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Cardiopulmonary arrest is an occasional occurrence during pregnancy. As soon as maternal arrest is noticed in a woman in the second half of her pregnancy, medical teams should be called for perimortem cesarean (C/S). A 31–week-pregnant female patient was brought to our emergency department by the emergency medical service team with cardiopulmonary resuscitation (CPR) after a traffic accident. The patient, with no pulse or spontaneous breathing, was recognized as exitus. However, CPR was sustained to maintain fetal well-being. Before the arrival of the on-call gynecologist, we as emergency physicians initiated C/S both for fetal well-being and to avoid heighten-ing the risk of fetal mortality and morbidity. The Apgar scores were 0/3/4 and oxygen saturation values were 35/65/75% at 1/5/10 min, respectively. On the postnatal 11th day, the patient did not respond despite the advanced cardiac life support (ACLS) and thus was considered exitus.The ACLS team should be knowledgeable and well-equipped to perform C/S, to do aftercare, to watch for related risks in the infant. In our case, it took 40 min for the fetus to be removed from the mother’s womb, starting from the estimated time of exitus. © 2023, Turkish Association of Trauma and Emergency Surgery. All rights reserved.

Hintergrund: Bei Patient:innen in der hausärztlichen Versorgung zählen neben den medizinischen häufig auch soziale Probleme, wie z.B. Probleme bei der Arbeit oder Einsamkeit, zu den Beratungsanlässen. Verschiedene Professionen, insbesondere die Soziale Arbeit, halten für [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Objectives: Terminally ill patients in need of palliative care present to emergency departments. This study aims to identify the usage level of the emergency departments by patients in need of palliative care, along with their experienced symptoms, preferences, needs, and the subsequent initiatives taken for symptom management. Methods: The study was designed as a cross-sectional study and conducted with a group of 208 patients. The Patient Information Form, the Form of the Criteria for Receiving Palliative Care, and the Karnofsky Performance Scale were used for data collection. Results: This report founda thatcancer patients were the most frequent users of emergency facilities within palliative care patient groups and more than half of those hospitalized patients were subsequently admitted to intensive care units. Patients with poorer functional conditions and in need of further palliative care preferred home care rather than receiving Advanced Cardiac Life Support. Conclusion: This study displays evidence that palliative care patients with a poorer functional condition in need of further palliative care should be able to spend the last days of their lives at home with their families rather than in the exhausting and crowded environment of the emergency departments. Furthermore, healthcare policymakers should actively support palliative care as well as taking the necessary actions to mitigate the burden placed on hospital resources. C1 [Bakan, Gulcan; Azak, Arife] Pamukkale Univ, Fac Hlth Sci, Internal Med Nursing Dept, Kinikli Campus, Denizli, Turkey. [Ozen, Mert; Erdur, Bulent] Pamukale Univ, Fac Med, Dept Emergency Med, Kinikli Campus, Denizli, Turkey. [Azak, Arife] Pamukkale Univ, Fac Hlth Sci, Internal Med Nursing Dept, Kinikli Campus,Univ St 11, TR-20160 Pamukkale Denizli, Turkey. [Ozen, Mert; Erdur, Bulent] Pamukkale Univ, Fac Med, Dept Emergency Med, Kinikli Campus,Univ St 11, TR-20160 Pamukkale Denizli, Turkey.

Introduction: Musculoskeletal system traumas are among the most common presentations in the emergency departments. In the treatment of traumatic musculoskeletal pain, paracetamol and non-steroidal anti-inflammatory analgesics (NSAID) are frequently used. Our aim in this study is to compare the efficacy of intravenous dexketoprofen and paracetamol in the treatment of traumatic musculoskeletal pain. Methods: This prospective, randomised, double blind, controlled study was conducted in a tertiary care emergency unit. The participating patients were randomised into two groups to receive either 50 mg of dexketoprofen or 1000 mg of paracetamol intravenously by rapid infusion in 150 mL of normal saline. Visual analogue scale (VAS), Numeric Rating Scala (NRS) and Verbal Rating Scale (VRS) was employed for pain measurement at baseline, after 15, after 30 and after 60 mins. Results: 200 patients were included in the final analysis. The median age of the paracetamol group was 34 (24-48), while that of the dexketoprofen group was 35 (23-50), and 63% (n = 126) of them consisted of men. Paracetamol and dexketoprofen administration reduced VAS pain scores over time (p = 0.0001). Median reduction in VAS score at 60 min was 55 (IQR 30-65) for the paracetamol group and 50(IQR 30.25-60) for the dexketoprofen group. There was no statistically significant difference between the paracetamol and dexketoprofen groups in terms of VAS reductions (p = 0.613). Conclusion: Intravenous paracetamol and dexketoprofen seem to produce equivalent pain relief for acute musculoskeletal trauma in the emergency department. (C) 2018 Elsevier Inc. All rights reserved. C1 [Yilmaz, Atakan; Ozen, Mert; Turkcuer, Ibrahim; Erdur, Bulent; Seyit, Murat] Pamukkale Univ, Med Fac, Dept Emergency Med, TR-20070 Denizli, Turkey. [Sabirli, Ramazan] Servergazi State Hosp, Emergency Serv, Denizli, Turkey. [Arikan, Cuneyt] Urla State Hosp, Emergency Serv, Izmir, Turkey. [Demirozogul, Ezgi] Gaziantep 25 Aralik State Hosp, Emergency Serv, Antakya, Turkey. [Sarohan, Ahmet] Hatay State Hosp, Emergency Serv, Antakya, Turkey. [Ok, Nusret] Pamukkale Univ, Med Fac, Dept Orthoped & Traumatol, Denizli, Turkey.

