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Öğe CAN BARTHEL INDEX PREDICT MORTALITY IN GERIATRIC PATIENTS ADMITTED TO THE EMERGENCY DEPARTMENT WITH A HIGH FEVER?(Gunes Kitabevi Ltd Sti, 2015) Yalcinli, Sercan; Ersel, Murat; Akarca, Funda Karbek; Can, Ozge; Midik, SadiyeIntroduction: Physical functional capacity decreases in geriatric patients owing to age and disease. In current practice, objective parameters to evaluate physical functional capacity in geriatric patients are rarely used in departments providing acute care, such as emergency departments. In our study, we aimed to determine whether the degree of change in basal admission Barthel Index scores has a prognostic significance for patients presenting with high fever. Materials and Method: Patients over 64 years of age without a history of or requirement for an emergency response and a tympanic membrane temperature >= 37.2 degrees C were included. Patients were divided into 3 groups according to their change of Barthel Index scores: >30 (major), 5-30 (minor) and no change. Results: The study population comprised 218 patients. Statistically significant differences were found among basal Barthel Index scores and those obtained at admission and 1 month later in surviving patients and between basal and admission Barthel Index scores in patients who died (p<0.001). Statistically significant difference was found in the proportion of survivors and non-survivors in patients whose change in Barthel Index score was >30 (major change) (p=0.011). No difference was found in the proportions of survivors and non-survivors in patients with minor changes and no change. Conclusions: Fever increases physical dependency in geriatric patients. Situations that result in a serious increase in functional dependency during admission may be related to short-term mortality in geriatric patients.Öğe Comparison of intravenous ibuprofen and paracetamol efficiency in soft tissue injuries: A randomized, double-blind study(W B Saunders Co-Elsevier Inc, 2020) Yalcinli, Sercan; Kryan, Guclu Selahattin; Can, Ozge[No Abstract Available]Öğe Comparison of intravenous ibuprofen and paracetamol in the treatment of fever: A randomized double-blind study(W B Saunders Co-Elsevier Inc, 2021) Can, Ozge; Kiyan, Guclu Selahattin; Yalcinli, SercanObjective: Fever is one of the frequent reasons for admission to the emergency department. Studies comparing oral forms of non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol with intravenous (IV) forms for fever are common in the literature. Our study is the first emergency department study comparing IV forms of ibuprofen and paracetamol in the treatment of febrile patients. Methods: A randomized, double-blind study was conducted in a tertiary university emergency department for a six-month period. Patients aged 18-65 years who had a fever of >= 38.0 degrees C were included. Patients were administered 400 mg of IV ibuprofen and 1000 mg of IV paracetamol. The primary aim of the study was to determine whether there was a difference in the effect of the two drugs on fever. The secondary aim was to investigate whether there was a difference in terms of numeric rating scale (NRS) measurements and the need for additional antipyretic therapy. Results: A total of 200 people, 100 of whom were female, were included in the study. The mean age was 30.77 +/- 10.61 years. The mean initial temperature for ibuprofen and paracetamol was 38.79 +/- 0.470 degrees C and 38.70 +/- 0.520 degrees C, respectively, with no difference noted between the groups (p = 0.380). It was found that both drugs significantly provided fever control in the first 30 min (p < 0.001), with no difference between them in terms of fever reduction (p = 0.980). Both drugs significantly improved in accompanying symptoms, although both drugs did not show superiority to each other (p = 0.0226). When evaluated in terms of a need for rescue medication, no significant difference was found between the two drugs (p = 0.404). No side effects were encountered during the study. Conclusion: In adult age group patients admitted to the emergency department with high fever, the IV forms of 1000 mg paracetamol and 400 mg ibuprofen effectively and equally reduce complaints, such as fever and accompanying pain. They can be effectively used as each other's rescue medicine and as an alternative to each other in patients with comorbid diseases. (c) 2021 Elsevier Inc. All rights reserved.