Emergency Medicine Association of Turkey Disaster Committee Summary of Field Observations of February 6th Kahramanmaras Earthquakes.

An earthquake measuring 7.7 magnitude on the Richter scale occurred at 04:17am on February 6, 2023 in the Pazarcik district of Kahramanmaras province Turkey. In the hours following the 7.7 magnitude event in Kahramanmaras, a second 7.6 magnitude earthquake struck the region and a third 6.4 magnitude earthquake struck Gaziantep, causing extensive damage and death. A total of ten provinces directly experienced the earthquake, including Kahramanmaras, Hatay, Gaziantep, Osmaniye, Malatya, Adana, Diyarbakir, Sanliurfa, Adiyaman, and Kilis. The official figures indicate 31,643 people were killed, 80,278 were injured, and 6,444 buildings were destroyed within seven days of the earthquakes (as of 12:00pm/noon on Monday, February 13th). The area affected by the earthquake has been officially declared to be 500km in diameter. This report primarily relies on observations made by pioneer Emergency Physicians (EPs) who went to the disaster areas shortly after the first earthquake (in the early stages of the disaster). According to their observations: (1) Due to winter conditions, there were transportation problems and a shortage of personnel reaching disaster areas on the first day after the disaster; (2) On the second day of the disaster, health equipment was in short supply; (3) As of the third day, health workers were unprepared in terms of knowledge and experience for the disaster; and (4) The subsequent deployment of health personnel to the disaster area was uncoordinated and unplanned on the following days, which resulted in the health personnel working there not being able to meet even their basic needs (such as food, heating, and shelter). During the first week, coordination was most frequently reported as the most significant problem.

The effect of body mass index on trauma severity and prognosis in trauma patients.

BACKGROUND: As in the rest of the world, the prevalence of obesity in Turkey has been increasing in recent years and has become a major public health issue. Although many trials have been conducted to study the effects of obesity on internal diseases, there are few studies investigating the effects of obesity on prognosis of trauma patients. The present study analyzed the effects of body mass index (BMI) on trauma severity and prognosis in trauma patients. METHODS: This study was prospectively conducted with trauma patients older than 15 years of age who presented at the Dicle University Faculty of Medicine emergency medicine department trauma unit between June 1, 2013 and May 31, 2014. Patients were grouped into high-energy trauma and low-energy trauma groups based on trauma severity. In addition, 4 groups were made according to BMI value (kg/m2). Group I was defined as BMI <25 (normal weight). Group II patients had BMI of 25-29.9 (overweight). Group III had BMI of 30-34.9 (obese), and Group IV was made up of patients with BMI ≥35 (morbidly obese). RESULTS: Comparison of whole patient population for inter-group differences showed significant differences between rate of head injury, thoracic injury, extremity injury, multitrauma, clinic admission rate, and mortality rate (p<0.001). No significant difference was observed between groups in abdominal injury rate (p=0.347). CONCLUSION: Clinic admission rate, length of intensive care unit stay, mortality rate, multitrauma rate, and injury severity score increased in proportion to greater BMI.

Demographic Properties of Civilians with Blast Injuries in Southeastern Anatolia Region.

OBJECTIVES: The present study conducted demographic analysis of blast injuries, with the authors aiming to guide the determination of groups and regions at risk, helping hospitals take preventive measures and providing information for accurate triage, rapid intervention, multidisciplinary approach, and lowering workforce losses. METHODS: This study retrospectively examined the demographic properties of civilians who presented to the Emergency Department of Dicle University after being injured in explosions of various origins between January 2005 and September 2013 in the Southeastern Anatolia Region of Turkey. RESULTS: Of the study population, 85.50% were male and 14.50% were female. The explosive responsible for injury was a mine in 20.51% of the cases, a bomb in 29.06%, a squib in 14.53%, dynamite in 7.69%, and some other explosive in the remaining 28.31%. Of those injured, 35.90% were students, 21.36% were farmers, 11.10% were shepherds or drivers, and 31.62% were from other occupational groups. CONCLUSIONS: In conclusion, injuries resulting from explosions are associated with higher morbidity and mortality rates, making it necessary to increase the number of trauma centers and emergency action teams in that region, as well as demining the region and educating the native population about explosives.

