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Öğe A fatal rabies case and experiences of a mass post exposure prophylaxis among healthcare workers(Akademiai Kiado ZRt., 2021) Şener, Alper; Akman, Canan; Akça, Anıl; Varışlı, BehcetWe aimed to monitor the adverse effects (AE) and efficacy of post exposure prophylaxis (PEP) in health care workers (HCWs) exposed to a rabies patient. In this study 109 HCWs and eight household contacts were PEP candidates. Contact persons without infection control precautions were in Group I (high risk-82 cases). HCWs indirectly exposed to environmental surfaces were classified in Group II (low risk-35 cases). PEP schedule was rabies vaccine (RBV) + equine rabies immunoglobulin (eRIG) in Group I and only RBV in Group II. Local and systemic AE were observed in all cases. Efficacy of post exposure prophylaxis (PEP) was determined by rabies development in a six month follow-up. 585 doses of RBV have been used in 117 cases and eRIG has been used in 82 cases. 32 Nurses (39%); 22 emergency medicine technicians (26.8%); 12 doctors (14%); six laboratory technicians (0.07%); six radiology technicians (0.07%); four cleaners (0.05%) were in Group I (82 cases), respectively. One doctor, laboratory technician, nurse and radiology technician (0.02%); two emergency medicine technicians (0.04%) and nine cleaners (25.7%) were in Group II (35 cases), respectively. Routes of transmission were blood in five (0.06%); saliva in 14 (17%); sweat in 50 (61%); CSF/serum in five (0.06%); sexual intercourse in one (0.01%); personal equipment in seven (0.09%) in Group I, respectively. Indirect contact was the only route in Group II. The most common local and systemic AE were seen in Group I; pain at injection side (19 cases) and fever (13 cases). Both of them showed statistically significant difference (P<0.05). Allergic rash has been seen at only one case. PEP failed in one case where the possible exposure way was sexual intercourse. PEP is the safest way to prevent rabies. Infection control precautions were still not enough applied. eRIGs are also safe and have rare AE.Öğe A RETROSPECTIVE ANALYSIS OF THE CAUSES OF SEVERE HYPONATREMIA IN THE PATIENTS AGED OVER 65 ADMITTED TO THE EMERGENCY DEPARTMENT(Gunes Kitabevi Ltd Sti, 2022) Akman, Canan; Cetin, MuratIntroduction: This study aimed to retrospectively analyze the data of patients older than 65 years and diagnosed with severe hyponatremia in the emergency department. Method: Patients >= 65 years and with severe hyponatremia (serum sodium levels <= 125 mEq/L) were included in the analyses. Results: Fifty-five patients were hypovolemic, 22 were normovolemic, and 23 were hypervolemic. 65.5% (n = 36), 59.1% (n = 13) and 60.9% (n = 14) of the groups were females (p > 0.05), and regarding comorbidities, 27.3%, 9.1%, and 4.3% of the groups were diagnosed with a malignancy, respectively (p = 0.031). Conclusions: Early diagnosis and treatment in the emergency department are critical considering the severity and prognosis of hyponatremia.Öğe Acil Servise Başvuran Hipertansif Hastalarda Serum Ürik Asit Düzeyleri(Kahramanmaraş Sütçü İmam Üniversitesi, 2022) Akman, Canan; Bakirdogen, SerkanAmaç: Hipertansif acil hastalarda serum ürik asit düzeylerinin önemi konusunda yapılan literatürde yeterli bilgi yoktur. Çalışmamız, yüksek tansiyon nedeniyle acil servise başvuran hastalarda serum ürik asit düzeylerinin rolünü araştırmayı amaçlamaktadır. Gereç ve yöntemler: Kan basıncı 180/110 mmHg ve üzerinde akut hedef organ hasarı olan hipertansif acil (grup I), kan basıncı 180/110 mmHg ve üzerinde olan akut hedef organ hasarı olmayan hipertansif acil hastalar (grup II) ve 140-180 mmHg arasında sistolik kan basıncı ve 90-110 mmHg arasında diyastolik kan basıncı olan kontrolsüz hipertansiyonu olan hastalar (grup III). Bulgular: Yüz yirmi dört hipertansif hasta (80 kadın, 44 erkek) dahil edildi. Grup I'de 33 (% 26.6), grup II'de 19 (% 15.3) ve grup III'te 72 (% 58.1) hasta yer aldı. Serum ürik asit düzeyi açısından karşılaştırıldığında gruplar arasında istatistiksel