Do Social and Environmental Factors Affect the Emergency Service Admission Characteristics of Preschool-Aged Pediatric Trauma Patients?: A Prospective Study.

OBJECTIVE: Studies related to the epidemiology of trauma play a major role in determining the health status of the communities living in the vicinity of the centers that they are conducted. We have found no epidemiological study related to emergency service admission conducted only on preschool-aged children in the literature. Our aim was to determine characteristics of trauma in this age group, to analyze encountered trauma types, and to investigate possible associations among epidemiological factors, characteristics of the trauma victims, and trauma itself in pediatric patients admitted to our emergency service. METHODS: We conducted a prospective study with patients aged 66 months and younger, admitted to Emergency Service of Istanbul Kanuni Sultan Suleyman Training and Research Hospital between July 1, 2015, and December 31, 2015. Data related to age, sex, occupational status of parents, number of siblings, Glasgow coma scale score, transport mode, admission time period of the day, general health status, type of trauma, the trauma site, involved body regions, radiologic imaging and laboratory results, consultations, clinical diagnosis and outcome, duration of emergency service stay, and treatment cost were collected and statistically analyzed. RESULTS: A total of 688 preschool-aged cases were admitted owing to trauma. The major mode of transport was a private vehicle (98.3%), and the major cause was falling (64.0%). The major traumatized body region was head and neck (51.0%), and the major diagnosis was soft tissue trauma (90.1%). The average duration of stay was 122.01 minutes and affected by sibling number, trauma type, and employment status. The total service fee was interrelated with the type of trauma and the site that trauma occurred; it also was strongly correlated with duration of emergency service stay. CONCLUSIONS: Our results suggest that both in-hospital and social/environmental aspects should be improved to reduce the clinical and social burden of trauma.

Comparison of normobaric vs. hyperbaric oxygen in the relief of carbon monoxide headache pain.

BACKGROUND: Headache is the most common symptom in carbon monoxide (CO) poisoning. While the mechanism of CO-induced headache is not well defined, it is felt that cerebral vasodilation plays a role. Clinical experience has demonstrated oxygen breathing is effective in resolving CO headache. However, the effectiveness of normobaric oxygen has never been compared to hyperbaric oxygen in this regard. METHODS: A 2016 paper by Ocak, et al. reported the response of CO headache pain severity to four hours of normobaric oxygen breathing in 82 patients using a 0-10 analog scale. The demographics, carboxyhemoglobin levels and response to therapy from that report were compared to data obtained by Hampson, et al. in an earlier study, but never published, using the same pain assessment method in 73 patients with CO headache and treated with hyperbaric oxygen. RESULTS: Comparing the normobaric and hyperbaric groups, neither average age nor presenting carboxyhemoglobin levels were significantly different. Baseline pain intensity scores were 6.5 ± 3.1 vs. 6.2 ± 2.6 (p=0.444) and post-treatment scores 1.5 ± 2.6 vs. 1.0 ± 1.5 (p=0.184) respectively on a 0-10 scale. CONCLUSIONS: In these two well-matched populations of patients with CO-induced headache pain, degree of resolution was not significantly different between normobaric and hyperbaric oxygen treatment.

Use of radiography and ultrasonography for nasal fracture identification in children under 18 years of age presenting to the ED.

