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In emergency medicine, ultrasound is frequently used in the diagnostic and therapeutic procedures and evaluation of treatment of critically ill patients simultaneously, due to its bedside applicability, rapidness and inexpensive cost.The competence of emergency physician in focused cardiac ultrasound evaluations and the success of diagnosing cardiac diseases were evaluated in a patient group presenting to the emergency department with complaints of non-traumatic chest pain and shortness of breath.We included patients with complaints of chest pain and shortness of breath and underwent cardiac ultrasound performed by emergency physician. Then, patients were evaluated by a cardiologist. The diagnoses made by the emergency physician were compared with the diagnoses made by the cardiologist.A total of 303 patients were included. The diagnoses made by the emergency medicine specialist and cardiologist as a result of the evaluation were recorded as 56.7% vs 52.10% for acute coronary syndrome, 29.70% vs 31.60% for congestive heart failure, 3.6% vs 3.30% for pulmonary embolism, 2.1% vs 2.10% for hypertensive pulmonary edema, 1.9% vs 2.10% for pericarditis, and 0.60% vs 1.30% for aortic dissection.It was determined that focused cardiac ultrasound performed by emergency physician was sufficient in terms of accuracy of findings and diagnosis, and played an important role in excluding or including fatal diagnoses and conditions. The success rates of emergency physician can be further increased with long-term and comprehensive training programs.

Introduction:The aim of this study was to investigate the usability of the age value listed on the labels on children’s clothes in the age-based weight estimation method recommended by the Pediatric Advanced Life Support (PALS) guidelines.Material-Method:This prospective, cross-sectional study was organized in Antalya Training and Research Hospital Emergency Department. Children aged between 1-12 years were included in the study. The weight measurements of the children were obtained based on the age-related criteria on the labels of their clothes. The estimated values were compared with the real values of the cases measured on the scale.Results:One-thousand ninety-four cases were included, the mean age of cases in age-based measurements was 6.25 years, which was 6.5 years in label-based measurements. Average weights measured 25.75kg according to age-based measurements, 26.5kg according to label-based measurements, and 26.0kg on the scales, and showed no statistical difference (P Conclusion:In the emergency department and prehospital setting, children with an unknown age and that need resuscitation and interventional procedures for stabilization, and have no time for weight estimation, checking the age on clothing label (ACL) instead of the actual age (AA) can be safely used for the age-dependent weight calculation formula recommended by the PALS guide.

Objective: The purpose of this study was to evaluate the association between V103V, 6140AG, TGA-Stop-TAA Stop, and 6016CA polymorphisms of the apelin (APLN) gene detected for the first time among young patients with acute coronary syndrome (ACS) and coronary artery disease (CAD). Methods: This was a prospective cross-sectional study. The study population was divided into 2 groups. The first group included 132 patients who were found to have critical lesions in their coronary arteries, while the control group consisted of 41 patients who were found to have normal coronary arteries or non-critical atherosclerotic lesions. Results: Among the gene polymorphisms, V103V was found to be more common in the critical CAD patients with the GG genotype compared with the control group (67.4% vs. 46.3%). On the other hand, the GT genotype was more common in the control group (53.7% vs. 32.6%). Univariate and multivariate logistic regression analysis revealed that the GG genotype of V103V was an independent predictor for the presence of critical CAD (odds ratio: 2.397; 95% confidence interval, 1.174–4.892; p=0.016). Conclusion: In cases of V103V polymorphism of the APLN gene, patients with the GG genotype were at a greater risk for the presence of atherosclerotic critical lesions compared with the control group.