Öğe Comparison of qSOFA, SIRS, and NEWS scoring systems for diagnosis, mortality, and morbidity of sepsis in emergency department(W B Saunders Co-Elsevier Inc, 2021) Oduncu, Ali Fuat; Kiyan, Guclu Selahattin; Yalcinli, SercanPurpose: This study was aimed to compare the quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS), and National Early Warning Score (NEWS) scoring systems for diagnosing sepsis and predicting mortality and morbidity. Patients and methods: A prospective study was designed. qSOFA, SIRS, and NEWS scores were calculated at the admission. The diagnosis of sepsis was made with SOFA scoring initially. The morbidity and mortality of the patients were identified during follow-up. Also, the sensitivity, specificity, negative predictive value, and positive predictive value of three scoring systems were calculated. The scoring systems were compared with ROC analysis. Results: A total of 463 patients were evaluated. There were 287 (62.0%) patients diagnosed with sepsis, and septic shock occurred in 64 (13.8%) of patients. Seven-day mortality rate was 8.4% (n = 39), 30-day mortality rate was 18.1% (n = 84). The sensitivity for qSOFA, SIRS, and NEWS for diagnosis of sepsis was 23%, 77%, 58%, and specificity was 99%, 35%, 81% respectively. The sensitivity of the qSOFA, SIRS and NEWS scoring systems for mortality was 39%, 82%, 77% and specificity 91%, 29%, and 64%, respectively. AUROC values for mortality detected as NEWS = 0.772, qSOFA = 0.758, SIRS = 0.542. According to the ROC analysis, the SIRS system was significantly less useful than the qSOFA and NEWS system in the diagnosis of sepsis and mortality (p < 0.0001). Conclusion: NEWS and qSOFA scoring systems have similar prognosis in both diagnosing sepsis and predicting mortality and both are superior to SIRS. (c) 2021 Elsevier Inc. All rights reserved.Öğe Comparison of Standard Technique, Ultrasonography, and Near-Infrared Light in Difficult Peripheral Vascular Access: A Randomized Controlled Trial(Cambridge Univ Press, 2022) Yalcinli, Sercan; Karbek Akarca, Funda; Can, Ozge; Uz, Ilhan; Konakci, GulbinObjectives: Successful placement of a peripheral intravenous catheter (PIVC) on the first attempt is an important outcome for difficult vascular access (DVA) patients. This study compared standard technique, ultrasonography (USG), and near-infrared light (NIR) in terms of success in the first attempt in patients with DVA. Methods: This was a prospective, randomized controlled study. The study was conducted in a tertiary care hospital. Emergency department patients who describe DVA history, have no visible or palpable veins, and were assessed by the nurse to have a difficult PIVC were included to study. The PIVC procedure was performed on patients by standard, USG, or NIR device techniques. For all approaches, the success of the first attempt was the primary aim. Total procedure time, the total number of attempts, and the need for rescue intervention were secondary aims. Results: This study evaluated 270 patients. The first attempt success rates for USG, standard, and NIR methods were 78.9%, 62.2%, and 58.9%, respectively. The rate of first attempt success was higher in patients who underwent USG (USG versus standard, P = .014; USG versus NIR, P = .004; standard versus NIR, P = .648). The total median (IQR) procedure time for USG, standard, and NIR methods was 107 (69-228), 72 (47-134), and 82 (61-163) seconds, respectively. The total procedure time was longer in patients undergoing USG (standard versus USG, P <.001; NIR versus USG, P = .035; standard versus NIR, P = .055). The total median (IQR) number of attempts of USG, standard, and NIR methods were 1 (1-1), 1 (1-2), and 1 (1-2), respectively. A difference was found among the groups regarding the total number of attempts (USG versus NIR, P = .015; USG versus standard P = .108; standard versus NIR, P = .307). No difference was found among groups in terms of the need for rescue methods. Conclusion: It was found that USG increases the success of the first attempt compared with the standard method and NIR in patients with DVA.