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Computed tomography of the abdomen (CT) is used as the gold standard for detecting solid organ injuries (SOI) after blunt abdominal trauma (BAT). However, patient selection for CT is still controversial due to its potential risks. In this study, we aimed to investigate the usefulness of laboratory tests in the detection or exclusion of SOI in pediatric patients evaluated in the emergency department due to BAT.The study was planned as a prospective, observational study and was conducted in the emergency department of a university hospital between February 2018 and February 2019. Patients under the age of 18 who were evaluated for BAT in the emergency department were included in the study. In the study, the diagnostic value of abnormal laboratory tests in detecting SOI was calculated by accepting CT results as the gold standard.Of the 323 patients included in the study, 118 (36%) were male. There were 283 patients who underwent CT. SOI was detected in 18 (6%) patients. Abnormal alanine aminotransferase, aspartate aminotransferase, amylase and lipase tests were found to be statistically significant in predicting SOI (p0.05). However, none of the tests were found to have sufficient sensitivity and specificity. Hemoglobin, hematocrit, lactate and base excess values were not found to be statistically significant in predicting SOI (p0.005).The hematologic laboratory tests are insufficient to rule out solid organ injury in pediatric patient with BAT.

Unenhanced computed tomography (CT) is a frequently used imaging method in patients who are evaluated in the emergency department with suspected cerebral vein thrombosis (CVT).The aim of this study was to investigate the usefulness of the Hounsfield unit (HU) value determined by CT and its ratio to the patient's hematocrit (Htc) value in the diagnosis of cerebral vein thrombosis.This retrospective study evaluated 41 patients with acute cerebral venous sinus thrombosis and 41 age- and sex-matched control participants. Two experienced observers independently evaluated the CT scan and measured the attenuation of the dural sinuses.There was no significant difference in age, gender, hemoglobin, and Htc values between the two groups. The mean HU value was 75 ± 7 HU in the CVT group and 52 ± 6 HU in the control group (p0.001). The mean HU/Htc ratio was 1.9 ± 0.3 in the CVT group and 1.3 ± 0.1 in the control group (p0.001). The optimal threshold value for HU was determined as 66, and sensitivity at this value was 93%, and specificity was 98%. The optimal threshold value for HU/Htc was determined as 1.64, and the sensitivity at this value was 90% and the specificity was 100%.Hyperattenuation in the dural sinuses and the HU/Htc ratio in unenhanced brain CT scans have high diagnostic value in detecting CVT.

Aim: Cardiac arrests can be brought to emergency departments with an intervention from out-of hospital, and they can also occur for different reasons in the emergency department. Due to the high rates of mortality in this important clinical situation, regulations are made through guidelines and algorithms. Most of these regulations cover acute coronary syndromes and special conditions. The aim of our study is to evaluate intracranial hemorrhages in non-traumatic cardiac arrest cases in our emergency department for a period of 10 years. Material and method: The data of patients 18 years of age and over who were found to have cardiac arrest in the emergency department between January 2011 and January 2021, who did not have trauma, were retrospectively scanned from the hospital information management system. Demographic information of all patients, computed tomography examinations for intracranial hemorrhage and emergency department outcomes were evaluated. Results: Of the 173 patients included in the study, 81 (46.8%) were women. The median age of the patients was determined as 72.00 (64.00-80.00). In the whole patient group, 20 (11.6%) patients had intracranial bleeding and 10 of these patients were women. More intrcranial hemorrhage was detected in the group that underwent CT before cardiopulmonary resuscitation (CPR) and it was statistically significant (p

