Jaaja Bujagail Bring Back Lost Love Spell Caster +27734818506 in Tasmania Victoria West Norway Hull London MISSOURI Algeria KUWAIT, QATAR USA, Canada Cosmo City Diepsloot, Uk,

initial rhythm for these patients was in Group A: VF 56 % , Corresponding author: Mr Dobias Viliam ([email protected])
pulseless electrical activity 16 % and asystole: 24 %; In Group B : Key-words: prehospital EMS ; diagnosis in PEMS ; prehospital management
VF 43 %, PEA 38 %, and asystole 19 %. The overall survival rate to
hospital discharge with CPC 1 or 2 was 10,2 % (46 of 452). Number of patients, diagnosis, appearance of dangerous symptoms
Incidence of shockable rhytm within patients discharged with CPC 1 and number of patients transported to hospital or left home after
or 2 was 80 % (37 of 46). treatment are not a matter of frequent evaluation. We analyzed
Conclusion: 293 cases of emergency call during November 2011 in various
Early recognition of cardiac arrest and subsequent initiation of regions of Slovakia by 2 crews with physician. There were 159
dispatcher-assisted cardiopulmonary resuscitation has important women with average age 64 (range 2 - 92 years) and 138 men –
role in prehospital patients management. Dispatchers have to average age 50 (1 - 94 yrs). Transported after treatment were 143
initiate chest compressions as soon as possible. Initial shockable patients (48%).
rhytm has significantly better prognosis as to hospital discharge From 154 left home 23 deceased before the arrival of crew (7,7%).
with good neurological status (CPC 1 or 2). The most frequent reason for emergency call is hypertension (20%
of calls), next are neurological symptoms and vertigo (10%), small
P733 ____________________ Pre-hospital / EMS / Out of Hospital psychiatry diagnoses (neurosis, phobia in 9%), acute coronary
syndrome (9%), respiratory diseases, psychiatric diseases, stroke,
INTRODUCING A PARALYTIC RSI SYSTEM TO HUNGARIAN arrhythmias, diabetes mellitus complications (mostly
HEMS hypoglycaemia), ebriety, medicament and chemical intoxication.
P. Temesvari, A. Soti, L. Hetzman When sorted by diagnosis, most frequent transport after primary
treatment at home is by stroke (100%), intoxications (89%), ebriety
Budaors Base, Hungarian Air Ambulance Nonprofit Ltd., Budapest, Hungary (83%), arrhythmias (77%), acute coronary syndrome (70%),
Corresponding author: Mr Temesvari Peter ([email protected]) respiratory diseases (68%), psychiatric diseases (psychosis, biphasic
Key-words: Intubation ; Pre-hospital ; HEMS disorder and suicidal tendencies), neurological diseases, small
psychiatry and diabetes mellitus complications (mostly
Advanced airway management and intubation in particular remains hypoglycaemia). At the end of the list is hypertension, only 2% of
a controversial topic in the field of Pre-Hospital Emergency patients were transported with this diagnosis.
Medicine. Traditionally, physician based and non-physician based To evaluate subjective symptoms we divided them into 3 groups.
Emergency Medical Services in Hungary used an intubation First group – critical: ECG changeovers, heart failure, cephalea,
technique - for patients with preserved cardiac output - based stenocardias, hypoxia, bronchospasms, dysarthria, TIA, epilepsy 1.
mostly on sedation and analgesia, in some sources called a Non- seizure, neurological lateralisation. Second group – potentially
paralytic RSI. Hungarian HEMS introduced a Paralytic RSI system in dangerous: palpitations, short time stenocardia, dizziness, nausea,
2011, after a 6 month survey of the previous practice. Along with disorientation, high temperature by old people, repeated syncope.
muscle relaxants previously unpracticed elements of Clinical Third group – chronical: difficulties lasting few days, dizziness,
Governance were introduced as well. This later includes the use of tingling of fingers and face, insomnia, tremor or difficulties that
Standard Operating Procedures that need to be followed - among disappeared after self medication.
others - in case of pre-hospital anesthesia. Highest number of critical symptoms is by stroke emergency calls
The aim of the presentation is to highlight the difficulties in (100%), intoxications (91%), followed by neurological diseases
introducing a protocol based procedure and SOPs to a system (69%), cardiovascular diseases (CAD, arrhythmia in 57%),
previously based on individual decision making by competent respiratory diseases (53%), psychiatry (40%), ebriety (22%) and
clinicians. We aim to look at human factors, aspects of training and hypertension (17%).
audit. All patients with hypertension were divided into 3 groups: left
The secondary aim of the presentation is to look at the first results home after treatment, transported to health facility and group with
of Paralytic RSI in HEMS practice in Hungary. We are collecting data other serious diagnosis except hypertension (myocardial infarction,
regarding indications, the overall success rate and other output cerebral stroke, respiratory insufficiency). Highest values of blood
measures like the number of attempts, the Cormack-Lehane grade pressure were found by group of left at home, then group with
at laryngoscopy, the drug doses, the complications. other serious diagnosis and lastly group of transported patients.
As usual in the Pre-Hospital Emergency Medical practice, our case (BP 187/94 mm Hg together, versus 187/101, 181/100 and
numbers are quite low, but the results are promising. Data 186/95).
collection will be a continuous part of our audit, but we can use the Discussed problems in lecture are for example high number of ride-
first more than 150 cases to show the differences between a Non- outs to hypertension with minimal need of hospitalisation,
paralytic and a Paralytic RSI system in the same setup with the relatively high number of transports by neurosis and phobia
same clinicians with access to the same equipment. The overall without critical symptomatology and high number of ebriety
success rate is 98.7% in the first 154 RSI cases. transports without any serious symptoms endangering life of the
patient. In the end we present algorhithms how to decrease the
number of not indicated ride-outs to diseases with serious
symptomatology and how to decrease number of transports to
hospital after treating regular neurosis and phobia.

P734 ____________________ Pre-hospital / EMS / Out of Hospital

DO WE NEED A PHYSICIAN IN PREHOSPITAL EMS ?

T. Bulikova (1), V. Dobias (2)

1. Prehospital EMS, LSE - Life Star Emergency, Senec, Slovakia
2. Chair of Emergency Medicine, Slovak Medical University, Bratislava, Slovakia

BOOK OF ABSTRACTS 397

P735 ____________________ Pre-hospital / EMS / Out of Hospital Bachground
Early reperfusion is the golden standard in managing ACS,massive
A DESCRIPTION OF A PUBLIC-PRIVATE PARTNERSHIP PE and stroke and the ways to achieve this standard are well
EMERGENCY MEDICAL SERVICE IN LAHORE, PAKISTAN. known.
H Chaudhary (1), K Paziana (1), M Rotte (1), R Naseer (2), H Simultaneously time standards in which the therapy is optimal are
Sule (1), JM Fields (1), B Ku (1) specified and particular.Excluding major contraindications for
trombolisis and therefore the application of this procedure always
1. Emergency Department, Thomas Jefferson University Hospital, Philadelphia, United remains a difficult problem to resolve.
States Study purpose
2. EMS, Punjab Emergency Medical Services, Lahore, Pakistan This study’s aim is to bring an solid argument for echocardiography
Corresponding author: Mr Chaudhary Hasan ([email protected]) as a mandatory standard to exclude aortic aneurism ,aortic
Key-words: Emergency medical services ; Pakistan ; Development and implementation of dissection, myocardial wall breach or other delay criteria for
Prehospital Emergency response trombolisis.
Material and method
Study Objectives: 3 patients received in the Emergency Department of County
In 2004 in response to the call for structured emergency medical Hospital of Craiova in one month time:2 patients(1male and 1
services, the Punjab Province piloted a public-private partnership female)with STEMI and one patient with massivePE.
called the Punjab Emergency Service (PES), otherwise known as Case analisis
Rescue 1122, in Punjab’s capital, Lahore. Since its establishment, The two STEMI patients were out of PTCA time ,their presentation
PES has expanded its service to all 36 districts of the Punjab in ED happened after five hours and eleven hours from the
province, which contains nearly 56% of the country’s population. In beginning of the symptoms. Cardiac echography for determination
order to better understand the success of PES we set out to of ejection fraction at the male patient showed an thoracic aortic
determine the volume and types of calls it receives and responds aneurism which compressed left bronchia.
to. The female patient with STEMI had another presentation 24 hours
Methods: before in another hospital for thoracic pain but with no ECG
This was a retrospective analysis of a prospectively gathered modifications;a new presentation occurred 11 hours after a new
database collected from 2004 to 2011. Emergency phone calls and episode of thoracic pain for repeated syncope and general clinical
rescue operations in Lahore were reviewed during this time period. deterioration. Regarding long distance towards a PTCA center and
Results: in absence of emergency air transport, the solution was land
In a 8 year period, PES received a total of 10,830,157 phone calls of transport with C1 ambulance. At the team arrival, the emergency
which 3.1% required an emergency response via ambulance. The physician performs an echocardiography and finds fluid intra
emergency responses were separated into the following pericardium. When the image was transmitted at the Cardiology
categories: road traffic accidents ( 46.6%), fire ( 2.8%), building Center, suspicion if myocardial wall breach postponed trombolisis
collapse (0.2%), explosions or bomb blasts (0.1%) and medical or and ulterior thoracic CT confirmed mechanical lesion of myocardial
other (50.3%). The average response time for rescues was 6.1 wall due to miocardial infarction of the right ventricle.
minutes and there was an average of 120 responded calls per day. At the third patient, echography and thoracic CT showed massive
From 2006 to 2011, there was a 266% increase in the number of thrombosis of the PA troncus, ASD, aortic, carothid and
emergency responses. subclavicular artery thrombosis and the management was
Conclusion: anticoagulation followed by cardiac surgery.
The high volume of emergency calls and increased utilization of Conclusions
services in Lahore suggests the successful implementation of a 1.vascular pathology associated with ACS is possible and often
public-private emergency medical service. PES may prove to be a unknown
model infrastructure in other regions of Pakistan in need of 2.association between obstructive and hemorrhagic elements is
emergency services. also possible.
3.in the presence of a massive floating thrombus, the risk of
P736 ____________________ Pre-hospital / EMS / Out of Hospital fragmentation is enormous and that is the reason for
anticoagulation as a first option.
PRO OR CON PREHOSPITAL TROMBOLISIS- EXCLUDING 4.echocardiography must always be performed to demonstrate this
MAJOR CONTRAINDICATIONS situations and telemedicine may be used for results interpretation.
A Amzulescu (1), A Popa (2), L Rotaru (3) 5.in absence of echocardiography and telemedicine, prehospital
trombolisis may be disastrous if one of this situations remains
1. ED, Filiasi Hospital, Filiasi, Romania unknown
2. emergency department, County Hospital Craiova, Craiova, Romania
3. emergency department, Medical University, County Hospital Craiova, Craiova,, P737 ____________________ Pre-hospital / EMS / Out of Hospital
Romania
Corresponding author: Mme Rotaru Luciana Teodora ([email protected]) EVALUATION OF THE 112 EMERGENCY MEDICAL SERVICES
Key-words: prehospital trombolisis for AMI, ; telemedicine and echocardiography ; EFFECTIVENESS
prehospital trombolisis for PE, S AKAY (1), A AKGUR (1), O DEMİR (2), O ÖNAL (2), G OZBAY
YENİCE (3), I PARLAK (1), N Satılmış (4)

1. EMERGENCY DEPARTMENT, BOZYAKA TRAINING AND RESEARCH HOSPITAL, IZMIR,
Turkey
2. EMERGENCY DEPARTMENT, BOZYAKA TRAİNİNG AND RESEARCH HOSPİTAL, İZMİR,
Turkey
3. EMERGGENCY DEPARTMENT, BOZYAKA TRAINING AND RESEARCH HOSPİTAL, IZMIR,
Turkey
4. emergency department, bozyaka training and research hospital, izmir, Turkey

BOOK OF ABSTRACTS 398

Corresponding author: Mme Özbay Yenice Gökçe ([email protected]) Objective. The objective of this retrospective study was to describe
Key-words: EMERGENCY MEDICAL SERVICES ; PREHOSPITAL CARE ; AMBULANCE RTA victims visited by ambulance team (age, gender, health
condition) and characteristics of EMS visits to RTA victims in Latvia
Introduction: We aim to research effectivity of patient from 1th of July to 31th of December, 2010 according to SEMS
transportation by 112 emergency medical services and compare data.
this with literature. Material and methods. In this study data from 2 925 medical
Method: Our research was performed four different ambulance records of SEMS were analyzed by RTA victim’s age, gender,
station which were defined by the local health authortiy during 01- alcohol impairment and injuries. Time and location (urban or rural
28 April 2012, between 16.00-24.00 hours at izmir. Datas were area) of RTA and EMS response time also were analyzed as factors
recorded by observer at the scene. that could be associated with RTA mortality.
Findings: Cases who were analyzed, %50 were male, %50 were Results. According to analysis, males more often than females were
female, average of the ages were 53,41+/-23,95. Consistency of RTA victims (61.2%; p<0,001). Average age of RTA victims, who
the pre diagnose between 112 command and control services and died in pre-hospital stage (42.8 for males; 45.3 for females), was
ambulance team was %68, 7. When we inspect the accession of the significantly higher (p=0,001) than average age of RTA victims, who
case between declared the patient to the accession of the patient, survived (35.4 for males; 40.1 for females). 68.7% of dead were
average time is 7,49+/-4,26 . Average time between the scene and males. Highest incidence of RTA was in age group 20-29 years
the hospital was 17,28+/-9,74 minutes was determined. Most (194.0 per 100 000 population), but highest mortality rate was in
finding which was measured was blood pressure, minor finding was age group 50-59 years (4.9 per 100 000 population). 26.5% from
fever. %62,2 cases were transported to the hospital. %20,4 cases males and 7% of females were under impairment of alcohol
were treated at the scene. When the team leader was the doctor, according to subjective evaluation of EMS professionals. A
treatment at the scene was higher than paramedic leader. When proportion of EMS visits to RTA victims under impairment of
we compare with the team leaders, ratio of vital signs, medical alcohol was higher on weekends (p<0.001). Emergency calls to RTA
treatment and fluid treatment were not different. %73,8 of the more often occurs on Fridays in urban areas and on Saturdays in
hospitals which were patients transported were tertiary hospitals. rural areas, but least often on Thursdays and on Sundays. There is
%58,8 of the patients delivery were delayed because of fail to no significant difference in number of RTA victims deaths in
reach the doctors who accept the patient. prehospital stage by day of week (p=0.064). Proportion of RTA
Results: Time of ambulance reply is better than the literature but victims’ deaths was 4% between 3:00 a.m. and 5:59 a.m., but
evaluation of vital symptoms and administration of stabilization to between 9:00 a.m. and 11:59 a.m. proportion of RTA deaths was
the multiple trauma patients were defective. When the doctor is 0.8% (p=0.008). Most common injuries of RTA victims were
team leader at the ambulance, unsuitable transportations were contusions and cerebral commotion (58.2%), dislocations and
prevented with treatment at the scene. Selection of the hospital fractures (23.0%) and opened wounds (8.6%). Open wounds were
which was patient transported is not oriented by the 112 command more often diagnosed to males than females (p<0.001). EMS visits
and control centre. to RTA victims statistically more frequently occurred in urban area
Key words: 112 emergency medical services, pre hospital care, (55.5%, p<0.001), but in rural areas statistically more often
ambulance, İzmir, Turkey occurred RTA deaths (71.5%, p<0.001). Odds that victim died in
prehospital stage after RTA in rural area was 2.5 times (95% CI 1.5
P738 ____________________ Pre-hospital / EMS / Out of Hospital – 4.4) higher than in urban areas. Average EMS response time in
urban areas was significantly shorter (8 minutes) than in rural areas
EMERGENCY MEDICAL SERVICE VISITS TO ROAD TRAFFIC (15 minutes) (p<0.001). There is no statistically significant
ACCIDENT VICTIMS’ IN LATVIA differences in EMS response time in cases of victims death in pre-
E Upite (1), D Klusa (2), G Brigis (3), R Pupele (4) hospital stage in comparison with victims who survived neither in
urban areas (p=0.23) nor rural areas (p=0.16).
1. Risk analysis and prevention department, Center for Disease Prevention and Control, Conclusions. 20-29 years old males more frequently receive EMS as
Riga, Latvia RTA victims. This was also observed in South India and Great
2. Unit of EMC organization and development, State Emergency Medical Service of Latvia, Britain. Average age was higher for dead RTA victims, in
Riga, Latvia comparison with those RTA victims, who survived in pre-hospital
3. Public Health and Epidemiology Department, Riga Stradins university, Riga, Latvia stage. Highest mortality rate was in age group 50-59 years. Higher
4. Deputy head, State Emergency Medical Service of Latvia, Riga, Latvia proportion of RTA fatalities was observed in rural areas although
Corresponding author: Melle Klusa Dace ([email protected]) more often emergency calls due to RTA were received from urban
Key-words: prehospital EMC ; road traffic accidents ; mortality areas. Higher proportion of fatalities was observed between 3:00
a.m. and 5:59 a.m. Males 5.7 times more often than females were
Background. In Latvia mortality rate from road traffic accidents under impairment of alcohol. 43% of all EMS visits where alcohol
(RTA) has decreased from 29.5 per 100 000 inhabitants in 2000 to abuse was identified occurred in week-ends. Similar results were
11.5 per 100 000 inhabitants in 2009. According to assessment of also observed by other researchers. Although some studies shows
European Commission such decrease of RTA mortality rate has association between EMS response time and increased mortality
been most rapid during recent years in European Union (EU). rates in rural areas, this study didn’t confirm such correlation.
However RTA mortality rate in Latvia is above the average in EU. In order to completely evaluate quality of medical care provided by
Studies on RTA victims, their injuries and the role of emergency SEMS in case of RTA further researches are necessary, including
medical service (EMS) response time in RTA victims’ mortality have assessment of treatment outcomes of RTA victims in hospital stage.
been published worldwide. Establishment of unified State
Emergency Medical Service of Latvia (SEMS) in 2009 was the
general precondition to initiate research activities in the
prehospital emergency medical care field also in Latvia.

BOOK OF ABSTRACTS 399

P739 ____________________ Pre-hospital / EMS / Out of Hospital are pretty experienced and their perception of patient safety in the
pre-hospital setting is very good, but the crewmembers should be
ASSESSMENT OF PATIENT SAFETY CLIMATE IN THE encouraged to report even more errors. The results from our study
NORWEGIAN AIR AMBULANCE SERVICE indicate that greater efforts are needed to make patient care an
HB Abrahamsen (1-3), SJM Sollid (1), L Öhlund (4), GT even more integral part of the HEMS pilot profession.
Bondevik (2,3) Statistical analysis regarding the psychometrical properties of this
sample is still in progress . We aim to present some of the results
1. Department of Research, The Norwegian Air Ambulance Foundation, Drøbak, Norway on the EuSEM 2012.
2. Department of Public Health and Primary Health Care, University of Bergen, Bergen,
Norway P740 __________________________________ Psychiatry
3. National Centre for Emergency Primary Health Care, Uni Research, Bergen, Norway
4. Faculty of Health and Occupational Studies, University of Gävle, Sweden BURNOUT, JOB SATISFACTION AND DEPRESSION IN THE
Corresponding author: Mr Abrahamsen Haakon Bjorheim ([email protected]) HEALTHCARE PERSONNEL WHO WORK IN THE
Key-words: Hospital Survey on Patient Safety Culture ; pre-hospital ; patient safety EMERGENCY DEPARTMENT: A STUDY ON A SAMPLE FROM
climate THE CITY OF GAZIANTEP
C Gökçen (1), S Zengin (2), MM Oktay (2), G Alpak (3), B Al
Background: (2), C Yildirim (2)
A number of different instruments are used to measure safety
climate in industry and healthcare. Hospital Survey on Patient 1. Child and adolescent psychiatry, Gaziantep University, Gaziantep, Turkey
Safety Culture (HSOPSC) is a standardized survey instrument 2. Emergency Department, Gaziantep University, Gaziantep, Turkey
developed to measure safety climate in hospitals. Little information 3. Psychiatry, Gaziantep University, Gaziantep, Turkey
is available on the usefulness of HSOPSC in the context of pre- Corresponding author: Mr Zengin Suat ([email protected])
hospital critical care. Key-words: Burnout, ; job satisfaction ; emergency department personnel
Objective:
Our primary objective is to describe the psychometric properties of Objective: This study aimed to determine the levels of depression,
the HSOPSC applied to crewmembers in the Norwegian air job satisfaction and burnout and the variables that could be related
ambulance services, and thereby to study the usability in a pre- to them in the healthcare personnel who were working in the
hospital healthcare context. The secondary objective is to compare emergency department in the sample from the city of Gaziantep.
our findings with similar national and international in-hospital data. Method: Study sample included a total of 347 participants,
Method: including doctors, nurses, healthcare officers, paramedics and
We used a Norwegian translation of the HSOPSC that was slightly emergency medical technicians (EMTs), who have been working in
modified to adapt to pre-hospital care. The survey was performed the emergency department of Gaziantep University Medical
as a cross-sectional study in Norway between May 8th and July 8th Faculty Hospital, in the emergency departments of the state
2012. All Helicopter Emergency Medical System (HEMS) physicians, hospitals and 112 emergency services located in the city center of
HEMS crew-members (HCM), HEMS nurses and helicopter pilots Gaziantep. In the study, we used socio-demographic data form,
working in the civilian air ambulance service in Norway at the start Maslach Burnout Inventory (MBI), Minnesota Satisfaction
of the study, were included. The questionnaires were answered Questionnaire (MSQ) and Beck Depression Inventory (BDI).
anonymously in a web (QuestBack) or paper based version. Results: Of the workers of emergency department, 18.5% (n=50)
The study was approved by The Regional Ethical Committee and were working in the university hospitals, 40% (n=108) in the state
the Norwegian Social Science Data Services. hospitals and 41.5% (n=112) in 112 emergency services. Of the
Results: workers, 23.3% (n=63) were doctors, 31.5% (n=85) were nurses
208 crewmembers were invited to take part in the study. A total of and 45.2% (n=122) were paramedics. Healthcare personnel who
171 responses were received of which 22 were paper based. Seven were working in the state hospital had significantly higher
participants had indicated a profession outside HEMS or did not emotional exhaustion (EE) and BDI scores and significantly lower
work clinically and were excluded from the sample. The majority of personal accomplishment (PA) scores compared to the workers of
the respondents were physicians (50%), followed by pilots (20%), 112 emergency department. Paramedics had significantly lower EE
HCM´s (26%) and nurses (4%). The overall response rate was 81% scores compared to both doctors and nurses. In terms of age, it
and the corresponding figures for each of the professions: was found that 18-24 age group had significantly lower MBI-EE
physicians 84% (82/98), nurses 100% (6/6), HCM 91% (42/48) and subscores compared to 25-29 and 30-34 age groups and that 40
pilots 65% (32/49). Five percent of the respondents reported they and over age group had significantly higher BDI scores compared to
did not have any direct contact with patients, and that questions 18-24 age group. All scales, except MBI-PA, were significantly
about patient safety, therefore, were difficult to answer. All these different between the subjects who willingly chose the job and
respondents were pilots. those who unwillingly chose the job. Again, all scales, except MBI-
More than two-thirds of the respondents had more than 5 years of PA, were significantly different between the subjects who gave the
experience from pre-hospital work. Only 5% of the crewmembers answer of “I am satisfied with my work environment” and those
in the Norwegian HEMS programs had less than 1 year of pre- who gave the answer of “I am not satisfied with my work
hospital experience. environment”.
Nearly 50 % of the respondents had not filled out and submittet Discussion: Evaluating the mental health and working conditions of
any event reports the past 12 months. Almost 80% percieved that the people who work in a unit under an intense work pressure,
the patient safety in their primary pre-hospital unit was very good which requires efficient, proper and rapid intervention to the
or even excellent. patients, would help to improve the quality of the services given in
Conclusion: this field.
The overall response rate in this survey was relatively high.
Representativeness is critical and makes the data reliable despite
the limited sample size. HEMS crewmembers working in Norway

BOOK OF ABSTRACTS 400

P741 __________________________________ Psychiatry antipsychotic characterised by rigidity, fever, autonomic
dysfunction and altered consciousness along with elevated serum
EMERGENCY DEPARTMENT VISITS FOR INTENTIONAL creatinine phosphokinase (CPK) levels and leucocytosis [2]
NON-FATAL SUICIDE ATTEMPT IN THE NORTHEASTERN Case Report
TURKEY, 2006-2008 A 68- year – old male patient with schizophrenia was admitted to
M. Eroglu (1), M. Uzkeser (2), A. Saritas (2), H. Acemoglu emergency depertment with complain of poor general health.
(3), M. Navruz (4), M. Emet (2) Patient’s vital signs were normal. ( BP: 12/8 HR: 78 O2Sat: 99 T:
38.2 °C ) Physical examination demonstrated rigidity in both upper
1. Emergency Department, Gulhane Military Medical Academy Haydarpasa Training extremities and he had mental dimness. The patient’s long term
Hospital, Istanbul, Turkey psychiatric treatment had been paliperidon 6 mg and biperiden 2
2. Emergency Department, Ataturk University Faculty of Medicine, Erzurum, Turkey mg. Before 10 days, olanzapin 10 mg was added for treatment.
3. Department of Public Health, Ataturk University Faculty of Medicine, Erzurum, Turkey A head CT scan showeed mild cortical atrophy. CK was 5759, CK-
4. Family Health, Fatih Family Health Center, Erzincan, Turkey MB was 155, WBC were 8300. Transaminases remained normal. A
clinical diagnosis of NMS was made.
Corresponding author: Mr Eroglu Murat ([email protected]) One day later his body temperature 37,4°C despite of paracetamol
Key-words: suicide attempt ; sociodemographic findings ; prevalence treatment.
Discussion
Objective : To assess suicide attempt rates and trends as well as Incidence of NMS side effect induced by olanzapine is extremely
the epidemiology of suicide attempts. rare. [5] Considering these facts, our case of NMS occurred after
Methods: This is a cross-sectional study included 893 parasuicide olanzapine treatment is of interest. NMS is a serious side effect of
“events” recorded in 17 EDs of state hospitals in two neighbor antipsychotic medications. [6] it may occur with in 10 days after
cities in three years. antipsychotic drug use and also at any phase of the treatment. [7]
Results: Mean parasuicide rates in 2007 per 100,000 inhabitants John et al.[8] have reported that in first 2 weeks, the occurrence
were 47.7 for females and 17.7 for males, and 32.5 for both sexes rate is 80%. In this case, our patient and NMS has been seen on the
combined. Nonfatal suicidal attempt was common among young 10th day of the olanzapine treatment.
people, with women outnumbering men. Self poisoning (93.3%) Hyperthermia, muscle rigidity, autonomic instability, delirium and
was the main deliberate self harm type. Males differ from females increased CPK values are the main symptoms of NMS. [9] In our
significantly as they use more violent methods (p=0.002), marriage case CK and CK_MB were high, both upper extremites had muscle
ratio is lower and bachelor ratio is higher (p=0.006), as males are rigidty.
more employed (p < 0.0001); and as hospitalization ratio of males Neuroleptic malignant syndrome is the deathly complication of
were higher (p=0.01). For females, familial problems (29.5%), neuroleptic medications. Death usually occurs as a reason of
mental illness (12.0%) and physical domestic violence (8.9%) were cardiovascular collapse, renal or respiratory insufficiency and
the main declared reasons of deliberate self-harm, respectively. dysrhythmias. [9] In this case, with the early diagnosis and
For men, they were arranged as familial problems (21.3%), appropriate treatment, none of the deathly complications, such as
problems with the opposite sex (16.5%) and mental illness (12.0%). cardiovascular collapse and renal or respiratory insufficiency, has
Physical domestic violence was a common reason among suicide been occurred. Major symptoms had been disappeared 15 days
attempted women aged 15-34 years. Financial difficulties were the after the neuroleptic drug has been stopped and physical
only cited reason of suicide attempt that male predominance was examination and laboratory findings all revealed normal. The
seen. patient has been completely cured and discharged from the
Conclusion: Due to its geographical location, Turkey has long been hospital.
the bridge between Europe and the East, between the Christian Conclusion
and Muslim worlds. As a result, epidemiology of suicide attempt The patients with NMS should admit to emergency services. In
cases in our region resembles a mixture of both European and differential diagnosis of the patients referred to emergency
Oriental communities’ parasuicide characteristics. services with the complaints of muscle rigidity, high fever,
unconsciousness and antipsychotic drug use in history, NMS should
P742 __________________________________ Psychiatry also be considered. Although it is rare, practitioners need to be
aware of that NMS may occur after olanzapine treatment. With
early diagnosis and appropriate treatment, NMS that may cause
death should be managed successfully

OLANZAPINE INDUCED NEUROLEPTIC MALIGNANT P743 __________________________________ Psychiatry
SYNDROME: A CASE REPORT
H Dogan, DN Ozucelik, A Avci, I Uzun, C Simsek, K Acıksari COMT VAL158MET GENOTYPE AS A RISK FACTOR FOR
CONVERSION DISORDER
Emergency department, Bakirköy Dr Sadi Konuk training and research hospital, Istanbul, E. Armagan (1), M. Almacıoglu (2), T. Yakut (3), A. Kose (1),
Turkey N. Kahrıman (1), M. Karkucak (3), O. Koksal (1)
Corresponding author: Mr Dogan Halil ([email protected])
Key-words: neuroleptic malignant syndrome ; Olanzapine ; schizophrenia 1. Department of Emergency Medicine, Uludag University, Faculty of Medicine, Bursa,
Turkey
İntroduction 2. Department of Emergency Medicine, Cekirge State Hospital, Bursa, Turkey
Neuroleptic malignant syndrome (NMS) is a life-threatening 3. Department of Medical Genetics, Uludag University, Faculty of Medicine,, Bursa, Turkey
condition that occurs as a result of dopaminergic receptor blockage Corresponding author: Mr Kose Ataman ([email protected])
in nigrostriatal pathways. [1] The neuroleptic malignant syndrome Key-words: Val158Met genotype ; COMT, ; conversion disorder
(NMS) is a rare but potentially fatal idiosyncratic reaction to

BOOK OF ABSTRACTS 401

Objective: To test the association between the catechol-O- reasons of suicide attempt are family problems and psychiatric
methyltransferase (COMT) Val158Met polymorphism and disorders. Patients still continue to encounter situations in which
conversion disorder. We hypothesized that a relation may be found they stated as the cause of suicide attempt and this may lead to
between Val158Met polymorphism and conversion disorder. recurrent attempts after discharge.
Method: 48 patients with conversion disorder and 48 control
patients investigated for COMT Val158Met genotype. P745 __________________________________ Psychiatry
Results: In the conversion disorder group 31 patients were Val/Met
heterozygotes, 15 patients were Val/Val homozygotes and 2 INCIDENCE OF ADHD AMONG PATIENTS ADMITTED TO
patients were Met/Met homozygotes. In the control group 32 EMERGENCY DEPARTMENT DUE TO TRAFFIC ACCIDENT,
patients were Val/Met heterozygotes, 16 patients were Val/Val BOZYAKA TRAINING AND RESEARCH HOSPITAL,
homozygotes. There is no statistically difference between the EMERGENCY DEPARTMENT, 2012, İZMIR
groups. S Akay (1), M Ardıç (1), B Kalender (1), M Küçük (2), I Parlak
Conclusions: COMT Val158Met genotype is not a risk factor for (1)
conversion disorder for Turkish population. Due to our study COMT
Val158Met genotype is quite common among normal population. 1. Emergency Department, İzmir Bozyaka Research Hospital, İzmir, Turkey
Other genetic risk factors may be considered for conversion 2. Emergency Deparment, İzmir Bozyaka Research Hospital, İzmir, Turkey
disorder. Corresponding author: Mr Ardiç Murat Enis ([email protected])
Key-words: ADHD ; Traffic accident ; Emergency Department
P744 __________________________________ Psychiatry
Traffic accidents consist a major group of patients during routine
PATIENTS PRESENTED TO OUR EMERGENCY DEPARTMENT practice in emergency departments, leading to undesired
WITH RECURRENT SUICIDAL ATTEMPTS economical and health problems.
M. Saritemur, M. Uzkeser, A. Akoz, A. Bayramoglu, M. Emet
This study compares traffic accident victims admitted to İzmir
Emergency Department, Ataturk University Medical Faculty, Erzurum, Turkey Bozyaka Research Hospital, İzmir, Turkey between December 2011
Corresponding author: Mr Saritemur Murat ([email protected]) – April 2012, consisting motor vehicle driver and control group by
Key-words: Emergency Department ; Suicidal Attempts ; Recurrence means of socioeconomical criterias and ADHD incidence. Each
group had 81 individuals.
Introduction: Suicide is one of the most frequent reasons for
emergency admittance. After discharge, patients may re-admit due In the motor vehicle driver group, ADHD diagnostic criterias were
to recurrent suicidal attempts. We examined the demographic present for the 17% (n=14) of the victims. Fort the control group
characteristics of the patients admitted to the emergency the percentage was 4,9% (n=4). Prevalence of ADHD in normal
department (ED) with recurrent suicidal attempt. population is 2-4 %. Although incidence in control group is parallel
Methods: Patients with recurrent suicidal attempt who presented to the normal population, the percentage was statistically
to our ED between 2008 and 2012 were retrospectively reviewed. significant in otor vehicle driver group.
Results: A total of 81 patients were included. 50 (61.7%) of patients
were women and the mean age was 26.4 ± 8.5 (min: 14, max: 51). When subgroups of Attention Disorder and Hyperactivity
30 (37%) patients came from outside of Erzurum province. dominant types are analysed, attention disorder percentage was
According to their settlements, 64 (79%) patients live in the city significantly higher in motor vehicle driver victims compared with
center, 13 (16%) patients in the counties and 4 (4.9%) patients in the control group. There was not any statistical significance for the
the village. On admission, 64 (79%) patients were due to drug hyperactivity dominant type between motor vehicle driver and
intake, 5 (6.2%) patients were due to superficial incisions in the control group. On the other hand, there was statistically
body accompanied by drug ingestion, 5 (6.2%) patients were due to significance for the latter subtype of ADHD when became a subject
penetrated injury, 4 (4.9%) patients were due to jumping from a of a traffic accident for two and more times.
high place, and 2 (2.5%) patients were due to hanging, and 1 (1.2%)
patient was due to gunshot wounds. 48 (59.3) patients had Motor vehicle drivers should be analysed for ADHD especially
attempted suicide with multidrug ingestion. when participating frequently in traffic accidents. Therefore
The most commonly cited causes of suicide were family problems preventing one of the reasons of traffic accidents resulting in
in 24 (29.6%) patients, psychiatric illness in 20 (24.7%) patients, economical and health problems, limitation of workload in
loneliness in 7 (8.6%) patients, and problems with the opposite sex emergency departments may be possible. We consider that
in 6 (7.4%) patients. There was family history of suicide in 9 (11.1%) analysing traffic accident victims by means of ADHD applying to the
patients and family history of psychiatric illness in 21 (25.9%) emergency department may be beneficial.
patients. 51 (63%) patients had a previously psychiatric diagnosis.
Psychiatric consultations in the ED were requested for 61 (75.3%) P746 __________________________________ Psychiatry
patients. As a result of these consultations, there were no definite
diagnosis for 34 (42%) patients on initial assessment. 26 (32.1%) MISDIAGNOSIS OF BUPROPION INTOXICATION CASE
patients were diagnosed as impulsive suicidal attempts, 19 (23.5%) PRESENTATION
patients as major depressive disorder, one (1.2%) patient as T Acar (1), H Seker (2), NO Kutlu (2), H Caksen (2), S Sahin
obsessive compulsive disorder and one (1.2%) patient as bipolar (2), M Ergin (1), B Cander (1)
disorder. 13 (16%) of these re-suicide attempt patients admitted to
the ED with recurrent suicidal attempt after being discharged. 1. Emergency department, University of Necmettin Erbakan, Meram Medical Faculty,
Conclusion: The majority of patients with recurrent suicidal Konya, Turkey
attempt refer to the emergency services by drug intake. The main 2. Pediatri department, University of Necmettin Erbakan, Meram Medical Faculty, Konya,
Turkey
Corresponding author: Mr Acar Tarik ([email protected])