Öğe Comparison of Video Laryngoscopy and Direct Laryngoscopy in the Success of Intubation Performed by Novice Personnel in Patients with Cervical Immobilization: A Manikin Study(Tehran Univ Medical Sciences, 2021) Can, Ozge; Yalcinli, Sercan; Altunci, Yusuf AliIntroduction: Pre-hospital intubation is a challenging but essential intervention. During intubation, it is difficult to identify vocal cords when using a cervical collar and trauma board. Therefore, the success rate of intubation by paramedics decreases in trauma patients. Video laryngoscopy increases intubation success rate and has been recommended for difficult airways in studies. Objective: In this study, we compared the intubation success rates when using a video laryngoscope and a direct laryngoscope in a manikin with simulated cervical immobilization. Methods: In this cross-sectional study, the manikin's neck collar and spine board created a complicated airway model with cervical immobilization. Inexperienced paramedic students tried intubation with both methods, and their trial periods were recorded. Students answered a question evaluating the convenience of the procedure for both methods after the trial. Results: In this study, 83 volunteers, who were first-year and second-year paramedics, participated; 32 (38.6%) of the volunteers were first-year students, while 51 (61.4%) were second-year students. All volunteers had previous intubation experience with direct laryngoscopy, but not with video laryngoscopy. There was a statistically significant difference in the first-attempt success rates of the procedure between the groups in favor of video laryngoscope (p=0.022). Note that there was no significant difference between the groups in terms of first attempt durations (p=0.337). Conclusion: Video laryngoscopy in airway management can increase the success rate of first-attempt intubation by inexperienced pre-hospital healthcare personnel.Öğe The diagnostic accuracy of ultrasonography in determining the reduction success of distal radius fractures(Elsevier Science Bv, 2018) Bozkurt, Ozgur; Ersel, Murat; Akarca, Funda Karbek; Yalcinli, Sercan; Midik, Sadiye; Kucuk, LeventObjective: We evaluated the sensitivity and specificity of bedside ultrasound (US) for determining the success of reduction of displaced distal radius fractures. In addition, we determined the ability of US to diagnose causes of unsuccessful reduction. Methods: In a prospective, double-blind fashion, patients over 18 of age whose acute distal radius fracture was to be reduced were approached for inclusion. The closed reductions were performed by orthopedics residents. Post-reduction, the fracture was checked by an EmergencyMedicine (EM) resident by US. Ultrasound images were evaluated by an EM attending physician blinded to X-ray findings and post-reduction X-ray images were evaluated by an orthopedic surgeon blinded to the US findings. Results: Sixty patients agreed to participate in the study. Of these, reduction was deemed successful by X-ray in 40 (66.7%). Of these 40, 39 (97.5%) were found to be successful reductions by US. In the 20 of 60 (33.3%) patients with unsuccessful reduction by X-ray, 19 (95%) were considered unsuccessful reductions by US. In evaluating the success of distal radius fracture reduction, compared to X-rays, US was 97.5% (95% CI 86.8 to 99.9) sensitive and 95% (95% CI 75.1 to 99.9) specific; its positive predictive value was 97.5% (95% CI 85.2 to 99.6) and negative predictive value 95% (95% CI 73.2 to 99.2). Conclusions: Ultrasonography is highly sensitive and specific in determining the success of distal radius fracture reduction. Copyright (c) 2018 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Öğe Factors affecting the first-attempt success rate of intravenous cannulation in older people(Wiley, 2019) Yalcinli, Sercan; Akarca, Funda Karbek; Can, Ozge; Sener, Alper; Akbinar, CemileAims and objectives To determine the factors affecting the first-attempt success of peripheral intravenous catheter (PIVC) placement in older emergency department patients. Background In older patients who require intravenous treatment, establishing a PIVC as fast as possible is clinically important. Design This is a prospective, observational, descriptive study. Methods Using a data collection form, researchers questioned both the patient and the nurse performing the procedure in terms of patient- and operator-related factors. