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Öğe 112 SAĞLIK ÇALIŞANLARININ HASTANE DIŞI KARDİYAK ARRESTLERDE KARDİYOPULMONER RESÜSİTASYON BİLGİ DÜZEYİNİN DEĞERLENDİRİLMESİ(2020) Çolak, Tamer; Çelik, Kaan; Tekten, Beliz ÖztokAmaç: Acil servislerde kardiyak arrest tanısı ile resusitatifmüdahale yapılan hastaların büyük çoğunluğunu hastane dışıkardiyak arrest vakalar oluşturmaktadır. Ayrıca bu vakalarınbirçoğu, olay yerinde 112 Acil Sağlık Hizmetleri ekiplerinceilk müdahale sağlandıktan sonra hastanelere getirilmektedir.Bu çalışmada, 112 sağlık çalışanlarının kardiyopulmonerresüsitasyon konusundaki bilgi düzeylerini ve tutumlarınıdeğerlendirmeyi amaçladık.Gereç ve Yöntemler: Çalışmamız, Üniversitemiz KlinikAraştırmalar Etik Kurulu Onayı alındıktan sonra, 1 Mayıs2019 ile 1 Haziran 2019 tarihleri arasında yüz yüze anketuygulanması yöntemi ile gerçekleştirildi. Tüm testlerdeistatistiksel anlamlılık düzeyi p<0.05 olarak kabul edildi.Bulgular: Çalışmamıza toplam 131 gönüllü 112 Acil SağlıkHizmetleri çalışanı dahil edildi. Katılımcıların meslekdağılımı: 9 (%6.9) doktor, 4 (%3.1) hemşire, 73 (%55.7) aciltıp teknisyeni, 34 (%26) paramedik ve 11 (%8.4) sağlıkmemuru şeklindeydi. Katılımcıların %90’ının daha öncekardiyopulmoner resüsitasyon uyguladığını ve 70 (%53.4)katılımcının daha önce hastane dışı kardiyak arrest vakalar ilekarşılaşmış olduğunu gördük. Doktorların %66.7’si,hemşirelerin tamamı, acil tıp teknisyenlerinin %95.9’u,paramediklerin %97.1’i ve sağlık memurlarının %81.8’i dahaönce kardiyopulmoner resüsitasyon ile ilgili bir eğitim/kursalmıştı (p=0.018). “Temel yaşam desteği sırasında göğüs basısısayısı dakikada kaç kez olmalıdır?” sorusuna, Amerikan KalpCemiyeti’nin 2015 yılında yayınlamış olduğu kılavuzunuokuyan katılımcıların %76.7’si doğru cevap verirken, kılavuzuokumayanların %54.5’i doğru cevap vermiştir (p=0.014).Sonuç: 112 sağlık çalışanlarının kardiyopulmoner resüsitasyonuygulamalarında bilgi düzeylerinde eksiklikler olduğunubelirledik. Bu eksikliklerin giderilmesi amacıyla, kılavuzlarışığında ve düzenli aralıklarla eğitimli uygulayıcılar tarafındankardiyopulmoner resüsitasyon eğitim programları ve kurslarındüzenlenmesi gerektiği düşünülmüştür.Öğe Acil serviste akut inme tanısı alan hastaların değerlendirilmesi: İki yıllık analiz(2020) Çolak, Tamer; Yencilek, Halil İlker; Kalaycıoğlu, Oya; Çelik, Kaan; Tekten, Beliz ÖztokAmaç: Çalışmamızda, acil serviste akut inme tanısı alan hastaların etiyolojik, demografik ve klinik özelliklerini araştırmayı ve bu sayede öncelikle bölgemiz verileri olmak üzere ülkemizin inme verilerine katkıda bulunmayı amaçladık. Gereç ve Yöntem: Çalışma, 01.01.2017-31.12.2018 tarihleri arasında acil servise başvuran ve inme tanısı alan toplam 236 hastanın verileri üzerinden retrospektif olarak yapıldı. Bulgular: Hastaların 210’u (%88,9) iskemik inme ve 26’sı hemorajik inme (%11,1) tanısı aldı. Yüz altı (%44,9) hasta ilk 4,5 saat içerisinde başvururken, 130 (%55,1) hasta 4,5 saatin üzerindeki bir süre de başvurdu. İki yüz beş (%86,9) hasta hastaneden taburcu edilirken, 31 (%13,1) hasta öldü. Hastalarda hipertansiyon en sık tespit edilen risk faktörü iken, ikinci sıklıkta sigara kullanımının olduğu görüldü. En sık hasta başvurusunun %29,7 oranıyla yaz aylarında olduğu görüldü. Atriyal fibrilasyon akut inmeli hastalarda mortalite için bağımsız bir risk faktörü olarak belirlendi ve atriyal fibrilasyonun mortalite riskini 3,18 kat artırdığı görüldü (p=0,008). Sonuç: Çalışmamız Bolu ilinin inme verilerinin büyük bir kısmını yansıtmakla beraber, Batı Karadeniz Bölgesi açısından kıymetli sonuçlar vermiştir.Öğe Confusion, respiratory rate, shock index (CRSI-65) score in the emergency department triage may be a new severity scoring method for community-acquired pneumonia(Saudi Med J, 2020) Tekten, Beliz Öztok; Temrel, Tuğba Atmaca; Şahin, SerkanObjectives: To investigate whether confusion, respiratory rate, shock index-age >= 65 years (CRSI-65) score, consisting of basic physiological parameters, can be used for severity prediction in patients with community-acquired pneumonia. Methods: This is a prospective cohort and single-center study conducted in Bolu Abant Izzet Baysal University Hospital, Bolu, Turkey between January 2018 and June 2018. The study investigated CRSI-65 score in predicting 4-week mortality and the need for intensive care for patients with community-acquired pneumonia. Results: A total of 58 patients with community-acquired pneumonia admitted to the emergency department were included in this study. Of the patients, 62.1% were males (n=36), and the mean age of the patients was 72.87 +/- 12.30 years. After 4 weeks of follow-up, CURB-65 and CRSI-65 scores showed similar results in predicting mortality with respect to specificity, sensitivity, and positive and negative predictive values. Area under the receiver operating characteristic curve was 0.926 for the CURB-65 (95% confidence interval [CI] 0.853-0.999) and 0.954 for the CRSI-65 (95% CI 0.899-0.999). Conclusion: Similar to the CURB-65 score, the CRSI-65 score appears to be useful in predicting 4-week mortality. The evaluation of CRSI-65 score can be used in emergency department triage, primary care, and non-hospital settings.