olarak anlamlı fark olduğu bulundu (p = 0,001). Grup I'deki hastaların ortalama serum ürik asit düzeyi diğer gruplara göre yüksekti (p <0.05). Sonuç: Acil servise yüksek tansiyon ile başvuran hastalarda serum ürik asit düzeyleri hipertansif acil durumu ayırt etmede önemli olabilirÖğe Acil Servise Başvuran Hipertansiyon Hastalarının Klinik Özellikleri ve Acil Servise Başvuru Sıklığını Etkileyen Faktörlerin İncelenmesi(2020) Akman, Canan; Akşit, ErcanGiriş ve Amaç: Acil servis doktorları yüksek kan basıncı nedeniyle acil servise başvuran hastalar ile sık olarakkarşılaşmaktadır. Bu çalışmanın amacı, acil servise başvuran hipertansiyon hastalarının klinik özelliklerini ve acilservise başvuru sıklığını etkileyen faktörleri incelemektir.Gereç ve Yöntemler: Bu çalışmaya hastanemiz acil servisine başvuran daha önce hipertansiyon tanısı olan 100gönüllü hasta alınmıştır. Araştırmanın veri toplama aşamasında yüz yüze görüşülerek anket uygulanmıştır.Bulgular: Hastaların %52’sinde 10 yıldan fazladır hipertansiyon mevcuttu. Hastaların %81’ine yaşam tarzı değişikliğihakkında bilgilendirme yapılmıştır. Hastaların sadece %32’sine acil durumda kullanması için ilaç reçete edilmiştir.Takipte olduğu doktor tarafından, hipertansiyonun uç organlarına zarar verebileceği hastaların yalnız %40’ınaanlatılmıştır. Son bir yıl içinde hipertansiyon nedeni ile iki veya daha fazla sayıda acil servise başvuran hasta oranı%57’dir.Sonuç: Bu çalışma hipertansiyon tanısı ile bir yıl içinde iki veya üstü sayı ile acil servise başvurunun olduğunugöstermektedir. Hipertansiyon hastalarına hastalıkları hakkında ayrıntılı bilgilendirme yapmak hastaların acil servisebaşvuru sıklıklarını azaltabilir.Öğe Acil Servise Özkıyım Girişimi Nedeniyle Başvuran Vakaların Retrospektif İncelenmesi(2024) Akman, Canan; Öksüz, Merve AtaçAmaç: Dünyada ve ülkemizde önemli bir psikososyal sorun olan özkıyım girişimleri, acilen önlem alınması gereken bir sorun olarak karşımıza çıkmaktadır. Bu nedenle çalışmada, Çanakkale ilinde bulunan bir hastanenin acil servisine özkıyım girişimi nedeni ile başvuran hastaların sosyodemografik ve bazı klinik özelliklerinin incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Bu çalışma, tek merkezli, gözlemsel ve retrospektif bir çalışmadır. Çalışmamızda 01.01.2013-31.12.2023 yılları arasında Çanakkale bulunan bir hastanenin yetişkin acil servis birimine özkıyım olgusuyla başvuran yetişkinlere ait veriler hastane otomasyon sistemi üzerinden taranarak geriye dönük olarak incelenmiştir. Bulgular: Acil servise 2013-2023 yılları arasında başvuran özkıyım girişiminde bulunan hastaların yaş ortalamasının 33.65 olduğu, %58.8’inin erkek, %52.4’ünün ise bekar olduğu görülmektedir. Başvuruda bulunan hastaların 69.4’üne konsültasyon istendiği, bu istemlerin ise en yüksek oranı %40.6 ile ruh sağlığı ve hastalıkları bölümüne ait olduğu belirlenmiştir. Başvuran hastaların %42.9’unun acil servise geliş saatinin 24:00-06:00 aralığında olduğu, %35.3’ü acil servise yaz ayları içerisinde başvurduğu görülmüştür. Acil servise özkıyım girişimi nedeniyle başvuran hastaların %24.7’si Keskin cisimle kendine zarar verme, %17.6’sı Kimyasallar ve zararlı maddelere maruz kalma ve kendine zarar verme tanısı ile başvurmuşlardır. Ayrıca hastaların geliş tanıları ile cinsiyetleri arasında anlamlı farklılık olduğu belirlenmiştir. Sonuç: Çalışmada özkıyım girişiminde bulunan hastalar arasında erkek cinsiyet oranı ve bekar olma oranın daha yüksek olduğu görülmüştür. Ayrıca çalışmada hastaların geliş tanıları ile cinsiyetleri arasında anlamlı farklılık olduğu belirlenmiştir.