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Öğe A Scientometric Analysis of Mechanical Cardiopulmonary Resuscitiation Device Publications(Düzce Üniversitesi, 2024) Ağaçkıran, İlter; Günay, Serkan; Ağaçkıran, Merve; Demir, Mehmet Cihat; Yürekli, Ümit Can; Komut, Seval; Öztürk, AhmetAim: Today, the use of automatic chest compression devices is increasing. The aim of this study is to identify popular publications about chest compression devices, save time for researchers, and summarize the important points of chest compression devices using the scientometric analysis method.Material and Methods: All data were collected using the Web of Science Core Collection between July 1-8, 2023. Articles related to the topic were selected using the keywords "automated chest compression device" or "mechanical chest compression device". All articles in the database were manually scanned and analyzed. The distribution of relevant articles in the database was analysed according to scientific journals. Global research productivity, international collaborations, and research themes were analyzed using the scientometric method.Results: A total of 589 articles were identified in the WoS. Out of these, 439 (74.407%) were original articles, followed by 63 (10.678%) review articles and 30 (5.085%) editorial materials. When examining the distribution of research articles by country, the United States (US) topped the list with 171 articles, followed by Germany (n=77). Although the UK ranked third in terms of the number of publications with 53 articles, it ranked first in terms of the number of citations. (n=3465). An assessment of the top 20 publishing journals revealed that the Resuscitation Journal led in terms of publication count (n=133), citation count (n=5906), and average citations per publication (n=44.41). Conclusion: Our bibliometric study analyzed 589 articles on mechanical cardiopulmonary resuscitation. This can help researchers identify trending topics and areas of interest more quickly. More research is needed to fully understand the effectiveness and best tools for saving lives in emergency situations.Öğe Acil Servis Hastalarında Serum Ürik Asit Düzeyi ve İnme İlişkisinin Değerlendirilmesi(Düzce Üniversitesi, 2024) Şengüldür, Erdinç; Demir, Mehmet CihatAmaç: İnme, sakatlık ve ölümlerin önde gelen nedenlerinden biridir. İnme yönetiminde klinik ve görüntüleme yöntemleri yaygın olarak kullanılırken, serum ürik asit (SUA) düzeyi gibi biyokimyasal parametreler büyük ölçüde göz ardı edilmektedir. Bu çalışmada, yüksek veya düşük SUA düzeyleri ile hem iskemik hem de hemorajik inme arasındaki ilişkinin incelenmesi amaçlanmıştır.Gereç ve Yöntemler: Bu çalışma retrospektif, tek merkezli gözlemsel bir çalışmadır. Çalışmaya 1 Ocak 2023 ile 31 Aralık 2023 tarihleri arasında acil servisten nöroloji ve/veya beyin cerrahisine konsülte edilen tüm ardışık hastalar dahil edilmiştir. Hastaların verileri hastane bilgisayar sisteminden ve acil servis kayıtlarından elde edilmiştir. ?2,8 mg/dL olan SUA düzeyleri hipoürisemiyi gösterirken, ?7 mg/dL olması hiperürisemi olarak kabul edildi.Bulgular: Çalışmaya toplam 1186 yetişkin hasta dahil edildi. Bunların 484'ünün inme tanısı aldığı, 394'ünün iskemik inme, 90'ının ise hemorajik inme olduğu görüldü. İnme hastalarının medyan SUA düzeyleri daha yüksekti (pÖğe Acil Serviste Kan Ürünü İstemlerinin Değerlendirilmesi: Prospektif Gözlemsel Bir Çalışma(2024) Özdamar, Yasemin; Demir, Mehmet Cihat; Ağaçkıran, İlter; Aksu, Nalan MetinAmaç: 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.Öğe Acute Systemic Toxicity Associated with Ingestion of Juniper Tar(Emergency Medicine Physicians Assoc Turkey, 2023) Ozdamar, Yasemin; Demir, Mehmet CihatJuniper Tar has been utilized in traditional folk medicine to treat various ailments. Despite its historical use, documented cases are scarce regarding the potential complications associated with Juniper Tar, some of which have been fatal. A 62-year-old male patient with no previous medical history presented to the emergency department complaining of confusion and respiratory distress after drinking a glass of Juniper Tar approximately four hours ago. The patient, who experienced multiple seizures and cardiac arrest at the emergency department, was discharged after an 11-day intensive care unit monitoring period. We present this case to raise awareness among emergency physicians about Juniper Tar, which is widely used for various purposes in folk medicine and cosmetics but can cause poisoning due to its content of essential oils, triterpenes, and phenols. This is a case of cardiac arrest and status epilepticus associated with juniper tar poisoning.