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Öğe Accidental Hypothermia and Transcranial Doppler Sonography: Case Report(Mary Ann Liebert, 2021) Bardakçı, Okan; Akdur, Gökhan; Akdur, Okhan; Daş, MuratWe present a patient who was diagnosed with hypothermia in the emergency department and the changes in bedside transcranial Doppler (TCD) measurements during and immediately after the diagnoses were recorded. To the best of our knowledge, this is the first case report in the literature in which TCD data were shared in an accidental hypothermia patient in the emergency department. A 78-year-old male patient was brought to the emergency department with the complaint of speech impairment. The respiratory rate was 24 bpm, pulse rate 40 bpm, body temperature 25.6 degrees C, blood pressure 80/50 mmHg, and glasgow coma scale 11. On electrocardiography, sinus bradycardia (40 bpm) and a small deflection (J wave) at the end of the QRS complex were observed. Immediately after the patient's admission, right middle cerebral artery end diastolic velocity (EDV) was 13.42 cm/s, peak systolic velocity (PSV) was 40.25 cm/s, and pulsatile index (PI) was 1.26 cm/s. After 1 hour, her body temperature was 34.5 degrees C. Measurements with TCD were repeated 1 hour later at the same point and EDV was found to be 26.12 cm/s, PSV 84.02 cm/s, and PI 1.33. At the fourth hour, the patient's body temperature was 36.4 degrees C, he was normothermic, and his mental status completely normalized. The patient was hospitalized for follow-up and treatment. This case supports that it can be used in the evaluation of cerebral perfusion and improvement during treatment in patients with accidental hypothermia in their admission to the emergency department.Öğe Acil Tip Stajını Alan Önhekimlerin Staj Öncesi ve Sonrası Meslekî Kaygılarının İncelenmesi (Çanakkale Onsekiz Mart Üniversitesi Örneği)(Tıp Eğitimini Geliştirme Derneği, 2021) Akman, Canan; Koşan, Ayşen Melek Aytuğ; Toraman, Çetin; Akdur, Gökhan; Akdur, OkhanAmaç: Bu araştırmanın amacı acil tıp stajını alan önhekimlerin, bu stajı almadan ve aldıktan sonraki mesleki kaygılarını karşılaştırarak, acil tıp staj eğitiminin önhekimlerin mesleki kaygılarında değişiklik yaratıp yaratmadığına dair fikir edinmektir.Gereç ve Yöntem: Araştırma izlem temelli bir araştırmadır. Araştırma, Türkiye’deki bir tıp fakültesinde öğrenim gören 83 önhekim ile yürütülmüştür. Önhekimlerin mesleki kaygıları “Acil Müdahale Hizmeti Sunan Personel Mesleki Kaygı Ölçeği” ile elde edilmiştir. Veriler, ilişkili örneklemler için t-test ile analiz edilmiştir.Bulgular: Önhekimlerin acil tıp stajını almadan önce en az kaygı yaşadıkları durumlar; “yaşım ilerledikçe fiziksel aktivitelerden dolayı mesleğimi verimli biçimde yapamamak”, “hizmet sunarken sakat kalma riski”, “sakat kalıp gelirimin düşmesi”, “çalışma arkadaşımın bilgi ve beceri yetersizliği”, “hasta nakil sırasında yaşanacak engeller (dar koridor vb.)” ve “müdahale ve nakil ekipmanlarının ergonomik olmaması”dır. Bu kaygılar staj sonunda da yaşanan en düşük kaygılar olarak belirlenmiştir. Önhekimlerin acil tıp stajını almadan önce en fazla kaygı yaşadıkları durumlar; “hizmet sunarken fiziksel şiddet görme olasılığı”, “hizmet sunarken sözel şiddet görme olasılığı”, “personel yetersizliği”, “hizmet sırasında karşılaştığım etik dışı davranışlar” ve “hasta ve hasta yakınlarının bize karşı önyargısı”dır. Araştırmanın sunduğu kayda değer bir bulgu, bu kaygıların acil tıp stajı alındıktan sonra da düşme eğilimi göstermemiş olmasıdır. Sonuç: Araştırmada önhekimlerin aldıkları acil tıp stajının onların yaşadıkları kaygılarda herhangi bir değişiklik yaratmadığı belirlenmiştir. Başka üniversitelerde önhekimlere uygulanan acil tıp stajı ile araştırmada geçen üniversitenin acil tıp stajının öğrencilerin yaşadığı kaygılara etkisi karşılaştırmalı olarak incelenmesi, uygulanan acil tıp staj programının gözden geçirilip, etkililiğinin incelenmesi, önhekimlerin acil vakalara müdahale konusunda yaşadıkları kaygıların nitel araştırmalar ile derinlemesine araştırılması önerilirÖğe Allergic contact dermatitis and periorbital oedema after permanent eyelash dye(Sciendo, 2024) Akdur, Okhan; Akdur, Gökhan; Bardakci, Okan; Das, MuratAllergic contact dermatitis is a rare cause of emergency room visits. However, it can progress to life-threatening conditions such as urticaria and angioedema. In this report, we describe a case that developed severe allergic contact dermatitis around the eye applying an eyelash dye containing p-Phenylenediamine. A 21-year-old female patient was admitted to the emergency department