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Genetik polimorfizmler bireyin farmakolojik ajanlara cevabını etkilerler. Warfarin dar bir terapötik aralığa sahiptir ve ilaç doz ayarlanması bireylere göre değişmektedir. Yetersiz doz tromboembolizmden korumayabilir ve aşırı doz ise kanama riskini arttırabilir. Giderek artan veriler özellikle CYP2C9 (sitokrom P450 oksidaz sisteminin bir üyesi) ve vitamin K epoksit redüktaz kompleks subünit 1 (VKORC1) geninin genetik varyasyonlarının warfarin dozunu önemli ölçüde etkilediğini göstermektedir (1). Biz bu makalede mitral kapak replasmanı uygulanmış olan hastada sık gelişen warfarin toksisitesinin sebebinin genetik mutasyonlara bağlı olabileceğini sunmaya çalıştık.

Genetic polimorphisms can affect an individual's response to the pharmacologic agents. Warfarin has a narrow therapeutic range and dose arrangement may vary interindividually. An insufficient dose may fail to prevent thromboembolism and overdose may increase the risk of bleeding. Increasing evidence suggests that genetic variation of CYP2C9 and VKORC1 greatly influences effective warfarin dose (1). In the present case report, we report a case of frequently occured warfarin toxicity as a cause of genetic mutation in a patient with mitral valve replacement.

Objective: Pulmonary embolism (PE) among cardiovascular diseases is an important emergency with high mortality.The purpose of this study was to investigate the relationship between morphometric measurements of other right ventricular function parameters and IVC and aortic measurements according to clot distribution in patients with pulmonary embolism.
Materials and Methods: A total of 198 patients were included in the study.Computed tomography pulmonary angiographies (CTPA) of 102 patients with acute (PE) were recorded and the patients were grouped according to the localization of the clot. The diameters of the inferior vena cava, aorta,pulmonary artery, and right and left ventricles were assessed.
Results: Inferior vena cava area (IVCA)/Aortic Area (AA) significantly predicted embolism in the main pulmonary artery (AUC = 0.957, p < 0.001). The optimal cut-off value was calculated to be 1.22 with 88% sensitivity and 90% specificity. Inferior vena cava diameter (IVCD)/Aortic Diameter (AD) significantly predicted embolism in the main pulmonary artery (AUC = 0.955, p < 0.001). The optimal cut-off value was calculated as 1.1 with 89% sensitivity and 88% specificity.
Conclusion: IVC and aortic ratio parameters determined by CTPA may be useful markers for predicting clot localization and evaluation of right ventricular disease in patients with pulmonary embolism.

Aim: This study aims to evaluate the outcomes of cross fixation with Kirschner wire (K-wire) following closed reduction of displaced supracondylar humerus fractures in children.
Materials and Methods: Between December 2012 and June 2015, a total of 32 patients with suprachondralhumerus fractureswere retrospectively analyzed. Data including demographic data, causes and types of fracture, associated injuries, postoperative complications, radiological parameters, and cosmetic and functional outcomes were recorded.
Results: Of the patients, 24 (75%) were males and eight (25%) were females with a mean age of 6.5 years (range 2 to 12 years). The mean follow-up was 19 months (range: 13 to 26 months). None of the patients developed iatrogenic vascular or nerve injuries. No postoperative complications were observed during follow-up. The functional result according to the Flynn criteria was excellent in 93.4% and good in 6.6% patients, while cosmetic results were excellent in 93.4%, good in 5.2%, and fair in 1.4%.
Conclusion: Percutaneous fixation with K-wire following closed reduction of displaced supracondylar humerus is a reliable method which can be applied with high success rates in pediatric cases.

Aim: This study aims to investigate the demographic and clinical properties of patients with angioedema presenting to the emergency department.
Materials and Methods: This prospective study was carried out in the Emergency Medicine Department of Erciyes University Medical School between April 15 and November 30, 2016. Those patients older than 18 years and presenting with angioedema were included in the study. The demographic and clinical data were then analyzed.
Results: A total of 100 angioedema patients were included in this study. The mean age was 41.48±14.097 years. Forty-five per cent of the patients experienced the first attack. The most frequent complaints were swelling (93%) and itching and redness (54%). Edema was most commonly seen in the periorbital region and on the lips. Drug use (52%) was the most frequent cause of angioedema. Use of nonsteroidal anti-inflammatory drugs was the most common drug-related cause (23%). All patients received antihistamine and steroid therapy. Adrenalin was administered to 67% of patients and fresh frozen plasma and complement 1 inhibitor concentrate to 3% of patients. The dermatology department was consulted about the majority of the patients (89%).
Conclusion: Angioedema is a medical condition which mostly necessitates admission to hospital as well as has the potential to progress promptly into a life-threatening stage, thus timely recognition and appropriate management of this clinical entity in the emergency department is of great importance.

Reversed Robin Hood syndrome (RRHS) is mainly described as arterial blood flow steal from ischemic to non-ischemic parts of the brain. It is one of the cause of early deteriorations in ischemic stroke patients. This presented case brought us to think about the relation of RRHS with risk of stroke. Flow steal with arterial occlusions is a well-known phenomenon. This phenomenon is coined due to its similarity with the phrase “rob the poor to feed the rich.” However, more studies are needed to evaluate the concept of blood flow steal in real-time. Possible mechanism is the vasodilation of non-ischemic areas that steal the blood flow from ischemic areas. 1

Introduction
We aim to describe and evaluate a new model for distance experiential learningin order to help reduce the transmission risk among professionals envolved in education activities
Methods
In April 2020, in partnership with our hospital’s Emergency Department educational leadership, Valdecilla Virtual Hospital tested and introduced an experiential distance learning model. Professionals wanted to engage from their homes without having to travel to a simulation facility.
Results
Between July 1 and 22, 2020 we ran seven courses following this new model of course. Each one consisted of a two-hour session on two consecutive days. There were 44 participants whose ages ranged from 26 to 53 years (average = 40), 62% identified as female, and 68% reported working at the Emergency Department, 19% at the Cardiology Unit, 7% in Primary Care, and 5% in Internal Medicine.
We evaluated the content validity, feasibility and acceptability of the model. The results of an anonymous survey filled in at the end of the course showed they considered the distance training model as realistic (92%), easy to use (95%), well-organized (94%), an engaging educational tool (94%), and desirable for practising in the future (94%).
Discussion
These results may encourage the educational community to develop more programs using this new approach of “taking care of patients from a distance” not only during a pandemic, but also on a regular basis.We think this model can achieve positive results using distance clinical simulation combining their traditional simulation technology to address the training needs of their healthcare organization

Aim: This study aimed to compare two different concentrations of Diphenhydramine vs. Lidocaine for median nerve block in terms of providing required anesthesia for repairing soft tissue injuries.
Materials and Methods: This double-blind randomized clinical trial was conducted in Tehran, Iran during 2019. Participants were randomly assigned to three groups. Group A received 3 cc of 0.5% diphenhydramine (n=68), group B received 3 cc of 1% lidocaine (n=68), and group C received 3 cc of 1% diphenhydramine (n=68). Onset of action, duration of anesthesia, pain during injection, and patients’ satisfaction level were evaluated between the groups.
Results: Two hundred two patients with the mean age of 35.09±13.5 years took part in this study (52.5% male). Age (p = 0.879), onset of action (p = 0.251) and duration of anesthesia (p = 0.081) had no significant difference among the 3 groups. The pain during injection between groups A and B (p = 0.001) and between groups B and C (p < 0.0001) had significant difference. Patients in group B had significantly the highest level of satisfaction (p < 0.0001).
Conclusion: In our study, two different concentrations of diphenhydramine had the same onset of action and duration of anesthesia compared to lidocaine. Lidocaine caused lower pain during injection compared to diphenhydramine and the level of satisfaction was higher with lidocaine. Diphenhydramine had no significant difference with different concentrations in term of pain during injection.

Background/Aims: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection epidemic has been named Coronavirus Disease 2019 (COVID-19) by the World Health Organization. Moderate and severe hyponatremia may develop in the SARS-CoV-2 infection. In this study, we aimed to evaluate the frequency of hyponatremia and predictors of hyponatremia in patients hospitalized due to COVID-19.
Materials and Methods: This is a retrospective study. Patients over the age of 18 who were admitted to our hospital between 01.08.2020-30.09.2020 with positive RNA polymerase chain reaction (PCR) test results that were followed up by hospitalization were included in the study. The patients’ demographic data, comorbidities, vital signs, physical examination findings, laboratory results, sodium levels and hospital outcomes were evaluated.
Results: The study included 760 patients with positive PCR test results. Of all the patients, 47.6% were female, and the median age was 63. The in-hospital mortality rate of the patients in our study was 11.7%. The median sodium value of the patients was 137 (134-140). Hyponatremia was present in 25.7% of the patients, and the majority of the patients had mild hyponatremia. We found that hyponatremia was observed more frequently in patients with advanced age, male gender, diabetes, and severe pneumonia (p=0.041, p=0.003, p <0.001, p = 0.002, respectively)
Conclusion: Hyponatremia is relatively common in patients admitted with COVID pneumonia, and it is associated with higher disease severity in our study. The incidence of hyponatremia increases in geriatric patients, male patients, patients with severe pneumonia, and diabetic patients.

Abstract | Full Text PDF

Objectives: Use of combination antibiotics piperacillin-tazobactam (PTZ) and Vancomycin (VAN) is so often used as ‘top guns’ for severe infections in hospitalized patients. VAN's nephrotoxicity is well-known. PTZ has been seen to prolong increased creatinine levels. Reports have surfaced in the literature of higher observed rates of acute kidney injury (AKI) among patients treated with combination of PTZ+VAN. The purpose of this study was to compare the prevalence of AKI with the use of VAN alone and combination of PTZ+VAN treatment at our institution. Our hypothesis was that the combination of PTZ+VAN will have higher prevalence of AKI as compared to VAN only.
Material and Methods: We performed study to compare the combination of PTZ+VAN and VAN alone in critically ill patients in our hospital from 2016 to 2018. Included patients were stratified by treatment with PTZ+VAN and VAN alone.
Results: A total of 113 patients were taken who were treated with PTZ+VAN and VAN alone. Patient demographics, comorbidities, sites of infection, and duration for 48 hours were compared. We found that PTZ+VAN is better than VAN alone.
Conclusion: The combination of vancomycin plus piperacillin-tazobactam is better use to prevent acute kidney injury over vancomycin monotherapy. Further research in the critically ill population is needed.

Aim: In this study, in province in XXX of Turkey where child population is high, it was aimed to determine the level of knowledge in nurses, emergency medicine technicians and paramedics who is dealing with pediatric patients according to the basic and advanced life support guide in children.
Methods: The study was conducted between July-August 2018, with 602 volunteer healthcare professionals. According to the American Heart Association 2015 guideline, a questionnaire including questions about basic and advanced life support in children, as well as questioning demographic data, was applied. Statistical comparisons were made between the groups.
Results: iMale percentage were 62% of 602 professionals. The average age of them was 28.4 years (min-max: 18-50 years). The basic and advanced knowledge scores of the nurses working in the service were lower than the emergency medical technician and paramedics. Those who work in pediatric emergency departments and child intensive care units, with 5-8 years of experience, and paramedics within professional groups; advanced life support scores, total knowledge scores were high. The basic life support knowledge scores, total knowledge scores of those with certification were good, and the advanced life support knowledge score was inadequate.
Conclusion: The basic and advanced life support knowledge scores of the professionals were moderate, the total knowledge scores of the nurses working in pediatric services were low. While basic life support knowledge scores of paramedics and professionals working in emergency departments and child intensive care units were low, advanced life support knowledge scores were high.

Aim: Given the importance of internship in emergency medicine, intern doctors are supposed to take more responsibility during this period. They are involved in the admission, examination, planning and implementation of the treatment of patients under the supervision of assistants and instructors. This study aims to specify the expectations and satisfaction levels of XXXXXXXXXX 6th grade medicine students for emergency medicine internship in 2018-2019 academic year.
Materials and Methods: The students who practised their emergency medicine internship within one year were evaluated with a questionnaire at the beginning and at the end of the internship period. Without writing their names, the respondents are expected to answer the survey questions designed on a 5-point Likert scale.
Results: The study group consists of 149 students, whose average age is 24.4 and, 68 of the participants were male, while 81 were female. The obtained results reveal that the participants thought they would use their practical knowledge at the end of the internship, that the internship period proved efficient, that they did not have reservations about practising in the emergency department (ED), and that they wanted to be an emergency medicine assistant (p: 0.009; 0.014; 0.05; 0.029).
Conclusion: The results of this evaluation demonstrate that the emergency medical internship was efficient, and that they were able to apply their practical knowledge. Our study concludes that, following the internship period, their fears for serving in the ED decreased, their communication skills improved, and their desire to work as emergency medicine assistants at XXX increased.

Aim
This study was carried out to determine whether the addition of a bedside ultrasound (US) to the Ottawa Foot and Ankle Rules (OAR) could decrease the need for radiographic imaging in the patients presenting to emergency department (ED) with foot and/or ankle trauma.
Methods
In this prospective observational study, adult patients with acute foot and/or ankle injuries were included. Patients were first examined and OAR results were recorded. Then, US exam was performed by emergency physicians who were blinded to the OAR results. After that, the patients received radiography regardless of OAR exam and US findings. The US and OAR results were then compared to the formal radiography interpretation.
Results
A total of 240 patients with a mean age of 36 ± 12 years were included in the study of which 86 (35.8%) were female. The sensitivity of OAR in detecting foot and/or ankle fractures was 97.5 %( 95% Confidence Interval (CI) 86.8 to 99.9 %) and the specificity of OAR increased from 48.5 % (95% CI 41.4 to 55.7%) to 99.5 %( 95% CI, 97.2 to 100) with the addition of US. The OAR can reduce radiography by 40%, and if ultrasonography was used before radiography, there would be an approximately 72% reduction in X-ray requests.
Conclusions
When used in conjunction with OAR, US can be used by trained physicians in ED to more accurately identify patients who would benefit from having an X-ray performed. US examination can further reduce the ordering of X-rays when compared to using OAR alone.

Background: Emergency department (ED) demand and overcrowding was increasing all over the world and significant portion of this overcrowding was created by “frequent users”. The aim of the study is to define the characteristics of this group of patient who contribute toward a disproportionate number of ED visits.
Methods: All ED visits during one-year period between 01.01.2018 and 31.12.2018 were investigated retrospectively by using electronic registration system of the hospital. Patients attended to ED ≥4 times between this periods were accepted as “frequent user”. Social-history related factors, disease related factors and care related factors of frequent users were investigated.
Results: A total of 335457 ED visits made in a calendar year of 2018 were investigated. Frequents users were 6.8% of all ED patient population and made 22.9% of all ED visits. Female gender proportion was greater among frequent ED users and frequent users were younger than occasional users. Yellow / red triage code ratio was higher in frequent user group and also median length of hospital stay was significantly longer. Uninsured patient was two times higher at the frequent users and half of this patient was immigrant or refugees.
Conclusion: Frequent users place a significant burden on the increasing patient volume of ED’s. Welfare status was an important indicator for being frequent user. However frequent users are a very heterogeneous patient group and more research is needed in order to better understand factors leading to frequent ED use and to develop effective strategies to meet their complex health care needs.

Aim:
This study was aimed to evaluate necessity of performing CXR in patients with multiple traumas and Injury Severity Score (ISS)>15.
Materials and Methods
In a cross-sectional study conducted on trauma patients, the clinical and radiographic findings of all the patients were collected and the relationships between these variables analyzed based on ATLS guidelines.
Results
A total of 170 patients were included that 114 (67.1%) of them were male. The mean age of male was 33.86±17.36 years and female 37.75±18.33 years (P=0.181). 26 patients complained of symptoms, 7 patients of dyspnea and 19 patients of chest pain. Clinical examination was abnormal in 28 patients, emphysema in one patient, ecchymosis in one patient and local tenderness in 26 patients.
CXR was performed for all patients, it was normal in 161 patients (94.7%). It detected rib fracture in 6 patients (3.5%), pulmonary contusion in 2 patients (1.2%) and hemothorax in 1 patient (0.6%).
Conclusion
Investigation the necessity of emergency CXR in multiple trauma patients with ISS> 15 showed that in stable patients who lacks signs and symptoms there is no need to perform CXR and instead we suggest physical exam to detect any problem.

Background: The aim of our study was to define the characteristics of occupational accident cases admitting to an emergency department and to evaluate these accidents in terms of emergency service costs.
Methods: This is a descriptive study. The age and gender of the patients, admission time, reason of admission and the sector in which the patient works were evaluated; trauma to the body area and patients' costs to Social Security Institution were also determined according to the hazard classification of the business lines.
Results: A total of 410 patients admitted to the emergency department due to occupational accidents were included in the study. 95.9% of the patients were male. Of the patients, 30.0% were working in construction sector. The maximum number of admissions was between 08: 00 - 12: 00 hours with a frequency of 34.6% and the costs of occupational accidents that workers were exposed to in very dangerous sectors were the highest (p = 0.012).
Conclusion: Occupational accidents cause most deaths after traffic accidents and home accidents. Occupational accidents have a significant negative impact on both workers' health and the national economy. Particularly in workplaces classified as dangerous and very dangerous, employees are at risk for accidents that can cause permanent injury and death.

