nonspecific symptoms could have CO intoxication. Innocent water synthetic amphetamine derivative. Extacy frequently exhibit some
pipe could be a reason of life threating CO intoxication with psychologic (e.g. confusion, sleep disorders, severe anxiety) and
hyperbaric oxygen requirement. physiologic (e.g. increased heart rate and blood pressure, blurred
Case vision, nausea, vomiting, and syncope) side effects. Higher doses
The 22-year old woman with blurred vision, dizziness, and near may lead to hyperthermia, serious systemic injuries and death due
syncope after smoking the water pipe, attended the emergency to rapid body temperature increase. In this paper we report a 19-
medicine department. The vital findings of the patient in the first year-old male patient presenting to the emergency department
examination were measured as arterial blood pressure: 95/65 with hyperthermia 2 hours after taking extacy.
mmHg, pulse: 76/min, breath rate 16/min, satO2: 99%. The CASE REPORT: A man of allegedly good health was brought to the
woman’s, who was totally healthy and had no specific diagnosis at emergency department with loss of consciousness and excessive
her history, Glascow Coma Score evaluated as E4M6V5. However, body heat. Medical staff has been informed that the patient had
the dizziness and feeling of nausea was sustained. In the had agitations followed by seizure and gradual loss of
neurological examination, no pathology was detected and the consciousness after taking 2 tablets of extacy. On arrival he was
other system examinations were normal as well. In the arterial unconscious (GCS 9/15), body temperature was 41.6°C, heart rate
blood gas examination the results were; pH: 7.38 pO2: 105 mmHg, 180 bpm, blood pressure 150/90 mmHg, and respiratory rate
pCO2: 33.2 mmHg, sO2: 98.8, FCOHb: 30.7%. her initial ECG and 18/minute. On physical examination, his skin was dry and warm;
blood glucose level were normal. wide-spread muscle fasciculations were observed. Urine color was
The patient who was given 100% nasal oxygen for six hours had a dark. He had two short-lasting generalized tonic clonic seizures in
control arterial gas evaluation as; pH: 7.40, pCO2: 30 mmHg, pO2: emergency room. Baseline laboratory results were as follows:
110 mmHg, sO2: 98.4%, FCOHb: 2.8%. In the follow up, the patient Na+: 146 mmol/L, K+: 6,8 mmol/L, BUN 121 mg/dL, creatinine 2,2
did not have symptoms like unconsciousness, headache or mg/dL, CK 13659 IU/L, glucose 158 mg/dL, ALT 169, and AST 147.
vomiting. The patient whom the clinical findings recovered quickly He was cooled by means of cooled intravenous fluid (1 L of normal
and discharged safely. saline) in addition to ice bags. Calcium gluconate and insulin-
Discussion dextrose infusions were begun for hyperkalemia. Diazem was
Interestingly, the prevalence of water pipe smoking among medical administered during seizure activities. He was admitted to
school students has been found to be 20-28% in different studies intensive care unit. Body temperature started to fall at 6th hour.
conducted at different countries. Similarly, our case was also a General status and laboratory tests gradually returned to normal at
university student. We found two case reports about CO day 2. No neurologic deficit developed and he was discharged at
intoxication due to water pipe their patients’ and ours admission day 3.
CO levels were similar DISCUSSION: Hyperthermia associated with extacy use is a
A study comparing the exposed CO levels after water pipe smoking common and life-threatening complication. It may develop
and cigarette smoking found that the CO levels are to be much independent of the dose taken. MDMA use should be remembered
higher after water pipe smoking The vaporized smoke of water in differential diagnosis in young patients presenting to emergency
pipe and the fruit flavored tobacco makes smoking less irritant and service with loss of consciousness and fever.
takes longer time of nicotine intake for the satisfaction of the
smoker. For these reasons, water pipe smokers are exposed to P851 __________________________________Toxicology
increased amounts of CO. The concentration of the inhaled toxins
depends on the frequency of smoking, depth of inhalation and LIPID EMULSION THERAPY: AN EMERGING TREATMENT
total smoking duration. Besides, CO levels may also increase with MODALITY IN CALCIUM CHANNEL BLOCKER INTOXICATION
the effect of the coal used to light the tobacco of the water pipe. F Karbek Akarca, S Kıyan, E Tavas, O Unek
In CO intoxication, patients in addition to non specific symptoms
like headache, nausea, vomiting and blurred vision may present Emergency Department, Ege University Faculty of Medicine, İzmir, Turkey
with serious clinical findings like coma, convulsion and syncope Corresponding author: Melle Tavas Ayse Ece ([email protected])
Conclusion Key-words: Calcium channel blocker ; Toxicity ; Lipid emulsion therapy
In young patients who admit emergency medicine departments
with syncope or near syncope, the questioning of a potential CO Introduction:
exposure, especially water pipe smoking, may speed up diagnosis Calcium channel blockers(CCB) are widely used agents in the
and treatment and provide efficient patient management. Water treatment of hypertension and arrhythmias. CCB overdose might
pipe smoking should be questioned in serious CO poisoning. be intentional or accidental, since elderly patients sometimes
forget that they took their pill and take it again. Even mild
P850 __________________________________ Toxicology overdose causes might develop serious outcomes. If not treated on
time, severe morbidity and mortality ensues. In this case report, we
A SERIOUS COMPLICATION ASSOCIATED WITH EXTACY: aim to draw attention to intravenous lipid emulsion therapy as a
HYPERTHERMIAEXTACY,HYPERTHERMIA,COMPLICATION useful treatment modality, which is effective even in the late
S GÖKHAN, M TAS, C YAYLALI phase.
Case:
Emergency Department, Diyarbakır Training and Research Hospital, Diyarbakır, Turkey 25-years old female presented to the emegency department three
Corresponding author: Mr Gökhan Servan ([email protected]) hours after committing suicide by ingesting 10 amlodipine pills.
Key-words: extacy ; hyperthermia ; complication Upon arrival her vitals were as follows: Blood Pressure:
84/47mmHg Pulse:65/min Respiratory Rate:16/dk Oxygen
INTRODUCTION: Commonly used in recent years particularly by saturation:99%. She had no active complaints. There were no
young people at parties and night clubs and publicly known as abnormal physical examination findings. Her initial
extacy, 3,4-Methylenedioxymethamphetamine (MDMA) is a electrocardiogram (ECG) rhythm was Mobitz Type I block and
BOOK OF ABSTRACTS 447
arterial blood gas (ABG) showed normoglycemia and 4) Intravenous fat emulsion therapy for intentional
normokalemia. The patient was started on iv fluids and %10 sustained-release verapamil overdose. Young AC, Velez LI,
intravenous calcium gluconate as fisrt line treatment. On follow up Kelinschmidt KC. Resuscitation. 2009;80(5):591.
the ECG rhythm turned to third degree atrioventicular (AV) block,
hypotension and bradycardia deepened. The patient was started P852 __________________________________Toxicology
on glucagone 0.1mg/kg iv bolus following 0.1 mg/kg/h infusion.
Hypotension and bradycardia resolved and ECG rhythm became EFFECTIVENESS OF METADOXINE IN THE MANAGEMENT
first degree AV block. A few hours later she developed Mobitz Type OF ACUTE ALCOHOL INTOXICATION
II block and hypotension recurred. Glucagone dose was increased E. Tesfaye
but no response was seen. Upon sixteenth hour of her arrival, 20%
intravenous lipid emulsion infusion therapy 2mL/kg bolus followed Emergency Department, Reinier de Graaf hospital, Delft, Netherlands
by 0.25mL/kg/min infusion for 60 minutes was administered. After Corresponding author: Melle Tesfaye Emebet ([email protected])
this treatment, the patients’s vitals stabilized and ECG was back to Key-words: Metadoxine ; Alcohol Intoxication ; Ethanol Elimination
normal sinus rhythm. No adverse events were noted and the
patient was fully recovered, and was discharged after completing Introduction
follow-up period. Acute alcohol intoxication is the most frequent of alcohol-related
Discussion: disorders present in patients referred to Emergency Departments
CCB toxicity is one of the most lethal drug overdoses, therefore an (ED). The treatment is mainly directed toward correcting the
emergency medicine physician should be adept at treating such possible acid-basic or electrolytic disorders as well as hypoglycemia
cases. Clinical features of CCB intoxication are bradycardia, and hypovitaminosis, and ensuring adequate respiratory functions.
hypotension, cardiac conduction abnormalities, altered mental The limiting step that conditions the time required for full recovery
status, metabolic acidosis, hyperglycemia, shock, electrolyte of the patient is the elimination of ethanol from the blood. An
abnormalities and cardiac arrest. In our case, hypotension, increase in the elimination rate of ethanol will conceivably
conduction abnormalities, bradycardia and metabolic acidosis were accelerate the recovery of patients from intoxication.
present. Diagnosis of CCB intoxication can be made through Since more than 25 years it has been known from clinical
patients history or by clinical suspicion regarding the patients observations in patients and different studies on patients and
physical examination and laboratory results. The patient with CCB animals that Metadoxine is capable of accelerating the removal of
poisoning should be monitorized and started on oxygen as two ethanol from the blood. However, thorough knowledge about the
large bore intravenous lines are established and ECG obtained. effectiveness of Metadoxine in the management of acute alcohol
Supportive treatment aiming to secure the airway and ensure intoxication might not be at the disposal of every ED.
hemodynamic stability is vthe first step. Blood samples for Objective
complete blood count, biochemical parameters and blood gas A literature research was performed with the aim to assess the
should be drawn. If the patient presents within 60 minutes of effectiveness of Metadoxine in the management of acute alcohol
ingestion, gastric lavage and activated charcoal therapy should be intoxication by reviewing studies related to this subject.
initiated. We could not use these treatment modalities because Methods
our patient arrived to the emegency department three hours after Databases of Cochrane, EMBASE and Medline were searched. Used
ingestion. First antidote of choice is intravenous calcium given as search terms were “Metadoxine”, “Alcohol Intoxication”, “Ethanol
10 mL of %10 calcium chloride (or 20-30 mL of calcium gluconate) Elimination”, “Ethanol Half-Life”, “Treatment” and “Alcoholism”.
solution in 100cc normal saline. If intravenous calcium is helpful, Results
the patient should be started on a continuous infusion. Our case Only 3 Randomized Controlled Trials (RCTs) related to this subject
was unresponsive to calcium therapy so we passed on to have been found 1,4,5. 2 of these RCTs have been published in
glucagone. After the initial bolus dose, clinical improvement 2002 4,5. The remaining RCT was only published as poster on a
occured so we continued with the infusion dose of 0.1 mg/kg/h. congress in 2010 1. Furthermore, the most recent review article on
However, the clinical imrovement did not endure more than a few this subject was published in 2008 2. Another review article was
hours. In cases refractory to glucagone treatment, catecholamines published in 2003 3.
or amrinone should be used. At this point, we took the road less Both RCTs from 2002 concluded that Metadoxine treated patients
traveled by, and started the patient on lipid emulsion therapy on exhibited a significantly greater decrease in blood alcohol
the sixteenth hour of her arrival. This therapy binds the toxins, concentration compared with those receiving standard treatment
inactivating them. The patient’s clinical status quickly improved (6.70 +/- 1.84 versus 5.41 +/- 1.99 hr, p<0.013 5) and that
with lipid emulsion therapy. This case points to the fact that lipid Metadoxine significantly improved behavioral toxic
emulsion therapy can be effective even in the late phase of toxicity. symptomatology (76.9% versus 42.3% improvement of at least one
Conclusion: clinical category, p=0.011 4).
CCB intoxication is a lethal drug overdose. Intravenous lipid The RCT from 2010 did not show a significant reduction in the
therapy, which has emerged as a new treatment modality for CCB alcohol blood level (*), but only showed a significant improvement
intoxication seems to be a useful option. Further clinical trials on of motor and cognitive function.
the subject should be carried out. All RCTs did not show any adverse effects of Metadoxine
References: treatment.
1) Emergent Management of Calcium Channel Blockers (*) This RCT only mentions the administration of 70 ml of alcohol to
Toxicity. http://emedicine.medscape.com/article/813485- the patients treated with Metadoxine, but not the resulting blood
overview#aw2aab6b3 alcohol levels from this administration.
2) Acilde Klinik Toksikoloji. 2009. Salim Satar. Adana Nobel Conclusion
Kitabevi. Metadoxine is an effective pharmacological treatment for patients
3) Lipid emulsions in the treatment of acute poisoning: a affected by acute alcohol intoxication. It must be noted that the
systematic review of human nad animal studies. Jamaty C, Bailey B,
Larocque A, Notebaert E, Sanago K, Chauny JM: Clin Toxicol (Phila).
2010;48(1):1.
BOOK OF ABSTRACTS 448
available studies are relatively moderate in level of evidence P854 __________________________________Toxicology
meaning there is room for additional studies with a larger sample
size to create a higher level of evidence. SYNCOPE, CARBONMONOXIDE POISONING AND
NARGHILE
P853 __________________________________ Toxicology F. SARI DOĞAN, E. ERKUŞ SİRKECİ, V. ÖZAYDIN, A. DEMİR, B.
VARIŞLI
RECENT EPIDEMIOLOGIC FEATURES OF CARBON
MONOXIDE POISONING IN KOREA: A SINGLE CENTER Emergency Department, Medeniyet University, Göztepe Training and Research Hospital,
RETROSPECTIVE COHORT STUDY Istanbul, Turkey
J Jeon, WY Kim, BJ Oh, DW Seo, CH Sohn Corresponding author: Mr Sari Dogan Fatma ([email protected])
Key-words: Carbon monoxide poisoning ; Narghile ; Syncope
Emergency Department, Asan Medical Center, Seoul, Korea, (South) Republic of
Corresponding author: Mr Sohn Chang Hwan ([email protected]) ABSTRACT:
Key-words: carbon monoxide poisoning ; sucide attempt ; epidemiology Introduction:
Carbon monoxide (CO) is a colorless, odorless gas produced by
Objective: incomplete combustion of carbonaceous material. Carbon
The aim of this study was to describe the epidemiologic monoxide poisoning has been reported as a result of exposure to
characteristics of adult patients with carbon monoxide poisoning various sources of smoke, such as fires, stoves, portable heaters,
presented to the emergency department in recent years. and automobile exhaust and tobacco smoke. Narghile (water pipe,
Methods: hookah, shisha, hubble bubble) is a traditional method of tobacco
This was a retrospective cohort study on adult (over 15 years old) use. In recent years, its use has increased worldwide, especially
consecutive patients with carbon monoxide (CO) poisoning among young people. We presented a case of symptomatic,
presented to the emergency department of a tertiary care moderately carbon monoxide (CO) poisoning in a young man after
university-affiliated hospital from January 1, 2008 to December 31, smoking a narghile.
2011. Diagnosis of CO the diagnosis was based on identifying a Case Report:
source of carbon monoxide emissions and measuring Our patient was a 26-year-old man and he had no past medical
carboxyhemoglobin (COHb) levels; more than 3% for non-smokers history. He presented to our ED following a syncope. He had been
and more than 5% for smokers. Demographic data, intent, source smoking narghile at home 30 minute prior to presentation. He had
of poisoning, poisoned place, annual frequency were reviewed and a headache. His vital signs revealed a temperature of 37°C, blood
described as frequency. pressure of 110/70, pulse rate of 94/min and pulse oximetry
RESULTS: reading of 97% on room air. Physical examination revealed that he
A total of 91 patients were included in this study. There were 56 was alert and orientated to time, place and person. He had a
(61.5%) unintentional and 35 (38.5%) intentional poisonings. For headache. There were no focal neurological signs or cranial nerve
unintentional CO poisonings, the principal sources of exposure to deficits. The baseline electrocardiogram was normal. Computed
CO were fire (39.3%), charcoal (17.9%), briquette charcoal (7.1%), tomography (CT) of the brain planned to exclude neurological
wood burning boiler (7.1%), gas boiler (5.4%), automobile heater syncope. CT scan of the brain revealed no intracranial hemorrhages
(3.6%), briquette boiler (3.6%), firewood (3.6%), and other items or skull fractures. However, a carboxyhemoglobin (COHb) level was
(12.5%). For intentional CO poisonings, the sources were ignition taken in view of the shisha smoking. The COHb level was 25.9%. He
charcoal (60.0%), briquette (31.4%), charcoal (5.7%), and butane was admitted to the observation monitoring area and put on 100%
gas (2.9%). In both men and women who selected CO poisoning as oxygen via a non-rebreather mask. A bedside arterial blood gas on
a method of suicide attempt, the most common source was high flow oxygen revealed with pH of 7.36, pCO2 of 41.4 mmHg
ignition charcoal and the second common source was briquette. and PO2 of 77.4 mmHg. He was placed on 100% oxygen for the
For unintentional CO poisonings, the poisoned places were home next 1–2 h while he was in the ED. Hyperbaric oxygen therapy is
(58.9%), workplace (10.7%), public accommodation (8.9%), tent recommended in patients with neurologic dysfunction, cardiac
(8.9%), automobile (3.6%), and parking place (1.8%). For dysfunction or a history of unconsciousness. Our patient presented
intentional CO poisonings, the poisoned places were home (77.1%), with syncope and he was transferred to hyperbaric center. His
public accommodation (11.4%), and automobile (11.4%). The COHb level dropped and his headache was resolved after the
proportion of intentional CO poisonings among total poisonings hyperbaric oxygen terapy. The patient was discharged with a
has been significantly increasing in recent years; 0.0% in 2008, 3.3% follow-up date for psychometric testing and neurological review at
in 2009, 5.5% in 2010, and 29.7% in 2011 (p = 0.009). Except for the outpatient clinic.
poisoning caused by fire, the proportion of intentional CO Conclusion:
poisonings was 0.0% in 2008, 37.5% in 2009, 50.0% in 2010, and Narghile smoking popularity has been increasing especially among
55.1% in 2011. young people recently. Finally, if the young patients presenting
CONCLUSIONS: with syncope, nonspecific neurologic symptoms or
Our study showed that in recent years in Korea, intentional CO unconsciousness should be asked specifically about this
poisonings from burning ignition charcoal or briquette have been exposure.This case highlights the importance of considering carbon
increasing and most of these poisonings has occurred in home. monoxide exposure in patients presenting with syncope to the
Prevention efforts should take these factors into consideration. emergency department (ED).
Key words: Carbon monoxide poisoning, narghile, syncope.
BOOK OF ABSTRACTS 449
P855 ________________________________Transportation transferred to emergency department of Ankara Ataturk Training
and Research Hospital by 112 ambulance service.
THE PROSPECTIVE ANALYSES OF INTER HOSPITAL PATIENT MATERIALS AND METHODS: In this retrospective study, we
TRANSFERS TO AN ACADEMIC EMERGENCY DEPARTMENT enrolled all off the adult patients transferred to Emergency
ıN TURKEY Department of Ankara Ataturk Training and Research Hospital by
M Ergin (1), MR Ozer (1), Y Durduran (2), A Nur (1), E 112 ambulance service between 01/01/2012 and 01/31/2012. The
Erdemir (1), AS Girisgin (1), S Kocak (1), M Gul (1), B Cander data about demographic characteristics, diagnoses and clinical
(1) outcomes were obtained from records of 112 ambulance service.
RESULTS: A sum of 385 patient were transferred by 112 emergency
1. Emergency Department, Necmettin Erbakan University Meram Medicine Faculty, ambulance service to our emergency department between 01-01-
Konya, Turkey 2012 / 31-01-2012 whereas a sum of 9658 patients admitted to our
2. Public Health Department, Necmettin Erbakan University Meram Medicine Faculty, emergency department in the same period. 55.3% of patients
Konya, Turkey were male, 44.7% were women and mean age of all patients was
Corresponding author: Mr Ergin Mehmet ([email protected]) 54.16 ± 20.1. Patients were classified in to three groups according
Key-words: Patient transferring ; Inter hospital transferring ; Patient safety to their triage examination, 80.1% were in yellow area, less than
4.5% were in red area, 5.7% were in the green area. Patients were
INTRODUCTION: During last decade, Ministry of Health of Turkey brought most frequently between 12: 00-18: 00 o’clock (32.9%),
has made many changes in the law related with emergency care. and least frequently between 00:00 to 06:00 o’clock (16.1%). The
Many important changes were also about inter-hospital patient causes of admission were trauma 28.5% (n=110), cardiac or
transfers. GOAL: To analyze management strategies of inter- pulmonary symptoms (chest pain, syncope, shortness of breath)
hospital patient transports in Turkey. MATERIAL – METHOD: The 27.5% (n=106), forensic events 16.6% (n=64) (traffic accident, work
study was conducted at Necmettin Erbakan University Meram accident, assault, suicide, carbon monoxide intoxication etc.),
Medicine Faculty Emergency Department between 1 February and neurological symptoms 13.2% (n=51), gastrointestinal symptoms
15 April 2012. All patients who firstly evaluated at other health 9.35% (n=36), respectively. For diagnostic purposes, in 180
care centers and then directed to our ED were included in our patients (46.7%) consultations with other departments were done,
study. RESULTS: There were 941 patients included. 60.1% (n=566) 54 of these patients (14.02%) were consultated with multiple
were men. The patients were transferred mostly from other departments. The most consultated departments were cardiology
hospitals located within the province (90.2%, n=849). The (12.2%), neurology (11.9%), chest diseases (9.35%) and orthopedics
distribution of types of hospitals which transferred patients was (8.05%) respectively. Following emergency department evaluation
like that 78.5% (n=739) government hospital (GH); 10.7% (n=101) and treatment 87.2% of the patients were discharged, 11.9% were
private hospitals (PH); 5.8% (n=55) education and research hospitalized, and 3 patients (0.77%) died. A sum of 593 patients
hospitals (ERH); and 3.4% (n=32) other medicine faculty hospitals hospitalized in the clinics or intensive care unit by emergency
(MFH). 42.3 (n=398) of cases were not under control of Command department and 7.75% of all hospitalized patients were
and Control Center of Emergency Medicine System. The reasons of transported by 112 in the one-month period. The hospitalization
transferring were determined as necessity of advanced evaluation rate of outpatient admissions were 5.66%. Of the 46 patients who
and treatment (95.7%, n=901), privation of specialist for the case were hospitalized 30 were hospitalized in clinics (7.79%) and 16
(67.1%, n=631), requirement of critical care (35%, n=329), request were hospitalized in the intensive care unit (4.15%).
of patient or patients’ relatives (3.9%, n=37), transferring patients DISCUSSION-CONCLUSION: 112 Emergency Ambulance Service
to other departments which works by appointment (2.3%, n=22), plays an active role in the transfer of critical patients and elderly
lack of appropriate hospital bed in the department dealing with the patients constitute the majority of the patients transported by
case (0.3%, n=3). CONCLUSION: Inter-hospital patient transfer is ambulance. The hospitalization rate of the patients transported by
still a problem of health care system of Turkey. The changes in law 112 is higher than those of who admitted themselves. 112
related with emergency care resulted in some improvement of ambulance services play the most important role
coordination of inter hospital patient transfers under control of in transportation to hospitals.
EMS centers. However, it was shown that it wasn’t enough.
P857 _______________________________ Transportation
P856 ________________________________Transportation
EMERGENCY RETRIEVAL UNIT ON A SHOESTRING
EVALUATION OF PATIENTS WHO WERE TRANSPORTED TO PK Cheah, LY Low, DF Ongkili, W Madsah, MY Arifin, N Chew
THE EMERGENCY DEPARTMENT BY 112
G Kurtoglu Celik (1), O Karakayalı (2), T Atmaca Temrel (1), Emergency and Trauma Department, Queen Elizabeth Hospital, Kota Kinabalu, Sabah,
YE Arık (1), F Icme (1), A Sener (1) Malaysia
Corresponding author: Mr Cheah Phee Kheng ([email protected])
1. Emergency department, Ataturk Training and Research Hospital, Ankara, Turkey Key-words: Retrieval ; Critically Ill ; Air and Land
2. Emergency department, Teaching and Research Hospital in Kocaeli Derince, Kocaeli,
Turkey Introduction
Corresponding author: Melle Kurtoglu Celik Gulhan ([email protected]) Sabah in North Borneo is blessed with impressive geographical
Key-words: 112 Emergency Ambulance Service ; triage examination ; hospitalization rate features such as mountainous regions and tropical rainforests.
Land distance between district and tertiary hospitals are far with
INTRODUCTION: The aim of this study was to evaluate the clinical treacherous road conditions. This represents a challenge in the
and demographic characteristics of the patients who was transfer of critically ill patients who are mobilised between district
and tertiary hospitals on a daily basis in the state. The very process
of patient transfer becomes hazardous and if executed poorly, can
potentially cause deterioration of care, resulting in more harm than
BOOK OF ABSTRACTS 450
good to the patient. These factors call for a highly skilled and MATERIALS AND METHODS : We employed a lung model to mimic
trained group of personnel who specialise in retrieval, a normal human lung. The three ventilators were disposed in a
resuscitation, stabilization, preparation and transfer of such decompression chamber. This chamber helped us to create a hypo
patients. Establishing a specialised team for air and land transfer of barometric environment (5000 feet, 8000 feet and 12000 feet). The
critically ill patients requires highly trained medical staff and strong set tidal volume was 700 ml. The inspired oxygen content was 100
financial resources. Can a solution be offered without burning a %. The respiratory rate was 20 breaths per minute. The oxygen
hole in the state medical budget? volume consumed per minute was measured with a Fleisch
Methodology pneumotachograph with an oxygen sensor, which was connected
An Emergency Retrieval Unit (ERU) was formed and comprised of between the ventilator and the oxygen cylinder.
15 members, which include an Emergency Physician, Senior RESULTS : The consumed oxygen volume per minute appeared
Medical Officers and Assistant Medical Officers from the different between the three ventilators. This observation was
Emergency and Trauma Department of Queen Elizabeth Hospital, made at each altitude. Equally, we found out that the oxygen flow
the largest tertiary hospital in Sabah. Team members were given was not the same from an altitude to another, for the same
training in the clinical aspects of transporting the critically ill as well ventilator. On the ground, the LTV1200 consumed 18.5 l/min of gas
as helicopter and ambulance safety. At the launch, the ERU while the Medumat Transport used 17.6 l/min and the Elisée 350
provides air and land ambulance transfer of critically ill patients 27.3 l/min. While the barometric pressure was decreasing, the
between the 23 hospitals in the state. oxygen consumption appeared quite stable for the first ventilator :
Results 19.3 l/min at 5000 feet, 19.0 l/min at 8000 feet and 18.6 l/min at
Based on our preliminary data, we received 42 referrals, 38 of 12000 feet. About the Medumat Transport, the more the
which were successful transfers. Reasons for unsuccessful barometric pressure decreased the less this ventilator used oxygen
outcomes include death prior to transfer, deteriorating condition in : 14.8 l/min at 5000 feet, 13.1 l/min at 8000 feet and 11.2 l/min at
which further intervention is futile and logistical deficiency. More 12000 feet. The Elisée 350 seemed to follow the same rule but,
than two-thirds of the transfers were patient retrieval and medical strangely, it increased suddenly its gas consumption at 12000 feet :
evacuation cases, while the rest were inter-facility transfers. 24.0 l/min at 5000 feet, 22.2 l/min at 8000 feet and 30.6 l/min at
Almost half of our patients (47.4%) were transferred by air. 12000. The oxygen consumption was the higher for the Elisée 350
Conclusion at each altitude, while it was the lower for the Medumat Transport.
Despite lack of data prior to the start of this service for CONCLUSION : Thus, despite the same parameters set, the three
comparison, it can be clearly seen that the establishment of this transport ventilators did not need the same oxygen flow to work.
specialised team of medical personnel greatly improves the Equally, the barometric changes seemed to influence the gas
outcome of patients during transfer. It removes the immense consumption. Focusing on these criteria, the Elisée 350 does not
pressure faced by the primary clinicians caring for the patient in appear as the best ventilator during an aeromedical evacuation.
the district hospital each time a transfer is needed. Public The oxygen consumption of a ventilator is a very important logistic
confidence in the health care system also improves when they constraint. Due to the volume and weight of the oxygen cylinders,
know that this part of the health service is well taken care of. a limited number of them are allowed aboard the aircraft for an air
Nevertheless, there is still room for improvement especially in medical evacuation.
terms of staffing, training, equipment and also organisation of the
unit. We hope to develop and expand this service that is still in its P859 ________________________________ Traumatology
infancy, as we take baby steps to improve and excel with an aim to
provide excellent, efficient and safe transportation for critically ill NECESSITY OF AN INTEGRATED ROAD TRAFFIC INJURIES
patients tailored to our resource availability and local settings. SURVEILLANCE SYSTEM: A COMMUNITY-BASED STUDY
H Hatamabadi (1,2), H Soori (2), M Haddadi (2,3), R Vafaee
P858 ________________________________Transportation (2), E Aini (2)
AIR TRANSPORT: OXYGEN CONSUMPTION DURING 1. Emergency department, Emam Hosein hospital, Tehran, Iran
VENTILATION. 2. Ministry of health, Tehran, Iran
C BOURRILHON (1), E FORSANS (2), L FRANCK (2), F LECLERC 3. Safety promotion and injury prevention research center, Shahid Beheshti University of
(1), JP TOURTIER (2) medical sciences
Corresponding author: Mr Hatamabadi Hamidreza ([email protected])
1. Research Department, Institut de Recherche Biomédicale des Armées, Brétigny-sur- Key-words: ; ;
Orge, France
2. Anesthesiology, Hôpital d'Instruction de Armées Val-de-Grâce, PARIS, France A prerequisite to improving the situation of traffic accidents and
Corresponding author: Melle Forsans Emma ([email protected]) injury prevention is to set up a road traffic accident and victim
Key-words: Ventilators ; Aeromedical evacuation ; Oxygen Consumption information system (RTAVIS), which does not exist in Iran. The
objective of this study was to compare the 3 major sources of
INTRODUCTION : Air medical evacuations of patients requiring information, including police, emergency medical services (EMS),
ventilator support are becoming more frequent. The use of and hospitals, to show the necessity of an integrated road traffic
transport ventilators needs pressurized oxygen cylinder. However, injury surveillance system. This prospective cohort study was
inside the aircraft, there are strict space and weight limitations : so, performed by pursuing all road traffic accident (RTA) cases during
a limited number of oxygen cylinder is available during the flight. one year (May 2008 to May 2009) within 30 days of their
We carried out a bench study to evaluate the oxygen consumption occurrence by a draft questionnaire and data pooling from
of three transport ventilators: LTV 1200 (Care Fusion, USA), participating sources. After pooling the data from all organizations,
Medumat Transport (Weinmann, Germany), Elisée 350 (Resmed, it was revealed that during one year, 245 road traffic accidents
Australia), at three different altitudes. occurred in Tehran-Abali route (with a 45-km radius) in which 434
people were either injured or deceased. Out of these crash injuries,
BOOK OF ABSTRACTS 451
police and EMS were unaware of 67 and 51 cases, respectively. In P861 ________________________________ Traumatology
other words, police, pre-hospital emergency services and hospitals
reported 56.2, 82.9, and 76.4 percent of the entire number of PANSCAN: TO SCAN OR NOT TO SCAN, THAT IS THE
injuries or deaths, respectively. None of the organizations QUESTION!
investigated, that is, police, EMS, and health care facilities, have A Wazzan
complete records on injuries and deaths caused by traffic
accidents. We recommend the formulation and implementation of Emergency Department, King Abdulaziz Medical City, National Guard HEalth Affairs,
an integrated and multidisciplinary data collection system of Jeddah, Saudi Arabia
national traffic accidents with the collaboration of police, Ministry Corresponding author: Mr Wazzan Ahmad ([email protected])
of Health and Medical Education (EMS and hospitals), forensic Key-words: Trauma ; Panscan ; CTscan
medicine, and the Iranian Red Crescent.
Trauma patients undergo different types and amounts of energy
P860 ________________________________ Traumatology that affect their bodies. With the blunt injuries being so prevalent
in our region the detection of the magnitude of the injury is a
THE ROLE OF BLOOD S100B AND LACTATE LEVELS IN CHILD cornerstone in the management of the traumatized patients.
AND ADULT MINOR HEAD TRAUMAS AND CORRELATION Panscan i.e. whole body CT scan, is a concept that is adopted by
WITH BRAIN COMPUTERISED TOMOGRAPHY many trauma centers as part of their management protocols. This
AA Sezer (1), E Akıncı (2), M Ozturk (1), F Coşkun (1) practice has improved the trauma outcomes and injury detection.
Time saved, hospital admissions, and money spent are other
1. Emergency department, Ankara Training and Research Hospital, Ankara, Turkey parameters that support the increasing use of this technology.
2. Emergency department, Konya Training and Research Hospital, Konya, Turkey On the contrary to the above mentioned, concerns started to rise
Corresponding author: Melle Akinci Emine ([email protected]) regarding the liberal use of panscan. Excessive radiation exposure,
Key-words: minor head traumas ; S100b ; lactate especially to the young trauma population, brings up the question
of probable risk of increasing malignancies. Ignorance of
Introduction appropriate clinical assessment and relaying solely on a radiological
In this study we aimed to set levels of blood S100b and lactate and study is another concern that we are facing not infrequently.
correlation brain computerised tomography (CT) in child and adult As with everything in medicine, the risks and benefits should
minor head traumas. always be balanced in a way that helps traumatized patients to
Material metods reach the optimum medical or surgical care possible. Long term
This clinical trial is a prospective study that has 100 child and adult observational studies are to be initiated to observe for the
head trauma patients who applied to Ankara Training and Research proposed risks of radiation on the young trauma victims.
Hospital emergency service.
Results P862 ________________________________ Traumatology
The persons’ who are taken in the research GCS is 15, %61 of the
coming people is man and %39 is woman. %12 of the patients are RUPTURING OF RENAL ANGIOMYOLIPOMA DUE TO
18 years old and under, and the patients of %88 is bigger than 18 PHYSICAL EXAMINATION
years. In this study cut off range is used in blood S100b levels 0,0– S Zengin, B Al, C Yildirim, MM Oktay, DA Yilmaz
0,15 ug/ml and lactate 0,9-1,7 mmol/L. 42 percent of patient S100b
level is higher and 56 percent of patient lactate level is higher than Emergency Department, Gaziantep University, Gaziantep, Turkey
cut off range. At a result no significant differences founded in age Corresponding author: Mr Zengin Suat ([email protected])
groups. Also S100B and lactate levels with brain CT was being Key-words: Renal angiomyolipoma, ; trauma, ; physical examination
related; there hasn’t determined any meaningful statistical
relation. Renal angiomyolipoma (AML) is relatively a rare benign tumor
Discussion including vascular smooth muscle, and fatty elements; and the
There was shown that S100B increased in the blood and majority of renal AML run an asymptomatic, benign course.
cerebrospinal fluid (CSF) during traumatic brain injury (TBI). The Potentially life-threatening complication of renal AML is tumor
results of the studies which made relevant to serum S100B rupturing that can be seen after a low-velocity trauma. Flank pain
increasing after the pediatric head traumas are incompatible. At and hematuria may be considered not important in Emergency
some studies there was shown that S100B is a reliable prognostic Department (ED) if underlying cause is not kept in mind. However,
index. At the other hand there is opposite results are present. At sometimes, flank pain and hematuria may be the symptoms of
the head traumas the increasing of lactate level at the brain tissue renal AML that may cause retroperitoneal hemorrhage and
and CSF was found relevant with severity of damage. 42 percent of hypovolemic shock. In present study, we aimed to discuss a patient
patients’ s100b level and 56 percent of patients’ lactate level are that developed ruptured AML during physical examination.
high but these results were not statistically significant. S100B and
lactate levels with brain CT was being related; there hasn’t
determined any meaningful statistical relation.
In conclusion
At the minor head traumas, the determination of elevated serum
S100B and lactate levels can’t take the place of clinical examination
and the using of cranial CT according to our results. Although the
patients of our study group have minor head trauma, we have
opinion that S100B and lactate aren’t reliable markers for guessing
progression.
BOOK OF ABSTRACTS 452
P863 ________________________________ Traumatology patients. Morbidty occured in seven patients and the most
common cause was improved atelectasis.
MISSED EXTREMITY FRACTURES IN THE EMERGENCY Conclusion: Since penetrating chest trauma causes a disruption of
DEPARTMENT the cardiorespiratory system in a very short time, early diagnosis
E. Er (1), P.H. Kara (1), O. Oyar (2), E.E. Unluer (1) and treatment is life saving. The accompanying extrathoracic
injuries that are due to increased mortality and morbidity rates can
1. Emergency Department, Izmir Katip Çelebi University, Ataturk Research and Training be minimized through a multidisciplinary approach.
Hospital, Izmir, Turkey
2. Radiology Department, Izmir Katip Çelebi University, Ataturk Research and Training P865 ________________________________ Traumatology
Hospital, Izmir, Turkey
Corresponding author: Melle Kara Pinar Hanife ([email protected]) A CASE OF COMMOTIO CORDIS CAUSED BY HORSE KICK
Key-words: missed fractures ; radiography ; Emergency department z karakaya (1), ss sagay (2), s demir (3), O. karakaya (4)
Objective: The purpose of the study was to analyse the accuracy of 1. Emergency department, adana state hospital, adana, Turkey
emergency physicians’ (EP) interpretation of extremity traumas to 2. thorasic surgery, adana state hospital, adana, Turkey
determine the most difficult area for interpretation compared with 3. cardiology department, adana state hospital, adana, Turkey
official radiology reports for direct X-ray . 4. radiology department, adana state hospital, adana, Turkey
Methods: The radiologist reports and the EP reports of the direct X- Corresponding author: Mme Karakaya Zeynep ([email protected])
rays from isolated extremity trauma patients were retrospectively Key-words: commotio cordis ; horse kick ; sudden death
compared from 01.05.2011 to 31.05.2011. A total of 181 fractures
in 608 cases were confirmed. Abstract: Sudden death in adults after non-penetrating chest blows
Results: The locations of the misinterpreted fractures were ankle are rare cases which are successfully resuscitated. Commotio
and foot (51.4%), wrist and hand (32.4%), elbow and forearm cordis is the most described report during sporting activities in the
(5.4%), shoulder and upper arm (5.4%), hip and thigh (2.7%), and youth. There have been very few reports of commotio cordis
knee and leg (2.7%). The diagnostic accuracy of the EPs and caused by other traumas. They endure a low survival rate. We
radiologists were not significantly different (kappa = 0.856 , reported a rare case of commotio cordis caused by a horse kick
p=0.001). injury in a middle-aged male, who was successfully resuscitated
Conclusion: Knowledge about the types of fractures that are most and discharged without any neurological sequelae. This case can be
commonly missed facilitates a specifically directed educational classified as commotio cordis as the ventricular fibrillation (VF) had
benefit. developed immediately after chest injury.
