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Öğe Acil serviste pulmoner tromboembolili hastaların farklı puanlama araçları ile değerlendirilmesi(2018) Özer, Muhammet Raşit; Ergin, Mehmet; Altunay, Fatih; Gökal, Aliye Nur; Dündar, Zerrin Defne; Vişneci, Emin Fatih; Koçak, SedatAmaç: Acil serviste pulmoner tromboemboli (PTE) tanısı alan hastaların mortalite ile demografik, klinik, laboratuvar ve skorlamaözellikleri arasındaki ilişkiyi araştırmak.Gereç ve Yöntem: Bu retrospektif çalışmada, 2012-2015 yılları arasında acil servise başvuran torasik bilgisayarlı tomografi (BT) veyapulmoner BT anjiyografisi ile PTE tanısı alan 166 hasta çalışmaya dahil edildi. Hasta grubu Grup I (sağ kalan) ve Grup -II (hayattakalmayan)olarak iki gruba ayrıldı. Hematolojik ve biyokimyasal laboratuvar parametreleri, laktat içeren arteriyel kan gazı değerleri vetüm hastaların klinik şiddeti MWS, PESI ve MEWS skorlama sistemleri kullanılarak değerlendirildi.Bulgular: Arteriyel oksijen basıncı (PaO2) ve laktat düzeyleri açısından, hasta grupları arasında istatistiksel olarak anlamlı bir farkbulundu. Grup II'de, PESI ve MEWS skorları Grup-I hastaları ile karşılaştırıldığında anlamlı olarak yüksek bulundu. Grup II hastalarındaMWS skoru daha yüksekti.Sonuç: Burada kullanılan parametreler ve skorlama araçları sayesinde, PTE olgularını tanılamayı amaçladık. PTE'nin bu bulgularınyardımıyla klinisyen tarafından daha erken teşhis edildiğinde, mortalite ve morbidite oranlarının azaltılacağını ve tedavinin dahaetkili olacağını düşünmekteyiz.Öğe Alpha-Amanitin Poisoning, Nephrotoxicity and Oxidative Stress: An Experimental Mouse Model(Kowsar Publ, 2015) Ergin, Mehmet; Dundar, Zerrin Defne; Kilinc, Ibrahim; Colak, Tamer; Oltulu, Pembe; Girisgin, Abdullah SadikBackground: Alpha-amanitin (alpha-AMA) plays a major role in Amanita phalloides poisoning, showing toxic effects on multi-organs, particularly on the liver and kidneys. Studies have shown a relationship between alpha-AMA-related injuries and reactive oxygen species. Objectives: We aimed to investigate whether there is renal injury and its relationship with oxidative stress after intraperitoneal injection of alpha-AMA in mice experimental poisoning models. Materials and Methods: There were 37 male BALB/c laboratory mice treated with alpha-AMA, according to the study groups: control group (n = 7); low dose (0.2 mg/kg) (n = 10); moderate dose (0.6 mg/kg) (n = 10), and high dose (1 mg/kg) (n = 10). The sample size was detected according to the ethical committee's decision as well as similar studies in the literature. After a 48-hour follow-up period, all the subjects were sacrificed for pathological and biochemical assays. The study was held in Turkey. Results: alpha-AMA poisoning in mice results in inflammatory changes and necrosis in renal structures. There were statistically significant differences between the study groups regarding measured levels of catalase, superoxide dismutase, glutathione peroxidase, total antioxidant status (TAS), total oxidant status (TOS) and malonyl dialdehyde in renal homogenates of mice (P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.001, and P = 0.001, respectively). The TOS and TAS measurements helped to eliminate cumbersome analysis of diverse oxidant and antioxidant molecules. The TOS levels in renal homogenate of mice were significantly higher in all the intoxication groups compared to the control group (5.73, 7.02, 7.77, and 9.65 mmol trolox eq/g protein and P = 0.002, P = 0.001, and P = 0.001, respectively). The TAS levels in moderate and high-dose groups were significantly lower than all the other groups treated with alpha-AMA (0.130, 0.152, 0.065, and 0.087 mmol trolox eq/g protein and P = 0.031, P = 0.001, and P = 0.001, respectively). Conclusions: Our results indicated that alpha-AMA poisoning in mice led to inflammatory changes and necrosis in renal structures. Biochemical analysis showed a shift in the oxidative/anti-oxidative balance towards the oxidative status.