BOOK OF ABSTRACTS 402

Key-words: BUPROPION ; INTOXICATION ; MISDIAGNOSIS 1. Emergency department, Marmara University Pendik Research and Training Hospital,
istanbul, Turkey
BACKGROUND: Bupropion inhibits catecholamine’s neuronal 2. Emergency department, Marmara University Pendik Research and Training Hospital,
reuptake selectively but has a minimal effect on indelamin Istanbul, Turkey
reuptake. It can be used in the treatment of major depressive Corresponding author: Mr Eroglu Serkan Emre ([email protected])
disorder and is the first non-nicotine medicine that gains approval Key-words: Conversion disorder ; Emergency service visits ; Domestic problems
in the treatment of smoking cessation. There are two forms of this
medicine: fast and constant. CASE: A 3½ year old and 15 kg- girl Objective: Conversion disorder is commonly seen in emergency
had started vomitting in the evening. Then she had disorders in her service (ES) which can be summerized as somatic outcome of
speech. After a time, she didn’t take breath and stared at one point psychological stress, even repeated visits with the same diagnosis
and had a seizure. In another health care unit, she was diagnosed have been recorded. The aim of this study is to determine the
with epilepsy and diazepam was given intravenously and since association between frequency of ES visits of these patients and
seizure couldn’t be stopped, phenytoin intravenously was given. their domestic problems.
After that, the patient was transferred to our clinic for further Method: This prospective, cross-sectional study is done between
treatment and evaluation. Upon the repeating seizures, phenytoin 01/01/2012 - 30/06/2012, in patients who had been admitted to
was regiven 10mg/kg IV. After loading dose of phenytoin, the ES with a conversion disorder. All these patients were asked
midazolam IV infusion was performed since her seizure had been questions to evaluate their domestic relationship problems. Among
continuing. T Since she had a history of falling from height 2.5 week these patients those who were admitted to the ES with the same
ago, she had magnetic resonance imaging (MR) and diffusion MR diagnosis more than once were included to the study. Statistical
and brain computed tomography all of which were reported as analyses were performed by using the SPSS 16.0 program.
normal. During her follow up, the general condition had been Results: 100 patients admitted to the ES with the diagnosis of
getting worse. Her pupillary was fixed and dilated. Although conversion disorder during the study. Average age was 30,62.
phenytoin loading and midazolam infusion, she had seizures Domestic problem was detected in 29 % of the patients. 17 out of
intermittently. When her head was thrown back, her hands 29 patients had medium to severe problems. As hospital records
trembled. Her anamnesis in terms of drug story was rechecked but, were reviewed, it was determined that 26 patients (89.6%) had
her family didn’t give any important data. Due to atypical process visited the ES with the same diagnosis before. It had been noted
in clinical picture, multi drug survey, stomach irrigation and that the relationship between repeated visits and domestic
activated charcoal were performed. Pediatric department agreed problems were statistically significant (p<0,001).
that her clinical picture wasn’t seizure and the possibility of Discussion: Multiple visits to the ES’s by psychologically disturbed
intoxication was higher. Midazolam infusion was stopped. The patients with domestic problems, increase the emergency crowd
patient was practiced 0.04 mg/kg biperiden 3 times; since the and work-load. These visits bring burden not only to the family but
patient’s atypical movements didn’t stop. In the multidrug survey, also to the public health care. Our proposal is to refer these
benzodiazepine was positive. The parents were asked to search patients to the social support offices instead of the emergency
their home and bring each and every drug in their home. The services, and follow up the family closely by the social network.
parent found that Welbutrin XL 150 mg® which patient’s mother
had used and said that there should be at least 7 pills in the box P748 __________________________________ Psychiatry
but there wasn’t any more. National Intoxication Center gave
information that even just one tablet of the drug is toxic and the PSYCHOGENIC POLYDIPSIA
patient was admitted to intensive care unit. During 14 day follow B. IŞIK (1), E. Kadıoğlu (2)
up, she was intubated and mechanical ventilation was performed.
Her seizure was taken under control. However she had 1. Emergency department, State hospital of Aydın, Aydın, Turkey
resuscitation for three times due to cardiopulmonary arrest. 2. Emergency department, D.P.Ü Evliya Çelebi Training and Research Hospital, Kütahya,
Fortunately, after successful conservative treatment, she was Turkey
discharged from ICU without any neurological sequel. DISCUSSION: Corresponding author: Melle Isik Bahar ([email protected])
Bupropion overdose mainly affects neurologic, cardiovascular and Key-words: Psyhogenic polydipsia ; polyuria ; psychosis
gastrointestinal system. Neurologic effects are tremor, pain,
halucinations, coma and seizures. Cardiovascular effects are Object: Psychogenic polydipsia is a spesific form of polydipsia and
tachycardia and widening in QRS and lengthened QT interval. is usually the result of a mental disorder. Psychogenic polydipsia is
Gastrointestinal effects are nausea and vomiting. Death cases were encountered 80% in the schizophrenic patients. It is rarely
reported rarely. In oor case, the patient had most of the findings observed in patients with mood disorders. It may also ocur in
stated above. So that wide QRS tachcardia firstly, then bradycardia individuals who do not have any disease. We wanted to put
and asistol finally had developed. CONCLUSION: When child was forward the necessity of taking medical history more detailed in
admitted to emergency service with seizures, their parents must be patients admitted to the emergency room with nonspesific
“asked about intoxication. We shouldn’t forget the fact that some complaints such as polyuria.
member of the family can hide their illness because of various Findings: 29-year-old female patient was admitted to the
reasons. emergency department with complaints of polyuria. He had also
numbness in fingers, palpitation, restlessness, blurred vision,
P747 __________________________________ Psychiatry balance disorder and nausea. For four days she was urinating 30
times a day. When she examined more detailed she said that she
REPEATED EMERGENCY VISITS OF CONVERSIVE PATIENTS had had a request of drinking execive amounts of water. Previously
AND THEIR DOMESTIC PROBLEMS she had similar symptoms especially when she was depressed. She
M Şinasi (1), C Özpolat (1), OE Onur (2), SE Eroğlu (1), A had a history of psychosis but had stopped using her drugs for a
Denizbaşı (1) while. Other than her blood sodium level is 128 mmol/land urine

BOOK OF ABSTRACTS 403

osmolarity is 1006 her physical examination was normal. Her ADH When we investigate according to month, most cases seen in
levels were in normal range. After the patient was evaluated she september and february least cases in april. The average
treated only with fluid restriction. When her general condition atmospheric pressure, wind speed, rainfall and temperature were
improved and she was discharged. Next day she came to the not statistically different between days with spontaneous
hospital to be checked and we showed she had no complaints. pneumothorax and days without. In days with spontaneous
Discussion: There are proponents of the idea that psychogenic pneumothorax, humidity was lower difference was not significant.
polydipsia is an anti cholinergic side effect of psychiatric drugs. Also In day the maximum-minimum daily humidity difference were
dopaminergic hyperactivity triggers the thirst field in lateral higher in the days with spontaneous pneumothorax and this
hypothalamus as well as psychosis. It is tought that psychogenic difference was statistically significant (p=0.011).
polydipsia was more frequent during periods of psychotic Conclusion: This study suggested that the risk of occurrence of
exacerbation. If blood sodium level is not below the value of spontaneous pneumothorax are increased in days presenting high
125mmol/l neurological signs don’t ocur. Headache, blurred vision, daily humidity difference.
weakness, cramps, vomiting, diarrhea, increase in salivation,
restlessness, confusion, lethargy, coma may ocur in case of P750 __________________________ Respiratory Emergencies
psychogenic polydipsia.Death is the result of pulmonary edema or
cerebral edema. In most patient fluid restriction treatment is MANAGEMENT OF SMOKE INHALATION INJURY IN
sufficient. In severe cases hypertonic saline solutions, clozapine, EMERGENCY DEPARTMENT
propranolol, diuretics may be needed in the form of medical MT Gokdemir, H Kaya, O Sogut
treatment. If the disease is accompanied by psychosis
electroconvulsive therapy can be applied. Emergency Department, Harran University, School of Medicine, Sanliurfa, Turkey
Conclusion: As a result in the patient who applied to the Corresponding author: Mr Gokdemir Mehmet Tahir ([email protected])
emergency department with complaint of frequent urination and Key-words: Smoke inhalation ; emergency department ; discharge
drinking too much water acute or chronic polydipsia should not be
forgetten. Introduction: Carbon monoxide (CO) is an odorless, colorless,
tasteless, non-irritating gas formed as a by-product of burning
P749 __________________________ Respiratory Emergencies organic compounds. The atmospheric concentration of CO is
generally below 0.001%. The affi nity of hemoglobin for CO is 200
ROLE OF METEOROLOGICAL CHANGES IN OCCURENCE OF to 250 times greater than its affi nity for oxygen. This results in
SPONTANEOUS PNEUMOTHORAX AND CLINICAL competitive inhibition of oxygen release due to a shift in the
CHARACTERISTICS OF OUR CASES oxygen-hemoglobin dissociation curve, reduced oxygen delivery,
S. Bozkurt (1),M. Tokur (2), M. Okumus (1), H. Kahraman and subsequent tissue hypoxia. This study evaluated smoke
(3), F. Ozkan (4), B. Utku (1) inhalation injuries admitted to emergency department. Our aim
was to determine the criteria’s of discharge from emergency
1. Emergency Department, Kahramanmaras Sutcuimam University, Medical Faculty, department.
Kahramanmaras, Turkey Material and Method: Emergency department patients presented
2. Department of Thoracic surgery, Kahramanmaras Sutcuimam University, Medical with smoke inhalation between January 2009 and November 2011
Faculty, Kahramanmaras, Turkey were included to this retrospective study. Patients with co-morbid
3. Department of Chest diseases, Kahramanmaras Sutcuimam University, Medical Faculty, diseases such as chronic obstructive pulmonary disease, heart
Kahramanmaras, Turkey failure were excluded from the study.
4. Radiology, Kahramanmaras Sutcuimam University, Medical Faculty, Kahramanmaras, Results: A total of 255 patients with smoke inhalation injury were
Turkey presented to emergency department. Fifty two patients with
Corresponding author: Mr Bozkurt Selim ([email protected]) incomplete records, co-morbid diseases and under eighteen were
Key-words: Spontaneous pneumothorax ; atmospheric pressure ; humidity excluded from study. Two hundred three patients were entered
the study [ 117 (58 %) men, 86 (42 %) ]. Ages ranged from 18 to 67
Background: Pneumothorax is defined as pathological air in the (mean 38) years. 180 (% 87,3) patients were discharged from
pleural space. Weather changes may influence the incidence of emergency department. Only 23 patients were hospitalized. 10 of
spontaneous pneumothorax. The purpose of this study was to 101 (50,5 %) patients due to coal stove, four of 78 (37,9 %)
define, role of meteorological changes in occurence of lahmacun bakehouse, nine of 24 (11,6 %) house fires, related to
spontaneous pneumothorax and clinical characteristics of our smoke inhalation were hospitalized. Hospitalization indications
cases. were burn ratio > 15 % (N = 11), smoke inhalation ( N = 5), carbon-
Methods: In our study a total 95 cases (87 men, 8 women; 67 dioxide narcosis ( N = 4) and COHb > 15 ( N = 3).
primary spontaneous pneumothorax, 28 secondary spontaneous Conclusion: Outpatients with short- term exposure ( < 7 minutes)
pneumothorax; mean age 36.7±16.7, range 16 to 78 years) with to smoke can be discharged without any laboratory confirmation.
spontaneous pneumothorax were detected betwen Jenuary 2008 Long-term exposures has to be observed even if they are
to December 2008 and April 2010 to March 2012 years Cases were outpatients. Hospitalization is required for patients with inhalation
retrospectively evaluated according to clinical characteristics and burns, carbon-dioxide narcosis, high COHb ( > 15).
day admission to hospital. The day of admission to hospital were
accepted as the day in which spontaneous pneumothorax was
ocuured. The meteorological data were obtained from
Kahramanmaras Meteorological Services. Meteorological data in
days spontaneous pneumothorax was occured was compared to
days without. Relationship between meteorological changes and
the occuring of spontaneous pneumothorax were investigated.
Results: During the study, the cases were mostly presented in
autumn season (31.6%) and least seen in spring season (12.6%).

BOOK OF ABSTRACTS 404

P751 __________________________ Respiratory Emergencies The NIV was administered on ward 4 in 90% (n=9) and 10% (n=1)
on HDU. 25% (n=2) of the NIV treatments recorded did not exceed
THE USE OF NON-INVASIVE VENTILATION (NIV) IN THE the minimum recommended duration of treatment (6 hours).
MANAGEMENT OF PATIENTS WITH COPD IN A&E. CONCLUSIONS
SD Parker (1), RA Sayers (2), J Taylor (2) The audit has highlighted the need for an improvement in care
needed for the management of type 2 respiratory failure in
1. A&E, Queen Elizabeth Hospital, Newcastle upton tyne, United Kingdom patients with COPD presenting to The Queen Elizabeth hospital.
2. Emergency Department, Queen Elizabeth Hospital, Newcastle upton tyne, United The standards have not been met because of the time taken to
Kingdom take 2 ABGs and waiting for NIV beds on other wards. All of the
Corresponding author: Mr Parker Sidney ([email protected]) above patients could have received NIV and should have been
Key-words: copd ; non invasive ventilation ; type 2 respiratory failure considered, the poor rate indicates the need for an A&E protocol to
ensure these patients receive the required treatment within the
BACKGROUND time for a maximum chance of recovery. An NIV in A&E would
Chronic Obstructive Pulmonary Disease (COPD) effects on average provide rapid treatment for the patients waiting for transfer to a
5-15% of patients in industrialised countries worldwide and is medical ward. Many of the patients do not tolerate the NIV due to
expected to become the fifth most common cause of combined becoming too agitated waiting to receive it, hence the poor
mortality and disability by 2020. After diagnosis patient’s 10-year duration of treatment.
survival rate is approximately 50%, more than a third die as a result This was compounded by the fact that in the current system in
of respiratory insufficiency. order to be admitted to NIV beds on ward 4 the patients have to be
Non-invasive ventilation (NIV) in selected patients with an acute first seen by a senior member of the medical team. One way of
exacerbation of COPD has been shown to reduce: the need for negating this delay would be to have NIV machines available in the
intubation, hospital stay, complications and in-hospital mortalities. Emergency Department (ED) so those patients could be started on
It is associated with a rapid improvement in respiratory acidosis NIV as soon as it is indicated whilst waiting for specialist beds to
and respiratory rate within an hour of initiation. become available. The decision as to whether to start NIV could be
The British Thoracic Society (BTS) guidelines recommend using NIV made by a senior ED doctor and would require a clear plan as to
in the management of COPD patients with type 2 respiratory what to do if NIV was unsuccessful or not tolerated.
failure within 60 minutes of their hospital arrival following
maximum medical therapy. P752 __________________________ Respiratory Emergencies
AIMS
The audit aims to assess the effectiveness of implementing NIV in A CASE REPORT OF SPONTANEOUS PNEUMOTHORAX IN
patients with COPD presenting to A&E with type 2 respiratory WEGENER’S GRANULOMATOSIS
failure at The Queen Elizabeth compared to the standards H Kahraman (1), S Bozkurt (2), N Koksal (1), M Tokur (3), M
proposed by the British Thoracic Society guidelines. Okumus (2), F Ozkan (4)
METHODS
The sample was generated by searching through A&E admissions 1. Department of Chest, Kahramanmaras Sutcuimam University, kahramanmaraş, Turkey
between 1st November 2012 and 29th February 2012 using the 2. Emergency Department, Kahramanmaras Sutcuimam University, Kahramanmaras,
codlings: exacerbation of COPD, shortness of breath, breathing Turkey
difficulties. This found 208 patients with a total of 396 admissions 3. Department of Chest Surgery, Kahramanmaras Sutcuimam University, Kahramanmaras,
during this period. The online A&E notes were accessed via Windip Turkey
and analysed for each admission, the case-notes were requested 4. Radiology, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey
for patients that met the criteria for non-invasive ventilation (NIV): Corresponding author: Mr Kahraman Hasan ([email protected])
•Acute exacerbation of COPD Key-words: Wegener’s granulomatosis ; pneumothorax ; cavitary mass
•Decompensated respiratory acidosis (pH 6kPa)
•Respiratory acidosis despite maximum medical treatment Wegener's granulomatosis, is a multiorgan system disease of
Patients were excluded if they had any of the following unknown etiology and characterized by systemic vasculitis
contraindications: respiratory arrest, cardiovascular instability, high (polyangiitis) with necrotizing granulomatous inflammation of the
aspiration risk, recent facial or gastrointestinal surgery, craniofacial upper and lower respiratory tracts, systemic necrotizing vasculitis,
burns or trauma, copious secretions. and necrotizing glomerulonephritis. Other organ systems that may
RESULTS be involved in Wegener's granulomatosis include: Joints, eyes, skin,
Of the 34 case-notes only 27 were available to audit. The sample nervous system, heart, and less commonly, the gastrointestinal
involved 41% (n=11) males and 59% (n=16) females, with a median tract, lower genitourinary tract, parotid glands, thyroid, liver, or
age of 76 (range 61-94). breast. Depending on the case series, the most commonly reported
NIV was considered in only 74 % (n=20) of the selected eligible chest radiograph findings are nodules that may cavitate (20 to 90
patients, of these it was given in 37% (n=10). percent), patchy or diffuse opacities that sometimes with an air
The mean time taken from arrival to NIV was 427 minutes, over bronchogram (20 to 50 percent), lobar or segmental atelectasis.
seven times the recommended time, the median was 357 (range Other less common findings include pleural efusions, hilar
138-1366) minutes. When this was broken down into tasks it took adenopathy, and spontaneous pneumothorax that induced by
the following mean times: time between arrival and 1st ABG 29 rupture of cavitary nodule. A 32-year-old man admitted to
minutes; time between first and second ABG 101 minutes; time otolaryngologist with complaint of facial paralysis and hearing loss
taken from 2nd ABG to NIV 297 minutes. Following the delay to at August 2011 and with treatment of corticosteroid, he became
NIV three DNAR’s were signed and one patient died. The patient well. At November 2011, he complained swelling and pain of both
who died waited 330 minutes from their arrival waiting for a ankle and he attended to orthopedia and then Rheumatology
transfer to ward 4 for NIV by this time the patient was too agitated clinic. At rheumatology clinic, he diagnosed as granulomatosis with
to tolerate the treatment and subsequently died. polyangiitis and he was treated with cyclophosphamide 1 gr
monthly and prednisone 80 mg daily. He was followed up our Chest

BOOK OF ABSTRACTS 405

and Rheumatology Clinics since January 2012. his chest radiogram evaluation is valuable in diagnosis of pulmonary thromboembolism
showed a mass like lesion presenting cavity and lobulated clear but we need to more prospective studies to support our study.
boundaries at upper zone of left lung. At April 2012, he referred to
our Emergency Department with sudden onset complain of P755 __________________________ Respiratory Emergencies
breathlessness and dry cough. On physical examination, he was
appeared as dyspneic and breath sound was diminished on left EARLY OR DELAYED DIAGNOSIS OF PULMONARY
side. Blood pressure was 120/80 mmHg, pulse rate was 110/min. EMBOLISM: DOES IT MAKE ANY DIFFERENCE ?
Plain chest film was taken and left cavitary mass and I Cabello, J Jacob, C Ferre, F Llopis, C Martinez, S Jordan, JR
pneumothorax were detected. Chest tube was inserted and he was Perez Mas, M Velasco, I Bardés
hospitalized, but left lung did not re-expended through 30 days.
Then wedge resection was conducted to left lung and he has been Emergency department, Hospital Universitari de Bellvitge, Barcelona, Spain
followed up. As a result pneumothorax, although is seen quiet Corresponding author: Mme Cabello Irene ([email protected])
rarely in Wegener's granulomatosis, are possible especially in cases Key-words: Embolism pulmonary ; Mortality ; Emergency department
with cavitated mass or nodules close to pleura.
Background: pulmonary embolism (PE) may be an elusive diagnosis
P754 __________________________ Respiratory Emergencies with a significant mortality. As far as we know, it has not been
reported whether there is any difference in terms of mortality
THE ROLE OF THE MPV LEVELS OF THE PATIENTS WHO between early diagnosis of PE in the emergency department (ED)
HAVE BEEN DIAGNOSED PULMONARY EMBOLISM or delayed diagnosis during hospitalization.
M. Memis (1), G. Kurtoglu Celik (2), A. Sener (2), H. Sahin Objective: to compare the general characteristics and outcome of
Kavaklı (2), F. Icme (2), O. Karakayalı (3), H. Yıldırım (4) patients with PE diagnosed in the ED or hospitalization units.
Methods: Design: descriptive and retrospective study. Setting: a
1. Emergency department, Teaching and Research Hospital in Urfa, Urfa, Turkey 7000-bed tertiary-care teaching hospital in the metropolitan area
2. Emergency department, Ataturk Training and Research Hospital, Ankara, Turkey of Barcelona, Spain. Period: one year from november 2010 to
3. Emergency department, Teaching and Research Hospital in Kocaeli Derince, Kocaeli, November 2011. Patients: all patients with a diagnosis of PE
Turkey according to CT scan or scintigraphy findings. Data were collected
4. Radiology, Ataturk Training and Research Hospital, Ankara, Turkey for demographic variables, comorbid conditions, PE extension
Corresponding author: Melle Kurtoglu Celik Gulhan ([email protected]) (either massive or segmental), echocardiographic findings,
Key-words: pulmonary tromboemboli ; mean platelet volume ; computed tomografi troponin level, type of treatment, admission to the Intensive Care
anjiografi Unit (ICU), mean stay and mortality rate.
Results: during the study period, PE was diagnosed in 147 patients.
Aim; Pulmonary embolism (PE) is a very common disease which is Mean age was 64.7 (SD 14.8) years, and 70 were men (47.6%). PE
hard to diagnose and treat and has high mortality rates. In this was diagnosed at the ED (early diagnosis) in 123 cases (84%) and 24
work we aimed to determine the role of the MPV levels of the cases (16%) during hospitalization (delayed diagnosis). When
patients who have been diagnosed PTE, and association between compared early and late diagnosis groups: CT scan was performed
the PABTOİ and MPV leves in prediction of the severity of the PTE. in 112 (84,2%) patients vs 21 (87,5%) and lung scintigraphy in 11
We also intended to show if MPV levels can be an alternative (8,9%) vs 3 (12,5%); PE was massive in 50 cases (40,7%) vs 6 (25%),
marker in identification of patients who has right ventricule segmental in 68 (55,3%) vs 15 (62,5%) and unknown in 2 (1,6%) vs
disfunctioning due to acute PTE. 2 (8,3%); 31 (25.5%) vs 7 (29.2%) patients had cancer;
echocardiography was undertaken in 44 (35,8%) vs 3 (12,5%);
Materials and methods: In this study, 120 patients who were troponin was determined in 38 (30,9%) vs 2 (8,3%). Standard low-
administered to hospital from 2009 to 2011, and diagnosed PTE weight molecular heparin was administered in 106 (86,2%) vs 20
had been evaluated retrospectively. In addition to general (83,3%) cases, thrombolytic therapy in 10 (8,1%) vs 1 (4,2%), and
characteristics of the patients; symptoms, physical examination inferior vena cava vein filter was placed in 6 (4,9%) vs 3 (12,5%); 25
signs, comorbid disease, MPV, troponin, D-dimer arterial blood gas (20,3%) vs 7 (29,2%) patients were admitted to the ICU; mean stay
analysis, chest radiography, electrocardiogram, transthoracal was 14 vs 23,6 days and mortality was 13 (10,6%) vs 3 (12,5%).
echocardiograph, lower and upper extremity venous dopler USG Differences were observed for echocardiography (p=0,03),
findings were recorded. We also calculated the by interpreting the troponins (p=0,024) and length of stay (p=0,044) but no statistical
pulmonary artery computed tomography index ratio (PACTOIR) for differences were found in mortality or other variables.
each case using the model of Qanadli at al. Conclusions:
1. In our study, PE diagnosis in the ED is associated with a shorter
Result: Of the patients 59 (%49,2) were men and 61 (%50,8) length of stay
were women. Mean age of the patients were 61,4±15,7 years. 2. No differences in terms of PE extension, type of treatment, need
There was a significant negative association between MPV and of ICU care or mortality were found between early and late
platelet count. However, there was a significant positive diagnosis of PE.
association between MPV and troponin, pulmonary artery
pressure, right ventricüle dilatation(p< 0,05). İn this study, we
found that there was a positive correlation between MPV and
PABTOİR in statistical meaning ( p< 0.05). İn the category of MPV
(< 8,5 fl), the averages of the PACTOİR was found to be 25; in the
category of MPV (>8,5fl) , the averages of the PACTOİR was found
to be 45. İn this category (respectively MPV < 8,5 ; MPV >8,5 )
the averages of PACTOİR for differentiation analysis was found to
be significant(p8,5), for the averages of d-dimer, there was no
significant differentiation analysis (P=0,127)

Conclusion: MPV, that is a fast, noninvasive, inexpensive
and easily available biomarker which provides accurate prognostic

BOOK OF ABSTRACTS 406

P756 __________________________ Respiratory Emergencies BACKGROUND: Pulmonary Embolism (PE); obstruction of the
pulmonary artery and its branches with different nature emerging
THE EFFICACY OF HIGH DOSE INHALED STEROIDS ON THE clinical entity substances. The most common substance that causes
ACUTE EXACERBATION AND EMERGENCY ADMISSION OF blockage of veins and venous blood flow through the lungs,
SEVERE AND VERY SEVERE CHRONIC OBSTRUCTIVE reaching the break and then thrombus.(1). Mean Platelet Volume
PULMONARY DISEASE PATIENTS (MPV) is an indicator of platelet activation, which has an important
DM yavşan (1), E Maden (1), z karakurt (2), E sulu (2), O role in the pathophysiology of thrombosis (2). Therefore, increasing
Taşolar (2), H Turker (2) values of MPV pathogenesis role in thrombus is seen as a simple
tool for monitoring oynağı different events.The purpose of this
1. pulmonary medicine, meram medical faculty, konya, Turkey retrospective study was to compare MPV between the patients
2. pulmonary medicine, sureyyapaşa thoracic surgery and chest diseaase education with PE and control subjects.
hospital, istanbul, Turkey METHODS: Between the Emergency Department January and
Corresponding author: Mr Maden Emin ([email protected]) December 2011 of patients preliminary diagnosed with PE were
Key-words: chronic obstructive pulmonary disease ; treatment ; corticosteroid included. Data were collected retrospectively from the patients
medical records. The study group consisted of 42 patients with
AIM: In this study we evaluated the effect of high dose inhaled newly diagnosed acute PE. An age and gender control group
steroids (2000mcg) treatment on frequency of exacerbations and consisted of 42 patients with normal findings. We compared the
emergency admissions, pulmonary functions, arterial blood gas mean platelet volume in patients with PE and control participants.
(ABG) parameters and carbon monoxide diffusion capacity (DLCO) RESULTS: There was no significant difference between the study
in severe and very severe chronic obstructive pulmonary disease and control groups in mean platelet volume (8.2±2.0 vs 8.8±1.4 fl,
(COPD) cases, especially in cases with emphysema. respectively; p>0.05). Age, gender and platelet count (p > 0.05)
MATERIALS AND METHOD: Fifty four cases with severe and very were statistically similar in both groups.
severe COPD were evaluated. They were divided into two groups CONCLUSION: There was no significant difference in mean platelet
by randomizing as group I receiving salmeterol(S) / Fluticasone volume between
Propionate (FC) (200/2000 mcg) and group II receiving salmeterol patients with acute PE and the control group.Previous studies have
(SAL) (200 mcg). The number acute exacerbations, emergency demonstrated that platelet activation occurs in patients with acute
admissions in six months period and variations in the DLCO, PFT PE (3). According to our result, we propose that mean platelet
and ABG parameters between the beginning of therapy and the volume should not be considered as an index of acute PE.
sixth month of therapy and number of acute exacerbation were
investigated. P758 __________________________ Respiratory Emergencies
RESULTS: The mean age of the patients was 60,24 ±7,26 in group I
and its was 57,08±7,82 in group 2. The number of acute COPD A RARE CASE IN EMERGENCY DEPARTMENT:
exacerbations and number of emergency admission significantly DECOMPRESSION SICKNESS
decreased in high dose inhaled steroid group. Also there was C Katı (1), HU Akdemir (1), L Duran (1), Y Şahin (1), F
significant difference between the variations of values (as liters) of Çalışkan (1), C Şahin (2), B Türköz (1)
initial forced expiratory volume in the 1 second (FEV1), forced vital
capacity (FVC) of the cases and the values derived at the sixth 1. Emergency Department, Ondokuz Mayıs University Medical Faculty Hospital, Samsun,
month of the therapy in two groups [FEV1 variation; group I=( Turkey
0,118) and group II=( -0,019), p=( 0,036 ); FVC(lt) variation; group 2. Emergency Service, Samsun Training and Research Hospital, Samsun, Turkey
I=( 0,314 ) and group II=( 0,030 ), p=( 0,05 )]. However, there was Corresponding author: Mr Akdemir Hizir Ufuk ([email protected])
no positive significant difference between ABG and DLCO% values Key-words: Decompression ; Hyperbaric oxygen ; Emergency department
of two groups.
CONCLUSION: we demonstrated that use of high dose inhaled Objective: The vast majority of dives are completed without
steroids in severe and very severe COPD significantly decreased the incident. However, there are physiologic effects and injuries are
acute exacerbations and emergency admission of the COPD secondary to pressure changes on the submerged human body and
patients and also it resulted with significant increment in the breathing of compressed gas. The most common diving
pulmonary function parameters. injuries: barotrauma of descent (otic, sinus, and pulmonary),
barotrauma of ascent, [decompression sickness (DCS, “the bends”)
P757 __________________________ Respiratory Emergencies and arterial gas embolism], immersion pulmonary edema, oxygen
toxicity, and nitrogen narcosis. We herein present a patient case
IS INCREASED MEAN PLATELET VOLUME A RISK FACTOR IN with semptoms consistent with decompression sickness.
PATIENTS WITH ACUTE PULMONARY EMBOLISM? Case: A 20-year-old, previosly healthy, male patient was referred to
BO BILIR (1), EG ERSUNAN (2), KA KALKAN (2), YS YENİOCAK our emergency department with prediagnosis of intraabdominal
(3), GB GIAKOUP (4) organ perforation and decompression sickness from other hospital
that he admitted with complaints of abdominal pain, loss of vision
1. emrgency department, Recep Tayyip Erdogan University, Medical Faculty, rize, Turkey and altered mental status. There was a history of scuba diving in 7-
2. emergency department, Recep Tayyip Erdogan University, Medical Faculty, rize, Turkey 8 m depth and there was an acute abdominal pain, loss of vision
3. Emergency Service, Haseki Training and Research Hospital, istanbul, Turkey and altered mental status since he started toscubadiving 7 hours
4. emegency department, Recep Tayyip Erdogan University, Medical Faculty, rize, Turkey ago. We learned that he had a tonic seizure at the patient
Corresponding author: Mr Ersunan Gökhan ([email protected]) transportation to our department and diazem 10 mg was
Key-words: Pulmonary embolism ; mean platelet volume ; platelet activation administered. He had compliants of nausea, vomiting, headache
and loss of visual at admission to our department. In his physical
examination, there was no abnormal finding without total right

BOOK OF ABSTRACTS 407

blindness and abdominal rigidity. WBC: 35000/uL, Hb: 19.7 g/dL, We present a case that esophageal food plug caused external
plt: 305000/dL were found in his pertinent laboratory tests and pressure and resulted in respiratory failure.
the patient’s arterial blood gas showed a pH of 7.29, a pCO2 of 34 Case report: 6 year old boy brought to our hospital by ambulance.
mmHg, a pO2 of 79 mmHg, a HCO3 of 16 mmol/L and an oxygen Major complaint was respiratory distress and failure to swallow.
saturation of 95%. His ECG showed heart rate 100 beats/min and a According to the information obtained from the family members
sinus tachycardic rhythm. There was no prominent feature in his and the ambulance team, his complaints was begun while eating
chest radiography (Image 1). In his direct abdominal radiography, meat. At the healt care center that they admitted just after his
there was no free air under the diaphragma (Image 2). There was complaints has begun; Heimlich maneuver was performed and
no pathological findings in his performed abdominal tried to give oral liquids.
ultrasonography. After general surgery consultation, upper and On the initial physical examination he was conscious, cooperative
lower abdominal CT with oral-intravenous contrast was performed and oriented. At the time of the arrival his vital signs were as
(Image 3). There was no pathological finding. There was no acute follows; blood pressure 90/50 mmHg, heart rate 130/minute,
pathology according to general surgery. The brain CT of patient respiratory rate 10/minute, oxygen saturation 85 % at room air and
with altered mental status was unremarkeble (Image 4). Neurology Glasgow Coma Score was 15. He had inspiratory stridor and
consultation was requested because of possibility of brain damage disability to speech. Because of the deterioration of respiratory and
due to decompression sickness. To illuminate the patient clinic, mental status rapid serial intubation has performed. Direct
brain diffusion magnetic resonance imaging (MRI) (Image 5) was laryngoscopy revealed completely open tracheal passage. Although
performed after request of consulting physician from neurology. an esophageal foreign body (a piece of meat) that obstructing
There was no limitation of acute diffusion. In patient’s follow up, trachea by the external pressure was detected. Foreign body
he was tachypneic and his oxygen saturation decreased, so thorax removed by the Magille forceps under the endoscopic visualization.
CT was performed. Thorax CT showed (Image 6, 7) free mediastinal On the cervical and thoracal CT scans no additional foreign body
air image that extends to neck region (pneumomediastinum) and resembled. There was intraalveolar fluid collection in the both
its thickness was about 1 cm. There was a bilaterally pneumothorax lower lobes spreading through the upward. Appearance thought to
in the apical and middle lobes of both lung and lingular segment (it be because of liquid aspiration.
was about 12 mm). In addition, minimal free air was observed in Discussion: Esophageal foreign bodies may cause tracheal
left major fissure. Therefore thoracic surgery consultation was obstruction and respiratory failure. Radiological findings are
requested. While he was followed up with O2 treatment by extremely important on the diagnosis. Therapeutic interventions
thoracic surgery, bilaterally chest tube was inserted (Image 8) should be performed as soon as possible following the diagnosis.
because of need of hyperbaric O2 treatment. However after 1. Macpherson R.I.,Hill J.G.othersen H.B., Tagge E.P.,Smith
detection of total right blindness, ophthalmology consultation was C.D. Esophageal Foreign Bodies İn Children :Dİagnosis Treatment
requested. According to ophthalmological examination, swelling and Complications AJR 1996;166:919-24.
around the optic disc and appearance compatible with ischemia 2. Remsen K,LAwson W, Biller HF, Esom ML:Unusual
were detected and eye USG and optic coherence tomography penestations of penetrating foreign bodies of the upper air
(OCT) was performed. They showed normal findings. There was no digestive system.,Ann Oto rhino laryngol 1983:92 :32-44
additional advice without hyperbaric O2 treatment by
ophthalmology. The patient was referred to nearest center due to P760 __________________________ Respiratory Emergencies
the need of hyperbaric O2 treatment, because in our hospital there
was no possibility for hyperbaric therapy. EARLY PREDICTORS OF HOSPITAL ADMISSION IN
Conclusions: Emergency physician should be able to think this EMERGENCY DEPARTMENT PATIENTS WITH CHRONIC
diagnosis in patients who has a physical examination and imaging OBSTRUCTIVE
findings compatible with decompression sickness and should be PULMONARY DISEASE
able to manage the patient appropriately according to this H Hedhli (1), S Souissi (1), K Mbarek (2), H Ghazali (1), Y
diagnosis. After determining endications of hyperbaric O2 Yahya (3), MA Cherif (1), M Chkir (1), B Bouhajja (1)
treatment
1. Emergency department, Regional Hospital, Ben Arous, Tunisia
P759 __________________________ Respiratory Emergencies 2. Unit of pneumology, Regional Hospital, Ben Arous, Tunisia
3. Emergency department, Regional hospital, Ben Arous, Tunisia
ESOPHAGEAL FOREIGN BODY CAUSING ACUTE Corresponding author: Mr Souissi Sami ([email protected])
RESPIRATORY FAILURE Key-words: COPD ; predictors ; hospitalization
H. Hocagil, Ş. Ardıç, EG. Gençer, Ö. Güneysel
Background :
Emergency Department, Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Türkiye The growing borden of COPD in the world is increasing the need for
Corresponding author: Mme Hilal Hocagil ([email protected]) emergency departments (EDs) to manage acute exacerbations.
Key-words: Esophageal foreign bodies ; Tracheal obstruction ; Respiratory failure Early identifying the need for hospital admission for acute
exacerbation of COPD in the ED episode of care has important
Introduction and objective: Foreign body aspiration is one of the clinical and organizational implications.
most important causes of emergency admissions. Esophageal Objective:
foreign bodies are commonly seen in especially pediatric patient The aim of this study was to identify early factors predictive of
populations. 28-68 % of the gastrointestinal foreign bodies are hospital admission in ED patients with COPD exacerbation.
seen in esophagus (1). Because of the anatomical structures Methods:
esophagus is the most common place of the foreign body In a prospective monocenter cohort study, consecutive ED patients
obstruction (2). with COPD acute exacerbation were enrolled. Patients with
respiratory distress on arrival who required mechanical ventilation
were not included.

