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Objectives: Overcrowding in the Emergency Department (ED) is a serious and growing problem during recent years and one of the main causes of it is dysfunctional consultation system. We aimed to determine the problems related to patients who were admitted to the ED and requested consultations from internal medicine (IM) physicians and to contribute to the gap in the literature regarding this isssue. Methods: In a period of one year, 3601 patients, who were admitted to the ED of a university hospital and were consulted by IM physicians were included in this prospective cross-sectional study. The epidemiological characteristics of patients, length of ED stay and consultation-related problems were investigated. Results: The most common problems related to consultations were delayed completion of the consultation procedures for 88 (2.4%) patients, and unnecessary consultation requests for 66 (1.8%) patients, and patient referrals with inappropriate indications from IM outpatient clinics to the ED for 53 (1.5%) patients. There were differences of opinion among IM physicians and emergency medicine specialists regarding the need for consultation for 36 (1%) patients. The most important difference was in the various infections seen in patients with histories of hematologic or solid organ malignancies (n = 9). Conclusions: According to these findings, good collaboration must be established among ED physicians and consultant physicians. Furthermore, physicians must avoid inappropriate referral patients from outpatient clinics to the ED. Additionally, unnecessary consultation requests from the ED must be avoided, and consultation requests must be addressed quickly.

WOS: 000376164400019, PubMed: 26289523, Introduction: The early detection of critically ill patients together with the rapid initiation of effective treatment in emergency departments(ED) increase the survival rates. Aim: This study investigated whether a correlation exists between haemodynamic parameters of critically ill patients and the diameter of the inferior vena cava (IVC). Materials and Methods: A cross-sectional study was performed included patients aged >= 18 years with an unstable haemodynamic and/or respiratory status who were referred to the ED for non-traumatic issues. IVC diameters were measured by ultrasound (US) and then central venous pressures (CVP) were measured. Anteroposterior (AP) and mediolateral (ML) diameters of the IVC, both in the inspirium (IAP, IML) and expirium (EAP, EML), were measured by US. Results: 102 patients were evaluated with a median age of 59. The relationship between the diameters of IVC and CVP was evaluated and significant correlation was found in IAP, EAP according to CVP values (p

Objective: We aimed to compare the efficacies of ice, lidocaine- prilocaine mixture cream and the classical method in reduction of the pain observed during intravenous cannulation, which is the most frequently performed procedure in emergency departments and to define the most effective method. Material and Methods: One hundred-twenty patients who applied to the emergency department of Uludag University Faculty of Medicine were included in this presented study. Cannulations were performed after one minute application of ice package in the ice group. Patients who applied to emergency only for blood transfusion were chosen for the lidocaine-prilocaine group and their cannulations were performed at the 60 th minute of cream mixture application. Finally, no applications before cannulation were used for the control group. All cannulations were performed from antecubital region and 18 G cannula were used. Visual analog scale (VAS) and patient satisfaction were scored. Results: VAS scores for ice, lidocaine-prilocaine and control groups are 2.8±1.7, 4.1±1.8, 4.4±1.9, respectively. VAS score in the ice group was significantly lower than both lidocaine- prilocaine and control groups. In addition, there was no statistically significant difference between lidocaine- prilocaine and control groups. Conclusion: Ice application method before intravenous cannulation, in addition to its advantages such as being inexpensive, easy to obtain and apply, is more effective than lidocaine- prilocaine cream. (JAEM 2013; 12: 27-9)

Introduction: The purpose of this study was to determine the factors affecting the long waiting times of the patients in a university hospital. Methods: This study included 3000 of the adults above 18 years and pediatric trauma patients under 18 years who applied to emergency department between February 2009 and April 2009. The examination period of the physician, length of stay, length of hospitalization, waiting times for hospitalization and follow up times in the emergency department were recorded. Moreover, the patients were divided into four groups according to the reasons for waiting. Results: In our study, the time period between 4 pm-12 pm was determined as the busiest time for the applications. Average length of stay in the emergency department for 3000 patients was 146.7±160.2 minutes. The length of stay for the patients consulted was longer than the length of stay for the ones who were not consulted. Because of the fact that our hospital did not have appropriate bed capacity, 41.1% of the patients waited less than two hours, 13. 4% of the patients waited more than 8 hours. It was also found that the waiting times of the Group two patients (206,7±145,2 minutes) was longer than Group one (95,5±73,9 minutes) patients and the waiting times of Group three patients (470,7±364,7 minutes) was longer than Group one patients. Conclusions: In conclusion, cooperation of the managers, relevant departments and a multidisciplinary approach are necessary to achieve the goals to reduce overcrowding in the emergency departments. Keywords: bed capacity; crowding; emergency department; length of stay.

Aortic arch blunt injury has highly lethal nature. Because the physical examination findings are subtle, immediate medical evaluation is very important. The case was a 72-year-old woman. Massive haemorrhage in the left haemotorax, contusion area in the left lung and a traumatic transection of the distal aortic arch was observed during autopsy. We described intersting autopsy case of aortic arch blunt injury.

Sepsis is one of the most important causes of morbidity and mortality in patients presenting to the emergency department. SIRS criteria that define sepsis are not specific and do not reflect the severity of infection. We aimed to evaluate the ability of the modified mortality in emergency department sepsis (MEDS) score, the modified early warning score (MEWS) and the Charlson comorbidity index (CCI) to predict prognosis in patients who are diagnosed in sepsis. We prospectively investigated the value of the CCI, MEWS and modified MEDS Score in the prediction of 28-day mortality in patients presenting to the emergency department who were diagnosed with sepsis. 230 patients were enrolled in the study. In these patients, the 5-day mortality was 17 % (n = 40) and the 28-day mortality was 32.2 % (n = 74). A significant difference was found between surviving patients and those who died in terms of their modified MEDS, MEWS and Charlson scores for both 5-day mortality (p < 0.001, p = 0.013 and p = 0.006, respectively) and 28-day mortality (p < 0.001, p = 0.008 and p < 0.001, respectively). The area under the curve (AUC) for the modified MEDS score in terms of 28-day mortality was 0.77. The MEDS score had a greater prognostic value compared to the MEWS and CCI scores. The performance of modified MEDS score was better than that of other scoring systems, in our study. Therefore, we believe that the modified MEDS score can be reliably used for the prediction of mortality in sepsis.

Objective: This study aimed to evaluate the demographic characteristics, methods of suicide and its causes in patients over the age of 15 years admitted to the emergency service for attempted suicide. The importance of the psychosocial support unit that has recently become active in the emergency department is emphasized. Material and Methods: In our study, we retrospectively evaluated the “Suicide Attempt Feedback Forms” of patients over the age of 15 years who were admitted to the emergency service of the Van Education and Research Hospital for suicide attempts between February and November 2009. Results: A total of 112 cases were enrolled in the study, of whom 92 were female (82.2%) and 20 were male (17.8%). The most prominent age range for suicide attempts was between 15-24 years of age (71.4%). In both sexes, the most common suicide attempt method was drug use, and family problems were the most common cause of suicide. Nearly all patients had made suicide attempts with the use of drugs/toxic substances. Suicide attempts were most commonly seen in March, April and October. Conclusion: Considering the number of patients in the emergency department, a team working as a psychosocial support and crisis intervention unit with experience in suicide attempts and enough time to address this issue is important for patients to receive adequate and appropriate service. Implementation of this mechanism in an uninterrupted manner in the emergency department can contribute to the prevention of recurrent suicide attempts. (JAEM 2012; 11: 193-6)

To evaluate the occurrence and distribution of mild traumatic brain injury (MTBI) caused by diffuse axonal injury (DAI) using magnetic resonance (MR) imaging and to attempt to correlate MR findings with post-concussion symptoms (PCS).Forty MTBI patients (mean age: 32.5 years) with normal cranial computed tomography (CT) findings were examined with standard MR protocol including T(1)-weighted, T(2)-weighted, fluid attenuated inversion recovery (FLAIR), gradient echo (GRE) and diffusion-weighted (DW) sequences. MR imaging was performed within 24 hours of injury. The lesions were classified as DAI based on their location and morphologic appearance.In MR imaging of five (12.5%) of the patients, the lesions compatible with DAI were observed. Four patients (10%) had the foci of low signal intensity compatible with hemorrhagic shear injury on the GRE sequence, and five (12.5%) patients had high signal intensity on FLAIR and DW sequence.MR imaging can be helpful in revealing DAI lesions in patients with normal CT scan findings after MTBI. FLAIR, GRE and DW sequences are superior to conventional spin-echo images in detecting DAI lesions.