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines (See Supporting Information Appendix S1). Results A total of 472 patients were included in the final analyses. According to the logistic regression analysis, independent factors which affected first-attempt failure were found to be: choosing a nonupper extremity site for PIVC (OR: 4.72, 95% CI: 1.35-16.45, p-value: 0.015), history of difficult intravenous access (OR: 3.02, 95% CI: 1.72-5.29, p-value: <0.001), nurse having less than 2 years of professional experience (OR: 3.45, 95% CI: 2.00-5.97, p-value: <0.001), nonpalpable veins observed after the application of tourniquet (OR: 2.21, 95% CI: 1.10-4.41, p-value: 0.025), a moderate degree of difficulty anticipated by the nurse prior to the procedure (OR: 4.32, 95% CI: 2.31-8.08, p-value: <0.001) and a high degree of difficulty anticipated by the nurse prior to the procedure (OR: 8.41, 95% CI: 4.10-17.24, p-value: <0.001). Conclusion Factors affecting first-attempt success rates in peripheral intravenous catheter placement in older emergency department patients may be listed as follows: the anticipated difficulty of the procedure rated by the nurse, previous history of a difficult intravenous cannulation, choosing a nonupper extremity site for cannulation, the level of experience of the nurse and the palpability of the vein. Relevance to clinical practice Healthcare providers should consider alternative methods in the presence of factors affecting first-attempt success in older emergency department patients.Öğe Fat embolism syndrome after gluteal augmentation with hyaluronic acid: A case report(Turkish Assoc Trauma Emergency Surgery, 2020) Uz, Ilhan; Yalcinli, Sercan; Efe, MehmetFat embolism syndrome (FES) occurs classically characterized by the combination of acute respiratory failure, neurologic abnormalities, and a petechial rash. Forty-six-year-old female presented to our emergency department with agitation, altered mental status, and drowsiness. We learned that the patient had received a hyaluronic acid (HA) injection into her buttocks at a beauty center a few hours before her admission. She had no skin findings, but she was hypoxemic. She had lung computed tomography (CT) findings bilateral ground-glass opacities and pleural effusion and had multiple cerebral white lesion on brain magnetic resonance images (MRI). Patients presenting to the emergency department with sudden alteration in mental status should be questioned for recent surgical or invasive aesthetic procedures. Fat embolism syndrome should be considered even if the patient has no petechial rash. Brain MRI and lung CT should be the imaging modality of choice in these patients.Öğe Flow-safe disposable CPAP efficiency in cardiogenic pulmonary oedema(W B Saunders Co-Elsevier Inc, 2020) Uz, Ilhan; Kiyan, Guclu Selahattin; Ozcete, Enver; Yalcinli, Sercan; Korgan, Mehmet Birkan; Altunci, Yusuf Ali; Yavuzgil, Oguz[No abstract available]Öğe Is the flow-safe disposable continuous positive airway pressure (CPAP) system as effective as non-invasivemechanical ventilation (NIMV) in the treatment of acute cardiogenic pulmonary Oedema?(W B Saunders Co-Elsevier Inc, 2021) Uz, Ilhan; Kiyan, Guclu Selahattin; Ozcete, Enver; Yalcinli, Sercan; Korgan, Mehmet Birkan; Altunci, Yusuf Ali; Yavuzgil, Oguz[No Abstract Available]Öğe Mortality-related factors in older adults with delirium: A prospective observational study(Mosby Elsevier, 2024) Boran, Yigitcan; Altunc, Yusuf Ali; Yalcinli, SercanBackground: Delirium is a common and serious neuropsychiatric syndrome characterized by acute changes in attention, cognition, and consciousness. It is frequently encountered in various clinical settings, including critical care units and postoperative care, and is associated with significant morbidity