[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to evaluate the frequency of posttraumatic stress disorder (PTSD) among the participants of the Turkish Red Crescent Disaster Relief Team after the Tsunami in Asia.
The Clinician Administered PTSD Scale-1 (CAPS-1) was administered to 33 of 36 team members one month after their Disaster Relief Team duty. Along with the CAPS-1 interview, demographic features, profession, previous professional experience, previous experience with traumatic events and disasters also were recorded. To be classified as present, a symptom must have a frequency score of "1" and an intensity score of "2" at the CAPS-1 interview. For a diagnosis of PTSD, at least one re-experiencing, three avoidance and numbing, and two increased arousal symptoms should be present.
The PTSD was diagnosed in eight of the 33 (24.2%) participants. No significant difference was detected in the distribution of PTSD diagnosis according to gender, age, profession, professional experience, previous disaster experience, and/or previous experience of traumatic events. However, the severity of PTSD symptoms as measured by the CAPS-1 score was significantly higher in women, nurses, and participants with <3 previous disaster duty experiences.
Post-traumatic stress disorder is prevalent within disaster teams and healthcare workers, and measures should be taken to prevent PTSD within this group.
Prehospital and disaster medicine: the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation 06/2006; 21(3):168-72.
[Show abstract][Hide abstract] ABSTRACT: The aim of this prospective, randomised, double-blind study was to evaluate the efficacy of intramuscular (IM) tramadol 100 mg in emergency department treatment of acute migraine attack and to compare it with that of IM diclofenac sodium 75 mg. Forty patients who were admitted to our emergency department with acute migraine attack according to the International Headache Society criteria were included in the study. Patients were randomised to receive either tramadol 100 mg (n=20) or diclofenac sodium 75 mg (n=20) intramuscularly. Patients rated their pain on a four-point verbal scale (0=none, 1=mild, 2=moderate, 3=severe) at the beginning of the trial and at 30, 60, 90 and 120 min. At each time interval, severity of associated symptoms were also questioned and recorded. Global evaluation of the drugs by patients and doctors were also recorded. Patients were also asked if they would prefer the same injection in future visits. Any adverse events, whether related to the drug or not, were also recorded. Patients were followed up by telephone 48 h later to check for any headache recurrence. Two-hour pain response rate, which was the primary endpoint, was 80% for both tramadol and diclofenac groups. There were no statistically significant differences among groups in terms of 48-h pain response, rescue treatment, associated symptoms' response, headache recurrence and adverse event rates. Fifteen (75%) patients in the tramadol group and 16 (80%) patients in the diclofenac group stated that they may prefer the same agent for future admissions. In selected patients, tramadol 100 mg IM may be an effective and reliable alternative treatment choice in acute migraine attacks.
The Journal of Headache and Pain 07/2005; 6(3):143-8. · 2.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Acute poisonings are frequent causes of admission to emergency departments and these cases may have hazardous outcomes.
In the present study, medical records of 1818 poisoned patients admitted to Uludag University Medical School's Emergency Department between January 1996 and December 2001 were investigated. The age, sex, outcomes of the patients, and type of poisoning are described.
. The mean age for females (63% of the patients) was 27 years, whilst the mean age of male patients was 31 years. The major types of poisonings were ingestions of medications (59.6%), mushrooms (3.3%), corrosives (2.5%), organophosphates (3.2%), and methyl alcohol (0.4%). Carbon monoxide accounted for 6.9% of intoxications. Approximately 65% of the patients survived, while the methyl alcohol and corrosive ingestions led to the highest fatality averages (100% and 14.8%, respectively).
The demographic and diagnostic features of acute poisoning cases treated in our hospital are similar to those reported in the literature. Adults and women are in a high-risk group for acute poisonings and medicine poisoning, which is the most common type of poisoning.
[Show abstract][Hide abstract] ABSTRACT: We evaluated compliance with standard patient transfer protocols in a pre- and post-interventional study among patients transferred from other hospitals to our tertiary care university hospital.
In the first phase, transfer information was recorded on the arrival in 174 consecutive patients transferred to our emergency department (ED) over a 2-month period in 1999. Emergency caregivers throughout the province then received education about proper transfer procedures. This training was provided through monthly citywide co-ordination and co-operation meetings among the physicians of the emergency medical services (EMS) and the emergency departments of the hospitals in the city and the nearby counties. Fifteen months after the beginning of these educational efforts, the second observational phase was implemented. Over a period of 2 months in early 2001, information was recorded from 180 consecutive patients transferred to our ED. Presence of patient medical records, laboratory results, and X-rays; clearly delineated reason for transfer; prior notification of transfer; and appropriate care during transport from the initial facility were the parameters compared in the pre- and post-intervention periods.
Patients in phase-II were found to have had more appropriate care in some respects, such as presence of cervical collar and proper airway management, during transport from the initial facility than patients in phase-I (P < 0.05). However, other parameters were not significantly different between the two phases.
We have concluded that our monthly meetings and conferences have made a positive impact on compliance with some of the standard transfer protocols. We must however, continue our efforts to increase compliance with other aspects of standard patient transfer guidelines.
