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Öğe A case of rhabdomyolysis related with low intensity body building exercise(Ondokuz Mayis Universitesi, 2015) Kara, Hasan; Bayır, Ayşegül; Ak, Ahmet; Doğru, Ali; Değirmenci, Selim; Akıncı, MuratRhabdomyolysis is a clinical and biochemical syndrome resulting from the acute necrosis of muscle fibers and the leak of cellular elements into circulation. It can usually develop after trauma and severe exercises. However, it may also occur following low intensity exercises. In our case, a 24-year-old man was admitted to our emergency department because of severe abdominal pain after low intensity bodybuilding exercise. The development of an acute exertional rhabdomyolysis was confirmed by the increased serum enzyme levels. The patient was treated with intravenous sodium chloride, and sodium bicarbonate. In patients admitted to the emergency room after trauma or intensive exercise who are suspected of having rhabdomyolysis, the serum creatine phosphokinase, creatinine and potassium levels should be evaluated and if found to be high, fluid treatment should be started early to avoid any potential complications. © 2015 OMU.Öğe D-dimer and D-dimer/fibrinogen ratio in predicting pulmonary embolism in patients evaluated in a hospital emergency department(MANEY PUBLISHING, 2014) Kara, Hasan; Bayır, Ayşegül; Değirmenci, Selim; Kayış, Seyit Ali; Akıncı, Murat; Ak, Ahmet; Çelik, Bülent; Doğru, Ali; Öztürk, B.Objectives: The D-dimer level, fibrinogen level, and D-dimer/fibrinogen ratio are used in the diagnosis of pulmonary embolism, but results vary. We evaluated these parameters in the diagnosis of pulmonary embolism in emergency clinic patients. Methods: In this prospective study, 200 patients (pulmonary embolism, 100 patients; no pulmonary embolism, 100 patients) had D-dimer and fibrinogen levels measured before intervention. Pulmonary embolism was diagnosed with computed tomography angiography or ventilation-perfusion scintigraphy. Results: Compared with patients who did not have pulmonary embolism, patients who had pulmonary embolism had significantly greater mean D-dimer level (pulmonary embolism, 6 +/- 7 mu g/ml; no pulmonary embolism, 1 +/- 1 mu g/ml; P <= 0.001) and D-dimer/fibrinogen ratio (pulmonary embolism, 3 +/- 3; no pulmonary embolism, 0.4 +/- 0.4; P <= 0.001), but similar mean fibrinogen levels (pulmonary embolism, 337 +/- 184 mg/dl; no pulmonary embolism, 384 +/- 200 mg/dl; not significant). In patients who had pulmonary embolism, mean D-dimer level and D-dimer/fibrinogen ratio were greater in high-risk than non-high-risk patients. With D-dimer cutoff 0.35 mu g/ml, sensitivity was high (100%) and specificity was low (27%) for pulmonary embolism. With D-dimer/fibrinogen ratio cutoff 0.13, sensitivity was high (100%) and specificity was low (37%) for pulmonary embolism. Conclusion: A D-dimer level <0.35 mu g/ml may exclude the diagnosis of pulmonary embolism. At a D-dimer cutoff 0.5 mu g/ml and D-dimer/fibrinogen ratio cutoff 1.0, the D-dimer/fibrinogen ratio may have better specificity than D-dimer level in the diagnosis of pulmonary embolism, but the D-dimer/fibrinogen ratio may lack sufficient specificity in screening.Öğe Prehospital cardiopulmonary resuscitation: A survey of prehospital providers(Ondokuz Mayis Universitesi, 2015) Kara, Hasan; Bayır, Ayşegül; Ak, Ahmet; Akıncı, Murat; Uyanık, Ahmet; Değirmenci, Selim; Kalaycı, Fatih; İnal, Fatih; Doğru, AliThis study evaluated the knowledge and skills, the attitudes, the behaviors of general practitioners, paramedics, emergency medical technicians (EMT) about cardiopulmonary rescucitation (CPR) practices, and the influencing factors. A total of 451 subjects working in 112 emergency ambulance services were included in the study. Of the participants, 61.2% were female and 38.8% were male. Of the personel, 8.6% were general practitioners, 14.6% were paramedics, 61.2% were EMTs, 15.5% were nurses and medical officers. A questionnaire form composed of 36 questions about demographic data and data which could influence the knowledge level was used. Descriptive statistics were performed and marginal tables were created. The age range was 25-34 years in 48.3% of the participants; 26.2% had been working for emergency services for 7-10 years. Of the participants, 83.1% were working in 112 emergency health units, and 16.9% were working at the command control center. When the participants were asked how frequent the courses should be, 49% of the participants stated that it should be carried out once a year, 12% said that it should be given once every 5 years, and 17% stated that the course should be repeated whenever new data are added to the literature or when the CPR guidelines change. Forty-eight percent of the participants responded as 'yes', and 1% as 'absolutely no' to the question 'Do you think that you perform CPR as required?'. Our questionnaire study indicates that education programs should be developed for the personnel working at prehospital health services, and that these programs should be repeated annualy for increasing the practice and to improve the knowledge level of the workers. © 2015 OMU.Öğe Red cell distribution width and neurological scoring systems in acute stroke patients(DOVE MEDICAL PRESS LTD, 2015) Kara, Hasan; Değirmenci, Selim; Bayır, Ayşegül; Ak, Ahmet; Akıncı, Murat; Doğru, Ali; Akyürek, FikretObjectives: The purpose of the present study was to evaluate the association between the red blood cell distribution width (RDW) and the Glasgow Coma Scale (GCS), Canadian Neurological Scale (CNS), and National Institutes of Health Stroke Scale (NIHSS) scores in patients who had acute ischemic stroke. Methods: This prospective observational cohort study included 88 patients who have had acute ischemic stroke and a control group of 40 patients who were evaluated in the Emergency Department for disorders other than acute ischemic stroke. All subjects had RDW determined, and stroke patients had scoring with the GCS, CNS, and NIHSS scores. The GCS, CNS, and NIHSS scores of the patients were rated as mild, moderate, or severe and compared with RDW. Results: Stroke patients had significantly higher median RDW than control subjects. The median RDW values were significantly elevated in patients who had more severe rather than milder strokes rated with all three scoring systems (GCS, CNS, and NIHSS). The median RDW values were significantly elevated for patients who had moderate rather than mild strokes rated by GCS and CNS and for patients who had severe rather than mild strokes rated by NIHSS. The area under the receiver operating characteristic curve was 0.760 (95% confidence interval, 0.676-0.844). Separation of stroke patients and control groups was optimal with RDW 14% (sensitivity, 71.6%; specificity, 67.5%; accuracy, 70.3%). Conclusion: In stroke patients who have symptoms <24 hours, the RDW may be useful in predicting the severity and functional outcomes of the stroke.