PURPOSE: To compare the diagnostic value of ultrasonography (USG), which is rapid, inexpensive, simple, and does not involve radiation, with that of direct radiography for identifying fractures in the nasal bones of pediatric patients presenting in the emergency department with nasal trauma. EQUIPMENT AND METHODS: Patients under 18years old presenting with nasal trauma at the emergency department included prospectively. The patients' age and sex distribution, trauma type, GCS, physical examination findings, direct radiography, and USG results were recorded. The physical examination made by the emergency medicine specialist on arrival was accepted as the gold standard for diagnosis. FINDINGS: In total, 133 patients, 34.6% female and 65.4% male, were included in this study. The average patient age was 7.44±5.05years, with the greatest proportion (21.8%, n=29) of patients in the age ranges of 0-2 and 6-8years. The most frequently observed finding on physical examinations was swelling (51.1%, n=68). In total, 50 (37.6%) patients had nasal fractures according to their first physical examination, which was performed by emergency medicine specialists. That is, fractures were detected by direct radiography in only 11 of the 34 cases who were diagnosed with fractures by USG. CONCLUSIONS: We consider that USG should be preferred over direct radiography for use at the bedside of pediatric patients who present at emergency department with nasal trauma, because of its superior diagnostic ability and the lack of a requirement for radiation.

Treatment in carbon monoxide poisoning patients with headache: a prospective, multicenter, double-blind, controlled clinical trial.

BACKGROUND: There is a lack of specificity of the analgesic agents used to treat headache and underlying acute carbon monoxide poisoning. OBJECTIVE: To compare effectiveness of "oxygen alone" vs "metoclopramide plus oxygen" vs "metamizole plus oxygen" therapy in treating carbon monoxide-induced headache. DESIGN: A prospective, multicenter, double-blind, controlled trial. SETTING: Three emergency departments in Turkey. POPULATION: Adult carbon monoxide poisoning patients with headache. METHODS: A total of 117 carbon monoxide-intoxicated patients with headache were randomized into 3 groups and assessed at baseline, 30 minutes, 90 minutes, and 4 hours. MAIN OUTCOME MEASURE: The primary outcome was patient-reported improvement rates for headache. Secondary end points included nausea, need for rescue medication during treatment, and reduction in carboxyhemoglobin levels. RESULTS: During observation, there was no statistical difference between drug type and visual analog scale score change at 30 minutes, 90 minutes, or 4 hours, for either headache or nausea. No rescue medication was needed during the study period. The reduction in carboxyhemoglobin levels did not differ among the 3 groups. CONCLUSION: The use of "oxygen alone" is as efficacious as "oxygen plus metoclopramide" or "oxygen plus metamizole sodium" in the treatment of carbon monoxide-induced headache.

Patients admitted to emergency units with injuries related to the four Hajj-associated annual animal sacrifice feasts from 2010 to 2013.

BACKGROUND: During the Eid al-Adha ("Sacrifice Feast") religious holiday in Muslim communities animal sacrifices are made over a period of 3 days every year. OBJECTIVES: The aim of this study was to determine the type of sacrifice-related injuries, the characteristics of patients, treatments for injuries, and relationships between these factors to determine precautions that could be taken to avoid or mitigate sacrifice-related injuries. DESIGN: Retrospective study of medical records. SETTING: Emergency units at two hospitals from 2010 to 2013. PATIENTS AND METHODS: Patients admitted for treatment for injuries associated with sacrificial cutting during the four annual sacrifice feasts were classified as professional butchers, apprentice butchers, and third persons who were neither professional butchers nor apprentices. MAIN OUTCOME MEASURE(S): Injuries associated with animal sacrifice. RESULTS: Of 592 patients, 22 (3.7%) were professional butchers, 149 (25.2%) apprentice butchers, and 421 (71.1%) third persons. Significant relationships were found between the profession of the injured person and the injury and subsequent treatment (P < .05). CONCLUSION: To prevent and minimize the injuries associated with sacrificial cutting, there should be an area designated for sacrificing animals. Moreover, sacrifices should be performed by professionals in possession of a sacrificial cutting certificate. If owners of sacrificial animals insist on slaughtering animals, they should be trained by professional butchers who have a teaching certificate. To deal with an increasing number of such injuries during the sacrifice feast, hospital emergency units need to be adequately resourced with adequate equipment and staff. LIMITATIONS: Regional and local data could not be assessed completely. Patients who presented on the 4th day were not included in the study.

A Mobitz type II atrioventricular block in multicentric ischemic stroke.

