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    The Analysis of Generalized Tonic Clonic Seizures Associated Injuries in Emergency Department
    (Elsevier Science Bv, 2010) Altunci, Yusuf Ali; Gokhan, Servan; Ustundag, Mehmet; Orak, Murat; Ozhasenekler, Ayhan; Guloglu, Cahfer
    Objectives: Persons with epilepsy are believed to be at greater risk of incurring accidental injury than those without seizures. During generalized seizures the individual is unable to utilize protective reflexes during falls and may consequently suffer head, orthopedic, or soft tissue injury. Our aim is to evaluate the spectrum of trauma in epilepsy patients presenting to our emergency department as a result of generalized tonic-clonic seizure (GTCS). Methods: We retrospectively reviewed patient records collected between January 2004 and December 2007 at the Emergency Department of Dicle University Medical School. All patients aged 15 years or more with epilepsy and trauma due to generalized tonic clonic seizures were included in the study. Records were analyzed for age, gender, type of injury, sufficiency of anti-epileptic medication, and mortality. Results: The average age of the 51 patients included in the study was 26.02 +/- 9.86 years, range 15-52 years. Thirty-three patients (64.7%) were male; the male female ratio was 1.83. Soft tissue injuries were the most common injury (26 instances). Head trauma, cuts, dental and tongue injuries were less common. Blood levels of anti-epileptic medication were in the therapeutic range in 9 (17.6%) patients, while 42 (82.4%) had sub therapeutic levels for effective treatment. Four (7.8%) of the patients died. The trauma in 2 mortalities involved burns; remaining deaths were associated with submersion injury and fall (subarachnoidal hemorrhage). Conclusions: There was no significant association between sub therapeutic levels of anti-epileptic medication and mortality.
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    Atypical Presentation in Lymphoma; Cyanosis in Left Hand: Case Report
    (Aves, 2011) Ozhasenekler, Ayhan; Atilgan, Zuhal Ariturk; Bakir, Sule; Gokhan, Servan; Yilmaz, Fevzi
    A 17 year old female patient was admitted to the emergency service with complaints of cough, asthma, and cyanosis in the left hand. Expanding in the mediastinum, a rightward deviation of the trachea was specified in the posterior-anterior lung x-ray. In her thoracic computerised tomography, soft tissue density, rightward deviation of trachea, narrowing inwards from outside with the left major bronchus was observed and there were common lymph nodules on the upper section of the left trachea. These lymph nodes applied pressure on major vascular structures leading to the left arm. Primarily lymphoma was considered because she was a young patient. Diagnosis-based left axial and left nodule excision was carried out. Histopathologically, a non-Hodgkin lymphoma (NHL) was diagnosed. The patient was given chemotherapy. The cyanosis in the hand was healed after the mass decreased, thus decreasing pressure on vascular structures. Lymphoma, which is one of the mediastinal masses, is also considered with congenital cardiac illnesses such as pulmonary hypertension, improved Patent Ductus Arteriosis Eisenmenger Syndrome in young patients admitted to the emergency service with atypical complaints such as cyanosis in the left hand.
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    Clinical Aspects and Emergent Management of Snake Bites Presented to Emergency Department
    (Derman Medical Publ, 2015) Sonmez, Bedriye Muge; Yilmaz, Fevzi; Yilmaz, Muhittin Serkan; Kavalci, Cemil; Gokhan, Servan; Akbulut, Ahmet Sami; Ozhasenekler, Ayhan
    Evaluating the epidemiologic characteristics and management of snake bites presenting to emergency departments. Material and Method: In this retrospective study 74 cases of snakebites admitted to Emergency Department of Diyarbakir Training and Research Hospital between 2008 and 2009 were retrospectively evaluated. Results: Fourty-six (62.2%) of patients were male and 28 (37.8%) were female. Mean age of the study population was 34.85 +/- 19.17 (min 7-max 80) years. Most of the snakebites occurred between 18.00 to 06.00 hours and at home (73%). 79.7% of snake bites occurred to upper extremities. %93 of cases had intravenous administration of antivenin (one dose). Neither none of the patients needed recurrent administration. Discussion: Snake bites are still a major public health problem especially in rural areas. Particularly emergency care physicians should be adequately capable and sophisticated in multidisciplinary management of snake bites.