BOOK OF ABSTRACTS 408

Patients characteristics, physiological data on arrival and ED should be considered in patients living in endemic areas with
management were compared between discharged and admitted suggestive radiologic findings, especially during pregnancy.
patients.
Binary logistic regression analysis was used to examine factors P762 __________________________ Respiratory Emergencies
predictive of hospital admission.
Results : THE ROLE OF NURSE ASSESSMENT IN CASE OF CHRONIC
During nine months period (October 2011 - June 2012), 374 OBSTRUCTIVE PULMONARY DISEASE
patients were enrolled. Mean age = 65 +/- 11 years, 80 % were D Barna (1), C Barna (2), I Solomon (1), A Golea (1)
males, 52 patients (14%) were hospitalized.
There was no significant difference between the two groups 1. Emergency Department, Spitalul Clinic Judetean de Urgenta Cluj, Cluj Napoca, Romania
(admitted and discharged) regarding age, duration of the 2. Internal Medicine, Spitalul Clinic de Urgenţă „Prof. Dr. Octavian Fodor”, Cluj Napoca,
obstructive disease and dyspnoea grade in the stable state Romania
Factors available on ED arrival associated with increased likelihood Corresponding author: Mr Barna Daniel ([email protected])
of admission were: Key-words: COPD ; nurse ; assessment
Male sex [Odds Ratio (OR), 2.28; 95 % confidential interval (CI),
1.17 – 4.41], signs of respiratory dysfunction: respiratory rate Objective
greater than 25 breaths per min ( OR, 2.2; 95% CI, 1.42– 3,47), Evaluation of the nurses role in case of patients with
arterial oxygen saturation less than 90% (OR, 1.58; 95% CI, 1.03–
2.42 ), use of accessory muscles of ventilation (OR, 1.71; 95% CI, acute exacerbations of chronic obstructive pulmonary disease
1.09 – 2.68), heart rate greater than 100 beats per min (OR, 1.93, (COPD) in emergency department (ED).
95% CI, 1.28- 2.91), drowsiness (OR, 7.O6, 95% CI, 1.87- 26.6) and Methods
pH < 7,38 (OR, 1.83; 95% CI, 1.1– 3.04).
Conclusion: It is a prospective, observational study over a period of
Streamlining the ED care of patients with COPD exacerbation by three months, which comprise 40 patients with acute exacerbation
early identification of objective predictors of hospital admission of chronic obstructive pulmonary disease (AE COPD) received in
may reduce the overcrowding of the ED and allows early and Emergency Department Cluj Napoca, Romania. All the patients
appropriate orientation of those patients. were adults, over 18 years old, accusing dyspnea as the main
symptom in triage and were already diagnosticated with COPD. We
P761 __________________________ Respiratory Emergencies analysed historical data of patients, associated symptoms and
clinical respiratory parameters during emergency therapy.
RUPTURED LUNG HYDATID CYST AT PREGNANCY WHICH Results
MIMICKING TENSION HYDROPNEUMOTHORAX
Most of the patients were men, over 70 years old, and
CM TULAY (1), A CEYLAN (2), IE ÖZSOY (1) came from the rural side. The pathology associated with COPD was
mainly cardiac. SpO2 was for 65% patients under 90% O2 in
1. THORACIC SURGERY, ŞANLIURFA EDUCATION AND RESEARCH HOSPITAL, ŞANLIURFA, prehospital and when they left ED just 10 % of patients had under
Turkey 90% O2 . 52% patients came with normal vital signs from
2. EMERGENCY DEPARTMENT, ŞANLIURFA EDUCATION AND RESEARCH HOSPITAL, prehospital area . The most used oxygenotherapy administration
ŞANLIURFA, Turkey in prehospital was simple face mask, in case of 76% patients. 70%
patients had hypoxia (PaO2: 23-75mmHg ) and 42% had an
Corresponding author: Mr Tulay Cumhur ([email protected]) abnormal PaCO2 value (46-90mmHg) at the arrival in ED. In the ED,
the mainly oxigenotherapy used was through Venturi mask (92%)
Key-words: hydatid cyst at pregnancy ; tension hydropneumothorax ; tachypnea and only 25% of patients had indications for CPAP and beneficiated
from it in ED.
Respiratory failure and hemodynamic instability are responsible for Conclusions
up to 80% of the obstetric admissions to the ICU. We report an 1. Prehospital oxygen administration by nurses improves SpO2
unusual case of a multigravida with ruptured pulmonary hydatid value at admission in ED, but it is not in direct concordance with
disease which mimicking tension hydropneumothorax. A 21-year- PaO2 value.
old multigravida, at 34 weeks of gestation, presented with syncope, 2. Choosing a proper method of oxygen administration improves
vomitting and respiratory failure. She told us that the symptoms the level of PaO2 and PaCO2.
had been continued for 10 days. She had gone to some medical 3. This study is helpful in identificating proper nursing measures for
centers, but doctors told her about sympmtoms which could be adecvate assessment of COPD patients.
related to last period of pregnancy. There were not any thoracic
imaging up to now. Her physical examination revealed severe P763 __________________________ Respiratory Emergencies
respiratory distress with a respiratory rate of 35/min, tachycardia
of 160-183/min, fever of 38.0°C, blood pressure of 90/60 mmHg, VALUE OF CARDIAC TROPONIN I FOR PREDICTING IN-
no breath sounds at the left hemithorax. Oxygen saturation was HOSPITAL OCCURRENCE OF HYPOTENSION IN
90% with facemask at 10 L/min. Chest X-ray taken on presentation HEMODYNAMICALLY STABLE PATIENTS WITH ACUTE
to the referring hospital revealed huge air-fluid level which was PULMONARY EMBOLISM
suurrounded by thick membrane at left hemithorax with sliding of WY Kim, MH Lee, CH Sohn
trachea and heart to right hemithorax which mimicking tension
hydropneumothorax. Toracentesis was made carefully to exclusion Emergency Department, Asan Medical Center, Seoul, Korea, (South) Republic of
of hydropneumothorax and neither fluid nor air were aspirated Corresponding author: Mr Sohn Chang Hwan ([email protected])
from left hemithorax. A decision was made to proceed
with caesarian section followed by left thoracotomy to save both
the mother and the baby. Ruptured pulmonary hydatid cyst

BOOK OF ABSTRACTS 409

Key-words: pulmonary embolism ; hemodynamically stable ; troponin I RESULTS: We found seven microRNAs differentially expressed in
rats exposed to OA compared to controls. The expression of five
Background: Although cardiac troponin I (cTnI) elevation during microRNAs was increased by two fold after 6 hours, and, in two of
acute pulmonary embolism (PE) predicts in-hospital death, the role them, a decrease of at least 50% was apparent. In the same
of cTnI measured at emergency department (ED) admission can samples increased levels of LDH, leukocyte counts, histologic
predicts occurrence of in-hospital hypotension, is unknown. The changes. Among the microRNAs identified to be differentially
aim of the present study was to evaluate whether an increased expressed several known to be associated with regulation of
level of cTnI can predict the in-hospital development of inflammation.
hypotension (SBP <90 mmHg) within 24 h, which may benefit from CONCLUSION: Our results show that OA is associated with altered
intensive monitoring and treatment, in hemodynamically stable expression in the lung of several microRNAs, including some known
patients with acute PE. Methods: Study subjects included all to be involved in EP. Therefore microRNAs may play an important
consecutive patients with acute PE, as diagnosed by chest role in acute lung injury resulting from OA.
computed tomography angiography, in the ED from January 2009
through December 2011. All patients underwent cTnI tests at ED P765 __________________________ Respiratory Emergencies
admission and were divided into two groups based on the
occurrence of hypotension within 24 h. PULMONARY EMBOLI WHICH IS IMPROVING IN THE
Results: Of 237 stable patients with acute PE admitted in ED during PATIENT UNDER TREATMENT OF ANTIKOAGULAN
the study period, 188 patients were included. Within 24 h of E Kadioglu (1), S Karaman (2), B Işık (3), E Ozer Unal (4)
hospitalization, 13 (6.9%) patients developed hypotension. The
mean value of serum cTnI was significantly higher in patients 1. Department of Emergency Medicine, D.P.Ü. Evliya Celebi Training and Research
developed hypotension than in patients did not (0.98 vs. 0.10 Hospital, Kütahya, Turkey
ng/mL, P<0.00). The prevalence of thrombolysis, 28 day mortality 2. Departman of Emergency Medicine, Erzurum Regional Training and Research Hospital,
and 6 month mortality were significantly higher in patients who Erzurum, Turkey
developed hypotension. Moreover, elevated level of cTnI (>0.05 3. Department of Emergency Medicine, Aydın State Hospital, Aydın, Turkey
ng/mL) on admission was independently predictor for developing 4. Deparment of Emergency Medicine, D.P.Ü. Evliya Celebi Training and Research
hypotension within 24h in patients with stable acute PE at the time Hospital, Kütahya, Turkey
of ED admission (odds ratio 11.0, 95% CI 2.8–43.8, p = 0.00). Corresponding author: Mme Kadioglu Emine ([email protected])
Conclusions: In stable patients with acute PE, an elevated cTnI can Key-words: antikoagulan ; pulmonary ; emboli
predict the in-hospital development of hypotension within 24 h.
This finding may be of value in selecting patients who benefit from INTRODUCTION AND PURPOSE : Incidence of PE in the U.S.A. is
intensive clinical surveillance and escalated treatment. 650.000/year.Each year over 2000.000 patient die.The deaths of
1/3 happen in the first hour.Despite the treatment over 16.000
P764 __________________________ Respiratory Emergencies patients die.The mortality rate of patients who are treated due to
PE İS %2-10.More than %50 of PE are diagnosed in autopsy.Before
MICRORNA EXPRESSION PROFILE IN A MURINE MODEL OF 50 years of age PE often happens in men more than women.Most
OLEIC ACID-INDUCED LUNG INJURY of the reasons of PE is troboemboli. Pulmonary thrombosis are
S Hong (1), S Jeong (2), I Kim (2), SM Lee (3) rare. DVT of sub-extremets is the reason of events and this
especially relates to the the central venous katater. Other
1. Dept of Emergency Medicine, Daejeon St Mary's Hospital, Daejeon, Korea, (South) resources of PE include pelvic vein thrombosis, right heart
Republic of thrombosis, and amniotic or oil emboli. Sceptical emboli can also
2. Dept of Eemrgency Medicine, Daejeon St Mary's Hospital, Daejeon, Korea, (South) be seen.
Republic of CASE : Forty-eight-year old woman patient applied to Emergency
3. Dept of Anaesthesia and Pain Medicine, Daejeon St Mary's Hospital, Daejeon, Korea, Service with complaining about a qualified severe chest pain
(South) Republic of which began nearly 1 hour before. In her background it was learnt
Corresponding author: Mr Hong Sungyoup ([email protected]) that hypertension and mitral replasman was made approximately
Key-words: Acute lung injury ; Oleic acid ; MicroRNA one month before. Patient used to use aspirin 100mg 1x1, 1x1
coumadin 5mg, delix 5 plus 1x1 regularly.In physical examination,
Introduction: Oleic acid (OA) essential fatty acid may initiate and/or blood pressure was 150/90 mmHg, heart rate was 80/minute
exacerbate acute lung injury (ALI) via a process like pulmonary (rhythmic), respiration number was 20 / minute, fever was 36.7
thromboembolism (PTE). It has direct toxicity to vascular and oC.The patient’s condition was good,conscious was clear,oryante
alveolar wall, activate immune system and eicosanoid pathway(EP). and koopere.In patient’s laboratory investigation,whose systematic
The mechanisms of ALI by oleic acid is not completely understood. examination and neurological examination was in the normal
MicroRNAs are short, non-coding RNAs that are recognized as limits, Hb 7.8 g / dL , Hct 23.5%, WBC 6,800 mL, Plt 240.000 mL, d-
important regulators of gene expression. They have important role dimer 845 UG / L, there is no found any patoloji in her biochemical
in regulation of inflammation. In this study we examined the effect investigation, APTT 73.2 sec, PTZ 46.5 sec, INR was measured as
of oleic acid on microRNA expression in the lungs. 4.00. In patient’s electrocardiogram, heart rate was approximately
METHODS: 20mg/kg OA diluted with 25% ethyl alcohol was 93/minutes and rhythm was in the normal sinus rhythm. Even
injected to male SD rats through tail vein for 20 min. Control mice though patient’s PA-AC Function Test was determined in the
underwent 25% ethyl alcohol injection. Rats were sacrificed 6 or 24 normal limits, in her computerized tomography which was taken
hours after ALI. Total RNA was extracted from whole lungs. Lactate from on the purpose of advanced investigation, filling defect, which
dehydrogenase (LDH), leukocyte count was estimated from was compatible with the emboli in left main pulmonary arter, was
bronchoalveolar lavage fluid. Histologic exam was done. The detected.On the purpose of advanced investigation and treatment
expression profile of 1020 microRNAs was assessed using the patient was sent to the Chest Diseases Service.
microRNA microarrays. The results were validated with mirVana RESULT : In the diagnosis of pulmonary emboli (PE) ;clinical
qRT-PCR miRNA detection Kit and qRT-PCR primer sets. suspicion, aware of predispoze, tests used in the diagnosis of PE

BOOK OF ABSTRACTS 410

are necessary to interpret together .In unexplained chest pain, 2. Emergency Department, Rize State Hospital, Rize, Turkey
dyspnea, or the existence of taşipne should always be thought the 3. Blood center, Izmir Katip Çelebi University, Ataturk Research and Training Hospital,
possibility of PE. The risk of emboli is very high in patients with Izmir, Turkey
mechanic prostate cardiac valve. Even in patients under treatment Corresponding author: Melle Kara Pinar Hanife ([email protected])
with appropriate antikoagulan this ratio is about %2-4.Emergency Key-words: IVC collapse index ; RVOT fractional shortening ; blood loss
doctor thinks emboli in the patients receiving treatment
antikoagulan in anemnez and/or physical examinations findings Background: We aimed to assess the correlation of right ventricular
and he/she must reach definite diagnosis as using further outflow tract (RVOT) fractional shortening and inferior vena cava
examine methods. (IVC) collapse index for estimating blood loss in healthy volunteers.
Methods: The values of the sonographic IVC collapse index and
P766 __________________________ Respiratory Emergencies RVOT fractional shortening were compared prior to and after blood
donation. The correlations between the mean arterial pressure
PARAOXONASE-1 GENE IN PATIENTS WITH CHRONIC (MAP), pulse rate, IVC collapse index and RVOT fractional
OBSTRUCTIVE PULMONARY DISEASE INVESTIGATION shortening were analysed using SPSS version 15.0 and G power
Q192R AND L55M POLYMORPHISMS version 3.1.
S. Gurbuz (1), M. Yıldız (1), M. Kara (2), K. Kargun (2), M. Results: Fifty-five consecutive blood donor participants with a
Gurger (1), M. Atescelik (3), OD. Alatas (1) mean age of 36.38 ± 8.87 years (%95 CI 33.98-38.85) were
recruited for this study. Six volunteers had orthostatic hypotension
1. Emergency Department, Firat University, Elazig, Turkey after blood donation. The percent change in RVOT fractional
2. Department of Genetic, Firat University, Elazig, Turkey shortening and MAP yielded a Pearson cc of 0.342 ( p=0,011). The
3. Emergency Department, Numune Hospital, Sivas, Turkey percent change in the IVC collapse index and pulse rate revealed a
Corresponding author: Mr Gurbuz Sukru ([email protected]) Pearson cc of -0.150 (p=0,273). The percent change in the IVC
Key-words: COPD ; paraoxonase ; polymorphism collapse index and MAP yielded Pearson cc of -0.078 (p=0,572).
The percent change in MAP and pulse rate revealed Pearson cc of -
The effect of increased oxidative stress in development of chronic 0.067 (p=0,628). RVOT fractional shortening and the IVC collapse
obstructive pulmonary disease (COPD) is well known. One of the index were well correlated in the group with orthostatic
antioxidative systems against oxidative stress in human body is hypotension after blood donation (Pearson cc:0.48) as well as pulse
paraoxonase (PON) enzyme that protects low density lipoproteins rate and MAP (0.38 and 0.83 for RVOTF; 0.53 and 0.40 for IVC,
(LDL) against oxidation. In this study we aimed to search the respectively)
polymorphisms on PON1, Q192R, L55M genes of patients with Conclusion: Although the IVC collapse index is a valuable
COPD. parameter to determine of hypovolemia, RVOT can be an early
The DNAs extraction was obtained from blood samples of the 50 marker for the detection of orthostatic hypotension and a valuable
patients pastly diagnosed with COPD and 50 patients as control diagnostic test in trauma.
group who were presented to emergency clinic. Genotypes were
obtained with polymerase chain reaction (PCR) and AIw I and P768 ____________________________________ Shock
Hsp92II restriction enzymes were used for Q192R and L55M
polymorphisms, respectively. Analysis of data was done with Chi- PENETRATING HEART INJURIES AND COMMON
Squire and Fisher’s exact tests. DIFFICULTIES ENCOUNTERED DURING EMERGENCY
A statistically significant difference regarding Q192R polymorphism SURGERY
was found between COPD patients and control group (P = 0.05). M Tokur (1), M Ergin (2), C Kurkcuoglu (3)
There was no statistically significant difference about L55M
polymorphisms in patient and control groups (P > 0.05). There was 1. Thoracic Surgery Department, Sutcu Imam University Medicine Faculty,
a significant correlation with Q192R polymorphism on PON1 gene Kahramanmaras, Turkey
and cigarette usage however other risk factors did not show 2. Emergency Department, Necmettin Erbakan University Meram Medicine Faculty,
significant correlation with this polymorphism. Though L55M Konya, Turkey
polymorphism had significant correlation with family history and 3. Thoracic Surgery Department, Harran University Medicine Faculty, Sanlı Urfa, Turkey
tuberculosis, no significant correlation was found with other risk Corresponding author: Mr Ergin Mehmet ([email protected])
factors. Key-words: Heart Injury ; Penetrating Trauma ; Emergency Surgery
The importance of our study is due to it is the first study in
literature searching Q192R and L55M polymorphisms on PON1 BACKGROUND: Penetrating heart injuries are seldom but are highly
gene in COPD patients. We believe that more studies are needed in lethal traumas. In-house cardiac surgery teams and adequate
this subject. technical equipment are generally not found outside of major
health institutions in Turkey. We evaluate the diagnosis and
P767 _____________________________________Shock treatment of penetrating heart injuries, the difficulties
encountered during surgical treatment of such conditions as well
COMPARISON OF ULTRASONOGRAPHIC METHODS AS A as problems faced by hospitals with limited cardiac surgery
MARKER OF BLOOD LOSS manpower and lacking adequate equipment to deal with such
P.H. Kara (1), E.E. Unler (1), O. Limon (1), N. Vandenberk (1), incidents. METHODS: The diagnosis of ‘penetrating heart injury’
O. Yavaşi (2), K. Kayayurt (2), B. Uzun (3) between 1 January 2008 and 31 December 2009 was scanned
through hospital data processing system. Eleven patients
1. Emergency Department, Izmir Katip Çelebi University, Ataturk Research and Training presenting to Kahramanmaras State Hospital were retrospectively
Hospital, Izmir, Turkey evaluated. RESULTS: Three (26%) of the patients presented with
signs of hypovolemia, four (37%) with progressive shock and four

BOOK OF ABSTRACTS 411

(37%) with shallow respiration in addition to progressive shock. hours are significant higher than LGS group. (p = 0.002 3h, p =
The etiology of the injuries were edged and sharp objects in 9 0.002 6h) Finally, there are significant differences in change in
(82%) cases, puncture from a fractured sternum and/or ribs in 2 serum IL-6 levels between two groups.(p < 0.001) Serum IL-6 levels
(18%) case. The total mortality was 63% in our case series. of HGS groups at 1, 3, 6 hours are significant higher than LGS
CONCLUSION: Cardiac injuries are the types of trauma that require group. (p = 0.026 1h, p = 0.026 3h, p = 0.002 6h)
rapid surgical intervention. However, combination of a lack of Conclusion: Initial low serum hemopexin concentration is
specialized surgical teams and/or the time for rapid intervention at significantly associated with higher 28 days mortality of patients
the initial health care facility reduces the possibility of surviving with septic shock. In pre-clinical study, there are significant in
patient. change of serum hemopexin levels pursuant to the sepsis severity.
Especially, serum hemopexin levels of HGS groups at 6 hours are
P769 _____________________________________Shock significant lower than LGS group after LPS infusion.

CHANGE OF HEMOPEXIN LEVEL IS ASSOCIATED WITH THE P770 ____________________________________ Shock
SEVERITY OF SEPSIS IN ENDOTOXEMIC RAT MODEL AND
THE OUTCOME OF SEPTIC PATIENTS. JUGULAR ıNDEX: A NEW NON-INVASIVE METHOD FOR
SY Park, D Suh, JY Jung, DK Kim, YH Kwak EVALUATION OF PATIENTS WITH GASTROINTESTINAL
HEMORRHAGE
Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea, (South) NB Akıllı (1), R Köylü (1), H Mutlu (1), E Akıncı (1), G Güngör
Republic of (2), B Cander (1)
Corresponding author: Mr Suh Dongbum ([email protected])
Key-words: Septic shock ; Hemopexin ; Mortality 1. emergency department, Konya Training and Research Hospital, konya, Turkey
2. Gastroenterology department, Konya Training and Research Hospital, konya, Turks and
Background: Sepsis is a pathologic condition do not control Caicos Islands
systemic inflammatory response to infection and organ damage. Corresponding author: Mr Akilli Nazire Belgin ([email protected])
Free heme is potent pro-oxidant in case of exposure to blood and Key-words: jugular index ; gastrointestinal hemorrhage ; shock
accelerates tissue damage with septic condition. Hemopexin is a
serum protein for eliminating free heme by binding directly heme. INTRODUCTION: Gastrointestinal hemorrhage is one of the most
In sepsis condition, serum hemopexin levels are correlated to important medical emergencies. It can lead serious hemorrhagic
patient's prognosis in some study, but there is little evidence about shock as a result of acute loss of blood. An enough definition of
that. riscs can not be estimated unless an endoscopical attempt is made,
Purpose: The purpose of this study is to identify the prognostic although some of the bad prognostic criteria have been
power of hemopexin from clinical study in septic shock patients determined. Therefore, we aimed to investigate any correlations
and to identify differences in change of serum hemopexin level between acute loss of blood either with diameter of jugular vena
pursuant to the sepsis severity from pre-clinical study. and with jugular index (Jugular Index=JI=respiration driven
Methods: 1. clinical study : A prospective, cohort study conducted alterational percentage of diameter of jugular vena to area of
in an emergency intensive care unit (EICU) of a tertiary referral jugular vena) with other shock parameters or involvement with an
hospital. We enrolled consecutive patients who were admitted to ongoing hemorrhage and endoscopical classification or any
the EICU with septic shock from February 2006 to May 2010. After connection with mortality in patients with gastrointestinal
collecting datas with respect to demographic findings, diagnosis, hemorrhage.
APACHE II scores, basal lactic acid and 28 days mortality, the METHODS: Patients who submitted to the Emergency Department
enrolled patients were divided into two groups according to the of Konya Education and Research Hospital with a doubt of
mortality, 28 days survival groups(survivors) and 28 days death gastrointestinal hemorrhage were taken for this study.And the
groups(non-survivors). We measured septic enrolled patients' control group was formed from healthy volunteers. All the patients
serum hemopexin levels at the time of admission to the ICU 2. pre- under 18 years old or those administered with IV fluid/blood and
clinical study : Male Spraque-Dawley rats (300-400g) were used. directed from another unit or those suffering from heart failure,
Rats were categorized into three groups ; 1) Control (n=6, normal chronic pulmoner disease, cor pulmonale, cardiac valvular disease,
saline), 2) low grade sepsis group (LGS group, n=18, 5mg/kg LPS), 3) radiotherapied on neck, operated or profound venous thrombosis
high grade sepsis group (HGS group, n=20, 10mg/kg LPS). Rats of in upper extremite were excluded. During a respiratory cycle, both
each group were infused saline, LPS and then we checked the diameter and area of internal jugular venous measurements were
serum hemopexin levels, TNF-α, IL-6 by time course (1, 3, 6 hrs). recorded before IV fluid administration at the end of expirium and
Results: 1. clinical study : Among 142 enrolled patients, 100 were inspirium in the healthy volunteers and patients. Then, JI was
survivors and 42 were non-survivors. The APACHE II score and calculated. These measurements were made by two experienced
initial lactic acid level of survivors were lower than non survivors. expert with double blind technic and average value of them was
(respectively p < 0.001, p < 0.001) Initial serum hemopexin level of recorded. At the hospital admission, values for tension arteriel,
non-survivors was lower than that of non-survivors (p < 0.001). pulse, shock index, haemoglobin, haemotocrit, urea, creatinin,
The AUC of the hemopexin was 0.754 (95% confidence interval, lactate and base access were recorded. Endoscopy was made to
0.670 - 0.839). In multivariate logistic regression, hemopexin levels the patient simultaneously. All the figures from endoscopic results,
have inverse relationship with 28 days mortality. (p = 0.032) 2. pre- endoscopic procedures, hospitalization period of the patient,
clinical study : There are significant differences in change in requirement for transfusion, undergone an operation or not,
serum hemopexin levels between HGS group and LGS group. (p = mortality rates were recorded and then compared with jugular
0.013) Especially, serum hemopexin levels of HGS groups at 6 hours venous diameter and JI.
are significant lower than LGS group. (p=0.002) Also, there are RESULTS: The number of healthy volunteers and patients with
significant differences in change in serum TNF-α levels between gastrointestinal hemorrhage in the study were respectively 30 and
two groups.(p < 0.001) Serum TNF-α levels of HGS groups at 3, 6 26. Average ages were similar to each other for both groups(p ˃

BOOK OF ABSTRACTS 412

0,05). Systolic tension, pulse,shock index and JI were significantly The mortality of the patient’s in shock is estimated between 40 and
different between these two groups. The diameter and area values 80 % this percentage change with the etiology, severity and the
were statistically different from each other except the transverse speed in start the treatment of the shock and its cause.
diameter and area of juguler vein during the period of expirium. In In the shock, several inflammatory responses are triggered; these
the group of gastrointestinal hemorrhage , no correlation between responses will determine the prognosis. It is why the time that the
jugular venous diameter and area values and JI arrival tension patient is in shock is vital for his/her evolution: the sooner, the
arteriel, pulse, haemoglobin, urea, lactate were detected(p ˃ 0,05). emergency phisicians diagnosis the shock, the better for the
Shock index was found to be correlated with JI of transvers patient.
diameter, JI of AP diameter and transvers diameter during This way to treat the patient in shock is against our normal
inspirium (p ˂ 0,05, r=0,41, 0,45ve 0,40). While no relevance was practice, first diagnosis and after treatment but the stabilization of
observed between JI, diameter and hospitalization periods, amount the patient’s vital signs is a priority in these kind of patients so the
of transfusion was found correlated with AP diameter value in initial management of the patient in shock must be directed to
inspirium and AP diameter, JI, expirium diameter and area values in stabilize the vital signs even before we know the cause of the shock
both inspirium and expirium(p ˂ 0,05, r=0,51, 0,51, 0,66, 0,52, and at the same time, we should perform any test that can confirm
0,62). Additionally, area, diameter and JI measurements were not the cause of the shock to be able to treat it.
correlated by Rockall scoring, a correlation in AP diameter was The organic response to a shock will try to revert the effect of the
noted by JI Forrest classification (p ˂ 0,05, r=43). No correlation hypo perfusion, perhaps when the hemodynamics parameters, we
was found for the lactate values and JI Forrest classification(p ˃ are used to manage with patients in shock, at the emergency
0,05). Only two patient were died, the relationship between jugular department were between normal intervals. For that the body
venous diameter, area and JI with the mortality were not activated some compensatory physiologic mechanisms to improve
evaluated. the cardiac index, the blood pressure and the priority.
CONCLUSION: In a previous study carried out on blood donors who Some of these mechanisms are: increase of the heart rate and the
have been used as class-I haemorrhagic shock model, cardiac contractibility, systemic arterial vasoconstriction, selective
measurements from JI, jugular venous diameter and area were venous vasoconstriction of the spleen, kidneys and striated muscle.
suggested to be indicators for acute blood loss and state of Due to some hormonal effect, there is water and salt retention by
volume. If so, this pilot study supports this hypothesis. the kidneys, There is a increment of the glucose and lipids
Correlations with amount of tranfusion and especially correlation availability and release of multiple substances responsible for the
of AP diameters, JI by forrest classification could guide the clinician inflammatory changes. When we are unable of reverting the hypo
on evaluation of a patient with acute blood loss and active perfusion effects or these effects have been affecting the organs
hemorrhage just on arrival as a simply applicable and a non- for long time, the dysfunctions of the organs become irreversible.
invasive method. Apparently JI diameter and area seem to be more The aim of the initial resuscitation of the shocked patient in the
advantageous since lactate and shock index have no correlation Emergency department is reduce the damage provoked by the
with the parameters above. New studies employing larger patient hypo perfusion, trying of improve the vital signs as soon as possible
groups are needed. and at the same time treat the cause of the shock.
There are different ways to classify the causes of the shock; a
P771 _____________________________________Shock simple way is classified it in 3 types: hypovolemic shock, shock due
to vasodilatation and cardiogenic shock. In the two first kind of
THE ISSS STUDY shock there is an inadequate venous return to the heart. This
A. Navío (1), F. Ayuso (2), E. Alvaro (3), M. Ayuso (1), inadequate return can be due to a reduction of the blood,
C.Gargallo (4), M. Cuesta (5), I. Gil (6), E. Gonzalez de (hypovolemic shock) as in hemorrhagic shock or in dehydratation
Linares (7), P. Guallar (8), C. Martin (9), O. Ortigosa (10), G. or due to vasodilatation or loss of vascular tone,(septic,
Palacios (11), R. Perales (12), A. Pérez (11), M. Riesco (13), anaphylactic , neurogenic and toxic shocks, and the terminal phase
A. Rodríguez of any shock).
The cardiogenic shock is due to a failure of the cardiac pump, it can
1. Emergency Department, La Paz Hospital, Madrid, Spain be provoked by, loss of miocardic contractibility, reduction of the
2. SUMMA 112, Pre-hospital Emergency, Madrid, Spain end of diastolic volume, dysrhythmias or reduction of the flow,
3. Emergency Department La Fe, Hospital, Valencia, Spain (pulmonary thrombus embolism, cardiac tamponate, obstructive
4. Emergency Department, Dr. Peset Hospital, Valencia, Spain valvulopaties).
5. Emergency Department, Cruces Hospital, Bilbao, Spain At the moment we do not have a precise clinical definition of when
6. Emergency Department, Reina Sofia Hospital, Murcia, Spain a patient is in shock, as well we do not have scales to evaluate the
7. Emergency Department, Valdeciila Hospital, Santander, Spain evolution of the shocked patient and his/her prognosis.
8. Emergency Department, Soria Hospital, Castilla Leon, Spain We know that when the symptoms are obvious we can do the
9. Emergency Department San Pedro de Alcántara Hospital, Cáceres, Spain diagnosis of shock easily, but it can happen to late, we do not know
10. Emergency Department, Miguel Servet Hospital, Zaragoza, Spain when the shock starts. That is why there are several kind of scales
11. Emergency Department, Calahorra Hospital, La Rioja, Spain and evaluations and the differences between clinical trials on
12. Emergency Department, Albacete hospital, Castilla la Mancha, Spain treatments which have failed after working in experimental
13. Emergency Department, Salamanca Hospital, Castilla Leon, Spain models, but in these models we knew when the shock started.
14. Emergency Department, Puerta del Mar Hospital, Cadiz, Spain Objectives
15. Emergency Department, Reina Sofia Hospital, Córdoba, Spain. • To create a simple scale, based in clinical and physiologic signs,
Corresponding author: Mme Ana Navio ([email protected]) and laboratory test to know the initial severity and the response to
Key-words: SHOCK, SCORE, TIME ; EMERGENCY DEPARTMENT, DYNAMICS ; MORTALITY, the treatment and repeat at time of contact with the patient, six
MORBIDITY, LIFE and twenty for hours later, because, everything in the shock
syndrome is dynamic.
Shock means generalized inadequacy of blood flow throughout the There is a prospective, observational, study in which collaborate,
body to the extent that the tissues are damaged because too little the following countries: Argentina, Colombia, Venezuela, Costa
flow, especially too little delivery of oxygen and other nutrients to Rica, México, Paraguay and Spain.
the tissue cells.

BOOK OF ABSTRACTS 413

The statistical treatment is gone begun july the first, by a team, P773 ____________________________________ Shock
which has nothing to do with the Spanish Group of Shock.
Because different events, some of the countries, cannot contribute EPIDEMIOLOGIC FEATURE AND OUTCOMES OF
with the subjects we estimated, at the beginning of the study, and EMERGENCY PATIENTS MANAGED IN THE RESUSCITATION
as the international coordinator of the study, we have decided to ROOM
make the validation of the score, by the argentine group. HK Choi, MJ Choi, MJ Choi, MY Kim, JY Lee, IH Park, IH Park,
Of course, it would be amazing, to make this kind study with SD Shin
European countries and see if there were differences.
Emergency Department, Seoul National University Hospital, Seoul, Korea, (South)
P772 _____________________________________Shock Republic of
Corresponding author: Melle Lee Jiyeon ([email protected])
THE EFFECTS OF Α1-RECEPTORS ON THE AREAL- Key-words: Resuscitation ; motality ; cardiac arrest
DEPENDENT AUTOREGULATION OF CEREBRAL BLOOD
FLOW (CBF) Objectives
S. Bischoff (1), R. Schiffner (2), F. Rakers (3), S. Rupprecht The resuscitation room is the critical space equipped with medical
(3), H. Schubert (1), M. Schwab (3) devices and staffed with trained professional providers for
emergency care for critically ill patients. This study aimed to
1. Institute for Animal Sciences and Welfare, Univ. Hospital of Friedrich Schiller Univ., investigate the epidemiologic features and outcomes of emergency
Jena, Germany patients managed in the resuscitation room.
2. Accident and Emergency Dept., Univ. Hospital of Friedrich Schiller Univ., Jena, Germany Methods
3. Neurology, Univ. Hospital of Friedrich Schiller Univ., Jena, Germany Emergency patients with level 1 emergency severity index were
Corresponding author: Mr Schiffner Rene ([email protected]) enrolled from Jan. 2009 to Dec. 2011, who were managed in the
Key-words: Cerebral Blood Flow (CBF) ; Redistribution ; severe haemorrhage resuscitation room in an urban, tertiary, academic hospital
emergency department. Data were collected from electronic
Introduction: medical record system for demographics and designed
In previous studies during an umbilical cord occlusion (UCO) in fetal resuscitation room registry (RRR) for specific risk factors for
sheep (Fig. 1) and at a controlled hypovolemia in adult sheep (Fig. patients managed in the room which were recorded by emergency
2) showed a distribution of a areal specific autoregulation of registered special nursing staffs.
Cerebral Blood Flow (CBF). That’s contrary to the previous We classified patients with emergency condition groups; out-of-
knowledge. We demonstrate that a redistribution of CBF exists. hospital cardiac arrest (OHCA), emergency department cardiac
The microperfusion of the cerebral cortex in favor of arrest (EDCA), neurologic emergency (NE) (altered mentality),
phylogenetically older regions (thalamus) exists (p< 0,05). medical emergency (ME) (shock and respiratory failure), and
Hypothesis: α1-receptors are involved in cerebral autoregulation multiple trauma (MT). Potential risk factors were age, gender,
during a controlled hypovolemia and areal distribution specific. ambulance use, injury or disease, systolic blood pressure,
Method: respiratory rate, and mental status (AVPU).
2 sheep were instrumented under general anesthesia and provided Primary outcome was hospital mortality. Secondary outcome was
with central catheters. Laser Doppler Flow probes were implanted ED mortality. We compared the demographics and outcomes by
in the cortex and subcortex after smart trepanation for the emergency condition groups. Adjusted odds ratios (ORs) and 95%
continuous analysis of the CBF changes. A controlled severe confidence intervals (95% CIs) for outcomes were calculated
haemorrhage was induced by intravenous administration of a adjusting for potential risk factors.
selective α1-receptor antagonist (urapidil) by the removal of 40% Results
of estimated total blood volume. Eligible population was 2,543, excluding less than 15years (46,572),
The density of α1- receptors in cerebral arterioles were examined non-RRR group (112,028), and death on arrival patients (556). Of
with an immunohistochemical workup. theses, OHCA was 230 (9.0%), EDCA 97 (3.8%), NE 525 (20.6%), ME
Results: 1,434 (56.4%), and MT 257 (10.1%), respectively. ED mortality was
Hypovolemia in adult sheep during severe haemorrhagic shock 4.6% for total group, 32.6% for OHCA, 25.8% for EDCA, 1.7% for NE,
with selective alpha-1- receptor antagonist (urapidil) leads to a 0.4% for ME, and 0.8% for MT group, respectively. Hospital
decrease in CBF in the parietal cortex and in the subcortex, n = 2, mortality was 16.1% for total group, 51.3% for OHCA, 57.7% for
MW (Fig. 3) EDCA, 10.7% for NE, 10.8% for ME, and 9.3% for MT group,
In accordance with the decreased CBF in the cortex but not in the respectively. Adjusted OR (95% CI) for hospital mortality was 4.13
subcortex, during UCO is the distribution density of the α1- (2.28-7.46) in EDCA, 0.15 (0.09-0.23) in NE, 0.16 (0.11-0.25) in ME,
receptors in fetal sheep in the cortex significant higher than in the 0.14 (0.07-0.27) in MT compared with OHCA group, respectively.
subcortex (p< 0,05). Conclusion
Conclusion: ED and hospital mortality for emergency patients managed in the
The detectable areal-dependent autoregulation of cerebral blood resuscitation room was 4.6% and 16.1%. EDCA showed significantly
flow capacity can be explained by a cerebral areal a1-receptor- higher hospital mortality while NE, ME, and MT group showed
dependent stocking. Further immunohistochemical and significantly lower hospital mortality than OHCA.
biochemical studies are needed to understand this phenomenon
better. Furthermore, this finding has a direct impact on the use of
catecholamines in emergency and critical care medicine.

BOOK OF ABSTRACTS 414

P774 _____________________________________Shock P775 ____________________________________ Shock

ANAPHYLAXIS IN EMERGENCY DEPARTMENT: FACTORS MEDİCAL CLİNİCİL MULTİTRAVMA PATİENTS ADMİTTED
ASSOCIATED WITH SHOCK TO INVASİVE LABORATORY VALUES AND THE
S Kooli, S Souissi, NE Nouira, S Bellili, N Laamouri, S TRADİTİONAL NON-İNVASİVE ASSESSMENT OF THE
Chiboub, A Raddaoui, B Bouhajja POTENTİAL BLOOD LOSS COMPARİSON OF THE MEASURED
LABORATORY VALUES
Emergency department, Regional Hospital, Ben Arous, Tunisia E Kadioglu (1), S Karaman (2), B Işık (3)
Corresponding author: Mr Souissi Sami ([email protected])
Key-words: anaphylaxis ; shock ; emergency 1. Department of Emergency Medicine, D.P.Ü. Evliya Çelebi Training and Research
Hospital, Kütahya, Turkey
Anaphylaxis in emergency department: factors associated with 2. Departman of Emergency Medicine, Erzurum Regional Training and Research Hospital,
shock Erzurum, Turkey
Background: The aim of this study was to investigate the clinical 3. Department of Emergency Medicine, Aydın State Hospital, Aydın, Turkey
characteristics and the factors associated with anaphylactic shock Corresponding author: Mme Kadioglu Emine ([email protected])
in anaphylaxis. Key-words: trauma ; bleeding ; pulse of hemaglobin
Methods: Data were prospectively collected from patients with
anaphylaxis for 2 years. Trauma takes place in the causes of the important among the
Study (june 2010 – may 2012). major causes of mortality and morbidity in a productive period of
Subjects were enrolled if the diagnosis of anaphylaxis was retained popilation. However, it brings a serious burden on the country's
on the criteria proposed by Simpson and al [1]. All the study economy formed by loss of manpower and financial losses brought.
subjects were divided into shock and nonshock groups. Trauma patients with occult (silent) bleeding in the detection and
Anaphylactic shock is diagnosed in case of Systolic blood pressure exclusion is the difficult and error-exit business emergency
lower than 90 mmHg requiring the use of intravenous adrenaline. service.More common in emergency departments, and the
Results: 186 patients were included. The mean age was 41 +/- 15 effective use of ultrasound reduces the problems and still contains
years old, and females comprised 116 patients (62%). There were several deficiencies in both ultrasound and other diagnostic
46 patients (25 %) in the shock group and 140 patients in the methods. In this study we aimed to compare the values of the the
nonshock group. possible non-invasive method of blood loss with hemoglobin values
There was no difference in age, sex and comorbidities between the tended to invasive laboratory methods among admitted
two groups. emergency room trauma patients. If a significant difference
Most frequent Causes of anaphylaxis were drugs in the shock between the results arise both in terms of both cost in terms of
group (76 %), drugs and food in the nonshock group (respectively time, especially in trauma patients in the emergency department
55 %, 35%). evaluation of potential blood loss, which might be easier in terms
Antibiotics were the most common cause of drug induced of diagnosis and early treatment, we will make it easier to monitor
anaphylaxis in the shock group (77%). Nonsteroidal anti- the hemoglobin value.
inflammatory drugs were most frequent in nonshock group 32% vs For these purposes, on 48 patients who have suffered a variety of
11% in shok group. reasons multitravmaya arrival of the first clock pulse, and
Factors associated with the anaphylactic shock were: previous hemoglobin values were measured three times, for the second
episode of anaphylaxis (OR, 1.85; 95% CI, 1.09 – 3.07), antibiotic time, and hemoglobin in laboratory tests were performed
drugs (OR, 2.39; 95% CI, 1.24 – 4.61), parenteral route of simultaneously. In addition to the vital parameters were recorded
administration of allergen (OR, 4.38; 95% CI, 1.87 – 10.27) and and included in the analysis.
neurological symptoms at admission (OR, 3.56; 95% CI, 1.16 – Among our patient’s population there is no serious bleeding was
10.85). detected. Our group of patients coming first, second, the blood and
Conclusion: patients with anaphylaxis induced by antibiotic drugs pulse measurements in parallel with the measured values of the
administered parenterally and which have neurological symptoms hemoglobin remains.ıt was found to be highly significant
at admission were at risk for the development of shock. Early correlation (r0 = 0,992, r1 = 0,997, r 2 = 0,994, p <0.001) between
recognition of anaphylactic shock by physicians in the ED is critical the mean values of hemoglobin With the measured values of the
for adequate treatment. hemoglobin in the blood as measured by pulse-hour follow-up . It
1. Sampson HA, Munoz-Furlong A, Campbell R et al. has not been significant changes in blood pressure and pulse rate
Second symposium on the definition and management of measurements with studying the effectiveness of vital parameters
anaphylaxis: summary report. J. Allergy Clin. Immunol. 2006; 117: in patients with re-investigation.
391–7. In the light of all this information in multitravma patients brought
to the emergency room in the light of all this information and the
other, especially during the diagnosis in patients suspected of
acute blood loss in the first case we have not detected abnormal
findings of physical examination and in the vital hemogloblin
monitörizasition even if we make 15% of patients with blood loss
was compensated by the body, even if determined necessary in the
early other diagnostic methods, using the necessary treatment
without delay and we can put the patient's diagnosis.
It is extremely important.when they are evaluated in terms of
working conditions in the emergency service In terms of both cost
and time to gain usefulness extremely similar technologies
.However, larger studies are needed for the reliability of the data.