Objective To assess the effectiveness of pre-treatment with aripiprazole and quetiapine to prevent acute cocaine toxicity in a mouse model of cocaine toxicity. Methods This experimental study included three groups (n = 25 per group) of mice that were intraperitoneally injected with normal saline solution, 10 mg/kg quetiapine or 10 mg/kg aripiprazole 15 min before 105 mg/kg cocaine hydrochloride. When the cocaine administration was completed, researchers blinded to the study groups observed the mice in terms of seizures and death for a further 30 min. Results In the cocaine + quetiapine group, the mean +/- SE time to the first seizure was 10.80 +/- 2.27 min and seizure activity was detected in 18 mice (72%) by the end of the 30 min. In the cocaine + aripiprazole group, the mean +/- SE time to the first seizure was 18.10 +/- 1.94 min and seizure activity was detected in 15 mice (60%) by the end of the 30 min. When compared with the control group, there was a significant difference between the cocaine + quetiapine and cocaine + aripiprazole groups in terms of seizure activity. Survival time was increased in the cocaine + aripiprazole group compared with the control and cocaine + quetiapine groups. Conclusion Quetiapine and aripiprazole pre-treatment reduced seizure activity and delayed the onset of seizures compared with the control group. C1 [Yilmaz, Atakan; Erdur, Bulent; Ozen, Mert; Turkcuer, Ibrahim; Seyit, Murat] Pamukkale Univ, Dept Emergency Med, Fac Med, Denizli, Turkey. [Sabirli, Ramazan] Servergazi State Hosp, Emergency Serv, Denizli, Turkey. [Sarohan, Ahmet] Univ Kyrenia, Dept Emergency Med, Fac Med, Kyrenia, Cyprus.

BACKGROUND High-flow nasal cannula (HFNC) is an alternative to conventional normobaric oxygen therapy (NBO) for hypoxemic patients. Since nothing is known about its effect on carbon monoxide (CO) poisoning, we hypothesized that HFNC might be a useful device in the treatment of CO poisoning victims. MATERIAL AND METHODS We retrospectively reviewed the medical records of patients who were admitted consecutively to the emergency department with CO intoxication. Patients were divided into 2 groups: patients treated with HFNC and patients treated with conventional face mask (CFM). Demographic data, pretreatment, and control (after 1 hour) arterial blood gas analyses values of the patients were evaluated. RESULTS Sixty-eight patients (mean age 35.8±18.7 years) were included in this study. NBO was given via HFNC to 38 patients (55.9%), and via CFM to 30 patients (44.1%). The demographic characteristics and pretreatment values of carboxy-hemoglobin (COHb) were similar in the 2 groups. The mean COHb value of the HFNC group at the first hour was found significantly lower than the CFM group: 9.5±4.7 and 12.0±5.1, respectively (P=0.041). Improvement of COHb level was significantly higher in the HFNC group compared to the CFM group: 12.5±4.5 versus 6.7±3.7, respectively (P=0.001). CONCLUSIONS HFNC was superior than CFM in alleviating COHb levels in the victims of CO poisoning. We believe that using HFNC will increase patient comfort by shortening the duration of treatment in emergency department settings, especially in patients who have mild clinical findings of CO poisoning.

Background:This study aimed to compare the clinical validity and reliability of two wireless telemetry electrocardiogram (ECG) devices in the Emergency Medicine Department. Material/Methods:Patients who attended the Emergency Medicine Department underwent wireless telemetry ECG testing (N=245) using the Infron Micro Cor and the Nihon Kohden Cardiofax M 1350 K devices. ECG recordings included heart rate, P-wave amplitude, PR segment length, QRS duration, QT and QTc intervals, ST depression and elevation, the number of ECG artifacts, the ECG diagnosis, and duration. Statistical analysis of reliability included the use of Cohen's kappa (kappa) values. Results:One hundred women (40.8%) and 145 men (59.2%) were included in the study. The duration for the Infron Micro Cor ECG readings (57.5 +/- 0.93 seconds) was significantly shorter compared with the Nihon Kohden Cardiofax M ECG readings (65.2 +/- 9.72 seconds) (p=0.0001). The Infron Micro Cor ECG readings contained significantly more lead artifacts (93 or 37.9%) compared with the Nihon Kohden ECG readings (71 or 28.9%) (p=0.01). There was no difference between the two devices in terms of the other ECG parameters. The compatibility of ST-segment elevation detection was found to be almost in complete agreement between the Infron Micro Cor and Nihon Kohden Cardiofax M ECG devices, as determined by the x-values for ST elevation and ST depression. Conclusions:Two wireless telemetry ECG devices were found to be reliable for use in the Emergency Medicine Department. The Infron Micro Cor wireless telemetry ECG device provided more rapid results. C1 [Sabirli, Ramazan] Servergazi State Hosp, Dept Emergency Med, Denizli, Turkey. [Erdur, Bulent; Yilmaz, Atakan] Pamukkale Univ, Med Fac, Dept Emergency Med, Denizli, Turkey.

