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Carbon monoxide (CO) is one of the most common causes of death due to intoxications. No biochemical marker is available to evaluate the severity of CO intoxication. We measured high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and interleukin-10 (IL-10) levels in patients with different degrees of CO poisoning. We prospectively included 40 CO-poisoned patients admitted to emergency services. Blood samples were collected from the patients at admission (0 hour) and after treatment (six hours). While all patients received normobaric oxygen (NBO2) therapy, patients with severe CO poisoning received additional sessions of hyperbaric oxygen (HBO2) therapy. Blood samples were also collected from a group of healthy volunteers (n=40). Serum IL-6 and IL-10 levels were measured with the ELISA method while hs-CRP was quantified by turbidimetric analysis. At admission, IL-6 levels were significantly higher in the patient group compared to the control group (P=0.001), but IL-10 and hs-CRP levels were not significantly different between the groups. Compared to admission levels, IL-6 levels were higher at six hours (P=0.014). The patients were grouped according to treatment type (NBO2, HBO2) and history of syncope, but no significant differences were detected in patient subgroups regarding IL-6, IL-10 and hs-CRP levels. A weak positive correlation was found between COHb and lactate levels in patients (P=0.013; r=0.390).This study shows that IL-6 level increases in CO-poisoned patients, but it is not correlated with the severity of the intoxication.

In this study, bodily injuries related to chest compression were examined in non-traumatic death cases that underwent autopsy. This study aimed to evaluate factors that can affect these injuries. Data were collected retrospectively, and injuries related to chest compression during cardiopulmonary resuscitation were determined over a 10-year period. Age, gender and cause of death were determined, and when cardiopulmonary resuscitation was performed, cardiopulmonary resuscitation duration, intubation and the injury that occurred due to chest compression were also determined. The study included data from 203 cases. The most frequent injuries were a single fracture in the left ribs (19.7%). Only the duration of cardiopulmonary resuscitation was determined to be associated with injuries. Ventricle rupture in 1 case and liver laceration in 2 cases were the most significant injuries. It has been shown that during cardiopulmonary resuscitation, severe injuries can occur due to thoracic compression. Only a positive correlation with the duration of cardiopulmonary resuscitation was found in our study.

SUMMARY: Disasters cause an acute deterioration in all stages of life. An area affected by the disaster in which the normal activities of life are disrupted is described as a “Field” in disaster terminology. Although it is not easy to define the borders of this zone, the area where there is normally functioning society is accepted as the boundary. Disaster management is the responsibility of the local government. However, in many large disaster responses many non-governmental and international organizations play a role. A Disaster Medical Team is a trained, mobile, self-contained, self-sufficient, multidisciplinary medical team that can act in the acute phase of a sudden-onset disaster (48 to 72 hours after its occurrence) to provide medical treatment in the affected area. The medical team can include physicians, nurses, paramedics and EMTS, technicians, personnel to manage logistics, security and others. Various models of Disaster Medical Teams can be observed around the world. There is paucity of evidence based literature regarding DMTs. There is a need for epidemiological studies with rigorous designs and sampling. In this section of the special edition of the journal, field organizations in health management during disasters will be summarized, with emphasis on preparedness and response phases, and disaster medical teams will be discussed. Keywords: Field organization, disaster, medical team, DMAT

This study was designed to investigate if the potential haemostatic efficacy of gauze-impregnated clinoptilolite created with nano-technology is as strong as the widely used kaolin to control pulsatile arterial bleeding due to major vascular injury.42 rats were separated into three groups of kaolin, clinoptilolite and control groups. The femoral artery was isolated and active arterial haemorrhage was performed. After 30 s of free arterial haemorrhage, compression was applied with a standard 100 g scale and haemostasis was assessed at the 1st, 3rd and 5th minutes. All groups were observed throughout 60 min for survival without any fluid resuscitation and the mean arterial pressure, pulse, body/surface temperature and arterial blood gas values were measured.In the control group, haemostasis did not develop in any of the 12 rats and the survival rate was 5/12 (41.66 %). In the kaolin group, haemostasis developed in seven rats and of these, bleeding reoccurred in four. The survival rate was 10/13 (76.92 %). In the clinoptilolite group, haemostasis developed in eight rats and bleeding recurred in only one. The survival rate was 100 %. In terms of survival, the clinoptilolite and kaolin groups showed superiority to the control group (p = 0.002, p = 0.082). In the evaluation of recurrent haemorrhaging in the rats with haemostasis, clinoptilolite was observed to provide better coagulation than kaolin.A statistically significant difference was determined in clinoptilolite and kaolin group, when they are separately compared with the control group in respect of the effect on MAP, HCO3 (-), lactate, base excess, haemostasis duration and survival rates. The effect of clinoptilolite on haemostasis and survival time was observed to be at least as good as that of kaolin; therefore, clinoptilolite can be used as an active ingredient in a topical haemostat.