How was Felt Van Earthquake by a Neighbor University Hospital?

OBJECTIVES: Natural disasters, which are defined as events causing great damage or loss of life, are events of natural origin unpreventable by human beings that occur in a short period of time and lead to loss of life and property. The aim of the study is to analyze which patient groups and problems at a university hospital after the earthquakes in Van. METHODS: For the purposes of this study, 169 patients who presented to our emergency room following the earthquakes that occurred on the 23rd of October, 2011 and the 9th of November, 2011 in Van and were treated as an outpatient or inpatient were enrolled. Patients were divided into two groups. Patient data including the clinical and demographic characteristics were analyzed. RESULTS: Among the 169 patients included in our study, 97 (57.4%) were male and 72 (42.6%) were female. The mean age was 26.95±16.44 years in Group 1 and 39.80±23.08 years in Group 2. In our study, the majority of the patients in Group 1 had orthopedic injuries, while internal problems were more common in Group 2. The need for intensive care was greater among the patients in Group 1 compared to Group 2 (p<0.05). The leading cause of death in Group 1 was multi-systemic trauma in 7 out of the 10 patients (70%) and internal problems in Group 2 with 5 out of 12 patients (41.5%). CONCLUSIONS: Our country is in a geographical location where earthquakes are responsible for great losses of life and property. An efficient disaster relief plan may help to minimize the possible damage of earthquakes.

Factors affecting mortality caused by falls from height.

BACKGROUND: Falls from height are among the most common trauma cases presenting to emergency departments and often cause mortality and morbidity. In the present study, we aimed to determine the factors that effectively reduce mortality caused by falls from height. METHODS: Data from 2252 trauma patients who presented to Dicle University Emergency Service between January 2005 and December 2008 due to falling from height in the Southeastern Anatolia region were retrospectively analyzed. We analyzed the parameters that are considered to have a positive effect on mortality, which included the following: month of fall; age; gender; etiology; place of fall; type of ground on which the patient fell; height of fall; intubation; hypotension; tachycardia; neck, head, thoracal, abdominal, pelvic, and extremity injuries; Glasgow Coma Score (GCS); Injury Severity Score (ISS); and Revised Trauma Score (RTS). RESULTS: There were 1435 males (63.7%) and 817 females (36.3%) included in the study. Two thousand thirty-one (94.6%) patients survived the fall while 121(5.4%) died. The mean age of the surviving patients was 15.55±18.60 years, while the patients who died had a mean age of 29.59±28.93 years. The mean height of the fall of the survivors' was 3.09 meters, and the mean height of the fall for those that died was 6.61±5.73 meters (p<0.001). CONCLUSION: The mean fatal height of the fall in falls from height is 6.61 m. Age, attempted suicide, height of fall, type of ground on which the patient fell, place of fall, and head, thoracic, and abdominal trauma are the primary factors affecting mortality caused by falls from height.

Comparative diagnostic accuracy of serum levels of neutrophil activating peptide-2 and pentraxin-3 versus troponin-I in acute coronary syndrome.

