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Panhypopituitarism Following Hemorrhagic Fever with Renal Syndrome Due to Hantavirus 汉坦病毒所致肾综合征出血热后全垂体功能减退
Pub Date : 2015-04-01 DOI: 10.5152/JAEMCR.2015.799
Abdulcelil Kayabas, A. Akgün, A. Atilla, M. Güzel, A. K. Erenler, G. Gürses
Giris: Renal Sendromlu Hemorajik Ates (RSHA), Hantavirus cinsine bagli viruslerce olusan akut bir viral hastaliktir. Hantavirusler; ates, dolasim bozuklugu, kanama ve renal yetmezlik ile karekterize bir hastalik spektrumuna neden olurlar. Hipopitutiarizmin bilinen nedenleri pituiter iskemi/infarkt ve nekroz olup klinik ozelliklerinin belirsiz olmasindan dolayi genellikle farkedilemezler. Bu yazida, acil servise (AS) aciklanamayan hipoglisemi nedeni ile sevkedilen RSHA sonrasi panhipopituitarizm gelisen 60 yasina erkek olgusunu sunduk. Olgu Sunumu: Biz acil servise RSHA sonrasi gelisen panhipopitutuarizm beraber AS’ye aciklanamayan hipoglisemi ile basvuran 60 yasinda bir erkek hasta sunduk. Hastanin kan tetkiklerinde panhipopituitarizm ve anti-Hantavirus IgG ve IgM pozitifligi tespit edildi. Hormon replasman tedavisi baslandi ve hasta ayaktan takibe alinarak tam iyilesme ile taburcu edildi. Sonuc: Panhipopituitarizm RSHA sonrasi cok nadir gorulen bir komplikasyondur. Morbidite ve mortaliteyi azaltmak icin; acil tip, dahili tip ve enfeksiyon hastaliklari uzmanlari bu komplikasyona karsi uyanik olmalidirlar
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引用次数: 1
Efficacy of Prothrombin Complex Concentrates for Oral Anticoagulant Therapy-related Major Hemorrhage 凝血酶原复合物浓缩液对口服抗凝治疗相关性大出血的疗效观察
Pub Date : 2015-02-23 DOI: 10.5152/JAEM.2015.37928
U. Çavuş, S. Yildirim, Aynur Yurtseven, Ertan Sonmez
In patients admitted to accident and emergency departments for anticoagulant use-related major hemorrhage and requiring urgent surgery or life-saving invasive intervention, the international normalized ration (INR) value should be rapidly corrected and bleeding should be controlled. With prothrombin complex concentrate (PCC), when used at optimal dose levels, target INR values are achieved within 15 min. In this study, we aimed to discuss the efficacy of the used four-factor PCC in 10 patients who were admitted to the accident and emergency department because of oral anticoagulant use-related major bleeding. Of all the patients to whom PCC treatment was administered, targeted INR levels could not be attained in 2 patients (20%). For our cases with gastrointestinal bleeding, the average baseline INR value was 7.3, while the average INR value after PCC administration was 1.9. For our subdural hematoma cases, the median baseline INR value was 2.5, while the median INR value after PCC administration was 1.3. We believe that PCCs used in eligible patient groups, as in this case series, may provide the desired results at lower doses and that they may be safer with regard to complications. (JAEM 2015; 14: 37-40)
对于因抗凝剂使用相关大出血而入住急诊科,需要紧急手术或介入挽救生命的患者,应迅速纠正国际标准化比(INR)值,控制出血。使用凝血酶原复合物浓缩物(PCC),在最佳剂量水平下,可在15分钟内达到目标INR值。在本研究中,我们旨在讨论10例因口服抗凝剂使用相关大出血而入住急诊科的患者使用四因素PCC的疗效。在接受PCC治疗的所有患者中,有2例患者(20%)无法达到目标INR水平。对于胃肠道出血的病例,平均基线INR值为7.3,而PCC给药后的平均INR值为1.9。对于我们的硬膜下血肿病例,中位基线INR值为2.5,而PCC给药后的中位INR值为1.3。我们认为,在符合条件的患者群体中使用PCCs,如在本病例系列中,可以在较低剂量下提供预期的结果,并且在并发症方面可能更安全。(JAEM 2015;14: 37-40)
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引用次数: 0
Five-Day Simulated Boot Camp Helps Prepare Medical Students for Transition to Internship Emergency Medicine Rotation 为期五天的模拟新兵训练营帮助医学生准备过渡到实习急诊医学轮转
Pub Date : 2015-02-23 DOI: 10.5152/JAEM.2015.68736
S. Yaylaci, D. Kitapcioglu