Case: The patient was a 46 year-old male who suffered a severe
P864 ________________________________ Traumatology horse kick impact to the chest while examining the horse. He had
no history of cardiac disease or other system diseases. The patient
EVALUATION OF THE CASES WHO UNDERWENT was transported to our hospital in a private car. He arrived at the
THORACOTOMY AFTER PENETRATING CHEST TRAUMA emergency room within 10 minutes of the accident. There was no
z karakaya (1), ss sagay (2), s demir (3), O. karakaya (4) basic life support until he arrived. Evidence of ventricular
fibrillattion led the doctor to carry out immediate defibrillation
1. Emergency department, adana state hospital, adana, Turkey with a biphasic defibrillator and started cardiopulmonary
2. thorasic surgery, adana state hospital, adana, Turkey resuscitation. We performed endotracheal intubation. Return of
3. cardiology department, adana state hospital, adana, Turkey the spontaneous circulation was restored within 10 minutes of
4. radiology department, adana state hospital, adana, Turkey CPR, and establishment of normal sinus rhythm was confirmed.
Corresponding author: Mme Karakaya Zeynep ([email protected]) The patient was immediately examined for internal organ injuries
Key-words: Penetrating trauma ; thoracotomy ; cardiac injury that might cause death.
General physical examination determined an 8 cm in length
Objectives: Penetrating chest traumas are one of the most serious abrasion in the chest wall resulting from blunt trauma, and
injuries with clinical results and target patient profile. İn this study, computerized tomography of the chest showed pulmonary
we evaluated our clinical experience that we obtained from contusion on the left lung. There wasn’t any pneumothorax,
thoracotomy applied patients along with the related literature. hemothorax or cardiac tamponade in the imaging of the
Materials and Methods: Records of 36 patients who were applied mediastinum. The patient was transported to our hospital’s
thoracotomy and were admitted for penetrating thorax trauma Intensive Care Unit. On arrival, he was hemodynamically stable and
from 2009-2011 were retrospectively reviewed. Only the image studies were clear. The vital signs were stable (blood
conservatively treated patients with penetrating chest trauma pressure: 125/77 mmHg, heart rate: 88 bpm, respiratory rate: 24
were excluded. bpm, body temperature: 36.0 c). Glosgow Coma Scale score was 3
Results: 32 of the cases were men and 4 of them were women. (E1 V1 M1). Serum CK-MB and Troponin I levels were normal. No
Twenty-eight patients had sharp penetrating trauma and eight evidence of any other critical injury was detected. The patient
patients had gunshot wounds. Pulmoner parancimal laseration remained in the ICU for two days. During the clinical course, the
was the most common intrathoracic pathology which was detected patient remained hemodynamically stable and there was no
at 28 patients. 7 patients had extrathoracic organ injury. The most recurrence of arrhythmia. On day 2, he had woken up and
common cause of extrathoracic organ injury was liver laceration, extubation had been performed by the ICU doctors. He was able to
observed in 4 patients, Cardiac injury was detected in 5 patients communicate and asked for discharge. Three days after being
and mortality occured in two patients among cardiac injury accepted to the intensive care unit, he was discharged on his
request.
Conclusion: It has been reported that the previous Commotio
Cordis cases involving adults may be considered again based
BOOK OF ABSTRACTS 453
clinical evaluation rather than the age of the patient or the severity P868 ________________________________ Traumatology
of the trauma.
P866 ________________________________ Traumatology RECTUS SHEATH RUPTURE AND HEMATOMA DUE TO TO
TAKE THE SHUTTLE
PANCREAS FRACTURE AFTER A GOKART ACCIDENT E Akıncı (1), NB Akıllı (1), MO Gonen (1), R Köylü (1), E
c elif çelikel (1), b bige sayın (2), ck cemil kavalcı (1), e engin Atayık (2), B Cander (1)
deniz arslan (1), f fevzi yılmaz (1), ms muhittin serkan yılmaz
(1) 1. Emergency department, Konya Training and Research Hospital, Konya, Turkey
2. Department of Allergy and Immunology, Cumhuriyet University School of Medicine,
1. emergency department, ankara numune eğitim ve araştırma hastanesi, ankara, Turkey Sivas, Turkey
2. radiological department, ankara numune eğitim ve araştırma hastanesi, ankara, Turkey Corresponding author: Melle Akinci Emine ([email protected])
Corresponding author: Mme Çelikel Elif ([email protected]) Key-words: Rectus sheath rupture ; Rectus sheath hematoma ; to take the shuttle
Key-words: pancreas fracture ; trauma ; go-kart
Introduction
Isolated pancreatic trauma is extremely rare because of its Rectus sheath hematoma (RSH) is a relatively uncommon condition
anatomic localization. Also; diagnosis of pancreatic injury may be and often a clinically misdiagnosed cause of acute abdominal pain.
difficult due to lack of sensitivity of initial clinical findings, It is caused by hemorrhage into the rectus sheath, which is caused
laboratory and imagining investigations in emergency department. by damage to the superior or inferior epigastric arteries or their
Morbidity and mortality is much higher in delayed presentation or branches, or by direct damage to the rectus muscle.[1,2] It is
if left unrecognized. In this paper we report a 20-years-old female usually localized in the lower abdominal wall.[3] Many causes of
with isolated pancreas fracture after a blunt abdominal trauma due RSH have been described, including trauma, anticoagulation
to go-kart accident. Repeated evaluation of patient by taking into medications, medication injection, hematological and coagulation
account the mechanism of trauma and suspicion of pancreatic disorders, increased abdominal pressure from straining, pregnancy,
injury is essential for early diagnosis. and hypertension.[1,2,4,5] The most frequent predisposing factor
is anticoagulation therapy. Women are more prone to RSH than
P867 ________________________________ Traumatology men. Although most cases are self-limiting, RSH can lead to
significant morbidity and its overall mortality rate is reported as
DELAYED MANAGEMENT OF SPLENIC INJURY 4%.[5] The most commonly presented feature is a painful lower
O Ghazanfar, E Holmes, A Qureishi abdominal mass that never crosses the midline. [3] If RSH is
suspected, the diagnosis is made on the basis of history, physical
Emergency Department, Wexham Park Hospital, Slough, United Kingdom examination, ultrasonography (US) and computerized tomography
Corresponding author: Mr Ghazanfar Omar ([email protected]) (CT) findings. With early diagnosis and conservative management,
Key-words: Trauma ; Splenic Infury ; Fast Scan surgical intervention can be avoided even with large hematoma.
Surgery would be necessary in cases in which hemodynamic
The spleen is the most common organ damaged after blunt stability is not achieved. Early diagnosis is mandatory in order to
abdominal trauma.There are several different ways of managing prevent unnecessary surgical interventions.[6]. We present a case
this particular type of injury and depends largely on the patient that RSH and rupture after take the shuttle.
clinical presentation and hemo-dynamic status. Case report
This poster will highlight the different ways of managing this type 15 years old male patient was admitted to the emergency
of injury and accepted practice. department with abdominal pain. In medical history, abdominal
A 55 year old gentleman presented to the Emergency Department pain was started 2 days before. He didn’t have nausea, vomiting,
one week after a road traffic accident whereby the impact was on diarrhea or constipation. His medical history was no history of
the left side of the torso.The presenting complaints included chronic disease. Physical examination general status open,
abdominal pain ,dizzy spells and bdominal bruising. cooperated and oriented, vital signs stable. In abdominal
The patient was initially hemodynamically stable and a examination, abdominal tenderness and defense of voluntary was
comprehensive clinical examination revealed tenderness in the left seemed but neither rebound nor hepatosplenomegaly. Laboratory
upper quadrant of the abdomen and brusing in the peri-umbilcal results are: WBC: 7080 K/uL Hb: 14.2 gr/dl AST: 217 U/L ALT:
region and on both flanks.A fast scan showed free fluid in the 117U/L ALP: 284 U/L GGT: 16 U/L BUN: 27mg/dl Cre: 0,65mg/dl
abdomen and a subsequent CT scan confirmed a grade 4 splenic LDH: 1294 U/L CK: 4480 U/L CKmb: 128 U/L. In abdominal
rupture.The patient was admitted under the surgical team and ultrasonography, abdominal organs natural but bilateral rectus
discharged 4 days later having managed him conservatively. muscles are dropsy, rupture and hematoma of the rectus sheath
We aim to present different modalities of treatment options was seemed. When the medical history was refined He has taken
available to manage blunt abdominal trauma and more specifically the shuttle 30 times a day last one week. The patient was admitted
splenic injury to the service. IV hydration was started. He has consulted to the
general surgery, don’t think any surgical intervention. During the
control CK, CKMB values returned to normal levels. His pain was
stopped. Four days after the ultrasound showed a significant
reduction in edema in rectus muscles. Patients were discharged by
polyclinic control.
Discussion
RSH is a rare but well-documented clinical entity with an elusive
diagnosis. Clinical presentation, past medical history and previous
medications in these patients should be carefully questioned in
order to obtain valuable information for the correct diagnosis. RSH
BOOK OF ABSTRACTS 454
demonstrates a female to male ratio of 2-3:1, with the highest Abstract
incidence in the fifth decade (7). It accounts for up to 2% of cases Hyoid bone fractures secondary to blunt trauma other than
of unexplained abdominal pain and may occur more often in the strangulation are rare accounting for only 0.002% of all fractures. It
right lower quadrant. Other than blunt abdominal trauma, RSH is generally associated with suicidal hanging. The importance of
typically occurs in patients who receive anticoagulant or fibrinolytic hyoid fracture, however, rests not with the rarity of it, but with the
treatment and in severe hypocoagulability states such as lethal potential of missed diagnosis. After fracture, the occult
hemophilia and von Willebrand disease.[8,9] Our patient had no compressive forces of hematoma formation and soft tissue
risk factors mentioned above. As the lesion is self-limited, most swelling may compromise airway patency. To ensure a positive
RSH can be treated conservatively with analgesia, the treatment of outcome, a strong degree of suspicion based on mechanism of
predisposing conditions and cessation of the anticoagulation. injury is mandated.
When necessary, the coagulation profile should be corrected with Here we presented an incidentally detected case of hyoid bone
the administration of vitamin K, fresh frozen plasma and protamine fracture and thyroid cartilage depletion in the emergency
sulfate in patients being treated with heparin or factor VIII department.
replacement in patients with hemophilia A. Active bleeding can be Case
managed either surgically by evacuating the hematoma and A 53-year-old male passenger on the front seat; seat belt-non-
ligating the bleeding vessels, or radiologically with catheter restrained was brought to the emergency department (ED) by an
embolization. We treated our patient conservatively with analgesia ambulance because of a motor vehicle accident. His Glasgow Coma
and there isnt any complications. Scale score (GCS) was 14 at the admission. After initial assessment,
Conclusion a cervical collar was placed. The patient was alert and awake with
RSH is rarely occur after minor trauma in youngs. RSH is rarely his baseline normal mental status. During the initial evaluation, the
fatal, but clinicians should be aware of this possibility especially in patient’s airway was intact with minimal swelling on the throat and
frail elderly patients. no difficulty in breathing. After that a non-contrasted
REFERENCES computerized tomography (CT) scan demonstrated the fractured
1. Cherry WB, Mueller PS. Rectus sheath hematoma: review of 126 body and left greater corn of the hyoid and depletion of the left
cases at a single institution. Medicine (Baltimore) 2006;85:105-10. part of the thyroid cartilage. The patient was observed in
2. Zengin K, Carkman S, Kiliç I, Beken E, Eyüboğlu E. Treatment otolaryngology department and was treated conservatively by rest,
approaches to rectus sheath hematoma. Ulus Travma Acil Cerrahi analgesia and restriction of head movements. The patient was
Derg 2007;13:55-9. evaluated with direct laryngoscopy, which revealed as normal
3. Siu WT, Tang CN, Law BK, Chau CH, Li MK. Spontaneous rectus except thyroid cartilage depletion. He was discharged after 3 days
sheath hematoma. Can J Surg 2003;46:390. of observation without any complication or sequellae.
4. Luhmann A, Williams EV. Rectus sheath hematoma: a series of Because diagnosis of this kind of fracture is difficult and easily
unfortunate events. World J Surg 2006;30:2050-5. missed, greater attention should be paid to the patients who
5. Donaldson J, Knowles CH, Clark SK, Renfrew I, Lobo MD. Rectus admitted to the Emergency Department with motor vehicle
sheath haematoma associated with low molecular weight heparin: accident.
a case series. Ann R Coll Surg Engl 2007;89:309-12.
6. Berná-Serna JD, Sánchez-Garre J, Madrigal M, Zuazu I, Berná- P870 ________________________________ Traumatology
Mestre JD. Ultrasound therapy in rectus sheath hematoma. Phys
Ther 2005;85:352-7. VERTEBRAL ARTERY DISSECTION A RARE CAUSE OF NECK
7. Osinbowale O, Bartholomew JR. Rectus sheath hematoma. Vasc PAIN AFTER TRAUMA
Med 2008;13:275-9. MC van Schepen
8. Klingler PJ, Wetscher G, Glaser K, Tschmelitsch J, Schmid T,
Hinder RA. The use of ultrasound to differentiate rectus sheath Emergency department, Isala Klinieken, Zwolle, Netherlands
hematoma from other acute abdominal disorders. Surg Endosc Corresponding author: Mme Van Schepen Marian Christine ([email protected])
1999;13:1129-34. Key-words: vertebral artery dissection ; neck pain ; trauma
9. Macías-Robles MD, Peliz MG, Gonzalez-Ordonez AJ. Prophylaxis
with enoxaparin can produce a giant abdominal wall haematoma Introduction
when associated with low doses of aspirin among elderly patients Vertebral artery dissection is a rare, but important cause of neck
suffering cough attacks. Blood Coagul Fibrinolysis 2005;16:217-9. pain after trauma in the adult population. Headache and/or
ipsilateral neck pain are the prominent symptoms. The most
P869 ________________________________ Traumatology frequent complication is artery-to-artery embolism and the
consequence is vertebro-basilar stroke (incidence 24-100%) with
A RARE ENTITY IN EMERGENCY DEPARTMENT: potentially severe disability or even death. It is important to
TRAUMATIC FRACTURE OF HYOID BONE AND THYROID recognize vertebral artery dissection because it is often a treatable
CARTILAGE DEPLETION entity with most patients having good functional recovery. We
P Durukan (1), O Salt (1), S Ozkan (1), B Durukan (2), K report a case of vertebral artery dissection in a middle-aged man
Tarhan (2) complicated by cerebellar infarction.
Case report
1. Erciyes University Faculty of Medicine, Department of Emergency Medicine, Kayseri, A 66-year-old man presented to the emergency department (ED)
Turkey complaining of neck pain after a high- velocity car accident. After
2. Erciyes University Faculty of Dentistry, Department of Periodontology, Kayseri, Turkey investigation he was thought to have musculoskeletal sprain.
Corresponding author: Mr Durukan Polat ([email protected]) However, the same evening, he returned to the ED with a collapse,
Key-words: hyoid bone ; thyroid cartilage ; trauma vomiting and tingling in his left arm. After obtaining a computed
axial tomography scan (CT) of the head and neck, which showed no
BOOK OF ABSTRACTS 455
abnormalities, he was admitted for observation. The next day he Survivors of tension pneumopericardium secondary to blunt
showed a deteriorating clinical picture with left-sided hemiparesis. thoracic trauma are rare.
CT-scan of the brain and arteriography of the extracranial arteries This case demonstrates the rapid and dramatic deterioration to
revealed cerebellar infarction due to a traumatic vertebral artery cardiac arrest of a patient with tension pneumopericardium and
dissection. He was admitted to the stroke care unit and managed severe multiple trauma. Tension pneumopericardium causing a life-
with anti-coagulant therapy. He was subsequently transferred to a threatening cardiac tamponade requires an immediate pericardial
rehabilitation unit but he developed severe left-sided spasticity. aspiration and subsequent pericardial drainage. In this case, the
Discussion poor prognosis was due to severe head injuries and not to the
Vertebral artery dissection can be spontaneous or can follow blunt tamponade secondary to tension pneumopericardium that was
cervical trauma. Head trauma with persistent neck pain should resolved successfully.
raise suspicion of an underlying vertebral artery dissection.
Diagnosis may be confirmed non-invasively by ultrasound. The P872 ________________________________ Traumatology
sensitivity of ultrasound in detecting vertebral artery dissection is
about 92%. Ultrasound can be easily obtained in the emergency CLINICAL CHARACTERISTICS OF OCCUPATIONAL FALL
department. With early confirmation of vertebral artery dissection INJURIES
and the start of anti-coagulant therapy potentially severe stroke SH KIM
can be prevented.
Emergency medicine, Ulsan University Hospital University of Ulsan College of Medicine,
P871 ________________________________ Traumatology Ulsan, Korea, (South) Republic of
Corresponding author: Mr Kim Sun Hyu ([email protected])
A CASE OF TENSION PNEUMOPERICARDIUM FOLLOWING Key-words: Accidental falls ; occupations ; Injury
BLUNT CHEST TRAUMA IN A PATIENT WITH SEVERE
MULTIPLE TRAUMA Objectives: The aim of this study was to investigate the clinical
V Gavrila (1), G Filip (1), RD Gavrila (2), LA Tandara (1) characteristics of fall injuries related to occupation and compare
with another causes of occupational injuries.
1. Emergency Department, Emergency County Hospital, Timisoara, Romania Methods: Data were used from Emergency Department(ED)-based
2. Department of Family Health Care Providers, Romanian National Society of Family Occupational Injury Surveillance System of Korea Occupational
Medicine, Timisoara, Romania Safety and Health Agency (KOSHA), to investigate the occupational
Corresponding author: Mr Gavrila Vasile ([email protected]) injuries from July to October 2010 at the 10 emergency
Key-words: tension pneumopericardium ; thoracic trauma ; pericardial drainage department in Korea. All the occupation related injured subjects
that were 2147, divided into two group, injured group due to fall
Introduction (fall group) of 213 patients (9.9%) and non-fall (non-fall group) of
Tension pneumopericardium is uncommon after blunt thoracic 1934. Data including baseline characteristic, factors and clinical
trauma and generally occurs following a penetrating injury. The characteristics associated with injury and outcome were compared
diagnosis is made by computed tomography scan of the thorax and between two groups.
abdomen that allows the additional detection of concomitant Results: Mean age was 46 years old in the fall group and 42 in the
injuries. Pneumopericardium following blunt chest trauma is due to non-fall group (p<0.001), male sex were 90% in the fall group and
tracheobronchial, pulmonary or esophageal injury. 86% in the non-fall group (p=0.158). Rate of presentation to ED via
Case report other facility were 46% in the fall group and 17% in the non-fall
We present the case of a 53 years old man, politraumatised, with group (p<0.001). Frequent area of injury occurred were the area
multiple injuries after a high speed motor vehicle crash, brought by related to secondary industry of 65%, especially related to
paramedics with signs of shock (low blood pressure, tachycardia, construction of 32 % in the fall group, however injury occurred in
tachypnea, and turgescent jugular veins), who developed tension construction area were only 8% in the non-fall group. Rate of injury
pneumopericardium shortly after the endotracheal intubation and occurred during the regular working hours from 9 a.m. to 6 p.m.
positive pressure ventilation. His Glasgow Coma Scale (GCS) on were 70% in fall group and 57% in non-fall group (p<0.001). Initial
arrival was 3/15 (E1, V1, M1), BP=100/60mmHg, HR=130/min, blood pressures were not different between two groups, however
SpO2=88%, RR=30/min, with multiple trauma marks on the head Glasgow Coma Scale were 14.6 in the fall group and 14.9 in the
and chest. Rapid sequence intubation was performed. Shortly after non-fall group (p=0.019). Injury severity was more severe in the fall
intubation, the patient developed cardiac arrest (pulseless group than the non-fall group resulting from that Injury Severity
electrical activity), that responded to resuscitation maneuvers: Score were 22.0 in fall group, 7.7 in non-fall group (p<0.001).
chest compressions, administration of adrenaline. Abdominal Predicted days away from work were 35 days in the fall group and
sonography didn’t revealed any trace of free fluid in the Douglas or 13 in the non-fall group (p<0.001). Death rate after ED arrival were
Morrison’s pouch, but upper abdominal examination was difficult . 4.2% in the fall group, 0.6% in the non-fall group (p<0.001), and
A CT “body” scan was performed: CT head - comminuted parietal rate of operation were 26% in the fall group, 11% in the non-fall
fracture, multiple brain lesions, multiple fractures of the facial group (p<0.001).
massif, massive cerebral edema: aspect of “gray brain matter“.CT Conclusion: Fall injuries related to occupation were more severe
thorax - tension pneumopericardium, lungs with emphysematous comparing to other causes of trauma and resulting to more longer
bullae. Laboratory: moderate increases in liver enzymes, loss for work. It is necessary to recognize the severity of fall injuries
respiratory acidosis. The subxiphoid pericardial window and in high risk industrial area such as construction and aim to prevent
pericardial drainage, successfully treated this patient. After a with all efforts.
pericardial drain was placed, the patient remained
hemodynamically stable.
Discussion
BOOK OF ABSTRACTS 456
P873 ________________________________ Traumatology Corresponding author: Mr Görmeli Gökay ([email protected])
Key-words: Earthquake; ; compartment syndrome ; ; fasciotomy
PELVIC BONE FRACTURES ASSOCIATED WITH INTRA-
ABDOMINAL SOLID ORGAN INJURY Objectives: The aim of this study is to report clinical profile and
SH KIM prognosis of patients with fasciotomy admitted to Van Training and
Research Hospital after the 2011 Van earthquake.
Emergency medicine, Ulsan University Hospital University of Ulsan College of Medicine, Patients and methods: Eleven male and 10 female patients aged 18
Ulsan, Korea, (South) Republic of to 60 (mean, 38.3) years had urgent fasciotomy. We conducted a
Corresponding author: Mr Kim Sun Hyu ([email protected]) retrospective review of medical records to document the clinical
Key-words: Pelvic bones ; Abdominal injuries ; Fracture profile, treatment and prognosis.
Results: Twenty-one patients had fasciotomies and amputation
INTRODUCTION. was required on seven of them. Fasciotomy incisions were closed
Early detection for the intra-abdominal solid organ injury is critical with skingrafting in nine cases, and with primary closure in three
in patients with pelvic bone fractures. cases. Eight patients had full range of motion, four patients had not
OBJECTIVES. This study analyzed the characteristics of pelvic bone gained full range of motion and needed rehabilitation, two patients
fractures associated with intra-abdominal solid organ injury. had sensory loss.
METHODS. Conclusion: Compartment syndrome is one of the serious problem
Medical records were retrospectively reviewed from January 2000 after the Van earthquake. The infection ratio was low, the
to December 2010 for patients with pelvic bone fractures. Pelvic amputation ratio was high.
bone fracture were divided into stable and unstable type; unstable
pelvic bone fracture defined as lateral compression types Ⅱ and Ⅲ P875 ________________________________ Traumatology
, antero-posterior compression types Ⅱ and Ⅲ, vertical shear and
combined type by young classification. Subjects were divided into THE IMPACT OF A NATURAL DISASTER ON THE INCIDENCE
two groups, with (injured group) and without (non-injured group) OF PENETRATING TRAUMA IN AN URBAN POPULATION
intra-abdominal solid organ injury. Data included demographics, JL Avegno (1), S D'Andrea (2), A McFarlin (1), L Moreno-
mechanism of injury, initial hemodynamic status, laboratory Walton (3), A Plyer (4)
results, revised trauma score (RTS), injury severity score (ISS),
amount of transfusion, admission to the intensive care unit (ICU), 1. Emergency Medicine, Louisiana State University Health Sciences Center, New Orleans,
and mortality. United States
RESULTS. 2. Emergency Medicine, Louisiana State University Health Sciences Center & Harvard
Of all 363 study subjects, injured group were 60 patients (16.5%). University, New Orleans & Boston, United States
Most common injured intra-abdominal solid organs were liver and 3. Emergency Medicine & Research Genetics, Louisiana State University Health Sciences
spleen. Mean age of injured group was younger than non-injured Center, New Orleans, United States
group (37 vs 45 years old, p=0.005). Male patients was 56% in non- 4. Demography, City of New Orleans, New Orleans, United States
injured group and 70% in injured group (p=0.048). Mechanism of Corresponding author: Mme Moreno-walton Lisa ([email protected])
injury and stability of pelvic bone fracture were not different Key-words: Penetrating trauma ; Natural disasters ; Interpersonal violence
between two groups, however fall from height was higher in
injured group (7.4 vs 4.1 m, p=0.002). Initial blood pressure at BACKGROUND: Sociological theories hold that interpersonal
emergency department (ED) and RTS in injured group was lower violence increases following a disaster due both to stress caused by
than non-injured group. Shock at ED was more presented in injured lack of resources and to break down of societal organization which
group. For bivariate logistic regression test with significant factors normally serves to control the behaviors of marginally functioning
from univariate analysis, early factors associated with intra- personality types. Although many studies have been done on the
abdominal solid organ injuries for pelvic bone fracture was fall impact of Hurricane Katrina (K), none have looked at the impact on
from height. Clinical outcomes including ISS, the amount of interpersonal violence.
transfusion, the rate of invasive treatment, ICU stays and mortality HYPOTHESIS: Interpersonal violence, as represented by PT,will be
was more severe in injured group. increased following K.
CONCLUSIONS. METHODS: This is a retrospective chart review of all entries to the
Higher fall from height was early factors associated with intra- Trauma Registry from 1/01-8/05 (pre-K data= 3824 entries) and
abdominal solid organ injures for pelvic bone fractures. There is a 4/06-12/10 (post-K data= 3076 entries). Entries representing self
need to decide on a early diagnostic and therapeutic plan regarding inflicted wounds were excluded. All individuals living in the Level
the possibility of intra-abdominal solid organ injury for patients One trauma catchment area were included in the population
with pelvic bone fractures. demographics. Being treated at the Level One Trauma Center was
used as the surrogate marker for being a victim of PT. Data was
P874 ________________________________ Traumatology analyzed by the calculation of totals and percentages. Odds ratios
and confidence intervals were calculated for discrete variables.
THE CLINICAL ANALYSIS OF PATIENTS WITH RESULTS: There is no significant change in the mean rate of PT in
FASCIOTOMIES IN THE 2011 VAN EARTHQUAKE the 5 years post-K compared to the 5 years pre-K. PT rate rose
G. Görmeli (1), CA Görmeli (2), R. Dursun (3) significantly in the 2004-5 pre-K period (63.74-70.23) and dropped
significantly in the year post-K (70.23-60.15). K had no statistically
1. Orthopedics and Traumatology, Van Training and Research Hospital, Van, Turkey significant impact on the likelihood of being stabbed vs. being shot.
2. Radiology, Van Training and Research Hospital, Van, Turkey Pre-K crude died of wounds in the ED rate = 7.48%; 4.71% post-K.
3. Emergency Department, Van Training and Research Hospital, Van, Turkey Patients were less likely to be resuscitated from PT pre-K (OR
0.612; CI 0.498-0.759). Pre-K post-resuscitation mortality (survived
to admission, death before discharge) = 12.42%; 9.59 post- K.
BOOK OF ABSTRACTS 457
Victims of PT pre-K who survived resuscitation were more likely to surrogate markers for severity of attack. Pearson's chi square test
die, even when adjusted for ISS. There was no difference in the was used to analyze categorical data; Wilcoxon rank test for non-
risk of being male. K had a negative impact on the risk of Black parametric data.
race on the likelihood of being a victim of PT (OR 0.489; CI 0.430- Results: In the two years immediately post-Katrina there was a
0.556). There was no impact on age as a risk factor. Alcohol was statistically significant per-capita increase in the incidence of
more likely to be associated with PT post-K than pre-K (OR 1.71; violence against women. Although the percentage of assaults by
95%CI= 1.16-1.37). Drug use was more likely to be associated with multiple perpetrators did not increase, an increase in other
PT post-K (OR 1.28; 95% CI= 1.164-1.411). There was no statistically markers of severity was noted.
significant difference in ISS levels. K made New Orleans (NO) Conclusion: There is an association between natural disaster and
residence less of a risk factor for being a victim (OR 0.499; CI 0.449- increased violence against women in this study. Implicaitons for
0.554), and post-K the impact of being within the city limits as a disaster workers include increased awareness and efforts at
risk factor was also diminished (0.773, 0.701-0.851). For patients prevention. Women should be empowered to self-protection and
who survived ED resuscitation, there were no differences in the vigilence. Increased knowledge and support is required to
distribution of dispositions from the ED to the floor, OR, ICU, step- stimulate immediate recovery of the affected female population.
down unit or home. Although all-cause mortality for victims of PT
was significantly higher pre-K, the disposition of survivors to home, P877 ________________________________ Traumatology
acute care facility, medical facility, non-medical facility or by AMA
was not affected by the storm. TRAUMATIC TENSION PNEUMOTHORAX DUE TO BICYCLE
CONCLUSIONS: Rates of PT actually decreased following K. ACCIDENT: A CASE REPORT
Mechanism of PT, gender, age, ISS, disposition from the ED and MT Gokdemir (1), H Kaya (1), O Sogut (1), MO Erdoğan (2), F
type of hospital discharge were unaffected. Victims of PT had Güngörmez (3)
improved overall survival post-K. Post-K victims were more likely
to be intoxicated (alcohol or drugs) than were pre-K victims. This 1. Emergency Department, Harran University, School of Medicine, Sanliurfa, Turkey
suggests a higher level of post-K substance use, but also a higher 2. Department of Emergency Medicine, Haydarpaşa State Hospital,, Dr, Istanbul, Turkey
level of disinhibition effect and a lower level of intent than pre-K. 3. Emergency Department, Dr, Şanlıurfa, Turkey
Being Black, living in NO and being in NO were less of a risk post-K Corresponding author: Mr Gokdemir Mehmet Tahir ([email protected])
than they were pre-K. Key-words: Tension pneumothorax ; Needle decompression ; Emergency Department
P876 ________________________________ Traumatology Background
A tension pneumothorax is the accumulation of air causing a
THE IMPACT OF HURRICANE KATRINA ON VIOLENCE pressure rise in the pleural space, generated by a unidirectional
AGAINST WOMEN IN ORLEANS PARISH, LOUISIANA valve mechanism. The diagnosis is said to be clinical since it results
JL Avegno (1), IA Espinal (2), L Myers (3), L Moreno-Walton in a life-threatening condition. Emergent needle decompression
(4) should be carried outbefore confirmation by chest x-ray when the
patient is haemodynamic instable.We present A children's case
1. Emergency Medicine, Louisiana State University Health Sciences Center, New Orleans, with left tension pneumothorax due to a bicycle accident, severely
United States deteriorated with loss of consciousness and clinically diagnosed in
2. Undergraduate, Oberlin College, Oberlin, United States Emergency Department.
3. Biostatistics, Tulane University School of Public Health & Tropical Medicine, New Case presentation
Orleans, United States On 2 october 2010 A 15-year-old male children transferred to the
4. Emergency Medicine & Research Genetics, Louisiana State University Health Sciences emergency department presented loss of consciousness and
Center, New Orleans, United States deteriorated vital signs. According to the 112 transfer team
Corresponding author: Mme Moreno-walton Lisa ([email protected]) records, he injuried due to bicycle accident. He complained of
Key-words: interpersonal violence ; women ; natural disasters aggravating dyspnea after accident and during ambulance transfer,
cyanosis was detected and supplemental oxygen was delivered by
Objectives: Intimate partner violence (IPV) is an ongoing public mask. Upon arrival to the emergency department, the patient
concern. Post-traumatic stress disorder (PTSD) is documented to presented with a cyanosis, stupor or semi-comatose mental state,
be a contributing factor in IPV perpetration. Major stressors and severe tachyarrhythmia. Heart auscultation demonstrated
include large scale natural disasters. In 2005, Hurricane Katrina tachycardia (140 bpm) and the jugular venous pressure was raised.
devastated the New Orleans. The percentage of homicides Physical examination of the lungs revealed tachypnoea, decreased
resulting from IPV rose from 9.56% before the storm to 14.22% in breath sounds on the left side and unequal chest rise. A large bore
the year following. The purpose of this study is to compare sexual needle (16 G) immediately inserted into the second intercostal
assault rates, severity, and characteristics pre- and post-hurricane; space of the mid-clavicular line to decompress intrathoracic
and to examine what effect the disaster itself had on this type of pressure and after than percutaneously checked SaO2 increased
violence as seen in the Emergency Department. dramatically to higher than 95%. After niddle decompression,
patient’s breeting was relieved relatively and portable chest X-ray
Methods: This study is a retrospective chart review of data was performed. On the chest x-ray a left tension pneumothorax,
collected routinely as part of the Sexual Assault Nurse Examiner subtotally collapsed left lung and right shift of the mediastinum
(SANE) program and maintained on excel spread sheets. Data was were seen on the left side. Subsequently an apical chest tube was
examined for the five year periods pre- and post-Katrina. Number inserted on the left side. The chest tube were kept on suction (-10
of assailants, verbal or physical threats, evidence of external cm H2O) to accelerate the rate of healing. For an emergency
trauma, trauma to the genitals or face (identified in the literature laboratory study blood samples also was drawn. The arterial blood
as markers of increased rage) and pain scale were used as gas results upon arrival and after insertion of the chest tube werea
pH of 7.2, PCO2 of 54.8 mmHg, PO2 of 81. mmHg, and SaO2 79.5%,
BOOK OF ABSTRACTS 458
and a pH of 7.38, PCO2 of 41.5 mmHg, PO2 of 168 mmHg, and a 2. Emergency Department, Haydarpasa Numune Training and Research Hospital,
SaO2 of 98.7%, respectively. The patient was transferred to the ICU Istanbul,Turkey
for close monitoring of the patient’s mental state and other 3. Radiology, Ministry of Harput General Hospital, Elazig, Turkey
parameters related to tension pneumothorax. Within several hours 4. Emergency Department, Medical Faculty Hospital of Dicle University, Diyarbakir, Turkey
after admission into the ICU, the patient’s mental state and vital Corresponding author: Mr Gülaçti Umut ([email protected])
signs were restored to within normal limits. Two hours after Key-words: fall ; shoulder ; pain
admission into the ICU breathing was maintained with an adequate
SaO2 level. Patient was evaluated by a neurosurgeon, who Introduction: Due to the anatomical and biomechanical
confirmed that there were no significant sequela assosiated with characteristics of the shoulder, traumatic soft tissue lesions are
the possibility of hypoxic brain damage. more common than osseous lesions. Superior labrum anterior-
Conclusion posterior (SLAP) lesions have been described as a cause of shoulder
In this case the presentation of the tension pneumothorax was pain in 1990. SLAP is injury or separation of the glenoid labrum
clinically diagnosed. When a traumatic tension pneumothorax is superior where the long head of biceps adheres. SLAP lesions are
clinically suspected a needle decompression should be performed. usually not seen on plain direct radiographs. Shoulder magnetic
In the absence of haemodynamic compromise, it is prudent to wait resonance imaging (MRI) and magnetic resonance arthrography are
for the results of an emergent chest x-ray prior to intervention. useful for diagnosis. Most valid method for patients’ not diagnosed
radiologically is arthroscopic examination. Our aim is emphasizing
P878 ________________________________ Traumatology the need to consider the diagnosis of SLAP lesions in post-
traumatic shoulder pain, for emergency department patients.
THE ROLE OF BEDSIDE ULTRASONOGRAPHY ıN Case report: Fifty-seven-year-old male patient was admitted to
EMERGENCY DEPARTMENT FOR SCAPHOID FRACTURES emergency department due to a low fall on his shoulder. In
A.Yildirim, N. Vandenberk, E. Unluer, A Karagoz physical examination, active and passive shoulder motion was
normal except painful extension. Anterior-posterior shoulder X-ray
Emergency Department, Izmir Ataturk Research and Training Hospital, Izmir, Turkey was normal. Patient required orthopedics consultation due to
Corresponding author: Mme Van Den Berk Nergiz ([email protected]) persistent shoulder pain in emergency observation unit and patient
Key-words: scafoid ; emergency ; ultrasound was admitted to orthopedic clinic. Type 2 SLAP lesion was detected
in fat suppressed Axial T2 weighted MRI sequences. Patient was
Abstract referred to a third level hospital due to lack of arthroscopy in our
Objective: Our objcetive was to study the accuracy of emergency hospital.
medicine (EM) physician performed bedside ultrasonography (BUS) Conclusion: Shoulder traumas are usually soft tissue injuries with
in patients with clinical suspicion of scaphoid fracture and normal no findings in X-rays. SLAP lesion is an uncommon cause of
radiographs. traumatic shoulder pain. For this reason, we recommend
Methods: After six-hour training program, from January to orthopedic consultation in post-traumatic persistent shoulder pain.
December 2011, an EM physician used BUS to prospectively
evaluate patients presenting to the emergency department (ED) P880 ________________________________ Traumatology
with clinical suspicion of scaphoid fracture and normal radiographs
underwent US examination of scaphoid prior to wirst MRI scan, VARIATION IN ACTIVATION OF TRAUMA TEAMS IN DUTCH
within 24 hours following wirst trauma. Outcome was determined EMERGENCY DEPARTMENTS
by official radiology reports of the MR Imaging. BUS and MR CJ Doggen (1), RE Egberink (2), MJ IJzerman (1), HJ Otten
imaging results were compared with Chi-square testing. (1), AB van Vugt (3)
Results: Of the 63 enrolled patients, 12 Patients were BUS-positive.
Of these, MR imaging results agreed with the BUS findings in 12 1. Health Technology & Services Research, MIRA Institute for Biomedical Technology and
patients who has cortical damages of scafoid with hematom. In 35 Technical Medicine, University of Twente, Enschede, Netherlands
cases have only hematom without cortical damages with the USG 2. Centre for Emergency Care (Acute Zorg Euregio), Medisch Spectrum Twente, Enschede,
and these were corroborated by MR imaging.A scafoid fracture was Netherlands
demonstrated by MRI in 2 patients in this group. The sensitivity, 3. Emergency Department, Medisch Spectrum Twente, Enschede, Netherlands
specificity, Positive predictive value, negative predicitive value, and Corresponding author: Mr Egberink Rolf ([email protected])
negative likelihood ratio for BUS were %85.7, %100, %100, %100 Key-words: trauma teams ; in-hospital trauma triage ; trauma team activation
and 0.14 respectively. The diagnostic accuracy of BUS were not
statistically different from MR imaging (kapa=0.938 p=0.001) Introduction: Trauma teams can be activated by emergency
Conclusion: BUS for diagnosis of scafoid fracture is another department (ED) staff to assess and treat a seriously injured
application of BUS in the ED. EM physicians can diagnose scafoid patient optimally. Some EDs have one trauma team available
fracture using BUS with high degree of accuracy. whereas other EDs have two or more different trauma teams. The
decision to activate a specific trauma team is mostly based on
P879 ________________________________ Traumatology information provided by the emergency medical service (EMS) and
is called in-hospital trauma triage. A system with a tiered response
POSTTRAUMATIC PERSISTENT SHOULDER PAIN: SUPERIOR may contribute to the efficiency of the in-hospital trauma triage
LABRUM ANTERIOR POSTERIOR (SLAP) LESIONS process by better resource allocation, improved cost containment
U Gulacti (1), MO Erdogan (2), Z Birkan (3), M İçer (4) and patient outcomes.