Öğe Analysis of cardiac and pulmonary injuries resulting from an experimental penetrating thoracic injury(2014) Tokur, Mahmut; Ergin, Mehmet; Okumuş, MehmetBACKGROUND: This study was planned to analyze the internal and external anatomical findings of cardiac injuries and the presence of accompanying pulmonary injuries in intentionally inflicted thoracic injuries to swine models. METHODS: We inflicted a penetrating heart injury in six suis domesticus female swine models. Two cardiac injuries, one on the left paratracheal of fourth intercostal space (ICS) and the other on the right side were inflicted on each model by the same researcher using a 20-cm long scalpel. All animals were then sacrificed for morphological evaluation. RESULTS: After strikes to the left fourth ICS, external evaluation showed that 50% of the subjects suffered a single laceration and that 33% suffered multiple lacerations. Internal evaluation showed additional intracardiac injuries in all five subjects. However, the subject that suffered a single laceration on the outer surface of the heart had multiple internal injuries while another subject that had multiple outer lacerations had only one intracardiac injury. Only three subjects suffered cardiac injuries and only two out of those three with pulmonary injuries after right fourth intercostal intrusions. CONCLUSION: This experiment has shown that external evaluation of the heart tissue may not alone be sufficient to determine the extent of cardiac injuries and accompanying pulmonary injuries caused by penetrating thoracic injuries.Öğe Approach to pleural effusions in the emergency department(2013) Tokur, Mahmut; Ergin, Mehmet; Girişgin, Abdullah Sadık; Demiröz, MustafaBenign ve malign hastalıklar neticesinde plevral boşlukta sıvı salınım-emilim dengesinin bozulması sonucu oluşan plevral efüzyon sıklıkla karşılaşılan bir du- rumdur. Torasentez hem efüzyon tanısını teyit etme hem de efüzyonun niteliği hakkında ön bilgi edinme amacıyla yapılmalıdır. Alınan numuneden yapılan biyokimyasal, mikrobiyolojik ve sitolojik incelemeler tedavinin etiyolojiye yöne- lik olarak belirlenmesine yardımcı olur. Benign nedenlerin tedavisi altta yatan etiyolojiye yönelik iken, malign durumlarda ise ilk önce sıvı drenajı ve takiben yeniden sıvı birikiminin önlenmesine yönelik ileri tedavi gerekir. (JAEM 2013; 12: 155-63)Öğe Assessment of right ventricular functions in patients with sepsis, severe sepsis and septic shock and its prognostic importance: A tissue Doppler study(W B Saunders Co-Elsevier Inc, 2013) Harmankaya, Atif; Akilli, Hakan; Gul, Mehmet; Akilli, Nazire Belgin; Ergin, Mehmet; Aribas, Alpay; Cander, BasarPurpose: This study aims to investigate the potential contributions of the right ventricle (RV) performance evaluated using tissue Doppler imaging (TDI) on the assessment of the severity and prognosis of sepsis. Methods: The study was completed with 55 patients (male/female 26/29, age 66.9 +/- 20.3 years) and 28 healthy controls (male/female 14/14, age 59.4 +/- 18.3 years). The RV-TDI parameters, mainly the RV myocardial peak systolic velocities (Sm, cm/s) and myocardial performance index (MPI) were recorded, in addition to the standard echocardiographic evaluation. Results: The patients were classified into 3 groups based on the severity of sepsis. The RV-Sm value was significantly lower in the severe sepsis-septic shock (n=31) than that of the sepsis (n=24) and the control groups (n=28) (P=.001). The RV-MPI was high both in the severe sepsis-septic shock and the sepsis compared with the control group (P=.02). The patients were classified into 3 groups based on in-hospital mortality. The RV-Sm was lower in non-surviving (n=27) than in the surviving (n=28) and the control groups (n=28) (P=.002). The RV-MPI was found to be higher in the non-surviving patients than the surviving and the control groups (P<.001). Conclusion: Our study shows that the RV dysfunction evaluated using TDI, particularly the RV-Sm and MPI values, were related with the severity of sepsis and mortality. (C) 2013 Elsevier Inc. All rights reserved.