Öğe Analysis of 12-lead electrocardiograms shared on Twitter(Rabia YILMAZ, 2022) Sultanoğlu, Hasan; Boğan, Mustafa; Demir, Mehmet Cihat; Sultanoğlu, Tuba ErdemIntroduction: A large number of electrocardiograms (ECG) are shared on Twitter every day. Some of them aim to provide information to the readers, and some of them aim to provide training with a mini quiz. This study aimed to discuss the evaluability of ECG images shared on Twitter. Methods: The study sample consisted of 12-lead ECG images shared on Twitter. ECG images shared on 08/01/2020 - 01/31/2021 were manually scanned. Results: A total of 286 tweets matching the criteria were included in the study on the specified dates. The majority of them (n = 231. 80.5%) asked the reader about the ECG. The average number of the tweets' interactions was 70.42 ± 112.17, and the interaction was mainly in the form of "likes" (50.49 ± 80.64). 83.5% of ECGs had a rhythm strip. Total interaction numbers and other parameters were compared. ECGs from which small squares could be selected collected more interactions (p = 0.015). ECGs explained the case or whose diagnosis was clearly stated collected more interactions (p <0.001). Also, it was observed that ECGs without a rhythm strip contained more interaction (p <0.001). Conclusions: We concluded that 12-derivation ECGs shared on Twitter are highly evaluable. There was also a moderate correlation between the number of followers and the number of interactions. For this reason, it is important for accounts with a high number of followers to following that are experts in their field to prevent information pollution.Öğe An Aortic Abscess Associated with Psoas Abscess: A Case Report(Emergency Medicine Physicians Assoc Turkey, 2023) Selki, Kudret; Demir, Mehmet Cihat; Bogan, MustafaIn this article, we report a case in which a psoas abscess opened into the aneurysmatic abdominal aorta, and abscess formation was observed in the aortic lumen containing a stent. A 57-year-old male patient presented to the emergency department with a complaint of abdominal pain. During the abdominal examination of the patient, tenderness and defense were detected in the right lower quadrant. Contrast-enhanced computed tomography (CT) angiography of the abdominal aorta was ordered because the patient had a history of previous stenting and right lower quadrant deficiency. In the right iliopsoas muscle, there was an increase in size suggestive of abscess formation with air densities. The diameter of the ascending aorta was 44 mm. At the level of the descending thoracic aortic bifurcation, an aneurysmatic appearance was noted in a segment of approximately 140 mm extending to the proximities of both main iliac arteries, and USG showed air in the wall in the aneurysmatic section and mural wall thickening with thrombus. In this case, although the abscess eroded the aneurysmatic aortic wall, acute bleeding did not develop due to the presence of a stent. We wanted to share the rare image on computed tomography (massive air-fluid level around the stent in the aortic lumen), especially in our case with the medical literature.Öğe Assessment of Patients Transferred from the Emergency Department to Home by Ambulance(Emergency Medicine Physicians Assoc Turkey, 2021) Sultanoğlu, Hasan; Boğan, Mustafa; Akpınar, Güleser; Demir, Mehmet CihatAim: 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 prehospital ambulance services is full, it lacks patients in need of post-hospital ambulance services. Since it is the first study on this subject, it aims to guide 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 an emergency treatment. Standardization should be developed by carrying out studies on this subject.