Journal of Academic Emergency Medicine Case Reports最新文献

{"title":"Determination of the Level of Emergency Medicine Resident Physicians to Recognize the Electrocardiography Findings","authors":"A. Ahmedali, A. Şener, H. S. Kavakli, Gülhan Kurtoğlu Çelik, F. Icme, Yavuz Otal, A. Kahraman, Y. Sezgin","doi":"10.5152/JAEM.2014.16769","DOIUrl":"https://doi.org/10.5152/JAEM.2014.16769","url":null,"abstract":"Objective: The aim of this study is to determine the accuracy and reliability of the interpretation of electrocardiography (ECG) findings by emergency medicine resident physicians (EMPs) and to provide training recommendations in line with emerging deficiencies. Material and Methods: This research depended on the data from a questionnaire that we conducted among EMPs in Ankara. The survey included multiple-choice questions, selected through conceived cases presented in major textbooks or congresses. EMP ECG assessment levels were compared according to the duration of residency education and the presence of ECG education. The data were evaluated by using the Statistical Package for Social Sciences 17.0 (SPSS Inc., Chicago, IL, USA). Results: A total of 112 volunteers participated. Mean age was 29.6±4.4; also, 47 were female and 65 were male. When all of the questions were taken into account, the mean number of total correct answers was higher for those who had received ECG training than who had not received it, those who underwent more training than those who underwent less training, and those whose duration of assistantship was longer than those whose duration was shorter. Conclusion: The results of our study revealed that the evaluation of ECG is improved by increasing clinical knowledge and training. Depending on these results, we suggest that effective and practical ECG courses and training programs should be organized for EMPs. (JAEM 2014; 13: 108-11)","PeriodicalId":14780,"journal":{"name":"Journal of Academic Emergency Medicine Case Reports","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91321659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Emergency Medicine Residents' Level of Knowledge of Arterial Blood Gases","authors":"I. Ertok, Gülhan Kurtoğlu Çelik, H. S. Kavakli, N. Doğan, F. Icme, Sinan Becel, A. Ahmedali","doi":"10.5152/JAEM.2014.74830","DOIUrl":"https://doi.org/10.5152/JAEM.2014.74830","url":null,"abstract":"Objective: Our purpose in this study was to determine the accuracy and reliability of interpretation of basic arterial blood gas (ABG) values and ABG values related to metabolic and respiratory disease by emergency medicine residents (EMRs). We also aimed to determine their deficiencies and create a basis for training during patient care. Material and Methods: This study was carried out through a survey taken by EMRs in training/research and university hospitals located in Ankara. The levels of knowledge of EMRs on ABG evaluation were compared based on the institution, duration of residency, and training. A 14-question test about ABG knowledge was also applied to residents. Results: The study was conducted with 25 EMRs in university hospitals (UH) and 88 EMRs in training/research hospitals (TRH); a total of 113 residents participated to the survey. There was no statistical significant difference between training/research and university hospitals according to the number of correct answers given. Year of residency did not affect the number of correct answers; however, residents who had training on ABG analysis in the residency period had more correct answers. Also, in a small study group (n=17), a significant improvement of the number of correct answers was observed with a short institutional course. Conclusion: According to the results, ABG evaluation improves with personal training in the residency period independently of residency years. Based on this result, training should be given in and out of institutions, and EMRs should be encouraged to personally study ABG evaluation. (JAEM 2014; 13: 100-3)","PeriodicalId":14780,"journal":{"name":"Journal of Academic Emergency Medicine Case Reports","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89476644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electricity, Heart and ST-Segment Elevation: A Closer