Introduction: The aim of this study is to determine the obesity and overweight frequency in children with phenylketonuria (PKU) and hyperphenylalaninaemia (HPA). Methods: From the patients' demographic data, diagnosis, type of diet, weight for height, body mass index, serum phenylalanine concentrations were obtained and recorded. Results: Four hundred and forty charts were evaluated and 288 of them were enrolled in the study. Two hundred and forty-six (85.4%) were under phenylalanine-restricted diet with protein support. Of those, 23 (9.3%) were obese and 16 (6.5%) were overweight. When we compared the obesity ratio of 246 patients with PKU and HPA to the obesity ratio in the Turkish population, the difference was statistically significant (p=0.025). Conclusion: The frequency of obesity was higher in PKU and HPA children who underwent phenylalanine-restricted diet treatment than in the normal population in Turkey. Detailed studies are needed to increase the understanding of the obesity risk factors in this special disorder group.

To gain better insight in the most current diagnosis and treatment practices for phenylketonuria (PKU) from a broad group of experts, a European PKU survey was performed. The questionnaire, consisting of 33 questions, was sent to 243 PKU professionals in 165 PKU centers in 23 European countries. The responses were compiled and descriptive analyses were performed. One hundred and one questionnaires were returned by 93/165 centers (56%) from 19/23 European countries (83%). The majority of respondents (77%) managed patients of all age groups and more than 90% of PKU teams included physicians or dieticians/nutritionists. The greatest variability existed especially in the definition of PKU phenotypes, therapeutic blood phenylalanine (Phe) target concentrations, and follow-up practices for PKU patients. The tetrahydrobiopterin (BH4 ; sapropterin) loading test was performed by 54% of respondents, of which 61% applied a single dose test (20mg/kg over 24h). BH4 was reported as a treatment option by 34%. This survey documents differences in diagnostic and treatment practices for PKU patients in European centers. In particular, recommendations for the treatment decision varied greatly between different European countries. There is an urgent need to pool long-term data in PKU registries in order to generate an evidence-based international guideline. Copyright (c) 2009 Elsevier Inc. All rights reserved.

Rotor syndrome is an autosomal recessive disorder presenting with chronic elevation of the conjugated serum bilirubin fraction. There are no spesific symptoms and physical examination findings of this syndrome and liver function tests are normal. Differential diagnosis is difficult in the existence of concomitant diseases. Here; we report a child with conjugated hyperbilirubinemia though to result from biliary tract compression by intraabdominal lymphadenopathies. The diagnosis was established as Rotor Syndrome and Toxoplasma lymphadenitis eventually., Rotor Sendromu kronik konjuge bilirubin yüksekliği ile seyreden otozomal resesif geçişli bir bozukluktur. Kendine özgü bir semptom veya fizik muayene bulgusu olmayan bu sendromda karaciğer fonksiyon testleri de normal bulunur. Eşlik eden başka hastalıkların varlığında, ayırıcı tanıda zorluklar yaşanmaktadır. Burada; konjuge bilirubin yüksekliği intraabdominal lenfadenopatilerin safra yollarına basısı ön tanısıyla kliniğimize yollanan, tanı zorluğu yaşanan ve sonuçta Rotor sendromu ile birlikte Toksoplazmozis tanısı almış olan bir vaka sunulmuştur

BACKGROUND: The treatment of cocaine toxicity is an important subject for emergency physicians. We investigated the effects of dexmedetomidine, moxonidine and alpha-methyldopa on acute cocaine toxicity in mice. OBJECTIVES: The aim of this study was to evaluate the effects of dexmedetomidine, moxonidine and alpha-methyldopa in a mouse model of acute cocaine toxicity. MATERIALS AND METHODS: We performed an experiment consisting of four groups (n = 25 each). The first group received normal saline solution, the second group received 40 µg/kg of dexmedetomidine, the third group received 0.1 mg/kg of moxonidine and the fourth group received 200 mg/kg of alpha-methyldopa, all of which were intraperitoneally administered 10 minutes before cocaine hydrochloride (105 mg/kg). All animals were observed for seizures (popcorn jumping, tonic-clonic activity, or a loss of the righting reflex) and lethality over the 30 minutes following cocaine treatment. RESULTS: The ratio of animals with convulsions was lower in all treated groups when compared to the control (P < 0.001). Furthermore, 68% (n = 17) of animals in the dexmedetomidine group, 84% (n = 21) of the alpha-methyldopa group, 92% (n = 23) of the moxonidine group and 100% (n = 25) of the control group showed evidence of seizure activity (P = 0.009). Cocaine-induced lethality was observed in 12% (n = 3) of the dexmedetomidine group, 48% (n = 12) of the alpha-methyldopa group, 52% (n = 13) of the moxonidine group, and 72% (n = 18) of the control group (P < 0.001). All treatments prolonged the time to seizure, which was longest in the dexmedetomidine group (P > 0.05). In addition, the time to lethality was also longer in the same group (P < 0.001). CONCLUSIONS: The present study provides the first experimental evidence in support of dexmedetomidine treatment for cocaine-induced seizures. Premedication with dexmedetomidine reduces seizure activity in a mouse model of acute cocaine toxicity. In addition, while dexmedetomidine may be effective, moxonidine and alpha-methyldopa did not effectively prevent cocaine-induced lethality.