Öğe Clozapine related Ogilvie syndrome with fatal outcome(Pensiero Scientifico Editor, 2020) Akkas, Meltem; Demir, Mehmet CihatBackground. Clozapine, an antipsychotic medication, can ordinarily cause gastrointestinal hypomotility, but clozapine-related Ogilvie Syndrome (colonic pseudo-obstruction) has been reported rarely. Case Report. A 29-year-old male was admitted to the emergency department (ED) with complaints of vomiting, abdominal pain, and distension lasting for a day. He was on clozapine therapy due to schizophrenia. An abdominal-CT scan revealed dilation from the cecum to the ileum and he was diagnosed with Ogilvie syndrome. During the observation period in the ED, respiratory distress, hypotension, and alteration in consciousness were observed, and the patient was intubated electively. Arterial blood gas showed primary metabolic acidosis, with a normal anion gap with full respiratory compensation. In the control CT scan there was no visible perforation but distension persisted; the cecum diameter was 93 mm and the colonic wall was thickened. After the CT scan, the patient went into cardiac arrest and died 13 hours after his admission. In this case, excessive colonic dilatation, high WBC, and lactate levels and increased thickness of the colon wall suggest sepsis due to intestinal ischemia. Conclusions. Clozapine-related gastrointestinal hypomotility (CRGH) is not a trivial symptom. It can cause Ogilvie syndrome, which can be fatal due to complications. In the current clozapine prescription content, information on CRGH is insufficient. Higher levels of suspicion, lower diagnostic thresholds in the case of mental and psychiatric patients may prevent delays in diagnosis and treatment and result in lower mortality.Öğe Emergency Department Neurosurgical Consultations in a Tertiary Care Hospital(Duzce Univ, Fac Medicine, 2023) Senguldur, Erdinc; Selki, Kudret; Tuncer, Cengiz; Demir, Mehmet CihatObjective: To reveal the characteristics of patients in need of neurosurgery by examining neurosurgery consultations within the emergency department (ED) admissions of a tertiary academic hospital.Methods: This is a retrospective, single-centre observational study. Patients admitted to the ED between 01.01.2022 -31.12.2022 and consulted to the neurosurgery department were identified through the hospital computer system and included in the study. The demographic information of the patients, mode of admission to the ED, the reasons for admission, the time of admission, the number of brain computed tomography (CT) scans, whether they underwent surgery or not, and the mortality results were recorded.Results: A total of 441 neurosurgery consultations were examined. Fall 35.6% (n=157) and traffic accident 16.6% (n=73) were the most common reasons for consultation. It was observed that 92.5% (n=408) of the patients had a brain CT scan, and 19.5% (n=86) had two or more brain CTs. It was determined that 12.7% (n=56) of the patients consulted to neurosurgery were operated on, and 4.1% (n=18) of the patients' hospital admissions resulted in death. Only 53.7% (n=237) of the patients who underwent neurosurgery consultation were discharged from the ED. It was determined that significantly more Neurosurgery consultations were requested during working hours (p = 0.013).Conclusions: Most consultation calls from the ED to neurosurgery are for trauma patients. Brain CT examination is frequently used in neurosurgical patient evaluation. As a result of the consultations, almost half of the patients are hospitalized. Emergency physicians can select patients who need neurosurgery well.Öğe Emergency Medicine Physicians' Approaches to Coping with Stress in COVID-19 Pandemic(Emergency Medicine Physicians Assoc Turkey, 2021) Demir, Mehmet Cihat; Ataman, Ali KaanAim: 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 an 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.