OBJECTIVE: We measured the levels of neutrophil activating peptide-2 (NAP-2) and pentraxin-3 (PTX-3) in acute coronary syndromes (ACS) patients and compared their diagnostic accuracy with cardiac troponin I (cTnI). METHODS: We conducted a prospective cohort study to determine the diagnostic accuracy of PTX-3, NAP-2 and cTnI for the prediction of ACS. Consecutively eighty-three patients with sudden chest pain admitted to Dicle University Emergency Department within the first six hours of symptom onset were included in our study. Mean serum levels of PTX-3, NAP-2 and cTnI were compared between control and patient groups and ACS subgroups. Their sensitivities and specificities in early diagnosis of ACS were identified. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic validity of the markers, and areas under the ROC curve (AUC) were compared. RESULTS: In the patient group, mean serum concentrations of NAP-2 (53.03+22.77 ng/ml) and PTX-3 (1.73+0.82 ng/ml) were considerably higher than those of the control group (24.54+9.50 and 0.50+0.39 ng/ml, respectively) (p<0.01). When compared with the control group, PTX-3 levels of all three ACS subtypes (unstable angina pectoris (USAP) - 1.62+0.41 ng/ml, non-ST elevation myocardial infarction (NSTEMI) -1.63+0.31 ng/ml and ST-elevation myocardial infarction (STEMI) - 1.75+0.89 ng/ml) were higher, whereas NAP-2 levels were higher in USAP (56.29+22.60 ng/ml) and STEMI (52.05+20.99 ng/ml) patients (p<0.01). For diagnosing ACS within the first six hours of presentation, PTX-3 sensitivity was 98.5% and specificity was 92.3%, and NAP-2 sensitivity - 98.1% and specificity - 41.3%. The ROC curve AUC values were: 0.962 for PTX-3 (95% CI 0.802 - 1.073), 0.840 for NAP-2 (95% CI 0.684 - 0.991), and 0.683 for cTnI (95% CI 0.610 - 0.940). CONCLUSION: Pentraxin-3 is a sensitive and specific marker for ACS diagnosis when compared with cardiac markers in patients admitted to the emergency department (ED) within the first six hours of onset of chest pain.

Analysis of amitriptyline overdose in emergency medicine.

INTRODUCTION: Amitriptyline is a tricyclic antidepressant. In general, toxicity effects develop within 30 min of overdose and peak from 2 h to 6 h. Anticholinergic effects predominate in cases of low dose ingestion. In cases of high dose ingestion, marked depression of the central nervous system is coupled with cardiotoxicity, seizures and hypotension. PATIENTS AND METHODS: Amitriptyline-intoxicated patients admitted to the emergency department (ED) of Dicle University Hospital were evaluated between January 2005 and April 2007. Social and demographic status, clinical and laboratory findings, treatments and outcomes were recorded. Age, sex, marital status, time of hospital admission, consciousness levels, ECG findings, requirement for respiratory support, follow-up periods and antidepressant overdose risk assessment (ADORA) criteria were analysed using SPSS software. RESULTS: A total of 110 cases of overdose by amitriptyline was evaluated. Suicide attempts by amitriptyline overdose in adult single women were the commonest finding. The commonest symptoms seen during initial examinations were sinus tachycardia (66.3%), altered mental state (78.1%) and hypotension (7.3%). Mechanical ventilatory support was required in 9.1% of cases. Most patients (n=76, 69.1%) were treated in the ED (p=0.001). 60 (54.5%) patients were discharged from the ED within 24 h after admission (p<0.0001). CONCLUSION: Most of the patients were young single women. Altered mental state and tachycardia were the commonest symptoms. The initial symptoms of amytriptyline overdose patients may be life threatening, but effective supportive treatments were helpful. There was high correlation between ADORA criteria and the dose ingested.

Relation between serum Pro-Brain natriuretic peptide, myoglobin, CK levels and morbidity and mortality in high voltage electrical injuries.

OBJECTIVE: In our study, in addition to evaluating the relation between Pro-Brain natriuretic peptide (Pro-BNP), myoglobin and creatinine kinase (CK) levels and morbidity and mortality, we aimed at identifying the demographic characteristics of patients admited to emergency service after exposure to high electrical voltage. METHODS: In this prospective study, 48 emergency service patients exposed to high electric voltage were included; 19 healthy individuals were included as the control group. Their blood samples and electrocardiographies (ECG) were taken at the time of recourse upon their written approval. Demographic data and laboratory data were checked and compared among the patient group. We investigated the correlation between inpatients that had special clinical manifestations (escaratomy, fasciotomy, exitus, myoglobulinuria, third-degree burn, arrhythmia and etc.) and serum Pro-BNP, myoglobin and CK levels. RESULTS: When serum Pro-BNP, myoglobulin and CK levels were compared for the special clinical manifestations; the pro-BNP levels were statistically significantly higher in patients who had arrhythmia than in those without arrhythmia, and significantly higher in patients who died than in those who healed (respectively p=0.002 and p=0.007). In contrast, serum CK and myoglobin levels were not statistically significant. The serum CK and myoglobin levels were statistically significantly higher in patients who had third-degree burn than the others (p<0.001). CONCLUSION: Serum pro-BNP level is a marker that can be used for mortality and morbidity with patients exposed to high voltage electrical injuries.