with the complaint of swelling and redness around both eyes. Swelling and redness started 3 days ago with permanent eyelash dye (containing p-Phenylenediamine) application in the beauty center. Clinically, periocular edema and rash was suspected to be an allergic reaction to a substance contained in the eyelash dye. For allergic contact dermatitis, 40 mg methylprednisolone, 45.5 mg pheniramine maleate, IV bolus was administered. The vesicular rash was thought to be a herpes lesion. She was discharged from the emergency department, with an initial dose of 16 mg methyl prednisolone (discontinued by reducing the dose), 500 mg oral valacyclovir twice a day, mupirocin cream on twice a day and oral levocetrizine 5 mg once daily. It was observed that the patient's lesions and redness regressed after 2 weeks. The effects of cosmetic products, which are the agents that come into contact with the skin most often, may differ individually. Agents included in cosmetic products, such as in our case, may cause severe contact dermatitis that requires treatment. Beauticians should also be informed about PPD. Patients who have had allergic reactions due to the use of PPD-containing dyes should use PPD-free cosmetic products. © 2024 Okhan Akdur et al., published by Sciendo.Öğe Diagnostic methods for carbon monoxide poisoning(Nova Science Publishers, Inc., 2023) Daş, Murat; Akdur, Okhan; Akdur, GökhanThe diagnosis of Carbon Monoxide (CO) poisoning consists of three elements: symptoms associated with carbon monoxide poisoning, exposure to CO, and an increase in COHb levels. The most common symptoms in people exposed to CO are non-specific complaints such as headache, nausea, vomiting, and dizziness. The most common environments that produce CO are counted as stoves or ovens using wood or coal as fuel, heaters using propane fuel, and building or forest fires. The COHb level is performed most accurately by co-oximetry blood gas analysis devices with samples obtained from arterial or venous blood samples. There is no correlation between Dechb level and clinical status. In victims with normal COHb levels, the diagnosis should be managed according to the complaints of exposure to CO and admission. © 2024 Nova Science Publishers, Inc. All rights reserved.Öğe Diagnostic utility of simple hematologic markers in acute gastroenteritis patients admitted to the emergency department(2020) Bardakçı, Okan; Daş, Murat; Akdur, Gökhan; Beyazit, YavuzThe contributions of hematologic parameters to the inflammatory response via different leukocyte and platelet pathways are well known. However, the diagnostic yield ofthese parameters in acute gastroenteritis (AGE) is not yet well understood. This study was planned to investigate the diagnostic value of simple hematological markers,including mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), platelet distribution width (PDW), and platelet-to-lymphocyteratio (PLR), in patients with AGE admitted to the emergency department. A total of 57 patients with AGE of either viral or bacterial origin and 69 age and sexmatchedcontrol subjects were studied. NLR, PLR, MPV, PDW, and RDW values in all patients were calculated and recorded from complete blood cell counts. A total of126 patients (57 men [45.2%] and 69 women [54.8%]) were included in the study. The mean NLR and PLR values of AGE patients were significantly higher than thoseof health controls (NLR = 4.44 ± 4.1 for AGE patients and 2.22 ± 1.2 for controls [P < 0.001]; PLR = 160.4 ± 102.4 for AGE patients and 113.8 ± 42.6 for controls [P =0.02]. ROC curve analysis suggested that the optimum NLR cut-off point for AGE was 2.08, with a sensitivity, specificity, PPV, and NPV of 70%, 65%, 62%, and 72%,respectively (AUC = 0.704). The optimum PLR cut-off point for AGE was 105.55, with sensitivity, specificity, PPV, and NPV of 71%, 50%, 54%, and 68%, respectively(AUC = 0.648). We demonstrated that NLR and PLR levels are elevated in AGE patients. Thus, NLR and PLR levels can be considered a valuable tool to differentiateacute gastroenteritis from other non-inflammatory emergent conditions.