Öğe Acil Serviste Spontan Pnömotoraks Tanısı Alan Hastaların Demografik Verilerinin Retrospektif Olarak Değerlendirilmesi(2021) Akman, Canan; Çetin, MuratAmaç: Pnömotoraks, plevral boşlukta hava bulunmasıdır. Pnömotoraks tanılarının yarıdan fazlası herhangi bir travma durumu söz konusu olmadan ortaya çıkmaktadır. Bu durum spontan pnömotoraks (SP) adını almaktadır. Aynı zamanda pnömotoraks vakaları ile acil serviste sıkça karşılaşılmaktadır. Tanı ve tedavisinin anında hızlı olarak yapılması gereken ve önem taşıyan bir plevra hastalığı olarak karşımıza çıkmaktadır. Bu çalışmada acil servise başvuran SP hastalarının demografik özellikleri, risk faktörleri, klinik özellikleri, tanı ve tedavi yaklaşımlarının farkındalığının ortaya konulması amaçlanmıştır. Gereç ve Yöntemler: Ocak 2018-Haziran 2020 tarihleri arasında Çanakkale Onsekiz Mart Üniversitesi Tıp Fakültesi acil servisine başvuran SP tanısı alan hastalar retrospektif olarak tek merkezli incelenmiştir. Hastalarda yaş, cinsiyet, acil servise geliş şekilleri, şikayetleri, alta yatan hastalık durumları, sigara öyküsü, daha önce pnömotoraks şikayeti varlığı, nüks ve sayısı, fizik muayene bulguları, eşlik eden durumlar, tansiyon pnömotoraks varlığı, tüp torakostomi tedavisi ve tedavinin sonuçları belirlenmiştir. Bulgular: Acil servise başvurup SP tanısı alan 53 hasta çalışmaya dahil edildi. Hastaların %92,5 (n=49) erkektir. %92,5’ine (n=49) tüp torakostomi işlemi uygulanmıştır. Bu hastaların %84,9’u (n=45) göğüs cerrahi servisine, %11,3’ü (n=6) yoğun bakıma ve %2’si (n=3,8) dış merkeze sevk edilmiştir. Tedavinin sonuçlarına bakıldığında ise %88,7’si (n=47) spontan pnömotoraks hastası şifa ile taburcu edilmiştir. Sonuç: Spontan pnömotoraks zamanında müdahale edilmediğinde hayati tehlike oluşturabilecek bir klinik durumudur.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 Akut böbrek hasarı olan hastalarda serum düzeltilmiş ve iyonize kalsiyum seviyelerinin karşılaştırılması(2021) Akman, Canan; Bakirdogen, Serkan; Daş, Murat; Balcı, Serdal; Aykan, Okyanus NecdetGiriş: Hastaneye yatırılan hastalarda akut böbrek hasarı (ABH) sık olarak görülmektedir (%1,92). ABH’lı hastalarda serum düzeltilmiş ve iyonize kalsiyum düzeylerinin acil hemodiyalizi öngörmedeki etkisi bilinmemektedir. Bu çalışmada acil serviste ABH tanısı alan hastalarda serum düzeltilmiş ve iyonize kalsiyum düzeylerini karşılaştırmayı amaçladık. Yöntem: Çalışmamız retrospektif olarak planlandı. Grup 1: En az bir kez acil hemodiyaliz seansı alan ABH hastaları. Grup 2: Hemodiyalize girmeyen AKIN evre 1-3 olan hastalar. Hastaların başvuru anında serum düzeltilmiş ve iyonize kalsiyum, kreatinin ve albümin değerleri incelendi. Çalışmanın tüm verileri SPSS 19.0 ile kaydedildi. İstatistiksel anlamlılık için p <0,050 kabul edildi. Bulgular: Serum düzeltilmiş kalsiyum düzeylerinin ortalaması grup 1'de grup 2'ye göre daha düşüktü ve fark istatistiksel olarak anlamlıydı (p <0,001). Kan gazındaki ortalama iyonize kalsiyum seviyeleri grup 1'de grup 2'ye göre daha düşüktü ve fark istatistiksel olarak anlamlıydı (p = 0,002).Öğe Analysis of Emergency Department Presentations due to Injuries From Motor Vehicle Crashes and Pedestrian Strikes(Springernature, 2020) Akman, Canan; Kuru, TolgahanObjective The objective of this study was to analyze the causes and outcomes of presentations to the emergency department (ED) due to injuries from motor vehicle crashes and pedestrian strikes along several parameters. Methods Data from 798 patients who were injured due to motor vehicle crashes or pedestrian strikes that occurred in Canakkale Province were retrospectively analyzed. Patient demographic data such as age and gender, emergency service outcomes, and the consulted clinics were also recorded. Distributions of the crashes by weekdays or weekends, national and religious holidays, official holidays, and Ramadan month were comparatively analyzed. Results A total of 253 people injured in motor vehicle crashes and 395 people injured in pedestrian strikes were directly brought to the ED from the crash or strike scene. While 656 patients were discharged from the ED, 142 patients were referred to other clinics for surgery. A total of 538 crashes occurred on weekdays and 206 on weekends, and 54 crashes occurred during official and religious holidays. Most crashes occurred in summer, and the second most occurred in autumn. The rate of pedestrian strikes that occurred in summer and autumn was statistically significantly higher than the rate of injuries from motor vehicle crashes observed in the same seasons. The majority of the weekend crashes were caused by persons who had not consumed alcohol. Conclusion Traffic crashes occur more commonly among young men and in the summer season, while national, official, and religious holidays do not seem to play a role in the frequency of traffic crashes.