Objective: The aim of this study is to investigate and compare
1. Emergency Department, Ministry of Harput General Hospital, Elazig, Turkey current practice of in-hospital trauma triage and activation of
trauma teams in Dutch EDs.
Methods: A cross-sectional survey was conducted between May
30, and July 26, 2011 among managers of all 102 EDs in the
BOOK OF ABSTRACTS 459
Netherlands, using a semi-structured online questionnaire. The Conclusion: Work-related accidents are seen mostly in younger
questionnaire contained items about type of in-hospital trauma men. Most frequent patients discharge from emergency
triage system, composition of trauma teams at the ED and the depertmant after eveluation. Clinicians often decide abolishing
criteria used to activate these teams. with simple medical intervention according to staying in
Results: Seventy-seven (76%) questionnaires were included in the hospital,and while injuring of more than one system,the life-
analyses. Most EDs use a one-team trauma triage system threating rates develop.
(64%).The overall number of trauma team members varies from 3
to 16 professionals. 96% Of the EDs receive a pre-notification from P882 ________________________________ Traumatology
EMS, mostly by telephone (92%). 40% Of the pre-notifications is
communicated directly, 31% via an Emergency Medical Dispatcher DEMOGRAPHIC ANALYSIS OF PEDIATRIC PATIENTS
(EMD), 20% by both EMS and EMD and 9% in another way. The ED ADMITTED TO DEPARTMENTS WITH HEAD TRAUMA
nurse usually receives the pre-notification (96%), whereas the N Kozacı
decision to activate a team is made by different professionals at
the ED. Information mostly available in pre-notification is: blood acil tıp, adana NEAH, adana, Turkey
pressure (84%), pulse rate, age and gender (all 81%). The following Corresponding author: Mme Kozaci Nalan ([email protected])
criteria are mostly used for trauma team activation: Glasgow Coma Key-words: trauma ; head ; pediatrics
Score (85%), Airway, Breathing, Circulation (84%) and Revised
Trauma Score (83%). Only 56% of the EDs were satisfied with the Objective: The purpose of this study was to determine the
current situation on in-hospital trauma triage and found their demographic characteristics and mortalityof the pediatric head
system useful. trauma patients who presented to the emergency department.
Discussion: We identified a large variation in trauma team Material and Methods: This retrospective observational study was
activation across Dutch EDs regarding: 1. the in-hospital trauma performed in the tertiary care emergency department. All pediatric
triage system (number of teams) and composition and size of head trauma patients admitted to the emergency department
trauma teams; 2. how and by whom information about the between 1.12.2009-31.12.2010 were included in the study.
incoming patient is communicated between EMS and the ED and Patients’ demographic data, head computed tomography (CT)
by whom the decision for trauma team activation is made; 3. the results and mortality rates were evaluated.
criteria to activate the different trauma teams. Future research Results: Four thousand, two hundred fifty seven patients were
needs to address the criteria that could be used to efficiently and included in the study. One thousand, five hundred sixty three were
safely activate a specific trauma team and in what way decision girls and 2694 were
makers in Dutch EDs can be supported in the in-hospital trauma boys. The mean age was 6.3±5.16, and the most frequent age
triage process. range of trauma was 0-2 years (infancy). The major etiologic factor
was falling down. Of the 4208 patients, (98.8%) were exposed to
P881 ________________________________ Traumatology mild head trauma according to the Glasgow coma scale (GCS)
score. The most frequent CT finding in 114 (3.2%) of patients was
ANALYSIS OF OCCUPATIONAL ACCIDENTS ADMITTED TO skull base fracture.
EMERGENCY MEDICINE DEPARTMENT Conclusion: Most of the pediatric head traumas were minor head
N Kozacı injuries. Furthermore, most of them were falls from heights. The 0-
2 aged patients especially were exposed to head trauma, unlike the
acil tıp, adana NEAH, adana, Turkey literature. Motor vehicle accidents were the leading cause of
Corresponding author: Mme Kozaci Nalan ([email protected]) trauma between 10-14 years pediatric patients in whom the clinical
Key-words: Emergency ; occupational accidents ; judicial case status becomes more critical. The most common cause of death
was motor vehicle accidents in the study and the most lethal CT
Objective: In this study, we aimed to analyse the demographic finding was subarachnoid hemorrhage.
features of accidents at work admitted to an education and
research hospital, life-threatening content of the forensic reports, P883 ________________________________ Traumatology
simple medical intervention situations and outcomes in the
emergency department. TRAUMATIC CERVICAL DISC HERNIA
Material and Methods: In this study, patients admitted to S Karaman (1), E. Kadıoğlu (2), C Şen Tanrıkulu (1), E Acar (1)
emergency department and diagnosed accident at work during
January 1, 2009 and December 31, 2010 were evaluated 1. Emergency Department, Erzurum District Training and Research Hospital, Erzurum,
retrospectively. All of accidents at work were included in this study. Turkey
Categorical measurements obtained from data were summarized 2. Emergency Department, Kütahya Evliya Çelebi Training and Research Hospital, Kütahya,
as the number and percentage numerical measurements were Turkey
summarized as the mean and standard deviation. And the data Corresponding author: Mr Karaman Serhat ([email protected])
were statistically analyzed with using SPSS 16.O statistical program. Key-words: trauma ; herniations ; neurologic deficit
Results: Of the 406 patients, 96.55% were male and 3.45% were
female. The mean age of the patients were 32.80. Accidents at The trauma is to be caused increasingly human mortality and
work admitted mostly in December 2010, the most frequent injury morbidity. Mostly young and healthy people suffer from trauma
were limb injury with 62 %. Of the 73.65 % the patients were and if it is correctly diagnosed and treated, they can live healthy
discharged after evaluation from the emergency department. life.
Looking at the contents of the life-threatening reports 14.53% of
the patients had life-threating and 28.57 % were not resolve with
simple medical intervention.
BOOK OF ABSTRACTS 460
A 49-year-old male patient, had traffic accident, was admitted to P885 ________________________________ Traumatology
the emergency department. He was conscious and cooperative.
Arterial blood pressure was 130/70 mmHg, and heart rate was RETROSPECTIVE ANALYSIS OF PEDIATRIC TRAUMA CASES
92/min, and body temperature was 36.4ºC. Patient was included ADMITTED TO EMERGENCY MEDICINE DEPARTMENT
under control, and IV saline hydration was given. On examination N Kozacı
at that time, he had intense cervical pain, paresthesias on his
shoulders and neurologic deficits in his right arm. A fracture in the acil tıp, adana NEAH, adana, Turkey
left clavicula was existed in directly X-ray. Other direct and cervical Corresponding author: Mme Kozaci Nalan ([email protected])
x-ray were evaluated normal. The cervical vertebras were observed Key-words: pediatric ; trauma ; emergency service
normal in the cervical tomography. MRI was taken because neck
pain and neurologic deficits continued in right arm. Introduction and Aim: The purpose of this study is to determine
C3-4, C5-6, and C6-7 disk traumatic herniations were observed at the prognosis of the demographic characteristics, etiology,
MRI. The patient was admitted for urgent surgery by brain surgery morbidity and mortality rates of the pediatric trauma patients
department. Neurologic deficit was recovered in the early stage admitted to the emergency department of a training and research
after operation. hospital.
According to this case, all suspected cervical trauma patients Materials and methods: Pediatric patients who have been brought
should be immobility for cervical and other vertebras, too. to the emergency department of a training and research hospital
Neurological deficits should be determined immediately. We between 01.01.2010- 31.12.2010 because of trauma have been
determined that MRI is required for a complete exclusion of acute included to this study. The demographic data of the patients,
cervical injury in this case, too. distribution by seasons and months, the etiologic factors that cause
to trauma, how the patients have been admitted to the emergency
P884 ________________________________ Traumatology department, the conclusion figures of the patients in the
emergency department, and the data of the units where patients
ESOPHAGEAL FOREIGN BODY have been hospitalized, the treatments, average hospitality time,
S Karaman (1), E Acar (1), Z. Turktarhan (2), A Bayramoğlu the conclusion figures of the clinics where they have been
(3) hospitalized has been analyzed statistically.
Findings: Of the 18936 patient 12096 were boys and 6840 were
1. Emergency Department, Erzurum District Training and Research Hospital, Erzurum, girls have been included to this study. The mean was as 8,11 ± 5,19
Turkey in boys and 6,89 ± 5,04 in girls. The most common age for trauma
2. Thoracic Surgery, Erzurum Distric Training And Research Hospital, Erzurum, Turkey was 7-14 (% 36.15) it has been stated that the pediatric trauma
3. Emergency Department, Atatürk University Medical Faculty,, Erzurum, Turkey cases have been mostly admitted in spring and summer months.
Corresponding author: Mr Karaman Serhat ([email protected]) Extremity injuries (% 42,40) and falls (% 40,67) were stated as the
Key-words: early diagnosis ; foreign bodies ; radiological methods most etiologic causes. 815 of the patients have been hospitalized.
353 cases (% 43,31) received surgical invention while 462 (% 56,69)
Esophageal foreign bodies an emergency situation which can be cases received only medical treatment. The pediatric trauma
seen in all age groups, especially in childhood, sometimes leading patients were exitus by the following reasons: 10 (% 47,62) of them
to significant morbidity and mortality. As the duration of symptoms due to traffic accidents, 5 (% 23,81) of them due to falls , 5 (%
of foreign bodies increase, symptoms become more complicated 23,81) of them due to burns and 1 (% 4,76) due to drowning. It has
and difficult to diagnosis. Foreign bodies which waited for long been stated that 13 (% 61,90) cases were male and 8 (% 38,10)
time mainly patients were girls of a total 21 cases resulting in death.
due to mediastinit, esophagus tracheal fistula, can cause vascular Results: Most of the pediatric traumas become due to falls or
fistulas. As at childhood usually metallic money and toy parts are simple extremity injuries. Traumas are mostly seen between the 7-
absorbed; at advanced ages the substances such as meat, bone and 14 age range during the primary school. The most common
dental prostheses are absorbed. etiological factor in hospital admissions are falls. The most
A 10-year-old male patient, with sudden onset of severe common etiological cause of death in pediatric trauma are traffic
retrosternal, brought to the emergency room with chest pain. accidents.
Patient was conscious, agitated was seen. Ta: 100/70 Heart rate:
97, fingertip pulse oxygen rate was 98%. The lung was evaluated P886 ________________________________ Traumatology
normal by auscultation. Chest radiography was normal. At the ECG
normal sinus rhythm, there was no pathological finding. At the RETROSPECTIVE ANALYSIS OF ADULT TRAUMA CASES
Thorax CT scan of soft tissue density a foreign body revealed close ADMITTED TO EMERGENCY MEDICINE DEPARTMENT
to the density in the central part of the esophagus. The patient N Kozacı
could absorb liquid foods. Foreign body was planned to remove
with esophaguscopy the patient had a sudden relaxation after a acil tıp, adana NEAH, adana, Turkey
few mouthful of food was given. On the soft chest tomography Corresponding author: Mme Kozaci Nalan ([email protected])
there was no foreign body in esophagus tomography. Key-words: adult trauma ; emergency services ; epidemiology
Early diagnosis and treatment of foreign bodies have vital
importance because of serious complications. Radiological Objective: In this study, we aimed to analyse the demographic
methods have an important place in diagnosis. After diagnosis it features, etiology, the morbidity and mortality rates and prognosis
should be treated as early as possible. For a successful removal of
foreign bodies in today's conditions, Esophagus tomography is the
most effective and reliable method. As in our case the foreign
bodies can progress into the stomach spontaneously as we
increase peristalsis.
BOOK OF ABSTRACTS 461
of the adult patients admitted to the emergency department of a Results and Conclusion: A total of 4995 trauma patients have been
training and research hospital and diagnosed trauma. accepted to the trauma clinic during 2011. The job definitions of
Materials and Methods: Patients, admitted to the emergency the trauma nurses in the trauma team determined according to the
department of Adana Training and Research Hospital over 18 ages trauma profile of our clinic have been written down as items.
and diagnosed general body trauma during March 1, 2011 and Accordingly;
August 31, 2011 were included in the study. The speciality,
including demographic data, etiologic reason of trauma, how to Tasks of Nurse – 1:
apply, duration of hospitalization, hospitalization unit and Taking the patient to the bed with trauma board
completion format, mortality rates were recorded. And the data Placing the patient identity card after the patient identification
were statistically analyzed with using SPSS 16 statistical program. verification
Results: In study period, 110.495 patients admitted to the Evaluation of the risks of falling for the patient and taking the
emergency department. Of the 110.495 patients, % 12,29 were necessary precautions; lifting of the gurney balustrades
general body trauma. % 62,16 of these patients were male. Mean Monitoring the vital findings of the patient
age of the patients were 35,82. The most reason of trauma was Cardiac monitorization
soft tissue injuries. % 92,09 of patients applied directly and % 6,1 Ensuring that the material required for airway clearanceare ready
applied by 112 services to the emergency department. The most Ensuring that emergency medicines and materials are kept ready
admission route was extremity trauma. Multiple trauma rate was % Giving medications
18,17. GCS was between 13 and 15 in % 99,71, 9-12 in % 0,08 and Pain follow-up
3-8 in % 0,21 of the patients. Brain tomography was applicated Keeping records in full
mostly for screening and % 77 of these had no pathological sign. % Ensuring privacy
93,8 of the patients were discharged after evaluation from the Tasks of Nurse – 2
emergency department. Most of patients were admitted to the Opening of vascular access and drawing the required amount of
ortopedic clinic and mean duration of hospitalization was 5,51 blood
days. % 0,9 of patients diagnosed GBT died. The most reason of Fluid resuscitation, heating up of blood products and supplying to
death at emergency depertment was needlestick and sharp injuries the patient
and at clinics of hospital, the most reason of death was traffic Taking out the clothes of the patient, handing over the precious
accident. items to the judicial authorities with delivery record after informing
Conclusion: Most of general body trauma is simple trauma. the team leader
Patients can be discharged easily and in a short time period from Providing the required materiaflor the patient
emergency depertmant by taking complete history and examining Taking the blood samples to the laboratory (Full blood count,
carefully. Thus, unnecessary labaratuar tecniques are excluded and blood type and crossmatch, Coagulation profile, Metabolic panel,
loss of time reduces. So time to deal with heavily bad injured Ethanol, toxicology examination, pregnancy test, lactate and base
patients increases. Transporting trauma patients carefully to the deficit)
relevant hospitals with eligible ambulances can be possible by Providing the blood and fluid products
working coordinated in trauma centers and establishing an Sending the relatives of the patient to the clinic social service
organized trauma system only. specialist in order to prevent crowding in front of the room
Comments and suggestions: It is thought that nurses will be able to
P887 ________________________________ Traumatology use their time more effectively and carry out their duties more
efficiently if the tasks of the trauma nurses in the trauma team are
THE ROLE OF TRAUMA TEAM NURSES AT THE ANKARA written down. Another study is planned for the efficiency of clinical
UNIVERSITY IBNI SINA HOSPITAL EMERGENCY guidance.
H KARABULUT, S EKINCI, A DEMIRKAN, O POLAT
P888 ________________________________ Traumatology
Emergency Department, Ankara University Faculty of Medicine, ANKARA, Turkey
Corresponding author: Mme Karabulut Hulya ([email protected]) ANALYSIS OF GERIATRIC TRAUMA
Key-words: Trauma team ; Nurse ; Emergency department
C SEN TANRIKULU (1), Y TANRIKULU (2), S KARAMAN (1)
Introduction: Traumatic injuries are complex events since in
general they effect more than one system of the body and an 1. Emergency Department, Erzurum Area Education and Research Hospital, Erzurum,
experienced team is required for successful treatment. The Turkey
responsibility of nurses are very important in this team. The quality 2. General Surgery Department, Erzurum Area Education and Research Hospital, Erzurum,
of resuscitation and treatment carried out during the hours right Turkey
after the trauma are very important. To this end, a trauma team
has been determined at our emergency clinic and job definitions Corresponding author: Mme Sen Tanrikulu Ceren ([email protected])
have been defined for the nurses in the team.
Objective: To determine the nursing approach and roles for the Key-words: Emergency room ; Geriatric ; Trauma
nurses in the emergency clinic trauma team.
Materials and Method: It is deemed suitable to have at least 2 Aim: Geriatric people more exposed to trauma due to changes
nurses in the trauma team determined according to the trauma physiopathological caused by aging. The aim of this study was to
profile. It is also suggested in literature that there should be two evaluate the demographic characteristics of geriatric patients
nurses working simultaneously for trauma cases. The job admitted to the emergency clinic and their diagnosis and treatment
definitions of these two nurses have been defined as Nurse – 1 and processes.
Nurse – 2. Material Method: In our study, was to evaluate 1450 geriatric
trauma cases, who referred to Erzurum Area Education and
Research Hospital Deparmetn of Emergency Medicine, between
May 2011- April 2012.The patients were to evaluated from the
demographic characteristics, monts of exposure to trauma, body
BOOK OF ABSTRACTS 462
region to the affected trauma and the number of regions covered P890 ________________________________ Traumatology
by trauma, incidence of local-multiple trauma and hospitalized
clinics. TRAUMATıC HıP DıSLOCATıON IN A 3 YEAR-OLD GıRL
Findings: Of the evaluated 1450 cases, 790 (51.3%) were male and M Zumrut (1), M Ayan (2), M Baltacıoglu (1)
750 (48.7%) were female. The mean of age was 73.9. 1368 cases
were local trauma patients and 72 cases were multipl trauma 1. Department of Orthopedics, Konya Numune Hospital, Konya, Turkey
patients. The falls were the most common cause of trauma (82.3%) 2. Department of Emergency Medicine, Gaziosmanpasa University , Faculty of Medicine,
(p < 0.05). The extremities were the most affected body region. Tokat, Turkey
The soft tissue injury was the most observed trauma in cases of
local trauma, while the coexistence of the extremity and head and Corresponding author: Mr Ayan Murat ([email protected])
neck trauma was the most observed trauma in cases of multiple Key-words: traumatic dislocation ; children ; hip
trauma.
Conclussion: Geriatric trauma cases should be better examined, Introductıon:
judicial records should be kept fully and patients should treated in Traumatic hip dislocation in the pediatric population is an
a multidisciplinary approach, increased geriatric population in our uncommen injury and constitutes an orthopaedic emergency. It
country due to development of living standards. can be a consequence of minor trauma in young children whereas
greater force is required in adolescents or adults. Most children
P889 ________________________________ Traumatology have an excellent outcome after this injury. The urgent reduction
should be performed to achieve normal hip. Avascular necrosis is a
BILATERAL SHOULDER PATHOLOGY SECONDARY TO well-known and catastrophic complication of traumatic dislocation
ELECTRıCAL INJURY of the hip in children. The aim of this report is to create an
M Zumrut (1), M Ayan (2), M Baltacıoglu (1), E Marcıl (3) awareness about this rare occurance
Case:
1. Department of Orthopedics, Konya Numune Hospital, Tokat, Turkey We report the case of a 3 year-old girl who dislocated her right hip
2. Department of Emergency Medicine, Gazi Osman Pasa University , Faculty of Medicine, after her brother fell on her. The patient was evaluated with an x-
Tokat, Turkey ray comfirmed a posterior dislocation of her right hip. The hip was
3. Department of Emergency Medicine, Konya Numune Hospital, Tokat, Turkey promptly reduced with gentle manipulation and immobilized with
Corresponding author: Mr Ayan Murat ([email protected]) hip spica cast for 3 weeks. After removing the cast, load bearing
Key-words: shoulder ; electrıcal ınjury ; fracture restriction was applied for 3 weeks. Review at 6 months revealed
normal examination and no evidence of avascular necrosis on x-
Introductıon: ray.
Shoulder injury and more in particular bilateral involvement caused Conclusıon:
by electric shock is extremely rare and is sometime diagnosed late. Traumatic hip dislocation in childhood is a relatively rare injury and
It can occur as a dislocation or fracture-dislocation. Early diagnosis can occur as a result of trivial force. Urgent reduction within six
and treatment prevent to increase the risks of permanent injuries. hours of injury reduces the risk of avascular necrosis.
Treatment includes surgical and non-surgical techniques with
physiotherapy. In this report a case of right shoulder fracture- P891 ________________________________ Traumatology
dislocation and left shoulder fracture developed after an electrical
injury is presented. DOG TOOTH
Case: S Karaman (1), C Şen Tanrıkulu (1), A Bayramoğlu (2), O
A 50 year-old male patient referred immediately to our emergency Delice (1)
department with complaints of pain and motion inability of
shoulders after an electric shock (220 V alternating household 1. Emergency Department, Erzurum District Training and Research Hospital, Erzurum,
current ). The physical examination and x-ray findings revealed Turkey
fracture of greater tuberosity and dislocation on right shoulder and 2. Emergency Department, Atatürk University Medical Faculty,, Erzurum, Turkey
also fracture of greater tuberosity on left shoulder. Dislocated Corresponding author: Mr Karaman Serhat ([email protected])
shoulder was promptly reduced under iv sedation. Velpeau Key-words: animal bites ; foreign bodie ; x-ray
dressings were applied for four weeks, then gentle physical therapy
was applied to improve range of motion capacity. Recovery was Animal bites can cause some bruises and injuries such as
uneventful for both shoulders four months after the injury. penetrating, lacerations, contusion, and rupture. As a result;
Conclusıon: infection, disfigurement, zoonotic disease, and even serious
Shoulder injury caused by electric shock is extremely rare. It must complications to lead a fatal may develop. Injuries associated with
always be kept in mind that fractures and dislocations of shoulder dog bites are mainly occurred in the extremities. Tendon, articular,
might occur in electrical injury. Early diagnosis and treatment mean bone, vascular tissue, hand, face, foot and genital area injuries
better outcome. have high risk infection.
52-year-old male patient applied to emergency department with
pain and swelling the right arm because of the dog bites a day
before. There were teeth marks, swelling, redness, and tenderness
in his right hand-wrist dorsal. Wound care, rabies and tetanus
vaccine was performed. Opacity, being compatible with the dog
teeth on the ulnar bone was observed in the patient's right
BOOK OF ABSTRACTS 463
forearm and wrist X-ray. The dog tooth on the right ulnar bone was capability to provide immediate surgical intervention to those
removed with surgery. who need it[4].
Dead - necrotic tissues and foreign bodies, caused by animal bites,
must be removed from the wound. Dogs can lead to bone fractures P893 ________________________________ Traumatology
during biting due to powerful jaws. Plain radiographs are required
to show the presence of fractures and tissue foreign bodies in ARE OCCUPATIONAL ACCIDENTS A DESTINY? ARE
articular and hand injuries. EMERGENCY SERVICES FUNCTIONAL?
N Kurt (1), H Gönüllü (1), R Dursun (2), S Karadas (1), S
P892 ________________________________ Traumatology Güner (3)
CASE REPORT: WHEN OBESITY SAVES LIFE. 1. emergency department, Yüzüncü Yıl University, van, Turkey
FT SÖNMEZ (1), F BÜYÜKÇAM (2), CI SÖNMEZ (3), MC 2. emergency department, Van Region Training and Research Hospital, van, Turkey
MERMERKAYA (4), M. TANDOĞAN (5) 3. ortopedy department, Yüzüncü Yıl University, van, Turkey
Corresponding author: Mr Dursun Recep ([email protected])
1. Department of Emergency Medicine, Yenimahalle State Hospital, Ankara, Turkey Key-words: Occupational Accidents ; emergency department ; injury
2. Department of Emergency Medicine, Dışkapı Y.B.Training and Education Hospital,
Ankara, Turkey Introduction
3. Family Medicine, Kalaba Primery Care Senter, Ankara, Turkey We encounteer occupational accidents as an important problem in
4. Family Medicine, Atatürk Training and Education Hospital, Ankara, Turkey Turkey like throughout the world . According to the statistics,
5. Department of Emergency Medicine, Esenyurt State Hospital, Istanbul, Turkey 64316 occupational accidents occured in Turkey in 20091. As being
Corresponding author: Mme Turan Sönmez Feruza ([email protected]) a center for immediate care of occupational accidents, the
Key-words: abdominal stab wounds ; conservative treatment ; penetrating trauma funtioning of emergency services are of great significance.
Case report
Introduction A male patient injured by an iron stick from his foot while working
Penetrating abdominal injuries are associated with high risk of life- at the construction site was assessed in the emergency
threatening organ injury. Most patients require acute surgery. department. During his examination, an entry cavity from 1/3 in
The management of penetrating abdominal injury has undergone a the sole of the right foot and an exit cavity from the right ankle of
few paradigm shifts in the past century. Up until the early 1900s, the right foot were available. In his taken graphics, there was a
penetrating abdominal injury was managed conservatively. During fracture line in his 4th and 5th metatarsus basis of the right foot
World War I, however, it was discovered that patients who and a foreign substance was also present. The patient was
underwent mandatory operative exploration with subsequent vaccinated against tetanus shot and his wound was dressed. He
intervention had a better chance of survival, and this soon was taken into the operation room after providing his analgesia.
became the standard of care[1]. In 1960, Shaftan, having noticed The exit end of the foreign substance was cut and removed from
a high rate of negative laparatomies, published a report on the the its entrance point. The tissues were sutured by carrying out
non-operative management of abdominal injury; he had managed injury debridement. The fractures in the metatarsus basis were
125 of 180 consecutive patients with abdominal injury without dealt with in clased reduction and short leg was encased in plaster.
surgery, with a mortality rate of less than 1 per cent[2]. Similar Conclusion
reports were subsequently presented and interest in the When compared with developed nations, it shows that we are not
selective non-operative management of penetrating abdominal in a good position in terms of the the number of the accidents
wounds began to increase[3, 4]. The ability to manage patients happened and mortality rate1. Protective measures and
without having to perform an operation means not only fewer compliance with the rules on the part of health personnel are
potential postoperative complications, but also decreased costs essentia in preventing occupational accidents, on the other hand,
and resource use[5, 6]. rapid funtioning at emergency rooms will also lessen the morbidity
Selective non-operative management for stab wounds is now and mortality rate.
commonly practiced. Reference
We reported a case of penetrated abdominal injury treated 1.Ceylan H. Türkiye’deki İş Kazalarının Genel Görünümü Ve Gelişmiş
conservatively . Ülkelerle Kıyaslanması. International Journal of Engineering
Case Report Research and Development. 2011:3.2,
A 30 year male was admitted to emergency department with a 18-24.
hobnail stabbed on his stomach.
He has fallen down on a bunch of industry nails on his workplace P894 ________________________________ Traumatology
and found out one of them stucked in his stomach.
On abdominal examination the stomach was soft, no tenderness THE EFFECTS OF THE BLOOD ALCOHOL LEVELS ON THE
was found. US showed an artifact on the anterior abdominal wall INJURY SEVERITY AND COST IN THE TRAUMAS CAUSED BY
and no free fluid inside. As the patient had abdominal obesity the MOTOR VEHICLE ACCIDENTS
nail had happen to slightly penetrate and not damage any solid N. Akay (1), G. Kurtoglu Celik (2), O. Karakayalı (3), M.
organ. Memis (4), F. Tanrıverdi (5), S. Vural (6)
The foreign body, about 5 cm length, was removed and the patient
was followed up for 24 hours. As no extra pathology developed he 1. Emergency department, Sivas Numune Hospital, Sivas, Turkey
was discharged. 2. Emergency department, Ataturk Training and Research Hospital, Ankara, Turkey
Dİscuscion 3. Emergency department, Teaching and Research Hospital in Kocaeli Derince, Kocaeli,
Selective non-operative management of penetrating abdominal Turkey.
injuries is recommended in facilities with the resources and 4. Emergency department, Teaching and Research Hospital in Urfa, Urfa, Turkey
experience to select and monitor patients carefully, along with the
BOOK OF ABSTRACTS 464
5. Emergency department, Necip Fazil Kahramanmaras City Hospital, Kahramanmaras, concurrent injuries, facial bone fractures were found in 25% and
Turkey 23.2% of adults and children, respectively. Thoracic (7.5%) and
6. Emergency department, Bartın State Hospital, Bartın, Turkey abdominal injury (2.5%) were diagnosed in adults, but not in
Corresponding author: Melle Kurtoglu Celik Gulhan ([email protected]) children. Skeletal injuries were seen in 12.5% of the adults, while in
Key-words: Alcohol ; Motor Vehicle Accident ; Cost 1.8% of the children. Among all patients, 10.5% required intensive
care unit admission for a mean duration of 8.63±9.47 (range: 1-30)
Introduction and Aim: Traffic accidents are one of the basic days. Linear fracture was the most common skull fracture both in
problems of the world and Turkey, which require to be examined children and adults, which was found as 69.6% and 52.5%,
and solved. The aims of this study are to detect the effects of the respectively. Frontal bone fracture (%46.4) was the most common
alcohol on the injury severity and death in the traumas which are fracture among children; followed by temporal (15.2%) and
caused by motor vehicle accidents, and to state the significance of occipital (14.3%) bone fractures . In adults, frontal bone fracture
the problem for society. (27.5%) was the most common skull fracture; followed by temporal
Material and Methods: Four hundred forty-five (445) patients who (25%) and parietal (15%) bone fractures. Trauma severity was
admitted to Atatürk Training and Research Hospital Emergency distrubited as mild head trauma in 92.9% of the children, whereas
Department between January 2010 and December 2011 because of moderate head trauma in 4.5% and severe head trauma in 1.8% of
the traumas after motor vehicle accidents are enrolled in the study, the children. In addition, it was found that there was mild head
and their ages, sexualities, blood alcohol levels and vehicle types trauma in 52.5% of adults, while moderate and severe head trauma
are recorded retrospectively. Abbreviated Injury Score (AIS) and in 17.5% and 30%, respectively. Glasgow Outcome Scale was found
Injury Severity Score (ISS) were detected for each patient according as 5 in 99.1% and 4 in 0.9% of children. In adults, GOS score was
to trauma regions and severity. The patients were divided into two found as 5 in 62.5%, 4 in 7.5%, 3 in 2.5% and 1 in 27.5% of adults.
groups according to the blood alcohol levels (< 0,5 promil and ≥0,5 Discussion and Conclusion. A statistically significant prognostic
promil). relationship was found between GOS score and concurrent injuries,
Results: The blood alcohol levels were < 0,5 promil in 341 scalp swelling, TBI, Glasgow Coma Scale (GCS) score or Child’s
patients(76,6%) and ≥0,5 promil in 104 patients (23,4%) of 445 Glasgow Coma Scale (CGCS) score at presentation, age or
patients who enrolled in the study. There was no statistically neurologic deficit. There was no significant prognostic relationship
significant difference between the groups in terms of ages (p: between GOS and sex, fracture type, nausea or vomiting.
0,754), but statistically difference was detected in terms of Injury
Severity Score (ISS), observation time in the emergency P896 ________________________________ Traumatology
department and cost (p< 0,001).
Conclusion: Drunk-driving is one of the most important reasons of EVALUATION OF ADULT PATIENTS WITH MINOR HEAD
the traffic accidents. In some studies it has been shown that drink- INJURY
driving was responsible for 47%of fatality, 20%of injury and 10%of E Coban, O Guneysel, G Simsek
financial damage in the traffic accidents. In conclusion drunk
driving increases the accident ratio as well as it affects the injury Emergency Medicine Clinic, Dr. Lutfi Kirdar Kartal Education and Research Hospital,
severity. Istanbul, Turkey
Corresponding author: Melle Simsek Gozde ([email protected])
P895 ________________________________ Traumatology Key-words: head injury ; head computed tomography ; emergency
EPIDEMIOLOGY AND PROGNOSTIC FACTORS OF SKULL Objective. The aim of this study is to analyze epidemiology of
FRACTURES DUE TO HEAD TRAUMA adults cases with minor head trauma and to identify the high risk
O Guneysel, M Simsek, G Simsek groups for head CT.
Methods. Four hundred and fifty patients who presented to
Emergency Medicine Clinic, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Emergency Department of Dr. Lütfi Kırdar Kartal Education and
Istanbul, Turkey Research Hospital with minor head trauma between 15 January,
Corresponding author: Melle Simsek Gozde ([email protected]) 2012 and 15 March, 2012 were prospectively and observationally
Key-words: head trauma ; skull fracture ; epidemiology evaluated. Age, gender, Glasgow Coma Scale at presentation,
trauma mechanism, complaint at presentation, status of additional
Objective. In the present study, it was aimed to identify measures (alcohol, anticoagulant use, drug intoxication, bleeding
epidemiological data of the cases with skull fracture due to head diathesis, history of shunt), head CT scan (performed or not),
trauma and factors those affect prognosis. physical examination and outcome (discharge, observation,
Methods. Electronic records and charts of 152 patients, who admission, operation) were evaluated. Patients under age of 16
presented to Emergency Department of Dr. Lütfi Kırdar Kartal and those with a trauma mechanism including penetrating injury or
Education and Research Hospital with trauma and were diagnosed firearm injury were excluded.
as skull fracture between May 1st and September 1st 2011, were Results. Of the cases, 126 (28%) were women and 324 (72%) were
retrospectively evaluated. men. Mean age was 40.99±17.87 years, ranging from 16 to 89
Results. There were 112 children (73.7%), aged between 0 and 16 years. Young patients (16-40 years old) were accounted from
years, and 40 adults (26.3%). Sixty-seven percent of the children 57.2% of the cases. Leading trauma mechanism was motor vehicle
were boys; whereas 80% of the adults were men. The leading accident; followed by falls and violence. Motor vehicle accidents
causes of trauma etiologies were consisted of fall from height, comprised 40.3% of all trauma causes, while in-vehicle accidents
simple fall and out-vehicle traffic accidents in children, while fall alone comprised 26.0%. Out-vehicle accidents and violence were
from height, out-vehicle traffic accident and violence were primary the most frequent causes for trauma in patients with skull fracture,
causes in adults. There was traumatic brain injury (TBI) in 17% of while fall from height was the most common cause in patients with
children and in 70% of adults. Among the most common traumatic brain injury (TBI). Of the cases, Glasgow Coma Scale
(GCS) was found as 15 in 94.7% and 14 in 5.3%. TBI was detected in
BOOK OF ABSTRACTS 465
higher rates among patients with a GCS of 14; whereas skull both groups. The indication for treatment with oral anticoagulant
fracture among patients with a GCS of 14. Head CT scan was was atrial fibrillation in 52.45% and thromboembolic disease in
performed in 73.6% (n=331) of the cases. Among CT scans, 13% 42% of the cases.
was interpreted as abnormal. Most frequent abnormal CT findings Patients in the “VKA” group returned significantly more frequently
included linear fracture (34.9%), subdural hematoma (25.6%) and in the ER than the “control without VKA” group (17.7% returned
subarachnoid hemorrhage (16.3%). Linear fractures were most more than once time versus 1.5%, p <0.001, Fisher’s test) but they
commonly accompanied by pneumocephalus and subdural had significantly fewer fractures (45% versus 74 %, p <0.001,
hematoma. Of all cases, 0.7% underwent operation. Fisher’s test). The frequency of bruises/hematomas was
Discussion and Conclusion. GCS of 14, vomiting more than 3 times significantly higher in the “VKA” group than the “control without
and scalp laceration comprised high risk for prediction of abnormal VKA” (31% versus 15%, p <0.001, Fisher’s test).
head CT. There was no statistically significant relationship between Concerning the need for hospitalization, patients in the “VKA”
abnormal CT scan and age, gender, cause of trauma, complaints at group were 2.6 times more likely to return home after a stay in ER
presentation other than vomiting more than 3 times, physical than the “control without VKA” group (44.2% versus 24.2%, p
examination findings other than scalp laceration, alcohol or <0.001, Fisher's test). The hospitalization of those in the “VKA”
anticoagulant use. group was significantly lower than those in the “control without
VKA” group. In particular hospitalization was much lower in the
P897 ________________________________ Traumatology trauma unit (28% versus 51%, p <0.001, Fisher's test) and less
surgery was performed (28% versus 51.3%) than in the “control
MANAGEMENT AND OUTCOME OF TRAUMA PATIENTS without VKA” group. However, patients with oral anticoagulant
(HEAD INJURIES EXCLUDED) OVER 75 YEARS OLD AT THE treatment stayed significantly longer in the ICU unit, (p = 0.019,
EMERGENCY DEPARTMENT: IMPACT OF ORAL Fisher's test) without having a significantly higher mortality (p =
ANTICOAGULANT TREATMENT 0.28, Fisher's test). The need for transfusion was not significantly
C.Patarin (1), P.Bilbault (2), J.Kopferschmitt (3), different in the two groups but the average number of blood units
Y.Gottwalles (1), C.Kam (2), M.Mihalcea (2) given was greater in “VKA” patients than in “control without VKA”
patients (3.22 versus 2.63, p = 0.050, Fisher's test).
1. Emergency Department, Hôpital Civil de Colmar, Colmar, France 9.8% of the “VKA” patients presented severity criteria described by
2. Emergency Department, Hôpital de Hautepierre, Strasbourg, France the HAS with need to reverse oral anticoagulant therapy. Only
3. Emergency Department, Nouvel Hôpital Civil, Strasbourg, France 11.54% of them had a correctly managed reversal of anticoagulant
Corresponding author: Melle Patarin Christelle ([email protected]) in accordance with the HAS guidelines. The hemoglobin rate for the
Key-words: Emergency ; anticoagulant ; elderly oral anticoagulant overdosed patients was significantly lower than
patients with correct INR (11.6 g / dL versus 12.4 g / dL, p = 0.024;
Introduction Fisher test).
Nine percent of the French population is over 75 years old, 1.4% of Conclusion
these are treated with oral anticoagulants. In our study, among patients over 75 years old admitted to our ED
Falls are the third cause of death in home accident among the for falls, there were fewer hospitalizations concerning patients
elderly. Vitamin K antagonists are the first cause of iatrogenic with oral anticoagulants than without. This was probably related to
accident. the lesser number of fractures observed in the “VKA” group
The purpose of this study was to analyze patients over 75 years old compared to the “control without VKA” group. Nevertheless
treated with oral anticoagulants admitted at the Emergency Room transfers to the ICU were significantly higher in the « VKA » group
(ER) for trauma (head trauma excluded). We studied mortality, than in the control group. So, we have shown in our ED that HAS
morbidity, management, and the outcome of these patients by guidelines have not been applied for the reversal of oral
comparing them to a control group. anticoagulant therapy.