Öğe Evaluation of Medical Skills of Medical Faculty Final Year Students Who Received Emergency Medicine Internship(Tıp Eğitimini Geliştirme Derneği, 2023) Akman, Canan; Toraman, Çetin; Daş, Murat; Bardakcı, Okan; Akdur, Gökhan; Akdur, OkhanAim: The final year of medical school is the last period of students in transition to the profession. In the post-graduation period, they are ready to make clinical decisions and practice in the approach to the emergency patient. Emergency medicine includes acute diagnosis and treatment of diseases (physical and mental) and injuries in all age groups. This management includes knowledge and skills. In emergency medicine internship, students have the opportunity to evaluate patients from many different clinics. In the National Core Education Program (UCEP), the minimum qualifications that a person graduating from medical school should have are presented. In our faculty, medical skills (history taking, physical examination, interventional procedures) are specified together with the goals and objectives. In our study, it was aimed to compare the medical skills of the senior medical faculty students who received emergency medicine internship, along with the medical skills of the students who took the emergency medicine internship as an elective internship according to their field of interest, together with the basic skills aimed to be achieved by the use of UCEP in a university hospital. Methods: This descriptive study covers the 2021-2022 academic year at Çanakkale Onsekiz Mart University Faculty of Medicine. The study started after the approval of the ethics committee. The questionnaire was applied face-to-face to 123 senior students who took emergency medicine internship for the first time and 29 senior students who took emergency medicine internship again optionally according to their field of interest. Questions were asked about demographic information and the status of following, performing and performing basic medicine skills and practices determined by the UÇEP Results: 52.6% of the students who participated in the study answered the reason for choosing a medical faculty as "my ideal profession of medicine". While 87.5% of the students stated that they would like to work as a "specialist physician" after graduation, 70.4% of them stated that they were preparing for the medical specialty exam. During the 8-week practice period of the emergency medicine internship, senior students are on duty for 12 hours. They are in clinical applications such as patient preparation, diagnosis, treatment planning, vascular access, catheterization and suturing. In our study, 99.3% of them stated that they felt competent in performing electrocardiography (ECG), 14.5% in intubation, 32.9% in the proper transportation of a severed limb after trauma, and 44.7% in the ability to provide advanced cardiac life support. Compared with students who are interested in emergency medicine internship and choose emergency medicine internship again as an elective internship; The rate of intubation increased to 27.6% (p=0.009) and the rate of prescribing was 100% (p=0.024). The results are statistically significant. Conclusions: Emergency medicine internships taken by senior medical students contribute to their medical skillsÖğe Evaluation of the factors predicting the need for intensive care of patients with COVID-19 aged above 65 years: data from an emergency department in Turkey(Associacao Medica Brasileira, 2021) Akman, Canan; Daş, Murat; Bardakcı, Okan; Akdur, Gökhan; Akdur, OkhanOBJECTIVE: Individuals aged ≥65 years are more susceptible to COVID-19 disease and admission to intensive care is most notable. The scoring systems (national early warning score, quick sequential organ failure assessment, shock index) are recommended for rapid assessment of patients in emergency room conditions. The goal of our study is to evaluate scoring systems in conjunction with predictive factors of need for admission to intensive care of patients ≥65 years old with a diagnosis of COVID-19 who applied to the emergency room. METHODS: Patients were divided into two groups according to evolution in the emergency room, being those who needed or not intensive care. National Early Warning Score, quick sequential organ failure assessment, shock index scores and serum biochemistry, blood count and blood gas values were evaluated from hospital information management system records. RESULTS: Of the patients included in the study, 80.8% were admitted to the ward and 14.5% to the unit of intensive care. Lymphocyte count, base deficit and bicarbonate levels were lower, and the levels of C-reactive protein, lactate, D-dimer, urea and lactate dehydrogenase were higher in patients who needed intensive care. Quick sequential organ failure assessment and shock index were considered significant in the group admitted to the intensive care unit. CONCLUSIONS: We recommend that quick sequential organ failure assessment and shock index be used quickly, practically and easily in predicting the need for intensive care unit in patients aged ≥65 years in emergency department diagnosed with COVID-19.