Introduction: Electrocardiography (ECG) is an indispensable method for fast and reliable cardiac assessment in emergency departments. Physicians should have proper knowledge of ECG for accurate patient management. The aim of this study was to evaluate the ECG knowledge of emergency medicine physicians. Methods: General practitioners (GPs), emergency residents (ERs), emergency physicians (EPs) and cardiology physicians interpreted a total of 40 ECG samples in non-cardiac pathologies, arrhythmias, conduction disorders, and myocardial infarctions. Results: A total of 178 physicians participated in the study - 27.5% of participants were ERs, 24.7% were GPs, 24.2% were EPs, and 23.6% were cardiologists. The general practitioners had the lowest success in ECG interpretation. Cardiologists were more successful in ECG interpretations of arrhythmias (A) and conduction delays (CD) than GPs, ERs and EPs (pA, Giriş: Elektrokardiyografi (EKG) acil servislerde hızlı ve güvenilir kardiyak değerlendirme için vazgeçilmez bir yöntemdir. Doğru hasta yönetimi için doktorlar uygun EKG bilgisine sahip olmalıdır. Bu çalışmanın amacı acil tıp hekimlerinin EKG bilgilerini değerlendirmektir.Yöntemler: Pratisyen hekimler (PH), acil tıp asistanları (ATA), acil tıp uzmanı (ATU) ve kardiyoloji uzmanları; kardiyak olmayan patolojiler, aritmiler, ileti defektleri ve miyokard enfarktüslerinde toplam 40 EKG örneğini yorumladılar.Bulgular: Çalışmaya toplam 178 hekim katıldı – katılımcıların % 27,5'i ATA, % 24,7'si PH, % 24,2'si ATU ve % 23,6'sı kardiyologdu. Pratisyen hekimler EKG yorumlamasında en düşük başarıya sahipti. Kardiyologlar, aritmi (A) ve ileti gecikmelerinin (İG) EKG yorumlamasında PH, ATA ve ATU’lara daha başarılıydı (sırasıyla pA

Introduction: Emergency clinics are the most important part of the health centers serving throughout the day uninterrupted for 24 hours for all kind of patients and diseases. In this study, we evaluated the reasons of referral and consultation processes of the patients who applied to the emergency outpatient clinic and were consulted to the cardiology department. Methods: Patients who were admitted to the emergency department at a secondary health center and consulted on cardiology were included in the study. The pediatric patient group was excluded from the study. Results: Cardiology consultation was requested for 0.22% (n=382) of the patients who applied to the Emergency Department. 58.4% (n=223) of the patients were male and 41.6% (n=159) were female. The initial diagnosis by the emergency physician for cardiology consultation were as follows; 30.4% (n=116) of patients had chest pain, 11.5% (n=44) had chronic obstructive pulmonary disease, 9.2% (n=35) had acute myocardial infarction, 5.2% (n=20) had hypertension, 4.2% (n = 16) had palpitation symptoms and 39.5% for other reasons. 11.7% (n=45) of the patients died in the emergency department after cardiac arrest. 39.2% (n=150) of the patients were referred to another center directly from emergency clinic for advanced examination and treatment. The remaining 27.2% (n=104) of the patients did not have an emergency cardiac pathology after cardiology evaluation. Conclusion: In this study, we determined the general characteristics of the patients who presented to the emergency clinic and who were considered suitable for cardiology consultation. Determining the patient profiles for consultation in emergency departments, evaluation of consultation functioning system and consultation related problems will be useful in shaping training programs, determining bed capacity and improving the quality of health services in health institutions., Giriş: Acil servisler, her türlü hasta ve hastalık için gün boyu 24 saat kesintisiz hizmet veren birimlerdir. Bu çalışmada acil polikliniğe başvuran ve kardiyoloji bölümüne konsülte edilen hastaların sevk nedenleri ve konsültasyon süreçleri değerlendirildi. Yöntemler: Çalışmaya ikinci basamak bir sağlık merkezi acil servisine başvuran ve kardiyoloji bölümüne konsülte edilen hastalar dahil edildi. Pediatrik hasta grubu çalışmadan dışlandı. Bulgular: Acil Servise başvuran hastaların %0,22’sine (n=382) kardiyoloji konsültasyonu istendi. Hastaların %58,4'ü (n=223) erkek, %41,6'sı (n=159) kadındı. Acil hekimi tarafından kardiyoloji konsültasyonu isteme sebepleri şu şekildedir; Hastaların %30,4'ünde (n=116) göğüs ağrısı, %11,5'inde (n=44) kronik obstrüktif akciğer hastalığı, %9,2'sinde (n=35) akut miyokart infarktüsü, %5,2'sinde (n=20) hipertansiyon, %4,2'sinde (n=16) çarpıntı semptomları vardı ve %39,5’i diğer nedenlere bağlıydı. Hastaların %11,7'si (n=45) kalp durması sonrası acil serviste öldü. Hastaların % 39,2'si (n=150) ileri tetkik ve tedavi için doğrudan acil servisten başka bir merkeze sevk edildi. Hastaların kalan %27,2'sinde (n=104) kardiyoloji değerlendirmesi sonrası acil kardiyak patoloji saptanmadı. Sonuç: Bu çalışmada acil polikliniğine başvuran ve kardiyoloji konsültasyonu için uygun görülen hastaların genel özelliklerini belirledik. Acil servislerde konsültasyon için hasta profillerinin belirlenmesi, konsültasyon işleyiş sisteminin değerlendirilmesi ve konsültasyonla ilgili sorunlar; sağlık kurumlarında eğitim programlarının şekillendirilmesi, yatak kapasitesinin belirlenmesi ve sağlık hizmetlerinin kalitesinin artırılmasında faydalı olacaktır.