BOOK OF ABSTRACTS 415

P776 ______________________________ Simulation in EM 3. Emergency department, Atatürk Training and Research Hospital, Ankara, Turkey
4. Department of Allergy and Immunology, Cumhuriyet University School of Medicine,
RESULTS OF A TRAINING PROGRAM FOR PRIMARY CARE Sivas, Turkey
PAEDIATRICIANS IN SPAIN IN EMERGENCIES WITH A Corresponding author: Melle Akinci Emine ([email protected])
MOBILE ADVANCED SIMULATION MANNEQUIN Key-words: Carbon monoxide poisoning ; lactate clearance ; hyperbaric oxygen therapy
ac antonio casal sanchez, ai antonio iglesias vazquez, ls luis
sanchez santos Introduction
Carbon monoxide (CO) poisonings are among the clinical problems
emergency department, public foundation of emergency health services of galicia 061, seen in emergency departments (EDs) with significant mortality
santiago, Spain and morbidity rates. The PaO2 and PCO2 levels in the blood gas
Corresponding author: Mr Sanchez Luis ([email protected]) analysis and oxygen saturation levels are usually measured as
Key-words: training ; pediatrics ; simulation normal; however this condition does not accurately reflect the
tissue hypoxia (1). Metabolic acidosis can develop secondary to
Objective lactic acidosis, which is seen following ischemia in CO poisonings
Advanced simulation tends to be focused on hospital and (2). This study aims to determine the feasibility of using the rate of
emergency health staff. Primary care paediatricians (PCP) rarely lactate clearance to evaluate the metabolic response to treatment
face true emergencies, but they need to be prepared to respond to in patients with CO poisoning after their lactate levels were
a wide range of serious events in children. In many cases, access to measured on initial presentation to the ED.
simulation centres and/or simulation courses is not easy for PCP. Metod
This study reports the results of the Spanish Society of Primary Patients, older than 18, who consecutively presented with CO
Care Paediatrics (SSPCP) project on mobile advanced simulation for poisoning to the ED of Ankara Training and Research Hospital
PCP. between November 2010 and February 2011. Lactate levels upon
Methods admission (Lactate-1) and after 6 hours of treatment (Lactate-2)
A program of travelling courses in Spain that was sponsored, and were compared to calculate the lactate clearance rate. Lactate by
credited by the SSPCP. The Simbaby® system was chosen. The 1.7 mmol/l or greater was considered as positive.
course content was designed after considering the special needs of A total of 100 patients were enrolled in the study (62 females and
PCP. At the end of each course, the participants answered an 38 males). We found that 94% of patients had elevated lactate
anonymous questionnaire about the main aspects of the course. levels on admission to the ED. When lactate levels and CO values
Each item was scored on a scale from 0 to 10. This program began were compared, the CO values were found to be significantly
in May 2008, and still goes on (75 activities). Results presented are higher in the elevated lactate level group compared to non-
from May 2008 to May 2009. elevated patients. The rate of lactate clearance was 52% in the
Results standard oxygen therapy group compared to 64% in the hyperbaric
The course program included an introduction to the simulation oxygen therapy (HOT) group, which suggests a faster removal of
system and six scenario-debriefing sessions, with a total duration lactate with this treatment modality.
of 8 hours (in one day or two half-days). Cases were selected and Conclusion
programmed after collecting data from real patients. The main We conclude that lactate levels increase in patients with CO
learning objective was to be able to detect the potentially seriously poisoning, and that those levels are correlated with COHb levels.
ill children, and to initiate emergency treatment and stabilization The rate of lactate clearance can be used to evaluate the
with the resources available at a primary care facility. Twelve effectiveness of therapy. Patients with significantly increased
courses were carried out in 12 cities. Total number of participants lactate and metabolic acidosis should be referred for HOT in early
was 192 and 178 (92.7%) completed the questionnaire. Mean (SD) phases of management.
score of the main items were: general organization 9.2 (0.5),
objectives related to personal expectations 9.3 (0.4), course useful P779 __________________________________Toxicology
for work demands 9.4 (0.4), scenarios resembling reality 9.1 (0.4),
good instructor-participant relationship 9.6(0.2). SUPRAVENTRICULAR TACHYCARDIA ASSOCIATED WITH
Discussion ACUTE CARBON INTOXICATION
A mobile paediatric emergencies advanced simulation course is S Zengin, MM Oktay, B Al, E Yavuz, C Yildirim
feasible. Our course has been very well accepted by PCP and our
results indicate that simulation programs may be very useful, Emergency Department, Gaziantep University, Gaziantep, Turkey
provided that the course contents and learning objectives are Corresponding author: Mr Zengin Suat ([email protected])
adapted to the specific target population Key-words: Carbon monoxide poisoning, ; Supraventricular tachycardia ; Emergency
department
P778 __________________________________ Toxicology
Carbon monoxide (CO) is a toxic gas produced by the incomplete
USE OF LACTATE CLEARANCE IN DETERMINING SERUM combustion of carbon-containing compounds. Exposure to high
LACTATE LEVELS AND EFFECTIVENESS OF TREATMENT IN concentrations of CO can be lethal and is the most common cause
CARBON MONOXIDE POISONINGS of death from poisoning worldwide. Cardiac manifestations after
E Akıncı (1), H Ramadan (2), Y Yüzbaşıoğlu (3), E Atayık (4), F exposure to CO, including myocardial ischemia, heart failure, and
Coşkun (2) arrhythmias, have been reported. A 28-year-old a patient was
admitted to our emergency department with altered consciousness
1. Emergency department, Konya Training and Research Hospital, Konya, Turkey as a consequence of acute domestic exposure to CO from a stove.
2. Emergency department, Ankara Training and Research Hospital, Ankara, Turkey His carboxyhemoglobin level was 39%. The oxygen treatment was
started promptly, and therapeutic red cell exchange was

BOOK OF ABSTRACTS 416

performed. An electrocardiogram revealed supraventricular Introduction:
tachycardia (SVT), and an echocardiographic examination There are around 140 species and subspecies of snakes in South-
demonstrated normal cardiac functions. To the best of our Africa. Approximately 25 of these species can cause medically
knowledge, this study is the second to report a case of SVT attack significant envenomation with only 12-14 species causing
due to acute CO intoxication. This paper discusses the potentially fatal bites. A polyvalent antivenin produced by the
management of this complication in patients poisoned with CO. South-African Vaccine Producers are effective against the venom of
the following snakes: Puff adder (Bitis arietans); Gaboon adder
P780 __________________________________ Toxicology (Bitis gabonica); Rinkhals (Haemachatus haemachatus);Green
mamba (Dendroaspis angusticeps);Jameson's mamba (Dendroaspis
ACUTE HEPATITIS ASSOCIATED WITH THE USE OF HERBAL jamesoni); Black mamba (Dendroaspis polylepis);Cape cobra (Naja
TEA (FENNEL AND CUMIN) nivea);Forest cobra (Naja melanoleuca); Snouted Cobra previously '
S Zengin, MM Oktay, M Kamalak, B Al, C Yildirim Egyptian cobra' (Naja annulifera) and the Mozambique spitting
cobra (Naja Mossambica). SAVP remains the only producer of a
Emergency Department, Gaziantep University, Gaziantep, Turkey monovalent antivenin effective against the bite of the Boomslang
Corresponding author: Mr Zengin Suat ([email protected]) (Dispholidus typus).An antivenin for the Exotic Saw-Scaled Viper
Key-words: Hepatotoxicity, ; herbal tea ; fennel and cumin (Echis carinatus/ocellatus) is also produced. Our Hospital is a major
referral facility in the region and our Emergency Department have
Herbal preparations have become increasingly popular throughout all three antivenins in stock. We look at four recent case studies
the globe as a result of disappointment with conventional and the lessons learned from them.
medicines. They are often regarded as harmless by the public. Case 1:
However, some of these products or their metabolites can cause The first case is a female in her thirties living on a smallholding
adverse effects such as liver damage. This case study describes two close to Pretoria (Gauteng). She felt a painful sting in her left 1st
women that developed acute hepatitis due to drinking an herbal toe standing next to her bed. She then observed that a large snake
tea. was biting her on that toe. She struggled to shake it of her foot. It
A 26-year-old woman and a 30-year-old woman were admitted to eventually let go of her foot and disappeared underneath a
our department with symptoms of nausea, vomiting, anorexia and cupboard. She phoned relatives who arrived shortly, found and
weakness. Serum alanine aminotransferase and aspartate killed the snake and administered first aid that included cutting
aminotransferase levels were increased; all serological tests for into the bite wound and attempting to remove venom by sucking
viral hepatitis and autoimmune disorders were negative. They had the wound. She was transported to our hospital by ambulance. On
consumed an herbal tea containing fennel and cumin to increase her way she received 10mg of Morphine in total for the
lactation everyday for 3-4 weeks. Discontinuation of the herbal tea excruciating pain in her left leg. The dead snake was transported
resulted in normalization of liver enzymes four-five weeks later. with her. In our ED she was seen by a junior doctor who noted that
To the best of our knowledge, this is the first report of hepatitis she was “sleepy” and could not open her eyes “probably due to the
possibly related to use of an herbal tea containing fennel and morphine dose.” A senior Emergency Physician also saw the
cumin. Fennel and cumin are used for the treatment of many patient and determined that the sleepiness was in fact ptosis due
different diseases worldwide. They have hepatoprotective and to the neurotoxic effect of the envenomation. A snake expert was
antioxidant activity but as these cases suggested they can also consulted and he confirmed that the dead snake was a snouted
possibly cause acute hepatitis. cobra. 10 Units of polyvalent antivenin was administered according
Clinicians faced with a case of acute hepatitis that is not readily to our protocol. The patient gradually improved over the next few
diagnosed should question patients about herbal use. hours and the ptosis eventually disappeared. She made a good
recovery and was discharged home after a few days in hospital.
P781 __________________________________ Toxicology Case 2:
A man came to our ED after being bitten on both hands by a small
THE MANAGEMENT OF SNAKE ENVENOMATION AT THE black snake. The snake was brought along for identification. He had
EMERGENCY DEPARTMENT OF STEVE BIKO ACADEMIC severe pain and swelling of both hands. We treated him with
HOSPITAL simple analgesia and elevation of the hands. A snake expert was
L Botha, A Engelbrecht brought in to identify the snake. It was confirmed to be a stiletto
snake, also known as a side stabbing snake due to the position of
Emergency Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, its fangs. No antivenin was indicated and the patient improved on
South Africa simple analgesia and elevation of the hands.
Corresponding author: Mr Engelbrecht Andreas ([email protected]) Case 3:
Key-words: Venom: a toxic fluid substance secreted by certain snakes, spiders, bees, A 5 year old boy was brought in to our ED after he was bitten by a
wasps and scorpions and transmitted by their stings or bites ; Venom opthalmia: an eye snake on his left hand. Two red puncture marks were observed on
condition that is caused by the introduction of venom into the eyes of an animal or his left index finger. The parents refused to have the child admitted
human being. It is typically caused by spitting cobras spraying their venom into the eyes and took him home with oral analgesics. During the night the
of a human or animal ; Neurotoxin: A venom or toxin adversely affecting the nerves or child’s hand started swelling progressively. His parents found the
nervous system. A neurotoxic snake envenomation is typically associated with paralysis of snake and killed it. They brought the child back the next day with
the respiratory and skeletal muscles leading to hypoventilation, apnoea, hypoxia and the killed snake. The snake was identified as a baby puff adder. It
death if left unt was decided to withhold antivenin because of the mild degree of
envenomation and the long time lapse since the bite. The child
made a full recovery.
Case 4:
A patient collected wood in an open veldt where he was
confronted by a large black and white snake. It sprayed venom into
the patient’s eyes. The patient arrived in our ED with severe pain
and redness in his left eye. He was treated with copious rinsing of
the eye. We used 1 ampoule of polyvalent antivenin diluted in a

BOOK OF ABSTRACTS 417

litre of ringers lactate to rinse the eye. No corneal erosions were - palpitations, 6% - dyspeptic syndrome, 5% - headache, 3% -
identified and he received an antibiotic eye ointment. He followed aggression.
up at our ophthalmology service and made a full recovery in 48 Association with alcohol was found in 24% of cases without a clear
hours. differentiation by age or gender.
Lessons learnt and discussion: The method of administration of the drug is known for only 19% of
1.Incision and suction of the wound is ineffective first aid and cases, of these, 10% - snuffed and 90% inhaled.
added to the local tissue damage caused by the snake venom. The average number of minutes of hospitalization was 228, with a
2.The administration of opiate analgesia can complicate the clinical minimum of 15 minutes and a maximum of 1105. 56% of patients
picture of neurotoxic snake envenomation and add to depression were discharged on medical advice, 18% on demand, the rest being
of respiration. It should be used judiciously if at all. transferred to ICU service - 14% psychiatry - 7%, pediatric - 4%, 1%
3.Clinicians should be made aware of ptosis as an important sign of neurology.
neurotoxic envenomation. Discussion:
4.An expert in snake identification can make a useful contribution We conclude that the patient admitted in the emergency room for
by identifying the snake species when it is available. psychoactive drug use is a male, with urban residence, aged 19-21
5.The stiletto snake cannot be handled safely because of the years, presents mainly on Thursdays and Saturdays, the months of
location of its fangs. Polyvalent antivenin cannot be used to treat autumn, and less in winter, from 9:00 p.m. to 11:00 p.m. hours. In
its bite and elevation and analgesia is usually sufficient. terms of symptoms, he presents with anxiety syndrome.
6.Baby snakes are dangerous and can cause significant Association with alcohol consumption is neither common nor
envenomation. occasional.
7.Copious rinsing is the best method to treat venom opthalmia.
Referral to an ophthalmologist to do follow up splitlamp P783 __________________________________Toxicology
examinations is usually indicated.

P782 __________________________________ Toxicology ACCIDENTAL INTOXICATION WITH VERATRUM ALBUM: A
CASE REPORT
THE PROFILE OF THE PSYCHOACTIVE DRUG CONSUMER G Filip (1), V Gavrila (1), RD Gavrila (2), FI Turcu (1)
THAT REACHES THE EMERGENCY ROOM
AM Busan, C Geormaneanu 1. Emergency Department, Emergency County Hospital, Timisoara, Romania
2. Department of Family Health Care Providers, Romanian National Society of Family
Emergency department, UMFC, Craiova, Romania Medicine, Timisoara, Romania
Corresponding author: Melle Busan Alina Mihaela ([email protected]) Corresponding author: Mr Gavrila Vasile ([email protected])
Key-words: profile ; psychoactive ; drugs Key-words: accidental intoxication ; Veratrum album ; veratrum alkaloids

The number of people who use psychoactive substances increased Introduction
lately, especially since legislation in Romania has named some of Veratrum album, commonly known as the False Helleborine (also
these drugs to be legal. known as European White Hellebore, White Hellebore, White
The purpose of this study is to develop a consumer profile of Veratrum) is a poisonous medicinal plant of the Liliaceae (lily
psychoactive drug that reaches the Emergency Department of family) or Melanthiaceae which is native to Europe. In Romania the
Hospitalul Clinic Judetean No. 1 of Craiova, in order to facilitate plant is known under various popular names: steregoaie, stirigoaie.
determining the diagnosis of acute intoxication with psychoactive All parts of the plant are poisonous, with the root and rhizomes
drugs. being the most poisonous.The rhizome extract has been used as
Methods: We conducted a retrospective study over a period of 16 insecticide for the treatment of sheep’s scab. Pharmaceutical
months, during 01.01.2011--31.03.2012, a group of 108 patients, preparations of this herb were used in rheumatism, gout, as a
0.09% of all patients who arrived in the emergency room, sedative in nervous disorders, in eclampsia, as a hypotensive and
representing all patients intoxicated with psychoactive substances. anticonvulsant.Case reportWe present the case of a 31-years-old
More parameters were followed so that we can achieve a more man, a shepherd, who accidentally ingested about 100 ml
accurate profile of psychoactive drug users. decoction of the Veratrum album roots, used as disinfection
Results: solution for sheeps. Shortly after ingestion, he developed sweating,
81% of them were male patients. Patients were aged between 11 tremor, difficulty in breathing, abundant salivation, diarrhea,
and 52, with a peak at 19 and 21 years, with limits: 14-29 for nausea, vomiting, oral paraesthesia, blurred vision, dizziness,
women and 11-52 for men. 76% of all patients have a urban diplopia. On admission to the hospital he suffered an episode of
residence, of whom 85% in Craiova, while 18% come from rural bradycardia (40 beats/min) and hypotension (the initial systolic
areas and for the remaining 6% we could not determine the origin, blood pressure was 60 mmHg). His vital signs improved after the
due to lack of cooperation. administration of atropine sulfate. He was treated with activated
Regarding the time when these patients present in the emergency charcoal, antiemetics (metoclopramide) and intravenous
room stands a peak in September and November, with a minimum electrolytic solution. Laboratory findings were unremarkable. EKG:
in June, December 2011 and January 2012. A large number of initial sinus bradycardia; after 8 hour sinus tachycardia, sinoatrial
presentations were on Thursdays and Saturdays, with a minimum block. The patient was admitted for observation of toxicity signs.
on Fridays. 71% of them end up in the emergency room between After the symptomatic treatment, the response to therapy was
18:00 - 6:00, with a peak between the hours of 9:00 p.m. to 11:00 favorable, with normalization of blood pressure and heart rate. The
p.m. patient recovered completely within 12 hours and was discharged
Symptoms that these patients present are varied: 47% - anxiety, from the hospital.ConclusionVeratrum album contains at least 20
12% - psychomotor agitation, 11% - dizziness, 8% - tachycardia, 8% highly toxic steroidal alkaloids, known as veratrum alkaloids,
including proveratrine, protoveratrine, protoverina, veratramine,
veratradine, cevadine, rubijervina, pseudojervina, jervine and

BOOK OF ABSTRACTS 418

various acids (chelidonic, veratric, acetic, butyric acid, alpha- P785 __________________________________Toxicology
methyl-butyric, tiglic, angelic).These alkaloids act by increasing the
permeability of the sodium channels. Following the symptomatic ROLE OF HEMODIALYSIS AND FLUMAZENIL IN BACLOFEN
treatment these patients were discharged well improved, 24-48 OVERDOSE
hours after ingestion.

P784 __________________________________ Toxicology NB Akıllı, E Akıncı, MO Gonen, R Köylü, B Cander

Emergency department, Konya Training and Research Hospital, Konya, Turkey

FATAL ALUMINIUM PHOSPHIDE POISONING: A CASE Corresponding author: Melle Akinci Emine ([email protected])
REPORT Key-words: hemodialysis ; flumazenil ; baclofen intoxication
V Gavrila (1), G Filip (1), RD Gavrila (2), A Petrica (1)
Introduction
1. Emergency Department, Emergency County Hospital, Timisoara, Romania Baclofen, a lipophilic analog of gamma-aminobutyric acid, is
2. Department of Family Health Care Providers, Romanian National Society of Family clinically used to control spasticity. Management of baclofen
Medicine, Timisoara, Romania overdose is primarily supportive. Several studies have noted that
Corresponding author: Mr Gavrila Vasile ([email protected]) hemodialysis can alleviate clinical symptoms of baclofen overdose.
Key-words: aluminium phosphide ; poisoning ; metabolic acidosis We present a patient with baclofen overdose presenting to the
emergency department with coma and successfully treated with an
Introduction infusion of flumazenil and hemodialysis treatment
Aluminium phosphide (AlP) is a solid fumigant which has been in Case report
extensive use as insecticide and rodenticide since the 1940s. Acute 19 years old female patient was admitted to emergency
aluminium phosphide poisoning is an extremely lethal poisoning. department with take baclofen (Lioresal®, Novartis) 10 mg 30
The toxicity of aluminium phosphide is attributed to the liberation tablets for suicide. Vital signs were heart rate 100, tension 130/70,
of phosphine gas which is cytotoxic and causes free radical respiratory rate 19 fever 36,7 degree Celsius. Physical examination
mediated injury. Both, aluminium phosphides and phosphine have was general status worse, consciousness off. Glasgow Coma Scale
corrosive actions. was eight. The patient was entubated and nasogastric tube
Case report inserted. 50g of activated charcoal was given after Gastric lavage
We report a case of a 54-years-old man who presented to the by 3000cc saline. The patient was admitted to the toxicology
Emergency Department (ED) about 3 hours after having ingested 6 intensive care and ventilated. Laboratory results were: arterial
g of Phostoxin in suicidal purpose. On arrival in the ED, the patient blood pH:7,29, HCO3:15,5 mmol, pO2: 44,8 mmHg, pCO2:33
was agitated, irritated, with signs of shock: clammy skin, cyanotic, mmHg, oxygen saturation:67,7. Other results were in normal
HR=105/min, BP=65/40 mmHg, RR=35-40/min, SpO2=75%, levels. The patient consulted to National poison control center
prolonged capillary refill time, a burning sensation in the throat, (UZEM). UZEM proposed dialysis. The patient dialised for 3 hours.
violent chest pain, abdominal pain, nausea, vomiting, diarrhea. IV 0.01mg/kg/hour flumazenil infused to the patient for four hours.
Laboratory: metabolic acidosis (pH=7.26, EB=-10.9). ECG: atrial The Patient’s consciousness was opened. Glasgow Coma Scale was
fibrillation, negative T waves in all leads. He was treated with fifteen and extubated. Laboratory results metabolic acidosis
intravenous fluids in bolus (sodium chloride 0.9% 1.500 ml) and improved. The patient didn’t dialysis again. The patient was
colloid, 100 g activated charcoal, 250 mg methylprednisolonum, 40 discharged the 4th day of hospitalization with consulted to
mg famotidinum, 10 mg metoclopramidum, 2g magnesium sulfate psychiatry.
and 50 mmol sodium bicarbonate. After 3 hours: BP=70/40 mmHg, Discussion
HR=95/min, SpO2=75%, the metabolic acidosis has worsened Baclofen is a lipid-soluble derivative of y-aminobutyric acid (GABA).
(pH=7,06, EB=-22.9). Subsequently, after the transfer in the It acts as an inhibitory neurotransmitter primarily at a spinal level
Intensive Care Unit (ICU), he developed respiratory distress to reduce muscle tone, along with some supraspinal activity. It is
syndrome (requiring rapid sequence intubation and mechanical commonly used in conditions like spasticity, dysfunctional voiding,
ventilation), renal failure, liver failure and disseminated intractable hiccups, palatal myoclonus, and trigemi¬nal neuralgia.
intravascular coagulation. Evolution was unfavorable and the Ingested baclofen is absorbed rapidly and completely, thereafter
patient died after 17 hours from the ingestion of poison. 69-85% is excreted without changes in urine and 15% is
Conclusion metabolized by the liver. The half-life is between 4.5 and 6.8 hours
Aluminium phosphide poisoning affects most of the organs and a in healthy subjects. Baclofen is moderately lipophilic, 30% of the
variety of signs and symptoms can appear in the clinical drug is protein bound, and can penetrate the blood-brain barrier.
presentation of the patients. Severe metabolic acidosis and Common manifestations of baclofen toxicity are change in level of
resistant hypotension are characteristic for severe poisoning and consciousness, hypotonia, hypotension, bradycardia, abdominal
have poor prognosis; AlP poisoning has a high mortality rate which pain, nausea, and vomiting; symptoms usually resolve when
is directly proportional with the ingested dose and the degree of baclofen is stopped. Management of baclofen overdose is primarily
shock. The management continues to be unsatisfactory, because supportive. Treatment consists of symptomatic and supportive
there is not a specific antidote and it remains only supportive. care, intravenous fluids, inotropes, and mechanical ventilation if
necessary. Several studies have noted that hemodialysis can
alleviate clinical symptoms of baclofen overdose and shorten the
recovery time in patients with end-stage renal disease (ESRD). Low
protein binding (31%) and low volume of distribution (2.4 l/kg) lead
to efficient removal of baclofen by dialysis. While improvement in
mental status was shown to parallel the fall in serum concentration
in one study, Lipscomb et al., noted that serum elimination half-life
may not reflect a slower elimination rate from the central nervous
system. Delayed diffusion across the blood-brain barrier is thought

BOOK OF ABSTRACTS 419

to account for the lag of a few hours in clinical recovery observed this issue further. Therapy with antioxidants may lead to an
in some people. Most of previous reports document management increase in the antioxidant defense system and, thus, improvement
of baclofen overdose with supportive measures and mechanical in clinical symptoms of scorpion envenomation.
ventilation. Hemodialysis has been tried only in patients with
chronic kidney disease (CKD). Dias et al. are the first reported case P787 __________________________________Toxicology
where hemodialysis was tried in a patient with normal renal
function. Also our patient has normal renal function but metabolic PLASMA EXCHANGE AS A COMPLEMENTARY APPROACH
asidosis was developed and hemodialysis treatment was succesfull TO SNAKE BITE TREATMENT: AN ACADEMIC EMERGENCY
. DEPARTMENT’S EXPERIENCES
It has also been reported that flumazenil, a specific benzodiazepine S Zengin (1), M Yilmaz (2), B Al (1), C Yildirim (1), P Yarbil (3),
antagonist, may counteract the central neuronal inhibitory effects H Kilic (4), S Bozkurt (5), A Köse (6)
of baclofen without interfering with its muscle relaxant properties.
Again, this has not been confirmed in other case reports.Flumazenil 1. Emergency Department, Gaziantep University, Gaziantep, Turkey
in this case led to a dramatic improvement in patient's 2. Hematology Department, Gaziantep University, Gaziantep, Turkey
consciousness and she could be extubated within 8 hours of 3. Emergency Department, 25 Aralik State Hospital, Gaziantep, Turkey
baclofen ingestion. 4. Emergency Department, Malatya State Hospital, Malatya, Turkey
Conclusion 5. Emergency Department, Sütçü İmam University, Kahramanmaraş, Turkey
Emergency physcians should consider baclofen overdose in patiens 6. Emergency Department, Uludag University, Bursa, Turkey
presenting with acute loss of consciousness, flaccidity and Corresponding author: Mr Zengin Suat ([email protected])
hyporeflexia even in the absence of history about suicidal Key-words: Snake bite; envenomation ; therapeutic plasma exchange ; emergency
ingestion. Emergency treatment of baclofen overdose should be department
considered in hemodialysis and flumazenil.
Background and objective: Snake bites are leading causes of
P786 __________________________________ Toxicology morbidity and mortality worldwide, especially in rural areas.
Therapeutic plasma exchange has been used in the treatment of
OXIDANT/ANTIOXIDANT STATUS IN CASES SCORPION many different conditions such as immunologic diseases,
STINGS toxicologic disorders, and snake envenomation. The aim of this
S Zengin (1), B Al (1), P Yarbil (2), M Orkmez (3), S Taysi (3), study is to evaluate the efficacy of plasma exchange treatment on
C Yildirim (1), N Aksoy (4) clinical status, outcomes, and discharge of patients who were
bitten by venomous snakes.
1. Emergency Department, Gaziantep University, Gaziantep, Turkey Method: The study was conducted retrospectively in the
2. Emergency Department, 25 Aralik State Hospital, Gaziantep, Turkey Emergency Department of Gaziantep University from January 2002
3. Biochemistry Department, Gaziantep University, Gaziantep, Turkey to December 2011. Thirty-seven patients were included in the
4. Biochemistry, Harran University, Şanlıurfa, Turkey present study. Routine biochemical and hematologic laboratory
Corresponding author: Mr Zengin Suat ([email protected]) parameters were studied before and after plasma exchange.
Key-words: scorpion sting ; paraoxonase, ; arylesterase Demographic data, clinical status, and outcomes of patients were
recorded. Plasma exchange was performed by using centrifugation
Objective technology via an intravenous antecubital or subclavian vein
The aim of this study was to investigate serum paraoxonase (PON), catheter access. Human albumin/fresh frozen plasma was used as
arylesterase (ARLY), ceruloplasmin (Cp), and myeloperoxidase replacement fluids.
(MPO) activity and lipid hydroperoxide (LOOH) and total sulfhydryl Results: A significant correlation was seen between therapeutic
group (-SH) levels in patients with scorpion sting. plasma exchange and improvement of laboratory results. None of
Method the study patients lost their limbs. Eight patients were sent to the
The study was conducted at Gaziantep University, School of intensive care unit. The mean length of the hospital stay was 12.2
Medicine, Departments of Emergency and Clinical Biochemistry, days (4-28). All patients were discharged with good recovery. No
between 2009 and 2010. Thirty-six patients with scorpion sting complications were seen during the 3 months following discharge.
(Group 1) and 36 healthy volunteers as the control group (Group 2) Conclusion: Plasma exchange appears to be an effective treatment
were enrolled in the study. Plasma PON, ARLY, Cp, and MPO intervention for snake bite envenomations, especially in the
activity and LOOH and -SH levels were measured. In addition, the management of hematologic problems and in limb
lipid parameters of all groups were determined with routine preservation/salvage strategies. In addition to traditional
laboratory methods. treatment methods, plasma exchange should be considered by
Results emergency physicians in cases of snake bite envenomation as a
The patients with scorpion sting had lower PON and ARLY activity therapeutic approach to facilitate rapid improvement.
and -SH levels than the control group (all p < 0.001), and higher
MPO and Cp activity and LOOH levels (all p < 0.001). Clinical P788 __________________________________Toxicology
characteristics of the patients with scorpion sting and the control
group were comparable in terms of age, sex, body mass index, and OXIDANT/ANTIOXIDANT STATUS IN CASES SNAKE BITES
lipid parameters. S Zengin (1), B Al (1), P Yarbil (2), S Taysi (3), H Bilinç (4), C
Conclusions Yildirim (1), N Aksoy (5)
The patients with scorpion sting had decreased antioxidant (PON,
ARLY, and -SH) and increased oxidant (MPO, LOOH) levels. While 1. Emergency Department, Gaziantep University, Gaziantep, Turkey
we determined that the oxidative/antioxidative balance shifted 2. Emergency Department, 25 Aralik State Hospital, Gaziantep, Turkey
toward oxidative status because of scorpion envenomation, 3. Biochemistry Departmant, Gaziantep University, Gaziantep, Turkey
prospective studies with larger groups are needed to investigate 4. Biochemistry Department, Akçakale State Hospital, Şanlıurfa, Turkey

BOOK OF ABSTRACTS 420

5. Biochemistry Department, Harran University, Şanlıurfa, Turkey in TAS arrival levels of study and control group, and there were no
Corresponding author: Mr Zengin Suat ([email protected]) changes with treatment (p˃0.05 for all).
Key-words: snake bite envenomation ; paraoxonase ; arylesterase Conclusion: Our results show that serum TOS and OSI levels
increase in COP. We think that reactive oxygen species play a role
Background: Snake bites are an important cause of mortality and in the pathophysiology of COP. Therapy with antioxidants may lead
morbidity worldwide, especially in rural areas. to an increase in the antioxidant defense system and, thus,
Objective: The aim of this study was to investigate serum improvement in clinical symptoms of COP.
paraoxonase (PON), arylesterase (ARLY), ceruloplasmin (Cp) and
myeloperoxidase (MPO) activity and lipid hydroperoxide (LOOH) P790 __________________________________Toxicology
and total sulfhydryl groups (-SH) levels in patients with snake
venom poisoning. IMPACT OF SCORPION STINGS ON
Method: The study included 49 patients with snake bite ELECTROCARDIOGRAPHIC CHANGES AND RELATIONSHIP
envenomation (Group 1) and 39 healthy volunteers as the control WITH BODY OXIDANT AND ANTIOXIDANT STATUS
group (Group 2). Plasma PON, ARLY, Cp and MPO activity and B Al (1), V Davutoğlu (2), S Ercan (2), P Yarbil (3), C Yildirim
LOOH and -SH levels were measured. Laboratory measurements of (1), S Zengin (1)
20 patients with snake bite envenomation (Group 3) were
performed again after treatment. 1. Emergency Department, Gaziantep University, Gaziantep, Turkey
Results: PON and ARLY activity and -SH levels was significantly 2. Cardiology Department, Gaziantep University, Gaziantep, Turkey
decreased in group 1 compared with those of group 2. Cp and MPO 3. Emergency Department, 25 Aralik State Hospital, Gaziantep, Turkey
activity and LOOH levels were significantly elevated in group 1 Corresponding author: Mr Zengin Suat ([email protected])
compared with those of group 2. PON and ARLY activity was Key-words: Scorpion stings ; electrocardiogram changes ; oxidant/antioxidant
significantly elevated in group 3 compared with that of group 1. Cp
and MPO activity and LOOH levels were significantly decreased in Objective: The aim of this study is to establish the
group 3 compared with those of group 1. electrocardiogram (ECG) changes due to scorpion stings and
Conclusion: Patients with snake bite envenomation had increased investigate the association between oxidant/antioxidant system
oxidants (MPO, LOOH) and decreased antioxidants (PON, ARLY and and the electrocardiogram changes.
-SH) status. The results obtained in this study showed that the Methods: 44 patients admitted to the emergency department for
oxidative/antioxidative balance shifted toward oxidative status scorpion sting and without history of heart failure, renal failure,
because of snake bite. Therapy with antioxidants may lead to the chronic obstructive pulmonary disease, diabetes mellitus,
increase in the antioxidant defense system and thus improvement malignancy or history of drug use are included and a control group
in clinical symptoms. of age and gender matched 20 persons were included to the study.
ECGs promptly was taken in the most painful phases of patients.
P789 __________________________________ Toxicology The heart rate, PR interval, QRS, prolonged Corrected QT Interval,
corrected shortened QT interval, QT dispersion, corrected QpT
ASSESSMENT OF OXIDANT/ANTIOXIDANT STATUS AND value, minimum P wave duration, maximum P wave duration and P
OXIDATIVE STRESS INDEX LEVELS wave dispersion were measured. Erythrocyte packages were
IN PATIENTS WITH CARBON MONOXIDE POISONING. prepared and stored in a freezer at -80 °C to detect
S Zengin (1), S Kartal (1), B Al (1), M Orkmez (2), S Taysi (2), toxin/antioxidant levels. Spearman's rank correlation coefficient
C Yildirim (1) was used to identify all the calculated values while Tukey’s multiple
comparison test was employed for multiple comparisons. Values
1. Emergency Department, Gaziantep University, Gaziantep, Turkey with p < 0.05 were considered statistically significant.
2. Biochemistry Department, Gaziantep University, Gaziantep, Turkey Results: Of the 44 patients, half of them were male and the others
Corresponding author: Mr Zengin Suat ([email protected]) were female. Average age of the patients was 45.22 ± 17.99. None
Key-words: Carbon monoxide poisoning, ; total antioxidant status, ; total oxidant status, of the patients required intensive care and none of them had limb
losses. PR interval, UQTc, QTd, QpTc, Pmin values of the patients in
Objective: The purpose of this study is to evaluate the variations of electrocardiogram were higher than those of the control group (p
pre- and post-treatment total antioxidant status (TAS) and total < 0.05). Difference between those with changed ECG and
oxidant status (TOS) levels in carbon monoxide poisoning (COP), unchanged ECG in terms of the values of total antioxidant status
and is find out more about the pathophysiology of COP. (TAS), total oxidant status (TOS), and oxidative stress index (OSI),
Methods: One-hundred-thirteen patients admitted to our were not statistically significant (p> 0.05).
emergency department with acute COP between 2011 and 2012 Conclusion: Scorpion stings are associated with an ECG changes
and 50 healthy volunteers as control group were included in this including increased PR interval, QT dispersion, corrected QpT value
study. Serum, plasma, and erythrocyte packages were prepared for and minimum P wave duration. The mechanism of this relationship
all patients with COP at the first application and at the controls is not related with the status of oxidant and antioxidant capacity.
after 90 and 180 minutes. The all samples were stored under -80° Increased QT dispersion warrants further study in terms of
in the freezer. Serum oxidant/antioxidant status levels were potential serious arrhythmias in scorpionism.
measured.
Results: No correlation was observed between age, gender,
carboxyhemoglobin (COHb) and the levels of TAS, TOS and OSI. TOS
and OSI arrival levels were higher than healthy volunteer group
levels and control levels taken after 90 and 180 minutes (p˂0.001
for all). On the other hand, no statistical differences were observed

BOOK OF ABSTRACTS 421

P791 __________________________________ Toxicology diagnosis is possible. To show the cardiac exposure of tricyclic
antidepressant and other cardiotoxic drugs objectively it is useful
DETERMINATION OF RELATIONSHIP BETWEEN to look at the level of serum BNP.
NATRIURETIC PEPTIDE AND CARDIOTOXIC DRUGS
POISONING P792 __________________________________Toxicology