Objective: This study aims to analyze the data of children in the 0-6 age group who were exposed to unintentional accidents through a data set representing Turkey.
Methods: The variables used in the analysis were obtained from the “TurkStat Health Survey” micro data set for 2016. Although there are fifteen accident types in total, the data for the two accident types were excluded from the analysis because there was no data about them. Each accident element was analyzed by frequency, rate and difference analysis. In addition, the frequency of occurrence of each accident type per hundred thousand was calculated by using the sample.
Findings: The first five accident types with the highest frequency of thirteen accident types, play-related injuries (8.7%), slips and falls (8.1%), insect bites and stings (3.4%), burns (2.9%) and foreign body aspiration (1.6%). The number of people exposed to thirteen accident types is 743 out of 2272 people. 43% of the people exposed to the accident applied for treatment. The frequency of occurrence of all accidents per hundred thousand is 3318.9.
Conclusions: According to the results of the research, the authorities directing the health policy should make an emergency action plan for the types of accidents with the highest frequency and the most sequelae.

Aim: The present study surveys the available evidence regarding the role and scope of nursing leadership in disaster and emergencies.
Materials and Methods: This scoping review was carried out between 2010 and 2020 through a series of database including Embase, Scopus, CINHAL, Web of Science, Cochrane Library, PubMed, ProQuest, and Google Scholar with keywords of “leadership,” “nursing,” “competency,” “disaster,” and “emergency”.
Results: Seven articles met the inclusion criteria of the scoping review. Three main research questions were addressed, relating to the role of nursing leadership in times of disaster, the skills required of a nursing leader, and the strategies recommended for promoting nursing leadership during a disaster or pandemic.
Conclusion: This study shows that nurses are a vital part of the healthcare system in times of disaster and that nursing leaders provide valuable services for maintaining individual and community health. Given that there is no agreement in the existing research as to which competencies are required of nursing leaders in times of disaster, more researches must be developed to enhance the effectiveness of nursing leaders in future disasters and pandemics.

Aim: The purpose of this descriptive study was to examine the anger states of the relatives of critically ill patients coming to emergency departments and the reasons of these anger states.
Materials and Methods: The study was conducted with 202 relatives of critically ill patients, who matched the inclusion criteria and accepted to participate in the study, at the Emergency Department of a University Hospital between September 2013 and January 2014. The “questionnaire”, which was prepared by the researcher in line with literature and involved the demographic characteristics of patient relatives and reasons of their anger at the emergency department, was used as the data collection tool.
Results: It was determined that 29.2% of patient relatives raged at the emergency department and 18.6% raged about registration procedures, 45.8% about treatment duration, 42.4% about deficiency of treatment, 13.6% about deficiency of medical staff, 3.4% about deficiency of the waiting environment, 49.2% about lack of information, 39.0% about lack of communication, 44.1% about irrelevance of medical staff, 57.6% about waiting duration and that 32.2% would have a decreased anger in case of reducing of the waiting durations.
Conclussion: As a consequence, it is thought that making the required explanations to patients/patient relatives, providing large and comfortable recreation places where they could wait, increasing the number of medical staff and approaching the patients with an empathetic attitude will increase the satisfaction of patients/patient relatives, meet their expectations, minimize the communication problems experienced and decrease the anger levels.

Objective: The objective of this study was to investigate whether there was a relationship between the levels of platelet mass index and OSAS and to compare biochemical parameters among comorbidity groups among OSAS patients.
Material & Methods: The patients were divided into two groups; patient group consisted of patients who had previously presented to the emergency department of our hospital and were diagnosed with OSAS through polysomnography, while control group included individuals who had no diagnosed chronic disease.
The Patients in the OSAS group were further divided subgroups as diabetes, diabetes + hypertension, diabetes + hyperlipidemia, diabetes + cardiovascular disease, diabetes + hypertension + hyperlipidemia, hyperlipidemia, cardiovascular disease and hypertension.
Physical examination, complete blood count and biochemical test outcomes of both groups, and polysomnography data of the patient group were retrospectively evaluated.
Results: The mean BMI value was statistically significantly higher in OSAS patients compared to the control group (24.28±1.00 vs 29.73±2.51 Kg/m2). The mean platelet volume (MPV) was significantly higher in the control group (10.13±1.09) compared to the OSAS group (7.98±1.32) (p<0.001). Total platelet mass indeks found with multiplying platelet counts and MPV was significantly higher in the control group (2,737.92±548.90) compared to the OSAS patients (2,104.89±462.86) (p<0.001).
Conclusion: According to the results of this study platelet mass index, MPV and/or total platelet count is not diagnostic. Especially in patients presenting to emergency department with the complaints of fatigue, headache, inattention and daytime drowsiness; however may be a warning parameter idicating that it might be OSAS.

Aim: To determine the incidence and clinical characteristics of ophthalmic emergency cases who required ophthalmic surgical intervention.
Materials and Methods: Patients who presented to our Ophthalmology Department with surgical ocular traumatic injuries from 2017 to 2018, were retrospectively examined. Demographic characteristics, details of the injury, diagnoses, examinations and surgical procedures were obtained. The time period between occurrence of eye injury and presentation to hospital and time to surgery were also recorded.
Results: Thirty-eight eyes of 35 patients, 74% males and 26% females (mean age: 31±19) were included. Three cases were bilateral. The main causes of ocular surgical injuries were traffic accidents in 15 eyes (39%), work accidents in 11 eyes (29%), assault in 5 eyes (13%) and other causes in 7 eyes (18%). The most frequent type of lesion was penetrating injury (58%). Most of the operations (33 eyes, 87%) were performed on the first day of the injury. The others were operated between 1-10 days. Single operation was performed in 28 eyes (74%), while additional surgical procedure was necessary in 10 eyes (26%). Twenty patients (57%) were hospitalized to the Ophthalmology service. There was an improvement in visual acuity in 19 eyes (50%), no change in 12 eyes (32%), and worsening in 7(18%) eyes.
Conclusion: Surgery-requiring ophthalmologic injuries involve mainly male at younger ages and traffic accidents are the most important cause of trauma. In 50% of these patients, an increase in visual acuity was observed after surgery so early and correct surgery can prevent visual impairment and blindness.

Objective: Coronary artery calcium (CAC) score is a scoring system used in stratification of coronary risks. Breast artery calcification (BAC) is a type of medial artery calcification which can be seen on mammography, and also known as arteriosclerosis. It has been reported that there is a significant correlation between BAC and CAC, and presence of BAC improves the ability for detection of women with CAC. In this study, we aimed to evaluate the relationship between BAC on mammography and CAC.
Methods: A total of 31 patients who presented to our hospital for screening or diagnosis with mammographic evaluation and who recently presented for CAC between 2015 and 2018 were included in the study. Agstston method was used to determine CAC score. Total BAC, which differs between 0-12 was measured based on the number and length of calcified vessels and severity of calcification on mammography.
Results: The mean BAC scores were found as 0 in one patient, 1-3 in nine patients, and 4-12 in 21 patients. The mean CAC scores were found as 0 in eight, 11-100 in 12 patients, 101-400 in 8 patients, and >400 in 3 patients. There was a statistically significant positive correlation between BAC and CAC scores.
Conclusion: Our study revealed a positive correlation between BAC and CAC scores. It was found that mammographic calcification scoring, which is already commonly used as a screening tool and is more advantageous over tomography, can be used to determine intermediate risk groups for cardiovascular diseases in an early period.

Aim: The aim of our study is to evaluate the relation between serum adropin levels in acute pulmonary embolism patients.
Materials and Methods: Patients examined with PE pre-diagnosis, didn't have exclusion criteria and had certain diagnosis with Computed Tomography Pulmonary Angiography were included as PE group and the same number of participants and comorbidities similar to the PE group, the control group was selected among patients again referring to the emergency department who were not considered to have PE diagnosis with their clinical symptom and risk scorings.
Results: Serum adropin levels were found rather high in PE group. Although adropin values found high in the presence of all comorbidity conditions, adropin values were measured significantly high only in patients who had hypertension (HT), acute ischemic stroke (AIS) and previous PE. Adropin values were also quite different according to Well's Scoring groupings. Mean adropin levels were found significantly different among PE and controlgroups.
Conclusion: Plasma adropin levels were found significantly high in acute PE patients in our study and had high positive predictivity, sensitivity and specificity.

Aim: To evaluate the knowledge level and beliefs of emergency department patients and their relatives about hypnosis and their attitudes towards use of hypnosis for purposes of sedation and analgesia in emergency department.
Materials and Methods: The study was conducted as a two-center study. Total number of participants recruited into the study was 384. A questionnaire including socio-demographic features, sources of information, knowledge and beliefs about hypnosis and attitudes of the participants towards use of hypnosis in emergency department in different clinical scenarios was applied to the participants. Overall results of the total study sample and differences between various sub-groups were evaluated.
Results: Mean age of the participants was 34.27 years. Two hundred and sixteen (56.3%) participants were male. Television was the source of information with the highest effect on the knowledge of the participants about hypnosis. The participants were seen to mostly believe the myths about hypnosis. They preferred hypnosis only in the case of the existence or possibility of drug dependence (Mean±SD= 3.78±1.979).
Conclusion: The participants were mostly misled by improper sources of information so they were seen to be reluctant to prefer hypnosis in all clinical scenarios other than the existence or possibility of drug dependence.

Objective: We aimed to investigate the relationship between increased lactate values and mortality in COVID-19 patients.
Material and Method: This study was conducted in a tertiary Training and Research hospital. According to the order of application, a total of 316 patients over the age of 18 who were admitted to the emergency department (ED) with symptoms of COVID-19 during the two months period and whose data could be completely accessed were included in the study retrospectively. Plasma lactate values and mortality within 28 days were determined.
Results: The median age of the patients was 69 years. Of the patients 53.5% were male, 72.2% had comorbidities and the most common comorbidity was COPD (13.0%). Of the patients 83.5% were hospitalized. The mean lactate value of the patients was 2.05 ± 1.45mmol / L. Mortality developed in 14.2% of the patients during the first 28 days. The 28-day mortality was significantly higher in patients with a positive Polymerase Chain Reaction (PCR) (23.8%) than that of negative PCR (8.2%) (p < 0.001). The lactate level was found to be significantly different in both PCR positive and negative groups in which mortality developed within 28 days (p < 0.001; p < 0.001). If the cut-off value of lactate in terms of mortality was 2.45, the sensitivity and specificity were determined as 80.0% and 81.2% respectively.
Conclusion: In patients with COVID-19 infection, the blood lactate level examined at the first admission to ED can be used as a useful screening test to predict mortality.

Aim: The purpose of this study was to investigate the protective effects of ethyl pyruvate (EP) and dimethyl sulfoxide (DMSO) against ischemic tissue in brain, cardiac and hepatic tissue in experimentally induced carbon monoxide (CO) intoxication.

Material and Methods: Thirty-five mature female Sprague Dawley rats were randomized into five groups of seven animals each. Group-I received no CO or treatment. Rats in groups II,III,IV and V were made to inhale a high-concentration 5000 ppm CO gas mixture for 60 min at 4 L/min. CO levels were then measured from 1ml tail vein blood. Group-II received no therapeutic agent, Group-III received 6 mg/kg intraperitoneal (ip) DMSO, Group-IV received 50 mg/kg ip EP, Group-V received 50mg/kg EP and 6mg/kg DMSO ip. All rats were sacrificed by decapitation. Brain, cardiac and hepatic tissues were removed and histopathological scores were compared.

Results: Comparison of Group-II with Group-III and Group-II with Group-V revealed that DMSO alone and EP+DMSO exhibited a reducing effect on degree of cerebral neuronal alteration, degenerative neuron rates, and total cardiac injury score (p=0.005, p=0.002, p=0.004 and p=0.002, p=0.001, p=0.004 respectively). There was not any histopathological difference between Group-II and Group-IV suggesting EP alone has no therapeutic effect on histopathological injury.

Conclusion: Based on our study findings, EP administered alone exhibited no protective effects against the organ injuries investigated, while DMSO exhibited reducing effects on degree of neuron alteration, rates of degenerative neurons, and total cardiac injury scores. An ameliorating effect on cardiac and hepatic injury was more prominent with combined treatment.

Abstract | Full Text PDF

Objective: To determine the working order of emergencymedicine (EM) residents, their individual preferences and the effects of their working order on their practice and social lives.
Methods: The study included 182 EM residents. A two-stage questionnaire study was designed: demographic questionnaire and residents' thoughts on their practice and social lives. Study included EM residents who were actively working, on duty with shifts, and volunteer to participate. All data were analyzed with SPSS software.
Results: The most common shift type practiced was 8/16 duty system among the residents. Majority of the the residents were working on 24 hour shifts (42,1%). Of the residents 54,9% stated that their concentration levels have been effected negatively after 8-10 hours of duty. While 102 (56,1%) of the physicians were glad to be EM residents, and 19 (10,4%) of them believed they had enough time for themselves, 22 (12,1%) of them have stated that they were able to study sufficiently in off-duty times. Sleeping issues were statistically lower in EM residents working 24 hour shifts. Residents on duty in a periodical order, have statedwith a higher rate that they could rest sufficiently. Meanwhile, an unstable relationship with the patients, and negative views on medical practice have been observed more frequently among residents who are on duty with irregular shifts.
Conclusion: The shift systems and the regularity of the shifts effect not only the residents’ social lives but also their aproach to the patients.

We describe a patient who developed acute chest pain and ST-segment elevation in inferior leads on electrocardiography. In his control electrocardiography after fifteen minutes ST-segment elevation was seen in anterior leads. Cardiac catheterization showed there was wrap around left anterior descending artery and an occlusion in proximal region. Occlusion was resolved by typical ballooning. To our knowledge in literature there are simultaneously ST elevations in anterior and inferior leads, but in our case with serial ECG records we realized inferior ST segment elevation altered to anterior ST segment elevation. It indicates the importance of serial ECG records in emergency department to explain the mechanism.

Aim: The study aimed to compare Siriraj Stroke Score (SSS) with computed tomography (CT) in differentiating stroke subtypes.
Materials and Methods: This cross-sectional study consists of eighty consecutive patients admitted to the emergency department of the tertiary care-teaching center within four hours of the onset of stroke. A single experienced emergency medicine physician observed the patients for Siriraj score. An independent radiologist analyzed the CT of the patients who was not aware of the clinical condition. CT findings were considered the gold standard. Siriraj score findings were considered as a screening test. The sensitivity, specificity, predictive values, and diagnostic accuracy of the screening test, along with their 95% CI, were presented.
Results: A total of 80 subjects were included in the study. The mean age of the participants was 56.4 years, with the majority being males (58.8%). The sensitivity and specificity for SSS were 96.92% and 90.91%, respectively. The Siriraj stroke score had excellent predictive validity in predicting CT findings, as indicated by the area under the curve of 0.994 (95% CI 0.983 to 1.000, P value <0.001).
Conclusion: The clinical score, Siriraj stroke score, showed high sensitivity and specificity, and the results were satisfactory compared with CT imaging. Thus, it was concluded that Siriraj stroke score could be used for the bedside diagnosis to differentiate stroke subtypes in settings where CT scan facility is lacking.

Background: The aim of this study was to evaluate the intravenous recombinant tissue plasminogen activator (iv r-tPA) and/or mechanical thrombectomy indications in patients with acute stroke and in case these treatments were not applied, to determine reasons why these treatments were not applied in our patients.
Methods: The study included 300 patients with accessible data due to stroke between January 2018 and June 2019.
Results: A total of 214 (71%) of these patients had been admitted to the hospital within the first 4.5 hours. Fifty-eight (19%) of the patients did not undergo iv r-tPA and/or mechanical thrombectomy due to contraindications.
Conclusion: In our study, we determined that the most common reason for not applying iv r-tPA and mechanical thrombectomy treatments to patients was the fact that these patients could not reach the hospital within the treatment window. Multi-center studies are needed to investigate the large number of factors contributing to delaying the access of patients with acute ischemic stroke to these treatments. Addressing these factors may increase the proportion of patients receiving thrombolytic therapy or undergoing mechanical thrombectomy.

Background
One of the non-invasive methods to monitor changes in cardiovascular hemodynamic is the measurement of Transthoracic Impedance (TTI). The most important features of this method is that it does not require catheterization, no risk of complications as well as being cost-effective and easily applicable.
Objective
The aim of this study was to determine the diagnostic value of thoracic fluid content (TFC), in particular, which is one the parameters obtained from TTI measurement in patients presented to the emergency department with dyspnea and suspected of Pulmonary Edema (PE) due to Acute decompensate heart failure (ADHF).
Methods
This single-center, prospective, cohort clinical study was conducted on patients older than 18 years of age who presented with acute dyspnea who were suspected of PE due to ADHF to the tertiary care university Emergency Department (ED). The primary outcome measure was to determine the diagnostic value of TFC measurement in patients presented to the ED with dyspnea, who were suspected of PE due to ADHF.
Results
113 patients were included in the study. BNP value was accepted as the gold standard in the diagnosis of PE due to ADHF, sensitivity – specificity of PE associated with ADHF was 64.3%, 31.4%, and 14.3% - 88.4%, 60.5% and 83.7% for TFC, CI, SI, respectively. Among these, only TFC was statistically significant difference to diagnose PE. (p<0.001)
Conclusion
TFC measured by TTI in patients suspected of PE due to ADHF could also be a better alternative for exclusion tests.

Aim: Flow of patients to emergency departments (EDs) and their stays in EDs (ED-LOS) depend significantly on their arrival modes. In this study, developing effective models for forecasting patient flow and LOS in EDs by considering arrival modes is aimed to lead better planning of ED operations.
Materials and Methods: In this study, by categorizing mode of arrival into two, self-arrived in and by ambulance, autoregressive integrative moving average (ARIMA) models are applied for forecasting four time series: daily number of patients self arrived/arrived by an ambulance and average LOS of patients self-arrived/ arrived by an ambulance. The models are validated with real-life data received from a large-scaled urban ED in Izmir, Turkey.
Results: While seasonal ARIMA is proper for forecasting daily number of patients on both modes, non-seasonal models are proper for forecasting average LOS. The mean absolute percentage errors (MAPE) for the models of four time series are respectively as 5.432%, 13.085%, 9.955% and 10.984%. Thus, daily arrivals to EDs show seasonality patterns.
Conclusion: By emphasizing the impact of mode of arrival in ED context, this study can be used to aid strategic decision making in EDs for capacity planning to enable efficient use of ED resources.