BACKGROUND: Violence and burnout are frequently seen among medical doctors; however, the relation is not clear. This study aimed to assess the violence and its possible effects on burnout in physicians working in emergency units.

BACKGROUND: Violence and burnout are frequently seen among medical doctors; however, the relation is not clear. This study aimed to assess the violence and its possible effects on burnout in physicians working in emergency units. METHODS: This cross-sectional study targeted all physicians working in the emergency units of Pamukkale University Hospital, County and City Hospitals, 112 Emergency Services, and Private Hospitals in Denizli. Data were obtained by means of a self-administered questionnaire that consisted of questions on the demographics of the participants, Turkish version of the Maslach Burnout Inventory, and of the perpetrators of violence. What was also documented on the questionnaire was whether participants had been subjected to or had witnessed any verbal or physical violence during the previous one month of emergency physicians' certification program. RESULTS: A total of one hundred and seventy-four physicians were included into the study (85% of the targeted group). Many of the participants were between 24 and 59 years of age, with a mean age of 36.8±5.8 years. Married male doctors working in the City Hospital made up the majority. There were significant associations between emotional exhaustion and total violence (p=0.012) and verbal violence (p=0.016); depersonalization and total violence (p=0.021) and verbal violence (p=0.012). CONCLUSION: The results presented here indicated that there was a strong relation between burnout and violence experienced by physicians working in emergency units. Violence in the emergency department has a substantial effect on the physicians' well-being.

Background: The treatment of cocaine toxicity is an important subject for emergency physicians. We investigated the effects of dexmedetomidine, moxonidine and alpha-methyldopa on acute cocaine toxicity in mice. Objectives: The aim of this study was to evaluate the effects of dexmedetomidine, moxonidine and alpha-methyldopa in a mouse model of acute cocaine toxicity. Materials and Methods: We performed an experiment consisting of four groups (n = 25 each). The first group received normal saline solution, the second group received 40 mu g/kg of dexmedetomidine, the third group received 0.1 mg/kg of moxonidine and the fourth group received 200 mg/kg of alpha-methyldopa, all of which were intraperitoneally administered 10 minutes before cocaine hydrochloride (105 mg/kg). All animals were observed for seizures (popcorn jumping, tonic-clonic activity, or a loss of the righting reflex) and lethality over the 30 minutes following cocaine treatment. Results: The ratio of animals with convulsions was lower in all treated groups when compared to the control (P < 0.001). Furthermore, 68% (n = 17) of animals in the dexmedetomidine group, 84% (n = 21) of the alpha-methyldopa group, 92% (n = 23) of the moxonidine group and 100% (n = 25) of the control group showed evidence of seizure activity (P = 0.009). Cocaine-induced lethality was observed in 12% (n = 3) of the dexmedetomidine group, 48% (n = 12) of the alpha-methyldopa group, 52% (n = 13) of the moxonidine group, and 72% (n = 18) of the control group (P < 0.001). All treatments prolonged the time to seizure, which was longest in the dexmedetomidine group (P > 0.05). In addition, the time to lethality was also longer in the same group (P < 0.001). Conclusions: The present study provides the first experimental evidence in support of dexmedetomidine treatment for cocaine-induced seizures. Premedication with dexmedetomidine reduces seizure activity in a mouse model of acute cocaine toxicity. In addition, while dexmedetomidine may be effective, moxonidine and alpha-methyldopa did not effectively prevent cocaine-induced lethality.

Objectives: To compare unenhanced low-dose computed tomography (LDCT) and ultrasound (US) in patients with suspected acute appendicitis. Methods: A total of 104 patients underwent US and LDCT examinations within an hour. Results: Thirty-nine of the 104 patients had surgically confirmed acute appendicitis. Sensitivity, specificity, and accuracy for US vs. LDCT were 82.5% vs. 92.5%, 83% vs. 89%, and 82.7% vs. 90.4%, respectively. The area under the curve (Az) was 0.85 for US and 0.92 for LDCT. The diagnostic performance of LDCT was better than US (P

OBJECTIVES: To compare unenhanced low-dose computed tomography (LDCT) and ultrasound (US) in patients with suspected acute appendicitis. METHODS: A total of 104 patients underwent US and LDCT examinations within an hour. RESULTS: Thirty-nine of the 104 patients had surgically confirmed acute appendicitis. Sensitivity, specificity, and accuracy for US vs. LDCT were 82.5% vs. 92.5%, 83% vs. 89%, and 82.7% vs. 90.4%, respectively. The area under the curve (Az) was 0.85 for US and 0.92 for LDCT. The diagnostic performance of LDCT was better than US (P

BACKGROUND: There is no specific laboratory method for the diagnosis of acute mesenteric ischemia (AMI). In this study, we aimed to determine the efficacy of the D-dimer test in selected cases prior to multi-detector angio-CT, which is expensive and has side effects.

BACKGROUND: There is no specific laboratory method for the diagnosis of acute mesenteric ischemia (AMI). In this study, we aimed to determine the efficacy of the D-dimer test in selected cases prior to multi-detector angio-CT, which is expensive and has side effects. METHODS: Patients, over 65, with abdominal pain were included in this study. The D-dimer test was applied to 230 (34%) of 676 abdominal pain patients admitted to our emergency service. The D-dimer levels of the patients diagnosed with AMI by angio-CT were compared. RESULTS: In AMI patients sensitivity of the D-dimer test was 84.6% and the specificity was 47.9%. Elevated D-dimer levels and AF were observed in 90.9% of the patients diagnosed with AMI by CT. CONCLUSION: D-dimer levels were elevated in the AMI patients. Patients suspected of having AMI with unclear clinical results and patients with D-dimer levels above 1000 ng/ml and AF should undergo further evaluation.