The secondary objective was to observe the compliance of the
reversal of vitamin K antagonist in this cohort in accordance with P898 ________________________________ Traumatology
the guidelines of the “Haute Autorité de Santé” or “HAS”, (High
Authority for Health in French), updated in 2008. EVALUATION OF DEMOGRAPHIC AND CLINICAL FEATURES
Patients and methods OF PATIENTS WITH HEAD INJURIES WHO HAD
We conducted a retrospective controlled cohort study from PATHOLOGICAL FINDINGS AT COMPUTED TOMOGRAPHY
January to June 2010, in our adult ED. IN EMERGENCY DEPARTMENT
The study included patients born in 1935 and earlier, coded « C Şahin (3), Y Yavuz (1), HU Akdemir (1), L Duran (1), C Katı
trauma » on the emergency register, and excluding those with « (1), C Çokluk (2)
head injury » (based on the International Statistical Classification of
Diseases and Related Health Problems, ICD-10). Two groups were 1. Emergency Department, Ondokuz Mayıs University Medical Faculty Hospital, Samsun,
defined: patients with vitamin K antagonists named “VKA” group, Turkey
and patients without anticoagulant treatment named “control 2. Neurosurgery Department, Ondokuz Mayıs University Medical Faculty Hospital,
without VKA” group. From the latter we used a random table of Samsun, Turkey
patients to obtain two cohorts of the same size. 3. Emergency Service, Samsun Training and Research Hospital, Samsun, Turkey
Results Corresponding author: Mr Akdemir Hizir Ufuk ([email protected])
During the 6 months of the study, 17617 patients were admitted in Key-words: Head injury ; Computed tomography ; Prognostic factors
the ER. Among these patients, 874 met the eligibility criteria. We
included 609 patients without anticoagulant treatment and 265 Objective: The clinical approach to patients head injury is one of
with vitamin K antagonists. After using the random table, we the most persistent and comprehensive problems of modern
obtained two panels of 265 patients in each group. Demographical emergency services at today. These injuries are pathologies that
data (age and sex) and in-hospital mortality were comparable in are fatal, debilitating and require long term treatment and care.
BOOK OF ABSTRACTS 466
Early diagnosis and treatment significantly reduces morbidity and Corresponding author: Mr Akdemir Hizir Ufuk ([email protected])
mortality. In this study, we aimed to evaluate retrospectively some Key-words: Tomography ; Blunt ; Chest trauma
demographic and clinical characteristics who had pathological
findings at computed tomography in emergency department. Objectives: In blunt thoracic injuries, thoracic computed
Materials and Methods: In this study, we analyzed retrospectively tomography (CT) is reported to be superior to chest radiography in
hospital records and patient file findings of total 260 patients ≥18 detecting pathologies. The purpose of this study is to investigate
years with head injury that were determined pathological finding whether pathologies detected only in thoracic tomography after
at computed tomography (CT) and evaluated for trauma between blunt thoracic trauma affect patients' treatment and follow-up.
January 2007-December 2009 ın our emergency medicine clinic. Materials and Methods: In the study, the data of 232 patients
Patients’ age, gender, date of application, Glasgow Coma Scale referred to Ondokuz Mayıs University, Medical Facu1ty Emergency
(GCS), Injury Severity Score (ISS), Revised Trauma Score (RTS), vital Clinics with blunt thoracic trauma and underwent , chest
signs, hypoxia or the presence of hypotension, injury radiography and thoracic computed tomography between January
characteristics, injury mechanism, CT findings, concomitant system 2007 and August 2009 were retrospectively analyzed. Patients
injuries, treatment methods and results recorded into the patient were divided into three groups according to the pathologies
informator form which was previously created. Data was installed detected in radiological examinations as group 1 patients having
to Statical Package for Social Science (SPSS) 15.0. For Statistical pathology in both che st radiography and thoracic CT, group 2
analysis Chi-square test, One-Way ANOVA, Tukey test and Cox patients having pathologyonly in thoracic CT and group 3 patients
Proportional Hazard model was used. Statistical analysis and having no pathology detected. Groups were compared with respect
p<0.05 was considered significant. to types of treatment, mortality and morbidity. SPSS 15.0 program
Results: Pathological findings were found in CT of % 4.3 of all was used for statistical analysis and p value of <0.05 was
trauma patients admitted to emergency department during 3 years considered significant.
the study performed. 83.1 % of patients were male and mean age Findings: Of the 232 patients participating in the study, 181 (78%)
was 43.6±18.1. The most common cause of trauma were motor were male and the mean age of the patients was 47 ± 16 years.
vehicle releated injuries (55.8 %). Multiple contusions (40.8 %) and Extravehicular accident 108 (46.6%) was the leading cause of
cranium fracture (37.3 %) were frequently determined at patients’ trauma. Of the patients participating in the study, 153 (65.9%) had
CT. It was determined that surgical treatment was performed in thorax trauma accompanied with at least one additional injury.
29.6 % of patients. There was no significantly difference between Head trauma (25%) was found to be the most frequent
deceased and survivors patient groups when performed treatment accompanying injury. 72 patients (31%) received tube
methods were compared (p>0.05). Frequency of cervical spine thoracostomy, 3(1.3%) received thoracotomy and the remaining
injury was 8.1 % in head trauma patients had pathological findings (67.8%) received medical treatment. All the patients were
at brain CT. Abdominal injuries (37.3 %) were determined the most hospitalized and followed. The mean hospital stay was 8.6 days. Of
common system injuries concomitant to head trauma. Average ISS these patients, 60 (25.8) were in the intensive care unit and 50
score was 35.7 and average RTS score was 5.1 in patients with poor (21.5) received mechanical ventilator support. Of the 232 patients,
neurological outcome. In our study, mortality rate was 27.7 %. 136 (58.6%) were in group 1,69 (29.8%) were in group 2 and 27
Diffuse brain edema, multiple contusions, subarachnoid hemorrage (11.6%) were in group 3. When treatments given to groups were
and epidural hematoma detective in CT was found associated with compared; tube thoracostomy rate in group 1 was 45.5% where as
mortality. The most common cause of death were serious brain it was 14.4% in group 2. There was statistically significant
injury (61.1 %) and multisystem injuries with head trauma (23.6 %), difference between group 1 and group 2 as well as group 3 (p
respectively. There was a significant difference when deceased and <0.05). However, no significant different was observed between
survivors patients groups were compared for ISS and RTS scores group 2 and group 3 (p> 0.05). No statistically significant difference
(p<0.05). We determined that the presence of hypoxia or between three groups was observed with respect to thoracotomy
hypotension episode in first 24 hours significantly didn’t effect the treatment (p> 0.05). Inter-group patients survival analysis revealed
neurological outcomes of patients (p>0.05). Age, GCS, ISS and RTS 19 (51.4%), 14 (37.8) and 4 (10.8) mortalities in group 1, group 2
scores were determined as the most important indicators. The and group 3 respectively. While there was no statistically
most common deaths are determined in the first 24 hours after significant difference between group 1 and group 2 with respect to
injury (36.1 %) and between 3-7 days (33.3 %) respectively. mortality rates (p <0.05), statistically significant difference was
Conclusion: Head injuries are major public health problem which is observed between group 3 and group 2 as well as group 1 (p>
frequently as a result of motor vehicle releated injuries especially 0.05).
effected male patients group between 18-45 years aged. It is Conclusion: In blunt thoracİc trauma, thoracic CT is superior to
observed that multiple contusions are the most common chest radiography in displaying thoracic pathologies. While
pathologic finding and diffuse brain edema and brain parenchym pathologies detected by chest radiography were administered
injuries are the most important pathologies associated with interventional treatment, detection of pathologies by thorax CT
mortality. The most important prognostic factors in patients with does not cause significant changes in treatments such as tube
head injury are ISS, RTS, GCS and avarage age. thoracostomy and thoracostomy.
P899 ________________________________ Traumatology P900 ________________________________ Traumatology
EVALUATION OF THE EFFECT OF THORACIC TOMOGRAPHY DETERMINATION OF THE DEMOGRAFIC AND CLINICAL
IN BLUNT CHEST TRAUMA CARACTERISTICS OF THE PATIENTS WITH HAND INJURY
B Şişman (1), Y Yavuz (2), HU Akdemir (2), L Duran (2), C Katı THAT ADMITTED TO ULUDAG UNIVERSITY EMERGENCY
(2) DEPARTMENT
S. Kulaç (1), T. Küfeciler (2), E. Kocabaş (3), S. Akköse Aydın
1. Emergency Service, Sinop Atatürk State Hospital, Sinop, Turkey (4), M. Bulut (5)
2. Emergency Department, Ondokuz Mayıs University Medical Faculty Hospital, Samsun,
Turkey
BOOK OF ABSTRACTS 467
1 Emergency department, The Taksim Training and Research Hospital, İstanbul, Turkey cases. Two cases died as the result of falling down from a cable car.
2 Emergency department, Kırklareli State Hospital, Kırklareli, Turkey This study was intended to describe a significant public health
3. Emergency department, Aksaray State Hospital, Aksaray, Turkey problem in the Eastern Black Sea region of Turkey.
4. Emergency department, Uludağ University Health Research and Application Center,
Bursa, Turkey P902 ________________________________ Traumatology
5. Emergency department, Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
Corresponding author: Mr Kulaç Semih ([email protected]) DO THE CHARACTERISTICS OF SERIOUSLY INJURED OLDER
Key-words: Hand trauma ; Emergency service ; Injury ADULTS DIFFER FROM THEIR YOUNGER COUNTERPARTS IN
THE ED?
Purpose: Hand trauma has been detected on the majority of A. Akoz (1), M. Isik (2), H. Sahin (1), M. Emet (1)
patients who applied to emergency departments due to injuries.
The purpose of this study is to establish the profile of patients, to 1. Emergency Medicine, Ataturk University Medical Faculty, Erzurum, Turkey
develop preventive measures, and to form a preliminary model for 2. Family Medicine, Ataturk University Medical Faculty, Erzurum, Turkey
emergency service structuring by determining demographic and Corresponding author: Mr Akoz Ayhan ([email protected])
clinical characteristics of patients with hand injury who applied to Key-words: Geriatric trauma ; aged ; emergency department
Uludağ University Medicine Faculty Emergency Department.
Materials and Method: Total 526 patients, who applied to Uludağ Aim: To analyze the injury characteristics of younger and older
University Medicine Faculty Emergency Department (U.Ü.T.F-AS) adult trauma victims.
between 01.04.2009- 30.06.2010, with isolated hand trauma were Methods: This is a prospective, cross-sectional, observational, and
included in the study. Patients with additional organ injury, with single-center study including both younger adult and geriatric
major trauma and the patients who were not willing to participate trauma patients. The relationships between the age groups and the
in the study were excluded. The data of patients included in the number of consultations in the ED were compared with ANCOVA
study were recorded into the form prepared previously. after adjusting for ISS.
Findings: 526 patients had a mean age of 34,94±15,54 years. Results: The data consisted of 779 patients, 131 (16.8%) of whom
82.5% of the patients (n=434) were male and 17,5% were female. were elderly. The ICU admission rate was 7.2%. For the adults and
In 19,6% of the patients (n=103) applied to the emergency service the elderly, 25.6% and 28.2% of the patients’ ISS were > 15,
the injury occurred between 10-12 am. Most frequent injuries respectively. Our results showed a significantly higher incidence of
were observed in 10.6% of the patients who were employed in intracranial hemorrhage, fracture and/or dislocation of the femur,
furniture industry. Also, 19, 8’% (n=104) of the patients were and fracture of the thoracic vertebra in the elderly patients as
admitted to emergency department on Friday. The most common compared to the adults. The adult trauma patients suffered
cause of applications due to hand trauma was work-related significantly from acute abdomen, bowel injury, and pelvic fracture
accidents with 247 cases (47%) and half of those cases had second when compared to the elderly. After adjusting for ISS and total
finger injury. 29.5% of the patients, who were covered in the consultations, the length of stay in the ED was significantly shorter
study, were admitted due to superficial injury. 69.8% of all cases in the elderly compared to the adults (115 min vs. 132 min; F =
were consulted with hand surgery and 34.2% were primary 24.2; p < 0.0001). After controlling for ISS, the total number of
sutured. consultations among the elderly was significantly lower than that
Results: Employed and young patients constitute the majority of of the adults (2.07 ± 1.42 vs. 2.53 ± 1.44; p < 0.0001).
admitted patients with hand trauma. Most of the injuries occur Conclusion: The findings of this study suggest that the
because of carelessness and lack of education, therefore; by taking characteristics of seriously injured older adults admitted to our ED
simple necessary measures and expanding vocational training differ from their younger counterparts.
programs, these injuries could be avoided. The data obtained in
this study is expected to shed light on more comprehensive studies
to be performed in the future.
P901 ________________________________ Traumatology P903 ________________________________ Traumatology
SINGLE-OCCUPANT PRIMITIVE CABLE CAR ACCIDENT COULD UNNECESSARY LAPARATOMIES BE REDUCABLE IN
BO BILIR (1), EG ERSUNAN (1), KA KALKAN (1), BS BALIK (2) ABDOMINAL TRAUMA PATIENTS?
A. Kısaoglu (2), B. Ozogul (2), S.S. Atamanalp (2), A. Akoz (1),
1. Emergency department, Recep Tayyip Erdogan University, Medical Faculty, Rize, Turkey A. Bayramoglu (1), G. Ozturk (2), M.I. Yıldırgan (2)
2. Department of orthopedics and traumatology, Recep Tayyip Erdogan University,
Medical Faculty, Rize, Turkey 1. Emergency Medicine, Ataturk University Medical Faculty, Erzurum, Turkey
Corresponding author: Mr Ersunan Gökhan ([email protected]) 2. General Surgery, Ataturk University Medical Faculty, Erzurum, Turkey
Key-words: CABLE CAR ; trauma ; emergency Corresponding author: Mr Akoz Ayhan ([email protected])
Key-words: Abdominal trauma ; unnecessary laparatomies ; physical examination
Accidents resulting from single-occupant cable cars, a primitive
means of transport frequently used in the Eastern Black Sea region Introduction
of Turkey, are often encountered in the area’s emergency Trauma is the one of the leading causes of death before 40 ages.
departments. In this retrospective study of 54 patients referred to Unnecessary laparotomies due to multisystem injury in abdominal
our university hospital due to cable car accidents, was analysed. trauma cases may cause additional morbidity and mortality.
68.5% of tehese patients were male, with an average age of 45. Materials and Method
The most common occurred injury associated with accidents was In our study, 395 patients' results were investigated retrospectively
the trapping of the upper extremity between the steel cables who had laparatomy due to abdominal trauma between the dates
(59.3%). Finger amputations were observed in 29.6% of these
BOOK OF ABSTRACTS 468
of January 2000-December 2010 in General Surgery Clinics of patients. There were multiple organ injuries in131 of patients and
Ataturk University Medical Faculty Hospital. Unnecessary most seen accompanying trauma to abdominal trauma was chest
laparotomy was accepted as the sum of nontherapeutic (patients trauma. Most common injured organ was spleen (47,4%).
who have abdominal injury but don't need treatment) and negative Abdominal ultrasonogrophy was applied to 154 (90,5%) of patients,
laparotomies. abdominal computed tomography was applied to 81 (47,6%) of
Results patients. Diagnostic peritoneal lavage (DPL) was applied to 60
Three hundred and twenty (81%) of patients were male, 75 (19%) patients (35,3%) and 36 of them (60%) was evaluated as positive.
of patients were female and average age of patients was 27.7 (16- All of the 11 patients who was diagnosed by direct graphy had free
81). 170 (43%) of patients had blunt abdominal trauma and 225 air under the diaphragm. Postoperative complication ratio was
(57%) of them had penetrant abdominal trauma. Additional 17,6% (n=30), mortality ratio was 8,2% (n=14). Most commonly
investigations weren’t made for laparotomy decision of 88 patients seen postoperative complication was pneumonia-atelectasis.
who had firearm injury predominantly in abdomen. Laparotomy Intraabdominal abscess and evisceration were inthe second and
decision inpenetrating stab wounds were made by local wound third place in postoperative complications. 11(78,6%) of dead
exploration in 62 of patients, by diagnostic peritoneal lavage (DPL) patients had multisystem injuries, 3 (21,4%) of them had more
in36 of patients, by organ evisceration in 21 of patients, by than one abdominal organ damage. Most common death reasons
peritoneal irrigation signs in14 of patients and by existing shock or were respectively head trauma, hypovolemic shock, sepsis and
resistant hypotension in 4 of the patients. Laparotomy was done in respiratory insufficiency. Sepsis and respiratory insufficiency were
blunt abdominal trauma patients by abdomen ultrasonography or consisting the most important reasons of late deaths. Being above
if needed abdominal computed tomography and/or DPL after the the age of 55, existing more than 12 hours between trauma and
physical examination, according to hemodynamic stability and operation, blood transfusion more than 5 units and postoperative
state of consciousness. Twenty seven (6,8%) of the patients had complication existence were accepted as independent prognostic
negative laparotomy and 37 (9,3%) of the patients had factors.
nontherapeutic laparotomy according the operations results. Conclusion
Unnecessary laparotomy ratio was 16,1 % (n=64). Negative
laparotomy ratio was 3% (n=12), nontherapeutic laparotomy ratio Preventable death ratio was high inblunt abdominal
was 6% (n=24) in penetrating stab wounds. In blunt traumas they trauma cases. Fighting with sepsis, and shock, performing surgical
were 3,8 % (n=15) and 3,3% (n=13) respectively. In our study, procedure as soon as possible had an important place inreducing
unnecessary laparotomy wasn’t detected in firearm injuries. mortality and morbidity rates inpostoperative period.
Postoperative complication ratio in unnecessray laparotomy cases
was 7,8% (n=5) and there was no mortality. P905 ________________________________ Traumatology
Conclusion
OUR APPROACH TO TRAUMATIC RECTUM INJURIES
We considered that unnecessary laparotomies could me B. Ozogul (2), A. Kısaoglu (2), S.S. Atamanalp (2), A. Akoz (1),
minimized by close follow-up, careful physical examination in A. Bayramoglu (1), M.I. Yıldırgan (2), G. Ozturk (2)
frequent intervals and if necessary repeating of imaging methods
incases which haven’t enough signs for laparotomy endication. 1. Emergency Medicine, Ataturk University Medical Faculty, Erzurum, Turkey
2. General Surgery, Ataturk University Medical Faculty, Erzurum, Turkey
P904 ________________________________ Traumatology Corresponding author: Mr Akoz Ayhan ([email protected])
Key-words: Rectum injuries ; treatment ; morbidity
ELEVEN YEARS-RETROSPECTIVE ANALYSIS OF
LAPARATOMY APPLIED BLUNT ABDOMINAL TRAUMA Purpose
CASES Rectum is positioned between sigmoid colon and anal
A. Kısaoglu (2), B. Ozogul (2), S.S. Atamanalp (2), A. Akoz (1),
A. Bayramoglu (1), M.I. Yıldırgan (2), G. Ozturk (2) canal in pelvis and it is approximately 12-15 cm. Rectum injuries
are divided into two as intraperitoneal or extraperitoneal. It is a
1. Emergency Medicine, Ataturk University Medical Faculty, Erzurum, Turkey clinic entity which has serious mortality and morbidity results and
2. General Surgery, Ataturk University Medical Faculty, Erzurum, Turkey its treatment is still controversial. In this study we aimed to detect
Corresponding author: Mr Akoz Ayhan ([email protected]) appropriate treatment options with the results of diagnosis,
Key-words: Blunt ; abdominal trauma ; physical examination treatment and follow-up for traumatic rectum injuries which
treated in our clinic.
Introduction and Purpose Materials and Method
Trauma is the one of the leading causes of death
We included patients to this study which operated due
inyoung population in developed countries. This study’s aim is to traumatic rectum injury between the dates of January 2004-
detecting factors which affects the prognosis of laparatomy applied December 2010 in General Surgery Clinic of Ataturk University
blunt abdominal trauma cases. Medical Faculty.
Materials and Method Results
In our study, 170 patients' results were investigated Twelve patients were included to this study. All of the
retrospectively who had laparatomy due to blunt abdominal patients were male and average age was 33,4 (17-65). 7 (58,3%) of
trauma between the dates of January 2000-December 2010 in the patients had penetrant trauma and 5 (41,7%) of patients had
Ataturk University Medical Faculty Hospital. blunt trauma. 7 (58,3%) of the patients had extraperitoneal injury
Results and 5 (41,7%) of patients had intraperitoneal injury. There was
additional organ damage in 6 of the patients. Most common seen
One hundred and thirty four (78,8%) of patients were additional organ damage was small intestine injury. Besides
male, 36 (21,2%) of patients were female and average age was 27,3 thatanal sphincter, colon, bladder, pelvis and bone fractures were
(17-76). Trauma cause detected as traffic accident in118 (69,4%) of other accompanying organ damages. All of the patients with
extraperitoneal injury were diagnosed by physical examination.
BOOK OF ABSTRACTS 469
Abdominal free air was observed in 3 patients with direct graphy That was concluded that, patients with middle-heavy
and in 1 patient with computed tomography. We applied primary fecal contamination and patients who had more than 3 colon
repair in 5 (41,7%) of the patients, primary repair with sigmoid loop injuring scores were appropriate for two staged treatment options.
colostomy in 4 (33,3%) of the patients and primary repair with
Hartman colostomy in 2 (16,7%) of the patients. Rectum primary P907 ________________________________ Traumatology
repair with small intestine resection and ileostomy was done to 1
(8,3%) of the patients who had small intestine perforation. OUR EXPERIENCES WITH PENETRANT COLON TRAUMA
Anastomose leakege occurred in 1 (8,3%) of the patient who had CASES
primary repair and this patient operated again and used Hartman B. Ozogul (2), A. Kısaoglu (2), S.S. Atamanalp (2), A. Akoz
colostomy. Wound infection occurred 2 (16,7%) of the patients. We (1), A. Bayramoglu (1), G. Ozturk (2), B. Aydınlı (2)
had no mortality.
Conclusion 1. Emergency Medicine, Ataturk University Medical Faculty, Erzurum, Turkey
2. General Surgery, Ataturk University Medical Faculty, Erzurum, Turkey
Treatment is still controversial in traumatic rectum Corresponding author: Mr Akoz Ayhan ([email protected])
injuries. Appropriate treatment option is an approach which has Key-words: Penetran trauma ; abdominal ; treatment
low morbidity and mortality rates.
Introduction
P906 ________________________________ Traumatology Colon injuries have an important place in abdominal
OUR EXPERIENCES WITH BLUNT TRAUMA CASES trauma cases due to high ratios of mortality and morbidity. In this
B. Ozogul (2), A. Kısaoglu (2), G. Ozturk (2), A. Akoz (1), A. study, we analyzed applied treatment procedures to patients who
Bayramoglu (1), B. Aydınlı (2), S.S. Atamanalp (2) operated due to penetrant colon traumas. We aimed to investigate
their effects on mortality and morbidity rates.
1. Emergency Medicine, Ataturk University Medical Faculty, Erzurum, Turkey Materials and Method
2. General Surgery, Ataturk University Medical Faculty, Erzurum, Turkey
Corresponding author: Mr Akoz Ayhan ([email protected]) In our study, colon injuries were investigated
Key-words: Blunt Trauma ; abdominal ; mortality retrospectively which operated after the penetrant abdominal
traumas between the dates of January 2006-December 2010 in
Purpose: General Surgery Clinics of Ataturk University Medical Faculty
Colon injuries have an important place in abdominal Hospital.
Results
trauma cases due to high ratios of mortality and morbidity rates.
Treatment of colon injuries is being a problem because of One hundred forty-six patients were included to this
mortalities occured by postoperative complications. Contrary to research. 13,7 % of these patients were female (n=20), 86,3% of
penetrant injuries, blunt traumas can be missed or there may be the patients were male (n=126) and average age was 29,47 (16-62).
delay indiagnose. In our study we investigated colon injuries after Colon injury was caused by firearm wounding in 96 (65,7%) of the
the blunt abdominal traumas, treatment options, effects on patients, by penetrant stab wounds in 50 (34,3%) of the patients.
morbidity and mortality retrospectively. 28,8% of the patients (n=42) had right colon injury and 71,2 % of
Materials and Method them (n=104) had left colon injury. 30 patients (20,6%) had Grade 1
injury, 40 patients (27,4%) had Grade 2 injury, 46 patients (31,5%)
In our study, colon injuries were included which had Grade 3 injury, 16 patients (10,9%) had Grade 4 injury and 14
operated after the blunt abdominal traumas between the dates of patients (9,6%) had Grade 5 injury. Our postoperative complication
January 2006-December 2010 in General Surgery Clinics of Ataturk ratio was 43,8% (64 patients). Most common seen complication
University Medical Faculty Hospital. was wound infection. Stoma opening to the patient, having middle-
Results heavy fecal contamination, having high grade injury were found as
significantly effective factors in morbidity rate (p<0,05). Mortality
Thirty-four patients included to this research. 5,8% of rate was 6,9% (10 patients). 6 of these patients became exitus by
them were female (n=2) , 94,2% of them were male (n=32) and sepsis due to colon, 4 of them became exitus by pulmonary emboli
average age was 40,7 (17-68). Colon perforation was inone area in due to extra colon reasons. Stoma opening to the patient, having
31 of patients. There were two or more colon perforations in3 middle-heavy fecal contamination, having high grade injury were
patients. Most accompanying intraabdominal injury was smal found as significantly effective factors in mortality rate (p<0,05).
intestine injury. There were left colon and sigmoid colon injuries Conclusion
in24 patients, transverse colon injuries in8 patients and right colon
injury in2 patients. One staged surgical option was applied as Having middle-heavy fecal contamination, having more
treatment choice to 14 (41,1%) of the patients, two staged surgical than 3 colon injury score, stoma opening to the patient were found
option was applied to 20 (58,9%) of the patients. Havig middle- as significantly effective factors in mortality and morbidity.
heavy fecal contamination (p<0,01), having more than 3 colon
injuring scores (p<0,05) were detected as significant indetermining P908 ________________________________ Traumatology
treatment choices. Having middle-heavy fecal contamination,
having more than 3 colon injuring scores and applying 2 staged ABC IT'S EASY AS 123 - TERTIARY SURVEY, MISSED
surgical operation (opening the stroma) were detected as INJURIES, TRAUMA PATIENTS
significant inoccuring postoperative complication (p<0,05). Having S. Mans, M. Oostenenk, O. Sir
middle-heavy fecal contamination, having more than 3 colon
injuring scores, applying 2 staged surgical operation (opening the Emergency department, Radboud University Nijmegen Medical Centre, Nijmegen,
stroma) and shock state of patient before operation were detected Netherlands
as significant inpostoperative complication mortalities (p<0,05).
Conclusion
BOOK OF ABSTRACTS 470
Corresponding author: Melle Mans Stacey ([email protected]) important not to overuse diagnostic imaging when performing a
Key-words: Tertiary survey ; Missed injuries, Diagnostic errors, Missed diagnosis ; Trauma tertiary survey. It is also advisable, for more accurate and earlier
patients detection of missed injuries, that diagnostic imaging is reviewed by
a radiologist.
Question Level of recommendation: B
P(multi)trauma patients Comments
I tertiary survey (TS) There is an inconsistency of the definition of ‘missed injury’.
C primary and secondary survey after trauma None of the studies has a sufficient follow up period. Two studies
O(clinically relevant) missed injuries (MI) had a follow-up after hospital discharge (3 months and 1 year) but
Background only of the documentation available in the (same) hospital.
The initial management of trauma patients is focused on The studies also didn’t correct for diagnostic imaging done in the
indentifying life threatening injuries. ATLS guidelines have primary and secondary survey. Improvements in diagnostic
introduced primary survey to prioritize the most threatening techniques may decrease the incidence of MI (especially in head to
injuries. Secondary survey addresses all other important injuries pelvis region with the upcoming of CT in the initial assessment of
and immediate interventions necessary. trauma patients).
The tertiary survey was introduced in 1990; a physical examination A dedicated trauma service/team may be of influence in the total
and review of all diagnostics after at least 24 hours post trauma to number of missed injuries; however, many articles don’t mention
detect all (missed) injuries. However, the tertiary survey is a cost- the consistence of their trauma team.
and recourse intensive survey; is it really necessary for all clinically Five studies are conducted in a level one trauma center and three
admitted (multi) trauma patients and is it really effective in finding in a level II.
all (relevant) missed injuries?
Search strategy and outcome P909 ________________________________ Traumatology
Terms: ((diagnostic errors) OR (missed injuries) OR (missed
diagnosis)), AND (trauma) AND (tertiary survey) CHARACTERISTICS OF PATIENTS WITH FLAME BURNS
Selection criteria: human, adult, language: English, Dutch, full M. Uzkeser, M. Saritemur, A. Akoz, A. Bayramoglu, M. Emet
version of article available Limits: -
MeSH term use didn’t give any useful search results. Emergency Department, Ataturk University Medical Faculty, Erzurum, Turkey
Excluded articles: Corresponding author: Mr Saritemur Murat ([email protected])
- Two editorial/abstract Key-words: Burn Injury ; Flame ; Emergency Department
- One full article in Spanish
- Three publications: in one publication TS was an abbreviation of Introduction: Burns are one of the leading causes of injury and a
Trauma Scan (not Tertiary Survey). In the other two publications frequent cause of hospitalization. The incidence and mortality of
there was no specification of the missed injuries found in Tertiary burn injuries are both higher and it is anticipated that 1% of the
Survey. worldwide population will suffer from a burn injury sometime
- Two reviews: (1) Thomson et al (2007) is a descriptive review during their life. Burn injuries are important because of their
describing twenty publications of which only three concern tertiary morbidity, mortality, and sequel.
survey and missed injuries. Two of these are already included in Method: We analyzed 208 patients with flame burns who admitted
the Pubmed search. The third article is included in the table as a to our emergency department (ED) between 2001 and 2011,
related article (Vles et al 2003). (2) Stanescu et al. (2006) is a retrospectively.
descriptive review with a non-independent reference standard. Results: The mean age was 17.7 ∓ 38.9 (min.18, max.100 years)
This review is mainly referring to publications not concerning and 69.2% (n=144) of the patients were male. Of the patients, 51%
tertiary survey. All publications about tertiary survey in this review (n=106) were admitted to our ED from provinces of Erzurum,
are already included in the Pubmed search. followed by 9.6% (n=20) from Agri, 9.1% (n=19) from Van, 6.7%
Conclusion (n=14) from Igdir and 5.8% (n=12) from Kars. Of the patients, 54.3%
There is no definitive evidence for the idea, that tertiary survey (n=113) had been living in the city centers and 23.1% (n=48) in the
after trauma is effective in finding all (relevant) missed injuries. village. The patients mostly admitted in summer (35.6%; n=74) and
However, this CAT shows that a number of missed injuries will be at least in winter 19.7% (n=41). The admissions to the ED were
diagnosed by a good tertiary survey; a mean percentage of 53.5% between 12:00 and 24:00 mostly (67.3%; n=14). The mean
(21.2% -100%) of missed injuries was an extremity injury, 39.6% (0- percentage of burn area was 22∓19.7 (min.1%-max.92%). The
67.3%) a head-pelvis injury and 23% (22-24.3%; Janjua, Chen) a soft frequency of burns according to body parts were as follows: head
tissue injury detected. and neck 76.9% (n=160), right upper extremity 73.6% (n=153), the
Clinical bottom line left upper extremity 70.2% (n=146), the right lower extremity
Tertiary survey is of value, when performed in a structured 44.2% (n=92), the left lower extremity 42.3% (n=88), anterior trunk
manner, including a review of blood results and diagnostic imaging. 40.4% (n=84), posterior trunk 33.2% (n=69), and genitals % 7.7
A well-performed tertiary survey will reveal a percentage of missed (n=16), respectively. Of the patients, 1% (n=2) had first degree
injuries. However, it is questionable whether all injuries will be burns, 76.5% (n=159) had second degree and 22.5% (n=47) had
found by doing a tertiary survey. But how many of the missed third degree burns. Mean length of stay in hospital was 20.6∓19.5
injuries are clinically relevant and have consequences for decision- (min.1- max.116 days).
making? There hasn’t been conducted any (double blind Conclusion: Flame burns are frequently seen in males. Patients
prospective) research to clarify, whether all trauma patients usually have second degree burns and the most common region is
admitted to the clinic really need a tertiary survey. It is thinkable, head and neck.
that a tertiary survey is of less value in a subgroup of multi trauma
patients (e.g. trauma patients with low ISS score, trauma patients
with maximum GCS and not involved in a vehicle accident).
Although there is no significant data to support this idea, the data
available shows a trend towards finding more missed injuries in
trauma patients with high ISS scores and altered GCS. Further, it’s
BOOK OF ABSTRACTS 471
P910 ________________________________ Traumatology breathing patients, there is uncertainty about patients receiving
positive pressure ventilation. We compared the lung point (i.e. the
CHARACTERISTICS OF PATIENTS WITH CHEMICAL BURN area where the collapsed lung still adheres to the inside of the
ADMITTED TO THE EMERGENCY DEPARTMENT chest wall) using the two modalities ultrasound (US) and computed
M. Uzkeser, M. Saritemur, A. Bayramoglu, A. Akoz, M. Emet tomography (CT), to determine whether US can reliably be used to
assess PTX progression in a positive pressure ventilated porcine
Emergency Department, Ataturk University Medical Faculty, Erzurum, Turkey model.
Corresponding author: Mr Saritemur Murat ([email protected]) Methods
Key-words: Burn Injury ; Chemical ; Emergency Department Air was introduced in incremental steps into five hemithoraces in
three intubated porcine models. The lung point was identified on
Introduction: Chemical burns are generally classified as acid and US imaging and referenced against the lateral limit of the
alkali burns. These burns especially caused by contact with intrapleural air space identified on the CT. The distance from the
chemicals as industrial accident, or are usually seen as a result of sternum to the lung point (S-LP) was measured on the CT scans and
ingestion or pouring on children. correlated to the insufflated air volume.
Methods: A total of 22 patients admitted to our emergency Results
department (ED) because of chemical burns between 2005 and The mean total difference between the 131 US and CT lung points
2011were evaluated retrospectively. was 6.8 mm (standard deviation ± 7.1 mm and range 0.0-29.3 mm).
Results: Median age was 37 (min.24 – max.65 years) and 90.9% A mixed-model regression analysis showed a linear relationship
(n=20) of patients were female. Of the patients, 72.7% (n=16) were between the S-LP distances and the PTX volume (p <0.001).
firstly admitted to our ED and 27.3% (n=6) were sent from other Conclusions
hospitals. The chemical burns were seen mostly in the summer In an experimental porcine model, we found a linear relation
(59.1%, n=13), especially in July (45.5%; n=10). Patients most between the PTX size and the lateral position of the lung point. The
frequently admitted to our ED between 12:00 and 24:00 (90.9%; accuracy of thoracic US for identifying the lung point (and thus the
n=20). Of the patients, 90.9% (n=20) had second degree burns, and PTX extent) was comparable to that of CT imaging. These clinically
9.1% (n=2) had third degree burn. The percentage of burn area relevant results suggest that US may be safe and accurate in
according to the parts of the body were as follows respectively: monitoring PTX progression during positive pressure ventilation.
1.5% on the head and neck, 1% on the anterior trunk, 10% on the
posterior trunk, 2% on the right upper extremity, 2.5% on the left P912 ________________________________ Traumatology
upper extremity, 2.5% on the right lower extremity, and 4% on the
left lower extremity. There was no genital burn. Median A CASE PRESENTATION WITH TRAUMATIC
percentage of burns was 5% (min.1 - max.34). Median days of PNEUMOPERICARDIUM AFTER BLUNT THORAX TRAUMA
hospitalization were 17 (min.7 – max.46 years). The percentage of
the body parts that affected were as follows: head and neck 18.2% M Ergin, T Acar, A Tuncar, AA Sevimli, S Kocak, M Tokur (2),
(n=4), anterior trunk 9.1% (n=2), posterior trunk 4.5% (n=1), right B Cander
upper extremity 50% (n=11), left upper extremity 36.4% (n=8),
right lower extremity 45.5% (n=10), and left lower extremity 40.9% 1. Emergency Department, Necmettin Erbakan University Meram Medicine Faculty,
(n=9). Konya, Turkey
Conclusion: Burns due to chemicals are rare compared to other 2. Thoracic Surgery Department, Sutcu Imam University Medicine Faculty,
types of burns, and common especially in men. They are mostly Kahramanmaras, Turkey
seen on the right upper extremity and in the summer in our region.
Corresponding author: Mr Ergin Mehmet ([email protected])
P911 ________________________________ Traumatology
Key-words: Pneumopericardium ; Blunt trauma ; Thorax trauma
USING THORACIC ULTRASOUND TO ACCURATELY ASSESS
PNEUMOTHORAX PROGRESSION DURING POSITIVE INTRODUCTION: Pneumopericardium is a rare and life threatening
PRESSURE VENTILATION A COMPARISON WITH condition which results from either penetrating or blunt thorax
COMPUTED TOMOGRAPHY trauma. CASE: 59 year-old man was admitted to our ED due to
L Knudsen (1), HM Lossius (2), NP Oveland (2), E Sloth (1), PJ chest pain and difficulty in breathing after falling from tractor while
Stokkeland (3), K Wemmelund (4) driving it. His vital signs were that blood pressure was 120/80
mmHg, heart rate 90/min and pulse saturation 85%. Physical exam
1. Anesthesiology and Intensive care, Aarhus University Hospital, Aarhus, Denmark showed that there was wide spread subcutaneous amphysema,
2. Research and Development, Norwegian Air Ambulance Foundation, Stavanger, Norway supraclavicular ecchymoses at left neck region, diminished breathe
3. Radiology, Stavanger University Hospital, Stavanger, Norway sounds at bilateral lungs. There was also crepitation at distal part
4. Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark of left forearm region. Chest X-ray showed bilateral multiple rib
Corresponding author: Mr Oveland Nils Petter fractures. The patient was monitorized, had hydration resuscitation
([email protected]) and oxygen supplement. Right tube thoracostomy was performed.
Key-words: Pneumothorax ; Ultrasound ; Computed tomography Chest and abdomen computed tomography which showed
pneumomediastinum, pneumopericardium, bilateral
Objectives pneumothorax, hemothorax and lung contusion, stenum fracture,
While thoracic ultrasonography accurately determines the size and widespread subcutaneous amphysema. Then, left tube
extent of occult pneumothoraces (PTXs) in spontaneously thoracostomy was performed. He had a conservative treatment at
critical care unit of Thoracic Surgery Department and discharged
from hospital at 5th day due to his own will. DISCUSSION: The
communication between lung, bronchi or esophagus and the
pericardial sac results in pneumopericardium following chest
trauma results. It is frequently together with pneumothorax.
