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Drug-induced hepatotoxicity is a major cause of hepatocellular injury in patients admitting to emergency services with acute liver failure. Hepatic necrosis may be at varying degrees from mild elevations in transaminases to fulminant hepatitis, and even death. The case of a 53-year-old female patient with toxic hepatitis due to levofloxacin and multiple organ failure secondary to toxic hepatitis is presented. Patient suffered itching, redness, and rash after receiving a single dose of 750 mg of levofloxacin tablets for pulmonary infection 10 days ago. Skin lesions had regressed within 3 days, but desquamation formed all over the body. After the fifth day of drug intake, complaints of abdominal pain, vomiting, and yellowing in skin color had started. The patient was referred to our emergency department with these complaints 10 days after drug intake. Patient was thought as a candidate for liver transplant, but cardiopulmonary arrest occurred, and the patient died before she could be referred to a transplant center. This case is important because hepatotoxicity and death due to levofloxacin is uncommon in the literature.

Objective: In this study, we aimed to analyze the demographic features of the victims of workplace accidents admitted to a teaching and research hospital. The life-threatening content of the forensic reports, the use of simple medical interventions and outcomes in the emergency department were evaluated. Material and Methods: This study retrospectively evaluated patients admitted to the emergency department who had been in a workplace accident from All workplace accidents were included in this study. Categorical measurements obtained were summarized as a number and numerical measurements were summarized as the mean and standard deviation. Data were statistically analyzed using SPSS version 16.0. Results: Of the 406 patients, 96.55% were male and 3.45% were female. The mean age of the patients was 32.80 years. Most of the workplace accidents occurred in December 2010. The most frequent injuries were limb injuries (62%). 73.65% of patients were discharged after evaluation in the emergency department. The forensic reports indicated that 14.53% of patients had lifethreatening injuries and 28.57% were not resolved with simple medical intervention. Conclusion: Work-related accidents occur mostly in younger men. Most frequently, patients were discharged from the emergency department after evaluation. Clinicians often decide abolishing with simple medical intervention according to staying in hospital. Cases of injury to more than one organ system were often life-threatening. (JAEM 2013; 12: 19-23)

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Objective: We aimed to present inferior vena cava (IVC) diameter as a guiding method for detection of relationship between IVC diameter measured noninvasively with the help of ultrasonography (USG) and central venous pressure (CVP) and evaluation of patient's intravascular volume status. Methods: Patients over the age of 18, to whom a central venous catheter was inserted to their subclavian vein or internal jugular vein were included in our study. IVC diameter measurements were recorded in millimeters following measurement by the same clinician with the help of USG both at the end-inspiratory and end-expiratory phase. CVP measurements were viewed on the monitor by means of piezoelectric transducer and recorded in mmHg. SPSS 18.0 package program was used for statistical analysis of data. Results: Forty five patients were included in the study. The patients had the diagnosis of malignancy (35.6%), sepsis (13.3%), pneumonia, asthma, chronic obstructive pulmonary disease (11.1%). 11 patients (24.4%) required mechanical ventilation while 34 (75.6%) patients had spontaneous respiration. In patients with spontaneous respiration, a significant relationship was found between IVC diameters measured by ultrasonography at the end of expiratory and inspiratory phases and measured CVP values at the same phases (for expiratory p = 0.002, for inspiratory p= 0.001). There was no statistically significant association between IVC diameters measured by ultrasonography at the end of expiration and inspiration and measured CVP values at the same phases in mechanically ventilated patients. Conclusions: IVC diameter measured by bedside ultrasonography can be used for determination of the intravascular volume status of the patients with spontaneous respiration.