Öğe A Diagnosis ofTotal Abdominal Aortic Occlusion in a Patient Who Entered the Emergency Department by Walking(Aves, 2014) Dundar, Zerrin Defne; Guven, Merve; Ergin, Mehmet; Cander, Basar; Girisgin, SadikIntroduction: The risk of thrombosis is increased in hypercoagulability. Hypercoagulability can be inherited or acquired. Here, we want to present a patient with inherited hypercoagulability who came to the emergency department by walking and was diagnosed with total abdominal aortic thrombosis and acute renal artery thrombosis. Case Report: A 48-year-old female patient presented to our emergency medicine department with a history of right flank pain for 30 minutes. The pain had started abruptly and was continuous. She came to the emergency medicine department by walking. The contrast-enhanced abdominal computed tomography showed right renal infarction, right artery occlusion, and abdominal aortic thrombus at the level of the iliac bifurcation. Conclusion: Abdominal aortic thrombus is a relatively rare complication of hypercoagulability. Total occlusion of the aorta is generally presented with pain, pallor, weakness, and numbness of the lower limbs. In our case, there was none of these signs due to the blood flow supplied by collaterals. It is a challenge to diagnose total aortic occlusion in a patient that comes to the emergency department by walking.Öğe Diagnostic and Prognostic Significance of Neutrophil Gelatinase- Associated Lipocalin and Pentraxin-3 in Acute Coronary Syndrome(2017) Özer, Muhammet Raşit; Ergin, Mehmet; Kılınç, İbrahim; Dündar, Zerrin Defne; Özer, Nejla; Önal, Mehmet Akif; Girişgin, Abdullah Sadık; Koçak, Sedat; Gül, Mehmet; Cander, BaşarAim: The aim was to evaluate the levels of serum pentraxin-3 (PTX-3) and neutrophil gelatinase-associated lipocalin (NGAL) and the efficiency of making a diagnosis and to estimate the prognosis in patients with chest pain.Materials and Methods: The study was conducted in the Necmettin Erbakan University Meram Medicine School Emergency Department. Patients who had chest pain and met the inclusion criteria were accepted. They were divided into the following groups: acute coronary syndrome (ACS), a diagnosis other than ACS (non-ACS), and control. The patients in theACS and non-ACS groups were divided into five sub-group -groups: ST Elevated Myocardial Infarction (STEMI) Non- ST Elevated Myocardial Infarction (NSTEMI), Unstable Angina Pectoris (USAP), stable angina, and pulmonary embolus. For all patients, serum PTX-3, serum NGAL, troponin I, and creatine kinase-MB fraction (CK-MB) levels were measured.Results: There were 199 patients in the ACS and non-ACS groups and 30 patientsin the control group. There was no significant difference among the study groups in terms of age and PTX-3 and NGAL levels. When comparing survival and non-survival in terms of in-hospital death, CK-MB and troponin I levels were significantly higher in the ACS and non-ACS groups than in the control groups, whereas there was no significant difference in terms of PTX-3 and NGAL levels.Conclusion: The results of our study demonstrated that PTX-3 and NGAL are not effective biomarkers in the differential diagnosis and the determination of in-hospital mortality in ACS. However, the limitations of the study should be considered. The results confirmed that CK-MB and Troponin I can be safely used in the differential diagnosis and the prediction of mortality.Öğe Diagnostic and Prognostic Significance of Neutrophil Gelatinase-Associated Lipocalin and Pentraxin-3 in Acute Coronary Syndrome(Galenos Publ House, 2017) Ozer, Muhammet Rasit; Ergin, Mehmet; Kilinc, Ibrahim; Dundar, Zerrin Defne; Ozer, Nejla; Onal, Mehmet Akif; Girisgin, Abdullah SadikAim: The aim was to evaluate the levels of serum pentraxin-3 (PTX-3) and neutrophil gelatinase-associated lipocalin (NGAL) and the efficiency of making a diagnosis and to estimate the prognosis in patients with chest pain. Materials and Methods: The study was conducted in the Necmettin Erbakan University Meram Medicine School Emergency Department. Patients who had chest pain and met the inclusion criteria were accepted. They were divided into the following groups: acute coronary syndrome (ACS), a diagnosis other than ACS (non-ACS), and