After the introduction of modern laboratory instruments and information systems, preanalytic phase is the new field of battle. Errors in preanalytical phase account for approximately half of total errors in clinical laboratory. The objective of this study was to share an experience of an education program that was believed to be successful in decreasing the number of rejected samples received from the Emergency Department (ED).An education program about laboratory procedures, quality requirements in the laboratory, patient and health-care worker safety was planned by the quality team to be performed on 36 people who were responsible for sample collection in the ED. A questionary which included 11 questions about the preanalytic phase was applied to all the attendees before and after training. The number of rejected samples per million was discovered with right proportion account over the number of accepted and rejected samples to laboratory after and before the training period.Most of the attendees were nurses (n: 22/55%), with over 12 years of experience in general and 2-4 years experience in the ED. Knowledge level of the attendees was calculated before training as 58.9% and after training as 91.8%. While the total rate of sample rejection before training was 2.35% (sigma value 3.37-3.50), the rate after training was 1.56% (sigma value 3.62-3.75).Increasing the knowledge of staff has a direct positive impact on the preanalytic phase. The application of a pre-test was observed to be a feasible tool to shape group specific education programs.Posle uvođenja modernih laboratorijskih instrumenata i informacionih sistema, preanalitička faza postala je novo mesto okršaja. Greške u preanalitičkoj fazi čine otprilike polovinu ukupnog broja grešaka u kliničkoj laboratoriji. Cilj ove studije bio je da se podeli iskustvo sa jednim edukativnim programom za koji se veruje da doprinosi smanjenju broja odbijenih uzoraka pristiglih sa odeljenja urgentne medicine.Edukativni program o laboratorijskim procedurama, laboratorijskim zahtevima za kvalitet, bezbednosti pacijenata i zdravstvenih radnika, isplanirao je tim za kvalitet tako da se uključi 36 osoba odgovornih za prikupljanje uzoraka na odeljenju urgentne medicine. Svim učesnicima dat je pre i posle obuke upitnik sa 11 pitanja o preanalitičkoj fazi. Broj odbijenih uzoraka u milion otkriven je pomoću odgovarajuće proporcije na osnovu broja prihvaćenih i odbijenih uzoraka u laboratoriji pre i posle obuke.Većinu učesnika činili su medicinski tehničari (22/55%) sa preko 12 godina iskustva ukupno i 2–4 godine iskustva na urgentnoj medicini. Nivo znanja kod učesnika izračunat pre obuke bio je 58,9% a posle obuke 91,8%. Dok je ukupna stopa odbijenih uzoraka pre obuke bila 2,35% (sigma vrednost 3,37–3,50), ova stopa posle obuke iznosila je 1,56% (sigma vrednost 3,62–3,75).Veći nivo znanja kod osoblja ima direktan pozitivan uticaj na preanalitičku fazu. Uočeno je da primena testiranja pre obuke može biti izvodljiv način da se oblikuju edukativni programi za specifične grupe.

This study evaluated the incidence and status of urgent medical conditions, the attitudes of health professionals who encounter such conditions, the adequacy of medical kits and training of cabin crew in data-received-company aircrafts suggested by Aerospace Medical Association, and the demographic data of patients.Data were collected from medical records of a major flight company from 2011 through 2013. All patients with complete records were included in the study. Numerical variables were defined as median and interquartiles (IQR) for median, while categorical variables were defined as numbers and percentage.During the study period, 10,100,000 passengers were carried by the company flights, with 1,312 (0.013%) demands for urgent medical support (UMS). The median age of the passengers who requested UMS was 45 years (IQR: 29-62). Females constituted 698 (53.2%) among the patients, and 721 (55%) patients were evaluated by medical professionals found among passengers. The most common nontraumatic complaints resulting in requests for UMS were flight anxiety (311 patients, 23.7%) and dyspnea (145 patients, 11%). The most common traumatic complaint was burns (221 patients, 16.8%) resulting from trauma during flight. A total of 22 (1.67%) emergency landings occurred for which the most frequent reasons were epilepsy (22.7%) and death (18.2%). Deaths during flights were recorded in 13 patients, whose median age was 77 years (IQR: 69-82), which was significantly higher compared to the age of patients requiring UMS (p 0.0001). A total of 592 (45%) patients did not require any treatment for UMS. Medical kits and training were found to be sufficient according to the symptomatic treatments.Most of the urgent cases encountered during flights can be facilitated with basic medical support. "Traumatic emergency procedures inflight medical care" would be useful for additional training. Medical professionals as passengers are significantly involved in encountered emergency situations. Adding automated external defibrillator and pulse oximetry to recommended kits and training can help facilitate staff decisions such as emergency landings and tele-assistance.