The role of the heart-type fatty acid binding protein in the early diagnosis of acute coronary syndrome and its comparison with troponin I and creatine kinase-MB isoform.

OBJECTIVES: The aim of this study was to research the effectiveness of the heart-type fatty acid binding protein (H-FABP) in the early diagnosis of acute coronary syndrome (ACS) in patients admitted to emergency service (ES) within 6 hours of onset of chest pain. EQUIPMENT AND METHOD: A total of 83 patients admitted with chest pain to our ES were included in this study. The patients were divided into 2 groups: those with a diagnosed ACS and those diagnosed with non-cardiac-related chest pain. Patients were also were divided into 2 groups according to the time of admission: those admitted within 0 to 3 hours and 3 to 6 hours of onset of chest pain. Peripheral venous blood samples were obtained from all patients for H-FABP, troponin I, and creatine kinase-MB (CK-MB) serum concentration measurements. RESULTS: Of a total of 83 patients, 21.6% (n = 18) were in the control group and 78.3% (n = 65) were in the ACS group. The average H-FABP value for the patients in the control group was 0.86 ± 0.54 ng/mL. When the ACS and control groups were compared in means of cardiac markers for CK-MB (P = .000) and H-FABP (P = .000), there was a statistically significant difference, whereas no difference was observed for troponin I (P = .013). In the ACS group, H-FABP sensitivity for diagnosis was found to be 98% and specificity was 71%; CK-MB sensitivity was 86% and specificity was 52%; and troponin I sensitivity was 77% and specificity was 20%. CONCLUSIONS: For patients admitted with chest pain to ES, H-FABP was found to be more sensitive and specific than troponin I and CK-MB in the early diagnosis of ACS.

Snakebites in adults from the Diyarbakir region in southeast Turkey.

BACKGROUND: Snake venom poisoning is a medical emergency requiring immediate attention. Bites from poisonous Turkish snakes can lead to local tissue damage and systemic symptoms. The Vipera ammodytes species accounts for the majority of envenomation in southeast Turkey. METHODS: The demographic and epidemiological characteristics, clinical symptoms and signs, laboratory findings, treatment, and outcome of 79 consecutive victims of V. ammodytes poisoning admitted to our hospital from 2003 to 2005 were reviewed and analyzed prospectively. RESULTS: The most common symptoms and signs included fang marks (100%), pain (100%), swelling (83.5%), ecchymosis (92.4%), tachycardia (24.1%), fainting or dizziness (14.5%), fever (19.0%), enlargement of regional lymph nodes (43.0%), nausea (70.9%), hypotension (21.5%), vomiting (36.7%), and dyspnea (3.2%). The main complications were thrombophlebitis, reduced range of motion, local hemorrhagic blister formation, bleeding from skin, rhabdomyolysis, reduced sensation, acute renal failure, necrosis with tissue loss, digit amputation, carpal tunnel syndrome, and compartment syndrome. CONCLUSION: A V. Ammodytes bite is a potentially serious event that requires immediate hospital care. Nevertheless, the majority of victims can be treated successfully with conservative methods. No deaths occurred in our series.

Clinical importance of ultrasonographic pelvic fluid in pediatric patients with blunt abdominal trauma.