control. The patients in theACS and non-ACS groups were divided into five sub-group - groups: ST Elevated Myocardial Infarction (STEMI) Non-ST Elevated Myocardial Infarction (NSTEMI), Unstable Angina Pectoris (USAP), stable angina, and pulmonary embolus. For all patients, serum PTX-3, serum NGAL, troponin I, and creatine kinase-MB fraction (CK-MB) levels were measured. Results: There were 199 patients in the ACS and non-ACS groups and 30 patientsin the control group. There was no significant difference among the study groups in terms of age and PTX-3 and NGAL levels. When comparing survival and non-survival in terms of in-hospital death, CK-MB and troponin I levels were significantly higher in the ACS and non-ACS groups than in the control groups, whereas there was no significant difference in terms of PTX-3 and NGAL levels. Conclusion: The results of our study demonstrated that PTX-3 and NGAL are not effective biomarkers in the differential diagnosis and the determination of in-hospital mortality in ACS. However, the limitations of the study should be considered. The results confirmed that CK-MB and Troponin I can be safely used in the differential diagnosis and the prediction of mortality.Öğe A Different Presentation of Urinary Tract Infections: Emphysematous Cystitis(Aves, 2013) Ergin, Mehmet; Atabey, Ertan; Atabey, Ersin; Gokmen, Ibrahim Erdem; Visneci, Fatih Emin; Cander, BasarEmphysematous cystitis (EC) tends to be seen in the geriatric population. Half of the patients have diabetes mellitus. Other predisposed factors are urinary retention, steroid and other immune suppressive treatments. We present the case of a 75-yearold female patient admitted to the emergency department with complains of abdominal pain and haematuria. She had diabetes mellitus type 2 and amputation below the knee of the left leg. Her vital signs were in the normal range except mild hypothermia. Her physical examination revealed abdominal sensitivity and a mass of 8x8 cm by palpation. Her laboratory results showed pyuria and haematuria, leukocytosis, and a high level of procalcitonin. Contrast-enhanced abdominal tomography showed gas in the wall and the air-fluid level within the lumen of the urinary bladder, which was pathognomonic for EC. There is great variability in clinical presentation and prognosis in cases of EC. Emergency physicians should know the radiological features of EC and associated pathologies of other abdominal organs to prevent the progression of infection.Öğe Electrocardiography interpretation training in emergency medicine: methods, resources, competency assessment, and national standardization(Pharmamed Mado Ltd, 2015) Ozel, Betul Akbuga; Demircan, Ahmet; Keles, Ayfer; Bildik, Fikret; Ozel, Deniz; Ergin, Mehmet; Gunaydin, Gul PamukcuObjective(s). The aim of this study was to evaluate the status of electrocardiography (ECG) training in emergency medicine residency programs in Turkey, and the attitude of the program representatives towards standardization of such training. Methods. This investigation was planned as a cross-sectional study. An 18-item questionnaire was distributed to directors of residency programs. Responses were evaluated using SPSS (v.16.0), and analyzed using the chi-square test. Results. Thirty-nine program directors (out of 42) responded to the questionnaire. Twenty-eight of them stated they did not have a formal ECG training curriculum. The most preferred ECG education method was clinical education in the Emergency Department; the most common education resource was ECG textbooks; and the most common evaluation method was case scenarios. Only thirteen of the programs had an obligation to prove competency. The most common competency-assessment method was obtaining a passing grade based on an instructor's observation. The majority of program directors are of the opinion that there should be a formal ECG teaching curriculum, and that a national ECG training program and national ECG database should be formed. Conclusions. The majority of programs do not have a formal ECG interpretation curriculum, which is an obligation to prove competency. As a result, their training methods, resources, and assessment tools were determined to be subjective.