Objective Migraine is a leading headache etiology that frequently presents to the emergency department (ED). In the present study, we aimed to determine the efficacy of dexketoprofen in aborting migraine headaches in the ED. Methods This prospective, randomized, double-blind study was conducted in an ED of a tertiary care hospital using allocation concealment. Patients were allocated into two arms to receive the study drug; 50 mg dexketoprofen in 50 ml saline and 50 ml saline as placebo. Change in pain intensity was measured by the visual analog scale at baseline, both at 30 and 45 minutes after the study medication was administered. Rescue medication requirement and pain relapse were also recorded by a telephone follow-up at 48 hours. Results A total of 224 patients (112 in each group) were included into the final analysis. Mean age of the study participants was 37 ± 11 (SD) and 25% ( n = 56) of them were male. The median pain improvement at 45 minutes for patients receiving dexketoprofen was 55 (IQR: 49 to 60) and 30 (IQR: 25 to 35) for those receiving placebo. The mean difference between the two groups at 45 minutes was 21.4 (95% CI: 14.4. to 28.5). Rescue drugs were needed in 22.3% of patients who received dexketoprofen compared to 55.4% in patients who received placebo (dif: 33.1%; 95% CI: 20% to 45%). There were no adverse events reported in either group during the study period. Conclusion Intravenous dexketoprofen is superior to placebo in relieving migraine headaches in the ED. It may be a suitable therapy with minimum side effects in patients presenting with a migraine headache to the ED.

Aim: There is limited information regarding patients with bluntminor thoracic traumas (MTT) in terms of diagnosis, treatment,emergency department (ED) management and follow-up after discharge.The aim of this research, was to investigate demographics,physical examination findings and their predictive value for concomitantthoracic injuries, and outcomes of patients.Material and Method: The mechanism of injury, physical examinationfindings, radiographic findings, pain levels, discharge andhospitalization diagnoses were recorded prospectively.Results: A total of 186 patients with a mean age of 48±17 (18–91) years were included in the study. 131 of the (70.4%) patientswere males. 171 of the patients (91.9%) were discharged, while 15(8.1%) patients were hospitalized. The most common diagnosisand physical finding were soft tissue trauma, and tenderness atinjury site (78.8%, 15.1%, 69.6%), respectively. The specificity ofphysical findings in predicting concomitant thoracic injuries werefound to be 100%, although their sensitivities were too low. Theinitial and 7th day pain levels of the patients with recurrent admissionswere significantly higher (p=0.019, p=0.025).Conclusion: Most patients are discharged from ED without significantmorbidity and mortality. Patients exhibiting the positive physicalfindings require detailed investigation for concomitant thoracicinjuries. As severe and long-lasting pains are determinants of hospitalre-admissions, it would be appropriate to provide adequateanalgesia and detailed information about the pain., Amaç: Künt minör toraks travmalı (MTT) hastalarda tanı, tedavi, acil servis (AS) yönetimi ve taburculuk sonrası takip bakımındanbilgiler kısıtlıdır. Hastaların demografik verilerini, fizik muayene bulgularını ve bu bulguların eşlik eden torasik yaralanmaları öngörmedeki değerliklerini, hastaların sonlanımlarını araştırması amaçlandı.Materyal ve Metot: Yaralanma mekanizması, fizik muayene bulguları, görüntüleme bulguları, ağrı düzeyleri, taburculuk ve hastaneyeyatış tanıları prospektif olarak çalışma formuna kaydedildi. Bulgular: Çalışmaya, alınan 186 hastanın yaş ortalaması 48±17 (18–91) 131’i (%70,4) erkekti. Hastaların 171’i (%91,9) acil servisten taburcu edilirken, 15’i (%8,1) hastaneye yatırıldı. En sık tanı, yumuşak doku travması (%78,8) ve en sık muayene bulgusu yaralanma yerinde duyarlılıktı (%69,6). Duyarlılıkları çok düşük olsa da fizik muayene bulguları eşlik eden torasik yaralanmaları saptamadaki özgüllükleri %100 bulundu. Tekrarlayan başvurusu olan hastaların başlangıç ve 7. gündeki ağrı düzeyleri istatistiki olarak daha yüksek saptandı (p=0,019, p=0,025).Sonuç: MTT’lı çoğu hasta, önemli bir morbidite ve mortalite olmadan AS’den taburcu edilmektedir. Pozitif fizik muayene bulgularıbulunan hastalar, eşlik eden torasik yaralanmalar açısından detaylı araştırılmalıdır. Ciddi ve uzun süren ağrı tekrar başvuruların belirleyicileri olduğundan yeterli analjezik tedavi sağlanarak ağrı konusunda hastalar detaylı bilgilendirmelidir.