and mortality. Understanding the factors contributing to delirium-related mortality is crucial for improving patient outcomes and healthcare practices. However, the factors associated with mortality in delirium have not been well-defined in the literature. Objectives: This study aimed to identify factors influencing 3-month mortality in older adults with delirium presenting to the emergency department (ED). Methods: The study was conducted prospectively and delirium was screened using the brief Confusion Assesment Method (bCAM). The primary outcome was 3-month mortality. Mann-Whitney U and Chi-square tests compared groups, Spearman correlation analyzed correlations, and multivariate logistic regression identified risk factors. Results: Among 243 patients, 29.6% experienced in-hospital mortality, and 56.4% had 3-month mortality. Factors associated with increased mortality risk included prior delirium history (3.32-fold increase, 95%CI: 1.51-7.30), active malignancy (3.49-fold increase, 95%CI: 1.61-7.56) and increased respiratory rate (1.18-fold increase, 95%CI: 1.08-1.29). An increase in mean arterial pressure (MAP) was associated with a 0.98-fold decrease in mortality risk (95%CI: 0.96-0.99), increase in body temperature was associated with a 0.48-fold decrease in mortality risk (95%CI:0.31-0.76). Conclusion: In delirious older adults at the ED, higher respiratory rate, lower MAP, lower body temperature, active malignancy and prior delirium history signal elevated mortality risk.Öğe Nivolumab, a new immunomodulatory drug, a new adverse effect; adrenal crisis(Elsevier Science Bv, 2017) Akarca, Funda Karbek; Can, Ozge; Yalcinli, Sercan; Altunci, Yusuf AliOwing to the advancements in medicine, new information is obtained regarding cancer, new antineoplastic agents are developed. Frequent use of these new pharmacological agents emergency physicians to be vigilant about their side effects. We present a case of adrenal crisis in a patient with non-small cell lung cancer (NSCLC), caused by an immunomodulatory drug; nivolumab. While adverse events are related to other immunomodulatory drugs have been reported in literature, our case is the first nivolumab-related adrenal failure to be reported. A patient with lung cancer presented to the emergency room(ER) with nausea and vomiting. Hyponatremia, hyperkalemia, persistent hypoglycemia led to the diagnosis of adrenal crisis. Having direct effect on the immune system, these drugs were claimed to be highly reliable. However, there is no reliable data on the side effect profile of these agents. It should be kept in mind that life-threatening auto-immune reactions may occur. Copyright (C) 2017 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner. This is an open access article under the CC BY-NC-ND license.Öğe REPRINT OF: REMEMBER ATROPINE FOR "KILLER B'S" RESPONSE(Elsevier Science Inc, 2020) Yalcinli, Sercan; Kiyan, Guclu Selahattin[No abstract available]Öğe Retrospective Evaluation of Patients with Angioedema Treated with C1 Inhibitors in an Emergency Department(Galenos Publ House, 2022) Yalcinli, Sercan; Kiyan, Selahattin; Akarca, Funda KarbekAim: We aimed first to investigate patients who received C1 inhibitor therapy in the emergency department (ED). The patients' complaints, examination findings, length of stay in the ED and whether the patients were treated with anything other than C1 inhibitor were investigated. Next, we examined the response of patients who received C1 inhibitor therapy in the presence of angiotensin converting enzyme inhibitor (ACEI)-induced angioedema. Materials and Methods: A retrospective descriptive study was designed. Patients who received C1 inhibitor therapy between January 2011 and February 2018 were reviewed using the hospital's records on file. Results: Data were evaluated from 62 admissions for 23 different patients. The diagnosis of hereditary angioedema (HAE) was present in 65.2% (n=15) of the patients, and 85.5% (n=53) of the admissions were related to acute HAE episodes. The main complaints of these patients were nausea, vomiting and abdominal pain and swell of the face, lips, throat and extremities. It was determined that C1 inhibitor treatment was given to 8% (n=5) admissions due to ACEI-induced angioedema. The complaints of these patients (5 admissions for 4 patients) were swelling of the tongue (n=3), lip (n=1) and face (n=1). Clinical improvement was observed in admission symptoms after treatment of C1 inhibitor in all patients with angioedema induced by HAE episodes or ACEIs. Conclusion: C1 inhibitor treatment is effective in treating acute HAE episodes. Although more evidence is needed for the treatment of ACEI-induced angioedema attacks, C1 inhibitor therapy may be considered in patients who do not respond to classical treatment.