Objective: In this study we evaluated the convenience of the transports and the prehospital interventions of the cases admitted to a third level hospital with the 112 ambulance service together with their demographic features. Material and Methods: All of the adult patients admitted to the hospital with the 112 ambulance service between January 2009, 1 and January 2010, 31 were included in the study. Patients were evaluated with the 112 ambulance patient register form data collected from the archives of the hospital and the computer recordings. Variables were sex, transport duration, admission time, place of event, reason of the transport, prehospital interventions of the ambulance team, initial diagnosis, disposition of the patint recorded in the emergency department. Results: The ambulance use rate of the patients admitted to our hospital was 0.54%. Of the patients 53.5% were male and 46.5% were female. The admission time from the scene of event was 20-29 minutes. 49% ofpatients were transported enrolled from the home in 49.3%. Of the 75.1% patients transported for diagnosis and treatment, 17.6% had been sent for consultation and 7.3% dispatched from an other hospital. 82.6% of the dispatched patients were admitted without approval. Forty precentage of the dead patients admitted to the hospital by ambulance were not intubated. Thirty-eight percentage of the intubated patients were reintubated in the emergency department after admission. Of the patients transported by the 112 ambulance service, 74% were discharged and 24.1% were hospitalised. Conclusion: The interventions carried out on the patients admitted to the emergency department by ambulance are not sufficient. It is thought that the education programmes are concentrated on inservice and the emergency medical services organisation should be developed.

Background:This study aims to compare the poisoned patients who could not be administered activated charcoal because of its unavailability with the poisoned patients who were administered charcoal in the later period and to reveal the results about its effectiveness.Study Question:Is the use of activated charcoal effective against poisoning caused by oral medication?Study Design:This retrospective cohort study with historical control was planned at a tertiary hospital. Patients older than 18 years were admitted to the emergency department because of oral drug poisoning during the study periods. A total of 1159 patients who were not given activated charcoal and 877 patients who were given activated charcoal were included in this study.Measures and Outcomes:The frequency of clinical findings secondary to the drug taken, the frequency of antidote use, the frequency of intubation, and the hospitalization length were determined as clinical outcome parameters.Results:There was no statistically significant difference in the development of central nervous system findings, cardiovascular system findings, frequency of intubation, and blood gas disorders, as well as the length of hospitalization periods according to the activated charcoal application. Hepatobiliary system findings and electrolyte disturbances were found to be less common in patients given activated charcoal. The frequency of tachycardia, speech impairment, coma, and respiratory acidosis was found to be statistically higher in patients who were administered activated charcoal. The hospitalization period of the patients who were given activated charcoal was longer in patients with drug findings; however, there was no difference in the hospitalization periods of the patients who were given an antidote.Conclusions:The use of activated charcoal in poisoned patients may not provide sufficient clinical benefits. However, clinical studies with strong evidence levels are needed to determine activated charcoal's clinical efficacy, which is still used as a universal antidote.

In this study, the analgesic effects of dexketoprofen trometamol and meperidine hydrochloride were compared in patients diagnosed with renal colic. This study was a prospective, randomized, double-blind study. Fifty-two patients, between the ages of 18 and 70 years who were diagnosed with renal colic, were enrolled in the study after obtaining ethics committee approval. Before drug injection, dexketoprofen trometamol and meperidine hydrochloride were placed in closed envelopes, and the patients were randomly given a single dose of intravenous infusion for 20 minutes. Severity of pain and symptoms was evaluated with the numerical rating scale and renal colic symptom score for each patient immediately before administration of drugs and 30 minutes after the end of the application. At the same time, systolic arterial blood pressure, diastolic arterial pressure, respiratory rate, heart rate, nausea, vomiting, and reactions due to drug administration were recorded before and after drug administration. In statistical methods, t test, analysis of variance, and repeated measure analysis were used for the analysis of normally distributed continuous variables and the Mann-Whitney U, Kruskal-Wallis and Friedman tests were used for analysis of not-normally distributed continuous variables. In the analysis of discrete variables, the χ test was used. In both groups, a significant decrease was found in numerical rating scale values measured 30 minutes after drug administration, but the decline in dexketoprofen trometamol group (P = 0.02) was found to be more. Although a significant decrease was found in the renal colic symptom score (P < 0.001) values measured after drug administration in the dexketoprofen trometamol group, no significant decrease was found in the meperidine HCl (P = 0.058) group. After drug administration, a statistically significant decrease was found in the systolic arterial blood pressure, heart rate, and respiratory rate in both groups. Also, a statistically significant decrease was found in the diastolic arterial pressure in the meperidine group. But these changes in vital findings were not serious enough to disrupt patients' clinical status. With this study, we concluded that dexketoprofen trometamol, from the nonsteroidal anti-inflammatory drug group, can be within the primary treatment options for renal colic because of better analgesic efficacy, being well tolerated by patients compared with meperidine hydrochloride.