Öğe Epidemiological Characteristics of Geriatric Patients in Emergency Departments: Results of a Multicenter Study(2015) Ergin, Mehmet; Karamercan, Mehmet Akif; Ayrancı, Mehmet; Yavuz, Yücel; Yavaşi, Özcan; Serinken, Mustafa; Acar, Tarık; Avcil, Mücahit; Al, Behçet; Bayramoğlu, Atıf; Durgun, Hasan Mansur; Gölcük, Yalçın; Arzıman, İbrahim; Dündar, Zerrin DefneGirifl: Beklenen yaflam süresinin uzamasının sonucu olarak yafllı popülasyondaki artıfl, bu yaflgrubu için daha sık sağlık bakımı verilmesini zorunlu kılmaktadır. Bu çalıflmada acil servise baflvuran 65 yafl ve üzeri hastaların genel özelliklerini, baflvuru nedenlerini, acil servis ve hastane ziyaretlerinin sonuçlarının saptanması amaçlandı. Gereç ve Yöntem: Çok merkezli, prospektif, gözlemsel çalıflma Türkiye'de 13 hastaneninacil servislerinde bir hafta süre ile gerçekleflti. Çalıflma süresi içinde akut tıbbi veya cerrahi sorunlar ile acil servise baflvuran 65 yafl ve üstü hastalar çalıflmaya dahil edildi. Altmıfl befl yafl altı ve/veya travma nedenli baflvurular ise çalıflma kapsamına alınmadı.Bulgular: Ortalama yaflı 74.87.3 yıl olan toplam 1299 hasta çalıflmaya dahil edildi. Bu hastalardan %51.9'u (n674) 65-74 yafl grubundaydı, %67.5'u (n877) hastaneden taburcu edildive %5.8'i (n75) yatıfl süreci içinde öldü. Acil serviste en sık konulan tanılar kardiyovasküler, gastrointestinal ve solunum hastalıklarıydı. Hastaneden taburcu olan ve hastane yatıflı sırasında ölenhasta grupları kıyaslandığında yafl açısından istatistiksel olarak anlamlı fark varken (p0.001), cinsiyet dağılımı (p0.259), hastane yatıfl süresi (p0.259) ve yoğun bakım ünitesi yatıfl süresi(p0.055) açısından fark tespit edilmedi. Sonuç: Yafllı nüfusunun ve genel nüfusa oranının artıflı ile birlikte yafllı hastaların acil servisbaflvuru sayısı artıyor ve gelecekte daha da artacaktır. Bu çalıflma, çalıflma merkezlerine baflvuranyafllı hastaların demografik özelliklerini ve klinik seyirlerinin sonuçlarını ortaya koymaktadır.Öğe Epidemiology of geriatric patients presenting to emergency departments in Europe: EGERS study(Lippincott Williams & Wilkins, 2023) Karamercan, Mehmet A.; Dundar, Defne Z.; Slagman, Ana; Ergin, Mehmet; Janssens, Kelly Ann C.; Fabbri, Andrea; Bjornsen, Lars P.Background and importancePatients aged 65 and above constitute a large and growing part of emergency department (ED) visits in western countries. ObjectiveThe primary aim of this European prospective study was to determine the epidemiologic characteristics of elderly patients presenting to EDs across Europe. Our secondary objective was to determine the hospitalization rate, characteristics, and in-hospital mortality rates of geriatric patients presenting to EDs. Design setting and participantsAn observational prospective cohort study over seven consecutive days between 19 October and 30 November 2020, in 36 EDs from nine European countries. Patients aged 65 years and older presenting to EDs with any complaint during a period of seven consecutive days were included. Outcome measuresData were collected on demographics, the major presenting complaint, the presenting vital signs, comorbidities, usual medication, and outcomes after the ED, including disposition, in-hospital outcome, and the final hospital diagnosis. The patients were stratified into three groups: old (65-74 years), older (75-84 years), and oldest age (>85 years). Main resultsA total of 5767 patients were included in the study. The median age of the patients was 77 (interquartile range: 71-84) years. The majority presented with a non-traumatic complaint (81%) and about 90% of the patients had at least one comorbid disease and were on chronic medication. An ED visit resulted in subsequent hospital admission in 51% of cases, with 9% of patients admitted to an intensive care unit. Overall in-hospital mortality was 8%, and ED mortality was 1%. Older age was associated with a higher female proportion, comorbidities, need for home care service, history of previous falls, admission rates, length of ED, and hospital stay. ConclusionThe characteristics of ED elderly patients and their subsequent hospital stay are reported in this prospective study.