The aim of this study is to determine the demographic and clinical features of the trauma in elderly patients, to describe the factors affecting mortality, and to compare the significance of the trauma scoring systems to evaluate the mortality rate. We had investigated the medical records of 481 patients, aged 65 and older, admitted to our emergency department between 01/01/1996-31/07/2005 retrospectively. All cases were evaluated according to demographic features, trauma presentation, injury sites, prognosis, trauma scores (GCS [Glascow Coma Score], RTS [Revised Trauma Score], ISS [Injury Severity Score], TRISS [Trauma Score-Injury Severity Score]), and mortality. The mortality rate was 9.6% (46/481). TRISS was determined as most significant factor affecting mortality according to ROC analysis. There was a significant difference between survivors and non-survivors with regard to the type of traffic accident, namely, vehicle-occupant, pedestrian, and motorbike accidents. The head injury influenced the mortality significantly (P < 0.001). The extremity trauma was the most frequent injury site while the head trauma was the second frequent one. TRISS was found to be more effective to predict mortality than other scoring systems., Bu çalışmanın amacı yaşlı travma olgularında demografik ve klinik özellikleri saptamak, mortaliteye etki eden faktörleri ortaya koymak, travma skorlarının mortaliteyi tahmin etmedeki etkinliklerini karşılaştırmaktır. Acil servise 01/01/1996-31/07/2005 tarihleri arasında başvuran 65 yaş ve üstü 481 olgunun tıbbi kayıtları retrospektif olarak incelenmiştir. Tüm olgular demografik özellikleri travma oluş şekli, yaralanma bölgeleri, prognoz, travma skorları (GKS [Glaskow Koma Skoru], RTS [Revize edilmiş Travma Skoru], ISS [Yaralanma Şiddet Skoru], TRISS [Travma Skoru-Yaralanma Şiddet Skoru]) ve mortalite açısından değerlendirilmişlerdir. Mortalite oranı %9.6 (46/481) olarak saptanmış ve ROC analizinde mortaliteyi en iyi tahmin eden faktör TRISS olarak belirlenmiştir. Araç içi trafik kazaları araç dışı trafik kazaları ve motorsiklet kazaları açısından ölen olgular ile yaşayan olgular arasında anlamlı bir fark olduğu saptanmıştır. Yaralanma bölgesi olarak kafa travması anlamlı olarak mortaliteyi etkilemiştir (P

Purpose. We review our 11-year experience of treating diaphragmatic injury (DI), to identify the factors determining mortality and morbidity. Methods. We analyzed the effects of demographic characteristics, type of injury (blunt or penetrating), number of injured organs, injury severity score (ISS), revised trauma score (RTS), Glasgow coma score, and intensive care unit and hospital stay, on complications and mortality, in 51 patients treated for DI between January 1995 and December 2005. Results. Twenty-six (51%) patients suffered blunt injury and 25 (49%) suffered penetrating injury. The left diaphragm was injured in 40 (78%) patients, the right in 10 (19%), and both sides in 1 (2%). Only three (5.8%) patients had no concomitant injury. The diagnosis was made by the findings of laparotomy on 34 patients (65%), preoperative chest X-ray on 13 (25%), computed tomography on 2 (3.9%), and laparoscopy on 2 (3.9%). Complications developed in 23 (44%) patients and overall mortality was 19.6% (10/51). An ISS > 13 was found to be an independent prognostic factor for morbidity, whereas an RTS = 48 years, and a major postoperative complication were independent prognostic factors for mortality. Conclusion. Establishing a preoperative diagnosis of DI is still problematic. Aggressive treatment and close monitoring of patients with an ISS > 13, an RTS = 48 years, or a postoperative complication may decrease morbidity and mortality.

This study was performed to investigate the relationships between markers of inflammation in serum (interleukin-6 [IL-6], interleukin-10 [IL-10], and granulocyte elastase [GE]), severity of injury, and clinical outcomes, and to evaluate the predictive value of these markers for major complications and mortality. This study, which was conducted between August 2003 and May 2005, examined patients older than 16 y who were admitted to the Emergency Unit of the Uludag University Medical School within 12 h after trauma, and who had traumatic hemorrhagic shock (THS) at admission. Three groups were established: the THS group (n=20), the pure hemorrhagic shock (PHS) group (n=20), and the healthy control group (n=20). Demographic data were recorded for all subjects, and blood samples were taken for lactate, base excess, GE, IL-6, and IL-1 0 measurements. The Glasgow Coma Score, the Revised Trauma Score, the Injury Severity Score, the New Injury Severity Score, and the Trauma Score-Injury Severity Score were calculated; complications and final clinical outcomes were monitored. A total of 35 men and 25 women were included in the study; mean patient age was 41 +/- 17 y. In the THS group, scores were as follows: Revised Trauma Score, 10.2 +/- 2.2; Trauma Score-Injury Severity Score, 0.86 +/- 0.2; Injury Severity Score, 24.8 +/- 9.0; and New Injury Severity Score, 32.7 +/- 9.0. IL-6, IL-10, lactate, and base excess levels in the THS group were significantly higher than those in the PHS and healthy control groups. The serum GE level of the THS group was significantly higher than that of the healthy control group, but it did not differ significantly from that of the PHS group. Complications such as sepsis, acute respiratory distress syndrome, and multiple organ failure occurred in 50% of the THS group and in 20% of the PHS group. Mortality was 30% in the THS group and 10% in the PHS group. In the THS group, no significant differences were noted between markers of inflammation and trauma scores of patients who died and those who survived. The investigators concluded that although the levels of markers of inflammation increased in THS patients, they were inadequate for predicting mortality and the development of complications such as acute respiratory distress syndrome, multiple organ failure, and sepsis. A larger study based on the use of serial marker measurements is warranted.

Acute poisoning is frequent cause of admission to emergency departments and these cases may have hazardous outcomes. In the present study, medical records of 3384 poisoned patients admitted to Uludag University Medical School's emergency department between January 1996 and December 2004 were investigated. The age, sex, outcomes of the patients, and type of poisoning are described. The mean age for females (% 62.5 of the patients) was 27±12.1 years, whilst the mean age of male patients was (%37.5) 31±14.5 years. The most common types of poisonings were ingestion of drugs (% 58.6), reaction to food (% 10.5) carbon monoxide (% 8.3) organophosphates (% 4.1) corrosives (%3.5), mushrooms (%2.5), ethanol overdose (% 3.2) and methanol (% 0.5). Of the patients, 56.4% were discharged from emergency department, 20.2% were hospitalized and 2.5% died. Young people and women are high-risk groups for acute poisoning and drug poisoning was found to be the most common type of poisoning., Acil servislere akut zehirlenme nedeniyle başvuru sık görülmektedir. Zehirlenme olguları ciddi mortalite ve morbiditeye yol açabilirler. Çalışmamızda Uludağ Üniversitesi Tıp Fakültesi (U.Ü.T.F) acil servisine Ocak 1996 – Aralık 2004 tarihleri arasında başvuran 3384 zehirlenme olgusu geriye dönük olarak taranmış ve olgular yaş, cinsiyet, zehirlenme türü ve prognoz açısından incelenmiştir. Olguların % 62.5'i kadın (yaş ortalaması 27.3±12.1), % 37.5'i ise erkektir (yaş ortalaması 31±14.5). Zehirlenme türü açısından % 58.6 olguyla ilaçla zehirlenme ilk sırayı almaktadır. Besin reaksiyonları % 10.5 olguda, karbonmonoksit zehirlenmesi % 8.3 olguda, tarım ilacı ile zehirlenme % 4.1 olguda, koroziv maddelerle zehirlenme % 3.5 olguda mantar zehirlenmesi % 2.5 olguda, metanol zehirlenmesi % 0.5 olguda görülmüştür. Olguların % 56.4'ü acil servisten taburcu edilmiş, % 20.2'si yatarak tedavi görmüş, % 21.6'sı başka bir hastaneye sevk edilmiş ve % 2.5'i ise ölmüştür. Sonuç olarak; zehirlenme olgularında genç yaş grubu ve kadınların yüksek risk taşıyan grupları oluşturdukları, ilaç ile zehirlenmenin en yaygın tür olduğu saptanmıştır.