COVID-19 disease is caused by SARS-CoV-2 virus infection and firstly appeared in China and then became a pandemic. The leading cause of mortality is respiratory failure in COVID-19; however, cardiovascular manifestations are frequent and also important causes of death in COVID-19. Incidence of arrhythmia is increased in patients with COVID-19 due to increased systemic inflammatory response, hypoxia, and administered drugs. All kinds of arrhythmias, including bradyarrhythmias, supraventricular and ventricular arrhythmias, may develop during COVID-19 course. QT prolongation plays a central role in COVID-19 related arrhythmias. Therefore, QT duration should be strictly followed. All of the clinicians should know the management of arrhythmias that they might face with frequently during the pandemic.

Aim: It is aimed to examine the relationship between short-term mortality and the blood glucose values (BGV) obtained in the first week of ischemic stroke, when neurological causes such as increased intracranial pressure are mainly predominant in mortality.
Materials and Methods: This is a retrospective study of 417 patients with acute ischemic stroke (AIS) who admitted to our hospital within the first 24 hours. Data were recorded using the International Classification of Diseases Code. The effect of BGV on the first, third, fifth and seventh day of the stroke on the patient’s functional outcome was evaluated.
Results: Of 417 patients, 90 (21.58%) died within a one-month follow-up period. There was no difference between the mortality and survival groups in terms of diabetes mellitus history (χ2 = 0.783, p: 0.224). BGV’s were significantly higher in the mortality group than in the others at 1st, 3rd, 5th, and 7th days (p <0.05). Blood glucose predictive values on these days for mortality were found 130.5; 124.5; 133.5; 132.5 mg / dL respectively, in the Receiver Operating Characteristic (ROC) analysis. The 5th day BGV (133.5 mg/dL) was an independent predictor for mortality (HR: 3.001; 95% CI (1.43 - 6.3) p: 0.004), while the others were dependent to coma scale.
Conclusion: Hyperglycemia predicting short-term-AIS mortality might be a DM-independent stress hyperglycemia. Although hyperglycemia is predominantly a coma scale dependent (mRS) predictor at first-week-blood glucose monitoring, the fifth day blood glucose value may be independent predictor of short-term mortality.

Background:
By sharing our experience in suicide cases, which constitute a significant part of the psychiatric emergency cases in our work, we hope to attract attention to the factors involved in suicide attempts. This is intended to contribute to taking precautions and prevent suicide attempts by determining the possible risk factors.
Method:
This study was conducted by retrospectively reviewing records of 292 cases filed with Dumlupınar University Kütahya Education Research Hospital Emergency Service as suicide attempts between January 01 and December 31, 2016, for which the “Suicide Attempt Registration Form” was completed.
Results:
Suicide attempts were found to occur more frequently in females in the age group of 15–24 years, particularly in cases with familial problems, psychiatric diseases, and problems with the opposite sex.
Conclusions:
In this study, we evaluated demographic and risk factors of suicide attempts in our hospital. Local government, non-governmental organizations, and health service providers need to cooperate for the development of policies to prevent suicidal behavior. In addition, because psychiatric diseases take an important place in the etiology of suicide attempts, it is vital that these patients are followed up closely and that symptoms indicative of suicide are treated and an absolute psychiatric evaluation and follow-up are done before discharge of the emergency patients.

Introduction

The aim of this study was to investigate the effect of inhaled ipratropium on pupil diameter when applied directly onto the eye in a closed environment.

Materials and Methods

A total of 14, 8-week-old and 350-g weight Sprague dawley rats were obtained from Yeditepe University Laboratory of Experimental Animals for research. At constant temperature (22 ± 3 ºC) and 12-hour light / dark cycle, the rats had access to standard feed and water. 7 rats were exposed to ipratropium while 7 rats were given saline nebular. Pupil diameters and pupillary-orbital diameter ratios were compared before exposure and 2 hours after exposure to the drug.
Pupil diameters and pupillary-orbital diameter ratios measured before and 2 hours after inhalation ipratropium administration were compared in the computer environment after 4288x2848 pixel magnification.
Results
There was no significant difference in pupil / orbital diameter ratios in either the right or the left eyes after treatment compared to baseline values (p >0.05, for both).
There was no significant difference in Delta rates. The numerical data fitted the normal distribution.

Conclusion
In our study, no significant difference in diameter changes were determined that would advocate that we should be more careful in the case of anisocoria development in patients receiving ipropropium treatment and to perform a detailed neurological examination and request neurology consultation as soon as possible. Anisocoria or changes in pupil diameters that we may encounter in both pupils may not always be associated with drug use.

Aim: This study was to investigate the efficacy of procalcitonin, CRP, lactate, albumin and procalcitonin / albumin parameters used as an indicator of infection on mortality in critical patients admitted to the Intensive Care Unit and their relationship with APACHE II, SOFA scores.
Materyal-Methods: The study was carried out from hospital records of patients and scans of patient files.Demographic characteristics, procalcitonin, CRP, albumin and lactate levels as well as APACHE-II and SOFA scores were recorded. Spearman's rank correlation was used for non-parametric data. ROC curve analysis was performed to determine the threshold value of blood parameters. Results: 61 patients were enrolled into the present study. The participants included 35 males (57.4%) and 26 females (42.6%) with an age average of 69.0. A positive and weakly significant association was detected between APACHE-II and procalcitonin.When the APACHE-II Score and lactate and procalcitonin / albumin ratio were evaluated; APACHE-II was positively significant and had a weak correlation with lactate and procalcitonin / albumin ratio. A moderate negative correlation was found between albumin and APACHE-II score.The SOFA score was positively associated with procalcitonin.The SOFA score was positively associated lactate. SOFA was positively significant and weakly correlated with Procalcitonin / Albumin ratio.
Conclusion: Procalcitonin, lactate, albumin and procalcitonin / albumin were considered as prognostic markers according to the cut-off points in terms of mortality in critically ill patients.In addition, these blood parameters were found to be useful in clinical follow-up as they were related to the APACHE-II and SOFA scoring systems used in intensive care units.

Aim: The aim of the study is to evaluate the Emergency Medical Services (EMS) cases in some mass gatherings held in Turkey between the years of 2015-2018 and to compare the PPR and TTHR rates of different types of MGs.
Methods: The research is a descriptive cross-sectional epidemiological study. The population of the study consists of 112 EMS records of the Commemoration Events of the Çanakkale Land Warfare (CEÇLW), Zeytinli Rock Festival (ZRF), Summer Deaflympics (DEAFLYMPICS) and European Youth Olympic Winter Festival (EYOF) organizations held in Turkey between the years of 2015-2018.
Results: the hours of 12: 00-17: 59 (34.0%, n = 161). 57.4% (n = 272) of the cases were due to medical 474 EMS cases were examined in the study. 49.5% (n = 235) of the cases were in DEAFLYMPICS and 57.6% (n = 273) of the cases were male. The mean age of the cases was 30.3 ± 16.5 (Min: 0, Max: 92). Most cases occurred between reasons. According to the triage codes, 57.7% (n = 153) of the cases were green, 32.3% (n = 153) were red and 15.8% (n = 75) were yellow. When the results of the cases were analyzed, 54.0% (n = 256) of the cases were transferred to hospital, 20.7% (n = 98) were on-site intervention and 14.1% were refusal of transfer.
Conclusion: As a result, differences in PPR and TTHR rates are observed in different types of MG.

Aim: Endotracheal intubation is an important element of cardiopulmonary resuscitation. It is necessary to have an adequate experience with endotracheal intubation during pediatric residency. In our clinic we prepare the simulation based endotracheal intubation educations for residents of pediatrics. In this study, we aimed to evaluate the success of our endotracheal intubation education program.
Materials and Methods: The residents received two simulation based endotracheal intubation training in a course program one-year apart. The success rates of residents were compared in terms of endotracheal intubation performance.
Results: Intubation success rates were 80 % (28/35) at the end of the first program and 100% (35/35) at the end of the second; the difference was found to be statistically significant (χ2 = 7.667, p = 0.006). The mean time of successful endotracheal intubation in both programs were 14,14 ± 4,16 sec and 8,22 ± 3,58 sec, respectively. Intubation times in the second program were found to be significantly lower than the first (p <0.01).
Conclusion: In our study, we found that simulation based endotracheal intubation educations which were performed one year apart through high-fidelity manikins, increased the success rate of endotracheal intubation attempts and shorten the time for intubation.

Introduction: The elderly population increases worldwide. The purpose of this study was to evaluate nosocomial infections (NI) detected in geriatric patients and to determine the risk factors leading to their development.
Materials and Methods: Patients monitored in our hospital’s Intensive Care Unit (ICU) are evaluated daily by intensive care and infectious disease specialists, including surveillance by our Infection Control Committee. we included the patients aged ≥65 years who were monitored in the adult ICU between January 2014 and December 2014, using the methods of retrospective file screening and computer record review. Patients were classified into two groups: patients with and without NI.
Results: Total 222 (38.07%) patients were ≥65 years old. Forty-four NI events were detected in 27 patients. Groups were compared with respect to age; sex; presence of mechanic ventilation(MV), central venous catheterization (CVC), cerebrovascular disease, chronic obstructive disease, diabetes mellitus, malignancy; and mortality. The presence of MV, CVC and mortality were seen to be significantly higher in patients with NI compared with those without. The most common NIs found were sepsis and pneumonia. The most common infectious agent was Acinetobacter.
Conclusion: NIs observed in hospital ICU are common but largely preventable conditions. A systematic approach and well-disciplined empiric therapy are very important. Our study revealed that the mortality rate is high in elderly patients who develop NI, and NI is more commonly seen in patients who undergo invasive interventions. We believe that using invasive interventions as little as possible in this group may improve their treatment success and outcome.

Giriş
Kırım-Kongo kanamalı ateşi enfekte keneler veya kontamine kan, doku ve vücut sıvılarının teması ile bulaşır. Tanı ve prognozda trombositopeni, lökopeni, anemi, biyokimya ve pıhtılaşma parametreleri gibi laboratuvar sonuçları kullanılabilir.
Araç ve yöntem:
2013-2018 yılları arasında KKKA teşhisi konan 17 yaş üstü hastaların dosyaları retrospektif olarak incelendi. Tam kan sayımı, karaciğer-böbrek enzimleri, elektrolit sonuçları ve protrombin zamanı, aktive parsiyel tromboplastin zamanı, D-dimer, fibrinojen ve uluslararası normalleştirilmiş oran kaydedildi ve analiz edildi.
Bulgular:
Mortal seyreden hastalarda biyokimya parametrelerinden ALP, ALT, Amilaz, AST, BUN, direkt bilirubin, GGT, kreatinin, K, toplam bilirubin ve ürik asit seviyeleri daha yüksek (p <0.05); CK, CK-MB ve Ca seviyeleri daha düşük (p <0.05)olarak saptandı. Tam kan sayımı (CBC) parametrelerinden bazofil, MCHC, MCV, nötrofil, NRBC, PDW ve WBC daha yüksek düzeylere sahipti (p <0.05).
Sonuç:
Acil serviste CCHF hastalarının rutin kan parametrelerinin değerlendirilmesi, hastanın tedavisinde gecikmeyi önlemek için yoğun bakımda hastaneye yatışın hızlandırılması için yararlı bir araçtır. Trombosit, aPTT, INR, BUN ve AST değerleri mortalite için prediktörlerdir.

Aim
Turkish Government launched an operation to transport the Turks living in Wuhan, China to Turkey because of COVID-19 pandemia. In this study, the transport method, medical measures taken and quarantine process were evaluated.
Methods
Turkish citizens living in China had reported to the Turkish Embassy in Beijing that they wanted to return to Turkey. Thereupon Turkish Embassy in Beijing contacted the Ministry of Foreign Affairs of Turkey, and it was decided to transport Turkish citizens from China to Turkey. The governments of Georgia, Bulgaria, Azerbaijan, and Albania, who were aware of this development, requested the Ministry of Foreign Affairs of Turkey for their own citizens to be included in this transport.
Results
A total of 42 people were transported from city Wuhan to Turkey. Among them, 27 were citizen of Turkey, 6 were citizens of Azerbaijan, 4 were dual citizens of China and Turkey, 3 were citizens of Georgia, 1 was citizen of Bulgaria and 1 was citizen of Albania.
Conclusion
It suggests that there is a serious outbreak, as COVID-19 disease transmits from human-to-human and spread rapidly worldwide. Therefore, taking this outbreak seriously and taking all necessary measures will reduce the spread of COVID-19.

Aim
In this study, we aimed to determine the health literacy level of the patients admitted to the emergency department with green triage code and discuss this in the light of current literature.
Material method
This cross-sectional descriptive-analytical study was performed on 285 subjects attending a tertiary hospital emergency department with green triage codes through convenience sampling method in 2019. Turkey Health Literacy Scale-32 was used to collect data.
Results
One hundred two participants aged 18-83 years were included in the study. Health literacy indexes of the participants ranged between 11.67 and 48.44 and the mean value was calculated as 30.9 (poor). The health literacy index of 59 (57.9%) participants was considered to be poor.
Conclusion
In our study, health literacy levels of patients who applied to emergency department with green triage code were found to be poor. More attention to health promotion programs and health education is needed.

Introduction: Acute stroke is one of the most common and debilitating diseases. Rapid diagnostic measures after entering the hospital and shortening the duration of treatment will increase the chances of access to treatment. The purpose of this study is to examine the accuracy of Field Assessment Stroke Triage for Emergency Destination (FAST-ED) in terms of stroke diagnosis.
Methods: This prospective diagnostic accuracy study had been conducted between March 2019 to January 2020. All adult patients transferred to the ED and suspected of having an acute ischemic stroke who had undergone brain magnetic resonance imaging (MRI) were eligible. After data collection, receiver operating characteristic curve, sensitivity, specificity, positive predictive value, and negative predictive value of FAST-ED were calculated and compared with the NIHSS scale.
Results
A total of 314 patients who receive MRI in the first 24 hours of symptom onset were included in this study. The mean age was 67.95 ± 13.11 years and 184 patients (58.60%) were males. Of all suspected patients, 274 patients (87.26%) had ischemic stroke based-on gold standard diagnosis.
The best predictor of stroke in FAST-ED with a sensitivity of 0.880 and specificity of 0.575 was a cut-off point of 2 (AUC: 0.836). Distribution of all FAST-ED symptoms was significant in stroke and non-stroke group except " Eye deviation ".
Conclusions
FAST-ED scale is relatively simple and has a comparable ability for recognizing AIS to more complex NIHSS.

Aim: In our study, the reliability of bedside ultrasonography (USG) in fracture diagnosis was evaluated in the cases who applied to emergency service due to nasal traumas.
Materials and Methods: 40 cases who presented to emergency department with nasal trauma between 01.01.2016 and 31.12.2017 were evaluated prospectively. The patients’ age, gender, physical examination findings, trauma type, causes of trauma, X-ray and USG results were recorded in the study. The physical examination was performed by an emergency medicine specialist and physical examination and X-ray were accepted as the gold standard for diagnosis. In patients with suspected nasal fracture; physical examination and X-ray results were compared with USG in terms of fracture diagnosis.
Results: the median age of the patients was 32.5 (IQR: 31) and 72.5% were male. There was no correlation between fracture presence with age or gender (p> 0.05). The most common findings were swelling (62.5%) and ecchymosis (47.5%). 77.5% of patients had isolated trauma; and the most common cause of injury was falls (52.5%). There was no correlation between the presence of fracture with the cause of trauma and the type of trauma (p> 0.05). The sensitivity, specificity, positive predictive value and negative predictive value of USG were identified as 88.5%, 78.6%, 88.5% and 78.6%, respectively
Conclusion: Bedside USG can be preferred as the first choice in the diagnosis of nasal fracture in patients applying to the emergency service due to nasal trauma.

Objective: It is highly important that the factors affecting the burnout and empathic tendency levels of emergency nurses be determined, in order to increase the contentedness of individuals receiving health care service and their relatives, and to make the health care services more quality. The purpose is to determine factors that affect the burnout and empathic tendency levels of emergency nurses.
Material and Methods: This research is a descriptive and cross-sectional study. In this study; the “Maslach Burnout Inventory”, the “Empathic Tendency Scale” and the introductory information form for nurses were utilized for data acquisition.
Results: 129 emergency nurses participated in this research.The participant nurses are 22.5% male. The mean score of MBI was observed to be higher in nurses, who partially voluntarily chose their vocation, who are uncontent with their job, and who regard their quality of work life as very bad and bad. The ETS score was observed to be higher in nurses, who voluntarily and partially voluntarily chose their vocation, and who love their profession.
Conclusion: As empathic skill and tendency can be improved via education; the empathic tendency skills of nurses to be improved via continuous education programmes

The 79-year-old female patient presented to the emergency unit with a cough and severe shortness of breath. Due to bilateral multilobular ground glass density on thoracic tomography, the patient was admitted to intensive care with the preliminary diagnosis of Covid-19, and continuous positive airway pressure (CPAP) was applied. The PCR (Polymerase Chain Reaction) test was performed, and treatment with hydroxychloroquine and azithromycin was begun. At the same time, the patient with an arterial blood pressure of 190/100 mm/hg was administered diuretic treatment to reduce lung congestion. On the follow-up CT of the patient who had recovered rapidly, we observed that the ground glass appearances had completely resolved. The PCR was negative and the patient was regarded as acute lung edema. The treatment was prescribed, and the patient was discharged from the hospital. Although thoracic tomography findings are useful in the early period for diagnosing Covid-19, it may show similar results as other diseases that cause respiratory failure and lead to misleading interpretations.