Introduction: The number of geriatric patients presenting to the emergency department increases every year. In addition, it is known that the mental status of geriatric patients may deteriorate as ...

Thermal crush burn injury due to roller type ironing press machine is relatively rare and can cause destructive effects with significant morbidity. These injuries can be avoided by taking some basic precautions. Early debridement after admission and definitive treatment after the extent of injuryare delineated and these are the preferred approaches in the management. We present a case of thermal crush injury of the hand caused by laundry roller type ironing press machine.

The aim of this survey was to identify practice differences in the treatment of carbon monoxide (CO) poisoning with hyperbaric oxygen (HBO₂) therapy among centers in Europe.Using a commercial online survey website (surveymonkey.com), we created a questionnaire and invited the medical directors of hyperbaric centers in Europe by email to complete the survey.Sixty-eight centers from 23 countries participated in the survey. While transient or prolonged unconsciousness was unanimously recognized as an indication for HBO₂ therapy, positive neurological findings, ECG suggesting acute ischemia and pregnancy were considered important indications of HBO₂ therapy in more than 95% of the centers. Twenty-three (44%) centers reported that they used carboxyhemoglobin (COHb) levels as a criterion for patient selection. Among responders, 39% (18/46) reported delivering a single session within the first 24 hours of CO poisoning, and nine (19%) reported delivering three sessions in the first day. The majority of the centers (52%) replied that they initially gave a single session per patient, which was repeated if symptoms persisted. We identified a total of 21 different HBO₂ profiles used in European centers.Our results showed that the indications of CO poisoning for HBO₂ therapy are still not universally recognized. Additionally, HBO₂ therapy protocols used at European hyperbaric centers varied significantly, suggesting a need for more education regarding the published guidelines.

Narghile known in different names as shisha, hookah, hubble-bubble, waterpipe has been smoked widely in Middle East countries traditionally and recently began to spread to European countries and USA. Narghile is consumed particularly by university youth in cafes as a social activity in Turkey. We report a case series of five patients presented with narghile induced carbon monoxide (CO) poisoning. We believe that this problem might be overlooked and underreported. We want to emphasize that, in the differential diagnosis of nonspecific neurological complaints (especially headache, nausea, vomiting and vertigo) CO poisoning must be considered and patient must be questioned about the usage of narghile smoking especially in areas popular of it.

Serum neuron-specific enolase (NSE) and S-100β levels are considered novel biochemical markers of neuronal cell injury. In this study, the initial and post-treatment levels of NSE and S-100β were compared in carbon monoxide (CO) poisoning patients, who received normorbaric oxygen (NBO) or hyperbaric oxygen (HBO) therapy. Forty consecutive patients with acute CO poisoning were enrolled in this prospective, observational study. According to their clinical symptoms and observations, twenty patients were treated with NBO, and the other twenty with HBO. Serum S-100β and NSE levels were measured both at time of admission and 6 h later (post-treatment). Serum NSE and S-100β values decreased significantly in both of the therapeutic modalities. The initial and post-treatment values of NSE and S-100β in NBO or HBO patients were comparable. A clear negative correlation was observed between the decrease of NSE and S-100β levels and initial blood carboxyhemoglobin levels. In conclusion, the present results suggested the use of serum S-100β and NSE levels as indicators for brain injury. Due to the significant increase of their values with oxygen therapy, they may also be useful as prognostic follow-up markers. However, the current findings reflected no difference between the efficacy of NBO or HBO therapy.