Öğe Risk factors for neurological complications and clinical outcomes in patients with left ventricular assist devices(Mre Press, 2021) Kodik, Meltem Songur; Yildiz, Ali Kemal; Uz, Ilhan; Yalcinli, Sercan; Kahraman, Umit; Bolat, Elif; Altunci, Yusuf AliObjectives: Patients with left ventricular assist devices (LVADs) frequently experience cerebrovascular complications. We investigated the complications, including intracranial hemorrhage (ICH) and ischemic stroke (IS), in patients with LVADs. Methods: A historical cohort study was performed at an emergency clinic including patients who underwent LVAD placement between February 16, 2015, and April 1, 2020. of the 295 patients with LVADs, 71 (24.1%) were admitted to the emergency service between the study dates because of IS and ICH. Electronic medical files were reviewed, and patients were categorized as ICH or IS. Results: of the included patients, 245 (83.0%) were male. The most common postoperative complications were pump thrombosis (26.8%, n = 79), blood culture positivity (19.3%, n = 57), and surgical bleeding (5.8%, n = 17). The most frequent LVAD indication was ischemic dilated cardiomyopathy (71.5%, n = 211). The mean age was 49.6 +/- 16.7 and 51.3 +/- 14.8 years for patients with and without neurological complications, respectively (P = 0.415). Neurological complications were seen in 65 (31.3%) patients with and in 6 (6.9%) patients without coronary ischemia (P < 0.001). Neurological complications were found in 39 (30.5%) patients with an implantable cardioverter defibrillator (ICD) and in 32 (19.2%) patients without an ICD (P = 0.024). Neurological complications were found in 19 (61.3%) patients with and in 52 (19.7%) patients without a history of stroke (P < 0.001). Logistic regression analysis revealed that age and Glasgow coma scale (GCS) were the only significant variables independently affecting mortality status. While a younger age was a protective factor, a one-unit increase in the GCS was associated with a 4.1-fold (95% CI: 1.308-13.071) increase in mortality. Conclusions: Coronary ischemia, ICD, cerebrovascular disease, and smoking significantly affected the presence of complications. Moreover, patients with combined IS and ICH had a lower chance of recovering. Interventional procedures should be performed as early as possible, especially in elderly patients with a low GCS.Öğe Use of ultrasonography for differentiation between bullae and pneumothorax(Springer Heidelberg, 2019) Karacabey, Sinan; Sanri, Erkman; Metin, Bayram; Erkoc, Fatih; Yildirim, Sener; Intepe, Yavuz Selim; Yalcinli, SercanPurposeModern lung ultrasound (US) is mainly applied not only in critical care, emergency medicine, and trauma surgery, but also in pulmonary and internal medicine. In some cases, pneumothorax (PTX) distinguishes with bullous diseases. In this study, we aimed to discuss the success of US on detecting PTX versus bullae.MethodsWe performed a prospective blinded study. Patients underwent thorax computed tomography (CT) if bullae or pneumothorax could not be differentiated from the chest radiography. An emergency medicine specialist trained in lung US and unaware of x-ray and CT findings performed US. All patients US performed from anterior and lateral wall.ResultsFinal study population included 81 patients. The sensitivity of the presence of pleural sliding in the diagnosis of bullae was 97.50% (86.84-99.94%), and specificity was 100.0% (91.4-100.0%).ConclusionIn conclusion, direct visualisation of ultrasonographic pleural sliding can be a good tool for differentiating bullae and pneumothorax.
