = 0.001, and p < 0.01, respectively). There was a statistically significant relationship between the rate of erythrocyte suspension replacement in the cases according to Glasgow-Blatchford scale levels (p = 0.001 and p < 0.01, respectively). The incidence of erythrocyte suspension replacement was 7.393 times greater in patients with Glasgow-Blatchford scale score of 12 and above. Conclusion: Glasgow-Blatchford scale is highly sensitive to the determination of mortality risk and the need for blood transfusion in upper gastrointestinal bleeding. Glasgow-Blatchford scale with lactate evaluation is more sensitive and more significant than Glasgow-Blatchford scale alone. This significance provides us to establish “modified Glasgow-Blatchford scale.” In the future, studies which will use Glasgow-Blatchford scale supported by lactate could be increased and the results should be supported more.

GİRİŞ ve AMAÇ: Sağlık bakanlığı 2014 yılı istatistiklerine göre sağlık bakanlığına bağlı kurumlarda 292 milyon hasta bakılırken acil muayene edilen hasta sayısı 87 milyon olmuştur. Bu çalışmanın amacı ürün tanıtım elemanlarının(ÜTE) acil tıp konusundaki bilgi düzeyini değerlendirmek, acil tıbbın ilaç sektörünün gözünden nasıl göründüğünü tasvir etmek ve her iki organizasyonun arasındaki iletişimin artırılmasına katkıda bulunmaktır.

Objectives: The primary aim of this study was to report the vital signs, hemodynamic parameters and pain scores of the patients who have received procedural sedation and analgesia (PSA) with either ketofol (combination of ketamine and propofol) or etofen (combination of etomidate and fentanyl) and compare the proportion of patients with airway or respiratory adverse events (AEs) requiring an intervention and calculate the relative risk of AEs with each combination. Methods: This study is a prospective observational study with survey analysis. All patients received procedural sedation and analgesia (PSA) with either ketofol (combination of ketamine and propofol) or etofen (combination of etomidate and fentanyl) were prospectively observed. Vital and hemodynamic parameters and pain scores of the patients were recorded by automated equipment and visual analog scale (VAS) charts. Results: 112 patients were enrolled, 55 received ketofol and 57 received etofen. All patients with a respiratory AE (n = 27) observed to receive a respiratory intervention. Respiratory AE rate and proportion of patient who required a respiratory intervention were significantly higher with ketofol (p = 0.0029). Overall AE rate, and rates of desaturation, emergence reaction were also significantly higher in ketofol group. Conclusion: Etofen is a promising combination for the PSA of adult patients with lower respiratory AE and intervention rates and with better hemodynamic profile. Copyright (C) 2017 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner.

ÖZETAcil servise bilinç değişikliği nedeniyle geti rilen ve karbonmonoksit zehirlenmesi tanısı koyu lan ; santral sinir sistemi görüntülemelerinde tipik difüzyon MR bul gularına rastlanan bir olgu

Amaç: Acil servise herhangi bir nedenle başvuran ve klinik kuşku sonrasında D-Dimer (DD) bakılan hastalarda; DD kullanım alanı ve sıklığı; pulmoner emboli (PE) ön tanılı 50 yaş üstü hastalarda DD eşik değeri

Objectives: Scoring systems have been used to risk stratify in intensive care units (ICU), but not routinely used in emergency departments. The aim of this study was to determine accuracy for predicting mortality in emergency medicine with Sequential Organ Failure Assessment (SOFA), Mortality in ED Sepsis (MEDS) score and Simplified Acute Physiology Score (SAPSII).Methods: This is a prospective observational study. Patients presenting with evidence of sepsis were all included. SAPSII, MEDS, and SOFA scores were calculated. Analysis compared areas under the receiver operator characteristic (ROC) curves for 28-day mortality.Results: Two hundred patients were included; consisting of 31 (14.3%) septic shock. 138 (69%) severe sepsis and 31 (15.5%) infection without organ dysfunction. 53 (26.5%) patients died within 28 days. Area under the ROC curve for mortality was 0.76 for MEDS (0.69-0.82), 0.70 for SAPSII (0.62-0.78); and 1.68 for SOFA (0.60-0.76) scores. Pair wise comparison of AUC between MEDS, SAPSII, SOFA and Lactate were not significant.Conclusion: According to our results; SOFA, SAPSII and MEDS were not sufficient to predict mortality. Also this result, MEDS was better than other scoring system. Copyright (C) 2016 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner. This is an open access article under the CC BY-NC-ND license