Introduction Femoral dislocation constitutes an orthopaedic emergency. For pain control in these cases, apart from procedural sedation, a regional block can be applied. Case report A 26-year old male was brought to the emergency centre after being struck by a motor vehicle. Dislocation of the left femur was determined on direct radiograph. It was decided to apply a fascia iliaca compartment block instead of procedural sedation due to the risk of side effects. After sufficient anaesthesia was provided, the dislocation was successfully reduced on the first attempt with the Allis technique. Conclusion The fascia iliaca compartment block (FICB) can be performed easily and successfully under ultrasound guidance. The pain associated with femoral dislocation is decreased and the reduction procedure can be achieved successfully. In many cases, FICB is easy to apply and carries a low risk of side effects.

Epileptic seizures can accompany benign diseases, also can be the first sign of malign tumors. In brain metastasis, epileptic seizures can be seen before the symptoms of the primary lesion. Brain metastasis is bad prognostic factor in all malignancies and it is determined that lung cancers are the most metastatic tumors to the brain. Especially in new onset epileptic seizures in elderly patients, metastatic brain tumors are frequent in etiology. We aimed to present a lung cancer patient with brain metastasis who admitted emergency department with first epileptic seizure.

Carbon monoxide (CO) poisoning is an important cause of mortality and morbidity worldwide. Because of non-specific symptoms of CO poisoning, a high vigilance in the acute care settings is required to diagnose CO poisoning. CO poisoning in the workplace is less recognized. Herein, we present two patients who have poisoned with CO at work but left undiagnosed at their initial admission to emergency department. We further discuss the importance of history taking in the diagnosis of CO poisoning.

Paraquat (PQ) overdose can cause acute lung injury and death. Ozone therapy (OT) was previously demonstrated to alleviate inflammation and necrosis in various pathologies. We therefore hypothesized that OT has ameliorative and preventive effects on PQ-induced lung damage due to anti-inflammatory and antioxidants properties. Sprague-Dawley rats ( n = 24) were separated into three groups: sham, PQ, and PQ+OT groups. 15 mg/kg PQ was administered intraperitoneally in PQ and PQ+OT groups to induce experimental lung injury. One hour after PQ treatment, PQ+OT group was administered a single dose of ozone–oxygen mixture (1 mg/kg/day) by intraperitoneal route for four consecutive days. The animals were sacrificed on fifth day after PQ administration. Blood samples and lung tissues were collected to evaluate the inflammatory processes, antioxidant defense and pulmonary damage. Serum lactate dehydrogenase (LDH) and neopterin levels, tissue oxidative stress parameters, total TGF-β1 levels, and histological injury scores in PQ+OT group were significantly lower than PQ group ( P

With great interest, we have read the article, “Dislocation of a total hip arthroplasty: acute management in the emergency room” by Fillingham et al [1]. We appreciate the authors sharing their enlightening study. We believe that one of the causes of reduction failure is a lack of peripheral nerve blocks or procedural sedation.We would like to contribute information about fascia iliaca compartment block to make the reduction of hip dislocations easier for the authors of this study. Hip dislocations are more frequent in patients who undergo total hip arthroplasty than in the healthy population. The reduction process for these patients is difficult and immensely painful. The reduction success rate in these cases increases when pain control and procedural sedation are used [2]. Fascia iliaca compartment block is commonly used for pain control in patients with hip fractures [3,4]. In addition, it has been shown that fascia iliaca compartment block can be used successfully in patients with hip dislocations [5]. Ultrasonography guidance is recommended to increase the ease and safety of this procedure [6]. As fascia iliaca compartment block avoids the adverse effects and complications of agents used in procedural sedation and general anesthesia, especially in elderly patients, it may also shorten the length of emergency service stay [5].