The coronavirus disease 2019 (COVID-19) pandemic has affected millions of people around the globe and vaccines against the disease have started to develop. Side effects of the vaccine have been reported in the literature, including myocarditis, which has a very low incidence and with a good prognosis. This case report aims to present two medical students’ vaccine-induced myocarditis cases after the first doses of BNT162b2.These patients were young males with no previous medical history and both of them had good recovery after the disease. Both of them had their vaccine very recently before the event. These cases show that myocarditis can be seen after the first dose as well.Global vaccination is the most effective prevention method against COVID-19. Considering the fact that morbidities after the disease occur more than the side effects of the vaccine, they are still the best option against the current pandemic.

Purpose Point-of-care ultrasound (POCUS) has been demonstrated as one of the primary diagnostic tools for deep vein thrombosis (DVT) screening in the emergency department, but there are quite different results in the literature regarding its diagnostic value. The aim of this study is to assess the diagnostic value of POCUS in DVT diagnosis. Methods Patients with a clinical suspicion of DVT who underwent POCUS and were monitored by the radiology department via ultrasonography (US) or venography for DVT were retrospectively examined. POCUS examination for DVT was performed in the femoral and popliteal regions by a two-point compression technique. The inclusion criteria were age >18 years and patients with both a POCUS report and venography or US examinations performed by the radiology department (RUS) and reported by the radiology clinic. RUS and venography were considered as the gold standards. Results The study included 266 patients. POCUS had a sensitivity of 93% (95% CI: 84-98) and specificity of 93% (95% CI: 89-96). Its positive likelihood ratio (LR+ ) was 14 (95% CI: 8-24), and its negative likelihood ratio (LR- ) was 0.08 (95% CI: 0.03-0.19). POCUS also had a positive predictive value (PPV) of 83% (95% CI: 74-89) and a negative predictive value (NPV) of 97% (95% CI: 94-99). Conclusions Our study verifies that POCUS has high specificity and sensitivity for the examination of the popliteal and femoral veins by an emergency physician to evaluate patients with a preliminary diagnosis of DVT.

