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    Characteristics of Patients Administrated Thrombolytics in the Emergency Department
    (Selçuk Üniversitesi, 2023 Şubat) Eraslan, Ahmet Tolga; Selvi, Fatih; Bedel, Cihan; Baltacıoğlu, Bora; Yıldız, Günay
    Objective: Arterial and venous thromboembolism is one of the most prevalent diseases and related to ischemic stroke, pulmonary embolism, and myocardial infarction leading to mortality or is morbidity. Fibrinolytic therapy is the most profound lifesaving therapy in these diseases. We aimed to evaluate the demographic features and post-tissue plasminogen activator (tPA) period of patients administered fibrinolytic in the emergency department (ED). Materials and Methods: This retrospective study was conducted with patients instituted fibrinolytic therapy in the ED between January 2018 and July 2021. Age and gender of the patients, vital signs, laboratory tests, comorbidities, drugs used, lifesaving therapies secondary to the present pathology, tPA complications, mortality and similar presentations within the six months period were recorded to the study form. Results: A total of 277 patients were included in the study. Ischemic stroke was the most prevalent disease entailing the institution of tPA (n=252; 91%). The study patients mostly used antihypertensives (n=155, 56%), followed by anti-aggregants (n=101, 36.5%). Intracranial hemorrhage (11.9%) was the most frequent complication secondary to tPA and the study patients had mostly undergone thrombectomy as a lifesaving therapy (n=34, 12.4%). The univariate analysis revealed that antiaggregant usage (n=21, 53.8% vs n=80, 33.6%; p=0.01), systolic blood pressure (160 mmHg, IQR: 138-190 vs 150 mmHg 130-169; p=0.02) and diastolic blood pressure (90 mmHg, IQR: 75-100 vs 83 mmHg, IQR: 72-94; p=0.03) differ between the patients with and without a post-tPA hemorrhage. Conclusion: According to the results of this study, ischemic stroke is the main pathology related to tPA administration in ED. Hypertension was the most seen comorbidity in study patients, mostly using anti-hypertensive and anti-aggregants. Intracranial hemorrhage was the most prevalent complication owing to tPA use, and systolic and diastolic blood pressures and anti-aggregant use pertain to post-tPA hemorrhages.
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    Clinical Importance of Tp-e Interval, Tp-e/QT Ratio and Tp-e/QTc Ratio in Blunt Trauma Patients
    (Selçuk Üniversitesi, 2023 Aralık) Yıldız, Günay; Bedel, Cihan; Selvi, Fatih; Zortuk, Ökkeş; Korkut, Mustafa; Kuş, Görkem; Özkaya, Muharrem
    Objective: Diffirents complications can develop after blunt chest trauma. Potentially destructive arrhythmias may develop after blunt chest trauma. In this study, our main objective is to evaluate the risk of cardiac arrhythmia in patients with blunt chest trauma using the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio as a potential marker of cardiac arrhythmia. Materials and Methods: Our study is in the form of a single-center, prospective case-control study and consists of all patients who applied to the emergency department with blunt chest trauma between 15.01.2022 and 15.06.2022. 12-lead ECG recordings at a paper speed of 50 mm/sec. were taken from all participants, and Tp-e interval, QT interval and the parameters obtained by their ratio to each other (Tp-e/QT, Tp-e/QTc) were compared between the groups. Patients were shared according to trauma severity and parameters were compared. Results: Tpe/QT ratio in trauma patients was found statistically significantly higher than the control group (0.23±0.03 vs. 0.19±0.03, p<0.001). In addition, the Tpe/QTc ratio in trauma patients was statistically significantly higher than the control group (0.21±0.02 vs. 0.17±0.02, p<0.001). In addition, when the analysis of age, gender and BMI, which are the factors affecting trauma severity, was performed, no significant difference was found in terms of QT interval, Tp-e/QT and Tp-e/QTc. Conclusıon: Based on the results of our study, we verified that the Tp-e interval in the ECG, Tp-e/ QT ratio, and Tp-e/QTc ratio might indicate possible arrhythmia in patients who presented to the emergency department with blunt thoracic trauma, and this was unrelated to the severity of the trauma.