Introduction Carbon monoxide (CO) poisoning is a life threatening emergency. Oxygen delivery to tissues is reduced and hypoxia develops. Most affected systems are the central nervous system and cardiovascular system. For the diagnosis of CO poisoning, first poisoning should be suspected and then blood carboxyhaemoglobin (COHb) levels should be measured. For cardiovascular evaluation ECG is required. Case 1 A 56-year-old male patient admitted to ED with complaints of syncope, headache, dizziness and blurred vision. Patient was mentally confused and on ECG sinus tachycardia was present (Fig. 1). On blood gas analysis COHb value was measured 33.3%. Due to syncope and ECG changes hyperbaric oxygen (HBO) therapy initiated. After the treatment, COHb value was measured 4.5% and ECG showed normal sinus rhythm. Patient was discharged with recommendations. Case 2 An unconscious 36-year-old female patient admitted to ED with a diagnosis of CO poisoning. ECG revealed ST depression on DII-DIII-AVF leads (Fig. 2) and elevated troponin I (0.1ng/ml) and CK-MB (47U/L) values were determined. On blood gas analysis, COHb value was measured 39.8%. HBO therapy initiated. After HBO therapy patient was conscious and for further follow-up patient was admitted to intensive care unit. Discussion and Conclusion Although there is no classic "carbon monoxide" ECG pattern, sinus tachycardia and ST-T depressions are the most common ECG findings. Even a small amount of exposure to CO can cause myocardial infarction, especially in patients with coronary artery disease. Patients admitting to ED with chest pain and ECG changes may be considered as a possible CO poisoning and patients with CO poisoning must be carefully evaluated for cardiovascular disease.

Hyperbaric oxygen (HBO) therapy has been shown to attenuate renal ischemia/reperfusion (I/R) injury in rats, when applied in the early reperfusion period. The aim of this study was to elucidate possible beneficial effects of HBO therapy on renal I/R injury, when applied 24 h after ischemia. Rats were randomized into three groups: (1) control group (n = 20), (2) I/R group (n = 20), and (3) I/R + HBO group (n = 20). Renal I/R injury was created by interrupting renal blood flow for 30 min with a non-traumatic vascular clamp. HBO therapy was administered 24 h after I/R injury and continued for 5 days. At the end of the study, rats were sacrificed under anesthesia, blood was drawn, and right kidneys were harvested for analysis. Renal I/R injury increased serum and tissue malondialdehyde (MDA) levels and reduced superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels. HBO therapy attenuated MDA levels by increasing SOD and GPx activities. HBO therapy also prevented neutrophil infiltration and tissue injury in kidneys. Taken together, HBO therapy has been found to be effective in the delayed period of I/R injury.

BACKGROUND The aim of this study was to present characteristics of internationally published articles originating from Turkish Emergency Medicine (EM) departments over the last 15 years. METHODS The PubMed database was searched for all articles published from 1995 to 2010 that originated from Turkish EM departments. RESULTS A total of 514 articles were included. Of all articles, 77% (n=396) were published in the last five years. Publications were detected to increase at a rate of 6.2 articles per year. 58.7% (n=302) of the articles were published in non-EM journals. Advances in Therapy in the non-EM group, with 27 articles, and the Turkish Journal of Trauma & Emergency Surgery in the EM group, with 48 articles, were the preferred journals. The most popular subjects were toxicology, at 26% (n=134), followed by trauma, at 16% (n=86). 7.7% (n=40) of all articles were animal studies and 6% (n=31) were randomized controlled trials. CONCLUSION Significant publication growth was detected related with the development of EM in Turkey. The preference for non- EM journals, toxicology as the most popular subject and the effect of university hospitals were the interesting results of this study. The low number of multicenter, randomized controlled trials and of published articles in high impact factor journals have led us to consider the importance of publication quality, which requires additional effort.

Study Objective The aim of this study was to compare the efficacy and safety of 3 nonsteroidal anti-inflammatory drugs—intravenous tenoxicam, lornoxicam, and dexketoprofen trometamol—for the treatment of patients with renal colic. Methods We conducted a prospective double-blind randomized trial of consecutive adult patients who presented to the emergency department with a chief complaint of acute flank pain and had a clinical diagnosis of suspected acute renal colic. Patients were randomly allocated to receive an intravenous bolus of tenoxicam, lornoxicam, or dexketoprofen trometamol in a blinded fashion. Primary outcome measure of the study was visual analog scale (VAS) score difference at 30 minutes. Secondary outcome measures were VAS scores at 5, 15, and 120 minutes as well as rescue analgesic need at 30 minutes and adverse events during the follow-up period. Results A total of 445 patients were screened, and 123 patients were enrolled in the study. The mean age was 36 ± 10 years. The mean reduction in VAS pain scores at 30 minutes was 42 ± 26 mm for tenoxicam, 57 ± 23 mm for lornoxicam, and 52 ± 25 mm for dexketoprofen ( P = .047). Lornoxicam demonstrated the fastest rate of VAS score reduction over the first 30 minutes. The mean reduction values in VAS pain scores at 5, 15, and 120 minutes were similar among the 3 groups. Rescue analgesics at 30 minutes were required by 16 patients (39%) receiving tenoxicam, 10 patients (24%) receiving lornoxicam, and 8 patients (19%) receiving dexketoprofen ( P = .121). No serious adverse events were observed. Conclusions Intravenous tenoxicam, lornoxicam, and dexketoprofen are all effective in the treatment of renal colic, although lornoxicam appears to reduce VAS pain scores with the fastest rate in this comparison.