Abstract | Full Text PDF

Primary retroperitoneal cysts are rare benign lesions. Generally this lesions originates from lymphatic system hipoplasia or pelvic or retroperitoneal operations. Although it is usually asymptomatic, they can cause symptoms as hipotension, tachicardia or even shock due to intracystic haemorhaggy, gas retantion or hydronephrosis due to compression of adjacent organs. Definitive diagnosis is diffucult before surgery. However, diagnosis can be estimated by direct graphy, computed tomography, ultrasound and other techniques. Conservative treatments, percutaneous drainage, marsupialization, open or laparoscopic cyst excision are the treatment options. In this case report, we present a case of retroperitoneal hemorrhagic cyst which was opened to the abdomen causing acute abdomen.
Türkçe
Primer retroperitoneal kistler nadir benign lezyonlardır. Genellikle konjenital lenfatik sistem hipoplazisi veya pelvik ya da retroperitoneal operasyonlara bağlı oluşurlar. Çoğu zaman asemptomatik olsa da kist içi kanamaya bağlı hipotansiyon, taşikardi ve hatta şok, çevre dokulara bası sonucu gaz distansiyonu ve hidronefroz gibi semptomlara neden olabilir. Ameliyat öncesi kesin tanının konması zordur. Ancak direk grafi, bilgisayarlı tomografi, ultrason ve diğer teknikler ile tahmin edilebilir. Konservatif tedaviler, perkutan drenaj, marsupializasyon, açık ya da laparaskopik kist eksizyonu tedavi seçenekler arasındadır. Bu olgu sunumunda akut batına neden olan batına açılan retroperitoneal hemorajik kist olgusunu paylaştık.

Aim: Renal colic pain is one of the most common agonizing forms of pain that is frequently treated in emergency departments. Computed Tomography (CT), which is used for the detection of kidney stones, is a costly application. Therefore, scoring systems that predict stone have been developed. This study was conducted to investigate the diagnostic accuracy of the modified STONE score to predict stones.
Materials and Methods: Among those who applied to the emergency department with renal colic pain, patients with CT were examined. 337 patients included in the study were divided into two groups as those with and without kidney stones. It was examined whether there was a difference between these two groups in terms of personal, seasonal, laboratory findings and Modified STONE Score.
Results: We found that ureteral stone history, pain duration less than 6 hours, presence of hematuria and nausea/vomiting, CRP value below 0.5 mg/dL, The Modified STONE score above 9, age ≤50 years were factors that increase stone. The Modified STONE score was significantly high in the stone-detected group. When the STONE score is calculated for all patients and divided into three groups (low, moderated, and high modified STONE scores), the prevalence of ureteral stones increases towards the high modified STONE scores group.
Conclusion: We found that the modified STONE score was quite successful in predicting ureteral stones. We determined that emergency physicians can diagnose stones using this score and avoid unnecessary CT. The diagnostic value of this score may increase when nausea/vomiting factor is added.

Aim: The aim of this study was to examine the basic mechanisms that play a role in the acute nephrotoxicity caused by diclofenac sodium.
Materials and Methods: Only water was given to the control group; however, the diclofenac sodium group was group intoxicated by giving water-soluble, 240 mg/kg, oral single dose diclofenac sodium. After 24 hours, all animals were sacrificed and histopathological analyzes were performed. The levels of spesific biomarkers (Vascular endothelial growth factor [VEGF], Nuclear Factor-Kappa B [NF-kB], Matrix Metalloproteinase-9 [MMP-9], Metalloproteinase Tissue Inhibitor-1 [TIMP-1] and Carcinoembryonic antigen [CEA]) that may be related to the nephrotoxicity mechanism were evaluated.
Results: As a result of biochemical analysis we found that VEGF, TIMP-1, NF-kB and CEA levels were significantly higher and MMP-9 levels were significantly lower in diclofenac sodium group compared to control group. Nephrotoxicity related histopathological changes were observed in the sections of diclofenac sodium group.
Conclusion: This study has shown that the biomarkers we evaluated in the diclofenac sodium-induced acute high-dose intoxication model we created can help us to identify the nephrotoxicity and to explain the nephrotoxicity mechanism with the 3 main steps (the hemodynamic-related pathway, the inflammation-related pathway, and the oxidative stress-related pathway). With a simple version of this panel adapted to emergency departments, we may be able to diagnose diclofenac sodium-related nephrotoxicity.

Aim: Traumas continue to be the leading cause of death in healthy adults presenting to emergency service throughout the world. The aim of this study was to analyze the epidemiological causes of life threatening thoracoabdominal traumas.
Materials and Methods: 1121 patients older than 18 years of age who presented to the emergency service due to trauma between January 1, 2017 and December 31, 2019 were included in this retrospective study. Traumas were grouped as falls, traffic accidents and penetrating injuries. Five groups were also formed according to radiological imaging methods.
Results: Mean age was 35.80±16.15 years in in-vehicle accidents and 46.56±17.64 years in penetrating injuries (p=0.001). It was found that 847 (75.6%) of the cases were falls, 222 (19.8%) were traffic accidents and 52 (4.6%) were penetrating injuries. 67 (%6) of the cases underwent USG in falls from higher than 2 m, 399 (35.6%) of the cases underwent direct X-ray in falls from lower than 2 m, 9 (0.8%) cases underwent abdominal CT, 19 (1.7%) cases underwent multiple imaging in non-vehicle traffic accidents and 24 (2.1%) cases underwent thoracic CT in falls from higher than 2 m. In the analysis of trauma types with variables, positive low and moderate correlation was found in all variables except for age.
Conclusion: Mortality and morbidity rates can be reduced by early multidisciplinary approach to trauma cases and early decision of radiological imaging procedures to be carried out.

Aim: Research the contribution of multiplanar sections to vertebral fracture detection by examining multislice computed tomographies of patients who referred to our emergency department (ED) with trauma.

Method: 896 cases who referred to ED between 01.06.2016-01.06.2018 and whose multislice computed tomographies were taken with vertebral fracture pre-diagnosis of the ED physician were scanned. The differences of axial and coronal sagittal reformat images in the detection of vertebral fracture were compared in 78 cases who were found to have fracture in their tomographies.

Result: Average age of 78 cases was found as 55.93±23.23 years. A total of 145 fractures were found in 78 cases. 24 fractures were detected in 12 cases at cervical area, 67 were detected in 36 cases at thoracic area and 54 fractures were detected in 30 cases at lumbar area. While there were no significant differences between axial and coronal sagittal reformat imaging techniques in the differentiation of cervical fractures, differences were found in thoracic and lumbar fractures (p=0.636, p<0.001, p=0.001, respectively). When the fracture detection rates of axial and coronal sagittal imaging techniques were assessed in terms of the anatomic region, there were significant differences in corpus assessment (p<0.001), while there were no significant differences in transverse process and lamina fractures (p=0.127, p=0.083).
Conclusion: In post-trauma physical examination, coronal sagittal reformat imaging is more sensitive when compared with axial imaging in patients who have tenderness in thoracic and lumbar region and we believe that it will be of use to the physician by distinguishing especially corpus fractures.

Background: To investigate the ability of routine cranial computerized tomography (CT) to detect facial bone fractures, taking maxillofacial, orbital and temporal bone CT as a reference.
Materials-methods: Patients presenting to the emergency department with head trauma and undergoing cranial CT imaging were included in the study. Cases in the study group were also assessed using at least one of maxillofacial, orbital or temporal CT.
Results: Fracture was present in 155 patients at maxillofacial, orbital or temporal CT. Fifty-nine patients had a single fracture and 96 more than one fracture. Fractures were determined completely and accurately in 71 patients using cranial CT. Cranial CT wassuccessful in thefracturediagnosis of 48 of 96 patientswithmultifractures but all of thefracturelines in thesepatientswere not ableto be shown. Eleven patients were reported as false positive.
Sensitivity of 45.8%, specificity of 93.1%, a positive predictive value (PPV) of 86.6%, a negative predictive value (NPV) of 63.8% and a kappa value of 0.39 were determined for the effectiveness of cranial CT. Eleven out of 21 fractures in the temporal bone, 33 out of 50 in the nasal bone, 27 out of 35 zygomatic fractures, 3 out of 4 occipital fractures, 8 out of 17 patients with ethmoid fracture and 19 out of 23 patients with frontal fracture were identified using cranial CT.
Conclusion: Advantages such as a thin slice thickness, a bone algorithm and reformat images assist the detection of small, non-displaced fractures at temporal, maxillofacial and orbital CT.

The purpose of this study is to research the effect of repeated theoretical and practical up to date BLS (Basic Life Support) training that provides teachers the opportunity to improve knowledge and skill levels.
Materials and Methods: This research was pre test- post test, quasi-experimental study. The scope of the study included 65 teachers who participated in theoretical and practical up to date BLS training thirty days apart. A survey form including 19 questions was administered to determine pre-test and post-test theoretical knowledge about BLS. Skill level in BLS was assessed via BLS simulator model in terms of the following; correct hand positioning, correct head positioning, sufficient depth and frequency of chest compressions
Results: A significant difference was found between pre-test level of knowledge before BLS training and post-test after the second training session (p<0.05). The levels of competence for correct hand positioning (38.2% vs. 61.8%; p=0.001), correct head positioning (27.6% vs. 72.4%; p=0.006) and adequate compression frequency (35.0% vs. 65.0%; p=0.005) increased and excessive compression rate (40.0% vs. 60.0 %; p=0.005) rose when pre-test and post-test levels were compared.
Conclusion: Promoting teachers' up to date BLS knowledge and skills with continuous training is beneficial. Repeated BLS training showed that the ability of the participants to develop adequate compression frequency with correct hand and head position positioning was increased.

Introduction: Workplace violence in the emergency department (ED) is a common occurrence existing worldwide affecting staffs across all roles, compromising the safety, health, self-esteem, and job satisfaction of healthcare workers. Combating workplace violence in healthcare settings is a huge challenge as the true scope of the problem is not known due to insufficient documentation or underreporting. Thus, this study aims to explore and examine the magnitude and attitude of ED residents (ERs) towards workplace violence.
Methods: This single centre, questionnaire-based, anonymous, and self-administered cross-sectional survey involving 63 ERs. A Chi-square test examined the relationship between variables. Composite measures condensed the vast number of variables data into a single indicator.
Results: Workplace violence in ED reported by 93.6% of respondents. Verbal assault (88.9%) was the predominant form of violence. Unforeseen perpetrators include physicians (17.5%), non-ED staffs of hospital (17.5%) and other ED staffs (14.3%). Common site of violence occurrence was non-critical area (81%). There was no significant relationship between attitude and gender (p = 0.93) or race (p = 0.70) or designation (p = 0.45). Composite measure of attitude scores revealed 50.8% of respondents had positive attitude towards workplace violence in ED.
Conclusion: Violence among ERs is an undeniable existence. Co-worker as the perpetrator is not acceptable at all. A continuous effort from ERs, ED staffs and ED managers is required to mitigate the growing phenomenon of workplace violence in ED.

Aim: It is a worldwide problem that non-urgent (NU) patients use emergency department (ED) instead of primary care providers. The aim of this study was to determine the characteristics of NU patients and to compare the use of EDs and family physicians (FPs).
Materials and Methods: This cross-sectional study was conducted in the ED of a tertiary hospital. A questionnaire was administered to NU (level-5) patients (≥18 years old) defined using the 5-level triage system.
Results: Upper respiratory tract infections symptoms (19.6%) and gastrointestinal system problems (18.6%) were the most common complaints. Family physician (FP) contact was made prior to the ED visit by 13.3% of patients. Most of them (79.6%) stated that they were satisfied with their FP, 6.1% stated that they never went to the FP. For health problems, 39.5% reported that they preferred the FP and 29.3% preferred the ED. It was indicated that visiting rate of three times or more per year was 30.1% for ED and was 42.9% for FPs. The frequency of ED visits of those who were not satisfied with their FP compared to other participants was significantly higher (p=0.025). A significant relationship was found between the frequency of ED visits and the frequency of FP visits.
Conclusion: It was found that less than half of the patients preferred FPs when they had health problems. Those who visits the ED frequently also visits FPs frequently. Dissatisfaction with the FP is associated with the frequency of visit rate of the ED.

Objectives: The aim of the study was to assess the diagnostic accuracy of the serum amylase and lipase in acute pancreatitis and perform a cost analysis of those enzymes to find out if one alone was sufficient for more cost-effective diagnostic process.
Methods: This was a retrospective study conducted in a hospital with a 335000 annual number of emergency department visits. All the patients to whom both amylase and lipase test were performed in 2019 were analyzed. Patients who had an elevation of three or more times the normal range of either amylase (> 300 U/L) or lipase (>195 U/L) were included into the study. Sensitivity of those enzymes in diagnosing acute pancreatitis were calculated. Cost measurement of amylase and lipase was determined.
Results: Number of patients with both enzyme levels measured for any reason at ED were 53944 in a year. 130 patients who met the including criteria were analyzed. 108 of the patients had raised levels of both enzymes. At 22 of those patients amylase was lower than the three fold of the normal range but lipase was significantly high. There were no patient with raised amylase with normal lipase levels. Sensitivity of serum amylase and lipase were 84% and %100 respectively. When lipase measured only for all patients whose amylase and lipase were measured, potential saving calculated as 71745 TL (10298 USD) annually.
Conclusion: “Lipase only” measurement is recommended in terms of diagnostic accuracy and cost effectiveness in the differential diagnosis of acute pancreatitis.

Aim: In our study, by analyzing the first national emergency medicine e-congress organized during the pandemic process, it was investigated what differences it made to the emergency medicine field.
Materials and Methods: The study was arranged by taking data from www.acilakademi.net website, which was published under the title of "1st National Emergency Medicine E-Congress of ATUDER" between 11 and 13 June 2020.
Results: A total of 120 speakers and 545 listeners attended. 66.7% of the speakers were male, 45% verbally (oral presentation) presented, and 45.8% participated with the title of a attending physicians. 13.3% of the topics presented by the speakers were critical care. The clothes 69.2% of them wore were in the style of daily clothes. The average speaking time of the invited speakers is 18.71±4.91 (13.3-31.19) minutes. While the average number of people watching the invited speakers was 46.65±43.86 (16-252), the number of those who watched the presentations until the end was calculated as 14.73±8.43 people. It was observed that the male gender was in a significant majority with oral presentations, invited speakers, and moderators (p = 0.020).
Conclusion: Organizing online congresses is advantageous for the participants as an alternative to the traditional congress and it can be made more effective with some arrangements.

Aim: The aim of this study is to evaluate the impact of Turkey’s first European accredited 2-day POCUS course on the theoretical knowledge and practical skills of physicians.
Materials and methods: Forty physicians and five lecturers attended the course. All lectures were arranged in the guidance of the International Federation of Emergency Medicine (IFEM) POCUS Curriculum Guidelines. At the beginning and the end of the course, a theoretical exam with the same questions was performed. Practical skills were evaluated at the hands-on training stations by checklists. Pre-test and post-test results were statistically compared.
Results: All attendants were included in the study. The numbers of the correct answers for pre-test and post-test were: 1.23 ± 0.89 and 1.95 ± 0.64 for abdominal aorta ultrasound (USG), 3.23 ± 1.27 and 5.08 ± 1.07 for cardiac USG, 0.95 ± 0.68 and 1.78 ± 0.42 for ultrasound physics, 3.03 ± 1.42 and 4.48 ± 1.11 for expanded-focused assessment with sonography in trauma, 1.75 ± 0.74 and 2.35 ± 0.62 for hepatobiliary USG, 1.4 ± 0.71 and 1.85 ± 0.36 for vena cava inferior USG, 1.18 ± 0.55 and 1.48 ± 0.51 for renal USG and 1.88 ± 1.04 and 2.7 ± 0.82 for lung USG, respectively. All differences were statistically significant.
Conclusion: Our study shows that our 2-day basic POCUS course can effectively convey basic POCUS knowledge and skills.

Background: The CRP/Albumin ratio is a new inflammation-based prognostic score and it is correlated to the inflammation severity.
Objective: The present study investigated the diagnostic value of the CRP/Albumin ratio for acute appendicitis to evaluate simple or complicated.
Design and Setting: This study was performed in University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Department of Emergency Medicine, it was taken retrospectively with the approval of the ethics committee
Methods: Total of 188 acute appendicitis cases; biochemistry parameters, CRP/Albumin ratio, ultrasonography and computed tomography results, operation findings, length of hospital stay compared in simple and complicated setting.
Results: There was no statistically significant difference in terms of leukocyte count, albumin value and diameter of the appendicitis in both USG and CT. CRP/Albumin ratio most spesific to indicate complicated appendicitis group. The cut-off point for the CRP/Albumin ratio in the diagnosis of complicated appendicitis is 4.4.
Conclusion: CRP/Albumin ratio may be used as a valuable biomarker in clinical diagnostic process and treatment planning, especially to differentiate complicated or non-complicated setting in patients with acute appendicitis.

Aim: Aim is to determine factors related to mortality in septic shock patients who transferred from emergency department(ED) to intensive care unit (ICU).
Materials and Methods: We used data from 206 patients, who were admitted to the ED with infection and were diagnosed septic shock between December 2016 and January 2020
Results: Of 206 patients had a mean Glasgow Coma score of 11.42 (range 3-15), mean APACHE-2 (Acute Physiology and Chronic Health Evaluation) score of 21.66 (range 8-49), and mean Sequential Organ Failure Assessment Score (SOFA) of 10.24 (range 2-22). There were no differences in 30-day mortality, renal replacement therapy (RRT) need, or mechanical ventilation (MV) need between patients transferred to the ICU within one hour of ED admission and those transferred to the ICU more than six hours after ED admission (p > 0.05). Those with APACHE-2 score ≥ 20 or SOFA score ≥ 8 had longer MV duration and ICU and hospital stay, greater RRT and MV need, and higher mortality (p < 0.05).
Conclusion: Septic shock patients who have high disease severity scores have a poor prognosis. Length of time between ED admission and ICU admission did not affect patient outcome.