Objective: This study was performed to evaluate the effects of 0.9% saline (SAL), 0.9% saline + sodium bicarbonate + mannitol (SAL/BIC/MAN), and hypertonic saline-dextran (HSD) on hemodynamic variables, tissue blood flow, and oxidant injuries in experimental traumatic rhabdomyolysis (TR) in rats subjected allogeneic muscle extract infusion. Design: Prospective, randomized, experimental. Setting: Physiology experiment laboratory. Subjects: Male Sprague-Dawley rats, weighing 250–300 g. Interventions: All groups (n = 8 each) underwent femoral artery and vein catheterization. The animals in the TR, SAL, SAL/BIC/MAN, and HSD groups received an infusion of 2 mL of autologous muscle extract for 60 mins. After autologous muscle extract infusion, the SAL and HSD groups received 30 mL/kg 0.9% saline for 30 mins or 4 mL/kg HSD for 5 mins, respectively. The SAL/BIC/MAN group received 30 mL/kg 0.9% saline for 30 mins plus a bolus of 1 g/kg mannitol and a bolus of 2 mEq/kg sodium bicarbonate diluted in 1 mL of saline. At 2 hrs of autologous muscle extract infusion, erythrocyte flows in liver and kidney were measured by using a laser Doppler flowmeter. Then, blood samples and kidney and liver biopsies were taken to measure levels of glutathione and malondialdehyde. Measurements and Main Results: TR caused decreases in mean arterial pressure, tissue blood flow, and tissue glutathione and an increase in malondialdehyde. Rats in the HSD group had significant metabolic acidosis. SAL resuscitation did not correct tissue blood flow and prevent oxidant injury. HSD increased tissue blood flow, mean arterial pressure, and liver and kidney glutathione and decreased serum, liver, and kidney malondialdehyde. SAL/BIC/MAN resuscitation corrected all oxidant damage variables but did not increase tissue blood flow. SAL/BIC/MAN preserved serum malondialdehyde and liver glutathione better than the HSD did. Conclusions: HSD prevented oxidant injury and restored tissue blood flow but increased metabolic acidosis that followed autologous muscle extract infusion. SAL/BIC/MAN seems to be more effective than HSD in decreasing oxidant injury. Further research on the effects of the solute overload and metabolic acidosis due to HSD resuscitation on renal function in experimental rhabdomyolysis is warranted.

Background. Acute poisonings are frequent causes of admission to emergency departments and these cases may have hazardous outcomes. Methods. In the present study, medical records of 1818 poisoned patients admitted to Uludag University Medical School's Emergency Department between January 1996 and December 2001 were investigated. The age, sex, outcomes of the patients, and type of poisoning are described. Results. The mean age for females (63% of the patients) was 27 years, whilst the mean age of male patients was 31 years. The major types of poisonings were ingestions of medications (59.6%), mushrooms (3.3%), corrosives (2.5%), organophosphates (3.2%), and methyl alcohol (0.4%). Carbon monoxide accounted for 6.9% of intoxications. Approximately 65% of the patients survived, while the methyl alcohol and corrosive ingestions led to the highest fatality averages (100% and 14.8%, respectively). Conclusions. The demographic and diagnostic features of acute poisoning cases treated in our hospital are similar to those reported in the literature. Adults and women are in a high-risk group for acute poisonings and medicine poisoning, which is the most common type of poisoning.

BACKGROUND: Pulmonary embolism (PE) is one of the most frequent diseases that could be missed in overcrowded emergency departments as in Turkey. Early and accurate diagnosis could decrease the mortality rate and this standard algorithm should be defined. This study is to find the accurate, fast, non-invasive, cost-effective, easy-to-access diagnostic tests, clinical scoring systems and the patients who should be tested for clinical diagnosis of PE in emergency department. METHODS: One hundred and forty patients admitted to the emergency department with the final diagnosis of PE regarding to anamnesis, physical examination and risk factors, were included in this prospective, cross-sectional study. The patients with a diagnosis of pulmonary embolism, acute coronary syndrome or infection and chronic obstructive pulmonary disease (COPD) were excluded from the study. The demographics, risk factors, radiological findings, vital signs, symptoms, physical-laboratory findings, diagnostic tests and clinical scoring systems of patients (Wells and Geneva) were noted. The diagnostic criteria for pulmonary emboli were: filling defect in the pulmonary artery lumen on spiral computed tomographic angiography and perfusion defect on perfusion scintigraphy. RESULTS: Totally, 90 (64%) of the patients had PE. Age, hypotension, having deep vein thrombosis were the risk factors, and oxygen saturation, shock index, BNP, troponin and fibrinogen levels as for the biochemical parameters were significantly different between the PE (+) and PE (-) groups (P

Background Cardiovascular or cerebrovascular events associated with drug abuse have been frequently reported, particularly in young patients. The drugs include generally cocaine, heroin, and amphetamines. Although marijuana is among the widely used narcotics in the world, stroke associated with the marijuana use is infrequently reported. Methods Stroke caused by the use of marijuana was investigated in a 23-year-old man and the importance of inquiry of drug abuse in case of stroke was emphasized. Results The patient was treated for 7 days in a follow-up, but he was not recovered. The patient was discharged in his existing condition and was directed for physiotherapy and rehabilitation. Conclusion Ischemic stroke is associated with drug abuse and/or substance use, mainly cannabinoids and amphetamines, particularly in young patients.

6. Avrasya Acil Tıp Kongresi ile birlikte düzenlenen 14. Türkiye Acil Tıp Kongresi’nde (8-11 Kasım, 2018, Antalya) Poster bildiri olarak sunulmuştur. Vertigo toplumda hem en sık görülen şikayetlerden hem de acil servis ve polikliniklere en sık başvuru nedenlerinden biridir ve etyolojisine yönelik yapılan çalışmalar önem taşımaktadır. Bu çalışmada, bir üniversite hastanesi acil servisine başvuran hastalar, 24.10.2017 – 01.05.2018 tarihleri arasında prospektif olarak incelenmiştir. Vertigo ile başvuran hastalardaki santral etyolojilerin tespit edilmesi amaçlanmıştır. Çalışmamızda nörolojik sistemi değerlendirmek için kullanılan muayene, testler ve tetkikler açısından hastalar incelendiğinde; Romberg testi pozitif olan hastaların %7,7’de, dismetrisi olan hastaların %15,8’de ve disdiadokinezisi olan hastaların %16,7’de beyin magnetik rezonans görüntülemede akut-subakut enfarkt saptanmıştır. Muayenede horizontal nistagmusu olan 5 hastanın hiçbirinde akut- subakut enfarkt saptanmazken (%0), nistagmusu olmayan 45 hastanın 3’ünde (%6,7) akut-subakut enfarkt saptanmıştır. Sonuç olarak vertigo hastalarını değerlendirirken, santral vertigo nedenlerini atlamamak için nörolojik semptomların sorgulanması ve eksiksiz bir nörolojik muayene yapılması gereklidir. Vertigo is one of the most common complaints as well as the most frequent reason for referral to emergency departments and outpatient clinics and because of this it is important to study the etiology of this complaint. In this study, the patients who applied to an university hospital emergency department between 24.10.2017-01.05.2018 with vertigo were studied prospectively. It was aimed to determine the central causes of the applicants who had been dizzy. In our study; acute-subacute infarction was found in brain MRI in 7,7% of patients with positive Romberg test, 15,8% of patients with dysmetria and 16,7% of patients with dysdiadokinezia. Acute-subacute infarction was found in 3 patients (6,7%) of 45 patients without nystagmus, while no acute-subacute infarction was detected in any of the 5 patients with horizontal nystagmus (0%). When evaluating vertigo patients, the careful examination of neurological symptoms is essential for not missing central vertigo causes.