Öğe Assessment of Awareness Levels About Anticoagulants in Patients With Atrial Fibrillation Presenting to Emergency Department(Springer, 2021) Akman, Canan; Kırılmaz, Bahadır; Balcı, Serdal; Akşit, Ercan; Yurtseven, Ersan; Duygu, AliAtrial fibrillation (AF) is a rhythm disorder observed mostly amongst adults. AF has been regarded as one of the most important medical problems because it leads to thromboembolism and paralysis risks. Although warfarin has been used in the past to cope with this health problem, new oral anticoagulant medicines have replaced it in the last few years. The new oral anticoagulants, namely, dabigatran etexilate, rivaroxaban, and apixaban, are currently being used in daily clinical practice and treatment guidelines. Since AF patients are supposed to receive long-term oral anticoagulant therapy, it is extremely important to provide them with accurate information and appropriate training regarding the treatment to decrease oncoming complications. This is a prospective study involving 168 patients who were admitted to the emergency department with AF and who were using oral anticoagulants. Findings indicate a lack of awareness in the patients regarding the effects and side effects of the drugs they take despite having been informed by the prescribing physician. We believe that informed action by patients with regard to the oral anticoagulants and their side effects will have an impact on the reduction in hospitalization observed. It will also make a substantial contribution to the quality of life of AF patients and to their use of medical services.Öğe Black Widow Spider Envenomation with Elevated Troponin I Levels(Aves, 2018) Das, Murat; Akdur, Okhan; Akman, Canan; Cetinkaya, YaseminIntroduction: The black widow spider is found worldwide. Alpha-latrotoxin is responsible for the toxic effects related to the spider bite. We report the case of a patient who presented at the emergency department after being bitten by a black widow spider that later developed increased cardiac enzymes. Case Report: The patient was a 24-year-old male who had been bitten by a black spider inside his shoe while he was working in the garden. The patient was referred to the emergency department of department of emergency medicine Canakkale Onsekiz Mart University Faculty of Training and Research Hospital with nausea, vomiting, and severe rigidity in the abdomen for the differential diagnosis of acute abdomen. With severe sweating, the patient had rales in the lower lung zones, and abdominal examination revealed diffuse abdominal guarding. Blood biochemistry revealed creatine kinase (CK): 1838 U/L, CKMb: 71.6 U/L, and troponin I: 0.14 ng/mL. In follow-ups, the troponin I levels increased to 3.01 ng/mL. Electrocardiography revealed normal sinus rhythm. He was followed with a bedside monitor for 3 days in the emergency department. When the patient's troponin I and CK levels decreased, at the end of the third day he was discharged.. Conclusion: Black widow envenomation should be followed for cardiac toxicity other than symptoms, such as muscle spasms, sweating, anxiety, and headache.Öğe Clinical, Demographic and Prognostic Evaluation of Patients Admitted the Emergency Department with Mushroom Poisoning(2023) Varışlı, Behçet; Yıldırım, Sinan; Akman, Canan; Ataç, Kenan; Çakır, OkanFungal intoxications can lead to a variety of conditions ranging from simple gastroenteritis to severe neurological manifestations, and even fatal liver and kidney failure. In this study, we aimed to evaluate the diagnosis, treatment, prognosis and demographic data of patients admitted to the emergency department due to fungal intoxication. The aim of this study was to conduct a retrospective evaluation of examination findings, laboratory investigations, duration