Look","authors":"S. Duyuler, A. Çoner, P. Bayır","doi":"10.5152/JAEM.2014.78736","DOIUrl":"https://doi.org/10.5152/JAEM.2014.78736","url":null,"abstract":"Dear Editor,We read with great interest the article by Uyanik et al., entitled “Delayed ST-Segment Elevation Due to Electrical Injury Mimicking Acute Myocardial Infarction,” which was published recently in this journal. This case report was mentioning a young patient admitted with late-onset chest pain and ST-segment elevation following ele-ctrical injury (1). Although the case was presented precisely, some points merit further highlighting.Abnormal electrocardiography (ECG) may be found in approxi-mately 31% of patients following an electric shock (2). Non-specific ST-segment changes and sinus tachycardia are the most commonly reported ECG findings; QT prolongation, bundle branch block, atrial and ventricular fibrillation, and atrial and ventricular premature con-tractions are also detected. As referred to in this case report, ST-seg-ment elevation with or without myocardial involvement may follow electrical injury.In a clinical setting, ST-segment elevation on ECG may be related with many conditions, such as myocardial infarction, early repolariza -tion, electrolyte imbalance, and pericarditis. In this case, myocardial infarction may easily be excluded, since cardiac biomarkers are nor-mal and ST elevation is not consistent with myocardial infarction. In this case, ECG shows diffuse and concave ST elevation (elevated at the J point) with the exception of V1 and aVR. In acute myocardial infarction, ST elevation is also accompanied by reciprocal ST depres-sions. In the case of early repolarization, ST elevation is most often present in the mid- to lateral chest leads (V3-V6), and the majority of subjects with early repolarization has no ST deviations in the limb leads. So, early repolarization would be excluded in this patient, who has pronounced ST elevation on D2, D3, and aVF.Zeana describes a 65-year-old electrocuted subject who experi-enced precordial pain, serous enzymes of negative myocardial necro -sis, and ST elevation during 2 weeks of hospitalization (3). These fin-dings suggest the possibility of widespread pericardial involvement. In the case presented by Uyanik et al., pericardial involvement seems to be the most possible cause of ST changes in the admission ECG. This ECG shows us sinus bradycardia with diffuse concave ST elevati-on except for V1 and aVR. ST depression in V1 and aVR is also a typical finding for acute pericarditis. Late-onset chest pain also supports this condition. However, addition of a follow-up ECG of the patient to the report would be more valuable for confirmation of this diagnosis. In our opinion, pericarditis deserves discussion as a possible diagnosis in the aforementioned case.","PeriodicalId":14780,"journal":{"name":"Journal of Academic Emergency Medicine Case Reports","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83663065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Analysis of Nasal Fractures in the Emergency Clinic","authors":"M. Akdağ, R. Dursun, A. Gül, S. Hattapoğlu, F. Meriç, İ. Topçu","doi":"10.5152/JAEM.2014.266","DOIUrl":"https://doi.org/10.5152/JAEM.2014.266","url":null,"abstract":"Objective: The aim of this study is to analyze the demographic and diagnostic characteristics of patients presenting to the emergency clinic with nasal trauma. Material and Methods: Data analysis was performed with imaging tests on the files of 77 patients presented to the emergency clinic between 2012 and 2013. Results: In order of prevalence, nasal fractures were caused by falls from heights, violence, trauma, sports injuries and traffic accidents. Physical examination findings in patients with nasal fracture were sensitivity, nose swelling, nasal mucosal hemorrhage and septal deviation. Fracture was also determined at physical examination in 26 (86.6%) of the 30 patients with fracture detected at tomography. In the analysis, approximately 26% were multiple depressed fractures, while linear fracture along a single line was determined in 31%, with fissure-type fracture in the remaining 43%. Pathologies such as septal edema or hemorrhage were present in 30 of the 77 patients, while the septum was mobile and dislocated in approximately 16 of these patients (33.7%). Conclusion: Falls