BACKGROUND: The necessity of routine tests as regarded in the Advanced Trauma Life Support protocols has become controversial in recent years. The aim of this study was to analyze the necessity of routine tests in trauma patients. METHODS: This was a prospective study. A total of 103 blunt trauma patients aged between 15 and 65 years who presented to the emergency department with major trauma, Glasgow Coma Scale of 15 and Revised Trauma Score of 12 were admitted to the study. RESULTS: The average age of the patients (30.1% female, 69.9% male) was 35 +/- 12.97 years. A total of 72.8% of the patients presented for motor vehicle crashes, 12.6% for pedestrian injury and 14.6% for fall from a height. All of the routine tests were evaluated separately. With the exception of cervical examination-lateral cervical X-ray results and pelvic examination-complete blood count and urinalysis test results, significant relations were determined between the reason for requiring a test and the results of the other tests (complete blood count, lateral cervical X-ray and abdominal ultrasonography). CONCLUSION: According to our study, biochemical tests, anterior-posterior chest X-ray and anterior-posterior pelvic X-ray can be ordered as targeted tests. Conducting targeted tests will reduce costs and workload. Son yıllarda ileri travma yaşam desteği protokollerine göre rutin testlerin gerekliliği tartışılmaktadır. Bu çalışmanın amacı, majör travma hastalarında rutin testlerin gerekliliği ve tanısal değerini analiz etmektir. GEREÇ VE YÖNTEM Bu prospektif çalışmada, Glasgow Koma Skoru 15, Revize Travma Skoru 12 olan ve 15-65 yaş arası majör travma ile acil servise başvuran toplam 103 künt travma hastası değerlendirildi. BULGULAR Hastaların (%30,1 kadın,%69,9 erkek) yaş ortalaması 35±12.97 idi. Tüm hastaların %72,8’i araç içi trafik kazası, %12,6’sı araç dışı trafik kazası ve %14,6’sı yüksekten düşme ile başvurdu. Rutin testlerin hepsi ayrı ayrı değerlendirildi. Servikal inceleme ile lateral servikal röntgen istemi, pelvik muayene ile tam kan sayımı ve idrar testi istemi hariç, tam kan sayımı, yan servikal röntgen ve karın ultrasonografisi istem nedenleri ile diğer test sonuçları ve istem nedenleri karşılaştırıldığında önemli farklılıklar saptandı. SONUÇ Çalışmamıza göre biyokimyasal testler, ön-arka göğüs grafisi ve ön-arka pelvis grafisi hedefe yönelik testler olarak istenebilir. Hedefe yönelik testlerin istemi ile maliyet ve iş yükü azalacaktır.

Çalışmamız acil hekimlerince abdominal aort anevrizması şüphesinde yapılan aorta odaklanmış ultrasonun hastaların tanı ve tedavi süresine etkisini araştırmak amacıyla yapılmıştır.Uludağ Üniversitesi Tıp Fakültesi acil servisine karın ağrısı, yan ağrısı, göğüs ağrısı, senkop, açıklanamayan hipotansiyon ile başvuran ve acil servis hekimi tarafından abdominal aort anevrizması şüphesi duyulan 50 yaş üstü hastalar çalışmaya dahil edilmiştir. Bu hastalarda abdominal aort anevrizması varlığını saptamak ya da tanısı net aydınlatılamayan hastalarda abdominal aort anevrizması tanısını dışlayabilmek amacıyla yatak başında abdominal aortanın ultrasonografik görüntülenmesi yapılarak çap ölçümü kaydedilmiştir.Çalışmaya 133 hasta alınmış ve 54 hastada (%43.2) aort çapı ?3 cm ölçülmüştür. Bu hastaların 8'inde (%6.4) aort çapı 5 cm'nin üzerinde bulunmuştur. Ultrason incelemeleri sonucunda 5 (%4) hastada anevrizma rüptürü, 13 (%10.4) hastada aort disseksiyonu ve 36 (%28.8) hastada aort anevrizması saptanmıştır. Aort patolojisi bulunan tüm hastalarda tanı bilgisayarlı tomografi ile doğrulanmıştır. Ultrason değerlendirmelerinde aort çapı 3 cm'nin altında ölçülen 23 (%18.4) hastanın klinik şüpheleri devam ettiği için bilgisayarlı tomografi görüntüleri elde edilmiş ve aort çapları normal sınırlarda saptanmıştır. Geriye kalan 48 (%38.4) hastada ön planda farklı tanılar düşünüldüğü için ileri görüntüleme yapılmamıştır.Ultrasonun abdominal aort anevrizmasını saptamadaki duyarlılığı %100, özgüllüğü %91, pozitif prediktif değeri %87, negatif prediktif değeri ise %100 olarak belirlenmiştir.Abdominal aort anevrizması tanısı acil servislerde %30 oranında atlanmaktadır. Bu tanı atlandığı taktirde yüksek mortalite ve morbiditeye sahiptir. Hastalarda şüpheli tanılar arasında abdominal aort anevrizması varlığında yatak başında ultrason ile aort çapının değerlendirilmesi tanısaldır. Tetkik ve zamanı etkin bir biçimde kullanabilmak için acil hekimlerince yatakbaşı ultrason değerlendirmesi rutin hale gelmelidir. Our study was carried out to investigate the effects of focused ultrasound usage by emergency physicians in diagnosis and duration of treatment of abdominal aortic aneurysm suspicion.The study was done in Uludag University Medicine Faculty Emergency Department, patients over years of 50 were included in the study, who presented with abdominal pain, chest pain, syncope, unexplained hypotension and under suspicion of abdominal aortic aneurysm by emergency physicians. Bedside ultrasound for abdominal aorta were done and diameter measurements of aorta recorded among the patients in order to determine presence of abdominal aortic aneurysm or to exclude the diagnosis.133 patients were included in the study; aortic diameter measured ? 3 cm with 54 patients (43.2%). Among these patients, 8 patients (6.4%) were found to have aortic diameter over 5 cm. In the result of ultrasound examinations following results detected; five (4%) patients had ruptured aneurysms, 13 (10.4%) patients had aortic dissection, and 36 patients (28.8%) had aortic aneurysm. All patients seemed to have aortic pathology with ultasound evaluation scanned with computered tomography in order to confirm diagnosis. In 23 (18.4%) patients whose aortic diameter measured under 3 cm in ultrasound evaluation, computered tomography were obtained for continued clinical suspicion and aortic diameters were found within normal limits. The remaining 48 (38.4%) patients diagnosed otherwise and advanced visualization did not performed.The sensitivity of ultrasound in detecting abdominal aortic aneurysm was definede as 100%, specificity 91%, positive predictive value 87%, negative predictive value of 100%, respectively.The diagnose of abdominal aortic aneurysm is omitted 30% in emergency departments. It has a high mortality and morbidity if the diagnosis is skipped. In the presence of abdominal aortic aneurysm suspect, evaluation of aortic diameter by bedside ultrasound is diagnostic. In order to use time and examination effectively bedside ultrasound evaluation of emergency physicians should become routine. 52