Öğe Evaluation of trailer attached-two wheel tractor (Pat- pat) accident - related pediatric injuries in Turkey's western black sea region(2021) Akpinar, Gulseren; Demir, Mehmet CihatTraumatic injuries related to agricultural production can lead to serious illness, disability, and even death. Pediatric injuries due to trailer attached-two wheel tractor (Patpat)accidents occupy a scarce place in the literature. To contribute to the literature, we aimed to evaluate the demographic characteristics and analysis of pediatric injuriesdue to a Pat-pat accident admitted to our emergency department in the last decade. The study data were obtained by retrospectively examining patients younger than 18years of age admitted to the Emergency Medicine Clinic between 01/01/2010 and 31/12/2019 with injuries due to Pat-pat accident. Demographic characteristics, injurysites, injury types, hospitalization status, length of hospital stay, injury severity score (ISS), and mortality status were recorded. Due to the Pat-pat accident, 32 childrenapplied to the hospital. The male/Female ratio was 25/7. The median age of pediatric patients ranging from 9 to 18 years was 17 years. When evaluated according to theinjury areas, extremity injuries were the most common. Admissions were most frequently in the summer season (n=21, 65.6%) and in July (n=13, 40.6%). These caseswere admitted mostly on Tuesday (n=8, 25.0%) and between 16:00 and 23:59 (n=22, 68.8%). According to the ISS, 20 of the patients had a mild injury (ISS?3), 3 had amoderate injury (4? ISS ?8), and 9 had a severe injury (ISS?9). To prevent accidents, the public should be made aware of this issue, and the authorities should be morecareful in making the necessary administrative decisions and in implementation. For young agricultural workers, it should be an obligation to ensure proper education andjob security. Pat-pat, which is not well known but often used in rural agricultural areas of the Western Black Sea region, can have dangerous consequences for children.Children should be kept away from such unsafe vehicles.Öğe Examination of Emergency Ophthalmologic Consultations in Terms of Urgency, Ophthalmic Pathology, and the Weekend Effect(2021) Demir, Mehmet Cihat; Boğan, Mustafa; Akçam, Hanife Tuba; Sultanoğlu, Hasan; Özdamar, Yasemin; Ağaçkıran, İlterObjective: To evaluate the urgency of ophthalmologyconsultations in the emergency department (ED) and thepresence of ophthalmic pathology. This study also aimedto determine whether the weekend phenomenon affectedemergency ophthalmologic consultation requests.Materials and Methods: Ophthalmology consultationsrequested by the emergency physician for patients whovisited the ED of a tertiary care hospital in Turkey fromJanuary to December 2019 were retrospectively investigated. Consultation requests were grouped as possibleemergent, unlikely to be emergent, and undetermined.Results: A total of 256 eligible patients were included.The top three reasons for ophthalmologic consultationswere blunt trauma (29.7%), foreign body (24.2%), andconjunctivitis (13.3%). 70.3% of the consultations werecategorized as a possible emergent, 18.4% as unlikely tobe emergent, and 11.3% undetermined. Most of the possible emergent consultations had ophthalmic pathology(p=0.001).Conclusion: Traumatic injuries are the most commoncause of ophthalmology consultation in the ED. Approximately one-fifth of patients are unlikely to be emergent.Early ophthalmology evaluation is required in possibleemergent category patients. The weekend effect does notinfluence ophthalmology consultations. Establishing eyeemergency services or having an available ophthalmologist is crucial in the emergency diagnosis and treatment ofpatients who require special practice skills.Öğe Investigation of the Effect of Leaky Gut on COVID-19 Clinic(2022) İnce, Nevin; Kayabaşı, Eda; Demir, Mehmet Cihat; Cangür, Şengül; Keskin, Banu Hümeyra; Öztürk, C. Elif; Kaya, SareAim: In the course of the COVID-19 pandemic, in millions of cases were observed those of some patients do not exhibit any symptoms whereas some others are hospitalized with having fatal outcomes. One of the most significant findings is that patients with existing comorbidities are extremely exposed to severe clinical conditions developed due to excessive inflammatory response. That is to say, the indicative cause of chronic inflammation may be bacterial translocation derived from the impaired intestinal mucosal barriers. This study is aimed to investigate the probable relations between the impaired intestinal barrier integrity and which would be associated