Pneumopericardium is usually self–limited but can progress into
BOOK OF ABSTRACTS 472
tension pneumopericardium causing cardiac tamponad. The Aim: To determine the percentage of intra-abdominal fluid (PIAF)
drainage of pneumothorax could be initial procedure in case of on computerized tomography (CT) scan via the Cavalieri method
pneumothorax associated with pneumopericardium. If, however, and to define whether this is correlated with mortality, overall
the patient has hypotension, an aggressive fluid resuscitation must hospital stay, intensive care unit (ICU) admission, and intra-
be followed by emergent pericardiocentesis. Definitive treatment abdominal operation in both pediatric and adult patients with liver
includes pericardial decompression and pericardial window to injury.
provide drainage at the operation room as in our case. Emergency Methods: Fifty-one patients (24 children and 27 adults) with blunt
physicians should think this rare entity for differential diagnosis of hepatic injury admitted to our emergency department (ED) were
thorax trauma with shock and familiar with its treatment options. studied cross-sectionally. The stereological method of point
counting based on the Cavalieri approach was adapted to CT data
P913 ________________________________ Traumatology so as to assess intra-abdominal hemorrhage and abdominal
volume. PIAF was calculated as intra-abdominal fluid volume /
THE PROSPECTIVE ANALYSIS OF FOREIGN OBJECTS IN EYE whole abdominal volume x 100. For statistical analyses, the Mann-
AT EMERGENCY DEPARTMENT Whitney U test, Pearson correlation analysis, and Receiver-
B Cander, I Kayitmazbatir, M Ergin, S Kocak, AS Girisgin, M Operator-Characteristic (ROC) curve analysis were used.
Gul Results: When children and adults were investigated
demographically and clinically, the following statistical differences
Emergency Department, Necmettin Erbakan University Meram Medicine Faculty, Konya, were observed, respectively: splenic injury (29.2%; 11.1%,
Turkey P=0.012), intra-abdominal operation (20.8%; 51.9%, P=0.041), in-
Corresponding author: Mr Ergin Mehmet ([email protected]) hospital mortality (12.5%; 40.7%, P=0.031), and total length of
Key-words: Foreign objects ; Eye injury ; Emergency Department hospitalization (14.8±8.3; 9.3±6, P=0.013). Mean PIAFs in children
and adults were 4.20±2.85% and 6.28±5.21%, respectively. Co-
BACKGROUND: Foreing bodies in eyes (FBIE) are common injuries existing intra-abdominal injuries in children and in adults were as
seen in emergency department (ED). The aim of this was to follows: splenic injury (29.2%; 11.1%, P=0.012), kidney (25%;
describe to demographic datas and occupational safety of the 11.1%), bladder (4.2%; 14.8%), and pelvic fracture (12.5%; 11.1%).
cases. METHODS: This study includes of all age categories in PIAF was moderately negatively associated with hemoglobin levels
Necmettin Erbakan University Meram Faculity of Medicine ED. (r=-0.301; P=0.032), hematocrit levels (r=-0.322; P=0.021), and
There were 121 patients came to ED with complaint of FBIE. Glasgow Coma Score (GCS) (r=-0.276; P=0.05). Neither ROC curve
RESULTS: There were 121 patients and %92.6 of them were male. analyses for PIAF nor outcomes were statistically significant in
%83.5 of cases were work-related injuries. The most common FBIE children. In adults, sensitivity and specificity of PIAF in predicting
were metal fragmants (%71.9) and dusts (%18). %52 of patients the prognoses when the cutoff levels were taken as 5.39%, 9.9%,
presented within 12 hours of the injury. %48.8 of patients have had and 12.4%, respectively, were as follows: operation (71%; 84%),
the same injuries before. %66.1 of patients didn’t try to remove the mortality (36%; 93%) and ICU admission (25%; 94%).
foreing bodies with physicial exemination but %52.9 patients used Conclusion: In patients with blunt hepatic injury, the Cavalieri
eye drops. %62 of the cases, firstly came to our ED. %21.5 of the principle of stereology can easily be added to the CT slices in order
cases referred from other hospitals without any intervention to to calculate PIAF. This method is repeatable in other institutions
remove FBIE. %14 of the patients referred to us because of non- and can be used as a guide to predict outcomes. It is suitable for a
removed FBIE. %17.4 of patients were using eyewear. %39.7 of the universal parameter to measure intra-abdominal fluid in blunt
cases have no educational background about using eyewear. %94.2 injury. PIAF has low sensitivity but high specificity to predict ICU
of the cases were consulted with ophthalmology. FBIE were admission and mortality in cases of blunt hepatic injury in adults.
determined in only left or right eye, were the %63.4 of the cases Its specificity in predicting the need for operation is better than the
and %5 of cases were bilateral. CONCLUSION: The work related anatomic liver injury grading systems in CT.
precoutions of eye health in Turkey are inadequate. The education
of worker must be provided. P915 ________________________________ Traumatology
P914 ________________________________ Traumatology CHARACTERISTICS OF TANDIR BURNS THAT ADMITTED TO
OUR EMERGENCY DEPARTMENT
DEFINING THE PERCENTAGE OF INTRA-ABDOMINAL M. Uzkeser (1), B. Ozogul (2), M. Saritemur (1), A. Akoz (1),
HEMORRHAGE IN ABDOMINAL CT USING STEREOLOGY IN A. Bayramoglu (1)
PATIENTS WITH BLUNT LIVER INJURY AND DETERMINING
ITS RELATIONSHIP WITH OUTCOMES 1. Emergency Department, Ataturk University Medical Faculty, Erzurum, Turkey
M. Uzkeser (1), H. Sahin (1), B. Ozogul (2), Y. Cayir (3), F. 2. General Surgery Department, Ataturk University Medical Faculty, Erzurum, Turkey
Alper (4), M. Emet (1) Corresponding author: Mr Saritemur Murat ([email protected])
Key-words: Burn Injury ; Tandir burns ; Emergency Department
1. Emergency Department, Ataturk University Medical Faculty, Erzurum, Turkey
2. General Surgery Department, Ataturk University Medical Faculty, Erzurum, Turkey Introduction: Tandir is the name given to a special oven used for
3. Family Medicine Department, Ataturk University Medical Faculty, Erzurum, Turkey baking bread in the eastern and southeastern part of Anatolia.
4. Radiology Department, Ataturk University Medical Faculty, Erzurum, Turkey Material and Methods: Tandir burns that admitted to our
Corresponding author: Mr Saritemur Murat ([email protected]) emergency department between 2001 and 2011 have been
Key-words: Stereology ; Blunt liver trauma ; Volume measurements investigated retrospectively.
Results: Forty-three patients with tandir burns with a mean age of
45 (min.20, max.75 years) and 97.7% of whom are female were
admitted to our emergency department (ED). Of the patients,
BOOK OF ABSTRACTS 473
58.1% were living out of the borders of Erzurum province. The has improved little in recent years. This can in part be attributed to
inhabitances of patients were as follows: 76.7% in the village, 7% in trauma induced coagulopathy whereby clotting factor and platelet
the county and 16.3% in the city center. Burn localizations of the consumption, haemodilution along with acidaemia, hypothermia
patients were as follows: right upper extremity 83.7%, left upper and tissue hypoxia combine to produce deficiencies in the clotting
extremity 79.1%, head-neck 67.4%, right lower extremity 60.5%, cascade and so worsened and prolonged haemorrhage.
left upper extremity 60.5%, trunk (front) 53.5%, trunk (back) In recent years damage control resuscitation has been developed
53.5%, perinea 2.3%. The median burn percentage was 18% (%1- to combine early transfusion of erythrocytes (PRBC), platelets,
%62). Percentage of 2nd and 3rd degree burns were 23.3% and fresh frozen plasma (FFP) and cryoprecipitate with correction of
76.7%, respectively. After primary treatment in our ED, 11.6% of hypoxia, hypothermia and acidaemia and rapid surgical
the patients were transferred to another facility due to intervention to arrest bleeding. Currently transfusion of blood
inappropriate bed. Of the patients, 41.9% were discharged with products is largely empirical with volume of FFP and platelets given
whole recovery, 41.9% left the burn unit before the treatment was decided by PRBC requirements. In some centres goal driven
completed and 4.7% were dead in the burn unit. Median resuscitation is being pioneered whereby objective measures are
hospitalization day was 35 (min.0, max.136 days). Median used to decide the need for the various blood products. While
treatment cost was 5772.29 (min.14.5, max.22774.59 Turkish lira). some centres are using traditional laboratory measures such as
Conclusion: Tandir burns are not only seen in our city, but also seen platelet count, prothrombin time and fibrinogen levels, others are
in neighbor cities as well as in the whole eastern Anatolia region. exploring the use of point-of-care methodologies such as rotational
These burns differ from others with female predominance, deep thromboelastography (TEG) and thromboelastometry (TEM).
burns, upper extremity and head-neck localizations, the need of Thromboelastography, first described in 1948, measures increasing
long hospitalization days. shear elastic strength of a whole blood sample during clot
formation in real time. This is achieved by measuring either the
P916 ________________________________ Traumatology torque applied to static pin in an oscillating, incubated sample of
whole blood (TEG) or by optical detection of reduced rotation of an
POSTTRAUMATIC DETECTION OF COMMON NON- oscillating pin within a static sample of blood (TEM). As clot is
TRAUMATIC BILATERAL SUBACUTE SUBDURAL formed it adheres to the cup and pin and either promotes
HAEMATOMA transmission of the cup’s oscillation to the pin (TEG) or impedes
S. Kulaç, A. Basa, A. İnce, C. Çaltılı oscillation of the pin (TEM). This information is then used to plot a
curve from which numerous parameters of coagulability can be
Emergency department, The Taksim Training and Research Hospital, İstanbul, Turkey determined. These parameters include time to initial clot
Corresponding author: Mr Kulaç Semih ([email protected]) formation, rate of clot formation and time achieve a pre-defined
Key-words: Subdural haematoma ; Trauma ; Elderly patient clot strength which are used as measures of clotting factor activity
in both the extrinsic and intrinsic pathway while other measures
Subacute and chronic subdural haematoma are usually more such as maximal clot strength indicate platelet concentration and
common in elderly patients due to head trauma or without trauma. function. Importantly many of these parameters can be assessed
It often progresses with altered mental status and neurological early in the process meaning that within five to ten minutes of
changes. . In this study, a male patient aged 72 years who was blood being taken, results are available and able to guide
admitted to ED, due to his falling down, was included. On resuscitation. This is in contrast to more traditional laboratory
admission, the patient had a 2 cm parietal superficial cut. Nothing based assays which tend to not be available for upwards of twenty
particular detected after full neurological examination. Since he minutes from sampling.
was over 65 years old, according to Canada BT principles, cranial The usefulness of thromboelastography has been well established
tomography (CT) scanning was done. Upon CT scanning, common in predicting the need for transfusion in both liver transplantation
bilateral subacute subdural haematoma was detected. Despite and cardiovascular surgery, where it has been proven to reduce
prior extensive bleeding history of the patient, his description of no transfusion requirements. In the trauma management, studies
symptom and therefore, incidental detection of the case show us have been carried out in varied settings including major trauma
that intracranial hemorrhages might easily be overlooked, centres across the US and Europe as well as in military settings in
especially in elderly patients. Afghanistan, where TEM has been shown to be a feasible option
for assessing coagulopathy in multiply wounded patients. Indeed in
P917 ________________________________ Traumatology numerous studies thromboelastography has been shown to be
effective in detecting post-traumatic coagulopathy more accurately
ROTATIONAL THROMBOELASTOGRAPHY IN MAJOR and in a much shorter time frame than standard laboratory based
TRAUMA RESUSCITATION. assays. Thromboelastography has also been proven effective in
L Stevens predicting mortality in major trauma and has been shown to be the
most useful predictor, along with injury severity score, of 30-day
Trauma and Orthopaedics, University College Hospital, London, United Kingdom mortality in major trauma. As well as being a useful prediction tool
Corresponding author: Mr Stevens Lewis ([email protected]) thromboelastography has also been demonstrated as effective in
Key-words: Trauma ; Haemorrhage ; Thromboelastography guiding need for various transfusion products: this has helped to
both reduce the number of patients given transfusion, reduce the
Haemorrhage remains a significant cause of mortality in patients amount of product used in those receiving transfusion and may
with major trauma, accounting for up to 40-50% of deaths from improve resuscitation as demonstrated by reduced lactate levels
trauma and despite advances in resuscitation techniques this figure and in reduced mortality in those receiving goal directed
resuscitation.
It is important to remember that the use of TEG and TEM in trauma
management is still relatively novel and as such requires more
validation. Given the promise demonstrated in trials so far it seems
warranted that large scale, prospective trial should be designed to
validate the use of TEG/TEM in trauma management and to
BOOK OF ABSTRACTS 474
formulate standardised resuscitation plans based on TEG/TEM Conclusion: Our study demonstrate datas about the frequency of
results. spinal injury among all emergency applications, clinical survive,
emergency care, follow up and acute prognosis. Also these results
P918 ________________________________ Traumatology represent the importance of emergency service approach (early
diagnosis and correct treatment) to acute spinal trauma cases.
THREE YEARS EXPERIENCE IN EMERGENCY DEPARTMENT: Emergency service physicians must be careful about not only the
RETROSPECTIVE EVALUATION OF SPINAL TRAUMA primary care of these patients but also preventing the
PATIENTS complications.
HU Akdemir (1), D Aygün (2), C Katı (1), M Altuntaş (1)
P919 ________________________________ Traumatology
1. Emergency Department, Ondokuz Mayıs University Medical Faculty Hospital, Samsun,
Turkey CONTROL HEAD CT: IS IT NECESSARY?
2. Neurology Department, Ondokuz Mayıs University Medical Faculty Hospital, Samsun, A Denizbaşı (1), SE Eroğlu (1), OE Onur (2), S Özkaya (1), C
Turkey Özpolat (1)
Corresponding author: Mr Akdemir Hizir Ufuk ([email protected])
Key-words: Spinal trauma ; Frequency ; Emergency Department 1. Emergency department, Marmara University Pendik Research and Training Hospital,
istanbul, Turkey
Objective: Spinal cord injury is one of the application reasons to 2. Emergency department, Marmara University Pendik Research and Training Hospital,
emergency department (ED) and the frequency of this is not rare. Istanbul, Turkey
In literature studies that research the frequency of spinal cord Corresponding author: Mr Eroglu Serkan Emre ([email protected])
injuries are rare. Key-words: Head trauma ; Cranial CT ; Neuroimaging
The aim of this study is to show the demographical findings,
localization of lesions, neurological deficits, clinical severity Introduction: The national average rate for neuroimaging in the ED
determined with the ASIA classification at the admission and is 6.7%. One of the leading complaints associated with
before discharge from hospital, effectivity of the therapies (medical neuroimaging is trauma. Computed tomography (CT) imaging has
and surgical), complications and mortality of the spinal truma proven essential in early diagnosis. Control cranial CT series is not a
patients who admitted to our ED. routine protocol in guidelines of head trauma, but there is a clinical
Material and Method: In our study frequency datas of 91 cases practice of serial cranial CTs in these patients by neurosurgeons.
applicated to ED of Ondokuz Mayıs University Faculty of Medicine This study aimed to determine if the results of these serial CTs are
Hospital in three years with spinal trauma were evaluated meaningfull for treatment of these patients.
retrospectively. Cases were divided into two groups; one of the Material and Methods: In this study all head trauma patients were
groups include complete injuries (Grade A/Group 1) and the other evaluated, radiological work-up made according to Canadian CT
group include incomplete injuries (Grade B, C, D/Group 2). Groups Head Rule and the patients were consulted to neurosurgery. We
were compared according to age, sex, mechanism of trauma, time collect the cases in whom first cranial CT was normal, but
of reach to hospital, Glasgow Coma Scale (GKS) score, complaints, neurosurgery advise control cranial CT after a couple of hours. We
accompanying trauma findings, types of neurologic deficits, values interpreted the control CT results and research if there was a
of clinically ASIA-IMSOP damage scale, radiologic imaging methods, statistically significant management in patients.
type of treatment, improving complications and mortality ratios. Results: In 3 months total neurosurgery consultation were 519 and
Results: Spinal cord injuries were 0,25 % of all applications. of them total 355 cranial CT imaging were wanted. Neurosurgery
According to sex; there was not any meaningful difference wanted 209 control CTs from them. After the evaluation of 209
between complete and incomplete injury groups. Most of the CTs, there were no extra-patologies reported in the control CT.
patients were male. The ratio of males to females were 1,8/1. 47 % Discussion: Although severe complications requiring neurosurgical
of the patients were complete injury, 53% of the patients were intervention are rare in mild TBI(traumatic brain injury) patients,
incomplete injury. Most of the patients were at <45 age group. For fear of the dire consequences of delayed treatment has led many
our patients, most frequent etiologic reason was falling from high to advocate for the liberal use of CT scanning in patients with TBI.
(50,5 %). Most of our patients (37 %) applicated at summer and But according to our study, there is no need to control cranial CT if
most seen complaint at application was loose of power (89 %). the initial head CT is normal in trauma patients.
Servical spinal damage was the most frequent type of injuries
(50,5). Approximately half of our patients had accompanying P920 ________________________________ Traumatology
trauma findings. Thorax (12 %), head (7,6 %) and abdominal (4,3 %)
trauma were determined with spinal cord injury. 87,9 % of our MINOR TRAUMA = MAJOR PROBLEM - CASE REPORT ON
patients had taken steroid for treatment. At 16,4 % of our patients, RECOGNITION AND NON OPERATIVE MANAGEMENT OF
clinical changes were found between application and discharge. SPLENIC INJURIES
According to ASIA-IMSOP damage scale, 14,2 % of our patients D.Yeo, P.Ketty
functionally improved and 2,1 % of them functionally deteriorated.
Most seen complications at our patients were bleeding (19,7 %), Emergency Department, Queen Elizabeth Hospital, Birmingham, United Kingdom.
respiratory insufficiency (16,4 %) and urinary system infections Corresponding author: Mr Ketty Pradeep ([email protected])
(10,9 %). Approximately one fifth of our patients dead and the Key-words: angioembolization, splenic laceration ; angioembolization, splenic laceration ;
frequency of mortality was higher at the complete injury group. angioembolization, splenic laceration
Falling from high was the injury mechanism at half of the exitus
patients. Respiratory insufficiency was the most frequent reason of
the exitus patients at our study group.
BOOK OF ABSTRACTS 475
Objectives: symmetrical and there were no Babinski signs present. Glasgow
A 65 male presented to with a sudden onset of epigastric pains Coma Scale was 15. There was no sign for blunt head injury.
following breakfast. He gave a history of minor fall on to his left Computed tomography (CT) scan suggested the fractures on
side 2 days ago but was well after the event. Clinically he was spinous process of cervical spine from C4 to C7. The patient
haemodymanically unstable with a HR of 50 bpm. BP 80/50mmhg. diagnosed with 3D CT scan and cervical MRI scan. There were no
He was tender over his epigastric/ left upper quadrant. FAST scan disturbance in medulla spinalis, but there was an injury on inter-
performed in resus showed free fluid. CT abdomen showed active spinous ligament.
haemorrhage from a splenic capsular rupture . The patient was CONCLUSIONS
transferred for interventional radiology of the splenic artery. He The rare cervical spine injuries in seat belt wearers are caused by
went on to make a good recovery. restraining effects of the belt. The cervical spine fractures are
Discussion: mostly seen in severe injuries. This case was showed us that, the
Splenic lacerations can occur even with seemingly innocuous hyperflexion of the cervical spine can cause the fractures of
circumstances. All emergency physicians must keep up-todate on spinous process of spine even though the crush was mild. It is also
issues regarding splenic injury diagnosis, indications for showed us the importance of the examination of cervical spine in
nonoperative treatment, and potential complications arising from mild, moderate or severe.
both operative and nonoperative splenic injury management. LITERATURE:
Interventional radiology became an integral part of the 1. Richter M, Otte D, Blauth M. Acceleration injuries of the
management of splenic injuries, in some institutions replacing cervical spine in seat-belted automobile drivers. Determination of
emergency operation as the treatment of choice. Trauma the trauma mechanism and severity of injury. Orthopade, 1999
admissions at Level 1 trauma centers across the country suggests May;28(5):414-23
splenic injury occurs in as many as 25% of the average 800-1200 2. Kumar S, Ferrari R, Narayan Y, Jones T. The effect of seat
admissions for blunt trauma per year. belt use on the cervical electromyogram response to whiplash-type
Angioembolization, once contraindicated in compensated shock, impacts. J Manipulative Physiology Ther. 2006 Feb;29(2):115-25
has now been reported as a safe method of splenic salvage when 3. Walz F. Whiplash trauma of the cervical vertebrae in
immediately available in the treating facility. Splenic traffic: biomechanical and expert-opinion aspects. Schweiz Med
angioembolization is increasingly being used in both stable Wochenschr. 1987 Apr 18;117(16):619-23
responders and transient responders for fluid resuscitation under 4. Robertson A, Branfoot T, Barlow IF, Giannoudis PV.
constant supervision by a surgeon with an operating room on Spinal injury patterns resulting from car and motorcycle accidents.
standby. Femoral artery access with embolization of the splenic Spine 2002 Dec 15;27(24):2825-30
artery or its branches can be
accomplished with gel foam or metal coils. P922 ________________________________ Traumatology
CONCLUSION:
Isolated splenic injury is more likely to have nonoperative or DIAGNOSISAND MANAGEMENT OF THORACIC TRAUMA:
interventional radiologic management in a trauma center, ANALYSIS OF 1139 CASES
Prognosis is usually excellent. Increased availability and ease of b Atlı (1), m Bayram (2), A Coskun (3), I Dongel (4), F
access to interventional radiologic equipment and personnel, may Koyuncu (5), s Ozbay (3)
salvage splenic injuries that previously required operative
intervention and splenectomy. 1. Emergency Medicine, karabük state hospital, karabük, Turkey
Disclosure of Interest: None Declared 2. chest diases, bezmialem university, istanbul, Turkey
Keywords: angioembolization, splenic laceration 3. Emergency Medicine, sivas state hospital, sivas, Turkey
4. chest surgery, suleyman demirel univercity, Isparta, Turkey
P921 ________________________________ Traumatology 5. Emergency Medicine, Mevlana University, KONYA, Turkey
Corresponding author: Mr Koyuncu F ([email protected])
SEVERAL CERVİCAL SPİNE FRACTURE: AN UNUSUAL EFFECT Key-words: Thoracic trauma ; hemothorax ; pneumothorax
OF SEAT BELT
M. Tas, S. Ercan, L. Karaman, S. Gokhan, C. Yaylalı Objective of thestudy: Age, gender, etiological reasons, distribution
of pathologies, diagnosis, treatment methods and mortality rates
Emergency Department, Diyarbakır Training and Research Hospital, Diyarbakır, Turkey were reviewed retrospectively in patients applying to emergency
Corresponding author: Melle Karaman Lale ([email protected]) service with thoracic trauma.
Key-words: cervical spine fracture ; seat belt ; motor vehicle accident Methodology: 1139 patients applying to the emergency service of
our hospital with thoracic trauma between January 2007 and
INTRODUCTION December 2011 were included in the study. 698(61,3%) patients
The indirect injury mechanisms of the cervical spine should be were male and 441(38,7%) were female and the average age
subdivided into “ non-contact injury” of the cervical spine, without was54,17±17,39.
head impact, by definition hyperflexion or hyperextension. The Results: 1090(95,7%) of the patients had blunt trauma while
objective of this case report is to determine the effects of seat belt 49(4,3%) had penetrating trauma. Etiological reasons were
on cervical spine. detected to be falls in 792(69,5%), car accidents in 259 (22,8%),
CASE animal accidents in 39(3,4%) and penetrating injuries in 49(4,2%)
A 32 years old man was brought to emergency service after 24 patients. It was found that 229(20%) patients had single, 35(3%)
hours then car accident. He was a set-belted driver on this patients had multiple, 10(0,008%) patients had bilateral rib fracture
accident. On admission, he has a sever neck pain. Neurological and 19(0,016%) patients had sternal fracture. Pneumothorax was
examination revealed normal muscle tone in all extremities present in 58(5,1%) patients while hemothorax,
without motor or sensory disturbance. Deep-tendon reflexes were hemopneuomothorax and other system injuries were present in
36(3,1%), 38(3,3%) and 292(25,6%) patients respectively.
BOOK OF ABSTRACTS 476
Conclusions: While a part of thoracic trauma patients can be Conclusion: Commonly, pancreatic injuries are quite rare.
treated as outpatients, mortality varies based on etiological Pancreatic injuries usually appear related to blunt trauma. It is
reasons, additional systemic pathologies and capabilities of the known that in pediatric age group it is associated with the falling
hospital.Webelievethat; in emergency services, a multi-disciplinary from the bicycle. Isolated pancreatic injuries are seen quite rarely.
approach thorax-traumatic patient sandthe application of the most The morbidity and mortality in pancreatic injuries are associated
appropriate treatment will significantly reduce the morbidity and with the injuries of the additional organs. The use of computerized
mortality. tomography (CT) in pacreatic injuries is very important and it
enables us to detect the additional organ injuries.
P923 ________________________________ Traumatology
P924 ________________________________ Traumatology
PANCREAS AND SUPERIOR MESENTERIC VEIN INJURY IN A
BLUNT TRAUMA PATIENT BURN INJURIES DUE TO LIGHTNING
HU Akdemir (1), A Polat (2), C Katı (1), L Duran (1), Y Çelenk M. Saritemur (1), M. Kurt (2), H.I. Tanboga (3), S. Aslan (1),
(1), B Güngörer (1) M. Emet (1)
1. Emergency Department, Ondokuz Mayıs University Medical Faculty Hospital, Samsun, 1. Emergency Department, Ataturk University Medical Faculty, Erzurum, Turkey
Turkey 2. Cardiology Department, Mustafa Kemal University Medical Faculty, Hatay, Turkey
2. General Surgery Department, Ondokuz Mayıs University Medical Faculty Hospital, 3. Cardiology Department, Ataturk University Medical Faculty, Erzurum, Turkey
Samsun, Turkey Corresponding author: Mr Saritemur Murat ([email protected])
Corresponding author: Mr Akdemir Hizir Ufuk ([email protected]) Key-words: Burn Injury ; Lightning ; Emergency Department
Key-words: Blunt Trauma ; Pancreatic Injury ; Computed Tomography
Introduction: Lightning is a flow of the energy rising into the sky
Objective: Pancreas injuries are seen rarely due to the anatomical from the ground and may reach as high as 100 million volts. Length
position of this organ. Morbidity and mortality in pancreas injuries of exposure is milliseconds. The effects of the lightning on the body
are associated with factors such as the existence of an are different when compared with high voltage electrical injury
supplemantary organ injury, whether the pancreatic canal is because of direct current (electric is an alternating current).
affected or not, and together with the existence of duodenal injury. Transient loss of consciousness, convulsions, amnesia, temporary
We aimed to report a case in which the patient was brought into paralysis of legs, respiratory failure, kidney damage, tympanic
the emergency department after an in-vehicle traffic accident, membrane damage, cardiac arrhythmias, cardiac arrest or
tenderness was detected by abdominal examination, after having extensive burns may be seen.
an abdominal computerized tomography (CT) scan, pancreas injury Method: The patients admitted to our emergency department (ED)
and intraabdominal free fluid were determined, so the patient was with burn injury due to lightning during the last 8 years were
taken under an operation and diagnosed an injury of intraoperative analyzed retrospectively.
superior mesenteric vein. Results: A total of 17 patients were included. The median age of
Case: A male patient aged 51 was admitted to emergency the patients was 38 years (min.23, max.58 years) and 76.5% (n=13)
department due to in-vehicle traffic accident. When the patient were male. According to provinces, 88.2% of the patients (n=15)
applied to the emergency department, he had a complaint of were from Erzurum, 5.9% (n=1) came from Agri and 5.9% (n=1)
abdominal pain. The patient was clinically well with normal mental came from Kars. Of the patients, 67.7% (n=11) were living in the
status. The vital signs: blood pressure: 130/70 mmHg, heart rate: village, 23.5% (n=4) in the county and 11.8% (n=2) were living in
76 beats/min, respiratory rate: 16/min. and temperature: 36,4 °C. the city center. All of the patients were sent to our ED from other
The patient, who had common tenderness in his abdominal centers. After initial treatment and follow-up in the ED, 52.9%
examination, was not detected defense and rebound. ECG findings: (n=9) of the patients were discharged, 29.4% (n=5) were admitted
the speed was about 80/minute and normal sinüs rhythm. In his to the burn center, 11.8% (n=2) were referred to another hospital
laboratory studies, WBC: 6440/uL, Hb:12.1 g/dL, Htc: % 37 and from our ED because our burn center was out of bed, and 5.9%
serum amylase level : 213 U/L, lipase level was 251 U/L. In his (n=1) was refused admission. All cases of lightning injury were seen
blood gas studies, pH: 7.35, pCO2: 33 mmHg, pO2: 89 mmHg, in four months: 17.6% (n=3) were in May, 41.6% (n=7) in June,
HCO3: 18 mmol/L and O2Sat: %96. In the abdominal ultrasound 17.6% (n=3) in July, and 23.5% (n=4) were in August. Of the
scan, free fluid was detected around liver and in pelvis. Following patients, 82.4% (n=14) were admitted to our ED between 12:00
the abdominopelvic CT scan, intraperitoneal fluid (hemorrhage) and 24:00. Median length of the hospitalization was 8 days (min.3,
was detected common in the left subdiaphragmatic and perisplenic max.39 days). The affected parts of the body were as follows:
areas, minimally in the right perihepatic area, both paracolic areas 17.6% (n=3) of the patients had burning of the head and neck,
and pelvis. Furthermore mesenteric hematom area was detected 52.9% (n=9) the anterior trunk, 23.5% (n=4) the posterior trunk,
at pancreatic uncinat process level and in the form of circling the 64.7% (n=11) the right upper extremity, 23.5% (n=4) the left upper
duedonum around the superior mesenteric vein. CT research extremity, 41.2% (n=7) the right lower extremity, and 29.4% (n=5)
findings were significant in terms of mesenteric injury. By these of the patients had burning of the left lower extremity. The mean
findings, pancreatic and mesenteric injury related to blunt percentage of burn area was 9.4% ∓ 10.4 (min.1, max.30%). Of the
abdominal trauma was thought. After the general surgery patients, 5.9% (n=1) had 1st degree burn, 11.8% (n=2) had 2nd
consultation patient was taken under operation urgently. It was degree burn and 82.4% (n=14) had 3rd degree burn.
learned from the hospital registery that pancreatic uncinat process Conclusion: Lightning injuries cause particularly 3rd degree burns
and superior mesenteric vein injury were detected during the and burning occur most frequently in the right upper extremity and
operation. The patient was discharged on the sixteenth day of his anterior trunk. High risk group is the men living in rural areas.
admission because his vital findings were stable and he had no
additional problems.
BOOK OF ABSTRACTS 477
P925 ________________________________ Traumatology CT scans and neurological examination. There were no pathological
sign in CT angiography and MRI angiography. After five days the
ISOLATED STERNUM FRACTURE WITH NO DIRECT decrease of hemorrhage on midbrain was observed on CT scans.
TRAUMA. --AN UNUSUAL CASE. The patient discharged on nineth day without any neurological
S. Coskun (1), A. Hasanbasoglu (1), M. Dakak (2), PK. Coskun disturbance.
(3) CONCLUSION:
Focal traumatic brainstem injury occurs most likely due to direct
1. Emergency Department, TOBB-ETU Hospital, Ankara, Turkey impact at the back of the head stretching forces affecting the
2. Thoracic Surgery Department, TOBB-ETU Hospital, Ankara, Turkey brainstem in cases of complex fall from height and car accident. It
3. Cardiovascular Surgery Department, TOBB-ETU Hospital, Ankara, Turkey is a serious and commonly fatal brain damage. In acceleration
Corresponding author: Mr Coskun Selcuk ([email protected]) injuries of the brainstem in seat-belted automobile drivers without
Key-words: Isolated Sternum Fracture ; Sternum Fracture ; Isolated Fracture of sternum blunt head injuries, the mechanism of the hemorrhage
determination is suggested that complication of hyperextension
Isolated fracture of the sternum is a rare injury except iatrogenic injury to the head have a benign course.
ones. Up to 8% of patients admitted with blunt chest trauma have LITERATURE
sternal fractures, caused primarily by anterior blunt chest trauma. 1. Al-Saraj S, Fegan-Earl A, Ugbade A,Bodi I, Chapman R,
Sternal fractures usually due to motor vehicle accidents by reason Poole S, Swift B, Jerreat P, Cary N. Focal traumatic brain stem injury
of the chest strikes the steering wheel. Nearly almost sternal is a rare type of head injury resulting from assault: a forensic
fractures are due to direct trauma. Stress or indirect fracture of the neuropathological study. J Forensic Leg Med. 2012 Apr;19(3):144-
sternum is a rare injury. Stress fracture can occur rarely in young 51
athletes due to repeated stress and sometimes in elderly patients 2. Sganzerla EP, Rampini PM, De Santis A, Tiberio F, Guerra
with osteoporotic bones or probably other pathological conditions. P, Zavanone M, Miserochi G. Primary traumatic benign midbrain
Herein case of a isolated sternum fracture with no direct trauma is hematoma in hyperextension injuries of the head. Acta
reported. Nurochirurgica Suppl (wein). 1992;55:29-32
A 50-year-old man who sustained fracture of the sternum without 3. Ropper AH, Miller DC. Acute traumatic midbrain
any history of direct trauma when he simply expose sudden fall hemorrhage. Ann Neurology. 1985 Jul;18(1):80-6
from two meter upon his hip. 4. Meyer CA, Mirvis SE, Wolf AL, Thompson RK, Gutierrez
Sternum fractures except iatrogenic ones, although rare, should be MA. Acute traumatic midbrain hemorrhage: experimental and
considered in patients who present with acute chest pain in any clinical observations with CT. No Shinkei Geka. 1996 Sep;24(9):849-
kind of trauma. 52
5. Hun JK. The prognostic factors related to traumatic
brainstem injury. J Korean Neurosurgery Soc 51:24-30, 2012
P926 ________________________________ Traumatology P927 ________________________________ Traumatology
PRIMARY TRAUMATIC BENING MIDBRAIN HAEMATOMA DESCRIPTION OF A CLINICAL CASE OF A PATIENT WITH
OF THE BRAIN; AN UNUSUAL CASE SUBCLAVIAN POST TRAUMATIC PSEUDOANEURYSM AND
S. Ercan, M. Tas, S. Gokhan, L. Karaman, C. Yaylalı IPSILATERAL BRACHIAL PLEXUS AVULSION.
T. Kokra (1), MP. Cadau (1), M. Paulis (4), L. Crissantu (2), C.
Emergency Department, Diyarbakır Training and Research Hospital, Diyarbakır, Turkey Di Angelo (3), S. Sau (1)
Corresponding author: Melle Karaman Lale ([email protected])
Key-words: midbrain haematoma ; brain injury ; motor vehicle accident 1. Emergency Department, San Francesco Hospital, Nuoro, Italy
2. Orthopedics Department, San Francesco Hospital, Nuoro, Italy
INTRODUCTION: 3. Department of Vascular Surgery, San Francesco Hospital, Nuoro, Italy
Brainstem hemorrhage is common in cases of head injury when it is 4. Neurosurgery Department, San Francesco Hospital, Nuoro, Italy
associated with space occupying lesion and increases in the Corresponding author: Mme Kokra Theodora ([email protected])
intracranial pressure (duret hemorrhage), in case of diffuse axonal Key-words: trauma ; shoulder ; pseudoaneurysm
injury and diffuse vascular injury (in periventricular tissue). Primary
traumatic brain stem hemorrhage after blunt head impact is an Introduction: Subclavian artery or peripheral nervous injuries
uncommon injury and has historically been associated with high represent an uncommon complication of blund chest, cervical or
mortality. shoulder traumas, because protected by subclavius muscle, the
CASE: clavicle, the first rib, and the deep cervical fascia as well as the
A 25 years old man was brought to emergency service after car costo-coracoid ligament. Nevertheless, various clinical cases have
accident. On admission, he was drowsy. Neurological examination been described surprisingly after months or years after the
revealed normal muscle tone in all extremities without motor or traumatic event, even though the initially physical examination
sensory disturbance. Deep-tendon reflexes were symmetrical and resulted “normal”.
there were no Babinski signs present. Glasgow Coma Scale was 15. Aims: In this work we report a case of a late diagnosis of subclavian
There was no sign for blunt head injury. Computed tomography artery injury and brachial plexus avulsion due to a post trauma
(CT) scan 30 minutes after the accident suggested the hemorrhage shoulder dislocation.
in the midbrain. Six hours later, increase of midbrain hemorrhage Methods: a 53-year-old male was admitted to our emergency
was diagnosed by consecutive CT scans. The treatment was department after a motorcycle accident, referring hypoesthesias
performed in intensive care unit. Follow up CT scans were and pain on his left arm, attributed initially to a posterior shoulder
examined after 24 hours and 72 hours. There was no difference on dislocation.
BOOK OF ABSTRACTS 478
On admission, the patient had a cervical collar and was when attempting to talk or chew. His facial expression was
immobilized on a spinal board. After a first physical examination asymmetric, but threre is no emotional response. His Blood
and stabilization of the clinical conditions, the patient has been pressure was 110/70 mmHg, heart rate 98 bpm, and temperature
moved to a ward stretcher; during that displacement the patient 36.5°C. Immediate cerebral CT showed no abnormalities except for
reduced spontaneously his shoulder dislocation without pain a minimal edema. Cranial and cervical magnetic resonance imaging
lamentation. (MR) were normal. Electrodiagnostic testing confirmed the
X-rays did non show any cervical, limb, costal or shoulder fractures. diagnosis of left facial paralysis. The laboratory examinations
Two hours later, symptoms described earlier and erroneously including complete blood cell counts, liver function tests, chest x-
attributed to a post shoulder dislocation syndrome, were still rays etc. was within normal limit. The diagnosis of left facial
present, though the limb aspect was normal. There were no paralysis was made based on the history, neurological
temperature or skin colour changes but nervous functions such as examinations and than he was admitted to intensive care unit by
sensibility and hand motility as well as radial pulse were absent. A closed head injury.
rapid colour ultrasound exam confirmed radial and brachial pulse CONCLUSION:
absence and demonstrated only collateral arterial flows. The traumatic facial palsy, due to its variety of forms and
Results: The CT scan revealed a subclavian arterial rupture with a outcomes, its difficult diagnostics and other accompanying injuries,
pseudoaneurysm formation for a 1,5 cm length; local thrombosis represents a challenge especially from the therapy standpoint.
has been described too. Treatment by endovascular stent grafting Most of the cases of the traumatic facial paralysis occur in traffic
was not possible because of temporary lack of the appropriate accidents and they are usually visible immediately after an injury
materials. Neither CT or MRI scans proved a cervical or dorsal has been inflicted. In many cases of significant facial trauma, other
spinal cord damage. The electromyography provided injury concomitant acute conditions may delay examination and testing
evidence of the left brachial plexus due to a plexus spinal avulsion. of the facial nerve. However, delayed surgical exploration, even
After admission to neurosurgery ward, patient chose to be months after the injury, can still be performed with reasonable
transferred to his native country for further exams and therapies. success rates of functional improvement and recovery. Only early
Conclusions: Traumatic brachial plexus injury and subclavian clinical detection and therapeutic interventions are important for
arterial rupture have been described after severe cervical, thorax functional recovery after facial nerve injury.
or limb fractures with clear signs that appear early after trauma.