Background: In this study, we randomized the patients without known hepatitis-B, hepatitis C and HIV infection who presented to the emergency department (ED). We measured the serum levels of HBsAg, Anti-HCV and Anti-HIV antibodies besides biochemical tests regarding the diagnostic process of the main complaint resulting in presentation to the ED. In this way, we aimed to determine the prevalence of occult chronic viral diseases among patients presenting to the ED and the risk of ED employees was evaluated.
Materials and Methods: The study included 800 patients who had presented to the emergency department for any reason over two month and who had no history of infectious viral disease.
Results: 434 (54.2%) of the patients were male, 366 (45.8%) were female, and the mean age was 32.7 (± 16.9) years. The rate of presence of a person with an infectious viral disease at the patient’s home was 1%, 0.5% and 0.0% for HBV, HCV, and HIV, respectively. The overall history of HBV vaccination was 15.5% in our study sample. HBsAg, anti-HCV and HIV-positivity were 2%, 0.8% and 0.0%, respectively.
Conclusion: The prevalence of HBV- and HCV-positivity in patients admitted to the emergency department who did not have any known chronic viral disease was consistent with the general population prevalence. No significant change in the prevalence of HCV compared to previous years can be explained by the absence of a protective vaccine. The absence of HIV-positivity can be explained by the low rate of HIV-positivity in our country.

Aim: This study aimed to compare the serum phospholipase A2, neutrophillymphocyte ratio (NLR), red cell distribution width (RDW), and mean platelet volume (MPV) levels of patients that presented to our emergency department due to scorpion stings and to determine a laboratory parameter that could assist in clinical grading.
Materials and Methods: Sixty-three patients presenting to the emergency department due to scorpion stings and 33 volunteers presenting for other reasons between May and October 2018 were included in the study. The serum phospholipase A2, NRL, RDW and MPV levels of the patients were determined and compared with the control group.
Results: In the evaluation performed in the patient group, the mean serum leukocyte and serum lymphocytes were higher and the RDW mean was statistically significantly lower compared to the control group, (p = 0.001, 0.003, and 0.004, respectively). There was no significant difference between the patient and control groups in terms of the serum MPV, platelet and serum phospholipase levels (p > 0.05). When the patients’ serum MPV values were compared according to their clinical grade, a statistically significant correlation was found (rho − 0.432, p < 0.001).
Conclusion: In scorpion stings, as the clinical grade progresses, the MPV rate decreases. Therefore, the MPV level can be used as an auxiliary parameter to show the severity of scorpion stings.

Technology has brought many innovations to the way healthcare providers acquire information, work and communicate. Emergency departments are the primary areas where these innovations are most common. One of the important innovations that technological developments offer to emergency departments is that imaging methods and diagnostic tests can be applied at the bedside. The main purpose of bedside imaging methods and diagnostic tests is to achieve rapid results and initiate appropriate treatment in a short time. The developing technology provides fast access to diagnostic tests and rapid results, as well as facilitating access to specialist physicians. Patients' data can be transmitted to advanced centers by telemedicine application, and consultation service can be obtained. Bedside consultation is also possible thanks to the telemedicine application supported by robotic technology. Biosensors, mobile applications, technological products used in the patient registration and follow-up process, and voice response systems used in patient monitoring after discharge can be listed among other technological innovations used in emergency departments. All these listed tools and systems provide many facilities for emergency service delivery. However, reasons such as being expensive, not supervised by medical professionals, or being time-consuming limit their use. While technological developments continue without slowing down, in order to ensure the same development in emergency departments, scientific studies with a high value of evidence are needed in this field.

Aim: We aimed to investigate the role of the quick sequential organ failure assessment (qSOFA) score in determining the prognosis of patients with acute pulmonary embolism (PE).

Materials and Methods: Patients older than 18 years old who were admitted to the emergency department with complaints of shortness of breath and/or chest pain for 3 years and who were found to have acute PE on computed tomography pulmonary angiography were included in the study. The values of qSOFA, pulmonary embolism severity index (PESI), simplified PESI were calculated in patients with acute PE. During the follow-up, in-hospital mortality and the requirement of intensive care continuation was determined.

Results: 166 acute PE patients, 88 (53%) women, were included in the study. The mean age of the patients was 67.4±17.3. 26 patients (15.7%) were admitted to the intensive care unit (ICU). Mortality rate was 9% (n=15). The predictive value of qSOFA in determining in-hospital mortality (AUC: 0.907, 95% CI: 0.852-0.946) was similar to PESI (AUC: 0.846, %95 CI: 0.782-0.897) and sPESI (AUC: 0.796, 95% CI: 0.726-0.854) (p=0.23 and p=0.16 respectively). While it was superior to PESI (AUC: 0.794, 95% CI: 0.724-0.852) and sPESI (AUC: 0.721, 95% CI: 0.646-0.787) in determining the inclusion of patients in ICU (AUC: 0.882, 95% CI: 0.823-0.927) (p=0.04 and p=0.01 respectively). There was a positive correlation between qSOFA and PESI (r=0.49, p=0.001) and sPESI (r=036, p=0.001).

Conclusions: As a result of this study, we found that the qSOFA score performed well in determining in-hospital mortality and ICU admission in acute PE patients admitted to the emergency department.

Aims: In this study, we evaluated the predictability of lung parenchymal involvement on computed tomography (CT) with laboratory parameters in patients with confirmed coronavirus disease 2019 (COVID-19) with and without lung parenchymal involvement at the first admission to the emergency department.

Methods: 109 patients diagnosed with COVID-19 in the emergency COVID department between April and September 2020 were included in the study. Laboratory parameters and thorax CT images were evaluated to evaluate the severity of the disease in all patients. The relationship between laboratory parameters was analysed in the patient groups with and without CT involvement.

Results: CT involvement was detected in 58 of 109 patients included in the study. There was a significant difference in lymphocyte, monocyte, eosinophil, ferritin, fibrinogen, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), platelet (PLT) and urea values in the group with CT involvement. ROC (Reciever Operator Characteristics) analysis was performed to evaluate the diagnostic performance of laboratory parameters in CT involvement. Significant diagnostic predictability values were determined for age, lymphocyte, monocyte, eosinophil, ferritin, fibrinogen, CRP, ESR, PLT and urea. The highest AUC (Area Under the Curve) values were obtained in CRP, ESR and eosinophil parameters.

Discussion: Lymphocyte, monocyte, eosinophil, ferritin, fibrinogen, CRP, ESR, PLT and urea parameters can be used to predict lung involvement in the emergency department in patients with COVID-19 disease. According to these values, thorax CT can be decided for the patients. CRP, ESR and eosinophil parameters provided the highest specificity and sensitivity values in predicting lung involvement.

Austrian syndrome is named in honor of the eminent doctor Robert Austrian, an American doctor specializing in infectious diseases, who described this pathology in 1957 [1]. Austrian syndrome is a clinical entity caused by disseminated Streptococcus pneumoniae infection and is usually characterized by the triad of pneumonia, endocarditis and meningitis. Before the discovery of penicillin, Streptococcus pneumoniae was one of the most common causes of endocarditis, but today it represents less than 1% [2]. Currently it is estimated that there are 0.9-7.8 cases per 10 million people each year who have Austrian Syndrome, with a mortality rate of around 32% [3]. Alcohol abuse is the main risk factor but it appears in only 40% of the patients. Additionally, only 14% of patients do not have any risk factor. The majority of the patients are males and it generally appears in people who are middle aged. It more frequently affects the native valve and in 50% of cases, the aortic valve is injured. [3,4]. Proper antimicrobial treatment and early surgery of endocarditis, both decrease the risk of mortality. We present a case of a patient without predisposing factors who presented this clinical entity with a satisfactory outcome.

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The Background: In this study, the short-term prognoses of patients who applied to the emergency department for any reason and were found to have hyperkalemia were investigated.
Methods: This retrospective cohort study was carried out in a tertiary care university hospital emergency department by using the data provided by a hospital information management system (HIMS) in a year period. The 1-week and 28-day survivals of the patients who applied to the emergency department for any reason and were found to have hyperpotassemia (K> 5.11 mg/dl) were evaluated. The relationship between potassium values at the first admission of patients with hyperkalemia and hospitalization or intensive care admissions, age, gender, hemodialysis needs, chronic kidney disease(CKD) and acute kidney injury(AKI), and survival were investigated.
Results: Hyperpotassemia results of 1934 patients were included in the final analysis. It was found that 130 (6.7%) of the patients died within seven days, and 245 (12.7%) died within 28 days. In the study, 7 and 28-day mortality of patients who developed AKI, needed hemodialysis, who were hospitalized or located in intensive care unit were found to be significantly higher (p <0.001 for each). It was found that AKI for patients, hyperpotassemia was associated with hospitalization, death and hemodialysis.
Conclusion: Patients with hyperkalemia accompanying AKI carry a risk in terms of mortality and other adverse prognoses. This risk has been found to be weaker in CKD. Hyperkalemia creates a serious risk even in hyperpotassemia close to normal value.

Introduction: The diagnosis and initial therapy of supraventricular tachycardia is always made in emergency departments. Vagal maneuvers are recommended as the first-line treatment for termination of SVT. Our aim was to compare the efficacy of standard and modified valsalva maneuvers in the treatment of patients with SVT.
Materials and Methods: This study was conducted between 16/03/2016 and 16/09/2016 at the Health Sciences University Ankara Training and Research Hospital Emergency Medicine Clinic. Our study was a randomized, prospective, case-control study. During the study, standard valsalva maneuver (SVM) and modified valsalva maneuver (MVM) were applied to two groups randomly allocated to patients with SVT. The maneuvering technique was determined by envelope pulling method.
Results: This study was enrolled by 47 patients that includes 23 patients who was treated by using SVM and 24 patients who was treated by using MVM. Four (%17,4) people from the patients that undergo SVM returned to sinus rhythm, nine (%37,5) people from the patients that undergo MVM returned to sinus rhythm. ( p > 0.05) Although the results from the MVM treated patients were more satisfying, no statistical significiant difference was detected.
Conclusion: In this study, we found that MVM is numerically superior in terms of success compared to SVM, but we could not prove this statistically. Therefore, we concluded that there was no difference between the two maneuvers in terms of success. In studies with more cases, we conclude that the result will be statistically significant.
Key Words: Supraventricular tachycardia, Vagal maneuvers, Modified valsalva maneuver

Objectives:
To know if Emergency physicians (EPs) screen mental health (MH) disorders in patients. This study aims at finding out the current knowledge, attitude and practices (KAP) of EPs and their departmental policies in management of patients with MH disorders.
Material and methods:
A personal interview based on a questionnaire was conducted with 117 EPs working in 38 multi-specialty hospitals (with minimum 50 total bed strength) across Hyderabad city, India during June 2015 to August 2015. The respondents had atleast one year of experience in core emergency medicine.
Results:
85% of EPs understand MH disorders are a major healthcare burden and over 90% of them have seen mentally ill patients in Emergency Department(ED). Yet 85% rarely evaluate MH of patients. Over 2/3rd don’t know any criteria of diagnosing depression and only 14% have recieved some training in managing MH issues of patients. 84% physicians said that their departments do not have a MH policy and 82% believe this is a major reason that evaluation of MH is ignored. 44% EPs say their attitude towards these patients is influenced by their personal experiences.
Conclusions:
MH evaluation of patients is neglected in EDs. Overall management of mentally ill patients is inconsistent. Absence of a departmental MH policy and lack of training in EPs are major causes.

Background
Acute urinary retention (AUR) is a fairly common presentation in the elderly but interesting to be noted in a healthy young individual as a manifestation of acute appendicitis.
Case
We presented a case of 32 year old male with decreased urine output with mild tenderness at the supra-pubic region later on shifted to right iliac fossa. Computed tomography of abdomen showed acute appendicitis.
Conclusion
Emergency physicians are challenged to recognize the uncommon presentation of acute appendicitis and need to be reminded of this common complaint as a rare presentation of it. This case also stressed on the repeated abdominal examinations to seek diagnostic clarity.

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Aim: This study aims to determine the anxiety levels of emergency health workers during the COVID-19 pandemic.
Materials and Methods: This is a descriptive and cross-sectional study. It was conducted using face-to-face interviews with 153 healthcare professionals in emergency service clinics and who intervened patients with suspected COVID-19. The study data were obtained using a descriptive characteristics questionnaire and the State-Trait Anxiety Inventory (STAI).
Results: The emergency health workers’ mean state anxiety score was 42.76±10.06, the mean Trait Anxiety score was 42.11±8.22 and the total scale mean score was 84.88±15.11. No statistically significant relationships were found between STAI scores and the participants’ descriptive characteristics (workplace, gender, marital status, age, profession, years in the profession and satisfaction with work conditions).
Conclusions: The results of the study revealed that emergency healthcare workers experienced anxiety at the panic level.
Keyword: Anxiety, Emergency, Covid-19

Objectives: There is a necessity to identify the specific therapeutic drugs most frequently responsible for the acute medicinal poisoning to take up appropriate preventive efforts and management.
Methods: This study includes all cases of medicinal poisoning exposures (7282 cases) presented to the emergency department of the national poisoning center, Cairo University, during the period January 2016 to December 2016. The data were statistically analyzed to assess a correlation for a gender, age, and most frequently agents.
Results: Therapeutic drugs (68%) were the most common cause of poisoning. It was found that 53 % of medicinal poisoning patients were adults. Accidental drug agents poisoning in children younger than 4 years represented 20 % of the medicinal poisoning cases. The medicinal poisoning distributed as females (74%) and males (26%). Detailed information on categories of pharmaceutical causing medicinal poisonings was presented. Paracetamol (9.6%), nonsteroid anti-inflammatory drugs (9.6%) and sedatives/ hypnotics (10.7%) were the most common pharmaceutical poisons.
Conclusion: Female gender and young age patients are most risk poisoning factors. The majority of poisonings is intentional poisoning in female adults. An important concern should be raised toward availability of prescription medications within the reach of children.

Objective: In this study, we aimed to investigate the diagnostic accuracy of Cincinnati Prehospital Stroke Scale (CPSS), Los Angeles Prehospital Stroke Screen (LAPSS) and Melbourne Ambulance Stroke Scale (MASS) in detecting acute ischemic stroke (AIS) in suspected patients, and to compare these scales with each other.
Methods: This was a diagnostic accuracy study that included patients with suspected AIS brought to emergency department (ED). Patients’ data were collected from their medical records. Collected data from all tests were compared with the final diagnosis of AIS based on the brain MRI report. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were measured separately using statistical tests with confidence interval (CI) of 95%.
Results: Finally, 766 patients were included, of whom 57.6% were males. The mean age for the study population was 66.8 ± 13.7 years. All patients underwent brain MRI and the results showed that 537 patients (70.1%) had actual diagnosis of AIS. The accuracy of CPSS, MASS, LAPSS were 82.9%, 79.2% and 78.1%, respectively. However, in the present study, the differences between the sensitivity and specificity of these three scales were statistically significant (p < 0.001).
Conclusion: Our study showed that the number of true positive cases diagnosed by CPSS was higher than those of MASS, and MASS true positives were higher than those diagnosed by LAPSS criteria. The number of true negative cases of LAPSS was higher than MASS criteria, and MASS true negatives were higher than CPSS criteria.

Aim: Previous studies revealed that Low dose ketamine promptly and satisfactorily resolved pain. The aim of this study was to compare the analgesic effects of morphine with placebo to a combination of morphine with ketamine for patients with multiple trauma in the emergency department (ED).
Methods: This randomized, controlled, double-blinded clinical trial was conducted in the ED of two university educational hospitals. Patients between 16 to 50 years with a severe acute pain defined as a visual analog scale (VAS) score of at least 70 (between 0 and 100) were enrolled. Patients were randomly assigned to receive intravenous morphine (0.1 mg/kg) with placebo or morphine (0.05 mg/kg) with low dose ketamine (0.3 mg/kg) for pain control. The pain intensity was asked before and 10, 20, 30, and 60 minutes, after the intervention, and probable side effects were recorded. Efficient analgesia was defined as a VAS score not exceeding 30. The primary outcome was VAS at 30 minutes.
Results: Seventy patients were enrolled in the study. The pain intensity decreased significantly in both groups after 30 minutes of the intervention. There was no significant difference between the mean VAS of the two groups before and after intervention. Morphine consumption was significantly lower in the ketamine group versus the morphine group (p=0.01). There was no significant difference between the two groups in terms of complications (p>0.05).
Conclusion: Low-dose ketamine in combination with morphine significantly reduced the need for an additional dose of morphine without increasing complications to morphine alone.

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Aim: Formation of our regional data with the results obtained through determination of clinical and demographical characteristics of the patients who revisited the pediatric emergency department of a university hospital within five days is aimed.
Materials and Methods: Patients who were revisit to the pediatric emergency department within first five days were included in the study. Patients’ age, gender, admission complaints, admission seasons, admission timeframe, whether they admitted within or out of working hours were recorded.
Results: 654 (1.32%) patient revisited emergency department. When distribution of the patients by age groups was examined, it was observed that 415 were under 5 years old When distribution of revisits by working hours was examined, it was determined that 302 patients admitted out of working hours and during holidays, 291 patients were admitted most commonly at evening time.
Conclusion: When clinicians inform the parents in details during first visit about their child’s disease, course of the disease and when to revisit a hospital after discharge may be an effective way not only for prevention of redundant return visits, but also for prevention anxiety of the parents, as well as for reduction of medical errors and negative patient outcomes.