of treatments, hospitalization rates, and mortality rates in patients admitted to our emergency department due to fungal intoxication between October 01, 2017 and October 01, 2018. Of the 40 patients included in the study, 25 (62.5%) were female, with a mean age of 44.83 ± 17.00 years and a range of 18 to 82 years. Nausea and vomiting had the highest frequency (28 patients) among the presenting complaints of the patients. Only 11 (27.5%) patients underwent gastric lavage and decontamination with activated charcoal, whereas 29 (72.5%) patients had no gastric decontamination. The highest frequency of admissions was recorded in November. The highest frequency of patient admissions was between 01:00 and 02:00. It was concluded that there was a low rate of the administration of gastric decontamination in patients admitted to the emergency department, especially those admitted to the ward. In our study, the majority of patients with fungal intoxication had early-onset mild symptoms. Particular attention should be paid to early diagnosis and adherence to appropriate treatment algorithms in emergency departments, particularly in patients presenting with late-onset symptoms that may result in mortality.Öğe DEVELOPMENT OF PRE-HOSPITAL EMERGENCY HEALTH SERVICES APPROACH SCALE TO TRAUMA PATIENTS(Paramedik Eğitiminde Standardizasyon ve Akreditasyon Derneği, 2022) Çebi, Gamze Ekrem; Akman, CananObjective: It is the development of a measurement tool that measures the level of approach of pre-hospital emergency health care workers to trauma patients in a valid and reliable way.Materials and Methods: The research was structured in a descriptive approach. The research group is pre-hospital emergency health care workers. Since participation in the research is on a voluntary basis, the sample in the research can be evaluated in the context of purposeful sampling. In order to collect data, a candidate measurement tool form with 27 questions was created. SPSS 26.0 and AMOS statistical software were used in the analysis of the data. Explanatory factor analysis, reliability analysis and confirmatory factor analysis were performed. A sample application was made with the developed scale and comparison analyzes were made between the scale scores of the participants and their demographic variables.Results: As a result of the analyzes, it was determined that the scale was a single factored 11-item scale. This structure was confirmed by confirmatory factor analysis. The reliability value of the scale was determined as 0.923. In the sample application, the awareness of trauma was found to be higher in the employees who received training on trauma and followed the developments and new publications.Conclusion: It was concluded that the developed scale measures the approaches of emergency health care workers to trauma cases in a valid and reliable way. For a better trauma approach, module trainings should be given to employees as soon as possible and updates should be made periodicallyÖğe Diagnostic and Prognostic Roles of Procalcitonin and Other Tools in Community-Acquired Pneumonia: A Narrative Review(Multidisciplinary Digital Publishing Institute (MDPI), 2023) Özbay, Sedat; Ayan, Mustafa; Özsoy, Orhan; Akman, Canan; Karcıoğlu, ÖzgürCommunity-acquired pneumonia (CAP) is among the most common causes of death and one of the leading healthcare concerns worldwide. It can evolve into sepsis and septic shock, which have a high mortality rate, especially in critical patients and comorbidities. The definitions of sepsis were revised in the last decade as “life-threatening organ dysfunction caused by a dysregulated host response to infection”. Procalcitonin (PCT), C-reactive protein (CRP), and complete blood count, including white blood cells, are among the most commonly analyzed sepsis-specific biomarkers also used in pneumonia in a broad range of studies. It appears to be a reliable diagnostic tool to expedite care of these patients with severe infections in the acute setting. PCT was found to be superior to most other acute phase reactants and indicators, including CRP as a predictor of pneumonia, bacteremia, sepsis, and poor outcome, although conflicting results exist. In addition, PCT use is beneficial to judge timing for the cessation of antibiotic treatment in most severe infectious states. The clinicians should be aware of strengths and weaknesses of known and potential biomarkers in expedient recognition and management of severe infections. This manuscript is intended to present an overview of the definitions, complications, and outcomes of CAP and sepsis in adults, with special regard to PCT and other important markers.