Medical simulation-based training offers a risk-free clinical environment and also promotes learner investment in active participation and allows for structured feedback for individual performance improvement. Adult learning needs specific methodologies for knowledge acquisition and skill improvement, which can be met by simulation sessions. Nowadays, integration of medical simulation into curriculum is the main concern of faculties. Patient safety, malpractice, and increased mortality rates caused by human errors increases the importance of medical simulation sessions for both undergraduate and postgraduate training programs (1). Many patient profiles that can be encountered in the emergency department (ED) can be simulated. High-fidelity patient simulators allow medical students to gain experience in contemporary educational practices before practicing on patients. For internship programs before they meet with real patients, boot camp courses in medical simulation centers are widely organized by universities. In Turkey, our university is pioneering this kind of educational programs. After preclinical conditions, interns feel fear and anxiety to take part in the real ED and work with the staff and equipment. Also, it is diffucult to manage that kind of situations for the instructors. This type of learner presents a challenge to the ED staff and physicians in teaching setings while still maintaining ED flow and the same level of patient care (1, 2). Center of Advanced Simulation and Education (CASE) is a multidisciplinary medical simulation center under the supervision of the university. The center has been running since 21 October 2013. CASE aims to give high-quality education with new training methodologies by using state-of-art simulation modalities and medical equipment. The center consists of two departments, medical simulation training center and advanced endoscopic/robotic surgery training center. CASE offers three types of simulation-based experiential learning via standardized patients, virtual reality task trainers, and high-fidelity manikins in a real hospital environment (Figure 1).
基于医学模拟的培训提供了一个无风险的临床环境,也促进了学习者积极参与的投资,并允许对个人绩效改进进行结构化反馈。成人学习需要特定的方法来获取知识和提高技能,这可以通过模拟课程来满足。目前,医学模拟与课程的整合是各院校关注的主要问题。人为失误导致的患者安全、医疗事故和死亡率上升,增加了医学模拟课程在本科和研究生培训计划中的重要性(1)。许多在急诊科(ED)可能遇到的患者档案都可以模拟。高保真病人模拟器允许医学生在对病人进行实践之前获得当代教育实践的经验。在与真正的病人见面之前,大学广泛组织了医学模拟中心的新兵训练营课程。在土耳其,我们的大学是这种教育项目的先驱。在经过临床前的条件后,实习生对参加真正的急诊科并与工作人员和设备一起工作感到恐惧和焦虑。此外,对于教师来说,很难管理这种情况。这种类型的学习者对教学环境中的急诊科工作人员和医生提出了挑战,同时仍然保持急诊科的流程和相同水平的患者护理(1,2)。高级模拟和教育中心(CASE)是大学监督下的多学科医学模拟中心。该中心自2013年10月21日开始运行。CASE旨在通过使用最先进的模拟模式和医疗设备,以新的培训方法提供高质量的教育。中心下设医学模拟实训中心和先进内镜/机器人手术实训中心。CASE通过标准化患者、虚拟现实任务培训师和真实医院环境中的高保真人体模型提供了三种基于模拟的体验式学习(图1)。
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引用次数: 2
A “But the Patient was Good with a Full ROM and She Could Walk” Case “但是病人很好,有一个完整的ROM,她可以走路”的情况
Pub Date : 2015-02-23 DOI: 10.5152/JAEM.2015.27048
Betul Akbuga Ozel
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引用次数: 0
History of Intubation 插管史
Pub Date : 2015-02-23 DOI: 10.5152/JAEM.2015.96720
S. Goksu, E. Şen
The history of airway management has become an issue of concern for clinicians because of the remarkable advances that have occurred in airway management in recent years. Endotracheal intubation became a routine medical practice in the second half of the 20 th century. Thereafter, progress was made in modern anesthesia and thoracic surgery. As the number of intubated patients increased, the need for a more effective placement of the tube also increased. (JAEM 2015; 14: 35-6)