Öğe Factors affecting survival and neurological outcomes for patients who underwent cardiopulmonary resuscitation(Pakistan Medical Assoc, 2020) Çolak, Tamer; Tekten, Beliz ÖztokObjective:To determine the impact of arrest location, arrest reason, the return of spontaneous circulation positivity, duration of cardiopulmonary resuscitation, chest compression method, and cardiac rhythm at the time of hospital admission on survival rates and neurological outcome in cardiac arrest cases. Methods: The retrospective study was conducted at Bolu Abant Izzet Baysal Training and Research Hospital, Turkey, and comprised data related to the period from January 1, 2016, to June 31, 2018, of patients who received cardiopulmonary resuscitation at the Emergency Department. Demographic characteristics of the patients, the return of spontaneous circulation, and 6-month survival rates were evaluated with the use of a modified Rankin scale. Data was analysed using SPSS 25. Findings: Of the 177 cases, 109(61.58%) were male. The return of spontaneous circulation was noted in 72(40.68%) patients. In-hospital, cardiac arrest developed in 80(45.20%) patients, and chest compression wasperformed on 105(59.32%) with the use of a mechanical chest compression device. A non-shockable rhythm state was observed in 150(84.75%) patients, and 18(10.17%) survived at the end of the sixth month. Conclusion: The return of spontaneous circulation rate was higher and the neurological prognosis was more positive in patients on whom cardiopulmonary resuscitation was performed for a shorter time period and who had a shockable cardiac rhythm at the time of admission.Öğe Inferior vena cava aneurysm in advanced age: A rare case report(2021) Borulu, Ferhat; Tekten, Beliz ÖztokAmong all vascular aneurysms, the venous type is quite rare compared to the arterial type. Although this is the case, venous aneurysms\rcan cause serious complications and even death. Most patients are asymptomatic; however, serious clinical indicators may occur including\rabdominal pain, gastrointestinal bleeding, venous occlusions, and pulmonary embolism. In this article, we present an 84-year-old male case\rof an inferior vena cava aneurysm presenting with a complaint of intermittent, non-specific abdominal pain in the right upper quadrant for\rthe last couple of years.Öğe Investigation of the reasons and frequency of geriatric patients applying to the emergency department(2022) Tekten, Beliz Öztok; Çelik, Kaan; Çolak, TamerAim: To determine the reasons for choosing the emergency department in patients aged 65 and over who \rapplied to the emergency department and investigate the effect of their use of primary health care services on \rthe frequency of emergency department visits.\rMethods: The study is a prospective cross-sectional study. It was performed in the emergency department of \ra university tertiary hospital between 1 November 2017 and 30 April 2018. Demographic characteristics of \rpatients aged 65 and over who applied to the emergency department, the reasons for applying to the emergency \rdepartment and their use of primary health care services were evaluated with a questionnaire. The data were \rstatistically analyzed.\rResults: 242 patients were included in the study. 57.9% (n: 140) of the patients were male. 82.2% of the \rpatients stated that they applied to the emergency department at least three times in a year. When the reasons \rfor applying to the emergency department were examined, it was seen that the most common reason (35.5% \rn: 86) was not wanting to wait in line in the outpatient clinic. 33.5% (n: 81) of the patients did not know their \rfamily doctor and 41.3% (n: 100) did not use primary health care services.\rConclusion: It has been observed that the problems experienced during outpatient services in patients aged 65 \rand over and the status of benefiting from primary health care services in this age group are effective factors \ron the frequency of emergency department visitsÖğe Is thorax CT necessary in emergency thoracic traumas?