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    Karın Ağrılı Hastalarda Ortalama Trombosit Hacmi Bir Belirteç Olarak Kullanılabilir Mi?
    (Selçuk Üniversitesi, 2020 Haziran) Yıldız, Özcan; Bedel, Cihan; Beceren, Nesrin Gökben; Tomruk, Önder
    Amaç: Kolay elde edilebilirlik ve yaygın kullanım imkanı akut karın ağrılı hastaların erken tanısında biyokimyasal belirteçleri oldukça önemli hale getirmektedir. Bu çalışmada akut karın ağrısı ile acil servise başvurup yatışı yapılan hastalarda ortalama trombosit hacmi (MPV)’nin tanısal değerinin araştırılması planlandı. Gereç ve Yöntem: Ocak 2012 -Mart 2013 tarihleri arasında acil servise başvuran 812 hasta ile 45 sağlıklı kişinin kayıtları retrospektif olarak incelendi. Kayıtlardan olguların; yaş, cinsiyet, fizik muayene bulguları, 5.gün MPV, platelet, nötrofil lenfosit oranı, lökosit, C-reaktif protein (CRP) ile MPV değerleri aralarındaki ilişki incelendi. Bulgular: Çalışmaya alınan hastaların 467’sini (%57,5) erkekler, 345’ini (%42,5) kadınlar oluşturmuştur. Hastaların yaş ortalamaları 53,09±0,75’dir (18-92). Hastaların kesin tanıları incelendiğinde en sık safra kesesi ve koledok patolojileri (%18,7), ikinci sırada nonspesifik karın ağrısı (%17,3), üçüncü ise ileus-volvulus (%13,8) idi. Çalışmaya alınan 812 hastanın 5. gün MPV ortalama değeri 8,358±1,046 fL, platelet değerleri ortalama 246,82±91,3 u/L, nötrofil lenfosit oranı ortalama değeri 10,025±12,75 u/L olarak bulundu. Çalışmadaki akut karın ağrılı hasta grubunda giriş MPV değerleri ortalama 7,869±1,071 fL, sağlıklı kontrol grubu MPV değerleri ortalama 8,47±1,058 fL olup, hasta grubunun ortalama MPV düzeyi, sağlıklı bireylerden daha düşüktü. Sonuç: Pankreatit ve ileus-volvulus tanısı alan hastalarda MPV’nin tanıya yardımcı bir belirteç olabileceğini düşünmekteyiz.
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    Vapocoolant Spray for Intravenous Cannulation Pain: A Prospective, Randomized Controlled Trial
    (Selçuk Üniversitesi, 2021 Eylül) Selvi, Fatih; Bedel, Cihan; Akçimen, Mehmet
    Introduction: Peripheral intravenous (IV) cannulation are routine procedures in emergency department (ED) admissions. Vapocoolant sprays have a potential advantage over other topical agents.We aimed to see how effective vapocoolant spray was in reducing pain during intravenous cannulation versus a control group in this study. Materials and Methods: This is a prospective, randomized control study consisting of patients who were admitted to the ED. The study included patients aged 18 and over who applied to the ED and had IV cannulation. The patients were divided into 2 groups as control and vapocoolant spray groups. Age, gender, and dominant hand status of all patient groups were recorded. Side effects were observed after the application. The Visual Analogue Scale (VAS), which is the most widely used scale to measure pain, was used. Results: 206 individuals were randomized. The mean age of the vapocoolant spray group was 46.40±16.44 years, while it was 46.75±17.49 years for the control group. The vapocoolant spray group was found to have significantly lower mean VAS values during IV cannulation than the control group (1.47±1.32 vs. 3.97±1.97 p<0.001). It was found that the vapocoolant spray-applied group had a significantly lower percentage in terms of moderate pain (VAS>3 cm) compared to the control group (7.8% vs 58.3%, p<0.001). Besides, the percentage of severe pain (VAS>5.4 cm) in the spray-applied group was found to be significantly lower than the control group (1% vs. 20.4%, p<0.001). Conclusion: The vapocoolant spray can be used effectively to mitigate the pain associated with the pre-IV cannulation procedure and can be an alternative method for reducing pain in emergency departments.