由于近年来气道管理的显著进步,气道管理的历史已成为临床医生关注的问题。气管插管在20世纪下半叶成为一种常规的医疗实践。此后,现代麻醉和胸外科取得了进展。随着插管患者数量的增加,对更有效放置插管的需求也在增加。(JAEM 2015;14: 35-6)
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引用次数: 4
Back Pain and Inability to Walk in a Young Girl 年轻女孩的背痛和无法行走
Pub Date : 2015-02-23 DOI: 10.5152/JAEM.2015.29052
Roya Ghiami, S. Vahdati, Roshan Fahimi, Farid Eftekhari Milani
A 20-year-old woman presented to the emergency department (ED) with progressive weakness, paresthesia, and back pain lasting for 8 days. She was conscious and her vital signs were normal. Her past medical history was unremarkable. No abnormality was found on radiography and computed tomography (CT). However, magnetic resonance imaging (MRI) showed an intramedullary mass at the dorsal cord at approximately the T8-T9 level, accompanied by mild perilesional edema. Consequently, the patient was diagnosed with hemangioma. The patient underwent preoperative embolization, with minimal bleeding during surgery. (JAEM 2015; 14: 47-8)
一名20岁女性以持续8天的进行性无力、感觉异常和背部疼痛就诊于急诊科。她意识清醒,生命体征正常。她过去的病史一般。x线及CT未见异常。然而,磁共振成像(MRI)显示脊髓背侧约在T8-T9水平处髓内肿块,伴轻度病灶周围水肿。因此,患者被诊断为血管瘤。患者接受术前栓塞术,术中出血极少。(JAEM 2015;14: 47-8)
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引用次数: 0
An Unusual Manner Is Up to Allopurinol: DRESS Syndrome 一种不寻常的方式是由别嘌呤醇引起的:DRESS综合征
Pub Date : 2015-01-08 DOI: 10.5152/JAEMCR.2014.624
E. Karaman, M. G. Turtay, S. Gurbuz, H. Oguzturk, M. Sarihan, Serkan Bican
Giris: Alerjik reaksiyonlar, acil serviste cok cesitli sekillerde gorulebilir. Olgu Sunumu: Altmis alti yasinda bayan hasta ozellikle yuzunde ve govdesinde olan kasintili dokuntuler nedeni ile acil servise basvurdu. Hastanin hikâyesinde 15 gun once rutin tetkiklerinde urik asit yuksekligi saptanmasi nedeniyle allopurinol baslandigi ogrenildi. Fizik muayenede vital bulgular stabildi. Konjonktivalar hiperemikti. Hastanin dudaklarinda erozyonlar ve hemorajik krutlar, oral mukoza, yuz, govde ve sirtta yaygin eritemli basmakla solan makulopapuler lezyonlar mevcuttu. Hastaya eozinofili ve sistemik semptomlar ile Ilac dokuntusu (DRESS) sendromu on tanisi ile Dermatoloji konsultasyonu istendi. Daha sonra hastaneye yatisi yapilan hastanin ilaclari kesildi, anti histaminik ve sistemik steroid tedavisi uygulandi. Hasta sifa ile taburcu edildi. Sonuc: Allopurinol kullanim oykusu ile acil servise basvuran cilt lezyonlari olan, karaciger fonksiyon testlerinde bozulma yani ic organ tutulumu tespit edilen hastalarda DRESS sendromu akla getirilmelidir.
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引用次数: 0
An Interesting Methanol Poisoning: Case Report 一个有趣的甲醇中毒:病例报告
Pub Date : 2015-01-08 DOI: 10.5152/JAEMCR.2014.578
R. Koylu, E. Akıncı, O. Koylu, Z. Dundar, Y. Gunaydin, N. Akilli, Y. Sakarya, B. Cander
Giris: Biz bu calismamizda gercekten cok ilginc ve nadir gorulen fakat ozellikle ulkemizde gorulme potansiyeli olabilecek bir metanol zehirlenme vakasini sunmayi amacladik. Metanol oral, inhalasyon ve dermal yolla cok az miktarda alimlarda dahi ciddi zehirlenmeye yol acabilen oldukca toksik bir alkoldur. Olgu Sunumu: Bu vakada da 48 yasinda erkek hasta bacaklarinda agri sikayeti nedeniyle son 3 gundur bacaklarini ispirto ile ovdugunu ifade ediyor. Ucuncu gun ani gelisen gorme kaybi sikayetinin olmasi uzerine acil servise basvuran hastanin yapilan norolojik muayenesi ve goruntuleme yontemleri sonucu gorme kaybini aciklayacak organik bir patoloji saptanmadi. Yapilan kan gazi tetkiklerinde yuksek anyon gapli metabolik asidoz mevcuttu ve kan metanol duzeyi 38 mg/dL olarak olculdu. Yapilan goz muayenesinde %99’luk gorme kaybi tespit edildi. Derin asidoz ve gorme sikayetlerinin olmasi