DOI: 10.4328/JCAM.236 Received: 21.03.2010 Accepted:14.04.2010 Publihed Online: 17.04.2010 Corresponding Author: Serkan Bilgic, GATA Ortopedi ve Travmatoloji AD, 06018, Ankara, Turkiye. GSM:+905052270148 E-mail: serbil11@gmail.com Ozet Izole proksimal tibiofibular eklem dislokasyonu, acil servislerde oldukca nadir karsilasilan ve kolaylikla atlanabilen travmalardandir. Injuri mekanizmasi tam olarak aciklanmamis olmakla birlikte siklikla diz fleksiyonda iken plantar fleksiyondaki ayagin ani inversiyonu ile es zamanli olarak meydana gelir. Tani fizik muayenede saglam tarafa kiyasla tibia proximalinde sislik ve hassasiyetin tespit edilmesi ve radyolojik goruntuleme yontemleri ile konur. Tedavi ise hala tartismali olup siklikla cogu olguda konservatif yaklasilmakta, secilmis olgularda cerrah stabilizasyona kadar gitmektedir. Burada bir futbolcunun izole proksimal tibiofibular eklem dislokasyonu olgusu sunmus bulunmaktayiz.

Objective This study was designed to determine whether the mainstream end-tidal carbon dioxide (ETCO 2 ) measurement can accurately predict the partial arterial carbon dioxide (Pa co 2 ) level of patients presented to emergency department (ED) with acute dyspnea. Methods This prospective, observational study was conducted at a university hospital ED, which serves more than 110 000 patients annually. Nonintubated adult patients presented with acute dyspnea who required arterial blood gas analysis were recruited in the study for a 6-month period between January and July 2010. Patients were asked to breathe through an airway adapter attached to the mainstream capnometer. Arterial blood gas samples were obtained simultaneously. Results We included 162 patients during the study period. The mean ETCO 2 level was 39.47 ± 10.84 mm Hg (minimum, 19 mm Hg; maximum, 82 mm Hg), and mean Pa co 2 level was 38.95 ± 12.27 mm Hg (minimum, 16 mm Hg; maximum, 94 mm Hg). There was a positive, strong, statistically significant correlation between ETCO 2 and Pa co 2 ( r = 0.911, P 2 and Pa co 2 as 0.5 ± 5 mm Hg (95% confidence interval, −1.3165-0.2680) and the limits of agreement as −10.5 and +9.5 mm Hg. Eighty percent (n = 129) of the ETCO 2 measurements were between the range of ±5 mm Hg. Conclusion Mainstream ETCO 2 measurement accurately predicts the arterial Pa co 2 of patients presented to ED with acute dyspnea. Further studies comparing mainstream and sidestream methods in these patients are required.

Objective In this study we aimed to analyse the trauma cases admitted to hospital and died in the 3-month follow-up. Methods The cases that admitted to various departments due to trauma in one year period and died in 3 month follow-up were analysed retrospectively. Demographics, causes of trauma, type of arrivals, arrival vital signs and admitted clinic data were saved. The data obtained were evaluated. Results For one year period 551 cases were admitted to hospital and 35 of them (6.35%) were died in follow up period. The mean age was 54.38 (min:11–max:90) and male/female ratio was 1,7. The most common causes were fall ( n = 14), firearm wounds ( n = 7) and traffic accidents ( n = 4). 15 (42.35%) cases were brought by ambulance. 16 (45.7%) cases were unstable at arrival and it is identified that 11 (68.75%) of them were died in early period. The most common admitted services were neurosurgery ( n = 14), orthopaedics ( n = 9) and intensive care unit ( n = 8). It is determined that 7 (20%) cases were died in early period (1 week) and other 24 (68.5%) cases were died in first one month period. Discussion and conclusion It is observed that early period mortality proportion was low in all trauma mortalities and more patients were died due to late complications. It can be considered as this result is an indirect indicator of the effectiveness of early resuscitation applications.

collected blood samples of patients with syncope within 48 h, which were taken at a time range of 15 min to 6 h after the index event, were evaluated. Serum S100B levels of patients with syncope within 48 h will be lower than expected because of the short half-life of S100B. We appreciate the authors’ valuable presentation and offer our respects.

