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Introduction. The purpose of this study is to analyze the frequency of other diagnoses and findings in patients that were diagnosed with or not diagnosed with PE following the CTPA in the ED and to analyze the relationship between diagnosis and D-dimer. Instrument and Method. This study involves all patients that presented to the ED that underwent CTPA with the prediagnosis of PE. The items considered in this study were their reason for presenting to the ED and pretest clinical risks for PE, D-dimer, and CTPA results. Findings. Of the 696 cases, the most common cause was shortness of breath (59.3%). The CTPA showed that 145 (20.83%) patients were suffering from PE. Among the remaining cases, 464 (66.66%) patients had pathological findings other than PE and 87 (12.5%) patients were reported as normal. The most common pathological results other than PE found in CTPA were atelectasis in 244 (39.9%) and ground glass in 165 (23.7%), as well as nonpulmonary results in 70 (10.05%) patients. The differences in D-dimer results of patients diagnosed with PE, patients diagnosed with another pathology, and patients with normal CTPA results were statistically significant (P

Background. Acute cholecystitis is a common complication of cholelithiasis. Delayed diagnosis may constitute morbidity and mortality; therefore, early diagnosis and determining the severity of acute cholecystitis are crucial. Objectives. This study aimed to determine the validity of blood procalcitonin (PCT) levels in assessing the severity of acute cholecystitis. Methods. The Emergency Department (ED) patients diagnosed as acute cholecystitis were included in the study. Patients were allocated into three severity grades according to the Tokyo Guidelines 2013. PCT level was measured after the clinical and radiological diagnosis of acute cholecystitis in the ED. Results. Ninety-five patients diagnosed with acute cholecystitis, among them 48 of were male. Forty patients (42.1%) were allocated to grade 1, 19 (20%) to grade 2, and 36 (37.9%) to grade 3. The median values of PCT were 0.104 ng/ml, 0.353 ng/ml, and 1.466 ng/ml for grade 1, 2, and 3 patients, respectively (p

INTRODUCTION: This study aims to evaluate demographic and clinical characteristics of the emergency department (ED) cases with a diagnosis of temporomandibular joint (TMJ) dislocation alongside the patient management of these cases. METHODS: Our single-center and retrospective study was conducted at the ED of Eskisehir Osmangazi Health, Practice and Research Hospital in 10 years and 10 months (01.01.2010-30.10.2020). All 18 years and older patients diagnosed with TMJ dislocation at the ED during the studied period were included in the study. The information on demographics, dislocation type and mechanism, medical history of repeated dislocation, imaging, application of reduction, reduction outcome, and necessity of sedo-analgesia were obtained from the patients' records. The lack of data required for analysis in the records was taken as an exclusion criterion. RESULTS: When the file records were examined 113 cases were diagnosed with TMJ dislocation in ED. 66 cases were primary admissions and 47 cases were recurrent admissions of these cases. Primary applications are evaluated; the mean age was 42.74+-20.83 and 69.7%(n=46) were women. The joint dislocation was present in 56.1%(n=37) bilaterally. 98.5%(n=65) of them were non-traumatic. When all the cases were evaluated, it was determined that 91.2%(n=103) did not perform radiological imaging. During reduction, it was observed that sedo-analgesia was applied in 13.3%(n=15) cases. It was observed that 98.2%(n=111) of the reduction applications resulted successfully. No complication records of the cases were found. DISCUSSION AND CONCLUSION: Management of TMJ dislocation is important for patient comfort and joint function. Emergency physicians successfully manage acute TMJ dislocation, which they rarely encounter.

INTRODUCTION: The aim of the study is to evaluate the cases with warfarin therapy in which elevated International Normalized Ratio (INR) was detected and Prothrombin Complex Concentrate (PCC) was used for treatment at the Emergency Department (ED), and their treatment outcomes. METHODS: The study was conducted retrospectively at the ED of Eskisehir Osmangazi University Medical School between 01.01.2013-31.07.2019. Patients 18 years and older having Warfarin therapy who had elevated INR and PCC indication at the ED were included in the study. Demographics, INR levels, and their relationship with mortality were evaluated. The target INR was set as 1.5. The study was conducted retrospectively at the ED of Eskisehir Osmangazi University Medical School between 01.01.2013-31.07.2019. Patients 18 years and older having Warfarin therapy who had elevated INR and PCC indication at the ED were included in the study. Demographics, INR levels, and their relationship with mortality were evaluated. The target INR was set as 1.5. The study was conducted retrospectively at the ED of Eskisehir Osmangazi University Medical School between 01.01.2013-31.07.2019. Patients 18 years and older having Warfarin therapy who had elevated INR and PCC indication at the ED were included in the study. Demographics, INR levels, and their relationship with mortality were evaluated. The target INR was set as 1.5. RESULTS: The average age in 106 evaluated cases was 71 (range, 28-97) and 59 (55.70%) were female. The most common reason for warfarin use was atrial fibrillation (42 cases-39.60%). The most common reason for PCC use was intracranial hemorrhage (48 cases-45.30%). The initial median INR was 8.96 (Q1-Q3: 5.06-15). There was no statistically significant relation between initial INR and the reasons for PCC use (p=0.93). The control median INR was 1.43 (Q1-Q3: 1.26-1.91). Target INR was achieved in 49 cases (49.00%). The median drop levels in INR was 81(Q1-Q3: 67-89). 24-hour mortality was 1.97% and 30-day mortality was 20.7%. There was no statistically significant relation between initial INR and mortality (p=0.06-0.09, respectively). No thromboembolic incident was encountered. DISCUSSION AND CONCLUSION: In patients, who have hemorrhage or hemorrhage risk due to warfarin overdose, treatment should be implemented considering hemorrhage. In life-threatening hemorrhages and emergency interventions related to warfarin, PCC has an efficient role in INR reduction.