BACKGROUND: The aim of this study was to evaluate the significance of the ultrasonographic finding of pelvic fluid as a predictor of organ injury in pediatric patients with blunt abdominal trauma. METHODS: We reviewed retrospectively the medical records of 85 consecutive pediatric patients who admitted to the Emergency Department of Dicle University from January 2008 to December 2008 with blunt abdominal trauma. Age, gender, mechanism of injury, isolated injuries, surgical interventions, hospitalization, and mortality were evaluated according to the location of fluid. RESULTS: A total of 85 pediatric patients (63 male, 22 female; mean age: 7.88+/-3.403 years) with blunt abdominal trauma were included in the present study. Forty percent of the patients had intraperitoneal fluid, while 60% had pelvic fluid. The majority (35.3%) of patients applied due to falling from height. The difference between the mechanism of the injuries and location and presence of the fluid was not statistically significant (p>0.05). Twenty-nine patients had solid organ injuries. Splenic injuries showed the highest association with intraperitoneal fluid (p<0.001). Of the patients, 15.3% underwent exploratory laparotomy and 44.7% required blood transfusion. The presence of intraperitoneal fluid statistically increased the probability of the exploratory laparotomy and necessity of blood transfusion (p<0.001). Mortality rate was 4.8%. CONCLUSION: In ultrasound examination, it was determined that the probability of solid organ injury was lower in the presence of pelvic fluid, while it was higher in the presence of intraperitoneal fluid outside the pelvis.

Mortality and morbidity in children caused by falling televisions: a retrospective analysis of 71 cases.

OBJECTIVES: To quantify injuries in children that result from toppled televisions. METHODS: Children presenting directly to emergency department due to injuries caused by falling televisions were identified from our digital patient database, and a retrospective chart review of 71 children was performed.Descriptive statistics were applied. RESULTS: 71(1.8%) out of 3856 admissions due to injuries sustained at home were TV-related injuries. There were 50 (70.4%) boys and 21(29.6%) girls. Mean age was 39.79 ± 20.14 SD months. Almost three quarters of the children (49/71) sustained various head and facial injuries. There was traumatic brain injury in 14 patients,extremity injuries in 30 patients, thoracic injuries in 13 patients and abdominal injuries in ten patients. 16 patients were hospitalized. 14 of them required follow-up in intensive care unit. Two patients (one with epidural hematoma and one with subdural hematoma) underwent surgical intervention. Four patients with subarachnoid bleeding died. The mean length of hospital stay was 71.25 hours (range, 48-168) in hospitalised patients. The overall mortality rate was 5.6%. CONCLUSIONS: Falling TVs may cause significant morbidity and mortality in children particularly those younger than 3 years old. Head and facial injuries are the most common body region involved and traumatic brain injury is the major cause of death.

Paroxysmal atrial fibrillation after smokeless tobacco (Maras powder) use.

Use of cigarettes and smokeless tobacco is a considerable public health problem. In Turkey, a type of smokeless tobacco called Maras powder (MP) is widely used in the Southeastern region. We present a case of paroxysmal atrial fibrillation that was suspected to be caused by the use of MP, which has never previously been noted in the literature. A 46-year-old man was admitted to our emergency department with angina pectoris and palpitation. He was a long time cigarette smoker and had begun using MP the fortnight before. Electrocardiography showed atrial fibrillation with rapid ventricular response. The patient had no medical history of alcohol use, surgery, palpitation, coronary arterial illness, hypertension or chronic bronchitis. Atrial fibrillation was converted to sinus rhythm after antiarrhythmic medication. Our patient was discharged from the emergency department with a suggestion to quit MP usage immediately. In conclusion, the use of MP may lead to the occurrence of paroxysmal atrial fibrillation.

Continuous infusion of small-volume fluid resuscitation in the treatment of combined uncontrolled hemorrhagic shock and head injury.

