Background: The aim of this study is based on the effects of the treatment, the recombinant tissue plasminogen activator (rTPA), applied to stroke patients in Emergency Departments (ED) by intravenous, to optic nerve sheath diameter (ONSD) measurements. Material and Methods: The study was designed as prospective and observational. A total of 41 patients were included in this study with the following diagnoses: an acute clinical stroke, known well-being within 4.5 hours, and who had a finding for rTPA. Ultrasonographic (USG) ONSD measurements have been performed on a voluntary basis with the consent of the patients and their relatives. Results: A statistically significant difference has been found between the ONSDs measured at the 0th, 15th, 30th and 60th minutes of the patients who were admitted to the ED and were on rTPA treatment due to stroke (p<0.05). Due to a large number of positive differences, the ONSD at the 15th, 30th, and 60th minutes was found higher than at the 0th minute. A statistically significant difference has also been found between ONSD measured at the 15th, 30th, and 60th minutes during rTPA treatment (p<0.05). Since the existence of a large number of positive differences, the ONSD at the 30th and 60th minutes is found to be higher than at the 15th minute. Finally, the difference of statistically significant values between the 30th and 60th-minute ONSD was determined by the Sign Test. According to the result of the Sign Test, a statistically significant difference was found to be between the ONSD differences of the 30th and 60th minutes of rTPA treatment (p<0.05). Conclusions: Serial ONSD measurements performed at the bedside during the early stage in order to follow up on the intracranial complications of stroke patients may be misleading for the follow-up of complications within the first 60 minutes, which is the most critical stage. In this stage, symptom monitoring should be used in combination with ONSD and the decision should be made for treatment continues, accordingly.
Background: The aim of this study is to evaluate the sociodemographic characteristics, clinical conditions, and results of patients who were admitted to the emergency department (ED) due to suicide attempts by self-poisoning intentionally. Methods: This retrospective study was conducted between January 1 and December 31, 2017, in the ED of Istanbul Lutfi Kırdar City Hospital, University of Health Sciences. Patients of only attempted suicide through taking overdose drugs with the intent of self-poisoning and over 12 ages were included in the study, which included 391 cases. Patients who attempted suicide in any different ways than self-poisoning were excluded. Results: Our study is consisted 69.8% (n=273) of female and 30.2% (n=18) of male patients. The mean age of the total cases was 31.01±12.064, which the youngest case being 14 years old and the oldest being 73 years old. The marital status of the cases is as follows: 140 (35.8%) married, 205 (52.4%) unmarried, 42 (10.7%) divorced, and 4 (1%) widow/widower. Istanbul is covering a major population of patients (93.1%) as a living place. The study has resulted in 58.3% ED discharge, 27.1% hospital leaving, and 10.5% Psychiatry unit admission. It can be stated that elderly people aim for death more than young people via their suicide attempts. The reasons for the suicide of the patients included in the study were grouped as a secondary gain, anger, and death. We found that secondary gain was the reason for teens mostly. We divided into categories clinical results as ED discharge, psychiatrist hospitalization, Intensive care unit (ICU) admission, and discharge against medical advice (DAMA). The patients who attempted suicide with the aim of death were hospitalized in the psychiatry unit, and the attempts caused by secondary gain were discharged from the ED. Patients who had taken paracetamol for suicide, which is contain 70.10% of the total cases, were discharged from the ED, after the examination. It was detected that 39.29% of the cases who had Suicidal ideations again, had a psychiatric disease in their medical history. Conclusions: Suicidal behavior is a very comprehensive topic when considering its etiology and risk factors, there are many variables as well. Since it is one of the serious public health issues and causes of death, the risk factors must be identified and preventions to be taken should be determined. In addition, when elderly people attempt suicide, more medical care should be taken during ED, since they are more focused to die and fall into the category of severe cases.
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