Though, even into less severe traumas, vessel or nervous injuries P929 ________________________________ Traumatology
should be researched carefully and repeatedly, even after hours or
days and readily recognized for potential treatment.- AFFECTING FACTORS OF MORTALITY IN FALLS FROM
HEIGHT
P928 ________________________________ Traumatology M İÇER, M ORAK, M ÜSTÜNDAĞ, C GULOĞLU
TRAUMATIC UNILATERAL FACIAL PALSY: A CASE REPORT Emergency department, Dicle University, Diyarbakir, Turkey
Y ZENGİN, M İÇER, HM DURGUN, E OZCETE, O KACMAZ, M Corresponding author: Mr Zengin Yilmaz ([email protected])
ÜSTÜNDAĞ Key-words: Falls from a height ; mortality ; SAH
Emergency department, Dicle University, Diyarbakir, Turkey Introduction: Falls from a height constitute a significant proportion
Corresponding author: Mr Zengin Yilmaz ([email protected]) of urban trauma and are responsible for many serious adult and
Key-words: facial palsy ; injury ; traumatic paediatric injuries. Falls are a leading cause of injury in the United
States, second only to motor vehicle crashes.
INTRODUCTION: Objective: The purpose of this clinical study was to identify and
Traumatic injuries to the head and cranium represent one of the evaluate potential prognostic factors for mortality among people
most common causes of acquired facial paralysis. In instances of injured by falling from a height.
blunt trauma, in which no lacerations or fractures occur, the facial Methods: The data of 2252 patients who come for falls from
nerve retains its continuity and is expected to recover. In a setting height that were admitted to emergency department of
of suspected nerve laceration (penetrating trauma through facial University of Dicle in South East Anatolia Region between January
skin and soft tissues), immediate surgical exploration with nerve 2005 and December 2008 was analyzed retrospectively. In the data
repair is warranted. Ideally, this would take place within 3 days of happening month of falls from height, age, sex, reason of falls
injury, during which the distal portion of the facial nerve can still be from height, place of falls from height, floor of falls from
stimulated and, thus, identified during surgery. We report a 13- height, intubation, hypotension, tachycardia, head -neck,
year-old boy who developed left facial palsy after head injury. thorax, abdomen, pelvis extremity injury, application period,
CASE REPORT: remaining time in the hospital, GCS(Glasgow Coma Scale),
A boy aged thirteen years was admitted because of mental status ISS(Injury
alteration and facial asymmetry after head injury. He collided with Severity Score), RTS(Revised Trauma Score) are analyzed. These
another child while playing, and his head was traumatized the day parameters of mortality which are explained above were analyzed.
before. The next morning, sixteen hours later, he developed left Results: 1435 (63,7 %) of patients were male and 817 (36,3 %) of
facial patients were female of the patients for falls from height who
paralysis, and mild left hemiparesis. He was previously healthy and were included into this study. 2131 (94,6 %) of patients were
had no history of neurological or haematological diseases. On alive and 121 (5,4 %) of patients were dead. The age average
initial examination in the emergency room, his general condition of the patients was
was moderate, he was confused and Glasgow Coma Scale score 16,305± 19,5462. The age average distribution is that the youngest
was 13.He was noted to have incomplete closure of left eye and is 1 month and the oldest
drooling during a feeding trial. He had difficulty moving his lips
BOOK OF ABSTRACTS 479
is 95 years. 1238 patients came to the hospital for falls from After 6 months from the traumatic event, we made a phone follow-
height in June, July, August, up To evaluate physical (PCS) and mental (MCS) health.
September and this had 54,9 % in whole patients. According to the Results: We retrospectively identified 307 patients (pts), admitted
falling floor 493 patient s for trauma, mean age 54±22 yrs, 203 (66%) male subjects, with 114
fallen to soft floor and 1759 patients fell to sharp floor. According subjects aged ≥65 years. Presence of comorbidity was more
to the place of falls from common in G1 subjects (47% vs 7%, p<0.0001). Multiple injury
height 1056 (46,9 %) of patients fell from roof, 1665 (73,9 %) of trauma was present in a comparable proportion of patients (25% in
patients fell from 1 -5 meters G1 and 21% in G2, p=NS) and the severity of trauma was similar
height. According to the system injury 594 of patients cranial between G1 and G2 subjects (ISS 11±8 in G1 vs 10±9 in G2, p=NS).
injury had first level. The mortality rate was 5,4 %. In this study, the Blood loss, evaluated through hemoglobin value, was higher in G1
average height of fatal falls is 6.612 m. both at T0 (13.9±1.7 vs 12.4±1.8 gr/L) and at T1 (12.3±1.6 vs
Age, suicide, falling height, floor of falls from height, falls 10.8±1.9, all p<0.0001), in presence of normal value of lactate
from roof, falls from (LAC) and base excess (BE), that were also similar between the two
balcony-window, falls from construction, falls from other places, groups (LAC at T0 1.7±1.3 in G1 vs 1.7±1.1 meq/L in G2, LAC at T1
cranial injury, thorax injury, 1.2±0.8 in G1 vs 1.0±0.8 meq/L in G2, all p=NS; BE at T0 -0.39±3.6
abdomen injury, rib fracture, hemotoraks, pnomotoraks, lung in G1 vs -0.73±2.8 in G2, BE at T1 0.18±4.1 in G1 vs 0.60±3.0 in G2,
contusion, hemopnomotoraks, all p=NS). Prognostic scores evidenced a significantly worst organ
internal abdomen free liquid, neurological deficit, cerebral damage in G1 vs G2 patients (SOFA T0 2.3±1.7 in G1 vs 1.51±1.41 in
edema, cranium fracture, EDH, G2, p<0.0001; SOFA T1 2.7±1,8 in G1 vs 1.8±1.2, p=0.009; APACHE
SDH(Subdural Hemorrhage), SAH (Subarachnoıd Hemorrhage), II T0 9±4 in G1 vs 4±3 in G2; APACHE II T1 10±5 in G1 vs 3±3 in G2,
ICH(Intracerebral Hemorrhage), cerebral contusion, all p<0.0001); MEWS were similar at T0 (1.6±1.3 in G1 vs 1.3±1.0 in
pnomosefalus, RTS, ISS, GCS had meaningful affect on mortality G2, p=NS), but significantly worst in the elderly at T1 (1.6±1.3 in G1
(P<0,05 of all). vs 0.8±0.9 in G2, p<0.0001). In G1 subjects the rate of in-hospital
SAH, hemopnomotoraks were determined and analyzed as admission was higher (88% in G1 and 67% in G2, p<0.0001) and
independent hospital length of stay (LOS) was longer (16±18 in G1 vs 8±9 days in
variables which effects to the mortality according to the result of G2, p<0.0001). Two of our patients died during the HDU-stay one
multivariate analyses. for acute intracranial hemorrhage and the other one for Acute
Conclusion: In this study, SAH and hemopnomotoraks are Respiratory Disease Syndrome; we observed 9 additional in-
significant factors for mortality following falls from height. hospital deaths, all in G1 group. Eleven patients, 5 in G1 and 6 in
G2, developed a depressive syndrome post event, 6, all in G1,
P930 ________________________________ Traumatology became bedridden with caregiver, 7 (5 in G1) developed a severe
walking impairment, 5 (3 in G1) reported severe memory
THE IMPACT OF MILD TRAUMA ON QUALITY OF LIFE: impairment; 1 patient in G1 committed suicide 6 months after the
DIFFERENCES BETWEEN OLD AND YOUNG PATIENTS. event, 1 patient in G1 became tetraplegic (cumulative incidence;
A Coppa (1), B Del Taglia (2), F Innocenti (3), R Pini (3), F 18% in G1 and 5% in G2, p=0.0003). During the follow-up we
Trausi (1) evaluated PCS and MCS before traumatic event (BE) and after
traumatic event (AE). Between before and after event, both in G1
1. Emergency Department, Careggi University Hospital, Florence, Italy and G2 there was a significant worsening in MCS (G1: BE 50±6 vs
2. Emergency departement, Careggi University Hospital, Florence, Italy AE 41±10, p<0.0001; G2: BE 51±6 vs AE 47±9, p<0.0001) and PCS
3. Emergency Department High Dependency Unit, Careggi University Hospital, Florence, (G1: BE 42±6 vs AE 38±7, p<0.0001; G2: BE 44±5 vs AE 42±6,
Italy p=0.002). Comparing G1 and G2, both MCS and PCS were worst
Corresponding author: Mme Innocenti Francesca ([email protected]) before and after the event (all p<0.001).
Key-words: mild trauma ; quality of life ; old and young patients Conclusion: Elderly trauma patients admitted in HDU, despite a
similar trauma severity, show worst prognostic scores and
Background: Severe trauma determines an especially bad prognosis significantly longer hospital length of stay. Moreover analysis of
in elderly subjects, but the most part of the previous works health status demonstrated that in all patients, regardless the age,
included trauma patients admitted to Intensive Care Unit (ICU); the perception of quality of life worsened significantly after
data about prognostic value of intermediate severit y trauma, both traumatic event both for physical and mental aspects. Moreover,
in terms of morbidity and mortality and respect to quality of life, elderly people experienced a worst outcome from a medical point
are lacking. Aim of this study was to evaluate the prognostic impact of view and perceived a worst a quality of life than young people.
of intermediate severity trauma according to age.
Materials and Methods: We included consecutive trauma patients P931 ________________________________ Traumatology
admitted from July 2008 to January 2012 in the Emergency
Department High Dependency Unit (HDU): this is a clinical setting PENETRATING UPPER EXTREMITY TRAUMA IN THE
with a sub-intensive level of care, without facilities for invasive EMERGENCY DEPARTMENT: A CASE REPORT
mechanical ventilation. According to age, we divided the study M. İÇER, Y. ZENGİN, H.M. DURGUN, A. ÖZHASENEKLER
population in Group 1 (G1, subjects aged ≥65 years) and group 2
(G2, subjects aged <65 years). Presence of comorbidity (including Emergency department, Dicle University, Diyarbakir, Turkey
COPD, chronic kidney disease, CAD, diabetes) and data to compute Corresponding author: Mr Zengin Yilmaz ([email protected])
Injury Severity Score (ISS), Sequential Organ Failure Assessment Key-words: upper extremity trauma ; penetrating ; local anesthesia
(SOFA), APACHE II and Modified Early Warning Symptoms (MEWS)
were collected at admission in HDU (T0) and after 24 hours in HDU
(T1). Multiple injury trauma was defined as presence of ISS ≥ 15.
BOOK OF ABSTRACTS 480
Introduction: Key Words: safety belt, hyperflexion injury, serial spinous process
Patients with skin and soft tissue wounds commonly present to the fracture
emergency department (ED) for evaluation and treatment. Case: A 23-year-old female patient was brought to our clinic after
Evaluation of a patient with penetrating trauma upper extremity an in-vehicle traffic accident. On arrival, her general condition was
begins with a careful history and physical examination.Patients moderately deteriorated, she was conscious with a GKS of 15,
who present with a wound or localized pain following trauma blood pressure of 110/70 mmHg, and a pulse rate of 115 bpm. She
should be questioned regarding the specific timing and nature of was complaining severe back pain. On physical examination she
the injury, the level of wound contamination, and any materials had multiple incisions and dermal abrasions on face and
involved in the injury (eg, wood splinters, shattered glass, shredded extremities, as well as extensive back pain on palpation. Other
metal). Physical examination of the affected area should systems were normal on examination. Laboratory examinations
adequately assess for nerve, tendon, vessel, and joint involvement. were normal. She was stabilized on a trauma board. Since she had
Perform a vascular assessment focusing on color, capillary refill, back pain and had back pain on palpation despite the lack of
and palpation of distal pulses. A neurologic examination should trauma sign on her back, a thorax CT was taken showing serial
include testing of the surrounding and distally distributed nerves fractures in spinous processes of T4-T9 vertebrae. She was
and assessing 2-point discrimination. Evaluate functional status, discharged with a thoracal corset following an uneventful trauma
concentrating on potentially involved muscles, tendons, and joints. monitoring period.
We report a case of a home-related accident involving a Discussion: Spinous or transverse process fractures may
penetrating upper extremity trauma. accompany thoracolumbar vertebral fractures due to blunt trauma
Case Report: presenting to trauma centers. Traffic accidents form more than half
A 24-year-old man was admitted because of penetrating upper of all causes of vertebral fractures. Cervical vertebrae are affected
extremity trauma by a home-related accident . W hen he pruned most commonly in traffic accidents due to hyperflexion or
trees, he fell down and the grate was entered into his arm. A hyperextension. However, thoracolumbar vertebrae may also be
fireman cut the great and the patient was transferred to the affected, albeit to a lesser extent. Radiologic examination may
emergency department( ED) by ambulance. Vital signs were within reveal compression fractures in vertebral bodies, as well as
normal limits at the time of admission. A part of great penetrated widening in interspinous spaces. We detected serial spinous
into right forearm. Neurovascular examination was normal. Right process fractures of T4-T9 vertebrae without any compression
forearm radiography was assessed as normal. Tetanus prophylaxis fracture.
and antibiotics were administered promptly. Wound dressings and
local anesthesia was performed. Penetrating foreign body was As a conclusion, it should be remembered that spinous
excluded on the same plan by retraction. Neurovascular process fractures may occur without vertebral body fractures in
examination was reassessed and there was no pathological sign. He hyperflexion injuries.
was discharged with daily wound dressing, antibiotic and
analgesic. There was no complication during the follow up patient. P933 ________________________________ Traumatology
Conclusion:
When a patient who was admitted to ED penetrating extremity C1 VERTEBRAE FRACTURE IN A CHILD DETECTED 4 DAYS
trauma, neurovascular examination should be evaluated carefully AFTER FALLING DOWN FROM HIGH GROUND
and Tetanus prophylaxis and antibiotics should be administered G. Cigsar (1), MB. Balioglu (2), G. Orman (3), A. Cakar (2),
promptly. Radiologic evaluation should be performed. If the CH. Yildirim (4), M. Kaya (4)
neurovascular examination is normal, the penetrating foreign body
can exclude from extremity with local anesthesia in ED. 1. Emergency Department, Kafkas University Faculty of Medicine, Kars, Turkey
2. Orthopedy and Traumatology Deparment, Kafkas University Faculty of Medicine, Kars,
P932 ________________________________ Traumatology Turkey
3. Radiology Deparment, Kafkas University Faculty of Medicine, Kars, Turkey
SERIAL SPINOUS PROCESS FRACTURES DUE TO 4. Neurosurgery Department, Kafkas University Faculty of Medicine, Kars, Turkey
HYPERFLEXION INJURY Corresponding author: Mme Çigsar Gülsen ([email protected])
HM Durgun, M Orak, E Ozcete, A Ozhasenekler, M Key-words: Spinal trauma ; children, ; C1 vertebrae fracture
Ustundag,
INTRODUCTION: Fractures and dislocations in children are rare
Emergency Department, University of Dicle, Medical School, Diyarbakir, Turkey after minor traumas, because of structural difference in spinal
Corresponding author: Mr Ozhasenekler Ayhan ([email protected]) column. Spinal trauma is detected in children rarely then adults.
Key-words: safety belt ; hyperflexion injury ; serial spinous process fracture The most common cause of spinal trauma in children is motor
vehicle accidents while the second common cause is falling down
Serial Spinous Process Fractures Due to Hyperflexion Injury from high ground (1). Detection of spinal traumas in children is
Introduction: It is well known that wearing safety belt is life-saving extremely difficult and SCIWORA is important to evaluate the
in in-vehicle traffic accidents. Wearing safety belt prevents the children with spinal trauma. Proximal cervical vertebrae injuries are
passenger from flying forward by stabilizing pelvic region to the more frequent in younger children, while distal vertebrae injuries
seat. However, sometimes the body of the person may be are more frequent in elder children (2). We would like to present a
hyperflexed as the thoracic part is not stabilized as much as the case with a story of falling down from approximately 2 meters
pelvic region, leading to thoracolumbar trauma. This paper reports altitude, 5 days ago, who has been carried by his family to the
a young female patient wearing safety belt in an in-vehicle traffic orthopedy outpatient clinic because of pain and posture deformity.
accident, in whom serial spinous process fractures in thoracal CASE REPORT: 8-year-old male admitted to the orthopedy
vertebrae developed due to hyperflexion. outpatient clinic with a neck and back pain and posture deformity
in his neck. His family explained that he has fallen down from the
roof of the cowshed which was approximately 2-2,5 meters
altitude about 5 days ago. They immediately took the child to the
BOOK OF ABSTRACTS 481
emergency service. After physical examination the radiographies of complained about swelling of the wound. Abscess is ruled out by a
his neck, head and abdomen have been taken. A probable IV clear fluid puncture. A seroma is suspected. On the fourth visit he
contrast enhanced abdominal tomography has been taken. After 8 reported to have sensory loss of the perineum and erectile
hours of observation in the emergency service and detection of no dysfunction. MRI and CT scan of the lower back is warranted and
pathology in the graphies, he was discharged. One day after his multiple glass foreign bodies are found in the subcutaneous tissue
discharge his neck pain and posture deformity started. His phsyical and in the spinal canal. Patient underwent 3 operations to extract
examination revealed cervical torticollis to the right side, proximal all the glass shrapnels and to seize the liquor leakage.
thoracal kyphosis increase and motion limitation of neck Methods of detecting foreign body in soft tissue vary from visual or
movements to the right side. No neurological issues was found. tactile detection in a wound exploration to ultrasound and CT. In a
Other system examinations were normal. CT was taken to his in vitro experiment performed by Aras et al CT is the best imaging
head, neck and thorax. Kranial CT was normal. A suspicious fracture technique for visualization of foreign bodies, especially localized in
line left parasagittaly on C1 vertebrae posterior arcus and wedge- air contained cavities5. Ultrasound is more effective with non-
shape in thoracal 4-9 vertebrae corpuses are detected in CTs. MRI radiopaque foreign bodies in superficial structures and its
was taken because of his pins and needles feeling of left arm and advantage is limited by depth and air6. In contrary to general
compression fracture suspect in T4-9 vertebrae corpuses. Cervical belief, glass is considered to by radiopaque and can be detected
lordosis was increased and wedge shape in T4-9 vertebrae was with plain X-ray up to 98%7. Non-radiopaque materials such as
detected in MRI. Because there was no sign of edema wedge shape wood and plastic do not show up in plain X-ray and CT. In an
was not concluded to trauma. No soft tissue pathology was extensive literature search for glass detection using plain
detected on MRI. radiography Weinberger concluded that despite adequate
CONCLUSION: Falling from high altitude is one of the most exploration of superficial wounds, 4% of the negative exploration
common causes of trauma in childhood. This may cause spinal retains glass on plain radiography. In our case, a plain radiography
trauma in children rarely. The features of their body structures of the lower lumbar spine is warranted because the depth of the
must be taken into account when evaluating childhood trauma in wound. The glass shrapnels could have easily detected.
emergency department. Spinal injuries may be without radiological References
evidence in children. It must be taken into consideration that every 1. M. Orlinsky The utility of routine x-ray in all glass-caused wounds
kind of injuries may be seen in traumas even if it’s a rare situation. American Journal of Emergency Medicine 2006; 24; 233-236
2. S Gul Penetrating spinal injury with a wooden fragment: a case
P934 ________________________________ Traumatology report and review of the literature Spine 2010 1; 35; 1534-6.
3. KH Lee An unusual case of penetrating injury to the spine
AN EXTREME CASE OF PENETRATING INJURY TO THE SPINE resulting in cauda equina syndrome: case presentation and a
RESULTING IN CAUDA EQUINA SYNDROME. A CASE review of the literature. Spine 2007; 20; 290-3.
REPORT AND LITERATURE REVIEW. 4. D Pal Penetrating spinal injury with wooden fragments causing
A Wei cauda equina syndrome: case report and literature review.
European Spine Journal 2006; 15 Suppl 5:574-7.
Emergency Department, University Hospital St Radboud Nijmengen, Nijmegen, 5. MH Aras Comparison of the sensitivity for detecting foreign
Netherlands bodies among conventional plain radiography, computed
Corresponding author: Mr Wei Abel ([email protected]) tomography and ultrasonography. Dentomaxillofacial Radiolgy
Key-words: cauda equina syndrome ; glass foreign body ; penetration 2010; 39; 72-78
6. MJ Ginsburg Detection of soft tissue foreign bodies by plain
Open wounds caused by glass are common in emergency radiography, xerography, computed tomography and
department visits. Relaying solely on wound exploration doesn’t ultrasonography. Annals of Emergency Medicine 1990; 19; 701-703
always expose glass foreign body, considering 8,7% of the glass 7. DE Man they Ultrasound versus radiography in the detection of
wounds does retain glass foreign body1. There are few reports soft-tissue foreign bodies. Annals of Emergency Medicine 1996; 28;
found in PubMed on spinal cord injury caused by foreign body and 7-9
only 3 with cauda equina syndrome2, 3,4. In this report we present
a rare case of spine penetration by glass goes undetected until P935 ________________________________ Traumatology
cauda equina syndrome developed.
The patient is brought to our ED with glass wound to the lower UNDAMAGED VASCULAR STRUCTURE AFTER A
back on a Saturday night. As a practical joke his friend raised him POSTEROLATERAL KNEE JOINT DISLOCATION; A CASE
up by the waist in the pub. His friend lost balance and they both REPORT
fell on their backs. Our patient fell unfortunately on a beer glass. S Inal (1), F Taspinar (2)
He reported that there is a brief moment of parenthesis in the left
calf and toes while he was in the waiting room. The wound is 1. Orthopaedics and Traumatology Department, Dumlupinar University School of
measured to be 8cm long, transversely, at L5-S1. Exploration of the Medicine, Kutahya, Turkey
wound after local infiltrating with lidocaine shows a minimal 2. Physiotherapy and Rehabilitation Department, Dumlupinar University Kutahya
laceration of fascia of right erector spine muscle. No glass was Graduate School of Health, Kutahya, Turkey
found in de wound. Physical examination of the lower extremities Corresponding author: Mr Taspinar Ferruh ([email protected])
rule out neurological deficits. The wound is sutured and the patient Key-words: vascular ; complications ; diagnosis
is booked for outpatient clinic over 3 days.
In the outpatient clinic our patient complained about headache, A knee dislocation is an unusual and extremely serious injury. The
nausea and photophobia. The headache is pounding in nature, dislocation occurs when the femur and tibia lose contact between
triggered when sitting up or standing. Neurology consult diagnosed each other. Knee dislocations are usually high-energy traumatic
it as a mild concussion and CT scan of the brain is not warranted. injuries. These injuries can occur with severe falls, sports injuries or
The three following check-up at the outpatient clinic he automobile accidents. When the knee dislocates, significant
BOOK OF ABSTRACTS 482
damage is done to the soft-tissues that surround the joint. Except P937 ________________________________ Traumatology
the torn ligaments of extra or intra articuler region of the knee and
damage of cartilage; in particular, high rates of damaged vascular EYE PAIN AFTER COUGH: ORBITAL EMPHYSEMA
and nerve structures has been reported. In fact, vascular injuries YE EYİ (1), M EROĞLU (2)
can be so severe that the leg health can be threatened to the point
of requiring emergency vascular surgery. Here, we are reporting an 1. Emergency department, Hakkari Miltary Hospital, Hakkari, Turkey
eighty three years old male patient who had a posterolateral 2. Emergency Department, GATA Haydarpaşa Training Hospital, İstanbul, Turkey
dislocation of the knee. He examined by the vascular surgeon at Corresponding author: Mr Eyi Yusuf Emrah ([email protected])
the emergency service and has not developed any vascular or Key-words: orbital wall fracture ; orbital emphysema ; orbital trauma
nerve damage from the injury. Because of high rates of vascular
injury during the knee dislocation as reported in the literature, the Introduction:
emergency service physicians must consult the patient to the While injuries relating the eye and surrounding area may be blunt
vascular surgeon. Because vascular injury is the first emergency and penetrating, complications of injuries at middle face region
that must be threat. would be more serious. Due to the anatomical structure of orbita
bounded by sinuses, fractures formed after traumas can cause
P936 ________________________________ Traumatology collection of sinusoidal air in orbita and then orbital emphysema.
Orbital emphysema is a radiological finding that can be seen in half
CHARACTERISTICS OF CHILDREN PRESENTING WITH of orbital fractures and a sign of fracture.
TRAUMA TO A EMERGENCY DEPARTMENT Case:
S. Ozdinc (1), A. Bukulmez (2) 35 years-old male patient has applies to our ER with complains of
pain, erythema, swelling around his right eye. He expressed he had
1. Emergency Department, Afyon Kocatepe University Medical Faculty, Afyonkarahisar, a crush by his friend’s elbow during soccer play about 6 hours ago,
Turkey then his pain severed after coughing. He has been evaluated
2. Pediatric Diseases Department, Afyon Kocatepe University Medical Faculty, normal after eye motions and eye examination. At first, his
Afyonkarahisar, Turkey craniography has been taken, then maxillofacial region CT has also
Corresponding author: Melle Ozdinc Serife ([email protected]) been evaluated. We have observed orbital medial wall fracture and
Key-words: children ; trauma ; emergency department related orbital emphysema. As eye examination of our case was
normal, we have not considered decompression and surgical
Background and aim: Trauma is the leading cause of mortality in intervention, he has been contented for conservative follow-up.
children over one year of age in industrialized countries Among Result:
patients in pediatric trauma patients admitted to the emergency Orbital emphysemas take place after situations where pressure
department(ED) is important. Bu travmaların bir kısmı acil serviste increases such as cough, nose blowing, straining. Generally it is
takip ve tedavi sonrası şifayla taburcu edilebilirken bir kısmı mortal benign and self-limiting, but it can rarely cause optical nerve
seyredebilmektedir. Some of these traumas discharged after damage and seeing-loss. The cases with sudden seeing loss,
treatment in the emergency department follow-up and a part of effected eye motion, disk edema, and reduced pupil-light reaction
the mortal. This study is aimed at the evaluation of the must be carried out decompression urgently.
demographic properties of the patients pediatric trauma cases who
were admitted to the to the Afyon Kocatepe University Faculty of P938 ________________________________ Traumatology
Medicine Department of Emergency.
Material and methods: Patients admitted to our ED between TRAVMA SONRASI TESPİT EDİLEN OSTEOİD OSTEOMA
January 1, 2010 – June 30, 2012 were retrospectively analysed OLGUSU
from the admission charts and patient files. Data were G. Çığşar (1), A. Çakar (2), M.B. Balioğlu (2)
analyzed with 18, SPSS.
Results: Our emergency service had been visited by 4097 trauma 1. Acil Tıp AD, Kafkas Üniversitesi Tıp Fakültesi, Kars, Türkiye
patients between the dates of January 2010 and June 2012, and 2. Ortopedi ve Travmatoloji AD, Kafkas Üniversitesi Tıp Fakültesi, Kars, Türkiye
1227 (29%) of them were acute pediatric trauma cases. Eight
hundred thirthy seven patients were (64.7%) boys, four hundred Corresponding author: Mme Çigsar Gülsen ([email protected])
fifty six patients (35.3%) were girls. Those children were younger Key-words: osteoid osteoma ; travma ; tümör
than 19 years old (Mean age was 8,3± 4,7 years). It is found that
the majority of cases admitted to ED on Saturday (%18,7), on May GİRİŞ VE AMAÇ: Osteoid osteoma; en fazla 10-20 yaş arasında
(14%) and at 04-12 hours pm (%58,1). The most frequent pattern görülen, benign osteoblastik bir kemik tümörüdür. Osteoid
of injury was related to the head/face(43%) and limb trauma osteoma tüm kemik tümörleri arasında görülme sıklığı %2-3 ve
(33,1%) Life threatining accident was head trauma (%1,1). benign kemik tümorleri arasında %11-12 dir(1). Tüm vücut
Conclusion:These kinds of investigations in ED may be useful in kemiklerinde görülmekle birlikte en sık alt ekstremite kemiklerinde
reducing childhood trauma for the measuring. Child trauma görülür(2.3). Osteoid osteomanın klinik olarak en belirgin özelligi
prevention and control is crucial. It should be an integral part of nonsteroidal antiinlamatuar ilaclar (NSAID)/salisilatlara dramatatik
child health and survival. Thus complementary childhood injury cevap veren lokalize ağrıdır. Diğer kemik tümörlerinden en önemli
prevention strategies were evaluated. farkı ise ozellikle geceleri artan belirgin ağrının olmasıdır.
Görüntüleme yöntemlerinden konvansiyonel radyografi, sintigrafi,
BOOK OF ABSTRACTS 483
BT ve MRI’den yararlanılır. cerrahi öncesinde tümörün lokalizasyon examination, vital signs were stable and low in the left upper eyelid
belirlemek için görüntüleme yöntemleri gereklidir(4). edema, were detected in the medial wall crepitus.In palpation
OLGU/BULGULAR: 9 yaşında kiz cocugu, basit travma sonrası gittiği orbital circumference is healty an there isn’t any diplopia and
acil serviste değerlendiriliyor; sonrasında ağrı şikayetlerinin looking restrictions at up-down-right and left looking were
geçmemesi üzerine hastanemiz ortopedi polikliniğine detected.In Orbital computed tomography scan on the left medial
yönlendiriliyor. Ortopedi polikliniğinde alınan ayrıntılı anemnezinde orbital wall fracture, and this level of the adjacent ethmoidal sinus
özellikle geceleri artan ve uykudan uyandıran ağrı tarifleyen ethmoidal sinus shows continuity with the fine irregular soft tissue
hastaya, iki yönlü sol cruris konvansiyonel radyografide; tibia density suggestive of a small hematoma in the soft tissues and also
proksimal 1/3 medialde subkortikal sklerotik ve sklerotik alan the left preorbital collections of free air around the medial rectus
proksimalinde litik alan tespit edilmesi üzerine osteoid osteoma ön muscle was found. After initiating prophylactic antibiotic and
tanısı ile salisilat başlanıyor(300 mg/gün geceleri). Salisilat tedavisi analgesic theraphy the patient was discharged with policlinic
sonrası ağrılarında dramatik bir şekilde azalma olması üzerine consulted recommendations from the emergency department to
tanısal olarak BT ve MRG istemi yapıldı. Çekilen görüntülemede the eye diseases and plastic surgery departments.
nidus formasyonu ve nidus proksimalinde litik alan tespit edildi. CONCLUSION: Diagnosis of orbital emphysema is usually confirmed
Osteoid osteoma tanısı kesinleştirilen hastanın tedavisi total by anamnez ,physical investigation and BT scan and it becomes
eksizyon şeklinde düzenlendi. resorbed via untreatment. Facial swelling,eyelids closing and
SONUÇ: Çocuk yaşta ekstremite travma olguları sık olarak acil extraorbital subcutaneous emphysema clinical symptoms occur in
servise basit travma sonrası müracat etmektedir. Bu olgularda acil patients who are intake in orbital space air.It can be
servis hekimleri altta olabilecek diğer patolojiler konusunda uyanık subconjunctival hemorrhage,crepitation,tenderness and
olmalıdırlar. pain.Rarely,as a result of orbital emphysema,developing orbital
Anahtar kelimeler: osteoid osteoma, travma, tümör compartment syndrome may develop central retinal artery
1.Orlowski JP, Mercer RD. Osteoid osteoma in children and young occlusion.Air which is entering the orbital area can make occlusion
adults. Pediatrics 1977;59:526-32. and loss of vision as mass effecting on the centra retinal
2. Worland RL, Ryder CT, Johnston AD. Recurrent osteoid-osteoma. artery.Because of our case,however,patients with orbital trauma
Report of a case. J Bone Joint Surg [Am] 1975;57:277-8. take diagnosis in different clinic departments (plastic
3. Lichtenstein L. Bone tumors. The CV. Mosbsy Company. Saint surgery,ENT.etc.) must consulted with the department of eye
Louis 4 ed. 1972. p. 89-102. disease.As a result, the benefit of treatment appears. Patients
4. Tuzuner S. Gur S. Aydın A. Osteoid Osteoma. Tani Yontemleri ve should be closely monitored due to developing risk of visual
Tedavi Kriterleri. Acha Orthop Traumotol Turc 1996 30.355.360 complications . Prophylactic antibiotic treatment should be given
to each patient with orbital emphysema.During this period
P939 ________________________________ Traumatology patients should be closely monitored.
DEVELOPING ORBITAL EMPHYSEMA DUE TO TRAUMA P940 ________________________________ Traumatology
E Kadioglu (1), B Işık (2), S Karaman (3)
A RETROSPECTIVE EVALUATION OF TRAFFIC COLLISIONS IN
1. Department of Emergency Medicine, D.P.Ü. Evliya Çelebi Training and Research A LEVEL 1 TRAUMA CENTER IN ISTANBUL
Hospital, Kütahya, Turkey E Aydeniz (1), R Demirhan (2), O Güneysel (3), M Ünaldı (3)
2. Department of Emergency Medicine, Aydın State Hospital, Aydın, Turkey
3. Departman of Emergency Medicine, Erzurum Regional Training and Research Hospital, 1. Emergency Department, Çerkezköy State Hospital, Tekirdağ, Turkey
Erzurum, Turkey 2. Thorax Surgery Department, Kartal Training and Research Hospital, İstanbul, Turkey
Corresponding author: Mme Kadioglu Emine ([email protected]) 3. Emergency Department, Kartal Training and Research Hospital, İstanbul, Turkey
Key-words: trauma ; orbita ; emphysema Corresponding author: Mr Ünaldi Mehmet ([email protected])
Key-words: Traffic Collision ; Emergency Department ; Injury
INTRODUCTION-PURPOSE: Orbital emphysema is associated with
fractures of the paranasal sinuses involving the orbita.Orbital Objective: As other developing countries, traffic collisions are also
fractures and subcutaneous are well-defined after blowing one’s an important public health problem in Turkey and thousands of
nose in accompanying with a few visual loss is seen. A sudden loss people suffer from traffic collisions per year. Increasing number of
of vision, which happens after orbital trauma, generally becomes traffic collisions are caused by provision of traffic load mainly with
due to retrobulbar hemorrhage. .In the paranasal sinus fractures roadway, increased number of car emerging into traffic, alcohol
including the orbital walls,orbital emphysema usually occurs consumption and lack of adequate education and control
within the first 24 hours. Benign, transient absorption, a measures; this causes significant mortality and morbidity. In the
phenomenon of spontaneous orbital emphysema occurs within present study, it was aimed to establish the outcomes of traffic
two weeks. Orbital emphysema, patients with a history of trauma accidents and to contribute local recommendations intending to
assessed by palpation and radiological examination. With prevent collisions; to improve survival and minimize disability after
increasing intranasal air pressure in orbital wall fracture traffic collisions by assessing data of the cases presented in
patients,the maxillary,ethmoid and less frequently air enters the Emergency Department of Dr. Lütfi Kırdar Teaching Hospital by
orbital area from frontal sinuses.In our studying we wanted to traffic collision.
show you a patient who has sweling and orbital emphysema on Materials and Methods:In our study, traffic accidents between
the eyelids due to blowing one’s nose after spending nearly five January, 2011 and June, 2011 were retrospectively reviewed from
hours of trauma. electronic records and patient registry. Overall, data were obtained
CASE: A thirty-one year old male patient had been hit to his head for 1463 patients. Age, sex, presentation, arrival time, areas of
around ten o’clock in the morning but in this process ,without any injury, mechanism of the accident (in-vehicle, out-vehicle,
symptoms,the patient applied to the emrgency room because of motorcycle) and distribution according to months, vital findings,
happening left eyelid swelling and pain while clearing his nose,after (Glasgow Coma Score, BP values), treatment and final outcome
five hours from the incident. Good general condition with physical
BOOK OF ABSTRACTS 484
(admission, disposition, mortality rate) were considered in patients conjunction with pneumocephalus, pneumothorax,
those included in the study. Statistical analyses were performed by pneumomediastinum, peumopericardium or subcutaneous
using SPSS Version 19.0. emphysema.
Results:Of the cases, 1011 (69.1%) were men, whereas 452 (30.9%) Thus, diagnosis of PR strongly suggests the possibility of the
were women. 21-30 years of age was the most frequent age coincidental associated and hidden injuries eslewhere in the body.
interval (29.2%). Of the patients, 58.6% were injured as a result of Penetrating spinal injuries may cause isolated subarachnoid PR
in-vehicle collision, whereas 30.1% and 10.7% as a result of out- without accompanying head injury. [Oertel MF et al., 2006.]
vehicle and motorcycle collision, respectively. In the assessment of Lessons Learnt : To the best of our knowledge, this is the first case
distribution, it was seen that the highest number of collision of Traumatic Pneumorrhachis to be reported without significant
(19.6%) occurred at June. Patients were most commonly arrived to vertebral or mediastinal injury. In particular there was no evidence
ED by EMS (76.9%) and at hours between 16:00 and 24:00 (44.4%). of pneumomediastinum or pneumothorax. There was a small
Of the patients, 59.1% were injured from extremity, which was the collection subcutaneous cervical emphysema but the aetiology of
most frequent injury area. Of the patients in our study, 87.1% were this remains unclear. One possible explanation is possible
disposed from ED after treatment and 9.4% were managed by barotrauma as a result of significantly increased intrathoracic
admission, while 1.8 were admitted to ICU and 0.8% died. Of all pressure at the time of injury result in extrusion of air into a fascial
patients, 0.9% was already death before arrival. Patients were envelope.
most commonly admitted to Orthopedics & Traumatology clinic.
Conclusion: P942 ________________________________ Traumatology
In the present day, traffic collisions are a significant social issue ANXIETY LEVEL OF FORMULA ONE ISTANBUL GRAND PRIX
due to unfavorable effects on individuals and social life. Traffic FIA TURKISH MEDICAL TEAM
collisions cause high rates of death, injury and disability in addition
to substantial economic losses.