with severity of COVID-19 clinical conditions. Material and Methods: According to the clinical and laboratory findings, the patients were classified into three groups as mild, moderate, and severe clinical conditions. All patients’ blood samples were collected on the first admission to the hospital. Serum concentrations of lipopolysaccharide-binding protein (LBP), were analyzed to evaluate the intestinal barrier function and bacterial translocation. Results: The proportions of those with high LBP levels among all the groups were significantly different (p<0.001). The proportion of the patients with high LBP levels in the mild patient group (65.4%) was significantly lower than those with moderate (100%) and with severe clinical conditions (95.2%) (p<0.05 for each). Conclusion: In recent years, it has been clearly demonstrated that the functions of the intestines are much more than the digestive function, and that the intestinal microbiota and mucosal barrier integrity have a great impact on the immune system. These results would indicate that the impaired intestinal barrier integrity and bacterial translocation might be effective in severe COVID-19 development.Öğe Investigation of Vitamin B12 Deficiency in Patients with Acute Coronary Syndrome and its Relationship with Gensini Score(Clin Lab Publ, 2022) Polat, Esra; Demir, Mehmet Cihat; Küçükdemirci, ÖmerBackground: Vitamin B12 deficiency is not an independent risk factor for cardiovascular disease. However, anemia due to vitamin B12 deficiency and also hyperhomocysteinemia are among the cardiovascular risk factors. The study aimed to determine the frequency of vitamin B12 deficiency in patients with acute coronary syndrome. We also aimed to ascertain whether there is a significant difference between obstructive coronary artery disease presence and its severity in patients with and without vitamin B12 deficiency using the Gensini score. Methods: Patients who underwent coronary angiography due to acute coronary syndrome between June 1, 2018, and November 30, 2019, and whose vitamin B12 levels were measured were retrospectively analyzed. Coronary angiography results of the patients were evaluated with the Gensini scoring system. Results: Anemia was observed in 32.6% (n = 135) of the patients who underwent coronary angiography with a diagnosis of acute coronary syndrome, and vitamin B12 deficiency was observed in 14.7% (n = 61). The median age was 69 years in anemic patients and 68 years in those with Vitamin B12 deficiency and was significantly higher than patients without anemia and vitamin B12 deficiency (p < 0.001 and p = 0.038, respectively). There was no statistically significant differences between the patients' Gensini scores with or without Vitamin B12 deficiency (p = 0.554). Conclusions: We concluded that anemia and vitamin B12 deficiency were higher in elderly patients with acute coronary syndrome. We found no significant difference when the Gensini score was used to evaluate obstructive coronary artery disease presence and its severity according to anemia and vitamin B12 deficiency. Investigating vitamin B12 levels in elderly patients with acute coronary syndrome should not be ignored.Öğe Knowledge of Local Anesthetic Systemic Toxicity among Emergency Medicine Physicians: A Cross-Sectional Study(Mre Press, 2020) Ilhan, Bugra; Demir, Mehmet CihatBackground: Local anesthetics (LAs) are widely used in medical practice. The prevalence of LAs used has attracted attention with increasing reports of toxicity. To our knowledge, there is no study that surveyed emergency medicine physicians (EMPs) about local anesthetic systemic toxicity (LAST). We aimed to assess EMPs' knowledge and awareness of LAST. Methods: This was a cross-sectional questionnaire-based study. EMPs working in the emergency department of a variety of hospitals (university, training and research, public, private) in Turkey participated in the study via e-mail. EMPs who did not use LAs and residents were excluded. The questionnaire was sent to physicians via e-mail, and responses were analyzed. Results: A total of 178 EMPs participated in the study and 20.8% and 22.5% of respondents recognized all the symptoms and treatment options of LAST