from heights were the most common cause in patients with nasal fracture, and although the most common imaging technique employed was x-ray, tomography provided more detailed information concerning rhinorrhea, smell perception disorders, maxillofacial traumas and multiple nasal fractures. (JAEM 2014; 13: 139-42)","PeriodicalId":14780,"journal":{"name":"Journal of Academic Emergency Medicine Case Reports","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86676222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominal Aorta Injury due to Lumbar Disc Hernia Operation: A Case Report","authors":"Erhan Hafız, M. Geyik, V. Sarıçiçek, H. Deniz, Meliha Hafiz, M. Aşam","doi":"10.5152/JAEM.2014.195","DOIUrl":"https://doi.org/10.5152/JAEM.2014.195","url":null,"abstract":"During lumbar disc hernia operations, large intra-abdominal injuries may develop, even though they are rare. Massive bleeding and hypotension are precursors of this complication, which often has a mortal prognosis. In this circumstance, emergent operation should be performed by laparotomy. We present a case in whom an abdominal aortic injury developed during lumbar disc surgery. (JAEM 2014; 13: 149-50)","PeriodicalId":14780,"journal":{"name":"Journal of Academic Emergency Medicine Case Reports","volume":"161 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83995338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation of Accuracy of FAST Findings of Multitrauma Patients in Comparison with Abdominal CT Results","authors":"Y. Demir, S. Akay, S. Yolcu, Ali Savas Miran, Tugba Cicek Durak, I. Parlak","doi":"10.5152/JAEM.2014.70037","DOIUrl":"https://doi.org/10.5152/JAEM.2014.70037","url":null,"abstract":"Objective: In our study, we aimed to investigate the accuracy of Focused Assessment Sonography for Trauma (FAST) findings of multitrauma patients in com parison with abdominal CT results. Material and Methods: Age, gender, demographic properties, trauma type, arrival method to the emergency service, abdominal USG results, abdominal CT results, results of other CT scans, hospitalization data, and hemoglobin (Hb) and white blood cell count (WBC) values of the patients were recorded. Results: One hundred eighty (79.6%) males and 46 (20.4%) females (total 226 patients) were included to our study. Mean age was 38.74±17.18; 203 (89.8%) patients were traffic accidents, and 23 (10.2%) patients were falls from heights. The sensitivity of FAST was 50% and specificity was 93.7%. The positive predictive value (PPV) was 60 and negative predictive value was 90.8%. Conclusion: Multiple trauma patients with positive USG findings according to their hemodynamic situations and multitrauma patients with suspicious USG findings should undergo abdominal CT scan in the emergency service. (JAEM 2014; 13: 104-7)","PeriodicalId":14780,"journal":{"name":"Journal of Academic Emergency Medicine Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76853691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Significance of Ischemia-Modified Albumin, S100b, and Neuron-Specific Enolase in Acute Ischemic Stroke","authors":"V. Çakmak, A. Gunduz, Yunus Karaca, Z. Ali̇oğlu, A. Menteşe, M. Topbaş","doi":"10.5152/JAEM.2014.37980","DOIUrl":"https://doi.org/10.5152/JAEM.2014.37980","url":null,"abstract":"Objective: Use of biochemical markers of cerebral ischemia is a newly favored approach for early diagnosis of ischemic stroke. Our aim was to establish the sensitivity and specificity of ischemia-modified albumin (IMA) in acute ischemic stroke and to compare it with S100b and neuron-specific enolase (NSE). We also intended to investigate the usefulness of a panel composed of these three biomarkers in acute ischemic stroke. Material and Methods: Consecutive adult patients who were admitted to the emergency department with focal neurological deficits were enrolled. Serum samples were obtained at the initial examination, and IMA, S100b, and NSE were measured. Receiver operating characteristics (ROC) curve analysis was used to determine the cut-off values of the biomarker and biomarker groups. Results: Serum IMA, NSE, and S100b levels were significantly higher in ischemic stroke patients (p<0.001, p=0.005, p=0.001, respectively). The optimum diag nostic cutoff point for IMA was 0.31 ABSU with 90% sensitivity and 