OBJECTIVE: To evaluate the effects of etomidate, ketamine, phenytoin, and phenytoin/midazolam in a mouse model of acute cocaine toxicity. METHODS: We performed a randomized controlled study consisting of five groups (n = 25 each) of rats that received intraperitoneal injections of normal saline solution, 5 mg/kg ketamine, 7.5 mg/kg etomidate, 40 mg/kg phenytoin, and 40 mg/kg phenytoin and 2 mg/kg midazolam 10 minutes before cocaine hydrochloride (105 mg/kg). Following cocaine administration, a blinded observer watched the animals for 30 minutes to assess seizures (popcorn jumping, tonic-clonic activity, or loss of righting reflex), and lethality for 30 minutes. RESULTS: The number of animals with seizures was lower in the etomidate (60%), phenytoin (40%), and phenytoin/midazolam (40%) groups (P

Objective To compare the effects of metoclopramide infusion in emergency department (ED) patients complaining of nausea to determine the changes in its therapeutic effect and prevention of side effects such as akathisia and sedation. Methods A prospective, randomised, double blind trial, from 1 March 2007 to 1 May 2008 in the ED of Pamukkale University Faculty of Medicine. Patients with moderate to severe nausea were randomised and divided into two groups: group 1 received 10 mg metoclopramide as a slow intravenous infusion over 15 min plus placebo (SIG); group 2 received 10 mg metoclopramide as an intravenous bolus infusion over 2 min plus placebo (BIG). The whole procedure was observed, and nausea scores, akathisia and vital changes were recorded. Results 140 patients suffering from moderate to severe nausea in the ED were included in the study. There was no significant difference between the groups in terms of mean nausea scores during follow-up (p=0.97). A significant difference in akathisia incidence was observed between the groups (18 (26.1%) in the BIG and 5 (7%) in the SIG) (p=0.002). There was also a significant difference in sedation incidence between the groups (19 (27.5%) in the BIG and 10 (14.5%) in the SIG) (p=0.05). Conclusion Even though slowing the rate of infusion of metoclopramide does not affect the rate of improvement in nausea, it may be an effective strategy for reducing the incidence of akathisia and sedation in patients with nausea.

OBJECTIVE: To compare the effects of metoclopramide infusion in emergency department (ED) patients complaining of nausea to determine the changes in its therapeutic effect and prevention of side effects such as akathisia and sedation. METHODS: A prospective, randomised, double blind trial, from 1 March 2007 to 1 May 2008 in the ED of Pamukkale University Faculty of Medicine. Patients with moderate to severe nausea were randomised and divided into two groups: group 1 received 10 mg metoclopramide as a slow intravenous infusion over 15 min plus placebo (SIG); group 2 received 10 mg metoclopramide as an intravenous bolus infusion over 2 min plus placebo (BIG). The whole procedure was observed, and nausea scores, akathisia and vital changes were recorded. RESULTS: 140 patients suffering from moderate to severe nausea in the ED were included in the study. There was no significant difference between the groups in terms of mean nausea scores during follow-up (p=0.97). A significant difference in akathisia incidence was observed between the groups (18 (26.1%) in the BIG and 5 (7%) in the SIG) (p=0.002). There was also a significant difference in sedation incidence between the groups (19 (27.5%) in the BIG and 10 (14.5%) in the SIG) (p=0.05). CONCLUSION: Even though slowing the rate of infusion of metoclopramide does not affect the rate of improvement in nausea, it may be an effective strategy for reducing the incidence of akathisia and sedation in patients with nausea.

OBJECTIVE: A prospective follow-up study to evaluate the ability of cardiac ultrasonography performed by emergency physicians to predict resuscitation outcome in adult cardiac arrest patients. METHODS: Ultrasonographic examination of the subxiphoid cardiac area was made immediately on presentation to the emergency department with pulseless cardiac arrest. Sonographic cardiac activity was defined as any detected motion within the heart including the atria, ventricles or valves. Successful resuscitation was defined as any of: return of spontaneous circulation for 20 min; return of breathing; palpable pulse; measurable blood pressure. RESULTS: The study enrolled 149 patients over an 18-month period. The presence of sonographic cardiac activity at the beginning of resuscitation was significantly associated with a successful outcome (19/27 [70.4%] versus 55/122 [45.1%] patients without cardiac activity at the beginning of resuscitation). CONCLUSIONS: Ultrasonographic detection of cardiac activity may be useful in determining prognosis during cardiac arrest. Further studies are needed to elucidate the predictive value of ultrasonography in cardiac arrest patients.

