YEAR: 2022

CAN HIGH-DOSE DRUG INTAKE BE PREDICTED? 

Hatice Şeyma Akça, Dilek Atik, Fulya Köse

p. 1-2 

ABSTRACT

Dear editor, In the approach to suicidal intoxications, we encounter many problems such as not being able to obtain sufficient information about the patient's complaints, the uncertainty of the level of medi-cation taken, patient non-compliance, and the patient's refusal to accept the treatment. It is also difficult to make the decision of service or intensive care follow-up. 

SPEECH IMPAIRMENT AND UNDETECTED ISCHEMIA

Hatice Şeyma Akça, Fulya Köse, Dilek Atik

p. 3-5

ABSTRACT 

It was aimed to present a patient who applied to the emergency department with speech impair-ment and clouding of consciousness, and whose clinical findings improved within 3 days and no vascular occlusion could be detected, and to show that a clinic resembling a transient ischemic attack can only be based on clinical findings. A 65-year-old female patient was brought to the emergency department due to gibberish, weak-ness, and confusion. The general condition was moderate, and the patient's glaskow coma scale was 12, with blurred consciousness. The patient was found to be disorientated. Brain computed tomography, diffusion MRI, and contrast-enhanced carotid vertebral artery brain CT angiog-raphy were found to be normal. The patient was admitted to the neurology service for follow-up with the suspicion of trans ischemic attack. 300 mg of acetylsalicylic acid 1x1 p.o. and intrave-nous saline was started. Neurological findings of the patient, who was followed up for 3 days, improved. It was detected as GCS:15. He was discharged with recommendations. We think that our case report will contribute to the literature, since transient ischemic attacks usually return to normal findings within 24 hours of diagnosis and may be accompanied by fin-dings such as plaque or vascular occlusion. 

Keywords: Trans Ischemic Attack, Confusion, Cerebrovascular Disease

RHABDOMYOLYSIS AND ACUTE RENAL FAILURE DUE TO GABAPENTINE USE; CASE REPORT 

Dilek Atik, Nuray Kılıç, Fulya Köse, Hatice Şeyma Akça, Yasin Karaman 

p. 6-9

ABSTRACT

Gabapentin is an anticonvulsion drug and is used especially in diseases with neuropathic  pain. The side effects of gabapentin, whose usage areas are expanding, are pain, drowsiness, fatigue, headache, and muscle twitching are among the most common symptoms.  A 31-year-old male patient was admitted to the emergency service after complaining of pain in all muscles and joint pain for 2 days. The patient with a previous cervical disc herniation was treated with 600 mg gabapentin every 12 hours for 3 days. The patient was conscious, cooperati-ve and oriented well. Respiratory system examination; It was normal. No additional pathology was detected in his neurological and other system examinations. In the blood and urine analysis of the patient; Blood: glucose: 111mg/dl; AST: 20IU/l; ALT: 65 IU/l; bilirubin: 0.8mg/dl; LDH: 2520 U/l; C-reactive protein: 258; CK: 14911 U/l; CKMB: 60.1; creatinine: 7.46 mg/dl; urea: 165mg/dl; Na: 140 mmol/1; K: 3.4 mmol/1; Ca: 5.5mg/dl; pH 7.35; bicarbonate: 19 mmol/l. Hydration and Ca infusion of the patient was started. Forced diuresis was started. Hydration was planned for the patient because the patient had a tendency to decrease in urea and creatinine, had urination and did not have acidosis in blood gas.  In conclusion, we can conclude that gabapentin can cause myotoxicity, rhabdomyolysis and renal failure even in patients with previously normal renal function, even at therapeutic doses. For this reason, we should pay special attention to the drug dosage, concurrently the patient's lifestyle, the drugs he uses and the patient's comorbidities.

Keywords: Gabapentin, Rhabdomyolysis, Renal failure.