Öğe Diagnostic utility of microhematuria in renal colic patients in emergency medicine: correlation with findings from multidetector computed tomography(2019) Daş, Murat; Bardakçı, Okan; Yurtseven, Ersan; Akman, Canan; Beyazit, Yavuz; Akdur, OkhanAlthough urine analysis is a simple and inexpensive method for the initial evaluation of renal colic patients presenting in emergency departments, it is regarded as unreliable for an exact diagnosis of urinary system stones. The aim of the present study is to assess the association between clinical demographics, and stone size and location, with the combined utility of urinalysis and unenhanced multidetector computed tomography (MDCT) in the emergency department. After gaining local Ethics Committee approval, a retrospective study was conducted with data from 186 patients who presented at our emergency service with flank pain and documented urolithiasis. Stone location and size was determined by MDCT, and the presence of microhematuria confirmed by urinalysis. The presence of hydronephrosis and clinical complaints were also recorded. A total of 186 patients were included in the present study, in which an absence of microhematuria was recorded in 24.7% patients. Urine density was found to be elevated in the microhematuria group (p=0.001). Upper urinary tract stones and hydronephrosis were found to be associated with the presence of microhematuria. Although statistically insignificant, an increased trend of microhematuria was observed with stones over 5 mm in size. Urinary stone size and location are directly associated with the incidence of microhematuria. Absence of microhematuria does not preclude MDCT imaging, however, especially in cases where stones are suspected in patients with renal colic.Öğe Efficacy and Safety Analysis of Botox Application and Iatrogenic Botulism: Panacea or Peril?(Bentham Science Publ Ltd, 2024) Karcioglu, Ozgur; Akman, Canan; Atnis, IlknurClostridium botulinum toxin-A (BoNT-A) creates temporary paralysis in the muscles by acting on the muscle-nerve junction. It is injected into the mimic muscles when a decrease in the movements of the mimic muscles is desired. Despite many favorable applications, the use of BoNT-A is not without drawbacks. Although there is no expected serious side effect on health in BoNT-A treatments, various problems can be encountered in patients treated for aesthetic purposes. Botulism is a rare but potentially life-threatening syndrome, which is caused by the toxin produced by the bacterium Clostridium botulinum, which acts on the nervous system, vegetative forms of C. botulinum can only survive in anaerobic conditions, while spore forms are common in nature and can withstand harsh conditions. Botulism can stem from bacterial spores which release toxin in the body; in the form of enteric botulism, and wound botulism. The cases that develop 'iatrogenic botulism' after such procedures are usually those receiving high-dose toxin for therapeutic purposes. The treatment of botulism mainly consists of anti-toxin therapy and, if necessary, intensive care to prevent organ failures, including respiratory support. This article aims to cover all these issues related to botulism and other adverse outcomes related to BoNT-A injection in light of the most recent literature.