Öğe Injuries with Sea Creatures(Nova Science Publishers, Inc., 2022) Bardakçı, Okan; Akdur, Gökhan; Akdur, OkhanVenomous marine animals can be dangerous to swimmers, divers, and fishers. Most marine envenomations are not severe, and victims may delay seeking emergency care. These mild envenomations include weever fish, lionfish, starfish, and coral abrasions. Also, severe envenomation from stonefish, stingray, blue-ringed octopus, cone snail, and box jellyfish (Irukandji) can be life-threatening. Rapid treatment in these cases can increase survival rates and minimize systemic (anaphylaxis) and local complications (allergic response, infections, pain) by venoms. © 2022 by Nova Science Publishers, Inc.Öğe Prediction of mortality in COVID-19 through combing CT severity score with NEWS, qSOFA, or peripheral perfusion index(W.B. Saunders, 2021) Akdur, Gökhan; Daş, Murat; Bardakçı, Okan; Akman, Canan; Sıddıkoğlu, Duygu; Akdur, Okhan; Akçalı, Alper; Erbaş, Mesut; Reşorlu, Mustafa; Beyazıt, YavuzIntroduction: The assessment of disease severity and the prediction of clinical outcomes at early disease stages can contribute to decreased mortality in patients with Coronavirus disease 2019 (COVID-19). This study was conducted to develop and validate a multivariable risk prediction model for mortality with using a combination of computed tomography severity score (CT-SS), national early warning score (NEWS), and quick sequential (sepsis-related) organ failure assessment (qSOFA) in COVID-19 patients. Methods: We retrospectively collected medical data from 655 adult COVID-19 patients admitted to our hospital between July and November 2020. Data on demographics, clinical characteristics, and laboratory and radiological findings measured as part of standard care at admission were used to calculate NEWS, qSOFA score, CT-SS, peripheral perfusion index (PPI) and shock index (SI). Logistic regression and Cox proportional hazard models were used to predict mortality, which was our primary outcome. The predictive accuracy of distinct scoring systems was evaluated by the receiver-operating characteristic (ROC) curve analysis. Results: The median age was 50.0 years [333 males (50.8%), 322 females (49.2%)]. Higher NEWS and SI was associated with time-to-death within 90-days, whereas higher age, CT-SS and lower PPI were significantly associated with time-to-death within both 14 days and 90 days in the adjusted Cox regression model. The CT-SS predicted different mortality risk levels within each stratum of NEWS and qSOFA and improved the discrimination of mortality prediction models. Combining CT-SS with NEWS score yielded more accurate 14 days (DBA: −0.048, p = 0.002) and 90 days (DBA: −0.066, p < 0.001) mortality prediction. Conclusion: Combining severity tools such as CT-SS, NEWS and qSOFA improves the accuracy of predicting mortality in patients with COVID-19. Inclusion of these tools in decision strategies might provide early detection of high-risk groups, avoid delayed medical attention, and improve patient outcomes.Öğe Should computed tomography be the first choice in blunt chest trauma?(Nobelmedicus, 2018) Bardakçı, Okan; Akdur, Okhan; Karatağ, Ozan; Akdur, Gökhan; Alar, Timuçin; Beggi, HalilObjective: We aimed to determine whether thorax tomography, which can be chosen as the first imaging method in blunt thoracic injuries early for and accurate diagnosis, has superiority to chest radiography. Material and Method: Patients who referred to Emergency Service between January 1st, 2011 and December 31st, 2013 with blunt chest trauma were evaluated. The examination was performed retrospectively. Results: 131 (75.3%) of blunt chest trauma patients were male. The mean age of the cases was 44.7±19.1. When trauma mechanisms leading to chest trauma were discussed, the most common cause of trauma in-vehicle was traffic accidents in 63 (36.2%) cases. There were 40 patients (28.5%) with normal radiography and pathologic findings in chest computed tomography. It was seen that costa fractures were the pathologies which escaped the attention most commonly in radiography and detected in computed tomography imaging in 27 (67%) of 40 cases. Pathologies not seen in radiography were pneumothorax in 12 cases (30%), hemothorax in 9 cases (22.5%) and sternum fracture in 3 cases (7.5%). Discussion: In conclusion, it would be useful to use thorax tomography as the primary imaging, especially in blunt chest trauma in emergency care, to be able to intervene quickly. © 2018, Nobelmedicus. All rights reserved.