AĞZI SULANDIRAN ŞEYLER PAROTİT VE SİYALOLİTİAZİS: VAKA TAKDİMİ  

Fulya Köse, Nuray Kılıç, Hatice Şeyma Akça, Dilek Atik, Eray Zeybekoğlu 

p. 10-12

ÖZET

Siyalolitiazis tükrük bezi kanalında tükürük akışının durması sonucu kalsiyum karbonat ve kalsi-yum fosfat taşının (siyalotit)oluşmasıdır. Ağrı, şişlik ve hassasiyet belirtileri parotitit taklit edebi-lir. Siyalolitiazis parotitten daha sıklıkla ayıran tipik bulgu olarak tek taraflıdır.  37 Yaşında erkek hasta acil servise çenede şişlik şikayeti ile başvuruyor. Hastanın alınan anam-nezinde hasta nar yerken birden dişlerinde bir kamaşma hissi olduğu ardında birden çenesinin tek taraflı şiştiği bilgisi öğrenildi. Hastanın bakılan labaratuvar sonuçlarında Wbc:10.12 K/uL Hb:15 g/dL Plt:230 K/uL CRP:18,9 mg/L Amilaz:1029 U/L Lipaz: 39.9 U/L, üre: 27 mg/dL krea-tin:0.99 mg/dL idi. Parotit tipik olarak çene bölgesinin tutulumu ile karakterizedir. Viral parotit, diğer tükürük bezle-rini kapsayabilir. Bazı hastalarda göğüs duvarına kadar uzanabilen yumuşak dokuları kapsayan yüz şişmesine neden olabilir. Hastalarda ağızda salivasyon artışına sebep ola-cak şeylerden sonra parotit ve siyaladenitis taşı tıkanıkları oluşabilmektedir.  Bu vakayı takdim etmekteki amacımız hastanın yemek yerken aniden çenesinde şişlik oluşması üzerine acil servise başvurması idi. Bu tür ani şişlik olaylarında hastaların allerjik reaksiyonlarla karışabileceği unutulmamalı ve hastaların anamnezleri ayrıntılı alınarak dikkatli muayene edilmeliler. 

Keywords: Siyalolitiazis, Parotit, Allerjik reaksiyon

DELİCİ KESİCİ ALET İLE PERİFERİK ARTER YARALANMASINA BAĞLI ARRESTTEN DÖNEN BİR OLGU SUNUMU 

Fulya Köse, Nuray Kılıç, Dilek Atik, Hatice Şeyma Akça 

p. 13-15
 

ÖZET

Perferik damar yaralanmaları acil müdahale gerektiren önemli bir sağlık sorunu olup ülkemizde hızla artmaktadır. Periferik damar yaralanmalarında hasta hayatı ve ekstremitenin kurtarılabilmesi için erken tanı ve acil müdahalenin önemi büyüktür.  57 yaşında erkek hasta delici kesici alet yaralanması sonucu 112 ile acil servisimize getirildi. Hasta GKS: 14 Ateş: 36.0 Nabız: 90, Kan basıncı: 130/80 SPO2 %93 olarak geldi. Sol alt extremitede dizden medial kısmında yaklaşık 5-10 cm kadar yukarıda 1 adet 1-2 cm genişliğinde düzgün sınırlı laserasyon mevcuttu. Hastaya bilateral alt extremite bilgisayarlı tomaografi (BT) anjiografi çekildi. Bt anjiografi de sağ femoral arter yaralanması tespit edildi. Hastanın ilk geliş GKS 14 olup, hızlı bir şekilde GKS 10 gerileyerek hemorajik şok tablosuna giren hasta acil müdahaleleri yapıldıktan sonra operasyona çıkarıldı. Hemorajik şok hayatı tehdit eden ve sağkalım için acil tıbbi tedavi gerektiren acil bir klinik durumdur. Hemorajik şokun temelde 4 evresi vardır. Total kan volümünün %15’inden azının kaybı (750 ml’ye kadar) neticesinde 1.evre, %15-30’u (750- 1500 ml) kaybedilince 2.evre, %30-40’ı (1500-200 ml) kaybı neticesinde 3.evre ve %40 üzeri kayıpla ölüm söz konusu olan 4. evre mevcuttur. Bu çalışmada sunulan vakada mental konfüzyon, ajitasyon ve ciddi metabolik asidoz gözlenen 3. evre hemorajik şok söz konusudur. Arter yaralanmalarında arterial rekonstrüksiyonun başarılı sonuç vermesinin ilk şartı rekonstrüksiyonun yaralanmayı takiben ilk 8 saat içerisinde gerçekleştirilmesidir.  Sonuç olarak; delici kesici alet yaralanmaları yüksek mortaliteye sahip olup, hastaların vital bulguları ve genel durumları prognozu belirler. Bu hastalarda hemorajik şok neticesinde hastalar arrest olabilir.  

Anahtar kelimeler: Perferik damar yaralanmaları, Hemorajik şok, Hemorajik şok evrelemesi

METOCLOPRAMIDE-INDUCED DYSTONIA; CASE REPORT

Nuray Kılıç, Fulya Köse, Dilek Atik 

p. 16-19
 

ABSTRACT 

Aim 

In this case, we aimed to describe the acute dystonia disease developed after the use of metoclopramide in an 8-year-old boy who started with complaints of nausea and vomiting. 

Case Report 

An 8-year-old boy was brought to our emergency department by his family because of a sudden onset of postural disorder about 2 hours after ingesting metoclpramide oral solution. The patient's physical vision was torticollis (deviated neck to the right), mouth deviated to the left, left elbow flexed and left wrist externally rotated. His left hand was clenched into fists. Our patient was admitted to the hospital for treatment and observation after receiving the opinion of the pe-diatrician. 