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 patients admitted to the emergency department with headache and undergoing neuroimaging(Bayrakol Medical Publishing, 2021) Akman, Canan; Erbil, Bülent; Topçuoglu, Mehmet Akif; Karaca, Mehmet Ali; Akpınar, Erhan; Özmen, Mehmet MahirAim: It is of great importance to differentiate the primary or secondary causes of headaches in the intensity of emergency services. The underlying causes of secondary headaches can be caused by neurological causes and may have a mortal course. In this study, it was aimed to determine red flags in neuroimaging for life-threatening secondary causes of patients who applied to the emergency department with headache complaints and underwent brain imaging.Material and Methods: Our study was planned retrospectively and descriptively. Patients who presented to the 3rd step emergency department with headache within 10 years were included. Demographic characteristics, disease history and information, imaging information and results of the patients were recorded.Results: In this study, the mean age of 704 patients was 48.9 (17-92) years, 62.8% of whom were female, and 99.6% of the patients presented to the de-partment within the first 24 hours after headache. Their cranial CT scans identified intracranial pathologies in 19.2% (n=139) of the patients. Intracranial pathologies were detected in 27.5% who experienced the most severe headache in their life, in 31.7% who had a sudden headache, in 52.9% who had focal neurological deficits, in 23.8% who were older than 50 years old, and in other headache reasons.Discussion: In the study on the elimination of secondary headaches in the emergency room, we concluded that having the most severe headache ever, sudden onset, neurological deficit, and being over 50 years of age are warning criteria. Although brain CT scans are generally used in clinically suspicious situations, MRI should also be used for mortality and morbidity in these patients.Öğe Evaluation of Patients Presenting to the Emergency Department with Suicidal Drug Poisoning(Fazile Nur Ekinci Akdemir, 2023) Varışlı, Behçet; Akman, Canan; Yıldırım, Sinan; Ataç, Kenan; Çakır, OkanIntroduction: Drug intoxications may be associated with accidental or suicidal ingestion of toxic agents. In both cases, emergency treatment includes administration of the relevant antidote and gastric decontamination. If necessary, patients are followed up in wards and intensive care units, whereas a group of patients are discharged directly from the emergency department. Materials and Methods: The aim of this study was to conduct a retrospective evaluation of examination findings, laboratory investigations, duration of treatments, psychiatric follow-up studies, hospitalization rates and mortality rates in patients admitted to our emergency department due to drug intoxication between 2017 and 2018. Results: Of the 126 patients included in our study, 83 were female, with a mean age of 33.58 ± 13.58 years and a range of 18 to 92 years. Of all patients, 76 were hospitalized in the ward and 1 in the intensive care unit, while 49 were treated in the emergency department. One patient had mortality on the eighth day of hospitalization. Eighty-six patients had been on psychiatric treatment prior to admission, whereas 82 patients were referred to the psychiatry department after admission. The rate of psychiatric consultation was significantly higher in patients who were hospitalized in any department due to drug intoxication than in patients who were discharged directly from the emergency department (p <0.001). Conclusion: Drug intoxications continue to be a growing problem for physicians working in emergency departments in Turkey as well as in the world. The incidence of drug intoxications was higher in patients who had previously applied to psychiatry outpatient clinics than those who had not. Our study highlighted the shortcomings of physicians in emergency departments in referring this patient group to the psychiatry department. There is a duty for health professionals in emergency departments to direct patients to receive adequate psychosocial support.Öğe 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.