Hastane öncesi acil sağlık hizmetleri ülkemiz için çok önemli ancak gelişmiş ülkelerle kıyaslandığında oldukça yeni bir kavramdır. Hastaların en kritik anlarında müdahale eden hastane öncesi sağlık hizmetlerinde sürekli daha iyiye ulaşmak hedeflenmelidir. Hastane öncesi hizmetlere dair ülkemizde yapılmış kısıtlı sayıda çalışma bulunmaktadır. Çalışmamız; ambulans hizmetlerinin irdelenmesi ve ülkemizde hasta nakil durumu ile ilgili fikir vermeyi amaçlamaktadır.Çalışmamız; 01.02.2010 ile 30.11.2010 tarihleri arasında olay yerinden veya diğer sağlık kuruluşlarından acil servisimize ambulansla getirilen 1000 hasta incelenerek yapılmış prospektif kesitsel bir çalışmadır. Bir çalışma formu oluşturulmuş ve veriler ambulansı karşılayan acil tıp araştırma görevlisi tarafından toplanmıştır. Toplanan veriler ambulansta görev yapan personele göre gruplandırılmış; bu gruplar kendi aralarında hastaların nakil ve stabilizasyon uygunluğu açısından karşılaştırılmıştır.Çalışmamızda ambulansla getirilen hastaların çoğunlukla erkek olduğu (%61,5), %92,8'inin naklinin 112 ile yapıldığı; sıklıkla hekimler (%43,6) ve paramedikler (%31) eşliğinde getirildiği gözlenmiştir. Hastaların %48,4'ünün travma olduğu ve ambulansların çoğunun olay yerinden (%64,4) getirildiği saptanmıştır. Hastaların nakli ile ilgili acil servise sıklıkla haber verilmemiştir (%75,1).Hekimler, paramedikler ve diğer sağlık çalışanları arasında travma stabilizasyonu açısından karşılaştırma yapıldığında; boyunluk, sırt tahtası uygulaması, damar yolu açılması, atel konması ve açık kanamanın kontrolü açısından paramediklerin daha başarılı oldukları saptanmıştır. Benzer şekilde hekimler, paramedikler ve diğer sağlık çalışanları arasında hastaların havayolu, ventilasyon ve dolaşım gerekliliklerinin yerine getirilmesi konusunda karşılaştırma yapıldığında paramediklerin daha başarılı oldukları saptanmıştır.Hekim, paramedik ve diğer sağlık çalışanları arasındaki karşılaştırmanın daha sağlıklı olması ve hastalara yapılan müdahalenin yalnızca nakil ekibini yansıtması için 1000 hastalık seri; olay yerinden getirilen 644 hasta üzerinden tekrar değerlendirilmiştir. 10 dakikadan kısa ve uzun sürede yapılan nakiller karşılaştırıldığında gruplar arasında bir fark olmadığı görülmüştür. Bununla birlikte travma stabilizasyonu açısından gruplar tekrar karşılaştırıldığında benzer şekilde paramediklerin hekimlere oranla boyunluk, sırt tahtası uygulaması, damar yolu açılması, atel konması ve açık kanamanın kontrolü açısından daha başarılı oldukları saptanmıştır. Benzer şekilde paramediklerin hastaların havayolu, ventilasyon ve dolaşım gerekliliklerinin yerine getirilmesi konusunda daha başarılı oldukları saptanmıştır.Paramediklerin, hekim ve diğer sağlık çalışanlarına göre daha başarılı saptanmalarının nedeni; paramedik eğitim programının hastane öncesi döneme odaklanması ile ilişkili olduğu düşünülmektedir. Hastaya olay yerinde müdahale eden ve acil servise naklini yapan tüm sağlık personeli bilgi ve donanım açısından yeterli olmalı, bunun sağlanması için de periyodik olarak eğitimler gerçekleştirilmelidir. Prehospital emergency medical services are very important for our country, but it is a relatively new concept when it is compared with developed countries. It should be targeted to reach constantly for the better on prehospital health care which deal the most critical moments of the patients. There are limited numbers of studies done in Turkey about the prehospital services. Our study aims to examine the ambulance services and give an idea about the patient transport in our country.Our study is a prospective cross sectional work that 1000 patients were examined who brought between 30.11.2010 to 01.02.2010 from the scene or other health institutions to our emergency service by ambulance. A study form created and the data were collected by emergency medicine research assistants who meet the ambulance. The data collected are grouped according to ambulance staff; and these groups were compared in terms of compliance with patient transport and stabilization.In our study it is observed that the patients which brought in by ambulance were mostly male (61.5%), 92,8% of transportation were done with 112, and were often accompanied by physicians (43.6%) and paramedics (31%). 48.4% of the patients were trauma and mostly the ambulances brought the patients from the scene (64.4%). The information about the transfer of patients was not given to the emergency department often (75.1%).When a comparison made between physicians, paramedics and other health providers in terms of trauma stabilization; paramedics found to be more successful about application of cervical collar and back board, to obtain vascular access, control of bleeding and to put on splint. Similarly, when the comparison was made between physicians, paramedics and other health providers about the fulfillment of the requirements of airway, ventilation and circulation; paramedics found to be more successful.Cases re-evaluated over 644 patients who brought in from the scene to reflect only the intervention of the transport team and grouped among physicians, paramedics and other health providers. When the transportations compared by means of less than 10 minutes and long than 10 minutes, no difference was seen between the groups. However, again, when similar groups compared in terms of trauma stabilization, paramedics are found to be more successful about application of cervical collar and back board, to obtain vascular access, control of bleeding and to put on splint. Similarly, paramedics are found to be more successful in the fulfillment of the requirements of the patients about airway, ventilation and circulation.The success of paramedics is thought to be associated with the paramedic training program which focuses on pre-hospital period. All health care providers who attend at the scene and transport the patients to the emergency service must have sufficient knowledge and equipment, and to ensure that the training must be carried out periodically. 64

Acil servislere yaralanma nedeni ile başvuran hastaların büyük bir bölümünde el travması tespit edilmektedir. Bu çalışmanın amacı Uludağ Üniversitesi Tıp Fakültesi Acil Servis'ine başvuran el travmalı hastaların demografik ve klinik özelliklerini belirlemek ve bu verilerin ışığında acil servise başvuran el travmalı hastaların profilini oluşturarak önleyici tedbirler geliştirmek ve acil servis yapılanması için ön model oluşturmaktır.Çalışmaya 01.04.2009- 30.06.2010 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Acil Servis' ine izole el travması ile başvuran 540 hasta alınmıştır. İlave el dışı organ yaralanması olanlar, major travmalı hastalar ve çalışmaya katılmak istemeyen hastalar çalışma dışı bırakılmıştır. Hasta verileri `El Travmalı Hastaların Değerlendirilmesi Formu` kullanılarak toplanmıştır.Çalışmaya alınan 526 hastanın yaş ortalaması 34,94±15,54'tür. Hastaların 434'ünü (%82,5) erkekler, 92'sini (%17,5) ise kadınlar oluşturmaktadır. El travmalarının meydana geldiği zaman dilimi incelendiğinde en fazla travmanın 103 hasta (%19,6) ile 10-12 saatleri arasında olduğu görülmüştür. En sık yaralanan meslek grubunun 56 olgu (%10.6) ile mobilyacılar olduğu saptanmıştır. Acil servise başvuran hastalardan 104'ü (%19,8) cuma günü başvurmuştur. Başvuruların en sık nedeni 247 olgu (%47) ile iş kazaları olup 121'inde (%23) ikinci parmak yaralanması tespit edilmiştir. Çalışmaya dahil edilen hastaların 155'i (%29.5) yüzeyel yaralanma nedeniyle başvurmuştur. Olguların 180'i (%34.2) primer sütüre edilmiş ve 367 hasta (%69.8) el cerrahisi ile konsülte edilmiştir.Sonuç olarak acil servise el travması ile başvuran hastaların büyük bir kısmını çalışan, genç erkek hastalar oluşturmaktadır. İncelenen hastalardaki yaralanmaların çoğu dikkatsizlik ve eğitimsizlikten kaynaklanmakta olup gerekli basit tedbirlerin alınması ve mesleki eğitim programlarının yaygınlaştırılması ile bu yaralanmaların önüne geçilebilir. Yaptığımız bu çalışma ile elde ettiğimiz verilerin gelecekte yapılacak daha kapsamlı çalışmalara ışık tutması hedeflenmiştir.Anahtar kelimeler: El travması, acil servis, iş kazaları, yaralanma. Majority of the patients admitted to the emergency services due to an injury, hand injury is detected. This study aims to determine the demographic and clinical characteristics of patients with hand injury that admitted to Uludag University, Faculty of Medicine, Emergency Department and, in the light of these data, to develop preventive measures by creating a profile of the patients with hand injury that admitted to emergency department and to create a preliminary model for the settlement of emergency service.A total of 540 patients with isolated hand injury, who have admitted to Uludag University, Emergency Department between 01.04.2009- 30.06.2010, were enrolled into the study. Patients with additional organ injury, major trauma and patients who did not give consent to participate to the study were excluded from study. Patient data were collected using `Form for the Evaluation of the Patients with Hand Injury`.For a total of 526 patients enrolled to the study, mean age was 34.94±15.54. Of the patients, 434 (82.5%) were male and 92 (17.5%) were female. When the time frame, during which the hand injuries occurred, was examined, it was seen that the injuries mostly occurred at 10-12 AM, with 103 patients (19.6%). It was found that the most commonly injured occupational group included the carpenters, with 56 patients (10.6%). Of the patients that admitted to emergency department, 104 (19.8%) presented on Friday. Most commonly encountered cause of admission was occupational accidents, with 247 patients (47%), 121 of which (23%) showed second finger injury. Of the patients enrolled to the study, 155 (29.5%) admitted because of a superficial injury. As an intervention, 180 (34.2%) patients had a primary suture and 367 (69.8%) patients had a consultation with hand surgery.Consequently, a major part of the patients that admitted to emergency department with a hand injury was consisted of working, young men. Majority of the injuries observed in the patients examined were the injuries due to inadvertency and lack of education, which can be prevented by taking simple but necessary measures and by disseminating the vocational training programs. We hope that the data obtained from this study will enlighten more comprehensive studies in the future.Key words: Hand injury, emergency department, occupational accidents, injury. 58