(2022) Yakşi, Osman; Tekten, Beliz ÖztokIntroduction: Recently, computed thorax tomography (Thorax CT) has replaced chest radiography as a routine imaging method in patients presenting to the emergency department after thoracic trauma. It has been shown that unnecessary use of thorax CT increases exposure to high-dose radiation, increases hospital costs, and prolongs the length of stay in the wards. Our study investigated the clinical necessity of thorax CT scans for patients who applied to our emergency department with thoracic trauma. Material Method: The data of 515 patients diagnosed with thoracic trauma in the emergency department between January 2017 and January 2021 were retrospectively reviewed. According to thorax CT findings, sternum fracture, diffuse parenchymal contusion, scapula fracture, presence of hemothorax, penetrating chest trauma, 3 or more costal fractures, vertebral fracture, diaphragm rupture, and mediastinal organ injury were evaluated as criteria showing that thorax CT was performed with a correct indication. Results: When we look at the thorax CT requirement criteria that we have determined, we saw that 391 (75.9%) patients had thorax CT performed with the correct indication, and 124 (24.1%) patients did not give us any additional pathological findings. Conclusion: As a result, we think that a good physical examination, evaluation of clinical findings, and performing thorax CT according to chest radiography findings will reduce unnecessary radiation exposure and hospital expenditure costs.Öğe Prognostic value of the optic nerve sheath thickness as an indicator of intracranial pressure among acute stroke patients(2020) Çelik, Kaan; Çolak, Tamer; Tekten, Beliz ÖztokAim: To evaluate the clinical value of optic nerve sheath thickness (ONST) in stroke patients.Method: The present study was prospectively performed on 386 stroke patients who were admittedto Emergency Department, and 75 healthy volunteers of similar age and gender groups. The followingcriteria were evaluated for each patient: age, gender, comorbidities, neurological deficit levels[Glasgow Coma Scale (GCS), the National Institute of Health Sciences Scale (NIHSS)], tomographyfindings (hemorrhagic / ischemic), ONST diameter in ultrasound scan, hospitalization and mortalityrates.Results: The median ONST value was 5.5 mm (IQR: 0.30) for the hemorrhagic stroke patients, and5.25 mm (IQR: 0.20) for the ischemic stroke patients. The median ONST value of the stroke patientswas significantly higher. Also, the ONST values of the hemorrhagic stroke patients were found to besignificantly higher. In our study, the area below the curve was 0.865. For the 4.5 mm cut-off value,the sensitivity was 96.1% and specificity was 82.7%.Conclusions: The results of our study showed that the ONST increased in the stroke patients and thisincrease was higher in the hemorrhagic stroke patients. We suggest that the treatment can beconsidered to decrease intracranial pressure if there is an increase in ONST in stroke patients.Öğe Serum prolactin level and lactate dehydrogenase activity in patients with epileptic and nonepileptic seizures: A cross-sectional study(Lippincott Williams & Wilkins, 2021) Yılmaz, Murat; Tekten, Beliz ÖztokIt is important to diagnose epilepsy in a timely and accurate manner, and also to distinguish it from non-epileptic conditions. The present study was aimed at determining postictal serum prolactin levels and lactate dehydrogenase (LDH) activities in patients with new-onset seizure admitted to the emergency department in order to assess whether they could be used in the differentiation of epileptic seizure (ES) from nonepileptic seizure (NES). Eighty-five patients were included prospectively in this study. Patients were divided into 2 groups with respect to epilepsy diagnosis, and the final groups were comprised of 36 patients with ES and 49 patients with NES. Blood samples were obtained within 1 hour of seizure. No significant differences between groups were observed in prolactin levels and in the percentage of patients with abnormal prolactin level (P = .569 and .239, respectively). The median LDH activity was significantly higher in those with ES compared with those with NES (P = .031). The percentage of patients with elevated LDH levels was similar between 2 groups (P = .286). This was the first study to examine LDH activities in terms of its role in differentiation of seizure origin in the postictal period in patients hospitalized with seizure. Our study demonstrated that serum LDH activities within 1 hour after the seizure appear to be increased in patients with ES compared with those with NES, suggesting the potential role of LDH activities as a diagnostic tool in distinction of seizure types. Our study supports the hypothesis that LDH-antagonists may have a role in the management of seizure and epilepsy.