Aim: In this study, we investigated the diagnostic value of IMA in the positive and negative predictive value of ACS, alone and in combination with TnI. The study population was divided into 3 groups. The first group included those patients with normal coronary arteries (n=40), the second group included the ACS patients with ST segment elevation myocardial infarction (STEMI) (n=49), and the third group included the ACS patients with Non ST-segment elevation myocardial infarction-Unstable Angina (NSTEMI-UA) (n=47). Although its use for diagnostic purposes did not provide an additional benefit for ACS patients, we found that the combination of TnI and IMA could better rule out ACS compared to TnI alone.

Introduction: In busy emergency departments, errors made during the pre-analytical phase can cause delayed diagnosis and treatment, and prolonged follow-up periods. The most common error in the pre-analytical phase is hemolysis in blood samples. In this study, we aimed to assess the effectiveness of the Luer-Lok (BD Vacutainer®) method of taking samples in avoiding hemolysis. Materials and Methods: The study was conducted at the emergency department of a tertiary healthcare facility on patients that register at level 1 or 2 of the Emergency Severity Index triage algorithm. Three sets of prospective observations were made, each lasting for five days. In the first period, hemolysis rates were determined. Following a training course on appropriate blood sampling techniques during the second period, hemolysis rates were determined again while Luer-Lok (BD Vacutainer®) was being used. Taking and processing of samples were carried out by the same personnel throughout the study. Assessment of hemolysis was performed by those that were blind to sampling. All the samples were analyzed at the laboratory located inside the emergency department. Results: In total, 2,027 blood samples were sent to the emergency laboratory for analysis. The hemolysis rate was 8.1% in the first period, 5.5% in the second and 1.4% in the third. The difference in rates between the first and second periods was not statistically significant (p=0.0793). The hemolysis rate in the third period was significantly lower compared to the other two periods (p=0.0001). Conclusion: Using Luer-Lok (BD Vacutainer®) may be effective in reducing hemolysis rates in busy emergency departments.

Aim: In this study we investigated the demographics and medical characteristics of acute stroke patients who applied to emergency department (ED) and were admitted to neurology department (ND). Material and Methods: This study was conducted in a tertiary hospital. The patientsÂ’ medical records were reviewed; age, gender, diagnosis, comorbid diseases, previously anticoagulant treatment, brain computerized tomography reports, brain magnetic resonance imaging reports, hospitalized unit, length of hospital stay, vitamin B12 levels, electrocardiography recordings, and the outcome of patients. Results: In the including time of the study, 523 patients were hospitalized to the ND from ED. The patients with cerebrovascular diseases (CVD) were 68.7% (n=357) of the hospitalized patients. The patients with acute ischemic stroke (AIS) were 74.8 % (n=267) of the patients with CVD. In AIS, the most common comorbid disease was hypertension, followed by atrial fibrillation (AF). The rate of AF was 31% in AIS. AF was newly diagnosed in 46% (38 patients) of patients with AIS, and these patients had no anticoagulation therapy. Vitamin B12 levels were found to be low in 58 (21.7%) of AIS patients. Conclusion: A large number of patients with undiagnosed AF are diagnosed following AIS. Therefore, it is important that these patients should be followed closely for AF and its management, and it is also important to treat vitamin B12 deficiency to prevent stroke development.