Bu çalışma, 01.06. 2009 ? 31.12. 2009 tarihleri arasında Uludağ Üniversitesi Sağlık Uygulama ve Araştırma Hastanesi Acil Servisinde kan ve kan ürünü transfüzyonu yapılan hastaların demografik özelliklerini, transfüzyon endikasyonlarını, kullanılan kan ürünü miktar ve cinsi ile gelişen reaksiyonlarını dökümante etmek amacıyla prospektif olarak yapılmıştır.Transfüzyon yapılan hasta sayısının 434 olduğu görülmüştür. Hastaların %54.6'sını erkek, %46.4'ünü kadın hastalar oluşturmuştur. En fazla transfüzyon %35.5 ile 65 yaş üstü hastalara yapılmıştır. Transfüzyon yapılan hastaların %32'si 15-49 yaş, %30.9'u 49-65 yaş ve %1.6'sı 15 yaş altı hastalardan oluşmuştur.Transfüze edilen ürünlerin %56.5'inin eritrosit süspansiyonu (ES), %11.3'ünün taze donmuş plazma (TDP), %11.3'ünün trombosit süspansiyonu (TS), %9.2'sinin ES + TS, %6.9'unun ES + TDP, %2.1'inin Faktör VII ve Faktör VIII, %0.7'sinin TDP + TS, %0.9'unun ES + TDP + TS, %0.7'sinin ise TDP + Faktör olduğu saptanmıştır.Acil serviste transfüzyon yapılan hastaların %43'ünü hematolojik rahatsızlığı olan, %20.1'ni ise onkolojik rahatsızlığı olan hastalar oluşturmuştur. Transfüzyon yapılan hastalarda transfüzyon kararının %19.6'sı acil tıp asistanları tarafından, %80.4'ü ise konsültan hekim tarafından verilmiştir. Transfüzyon yapılan hastaların %62.7'sinin transfüzyon öyküsü olduğu saptanmıştır. Bu hastaların % 8.5'ine ise son bir hafta içinde transfüzyon yapıldığı belirlenmiştir.Hastalar vital parametreleri açısından değerlendirildiğinde, %83'ünde patoloji saptanmamış, %3.4'ünde hipotansiyon, %2.1'inde taşikardi %1.1'inde ateş, %9.7'sinde hipotansiyon + taşikardi ve %0.7'sinde ise hipotansiyon+ taşikardi + ateş olduğu görülmüştür.Transfüzyon yapılan hastalar hemoglobin miktarı açısından incelendiğinde %40.6'sının 7g/dl altında, %13.1'inin 7-8 g/dl arasında, %26.7'sinin 8-10 g/dl arasında ve %19.6'sının 10 g/dl üstünde olduğu belirlenmiştir. Eritrosit süspansiyonu en çok hemoglobin değerleri 7 g/dl altında olan hastalara, TS ise en çok trombosit sayısı 10-20x103/mm3 arasında olan hastalara verilmiştir. Taze donmuş plazma transfüzyonu yapılan hastaların %51'inde oral antikoagülan kullanımına bağlı kanama olduğu tespit edilmiştir.Çalışmamızda %1.2 hastaya acil 0 Rh negatif, %1.8 hastaya da coombs (+) kan transfüzyonu yapılmıştır.Transfüzyon yapılan hastaların %3.9'unda transfüzyonla ilişkili akut komplikasyonlar gelişmiştir. Bu komplikasyonlar incelendiğinde %1.2'sinin akut febril nonhemolitik reaksiyon (FNHR), %1.1'inin dolaşım yüklenmesi, %0.9'unun alerjik reksiyon, %0.7'sinin ise hem FNHR hem de alerjik reaksiyon olduğu gözlenmiştir.Transfüzyon yapılan hastaların %76.5'i acil servisten taburcu edilmiş, %19.4'ü hastaneye yatırılmış, %2.5'i başka bir sağlık kuruluşuna sevk edilmiş ve %1.6'sı da acil serviste ölmüştür.Çalışmamız süresince elde ettiğimiz tüm bu tespitler ışığında, acil serviste çok sayıda transfüzyon yapıldığını, endikasyon belirlemede belirli bir protokole bağlı kalınmadığını ve daha çok poliklinik takibinde olan hastalara ve destek niteliğinde transfüzyon yapıldığını söyleyebiliriz.Acil transfüzyon kararı; hangi amaçla ve ne için transfüzyon yapıldığının bilincinde olunarak, laboratuar düzelmeden çok klinik düzelmenin takibi yapılarak ve gerçek acil transfüzyon gerekliliği ortaya konularak verilmelidir. This study was designed prospectively to investigate the demographic data of the patients which had blood and blood products in Uludag University Medicine Faculty Research Hospital Emergency Service between June 2009-December 2009, also to investigate the endications for blood products used, the amount and the type of the products used and to document the reactions and compare the data with the literature.The percentage of transfused blood products was as following: 56.5% erythrocyte suspention, 11.3% fresh frozen plasma, 11.3% platelet suspention, 9.2% ES + TS, 6.9% ES + TDP, 2.1% factor replacement, 0.7% TDP + TS, 0.9%?u ES + TDP + TS, 0.7% TDP + factor.Within the patients who had blood product transfusion; 54.6% were male and 46.4% were female. 35.7% of the patients were older than 65. 31.6% of the patients were between the ages 15-49, 30.4% were between the ages 49-65 and 1.6% were younger than 15.Most of the patients who had blood product transfusion in Emergency Service were hematology and oncology patients with 43% and 20.1% respectively. The physician who decided to transfuse was emergency residant with 19.6% and mostly consultant physician with 80.4%. 62.7% of the patients had transfusion before. 8.5% of the patients had transfusion at last one week. 83.0% patients had normal vital parameters, 3.4% had hypotension, 2.1% had tachycardia,1.1% had fever, 9.7% had hypotension and tachycardia and 0.7% had both hypotension and tachycardia and fever. 40.6% of the patients had hemoglobine level under 7g/dl, 13.1% of the patients had between 7-8 g/dl, 26.7% of the patients had between 8-10 g/dl and 19.6% of the patients had above 10 g/dl. The pateints who transfused erytrocyte suspension were mostly the group who had hemoglobin under 7 g/dl. Platelet was transfused mostly for thrombocytopenia and whom platelet count were between 10-20x103/mm3.The patients who had given fresh frozen plasma were oral anticoagulant users with 51% (with mostly hematuri). 1.2% of the patients had emergent 0 Rh (-) blood transfusion. 1.8% of the patients had coombs + blood transfusion.Within the all transfused patients 3.9% had acute complication related transfusion. 1.2% of them were acute febrile nonhemolytic reaction (FNHR), 1.1% were heart failure, 0.9% were allergic reaction, 0.7% both FNHR and allergic reaction.While 76.5% of all transfused patients discharged from emergency department, 19.4% hospitalized, 2.5% sent to other hospitals and 1.6% dead in emergency department.By the light of all our findings we can easily say that lots of transfusion performed in emergency department, transfusion protocols usually is not followed and most of the transfusion is performed in order to support outpatient clinic.Emergency transfusion decision should be performed with true emergency indication, follow-up with clinical response rather than laboratory response and consciousness about the aim of transfusion. 73