E Karakilic (1), F Buyukcam (2), A Solakoglu (1), A Gurbay (3) EARLY WARNING: LETHAL EFFECTS OF 4-
METHYLAMPHETAMINE.
1. Emergency Department, Ankara Numune Training & Research Hospital, Ankara, Turkey K Anseeuw (1), P Blanckaert (2), KE Maudens (3), H Neels
2. Emergency Department, Ankara Diskapi Yildirim Beyazit Training & Research Hospital, (4)
Ankara, Turkey
3. Pharmaceutical Toxicology, Hacettepe University, School of Pharmacy, Ankara, Turkey 1. Emergency Department, ZNA Stuivenberg, Antwerp, Belgium
Corresponding author: Mr Karakilic Evvah ([email protected]) 2. Belgian Early Warning System on Drugs, Scientific Institute of Public Health, Brussels,
Key-words: toxycology ; brain natriuretic peptide ; cardiac effect Belgium
3. Toxicological Centre, University of Antwerp, Antwerp, Belgium
OBJECTIVE: Brain natriuretic peptide (BNP) is a sensitive indicator 4. Toxicological Laboratory, ZNA Stuivenberg, Antwerp, Belgium
of ventricular dysfunction in symptomatic and asymptomatic Corresponding author: Mr Anseeuw Kurt ([email protected])
patients. The level of BNP is associated with the severity of Key-words: 4-methylamphetamine ; emerging drug ; lethal
dysfunction and the value of 100 pg/ml is considered as the cut off
point for the cardiac failure. Serum BNP levels rise due to cardiac The emergency medical services were called out to a 34-year old
effects such as pulmonary hypertension, valvular heart disease, female suffering from an epileptic fit after using ketamine, cocaine
heart rhythm disorders, acute coronary syndrome, cardiac and amphetamines during the previous 24 hours. On arrival at the
inflammatory diseases, restrictive myocarditis, constrictive scene, the medical team found a patient in cardiorespiratory
pericarditis and cardiogenic syncope. arrest. Resuscitation was started, including intubation, artificial
In case of poisoning with cardiotoxic drugs such as tricyclic ventilation and cardiac massage. Blood was drawn for toxicological
antidepressants, beta blockers, calcium channel blockers, and analysis before administering any drugs. The patient was found to
digoxin, the most frequent problem observed for the mortality and be hyperthermic (39 °C), hypercapnic (ET CO2 19 mmHg) and
morbidity is the clinical condition due to cardiovascular influence. mydriatic. Initial heart rhythm was an electromechanical
Overdose of these drugs decrease the myocardial contractility, and dissociation. During resuscitation increasing body temperature was
also worsen the known cardiac insufficiency. In order to observed despite efforts to control body temperature (external
understand the severity of the intoxication, early recognition of cooling, muscle relaxation, benzodiazepines, acetaminophen). The
these effects is important. In the literature, blood BNP levels have patient also developed a marked muscle rigidity. After 50 minutes
been using to determine the cardiac effects of numerous diseases of resuscitation core body temperature was determined to be
by several researchers. However, there are few investigators that higher than 45 °C and the patient was declared dead. Hetero-
evaluate the cardiac effects of drug intoxications by blood BNP anamnesis revealed that the patient suffered from hyperactivity,
level. The aim of this study was to investigate the relationship agitation, palpitations, nausea and tremor, in the hours leading to
between blood BNP levels and the severity of the cardiotoxic drugs the epileptic fit. A white-yellow powder was found in the
intoxication. possession of the patient. Toxicological analysis of this powder
MATERIAL AND METHODS: The patients admitted to the revealed amphetamine (11%) and 4-methylamphetamine (4-MA)
emergency department with intoxication of cardiotoxic drugs like (25%). Toxicological analysis of the pre-mortem blood sample
tricyclic antidepressants, beta blockers, ca-channel blockers, and showed 4-MA levels of 620 ng/ml and amphetamine levels of 480
cardiac glycosides were included in the study. The patients which ng/ml. In the period August 2011 – April 2012, three severe cases
had history of chronic diseases were excluded from the study. If of intoxication and five deaths have been reported in Flanders
the patient was conscious, the informed consent was signed by the involving the use of 4-MA. The deaths related to 4-MA are
patient; if not, the informed consent was signed by their relatives. disproportionally high considering the total number of drug-
Twenty-four patients were included in the study. Blood BNP levels induced deaths (78 in 2008 in Flanders). 4-MA is a substituted
were determined in the first 24 hours using by Triage BNP kit and amphetamine-derivative, and belongs to the class of new
BNP concentrations over 100 pg/ml were accepted as a positive psychoactive substances, as defined by the European Monitoring
result. To determine the cardiovascular effects, the arterial blood Centre for Drugs and Drug Addiction. We hypothesize that the
pressure and electrocardiogram findings (PR, QRS and QT presence of 4-MA in these samples is probably due to a change of
durations, rhythms) were evaluated. Statistical relationship the precursors used for the illegal synthesis of amphetamine. No
between cardiac effects of these drugs and the level of BNP was human toxicological data regarding 4-MA are available in scientific
investigated. literature, only limited pre-clinical information from rodent studies
RESULTS: 19 patients were intoxicated by TCA. 1 patient with (Pubmed search, 20/05/2012). Amphetamine-type stimulants
digoxin, 1 patient with calcium channel blocker, 3 patients were target monoamine transporter proteins by acting as substrates and
intoxicated with beta blockers. 10 of 24 patients (41.7%) were triggering the efflux of monoamine transmitters, especially
hypotensive. Hypotension was observed in 7 of 8 patients that BNP dopamine (DA) and norepinephrine. 4-MA is non-selective with
was detected above the reference value. BNP was significantly regard to in vitro potency as a releaser of DA and serotonin, in
higher in hypotensive patients (p < 0.05). BNP levels were sharp contrast to amphetamine, which is a potent DA releasing
significantly higher in patients with QRS duration over 100 msc in agent.1 Amphetamine intoxication is characterized by mydriasis,
the same way that patients with high BNP levels and QRS duration central nervous system symptoms (hyperactivity, confusion,
was significantly longer (p < 0.05), but the PR and QTc prolongation agitation, bruxism, insomnia), cardiovascular symptoms
didn't associated with BNP elevation. (vasoconstriction, hypertension, tachycardia, chest pain,
CONCLUSION: Today, in spite of using many methods to identify palpitations) and nausea. 4-MA (or mixtures of 4-MA and
cardiac dysfunction, BNP is a frequently used method in the
emergency departments because it is easy to reach and a rapid

BOOK OF ABSTRACTS 422

amphetamine) intoxication can result in the above symptoms; P794 __________________________________Toxicology
moreover, due to the pronounced serotonergic action of 4-MA,
there is a supplementary risk of developing a serotonin syndrome, FACTORS AFFECTING THE PROGNOSIS IN ACUTE
characterized by, among other things, tremor and extreme INSECTICIDE INTOXICATIONS CONTAINING ORGANIC
hyperthermia.1,2 Several amphetamine-induced deaths have been PHOSPHORUS
described in medical literature with mean lethal blood N Kozacı
amphetamine concentrations of 2000 ng/ml. The amphetamine
concentrations described in the deaths in Belgium are significantly acil tıp, adana NEAH, adana, Turkey
lower, indicating that most likely, amphetamine intoxication was Corresponding author: Mme Kozaci Nalan ([email protected])
not the sole cause of death. Data on lethal concentrations of 4-MA Key-words: organic phosphorus ; intoxication ; prognosis
are currently unavailable, but 4-MA-related toxicity seems to be, at
least in part, responsible for the observed deaths. The severe Objective: The goal of the study was to investigate the
hyperthermia could potentially be caused by the dopaminergic, complications encountered during the follow up and treatment of
noradrenergic and serotonergic effects of combined the patients intoxicated with insecticides that contain organic
amphetamine/4-MA use.2,3 Since mixtures of 4-MA and phosphorus and assess the effects of these complications on the
amphetamine are sold on the street as “speed”, this puts a treatment periods of these patients.
significant population at risk of exposure to 4-MA. We want to Material and Methods: Patients who presented to the tertiary care
warn the medical community about this new dangerous and emergency department with the diagnosis of intoxication with
potentially lethal designer drug. An early and aggressive treatment, insecticides containing organic phosphorus (OPi) between March
targeted at lowering the body temperature, seems warranted 2004-September 2005 were included into the study.
where 4-MA toxicity is suspected.References:1.Kelly JP. Cathinone Results: Thirty four patients were included into the study. Seven of
derivates: a review of their chemistry, pharmacology and them underwent mechanical ventilation due to respiratory failure.
toxicology. Drug Test Anal 2011; 3:439-453 2.Rothman RB and The Glasgow Coma Scale (GCS) score was found to be 300 U/L. The
Baumann MH. Monoamine transporters and psychostimulant total dose of atropine used in these patients and the duration of
drugs. Eur J Pharmacol 2003; 479 :23-40 3.Jones WA, et al. hospital stay were found to be higher than in the other patients.
Quantitative analysis of amphetamine in femoral blood from drug- Conclusion: The clinical presentation and course of the patients
poisoning deaths compared with venous blood from impaired especially with respiratory failure and hyperamylasemia are
drivers. Bioanalysis 2011; 3:2195-204 observed to be more serious, their atropine needs are greater r
and they have longer hospital stays. GCS is a useful parameter in
P793 __________________________________ Toxicology determining the need for intubation.

EMERGENCY MEDICINE ADMISSIONS OF PEADIATRIC P795 __________________________________Toxicology
INTOXICATED CASES
N Kozacı RAPID REVERSAL OF ANTICOAGULANTS EFFECT OF
WARFARINE IN ED: PROTHROMBIN COMPLEX
acil tıp, adana NEAH, adana, Turkey CONCENTRATES
Corresponding author: Mme Kozaci Nalan ([email protected]) M Ergin, B Cander, S Kocak, AS Girisgin, M Gul, L Ozturk, MR
Key-words: Emergency ; Intoxication ; Peadiatrics Ozer, MA Onal, C Dikmetas

Objective: In this study, we aimed to analyse the demographic Emergency Department, Necmettin Erbakan University Meram Medicine Faculty, Konya,
features and the mortality rates of the pediatric patients admitted Turkey
to the emergency department and diagnosed intoxication. Corresponding author: Mr Ergin Mehmet ([email protected])
Material and Methods: Patients, admitted to the pediatric Key-words: Prothrombin complex ; Hemorrhage ; Warfarine overdose
emergency department and diagnosed intoxication during 12.
1.2009 and12.31.2010 were included in the study. Patients were INTRODUCTION: Reversion of the anticoagulant effect of vitamin K
evaluated from the patient cards. The specialities, including age, antagonists (VKAs) in cases of symptomatic overdose, active
sex, reason of the poisoning, time till admission, time after bleeding episodes, or need for emergency surgery is the most
poisoning treatment till admission, treatment after admission, important indication for human prothrombin complex
administration route, mortality rates were recorded. concentrates (PCCs) and this effect of PCCs appears to be more
Results: In our study 1029 cases were included. 66.47% of the complete and rapid than that caused by administration of fresh
patients were female. Poisoning was the most 13- 18 years group frozen plasma. CASES: We are presenting four cases of hemorrhage
(% 56.17). Patients were admitted mostly in spring. The most associated with warfarin use (Table). DISCUSSION: In an in-vivo
reason of poisoning was administration of drugs. Suicide rate was study, PT/INR was restored by either 3- or 4- factor PCCs in plasma
56.07%, and 54 patients (5.2%) had the second suicide attempt. with INR 3.0, but they were more effectively corrected by 4-factor
85,71% of the patients admitted to the emergency room the first 2 PCC than 3-factor PCC in plasma with INR 10.3. Effects of free
hours. frozen plasma (FFP) were similar to 0.3 U/ml of PCCs in terms of PT,
Conclusion: For decreasing the poisoning rate, preventive but FFP was less efficacious than PCCs in recovering thrombin
measures, education ofthe family, where a more secure storage of generation or factor II levels. In flow experiments, the onset of
drugs, pharmaceutical companies produce drugs more prudently in thrombus formation was shortened by either PCC, but not by FFP,
boxes, and regional epidemiological studies should be the contrary to shortened PT values. For warfarin reversal 20% volume
prevention of childhood poisonings is necessary.

BOOK OF ABSTRACTS 423

replacement with FFP is inferior to PCCs. In another study from İntraduction: Glyphosate is a non-selective organophosphate
Italy, 3-factor-PCCs was found to be effective and safe in rapidly herbicide which has a wide spectrum and systemic effects and used
reversing the effects of VKAs, although it was not always widely in many countries including Turkey. Glyphosate which was
administered in accordance with international or national produced by Monsanto at the beginning of 1970s is commonly
guidelines. A study on trauma patients, it was found that PCCs, used for especailly crabgrass control in agricultural areas.
when added to FFP and vitamin K, resulted in a more rapid time to Case: Seven male patients who work in the same workplace
reversal of the INR.On the other side, it was suggested that there is admitted to our emergency department as they noticed that they
a low but quantifiable risk of thromboembolism in VKA-treated had added herbicide, glyphosate that they used in the field, into
patients receiving PCCs for anticoagulation reversal. But these the meal instead of oil. They were conscious and cooperated on
findings should be confirmed in randomised, controlled trials. admission. They had no complaints except nausea. No pathologic
findings were found on their physical examination. A vascular
P796 __________________________________ Toxicology access was opened and fluid replacement was initiated. Gastric
irrigation was done and activated carbon was given. All patients
LIPID THERAPY IN VERAPAMIL AND PROPRANOLOL were monitored in emergency department. A reduction was
POISONING: REPORT OF TWO CASES detected in platelet and hemoglobin values of the first patient on
S. Acehan (1), A. Açıkalın (2), E. Çağlıyan (3), M. Gülen (4), S. the first day of hospitalization. Peripheral blood smear examination
Satar (5) was consistent with the detected platelet values. The patient had
no complaints and spontaneous hemorrhages. The patient was
1. Emergency Medicine, Adana Numune Education end Reseach Hospital, Adana, Turkey discharged with instructions as his platelet and hemoglobin values
2. Emergency Medicine, Adana Numune Education and Reseach hospital, Adana, Turkey tended to elevate on the third day of hospitalization. The first
3. Kardiology Department, Adana Numune Education and Reseach Hospital, Adana, patient was invited for control on the seventh day of glyphosate
Turkey intake. His platelet (243.000/mm³ ) and hemoglobin values (14.3
4. Emergency Medicine, Adana numune Education and Reseach Hospital, Adana, Turkey g/dl) were within normal ranges. Creatinine values of the second
5. Emergency medicine, Adana Numune Education and Research Hospital, Adana, Turkey and the third patients were detected to elevate on the second day
Corresponding author: Mme Acikalin Ayca ([email protected]) of hospitalization (1.3 mg/dl and 1.5 mg/dl, respectively). Urinary
Key-words: Poisoning ; lipit therapy ; Cardiovascular output of the patients was monitored. No reduction occured in
urine volume. The patients were administered IV fluid replacement
İntraduction: Verapamil and propranolol, drugs used in therapy. Control values were normal on the third day of
cardiovascular medicine, may cause death due to conduction hospitalization. Remaining four patients were discharged with
abnormalities and drug refractory shock in high doses. Cardiotonic instructions as they did not have any complaints and normal
drugs are usually required for therapy. However, cardiogenic shock biochemistry and hemogram values 24 hours after hospitalization.
may deteriorate in spite of cardiotonic drugs in serious The first three patients were hospitalized for three days and other
intoxications. patients were hospitalized for two days.
Case Report: Drug refractory cardiogenic shock had evolved in two Results: To conclude; GlySH is an available, commonly used
separate patients admitted to our emergency department due to herbicide of which poisoning may be fatal. Clinical findings are
verapamil and propranolol intoxication. Vasopressor therapy failed closely related with plasma GlySH concentration and vary from
in both patients and 100 mL of bolus 20 % lipid solution was given asymptomatic findings to fatal manifestations. Securing airway and
without delay followed by 1mL/kg infusion given in 1 hour. Shock initiating supportive treatment in the early period would
findings resolved in both patients after lipid therapy(ILT). contribute perfusion of all organs and significantly reduce
Discussion: Application of ILT before generation of multi-organ mortality.
dysfunction due to perfusion deterioration and usage of positive
inotropic drugs may be reasonable. Also, its application before P798 __________________________________Toxicology
performing extracorporeal excretion methods is less invasive.
Further prospective and controlled studies are required to EFFECT OF INTRAVENOUS LIPID EMULSION THERAPY ON
determine the dosage and duration of ILT. SERUM PSEUDOCHOLINESTERASE IN EXPERIMENTAL
MODEL OF DIAZINON INTOXICATION

P797 __________________________________ Toxicology M Ayan (1), U Tas (2), E Sogut (3), M Esen (1), N Basol (1), T
Alatlı (1)
A RARELY SEEN POISONING IN THE EMERGENCY
DEPARTMENT: GLYPHOSATE 1. Department of Emergency Medicine, Gaziosmanpasa University , Faculty of Medicine,
Tokat, Turkey
2. Department of Anatomy, Gaziosmanpasa University, Tokat, Turkey
3. Department of Biochemistry, Gaziosmanpasa University, Tokat, Turkey

S. Acehan (1), A. Açıkalın (2), F. Bektaş (3), M. Gülen (4), S. Corresponding author: Mr Ayan Murat ([email protected])
Satar (5) Key-words: diazinon ; pseudocholinesterase ; lipid

1. Emergency Medicine, Adana Numune Education end Reseach Hospital, Adana, Turkey Introduction: This study aimed to research the positive effect of
2. Emergency Medicine, Adana Numune Education and Reseach hospital, Adana, Turkey intravenous lipid emulsion (% 20 lipid solution) on serum
3. Emergency Medicine, Akdeniz University, Antalya, Turkey pseudocholinesterase in the toxication model of diazinon.
4. Emergency Medicine, Adana numune Education and Reseach Hospital, Adana, Turkey Organophosphate poisoning has a different importance among
5. Emergency medicine, Adana Numune Education and Research Hospital, Adana, Turkey patients with poisoning, which admitted to the emergency service.
Corresponding author: Mme Acikalin Ayca ([email protected]) The most commonly used organic phosphorus compounds,
Key-words: Glyphosate ; Poisoning ; Toxicology diazinon, malathion, and parathion. Intravenous lipid emulsion

BOOK OF ABSTRACTS 424

(ILE) treatment is used as a new treatment method in cases of Introduction: Carbamazepine (CBZ) is used for the treatment of
systemic toxicity caused by local anesthetics. partial and generalized epilepsies, bipolar affection disorder,
Materials and Methods: 21 male Wistar albino rats, (weighing 180– trigeminal neuralgia, post herpetic neuralgia, phantom extremity
200 g) randomly divided into three equal groups. Groups organized pains. CBZ poisoning is occasionally seen in emergencies and could
as; Group I control, Group II diazinon, Group III diazinon + lipid be vital. In the event of intoxication neurologic symptoms such as
emulsion treatment. Group I, only 1 ml corn oil was given by nystagmus and cardiac arrhythmia, breathing depression can be
gavage. Group II, 335 mg/kg diazinon were given by gavage. Group noted extending to even coma. It requires support treatment since
III, in addition to diazinon 20% lipid solution (3 ml/kg) were it does not have a specific antidote. In this report, a patient who
administered via tail vein into rats. At the end of the experimental has increased frequency of seizures due to high doses of
period blood sample were taken from animals and Serum carbamazepine taken for epilepsy treatment is presented.
pseudocholinesterase levels were measured. Case: A 22 years old male was brought to our emergency
Results: When the pseudocholinesterase levels were analyzed, no department with increased focal motor seizures during last 24
significant difference was found between diazinon and diazinon + hours. Two days ago, after a partial seizure, patient’s dose of CBZ
lipid emulsion treatment groups. However, a significant difference treatment was increased to 1000mg/day in the emergency
was found between control and the others. department. His examination has not yielded anything specific
Conclusion: In our study we could not detect a positive effect of other than a slight mental retardation and mild paresis of the right
lipid treatment on serum pseudocholinesterase. Toxication models arm which was previously known. Hemogram, biochemistry and
with lower doses can try in future studies. ECG tests were all normal.After noting the drug level in the blood
as 24microgr/ml. (normal:4-12microgr/ml.),a treatment against the
P799 __________________________________ Toxicology drug overdose was started and CBZ dose was reduced. The blood
drug level was determined as 12 microgr/ml a few days later. And
MASSIVE INGESTION OF CLOPIDOGREL AS A SUICIDE the seizures were not repeated.
ATTEMPT Conclusion: In clinical practice, it is important to monitor the drug
F Yılmaz, C Kavalci, A Demir, M Ozlem, A Solakoglu, ED levels in the blood for the patients with epilepsy. The increased
Arslan, E Karakılıc frequency of the seizures does not necessarily indicate the
inadequate drug dose; it can also be an indication of drug
Emergency Department, Numune Training and Research Hospital, Ankara, Turkey overdose.
Corresponding author: Mr Yilmaz Fevzi ([email protected])
Key-words: Clopidogrel ; suicid ; overdose P801 __________________________________Toxicology

A 55 year old male patient admited to our emergency depertmant EPIDEMIOLOGY OF DRUGS OR POISONOUS SUBSTANCES
taking oral 56 pills of clopidogrel (plavix 75 mg) (total 4200 mg) USED IN SUICIDE ATTEMPTS BY SUBJECTS ADMITTED TO
after pscyho-social stres. . He has no significant medical history and THE MILITARY HOSPITAL OF TUNIS
currently he is not on medication. He had shown no koagulation M. Ben Lassoued, O. Djebbi, M. Ben Salah, M. Haggui, G.
test anomalies with the rates of PT:13.3 sec, APTT:35.7 sec, Ben Jrad, H. Kefi, K. Lamine
INR:0.99, fibrinojen350mg/dl.
Reports of overdose of clopidogrel were very rarely reported in the Emergency department, Military Hospital of Tunis, Tunis, Tunisia
literature. Overdose symptoms may include vomiting, feeling Corresponding author: Mr Ben Lassoued Mehdi ([email protected])
exhausted or short of breath, and blood in your stools or vomit, Key-words: epidemiology ; drugs or poisnous substances ; suicide attemps
unusual bruising or bleeding. He was observed in our emergency
room for 48 hours. No complications were observed. Patient was Introduction :
discharged safely. It is very important to know the epidemiology of drugs or
poisonous substances used in suicide attempts. This epidemiology
P800 __________________________________ Toxicology varies according to the type and location of the health care
facilities. The objective of this study is to determine the incidence
EPILEPTIC SEIZURE CAUSED BY CARBAMAZEPINE of suicide attempts (SA), their characteristics and mode of
OVERDOSE: A CASE REPORT management through a retrospective study carried out over a
H Barut (1), D Aksoy (1), M Esen (2), M Ayan (2), M Barut period of 4 years.
(3), E Gokce (4) Material and methods :
This retrospective study covered the period going from January
1. Department of Neurology, Gazi osmanpasa University , Faculty of Medicine, Tokat, 2007 to December 2010. Data were retrospectively collected from
Turkey the files of the department of psychiatry of the military hospital of
2. Department of Emergency Medicine, Gazi osmanpasa University University , Faculty of Tunis where most the victims of suicide attempts were
Medicine, Tokat, Turkey hospitalized. We included in the study all patients aged > 15 years
3. Department of Internal Diseases, Gazi osmanpasa University , Faculty of Medicine, admitted for deliberate self-poisoning. We excluded from the study
Tokat, Turkey victims aged < 15 years admitted and victims of therapeutic errors
4. Department of Radyology, Gazi osmanpasa University , Faculty of Medicine, Tokat, or accidental poisoning. Were also excluded incomplete hospital
Turkey records lacking important data.
Corresponding author: Mr Ayan Murat ([email protected]) Results :
Key-words: Epilepsy ; Carbamazepine overdose ; Drug blood level There were 52 recorded suicide attempts during the study period.
Incidence of SA by deliberate self-poisoning accounted for 0.6 per
thousand patients in the emergency department and for 51 per
thousand in the psychiatry department. Sex ratio was 1.36. Mean

BOOK OF ABSTRACTS 425

age was 32 + 9 years. A history of mental disturbances was noted in P803 __________________________________Toxicology
65% of cases. Thirty-six patients used a medication, mainly a
psychotropic drug (44%), as a means for suicide. Nineteen patients THE EFFECT OF “TRIS-HYDROXYMETHYL AMINOMETHANE”
used a poisonous substance other than a medication for their (THAM™) TREATMENT ON SURVIVAL OF RATS ON WHICH
suicide attempt; chlohalose was the most used (13.4%). A EXPERIMENTAL METABOLIC ACIDOSIS WAS DEVELOPED BY
combination of poisonous substances was used in 39% of cases. INTRAGASTRIC INGESTION OF HYDROCHLORIC ACID
Conclusion : V Ozaydin (1), G Ersoy (2), E Ocmen (3), H Ciftcioglu (2), O
Patients admitted to emergency departments for suicide attempts Yilmaz (4), N Gokmen (5), A Celik (4), K Ozturk (6)
represented 0.6 per thousand of the total number of admitted
patients against 51 per thousand patients admitted to the 1. Emergency Medicine,, Ministery of Health, University of Medeniyet, Education and
department of psychiatry. Psychotropic drugs and chlohalose are Training Hospital of Goztepe, Istanbul, Turkey
the most incriminated poisons. 2. Emergency Medicine,, University of Dokuz Eylul, School of Medicine, Izmir, Turkey
3. Department of Anesthesiology and Intensive Care, University of Dokuz Eylul, School of
P802 __________________________________ Toxicology Medicine, Izmir, Turkey
4. Laboratory Animal Science, University of Dokuz Eylul, School of Medicine, Izmir, Turkey
SECURITY AND EFFICACY OF THE ANTIVENOM PRODUCED 5. Anesthesiology and Intensive Care, University of Dokuz Eylul, School of Medicine, Izmir,
WITH THE FRACTION FAB2 IN THE TREATMENT OF Turkey
POISONOUS SNAKEBITES OF CROTALUS GENERA 6. Emergency Medicine,, Education and Training Hospital of Okmeydani, Istanbul, Turkey
R Marquez Martin (1), GE Muñoz Maldonado (2), E Pérez Corresponding author: Mr Ersoy Gurkan ([email protected])
Rodríguez (2) Key-words: Metabolic acidosis ; hydrochloric acid ; tris–hydroxymethyl aminomethane

1. Emergency Department, Hospital Universitario, Monterrey, Mexico Introduction and goal
2. General Surgery, Hospital Universitario, Monterrey, Mexico We aimed to compare the efficiency of “tris–hydroxymethyl
Corresponding author: Mr Marquez Martin Rodolfo ([email protected]) aminomethane” (THAM) with saline treatment on mortality of rats
Key-words: Antivenom ; Poisonous snakebites ; Fabotherapy with metabolic acidosis created experimentally by intragastric
ingestion of hydrochloric acid.
SUMMARY Material and methods
Every year The University Hospital of Nuevo Leon admit in average Following anesthesia, neck dissection of 14 rats, a. carotis interna
45 patients by poisonous snakebites. A study was done to evaluate was canulated and basal blood samples were drawn. Then,
the security and efficiency of the Antivenom Antivipmyn® oesophagus of rats were penetrated with branule, 1ml/rat
produced with the Fab(2) fraction. hydrochloric acid was injected into the gaster and waited for 30
MATERIAL AND METHODS minutes to see if acidosis was occured. Later rats were seperated
Was an open, prospective study. into two groups (THAM and saline) and treatment was started. On
Inclusion criteria were: Adult patients with II, III or IV degree on the 30th and 60th minutes of treatment pH, PaO2, HCO3, PaCO2
poisoning. No administration of antivenom, steroids or and base deficit parameters were checked. On the second hour of
antihistaminic previous to arrive, written consent to participate in the experiment, the variation of blood gas parameters according to
the study. the treatment and the mortality of rats was observed and the
Exclusion criteria: Pregnancy or lactation, patients under 16 year experiment was terminated.
old, hypersensitivity to horse products derivates, negation to Results
participate in the study. Six in saline, 4 rats in THAM group died before the study was over.
The patients receive 10 vials of Antivipmin® intravenous by one When THAM and saline groups were compared on behalf of body
hour as an initial doses, and receive extra doses when were temperature, blood pressure and heart rate, PaCO2 and PaO2,
necessary. We take samples for laboratory tests including basal and there was no statistically significant difference between groups.
one hour post antivenom infusion for serum levels of venom and Survival of rats in the THAM group differed statistically significant
antivenom. All patients receive antibiotics, analgesics, tetanus compared to saline group. pH on 60th minute was statistically
prophylaxis, and various medications as necessary. significantly lower at THAM group and base deficit values on 30th
Data analyzed were: Demographic data, evolution time, and 60th minutes were statistically significant when compared to
symptomatology, laboratory tests, morbidity and mortality. the saline group.
RESULTS Discussion
23 patients had inclusion criteria. 80% arrived within the first 3 We observed that IV tris–hydroxymethyl aminomethane (THAM)
hours of evolution. Pain, edema, and ecchymosis, were present in treatment prolonged the survival of rats with metabolic acidosis,
all the cases. Site of the bite: Legs: 12 cases, upper limb 11 cases. created by intragastric ingestion of hydrochloric acid, compared
Serum levels of venom showed important decrease between basal with the group treated with saline.
level and 1 hour post antivenom infusion. Laboratory exams and
clinical evolution showed significant statistic improve. The
morbidity was 17%, Hospital stays average of 2.8 days.
CONCLUTIONS
The fabotherapic Antivipmyn® is safe and decrease the
complications when in comparation with other antivenoms, and is
efficient because improve all clinical and laboratory parameters.

BOOK OF ABSTRACTS 426

P804 __________________________________ Toxicology Elevations of creatine kinase (CK) have been described previously
in patients with schizophrenia, mania and psychotic depression. In
RHABDOMYOLYSIS SECONDARY TO QUETIAPINE AND these patients, the elevations of CK during the acute psychotic
OLANZAPINE INTOXICATION episode are not necessarily related with an elevated physical
E Akıncı (1), R Köylü (1), NB Akıllı (1), O Koylu (2), E Atayık activity during the episodes but are a manifestation of a variety of
(3), B Cander (1) neuromuscular dysfunctions characteristic of psychotic patients
(especially those with schizophrenia). Other causes of elevation of
1. Emergency department, Konya Training and Research Hospital, Konya, Turkey CK in psychiatric patients are intake of drugs, seizures, traumatisms
2. Biochemistry Department, Konya Training and Research Hospital, Konya, Turkey and different infectious diseases.
3. Department of Allergy and Immunology, Cumhuriyet University School of Medicine, Quetiapine and olanzapine have been held responsible for
Sivas, Turkey neuroleptic malignant syndrome, rhabdomyolysis or elevation of
Corresponding author: Melle Akinci Emine ([email protected]) serum creatine kinase, and overdose of olanzapine is associated
Key-words: Rhabdomyolysis ; Olanzapine ; Quetiapine with acute muscle toxicity. We consider that rhabdomyolysis
developed not because of chronically usage but utilization of an
Introduction excessive amount of these drugs.
Quetiapine and olanzapine are antipsychotic drugs used most in Conclusion
the treatment of behavioral disorders. Its indications include After taking excessive amount of atypical antipsychotic drugs,
treatment of schizophrenia, moderate or severe manic episodes patients should necessarily be followed for the risk of developing of
and major depressive episodes in bipolar disorder (not the rhabdomyolysis.
prevention of recurrence of manic or depressive episodes). Among
its most frequent adverse effects (>10% of the patients) are those P805 __________________________________Toxicology
that affect the CNS (dizziness, somnolence and headache),
alterations (dyslipidemia) and gastrointestinal (xerostomy and CLINICAL PRESENTATION OF GAMMA HYDROXYBUTYRATE
weight gain) metabolic, although different alterations may be INTOXICATION: A RETROSPECTIVE, OBSERVATIONAL
produced with much less frequency: leukopenia, increase in STUDY.
transaminases, blurred vision and others. K Anseeuw (1), G Dieltiens (1), H Neels (2), E Van Turnhout
We present the case of a 49-year old male who take a lot of (1)
olanzapine and Quetiapine for suicidal purpose has developed
rhabdomyolysis early due to drugs. 1. Emergency Department, ZNA Stuivenberg, Antwerp, Belgium
Case report 2. Toxicological Laboratory, ZNA Stuivenberg, Antwerp, Belgium
Forty nine years old male patient was submitted to emergency Corresponding author: Mr Anseeuw Kurt ([email protected])
department with complain of taking excessive amount of drug in Key-words: GHB ; Predictors GHB toxicity ; Clinical manifestations GHB
order to commit suicide. By anamnesis, it was found out that the
patient has taken 20 number of each of olanzapine (10 mg) and Gamma hydroxybutyrate (GHB) is a drug of abuse that is used for
Quetiapine (300 mg). No emesis has been informed, either. In brief its euphoric, stimulant, sedative and sexual effects. Being
history of his life, he was also found out that he had been inexpensive and easily to manufacture, GHB is readily available. It is
previously diagnosed with bipolar disorder with the finding that the often used as a recreational drug, being taken at social gatherings,
drugs in question were also prescribed to him. clubs and bars. Co-ingestion with other recreational drugs, such as
By physical examination, a midlevel of general position, in a state cocaine, cannabis and alcohol, is common. GHB occurs naturally as
of being confused, having tendency with sleeping, 14 GCS, 36 C a metabolite and precursor of gamma-aminobutyric acid (GABA)
fever, 70/min pulse, 12/min breathing number, 120/80 mmHg and interacts mainly with GABA-B receptors and GHB-specific
blood pressure were detected. Systematic physical examination receptors.
was evaluated as normal. As to laboratory analysis, the results GHB is rapidly absorbed and metabolized with nonlinear and dose-
were as below: Hgb:13,5gr/dl, AST:157 U/L, ALT:56 U/L, CK:7761 dependent pharmacokinetics. Absorption and elimination are
U/L, CKMB: 178 U/L, Troponin:0,03ng/ml, pH 7,44, capacity-limited. Onset of effects, often abrupt, begin within 15
pCO2:34,8mmHg, pO2: 31,1 mmHg, HCO3: 22,9 mmol/L and minutes after oral consumption and peak after 30 – 90 minutes.
Lactate: 0,50 mmol/L. The other parameters were within the GHB has a short, dose-dependent half-life of 30 minutes.
normal limits. After applying standard decontamination procedure Clinical effects may be triphasic, with initial stimulant-like effects
to the patient, an infusion of saline (250 ml/hour) was began. (with reported agitation and hallucinations) followed by sedation
Mannitol 4x50 g, furosemide 3x20 mg and NaHCO3 40meq were as blood concentrations rise, consequently followed by another
added to the therapy. The patient who had been using the stimulant phase with amphetamine-like effects. Clinical effects
medicines (olanzapin 10mg/day, Quetiapine 300mg/day) for two include somnolence, confusion, amnesia, loss of consciousness,
years has not been come across that high levels for enzymes which hypotension, bradycardia, coma and respiratory depression.
had not previously been detected by laboratory analysis. During Sudden onset of effects, as well as abrupt awakening and
hospitalization, no renal function disorder or metabolic acidosis resolution of effects, frequently occur.
occurred. Levels for urea and creatine have been detected in Literature suggests that the steep dose response, variable effects
physiologic limits. In second day the results were like that: CK:4008 and abuse liability of GHB may result in substantial morbidity and
U/L, CKMB: 100 U/L, and in third day: CK:1924 U/L, CKMB: 86 U/L mortality. Though for this finding, systematic data on GHB
and in forth day CK:1510 U/L, CKMB: 80 U/L. Therapy with diuretics mortality and morbidity seem to be lacking.
and NaHCO3 was gradually reduced and finished. On the fifth day We did a retrospective review of our emergency department cases
of hospitalization, the patient who has been evidenced with no between 01/03/2009 and 31/12/2011. Patients admitted to our
problem by the monitoring has been discharged with department with a clinical picture of drug poisoning are regularly
recommendations after consultation with psychiatry. screened for common drugs by urine and/or serum analysis.
Discussion

BOOK OF ABSTRACTS 427

Inclusion criteria were all patients with a GHB-positive plasma risk of ischemic heart disease events, heart failure and arrhythmias.
screening. We have studied the potential association of short term exposition
Data retrieved for each patient were age, gender, time of to particulate matter and Emergency Department admissions for
admission, plasma GHB level, agitation, pupils,respiratory rate, atrial fibrillation and flutter (AF).
heartfrequency, blood pressure, Glasgow Coma Scale (GCS), length In a retrospective study ,we examined the admissions in the
of stay (LOS) in hospital, admission to ICU, LOS ICU, intubation, Emergency Department of Verona for Atrial Fibrillation and Flutter
signs of aspiration, means of transport, ethanol level and (International Classification of Disease, 9th ed. (IDC-9): 427.3) from
toxicological screening. The objectives were to determine Jan 2008 to Apr 2012. We recorded the number of ED admissions
predictors of hospital LOS, need for intubation and ICU admission. for AF on the day when limit values were exceeded (t0), the
We included 28 patients, 86% males and 14% females. Mean age following day (t1), as well as 2 (t2) and 4 (t4) days later.For each
was 26,2 (SD 6,9) with mean plasma GHB-levels of 201,4 (SD 104,7) case we considered: gender (male/female), age (>15 years old),
mg/L. Median (Q1,Q3) GCS was 3,5 (3,8). One third (29%) of date of ED admission and diagnosis. In all the cases ECG
patients was agitated and one patient was found in registration confirmed the presence of atrial fibrillation/flutter.
cardiorespiratory arrest. 50% of patients presented with mydriasis, Particulate Matter (PM) values collected by the 2 detection unit in
36% had pinpoint pupils and 7% had normal pupils. Median ethanol the urban area of Verona were provided by ARPAV - Regional
level was 12 (0,91) mg/dl. Urine toxicological screening revealed Agency for Environmental Prevention and Protection of Veneto.
25% of patients positive for cannabis and 18% for cocaine. Ten PM limit values were, accordingly to the World Health Organization
(36%) patients were intubated and 4 (14%) patients showed signs (WHO) Air Quality Guidelines (AQG) and the European Union
of aspiration. Median hospital LOS was 269 (128, 557) minutes, health based standards and objectives for pollutants in air (EU
with 7 (25%) patients admitted to ICU with median ICU LOS of 466 2008/50/CE), PM10: >50 µg/m3 24 hour mean and PM2.5: >25
(360, 1779) minutes. 93% of patients were transported to the µg/m3 24 hour mean. For each of the two pollutants we compared
hospital by emergency medical services, with 17 (61%) requiring the daily number of cases in presence of 24-hour-mean-values up
medical support. to the WHO/EU limit and in case of exceeding those limits.
We performed a univariate analysis to detect statistical significant The study population was divided into 3 age groups: 16-64; 65-74
(p < 0.05) relationships between these variables. Risk of aspiration and over 75 years old. In the oldest group women were more than
was univariately correlated with GHB-level, lower blood pressure, men (1,041 vs 673) with a mean age of 71 years old. The mean age
ethanol level, ICU admission and hospital LOS; mydriasis with of the youngest group of patient was 54.9 years old with reverse
agitation; ethanol level with intubation, risk of aspiration and ICU gender distribution (female 302 vs males 685). The middle group
admission; intubation with GCS, ethanol level, cannabis in urine age was 69.7 years old with females equal to males (584 vs 583).
and ICU admission; risk of aspiration with GHB-level, lower blood During the study period we recorded a total of 3,868 ED admission
pressure, ethanol level, ICU admission and LOS. for atrial fibrillation and flutter: 987 in the 16-64 years old group,
Multivariate analysis showed that aspiration (p=0.004), low heart 1,167 in the 65-47 years old group and 1,714 in the over 75 years
rate (p=0.001), low respiratory rate (p=0.050) were the significant old group. During the consecutive 1,582 days of the study period,
risk factors for hospital LOS. Main predictors for ICU admission PM10 exceeded the limit value in 438 days and PM2,5 in 602 days;
were intubation (p=0.005) and low respiratory rate (p=0.047). in 94 days we had no available data for PM2.5 and they were
Cannabis in urine (p=0.004), male sex (p=0.004), ethanol level excluded from the analysis for the PM2,5 effect. Data showed an
(p=0.026) and aspiration (p=0.033) were the predictors for increased incidence of AF in all the age groups only for PM10 (16-
intubation. 64 yrs: t0: +11.5%, t1: +22%, t2: +15%, t4: +6.6%; 65-74 yrs: t0:
Our study demonstrates that co-ingestion of drugs of abuse is +29.4%, t1: +15.5%, t2: +18.6%, t4: +14.1%;
common in GHB-users. Most patients remained at the emergency 75 yrs: t0: +15.4%,
department overnight. Prolonged LOS were associated with
pulmonary aspiration and deep sedation. One third of the patients +16.3%, t2: +14.4%, t4: +18.4%). The comparison of AF ED
required intubation and ventilation. The severity of clinical admissions for normal and elevated PM2.5 values did not show any
symptoms seems rather be related with concomitant use of difference. Gender distribution for both the pollutants was the
ethanol or other drugs of abuse than plasma GHB-levels. same as in the study population age groups.
Atrial fibrillation is uncommon in younger population, doubles with
P806 __________________________________ Toxicology each decade of adult life afflicting about 10% of the population in
the elderly. Distribution of atrial fibrillation in our population study
PARTICULATE MATTER POLLUTION AND ATRIAL reflects literature data with figures increasing accordingly with the
FIBRILLATION EMERGENCY DEPARTMENT PRESENTATION age groups. Our study included atrial fibrillation ED’s admission for
FROM 2008 TO NOWADAYS: PRELIMINARY REPORT studying the population as a whole. It is possible that short
M Zannoni (1), MC Bonito (1), R Codogni (2), E Formaglio duration episodes or subclinical arrhythmias have been missed
(2), S Puglisi (2), C Tobaldini (2), G Ricci (1) nevertheless we included a large number of atrial fibrillation
events. It had been previouslyreported that arrhythmias occur
1. Emergency Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy within a few hours of increased levels of air pollutants. We
2. Postgraduate School in Emergency Medicine, University of Verona, Verona, Italy observed an increase of arrhythmic events admissions already in
Corresponding author: Mr Zannoni Massimo ([email protected]) the day that the thresholds had been exceeded. The preliminary
Key-words: Particulate Matter ; Atrial fibrillation ; Pollution data from this study confirm the potential association of exposure
to large particulate matter pollutants and arrhythmias. Previous
Epidemiological studies support a positive relationship between studies found the lack of association in PM2.5 levels and atrial
exoposure to air pollution and cardiovascular disease. Previous fibrillation hospitalizations. The major finding from our data is that
studies showed that short-term exposure to elevated PM10 pollution effect on supraventricular arrhythmias onset
concentrations of particulate matter (PM) air pollution increases involves also young patients with an effect size similar to that in
the elderly patients. Although atrial fibrillation is not usually
considered a lethal rhythm, it is associated with increased risk of
stroke and premature mortality. Consequently, an increased risk of
atrial fibrillation due to acute exposure to elevated air pollution in
the general population would have a relevant attributable effect on
young adults too.