Study Objective: The study aimed to evaluate the effects of midazolam and diphenhydramine for the prevention of metoclopramide-induced akathisia. Methods: This randomized, double-blind, and controlled trial aimed to investigate coadministered midazolam vs diphenhydramine in the prophylaxis of metoclopramide-induced akathisia. Patients 18 to 65 years of age who presented to the emergency department with primary or secondary complaints of nausea and/or moderate to severe vascular-type headache were eligible for this study. Patients were randomized to one of the fallowing 3 groups: ( 1) metoclopramide 10 mg + midazolam 1.5 mg; ( 2) metoclopramide 10 mg + diphenhydramine 20 mg; ( 3) metoclopramide 10 mg + placebo. Metoclopramide was administered as a 2-minute bolus infusion. Midazolam, diphenhydramine, and normal saline solution were administered as a 15-minute slow infusion. The whole procedure was observed; and akathisia and sedation scores and vital changes were recorded. Results: There were significant differences among groups with respect to akathisia ( P = .016) and sedation ( P < .001). The midazolam group showed the lowest mean akathisia score but the highest mean sedation score. Akathisia scores of the diphenhydramine group were not different from placebo. There were significant differences among groups in terms of changes in mean vital findings such as respiration rates, pulse rates, and systolic blood pressures ( P < .05). There were no significant difference among groups in terms of changes in mean diastolic blood pressures ( P = .09). Conclusion: Coadministered midazolam reduced the incidence of akathisia induced by metoclopramide compared to placebo but increased the rate of sedation. No difference was detected from diphenhydramine. Routine coadministered 20 mg diphenhydramine did not prevent metoclopramide-induced akathisia. (C) 2012 Elsevier Inc. All rights reserved.

STUDY OBJECTIVE: The study aimed to evaluate the effects of midazolam and diphenhydramine for the prevention of metoclopramide-induced akathisia. METHODS: This randomized, double-blind, and controlled trial aimed to investigate coadministered midazolam vs diphenhydramine in the prophylaxis of metoclopramide-induced akathisia. Patients 18 to 65 years of age who presented to the emergency department with primary or secondary complaints of nausea and/or moderate to severe vascular-type headache were eligible for this study. Patients were randomized to one of the fallowing 3 groups: (1) metoclopramide 10 mg + midazolam 1.5 mg; (2) metoclopramide 10 mg + diphenhydramine 20 mg; (3) metoclopramide 10 mg + placebo. Metoclopramide was administered as a 2-minute bolus infusion. Midazolam, diphenhydramine, and normal saline solution were administered as a 15-minute slow infusion. The whole procedure was observed; and akathisia and sedation scores and vital changes were recorded. RESULTS: There were significant differences among groups with respect to akathisia (P = .016) and sedation (P < .001). The midazolam group showed the lowest mean akathisia score but the highest mean sedation score. Akathisia scores of the diphenhydramine group were not different from placebo. There were significant differences among groups in terms of changes in mean vital findings such as respiration rates, pulse rates, and systolic blood pressures (P < .05). There were no significant difference among groups in terms of changes in mean diastolic blood pressures (P = .09). CONCLUSION: Coadministered midazolam reduced the incidence of akathisia induced by metoclopramide compared to placebo but increased the rate of sedation. No difference was detected from diphenhydramine. Routine coadministered 20 mg diphenhydramine did not prevent metoclopramide-induced akathisia.

Objective: To evaluate the effects of etomidate, ketamine, phenytoin, and phenytoin/midazolam in a mouse model of acute cocaine toxicity. Methods: We performed a randomized controlled study consisting of five groups (n=25 each) of rats that received intraperitoneal injections of normal saline solution, 5 mg/kg ketamine, 7.5 mg/kg etomidate, 40 mg/kg phenytoin, and 40 mg/kg phenytoin and 2 mg/kg midazolam 10 minutes before cocaine hydrochloride (105 mg/kg). Following cocaine administration, a blinded observer watched the animals for 30 minutes to assess seizures (popcorn jumping, tonic-clonic activity, or loss of righting reflex), and lethality for 30 minutes. Results: The number of animals with seizures was lower in the etomidate (60%), phenytoin (40%), and phenytoin/midazolam (40%) groups (P

PURPOSE In this study, we aimed to document imaging practices and diagnostic strategies used by emergency physicians in patients with suspected high-probability pulmonary embolism (PE).

Background Biguanides pose a significant risk of morbidity, mortality and permanent sequelae secondary to prolonged periods of hypoglycaemia. Objectives To investigate the treatment of massive metformin overdose associated with lactic acidosis. Case report We present the case of a 30-year-old woman, who attempted to commit suicide by ingesting an 85-g massive metformin overdose associated with severe lactic acidosis, which we treated by performing prolonged haemodialysis with bicarbonate and plasma exchange. Conclusion For the maximum elimination of metformin, extended haemodialysis is required and the treatment of the accompanying metabolic acidosis with bicarbonate is important for the effectiveness of the treatment. Patients benefit much more from the treatment of combined haemodialysis with plasma exchange. European Journal of Emergency Medicine 16:11-13 (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

PURPOSE: In this study, we aimed to document imaging practices and diagnostic strategies used by emergency physicians in patients with suspected high-probability pulmonary embolism (PE). MATERIALS AND METHODS: A questionnaire investigating the diagnostic strategies used by the emergency physicians in the evaluation of venous thromboembolism was mailed electronically to all emergency department residents and specialists practicing in 62 medical institutions in Turkey. The questionnaire gathered information about the availability and frequency of use of diagnostic imaging modalities in different scenarios in patients with suspected high-probability PE. RESULTS: Echocardiography, helical computed tomography (CT), and D-dimer test were the most available tools around the clock with a frequency of use of 78%, 73%, and 67%, respectively. One hundred and nineteen of 176 respondents (68%) reported that they request D-dimer "invariably" before performing an imaging examination in patients with suspected highprobability PE (SHPPE). Before ordering advanced imaging, 136 EPs (77%) would always obtain chest radiographs. Fifty-four residents (55%) and 39 specialists (51%) indicated that CTPA would likely be the first examination for patients with SHPPE and with signs of deep venous thrombosis (DVT) (P = 0.8). The most frequently selected examination for patients with SHPPE and without signs of DVT was CTPA, reported by 69 of the residents (70%) and 53 of the specialists (69%) (P = 0.9). CONCLUSION: This survey did not show significant variations either in the practices and policies used by emergency physicians, or in the methodological approaches between specialists and residents. Among the imaging modalities, CTPA was the tool most preferred by physicians for patients with suspected acute PE.