Bu çalışmanın amacı yaşlı travma olgularında demografik ve klinik özellikleri saptamak, mortaliteye etki eden faktörleri ortaya koymak, travma skorlarının mortaliteyi tahmin etmedeki etkinliklerini karşılaştırmaktır. Acil servise 01/01/1996-31/07/2005 tarihleri arasında başvuran 65 yaş ve üstü 481 olgunun tıbbi kayıtları retrospektif olarak incelenmiştir. Tüm olgular demografik özellikleri travma oluş şekli, yaralanma bölgeleri, prognoz, travma skorları (GKS [Glaskow Koma Skoru], RTS [Revize edilmiş Travma Skoru], ISS [Yaralanma Şiddet Skoru], TRISS [Travma Skoru-Yaralanma Şiddet Skoru]) ve mortalite açısından değerlendirilmişlerdir. Mortalite oranı %9.6 (46/481) olarak saptanmış ve ROC analizinde mortaliteyi en iyi tahmin eden faktör TRISS olarak belirlenmiştir. Araç içi trafik kazaları araç dışı trafik kazaları ve motorsiklet kazaları açısından ölen olgular ile yaşayan olgular arasında anlamlı bir fark olduğu saptanmıştır. Yaralanma bölgesi olarak kafa travması anlamlı olarak mortaliteyi etkilemiştir (P

1.TÜRKÇE ÖZETUludağ Üniversitesi Sağlık Uygulama ve Araştırma Merkezi (UÜ-SUAM) Erişkin Acil Servisi' ne başvuran hastaların demografik ve klinik özelliklerini saptamak, acil servis çalışmalarını değerlendirmek ve aksaklıkların belirlenmesine yönelik olarak yaptığımız bu çalışmaya toplam 3000 hasta dahil edilmiştir.Çalışma 25.05.2008 ve 25.06.2008 tarihleri arasında yapılmıştır. Çalışmaya alınan hastalar erişkinler ve çocuk travmalardır. Hasta bilgilerini kaydetmek için bir veri toplama formu hazırlanmış; veri girişi acil servis hemşireleri ve acil tıp araştırma görevlileri tarafından yapılmıştır. Toplanan veriler Statistical Package of Social Science (SPSS) 13.0 programında değerlendirilmiştir.Çalışmaya alınan hastaların %51,53'ünün (n:1546) erkek, %48,47'sinin (n:1454) kadın olduğu belirlenmiştir. Erkek hastaların yaş ortalaması 41,0 ± 21,138; kadın hastaların yaş ortalaması ise 43,0 ± 20,478 olarak saptanmıştır. Hastaların %70'i (n:2099) acil servise özel araçla %10,1' i (n:302) ise ambulansla gelmiştir. Başvuruların en yoğun olduğu saatler 12:00-16:00 arası olarak tespit edilmiştir. Hastaların, acil servise kayıtlarının yapılmasından çıkışlarına kadar geçen süre ortalama 143,07 dakika olarak saptanmıştır. Başvuran hastaların %39,1' inden (n:1174) konsültasyon istenmiş olup en sık konsültasyon sırasıyla iç hastalıkları, kardiyoloji ve ortopedi bölümlerinden istenmiştir. Çalışmaya alınan hastaların %12,2 `si (n:367) hastaneye yatırılmış ve %4,5' i (n:134) ise sevk edilmiştir. Hastaların en sık yatırıldığı bölümlerin İç Hastalıkları, Plastik Cerrahi ve Kardiyoloji olduğu görülmüştür. Hastaların %12.6' sına (n:380) ileri radyolojik tetkik istenmiştir. En sık istenilen ileri radyolojik tetkik ise bilgisayarlı beyin tomografisi (BBT)' dir. Çalışmaya alınan hastaların %19,6'sının (n:585) triaj 1 olarak değerlendirilen çok acil gruptaki hastalar olduğu tespit edilmiştir. Tüm hastaların %76,4' nün (n:2291) hekim tarafından ilk 5 dakika içerisinde görülüp değerlendirildiği belirlenmiştir. Acil servisten hastane kliniklerine yatırılan 367 hastanın %19.9'unun (n: 73) acil serviste 240 dakikadan fazla kaldığı belirlenmiştir.Tüm verilerin ışığında giderilmesi gereken eksikler olsa da UÜ-SUAM Hastanesi Acil Servisi'nin iyi bir üçüncü basamak hastane acil servisi olduğu sonucuna varılmıştır. Acil servisteki hizmet kalitesinin arttırılmasına yönelik olarak yatış bekleyen hastaların uzun süre beklemesinin önlenmesi ve acil serviste ultrasonografi kullanılması gibi bazı önerilerde bulunulmuştur.Anahtar Kelimeler: Acil servis, Triaj, Konsültasyon, Acil Tıp, Demografik 2.SUMMARYDemographic Specialities of the Patients Referred to the Emergency Service of Uludag University Health Administraation and Research CenterThere are 3000 patients included in this study to determine the demographic and clinic specialities of the patients who referred to UU-HARC, to evaluate the emergency service studies and to identify the impediments.The patients included to the study are adults and trauma patients under 18 years. A data form prepared to save the patient informations; and data input is done by emergency service nurses and emergency service research assistants. the addend data analyzed with Statistical Package of Social Science (SPSS) 13.0 programme. The study accomplished between the date of 25.05.2008 and 25.06.2008.51,53% (n:1546) of the patients included to the study were male, and 48,47% (n:1454) were female. Mean age was 41,0 ± 21,138 in male group, and 43,0 ± 20,478 in female group. 70% (n:2099) of the patients transferred to the emergency service by a car and 10,1% (n:302) were by an ambulance. The heaviest traffic on application determined between 12:00-16:00. The average staying time in emergency service from admittance to discharge was 143,07 minutes. From 39,1% (n:1174) of applied patients were required consultation and the consultations mostly required from internal medicine, cardiology and orthopedics. 12,2% (n:367) of the patients in the study admitted to the hospital and 4,5% (n:134) was send to another hospital. The most admittion is done to internal medicine, plastic surgery and cardiology services. 12.6% of the patients required further radiologic investigation. The most often required further radiologic investigation was computed cranial tomography (CT). 19,6% (n:585) of the patients in our study were classified as triage 1 which is defined as very urgent group. 76,4% (n:2291) of the patients were evaluated in the first 5 minutes of appliance to the emergency service by emergency physician. The 19,9% (n:73) of the 367 patients who admitted to the hospital from emergency service waited in ER longer than 240 minutes.In the light of all this data, even though there are some deficiencies needed to be removed, it is decided that the Emergency service of UU-HARC is well enough for a third step hospital. For redound the quality in emergency service some recommendations made to prevent the long waiting time for admittion and about the usage of ultrasonograpy in emergency service.Key words: Emergency service, triage, consultation, emergency medicine, demographic 59