P941 ________________________________ Traumatology MA Karamercan (1), P Atilla (2), ZD Balkanci (3), G Ozel (4),
AM Sevgili (3)
TRAUMATIC PNEUMORRHACHIS : AN UNCOMMON BUT
SIGNIFICANT FINDING IN MAJOR TRAUMA 1. Emergency Department, Gazi University Faculty of Medicine, Ankara, Turkey
M Hassan (1), A Majeed (1), D Yeo (2) 2. Histology and Embryology Department, Hacettepe University Faculty of Medicine,
Ankara, Turkey
1. Emergency Department, University Hospital Birmingham, Birmingham, United Kingdom 3. Physiology Department, Hacettepe University Faculty of Medicine, Ankara, Turkey
2. Emergeny Department, University Hospital Birmingham, Birmingham, United Kingdom 4. Microbiology Department, Yozgat Goverment Hospital, Ankara, Turkey
Corresponding author: Mr Yeo David ([email protected]) Corresponding author: Mr Karamercan Mehmet Akif ([email protected])
Key-words: Pneumorrhachis ; Trauma ; Radiology Key-words: Formula One and Motor GP ; Motor Sports Medicine ; Trauma
Introduction : Pneumorrhachis is an uncommon radiological finding INTRODUCTION
consistent with air in the spinal canal. Taken in context with major Motor sports are among the most popular types of sports
trauma, this finding is a marker of severe trauma. We report a case worldwide, practiced in practically all countries and as a wide
of Traumatic Pneumorrhachis following chest and abdominal variety of disciplines. Grand Prix racing refers to the premier
injury, but no skull or cervical spin injury. categories of road racing worldwide, including Formula One and
Case Presentation : A mid 30s professional BMX rider was admitted Moto GP. Although there is a common misconception that
to the Emergency Department following a high speed collision with motorsports medicine is analogous to standard emergency medical
the ground. He was wearing body armor and had a high impact services (EMS) or sports medicine, due to the unique racing
helmet. On arrival, he complained of left sided chest and environment a traditional approach to EMS can be ineffective and
abdominal pain. Primary survey observations were stable, apart may expose drivers, spectators, and medical personnel to great
from left lower chest wall and left upper quadrant abdominal danger. Motorsports medicine is unique due to medical personnel
tenderness. must be knowledgeable regarding vehicle configurations, crash
Secondary survey did not identify any further abnormalities or characteristics, changing safety equipments those uniquely impact
neurological deficit. patients care, providing patient care in a potentially dangerous
A CT head to pelvis scan on a biphasic single pass protocol environment, required specialized training in extrication and
demonstrated small locules of air in the spinal canal and under the packaging of patients from various types of race vehicles. This
vertebral arteries at the level of C2. His head scan was normal with purpose of this research was to determine the medical team stress
no skull fractures. There were no cervical or thoracic vertebral level and probable factors affecting these.
fractures. METHODS
He had a fracture of left posterior 7-12th ribs and left lateral 6-7th Standardized data collection forms were used throughout the
ribs with underlying minor left lung contusion but no study which included a letter of explanation of the study and
pneumothorax or haemothorax. There was a Grade 1 splenic demographic characteristics of the participants and a copy of the
lacerations with no active bleeding or intra peritoneal air or free Spielberger State-Trait Anxiety Inventory (STAI). The participants
fluid and no pelvic fracture. completed the data collection forms in the morning for three
The patient was admitted for conservative management and consecutive day of the race while waiting in the medical center
observation, and was discharged 3 days later pain free with no before they go to the positions within the course.
neurological sequale with no follow up required. The STAI is used to determine the anxiety level and the inquiry
Discussion : Almost exceptionally, Traumatic Pneumorrhachis is is used to determine their personal information. The
found in combination with associated air distribution in other Independent Sample t-test and the One Way Variance Analyses are
compartments and cavities of the body: in particular, in used for relation. All the statistics are have 95% confidence and p
<0.05 accepted as statistically significant.
RESULTS
BOOK OF ABSTRACTS 485
A total of 46 medical personal included in this study. 87 % (n=40) of INTRODUCTION
the study group worked in intensive care unit, surgery room or Glenohumeral joint, is the most active and the most common joint
emergency department and mean work time is 6.1 ±4.1 year. 94 % in the body. The mean age of the shoulder dislocated patient is
(n=43) had done resuscitation, 89 % (n=41) had intubated a 20,and 85-95% of patients are male. %85 -95 of shoulder
patient, 85 % (n=39) had seen thoracic tube insertion, 61 % (n=28) dislocations are anterior and 56% of the dominant-sided. As a
had actively participated in thoracic tube insertion and 57 % (n=26) complication bone fractures, ligament injuries, rotator cuff tears
had participated in emergency thoracotomy. occur frequently, but nerve injuries rarely encountered.
Although 67 % (n=31) of the participants declared that they don’t CASE:
want any accident in this race, 98 % (n=45) want to be in the first 76-year-old male patient, shoulder pain started after a fall on the
intervention team in case of an accident and 74 % (n=34) at least to right side of the right arm while walking and presented to our
see the accident within the course. emergency department with loss of motion. As a result of right
While there is no correlation between profession/duty in the team shoulder’s physical examination swelling posterior to the shoulder,
(physician, nurse, driver etc) and first-second day anxiety scores of ecchymosis and epaulet sign were observed. On palpation pain
the participants, there is significant correlation between and tenderness in the right shoulder and anterior right humeral
profession/duty in the team and third day anxiety scores of the head were found. Neurological examination revealed paresthesia
participants. (p=0.007) The anxiety scores were highest in drivers at lateral skin of right humerus, dorsal aspect of the wrist that fits
of the medical vehicles whereas lowest in the physicians. There is to the radial nerve sensory area and inner side of the arm , ulnar
neither correlation between sex and anxiety scores nor education side of the fingers that fits to the ulnar nerve sensory area. Also
level and anxiety scores. There is moderate negative correlation loss of extension and ulnar deviatation at wrist and fingers were
between work and/or previous hospital experience and anxiety found. This result of neurologic examination evaluated as radial
scores on second and third day. (p=0.001) Anxiety scores rank nerve and ulnar nerve motor and sensory loss . X-ray showed an
highest in the ones who have not attended to resuscitative anterior shoulder dislocation of the shoulder. After consultation of
procedures before. orthopedics, reduction was achieved by the method of koher by
DISCUSSION sedation-analgesia with midazolam and fentanyl. Control
The results show that, the anxiety of medical team is lowest on the radiograph after reduction indicated no fracture, the patient
first day and increasing through third or last day. Although not pointed out no improvement in neurological findings and
always needed but on-site medical personnel are able to provide underwent velpau bandage. 3 weeks later, the EMG examination
and/or assist an expanded scope of practice such as a surgical of the radial nerve showed mild axonal degeneration and ulnar
cricothyrotomy, rapid sequence intubation, other advanced nerve severe axonal degeneration. At 3. week partial and at 10.
alternative airway and amputation, which have been shown to save week full neurological recovery was seen .
the lives of drivers. In this study the medical team has a good self- CONCLUSION:
confidence which is obviously seen that 98 % of the participants Brachial plexus injuries after shoulder dislocations are mixed
want to be in the first intervention team in case of an accident. lesions rather than isolated nerve lesions. In both cases, the most
There was no correlation between duty in the team and first- affected nerve is axillary nerve. Neurological examination and
second day anxiety scores. However on third day which is the most recording before reduction must make, when nerve damage is
stressful day of the race schedule, anxiety scores were high in detected orthopedic orthopedic consultation should be
drivers and low in physicians. This is also true for hospital taken.These are important in the prevention of medicolegal
experience and negatively correlated. Although all drivers are problems.
professional race car drivers as a rule, they are less experienced in
hospital work. Because of this they are very familiar on race stress P944 ________________________________ Traumatology
but less on the medical interventions and resuscitative procedures.
As a result we should start a program that will increase the INTRA-ARTICULAR CALCANEAL FRACTURE: A CASE REPORT
experience of medical car drivers on medical interventions and YE EYİ (1), AO YILDIRIM (2), SK TUNCER (3), U KALDIRIM (3),
resuscitative procedures. B KARSLIOĞLU (4), M EROĞLU (2), S ARDIÇ (3), I ARZIMAN
(3), M DURUSU (3), C KAYA (3)
P943 ________________________________ Traumatology
1. Emergency department, Hakkari Miltary Hospital, Hakkari, Turkey
BRACHIAL PLEXUS INJURY DUE TO SHOULDER 2. Emergency Department, GATA Haydarpaşa Training Hospital, İstanbul, Turkey
DISLOCATION AT EMERGENCY DEPARTMENT: A CASE 3. Emergency Department, GATA, Ankara, Turkey
REPORT 4. Orthopeadics and Traumatology Department, Hakkari Miltary Hospital, Hakkari, Turkey
YE EYİ (1), SK TUNCER (2), M EROĞLU (3), B KARSLIOĞLU (4), Corresponding author: Mr Eyi Yusuf Emrah ([email protected])
A PARLAK (5), T TÜRE (2), G AYDIN (2) Key-words: CALCANEUS ; FRACTURE ; INTRA-ARTICULAR
1. Emergency department, Hakkari Miltary Hospital, Hakkari, Turkey INTRUDUCTION
2. Emergency Department, GATA, Ankara, Turkey Calcaneal fracturec constitutes 2% of all fractures and the most
3. Emergency Department, GATA Haydarpaşa Training Hospital, İstanbul, Turkey common fractures in the tarsal bone fractures. 65% of all tarsal
4. Orthopeadics and Traumatology Department, Hakkari Miltary Hospital, Hakkari, Turkey bone fractures are calcaneal fractures. Calcaneal fractures are
5. Family Doctor, Ağrı Military Hospital, Ağrı, Turkey high-energy fractures are also damage surrounding soft tissues.
Corresponding author: Mr Eyi Yusuf Emrah ([email protected]) Especially at Intra-articular calcaneal fractures fracture line isnt
Key-words: SHOULDER DISLOCATION ; BRACHIAL PLEXUS INJURY ; EMERGENCY obvious at direct radiography, and can be diagnosed by calculating
DEPARTMENT angles with computed tomography.
CASE:
34-year-old male patient. He admitted to the emergency
department complaining left foot pain and not weight-bearing
BOOK OF ABSTRACTS 486
after falling onto foot at home. Physical examination: edema of the POI or in its immediate vicinity, after self aid or buddy aid, first
the left lateral malleolus of ankle, and there was tenderness in the aid is delivered by the combat life saver: the aidman in a
calcaneus with tenderness. Neurovascular examination was conventional forces operations setting or when in support of
normal. At lateral ankle radiograph, calcaneal disorder observed Special Operations Forces (SOF), the SOF Advanced First Responder
but there was no significant pathology associated with calcaneal (aidman SO).
fracture in the monitoring. Considering the mechanism of trauma The certification levels of these personnel, the various life saving
and result of physical examination to exclude a possible tarsal bone skills and techniques they will be trained in, the assets they are
fracture limb tomography was planned . There was a fracture line equipped with as well as the notification procedures to initiate
that extends to talus joint line and, calcaneal height decreased, was prompt evacuation are discussed.
observed at tomography. Patient was admitted to the orthopedic Additional emphasis is laid on several challenges the evolution
clinic for the operation. towards this new 10-1-2 timeline holds for the BEL Defense
CONCLUSION: Department as a whole and the Medical Component in particular.
Two major angle evaluating calcaneus at lateral radiograph are Creating a performant battlefield first response capacity capable of
Böhler angle and gissane angle. Although measurements made providing enhanced first aid, suddenly becomes a concern of
good, X-ray is required separately for each articular surface and utmost importance for ALL components (land, air and navy). On the
intra-articular fractures of the calcaneus radiographs exposure other hand, matching the ‘new’ needs for extended (-sive) medical
techniques are difficult because it requires experience to diagnose. education of each deployable soldier and the combat life saver
Computed tomography is the method that eliminates all these puts a significant burden on the instruction and training resources
problems. Coronal and transverse images obtained with this of the Medical Component. Last but not least, as a continuum of
method is focused in the geometry of the fracture, and care has to be maintained throughout the whole treatment and
tomography based classification shaped the treatment. evacuation chain, bridging the gap with medicalized rotary wing
assets for forward tactical aeromedical evacuation to the right next
P945 ________________________________ Traumatology echelon of care must be emphasized.
HOW IS THE BELGIAN DEFENSE IMPLEMENTING THE 10 P946 ________________________________ Traumatology
MINUTES TIMELINE RULE?
E DHONDT, G LAIRE ELEKTRICAL INJURY-INTRAALVEOLAR HEMORRHAGE: CASE
STUDY
Medical Component Operational Command, BEL Defense, Brussels, Belgium M Gul, T Acar, C Dikmetas, M Ergin, H Nak, B Cander
Corresponding author: Mr Dhondt Erwin ([email protected])
Key-words: preventable combat death ; platinum 10 minutes ; battlefield casualty care Emergency department, Necmettin Erbakan University Meram Medicine
Faculty, Konya, Turkey
Operational medical support aims at ensuring that every battlefield Corresponding author: Mr Acar Tarik ([email protected])
casualty gets the right treatment, in a timely manner and at an Key-words: ELEKTRICAL INJURY ; INTRAALVEOLAR HEMORRHAGE ; thorax ct
appropriate facility. Timeliness of treatment is a fundamental
principle of this echeloned medical support. Based on available ABSTRACT
clinical evidence and experience gained from operations during the Electrical İnjuries may come with a wide gap of damage from
last decade, the main NATO medical planning guideline for medical superficial skin burn to death. It is quite important to doubt about
support has evolved to become the 10 Minutes -1 hour - 2 hours the injuries which come into existence on the tissues and organs
timeline. over the path of current. Most of the electrical injuries are
Especially the initial response capability with the provision of common to children, adolescent men and workers who are
appropriate urgent medical care at the point of injury (POI) is exposed to electric. Respiratory standstill, aspiration pnemuonia ,
crucial, in particular for those casualties who are critically injured pulmonary edema and pulmoner contusion may be seen as the
and potentially face survivable causes of death, such as extremity result of electrical injury . CASE: A 15 years old male patient who
hemorrhage exsanguination, airway obstruction and tension works at a hairdresser is brought to our emergency service with
pneumothorax. 112 ambulance upon exposing to household type electric while
To reduce this “preventable combat death” and in accordance with preparing shave creme with water and soap for a haircut. During
this 10-1-2 medical planning timeline, the provision of bleeding the physical examination which was done just after the arrival of
control, airway control and adequate breathing for the critically the patient , It was observed that general condition was good,
injured casualties must be achieved within 10 minutes of arterial blood pressure was 120/70mmHg, pulse was 70
wounding. throb/min. and fever was 36.54ºC. Electric inlet burn on the 1th
Within these so called “platinum 10 minutes” immediate life saving and 2nd fingers of the left hand and electric outlet burn on the left
measures have to be applied by non-medical professionals trained aerola of the chest were seen. During the examination of the
in Enhanced First Aid: stopping extremity bleeding applying patient both of the hemithoraxes were participating equally and
tourniquets as well as pressure and hemostatic dressings, securing there was no ral rhonchus. The number of respitarion was 25. A
the airway by oro- and/or nasopharyngeal tube and treating for blood test analysing Na, K, urea, creatinin, , CPK, CK MB, troponin,
tension pneumothorax by closing sucking chest wounds and/or Myoglobulin, hemogram was done . The results of the blood test
needle thoracostomy. were at the normal limits. Because of the weak tachypnea of the
To provide this, sufficient combatant personnel need to be patient, contrasty thorax bt x-ray was taken. From the contrasty
permanently trained to deliver enhanced first aid, be competent in thorax ct x-ray, a harmonic condition with hemorrhage was viewed
maintaining the skills needed and finally equipped accordingly. on the right lung parenchyma widely and on the superior lob at the
The Belgian Defense has adopted a tiered approach to this novel left. For the follow-up treatment the patient was transfered to
combatant non-medical battlefield casualty care requirement. At emergency bed service. Betamimetic nebul and regular oxygen
together with N-ASETİLSİSTEİN were given to the patent. On the
BOOK OF ABSTRACTS 487
3th day of the patient follow- up at the emergency bed service durumları, çalışma günleri ile yaralanma ilişkisi, mesleki tecrübeleri,
contrasty thorax ct was taken. It was determined that the dominant el kullanımının yaralanma şiddeti ve tekrarlayan
hemorrage disappeared. Upon stable symptoms , the patient was yaralanmalar üzerine etkisinin incelenmesi amaçlandı.
discharged. CONCLUSION: Through this case we identify that even MATERYAL METOD: Çalışma 2011- 2012 yılında Ankara Ostim
there is no significant finding during the physical examination Sanayi Sitesi semt polikliniğine 5 aylık sürede başvuran küçük
following the electric shock , there can be serious lung injuries. We mesleki yaralanmalı hastaların retrospektif dosya kayıtlarının
presented this article in order to emphasize that a complete incelenmesi ile gerçekleştirildi. Hastaların yaş, cinsiyet, başvuru
physical examination should be done in this type of cases and even günü ve saati, dominant el kullanımı(sağ, sol), mesleğindeki çalışma
the smallest finding may signal a serious injury. yılı(tecrübe), daha önceki yaralanma hikayesi, iş sahası, yaralanan
elin hangi el olduğu(sağ, sol), ek hastalığı, açlık-tokluk durumu,
P947 ________________________________ Traumatology meslek grubu, başvurunun yaralanmanın kaçıncı saatinde yapıldığı,
yaralanmanın özelliği, yaralanmaya neden olan aletin mesleki alet
AN UNEXPECTED COMPLICATION OF TRAUMA: CAROTID olup olmadığı ve hastanın muayenesinin nasıl sonuçlandığına
ARTERY DISSECTION bakıldı. İstatistiksel çalışmalar SPSS for Windows 17 programı ile
M Ergin, FE Visneci, K Kucukceran, AA Sevimli, B Cander yapıldı.
BULGULAR: Çalışmaya bu dönemde polikliniğe başvuran küçük el ve
Emergency Department, Necmettin Erbakan University Meram Medicine Faculty, Konya, el bileği yaralanması bulunan 80 hasta dahil edildi. Hastaların
Turkey 79’u(%98,8) erkek, 1’i(%1,2) kadın yaş ortalaması ise 33,06±11,28
Corresponding author: Mr Ergin Mehmet ([email protected]) (min:16-max:64) idi. 21(%26,3) hasta ile en fazla başvuru pazartesi
Key-words: Blunt trauma ; Carotid arterial dissection ; Emergency department günü yapılırken, en az başvuru 10(%12,5) kişi ile Salı günü idi. En
fazla başvurunun 26(%32,5) hasta 12-14 saatleri arasında; en az
BACKGRUOND: Although carotid arterial dissection is not common başvurunun ise 3(%3,8) hasta 16-18 saatleri arasında olduğu
presentations to the ED, timely and appropriate diagnostic görüldü. Eğitim durumları incelendiğinde 23’ü(%28,8) ilkokul,
strategies will allow early initiation of effective treatment 27’si(%33,8) ortaokul, 29’u(%36,3) lise, 1(%1,3) üniversite mezunu
therapies. CASE: 35 year – male adult patient admitted to ED after idi. 55’inde(%68,8) daha önce mesleki yaralanma öyküsü yoktu.
falling from 1 meter-height. He complained about pain and 57(%71,3) hastanın kaza anında aç olmadığı tespit edildi. 75(%93,8)
deformity at his right elbow. His vital signs were in normal range. hastada ek hastalık öyküsü tespit edilmedi. Hastaların 75’i(%91,3)
He had right elbow dislocation and no other abnormal physical dominant olarak sağ elini kullanıyordu. Hastaların yaralanan elleri
exam findings. After procedural sedation, closed reduction of joint 38’inde(%47,5) sağ ve 42’sinde(%52,5) sol eldi. Mesleki tecrübeleri
was performed. The procedure was successful after first attempt. değerlendirildiğinde mesleki tecrübeleri az olanların daha fazla
While he was observed in trauma room, he had left hemiplegia and oranda yaralandığı görüldü(%48,8). Dosya kayıtlarından 57(%71,3)
facial asymmetry. After that, brain computed tomography was işçinin meslek bilgilerine ulaşılmıştır. En fazla yaralanma 15’i(%18,8)
reported no abnormality. The brain magnetic resonance (MR), oto sanayi işçisi idi. 57(%71,3) hastanın yaralanma nedenine
diffusion MR and cranial MR angiography demonstrated acute ulaşılmış ve bu hastaların 56’sı(%70,0) mesleki aletle yaralanırken
ischemia, occlusion of right middle cerebral artery and dissection of 1’i(%1,3) mesleki alet olmayan bir aletle yaralanmıştı. Hastaların
internal carotid artery. The patient was admitted to critical care 54’ü(%67,5) yaralanmadan sonraki ilk bir saat içinde başvuruda
unit of ED. CONCLUSION: Emergency physicians should consider bulunurken 3’ü(%3,8) bir saatten sonraki bir sürede polikliniğe
dissection of carotid artery when neurologic deficit takes place başvurmuştu. Yaralanma özellik bilgilerine ulaşılan 75(%93,8)
after blunt trauma. hastanın 9’unda(%11,2) sol el başparmak kesisi, 8’inde(%10,0) sağ
el birinci parmak kesisi, 6’sında(%7,5) sağ el ikinci parmakta 2cm
P948 ________________________________ Traumatology kesi vardı. Sağ eli dominant olanlarla sol eli dominant olanlarda
dominant elin yaralanma yüzdesi arasında anlamlı fark yoktu.
KÜÇÜK MESLEKİ EL YARALANMALARININ RETROSPEKTİF Dominant eli sağ olanlar ve dominant eli sol olanlar arasında önceki
ANALİZİ yaralanma öyküsü açısından anlamlı farklılık yoktu.
BC. Bilgin (1), T. Karaca (2), G. Çığşar (3), S. Özer (2), U. SONUÇ: Mesleki el yaralanmaları çok sık görülmekte ve en fazla
Türktaş (4), H. Yılmaz (2) tecrübesi az olan grubu etkilemektedir. Küçük mesleki
yaralanmaları değerlendirmek amacıyla sanayi bölgelerine
1. Genel Cerrahi AD, Kafkas Üniversitesi Tıp Fakültesi, Kars, Türkiye poliklinikler kurulması hem acil servislerin iş yükünü azaltacak hem
2. Genel Cerrahi Kliniği, Ankara Meslek Hastalıkları Hastanesi, Ankara, Türkiye de hızlı ve çabuk müdahaleyi sağlayacaktır.
3. Acil Tıp AD, Kafkas Üniversitesi Tıp Fakültesi, Kars, Türkiye Anahtar Kelimeler: El yaralanması, tecrübe, dominant el
4. Ortopedi ve Travmatoloji AD, Van Yüzüncü Yıl Üniversitesi Tıp Fakültesi, Van, Türkiye
P949 ________________________________ Traumatology
Corresponding author: Mme Çigsar Gülsen ([email protected])
Key-words: El yaralanması ; Tecrübe ; Dominant el EFFICACY OF PROPOLIS IN EXPERIMENTAL RAT MODEL
WITH ISOLATED BILATERAL PULMONARY CONTUSION
GİRİŞ: Sosyal hayattaki tüm çalışanlarda olduğu gibi sanayi CREATED BY BLUNT THORACIC TRAUMA
çalışanlarında da el vücudun fiziksel olarak en sık kullanılan T Çevik (1), O Solak (2), M Sırmalı (3), Y Yürümez (4), NN
organıdır. Bu nedenle vücudun en sık travmaya maruz kalan User (5), Ş Özdinç (5), G Öz (2), K Öcalan (6), R Sırmalı (7), Y
organlarından birisi eldir(1). El yaralanmalarının hayatı tehdit etme Ağaçkıran (8)
sıklığı nadirdir(2). Bu çalışmada büyük bir sanayi sitesindeki
polikliniğe başvuran küçük mesleki el yaralanmalarının açlık 1. Emergency Medicine Department, Afyonkarahisar State Hospital, Afyonkarahisar,
Turkey
2. Thoracic Surgery Department, Afyon Kocatepe University, School of Medicine,
Afyonkarahisar, Turkey
3. Thoracic Surgery Department, İstanbul Medeniyet University, School of Medicine,
İstanbul, Turkey
BOOK OF ABSTRACTS 488
4. Emergency Medicine Deparment, Sakarya University, School of Medicine, Sakarya, Giriş:
Turkey Dalış yaralanmaları öncelikle omurgayı etkiler, potansiyel olarak
5. Emergency Medicine Deparment, Afyon Kocatepe University, School of Medicine, yıkıcı travma nedenidir. Servikal dalma yaralanmaları yüksek
Afyonkarahisar, Turkey mortalite ve morbidite oranları göstermektedir. Iyileşme ilk
6. Thoracic Surgery Department, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey nörolojik hasarın şiddetine bağlıdır. İki metre yüksekten denize
7. Biochemistry Department, Dr. Lutfi Kırdar Kartal Training and Research Hospital, atlama sonucu kafnın zemine çarpmasına bağlı ikinci servikal
İstanbul, Turkey vertebrada frakrür olgususnu sunarak, denize atlama sonucu
8. Pathology Department, Atatürk Chest Diseases and Thoracic Surgery Training and oluşan cervikal yaralanmaları literatürler eşliğinde tartıştık.
Research Hospital, Ankara, Turkey Olgu:
Corresponding author: Mr Çevik Talip ([email protected]) 33 yaşında erkek hasta tramplenden suya atlama sonrası boyun
Key-words: Thoracic trauma, Pulmonary contusion ; Experimental rat model ; Propolis ağrısı şikayeti ile acil servisimize getirildi. Hasta yarım metre
yükseklikten denize atlamış ve yaklaşık iki metre derinliğindeki
Aim: In our study, we aimed to investigate anti-inflammatory suyun zemine kafası çarpmış.
mediator effects of Propolis on pulmonary contusion in Fizik muayenesinde genel durumu iyi ,kan basıncı 123/82mmhg,
experimental rat model whose isolated bilateral pulmonary nabzı: 82/dakika solunum sayısı 18/dakika’dir. Palpasyonda servikal
contusion was created by blunt thoracic trauma. iki ve üçüncü vertebra düzeylerinde hassasiyeti mevcuttu. Diğer
Material and Method: In the study, 61 male Sprague Dawley rats sistem muayeneleri doğal olan hastanın nörolojik defisiti tespit
were used. Except the sham and control groups, pulmonary edilmemiş motor ve duyu kusuru saptanmamıştır. Çekilen servikal
contusion was created performing isolated blunt thoracic trauma in vertebra bilgisayarlı tomografisinde ikinci servikal vertebra
other groups. Trauma’s severity was determined as 1,5 joule. korpusunda tip 3 fraktürü tespit edildi.(resim 1). Servikal magnetik
Propolis was administered intraperitoneally after the application of rezonans görüntülemede ikinci servikal vertebra korpusunda tip 3
blunt chest trauma, on the 1st, 2nd and 3rd days. Only blunt fraktürü mevcut olup kanal işgali,hemotom veya travmatik disk
thoracic trauma was performed for the contusion group. Arterial hernisi saptanmadı.(Resim 2) Hasta acil serviste 2 gün müşade
blood gas, tissue myeloperoxidase, catalase, wet / dry lung weights altına alındı. Sonrasında servikal kalar ile eksterne edildi.
values were recorded on 0th, 1st, 2nd and 3rd days. Tarışma:
Histopathologic examination was performed on pulmonary tissue. Dalış yaralanmaları öncelikle omurgayı etkiler, potansiyel olarak
Results: Arterial blood gas analysis revealed that pH values on the yıkıcı travma nedenidir. Sıklıkla beşinci ve altıncı servikal
2nd and 3rd day were significantly lower in the sham group vertebralar etkilenir. Bizim olgumuzda ikinci servikal vertebrada
compared to propolis group (p <0.05). PaO2 values, 3rd day was fraktür gelişmiş diğer vertebralar doğaldır. Hangi servikal
significantly higher in the propolis group compared to sham and vertebranın etkileneceğini zemine çarpan kafa bölümü ile çarpma
contusion groups (p <0.05). PaCO2 values, on the 2nd and 3rd day açısının,atlanan yüksekliğin, zeminin yapısının,kişinin kilosunun ve
were significantly higher in the contusion group compared to suyun derinliğinin etkili olduğunu düşünüyoruz. Bizim olgumuzda
propolis group (p <0.05). sert bir zemine kafanın parietal bölümü çarpmıştır. Servikal dalma
Myeloperoxidase values in the sham and control groups were yaralanmaları yüksek mortalite ve morbidite oranları
lower than contusion and propolis groups (p<0.05). On the 1st and göstermektedir. Iyileşme ilk nörolojik hasarın şiddetine bağlıdır.
3rd day was significantly higher in the contusion group compared Olgumuzda spinal kanala basının olmaması, nörolojık hasarın ve
to propolis group (p <0.05). Catalaz values in the sham and control hematomun olmaması prognozlu iyi olmasına neden olmuştur.
groups were lower than on the 1st, 2nd and 3rd day contusion and
1st and 3rd day propolis groups (p<0.05). On the 2nd day was P951 __________________ Ventilation / Invasive and Non Invasive
significantly lower in the propolis group compared to sham group
(p> 0.05). On the 1st, 2nd and 3rd day were significantly higher in MOROCCAN EXPERIENCE IN THE NON INVASIVE
the contusion group compared to 2nd and 3rd day propolis group VENTILATION : A MEDICAL INTENSIVE CARE STUDY
(p <0.05). H EZZOUINE, A BENSLAMA, B CHARRA, S MOTAOUAKKIL
Pulmonary pathology and leukocyte infiltration scoring in the sham
and control groups were observed to be lower than contusion and Medical intensive care unit, university teaching hospital Ibn Rushd, CASABLANCA,
propolis groups (p<0.05). On the 1st ,2nd and 3rd day were Morocco
significantly higher in the contusion group than 3rd day propolis Corresponding author: Mme Ezzouine Hanane ([email protected])
group (p <0.05). Key-words: Moroccan experience ; non invasive ventilation ; medical intensive care unit
Conclusion: In this rat experiment model whose isolated
pulmonary contusion was created by blunt trauma, propolis was Introduction
observed to reduce contusion severity in the lung, the protective The non invasive ventilation (NIV) is probably one of the major
effects and minimize inflammatory reaction. progresses during the last years in the treatment of respiratory
disease in the medical intensive care unit (ICU) .The purpose of this
P950 ________________________________ Traumatology study is to rate the effectiveness of the NIV in the treatment of
respiratory disease and demonstrate its place as a method of
A CASE OF CERVICAL VERTEBRAE FRACTURE AFTER JUMP support and reoxygenation before intubation in ICU Medical UHC
ıNTO THE SEA Ibn Rushd of Casablanca.
H Dogan, DN Ozucelik, A Avci, O Sancak, K Acıksari Materials and methods
This is a retrospective study spanning from March 2009 to
Emergency department, Bakirköy Dr Sadi Konuk training and research hospital, Istanbul, November 2010.It includes all the patients who had non invasive
Turkey ventilation in the period studied
Corresponding author: Mr Dogan Halil ([email protected]) Results
Key-words: jump ınto the sea ; vertebrae ; trauma 74 patients received this ventilation mode due to various etiologies
;8 patients (10,8%) with an ischemic stroke as a method of
BOOK OF ABSTRACTS 489
support,preoxygenation before intubation in 7 patients (9,5%) and Traumatic cervical spinal cord injury is frequently associated with
59 patients (79,7%) as a mode of respiratory support :hypoxemic tetraplegia and alterations in respiratory and cardiovascular
pneumonia in 14 patients(18,9%) ,cardiogenic acute pulmonary function that require critical care management.
oedema (APE) in 12 patients (16,2%), acute decompensation of Complications include respiratory failure, atelectasis,
chronic obstructive pulmonary disease (COPD) in 10 patients pneumonia,while complications may be managed with supportive
(13,6%), care, endotracheal intubation will be needed.
hypoxemic acute respiratory failure (ARF) in 5 patients (6,8%) But,when intubationis is performed, patient that cannot write
,severe acute asthma in 4 patients (5,4%),weaning from invasive and communicate his complaint to medical stuffs and others. That
ventilation in 3 patients (4%) ,neuromuscular disease in 2 patients is huge stress for patients.We perform cricothyroidotomy set(Mini
(2,7%) and one closed chest trauma. Track Ⅱ, Portex ®) as a minitracheotomy. Minitracheotomy is very
All the patients benefited from a NIV in spontaneous ventilation useful and convenient for postoperative patients with tetraplegia
following a positive expiratory pressure mode with inspiratory because they can talk.However, there is no standard theory
assistance (VS+PEP+AI) and a medical treatment according the concerning the indications, index of the intubation and extubation
indication. The effectiveness of the NIV in 59 patients has been of the minitracheotomy. In this study, we examined the
judged according the evolution of the clinical and gazometric effectiveness, duration and complications of the minitracheotomy.
parameters.The improvement has been observed in 41 patients Patients and Methods. We performed minitracheotomy in 7
(69,5%) against 18 patients (30,5%) that their state worsened patients for postoperative treatment from January 2006 to
under this mode of ventilation.The application of the NIV for December 2011. The procedures were anterior fixation (4),
hypoxemic pneumonia has been succeful in 8 patients (57%) posterior fixation (2),extracorporeal fixation. Results. We
against failure in 6 patients(43%) .For the APE , the application performed the minitracheotomy on the operative day in 1 cases, 1
knew a success in 9 patients (75%) against (25%) of failure in 3 cases were on day 1 postoperatively, 1 on day4, 1 on day6,1 on
patients .For COPD,7 patients (70%) improved against the day10, 2 were on day 11. The duration time of the
worsening of 3 patients (30%) .For the hypoxemic ARF, 3 patients minitracheotomy is 12 to 41 days. There was no severe
(60%) improved against 2 patients (40%). For asthma, 4 patients complication related to this procedure. Conclusions. The
(100%) improved.In postoperative,3 patients (75%) improved minitracheotomy is very useful and convenient for the
against a single patient (25%) worsened .For the prevention of postoperative spinal injury patients. There is no specific
postextubation ARF ,2 patients have improved against 2 which contraindication of minitracheotomy.
worsened (50% vs50%).In weaning from invasive ventilation the 3
patients (100%) improved.For neuromuscular diseases ,1 patient P953 __________________ Ventilation / Invasive and Non Invasive
improved against one that has worsened.One closed chest trauma
is much improved.The complications of NIV were dominated by NONINVASIVE VENTILATION IN PRIMARY ANGIOPLASTY
the erythems of the face (47,2%),dry mouth (14,8%), sino nasal J ALONSO, JM FERNANDEZ, E GARCIA, O GARCIA, MC
pain (14,8%),gastric distension (12,6%) and earache (9,4%).6 GONZALEZ, A MARTINEZ, ML MOSTEIRO, S RODRIGUEZ, M
patients (10%) were intubated ,ventilated and wellimproved RUBIO, J SANTAMARIA
against 12 patients( 20,5%) were intubated,ventilated and died
secondary to multiple causes. EMRGENCY DEPARTMENT, COMPLEJO HOSPITALARIO PONTEVEDRA, PONTEVEDRA, Spain
Discussion/Conclusion Corresponding author: Mr Santamaria Jesus ([email protected])
It was found that the NIV has been effective in absolute value in Key-words: NIV ; Acute cardiogenic pulmonary edema ; Primary angioplasty
the PAE,the acute decompensation of chronic obstructive
pulmonary disease (COPD) ,the asthma,in post-operative and in the Introduction
weaning of the invasive ventilation.The non significance was Acute cardiogenic pulmonary edema is a frequent medical
probably due to the smallnessof ours ample. emergency with a mortality rate ranging from 10% to 20%,
The role of our study is to corroborate the effectiveness of the NIV especially when associated with myocardial infarction. Although
in the treatment of the cardiogenic APE, the acute decompensation many patients respond to conventional therapy, some need
of COPD, the asthma,in post-operative and in the weaning of the temporary ventilatory support.
invasive ventilation. We submit the case of 71 years old male patient attended in the
emergency department with symptoms of oppressive chest pain
P952 ___________________Ventilation / Invasive and Non Invasive and shortness of breath
of 4 hours evolution, without other accompanying symptoms.
PRESSURE CONTROL VENTILATION AND His medical record include hypertension, chronic alcoholism,
MINITRACHEOSTOMY IN TREATING TRAUMATIC CERVICAL severe peripheral vascular disease and ex-smoker, so he receives
SPINAL CORD INJURY,SPINAL INJURY, regular treatment with Clopidogrel, Irbesartan /
MINITRACHEOSTOMY, PERIOPERATIVE MANAGEMENT Hydrochlorothiazide and anxiolytics.
Y Iwasaki (1), Y Maeda (2), H Nakao (3), T Nakatani (4) On arrival presents SatO2 80% with ventimask 35%, tachypnea of
35rpm, a heart rate of 120bpm and blood pressure of
1. surgery, Iwasaki Hospital, Kagawa, Japan 129/81mmhg, without significant changes in the
2. Department of Emergency and Critical Care Medicine, Kansai Medical University, electrocardiogram.
Osaka, Japan With the clinical suspicion of acute pulmonary edema, noninvasive
3. Emergency department, Kobe University, Kobe, Japan ventilation with CPAP Boussignac simultaneously with drug therapy
4. Department of Emergency and Critical Care Medicine, Kansai Medical University, was started, acetyl salicylic acid p.o. and intravenous Solinitrina,
Osaka, Japan morphine, and furosemide.
Corresponding author: Mr Maeda Yuuji ([email protected]) Diagnosis
Key-words: spinal injury ; minitracheostomy ; perioperative management
BOOK OF ABSTRACTS 490
The arterial gasometry obtained on the patient's arrival shows a The purpose of this study was to describe the characteristics and
respiratory acidosis with pH 7.198, PO2 43.1 mmHg, PCO2 41 clinical outcome of this subset of patients who were treated first in
mmHg, HCO3 15.6 mmol / l, EB -12.5 mmol / l, which, together ER and subsequently in ICU or conventional wards.
with radiological findings of cardiogenic edema confirms the initial Material and methods
clinical suspicion. Retrospective descriptive study from July 2007 to October 2010.
In turn, the first determination of cardiac Troponin I is 13.74 ng / It covered 58 patients matching the following inclusion criteria:
ml, with 2 mm elevation in the ST segment from V1 to V4 in the Existence of severe ARF in need of ventilatory support with pH <
control ECG an hour later. 7,25 and one or more of the several conditions that may led to
After discussing the case with the hemodynamic reference service, the decision of withholding invasive ventilation and ICU admission:
located in another hospital 20 Km away, the patient is transferred advanced age ,multiple comorbidities ( high Charlson index) and /
to his unit for primary angioplasty with the diagnostic of STEMI and or Dependant for Daily Living Core Activities (DDLCA) and /or
acute cardiogenic pulmonary edema. similar episodes of ARF in the past year requiring hospital
Prior to the transfer 300 mg of clopidogrel, intravenous anti IIb-IIIa admission.
and a bolus of heparin was administered. Severity of illness classification was assessed by the Acute
It was necessary to maintain noninvasive ventilation initiated in the Physiology and Chronic Health Evaluation (APACHE) II. Comorbidity
emergency room for both, emergency ambulance transfer, and to was measured by Charlson index. and computerized clinical records
allow the patient to tolerate the supine position required for the were used to establish the amount of time spent in the ER with NIV
development of interventional procedure. A number of monitoring variables were measured at the procedure
Coronary angiography demonstrated multivessel coronary disease start and 60-120 minutes afterwards: Glasgow Coma Score; Heart
with 100% occlusion of LAD, Cx 85% and PL 75%. Rates; Respiratory Rates; pH; O2 Saturation; Fraction of Inspired
The echocardiogram revealed LVEF 30-35% with severe lateral and O2; Blood Pressure.
posterior hypokinesis. Results
Given the findings the case was discussed with the cardiac 72 % of the patients (59% males and 41% females) were over 70
surgeons and was accepted for surgical revascularization, which years and 28% over 85, of these patients only 7% were admitted to
was held a week later after a proper stabilization of the patient in the ICU.
coronary care unit. 72% of the patients showed an APACHE> 20 and in 76% Charlson
Conclusions index was greater than 5; 22% had 3 or more similar episodes of
Noninvasive mechanical ventilation was applied early in the ARF in the past year requiring hospital admission; 43% were
emergency department as part of initial management of acute Dependant for Daily Living Core Activities (DDLCA).
cardiogenic pulmonary edema, later proving necessary to permit The causes of ARF were acute cardiogenic pulmonary edema
the proper execution of primary angioplasty. In both cases it was (32,76%), COPD exacerbations (39,65%), community-acquired
fundamental for the good handling of this case, avoiding intubation pneumonia in COPD (8,62%), community-acquired pneumonia
of the patient, the complications of this procedure and his (5,17%), and other causes (8,62%).
admission to the ICU. Overall mortality was 22,41% with a significant trend to increase
according to: age (patients older than 85 doubling overall
P954 ___________________Ventilation / Invasive and Non Invasive mortality) and the diagnosis of DDLCA and shows linear correlation
with severity of illness assessed by (APACHE) II.
