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  • Küçük Resim
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    Acil Serviste Kan Ürünü İstemlerinin Değerlendirilmesi: Prospektif Gözlemsel Bir Çalışma
    (2024) Özdamar, Yasemin; Demir, Mehmet Cihat; Ağaçkıran, İlter; Aksu, Nalan Metin
    Amaç: Acil servis kan ürünü istemleri artıyor, ancak aşırı olup olmadığı belirsizdir. Acil hekimleri tarafından yapılan kan ürünü istemlerini ve kullanım oranlarını inceleyerek kan ürünleri istemlerinin aşırı olup olmadığını tespit etmeyi amaçladık. Gereç ve Yöntem: Bu prospektif, gözlemsel ve tek merkezli çalışma, beş ay içinde üçüncü basamak bir yetişkin acil servisine başvuran 18 yaş ve üzeri hastaların demografik verilerini, kan transfüzyonu endikasyonlarını ve transfüzyon oranlarını incelemiştir. Bulgular: Bin dört yüz yetmiş beş kan ürünü istemi (hasta başına ortalama 6,92 ünite) incelendi. Bu istemlerin %63,1’i kullanılmadı. Transfüzyon oranları eritrosit süspansiyonu için %40,89, trombosit süspansiyonu için %25,61 ve taze donmuş plazma için %44,34 idi. Kan ürünleri istemenin ana endikasyonları gastrointestinal kanama ve anemiydi. Gastrointestinal kanaması olan hastalarda spesifik olarak eritrosit süspansiyonlarının %30,04’ü, trombosit süspansiyonlarının %31,9’u ve taze donmuş plazmaların %60,56’sı kullanıldı. Travma hastalarında istenen eritrosit süspansiyonlarının %12,75’i, trombosit süspansiyonlarının %0,083’ü ve taze donmuş plazmaların %13,89’u kullanıldı. Sonuç: Acil serviste kan ürünlerine yönelik aşırı istemler, kaynakların yanlış kullanılmasına neden olabilir. Transfüzyon komitesi, gereksiz istekleri azaltmak ve kaynak kullanımını optimize etmek için özel stratejiler geliştirmeli ve hekim farkındalığını arttırmalıdır.
  • Küçük Resim Yok
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    EMERGENCY MANAGEMENT AND NURSING CONSIDERATIONS OF CAROTID BLOWOUT SYNDROME
    (Elsevier Science Inc, 2024) Kudu, Emre; Ozdamar, Yasemin; Danis, Faruk; Demir, Mehmet C.; Ilhan, Bugra; Aksu, Nalan Metin
    Introduction: Carotid blowout syndrome is a rare but fatal complication often witnessed secondary to treating patients with head and neck cancer. It occurs when damage and necrosis lead to the carotid artery wall rupture. The symptoms encountered in these patients range from asymptomatic to cardiac arrest. Here, we present 5 cases of carotid blowout syndrome in the emergency department. Case Presentations: Patients demonstrated symptoms ranging from subtle bleeding to hemodynamic instability, highlighting the diverse nature of carotid blowout syndrome in this population. Notably, while all patients had a history of radiotherapy, some had additional risk factors for carotid blowout syndrome, including prior surgery (n = 2), malnutrition (n = 3), and tracheostomies (n = 2). Definitive diagnoses were established through clinical evaluation and computed tomography angiography. Immediate interventions included bleeding control, resuscitation, and consultations with relevant specialties. Four patients underwent interventional radiology procedures, and 1 patient received otolaryngology care. While 2 patients recovered completely, 1 died in the emergency department, and 1 in the intensive care unit. One patient's clinical course was complicated by a stroke. Conclusion: The approach to the carotid blowout syndrome patient includes complex steps that proceed in a multidisci- plinary manner, starting from triage until discharge. Emergency nurses play crucial roles at every stage. They should be aware of carotid blowout syndrome when evaluating patients with head and neck cancer presenting with bleeding. When treating these patients, emergency nurses should be ready for airway in- terventions, bleeding control, and massive transfusion protocol. In this context, the multifaceted approaches made by nurses contribute significantly to carotid blowout syndrome manage- ment in the emergency department.
  • Küçük Resim
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    NEDOCS: is it really useful for detecting emergency department overcrowding today?
    (Lippincott Williams & Wilkins, 2020) Ilhan, Bugra; Kunt, Mehmet Mahir; Damarsoy, Filiz Froohari; Demir, Mehmet Cihat; Aksu, Nalan Metin
    The Emergency Department (ED) overcrowding is an ongoing problem all over the world. The scoring systems are available for the detection of this problem. This study aims to test the applicability of the National Emergency Department Overcrowding Study (NEDOCS) scoring system, one of the scoring systems that evaluate the ED overcrowding. In this prospective observational study, the survey was applied on on-duty doctors, nurses, paramedics, intern doctors, and ward persons working in a University Adult Emergency Department and agreed to participate in the study, between certain hours during the day and the NEDOCS score was calculated simultaneously. The demographic characteristics of the on-duty staff, overcrowding of ED, and the number of the on-duty staff members were recorded in the questionnaires. During the study, 153 measurements were performed, and 3221 questionnaires were filled. The NEDOCS mean score was determined as 101.59 and the most reached result was extremely busy but not overcrowded (32%). The ED was rated mostly as busy (33.7%) by the on-duty staff. A significant difference was found between ED overcrowding and NEDOCS score. There is a significant difference between ED overcrowding and on-duty emergency nurse and intern doctor count. The NEDOCS score is not suitable for evaluating ED overcrowding. Accurate determination of the ED overcrowding is very important to avoid the negative consequences of the ED overcrowding. Increasing emergency nurse and intern doctor count will decrease ED overcrowding. Also, there is an urgent need to constitute local hospitals and also public health policies to satisfy the increasingly ED's presentations.