BOOK OF ABSTRACTS 428

P807 __________________________________ Toxicology Case description
A 31-year-old male attended the emergency department with an
A RESTLESSNESS AND CARDIAC ARRHYTHMIAS REVEALING 11 hour history of nausea, vomiting, abdominal pain and
THE CRACKING OF A CAPSULE OF COCAINE IN A BODY- hallucinations. He admitted drinking tea, made from the powder of
PACKER three nutmegs, for aphrodisiac reasons seventeen hours ago.
I MALAJATI, H EZZOUINE, B CHARRA, A BENSLAMA, S Symptoms including nausea, vomiting, dry mouth, abdominal pain
MOTAOUAKKIL and urinary retention, developed six hours after ingestion. Physical
examination revealed an agitated man with visual hallucinations
MEDICINE INTENSIVE CARE, CHU IBN ROCHD, CASABLANCA, Morocco and stable vital signs (tachycardia of 105/minute; normotensive;
Corresponding author: Melle Malajati Ibtissam ([email protected]) respiratory rate of 18/minute). No fever. Miotic, light reactive
Key-words: BODY-PACKER ; COCAINE ; CARDIAC ARRYTHMIAS pupils and normal neurological examination. Abdominal
examination revealed a vesical globe and hypoperistalsis.
Cocaine is a narcotic product which consumption is steadily Electrocardiography showed a sinustachycardia and laboratory
increasing all over the world. The transport intradigestif, intrarectal investigations were normal.
or intravaginal in capsule form, exposed to many complications Treatment consisted of urinary catheterization, fluid
particularly acute poisoning due to a cocaine crack a capsule, administration, benzodiazepines and antiemetic drugs. His altered
gastrointestinal obstruction or death. state of mind and gastrointestinal symptoms persisted for about 9
This is a patient of 31 years, from Nigeria, who has been hours (26 hours after ingestion). He was discharged after an
intercepted by the customs authorities at the airport for observation period of 15 hours without sequelae.
transporting 82 packets of cocaine. At admission, the patient was Discussion
conscious, agitated ,tachycardia to 120 beats / min, high blood Nutmeg is a well-known household spice, which also possess
pressure SBP / DBP = 190/100 mm-Hg, eupneic in the open air euphoric, hallucinogenic and anticholinergic effects. The main
SpO2 = 98%, pleuropulmonary auscultation was normal . The blood psychoactive constituents of nutmeg are myristicin and elemicin,
analysis had demonstrated elevated rate of CPK = 18 497 and LDH both having anti-cholinergic and psychotropic properties.
= 1136. The ECG has showed a sinus tachycardia, with sub-ST An acute nutmeg poisoning causes mostly gastrointestinal
segment at 3 leads (V3, V4 and V5), a troponin was negative. symptoms (nausea, abdominal pain and vomiting). Other clinical
The Abdominal x-Ray has objectivated the presence of many features resemble anticholinergic toxicity, with facial flushing,
capsules in the colon, prevailing in the left colon and sigmoid, the tachycardia, hypertension, dry mouth, blurred vision and delirium.
abdominopelvic CT scan also revealed the presence of multiple Symptoms usually begin about 3-6 hours after ingestion and may
training spontaneously hyperdense in the digestive tract , oval and last up to 24-36 hours.
limited , place of a few air bubbles, at the left and right transverse Treatment is mainly symptomatic and supportive: hydratation,
colon, the sigmoid and rectum, corresponding to capsules of antiemetics and sedatives. Gastric decontamination measures are
cocaine. usually unnecessary because of delayed presentation.
The management was :rehydration 4 liter / day , laxatives , with the Conclusion
completion of abdominal x-Ray daily, associated with When nutmeg is taken in excess, a typical clinical syndrome
antihypertensive therapy made from nicardipine (2 mg / h in resembling an anti-cholinergic syndrome occurs. Emergency
electric syringe according to blood pressure). The evolution was medicine physicians should be aware that household spice may
marked by the emission of capsules of cocaine from the first 24 provoke clinical intoxications.
hours of hospitalization, , with Stabilisation of the hemodynamic
status . The patient was moved from the ICU on day 7. P809 __________________________________Toxicology
The transport in corpore of cocaine body-packer exposed to
serious complications. A conservative treatment by accelerating AMOUNTS OF TOXIN IN AMANITA PHALLOIDES ALBA
the transit using laxatives is usually sufficient. Surgical evacuation R Bayram (1), S Colakoglu (2), S Karahan (3), E Kaya (3), A
may nevertheless become necessary and urgent because of Saritas (4), KO Yaykasli (5)
complications that may develop life-threatening.
1. Pharmacology, Abant Izzet Baysal School of Medicine, Bolu, Turkey
P808 __________________________________ Toxicology 2. Anatomy, Duzce University School of Medicine, Duzce, Turkey
3. Pharmacology, Duzce University School of Medicine, Duzce, Turkey
ACUTE NUTMEG INTOXICATION: A CASE-REPORT 4. Emergency department, Duzce University School of Medicine, Duzce, Turkey
K Anseeuw (1), K Dechamps (2), LJ Mortelmans (1) 5. Medical Genetic, Duzce University School of Medicine, Duzce, Turkey
Corresponding author: Mr Saritas Ayhan ([email protected])
1. Emergency Dept, ZNA Stuivenberg, Antwerp, Belgium Key-words: Amanita phalloides alba ; mushroom intoxication ; HPLC
2. Emergency Medicine, ZNA Stuivenberg, Antwerp, Belgium
Corresponding author: Mr Mortelmans Luc ([email protected]) Introduction and Purpose:
Key-words: nutmeg ; intoxication ; poisoning Alba type which is a sub-species of Amanita Phalloides is very rarely
grown, and some of the poisonings is consisted of these sub-
Introduction species. In this study, we aimed to measure of alpha, beta and
We report a case of a rare poisoning. gamma amanitin with phalloidin and phallocidin toxin
concentrations at different zones of Amanita Phalloides Alba.
Material and Methods:
Six Amanita Phalloides mushrooms were gathered from the
wooded area of town Yeşilyayla-Gümüşova-Düzce-Türkiye in 17
November 2011. These mushrooms were divided into two parts as
sagittal, each of them were weighted, and dried under stream of

BOOK OF ABSTRACTS 429

air to 50 ºC in 24 hours. A piece of the dried mushroom was ammonium acetate + acetonitrile (90+10, v/v) were used
analyzed totally. The other piece’s cup, gills stipe and volva were 1mL/minute flow rate. 150x4,6 mm C18 reverse phase column
left, and analysis was performed separately on the each of these (5um particle) was used. Results were given as mean ± SD.
parts. Dried materials were ground, per 1 gram is waiting in Results:
extraction solution for one day, extraction was achieved. Methanol Sample HPLC chromatogram of toxin analysis was given in Figure 1.
+ water + 0.01 m HCl (5:4:1 v/v/v) were used for extraction For each material, toxin results by applying data (obtained from
solution. At the end of the extraction, by centrifugation at 4000 HPLC chromatograms) in the calibration graph were given in Table
rpm for 5 minute, it was injected into 20 µL HPLC device. Results 1.
were given as the amount for every 1 gram of dry mushroom. Also, Conclusion:
the amount of toxin in wet mushroom was calculated from the The amount of toxin varies according to climate and environmental
ratio. Measurements were performed by HPLC device. Alpha, beta conditions. Herein, the amount of toxin in spores of amanita
and gamma amanitin with phalloidin and phallocidin were phalloides was published the first, and this is the only study about
analyzed. As the mobile phase, 50 mM ammonium acetate + amount of toxin in mushrooms grown in Turkey.
acetonitrile (90+10, v/v) were used 1mL/minute flow rate. 150x4,6
mm C18 reverse phase column (5um particle) was used. Results P811 __________________________________Toxicology
were given as mean ± SD.
Results: ORGANOPHOSPHATE POISONING CASES TREATED WITH
For each material, toxin results by applying data (obtained from HIGH-DOSE OF ATROPINE IN INTENSIVE CARE UNIT AND
HPLC chromatograms) in the calibration graph were given in Table NOVEL TREATMENT APPROACHES
1. A Karakus (1), M Murat Celik (2), M Karcioglu (3), K Tuzcu
Conclusion: (3), E Sukru Erden (4), C Zeren (5)
There is no any data about toxin analysis associated the Amanita
Phalloides Alba in literature. Amount of toxin in Amanita Phalloides Mustafa Kemal University, Faculty of Medicine
Alba was published first. 1. Department of Emergency Medicine, Hatay, Turkey
2. Department of Internal Medicine, Hatay, Turkey
P810 __________________________________ Toxicology 3. Department of Anesthesia, Hatay, Turkey
4. Department of Chest Diseases, Hatay, Turkey
AMOUNTS OF TOXIN IN AMANITA PHALLOIDES 5. Department of Forensic Medicine, Hatay, Turkey
MUSHROOM Corresponding author: Mr Karakus Ali ([email protected])
R Bayram (1), S Colakoglu (2), S Karahan (3), E Kaya (3), A Key-words: Organophosphate poisoning ; Atropine . Alternative treatments ; Intensive
Saritas (4), KO Yaykasli (5) care

1. Pharmacology, Abant Izzet Baysal School of Medicine, Bolu, Turkey Being responsible for symptoms due to the cholinergic effects
2. Anatomy, Duzce University School of Medicine, Duzce, Turkey organophosphate poisonings are life-threatening cases. Clinical
3. Pharmacology, Duzce University School of Medicine, Duzce, Turkey status and blood levels of cholinesterase are used in diagnosis.
4. Emergency department, Duzce University School of Medicine, Duzce, Turkey While atropine and pralidoxime (PAM) appear as essential
5. Medical Genetic, Duzce University School of Medicine, Duzce, Turkey medications, haemofiltration treatments and lipid solutions have
Corresponding author: Mr Saritas Ayhan ([email protected]) been widely studied in recent years. In this study, the importance
Key-words: Amanita phalloides ; mushroom intoxication ; HPLC of high-dose atropine therapy and early intervention, and novel
treatment approaches are discussed.
Introduction and Purpose: Records of the 25 patients treated for organophosphate poisoning
Amanita phalloides is the type of factor in most fatal cases of in the intensive care unit between April 2007 and December 2012
mushroom poisoning. The amount of toxin in this mushroom has were evaluated retrospectively.
been varied. In this study, we aimed to measure of alpha, beta and Out of 25 patients, 14 (56%) were male and 11 (44%) were female
gamma amanitin with phalloidin and phallocidin toxin with a mean age of 34.8±17.66 years (range: 14-77 years). The
concentrations. patients most frequently admitted in June (n:4) and July (n:4)
Material and Methods: (16%). Twenty-two patients (88%) were poisoned by oral intake, 2
Six Amanita Phalloides mushrooms were gathered from the (8%) by inhalation and 1 (4%) by dermal route. Twenty patients
wooded area of town Yeşilyayla-Gümüşova-Düzce-Türkiye in 24 (80%) took organophosphates intentionally for suicidal purposes
November 2011. These mushrooms were divided into two parts as while 5 (20%) cases poisoned due to accidental exposure. The
sagittal, each of them were weighted, and dried under stream of Glasgow Coma Scale of 9 patients (36%) was below 8 point on
air to 50 ºC in 24 hours. A piece of the dried mushroom was admission to hospital. The highest dose of atropine given was
analyzed totally. The other piece’s spores, mycelium, cup, gills stipe 100mg intravenously on admission and 100 mg/kg/day during
and volva were left, and analysis was performed separately on the follow-up. The total dose given was 11.6 g/12 days. Eleven patients
each of these parts. Dried materials were ground, per 1 gram is (44%) were on mechanical ventilation for a mean duration of 5.73 ±
waiting in extraction solution for one day, extraction was achieved. 4.83 days. The mean duration of intensive care unit stay was 6.52 ±
Methanol + water + 0.01 m HCl (5:4:1 v/v/v) were used for 4.80 days. Twenty-three patients (92%) were discharged in good
extraction solution. At the end of the extraction, by centrifugation clinical condition and one patient (4%) was referred to another
at 4000 rpm for 5 minute, it was injected into 20 µL HPLC device. hospital.
Results were given as the amount for every 1 gram of dry This study suggests that, atropine can be administered until
mushroom. Also, the amount of toxin in wet mushroom was secretions disappear and intensive care should be exerted in
calculated from the ratio. Measurements were performed by HPLC follow-up of these patients. In addition, in case of necessity for
device. Alpha, beta and gamma amanitin with phalloidin and high doses, sufficient amounts of atropine and PAM should be
phallocidin were analyzed. As the mobile phase, 50 mM available in hospitals.

BOOK OF ABSTRACTS 430

P812 __________________________________ Toxicology Corresponding author: Mr Sabbe Marc ([email protected])
Key-words: poisoning ; epidemiology ; emergency department
PROTECTIVE EFFECTS OF EBSELEN AGAINST IRON-
INDUCED CARDIOTOXICITY IN RATS Introduction: To approach and treat poisoned patients optimally, it
is necessary to be aware of the actual poisoning characteristics and
A Karakus (1), C Zeren (2), F Sefil (3), H Gokce (4), S Motor trends during the last years. The goal of this study was to examine
(5), M Murat Celik (6) recent evolutions and to compare them with previous data.
Methods: The study was approved by the ethical committee of the
Mustafa Kemal University, Faculty of Medicine university hospital. In this study, poisoning characteristics were
1. Department of Emergency, Medicine, Hatay, Turkey. prospectively collected in 2011 and compared with historical data
2. Department of Forensic Medicine, Hatay, Turkey. (1993-1996). Both studies are performed in the same emergency
3. Department of Physiology, Hatay, Turkey. department of a university hospital in Leuven – Belgium. The data
4. Department of Pathology, Hatay, Turkey. for 2011 are a convenience sample in two blocks of three months
5. Department of Biochemistry, Hatay, Turkey. (February-April; October-December). Data are compared using chi-
6. Department of Internal Medicine, Hatay, Turkey. square tests on SPSS software.
Results: 550 patients were included in 2011, 3167 patients from
Corresponding author: Mr Karakus Ali ([email protected]) 1993 until 1996. Products most frequently responsible for
intoxications in 2011 were alcohol, benzodiazepines and analgesics.
Key-words: Ebselen ; heart influences ; iron induced toxicity In contrast, alcohol, benzodiazepines and carbon monoxide were
most frequently registered from 1993 until 1996. From 1993 until
Objective: Ebselen, a substance with glutathione peroxidase-like 1996, only 15.7% of intentional intoxications were committed by
activity, shows antioxidant, anti-inflammatory, neuroprotective men, but in 2011 this number increased up to 26.8%. Remarkable
and immunomodulatory effects. The purpose of this study was to changes are found between the two study periods.
find out the effects of ebselen against iron-induced cardiotoxicity in Conclusion: Our study demonstrates important changes in
rats. poisoning characteristics between 1993 until 1996 and 2011. It is
Material and Method: After obtaining ethical committee approval, necessary to obtain up-to-date information about poisoning
fifty-six male Wistar Albino rats were divided into seven groups. regularly, to improve approach and treatment of poisoned
Serum iron, ferritin, lactate dehydrogenase, creatine kinase and patients. It is possible that these data are not representative for
creatine kinase-MB (CK-MB) levels were measured biochemically. every ED in Belgium. To acquire current information about
Iron accumulation in cardiac tissue samples was measured using poisoning in Belgium, it would be useful to organize a national
inductively coupled plasma atomic emission spectrometry (ICP- registration period for one week.
AES). Comparison of iron accumulation histopathologically
performed using Prussian blue stained sections by semi- P814 __________________________________Toxicology
quantitative method.
Results: Serum LDH levels in ebselen+iron, iron+deferoxamine and INVESTIGATION OF EFFICIENT CAUSES ON REPETETIVE
iron+deferroksamine+ebselen groups were significantly hihger SUICIDE ATTEMPTS
compared to control group, while significant difference was O. Karakayalı (1), G. Kurtoglu Celik (2), A. Ahmedali (2), I.
observed between serum CK-MB level of Ertok (2), T. Oz (2), M. Yılmaz (2)
iron+deferroksamine+ebselen group and control samples (p<
0.001). Serum iron levels in iron+deferoxamine and 1. Emergency department, Teaching and Research Hospital in Kocaeli Derince, Kocaeli,
iron+deferroksamine+ebselen groups were highly significanly Turkey
hihger than controls, and serum ferritine levels in iron, 2. Emergency department, Ataturk Training and Research Hospital, Ankara, Turkey
ebselen+iron, iron+deferroksamine and Corresponding author: Melle Kurtoglu Celik Gulhan ([email protected])
iron+deferroksamine+ebselen groups were significantly higher Key-words: Suicide ; resuicide attempt ; emergency department
compared to control group (p < 0.001). Iron levels of cardiac tissue
measured by ICP-AES in iron, iron+deferroksamine and INTRODUCTION: Suicide is one of the major public health problem,
iron+deferroksamine+ebselen applied groups were highly besides one of the leading causes of death around the world. In our
significantly different compared to those in controls (p < 0.001), study, we propose detecting effective causes and taking preventive
while a relatively less significant difference observed between measures for repetetive suicide.
ebselen+iron group and control (p < 0.05). Iron accumulation was RESULTS:266 patients with suicide attempts including a
found to be decreased in ebselen and deferroksamine given groups percantage of %0,26 of total 98.658 patient appealing to our
when histopathologically compared to iron applied group. emergency service, were admitted in our emergency department
Conclusion: In conclusion, obtained findings indicated the efficacy for one year period. The patients consisted of 155 (67,4%) woman
and utility of ebselen treatment on iron induced cardiotoxicity. In and 75(32,6%) man. In our study we observed 32 patients (13,8%)
this regard, ebselen might contribute to treatment in β-thalassemia have past attempted suicide.
and sickle cell patients, and those in need of frequent blood In this study, we observed 84,4% of patients were attempting
transfusion. suicide by taking drug. Our observations show that 49 patients
(25,4%) has re-suicide attitude, in addition 19 patients (8,3%) have
P813 __________________________________ Toxicology committed suicide attempt.
We observed patients who re-suicide attitude after discharge
DOES EPIDEMIOLOGY OF POISONING CHANGE OVER TIME attempting suicide most frequently with sharp objects contact
IN AN ACADEMIC EMERGENCY DEPARTMENT? (47,3%). Observation of study shows 13 of 91 patients that have
A Meulemans (1), M Sabbe (1), L van Gennep (2) not been consulted with a psychiatrist during emergency service

1. Dept of Emergency Medicine, University Hospitals, Leuven, Belgium
2. Medical Sciences, University of Groningen, Groningen, Netherlands

BOOK OF ABSTRACTS 431

follow up process have re-suicide attempt. In addition,7 of 133 Key-words: Datura stramonium, ; anticholinergic effects, ; poisoning
patients that have been consulted with a psychistrics have re-
suicide attempt. Datura stramonium mentioned with many different names in our
While re-suicide attitude ratio is rising in patients that have not country is commonly known as tatula. This plant including atropine,
been consulted with a psychistrics against patients that have been hyoscyamine and scopolamine can cause serious anticholinergic
consulted with a psychistrics. There was no statistically poisoning after unappropriate and unconsciously usage. In this
significance.13 patients (16,7%) of known history of psychiatric article, we would like to present an approach, accompanied by
illness have re-suicide attempt after discharge from emergency literature, to the poisoning case for a-69-year-old man who
service. Patients who has a psychiatric illness have a greater ratio appealed to the emergency service with the symptoms of
of resuicide than the group of not known psychiatric illness and a conscious disturbance and agitation after drinking Datura
statistically significant difference between resuicide ratio of both stramonium tea. As a result, wild plant poisoning has to be
groups could be found (p< 0.005). considered in every patient admitted to emergency services with
We determine that %55,2 of patients were totally healed in the unexplained anticholinergic symptoms and complaints, every
emergency service after investigation of etiology and therapy, patient should be examined and evaluated accordingly.
18,3% of patients were discharged with their own or family
request, 11,3% of patients were hospitalized at least one service, P816 __________________________________Toxicology
6,5% of patients were dispatched to another hospital because of
inadequate amount of intensive care bed capacity, 6,1% of patient PROLONGED BLEEDING: SUPERWARFARIN POISONING
were hospitalized in intensive care unit, 2,6% of patients were A. Kose, S. Eraybar, E. Armagan, E. Ahun, F. Ozdemir, O.
death in emergency service . Koksal
Nine patients (64,3%) who hospitalized in intensive care unit, 21
patients (50%) who discharged with their own request, 6 patients Department of Emergency Medicine, Uludag University, Faculty of Medicine,, Bursa,
(%40) who being dispatched to an intensive care unit of another Turkey
hospital have an opinion on re-suicide attempt. Patients who is Corresponding author: Mr Kose Ataman ([email protected])
hospitalized in intensive care unit or want to be dispatched from Key-words: Suicide ; Superwarfarin ; , bleeding
emergency service with their own requests has an elevated ratio of
suicide attempts against the other patients and this difference is INTRODUCTİON: Superwarfarins are anticoagulant rodenticides
significant statistically.(p< 0.005). similar to warfarin, but which have various substituted phenyl
Although, there were 4 patients (28,6%) hospitalized in intensive groups replacing the terminal methyl group, resulting in a fat-
care and 7 patients(16,7%) discharged with their own request who soluble, long-acting anticoagulant that is nearly 100 times more
had a history of re-suicide, there was just only one patient (%3,8) potent than the parent compound. There were 3 major categories
hospitalized in an another service who had an attempt to suicide of exposure or poisoning: accidental ingestion (in children),
again. attempted suicide, and deliberate selfpoisoning with denial
Patients who is hospitalized in intensive care unit and want to be (Munchausen syndrome). Superwarfarins inhibit the carboxylation
dispatched from emergency service with their own requests has an of vitamin K dependent factors (II, VII, IX, and X) in the liver.
elevated level of re-suicide ratio against the other patients and this Coagulopathy might manifest as epistaxis, gingival bleeding,
difference is significant statistically (p< 0.005). hematemesis, hematuria, hematochezia, menometrorrhagia,
50,9% of cases did not follow up psychiatry examination for one ecchymosis, petechial hemorrhages, intracranial hemorrhages, or
year period after dischargement and 47% (55 patients) of this bleeding that is not in proportion with the level of the injury.
group have re-suicide attempt opinion. Although 18 patient CASE: A 32 years-old previously healty woman presented to
(15,3%) who did not follow up psychiatry examination have an emergency department with vaginal bleeding. She had no personal
attempt of suicide, there were just 2 patients (1,8%) attempt to or family history of bleeding disorder, additional symptoms or
suicide again in the psychiatry controlled group. Patients who do suspected pregnancy. Laboratory studies werenotable with
not attend to a psychiatry controlled programme has a greater prolonged prothrombin time (PT) and international normalized
ratio of re-suicide attempt against psychiatry controled group and ratio (INR). She was given two fresh frozen plasma but did not
this difference is significant statistically in both group.(p< 0.005) achieve normal values. During follow up learned that 2 months ago
CONCLUSION:The results of our study suggest that there is a close she had hospitalized in intensive care unit for brodifacoum
relationship with resuicide attempt and the groups of patients who ingestion.
known psychiatric illness history, who have not been consulted DİSCUSSİON: Superwarfarin ingestion can be a serious problem
with psychiatry clinic before being discharged, who did not follow resulting in life-threatening bleeding. Many reviews o fthe problem
up psychiatry examination after dischargement and who have been published, and even though the awareness of the
hospitalizing in intensive care unit or discharged by their own condition has increased, the incidence is not decreasing. The
request. Accordingly, We think that an emergency service doctor knowledge of ingestion is usually not available initially during the
has an effective role for preventing suicide attempts. patient’s presentation, and therefore a high threshold of suspicion
is warranted in any patient with bleeding issues or prolonged
P815 __________________________________ Toxicology coagulation assays

ANTICHOLINERGIC INTOXICATION DUE TO DATURA
STRAMONIUM

P Sert (1), A Kose (1), E Armagan (2), T Inal (1), S Akkose (1)

Department of Emergency Medicine, Uludag University, Faculty of Medicine, Bursa,
Turkey

Corresponding author: Mr Kose Ataman ([email protected])

BOOK OF ABSTRACTS 432

P817 __________________________________ Toxicology lethargy, seizures, coma and death and it has high mortality and
morbidity rates. 1-4.
MAD HONEY POISONING PRESENTING WITH Salicylates are also used for non medical purposes in food and
VENTRICULAR TACHYCARDIA AND ACUTE MYOCARDIAL agricultural industry 5. In this paper we present a case of salicylate
İNFARCTION: CASE REPORT intoxication due to accidentally use of commercial bag form of
T Ocak (1), A Duran (1), M Basturk (2), I Sahin (3) powdered salicylic acid which is used for making pickles.
CASE
1. Emergency Medicine, Abant Izzet Baysal University, Medical Of Faculty, Bolu, Turkey2 A 63 year old female patient has prepared a solution with 10 grams
2. Emergency department, Bagcilar Research and Education Hospital, Istanbul, Turkey of salicylic acid and drinking water in order to use it for making
3. Cardiology, Bagcilar Research and Education Hospital, Istanbul, Turkey pickles (165 mg / kg) and has drunken it by forgetfulness. She was
brought to our emergency department by her relatives with
Corresponding author: Mr Ocak Tarik ([email protected]) complaints of nausea, vomiting, tinnitus and loss of hearing. Ten
Key-words: Mad Honey ; Ventricular Tachycardia ; Acute Myocardial İnfarction hours was passed after she had drunken it.
The patient was conscious, cooperated and vital signs were normal
Abstract and GCS was 15. No abnormality was detected on the
Cases presenting with severe hypotension, bradycardia, electrocardiogram. Neurological examination was normal except
atrioventricular block and asystole have been reported following horizontal nystagmus on the right and other signs were normal in
ingestion of honey in northern parts of Turkey, and certain parts of the physical examination. In the laboratory tests, blood urea
Japan, Brazil and Nepal. Herein, we report a case presenting with nitrogen was 54 mg / dL and creatinine was 1.48 mg / dL and no
ventricular tachycardia and acute inferoposterolateral myocardial other pathological findings were observed. Blood levels of
infarction developing after ingestion of mad honey (grayanotoxin), salicylate was 33.4 mg/dL.
being reported for the first time in the literature. Gastric irrigation was applied to the patient and 50 g of activated
Case Report charcoal was given. A supportive treatment with NaHCO3, and KCl
39 year old female patient who did not have any complaints before was continued in order to maintain the urine pH at 7.4 and serum
was admitted to the emergency department with nausea and potassium levels over 4 to 4.5 mEq / L. The patient was followed in
feeling of fainting. When she was questioned in detail, it was learnt the emergency department for 24 hours. After complaints of the
that she had ingested 2 teaspoonfuls of mad honey and her patient ameliorated and control salicylate levels decreased to 15.4
complaints began 45 minutes later. On admission, arterial blood mg / dl, she was discharged and her relatives were informed about
pressure was 75/50 mmHg, heart rate was 49 bpm. ECG revealed emergency situations.
sinus bradycardia. 0.9% NaCl infusion was commenced. 0.5 mg iv DISCUSSION
atropine administeration was begun when the heart rate Salicylates can be bought from drugstores without prescription and
decreased to 40 bpm. Her heart rate and blood pressure returned it has been used in the food industry as well as for medical reasons.
to normal following atropine administration; however, she The content of non medical preparations is generally similar to
developed polymorphic VT after approximately 45 seconds. 2% those of medical types. Therefore in case of oral intake of these
lidocaine 100 mg iv was administered as bolus. On control ECG, ST commercial products no clinical difference is expected. But except
elevation was observed on the inferior and lateral derivations and seeing the package or patient’s story, it is difficult to consider
ST depression was observed on the V1-V2 derivations. Her intoxication depending on only the clinical signs and symptoms.
condition was stable on the follow-ups and she was discharged Signs and symptoms of salicylate intoxication depends on the
without any complications. amount of the salicylate intake. Under 150 mg / kg acute doses
Mad honey poisoning should be excluded in cases presenting to clinical signs of toxicity may not be seen or mild symptoms may be
the emergency unit with unexplained hypotension, bradycardia seen such as tinnitus, deafness, gastric irritation, nausea and
and even acute myocardial infarction, especially in endemic areas. vomiting. The doses at 300 mg / kg or above may cause severe
symptoms of intoxication such as seizures, coma, pulmonary
P818 __________________________________ Toxicology edema and renal failure.
Intake of salicylates at doses of 150 mg / kg or above requires
A RARE CAUSE OF SALICYLATE İNTOXİCATİON: emergency treatment. There is no antidote for medication and the
PRODUCING PİCKLES AT HOME treatment includes administration of activated charcoal in order to
A Ahmetali, M Aktoklu, S Becel, I Ertok, F İçme, O decrease absorption, intravenous hydration and correcting
Karakayalı, A Şener electrolyte imbalance. In order to increase renal excretion of
salicylate urine pH should be increased to exceed 7.5 by
Emergency Department, Republic of Turkey Ministry of Health Ankara Atatürk Training alkalization of urine (NaHCO3) and blood pH should be titrated to
and Research Hospital, Ankara, Turkey be above 7.4 but not to exceed over 7.55. Potassium replacement
Corresponding author: Mr Sener Alp ([email protected]) is required in order to maintain a blood level of 4 to 4.5 mEq / L.
Key-words: Salicylate intoxication ; Home made pickles ; Different package CONCLUSION
It should be kept in mind that salicylates are used also for non-
INTRODUCTION medical purposes. In such cases seeing empty packets or boxes of
Salicylates are widely used for their analgesic, antipyretic, anti- different commercial products is important. In our case, there was
inflammatory and antithrombotic properties. In cases of acute no difference between medical and commercial preparations in
high-dose intake and chronic use it may lead to clinical situations terms of clinical features and management.
such as nausea, vomiting, tinnitus and hearing loss, respiratory
alkalosis, metabolic acidosis, hypoglycemia, hyperthermia,

BOOK OF ABSTRACTS 433

P819 __________________________________ Toxicology Key-words: Oxcarbazepine ; Hyponatremia ; Altered consciousness

CARBON MONOXIDE INTOXICATION AND HYPERBARIC Introduction
OXYGEN THERAPY It has been reported that it should be followed closely for
F İçme (1), N Kozacı (2) hyponatremia. It is known that Oxcarbazepine (OCBZ) compared to
Carbamezapine, it is better tolerated. Hyponatremia frequently is
1. Emergency department, Ankara Atatürk Training and Research Hospital, Ankara, defined as serum sodium (Na) value below 135 mEq / L. It does not
Turkey generally give clinical findings until it is dropped below 125 mEq / L.
2. Emergency department, Adana Numune Training and Research Hospital, Adana, Turkey Hyponatremia is mostly asymptomatic in patients, treated with
Corresponding author: Mr Içme Ferhat ([email protected]) OCBZ, and it is very rarely severe enough to require stopping
Key-words: Carbon monoxide poisoning ; hyperbaric oxygen therapy ; lactate medication. When serum Na value falls below 120 mEq / L, serious
complications may develop, such as headache, seizures, brain
Purpose: The purposes of this study are to compare the clinical and edema, herniations, and death.
laboratory findings of the patients who admitted to emergency Case
department and sent to hyperbaric oxygen (HBO) therapy and who 65-year-old female patient was admitted to Emergency
received only normobaric oxygen (NBO) treatment due to carbon Department because some complaints continued for 1 week, such
monoxide (CO) intoxication, and to investigate the the relationship as nausea, vomiting, increasing lethargy, and malnutrition.
between the increase of lactate, an indicator of tissue hypoxia, and According to her medical history, she has no and disease except
the severity of clinical findings. epilepsy, and she has been using 2x1 OCBZ 600mg for a long time.
Material and Methods: In this retrospective study 201 patients who When she came to emergency services, she tended to fall asleep.
were diagnosed with CO intoxication were enrolled. The levels of When she woke up, she became kopere. There were no stiff neck
consciousness, physical examination findings, ECG findings, and fever. Other system examinations were natural. Sinus heart
laboratory results (arterial blood gas and the carboxy-hemoglobin rhythm rate was 84 beats / minute in her TA: 140/100mmHg
(COHb), CK-MB, troponin I, lactate) on admission and applied Electrocardiograph. Blood test results were natural except Na: 120
treatments were recorded for each of the patients. The Gloskow mEq / L. According to her last week records, Na was 125 mEq / L
Coma Scale (GCS) was used to assess the level of consciousness. and she had nausea. The patient was considered drug-induced
Results: 201 patients were enrolled in this study who were chronic hyponatremia. OKBZ was changed by Neurology services.
diagnosed with CO poisoning. In 5% of patients (10 patients) GCS Drowsiness tendency passed when Na value dropped below 125
was <15. In 5% of patients (10 patients) both CKMB and troponin I mEq / L with isotonic solution. She began feeding and she did not
were elevated. 17.4% of the patients (35 patients) received HBO have vomit problem. There was no additional complaint, so patient
treatment whereas 82.6% (166 patients) received NBO therapy. All was discharged with instructions.
of the cases in which Troponin I and CKMB were elevated together Result
and GCS <15 were sent to HBO therapy. COHb, lactate, CKMB and When hyponatremia, depended on OCBZ, appropriately treated, it
Troponin I levels were higher in patients who referred for HBO can cause serious complications, such as nausea, vomiting, altered
therapy than the other patients. COHb and lactate levels were consciousness, seizures, encephalopathy, and even death For this
significantly higher in patients with GCS<15 than the ones with reason, especially elderly patients should be closely monitored
GCS= 15. Lactate levels of the patients whose both troponin I and when they take OCBZ and serum Na levels.
CKMB levels increased were higher than the other patients,
whereas COHb levels were not different. P821 __________________________________Toxicology
In all of the patients enrolled in the study a positive correlation was
observed between the lactate levels and COHb (r: 0.331, p = 0.001), MAD HONEY POISONINGS IN THE MIDDLE BLACK SEA
CKMB (r = 0449, P = 0.001) and troponin I (r: 0313, p: 0.001) levels REGION IN TURKEY: A 5 YEARS ANALYSIS
whereas we found a negative correlation between the levels of C Katı (1), T Yardan (1), HU Akdemir (1), L Duran (1), N Başol
lactate and GCS (r: -0.325, p = 0.001). We also found a negative (2), M Yılman (3), P Henden (1)
correlation between the levels of COHb and GCS (r = -0267, p =
0.001) and there was no correlation between the levels of COHb 1. Emergency Department, Ondokuz Mayıs University Medical Faculty Hospital, Samsun,
and CKMB (r: 0.073, p: 0.342) and troponin I (r = 0.053, p = 0491). Turkey
Conclusion: The findings of our study showed that blood lactate 2. Emergency Department, Gaziosmanpaşa University Medical Faculty Hospital, Tokat,
levels predicate the clinical severity better than COHb levels, Turkey
consequently we suggest that blood lactate levels can be used 3. Emergency Service, Samsun Gazi State Hospital, Samsun, Turkey
together with COHb in defining indications for HBO treatment . Corresponding author: Mr Akdemir Hizir Ufuk ([email protected])
Key-words: Mad honey poisoning ; Bradycardia ; Emergency department
P820 __________________________________ Toxicology
Introduction: Mad honey poisoning is a little known outside of
SEVERE HYPONATREMIA DEPENDING ON OXCARBAZEPIN Turkey, but it is well- known phenomenon, frequently observed in
USING Black Sea Region of Turkey. This phenomenon is caused by
E Acar, S Karaman, CS Tanrıkulu, O Delice ingestion of grayanotoxin-contaminated honey. Low doses of the
toxin may cause dizziness, hypotension, and bradycardia whereas
Emergency department, Erzurum district education and research hospital, Erzurum, high doses may result in impaired consciousness, seizures, and
Turkey several degrees of atrioventriculer (AV) blocks due to vagal
Corresponding author: Mr Acar Ethem ([email protected]) stimulation. Complete recovery after hospital admission is normally
the rule, because hypotension usually responds to appropriate
fluids, and correction of bradycardia and conduction defects, which
usually respond to atropine treatment.