EMERGENCY UNIT AND NON INVASIVE VENTILATION IN There was no relation between Ph at the onset of NIV, Charlson
SEVERE ACIDOSIS: A VIRTUAL STEP DOWN UNIT. index or previous admission with mortality
J Alonso, JM Fouce, E Garcia, MC Gonzalez, MT Lopez, A The statistical median of time spent in the ER with NIV was 7 hours
Martinez, JR Parada, S Rodriguez, J Santamaría 15 minutes with wide statistical deviation (Interquartilic range P25:
4h3m-P75: 10h39m).
Emergency, C.H. Pontrevedra, Pontevedra, Spain Overall mortality of patients who spent less than 8 hours in ER are
Corresponding author: Mr José Ramón Parada ([email protected]) very high (35,29%), including patients managed in conventional
Key-words: Non Invasive Mechanical Ventilation ; Step-down units ; Severe Acidosis ward and ICU, compared with patients managed in ER during the
first 8- 12 hours (7,29%), although only 1 patient died in this period
Introduction of time.
Non Invasive Mechanical Ventilation (NIMV) means an alternative The controlled parameters improved in a relevant statistical way
approach to Conventional Mechanical Ventilation (CMV) treating along the second measurement.
patients with acute respiratory failure (ARF) requiring ventilatory Conclusions
assistance, reducing endotracheal intubation, decreasing infection In real life medical practice there is an important percentage of
complications, mainly ventilator associated pneumonia and patients (elderly, with major comorbidities and chronic disabilities)
shortening hospital stay and mortality. with severe ARF that are denied ICU admission, since conventional
Over the last decades in the Emergency Room (ER) we have been ventilation is not (deemed app) considered to be in their best
treating and increasing number of severe but reversible acute interest and are managed in conventional medical wards.
respiratory events in patients often very elderly and with mayor As life expectations in chronic ill patients and general population
comorbidities or chronic disabilities ; several studies provide increases, there is a great amount of patients with ARF treated in
evidence that denial of intensive care unit (ICU) admission is high the ER with proved success for which NIV is their ceiling of
in despite of the severity of the respiratory failure , related with treatment.
high cost and scarcity of ICU beds and to protect patients from Overall mortality increases highly in unstable patients admitted in
useless interventions. Although invasive ventilation is advocated by hospital areas without the means and personal expertise for the
guidelines in severe acidosis, frecuently NIV is deemed the ceiling secure management of this patients, thus the urgent need of step-
of treatment down units that warranty the optimal monitoring, care and survival
of this patients after appropriate stabilization in the ER seems
increasingly clear, avoiding prolonged stay in emergency
departments.
BOOK OF ABSTRACTS 491
P955 ___________________Ventilation / Invasive and Non Invasive P956 __________________________ Wound Care / Burn Care
CEREBRAL BLOOD FLOW, HYPERCAPNIA, ETCO2, FIO2 AND PREDICTORS OF MORTALITY AMONG BURN PATIENTS IN
PAO2 CHANGES IN MECHANICALLY VENTILATED PATIENTS. NATIONAL GUARD HOSPITAL IN SAUDI ARABIA
R Koylu (1), ZD Dundar (1), NB Akilli (1), E Akinci (1), B MA Aljohani (1), MA Alsalamah (2), MO Alotaibi (3), AN
Cander (1), O Koylu (2), MO Gonen (1), H Mutlu (1) Alnamlah (4), SQ Alqahtani (2), GC Ciottone (5)
1. Emergency Department, Konya Education and Research Hospital, Konya, Turkey 1. Emergency Medicine, King Abdulaziz Medical Center, National Guard Hospital. BIDMC,
2. Biochemistry Department, Konya Education and Research Hospital, Konya, Turkey Harvard Medical School, Waltham, United States
Corresponding author: Mr Koylu Ramazan ([email protected]) 2. Emergency Medicine, National Guard Hospital-RIyadh, Riyadh, Saudi Arabia
Key-words: Cerebral oximetry ; mechanical ventilation ; hypercapnia 3. Emergency Medicine, Security Force Hospital, Riyadh, Saudi Arabia
4. Plastic Surgery, National Guard Hospital-RIyadh, Riyadh, Saudi Arabia
BACKGROUND AND PURPOSE: Hypercapnia can reduce cerebral 5. Harvard-Affiliated Disaster Medicine/Emergency Management Fellowship.Harvard
perfusion pressure, and early initiation of mechanical ventilation Medical School Disaster Section / Division of Disaster Medicine.Beth Israel Deaconess
may improve cerebral hemodynamics in critically ill patients. We Medical Center., Beth Israel Deaconess Medical Center, Boston, United States
aimed to evaluate whether there was a correlation between Corresponding author: Mr Aljohani Majed ([email protected])
hypercapnia and cerebral blood flow and the effects of ETCO2, Key-words: Age and total body surface area are the most significant predictors of
FiO2 and PaO2 changes on it. Mortality among Adult Patients. ; There is clear association between type of burn and
SUBJECTS AND METHODS: Mechanically ventilated patients were Mortality, Flame burn having the highest association. ; Age was an insignificant predictor
evaluated for this study. The presence of serebral edema or any of Pediatric Mortality in our population
intracranial pathology was a cause of elimination. All parameters
were estimated just before mechanical ventilation and again Background:
before all changes in ventilator settings until the PaCO2 was stable. Advances in burn and critical care, including aggressive
On admission, serebral edema or any intracranial pathology was resuscitation and early excision and grafting, have significantly
eliminated by computed brain tomography. Cerebral oxygenation decreased Morbidity and Mortality in these cases. Nevertheless,
was monitored noninvasively using oximetry with transcutaneous severe burn remains a major cause of debilitation and death. Age
oxygen electrodes. Invasive mechanical ventilation care (IMVC) was and Total Body Surface Area (TBSA) affected have been shown to
started on hospital admission as standard of care when considered be the most significant predictors of mortality in most of the
necessary by treating physicians. IMVC was initiated using bilevel studies.
mode with 100% fraction of inspired oxygen. The differences Objectives:
between these parameters were compared. To determine if by using Linear Regression module taking into
RESULTS: The mean age of 21 patients was 53±17.9 years old. 9 of account age and TBSA% we can accurately predict Mortality in our
them were male. 6 patients were entubated and connected to the study population. And to determine the demographics of Patients
invasive mechanical ventilator because of breathing disorders due with burn in our population.
to cardiac arrest, 9 of them were obstructive pulmonary disease, 3 Methods:
of them were renal failure, 2 of them were diabetes mellitus and A retrospective chart Review study, Retrospective Cohort, of 619
one of them was for pulmonary embolism.Patients who have patients who were admitted with acute burn injury to the King
normal PO2, ETCO2 and PaCO2 values have higher cerebral Abdulaziz Medical Center burn unit in Riyadh from January 2003 -
oxygenation index over %65.And decreasing in sistemic arterial May 2009. Linear regression Analysis was used.
blood pressure was concluded with a decrease in cerebral Results:
oxygenation index. Six hundred and nineteen patients were included in the study. The
CONCLUSIONS: mean age was 18 +/-(19) with a range of 1-93 years. There were
Setup of mechanical ventilators must be truly adjusted for 61% males. The mean TBSA% was 21% +/-(23) with differing types
continuing adequate cerebral perfusion in ventilated patients. of burn; Flame (43%), scald (44%), chemical (10%), electrical (2%)
Cerebral oxygenation has to monitored closely with the vital and others (1%). The overall mortality was 8.6%, with clear
signs.Hypoxia and hypercapnia cause increased intracranial significance between type of burn and mortality (Value 0.000,
pressure by cerebral vosodilatation. Because of this reason, we Fishers exact test). The highest mortality was associated with flame
have to avoid from hypoxia and hypercapnia. burn (89%). By combing Age and TBSA% we came up with a linear
On the other hand, decreased CO2 level because of regression module that predicts mortality in adults (R square = 0.5).
hyperventilation can cause vasoconstriction and ischemia. The coefficient of age was 0.3 (p-value = 0.01) and the coefficient
Therefore, it can be resulted with undesirable reasons. of TBSA was 0.9 (p-value=0.00).
Secondary damage due to cerebral hypoxia must be prevented.The Mortality in Adults = -19 + (0.3 x AGE) + (0.9 x TBSA%).
most important factors that cause secondary damage are ischemia For pediatric patients, the model showed insignificant age
and hypoxia.Because of all these reaons, it is so important to coefficient (0.12; P.Value =0.6) while the TBSA was (0.45 ;
monitorize the vital signs and cerebral oxygenation by using P.Value=0.00) with an R-square (0.25).
noninvasive oximetry with transcutaneous oxygen electrodes in Conclusion:
critically ill and ventilated patients. Although mortality in adults increases with rising TBSA% and Age,
This report provides useful clinical anecdotes but must be followed Age was an insignificant predictor of Pediatric Mortality in our
by more carefully controlled clinical trials to ascertain the population. More studies and a consensus should be established
indications for and benefits of this type of monitoring in emergency before creating clinical guidelines.
departments
BOOK OF ABSTRACTS 492
P957 __________________________ Wound Care / Burn Care K/uL (NEU: 96.3%)] and a high sedimentation rate, other
parameters were in normal limits. Computerized tomography (CT)
TOY BALOONS ARE NOT SO INNOCENT : A RARE CAUSE OF of thorax with intravenous contrast (IVC) showed nodular areas of
BURN ıNJURY infiltration-consolidation with air bronchograms within in both
A Karagöz, N Vandenberk lungs and multiple lymph nodes at both axillae, the largest being of
21x15 mm on the right side. Neck CT with IVC revealed multiple
Emergency Department, Izmir Ataturk Research and Training Hospital, Izmir, Turkey lymph nodes at the anterior-posterior cervical chain and
Corresponding author: Mme Van Den Berk Nergiz ([email protected]) supraclavicular area bilaterally, the largest being 22x18 mm, with a
Key-words: burn ; chılderen ; baloons tendency to coalesce, fistulizing to skin, containing areas of
necrosis within, and extending to vocal cords at the level of hyoid
Burns are common type of injuries in patients presenting to bone. Based on these radiologic findings, initial diagnoses of miliary
Emergency Department. Spontaneus flaming of flying toy balloon tuberculosis and neck abcess related to tuberculous lymphadenitis
is a very rare cause for these injuries. Here, we present a case of were made. The patient was transferred to the department of
burn injury caused by spontaneous flaming of flying toy balloons. chest diseases. There were no proliferation in sputum and abcess
He had grade 2 intermediate burn injury on both sides of both cultures; however, (+++) bacilli were observed on Ziehl-Neelson
hands and grade 1 on his face. His injuries were healed without histochemical staining of sputum. Multi-drug antituberculosis
complications with wound dressing and medical therapy. It’s treatment, wide-spectrum antibiotherapy and symptomatic
essential to take measures about using acetylen to inflate flying toy supportive treatment were begun.
balloons for preventing these injuries. Discussion: Tuberculosis maintains its importance in developing
countries owing to its high risk of morbidity and mortality. In
P958 __________________________ Wound Care / Burn Care recent years, skin tuberculosis has been increasingly observed in
developing countries because of increased prevalence of HIV
A RARE CAUSE OF NECK ABCESS: SCROFULODERMA infection and immunosuppressive drug treatment. Although
HM Durgun, C Guloglu, O Kaçmaz, M Orak, A Ozhasenekler, mortality of skin tuberculosis is not that high, it should be
M Ustundag, remembered in differential diagnosis owing to its chronic course
and requirement of multi-drug regimens.
Emergency Department, University of Dicle, Medical School, Diyarbakir, Turkey Conclusion:Skin tuberculosis is a rare form of extra-pulmonary
Corresponding author: Mr Ozhasenekler Ayhan ([email protected]) tuberculosis. Skin tuberculosis has no increased morbidity;
Key-words: neck abcess ; scrofuloderma ; emergency department however, its chronic course and necessity of multi-drug regimens
increase its importance. In countries like ours, where tuberculosis
Introduction: One of the extra-pulmonary manifestations of poses a risk for public health, the differential diagnosis of chronic
tuberculosis is skintuberculosis. The second most common form of skin lesions should always include skin tuberculosis.
skin tuberculosis is scrofuloderma. Scrofuloderma typically extends
to neighboring structures or results from a tuberculous P959 __________________________ Wound Care / Burn Care
lymphadenitis. In cold abcess formation, scrofuloderma causes
disruption of the underlying skin. It frequently involves parotideal, ANALYSIS OF BURN CASES OBSERVED AFTER 2011 VAN
submandibular, and supraclavicular regions and lateral aspects of EARTHQUAKE
the neck. Ulcers and sinuses develop and a fluid, purulent or R Dursun (1), S Karadas (2), G Görmeli (3), Y Isık (4), C Cakır
caseous material discharge may be observed. Sinusoidal tracts (5), CA Görmeli (6)
deform the skin and causes subcutaneous pocket and soft nodule
formations. 1. emergency department, Van Region Training and Research Hospital, van, Turkey
Key Words: neck abcess, scrofuloderma, emergency department 2. emergency department, Yüzüncü Yıl University, van, Turkey
Objective: The aim of this study is to draw attention to rare 3. ortopedy department, Van Region Training and Research Hospital, Van, Turkey
presentations of tuberculosis and to remindreaders scrofuloderma 4. Anesthesiology department, Yüzüncü Yıl University, van, Turkey
as an etiology in patients presenting to emergency department 5. Burn department, Van Region Training and Research Hospital, van, Turkey
with neck abcess. 6. Radiology department, Van Region Training and Research Hospital, van, Turkey
Case report: A 79-year-old lady presented to our emergency Corresponding author: Mr Dursun Recep ([email protected])
department with a purulent wound on the right side of her neck. Key-words: Earthquake ; burn ; tent
Her lesions had been present for 2 months with no response to
various oral and topical antibiotics. She had no history of previous INTRODUCTION
tuberculosis. She did not have any systemic complaints like cough, Earthquake is one of the natural disasters which cause the greatest
weight loss, and fever. On physical examination, she had a poor deaths and injuries in the world and in turkey. The Van earthquake
general appearance, was conscious, and had purple-colored 12-cm- was a destructive magnitude (7.2 Mw) earthquake that struck
long cicatrices with an erythematous circumference extending eastern Turkey near the city of Van on Sunday, 23 October 2011 at
anteroposteriorly on the right side of the neck, as well as an 13.41 local time. It occurred at a shallow depth of 19 kilometres.
ulcerated lesion of 1x6 cm with irregular and protruded borders There were 604 casualties at this earthquake. 17 days after the
and a center with a purulent discharge. Other systems were normal earthquake (on 9 November, 2011), another earthquake on
on examination. She had a blood pressure of 90/50 mmHg, pulse different fault line occurred on 21.23 local time due to trigger of
rate of 114 bpm, respiratory rate of 14/min, and body temperature first earthquake. It was centred as Edremit which is in the
of 37.2°C. Laboratory tests revealed a white blood cell (WBC): 19.3 southwest of Van and 10 km far from here; the magnitude was 5.6
(Mw) and occurred at a depth of 5 km. since people had
immigrated to other cities and others had settled into tents, there
were only 40 casualties. While 222 people were rescued alive from
the wreckage from both earthquakes; nearly 6000 people were
BOOK OF ABSTRACTS 493
injured. 72242 houses were determined to be destructed and P960 __________________________ Wound Care / Burn Care
heavily damaged.
One of the most important morbidity and mortality reasons PREDICTORS OF MORTALITY IN CHILDHOOD BURNS: AN
observed after earthquake is fire. Determination of the reasons of EIGHT-YEAR REVIEW
these fires and risk groups may help increase morbidity and MN Akcay (1), S Aslan (2), ZG Cakir (2), G Ersunan (3), H
mortality which occur due to earthquake. Therefore, in the current Kandis (4), G Ozturk (1), A Saritas (5)
study burn cases observed after Van earthquake was compared
with the burn cases of the same months and same city in previous 1. General Surgery, Ataturk University Medical Faculty, Erzurum, Turkey
year; changes which occur in the number, way, degree of burn and 2. Emergency department, Ataturk University Medical Faculty, Erzurum, Turkey
on the surface of burning body were analyzed. 3. Emergency department, Rize University Medical Faculty, Rize, Turkey
MATERIALS AND METHODS 4. Emergency department, Duzce University Medical Faculty, Duzce, Turkey
Patients who registered at Van Region Education and Research 5. Emergency department, Duzce University School of Medicine, Duzce, Turkey
Hospital within 3-months-period after earthquake was determined Corresponding author: Mr Saritas Ayhan ([email protected])
as group 1; patients who registered within same time interval in Key-words: Burns ; pediatric ; death
the previous year were determined group 2.
RESULTS Background: This study aims to analyze the epidemiological
There were 121 patients in Group 1. 16 of the cases were sent to characteristics and predictors of mortality from burn injuries in
other center after earthquake due to renovation of local burn unit, childhood patients admitted to our hospital during the eight-year
42 of them had outpatient treatment 63 cases received inpatient period.
treatment at burn-unit. There 89 cases in Group II. 4 of the cases Methods: The medical records of acute childhood burn patients
were sent to other centers due to patient occupancy at burn unit, were reviewed retrospectively. All variables thought to be
28 of them had outpatient treatment 57 cases received inpatient associated with mortality were entered in a multiple binary logistic
treatment at burn-unit. It was determined that 35,95% of the burn regression model (method=stepwise). The magnitude of risk was
cases in Group 1 has increased. Scald burns were much more than measured by the odds ratio, and the confidence interval 95% was
flame and electric burns in both groups and rate of scald burn was estimated.
statistically significant in both groups compared to other kind of Results: A total of 2,269 acute childhood burn patients were
burns (p=0,001). Flame burns were observed 4.8 times more in admitted during the study period. A total of 86 (3.8%) children died
Group 1 compared to Group II (p=0,002). 48% (39,6%) of the burn due to burn injuries. Deaths were seen 1.849 times more in males
cases observed in Group 1 had occurred due to 28 tent fire. than in females. According to the 1–10% TBSA burned group,
Both superficial and deep burn were broader in Group 1 compared mortality occurred 121.116 times more in the > 41% TBSA burned
to Group 2 (respectively p=0,004 and p=0,001. group.
Exitus was observed at 25,4% of the cases (n:16) in Group 1; 7% Conclusions: Most burn injuries can be avoided by keeping children
(n:4) of the cases in group II. There was no statistically significant away from hazardous and dangerous environments. Also, requiring
relation between mortality and age, gender, burn degree, a multidisciplinary management in these patients, quality of care
interventions between groups. While 75% (n: 12) casualties at services given by physicians and nurses certainly will create a
group I occurred as a result of flame burns of tent fires, 75% (n:3) positive impact on patients’ outcomes.
casualties at group II occurred due to electric shock.
DISCUSSION P961 __________________________ Wound Care / Burn Care
It was observed that burn cases in this study have increase
compared to the previous year and much of the cases are flame SOCIO-DEMOGRAPHIC CHARACTERISTICS OF PATIENTS
burns (44,4%). The reason for flame burns being observed much WITH ELECTRICAL BURN
following Van earthquake is that generally tents were used for A. Akoz (1), B. Ozogul (2), U. Avsar (3), Z.G. Cakir (1), S.
temporary shelter. Moreover, due to the earthquake having Aslan (1), M. Emet (1)
occurred in winter and that the temperature falls down to -20°C in
this city, stoves and electrical devices are used in the tents. Heating 1. Emergency Medicine, Ataturk University Medical Faculty, Erzurum, Turkey
these inflammable tents which such kind of heating techniques 2. General Surgery, Ataturk University Medical Faculty, Erzurum, Turkey
poses potential risk for fires. In this study, burn cases observed 3. Family Medicine, Ataturk University Medical Faculty, Erzurum, Turkey
both before and after earthquake influenced young people more. Corresponding author: Mr Akoz Ayhan ([email protected])
As a result; in the study presented here, it was found that the Key-words: Electrical burn injury ; emergency department ; mortality
number of cases registered for burns, the number of flame burns,
percentage of total body burn and mortality rate is higher after the Introduction: Electrical burns may develop due to direct effect of
earthquake compared with the time previous earthquake. In order electric current on cell membrane and smooth muscle of blood
to decrease the effect of disasters, it is compulsory to conduct vessels, and due to transformation into heat energy while passing
plans before the disaster. Precautions should be taken, training through body tissues. Electrical burns account for 3 to 5 % of all
shall be given; temporary settlement places such as tent cities cases of burns.
should be built by the experts for the hindrances to occur in Methods: A total of 213 patients with electrical burns admitted to
settlements following the disaster. our emergency department (ED) between 2001 and 2011 were
analyzed retrospectively.
Results: The mean age of patients was 32 ∓ 10.8 (min.18 - max.72
years) and 86.9% (n=185) of the patients were male. According to
provinces, 63.4% (n=135) of patients were from Erzurum, 10.3%
BOOK OF ABSTRACTS 494
(n=22) came from Agri, and 5.2% (n=11) came from Van. The Conclusion: Burns due to hot milk and oil are more frequently seen
majority of patients (63.4%; n=135) were living in the city centers, in women and in the spring unlike other burns. These burns are
followed by patients in the village (22.5%; n=48) and the county usually 2nd degree and have higher percentages of discharge from
(14.1%; n=30) respectively. The most common occurrence times of ED.
burns were 14:00 (5.6%; n=12), 10:00 and 11:00 (4.2%; n=9). Of the
patients, 39.4% (n=84) had admitted to our ED between 18:00 and
24:00. Third degree burns were seen in 57.9% (n=127), second
degree in 39.4% (n=84) and first degree in 0.9% (n=2).
Subarachnoid hemorrhage was accompanied to one patient, and
acute abdomen to another one. Of the patients, 51.2% (n=109) was
sent to our ED from other centers, 59.2% (n=126) of patients were
directly admitted to our burn center, 9.9% (n=21) of the patients
were referred to another hospital from our ED because our burn
center was out of bed, and 5.2% (n=11) of the patients refused
admission. Mortality was 2.7% (n=6) in the burn center. Electrical
burns were seen most frequently in August (14.1%; n=30), June
(11.3%; n=24), and July (10.3%; n=22). However, it was rarely seen
during winter months (16%; n=34). The average days of
hospitalization were 26.4 ∓ 17 (min.1 - max.141 days).
Conclusion: Electrical burns are not common compared to other
burns but have high percentage of third degree burns. Frequency
of electrical burns increases especially in the summer in our region.
P962 __________________________ Wound Care / Burn Care
CHARACTERISTICS OF PATIENTS WHO ADMITTED TO THE
EMERGENCY DEPARTMENT BECAUSE OF BURNS DUE TO
DENS LIQUIDS SUCH AS HOT MILK / OIL
A. BAYRAMOĞLU (1), M.T. SENER (2), Z. ÇAKIR (1), S. ASLAN
(1), M. EMET (1)
1. Emergency Department, Ataturk University Medical Faculty, Erzurum, Turkey
2. Forensic Medicine, Ataturk University Medical Faculty, Erzurum, Turkey
Corresponding author: Mr Bayramoglu Atif ([email protected])
Key-words: Burn injury ; Dens liquıds ; Emergency department
Introduction: Burns are life-threatening conditions that cause great
destructions. In the literature, almost all burns regarding liquids are
found to be due to hot water. However, according to our
experience, dens liquids such as hot milk/oil should be analyzed
alone as the clinical course and outcomes of the patients do differ.
Here, we represent characteristics of dens liquid burns.
Method: We analyzed the patients with dens liquid burns admitted
to our emergency department (ED) between 2003 and 2008,
retrospectively.
Results: Totally, 28 patients were included in the study. The median
age was 26.5 (min.20-max.53 years) and 75% (n=21) of patients
were female. Of the patients, 89.3% (n=25) were directly admitted
to our ED and 10.7% (n=3) were referred to our hospital after first
aid in another ED. Of the patients, 75% (n=21) were discharged
after the treatment in the ED, 14.3% (n=4) were hospitalized in the
burn center, 7.1% (n=2) were referred to another hospital from our
ED because our burn center was out of bed, and 3.6% (n=1) refused
hospitalization. This burns were seen most common in the spring
(28.6%; n=8) and mostly in May and June (17.9%, n=5). In the burn
center, the median duration of hospitalization was 24.5 (min.3-
max.37 days). The median percentage of burn area was 3%.
Frequencies of burned area according to body parts were as
follows: the head and neck 39.3% (n=11), the anterior trunk 14.3%
(n=4), the posterior trunk 17.9% (n=5), the right upper extremity
50% (n=14), the left upper extremity 35.7% (n=10), the right lower
extremity 21.4% (n=6), and the left lower extremity 89.3% (n = 25).
All of burns were 2nd degree.
BOOK OF ABSTRACTS 495
P150 = Poster with final number 150 / F11:4 = 4th Oral presentation in the F11 Session / G22:5 = 5th Oral presentation in the G22 Session
AUTHORS’ INDEX AKKAYA A. P189, P590 ANCELET FJ. P100, P101 AVEGNO JL. P014, P875, P876
A AKKÖSE AYDıN S. P900 ANCI Y. P178 AVERY P. P399
AKKOSE S. P061, P604, P815, F11:7 ANDERSEN G. P456 AVSAR U. P961
AARGAARD R. P457 AKKUCUK S. P186 ANDıÇ C. P383 AVSAROGULLARI L. G31:2
ABD EL HADI F. F34:8 AKMAN C. P637 ANDRES GOMEZ M. P075, P515, G31:8 AY MO. P695
ABDUKHALIKOV T. P522, G23:8, G23:7 AKMANGIT I. P397 ANGELL S. F21:4 AYAN E. P118
ABDULLAH MH. P130 AKOGLU H. P376, P377, P574, G22:4 ANNIBALLI F. P496 AYAN M. P054, P582, P798, P800,
ABDULLAH TA. G24:3 AKOGLU T. G22:4 ANSEEUW K. P411, P412, P413, P792, P889, P890
ABRAHAMSEN HB. P739 AKÖZ A. P205, P213, P214, P216, P805, P808, G21:2 AYAN MU. G31:4
ABRAMOV B. P540 P222, P224, P254, P257, APRILI G. P680 AYATHAN S. P331
ABU ASBEH J. F21:5 P258, P288, P673, P744, ARANA-ARRI E. P334, P511, P557 AYCAN KAYA O. P506, P719
ACAR A. P524 P902, P903, P904, P905, ARDELEAN V. P422 AYDENIZ E. P940
ACAR E. P018, P052, P143, P144, P906, P907, P909, P910, ARDıÇ M. P745 AYDIN AA. P307, P308, P310
P201, P205, P463, P595, P915, P961 ARDıÇ Ş. P134, P299, P312, P313, AYDIN AG. P246
P596, P658, P820, P883, AKPAK YK. P239, P240, P382, P383, P398, P567, P759, P833, AYDIN C. P307, P308
P884 P448, P449, P504, P505, P944 AYDIN G. P943
ACAR HI. P353 P618 ARIBAS A. P521, P522, G23:8, G23:7 AYDIN H. P200
ACAR T. P021, P384, P609, P727, AKPıNAR ORUC O. P327 ARıCA S. P033, P651 AYDıN H. P380
P728, P746, P912, P946, AKSELI A. P195 ARIF A. P399 AYDıN K. P032
G32:1, G32:3 AKSOY A. P839, P845 ARIFIN MY. P130, P857, F23:6 AYDıN M. P152, P153, P164
ACEDO YY. P701 AKSOY D. P582, P800 ARıK YE. P856 AYDıN O. P668
ACEHAN S. P796, P797 AKSOY N. P786, P788 ARIKAN DC. P080, P467 AYDIN OC. P206
ACEMOGLU H. P741 AKTHAR N. P520 ARINC H. P119 AYDıN ÖF. P630
ACHESON J. P703 AKTOKLU M. P818 ARMAGAN E. F11:7 AYDıN S.A. P341, P693, P826
AÇıKALıN A. P695, P796, P797 AKYUZ M. P093 ARMAĞAN E. P061, P341, P572, P604, AYDıN Y. P185, P247, P265, P823
ACıKSARI K. P324, P742, P950 AL B. P378, P640, P740, P779, P693, P743, P815, P816, AYDıN YY. F11:1
ACKERMANS R. P417 P780, P786, P787, P788, P826 AYDıN ZB. P380
ADNET F. P664 P789, P790, P862, G21:1 ARMAS J. P010, P518, F21:4 AYDıNLı B. P906, P907
ADSIZ I. P649 ALAÇAM H. P030, P032 ARMIRIOTI M. P373 AYDıNOK G. P273, P840
ADSIZ N. P649 ALAGÖZ N. P149, P150 ARSINTE T. F11:4 AYDOGAN A. P186, P652
AFACAN G. P834 ALASOW H. P271 ARSLAN D. P133 AYGÜN A. P117, P118, P326,
AFACAN MA. P168, P177, P219, P232, ALATAS OD. P766 ARSLAN ED. P212, P513, P629, P638, P628
P251, P252, P278 ALATLı T. P054, P798 P799, G33:1 AYGÜN D. P918
AĞAÇKıRAN Y. P949 ALAVI-MOGHADDAM M. P542 ARSLAN G. P597, P599 AYGUN H. P341, P693
AGUILAR MOSSI JI. P533 ALBAYRAK L. P044, P115, P116 ARSLANTAŞ U. P487 AYTEKIN MN. P152
AHMEDALI A. P814, F34:7 ALBAYRAK LE. G24:3 ARZıMAN İ. P132, P133, P134, P299, AYTEMIZ E. P160
AHMETALI A. P818 ALBAYRAK M. P619 P307, P308, P309, P310, AYTEMUR ZA. P389
AHN HC. P535 ALBERGONI E. F23:3 P311, P312, P313, P323, AYUSO F. P771
AHN JY. P535 ALBERTO G. G34:6, F24:6 P524, P567, P677, P678, AYUSO M. P771
AHRENKIEL NIELSEN J. G33:7 ALDEEN A. F21:2 P944 AZIZKHANI R. P459
AHUN E. P816, P826 ALI A. P501 ASARI Y. P403 AZZOUZ N. G24:8
AINI E. P859 ALJOHANI MA. P956, F23:1 ASHFAQ M. P532
AJMI M. P078 ALKAN A. P233, P465 ASLAN EC. P474 B
BABADOSTU H.
AKAY H. P167 ALKAN BA. P268 ASLAN L. P839, P845 BABAGIL B. P243
BABAROGLU S. P124, P128, P366
AKAY N. P894 ALKAN G. P609 ASLAN N. P561 BÄCKSTRÖM D.
BACKUS B. P486
AKAY S. P042, P167, P737, P745, ALMACıOGLU M. P743 ASLAN Ö. P637, P638 G24:9
BAENA C. P077, F32:9, F34:2,F34:4,
G33:1 ALMEIDA H. F24:8 ASLAN S. P214, P224, P257, P258, BAEZA GALDÓN I. F34:3
BAGLEY N. P498, G23:3
AKBULUT F. P261 ALNAMLAH AN. P956 P316, P317, P345, P924, BAGRIYANIK A. P533
BAILEY C. P340
AKBULUT G. P259 ALOISE M. P494, P495, P497, G21:5 P960, P961, P962 BAIONI M. G21:4
BAJGUR S. P331
AKBULUT S. P065, P089, P513 ALONSO J. P953, P954 ASLANIDIS T. P369, P370 BAKAN V. G23:6
BAKKER AM. G24:2
AKÇA HS. P027, G11:4 ALONSO JV. P573 ASLANKURT M. P839, P845 BAKKOUCH A. P467
BAKTIR AO. P411
AKCALI A. G21:1 ALONSO VALLE H. P075, P515, G31:8 ÅSLUND K. G24:9 BALAS A. P445
BALCI AK. P119
AKCAY MN. P960 ALOTAIBI MO. P956 ASTAUD CE. F33:6, F22:9 BALIK BS. P714
BALIN M. P572
AKCAY S. P363 ALP SB. P221 ATABEY E. P519, P519, F32:4 BALIOĞLU M.B. P901
BALIOGLU MB. P026
AKDEMIR HU. P030, P032, P065, P169, ALPAK G. P740 ATAC K. P254 BALKAN E. P938
BALKANCI ZD. P933
P170, P171, P176, P181, ALPER F. P914 ATALAR E. P047 BALTA M. P085, P646
BALTACI D. P942
P332, P586, P758, P821, ALPMAN BN. P089 ATAMANALP S.S. P903, P904, P905, P906, BALTACıOGLU M. P225, P286
BANIHACHEMI JJ. P207
P898, P899, P918, P923 ALQAHTANI AQ. F23:1 P907 BAOMBE JP. P889, P890
BARBIERI MG. G33:6
AKDENIZ YS. P225, P226, P227, P228, ALQAHTANI SQ. P956 ATAOGLU S. P824 BARDÉS I. P394
BARNA C. F24:6
P229, P230, P283, P284, ALSALAMAH MA. P956 ATAY V. P618 BARNA D. P755
BARREÑA I. P762
P286 ALTıN H. P571 ATAYıK E. P022, P083, P091, P350, BARTHA CL. P762
BARTOLUCCI M. G11:7
AKDUR G. P641 ALTINBILEK E. P825 P461, P475, P476, P778, BARTON D. P462, P686
F22:6
AKDUR O. P668, P834 ALTıNTAŞ N. P030 P804, P868, F11:1, P390
AKGOL GUR S.T. P673 ALTINTOPRAK F. P259 G31:10
AKGÜÇ L. P846 ALTUN R. P160 ATESCELIK M. P766
AKGUN FS. G23:5 ALTUNAY F. P612, G32:4 ATıFOĞLU B. P595
AKGUR A. P273, P737, P840 ALTUNBAŞ E. P248 ATILLA A. P239, P240, P433
AKILLI B. G23:8 ALTUNBILEK E. P637, G33:1 ATILLA P. P942
AKILLI H. P038, P522, G21:8, ATLI B. P200, P298
G23:8, G23:7 ALTUNCı YA. P289, P290, P610, P848, ATLı B. P922
AKıLLı NB. P027, P091, P315, P339, P849 ATMACA TEMREL T. P856
P475, P576, P770, P785, ALTUNKAS F. P054 AU A. G22:9
P804, P868, P955, G21:8, ALTUNOLUK B. P294, P471 AUFDERHEIDE TP. F22:1, F22:3
G11:4, G21:3 ALTUNTAŞ M. P918 AUGUSTE B. P699
AKıNCı E. P022, P027, P083, P091, ALVAREZ R. P635 AUTILIO M. P296, P297, F11:6
P315, P339, P350, P461, ALVARO E. P771 AVANAZ E. P250
P475, P476, P477, P576, ALVES CF. F24:8 AVCI A. P085, P320, P324, P602,
P770, P778, P785, P804, AMERICA O. P601, P721 P742, P950
P860, P868, P955, G21:3, AMIRA F. P078, P501, P514, F32:7 AVCı S. P151, P152, P161
F11:1, G31:10, F34:6, AMORNSONGCHAI W. P416, P672 AVCIL M. P508
G21:8, G11:4 AMZULESCU A. P736 AVCIOGLU A. P579
47
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Austria, Australia, Uk, USA, Great Britain, South Africa Namibia, Canada, Berhrain, Dundalk, USE, Dublin, Cyprus, Botswana, Zambia, Pretoria, Johannesburg, Cape Town, Italy, California, Washington, Texa, George, Barbados , Iceland, Denmar, Singapore, United States, Switzerland, Australia, Dubai Kuwait, Sweden, Austria, Norway, Europe, Bahrain, Ghana, Egypt, Ukraine LOST LOVE SPELL CASTER, QUICKEST LOVE SPELL IN NORWAY AUSTRALIA Spike money spells spiritual healer. Traditional love spells by MAAMA HAMIDA (the Tradirtional Healer) will help you find your love. So you've been unlucky in a love relationship to your heart's life, bitterness and the desire to stay away from relationships. Love life, love life, love life, love life, love, love, love, love, love, love, love, love, love life Contact +27734818506 I love you, I love you, I love you, I love you and I love you. Traditional love spells will help you experience the joy of true love, meeting that special someone who you have mutual and reciprocal love for. True trust, respect, friendship, intimacy and dependency. You both live without each other. Love spells Love spells Love spells Love spells Love spells Love spells Love spells by maama hamida Traditional. traditional spells, spells, spells and lust spells. Make someone you want to fall in love with, find the most perfect lover, bring your lover back. For this & more order these ancient classical spells by maamahamida Bring back lost love spells Contact; +27734818506 Do not throw in the towel. Do not accept defeat. MAAMA HAMIDA has a powerful relationship with you and your ex-lover. MAAMA HAMIDA will help you relax your feelings of affection and sexual attraction between you and your ex-lover. Bring back lost love spells will cause your ex-lover to be with you and feel a deep affection & emotional attachment to you. Restore the love interest, passion & watch your ex-lover is consumed with desire for your kind of love & affection lost love spells Prevent a breakup or divorce love spells whatsupp +27734818506 no matter what time has passed away by MAAMA HAMIDA will love you and your ex-lover Bring back lost love spells will cause your ex-lover to be with you and feel a deep affection & emotional attachment to you. Restore the love interest, passion & your ex-lover is consumed with desire for your kind of love & affection lost love spells Prevent a breakup or divorce love spells whatsupp +27734818506 no matter what time has passed away by MAAMA HAMIDA will love you and your ex-lover. Bring back lost love spells will cause your ex-lover to be with you and feel a deep affection & emotional attachment to you. Restore the love interest, passion & watch your ex-lover is consumed with desire for your kind of love & affection lost love spells Prevent a breakup or divorce love spells whatsupp +27734818506 emotional attachment to you. Restore the love interest, passion and watch your ex-lover is consumed with desire for your kind of love & affection lost love spells Prevent a breakup or divorce love spells whatsupp +27734818506 emotional attachment to you. Restore the love interest, passion &[email protected] .
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