Aim: Oncologic emergencies in lung cancer are common and potentially severe. We sought to describe the common causes of oncologic emergencies in patients with lung cancer who applied our emergency department (ED)., Method: A retrospective chart review was conducted of lung cancer patients seen in our ED over one-year period. ED and subsequent consultation records were reviewed for the following: symptoms, laboratuary findings, smoking histories, chest radiograph results, chest computed tomographies, and final diagnosis., Results: There were 45 patients with lung cancer who were applied to the ED. The mean age was 62.6 +/- 11.5 years. The most common complaints for the patients for applying ED were; dyspnea (62%), cough (29%), chest pain (22%), palpitation (18%), fever (13%) and neurological findings (11%). After initial evaluation the common diagnosis were; burden of chronic obstructive pulmonary disease (COPD) (24%), pneumonia (20%), pleural effusion (11%), Coronary artery disease (9%), pulmonary embolism (7%), electrolyte imbalance (7%), severe respiratory insufficiency (7%). Out of 45 patients 14 were admitted to inpatient service, 2 patients with severe respiratory insufficiency died in ED, and 28 were discharged after they had appropriate therapy at ED., Conclusion: A high rate of COPD burden for the reason of ED applications among patients with lung cancer was found. The reason of this might be heavy smoking histories among Turkish lung cancer patients. Another interesting finding in our study was the high rate of pulmonary embolism cases which usually not mentioned under oncologic emergencies, but could be life saving if diagnosed.

Aim: The aim of this study was to identify the clinical characteristics of patients with a diagnosis of non-ruptured aortic aneurysm (AA) fallowing the evaluation of their history and physical examination in the emergency department., Methods: The records of patients investigated retrospectively for a 12 months period who has the diagnosis of a non ruptured AA or aortic dissection (AD). The main complaints, vital signs, physical examination findings, ECG, chest xray, thorax and abdominal CT reports were recorded in addition to the demographics of the patients. In AD patients, the type of the dissection was noted in order to Stanford and De Bakey classifications., Results: Twenty-four patients were diagnosed with AA or AD in the study period. Sixteen (% 66.7) of the patients were man and 8 (33.3 % 7) were woman with a mean age of 50.6 years (r: 19-73). The most common presenting complaints chest pain (45.8 %, n=11), back pain (25%, n=6), syncope (12.5%, n=3), abdominal pulsation (8.3%, n=2) and abdominal tenderness (8.3%, n=2). The physical examination findings were cardiac murmur (33.3%, n=8), pulse deficit (20.8%, n=5), pulsatile mass (12.5 %, n=3), discrepancy of blood pressure in right and left extremity (12.5%, n= 3), carotid murmur (12.5 %, n=3). AD was identified in 11 patient (45,8%), which was Stanford A in 9 (72,7 %) and Stanford B in 3 (27.3 %). For the De Bakey classification, 5 of the patients were in type I (45, 4%), 4 in type II (36, 3%) and 3 in type III a (18, 3 %), Conclusion: In patients presenting to emergency department with chest, back pain and syncope and who have cardiac murmur, pulse deficit and a pulsatile mass in physical examination, AA and AD must be considered in differential diagnosis in patients.

BACKGROUND Fractured ribs and sternum are frequent complications of thoracic compression during CPR (cardiopulmonary resuscitation) in adults. This study was conducted to determine the incidence of rib and sternal fractures after conventional closed-chest compression in the treatment of cardiac arrest.

Introduction: Emergency medicine is characterised by rapid decisionmaking to help patients in life-threatening situations. For this purpose, special qualifications are necessary. The aim of our study was to evaluate the emergency medicine knowledge obtained during an obligatory postgraduate emergency medicine training programme that has been recently applied among Turkish physicians. Methods: The training targeted all general practitioners (GPs) working in emergency units in the city hospitals, city-wide primary healthcare centres, public health offices, emergency services and private hospitals. Over an 8-month period between September 2004 and April 2005, seven individual groups of approximately 45 physicians were formed. Each group undertook an identical 5-day training programme and every participant completed identical pre-and post-training tests. Results: Two-hundred and ninety-eight physicians participated in the training programme. The majority of participants were male (n=224, 75.2%), aged between 35 and 39 years (n=127, 42.6%), had been in the medical professional for 11 to 15 years (n=121, 40.7%), and were employed in city hospitals (n=102, 34.2%). Surprisingly, the majority of GPs had never participated in a postgraduate training programme before (n=166, 55.7%). Mean post-test scores of the participants were significantly higher than the pre-test scores (89.70%+/- 12.41% vs 43.15%+/- 10.47%, respectively; P < 0.001). Mean pretest scores were significantly higher in the emergency services subgroup (51%, P=0.001) and in the subgroup of participants that had previously undertaken two or more postgraduate training courses (47.9%, P=0.004) compared with the mean pre-test scores of the other subgroups. However post-test scores were not statistically different between the groups. Conclusion: This postgraduate emergency medicine training programme appears to be effective in improving physicians' knowledge regarding emergencies. Any developing emergency medicine system in Turkey should include continuous, up-to-date, standardised educational programmes for emergency professionals. These may include postgraduate workshops to improve the knowledge and skill levels of emergency professionals.