Aim: We aimed to determine factors influencing the hospitalisation durations and discharge status of snakebite patients, starting from prehospital care in the field.
Materials and Methods: Thirty-eight consecutive snakebite patients who were admitted to the Emergency Medicine Department between 1 May 2013 and 31 August 2016 were enrolled in the study. The data were evaluated using SPSS 17.0.
Results: Thirty-eight patients were enrolled, of which, 17 (44.7%) were females. Of the 38 patients enrolled, nine patients were in stage 1, 24 were in stage 2 and 5 were in stage 3. The mean antivenoms given to the patients were 3.33 ± 1.29 vials in stage 2 and 4.40 ± 1.14 vials in stage 3. The mean time from bite to antivenom infusion was 80.92 ± 47.57 minutes. The hospitalisation durations of the patients who had shorter bite-to-antivenom infusion intervals (bite-to-needle) were also shorter (p<0.001). In addition, overweight patients were found to stay longer in the hospital (p=0.027). Patients with low haemoglobin and platelet counts and high creatine kinase (CK) levels were found to stay longer in the hospital (p<0.05).
Conclusion: The shorter hospitalisation durations of the patients with shorter bite-to-needle times show the importance of early administration of antivenom. The longer hospitalisation durations of the overweight patients seem to reflect their slow wound-healing times, which may be due to co-morbidities. Low platelets, low haemoglobin(Hb) and high Creatinine Kinase (CK) are found to be poor prognostic markers in snakebite patients.

Aim: Our aim was to measure optic nerve sheath diameter (ONSDM) by ultrasonography and to detect whether optic nerve sheath diameter reflects intracranial pressure in hypertensive patients.
Materials and Methods: This observational study was performed prospectively on 149 individuals, of whom 77 (51.7%) were female, including 54 hypertensive-symptomatic patients, 45 hypertensive-asymptomatic patients, and 50 healthy volunteers referred to Emergency Medicine Service of Necmettin Erbakan University, Meram Faculty of Medicine. Blood pressure was measured on the right and left upper extremity by the same sphygmomanometer following at least five minutes of rest. ONSDM was recorded. All measurements of hypertensive-symptomatic patients were repeated at 30th minute following antihypertensive therapy.
Results: Moderate-to-well statistically significant correlations were determined between initial mean systolic blood pressure and ONSDM (rho=0.629, p=0.001) as well as between initial mean diastolic blood pressure and ONSDM (rho=0.561, p=0.001) in all study groups. Statistically significant differences were determined between the mean pre and post-treatment systolic and diastolic blood pressures as well as the mean pre and post-treatment ONSDM values of 40 patients who received antihypertensive therapy (p=0.000, p=0.000, p=0.000, respectively).
Conclusion: ONSDM by ultrasonography reflected increased intracranial pressure in hypertensive patients. The reduction of intracranial pressure was also detected by the same method following antihypertensive treatment. Ultrasonographic ONSDM along with clinical findings and blood pressure measurements may be used for evaluation of response to treatment and deciding on further imaging.

Introduction: Recently a growing number of studies has been reported an association between the incidence of seizures and using or abusing of tramadol.the aim of this study was to review the articles over the patients with tramadol induced seizure which reported their characteristics and consumed tramadol dosage
Methods: The following databases were searched from inception until 30October 2018: PubMed,EMBASE,the Cochrane Library,Scopus, Ovid,Proquest,and Science direct.All cross-sectional studies which were reported the tramadol dosage and individual characteristics in patients with tramadol induced seizure were included.The studies were assessed for any risk of bias using the adapted Newcastle-Ottawa Scale.The pooled estimates were reported using random-effects meta-analysis
Results: Our research resulted in an overall number of 3,275 articles and finally we pooled the data from 11studies involving 970patients. The included studies were all conducted in developing countries.the pooled data resulted in an estimated mean(±standard deviation)of 1,454.5±333.6mg for tramadol dosage inducing seizure in the patients.The average minimum dose of tramadol causing seizure showed an average of 169.5 ± 131.2mg from the pooled data. the mean age of them was estimated as 25.85 ± 0.86 years.Also,83.37±12.6 percent of the patients were male and the manner of poisoning in70.51±29.07 percent of the patients was suicide or abuse.
Conclusion: Our findings demonstrated that the prevalence of seizure following the consumption of tramadol was higher in male sex. Therefore,the probability of seizure should be considered by physicians in prescribing tramadol and the individuals receiving it,especially the ones in a higher risk of exposure,should be properly get informed about its complications.

Aim: Cardiopulmonary resuscitation(CPR) is the main skill that all health care professionals are advised. Dentists, as a health professional, should be able to recognize cardiac arrest and perform effective CPR. Aim of the study to evaluate the knowledge and experiences of general dentists in Turkey related CPR.

Materials and methods: A cross-sectional study was conducted among 152 general dentists working in Turkey. Data were obtained through an electronic survey including knowledge and attitude of dentists on CPR based on the 2015 American Heart Association guidelines update. Data were evaluated using statistical package for social sciences (SPSS version 22).

Results: Totally 152 general dentists took part in the present study giving a response rate of 76 %. While 44% of the dentists answered more than half of the questions, there were no dentists who answered all the questions correctly. While 1.3% of dentists stated that they encountered cardiac arrest, 34.2% stated that they could evaluate the cardiac arrest case. While 73.7% of dentists previously had received cardiopulmonary resuscitation training, only 6.6% of them considered themselves adequate for CPR administration. The number of people aware of the 2015 CPR guide is 11.8 %. While 88.2 % of dentists stated that they should know CPR as a dentist, 90.8% want to get CPR training.

Conclusion: This study showed that the majority of general dentists in Turkey had insufficient knowledge of CPR. So, training of CPR should be regularly provided to general dentists in the country.

Aim: To determine the prevalence of abnormal coagulation studies in emergency department (ED) patients, and to investigate if a relationship exists between patients’ chief complaints, past medical history or drug history; and abnormal coagulation studies results.

Materials and Methods: In this retrospective chart review study, ED records were obtained for patients who had undergone coagulation studies. ED records were reviewed for certain data including demographics, chief complaint, past medical history, drug history, and clinical impression. Descriptive and statistical analyses were performed.

Results: A total of 322 charts were reviewed. 13 patients (4.04%) had an abnormal International normalized ratio (INR); of which 6 patients (46.2%) were on Warfarin therapy. Although chest pain was the most prevalent chief complaint (10.4%), no statistically significant relationship was found between chief complaints and INR level. Patients with past medical history indicative of thromboembolic risk had an 8.8 likelihood ratio to have an abnormal INR. Warfarin intake has a statistically significant likelihood of abnormal INR (32.8 LR). Coagulation profile was repeated in 4.35% of patients with a request gap mean of 6 days.

Conclusions: Chief complaints presenting to ED are not good predictors for INR abnormalities. However, warfarin therapy and past medical history of thromboembolic events have a strong association with abnormal INR levels. Routine coagulation studies are not indicated in all patients presenting to ED.

Keyword: Coagulation, emergency department, utilization

Aim: This study aimed to determine the quality perceptions and factors affecting emergency medicine specialty training with a questionnaire applied to Emergency Department (ED) residents.
Materials and methods: This study was conducted at the ED between February 2019-June 2019. ED residents working at state universities, foundation universities, and educational research hospitals were included in the study. The first 3 survey questions aim to reveal the characteristics of the participants. Other questions are focused on the application and practice of residency.
Results: 336 residents were included in this study. 85.1% of residents were worked at public universities. 250 (74.4%) of the participants declared that they had between 4-6 instructors. 96.3% stated that training meetings were held every week, 32.2% stated that education was adequate and 85.9% did not apply a resident exam in their clinics. While the difference between the patient care rate (p = 0.006) and the education rate (p <0.001) in the department and the institution received training, there was no significant difference between the research rate in the department and the institution received training (p = 0,238). When the numerical adequacy of the educational staff is evaluated by the educational evaluation, the quality perception of the educational staff and the quality perception of the education received in the institution affect each other (p<0.001).
Conclusion: It was concluded that a standard residency program was needed and that the capacity, infrastructure characteristics, and training staff of the training institutions should be reviewed and properly regulated.

Introduction: Traumatic rib fractures are a common injury in the trauma population and may cause severe pain in cases of both isolated rib fractures and chest injuries. The aim of our study was to compare the early pain control of intercostal block with that of intravenous analgesia + intercostal block in patients with rib fractures admitted to the emergency department due to blunt thoracic trauma.

Method: Patients admitted to the emergency department due to blunt thoracic trauma in a tertiary medical facility were retrospectively evaluated. 48 patients were included in the study. The patients were divided into 2 groups as performed only intercostal block and intravenous analgesia+intercostal block.

Results: 9 patients (18.7%) were performed only blockage, while 39 patients (81.3%) were performed intravenous analgesia+intercostal block. Considering the early pain results of group A(intercostal block) and group B(intravenous analgesia+intercostal block), a significant improvement was observed in group B in terms of pain results after the first 15 minutes.

Conclusion: We concluded that the combination of intravenous NSAIDs or opioid derivatives and intercostal nerve blockage would be an effective combination in pain control in patients with rib fractures. In addition, we think that intercostal nerve block will be beneficial in pain control and increase respiratory efficiency in patients with rib fractures, since it is both easy to apply and accelerates healing by providing effective analgesia. Due to these positive effects, we think that it reduces the duration of hospital stay and will be very beneficial in terms of efficiency and cost.

Purpose: The aim of this study was to evaluate the diagnosis performance of non-contrast rapid sequences MRI (RAMRI) visualization on cases who have been clinically diagnosed as acute abdominal pain (AAP).
Material and methods: 46 were chosen from 2850 patients who have applied to emergency service between January 2016-January 2019 because of sudden onset of abdominal pain and could not get a CT analysis. 1.5 Tesla MR device (GE Signa Hi-Speed, Milwaukee) was used for analysis. Coronal and axial T2-weighted SS FSE series were used as scan protocol. No intravenous, oral or rectal contrast material were used. The cases identified as positively (+) and negatively (-) by MRI. The cases who have symptoms, related with AAP, considered as positive (+), normal or symptoms which are not related with AAP, considered as negative (-).
Results: 26 of the cases were female (56.5 %), 20 of them were male (43.5 %) and the median age was calculated as 38.65 (18-86). The treatment methodology was surgery for 25 cases (54 %) and conservative for 21 (46 %) cases. The operative group (surgically treated) includes 24 MR (+) and 1 MR (-) cases. There is a harmony between the clinic and MRI data of all members of non-surgical group. The accuracy of the study was calculated as 95.6 % (44/46). The sensitivity and specify of RAMRI was detected 96 % for operative group and 100 % for non-operative group
Conclusion: A successful diagnostic performance has been applied to the AAP cases by non-contrast RAMRI.

Background: Ketamine administration in higher dosage causes some adverse reactions. This study was aimed to evaluate the effect of low-dose intravenous ketamine bolus versus conventional injection for reduction of upper and lower extremity fractures in children.
Materials and Methods: In this study 198 patients with extremity fractures were enrolled. The patients were randomly assigned to two groups. In the intervention group, ketamine 1% was administered at a dose of 0.5 mg / kg (within 5 seconds), and in the control group, ketamine 1.5 mg / kg was injected for 30 to 60 seconds. Then outcomes were measured and satisfaction of patients and physicians were recorded.
Results: Results showed that the successful sedation rate in the low dose ketamine group was significantly lower, as compared to the control group (7% vs 100%) (p<0.001). Moreover, In terms of duration of drug effect and of recovery, the low dose ketamine group were significantly lower compared with the group receiving higher dosage of ketamine (p<0.05). We also found that the rate of neurological (20.4 % vs 5%) and physiological (10.2% vs. 2%) side effects in the control group was significantly higher. (p<0.05).
Conclusion: The findings of this study did not show any beneficial effects of low-dose intravenous ketamine bolus, in sedating pediatric patients, suggesting that it should not be considered as a treatment in accompany with standard therapy for control of pain in a short period of time.

Bilateral hip dislocations are rare traumatic injuries considered as an orthopedic emergency. Most of the reported cases were caused by high-energy traffic accidents, a majority of which were along with femoral and acetabular fractures. The case in the present study was a 25-year-old male who had severe pelvic tilt and lumbar lordosis due to the unusual mechanism of falling a heavy object from a high distance on his back. The vital signs were stable and the patient had no underlying disease. On examination, he had lower limb paresthesia, and the pelvic x-rays clearly showed that the patient had right femoral head posterior dislocation with acetabular fracture and left femoral head obturator dislocation. Right after cardiopulmonary monitoring and checking the stability of vital signs as well as applying appropriate analgesia, a reduction was made, following which the patient’s lower limb paresthesia gradually reduced. The patient was transferred to the orthopedic ward and the surgical treatment of the right acetabular fracture was performed. He was then discharged from the hospital with a good and stable general condition.

Aim: To examine the demographic and epidemiological characteristics of children who were exposed to physical violence

Materials and methods:
The data of patients younger than 18 years old who admitted to the Emergency Medicine Clinic of a tertiary university hospital due to exposure to physical violence were retrospectively reviewed.

Results:

120 cases met the study criteria. The median age of the patients was 15 (4-18) years and 70.8% of them were male. The F / M ratio was 35/85. Emergency admissions due to physical exposure were made most frequently in July (n = 16 13.3%), and 57.5% of the presentations were made between 16: 00 and 23: 59. The most common injury site was the head (n = 39, 32.5%) followed by the extremities (n = 21, 17.5%). According to ISS levels, 87.5% of patients had minor injuries.

Conclusion:
Most of the pediatric forensic cases were male adolescents. Education a safe environment should be provided by taking protective measures to reduce the incidence of these cases, and awareness activities in which parents and children can participate effectively should be supported and expanded by social institutions.

Abstract | Full Text PDF

Introduction: Inflammation and some infectious agents play a key role in acute coronary syndrome (ACS) caused by atherosclerosis. The purpose of this study was to assess the effects of inflammatory markers and the positivity of CP, HP, and CMV on the level of atherosclerosis in patients with ACS.
Methods: Fifty-seven patients referring to the emergency unit with classic angina symptoms or angina equivalent symptoms and were determined to have critical lesions in coronary angiography (>%70 stenosis, CAD severity assessed by the Gensini score) were compared with 27 ACS patients who had no critical lesions in terms of PCT, TNF-a, IL-2r, IL-6, and IL-10 levels and positivity of CP, NP, and CMV. Also, the two groups of ACS patients were compared in terms of cytokine levels measured at hours 0 and 48.
Results: No significant association was found between the degree of the coronary lesion and the inflammatory and infectious agents. However, in patients with critical coronary lesions, as markers of inflammatory agents, the levels of IL-6 were significantly lower and levels of IL-10 were significantly higher (p<0.001 and p=0.030, respectively) at hour 48 than their levels at hour 0.
Conclusion: There is no association between the severity of coronary lesions and cytokine levels and positivity of infectious agents in ACS since the levels of proinflammatory cytokines in ACS are higher than those in atherosclerosis. The changes in cytokine levels at hour 48 were found to be significant.

Aim
Urinary stone disease is a common cause of comorbidity in the population. It causes an increased sympathetic tone due to pain during renal colic attacks. It is thought that increased sympathetic tone may also trigger vasospasm in coronary arteries and make ischemic changes more pronounced.
However, there is no study in the literature that evaluating electrocardiogram parameters in patients with renal colic pain.
In this study, the electrocardiogram parameters such as QTc interval, QTc dispersion, Tp-e interval and Tp-e / QTc that are recorded when the patients are pain-free and during an episode of renal colic attack have been compared.
Materials and Methods
Patients who were clinically suspected of having renal colic and whose diagnosis was confirmed by abdominal computed tomography were included in this prospective observational study.
On electrocardiograms in the episode of renal colic attack and when they are painless; QTc interval, QTc dispersion, Tp-e interval and Tp-e / QTc parameters were compared.
Results
Mean age of the 101 patients included in this study was 44.19 ±14.13 and 48.5% of them were female.
Maximum QTc interval, and QTc dispersion parameters were significantly higher during renal colic attacks than pain-free periods. QTc interval was higher for females compared to males.
Conclusion
We found that renal colic pain is associated with increased QTc max and QTc dispersion. QTc interval was higher for females compared to males. These findings suggest that patients with renal colic pain may be under risk for ventricular arrhythmias especially in females.

Purpose of Study: The Computerized Brain Tomography is extremely used in the diagnosis of the neurological diseases. The aim of the study was to evaluate the competency of emergency medicine physicians’ in the evaluations and diagnosis of “Computerized Brain Tomography” (CBT) of the neurological disease findings in non-traumatic cases
Patients and Methods: This study was made in the Emergency Department of a tertiary training hospital between 2015 and 2016. The CT images, taken for the patients were evaluated by the emergency medicine physician. The tomography interpretations, provided by the radiology physicians, were considered as the gold standardas the accurate finding, and findings of the emergency medicine physician were compared with the accurate findings.

Findings: Totally 197 patients inclueded. It was found that the sensitivity and specificity were as 96% and 88% in the grey white or separation, sensitivity was 91% and specificity was 76% in the ventricle constriction, average sensitivity and specificity were 99% and 86% in the SAK, EDH and SDH, and 99% and 97% in the cerebral infarct, and 97% and 91% in the cerebellar infarct, respectively.
Conclusion: In our study, emergency medicine physicians were highly successful in the interpretation of the CBT of patients with non-traumatic neurological incidents and it was in an excellent harmony with the radiologists’ interpretations. The success rates of interpretation of CBT may be increased with practical and theoretical comprehensive training of the emergency medicine physicians.