Objective Point-of-care ultrasonography (POCUS) is an easily available and noninvasive tool without radiation exposure that is also gaining a broad range of use in emergency departments. The aim of this study is to evaluate the value of POCUS in the diagnosis of shoulder dislocation by comparing with plain radiography. Methods This prospective observational study with a convenience sampling was conducted in emergency departments of 2 hospitals. Patients older than 15 years with possible shoulder dislocation during the physical examination composed the study population. All the study patients underwent POCUS evaluation to detect a shoulder dislocation or fracture before radiography, and the POCUS procedure was also achieved after the reduction attempt. Results A total of 103 patients were enrolled in the study. The mean age of study subjects was 33.9 ± 15 years, and 80.6% (n = 83) of them were male. The sensitivity and specificity of POCUS in identifying dislocation were 100% (95% confidence interval [CI], 96%-100%) and 100% (95% CI, 48%-100%), respectively. POCUS also confirmed reduction in 93 of 94 patients with a specificity of 100% (95% CI, 96%-100%). POCUS has a sensitivity of 100% (95% CI, 63%-100%) for excluding a shoulder fracture but a specificity of 84.2% (95% CI, 75%-91%). Conclusion Point-of-care ultrasonography is an effective tool to either rule in or rule out shoulder dislocation in the emergency setting. Furthermore, it is a robust sensitive tool for excluding fractures but with false-positive results.

Shoulder joint is the most common joint requiring reduction by emergency physicians. Successful reduction is based on the overcoming of resistance of the shoulder muscles. Pain is the most important factor in resistance increase and sedation; analgesia and, in certain cases, intra-articular anesthesia are preferred for reduction. The external rotation (ER) method can provide successful reduction without causing an increase in muscle resistance if applied slowly and gently. The aim of this study was, therefore, to determine the usefulness of the ERWOSA method in the reduction of acute anterior shoulder dislocations (AASDs). This was a retrospective descriptive study. The records of patients admitted to the emergency department with anterior shoulder dislocation between 2009 and 2011 were reviewed for demographic data, sedation, analgesia, and discharge times. Patients were then divided into ERWOSA (n = 80) and external rotation and sedation-analgesia (ERASA, n = 59) groups, with regard to the application of SA (sedation-analgesia). The study data were analyzed using SPSS version 22.0 software for Windows. Numerical data were presented as mean ± standard deviation and categorical data as rates. A total of 139 patients were included in the study. The patients’ average age was 35 ± 14 years, 108 (77.7%) were male. Successful reduction rates for 59 male and 21 female patients in the ERWOSA group were 83% and 66.7% (78.7% total success), respectively. Successful reduction rates for 49 male and 10 female patients in the ERASA group were 87.7% and 90% (88.1% total success), respectively. The length of stay of the ERWOSA and ERASA groups in emergency services were found to be significantly different, with 55 ± 17 and 118 ± 23 minutes for each group, respectively. There were no complications. The ER method can be used in reduction of anterior shoulder dislocations without sedation and analgesia, if applied slowly enough to overcome the resistance of shoulder muscles. The ERWOSA method causes both a significant decrease in the length of stay of patients in the emergency department results in negating the possibility of adverse drug effects. In busy emergency departments, male patients with anterior shoulder dislocation are particularly suitable candidates for ERWOSA.

A 22-year-old boy presented to the emergency department with penile pain and acute urinary retention. The patient had a tender and painful mass along the distal volar surface of the penis, 5 cm away from the external urethral meatus. Bedside ultrasound was performed in the emergency department. Revealing penile urethral calculus in the emergency department with bedside sonography allowed a prompt diagnosis for the patient without additional invasion or radiation exposing diagnostic modalities such as X-ray, CT or retrograde urethrography.