Lactate and base deficit (BD) values are parameters evaluated as indicators of tissue perfusion and have been used as markers of severity of injury and mortality.The aim of the study was to determine the relationship between combined score (CS) and blood transfusion need within 24 h and comparison of the variables between transfusion and non-transfusion group, correlation lactate with BD and with physiological, laboratory parameters, and determining the major risk factors of patients for the need for blood transfusion.The study included a total of 359 patients (245 males, median age: 40, min-max: 18-95) with blunt multi-trauma. De-mographics data, laboratory parameters (hemoglobin [Hb], hematocrit [Htc], lactate, BD, pH), physiologic parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], respiratory rate [RR]), shock index (SI), and revised trauma score (RTS) were recorded. Logistic regression method was used to create the CS formula using lactate and BD values. According to this formula, the probability value of 0.092447509 was calculated for the need for blood transfusion within 24 h. If CS was higher than the probability value, the need for blood transfusion within 24 h was considered. Furthermore, univariate analysis was used to determine major risk for blood transfusion need in 24 h, and the receiver operating characteristic curves were performed to compare CS, lactate, BD, SI and RTS.The comparison between transfusion and non-transfusion group there was significance between SBP, DBP, HR, RR, SpO2, Glasgow coma scale, Hb, Htc, lactate, BD, pH, SI and RTS (for each p0.05). Lactate value has a positive correlation with SI, HR and has a negative correlation with BD, RTS, SBP, and DBP. BD values has a positive correlation with RTS, SBP, DBP, Hb, and Htc and has a negative correlation with SI, HR, and RR. The main risks for blood transfusion need were SI, lactate, BD, SBP, and SpO2%. CS was 0.09 in 100 (27.85%) patients and 41 with high CS had blood transfusion within 24 h (p0.001; OR21.803, sensitivity 83.7%, specificity 81%,positive predictive value 41%, and negative predictive value 96.9%). A ROC curve showed that CS (AUC: 86.) was more significant than SI and RTS for the need for blood transfusion.CS is effective for predicting blood necessity in 24 h for blunt multi-trauma patients.

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Atrioesophageal fistula (AEF) is an important complication of radiofrequency ablation (RFA). Delayed diagnosis is associated with increased morbidity and mortality. Despite the name “atrioesophageal fistula,” fistulas functionally act esophageal to atrial, which accounts for the neurologic and infectious complications. This report presents the management of a 60-year-old male patient who was admitted to the emergency department (ED) with AEF-caused gastrointestinal bleeding. The patient was operated urgently, but he had serious comorbidities and died after the operation. The aim of this case was to evaluate patients who underwent RFA, within 10 days to two months, carefully in the ED and to know the possible complications.

Syncope is a clinical picture that can affect all age groups and has an important place in admissions to the emergency department. There is an important diagnostic challenge in cases where there are different clinical presentations and patients cannot express the situation clearly. Although the emergency department facilities for the diagnosis of syncope are limited, the diagnosis of many patients can be differentiated from life-threatening conditions with a detailed history and physical examination. High-risk patients should be identified and directed for definitive treatment by emergency medicine physicians. This review contains information about the management of the syncope patient in the emergency department.

Pulmonary embolism is a clinical condition with high mortality rates in all age groups. The treatment includes anticoagulation and fibrinolytic therapy, and clinical management is challenging in cases of bleeding diathesis. Sepsis-induced coagulopathy (SIC), which has been recently defined to cause disruption of coagulation cascade accompanied by organ dysfunctions, is regarded as a major cause of mortality. It is noteworthy that there is no decrease in fibrinogen levels, unlike disseminated intravascular coagulopathy (DIC). This study aimed to present the management of a 70-year-old female patient who was admitted to emergency department with atypical complaints and diagnosed with pulmonary embolism due to deep vein thrombosis and septic shock. The clinical success of fibrinolytic therapy following the administration of fresh frozen plasma (FFP), although the patient had elevated international normalized ratio (INR), is presented in this case report. Since elevated INR and thrombocytopenia, which are observed in SIC, are caused by the inhibition of fibrinolysis, fibrinolytic therapy can be a rational treatment choice considering the profit/loss rate.

This case report illustrates the follow-up of a 57-year-old female with a type B aortic dissection (AD) under dabigatran treatment. The patient had been operated on 8 years earlier due to type A AD. The aortic valve was repaired and a 26-mm polyester fiber graft was applied to the ascending aorta and the aortic arch. In computerized tomography scans taken after the procedure, a dissection flap extending from the descending aorta to the iliac arteries was seen, but the patient was asymptomatic and no further surgery was performed. The patient was subsequently diagnosed with atrial fibrillation. A CHA₂DS₂VASc score of 3 was recorded and dabigatran treatment was initiated. The aortic aneurysm and dissection were followed up via computed tomography and echocardiography at regular intervals, and at 6 months no progression was seen. No thromboembolic or hemorrhagic events were observed. To our knowledge, this is the first case report of dabigatran treatment for a patient with a type B AD. Based on this case, the use of dabigatran would appear to be safe in a patient with an uncomplicated type B AD, but the results of this case need to be confirmed with extended follow-up and additional patients.