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    Easy and Rapid Diagnosis in Central Venous Catheter (CVC) Malpositions: Posterior-Anterior (PA) Lung Graphy: 3 Case Reports
    (Aves, 2010) Ozhasenekler, Ayhan; Gokhan, Servan; Icer, Mustafa; Orak, Murat; Ustundag, Mehmet
    The central venous catheter (CVC) interventions have recently become very important as a small surgery intervention. It has frequently been used in intensive care units and in emergency services for medicine and blood production infusion, central venous pressure observation, urgent dialysis access pathway, parenteral nutrition, infusion of chemothrapy drugs and in complicated cases which require long term follow-up and a wide vein passage. We aimed at stressing the importance PA lung graphy in early detection of CVC malposition, one of the complications encountered with the increase in frequency of usage.
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    Effects of suicide methods and demographic data on mortality in patients presented with suicide attempts to the emergency department
    (Elsevier Science Bv, 2009) Guloglu, Cahfer; Gokhan, Servan; Ustundag, Mehmet; Orak, Murat
    Objective: The aim of this study was to evaluate the relation between demographic properties, suicide methods and mortality in patients presented with suicide attempt to the emergency department (ED). Methods: The patient charts presented with suicide attempt to ED of Dicle University between 01.01.2003 and 31.12.2007 were evaluated retrospectively. Age, gender, social and demographic features, suicide methods, period from attempt to admission and mortality were recorded.. Results: One thousand and eighty one patients were included into the study. Nine hundred and one (70.4%) patients were female and 380 (29.6%) were male. Mean age was 23.36(i-7.53). Eight hundred and fifty five (66.7%) attempted suicide by taking drugs, 337 (% 26.3) by taking insecticides, 33 (% 2.6) by hanging, 19 (1.5%) by gunshots, 13 (1%) by jumping and 24 (1.9%) by ingesting corrosive solvents, Nine hundred fourty six (73.9%) patients were admitted from the city centers and 335 (% 26.1) were from rural areas. Five hundred seventy seven (45%) were married, 704 (55%) were single. Twon hundred ninety three (22.9%) had been working, 988 (77.1%) were unemployed. The mortality rate was 5.78% (n=74) cases. The mortality rates were significantly higher in patients with female gender, suicide with insecticide ingestion, hanging, gunshot and jumping. Conclusions: Suicide is an important public health problem that concerns patients, relatives and society. Preventing mortality from suicide, social and demographic characteristics should be regarded by a multidisciplinary approach.
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    Hand and Wrist Injuries Caused by Glass Cuts: Accidental or Due to Sudden Anger?
    (Elsevier Science Bv, 2011) Gokhan, Servan; Altunci, Yusuf Ali; Orak, Murat; Ustundag, Mehmet; Sogut, Ozgur; Ozhasenekler, Ayhan
    Objectives Traumatic hand and wrist injuries are the type of injuries commonly seen in the emergency department (ED). Hand and wrist injuries related to punching windows due to sudden discomposes are frequent in Turkey. The aim of this study was to analyze clinical and demographic specifications of hand and wrist injuries related to glass cuts and their underlying causes. Methods The patient files who presented to the Dicle University Hospital ED (Diyarbakir-Turkey) with injuries due to glass cuts have been examined. Demographic data of the patients have been recorded in the standard work form and then were analyzed. Results One hundred and fifty four patients were included in the study. 53.8% of the patients constituted those who punched on the glass during an angry episode. Punching on the glass was more frequently observed in men (n= 81, 97.6%), with cuts to the right hand being the most frequent type of resulting injury (n= 65, 78.3%). Twenty four (28.9%) of the patients with injuries related to glass punching were under the influence of alcohol during the incidents and injury rates of radial artery, ulnar nerve, median nerve and ulnar artery have been found considerably higher in this group. Conclusions A thorough artery, nerve and tendon examination of the patients presenting to the ED with hand and wrist injuries needed to be performed, and especially for those under the influence of alcohol in order to prevent functional losses of the underlying structures.
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    Mortality and morbidity in children caused by falling televisions: a retrospective analysis of 71 cases
    (Springer London Ltd, 2010) Gokhan, Servan; Kose, Ozkan; Ozhasenekler, Ayhan; Orak, Murat; Ustundag, Mehmet; Guloglu, Cahfer
    Background Femoral artery pseudoaneurysm following cardiac catheterization is a serious groin complication requiring careful assessment and prompt intervention. Aims The risk of femoral artery pseudoaneurysm is estimated at 0.6 to 17% following diagnostic and interventional procedures. Methods The clinical use of bedside ultrasonography as part of the physical examination by attending emergency physicians has increased significantly over recent years. Results Bedside emergency department ultrasonography provides the clinician with critical information noninvasively, rapidly determining various anatomical structures. Conclusions We present the case of a patient with femoral artery pseudoaneurysm detected by bedside emergency department ultrasonography secondary to angiographic catheterization.