Cardiac and cerebrovascular illnesses are major causes of mortality and morbidity. Thromboembolisms, which are the result of cardiac arrhythmia, are important causes of ischemic stroke. In this study, we present a rare case of multicentric ischemic stroke induced by Mobitz type II atrioventricular block.

Uveitis attack and drug reaction due to cefuroxime axetil.

Antibiotics are natural or synthetic substances that are used to control bacterial infections because antibiotics are by definition only effective against bacteria. A 30-year-old female came to our emergency clinic complaining rubor in both eyes, especially in the left eye, with swelling, rubor and pain in ears, and eruption in lips extremities. In her anamnesis, it has been determined that she did not have any medical disease that requires regular utilization of drugs. After the patient received cefuroxime axetil for acute tonsillitis, she observed eruptions in lip extremities on the 3rd day, but she did not care about it. On the 5th day, rubor in both eyes and, especially in the left eye, have been developed, and complaints such as unable to look toward light and pain have started together with swelling, rubor, and pain in both ears. She came to our clinic because she was very much worried about the situation. In this study, we aimed to discuss a drug reaction characterized by face and ear skin observations, due to uveitis after the use of antibiotics including cefuroxime axetil for acute tonsillitis.

Evaluation of patients with Tularemia in Bolu province in northwestern Anatolia, Turkey.

INTRODUCTION: Tularemia is a zoonotic disease caused by Francisella tularensis. Here we present an epidemic occurring in Bolu province, located in northwestern Anatolia in Turkey, and some features of the cases. METHODOLOGY: The data was provided by the Bolu Provincial Health Directorate. All of the antibody response tests were studied in the National Health Institute (formerly named Refik Saydam Hygiene Department), the reference laboratory of the Ministry of Health of the Turkish Republic. A total of 393 individuals were tested by microagglutination test (MAT) for tularemia between 2006 and 2011. A total of 218 patients whose demographical data were available were included in the study; 83 were accepted as the patient group and 135 were the controls. Of the patients, 31 (37.3%) were male and 52 (62.7%) were female. RESULTS: Fever (p < 0.001), URTI symptoms (p = 0.047), conjunctivitis (p = 0.004), and rash (p = 0.026) were significantly higher in the patient group. A positive association was found between MAT and fever (r = 0.324; p < 0.001), and a negative association was found between MAT and both lymphoadenopathy (r = -0.25; p = 0.013) and chills (r = -0.218; p = 0.035). Higher MAT titers were detected in oropharyngeal tularemia (r = 0.306; p = 0.003). CONCLUSIONS: In conclusion, tularemia must be considered in differential diagnosis in patients presenting with fever and LAP in non-endemic regions. Furthermore, water sources and contact with rodents must be investigated.

Lower Extremity Tissue Defect Caused by Mobile Phone Charger Explosion: A Case Report.

As the usage of cell phones is markedly increasing worldwide, accidental injuries and even lethal damages caused by cellular phone explosions have been reported lately. Although, cell phone charger explosion related scalding and tissue loss is extremely rare, they generally cause severe damage to tissues and cause severe complications, ending up in hospitalization. We are presenting a case of 9-year old female patient who was admitted to our emergency service due to a phone charger explosion that resulted in a lower extremity tissue defect.

A new diagnostic marker for acute pulmonary embolism in emergency department: mean platelet volume.

OBJECTIVE: To investigate the diagnostic importance of mean platelet volume (MPV) on acute pulmonary embolism (APE) in the emergency Department (ED). METHODS: Subjects were selected from patients admitted to ED with clinically suspected APE. Demographic, anthropometric and serologic data were collected for each patient. RESULTS: A total of 315 consecutive patients were analyzed, including 150 patients (53.44 ± 15.14 y; 92 men/58 women) in APE group and 165 patients (49.80 ±13.76y; 94 men/71 women) in the control group. MPV in the APE group was significantly higher than in the control group (9.42±1.22 fl vs. 8.04±0.89 fl, p<0.0001). The best cut-off values for MPV when predicting APE in patients with clinically suspected APE presenting at the ED were 8.55 fl (sensitivity 82.2%; specificity 52.3%). CONCLUSIONS: MPV is a helpful parameter for the diagnosis of APE in ED, for the first time in the literature.