Öğe Evaluation of Patients' Families' Attitudes to Witnessing Invasive Procedures in the Emergency Department(Aves, 2013) Kurtoglu Celik, Gulhan; Keles, Ayfer; Demircan, Ahmet; Bildik, Fikret; Ilhan, Mustafa; Gunaydin, Gul Pamukcu; Ergin, MehmetObjective: The aim of this study was to evaluate patients' family members' attitudes to witnessing medical care and emergency procedures in an adult emergency department. Material and Methods: A prospective study was performed at a university emergency department (ED) in Turkey. A survey form with the face-to-face method was used. The relationship between the patients' family members' answers and their sociodemographic status was evaluated. Chi square test was used and p<0.05 was considered as statistically significant. Results: A total of 454 patients' family members were included in the study. Some 66.5% of them stated that their presence during invasive procedures could prevent physicians from providing optimal care and 13.4% of participants stated that being present by the patient's side improved the physician's performance. The question 'Is it the patient's right to have someone by his/her side?' drew positive answers from 87.9% of them. A statistically significant difference was found between the level of education and the desire to witness resuscitation (p=0.002). Conclusion: In this study we did in the emergency department, increasing number of family members request to witness invasive procedures on their patients. Family members also think witnessing procedures is a right of both patients and family members.Öğe An experimental comparative study on classic tube thoracostomy and thoracostomy with a newly designed thorax drainage catheter(2016) Dündar, Zerrin Defne; Tokur, Mahmut; Ergin, Mehmet; Okumuş, MehmetBackground/aim: The collection of fluids, blood, pus, or air in the pleural cavity is a pathological condition requiring pleural drainage. A newly designed thorax drainage catheter in the prototype phase was used in this experimental study to test its efficacy. Materials and methods: A hemopneumothorax was first caused by a penetrating injury on the frontal axis of the sixth intercostal space on the right hemithorax with a scalpel on 6 female Sus domesticus swine subjects. After resting for 5 min, a tube or catheter was inserted. The same procedure with a tube thoracostomy or thorax drainage catheter was repeated on the left hemithorax. The time periods were recorded. After all procedures were completed, the thoracic organs were assessed for iatrogenic injuries. Results: In terms of time elapsed for procedure, statistically significant differences between the tube thoracostomy and thorax drainage catheter applications were identified (P0.05). Additional iatrogenic injuries were nonexistent for both groups. During the thorax drainage catheter application, a surgical set or the use of sutures was not required. Conclusion: This study showed promising results regarding the efficacy of the thorax drainage catheter for convenient use in prehospital and hospital settings by physicians with little experience with tube thoracostomy.Öğe An Experimental Study: Does the Neuroprotective Effect Increase When Hypothermia Deepens After Traumatic Brain Injury?(Kowsar Publ, 2015) Girisgin, Abdullah Sadik; Kalkan, Erdal; Ergin, Mehmet; Keskin, Fatih; Dundar, Zerrin Defne; Kebapcioglu, Sedat; Kocak, SedatBackground: Experimental approaches have been promising with the use of therapeutic hypothermia after Traumatic Brain Injury (TBI) whereas clinical data have not supported its efficacy. Objectives: This study aimed to investigate whether using selective deeper brain cooling correlates with a more neuroprotective effect on Intracranial Pressure (ICP) increments following TBI in rats. Materials and Methods: Adult male Sprague-Dawley rats (mean weight = 300 g; n = 25) were subjected to brain injury using a modified Marmarou method. Immediately after the onset of TBI, rats were