Introduction Cardiopulmonary resuscitation (CPR)-related injuries are complications of chest compressions during CPR. This study aimed to investigate the differences and complications between mechanical and manual CPR techniques by using computed tomography (CT). Methods Patients in whom return of spontaneous circulation was achieved after CPR and thorax CT imaging were performed for diagnostic purposes were included in the study. Results A total of 178 non-traumatic cardiac arrest patients were successfully resuscitated and had CT scans in the emergency department. The complications of CPR are sternum fracture, rib fracture, pleural effusion/hemothorax, and pneumothorax. There were no statistically significant differences in terms of age, first complaint, cardiac arrest rhythm, CPR duration, and complications between mechanical and manual CPR. The number of exitus in the emergency department was similar (p=0.638). The discharge from hospital rate was higher in the mechanical CPR group but there was no statistically significant difference (p=0.196). The duration of CPR was associated with the number of rib fractures and lung contusion, but it did not affect other CPR-related chest injuries. Conclusion There was no significant difference observed in terms of increased complications in patients who received mechanical compression as compared with those who received manual compression. According to our results, mechanical compression does not cause serious complications, and the discharge from hospital rate was higher than for manual CPR; therefore, its use should be encouraged.

The use of anticoagulants is still a matter of debate in deep venous thrombosis (DVT) and other thrombotic events in Behcet's disease (BD). Anticoagulant therapy is an integral part of treatment in cases of a pulmonary embolism (PE) that develops in other disorders. The issue of how to act when a pulmonary artery thrombosis is reported in the Behcet's patient may pose a major dilemma among emergency physicians. A 61-year-old male came to our ED with a complaint of chest pain and hemoptysis. The patient had tachypnea, dyspnea, tachycardia, a decrease of breath sounds in the basal regions of both lungs, and a few crackling rales were heard in the left lung field. Chest CT angiography showed pulmonary thromboembolism in the right middle and lower lobe segment arteries with pulmonary infarction as well as ground glass densities compatible with alveolar hemorrhage. High-dose steroid and cyclophosphamide were administered immediately without anticoagulant therapy based on pulmonary vasculitis and de novo clot formation in the pulmonary circulation. Clinical improvement was observed after four days of admission. The patient remained under observation with oral prednisolone and cyclophosphamide monthly. PE is almost non-existent in patients with BD, and signs of pulmonary artery thrombosis are associated with pulmonary vasculitis. Delaying immunosuppressive therapy may result in unwanted results in these kinds of patients. This case underlines the importance of recognizing this manifestation early to prevent potentially fatal consequences.

Calismamiz, plevral efuzyonlu hastalarda transuda ve eksudayi ayirt etmenin guvenilirligini ve gecerliligini belirleyerek plevral laktat duzeylerini degerlendirmeyi amacladi.1 Temmuz 2017 ile 31 Ocak 2018 tarihleri arasinda bir universite hastanesine basvuran ve plevral efuzyon tanisi alan hastalar uzerinde yapilan prospektif, gozlemsel bir calismadir. Transuda ve eksuda plevral sivi siniflandirmasi Light kriterlerine gore yapilmistir. Calisma grubu pevral effuzyonlu toplam 169 hastadan olustu [99 (% 58.6) erkek ve 18-93 yas arasi (ortalama ± SS, 64.6 ± 16.1 yil)]. Hastalarin 44'u (% 26) eksuda ve 125'i transuda olarak degerlendirildi. Laktatin ortanca degeri eksuda hastalarda 3.20 mmol / L (min-maks: 0.90-14.3) ve transuda hastalarda 1.85 mmol / L (min-maks: 0.90-4.70) idi ve her ikisinin karsilastirilmasinda anlamli farklilik saptandi. (z: 5.894; p