respectively. About 4% had no knowledge on intravenous lipid emulsion (ILE) treatment, 41.6% used ILE treatment, and 42.1% were correct in the treatment dose of ILE. A significant correlation was found between the type of hospital and related training and the correct response of the ILE dose. Participants working at a university hospital had significantly higher correct answers (58.3%) on the treatment dose of ILE, but the correlation was weak (r: 0.165). Conclusion: Although LAST might have high mortality and morbidity in emergency patients, the level of EMPs' knowledge and awareness of LAST is poor. The current training about LAs should be increased and standardized. EMPs should be encouraged to use ILE if indicated.Öğe Local Anesthetic Systemic Toxicity Knowledge of Emergency Medicine Residents: A Cross-Sectional Study(2020) İlhan, Bugra; Demir, Mehmet CihatObjective: Local anesthetics (LAs) are starting to be used after the discovery ofcocaine, which is used in medical practice. Now LAs are used many procedures in manyclinics, especially in emergency departments (EDs). The extensive use of LAs wasbrought side effects and toxicity. Local anesthetic systemic toxicity (LAST) have beenreported from simple allergic conditions to cardiovascular and neurologicalcomplications that can be fatal. The study aims to evaluate the level of knowledge andawareness of LAST among emergency medicine residents (EMRs).Methods: This was a questionnaire-based cross-sectional study. The questionnaireswere sent to EMRs via e-mail, and responses were collected. The participants who gaveinformed consent included in the study, and who didn’t use LAs in their daily practicewere excluded. All of the participants responded all of the questions and responses wereanalyzed.Results: 92 EMRs were included in the study. The median age of the participants was29 (24-50) years, and 48.9% were women. In the research, no one could recognize allLAST symptoms, ranging from mild to severe. Only 16.3% of the participants answeredall treatment options of the LAST correctly, and 27.2% knew the intravenous lipidemulsion dosage accurately.Conclusions: The level of knowledge and awareness of the EMRs on LAST wereinsufficient. EMRs training rates on LAs and LAST were found to be low. In addition, itwas stated that the patient's informed consent was not appropriately obtained from thevast majority of patients undergoing LA procedure. As the first study on LAST amongEMRs, we believe that necessary arrangements should be made regarding the detecteddeficienciesÖğe Mantar Zehirlenmesiyle Acil Servise Başvuran Hastaların Karakteristik Özellikleri ve Laboratuvar Parametrelerinin Prognoz Tayininde Rolü(2023) Şengüldür, Erdinç; Demir, Mehmet Cihat; Baydın, AhmetAmaç: Bu çalışmada acil servise mantar yeme sonrası gelişen zehirlenme tablosu ile başvuran hastaların genel karakteristiklerinin araştırılması ve olası prognostic faktörlerin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Bu çalışma Samsun, Türkiye’deki bir üniversite hastanesi acil servisine 6 yıl içerisinde mantar zehirlenmesi ile başvuran 18 yaş ve üzerindeki hastaların kayıtlarının geriye dönük olarak incelenmesi ile yapıldı. Çalışmada mortalite öngördürücü ve zehirlenme ciddiyetini gösteren modeller kullanılarak hastalar gruplandırıldı. Son dönem karaciğer hastalığı için model (MELD) skorlaması ve zehirlenme şiddet skoru (PSS) bu amaçla kullanıldı. Bu çalışmaya ait elde edilen tüm veriler Statistical Package for Social Sciences (SPSS) for Windows 15.0 paket programı kullanılarak analiz edildi. Bulgular: Mantar zehirlenmesi ile acil servise başvuran 471 hastadan 16 tanesinde karaciğer yetmezliği geliştiği saptandı. Karaciğer yetmezliği gelişmeyen 455 hastada semptom başlangıç süresinin ortalama 2 saat olduğu, karaciğer yetmezliği gelişen 16 hastada ise semptom başlangıç süresinin ortalama 9,5 saat olduğu saptandı. Mantar zehirlenmeli hastalar PSS’sine göre sınıflandırıldığında, hastalarımızın %91,1’i PSS 1 olarak acil servise başvurmuş iken, %2,1’i ise şiddetli semptomlarla acil servise başvurmuştu. Mantar zehirlenmesiyle gelen hastaların %93,6’sı MELD skoru hafif olan hastalardı. Sonuç: Mantar intoksikasyonu olgularında en sık klinik bulgu bulantı ve kusmadır. Mantar intoksikasyonu hastalarında semptomların 2 saat içerisinde ortaya çıkması iyi prognoz göstergesidir. MELD skoruna göre Bun değeri yükseldikçe hastalık ciddiyeti de artmaktadır. Aynı zamanda BUN ve amilaz değeri yüksekliği PSS’ye göre hayatı tehdit edici bir zehirlenme açısından hekimi uyarıcı roldedir.