57% specificity; 18 µg/L for NSE with 61% sensitivity and 53% specificity; and 65 pcg/l for S100b with 87% sensitivity and 72% specificity. With a combination of IMA with either S100b or NSE, instead of IMA alone, the best results were obtained with IMA and S100b, at 97% sensitivity and 37% specificity. Conclusion: This study indicates that IMA was a sensitive diagnostic biomarker in the acute phase of ischemic stroke, although its specificity is low. The combi nation of IMA with S100b and NSE did not add any beneficial effect to the specificity of IMA alone. (JAEM 2014; 13: 112-7)","PeriodicalId":14780,"journal":{"name":"Journal of Academic Emergency Medicine Case Reports","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86404362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meeting Report of 10th National Emergency Medicine Congress & 1st Intercontinental Emergency Medicine Congress","authors":"Z. Dundar, M. Ergin, M. Karamercan, S. Satar, A. S. Girişgin, M. Yıldız, B. Cander","doi":"10.5152/JAEM.2014.379","DOIUrl":"https://doi.org/10.5152/JAEM.2014.379","url":null,"abstract":"","PeriodicalId":14780,"journal":{"name":"Journal of Academic Emergency Medicine Case Reports","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89173887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Abdominal Wall Endometriosis Mimicking Strangulated Incisional Hernia","authors":"M. Kılıç, G. Değirmencioğlu, C. Dener","doi":"10.5152/JAEMCR.2014.436","DOIUrl":"https://doi.org/10.5152/JAEMCR.2014.436","url":null,"abstract":"Giris: Endometriozis, uterus disinda fonksiyonel endometrial doku varligi ile karakterize bir klinik antitedir. Bu lezyon genellikle overler, rektovaginal bolge ve pelvik taban peritonunda gorulur. Karin duvari endometriozisi, oldukca nadirdir ve genellikle tek olgu sunumlari ya da kucuk seriler olarak bildirilmektedir. Olgu Sunumu: Bu yazida, bogulmus kesi fitigini taklit eden karin duvari endometriozisi olgusu bildirildi. Vakalarin cogu, ozellikle sezaryen gibi cesitli obstetrik ve jinekolojik operasyonlarin ardindan olusur. Karin duvari endometriozisi bazen akut karin bulgularina neden olabilir ve kolayca deri alti apsesi, rektus kilifi hematomu ya da bizim olgumuzda oldugu gibi bogulmus kesi fitigi ile karisabilir. Sonuc: Karin duvari endometriozisinin dogru tanisi genellikle zordur ama ozellikle siklik agrisi olan menstruasyon goren bir kadinda dusunulmelidir. Ayrica, obstetrik ve jinekolojik ameliyat oykusu de sorgulanmalidir. Tedavisi total eksizyondur.","PeriodicalId":14780,"journal":{"name":"Journal of Academic Emergency Medicine Case Reports","volume":"23 1","pages":"229-231"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82176531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Unusual Case of Dyspnea: Substernal Goiter","authors":"D. Öztürk, E. Altınbilek, M. Koyuncu, Ahmet Cevdet Toksoz, F. Çakmak, I. Ikizceli, C. Kavalci","doi":"10.5152/JAEMCR.2014.15010","DOIUrl":"https://doi.org/10.5152/JAEMCR.2014.15010","url":null,"abstract":"Introduction: Substernal thyroid goiter is defined as extension of the thyroid gland into the mediastinum. Vocal cord paralysis, vena cava superior syndrome due to the compression on major vessels, and Horner syndrome can be rarely seen in patients. Case Report: A 77-year-old female patient presented to our emergency department with complaints of dyspnea, flushing, and edema on her face. Her vital signs were as follows: BP: 140/90 mm Hg, HR: 135 bpm, respiratory rate: 28 per minute, and SpO2: 88%. On her physical examination, there was increased jugular venous distension, both thyroid lobes were palpable, and breath sounds decreased in the right lung. A contrast-enhanced pulmonary computed tomography (CT) was planned, and substernal goiter was seen on CT. Then, 4 L/min supplemental O2, 2 puffs of 200 mcg budenoside 3 times a day and 250 mg IV methylprednisolone therapy were started. Conclusion: In patients presenting with dyspnea, retrosternal (substernal) goiter should also be considered.","PeriodicalId":14780,"journal":{"name":"Journal of Academic Emergency Medicine Case Reports","volume":"28 1","pages":"165-167"},"PeriodicalIF":0.0,"publicationDate":"2014-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89449354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}