BOOK OF ABSTRACTS 434

Material and Methods: This is a retrospective study, that scanning P823 __________________________________Toxicology
the files of patients with mad honey poisoning who admitted to
Ondokuz Mayis University Emergency Department, from January HYPOGLYCEMIA FOLLOWING A GLIMEPRIDE OVERDOZE IN
2006 to May 2011 Patients’ demographic datas such as age and A SUICIDE ATTEMPT
gender, clinical findings, laboratory values, vital signs, treatment Y Aydin (1), A Bicer (1), G Celbek (2), F Ermis (3), A Kutlucan
protocols and clinical outcomes were recorded by using survey (1), L Kutlucan (4), A Saritas (5), T Soysal (1)
questionnaire. Patients aged 18 years and older were included in
the study. All data recorded using SPSS 15.0 (Statistical Package for 1. Internal Medicine, Duzce University, Duzce, Turkey
Social Sciences) computer program. 2. Department of Internal Medicine, Duzce University, Duzce, Turkey
Results: The 29 of the 37 patients were males (78.4%), 8 of the 37 3. Internal Medicine, Gastroenterelogy, Duzce University, Duzce, Turkey
patients were females (21.6%). The mean age of the patients was 4. Anesthesiology and Reanimation, Duzce University, Duzce, Turkey
52.7 ± 17 years. The beginning of symptoms was 2±1.1 hours after 5. Emergenecy Medicine, Duzce University, Duzce, Turkey
ingestion. The systolic blood pressure mean value was 92.7±19 and Corresponding author: Mr Kutlucan Ali ([email protected])
the diastolic blood pressure mean value was 56.3±13. There was no Key-words: glimepiride ; suicide ; hypoglycemia
abnormality about blood biochemical markers levels. All patients
were hydrated with saline, in addition 51.4% of the patients were Sulfonylureas are the oldest oral anti-diabetic agents which are
treated with atropine. The patients did not require any external used at treatment of type 2 DM. Major risk factor associated with
pacemaker. The mean heart rate of the patients was 45.7±7.5, and sulfonylureas is hypoglycemia, especially at elders it’s the result of
respiratory rate was 21±1.9. The 94.6% of the patients were wrong usage. Utilization of sulfonylureas for suicidal purpose is
hospitalized in emergency department and 5.4% of the patients uncommon, but it is associated with high mortality and morbidity
were hospitalized in cardiology department. The mean duration of rate. Cases reported about long lasted hypoglycemia due to
hospital stay of the patients was 1±0.2 days. suicidal purpose are mostly associated with 1. generation
Discussion: Mad honey intoxication is rarely fatal and complete sulfonylurea. Previously, cases about newly developed
recovery after hospital admission is normally rule. Mad honey hypoglycemic and neurologic symptoms as a result of usage of
poisoning may cause a wide variety of dysrhythmias, such as gliclazide, glibenclamide and tolbutamide are reported. We
nonspecific bradycardia, sinus bradycardia, nodal rhythm, second presented case about usage of high dose glimepiride for suicidal
degree AV block, complete AV block and asystole. In this reason, purpose. 26 years old female patient with no medical history, has
emergency clinicians should be awake for dysrhythmias in mad applied to emergency room after 16 hours that she used 15 pills of
honey poisened patients. 3 mg glimepiride. She came to her with cold sweating, weakness
and somnolence. Patient's general condition was fair, conscious
P822 __________________________________ Toxicology and has confusion. Her blood glucose:39 mg/dl, parameters at
blood gas analyze pH:7.28 (7.35-7.45), pCO2:58.9 mmHg (35-48),
MERCURY INTOXICATION:CASE REPORT pO2:20.9 mmHg (83-108), HCO3:27.3 mEq/L, (21-26) lactate: 20
B CANDER, C DIKMETAS, M ERGIN, AN GOKAL, M GUL, M. mg/dl (4.5-12.4). At emergency room infusion of 5% intravenous
KASA, MA ONAL dextrose treatment has given after 50 cc 50% dextrose intravenous
injection cause of continue to have low blood sugar. Patient has
Emergency Department, Necmettin Erbakan University Meram Medicine Faculty Hospital, monitored in the way of hypoglycemia with one hour periods at
Konya, Turkey our clinic. Intravenous 10% dextrose infusion treatment has started
Corresponding author: Mr Dikmetas Cesareddin ([email protected]) at our clinic after patient's blood glucose has leveled 55 mg/dl.
Key-words: Mercury ; Intoxication ; Emergency Intravenous 20% dextrose infusion treatment given after patient's
5 hour blood glucose has leveled 41 mg/dl. Low blood glucose level
Mercury is the only metal that is liquid at room temperature but it has continued in despite of patience normal oral nutrition and 20%
can evaporate easily. Metallic mercury (elemental mercury), is intravenous dextrose infusion treatment. During first day of
used inorganic and organic mercury compounds such as paper, 100cc/h 20% intravenous dextrose infusion treatment, max blood
leather,paint industry and electric devices, such as thermometers, sugar interval was 100-110 mg/dl. Hypoglycemia symptoms are
batteries, measuring stuff, antiseptic stuff and in dentistry. observed. During second day of treatment which hypoglycemia
However, schools can be had mercury for the experiment.It is an symptoms are still observed, arterial blood gas parameters were
easy-to-get Mercury metal.The type and seriousness of poisoning pH:7.43 (7.35-7.45), pCO2:34.7 (35-48), pO2:104 mmHg (83-108),
mercury is due to form of mercury that is because of the technical HCO3:22.6 mEq/L (21-26), lactate:14 mg/dl (4.5-12.4). 3 day of 20%
specifications different exposure path of pharmacokinetics. All intravenous dextrose treatment, patient's blood sugar has leveled
chemical forms of mercury can cause toxic findings. CASE: 23 years 130-150 mg/dl, because of this treatment has stopped and hasn't
old male patient came to emergency service due to accidentally observed hypoglycemia. Patient has discharged healthy because of
swallowing mercury piece Patient said that the amount of blood sugar interval which has leveled 100-120 mg/dl at 4 and 5
mercury he swallowed was as large as the size of a walnut. The day of treatment. Hypoglycemia due to sulfonylureas is determined
physical exam was in normal range. Abdomen X raybeing taken at especially at the first generation of sulfonylureas and among the
standing identified opacites of mercury. Patients were followed up elderly population. But in our case, extending up to 72 hours of
on the emergency observation unit. The laxatives was given to the hypoglycemia, due to usage of high doses glimepiride for suicidal
patient till patient got away mercury from his body. At 5th day purpose should be taken into account. In the second generation of
after being discharged, Abdomen Xray for control identified that sulfonylureas gliclazide usage at 2.8 gr and 1gr doses for suicidal
mercury was totally missing. In this presentation, we want to purpose were reported before but related with high doses of
demonstrate elemental mercury poisoning via the gastrointestinal glimepiride usage for suicidal purpose was not reported. Although
tract and discuss treatment and follow up with up dated literature. in our case any complications were not developed, it has reported
that neurological, renal, hepatic complications can occur due to the
usage of high dose sulfonylurea and patients should be closely
monitored.

BOOK OF ABSTRACTS 435

P824 __________________________________ Toxicology P825 __________________________________Toxicology

TNF-Α BLOCKING AGENT INDUCED THROMBOCYTOPENIA PNEUMOMEDIASTINUM; BECAUSE OF ECSTASY OR
IN A MAN WITH ANKYLOSING SPONDYLITIS: A CASE CARDIAC MASSAGE?
REPORT E. Altinbilek, D. Oztürk, M. Koyuncu, I. Ikizceli
S Ataoglu (1), E Celebi (1), H Demirin (2), A Kutlucan (3), M
Ozsahin (1), A Saritas (4) Department of Emergency Medicine, Sisli Etfal Education and Research Hospital, Istanbul,
Turkey
1. Physical Medicine and Rehabilitation, Duzce University, Duzce, Turkey Corresponding author: Mr Altinbilek Ertugrul ([email protected])
2. Biochemistry, Duzce University, Duzce, Turkey Key-words: MDMA ; Pneumomediastinum ; Cardiac massage
3. Internal Medicine, Duzce University, Duzce, Turkey
4. Emergency department, Duzce University School of Medicine, Duzce, Turkey MDMA (3, 4-methylenedioxymethylamphetamine) which is called
Corresponding author: Mr Saritas Ayhan ([email protected]) Ecstasy is an amphetamine derivative and is a substance commonly
Key-words: Thrombocytopenia ; TNF-α blocking agents ; toxic abused. It has forms which are used orally and is illegal that in
various shapes and brands. The most important effect of ecstasy is
Case: A 36-year-old male with an 11-years diagnose of ankylosing to create euphoria and to cause changes in consciousnesses. These
spondylitis (AS) was presented at a physical medicine and effects are related to the intake dosage and the mood that person
rehabilitation clinic with routine control. He was being treated with has.
infliximab (3 mg/kg every 8 weeks) for approximately four years. Pneumomediastinum is formed due to passing of mediastinal air
During the physical examination of the patient, lumbar Schober’s following the perforation of organs of respiratory system or
Test was 2 cm, chest expansion was 3 cm, and lumbar spinal digestive system. It is a clinical condition which are seen in mainly
motions were limited in all directions. Anteroposterior pelvis young patients and mostly regressed spontaneously.
radiography showed grade 3 bilateral sacroiliitis. He had no severe We intend to present our case since the pneumomediastinum
back pain or stiffness complaint, however, epistaxis repeated up to development associated with ecstasy use is a rare case.
3-4 times in last two months, consequently he referred to CASE
emergency unit of a local hospital. A male patient at the age of 22 applied to emergency service with
In the laboratory tests, erythrocyte sedimentation rate (ESR) was complaints of unexpected anxiety, pain in the neck, and palpitation
found to be 11 mm/h, C-reactive protein (CRP) was 0,69 mg/L 36 hours later taking ecstasy. In his history he expressed that he
(normal 0.1–0.5) and other biochemical parameters were within has used the drug for the first time and after he felt cardiac rhythm
normal ranges, as well. A complete blood count (CBC) showed disorder approximately 30 minutes later taking the drug following a
thrombocytopenia (24000 cells/μL) with normal hemoglobin, white cardiac massage for 5 minutes had been performed by his friend its
blood cell count and coagulation tests. rhythm returned to normal and he got better. In the meantime he
With no other additional drug use, TNF-α blocker (infliximab) was stated that he never lost his consciousness and he only had nausea.
accused to be the reason for his thrombocytopenia. He was also In the physical examination he had swelling and redness in the
consulted to an internalist, and no other concomitant pathology neck, subcutaneous crepitation, and roughening of his voice. In his
was found in terms of explaining the thrombocytopenia. Thus, TNF- electrocardiogram no pathology was detected except for sinus
α blocker was ceased. His thrombocytopenia recovered tachycardia (130 pulse/minutes). The complete blood cell count,
approximately in three months. After this period, another TNF-α biochemical examinations, and bleeding and coagulation
blocker, adalimumab (40 mg every other week) was given due to parameters carried at emergency service were normal. Following
his re-emerged complaints. determination of subcutaneous emphysema in the PA chest
TNF-α blocking agents (infliximab, etanercept, adalimumab, etc.) radiography, pneumomediastinum was monitored in addition to
are used for treatment of a variety of inflammatory diseases such subcutaneous emphysema in the thoracic computerized
as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis tomography. For the purpose of advanced examination contrast-
and Crohn’s disease. The most important side effects of those enhanced esophagography was planned. No contrast substance
treatments are as follows: infections, malignancies, congestive escape was detected in the esophagography. The patient referred
heart failure, demyelinating diseases, lupus-like syndromes, to the thoracic surgery was applied second generation
autoantibody formation, injection site and infusion reactions. cephalosporin as IV. The patient whose complaints regressed and
Although they do not have common potential side effects, drug- who progressed stable for 72 hours was discharged from the
induced thrombocytopenia can also occur. However, hospital to come for daily checkup. The patient did not have any
thrombocytopenia was reported in a study to occur in psoriatic complaints in the checkups and in the PA chest radiography taken 7
patients due to use of these agents (5,97%). The precise days later it was determined that subcutaneous emphysemas were
mechanism of thrombocytopenia is still unclear. completely recovered.
Thrombocytopenia is detected occasionally by platelet count DISCUSSION
monitoring or may be manifested as symptomatic petechiae, Pneumomediastinum is a case generally formed by high
purpura, gingival bleeding and epistaxis, as in the present case. intrathoracic pressure in conditions such as epileptic attack,
Conclusion: Use of TNF-α blocking agents is expanding all over the asthma, and positive pressure ventilation. At first the alveolar
world, and consequently the incidence of concerning complications laceration which causes pulmonary interstitial emphysema is
speeds up. Clinicians especially emergency physicians should be formed. This laceration can develop with various mechanisms
aware of the possible complications may occur in patients receiving which cause for transmural differential pressure between alveolar
anti-TNF- therapies. CBC of emergency patients with onset of and interstitial spaces. On the other hand alveolar pressure
petechiae, purpura, gingival bleeding and epistaxis should be increases with vomit and high physical activity developed in
performed in terms of thrombocytopenia misdiagnose. associated with materials taken to increase the euphoria. The
clinical manifestation in the patients with spontaneous
pneumomediastinum is sudden onset chest pain and dyspnea,

BOOK OF ABSTRACTS 436

dysphagia, dysphonia, subcutaneous emphysema, possible neck P827 __________________________________Toxicology
and back pain. In our patient pneumomediastinum following taking
ecstasy is determined. However a certain consensus is not reached A RARE COMPLICATION ASSOCIATED WITH THE USE OF
that developing pneumomediastinum happens due to whether WARFARIN SODIUM : LINGUAL HEMATOMA
vomiting following taking ecstasy or cardiac massage performed by I Beydilli, N Bozdemir, F Güngör, R guven, M. Şaşmaz, V
reason of rhythm disorder. PA chest radiography, thoracic Sayraç
computerized tomography, and esophageal passage radiography
are used in the diagnosis. So we took PA chest radiography, Emergency department, Antalya Training and Research Hospital, Antalya, Turkey
following determination of subcutaneous emphysema in the Corresponding author: Mr Beydilli Inan ([email protected])
radiography we took thoracic computerized tomography and we Key-words: Warfarin ; Lingual hematoma ; INR
determined pneumomediastinum in the tomography taken. In
monitoring it is seen that the symptoms of the patients regresses Anticoagulation is effective for prevention of thromboembolic
rapidly and the patients who progress stable can be discharged events. In patients receiving long-term warfarin therapy, including
from the hospital. intracranial hemorrhage rate of major bleeding that causes death
Consequently since the usage of ecstasy increases each passing day or hospitalization rate per year is 1.2% -8.1% (1,2). Warfarin
we should pay attention to the complications. The nausea and sodium is the best known and most frequently used oral
physical activities with increasing euphoria, which occur by using anticoagulant. Despite the risk of bleeding, warfarin utilization rate
ecstasy, increase the interalveolar pressure. Eventually it should be increased by 9% every year (3). Oral anticoagulants are frequently
kept in mind that pneumomediastinum might develop as well as used in clinical situations, such as atrial fibrillation, valvular heart
pneumomediastinum might occurs with pressure increase due to disease, cerebrovascular accident and deep vein thrombosis.
cardiac massage. Warfarin acts by inhibiting the synthesis of K-dependent clotting
factors (II, VII, IX,X) (4). Warfarin has no effect on the existing
P826 __________________________________ Toxicology thrombus, prevents more clot formation and secondary
thromboembolic complications (4). The mean half-life of warfarin is
THE ROLE OF HUMAN FATTY ACID BINDING PROTEIN (H- 20-60 hour, duration of action is 2-5 days. Increased levels of INR,
FABP) IN EMERGENCY DEPARTMENT FOR EARLY approximately 24-36 hours after ingestion of the first dose is
DETECTION OF CARDIAC DAMAGE IN CARBON MONOXIDE observed. Bleeding is the most common and serious complication
INTOXICATION of the use of warfarin sodium. External bleeding and bleeding into
E. Ahun, O. Köksal, E. Armagan, H. Yıldırım, F. Özdemir, S.A. the tissues due to prolonged bleeding time may be at a level that
Aydin, A. Köse, V.A. Durak even this can be life-threatening bleeding. INR is the level of the
main determinants for bleeding. The diagnosis and treatment of
Emergency Department, Uludag University Faculty of Medicine, Bursa, Turkey excessive intake of warfarin sodium is determined by looking at
Corresponding author: Mme Köksal Özlem ([email protected]) levels of INR. Age and specific comorbid diseases has been
Key-words: Carbon monoxide intoxication ; Human Fatty Acid Binding Protein (H-FABP) ; reported to be risk factors for bleeding (Table-1) (5,6).
Cardiac damage Lingual hematoma is important clinically because it may cause
airway obstruction (7,8,9). Looking at the literature, resulting from
Introduction: Carbon monoxide (CO) intoxication constructs excessive use of Warfarin Sodium airway obstruction caused by
disseminated tissue hypoxia and leads to cardiac damage. Some lingual hematoma, intubation and tracheostomy for some cases
electrocardiographic changes and biochemical indicators were were made to ensure the stability of the airway. Other cases do not
reported in cardiac occurring due to carbon monoxide intoxication. require invasive method for the airway, due to vitamin K and fresh
In this study, it is aimed to reveal whether Human Fatty Acid frozen plasma has been improvement in levels of INR
Binding Protein (H-FABP) provide advantage in early period in (7,8,9,10,11,12).
presenting cardiac damage depending on carbon monoxide 62-year-old patient, 3 years ago had undergone mitral valve
intoxication. replacement and 3 years using warfarin sodium 5 mg daily. The
Method: Carboxihemoglobin (COHb) levels, electrocardiographic patient's vital signs were normal values and the INR was 13.1.
(ECG) changes, creatinine kinase, creatinine kinase-MB, troponin I There was no source of bleeding in his body except for the lingual
and H-FABP levels were investigated in 60 patients presenting to hematoma. The patient was treated with fresh frozen plasma, and
Emergency Department and diagnosed with CO intoxication. any invasive procedure was not needed for the stabilization of the
Findings: Average COHb levels of the patients were determined as airway.
22.7±9.7%. Negative T wave in ECG of 24 patients and ST segment Our purpose for doing the presentation of this case is to emphasize
elevation in ECG of 1 patient were detected. Cardiac biochemical during use of oral anticoagulants can be life threatening bleeding.
indicators and H-FABP levels of the patient with ST segment Lingual hematoma due to use of warfarin sodium is one of a rare
elevation were positive. Also the biochemical indicators of the but potentially life-threatening bleeding.
patient with ST elevation and myocardial infarction had an
increase.
Results: In a number of studies, H-FABP has been shown as a
reliable early period indicator together with cardiac chemical
indicators in cardiac damage. In this study, sufficient data could not
be reached whether H-FABP provides advantage in early period in
presenting cardiac damage depending on carbon monoxide
intoxication.

BOOK OF ABSTRACTS 437

P828 __________________________________ Toxicology Normalde COHb düzeyi erişkinlerde %0.5-1.5, yeni doğanlarda %3-
7 ve sigara içenlerde %4-9 civarındadır. Zehirlenmenin klinik
OUTDOOR CARBON MONOXIDE POISONING DEVELOPED bulguları COHb düzeyi %10 civarında iken başlar, toksik düzey %20-
AFTER BURNING BRAZIER 50 iken öldürücü düzey %50'nin üzerindedir. Ancak klinik bulgular,
O Dikme (1,2), H Topacoglu (2), C Gulsan (1), GA Karadana özellikle nörolojik bozukluklar, ile COHb düzeyleri arasında
(1) korelasyon bulunmamaktadır. COHb düzeyinin %4-5 olduğu
olgularda kognitif bozukluklar saptandığı bildirilmiştir.
1. Emergency Department, Haseki Training and Research Hospital, Istanbul, Turkey Kanda COHb düzeyi olabilecek en kısa sürede ölçülmelidir. Kişiden
2. Emergency Department, Istanbul Training and Research Hospital, Istanbul, Turkey kişiye farklılıklar olmakla birlikte kanda CO düzeyi hafif yüksek
Corresponding author: Mme Dikme Ozlem ([email protected]) olanlarda bile belirgin zehirlenme bulguları ortaya çıkabilir. CO'e
Key-words: carbon monoxide ; poisoning ; brazier maruz kaldıktan sonra uzun bir süre geçmişse veya destekleyici
oksijen tedavisi uygulanmışsa kanda CO düzeyi düşük saptanabilir.
Karbon monoksit (CO) karbon içeren yakıtların tam yanmaması Oda havasında COHb yarılanma süresinin 320 dk olduğu göz önüne
sonucu ortaya çıkan, renksiz, kokusuz, irritan olmayan bir gazdır. alındığında ve hasta başvurusunun sekiz saat sonra olması
Hemoglobine bağlanarak karboksihemoglobin (COHb) haline nedeniyle COHb düzeyini olması gerekenden daha düşük saptanmış
dönüşür, oksijen taşıma kapasitesini ve hemoglobinin dokulara olabileceği düşünülebilir.
oksijen sunumunu azaltır. Direkt hücresel toksindir. CO SONUÇ
zehirlenmesi, doku hipoksisi nedeniyle birçok organı etkiler ve Ülkemizde karbon monoksit zehirlenmesi kış aylarında sıklıkla
çeşitli semptomlara neden olur. Semptom ve bulgular erken kömür sobası kullanılan evlerde kömürün tam yanmaması sonucu
dönemde ortaya çıkabileceği gibi haftalar sonra da görülebilir. ortaya çıkan karbonmonoksit gazı ile oluşan bir zehirlenme
Başlıca semptomlar nöropsikiyatrik ve kardiyovasküler çeşididir. Ancak yaz aylarında nargile içimi yada mangal yakma
semptomlardır. Ülkemizde de olduğu gibi genellikle havalandırması sonrasında başağrısı, bulantı, halsizlik gibi ılımlı şikayetleri olan
yetersiz kapalı alanlarda karbon içeren yakıtların yakılması sonucu kişilerde CO zehirlenmesi akılda tutulması gereken tanılar içinde
(soba, şofben, mangal ya da otomobil eksozu gibi) kaza ile meydana olmalıdır.
gelen bir zehirlenme çeşididir.
OLGU SUNUMU P829 __________________________________Toxicology
22 yaşında erkek hasta beş saattir devam eden başağrısı, bulantı,
halsizlik şikayetleri ile acil servise başvurdu. Hastanın öyküsünde DRUG ABUSE-ETHNOBOTANICAL USE: OBJECTIVE
yaklaşık sekiz saat öncesinde açık havada mangal yaktığı öğrenildi. POPULATION STUDY
Hasta mangalı kendisinin yaktığını, bir buçuk saat boyunca E Butnaru (1), DC Cimpoesu (1), M Corlade-Andrei (2)
mangalın başında kaldığını ve 1-2 saat sonrasında şikayetlerinin
başladığını ifade etti. mangal kömürünü paketli halde marketten 1. Emergency Department, University of Medicine and Pharmacy Gr.T.Popa, Iasi, Romania
aldığını belirtti. Öz ve soy geçmişinde özellik yoktu. Alışkanlıkları 2. Emergency Department, Hospital St.Spiridon, Iasi, Romania
sorgulandığında sigara ve nargile içmediği öğrenildi. Vital Corresponding author: Melle Cimpoesu Diana ([email protected])
bulgularında kan basıncı 120/80mmHg, nabız: 80/dk, solunum Key-words: ethnobotanical ; population study ; drugs
sayısı:18/dk, aksiller vücut ısısı:36,5 ºC ve periferik oksijen
saturasyonu %99 olarak ölçüldü. Fizik muayenesinde baş boyun, Aim: To identify the risk factors for the use of ethnobotanicals and
kulak burun boğaz ve nörolojik muayenesi olağandı, ense sertliği the people at risk of becoming users. Material and methods: The
yoktu. Yapılan diğer sistem muayenelerinde anormallik study was performed in Iasi, in 5 information points, opened in the
saptanmadı. Hastanın EKG ve biyokimyasal tetkikleri normal olarak street, for distributing information leaflets and answering
değerlendirildi. Arteriyel kan gazı değerlerinde COHb düzeyi %4.5 questions, during the “Day against drugs”( 25th of June, 2011)- a
bulundu (normal değer %0.5-2.5). Hastaya geri solumasız maske ile project done by the Emergency Medicine Department and the
%100 oksijen verildi. Dört saatlik oksijen tedavisi sonrasında local authorities. Five emergency medicine residents administered
hastanın yakınması kalmadı. Alınan kontrol arteriyel kan gazında to volunteers a 13-item questionnaire, with 8 open questions and 5
COHb düzeyi %2.3 bulundu. Hasta asemptomatik olarak önerilerle closed questions. Results: We collected 89 filled in anonymous
acil servisten taburcu edildi. questionnaires, so the study included 89 subjects aged 14 to 42
TARTIŞMA years. 19.10% of the subjects admitted using ethnobotanicals, most
CO zehirlenmesi, ülkemizde çoğunlukla kış aylarında görülen ve of them being 20-25 years old (35.29%), males (82.35%), with an
ölümle sonuçlanabilen önemli bir morbidite ve ölüm nedenidir. average educational level, and unmarried. It should be noted that
Kaza sonucu gelişen zehirlenme, çoğunlukla gazla çalışan ısıtma ve 23.52% of the users were underage. 85.15% of the subjects first
aydınlatma aygıtlarının hatalı kullanımından ya da mekanik used ethnobotanicals out of curiosity, 29,41% under the influence
hatalarından, kapalı yerlerde soba ve mangal yakılması veya of friends (94.11% of them having friends that use these products).
otomobil eksoz dumanının solunması ile meydana gelmektedir. 11.76% of the respondents stated that they did not know what
Olgumuzda ise zehirlenme, literatürde sık görülen biçimden farklı they used, the product being offered to them by friends as a
olarak yaz döneminde ve açık havada mangal yakma sonrasında cigarette or candy. Favorite places for consumption were: at home
gerçekleşmiştir. (64.70%), parks and public areas (23.52%), coffee shops and night
Olgumuzda olduğu gibi hafif CO zehirlenmelerinde halsizlik, baş clubs (11.76%). Cigarette was the preferred method of use
ağrısı, baş dönmesi, bulantı ve kusma gibi nonspesifik bulgular (70.58%), followed by joint (23.52%) and “bath salt” (5.88%). The
gözlendiğinden bu hastalara kolaylıkla gribal enfeksiyon, besin described effects were: hallucinogen (35.29%), aphrodisiac
zehirlenmesi, gastroenterit gibi yanlış tanılar koyulabilmektedir. Bu (29.41%) and relaxing (23.52%). To strengthen these effects, most
nedenle ayrıntılı hikaye alınmasının hastanın tanısının users associated alcohol and tabacco (70.58%) or other illegal drugs
konulmasındaki önemi aşikardır. (7.14%). According to this study all users were familiar with the
risks associated with the use of these products, but only 64.70%
agreed to the decision that the weed-shops be closed. Conclusions:

BOOK OF ABSTRACTS 438

The profile of ethnobotanical user is the curious friendly young Key-words: Poisining ; Emergency department ; Anticholinergic syndrome
unmarried man. The obtained data are of help in initiating
prevention and rehabilitation programs in school and colleges. Herbal poisoning is one of the most important type of poisoning in
patients applied Emergency department. In the east of Turkey,
P830 __________________________________ Toxicology Hyoscyamus niger, traditionally named as ‘ban otu’, is used for the
treatment of asthma, diarrhea, abdominal pain and urinary
ACUTE MYOCARDIAL INFARCTION AFTER SILDENAFIL incontinence. This herb containing hiyosiyamin, hiyosin, hyospikrin,
INTAKE for that faulty used this causes the anticholinergic syndrome.
BV Boz (1), M Candar (2), M Cikman (1), E Kaya (3), A In this case, three person of the same family have eaten
Kutlucan (4), A Saritas (5) Hyoscyamus niger and they applied The emergency department of
Turgut Ozal medical center with dizziness, tachycardia, dispense
1. Emergency department, Duzce University, Duzce, Turkey and emesis complaints. In this patients, we aimed to determination
2. Emergency Medicine, Duzce University, Duzce, Turkey of the important early diagnosis and treatment in anticholinergic
3. Pharmacology, Duzce University School of Medicine, Duzce, Turkey syndrome.
4. Internal Medicine, Duzce University, Duzce, Turkey
5. Emergency department, Duzce University School of Medicine, Duzce, Turkey P832 __________________________________Toxicology

Corresponding author: Mr Saritas Ayhan ([email protected]) MAD HONEY… DOES IT HAVE AN ADDICTIVE EFFECT?
Key-words: Sildenafil ; chest pain ; acute coronary syndrome A Denizbaşı (1), SE Eroğlu (1), OE Onur (2), O Urgan (1)

Introduction: Erectile dysfunction is a sexual dysfunction 1. Emergency department, Marmara University Pendik Research and Training Hospital,
characterized by the inability to develop or maintain an erection istanbul, Turkey
during sexual performance. It is seen currently in men more than 2. Emergency department, Marmara University Pendik Research and Training Hospital,
45 years old and main reasons are vascular and neurogenic Istanbul, Turkey
disorders. Type 5 (phospho diesterase 5) inhibitors are often used Corresponding author: Mr Eroglu Serkan Emre ([email protected])
in impotence treatment. Key-words: Mad honey ; Poisonig ; Grayanotoxin I
Case: A 62 year old male patient admitted to emergency
department with burning and compressive characterized chest pain BACKGROUND: A toxin made from plants in the Ericaceae family,
which had been started 45 minutes before arrival. We learnt that found in certain geographical regions can turn honey (also called as
chest pain disperses to left shoulder and left arm. The pain of the “Mad Honey”), into a cause of poisoning. Our study is aimed at
patient was not altering with breathing and told that the pain level analyzing the patients diagnosed with this poisoning and their
was same from the beginning. His vital signs were: Tension arterial: behaviors towards consumption of this honey afterwards.
160/90 mmHg, pulse: 90 bpm, respiration was 14 /min. His body METHODS: This prospective study was based on complaints and
temparature was measured as 36.90C. The electrocardiograph was findings about mad honey poisoning. Patient information and
in sinus rhythm, but V1-4 derivations showed 3 mm ST elevation. findings at the time of admission were compared with those at one
As medical history, patient had hypertension and dyslipidemia as month after discharge through telephone interviews. They were
the risk factors. asked if they or their relatives continued consuming the same
After detailing anamnesis it was learnt that the patient had taken honey.
two doses of 50 mg sildenafil preparation 60 minutes before the RESULTS: 38 patients were participitated in this study. The most
symptoms. Acute anterior myocardium infarction was thought for common complaint of patients was dizziness and unconsciousness
the patient and after initial treatment in emergency department, while the initial hospital finding for all of the patients was sinus
he was transferred to the coronary intensive care unit. bradycardia. 18 of the patients had to be followed up in coronary
Conclusion: In patients who have cardiovascular disorders, erectile intensive care unit. We were able to reach 34 patients by phone
dysfunction is more often seen according to the normal population. after discharge. It was found that 12 (75%) of 16 patients
While prescribing the patients who have cardiovascular disorders, discharged after 6 to 10 hours of emergency unit observation or
have to be inspected comprehensively in terms of having coroner their close relatives were continuing to consume mad honey,
artery diseases. The patients who are going to be prescribed whereas 16 (88.9%) of 18 patients under coronary intensive care
fosfodiesterase type 5 inhibitors, has to be informed about the had discontinued consuming mad honey. The difference in the
usage instruction and warned about the hazards of inappropriate continuation of mad honey consumption between patient groups
usage. Furthermore authorities should make community conscious followed up in intensive care unit and those discharged after
of the hazards of inappropriate sildenafil usage. emergency observation was statistically significant.
CONCLUSIONS: Hazards associated with and serious consequences
P831 __________________________________ Toxicology of consumption of mad honey must be clearly explained to patients
who are found to be consuming mad honey.
ANTICHOLINERGIC SYNDROME CAUSED BY HYOSCYAMUS
NIGER

H Oguzturk (1), MG Turtay (1), O Ciftci (2), OH Miniksar(1),
K Turgut (1)

1. Toxicology deparment, Inonu University, Malatya, Turkey
2. Emergency department, Inonu University, Malatya, Turkey

Corresponding author: Mr Oguzturk Hakan ([email protected])

BOOK OF ABSTRACTS 439

P833 __________________________________ Toxicology 2. Emergency Medicine, Canakkale Onsekiz Mart University Medical Faculty Emergency
Medicine, CANAKKALE, Turkey
ACUTE HYPONATREMIA CAUSING ALTERED MENTAL 3. Emergency, Çanakkale Onsekiz Mart University Medical Faculty Emergency Medicine,
STATUS DUE TO MEXICAN CHILLY PEPPER CANAKKALE, Turkey
EG. Gençer, Ş. Ardıç, H. Hocagil, Ö. Güneysel 4. Hyperbaric Medicine, Çanakkale Onsekiz Mart University Medical Faculty, CANAKKALE,
Turkey
Emergency Department, Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Türkiye Corresponding author: Mr Okhan Akdur ([email protected])
Corresponding author: Mme Hilal Hocagil ([email protected]) Key-words: Carbon Monoxide Poisonings ; Emergency Treatments ; Hyperbaric Oxygen
Key-words: : Acute hyponatremia, ; : Altered mental status, ; : Mexican chilly pepper Therapy

Introduction: The increasing incidence of obesity in the last century Carbon monoxide poisonings appear in the first lines of poisonings
leads the contemporary people to medical and paramedical with fatal progress which are already in place in our country and
solutions. Mexican chilly pepper is very commonly preferred for the world. Requirement of hyperbaric oxygen therapy (HBO) in
slimming and easily available in the herbalist stores. The import these cases is decided by debating of a lot of factors after an
and commerce of the product is not under any kind of control. attentive evaluation. Discussions about which of these patients
Commercially available products that containing Mexican chilly with carbon monoxide poisoning will be able to gain favor from this
pepper are rarely reported cause of toxicity. Inappropriate use of therapy are attending in spite of a lot of clinical study made in
this product that imported from Southern Asia is presenting with recent times. We aimed to evaluate the sharing of patients
nausea, vomiting, diarrhea and abdominal pain even in the between Emergency Service and Hyperbaric Medicine Clinic by
therapeutic doses. Excessive use of this product may cause altered investigating the patients appealed with carbon monoxide
mental status and coma. poisoning to our Emergency Service and applied HBO by consulting
with Hyperbaric Medicine Clinic. Six carbon monoxide poisoning
We report an acute onset hyponatremia as the only clinical cases received the HBO in our clinic since the date 13.12.2011 on
condition to explain the cause of mental alteration. which the hyperbaric oxygen therapy started in our hospital.
Case report: 34 year old female was brought to our emergency Transfer to the Hyperbaric Medicine Clinic for HBO after the first
department with alteration in mental status and agitation. treatment planned in these cases according to history,
According to her husband several hours ago she ingested 7-8 of examination, laboratory and the clinical status of the patients. The
slimming pills and unknown amount of pasty nutritional support treatment was applied by breathing %100 oxygen two times in a
product in a suicidal attempt. Content of the product was Mexican day, under the 2-3 ATA (atmosphere absolute) for 120-135
chilly pepper. minutes. Five of these carbon monoxide poisoning cases to which
On the initial examination vital findings and blood glucose level HBO was applied were women and five of these cases again were
were in the normal range. She was conscious but disoriented and from the towns. The mean of ages of the patients was 50.6±26.8.
uncooperated. The physical examination revealed hyperkinetic Carbon monoxide source caused to poisoning were stoves in four
bowel sounds. Physical examination was completely normal cases and water heaters in two cases. Referral complaining was lost
otherwise. of consciousness in five cases; the nausea and vomiting in one
Orogastric lavage has not been performed. She was hospitalized case. There was no abnormal finding in vital signs except
for close observation with the initial diagnoses of encephalitis and tachycardia (114/min) in one case. In their physical examination;
intoxication. Electrocardiogram, blood gases, count of blood cells the lost of consciousness was seen in one case and the confusion in
and coagulometric parameters were completely normal. Serum another; other five cases had no abnormal finding. In laboratory
sodium level was the only pathological finding (120 mEq/l). Four signs; there was hypoxia (PaO2 65 mmHg) in the patient who has
milligrams of Midazolam was given via intravenous route for the confusion; the hemoglobin value of the patient has lost of
agitation; and brain CT and MRI were performed. On the consciousness was 10.6 and the WBC value 14.5. The time
radiological studies no pathology has been detected. She was between referral and the acceptance to the HBO was 42.5±14.7
referred to the intensive care unit due to the condition of min.; the numbers of the treatment seances applied to patients
consciousness. After the sodium replacement her mental status were 2.8±1.7. The follow-up for all patients received hyperbaric
improved and discharged healthy. oxygen therapy performed in Emergency Clinic. Observation times
Discussion: Gastrointestinal side effects of Mexican chilly pepper is of the patients were 52±18.0 hours on average and the all cases
well known and commonly reported. But acute and symptomatic were discharged by recovery. We think that the planning in
hyponatremia was not found in the literature. Pathophysiology of emergency services by consulting with a hyperbaric medicine
hyponatremia may be concerned with the clearance of the urine specialist for patients with serious poisoning findings and high risk
but we could not demonstrate because of the lack of urine Na who are thought HBO need can bring serious benefits the clinical
analyzes. Therefore we objected to emphasize there is not progress of these cases.
sufficient information about the adverse effects and the hazardous
potential of herbal products. P835 __________________________________Toxicology