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    Mortality and morbidity in children caused by falling televisions: a retrospective analysis of 71 cases
    (Springer London Ltd, 2011) Gokhan, Servan; Kose, Ozkan; Ozhasenekler, Ayhan; Orak, Murat; Ustundag, Mehmet; Guloglu, Cahfer
    Objectives: To quantify injuries in children that result from toppled televisions. Methods: Children presenting directly to emergency department due to injuries caused by falling televisions were identified from our digital patient database, and a retrospective chart review of 71 children was performed. Descriptive statistics were applied. Results: 71(1.8%) out of 3856 admissions due to injuries sustained at home were TV-related injuries. There were 50 (70.4%) boys and 21(29.6%) girls. Mean age was 39.79 +/- 20.14 SD months. Almost three quarters of the children (49/71) sustained various head and facial injuries. There was traumatic brain injury in 14 patients, extremity injuries in 30 patients, thoracic injuries in 13 patients and abdominal injuries in ten patients. 16 patients were hospitalized. 14 of them required follow-up in intensive care unit. Two patients (one with epidural hematoma and one with subdural hematoma) underwent surgical intervention. Four patients with subarachnoid bleeding died. The mean length of hospital stay was 71.25 hours (range, 48-168) in hospitalised patients. The overall mortality rate was 5.6%. Conclusions: Falling TVs may cause significant morbidity and mortality in children particularly those younger than 3 years old. Head and facial injuries are the most common body region involved and traumatic brain injury is the major cause of death.
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    Pneumomediastinum and Pneumothorax After Blunt Neck Trauma
    (Emergency Medicine Physicians Assoc Turkey, 2010) Ozhasenekler, Ayhan; Gokhan, Servan; Yilmaz, Fevzi; Tas, Mahmut; Tan, Omer; Nasir, Ahmet
    Pneumomediastinum is air presence in mediastinum. It is spontaneously and traumatically divided into two. While spontaneous pneumomediastinum is generally found in healthy young men, traumatic pneumomediastinum may develop due to skull, neck, chest traumas and intraoral injuries. Pneumomediastinum is a clinical state with high morbidity and mortality due to complications it causes. It should be considered that it can improve and also accompanied by pneumothorax even without trachea and esophagus injury after blunt neck, face and eye traumas.
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    Relation between Serum Pro-Brain Natriuretic Peptide, Myoglobin, CK Levels and Morbidity and Mortality in High Voltage Electrical Injuries
    (Japan Soc Internal Medicine, 2010) Orak, Murat; Ustundag, Mehmet; Guloglu, Cahfer; Gokhan, Servan; Alyan, Omer
    Objective In our study, in addition to evaluating the relation between Pro-Brain natriuretic peptide (Pro-BNP), myoglobin and creatinine kinase (CK) levels and morbidity and mortality, we aimed at identifying the demographic characteristics of patients admited to emergency service after exposure to high electrical voltage. Methods In this prospective study, 48 emergency service patients exposed to high electric voltage were included; 19 healthy individuals were included as the control group. Their blood samples and electrocardiographies (ECG) were taken at the time of recourse upon their written approval. Demographic data and laboratory data were checked and compared among the patient group. We investigated the correlation between inpatients that had special clinical manifestations (escaratomy, fasciotomy, exitus, myoglobulinuria, third-degree burn, arrhythmia and etc.) and serum Pro-BNP, myoglobin and CK levels. Results When serum Pro-BNP, myoglobulin and CK levels were compared for the special clinical manifestations; the pro-BNP levels were statistically significantly higher in patients who had arrhythmia than in those without arrhythmia, and significantly higher in patients who died than in those who healed (respectively p=0.002 and p=0.007). In contrast, serum CK and myoglobin levels were not statistically significant. The serum CK and myoglobin levels were statistically significantly higher in patients who had third-degree burn than the others (p<0.001). Conclusion Serum pro-BNP level is a marker that can be used for mortality and morbidity with patients exposed to high voltage electrical injuries.