OBJECTIVE: To determine the effect of continuous limited fluid resuscitation on the hemodynamic response and survival in rats in a model of uncontrolled hemorrhage shock due to massive splenic injury (MSI) and head injury (HI). DESIGN: An experimental study. PLACE AND DURATION OF STUDY: Dicle University Animal Research Laboratory, Turkey, between January and February 2005. SUBJECTS AND METHODS: Seventy Sprague-Dawley rats were used in this study. Group 1 rats (n=10) was sham-operated. In group 2 (n=10), only Massive Splenic Injury (MSI) was performed and untreated. In group 3 (n=10), only head injury (HI) was performed and untreated. In group 4 (n=10), HI and MSI were performed and were untreated. In group 5 (n=10), HI and MSI were performed and 15 minutes later treated with 7.5% NaCl. In group 6 (n=10), HI and MSI were performed, and rats were treated with Ringer's Lactate (RL) solution. In group 7 (n=10), HI and MSI were performed, rats were treated with 0.9 % NaCl. In groups 2,4,5,6 and 7 midline incision was reopened and splenectomy was performed at 45 minutes. RESULTS: In group 4 rats, Mean Arterial Pressure (MAP) was decreased from 104 +/- 6.1 mmHg to 75 +/- 19.5 mmHg at 15 minutes; heart rate decreased from 357 +/- 24.9 beats/min to 321 +/- 62.1 beats/min and hematocrit decreased from 46 +/- 1.3 % to 43 +/- 2.5 % (p<0.01). Similar early changes in MAP, heart rate and hematocrit were observed in groups 5, 6, and 7, at 15 minutes. At 45,60 and 120 minutes, in fluid resuscitated rats (group 5,6,7) MAP, heart rate and hematocrit values were measured higher than group 2 and 4 (p<0.01 for all). At 120 min. in group 6, hematocrit was higher than group 4, 5 and 7, in group 6, total blood loss after splenectomy was calculated at 20 +/- 2.4% of blood volume and was the best value compared to other fluid resuscitated group 5 and 7 (28% and 27% of blood volume) (p<0.01). Mortality was lower in all fluid resuscitated groups when compared to group 3 and 4 (p<0.05). The median survival time was again higher in fluid resuscitated groups. CONCLUSION: Continuous infusion of 7.5% NaCl, RL and 0.9 % NaCl following uncontrolled hemorrhagic shock with massive splenic injury and combined head injury resulted in better survival and RL did not increase abdominal bleeding before splenectomy was performed.

A case of neuroleptic malignant syndrome induced by olanzapine in postpartum period.

Neuroleptic malignant syndrome (NMS) is a life-threatening medical complication that occurs as a result of dopaminergic receptor blockage in nigrostriatal pathways. This syndrome is mainly accepted to be an idiosyncratic reaction for antipsychotic medications. Incidence of NMS induced by olanzapine - an atypical antipsychotic - is extremely rare. However, there has been contradiction on postpartum period as a risk factor for NMS. This case is of interest due to the fact that it happens on postpartum period and is induced by olanzapine. We aimed in this study to evaluate the successfully cured case of neuroleptic malignant syndrome induced by olanzapine in postpartum period with the literature view.

Falls from flat-roofed houses: a surgical experience of 1643 patients.

PURPOSE: High falls from flat-roofed houses are a common cause of death and disability in the south-east part of Turkey; the aim of this study was to describe our experience of such falls seen over a 4-year period in Diyarbakir. METHODS: One thousand six hundred and forty-three patients (570 females and 1073 males) who sustained injuries after an accidental fall from a flat-roofed house were entered into the study. RESULTS: The mean age was 18 (1-95) years; 49.4% of patients were under 10 years old; 81.5% were under 30 years old. The mean fall height was 4.5m (1-20 m). The mortality rate was 5.8% (96 patients). The mean fall height in children under the age of 15 years who died from the fall was 4m (67 patients) and in patients over the age of 15 years, 9m (29 patients). The most common injuries were to the head (45.1%) and 93.75% of those (n = 90) who died had a head injury. One hundred patients (6%) were followed because of abdominal bleeding: one of these had fallen from 2m, the reminder from 4 to 9 m; 12 were operated on and 88 treated conservatively. CONCLUSION: Craniocerebral trauma is the most common injury in fatal falls from flat roofs and blunt abdominal trauma is an uncommon injury after falling from less than 4m.