P834 __________________________________ Toxicology GHB INTOXICATION: BE AWARE OF THE POTENTIATING
EFFECT OF SOME DRUGS
OUR EXPERIENCES ABOUT HYPERBARIC OXYGEN THERAPY P Bilbault (1), M Gandoin (1), JE Herbrecht (2), M Mihalcea
IN CARBON MONOXİDE POISONING (1), H Slimani (1)
G Afacan (1), O Akdur (2), S Can (3), S Zeren (4)
1. Emergency departement, Hopital Hautepierre, Strasbourg, France
1. Emergency Medicine, Çanakkale Onsekiz Mart University Medical Faculty Emergency 2. Intensive Care Unit, Hopital Hautepierre, Strasbourg, France
Medicine, CANAKKALE, Turkey Corresponding author: Melle Mihalcea Mihaela ([email protected])
Key-words: coma ; GHB ; potentiating effect

BOOK OF ABSTRACTS 440

Introduction: Liquid ecstasy, also known as «fantasy» is the street 2. Department of Emergency Meicine, Bursa Şevket Yılmaz Education and Research
name of gamma-hydroxybutyric acid (GHB), a physiological Hospital, BURSA, Turkey
neurotransmitter synthesised as an alternative anaesthetic 3. Department of Emergency Medicine, Bursa Şevket Yılmaz Education and Research
because of its ability to induce sleep and reversible coma. Acute Hospital, bursa, Turkey
overdose leads to profound alteration of mental status and Corresponding author: Mme Bulut Mehtap ([email protected])
variable degree of respiratory depression. With proper Key-words: Carbonmonoxide poisoning ; Carboxy haemoglobin level ; Normobaric and
management, most patients fully recover within six hours. hyperbaric oxygen therapy
However, respiratory arrest and death have been reported in
severe GHB intoxication. We describe the case of a patient with Objective: Carbonmonoxide (CO) poisoning is a common problem
HIV infection treated by antiretroviral treatment, who experienced in Turkey. While CO inhalation is a common method of suicide in
a nearly fatal reaction from a small dose of GHB. some countries, in Turkey most deaths caused by CO poisoning
Case report: A 40-year-old man was admitted to the emergency result from accidents. Especially in the winter months, leaks from
department after been found comatose in his car stopped on road. coal heaters are the major culprits.With our defining study, we
He was diagnosed recently with a HIV infection treated by Atripla. aimed at finding out the distribution and demographic features of
On admission, the patient had a Glasgow Coma Score of 6 without cases of CO poisoning applied to emergency department (ED).
focal signs. The pupils were miotic but reactive. He presented one Material and methods: From March 2011 through March 2012, the
episode of vomiting. The heart rate was 45 bpm and the blood patients admitted in suspect of CO intoxication to Bursa Şevket
pressure was 88/42 mmHg. He had moderate hypothermia 35,5°C. Yılmaz Education and Research Hospital ED investigated
A 12-lead electrocardiogram showed a sinual bradycardia. There retrospectively. Teh following data were collected for patients: age,
was no acidosis in blood gases. A test at Naloxone was initiated sex, source of CO and exposure duration, initial vital signs,
with no significant improvements in the level of consciousness. symptoms and Glasgow Coma Score at admission, blood carboxy
Because of a rapidly installation of respiratory distress with apnea, haemoglobin (HbCO) level at admission measured using Rad-57
an endotracheal intubation was performed and the patient was signal extraction pulse CO-oximeterş(Masimo Corporation, Irvine,
transferred to the Intensive Care Unit. Blood tests were normal. CA), ECG evaluation, administered therapies (normobaric and
The toxicological screening was negative for ethanol, barbiturics, hyperbaric oxygen therapy) recorded from ED patient assessment
acetaminophen, tricyclic antidepressants, opiates and cannabis. forms.
The cranial CT scan, as well as the lumbar puncture was normal. Six Results: Total patients were 473 (male 30,23% and female
hours later, the rapid recovery of complete consciousness allowed 69,76%). The mean age was 36,09. The mean exposure duration
extubation. The patient acknownledged that someone had poured was 3,38 hour (1-34 hours) and main exposure agents were coal
an unknown liquid in his glass of soft drink that evening. stove (75,6%) and natural gas heaters (19,02%). No intentional or
Toxicological analysis of that liquid confirmed GHB. The supposed suicidal attempt caused by CO intoxication was reported. As to
ingested dose was about 350mg of GHB. The patient was seasonal distribution, winter season mostly detected as 32,3%
discharged home after 6 hours of observation. December, 21,5% January, 17,7% February. The initial mean HbCO
Discussion: GHB, together with cocaine, ecstasy, amphetamines, level was 19,2% (6-38). The mean GCS at admission was 14,5.
LSD, phencycline and ketamine are the most-characteristic “club 84,5% (400) of patients had normal sinus rhythm and 15% (71) had
drugs”. GHB intake may lead to crimes such as robbery and rape, sinus tachycardia in ECG. Application complaints were 46% (271)
and is used frequently by homosexual men as aphrodiasic during nausea/vomiting, 30,6% (176) headache and 9,6% (56) dizziness.
sex. The effects of GHB usage depend on the dose and on any One patient obtained hyperbaric oxygen therapy and 472 patients
other co-ingested substances. Studies correlating level of obtained normobaric oxygen therapy. 99,3% of patients
consciousness with oral dose, found that 50-70mg/kg induces discharged, 0,34% admitted to hospital and 0,21% dead.
coma in adults. Discussion and conclusion: Signs and symptoms of CO poisoning
Despite the small dose of GHB ingested (5,38mg/kg), our patient are frequently uncertain which cause misdiagnosis and delayed
presented a coma with respiratory depression that required treatment. Diagnosis is placed by anamnesis, clinical situation and
mechanical ventilation. This fact is explained by his antiretroviral detecting HbCO level. In our country,especially for more frequent
treatment. Efanvirez contained in Atripla, like most of regions such as Bursa, CO poisoning should be asked to patients
antiretrovirals drugs, is known to inhibit the cytochrome p450 admitting to ED in winter season. We think that remarkable there
system, which may decrease first- pass hepatic metabolism of GHB, was only one patient had hyperbaric oxygen therapy in our study.
leading to potentiation of its effects. Hyperbaric oxygen therapy should be provided to those who have
Conclusion: Severe GHB poisoning should be included in the proper indication.
differential diagnosis of unknown origin coma cases admitted to
the ED. In the patients receiving antiretroviral therapy, a small dose P837 __________________________________Toxicology
of GHB can induce coma. Emergency physicians should be familiar
with presentation, pharmacology and management of GHB-related A CASE REPORT: ALUMINIUM PHOSPHİDE POISONING IS
emergencies. ONE OF THE UNCOMMON POISONINGS
MF KAYNAK (3), F YILDIRIM (2), M BULUT (1), E OZDOGAN
P836 __________________________________ Toxicology (4), S KAYA (2)

ANALYSIS OF CARBONMONOXIDE POISONINGS ADMITTED 1. Department of Emergency Medicine, Bursa Şevket Yılmaz Education and Research
TO OUR EMERGENCY DEPARTMENT FOR LAST ONE YEAR Hospital, BURSA, Turkey
K Uz (3), M BULUT (1), A SAK (2), S KAYA (2), F YILDIRIM (2), 2. Department of Emergency Meicine, Bursa Şevket Yılmaz Education and Research
HO OZKAN (2) Hospital, BURSA, Turkey
3. Emergency department, . Bursa Şevket Yılmaz Education and Research Hospital, bursa,
1. Department of Emergency Medicine, Bursa Şevket Yılmaz Education and Research Turkey
Hospital, BURSA, Turkey 4. Emergency department, . Bursa Şevket Yılmaz Education and Research Hospital, BURSA,
Turkey
Corresponding author: Mme Bulut Mehtap ([email protected])

BOOK OF ABSTRACTS 441

Key-words: Aluminium phophide ; pesticide ; emergency department ingestion of Kırkdamar herb (plantes cryptogames). She had no
disorder in medical history. The vital signs were stable, except
pulse rate (Pulse:110 beats/minute). Systemic examination was
Introduction: Acute poisoning due to pesticide is one of the health normal except epigastrical tenderness. Sinus tachycardia was
problems in the world. Aluminium Phosphide (AP),which is toxic at observed at ECG. Potassium was found 6mEq/L in laboratory,
%37-100 mortality level is a pesticide. We would like to present complete blood count and other biochemical tests were normal.
this case report since AP has a high mortality rate and it isn't National Poison İnformation Center was called if the finding is
known much in our country. associated with the herb. Center notified that herb may cause
Case report: A 22-year-old female was brought to the emergency electrolyte imbalance, kidney failure, Gastrointestinal tract
department (ED) because of taking 6 gr AF that was used for irritation, blood glucose regulation disorder and acute leukemia in
suicide. She had no disorder in medical history. She was confused. animal experiments in longterm. There was no patient in center’s
She had nausea and vomiting. Vital signs were recorded as blood database for Kırkdamar herb ingestion. Medical treatment was
pressure: 66/48mmHg, pulse:80 beats/min, respiratory rate:16 Cap. rarStaiaenlnignteedadifnomfruitshtieoydpnetrwokaalsseemrsvitaiac.retAeffdot.err internal medicine consultation,
breaths/min, temperature: 37 observation. No hyperkalemia
Nasogastric lavage was performed and active charcoal was given. found at followup. Patient discharged after 72 hours.
The electrocardiogram was concidered to be within normal limits Discussion and result: Intoxications are common diseases in ED.
except for sinus tachycardia of 110 beats/min. However, the agent may not be detected in non-drugtoxications.
After 1500cc saline infusion, the blood pressure was recorded as As far as we know, there is no case in literature informing
110/70mmHg but then she was hypotensive. Vasopressor Kırkdamar herb ingestion. Serious medical disorders may ocur due
treatment was started besides fluid resuscitation. Her arterial to eating/drinking various plants. For all patients admitted to ED,
blood gas analysis was as follows; pH:7.147, HCO3:12.5mmol/L and emergency physicians should ask herb consumption in anamnesis,
methemoglobin level:2.9%. NaHCO3 infusion was performed at should advise with National Poison İnformation Center and if
intervals on patient. The biochemical tests were normal limits necessary admit to hospital for follow-up.
except leukocytosis and hyperglycemia. National Poison
İnformation Center was called. They didn't recommed PAM or
atropin. Supportive care and intensive care unit follow-up was
recomended by the center. The patient fell into a coma after 1 P839 __________________________________Toxicology
hour later from her admitted and she was entubated. And then,
she was cardiopulmonary arrest. Cardiopulmonary resuscitation
(CPR) was started. Patient didn't respond to CPR and ultimately, OPHTHALMIC FINDINGS IN ACUTE ACCIDENTAL MERCURY
she died. POISONING IN ADULTS: A CASE SERIES STUDY

Discussion and result: Pesticide poisinings continue to be one of L. Aslan (1), S. Bozkurt (2), M. Aslankurt (1), M. Okumus (2),
the most commonly encountered poisoning cases in our country as A. Aksoy (1), H. Bolat (1), D. Dilsizoğlu (1)
become in the world. However, AP related pesticide poisonings are 1. Department of ophthalmology, Kahramanmaras Sutcu Imam Universty, Faculty of
rarely seen in our country. Because of this, the teoric knowledge medicine, Kahramanmaras, Turkey
and experiences of ED doctors about this phenomenon is 2. Emergency Department, Kahramanmaras Sutcuimam University, Medical Faculty,
inadequate. Clinical presentation of AP poisonings were serious Kahramanmaras, Turkey

vomitting, persistant hypotension, metabolic asidosis, and multi-
organ failure. ED doctors should be familiar with this kind of Corresponding author: Mr Bozkurt Selim ([email protected])
poisonings, rapid and adequate treatment should be applied.
Key-words: Mercury poisoning ; ophthalmic finding ; public health

P838 __________________________________ Toxicology Purpose: Adult persons exposed to accidental mercury poisoning
referred to our clinic from the emergency department (ED) were
HYPERKALEMIA DUE TO INGESTION OF KIRKDAMAR HERB: evaluated in terms of ophthalmic findings.
A CASE REPORT Methods: Forty eight subjects exposed to mercury and age-sex
K CELİK (2), M BULUT (1), A SAK (3), E UYGUN (2), S KAYA matched 30 healthy controls were enrolled study. Full
(3), K Uz (4) ophthalmologic examination including best corrected visual acuity,
external eye examination, reaction to light, a slit-lamb
1. Department of Emergency Medicine, Bursa Şevket Yılmaz Education and Research examination, fundoscopy, intraocular pressure measurements,
Hospital, BURSA, Turkey visual field and color vision test were performed after two days
2. Emergency department, Bursa Şevket Yılmaz Education and Research Hospital, BURSA, from admitted to ED and 6 months follow up period.
Turkey Results: The visual acuity decreased 2-3 line in Snellen chart in 6
3. Department of Emergency Meicine, Bursa Şevket Yılmaz Education and Research (12.5%) patients, reduction of the light reaction in 4 (8.3%)
Hospital, BURSA, Turkey patients, color vision impairment in 5 (10 %) patients were
4. Department of Emergency Medicine, Bursa Şevket Yılmaz Education and Research determined after the ophthalmic examination. The parametric
Hospital, bursa, Turkey values of visual field, both mean deviation and pattern standard
Corresponding author: Mme Bulut Mehtap ([email protected]) deviation in subjects exposed to mercury compared with the
Key-words: intoxication ; plantes cryptogames ; hyperkalemia control group were found statistically significant differentiations
(respectively p<001, p<0,001). There wasn’t any correlation
Objective: Herbs are frequently consumed on treating illnesses in between ocular findings and the urine and blood mercury levels.
Turkey. However, inappropriate use of those kind of herbs may The ophthalmic findings were not change in the six-month follow-
cause serious complications. We would like to present a case who up period
admitted to emergency department (ED) after consuming a herb Conclusion: The mercury widely dispersed in nature may be cause
and detected hyperkalemia. hazard effect on visual systems such as impairment of visual acuity,
Case report: A 37 year old female patient presented to our ED with color vision and visual field. We emphasized that the importance of
nausea, vomiting, weakness and palpitation six hours after public education on potential hazards of mercury for preventive
community health.

BOOK OF ABSTRACTS 442

Key words: Mercury poisoning, ophthalmic finding, public health Introduction: Attempted suicide by drug overdoses is a public
health issue,psychiatric but also somatic. Indeed, 90% of the
P840 __________________________________ Toxicology attempted suicides are done by drug overdose and most of those
patients arrive directly or through SAMU (mobile emergency unit)
OCCULT CARBONMONOXIDE INTOXICATION INCIDENCE IN in emergency departments. However, there is no national register
EMERGENCY DEPARTMENT of drugoverdoses. Knowledge on this subject is then exclusively
A AKGUR (1), G Aydınok (2), Z Doğan (3), G OZBAY YENİCE based on national monocentric studies or studies from abroad.
(4), I PARLAK (1), N Satılmış (5), E YILDIRIM (6) Some of them have shown that responsible pharmaceutical classes
have changed in the last decades and a decreasing trend in the use
1. EMERGENCY DEPARTMENT, BOZYAKA TRAINING AND RESEARCH HOSPITAL, IZMIR, of activated charcoal or gastriclavage. Nonetheless, to assess and
Turkey actualize epidemiological characteristics of drug overdoses seems
2. emergency department, bozyaka eğitim araştırma hastanesi, izmir, Turkey essential in order to improve our medical care and to elaborate
3. emergency department, bozyaka eğt. arş. hastanesi, izmir, Turkey better ways of preventing those behaviors.
4. EMERGGENCY DEPARTMENT, BOZYAKA TRAINING AND RESEARCH HOSPİTAL, IZMIR, Material & methods : We did a one year retrospective study on all
Turkey patients arriving in the emergency department of ourteaching-
5. emergency department, bozyaka training and research hospital, izmir, Turkey hospital for a drug overdose. We analyzed through their
6. EMERGENCY DEPARTMENT, BOZYAKA TRAİNİNG AND RESEARCH HOSPİTAL, İZMİR, computerized medical record demographic and medical data such
Turkey as details concerning drugs, clinical evolution and care modalities.
Corresponding author: Mme Özbay Yenice Gökçe ([email protected]) Results : In 2011, n=204 patients consulted in the emergency
Key-words: CARBONMONOXIDE INTOXICATION ; WINTER ; EMERGENCY DEPARTMENT department for a drug overdose. It represents approximately 1% of
all medical consultation per year. Sex ratio was 0.4. Mean age was
Introduction: During winter, research the frequency of occult CO 37±13 y.o. A large majority of the overdoses (68.6%) are due to 2
intoxication from the patients who apply to the emergency services or more drugs. Benzodiazepines, hypnotic drugs and serotonin
for different signs and symptoms reuptake inhibitors were the 3 classes the most represented. For
Method: Research was performed between 15.03.2012- 29.9% of our patients, an alcoholic intoxication was also associated.
21.03.2012, during 24 hours, from the patients who apply to the 75.5% had psychiatric history but only 35.8% had a current
emergency services, COHb level was recorded via pulseoximetry at psychiatric follow-up. Out of 144 patients (70.6%) for whom we
the triage noninvazively. could assess time of ingestion when took in charge, median delay
Findings : Research patients who were determined CO intoxication was 3 hours (mean delay=4.55±5.14 hours). 10 patients needed
47 % are male, 53 % are female, average of ages are 36,74+/-16,98. antidote. Finally, 10 patients received activated charcoal (all but
The cases of the age groups are 19-64 ages (81,8%) determined the one inappropriately) and one patient had an inappropriate gastric
most. Application time ranges the mostly (55.5%) 16.00-00.00. lavage. Even though 5.4% needed intensive care unit, a majority of
Most co-morbid disease assigned was HT(%12.7) . CO intoxication them were taking in charge ambulatory (55.4%). We also observed
patients with coronary artery disease have chest pain %66.7. The that 17.2% couldn’t be taking care of since 7.4% refused
patients who do not smoking CO intoxication determined hospitalization and 9.8% ran away.
significant (%83.6). The patients who smoking average of the COHb Discussion: Our study confirms some of the demographic data
level was (11,29+/-1,11) significantly high compare with not presented in abroad studies. However it highlights that patients
smoking. The most warming source was stove(%84,5). The most coming to the emergency department for a deliberate drug
presenting complaints were head pain (%29,1) and overdose are frequently known from psychiatric services but
weakness(%19,1). CO intoxication patients have tachycardia somehow escape psychiatric follow-up which should in fact help in
(%32,7) that was significantly high from the normal population. preventing those events. Efforts must be concentrated on this
Results: During winter months, occult CO intoxication incidence is particular population. Moreover, our study shows the weaknesses
significantly high from the patients who applied to the emergency in medical care especially concerning activated charcoal or gastric
services for any complaint. CO intoxication is usually between lavage, care modalities that could easily be improved by
16.00-24.00 time intervals and exposure resource is mostly the appropriate training. This pilot-study is the first stone of a multi
stove. CO intoxication is seen highly probable from the patients centric study that will improve our understanding of deliberate
who is complaining of head pain, weakness and cough. CO drug overdoses, their medical management and help us elaborate
intoxication patients often have tachycardia frequent than non CO key-actions in order to improve prevention. It is also a first step
intoxication patients. towards the elaboration of a national register.
Key words: carbonmonoxide intoxication, pulse oximetry, winter
months, izmir, turkey P842 __________________________________Toxicology

P841 __________________________________ Toxicology ASSOCIATION BETWEEN THE MENSTRUAL CYCLE AND
SUICIDE ATTEMPTS IN EMERGENCY DEPARTMENT
EPIDEMIOLOGY OF DELIBERATE DRUG OVERDOSES IN AN Y. ZENGİN (1), A. CEYLAN (2), M. ÇALIK (3), F. BÜYÜKCAM
EMERGENCY SERVICE (4), A.B. ERDEM (5), J. ŞEN (6), O. ODABAS (7)
W. Nahmiash, A-L. Feral-Pierssens, P. Juvin, S. Beaune
1. Emergency department, Dicle University, Diyarbakir, Turkey
Emergency Department, European George Pompidou Hospital, Paris, France 2. Emergency department, Şanliurfa Training And Research Hospital, Şanliurfa, Turkey
Corresponding author: Mme Feral-pierssens Anne-laure (anne-laure.feral- 3. Emergency department, Hospital of Bursa, Bursa, Turkey
[email protected]) 4. Emergency department, The Ministry of Health, Diskapi Yildirim Beyazit Training and
Key-words: drug overdose ; epidemiology ; intoxication Research Hospital,Ankara, Turkey
5. Emergency department, Konya Numune Hospital, Konya, Turkey
6. Emergency Department, Nevşehir Dr.İ.Şevki Atasagun Hospital, Nevşehir, Turkey
7. Urology department, D.Y.B. Training anad Research Hospital, Ankara, Turkey

BOOK OF ABSTRACTS 443

Corresponding author: Mr Zengin Yilmaz ([email protected]) and Klomipramin 37.5 mg for five years for an obsessivecompulsive
disorder, schizoaffective disorder and antisocial personality
disorder.He was taken to the emergency unit wiht an semi
Key-words: menstrual cycle ; menstruation ; suicide attempt unconscious situation. It was learned from his roommate and

INTRODUCTION: The aim of this study is to investigate whether patient when conscious that he took high doses of Ziprasidone
there is a relationship between the menstrual cycle and suicide (480 mg), Fluvoksamine (1000 mg), Lamotrigine (4000 mg)
attempts in Emergency Department. approximetaly 4 hours before being adimitted tothe emergency
MATERIALS AND METHODS: This prospective and cross-sectional department. On physical examination, he had a temperature of
descriptive study was carried out through examination of 102 37°C, a heart rate of 85 bpm, a respiratory rate of 18 breaths/min,
patients. Inclusion criteria were fertility(16-45 age), regular and a right upper extremity manual blood pressure of 110/70 mm
menstrual cycles of 28 3Hgdaiyns,theansdupliancek poosfitiionnta. keEleocftroocraarldiography was evaluated as
contraceptive or other gonodal hormones. To determine the QT-interval prolongation. Gastric lavage was performed via a
menstrual phase for each participant, serum hormones(LH, FSH, nasogastric catheter of 16 G. As the aspiration material was not
progesterone and estradiol) measured within 24 h of the attempt enough we decided to give 50 grams of active charcoal via the
as described in endocrinology literature and with question the nasogastric catheter in the supine position. The patient was
patient about whether she was menstruating at the time of monitored and followed by ECG-hour. We used magnesium
assessment the date of last menses. sulfate for QT-interval prolongation. Parenteral fluid was
RESULTS: In our study, 14.7% patients have a history of prior administered for symptomatic treatment He was discharged from
suicide attempts and 35.3% patients have a history of psychiatric hospital later two days with healing.
illness. All of the patients with suicidal attempt were detected by Conclusion: Lamotrigine, an antiepileptic drug of the phenyltriazine
drug intake. The most common cause of suicide attempts were class, is metabolized predominantly by glucuronidation. The major
mental depression(47.1%). Period of menstruation, the average 28- inactive urinary metabolites isolated are a 2-N-glucuronide (76%)
day cycle of 6-7 days as the largest portion of 62.7% but contained and a 5-N-glucuronide (10%). The aromatic ring is deactivated by
suicide. The reason is that this period may be hormonal, estrogen the presence of chlorine atoms toward aromatic oxide formation.
and progesterone in women is the lowest phase. Menstrual period, Fluvoksamine is an inhibitor of cytochrome P450 isoenzymes,
cases of attempted suicide about ¾ of customs 2 and 3 days, especially CYP1A2. Fluvoksamine has a moderate inhibitory effect
performed it. on CYP2C19 and CYP3A4. Ziprasidone has a moderate inhibitory
DISCUSSION: The explanation for this may be the reasons just effect on CYP2D6 and CYP3A4. It is conceivable that in the
mentioned, hormonal and social. Menstrual period as a result of presence of Fluvoksamine and Ziprasidone (an inhibitor of
both mind and physically distressed women in particular face glucuronidase enzyme) the concentration of the reactive are ne
difficulties understanding the psychological approach can decrease oxide intermediate may be increased due to the reduced capacity
suicide attempts. of glucuronidase to metabolize lamotrigine. Multi-drug poisonings,
a drug can increase the toxic effects of another drug by reducing
degradation. This situation should be kept in mind.

P843 __________________________________ Toxicology

FLUVOXAMINE INDUCED LAMOTRIGINE TOXICITY :A CASE P844 __________________________________Toxicology
REPORT
MAD HONEY POISONING: A CASE REPORT

Y. ZENGİN, M. İÇER, E. OZCETE, A. SEN, N. GORMELI KURT, M. İÇER, Y. ZENGİN, H.M. DURGUN, M.N. GÜLLÜ, E.
H. GURBUZ GÜNDÜZ, A. ÖZHASENEKLER

Emergency department, Dicle University, Diyarbakir, Turkey Emergency department, Dicle University, Diyarbakir, Turkey

Corresponding author: Mr Zengin Yilmaz ([email protected]) Corresponding author: Mr Zengin Yilmaz ([email protected])

Key-words: lamotrigine ; an inhibitor of cytochrome P450 isoenzymes ; QT-interval Key-words: bradycardia ; dizziness ; mad honey
prolongation

Introduction: Lamotrigine inhibits sodium channels in the Introduction: Mad honey poisoning is common in the
eastern Black Sea region of Turkey. The poisoning is due to the
central nervous system neurons and likely has the same effect in concentrated grayanotoxine (andromedotoxine) content of the
the heart. However, serious neurologic and cardiovascular toxicity
has been reported following lamotrigine overdose, usually with honey made by the bees from the wild flowers of the rhodendron
species. The most frequent symptoms of the intoxication are
coingestants. Neurologic toxicity can include provoking of seizures, hypotension and bradycardia. We report a case of mad honey
status epileptics, and coma. Cardiac toxicity can include QRS-
complex widening and QT-interval prolongation. A growing list of poisoning where the patient visited our emergency room with
bradycardia and hypotension.
anticonvulsants is being utilized to treat bipolar and schizoaffective Case Report: A 56-year-old woman visited our emergency room
disorders in conjunction with antidepressants and neuroleptics.
Some of these serotonergic specific re-uptake inhibitors (SSRIs) are complaining of weakness, profuse sweating, nausea and dizziness.
Upon history-taking from patients relatives, we learned that the
noted to have potent cytochrome P450 inhibition with expected symptoms had begun within 1 hours of eating a few spoons of
drug-drug interactions Ziprasidone has a moderate inhibitory effect
on cytochrome P450. A case is described wherein the honey, which was known as “mad-honey’’, Turkish honey from the
Black Sea coast of Turkey. She had a previous history of
schizoaffective patient had been maintained on lamotrigine with hypertension and aspirin, angiotensin-converting enzyme inhibitors
the addition of Fluvoksamine and ziprasidone toxic effects was
noted. used. On physical examination, the patient had a temperature of
37°C, a heart rate of 50 bpm, a respiratory rate of 13 breaths/min,
Case Report: A 24-year-old male had been treated with and a right upper extremity manual blood pressure of 80/50
Ziprasidone 120 mg, Fluvoksamine 200 mg, Lamotrigine 200 mg

BOOK OF ABSTRACTS 444

mmHg in the supine position. The electrocardiogram showed sinus P846 __________________________________Toxicology
bradycardia. Her routine haematological and biochemical
parameters were within normal limits. Parenteral fluid was ACUTE DYSTONIA INDUCED BY HIGH DOSES OF
administered, and atropine (0.5 mg) were given for symptomatic CITALOPRAM: A CASE REPORT
treatment of hypotension and bradycardia. Five minutes later her L Akgüç (1), I Beydilli (2), F Güngör (2), R guven (2), M.
heart rate increased to 70 beats per minute. Half an hour later her Şaşmaz (2)
blood pressure increased to 110/60 mmHg. She was then
monitored in the emergency room. The patient became clinically 1. psychiatry, Mediterranean university faculty of medicine, Antalya, Turkey
asymptomatic, she was discharged after eight hours. 2. Emergency department, Antalya Training and Research Hospital, Antalya, Turkey
Conclusion: The mechanism of toxicity is related to attachment of Corresponding author: Mr Beydilli Inan ([email protected])
grayonotoxin to sodium channels, which are involved in voltage Key-words: dystonıa ; cıtolopram ; seratonin
dependent activation and inactivation, in the cell membrane. The
toxic effects of may honey poisoning are rarely fatal and last for no INTRODUCTION
more than 24 hours. Generally, it induces dizziness, weakness, Citalopram is an antidepressant selective serotonin reuptake
perspiration, salivation, nausea, vomiting, hypotension, inhibitors group (1). There are four case reports of extrapyramidal
bradycardia, atrioventricular block, and syncope. Mad honey system(EPS) side effects of citalopram in the literature (2). We
induced bradycardia and hypotension can be treated with present a case of acute dystonia induced by high doses of
intravenous fluids and atropine. citalopram intake in this article .
CASE PRESENTATION
P845 __________________________________ Toxicology The case is 20 years old, women and university students. She
admitted to psychiatric outpatient clinic due to depressive
PARAPARACAIN TOXICITY CAUSED BY THE DRUG ABUSE: A symptoms about a week ago. Citalopram 20 mg/day is proposed to
CASE REPORT be given to the patient followed up as outpatients. The patient
L. Aslan (1), S. Bozkurt (2), M. Aslankurt (1), M. Okumus (2), received citalopram 42 (20 mg) tablets for suicidal purposes in the
A. Aksoy (1), H. Bolat (1), D. Dilsizoğlu (1) evening. After about three hours after drug intake advanced
contraction of neck and sensation in the throat, swallowing
1. Department of ophthalmology, Kahramanmaras Sutcu Imam Universty, Faculty of difficulty, and excessive yawning complaints. The patient was
medicine, Kahramanmaras, Turkey admitted to emergency service. Priority was considered as a
2. Emergency Department, Kahramanmaras Sutcuimam University, Medical Faculty, diagnosis of acute dystonia. Patient was monitored. Acute dystonia
Kahramanmaras, Turkey was stopped by applying intramuscular administration of 5 mg
biperiden. The patient was admitted to intensive care after being
Corresponding author: Mr Bozkurt Selim ([email protected]) evaluated by psychiatrist as a suicidal impulse.
Key-words: Alcain drop ; drug abuse ; eyes DISCUSSION
The most common side effects of EPS associated with the use of
Seventeen years old male patient was admitted to the emergency SSRIs are akathisia, dystonic reactions, parkinsonism and tardive
department with decreased visual acuity in both eyes and dyskinesia-like conditions. The precise mechanism of EPS side
complaints of burning pain and photophobia. The patient was effects associated with antidepressants is not known (2).
consulted to ophthalmologist. On the ophthalmological In our patient had developed an acute dystonic reaction. Acute
examination, visual acuity was found 0.1 in the right eye and dystonia in particular, the use of typical antipsychotics,
counting fingers from two meter in the left eye. Biomicroscopic metoclopramide, the use of antidepressant medications, head
examination, ciliary injection, corneal opacity, epithelial defect and trauma and can occur in cases of an emergency situation affecting
anterior chamber the right eye and left eye for about 1-2mm the extrapyramidal system (3). Anticholinergic agents used to treat
hypopyon, which found levels of about 3mm. Patient was admitted the symptoms of EPS induced by antidepressants. In the treatment
to ophthalmology department. The patient's detailed medical of our patients, anticholinergic (biperiden) were used, and
history, Because the industry working pain in the eyes of that from antidepressant use has been interrupted.
time to time CONCLUSION
and to resolve several times a day paraparacain (alcain) drops Serotonin reuptake inhibitors are often used by clinicians.
used, recently drop even more because of increased pain, reached Extrapyramidal side effects before prescribing these drugs should
more frequently used information. One week of the patient's be considered.
artificial tears, antibiotics, and nonsteroidal anti-inflammatory
treatment decreased anterior chamber reaction, epithelial defects P847 __________________________________Toxicology
were closed
corneal opacity, but not lost. Topical anesthetics prescribed by ALCOHOL WITHDRAWAL MIMICKING
some doctors or obtained from pharmacies without prescription ORGANOPHOSPHATE INTOXICATION: A CASE REPORT
has been using unconsciously by patients due to the temporary N.R. Disel, Z. Kekec
relaxing effects. These patients need more frequently instillation
on over time because of increasing pain and eventually Department of Emergency Medicine, Cukurova University Faculty of Medicine, Adana,
dependency occurs. When these drugs are used unconsciously for Turkey
a long time they can lead to thinning, opacification and even Corresponding author: Mme Disel N.rana ([email protected])
perforation on cornea and sclera. Key-words: Alcohol ; Organophosphate ; Withdrawal
Key Words: Alcain drop, drug abuse, eyes

BOOK OF ABSTRACTS 445

Organophosphate (OP) intoxication is one of the most frequent improved. Blood cardiac enzyme and other biochemical levels were
intoxications in our region. OP insecticides are easy to find because all in normal range. Vital instability and another ECG changes have
of the city we live in is the agriculture center of South of Turkey. It not seen during the follw period. She discharged safely at her 36th
is not difficult to diagnose OP intoxicated patients when they have hour of admission but negative T waves persist at her ECG.
the history of exposure in any route and the obvious physical Discussion
findings such as fasciculation, diaphoresis, bradicardia, myozis, and Before 1950s elemental mercury has been using in the treatment
other cholinergic manifestations. But it may be sometimes of bowel obstruction by physicians. They thought orally
confusing when you easily diagnose without revising other possible administrated mercury could force to open bowel by virtue of its
diagnoses or you may overdiagnose although there is no illness. weight . Intact gastrointestinal mucosa can protect patient from
In our case, a-60-year old man who worked as a farmer for over 40 local or systemic mercury intoxication which administered orally.
years, admitted to our clinic with some complaints overlapping OP Previously published case reports showed that elemental mercury
intoxication after spraying OP insecticide. Besides having chronic was ingested by, or spilled in, patients with intact gastric mucosa,
OP exposure, he had some cholinergic findings. Having decreased the mercury was safely evacuated without complication. In the
serum pseudocholinesterase level, so he was started atropine and literature there is a case of elemental mercury retained in the
oxime treatment. But it was difficult to manage the patient, his appendix in which conservative management alone resulted in its
anxiety and agitation. When he became awake and cooperative elimination without the development of appendicitis or clinical
after sedation with repeated doses of benzodiazepines and signs of mercury poisoning. During the patient’s stay in ER any of
haloperidol on the 6th day of hospitalization, tremors in his hands systemic symptoms developed. We think that her intact
made us to investigate alcohol consumption. gastrointestinal system protect her.
The physical findings of a patient is sometimes more than it seems. Mercury intoxication’s cardio toxic effects have seen in some of
Focusing on the most probabl diagnose, especially when you are case reports. Both of them are self ınjection of mercury. For our
familiar with some frequent situations such as OP intoxication in patient we thought that the toxic effect may be due to inhalation
our region, may cause conflicts if you do not overlook gross. Here of mercury when the thermometer was broken or trace amount of
we want to emphasize the importance of past medical history and gastrointestinal absorption. One study estimated that mercury
ongoing illnesses and habits of a patient and differential diagnoses effect cardiovascular conduction according to free radicals the
of OP intoxication. other one suggested that mercury may have affected
parasympathetic dysfunction. But both of these reports evaluated
P848 __________________________________ Toxicology the chronic mercury exposure. Our case is acute toxicity. One of
experimental study found that mercury affects heart rate and
CARDIO TOXICITY A RARE EFFECT OF MERCURY atrioventricular conduction, has arrhythmogenic effects, decreases
POISONING arterial blood pressure and increases autonomic neurotransmitter
YA Altuncı, M Ersel, F Karbek Akarca, S Kiyan activity. Like in our case mercury cause bradycardia and first
degree AV block.
Emergency Department, University of Ege Faculty of Medicine, İzmir, Turkey The forbidding of the use of thermometers with mercury will
Corresponding author: Mr Altunci Yusuf Ali ([email protected]) minimize intoxications. In our country ministry of health prohibited
Key-words: Cardiotoxicity ; mercury ; toxicity the using of mercury thermometers.
Conclusion
Introduction Supportive therapy was effective for our patient. Physicians should
Mercury is an element which commonly used in health, chemistry be aware of mercury’s arrhythmogenic effects and close follow up
and electricity sector. The dangerous effects of mercury on human is sufficient for asymptomatic oral elementary mercury ingested
health are as effective as its silver brightness. There are three patients.
forms of mercury from a toxicological point of view: inorganic
mercury salts; organic mercury compounds; and metallic mercury. P849 __________________________________Toxicology
It is toxic in any of these forms. The source of elemental mercury
can be broken thermometer. According to literature broken WATER PIPE SMOKING PLEASURE CAN BE END AT
thermometers could be responsible for mercury poisoning. Our HYPERBARIC OXYGEN CENTER
aim is to report suicidal mercury ingestion and evaluate its toxic YA Altuncı, O Bozkurt, M Ersel, F Karbek Akarca, S Kiyan
effects.
We report cardiac effect of suicidal oral mercury ingestion which Emergency Department, University of Ege Faculty of Medicine, İzmir, Turkey
commonly cause mild symptoms like diarrhea Corresponding author: Mr Altunci Yusuf Ali ([email protected])
Case Key-words: Water pipe ; carbon monoxide ; near syncope
A twenty seven years old female patient admitted to our
emergency(ER) due to mercury ingestion. She broke two Introduction
thermometers with mercury (totally about 1 gr) and ingested it for Water pipe smoking has been a tradition for centuries in the
suicide. Her vital signs were blood pressure: 122/74 mmHg, pulse: Eastern Mediterranean. The fact that the inhaled smoke is going
105/min and no significant pathology seen in initial examination. through water causes a misinterpretation that it is less harmful or
Gastric lavage and charcoal applied. She monitored in ER intensive has less addictive effect. Considering the toxins involved, a period
care unit. Opaque materials were in plan abdomen radiography. of water pipe smoking when compared with a single cigarette
Her first electrocardiogram evaluated as normal sinus rhythm. At smoking exposes the individual to a 3-9 fold more CO.
her fifth hour in ER bradycardia, first degree AV block and Our aim is to present the case about a young healthy woman who
hypotension were developed and T waves changed in V1-4 attended emergency medicine department with a near syncope
derivations. After 1 lt %0.9 NaCl infusion bradycardia and and had CO intoxication due to water pipe smoking and to remind
hypotension improved but during the follow up period ECG did not that patients who attend emergency medicine departments with

BOOK OF ABSTRACTS 446