Aim: The aim of this study is to evaluate factors related mortality in occupational injuries admitted to emergency department.
Methods: Patients admitted to emergency department because of occupational injuries between January 2015 and December 2019 were retrospectively analyzed. The first admission to the emergency department following each occupational injuries was recorded.
Results: 3240 patients included the study. We observed that occupational injuries decreased with age and were more common in males (91.4%), in agriculture (27.6%) and construction (24.9%) industries, and in summer (29.9%) and autumn (28%). In addition, occupational injuries generally occurred due to falling (31.8%) and caused superficial injuries (39.8%). A majority of patients (83.6%) were discharged from the emergency department. 351 and 156 patients were hospitalized in the surgical clinics and intensive care unit respectively. A total of 25 and 18 patients died in emergency department and intensive care unit, respectively (total 43 deaths, 1.32%). Moreover, increasing age (p: 0.000), construction industry (p: 0.008), immigration (p: 0.037) and working in night shifts (p: 0.009) are independent risk factors related to mortality after occupational injuries.
Conclusion: The labor conditions of immigrants as well as of those working at night shifts and in the construction industry should be supervised. Their job security should be increased and working without social security should not be allowed.

Aim: Study was planned to determine and compare the knowledge level of senior year students studying in the paramedic programs at XXX universities, about frequently used drugs and interventional procedures.
Material and Methods: This descriptive study was conducted with 167 students in XXX of three universities with XXX in ….. between March 30, 2019 and December 30, 2019. Descriptive findings were presented as percentage, mean, standard deviation, and median.
Results: The 52.1% of the participants were female and rest 47.9% were male. The most common issues about which the paramedic students felt incompetent were drug doses (58.6%) and interventional procedure complications (60.4%). The mean total score of paramedic students on their knowledge level of drugs and administration methods is 54.724. The total mean total score of paramedic students on their knowledge level of interventional procedures is 65.653. There was no difference in the knowledge level on drugs and administration methods in terms of different universities (P = 0.470). However, a significant difference was found in the knowledge level on interventional procedures between the students studying at different universities (P = 0.002). Advanced analysis revealed that the difference was due to XXX students (P < 0.806) (P < 0.004 for XXX and XXX).
Conclusions: It was determined that the low knowledge level of paramedic students on drug usage and interventional procedures. Training of paramedics who will work in pre-hospital emergency health service it is thought that should be provided standardization considering deficiencies and including updates.

Aim: Our aim in this study is to evaluate the "Drug poisonings & Emergency service" studies published in Pubmed between 01.01.2019 and 01.01.2020.

Methods: The literature review was carried out using the terms “drug poisoning & emergency medicine” in PubMed (http: // www.ncbi.nlm.nih.gov/sites/ entrez) between 01.01.2019 and 01.01.2020. All summaries defined in the searches were reviewed and suitable studies were selected.

Results: Between 01.01.2019 and 01.01.2020, 85 studies were identified in Pubmed. 28.24 % (24) of these studies are retrospective, prospective, cohort studies, meta-analyzes, 56.47 % (48) original studies, of which 20.83 % narcotic poisoning (opioid, synthetic cannabinoids, cannabis, heroin), 8.33 % (4) cases of overdose paracetamol poisoning, 8.33 % allergic reactions due to drug use, 6.25 % (3) cases of acute alcohol poisoning, 56.25 % of other original studies. Studies to treat complications from intoxication are 15.29 %.

Conclusion: According to this annual evaluation, the most common study in applications to emergency departments and poison centers was original articles on drug poisoning 56.47 %. Retrospective, prospective, cohort studies and meta-analyzes were 28.24 %, and studies on the treatment of complications resulting from drug poisoning were 15.29 %.

Background: Technology has enabled the utilization of dispatcher-assisted CPR (DA-CPR) via mobile video call for layman bystanders as opposed to the conventional audio call. This study is aimed at examining the effects of medical guidance through a video call on CPR quality during the management of cardiac arrest.
Methods: A quasi-experimental study was carried out on 102 subjects. These subjects were divided into two groups; layman who received CPR instructions via dispatcher-assisted video call (n=51) and healthcare personnel (n=51) who did not receive any assistance. The compression rate and depth, compression fraction, chest recoil, and hand positioning were compared between the groups.
Results: Laymen who received video call DA-CPR performed better than healthcare personnel in adhering to the recommended compression rate (109.7min-1 vs 126.7min-1, P < 0.05) and allowing chest recoil (94.8% vs 84.4%, P < 0.05) but performed poorer in terms of compression depth (58.8% vs 98%, P < 0.05) and chest compression fraction (49.2% vs 60.8%, P < 0.05). Hand positioning in the layman video calls DA-CPR was less accurate in comparison to the healthcare personnel (90.2% vs 96.1%) but the result was not statistically significant (P = 0.24).
Conclusion: In our study, video call DA-CPR allows laymen to deliver CPR with better compression rate, chest recoil and hand placement compared to healthcare personnel. However, inadequate compression depth and low chest compression fraction in the video call DA-CPR group show that more study is needed to deliver effective instructions during the video call to improve in these areas.

Objectives: We aimed to determine the anxietylevel in prehospital emergency medical services personnel (PHEMSPs), andto investigate factors that potentially affect the anxietylevelduring the pandemic.
Methods: This cross-sectional survey was conducted with PHEMSPsduring the COVID-19 pandemic. The surveycomprised 60 items,including socio-demographic characteristics, demographic factorsthat are thought to be related to anxiety, and State-Trait Anxiety Inventory (STAI) scale scores.
Results: Among 586 PHEMSPs participatingin the study, 50.5% were female, and the median age was 30 years.The mean STAI-Svalue was 42.2, and the median STAI-T value was 48.The anxiety levels of female PHEMSPs(STAI-S=51, STAI-T=44.14) were higher than male(STAI-S=44, STAI-T=40.26). The anxiety level of patients with chronic diseases(STAI-S=56, STAI-T=45.77)was significantly higher than without chronic diseases. State anxiety scores in married individuals (STAI-S=49)were higher than thoseinunmarried individuals.
Conclusion: It is obvious that people who provide this service should be psychologically healthy so that people can benefit from healthcare provision more efficiently. All types of mediaassume a great responsibility inreducing the unrest or anxiety that may occur in humans, especially because of theirpotential to reach many parts of the society.

Objective: As far as we have investigated, although there are researches on QT and QTc interval, there are no studies evaluating T wave peak-to-end distance (Tp-e interval), the ratio of Tp-e to QT and QTc used in the evaluation of cardiac arrhythmia risk and ventricular repolarization changes in patients with hypoxia due to hypertensive pulmonary edema. Therefore, in this study was aimed to study whether there is a change in Tp-e interval, the ratio of Tp-e to QTc in hypoxia due to hypertensive pulmonary edema.
Methods: Forty patients diagnosed with hypertensive pulmonary edema in the emergency room were included in the study retrospectively. Forty patients with similar age and gender distribution were included in the study as a control group. All patients underwent 12-lead electrocardiography (ECG). In addition to the routine measurements, Tp-e interval, the ratio of Tp-e to QTc were measured in ECG. Study data were grouped as patients with and without hypoxia
Results: Mean age for patients was 68.60 ± 15.25. QTc interval, Tp-e interval and Tpe / QTc values were found to be significantly higher in hypoxia caused by hypertensive pulmonary edema (p <0.001 for each). QTc interval, Tp-e interval and Tpe / QTc ratio showed significant negative correlation with hypoxia levels.
Conclusion: In patients with hypertensive pulmonary edema, Tp-e interval and Tp-e/QTc rates are increased significantly compared to those without hypertensive pulmonary edema, and these measurements can be used more effectively in the close follow-up of cardiac fatal arrhythmias.

Aim: The study aims were to assess the adequacy of knowledge among emergency residents (ERs) and to determine the correlation coefficient between the knowledge and practice of capnography waveform (CW).
Materials and methods: This 6-months questionnaire-based, cross-sectional study was conducted at the Emergency Department (ED), XXXX. All ERs were included in this study. Respondents’ knowledge was evaluated by exploring their interpretation of CW according to clinical situations and ability in making appropriate clinical decisions and management. Pearson correlation statistic was used to determine the correlation coefficient between knowledge and practice.
Results: Forty-eight ERs participated in the study. The mean score for knowledge and practice (± SD) was 5.69 ± 1.82 and 4.40 ± 1.8, respectively. There was no correlation between knowledge and practice (r = 0.186, p = 0.207).
Conclusions: The ability to interpret the CW among ERs was decent. However, understanding the relevance of the CW findings and the subsequent clinical management was poor.

Aim
Signal peptide complement C1r/C1s, Uegf, and Bmp1 – epidermal growth factor – like domain- containing protein 1 (SCUBE1) has been used in research as a biomarker in acute coronary syndrome (ACS). The aim of this study is to determine if SCUBE1 and routine laboratory parameters are effective or not in distinguishing the patients presenting with clinical symptoms of unstable angina pectoris (USAP) from the patients who have non- ST-segment elevated myocardial infarction (NSTEMI) and non-cardiac chest pain patients (NCCP).

Material and Methods
The study group consisted of patients having chest pain or those suspected of having an ACS complaint. The study consisted of 5 groups of 185 patients with USAP, NSTEMI, STEMI, or NCCP and a control group of 45 healthy patients (CG). The study was conducted according to the American Heart Association (AHA) guidelines.

Results
There was no statistical difference between the patient groups and CG in terms of SCUBE1 (p=0.650). Troponin I value was significantly lower in USAP group than STEMI and NSTEMI groups (p < 0.001). There was no difference among the sub-groups of USAP in terms of the SCUBE1, GENSINI and the GRACE scores (p = 0.485, 0.932, 0.585).

Conclusion
SCUBE1 was not diagnostic for USAP, NSTEMI and STEMI. We need further studies to understand the value of SCUBE1 in ACS.

Aim: To determine the agreement between Arterial Blood Gas (ABG) and Venous Blood Gas (VBG) in a pathologically diverse patient population presenting to the emergency department.
Materials and Methods: This cross-sectional study was conducted in the emergency department of a tertiary care hospital during February 2019 - June 2020. A total of 113 Patients presenting with various medical conditions deemed ABG by the physician were recruited. Both arterial and venous blood samples were collected for blood gas analysis. Using a Bland Altman plot, the data obtained were analysed for agreement. IBM SPSS version 22 was used for data analysis.
Results: Among the 113 study participants, the arterial and venous pH values, BE and bicarbonate show acceptably narrow 95% limits of agreement using the Bland–Altman method (-0.06 to 0.08, -4.08 to 2.30 and -2.59 to 0.89, respectively). Agreement in PO2 and SPO2 measurements was poor (95% limits of agreement -8.38 to 101.06 and 0.35 to 0.58 respectively). Agreement of PCO2 shows an acceptably narrow agreement (95% limits of agreement -10.61 to -2.18).
Conclusion: Venous blood gas analysis for pH, bicarbonate and Base Excess may be a reliable substitute for ABG analysis in the initial evaluation of an adult patient presenting to the Emergency Department.

Aim: The purpose of this study was to determine the attitude of nurses working in surgical clinics regarding the safe use of sharps and needlestick.
Materials and Methods: This descriptive study was conducted between December 2013 and February 2014 simultaneously in the surgical clinics of research hospitals located in three cities. The sample group consisted of 360 nurses who agreed to participate in the study and were not on sick leave or off duty (participation rate was 88.2%).
Results: The mean scores obtained by nurses from scale of medical staff’s attitude regarding the safe use of sharps and needlestick were 108.64±11.30. It was also determined that 46.1% of the nurses got injured for 1-5 time(s) a year; 40.6% of them got injured with injector needles, 32.5% got injured with broken ampoule pieces, 54.4% were vaccinated against hepatitis and tetanus and 63.0% had knowledge about the activities of the infection control committee.
Conclusions: When it is considered that they are exposed to a high level of sharp and needlestick injuries, it can be recommended to conduct serologic tests of the personnel routinely, turn the submittal of annual assessment reports into an institutional policy and offer the personnel through in-service training programs periodically regarding this subject.

Aim
This study aimed to investigate the stress experienced by emergency medicine physicians working in emergency departments during the coronavirus disease 2019 (COVID-19) pandemic, the factors they stated to be effective against stress, and their coping approaches to stressful situations.
Materials and methods
The study was designed in a general screening model, and 200 emergency medicine physicians participated via e-mail who work in emergency departments in Turkey. The sources of stress related to the pandemic, the factors that they find effective in combating stress, and their strategies to cope with stress were investigated with relation to their gender, marital status, after-shift accommodation, manner of working in a shift, smoking behavior, having a chronic disease, having children, and spouse's job as a healthcare professional.
Results
While the primary source of stress of emergency medicine physicians during the pandemic was the risk of transmitting the virus to their families, the most influential factor in combating stress was leisure activities. Emergency physicians’ approaches to coping with stress were significantly predicted by the variables of using full personal protective equipment while working, having adequate sleep and resting opportunities, obtaining additional economic income, and not knowing the pandemic’s end date.
Conclusion
Emergency medicine physicians used active problem-oriented approaches, and among these, they used the social support seeking approach the most during the pandemic. It is necessary to provide social support, take precautions to care for healthcare workers' families, and arrange emergency physicians' shifts to allocate their time to their leisure activities appropriately to reduce stress.

Aim: The aim of our study is to investigate the predictive value of the neutrophil lymphocyte ratio (NLR) assessed in the emergency department to distinguish complicated and uncomplicated acute appendicitis (AA) cases.

Method: In our study, the files of the AA cases who visited our emergency clinic between 01.06.2015 and 01.01.2016 and then were operated in our hospital were reviewed retrospectively. The age, gender, the imaging method performed in the emergency clinic with an AA preliminary diagnosis, the result of the radiologic report in terms of AA and histopathological examination results were recorded according to the patient records. The patients were divided into two groups such as complicated AA (Group 1) and uncomplicated AA (Group 2) based on their histopathological analysis results. The laboratory parameters of the patients, which were seen within the first 30 minutes after they visit the emergency clinic, were examined.

Result: 121 of the 154 patients who were involved in the study were in Group 1 and 33 of the patients were in Group 2. A statistically significant difference was found between two groups in terms of the number of white blood cells (WBC) and NLR (p=0,000). The cut-off value for NLR in the complicated AA distinction was detected as 7,3 (75.8% sensitivity, 81.8% selectivity).

Conclusion: As an easy and effective analysis method, we think that NLR might be a good guide for to diagnose complicated AA cases quickly.

Aim
In this study, we aimed to investigate the accuracy and reliability of emergency medicine residents in the interpretation of radiological investigation of patients with trauma, who received abdominal computed tomography in the emergency department.
Materials and Methods
We prospectively evaluated the reports of 200 patients who presented to the Emergency Medicine Department of a University Hospital with trauma, and who received abdominal computed tomography (CT) due to suspected abdominal pathology.
Results
In this study, 33% (66/200) of the patients were female and 67% (134/200) were male. CT scans of these 200 patients were examined by emergency medicine residents and radiology specialists. The results of the study showed that emergency medicine residents performed well in interpreting abdominal CT scans of patients with trauma with an agreement rate of 90.5%. Evaluation of the results obtained in our study suggested that emergency medicine residents generally performed well in interpreting abdominal CT scans of patients with trauma with suspected abdominal pathology in the emergency room.
Conclusion
The high rate of agreement may be associated with the fact that emergency medicine residents are usually the first physicians who meet and treat patients with trauma and thus have gained sufficient experience in this field.

Spontaneous spinal epidural hematoma is an uncommon and emergency condition leading to spinal cord compression. Early diagnosis can be achieved by magnetic resonance imaging (MRI) or computerized tomography, but preferably MRI. Surgical decompression is urgent and could relieve neurologic deficits.
A 27-year-old man presented to the emergency department with back pain which began about 10 days before. While waiting for the results of biological markers for differential diagnosis right hemiplegia became evident. Epidural hematoma was captured by thoracic and lumber MRI at level T1 to T2. Hematoma evacuation and decompression laminectomy was performed immediately.

Aim: Our research aimed to examine patients' sociodemographic characteristics transferred from the emergency department to home by ambulance and the factors that cause ambulance transport. To our knowledge, there is no study presenting a perspective on patients who were discharged from the emergency department but were transferred home by ambulance. Although the literature on patients using pre-hospital ambulance services is full, it lacks patients in need of post-hospital ambulance services. Since it is the first study on this subject, it is aimed to be a guide for future studies.
Materials and Methods: This retrospective study was conducted at an academic tertiary care emergency department in Turkey between March 2019 and March 2020.
Results: Of the 1059 patients included in the study, 56.1% were women, 43.9% were male and their average age was 74.21 years. The most influential factors in transporting patients from the emergency department to home by ambulance were bedridden (%47,4), social reasons(%37,7) and oxygen need (%14,9).
Conclusion: The high average age of patients transferred from the emergency department to the home and the reasons for their transportation demands show that the increasing elderly population creates new requirements in health. Providing ambulance service to special groups for home transport after emergency room discharge should be seen as a part of emergency treatment. Standardization should be developed by carrying out studies on this subject.

Aim: To compare 25-hydroxyvitamin D (25-OH Vit D),Vitamin B12,and folic acid levels of patients presenting with vertigo and who were diagnosed with Benign Paroxysmal Positional Vertigo (BPPV) and of the healthy volunteer control group without vertigo and to examine whether they are associated with the disease.

Materials and Methods: 190 patients who applied to between October-December 2019 and who were diagnosed with BPPV,and 49 volunteers without any complaints (control group) who came only for check-up were included in the study. Serum 25-OH Vit D,Vitamin B12, and folic acid levels of all participants were examined.

Results: Of the participants,209(61.6%)were male and 130(38.4%)were female.Of 94 participants included in the study,25-OH Vit D level was found to be at low levels. Of the participants with low 25-OH Vit D levels,65 (69.1%)were in the BPPV group and 29(30.9%) were in the control group. Of all participants included in the study, 68 had low folic acid levels and 33 (48.5%)of them were in the control group, while 35 (51.5%) of them were in the BPPV group.The level of Vitamin B12 of 2 participants among all participants included in the study was below the normal values and these 2 participants were in the BPPV group.