Öğe 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 MetinThe 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.Öğe ntravenous Diltiazem or Metoprolol Administration in the Emergency Department for Acute Rate Control of Atrial Fibrillation Patients with Rapid Ventricular Response with Unknown Ejection Fraction(2021) Demir, Mehmet Cihat; Doğan, Muharrem; Polat, Esra; Akpinar, Gulserenim: Atrial fibrillation (AF) is the most widespread persistent cardiac arrhythmia in adults.There is no standard procedure applied in AF patients with rapid ventricular response withunknown ejection fraction (EF) in the emergency department. This study aimed to comparethe effectiveness and side effects of diltiazem and metoprolol treatments without knowing theEF in AF patients with rapid ventricular response in the emergency department.Material and Methods: Patients with a ventricular response ?110/min were selected as havingAF with rapid ventricular response. The patients first received 25 mg intravenous diltiazem asa rate control drug were compared with those first received 5 mg metoprolol. A total of 50patients whose EF were not registered before the admission date and was measured after beingconsulted for cardiology following acute rate control in emergency department were includedin this study.Results: For the first drug treatment, diltiazem was given to 56% (n=28) of the patients andmetoprolol to 44% (n=22). Moreover, 44% (n=22) of the patients needed a second druginfusion. The proportion of patients received diltiazem in those with preserved EF wassignificantly higher than those with reduced EF (p=0.032). No statistically significantdifference was found between the rates of needing a second administration based on the EF(p=0.157).Conclusion: Diltiazem was found to reduce heart rate earlier than metoprolol. While updatingthe guidelines for drug selection in acute rate control of AF with rapid ventricular response,rural emergency departments, where EF measurement cannot be achieved, should also beconsidered.Öğe Pain management in ST-segment elevation myocardial infarction: an observational analysis(MediHealth Academy Yayıncılık, 2022) Polat, Esra; Yüce, Elif İlkay; Dondurmacı, Engin; Demir, Mehmet CihatAim: ST-segment elevation myocardial infarction (STEMI) is one of the most severe forms of pain. However, the guidelines give quite a few places for pain control in STEMI and, do not offer strong recommendations on this issue. This study aimed to reveal which medications are given to STEMI patients for pain control until they arrive at the catheter laboratory, in which situations they are used, and the frequency of use. Material and Method: A total of 272 consecutive STEMI patients were prospectively collected. Medications were administered to the patients until they arrived at the angiography laboratory; vital signs, comorbidities, referral status, infarction types, the time between the onset of pain and the admission to the emergency department, and the door-balloon time were also noted. The patients’ pain characteristics and intensity were evaluated. Results: It was observed that 96.3% of the patients presented with chest pain. The pain of diabetic patients was severe according to the visual analog scale (VAS) score (p=0.023). It was witnessed that 9.92% of the patients were administered drugs for analgesic purposes. The most commonly administered medication was paracetamol. It was noticed that morphine was used frequently after paracetamol. Medication administration for analgesia was more common in referred patients (p=0.040). Conclusion: Physicians behave timidly in their clinical practice in pain control of STEMI and move away from the guideline. In terms of comfort and hemodynamic stabilization of the patients, it will be beneficial for the applications in the field to give more place to the treatments for pain control in the guidelines.