randomized into three groups. Selective brain cooling was applied around the head using ice packages. Intracranial Temperature (ICT) and ICP were continuously measured at 0, 30, 60, 120, and 180 minutes and recorded for all groups. Group 1 (n = 5) was normothermia and was assigned as the control group. Group 2 (n = 10) received moderate hypothermia with a target ICT of between 32 degrees C-33 degrees C and Group 3 (n = 10) was given a deeper hypothermia with a target ICT of below 32 degrees C. Results: All subjects reached the target ICT by the 30th minute of hypothermia induction. The ICT was significantly different in Group 2 compared to Group 1 only at the 120th minute (P = 0.017), while ICP was significantly lower starting from the 30th minute (P = 0.015). The ICT was significantly lower in Group 3 compared to Groups 1 and 2 starting from the 30th minute (P = 0.001 and P = 0.003, respectively). The ICP was significantly lower in Group 3 compared to Group 1 starting from 30th minute (P = 0.001); however, a significant difference in ICP between Group 3 and Group 2 was observed only at the 180th minute (P = 0.047). Conclusions: Results of this study indicate that selective brain cooling is an effective method of decreasing ICP in rats; however, the deeper hypothermia caused a greater decrease in ICP three hours after hypothermia induction.Öğe How successful is pleural sound sign in the identification of pneumothorax?(Kare Publ, 2019) Calik, Saniye Goknil; Calik, Mustafa; Girisgin, Sadik; Karaoglan, Osman; Dundar, Zerrin Defne; Ergin, MehmetOBJECTIVE: In the present study, in thorax ultrasonography (USG) Doppler images obtained from cases with occult pneumothorax, we investigated the status of pulsatile pleural sounds over the pleural line and called these as the pleural sound sign (PSS). The purpose of the present study was to identify the efficacy of the proposed PSS in diagnosing pneumothorax and to compare it with the other USG findings including the sliding lung sign (SLS) and seashore sign (SSS). METHODS: The present study included 66 consecutive patients who were referred to the emergency unit with a blunt trauma from October 2009 to January 2010 at a tertiary university hospital. RESULTS: Of the 66 patients, 34 were in the patient group, and 32 were in the control group. Males accounted for 66.7% (n=44) of the study population. In predicting pneumothorax, the areas under receiver operating characteristic (ROC) curves of PSSmax and PSSdifference were 0.989 and 0.990, respectively. While the sensitivity of the SLS was 88% and the sensitivity of the SSS was 56%, the specificities of the SLS and SSS were 100%. Based on our findings, accuracy ranking was as follows: PSSmax = PSSdifference > SLS > SSS. CONCLUSION: New applications of thorax USG are rapidly growing. Our findings have to be confirmed in a large patient series. PSS is not a novel method, but it enhanced the importance of USG in the diagnosis of pneumothorax. We can stipulate that it can replace thorax computed tomography imaging particularly for the diagnosis of occult pneumothoraxes.Öğe How successful is pleural sound sign in the identification of pneumothorax?(Kare Publ, 2019) Calik, Saniye Goknil; Calik, Mustafa; Girisgin, Sadik; Karaoglan, Osman; Dundar, Zerrin Defne; Ergin, MehmetOBJECTIVE: In the present study, in thorax ultrasonography (USG) Doppler images obtained from cases with occult pneumothorax, we investigated the status of pulsatile pleural sounds over the pleural line and called these as the pleural sound sign (PSS). The purpose of the present study was to identify the efficacy of the proposed PSS in diagnosing pneumothorax and to compare it with the other USG findings including the sliding lung sign (SLS) and seashore sign (SSS). METHODS: The present study included 66 consecutive patients who were referred to the emergency unit with a blunt trauma from October 2009 to January 2010 at a tertiary university hospital. RESULTS: Of the 66 patients, 34 were in the patient group, and 32 were in the control group. Males accounted for 66.7% (n=44) of the study population. In