Conclusion: In our study,we did not found any significant relationship between BPPV and serum Vitamin B12 and serum folic acid levels.We determined a significant relationship between BPPV and decreased serum 25-OH Vit D level (p<0.01). We identified that low serum 25-OH Vit D levels may be an independent risk factor in the progress of BPPV.

Cornual pregnancy, a rare and hazardous form of ectopic pregnancy, can cause massive hemorrhage and death. We present a 38-year old lady who was brought to our Emergency Department at 30+6 weeks of gestation for abdominal pain and hypotension due to uterine rupture as a result of left cornual pregnancy. Here, we highlight how cornual pregnancy can be confused with normal intrauterine pregnancy, as well as the catastrophic complications of uterine rupture and fetal demise associated with cornual pregnancy. This case report demonstrates the importance for an emergency physician to maintain the suspicion for ectopic pregnancy even at advanced gestational age.

Aim: Ramadan is a month, in which changes in diet and lifestyle are observed. These changes have charestetic, which may affect the causes and time pattern of emergency department (ED) attendances. However it is unclear how ED attendances are affected during Ramadan. The aim of this study is to investigate the effect of Ramadan month on the ED attendances.
Materials and Methods: Hospital records and files of patients older than 17 years old who attendent to a university hospital ED in just before, during and immediately after Ramadan months between 2014- 2016 were reviewed retrospectively.
Results: In the study, 44146 ED attendances were evaluated. It was found that during Ramadan months, attendances decreased compared to the other months (p<0.001). It was determined that in Ramadan, there was a significant increase in ED visits one hour after iftar and one hour before sahur (p<0.001). It was detected that forensic cases decreased during Ramadan (p <0.001).
Conclusion: In the Ramadan months, the number of ED attendances have decreased and the time period of the ED attendances has changed. There is a noticeable increase in attendances in the one hour after iftar and one hour before sahur.

Objective: This study was conducted to determine the driver behavior of emergency health personnel driving ambulances.

Material and Method: This descriptive study was conducted with ambulance drivers at the Izmir 112 Emergency Medical Services Department. A questionnaire consisting of 21 items was prepared as the data collection tool. This questionnaire was used to evaluate personal information as well as driver behavior. Data was obtained by the researcher through face-to-face interviews conducted at ambulance stations.

Results: 90.9% of the participants were self-confident in ambulance driving. 88.8% of the participants followed traffic rules and 74.1% followed speed limits. 55.2% of the participants previously had traffic accidents, and this ratio was lower in personnel taking 24-hour shifts.

Conclusion: It was found that ambulance drivers are self-confident and follow speed limits and traffic rules. It was determined that approximately half of the participants previously had a traffic accident.

Aim: TAPSE and pPTT are new echocardiographic parameters recommended in the evaluation of right ventricular function. Examine the echocardiographic parameters of patients diagnosed with acute pulmonary thromboembolism and determine the predictive of mortality.
Materials and Methods: The study was prospectively. Patients diagnosed with PTE in the Emergency Department between 01.03.2019 and 31.12.2019 were included (86 patients (42 case - 44 control))in the study.
Results: pPTT mean scores of the case and control groups were 91.88 ms and 127,09 ms (p< 0,001). Also, the TAPSE mean scores were 1.76 mm and 2.60 mm for the case and control groups (p< 0,001). In terms of sPESI, 8 patients (19%) were determined to be at low risk in the case group. On the other hand, of the 34 patients (81%) in the case group determined to be at high risk, In the first 30 days after diagnosis, mortality developed in 2 patients (4.7%) in the case group. In the control group, the sPESI score of all participants was determined as low risk and no mortality developed (p <0.001). pPTT parameter was observed to be not at statistically significant levels to determine the predictive of mortality (AUC 0.194: p = 0.07). TAPSE parameter was observed to reach statistically significant levels of distinctive markers to determine the predictive of mortality (AUC 0.171: p = 0.05).
Conclusion: We recommend the determination of pPTT and TAPSE with acute PTE patients in emergency departments to predict mortality indicators and pulmonary pressure changes in the early period.

Aim: The aim of this study is to investigate the effect of treatment in the emergency department on the purchase behavior of prescribed medicines in patients with an emergency upper respiratory tract infection with a diagnosis of respiratory tract infection.
Materials and Methods: This retrospective study was performed on patients who were admitted to the emergency department clinic of Atatürk University in March 2016 and who were discharged with the diagnose of upper respiratuary infection (URI). 1104 patients were included in the study. Using the pharmacy medulla system of the Turkish Social Security Institution, cases of patients taking prescriptions written to them were recorded. Data entry and statistical analysis were performed using SPSS statistical data program.
Results: A total of 1104 patients were examined, of which 553 were had therapy (50,09%), 543 (49,18%) were not have and 8 patients (0.72%) were identified as missing data. It was determined that 336 (60,75%) of the intervention patients received the prescription written by them and 207 (37,43%) did not.
Conclusion: Patients who are discharged by the diagnosis of URI from the emergency service do not receive prescriptions that will help their actual treatment if they receive any interventional therapy when they arrive.

Aim: Pulmonary embolism (PE) is a life-threatening disease that early diagnosis and treatment is life saving.There is still a need for easy and non-invasive alternative biomarkers that can be used to diagnose PE.The purpose of this study was to determine the diagnostic value of CT-1 in patients with acute PE and to analyze whether any relation exists between serum levels and prognosis and severity
Materials and Methods: In this prospective study, the serum CT-1 levels of 165 patients with suspected acute PE were measured.Patients were divided into two groups based on the computed tomography angiography (CTA) results, PE(+) and PE(-) and their serum CT-1 levels were compared.
Results: Median CT-1 values were 4.18 pg/ml (3.57-9.55) in the PE(+) group, and 4.38 pg/ml (3.57-51.64) in the PE(-) group (p=0.08).In the evaluation of CT-1 levels in patients with PE (+) according to the severity of the disease, the median values of CT-1 were 4.19 pg/ml (3.62-5.32) in the intermediate-low risk group, 4.06 (3.57-9.31) pg/ml in the intermediate-high risk group and 5.01 pg/ml (3.89-9.55) in the high risk group(p = 0.001).In terms of clinical course, median CT-1 values were 4.15 (3.57-9.31) in the good clinical course group and 4.53 pg/ml (3.66-9.55) in the poor clinical course group (p=0.004).
Conclusion: CT-1 was not determined to be a useful biochemical marker in the diagnosis of acute PE.However, it has been determined that serum CT-1 levels can be used as a useful biomarker in evaluating the severity and prognosis of patients with pulmonary embolism.
Keywords: Pulmonary embolism, diagnosis, severity, prognosis, Cardiotrophin-1

Aim: To evaluate the accuracy of emergency physicians performed Point-of-Care Ultrasonography (EP-POCUS) in diagnosing acute appendicitis (AA) in the pediatric age group who had abdominal pain and compare sonographic findings with those of radiologists.
Materials and Methods: One hundred twenty-three children who had abdominal pain were included in the study. EP-POCUS and radiology department ultrasonography (RADUS) performed on each case. Sonographic findings (non-compressible bowel loops, target sign, edema in the surrounding tissue, appendix diameter, peri-appendiceal abscess, appendicitis positivity (a non-compressible and non-peristaltic blind ending tubular structure >6mm ) and presence of mesenteric lymphadenitis) of the EP-POCUS and RADUS were recorded seperately and compared to evaluate accuracy of the EP-POCUS and RADUS. Definitive diagnoses were determined by pathological evaluation of appendectomy specimens.
Results and Conclusion: Thirty six (29,2%) patients were diagnosed AA and hospitalized by the surgeon, 30 (24,3%) of which were confirmed pathologically. According to pathological diagnose, the EP-POCUS’s sensitivity was 73.3%, specificity was 89.2%, the RADUS's sensitivity was 76.7%, the specificity was 96.8% and significantly consistent with in diagnosing AA (Kappa coefficient: 0.64, p<0.005). EP-POCUS accuracy in AA diagnosis did not differ between age groups. In conclusion, EP-POCUS on pediatric patients acts as an auxiliary and useful approach in AA diagnosis. Training and experience may increase the accuracy rates.

Aim: To examine changes in door-to-antibiotic time in pre- and post-intervention groups.
Materials and Methods: A quasi-experimental study was conducted in the Emergency Department (ED) of adult patients who were diagnosed with sepsis or septic shock in university-based hospital. The patients were defined as being in one of two groups, either a pre-intervention or post-intervention group. In the post-intervention group, patients with a suspected infection and a National Early Warning Score (NEWS) ≥5, the sepsis fast track protocol was used in the normotensive group and the sepsis with shock fast track protocol was used in the hypotensive group. Our primary outcome was the difference in door-to-antibiotic time in pre- and post-intervention groups.
Results: One hundred and seventeen patients were in the pre-intervention group and 102 patients in the post-intervention group. The median door-to-antibiotic time in the pre-intervention group was 45 minutes (interquartile range (IQR) 30 to 65) and the median door-to-antibiotic time in the post-intervention group was 30 minutes (IQR 20 to 55, p = 0.009). However, there was no significant difference in mortality rates (p = 0.194).
Conclusion: Use of the activated system using NEWS for screening patients who are suspected of sepsis helped reduce door-to-antibiotic time.

AİM: The study was planned to assess delirium for the oncologic patients admitted to ED with the complaint of altered level of consciousness, based on Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnostic criteria, research for influencing etiologic factors and comparison of the brief Confusion Rating Method (bCAM), Mini Mental State Examination (MMSE) and New Delirium Rating Scale (NDRS), which are considered as delirium screening tests.
Methods: The Richmond Agitation-Sedation Scales (RASS) calculated for all patients before applying bCAM. The patients with the RASS score between -3 and +4 had been evaluated with bCAM. Delirium was diagnosed when the third or fourth characteristic was positive as well as the first two. The MMSE and NDRS scores of all patients and the duration of three tests were calculated.
Results: The MMSE and NDRS scores were 13,46±3,78 (7-20) and 21,42±3,28 (11-26) in the patients who were in delirium, respectively. Harmony between bCAM and MMSE are also statistically significant (Eta=0,70). Application period of bCAM was the shortest as 46,92±6,16 (30-60) sec.
Conclusion: bCAM was applied in the shortest period of time. This result is very useful for the EDs which are racing against time in the world.

Aim: To analyze the cost of patients hospitalized in secondary and tertiary hospitals due to the diagnosis of Chronic Obstructive Lung Disease (COPD) and to draw attention to the cost of COPD and the reasons that increase the cost in our country.
Method: This research was carried out to chest diseases clinic in second and third level hospitals affiliated to the ministry of health, between 1 January 2018-31 December 2018. Demographic features, smoking, duration of hospitalization, length of hospitalization in intensive care, antibiotics used, number of outpatient apply, total hospitalization cost, total costs and duration of antibiotics used were recorded. Costs were stated in Turkish Lira and converted into dollars. Cost data of patients with more than one hospitalization were entered separately.
Results: The numbers of men and women were equal in both 2rd level and 3rd level patients. Looking at patients with COPD in both the secondary and tertiary, total hospital cost in patients was significantly higher than those who did not. When the length and number of hospitalization increased, the total cost of the hospital increased significantly. Significant differences were not found between age groups, gender, smoking status, comorbidities, antibiotic use, number of outpatient clinic admissions, and the number of hospitalizations in the last two years in terms of total hospital cost.
Conclusion: The elimination and prevention of the both of internal and external factors that cause the disease, especially without the need for medication, is of great importance in terms of both financial and labor loss prevention and reduction.

Aim: In the emergency department (ED), some patients are discharged following initial diagnosis and treatment, whereas others are hospitalized for treatment and/or further diagnostic examination. The ED physician usually does not receive feedback regarding the accuracy of their diagnosis, the effectiveness of the treatment, or the morbidity/mortality of the patient. In this study, we follow up with non-traumatic ED patients in order to obtain data regarding these subjects.
Materials and Methods: This prospective cohort study includes all non-traumatic patients that were admitted to the ED of a tertiary hospital during a two-month time frame that were hospitalized in various clinics. The following data were recorded for each patient: demographic information, vital signs, diagnosis at the time of admission, diagnosis after hospitalization, length of stay, mortality and complications.
Results: This study includes a total of 740 patients that met the inclusion criteria. Mean age was 54 years, 398 patients (53.8%) were male. The initial diagnosis of 22 patients (2.9%) changed after further examinations. The mean age of these patients were 42, and 11 patients were male (50%). Emergency invasive intervention was significantly more common among patients with changed diagnosis (cDx) (40.9% vs. 4.1%, p <0.001). Consequently, the incidence of complications was higher in cDx patients (31.8% vs. 10.8%, p = 0.01).
Conclusion: Majority of the patients that were hospitalized from the ED were treated with their initial diagnosis and in the initial department of hospitalization. We conclude that the ED functions at an adequate accuracy despite their high workload.

Objective: We aimed to determine the clinical and demographic features of pediatric patients monitored after organophosphorus or carbamate intoxication in our hospital. We further aimed to determine the clinical and laboratory indicators that may be effective on the clinical severity scores and the prognoses of the patients.
Methods: We retrospectively analyzed 117cases who were younger than18 years of age and were admitted to the pediatric emergency department for organophosphate or carbamate intoxication.
Results: The median age of the cases was 56 months (8–226 months) and the male/female ratio was 1.72 (74/43). The most frequent causes of intoxication were accidental ingestion (83.8%) and the most common cause and oral exposure as the most common route (73.5%). The Glasgow Coma Scale score and levels of pseudocholinesterase were significantly lower in the following groups: in the patient group with severe grade intoxication, in cases admitted to the intensive care unit, and in those with complications. However, lactate and glucose levels were significantly higher in those patient groups (p<0.001). The mean Red Distrubution Width levels were significantly higher in the patient group admitted to the intensive care unit compared with the group monitored in the emergency department (p= 0.029)
Conclusion: Our study helped us to conclude that the Glasgow Coma Scale score and serum Pseudocholinesterase, serum glucose, and serum lactate levels at baseline can be helpful in predicting the presence of a serious intoxication and aid in the prognosis in pediatric cases.

Objective: In this study, we aimed to evaluate short-term clinical and radiographic results of combined open reduction and internal fixation in the treatment of trans-scaphoid perilunate fracture-dislocation (TSPLFD).
Patients and Methods: A total of eight patients who underwent combined open reduction and internal fixation with the diagnosis of TSPLFD and followed for minimum eight months were retrospectively analyzed. All patients were surgically treated with an Acutrak® screw, ligament repair using suture anchors, and Kirschner wire. The functional outcomes were evaluated using the modified Mayo wrist scores and total active range of motion (TAROM) scale. Radiographic outcomes were assessed based on standard X-ray images of the wrist.
Results: Of the patients, seven were males and one was female with a median age of 32 (range, 20 to 44) years. The median follow-up was 12 (range, 8 to 16) months. According to the TAROM scores, the results were excellent in one patient and good in seven patients. The median Mayo wrist scores were 84 (range, 80 to 95). Good radiographic results were achieved in all patients. No surgery-related complications such as infection, loss of reduction, or Sudeck's atrophy were observed.
Conclusion: Although TSPLFD is rare, early diagnosis and surgical treatment yield favorable functional and radiographic results. However, post-traumatic arthritis and functional dissatisfaction may occur in the long-term.

Background
Spinal cord injury (SCI) is a devastating neurologic disorder. It is estimated to effect approximately a thousand patients each year, in Republic of Turkey. The purpose of this review was to populate the recent evidence related to acute management of the patients with spinal cord injuries in pre-hospital and emergency care settings.
Methods
We performed a literature review of publications in English language, indexed in Pubmed, ScienceDirect and Scopus using the following search terms: “spinal cord injury” and “acute management”, “spinal cord injury” and “immobilization”, “spinal cord injury” and “transfer”, “spinal cord injury” and “transport”, “spinal cord injury” and “airway management”, “spinal cord injury” and “hemodynamic management”, “spinal cord injury” and “steroid”. We also reviewed the recent international guidelines.
Results
This review reports the immobilization of patient with SCI and management strategies relevant to the transfer of SCI patient, airway management in cervical SCI, hemodynamic management of SCI, and methylprednisolone use in SCI.
Conclusion
Patient’s spinal aliment should be maintained with the appropriate techniques for sufficient immobilization for safe extrication and transport. The patient with an acute spinal injury should be rapidly and carefully transported from the site of injury to the nearest specialist SCI facility.

Background/Aims: Acute upper gastrointestinal (UGI) bleeding is a common gastrointestinal emergency and a cause of morbidity and mortality among the elderly. We aimed to evaluate demographic and epidemiological properties to identify predictors of 28-day mortality among geriatric patients diagnosed with upper GI bleeding in an emergency department(ED).
Materials and Methods: This is a retrospective study. All patients aged ≥65 years admitted to the ED and diagnosis of UGI bleeding were included in the study. Basic demographic and clinical/endoscopic findings were evaluated. The primary outcome was the identification of a 28-day mortality rate and its mortality predictors, which included ofmortality
Results: Two hundred and ninety-seven geriatric patients were included in the study. One hundred and thirty-one patients were women (44.1%); the median age of the all patients was 79 (65-98). In endoscopy, the most cause of bleeding was a gastric/duodenal ulcer in 53.9% of patients. A comparison of the patient characteristics regarding in-hospital mortality (survivor/non-survivor) revealed significant differences for chronic renal failure, hemodynamic instability, Hematocrit, blood urea nitrogen, creatinine, albumin, erythrocyte transfusion, rebleeding and Rockall scores (for all variables, p<0.05). The regression analysis revealed that low albumin and Hematocrit levels and hemodynamic instability were the independent predictors of mortality
Conclusion: Peptic ulcer bleeding is the main cause of acute UGI bleeding. Low albumin and Hematocrit levels as well as hemodynamic instability were shown to be the independent predictors of mortality. We think that, particularly patients with hemodynamic compromise at the time of hospital admission should be closely monitored and rapidly treated.