The importance of the mean platelet volume in the diagnosis of supraventricular tachycardia.

BACKGROUND: The diagnosis of palpitation can be difficult in the emergency department (ED) and the waiting time for a first appointment with an arrhythmia clinic can be very long. The inflammation is sufficient to facilitate the initiation of supraventricular tachyarrhythmia (SVT). The increased mean platelet volume (MPV) is closely correlated with inflammation and to reflect inflammatory burden in different condition. OBJECTIVE: In this study, we aimed to investigate the relation between MPV and SVT in patient with documented atrial tachyarrhythmia in ED. METHODS: Two study groups were compared; a SVT group with arrive at the ED with documented SVT (n=122) and 100 healthy adult without any palpitation symptom, arrhythmic disease, and with normal physical examination results that were brought for checkups to the cardiology polyclinic were classified as control group. Blood samples were obtained from all patients for determining the hematologic counts and MPV during first hour in ED period. RESULTS: In terms of the focus of the study, hemoglobin, neutrophil count, mean cell volume (MCV), red cell distribution width (RDW), platelet, white blood cell (WBC), and lymphocyte counts were similar in both group (p>0.05). MPV in the SVT group was signifi cantly higher than in the control group (9.12±1.22 fl vs 8.64±0.89 fl , p<0.001). Multivariate logistic regression analysis showed that just MPV was independent predictor of SVT in patients with palpitation in ED (odds ratio [OR] 8.497, 95% confidence interval (6.181 to 12.325), p=0.012). CONCLUSIONS: Our study described that MPV is helpful parameter for the diagnosis of SVT in emergency department, for the first time in the literature.

Torsades de Pointes due to ischemic stroke.

Cardiac and cerebrovascular illnesses are among the leading causes of mortality and morbidity today. Thromboembolic cases, which are the result of cardiac arrhythmia, are one of the important causes of cerebral stroke. However, various abnormalities, especially ST-T wave changes on electrocardiography can be seen in patients who do not have any heart disease history but had ischemic cerebral stroke. In this study, we have presented an interesting case of Torsades de Pointes due to ischemic cerebral stroke.

The diagnostic significance of NT-proBNP and troponin I in emergency department patients presenting with palpitations.

OBJECTIVE: This prospective study investigated the diagnostic significance of the N-terminal pro-brain natriuretic (NT-proBNP) and troponin I peptides in emergency department patients presenting with palpitations. METHODS: Two groups of patients with palpitations but without documented supraventricular tachycardia were compared: a group with supraventricular tachycardia (n = 49) and a control group (n = 47). Both groups were diagnosed using electrophysiological studies during the study period. Blood samples were obtained from all of the patients to determine the NT-proBNP and troponin I levels within the first hour following arrival in the emergency department. RESULT: The mean NT-proBNP levels were 207.74±197.11 in supraventricular tachyarrhythmia group and 39.99±32.83 pg/mL in control group (p<0.001). To predict supraventricular tachycardia, the optimum NT-proBNP threshold was 61.15 pg/mL, as defined by the receiver operating characteristic (ROC) curve, with a non-significant area under the ROC curve of 0.920 (95% CI, 0.86-0.97, p<0.001). The NT-proBNP cut-off for diagnosing supraventricular tachycardia had 81.6% sensitivity and 91.5% specificity. Supraventricular tachycardia was significantly more frequent in the patients with NT-proBNP levels ≥61.15 pg/mL (n = 44, 90.9%, p>0.001). The mean troponin I levels were 0.17±0.56 and 0.01±0.06 pg/mL for the patients with and without supraventricular tachycardia, respectively (p<0.05). Of the 96 patients, 21 (21.87%) had troponin I levels ≥0.01: 2 (4.25%) in the control group and 19 (38.77%) in the supraventricular tachycardia group (p<0.001). CONCLUSION: Troponin I and, in particular, NT-proBNP peptide were helpful for differentiating supraventricular tachycardia from non- supraventricular tachycardia palpitations. Further randomized, large, multicenter trials are needed to define the benefit and diagnostic role of NT-proBNP and troponin I in the management algorithm of patients presenting with palpitations in emergency departments.