Background. Emergency physicians (EPs) face critical admission decisions, and their judgments are questioned in some developing systems. This study aims to define the factors affecting mortality in patients admitted to the hospital by EPs against in-service departments’ decision and evaluate EPs’ admission diagnosis with final discharge diagnosis. Methods. This is a retrospective analysis of prospectively collected data of ten consecutive years (2008–2017) of an emergency department of a university medical center. Adult patients (≥18 years-old) who were admitted to the hospital by EPs against in-service departments’ decision were enrolled in the study. Significant factors affecting mortality were defined by the backward logistic regression model. Results. 369 consecutive patients were studied, and 195 (52.8%) were males. The mean (SD) age was 65.5 (17.3) years. The logistic regression model showed that significant factors affecting mortality were intubation (p

Aim: The aim of our study is to establish the point at which a high blood alcohol concentration (BAC) in patients admitted to a hospital’s emergency department (ED) after an automobile accident can increase the severity of the injury and influence the survival and death rates.Materials and Methods: Our study is a prospective performed on patients ≥18 years of age admitted to the ED for in-car road accidents (ICRA) between September 15, 2011 and September 14, 201214-09-2012. Information such as demographic features, trauma score systems, BACs, hospital charges, discharge, hospitalization, and death of the patients was recorded.Results: The BACs of 52 out of a total of 324 patients were determined to be above normal limits (50 mg/dL). The clinical condition of patients with a BAC above normal limits was relatively worse (42.9%) than those with a BAC within normal limits (p

SUMMARY: Splenic infarcts are rare cases. It may not be noticed in the emergency department because the clinical picture is likely to mimic various acute abdominal pains. The splenic infarct is often the result of systemic thromboembolism associated with cardiovascular disorders. The aim of this study is to present an evaluation of the patients that presented to the emergency department (ED) with abdominal pain and were diagnosed with splenic infarct. Key words: Emergency department, D-dimer, infarct, spleen

SUMMARY: Objectives: In emergency departments, emergency physicians frequently have to perform central venous access. In cases where peripheral venous access is not possible, central venous access is required for dialysis, fulfillment of urgent fluid need, or central venous pressure measurement. This study was carried out to evaluate the emergence of complications in the process of and in the 15 days following the insertion of central venous catheter under ultrasound guidance in the emergency department. Methods: For this study, patients who presented to the emergency department over a period of eight months with an urgent need for central catheter were examined prospectively. Age, gender, and accompanying diseases of patients as well as the type, time, duration, and indication of the venous access were recorded. Furthermore, the amount of experience of the physician was taken into consideration. Results: In the emergency department, physicians performed ultrasound-guided central venous catheter insertion for 74 patients (40 men and 34 women). For access, internal jugular vein was used in 65 (87.8%) patients, and femoral vein was used in 9 (12.2%) patients. The reason for access was urgent dialysis need in 55 (74.3%), CVP measurement in 3 (4.1%), fluid support due to severe hypovolemia in 6 (8.1%), and difficulty of peripheral venous access in 10 (13.5%) patients. None of the patients developed complications in the process of or after the insertion. Patients did not have infections related to the catheter in 15 days following the insertion. Conclusions: Central venous access is frequently required in emergency departments. The risk of complication is little if any in ultrasonographyguided access carried out under appropriate conditions. ÖZET: Amaç: Acil servislerde acil tıp hekimlerince santral damar yolu işlemi sık uygulanır. Periferik damar yolu açılamadığı hallerde, diyaliz, acil sıvı ihtiyacı veya santral venöz basınç ölçümü gereken durumlarda hastalar için santral damar yolu gerekmektedir. Acil serviste, ultrasonografi (USG) kılavuzluğunda uygulanan acil santral venöz katater girişimi sürecinde ve uygulamayı takip eden 15 gün içerisinde komplikasyon varlığını değerlendirmek amacı ile bu çalışma yapıldı. Gereç ve Yöntem: Sekiz aylık sürede acil servise başvuran ve acil santral katater gereksinimi olan hastalar ileriye dönük olarak incelendi. Hastaların yaşı, cinsiyeti, eşlik eden hastalıkları ile tercih edilen girişimin yolu, saati, süresi ve endikasyonu kaydedildi. Ayrıca girişimi yapan hekimin çalışma yılı da değerlendirmeye dahil edildi. Bulgular: Ultrasonografi eşliğinde santral venöz katater takılan 74 (40 erkek, 34 kadın) hastanın 65'inde (%87.8) internal juguler ven, dokuzunda (%12.2) femoral ven girişim için kullanıldı. Uygulama olguların 55'inde (%74.3) acil diyaliz ihtiyacı, üçünde (%4.1) CVP ölçümü, altısında (%8.1) ciddi hipovolemi için sıvı desteği, 10'unda (%13.5) periferik damar yolu güçlüğü nedeniyle yapıldı. Hastaların hiçbirinde işlem esnasında ve sonrasında komplikasyon izlenmedi. Yatırıldıkları bölümde takiplerinde 15 günlük süre içerisinde katater ile ilişkili enfeksiyon da saptanmadı. Sonuç: Acil servislerde santral damar yolu gereksinimi sıktır. Kılavuzların önerisi doğrultusunda USG eşliğinde uygun şartlar altında yapılan girişimlerde komplikasyon riski yok denecek kadar azdır. Key words: Central venous catheter, emergency department, ultrasound-guided, Anahtar sözcükler: Santral venöz katater, acil servis, ultrason kılavuzluğu