Introduction: In this study, we evaluated the applicability and interpretation of point- of- care emergency ultrasound (POCEUS) performed by an emergency physician (EP) in non-traumatic adult cardiac arrest and near-arrest patients at presentation to the Emergency Department (ED). Methods: POCEUS was performed in 5 steps on 73 adults to assess; 1. Qualitative global cardiac function, cardiac chambers and presence of pericardial effusion; 2. Presence of pleural sliding, B-lines, A-lines or consolidation on anterior-superior; 3. Presence of an abdominal aorta aneurysm and pelvic free fluid; 4. Presence of pleural effusion, consolidation, free fluid on lateral-inferior; 5. Qualitative width and collapsibility of the inferior vena cava. A fulfilled checklist and real-time images of ultrasonography were sent by WhatsApp to the head of the study to generate the evidence and collect the data. The process of patient care, in-hospital diagnosis and survival were retrieved from digital hospital records. This prospective multicenter sample study was conducted from November 16, 2015, to January 5, 2016. Results: The most common findings of POCEUS were performed and interpreted to have a first prediction of patients' acute clinic problem by EPs were compatible with global systolic dysfunction (n = 16, 22.9%), pulmonary edema (n = 17, 23.3%), pulmonary embolus (n = 6, 8.2%), distributive/hypovolemic shock (n = 12, 16.4%), cardiac tamponade or pericardial effusion (n = 5, 6.8%), and pneumonia (n = 31, 42.5%) at presentation. The kappa correlation coefficient value of the POCEUS at presentation versus the final, traditional clinical diagnosis of the admitted ward, was 0.773 (95% CI, 0.747-0.892; p = 0.064, McNemar). Conclusions: POCEUS performed by an EP at presentation had a good agreement between in qualitative prediction of the first differential diagnosis in life-threatened patients and the last diagnosis obtained during hospitalization. Furthermore, this study showed the requirement of evidence in comparison of measurements to the qualitative manner and new descriptive processes in POCEUS for unexplained situations and questions. © 2020 Via Medica.

Diyetle fazla miktarda potasyum alımı sonrasında hiperkalemi nadir gelişen bir durumdur. Özellikle böbrek fonksiyon bozukluğu ve çoklu ilaç kullanımı olan hastalarda görülme ihtimali artabilir. Potasyum bozuklukları kardiyak etkilenime yol açtığından tanınmadığı veya tedavi edilmediği durumlarda hayatı tehdit eden kardiyak aritmiler görülebilir. Acil servisimize bulantı şikayeti ile gelen hastada hiperkalemi saptanmıştır. Hastanın anamnezi tekrar alındı ve diyetle aşırı miktarda muz tüketimi olduğu öğrenildi. Yaşlılarda ve ek hastalığı olan hastalarda potasyumun atılımı ile ilgili problemler olabileceği akılda tutulmalıdır. Hastamızın acil serviste tedavisi erken dönemde başlanarak ve potasyumu normal sınırlara düşürülmüştür. Hiperkalemi saptanan tüm hastalarda böbrek fonksiyon bozukluklarına ek olarak diyet alımı da sorgulanmalıdır., Hyperkalemia is a rare condition after the dietary intake of large amounts of potassium. It may be more likely to occur in patients with impaired renal function and multiple drug use. Since potassium disorders lead to cardiac effects, life-threatening cardiac arrhythmias may occur when they are not recognized or treated. We detected hyperkalemia in the patient who came to our emergency department with a complaint of nausea. The anamnesis of the patient was detailed, and it was learned that the patient had excessive consumption of bananas with diet. It should be borne in mind that there may be problems with excretion of potassium in the elderly and patients with additional diseases. Treatment of our patient in the emergency department was started early and potassium was reduced to normal limits. Dietary intake should be questioned in addition to kidney dysfunction in all patients with hyperkalemia.