uzerine eliminasyon amaciyla hemodiyaliz uygulandi. Ayrica antidot olarak uygulanan etil alkol ve fomepizol tedavisi baslandi.Bunlara ek olarak goz konsultaninin onerileriyle 1 mg/kg dozunda, 1 ay sureyle prednol tedavisi de eklendi. Tedavi ile 2.ayin sonunda gorme keskinligi sag goz icin 1, sol goz icin 0.4’e yukselmistir. Sonuc: Metanol zehirlenmesi uygun sekilde tedavi edilmedigi zaman olumcul olabilen bir zehirlenme turudur. Acil hekimleri iyi anamnez alinamayan, bilinc degisikligi olan, artmis anyon acigi olan hastalarda metanol zehirlenmesi olasiligini dusunmeli ve uygun tedaviye baslamalidir
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引用次数: 0
Acute Myocardial Infarction with Normal Coronary Angiography after Butane Inhalation 吸入丁烷后冠脉造影正常的急性心肌梗死
Pub Date : 2015-01-01 DOI: 10.5152/JAEMCR.2015.778
Ş. K. Çorbacıoğlu, Ş. Akkuş, Y. Çevik, E. Emektar, Ibrahim Kember, Tuba Sarıaydın
Giris: Cakmak gazi olarakta bilinen butan gazi genellikle gencler arasinda keyif yapici bir madde olarak kullanilmaktadir. Bu gazlar eglence ve keyif alma amacli soluma veya koklama yoluyla kullanildiginda akut myokard infarktusu (MI), ventrikuler fibrilasyon veya ani olum gibi ciddi kardiyak yan etkilere neden olabilmektedir. Olgu Sunumu: 19 yasinda erkek hasta 112 tarafindan cakmak gazi koklama sonrasinda kardiyak arrest olarak acil servise getirildi. Basarili bir resusitasyon sonrasi cekilen elektrokardiyografisinde yuksek lateral MI tanisi alan hastanin yapilan koroner anjiyografisinde normal koroner damarlar saptandi. Bizim vakamiz butan gazi inhalasyonu sonrasi MI tanisi alan ve koroner anjiyografisi yapilabilen nadir vakalardan birisidir. Sonuc: Butan gazi inhalasyonu ST segment elevasyonlu MI nedeni olabilmektedir. Bu butan gazi iliskili MI nedeni ise mekanik obstruksiyondan daha cok koroner vazospazma baglidir
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引用次数: 5
Melena Associated with Ganoderma lucidum: A Case Report 与灵芝有关的黑疹1例报告
Pub Date : 2015-01-01 DOI: 10.5152/JAEMCR.2015.741
Demet Acar, Mustafa Gulpembe, N. Akilli, S. Calik, R. Koylu, Y. Gunaydin, B. Cander
Giris: Melena acil servis hastalari arasinda gorulen hayati tehdit edebilecek bir bulgudur. Olgu Sunumu: Biz burada, onceden bilinen herhangi bir mide sikayeti olmayan genc bir erkek hastada Ganoderma Lucidum kullanimi ile induklenen bir melena olgusu sunacagiz. Sonuc: G. lucidum'un bazi toksik etkileri bildirilmistir ancak bildigimiz kadariyla, bu vaka bildirilen G. lucidum ile iliskili ilk ust gastrointestinal sistem kanamasidir.
{"title":"Melena Associated with Ganoderma lucidum: A Case Report","authors":"Demet Acar, Mustafa Gulpembe, N. Akilli, S. Calik, R. Koylu, Y. Gunaydin, B. Cander","doi":"10.5152/JAEMCR.2015.741","DOIUrl":"https://doi.org/10.5152/JAEMCR.2015.741","url":null,"abstract":"Giris: Melena acil servis hastalari arasinda gorulen hayati tehdit edebilecek bir bulgudur. Olgu Sunumu: Biz burada, onceden bilinen herhangi bir mide sikayeti olmayan genc bir erkek hastada Ganoderma Lucidum kullanimi ile induklenen bir melena olgusu sunacagiz. Sonuc: G. lucidum'un bazi toksik etkileri bildirilmistir ancak bildigimiz kadariyla, bu vaka bildirilen G. lucidum ile iliskili ilk ust gastrointestinal sistem kanamasidir.","PeriodicalId":14780,"journal":{"name":"Journal of Academic Emergency Medicine Case Reports","volume":"190 ","pages":"7-9"},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91466176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
期刊
Journal of Academic Emergency Medicine Case Reports
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