BACKGROUND: Fractured ribs and sternum are frequent complications of thoracic compression during CPR (cardiopulmonary resuscitation) in adults. This study was conducted to determine the incidence of rib and sternal fractures after conventional closed-chest compression in the treatment of cardiac arrest. METHODS: We reviewed the forensic autopsy findings of 231 deaths referred to the Pamukkale University Department of Forensic Medicine over a 12-month period, 2004-2005. CPR-related chest injuries comprising rib and sternum fractures, ecchymosis and subcostal hemorrhage were compared retrospectively in 104 patients. RESULTS: Ninety-one (87.5%) of the 104 patients were adults, and 13 patients (12.5%) were children. The mean (SD) age in the pediatric group (5F/8M) was 5.48 (+/-5.96) and in the adult group (18F/73M) was 44.88 (+/-18.31). Forty-four (42.3%) of the 104 patients died of traumatic cause and 60 (57.7%) of non-traumatic cause. Ecchymosis was present in 26 (28.8%) patients, subcostal hemorrhage in 16 (17.6%) patients and fractures (sternal and costal) in 12 (13.2%) patients in adults. There were no significant differences between groups according to age, sex and traumatic-nontraumatic cause in terms of skeletal chest injuries associated with CPR in adult patients (p>0.05). CONCLUSION: This study shows a low incidence of rib and sternal fracture after closed-chest compression in the treatment of cardiac arrest in forensic autopsy cases.

The objective of this study was to evaluate the outcomes and associated factors for short-term success and long-term survival rates of resuscitated non-traumatic out-of-hospital cardiac arrest (OHCAs) in Denizli, Turkey. All non-traumatic OHCA patients from the Emergency Departments of the Pamukkale University and City Hospitals between the dates of January 1, 2004 and March 1, 2005 were included in this study. A successful outcome was defined as the return of spontaneous circulation or breathing, or evidence of a palpable pulse or a measurable blood pressure. Information on post-resuscitation long-term survival up to 9 months also was obtained by telephone. A total of 222 adults experiencing OHCAs were resuscitated. The number of successful outcomes was 85 (38.3%); 25 (11.2%) were discharged alive; and 21 (9.4%) were alive at the 9-month follow-up. The predicted mean arrest time was 11.7 min (95% confidence interval 10.27-13.2). Type of transportation to the Emergency Department (ambulance, 32.1% vs. private vehicle, 44.5%; p = 0.057), place of arrest (home, 32.6% vs. other, 44.0%; p = 0.08), first rhythm at the scene (asystole, 22.9% vs. ventricular fibrillation-pulseless ventricular tachycardia, 48.0%, vs. pulseless electrical activity, 12.5%; p = 0.056), and advanced cardiac life support starting time (the first 8 min, 46.8% vs. later than 8 min, 32.0%; p = 0.025) had an effect on outcome. Intensive public education for diagnosis and appropriate reporting of OHCA, the importance of bystander cardiopulmonary resuscitation, and the use of automated external defibrillators have an impact on the potential to increase the number of survivors.

INTRODUCTION: Emergency medicine is characterised by rapid decision-making to help patients in life-threatening situations. For this purpose, special qualifications are necessary. The aim of our study was to evaluate the emergency medicine knowledge obtained during an obligatory postgraduate emergency medicine training programme that has been recently applied among Turkish physicians. METHODS: The training targeted all general practitioners (GPs) working in emergency units in the city hospitals, city-wide primary healthcare centres, public health offices, emergency services and private hospitals. Over an 8-month period between September 2004 and April 2005, seven individual groups of approximately 45 physicians were formed. Each group undertook an identical 5-day training programme and every participant completed identical pre-and post-training tests. RESULTS: Two-hundred and ninety-eight physicians participated in the training programme. The majority of participants were male (n=224, 75.2%), aged between 35 and 39 years (n=127, 42.6%), had been in the medical professional for 11 to 15 years (n=121, 40.7%), and were employed in city hospitals (n=102, 34.2%). Surprisingly, the majority of GPs had never participated in a postgraduate training programme before (n=166, 55.7%). Mean post-test scores of the participants were significantly higher than the pre-test scores (89.70%+/-12.41% vs 43.15%+/-10.47%, respectively; P

Aortic dissection is an uncommon life-threatening condition that may cause death or significant morbidity. An on time diagnosis is difficult in cases with atypical presentation. A "classical" presentation encompasses sudden, severe chest, back, or abdominal pain that is characterized as ripping or tearing. This article reports a case of aortic dissection presented with syncope and bradycardia with no pain. Aortic dissection was diagnosed by a combination of clinical suspicion, emergent bedside echocardiography, and computed tomography scan. The patient underwent immediate surgery, and ultimately dischared with a favourable outcome.