Frequency of MEFV mutation and genotype-phenotype correlation in cases with dysmenorrhea.

AIM: We aimed to investigate the relation between mutations and polymorphisms playing roles in the onset of clinical findings of Familial Mediterranean Fever (FMF) and clinical phenotypic reflections manifesting with painful episodes, such as dysmenorrhea. MATERIAL AND METHODS: A total of 1000 female patients who had not responded well to non-steroidal anti-inflammatory drugs in the menstrual period, and who had presented to the emergency room with the complaint of recurrent pain episodes were included in the study. All the patients were Turkish women living in Istanbul. In this study, the mutations most frequently seen in the Mediterranean Fever Gene (MEFV), namely M694V, E148Q, M680I(G/C), V726A, P369S, R761H, A744S, M694I, K695R, F479L, M680I(G/A), and I692del were examined using the DNA sequence analysis following DNA isolation. RESULTS: The number of individuals who had a mutation in at least one allele for FMF was 511 out of 1000 patients. Of these 511 patients, homozygous mutations were found in 21% (n = 109), compound heterozygous mutations were found in 27% (n = 136), and heterozygous mutations were found in 52% (n = 266). The most frequent homozygous genotype seen in our study population was M694V/M694V. The most common compound heterozygote genotypes were M694V/M680I, M694V/V726A, M694V/E148Q, and M680I/V726A; and 11.7% (n = 60) of the families in whom mutations were found had consanguinity. CONCLUSION: Women who present to the emergency room with the complaint of dysmenorrhea that is irresponsive to non-steroidal anti-inflammatory drugs may have several types of MEFV mutations that are responsible for FMF.

Emergency upper gastrointestinal endoscopy at the Emergency Department of Izzet Baysal Hospital: analysis of 263 patients.

To evaluate the epidemiological characteristics, etiology, and therapeutic outcome of gastrointestinal disorders in 269 patients who underwent emergency upper gastrointestinal (EUGI) endoscopy at the Emergency Department. Abdominal pain was the most common clinical indication, in 90 (33.5%) patients. The clinical reasons for emergency admission were significantly related to endoscopic diagnostic yield. Non-erosive gastritis was the most common diagnosis, in 76 (28.3%) of EUGIE patients. Erosive duodenitis and gastric ulcer were found to be the other most common clinical indications, in 69 (25.7%) and 31 (11.5%) of EUGIE patients, respectively. The majority of patients who presented with abdominal pain and loss of appetite were between the age of 41 and 60 years, while a significant number of patients presenting with the same symptoms did so during the winter season. Emergency endoscopy is a procedure of choice for the investigation of upper gastrointestinal complaints. Emergency endoscopy is not only a diagnostic tool but also a therapeutic modality.

Pseudo-subarachnoid hemorrhage and death after a bee sting.

We report a case of a 33-year-old woman who developed severe brain edema and pseudo-subarachnoid hemorrhage (SAH) at 36-hour follow-up after successful cardiopulmonary resuscitation for anaphylactic shock as a result of a bee sting. The patient died on the sixth day of the follow-up due to multiple organ failure and brain herniation. Our case suggests that the SAH-like findings on computed tomography scanning were not a new complication ("real" SAH) arising from the bee sting; rather, it was a pseudo-SAH related to prolonged cardiopulmonary resuscitation).