[Show abstract][Hide abstract] ABSTRACT: Aortic injuries can easily be missed in polytraumatized patients due to either associated injuries or vagueness of physical examination findings. Especially in young adults without associated injuries, relatively low atherosclerotic changes may limit the dissection of traumatic descending aortic injuries. We present a 34-year-old male patient who only had a complaint of back pain following a traffic accident. Upon detection of no abnormalities on plain X-ray films, he was discharged home with analgesics. One week later, he presented with dypsnea and dysphagia. Aortography showed rupture of the aorta and a pseudoaneurysm near the isthmus. Following surgical excision of the pseudoaneurysm and aortic repair with a Dacron graft interposition he was discharged with complete relief of symptoms. This case emphasizes the need for a high index of clinical suspicion in timely diagnosis and prompt treatment of traumatic aortic ruptures.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 02/2004; 10(1):57-9. · 0.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Descending necrotising mediastinitis rarely develops and this variety of mediastinitis is a highly lethal disease. A case is reported of descending necrotising mediastinitis caused by an odontogenic infection. The importance is emphasised of prompt diagnosis and aggressive surgical mediastinal drainage for the survival of these patients. Most acute mediastinal infections result from oesophageal perforation, either secondary to oesophagoscopy or tumour erosion. Mediastinitis occasionally develops as descending necrotising mediastinitis originating from the complications of cervical or odontogenic infections. Descending necrotising mediastinitis usually has a fulminant course, leading commonly to sepsis and death.
Emergency Medicine Journal 02/2004; 21(1):122-3. · 1.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Injury severity score (ISS), Glasgow coma score (GCS), and revised trauma score (RTS) are the most frequently used methods to evaluate the severity of injury in blunt trauma patients. ISS is too complicated to assess easily and GCS and RTS are easy to assess but somewhat subjective. White blood cell count (WBC) is an easy, quick and objective test. This study was performed to evaluate the significance of the WBC count at presentation in the blunt trauma patients.
713 blunt trauma patients, who were admitted to the Uludag University Medical Center Emergency Department between 01.04.2000-31.12.2000, were retrospectively evaluated in terms of ISS, GCS, RTS and white blood cell count at presentation.
Statistical analysis revealed that WBC was correlated positively with ISS, but negatively with GCS and RTS.
The leukocyte count at presentation can be used as an adjunct in the evaluation of the severity of injury in blunt trauma patients.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 05/2003; 9(2):111-3. · 0.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to analyze the victims of the Marmara earthquake who injured, especially had the crush syndrome. Our hospital received a total of 645 victims after the earthquake and admitted 330. Victims were classified into five different groups according to their diagnosis (crush syndrome, vital organ injury, vertebral and pelvic injuries, others and unknown) and their mortality rates were determined. Mortality was highest (21%) in the crush syndrome group. Second and third highest mortality were in the unknown (20%) and vital organ injury (20%) groups. The overall mortality rate was 8%. In conclusion the earthquake victims with crush syndrome and vital organ injury had the highest mortality and morbidity rates. Because of that so many departments (General Surgery, Emergency Medicine, Orthopedics Surgery, Plastic Surgery, Nephrology, Infection Disease etc.) had to be study in a great harmonious.
Ulusal travma dergisi = Turkish journal of trauma & emergency surgery: TJTES 11/2001; 7(4):262-6.
[Show abstract][Hide abstract] ABSTRACT: Emergency departments must comply with the rules of patient transportation. The aim of this study was to find out the compliance of the emergency departments in our region with patient transport the rules and regulations. 180 patients transported to our emergency department by an ambulance from another hospital, between 01.05.1999-01.07.1999 were analyzed. ACEP's (American College of Emergency Physicians) patient transportation rules were taken as a reference for comparison. Our findings have shown that the compliance to these rules is insufficient. Results of the study, will be presented to our colleagues working in the emergency departments in our region, in one of our monthly trauma meetings. State Department of health in the city, two state hospitals and Social Security hospitals in the region will also be informed about the results so that certain guidelines for better patient transportation can be established in the region.
Ulusal travma dergisi = Turkish journal of trauma & emergency surgery: TJTES 02/2001; 7(1):13-6.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine the effect of the institution in an in-hospital integrated approach to trauma on the mortality of severely injured patients in a university hospital in Turkey. We examined the effects of several risk factors, namely physiological parameters, anatomical findings, and the timeliness of therapeutic approaches, on the mortality of major trauma patients before and after the institution of integrated trauma care. The investigated risk factors were injury severity score (ISS), revised trauma score (RTS), anatomical localization of the injury, the type of injury, prehospital time, emergency room time, and referral from another hospital. TRISS (RTS, ISS, and age combination index) analysis was done for each patient and the M-, Z-, and W-statistics were calculated. Mortality in the low RTS and the penetrating injury groups decreased significantly. The overall mortality decreased from 32.5% to 23.3%. There were three unexpected survivors in the second period, but there were no unexpected survivors in the first period. Twenty-six of the first period and nine of the second period deaths were unexpected. A significant improvement was seen in the Z-statistics between the two periods. Z value increased from -2.47 to 0.55. In-hospital integrated approach to trauma made major improvements in the care of the patients with severe injuries, especially those with significant airway, ventilation and circulation problems.
European Journal of Emergency Medicine 10/2000; 7(3):183-8. · 1.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: The first step in dealing with a problem such as trauma is to identify the injury patterns and characteristics. Therefore, we aimed to demonstrate the current status of trauma admissions to a Level I trauma center in a major city of a developing country to be used as a model in establishing effective interventions for reducing injuries and their adverse