Calismamizin amaci hastanemiz acil servisine kardiyak arrest olarak getirilen ve acil koroner kateterizasyon yapilan hastalardaki mortalite ve morbiditeyi degerlendirmektir. 2011-2014 arasi Eskisehir Osmangazi Universitesi Tip Fakultesi acil servisine kardiyak arrest olarak nakli gerceklestirilen ve kardiyopulmoner resusitasyon sonrasi spontan dolasim saglanan ve EKG’lerinde patoloji saptanip acil kateterizasyona alinan hastalar incelendi. Degerlendirmeye 11’i erkek toplamda 15 hasta alindi. Yas ortalamalari 57.80 (min:32, maks:85) idi. Hastalarin tamami 112 ambulans servisi ile getirildi. Hastalarin ilk gelis EKG ritimlerinde 5’inde ventrikuler fibrilasyon, 5’inde nabizsiz elektriksel aktivite, 3’unde asistoli ve 2’sinde nabizsiz ventrikuler tasikardi saptandi. Acil serviste yapilan KPR suresi ortalama: 18.60 dakika (min:10, maks: 40) idi. Post resusuitasyon EKG degerlendirmelerinde 10’unda ST segment elevasyonu, 4’unde ST-T degisiklikleri, 1’inde nodal ritim saptandi. Kapi anjiografi zamani ortalama 60,73 dakika (min: 27, maks: 110) idi. Tedavileri sonrasinda hastalarin 9’u taburcu edilirken 6’si eksitus kabul edildi. Acil serviste kardiyak arrest olarak getirilen, algoritmalara uygun sekilde mudahale edilen ve spontan dolasim saglanan hastalarda, acil servis hekimlerinin EKG degerlendirmelerini hizlica yapmalari gerekir. Anormal EKG bulgusu saptanan hastalarin acilen koroner girisimsel tedaviye alinmalari icin acil servis ve Kardioloji bolumu ile ortak prtokoller hazirlanmasi mortalite ve morbiditeyi azaltmasi acisindan onemlidir.

Introduction. The most important result of head trauma, which can develop with a blunt or penetrating mechanism, is traumatic brain injury. Tranexamic acid (TXA) can be used safely in multiple trauma. Recent studies showed that TXA can be useful in management of intracerebral hemorrhage, especially in reducing the amount of bleeding. The TXA given in the first 3 hours has been shown to reduce mortality. The aim of our study was to evaluate the effectiveness of tranexamic acid used in patients with traumatic brain injury. Method. Patients with trauma in the emergency room between January 2012 and January 2020 were screened in this retrospective study. The inclusion criteria were being over the age of 18 years, tranexamic acid administration in the emergency department, and traumatic brain injury on brain computerized tomography (CT) and control CT imaging after 6 hours. Results. The number of study patients was 51. The median score of GCS was 12.00 (8.00–15.00). Subdural hemorrhage and subarachnoid hemorrhage were the most common findings on brain CT scans. In the group TXA treatment for less than 1 hour, the arrival MAP was low and the pulse was high (p=0.022 and p=0.030, respectively). All the patients were admitted with multiple trauma. None of the 51 patients had thrombotic complications and died due to head injury. Conclusion. TXA appears to be a safe drug with few side effects in the short term in head injuries. According to our experience, it comes to mind earlier in multiple trauma, especially in head trauma with pelvic trauma.

Background and Aim. The nonsatisfaction among emergency medicine specialty trainees is an underrated issue in Turkey. Several previous studies have evaluated the burn-out and its consequences among physicians, but there is no study conducted with specialty trainees. The aim of this study is to evaluate the reasons for resignation among emergency medicine specialty residents in Turkey.Method. A total of 41 participants, who resigned from emergency medicine residency, were contacted by phone and invited to complete an online survey that included 25 questions about personal characteristics and departmental information.Results. Most frequent reasons of resignation were violence/security concerns (63.4%), busy work environment (53.7%), and mobbing (26.8%). Participants who reported that they have resigned due to inadequate training were mostly over 30 years old (p=0.02), continued more than 6 months to EMST (pConclusion. Major barriers against a high-quality and sustainable emergency medicine residency are violence in emergency services, mobbing in academic or administrative bodies, and inaccessibility to scientific resources. These obstacles can only be removed by cooperation of multiple institutions in Turkey.