Conclusion 

When using metoclopramide hydrochloride in adult or pediatric patients in our emergency de-partments, we should be very careful and be prepared for its side effects. Acute dystonia muscle disease after metoclopramide, which is used very frequently, is a condition that must be kept in mind of emergency medicine physicians. 

Keywords: Metoclopramide, Acute dystonia, Pediatric emergency medicine. 

ABDOMINAL AORTIC ANEURYSM RUPTURE 

Nuray Kılıç, Fulya Köse, Dilek Atik 

p. 20-23
 

ABSTRACT

An increase in the diameter of the vessel wall more than one and a half times is called an aneurysm. Abdominal aortic aneurysm is defined as aortic diameter ≥3 cm and repair is conside-red when ≥5 cm. In the United States, the most common cause of death in middle-aged individuals is complications from abdominal aortic aneurysm (1). Today, aneurysms are common in our country due to increasing risk factors. In this case, we aimed to describe a ruptured abdominal aortic aneurysm in a 64-year-old male patient who applied to the emergency department with the complaint of abdominal pain.

Keywords: Abdominal aortic aneurysm, Abdominal pain, Emergency department.

YILAN ISIRIĞINA GENEL YAKLAŞIM; VAKA BİLDİRİMİ 

Fulya Köse, Nuray Kılıç, Dilek Atik, Hatice Şeyma Akça 

p. 24-30
 

ÖZET 

Tüm dünyada olduğu gibi Türkiye’de de yılan ısırmaları önemli bir mortalite ve morbidite nedenidir. Yılan zehri, yaygın damar içi pıhtılaşma gibi sistemik zehirlenme durumuna yol açabileceği gibi, doku nekrozu etkisiyle ekstremite kaybına da neden olabilir.  30 yaşında erkek hasta sol ayak topuk bölgesinden yılan tarafından ısırılması sonucu servisimize başvurdu. Hasta gelir gelmez yapılan fizik muayenesinde Ateş: 36.4 °C  Nb: 78/dk Tansiyon: 110/80 mmHg Spo2 %98 Glaskow Koma Skalası (GKS) 15 idi. Hastanın ayağında ödem yoktu, dolaşım muayenesi doğaldı nabızlar açıktı. Hasta gelir gelmez acil takip ve tedavi protokolü baş-landı. hastanın yakın takibi sırasında hastanın tansiyonları 80/50 mm/Hg olup, nabız: 62, renginde solukluk oluştu. Hastanın yılan ısırığı olan bölgede şişlik, ağrı, ekimoz başladı ödem takibi yapıldı. Hastanın genel durum kötüleşmesi üzerine hastaya yılan antivenomu başlandıktan 4 saat sonra hemogram kontrolünde trombosit değeri 156 K/ul tespit edildi. Hasta yoğun bakımda yer açılması üzerine yoğun bakıma yatışı yapıldı. Biz bu vakada yılan ısırığına maruz kalan semptomsuz hastaların çok hızlı bir şekilde DİC tablo-suna doğru kayabildiklerini gördük. Bu yüzden yılan antivenomunun önemini ve hızlı müdahalenin hayat kurtarıcı olduğunu vurgulamak istedik. Yılan antivenomonun anaflaksi riski açısından kar zarar oranı değerlendirilerek ve hasta evrelemelerine dikkat edilerek hastaların mortalitesinin düşürülebileceği kanısına vardık.   

Anahtar Kelimeler: Yılan ısırığı, Antivenom, Yılan Isırmalarının Klinik Evreleri. 

1. OPEN BOOK PELVİS YARALANMASI; OLGU SUNUMU 

Nuray Kılıç, Dilek Atik

p. 1-5 

ÖZET

Acil servise pelvik travması ile gelen hastanın hemodinamik olarak stabilitesi belirlenmeli, mortalite ve morbilidite açısından risk oluşturacak yaralanmalar uygun ve hızlı bir şekilde değerlen-dirilmelidir. Ciddi pelvis yaralanmaları multidisipliner yaklaşım gerektirir ve genellikle multisistem travmaları ile birlikte görülür. Şiddetli pelvik travmalarında hemoraji en önemli ölüm nedenidir. Risk altında hastalar acil hekimi tarafından hızlıca tanımlanmalı ve vakit kaybetmeden ilk müdahaleye başlanıp ilgili branşlarca ileri tetkik ve tedavi başlanmalıdır.