[1] Everon SH,WeisenbergM,Haroe E, et al. Proper insertion depth of endotracheal tubes in adults bytopographic landmarks measurements. J Clin Anesth 2007;19:15–9. [2] Rigini N, BoazM, Ezri T, et al. Prompt correction of endotracheal tube positioning after intubation prevents further inappropriate positions. J Clin Anesth 2011;23:367–71. [3] Hossein-nejadH, PayandemehrP, Bashiri SA, et al.Chest radiographyafter endotracheal tube placement: is it necessary or not? Am J Emerg Med 2013;31(8):1181–2.

The ame of this article is to demonstrate a case finally diagnosed aortic dissection presented with syncope and afterward transported via air ambulance system from Kabul/Afghanistan to Turkey. Drainage catheter was inserted into pericardial space with the intend to prevent repetitive shock and tamponade during transportation. He underwent surgery and was discharged home without any complication in Turkey.

In this study, it has been purposed to share practice of event-scene administration, search and rescue and evacuation of injured and acquired experiences carried out throughout a building collapse. After an explosion at Diyarbakir Kurdoglu housings at 11 December 2006 about 08:20AM, five flats of an apartment that has five floors-ten flats were collapsed. Local military hospital ambulances, city ambulances, and fire-fighting vehicles arrived to event-place 10 minutes later. It has been found out that there were 13 people inside, 6 of which were children. Army rescue team arrived event-place about 01:30PM, then all non-professional persons has been sent away from region. Eight dead including five children, and five injured including one child have been taken out. Two people from close area have been also injured mildly due to the explosion. It has been found out that accident caused by boiler tank exploding. Sixth of total eight injured had only superficial wounds. Other two injured have been followed because of head trauma at first one and hepatic contusion and rib fracture at the other one. No complication observed after follow-up. Building collapses can create disaster potential according to the number of people inside and facilities of nearby region of the place accident taken place. The evaluation of the direction of building collapse during search and rescue operation would enhance possibility to reach more living in shorter time. Building collapses which can be considered as a miniature of big disaster potentials like earthquakes can be appraised as an important practical training and experience source on event-place administration, search and rescue operations and injured evacuation. We believe that share of the analysis and acquired experiences of this kind of studies would contribute interfering big disaster potentials. [TAF Prev Med Bull 2012; 11(2.000): 241-244]

The incidence of firearm related non-fatal and fatal accidents has increased worldwide. Most of firearm accidents result often due to human errors included extreme carelessness while handling, carrying or storing a loaded firearm. Most of the unintentional or intentional nonfatal gunshot injuries involve an extremity. Most gunshot injuries to the hand are result of low-velocity handguns. While low-energy firearm injuries are caused by small calibre hand guns, BB (ball bearing) guns and zip guns, high energy firearm injuries are caused by high calibre handguns or assault rifles. Gun-cleaning accidents occur rarely. All firearms are being cleaned periodically and gun-cleaning mistakes can cause accidents and even fatalities. The most dangerous type of gun-cleaning mistake is forgetting to check whether it is loaded or not, before attempting to clean the gun. The MG3 is a German general-purpose machine gun and is a short recoil-operated, belt-fed, heavy-barreled, air-cooled machine gun suitable for bursts and sustained fire. The weapon and its derivatives have also been acquired by the armed forces of over 30 countries. We report a case with gunshot wound to the hand caused by ignition of a bullet while the cleaning a MG3 barrel with gun cleaning rod. In this study, the circumstances accompanying these injuries, and preventive measures are discussed. These injuries are preventable, and therefore, some basic measures may reduce the incidence of accidental injury during gun cleaning procedure.