ÖZETBu çalışmanın amacı acil serviste yorumlanmış elektrokardiyografilerin (EKG) doğruluk ve güvenilirliğini değerlendirmek, acil tıp asistanları (ATA) ve kardiyoloji uzmanınca (KU) okunmuş EKG'lerin yorumları arasındaki uyumu belirlemektir.Bu çalışma Uludağ Üniversitesi Sağlık Uygulama ve Araştırma Merkezi acil servisine 12.06.2008 ? 12.07.2008 tarihleri arasında başvurmuş ve triyaj kategorisi 1 ve 2 olan 252 hasta üzerinde prospektif kesitsel olarak yapılmıştır.Çalışmaya alınan hastaların %60.3'ü erkek (n:152), %39.7'si kadın(n:100) olup, yaş ortalaması 59,4 (± 13,6) (min:19, maks: 91) olarak bulunmuştur.Hasta EKG'leri hem ATA'ları hem de KU tarafından birbirinden bağımsız olarak değerlendirilmiştir. Altın standart olarak KU'nın yaptığı yorumlar kabul edilmiştir. EKG'ler normal ve anormal olmak üzere 2 gruba ayrılmıştır. Anormal grubun içerdiği patolojik bulgular; hayatı tehdit eden (kategori lll-majör), potansiyel olarak klinik önemi olan (kategori ll) ve potansiyel olarak klinik önemi olmayan (kategori l-minor) bulgular olmak üzere 3 kategoride incelenmiştir. Yorumlar karşılaştırıldığında; KU'nınca normal olarak yorumlanan 73 EKG'nin %23'ünün (n:58) ATA'larınca da normal olarak yorumlandığı, 15 olgunun ise ATA'larınca normal olarak değerlendirilmediği görülmüştür. KU'nınca anormal olarak değerlendirilen 179 EKG'nin 39'unun majör, 78'inin potansiyel klinik önemi olan ve 62'sinin de minör EKG patolojileri içerdiği saptanmıştır. ATA'larınca anormal olarak değerlendirilen 187 EKG'nin ise 25'inin majör, 89'unun potansiyel klinik önemi olan ve 73'ünün de minör EKG patolojileri içerdiği saptanmıştır. Aralarındaki uyum incelendiğinde; Kategori-l'de, sinüzal taşikardi ve bradikardi için mükemmel uyum saptanırken, erken repolarizasyon için çok düşük oranda uyum tespit edilmiştir. Kategori-ll'de, atriyal fibrilasyon için mükemmel uyum saptanırken, tam olmayan sol ve sağ dal bloklarında daha az oranda uyum tespit edilmiştir. Kategori- lll'de ise 3. atriyoventriküler blok ve ventriküler taşikardi için tam uyum, akut myokard infarktüsü için çok iyi uyum olduğu tespit edilmiştir.Anahtar kelimeler: Elektrokardiyografi, acil tıp asistanı, acil servis ASSESSMENT OF ACCURACY AND RELIABILITY OF ELECTROCARDİOGRAMS THAT IS COMMENTED BY EMERGENCY MEDICINE ASSISTANTSThe aim of this study is to evaluate the accuracy and reliability of the electrocardiograms interpreted at emergency service, to examine the concordance ofthe interpretation of electrocardiograms (ECG) comment by emergency medicine research assistants (EMRA) and cardiology specialist (CS), and to determine the deficiencies.A prospective, cohort study was conducted on 252 patients who referred between 12.06.2008 ? 12.07.2008 to Uludag University and Research Center emergency service and categorized triage category 1 and 2.252 patients were entered in the study, of which 60.31% were male, 39.69% were female, mean age was 59,4 ± 13,6 years (19-91). EMRA and CS were independent while reading the ECG of patients. The comment of CS is received as gold standard. The ECGs are separated as normal and abnormal. The pathological findings in abnormal group were discussed in three groups as life threatening (category III - major), potentially clinical important (category II) and potentially not clinical important (category I ? minor) ECG findings.When we compare the interpretations of ECGs commented by CS and EMRA; 58% of 73 ECGs which were describe as normal by CS interpreted normal by EMRA. ECG interpretations of 15 cases were normal but couldn?t determine by EMRA (false negative), and 7 cases were abnormal but determined as normal (false positive).The 179 ECGs which were described as abnormal; classified by CS as 39 major, 78 potentially clinical important and 62 minor changes in ECG. When we observe the ECG readings of EMRA, 25 cases were classified as major, 89 cases potentially clinical important and 73 cases minor changes in ECG.In our study we found significant discordance between CS and EMRA interpretations of the ECG which obtained at emergency service.İİİWhen the concordance between them was examined in catogory 1 excellent concordance was obtained for sinusoidal tachycardia and bradycardy while very lowconcordance was detected for the early repolarization. İn catogory 2, although an excellent concordance was obtained for the atrial fibrillation, a low concordance was detected in partial right and left bundle branch blocks. In catogory 3, it was detected to have a complete concordance for the 3rd degree AV block and VT and a very good concordance for the AMİ.Key words: Electrocardiogram, emergency medicine research assistant, emergency service 46

Resorcinol is a pharmaceutical agent used topically in dermatological treatments for acne, eczema, psoriasis and related skin conditions. Although there are a few studies that indicate chronic toxic effects of resorcinol on humans after topical application, information on the effects of resorcinol in acute poisoning after oral ingestion is limited. Thus, we wish to report the clinical and laboratory findings of a patient who was admitted to our emergency department (ED) after inadvertent oral ingestion of resorcinol and later died, as well as the patient's autopsy findings. The major clinical and laboratory findings were unconsciousness, respiratory failure that required mechanical ventilation, generalized tonic-clonic seizures, leukocytosis and severe metabolic acidosis. In the blood sample taken at the autopsy, a high level of methemoglobin was found. In the serum, resorcinol was revealed by gas chromatography-mass spectrometry. It can be concluded that the basic approach to patients with resorcinol poisoning should include initial stabilization of the patient by supporting the airway, respiration and circulation, and treating complications such as seizures or metabolic acidosis in the ED, as soon as possible after oral ingestion.

Bu çalışma, 1. Disiplinler Arası Toksikoloji Kongresinde (20-22 Nisan 2005 Ankara) sözlü bildiri olarak sunulmuştur. Acil servislere akut zehirlenme nedeniyle başvuru sık görülmektedir. Zehirlenme olguları ciddi mortalite ve morbiditeye yol açabilirler. Çalışmamızda Uludağ Üniversitesi Tıp Fakültesi (U.Ü.T.F) acil servisine Ocak 1996 – Aralık 2004 tarihleri arasında başvuran 3384 zehirlenme olgusu geriye dönük olarak taranmış ve olgular yaş, cinsiyet, zehirlenme türü ve prognoz açısından incelenmiştir. Olguların % 62.5’i kadın (yaş ortalaması 27.3±12.1), % 37.5’i ise erkektir (yaş ortalaması 31±14.5). Zehirlenme türü açısından % 58.6 olguyla ilaçla zehirlenme ilk sırayı almaktadır. Besin reaksiyonları % 10.5 olguda, karbonmonoksit zehirlenmesi % 8.3 olguda, tarım ilacı ile zehirlenme % 4.1 olguda, koroziv maddelerle zehirlenme % 3.5 olguda mantar zehirlenmesi % 2.5 olguda, metanol zehirlenmesi % 0.5 olguda görülmüştür. Olguların % 56.4’ü acil servisten taburcu edilmiş, % 20.2’si yatarak tedavi görmüş, % 21.6’sı başka bir hastaneye sevk edilmiş ve % 2.5’i ise ölmüştür. Sonuç olarak; zehirlenme olgularında genç yaş grubu ve kadınların yüksek risk taşıyan grupları oluşturdukları, ilaç ile zehirlenmenin en yaygın tür olduğu saptanmıştır. Acute poisoning is frequent cause of admission to emergency departments and these cases may have hazardous outcomes. In the present study, medical records of 3384 poisoned patients admitted to Uludag University Medical School’s emergency department between January 1996 and December 2004 were investigated. The age, sex, outcomes of the patients, and type of poisoning are described. The mean age for females (% 62.5 of the patients) was 27±12.1 years, whilst the mean age of male patients was (%37.5) 31±14.5 years. The most common types of poisonings were ingestion of drugs (% 58.6), reaction to food (% 10.5) carbon monoxide (% 8.3) organophosphates (% 4.1) corrosives (%3.5), mushrooms (%2.5), ethanol overdose (% 3.2) and methanol (% 0.5). Of the patients, 56.4% were discharged from emergency department, 20.2% were hospitalized and 2.5% died. Young people and women are high-risk groups for acute poisoning and drug poisoning was found to be the most common type of poisoning.