predicting pneumothorax, the areas under receiver operating characteristic (ROC) curves of PSSmax and PSSdifference were 0.989 and 0.990, respectively. While the sensitivity of the SLS was 88% and the sensitivity of the SSS was 56%, the specificities of the SLS and SSS were 100%. Based on our findings, accuracy ranking was as follows: PSSmax = PSSdifference > SLS > SSS. CONCLUSION: New applications of thorax USG are rapidly growing. Our findings have to be confirmed in a large patient series. PSS is not a novel method, but it enhanced the importance of USG in the diagnosis of pneumothorax. We can stipulate that it can replace thorax computed tomography imaging particularly for the diagnosis of occult pneumothoraxes.Öğe Is it possible to objectify the visual pain scale?(Professional Medical Publications, 2015) Ergin, Mehmet; Girisgin, Abdullah Sadik; Dundar, Zerrin Defne; Calik, Goknil Saniye; Ertas, Izzetin; Egici, Mehmet TaskinObjectives: To test our hypothesis that a new modified VAS (mVAS) is superior and more objective than VAS in evaluating pain perception and treatment response between genders who have renal colic pain. Methods: The individuals in patient and control groups were first asked to mark the pain perceived during access of IV line (VAS IV score). Then the patients with renal colic were asked to mark the pain they experienced before treatment (VAS RC score) and at 15 and 30 minutes after the administration of the first analgesic drug. The modified VAS scores (mVAS score) were obtained by subtracting the VAS IV score from VAS RC score. Results: When VAS was used, the female patients had significantly higher level of pain at 0, 15, and 30th minutes than men (p = 0.012, p = 0.001, and p = 0.003, respectively). However, there was not any significant difference at 0 and 30th min between sexes while female patients had significantly higher level of pain scores only at 15th minute according to mVAS scores (p = 0.027). Conclusion: We think that the mVAS is superior and more objective than VAS in evaluating pain perception and abolished the difference in the perceived level of pain due to gender.Öğe 'Lichtenberg Figure' as a Result of Lightning Shock(2014) Ergin, Mehmet; Önal, Mehmet Akif; Dikmetaş, Cesarettin; Cander, BaşarA 30 year-old-male was found unconscious while working outdoors. After completion of the initial evaluation, the Primary Health Care Center referred him to our emergency department. He couldn’t remember what had happened to him and he was complaining of chest and back pain. His vital signs were in the normal ranges, and his physical examination values were normal except for the skin findings. The findings in his ECG, complete blood count, other laboratory results and braincomputed tomography were in the normal ranges. Mainly six types of cutaneous findings occur as a result of being struck by lightning. They include linear burns, punctate burns, Lichtenberg figures (LF), contact burns from overlying metal objects, superficial erythema and their combinations. Moreover, entry and outlet holes of lightning strikes are rarely seen. The painless, hyperemic, spreading and ferning patern figure on the skin is called Lichtenberg figure (LF). It matches no anatomical, vascular, or neural patterns. Contrary to thermal and electrical burns, it is harmless to epidermis and deeper tissues. Although the exact mechanism is unknown, it is thought that they represent red blood cells extravasated into the superficial layers of the skin from capillaries secondary to the dielectric breakdown of the skin and subsequent massive electron shower. Our patient was admitted to the observation unit. The patient, who was on observation status for 48 hours, discharged from the hospital and recommended to attend the outpatient clinic. If a victim found unconscious outdoors, strike of lightning should be considered in the differential diagnosis. Pathognomonic skin findings should not be overlooked.Öğe 'Lichtenberg Figure' as a Result of Lightning Shock(Aves, 2014) Ergin, Mehmet; Onal, Mehmet Akif; Dikmetas, Cesarettin; Cander, Basar[Abstract Not Availabe]