Anahtar Kelimeler: Pelvik travması, hemoraji, Open book pelvik kırıkları

2. A CASE OF PNEUMOMEDIASTINUM AFTER HITTING A BALL WITH THE CHEST

Ramazan Ünal, İsmail Yeşiltaş, Mert Ruşen Gülşen, Sevgi Özen, Nurşen Saraçbaşı, Ramazan Güven, Başar Cander

p. 7-8

ABSTRACT

Among all the trauma cases, thoracic trauma is the third most common after head-neck and extremity trauma. Pneumomediastinum is defined as the presence of air in the mediastinum and it can occur spontaneously, iatrogenic or due to trauma. A case of pneumothorax with accompanying pneumomediastinum developed after blunt thorax trauma who had the complaint of chest pain is being presented in this case report.

A 27-year-old male was admitted to the Emergency Room with complaints of chest pain and shortness of breath. Decreased lung sounds were heard on the left hemithorax with auscultation. The patient’s learned from the anamnesis of the patient that a ball hit his chest during a football match one week before the admission and that he had chest pain and respiratory distress that gradually increased since then. Computed Tomography image of the thorax had an appearance compatible with pneumothorax in the left lung as well as diffuse images of air at the anterior mediastinum. Tube thoracostomy was applied under emergency conditions and was admitted to Thoracic Surgery for follow-up and treatment.

Traumatic pneumothorax and pneumomediastinum should be kept in mind in patients admitted to the emergency department with the complaint of chest pain who also has a history of minor chest trauma.

Keywords; Traumatic pneumothorax, traumatic pneumomediastinum, chest pain, football match 

3. A CASE OF SPLENIC INFARCTION

Ramazan Ünal, Mert Ruşen Gülşen

p. 9-11

ABSTRACT

Splenic infarct is a rare pathology of the spleen which is most commonly observed as a complication of another disease. A case of splenic infarct which is diagnosed after admission to the emergency room with symptoms mimicking renal colic and exacerbation of peptic ulcer is being presented in this case report.

A 59-year-old male patient with unremarkable medical history was admitted to our Emergency Room (ER) with the complaint of pain in the epigastric area and left flank. There were significant findings in terms of spleen infarction in the contrast-enhanced abdominal computed tomography of the patient. The patient, who was hospitalized in the General Surgery Department with the diagnosis of splenic infarct, was taken to the emergency operation and underwent a total splenectomy.

The presence of well-circumscribed, non-enhancing, hypodense area on contrast-enhanced abdominal computed tomography is diagnostic at a rate of 75% for splenic infarct. While conservative treatment is sufficient in the early period, surgical intervention may be required in complicated cases such as ours.

Keywords: Splenic infarct, total splenectomy, pain in the epigastric area.

4. FATAL COMPLICATION OF FRONTAL SINUSITIS; POTT'S PUFFY TUMOR

Ramazan Ünal, Ahmet Erdur, Hasan Çam, Ramazan Güven, Başar Cander

p. 13-17

ABSTRACT

Pott's Puffy Tumor (PPT) is a rare clinical entity characterized by subperiosteal abscess accompanied by osteomyelitis due to frontal sinusitis. It is a rare complication in the adult age group. A systematic review of literature in 2020 reported 128 cases of PPT identified in adults.

In this case report, a 19-year-old male patient who was admitted to the emergency service with a complaint of swelling and headache on his forehead for the past month and was diagnosed with PPT due to complicated frontal sinusitis is described. PPT was storage as a result of the physical examination and anamnesis of the patient who admitted to the emergency department with complaints of swelling in the forehead, headache and fever. Computed tomography was preferred as the imaging method in our patient and radiological images consistent with clinical suspicion were observed. The patient was consulted with an Otorhinolaryngology and Neurosurgery specialist. Abscess drainage was performed with Functional Endoscopic Sinus Surgery (FESS) by the Otorhinolaryngology department. The patient was called for control 3 months later. It was observed that the abscess did not recur.

In conclusion, PPT should be kept in mind in the differential diagnosis of patients with a history of swelling in the forehead and sinusitis, and low socio-cultural level.

Keywords: Frontal Sinusitis, Complication, Pott's Puffy Tumor, Functional Endoscopic Sinus Surgery

5. GEBELİK KAŞINTILARI SADECE ALERJİK MİDİR?

Hasan Burak Kaya, Dilek Atik

p. 19-21

ÖZET

İntrahepatik gebelik kolestazı genellikle gebeliğin son trimesterinda ortaya çıkan karaciğer fonk-siyonlarında anormallik gösteren gebelik kaşıntısı olarak karşımıza çıkmaktadır. Hem maternal hem de fetal komplikasyonları göz önüne alındığında akılda tutulması gereken bir tablodur. Biz yazımızda acil servise kaşıntı ile başvuran ve gebelik kolestazı düşünülen 29 haftalık bir gebe olgusundan bahsedeceğiz. Acil servise kaşıntı ile başvuran gebe hastalarda intrahepatik gebelik kolestazı acil servis hekimi için gözden kaçmaması gereken bir tanıdır.

Anahtar Kelimeler: Gebelik, Kolestaz, Kaşıntı.