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    Analgesic Treatment in Patients With Acute Extremity Trauma and Effect of Training
    (Elsevier Science Bv, 2012) Akarca, Funda Karbek; Karcioglu, Ozgur; Korkmaz, Tanzer; Erbil, Bulent; Demir, Omer Faruk
    Objectives Studies indicate that emergency physicians (EP) under-evaluate and undertreat the pain experienced by their patients. The objective of this study was to investigate how EPs treat pain in adult patients with limb trauma and to determine if their behavior could be affected by training in the short-term. Methods All consecutive adult patients admitted to the university-based emergency department (ED) within two months were enrolled in the study. The patients were asked to rate their level of pain on the NRS in triage. NRS scores were noted again after 30 minutes and 60 minutes, and on discharge. Patient prescriptions were also tracked to identify any analgesics. After completion of the pre-education phase, four hours of training on pain evaluation and treatment were undertaken under the leadership of experienced staff faculty. The aforementioned outcomes were gathered again in a 30-day period after training and we compared the pre and post training periods. Results A hundred and forty-three patients (81 female) were enrolled in the pre-education phase, and 130 patients (58 female) were eligible for the post-education phase. The mean NRS scores of the females noted on admission were significantly higher than those of the males (7.4 +/- 2.3 vs. 6.7 +/- 2.5, respectively; p=0.020). Patients included in the first phase received analgesia less frequently (42.7% vs. 70.0%, respectively; p<0.001). The mean period of time between admission and initial analgesic administration was shorter in the second phase (41.3 vs. 19.3 minutes, respectively; p<0.001). The ratio of patients receiving analgesia within thirty minutes was greater after training. All patients in the second phase received analgesia within 60 minutes. The residents prescribed analgesics more frequently after training. Conclusions A four- hour training program resulted in apparent changes in the residents' management of pain in patients with extremity trauma. In addition to a more timely administration, the rates of analgesic treatment increased.
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    An evaluation of pre-admission factors affecting the admission time of patients with stroke symptoms
    (2010) Korkmaz, Tanzer; Ersoy, Gürhan; Kutluk, Kürşad; Erbil, Bülent; Akarca, Funda Karbek
    Objective: New drugs to be optimally curative in stroke therapy should be given quickly after the appearence of the symptoms. In this study, we studied the factors regarding the delay of the patients' admissions to the emergency departments and the knowledge level of the people about the stroke. Methods: A prospective study was designed in a third referral hospital. The adult patients admitting to hospital with neurologic symptoms were recruited in the study. The patients who admit to the hospital in more than 3 hours after the symptoms appear were asked about the reasons of the delay with open ended questions. Results: The mean age of 117 patients that included in the study were 66.7±13.2. Of these patients, 44% (n=52) were admitted in the first three hours. For patients arriving at hospital in the first three hours the demographic analysis were statistically significant for those living with family members (p=0,008) and for those with speech impairment (p=0,002). Of the patients who arrived at the hospital in more than three hours (n=61, 45.9%), most had either waited for the symptoms to disappear or were hesitant about coming to the hospital. Conclusions: The general knowledge level of the people about the symptoms and risk factors of stroke is thought to be the most important parameter concerning the early admittance. However in this study we found that even the knowledge level is insufficient stroke patients have been reported to admit to the emergency department in the first six hours.