Objective: We aimed to evaluate and compare the performance of BIG score (Base deficit, INR, GCS),pediatric trauma score(PTS), revised trauma score(RTS),injury severity score(ISS),new injury severity score(NISS) in mortality and stay intensive care unit.
Materials and Methods: 1510 pediatric patients aged less than 18 years who were admitted to the emergency department with multitrauma between 1 July 2012 and 1 July 2016 were included in the retrospective research.Demographic data,vital signs in the emergency department,trauma location,injury severity indexes and follow up of patients were examined.
Results: 1510 patient were included,40.5% were female and 59.5% were male.Mean age was 7.81±4.8;mortality was 4.2%.The best score to evaluate mortality was “Probability of Survival 2014 (PS14)”. The best score to force the stay in ICU was found as NISS, the most sensitive system was NISS and PS14 (94.9%) and the most specific was NISS (86.7). PS14 was the first to evaluate the survival. In our research, 94.3% of patient had blunt trauma and 5.7% had penetrating trauma. PS14 was found the best score to determine survival and mortality for blunt trauma patients.
Conclusion: Although all scoring systems appeared similarly predictive among pediatric trauma patients, The PS14 score was more predictive for mortality and survival, and the NISS score for the need of intensive care admission. The NISS score was the most predictive score for intensive care admission in blunt and penetrating traumas combined. Particularly the newly developed PS14 score can be used as a powerfully predictive scoring system for outcomes among all pediatric trauma patients, irrespective of trauma mechanism.

Aim: The aim of this study was to measure a variety of clinical and radiological outcomes in a group of patients with thoracolumbar fractures who underwent surgery at a single center.
Materials and Methods: We retrospectively analyzed 50 consecutive patients who underwent surgery for thoracolumbar vertebral fractures between September 2000 and December 2011. We assessed clinical outcomes with the Visual Analogue Scale(VAS) for pain, Oswestry Disability Index (ODI), and Frankel Scale. We measured radiological outcomes using the Sagittal Index (SI), Local Kyphosis Angle (LKA), and Anterior Corpus Height Loss(ACHL).
Results: Preoperative, postoperative, and final visit mean VAS values were 82 mm, 60 mm, and 13.5 mm, and mean ODI values were 65%, 40%, and 15%, respectively. These clinical outcome improvements were all statistically significant (P<.05). Similarly, mean SI values were 20°, 14°, and 15°, mean LKA values were 17°, 9°, and 13°, and mean ACHL values were 45%, 25%, and 28%, respectively. The preoperative to postoperative radiological outcome improvements were all statistically significant (P<.05), whereas the postoperative to final visit measures actually demonstrated loss of correction, although these changes were not statistically significant.
Conclusion: Although major progress has been made in the treatment of thoracolumbar vertebral fractures, the lack of standardized, verified clinical and radiological outcome measures continues to pose a challenge to the accurate assessment of the results of management.

Objective: Heart-type Fatty Acid Binding Protein (H-FABP), an early marker of cardiac necrosis, is released rapidly from myocardium as a consequence of ischemic injury. We hypothesized that more severe and extensive coronary atherosclerosis would result in more pronounced myocardial injury and necrosis in patients with acute myocardial infarction (AMI). Therefore, we sought the relationship between serum H-FABP levels and the severity and extent of coronary artery disease (CAD) assessed using the Gensini score.
Methods: Fifty patients with AMI who underwent invasive coronary angiography were divided into 2 groups according to the angiographic Gensini score, namely the moderate to severe CAD group (Group 1) and the mild CAD group (Group 2). A point of care test and Cardiodetect Quant device were used to detect whether H-FABP was positive and the quantitative measurements. The data obtained from this study were evaluated using the PASW statistic programme.
Results: Mean serum H-FABP concentration was significantly higher in Group 1 when compared to that in Group 2. Furthermore, a strongly positive correlation was found between the Gensini score and serum H-FABP levels.
Conclusions: The findings of our study suggest that the quantity of myocardial necrosis demonstrated by serum H-FABP levels is higher in patients with AMI who have more severe and extensive CAD. H-FABP levels are also positively correlated to the Gensini score. We propose that H-FABP, an early marker of myocardial necrosis, may also provide a clue about the severity and extent of CAD, especially in the setting of AMI

Introduction: Moral distress is one of the recurring issues in the nursing profession that has gained importance by creating changes in the health care system, including increasing the number of legal roles, protocols, and clinical guidelines, and greater emphasis on accountability, and acts as an obstacle to achieving personal and social development goals. This study was conducted to determine moral distress and related factors.
Material and Methods: A cross-sectional and analytic-descriptive study was conducted, in which 180 nurses working in emergency education and health centers in Rasht using a census in accordance with the conditions of entry were considered. For data collection, questionnaires assessing related factors and moral distress were used. Data were analyzed using descriptive statistics (frequency percentage, mean, and standard deviation) and inferential statistics (t-test, ANOVA, and logistic regression) with the software SPSS 22.
Results: The findings showed that moral distress in emergency nurses (4.93 ± 1.08) was high. Most moral distress was in the area of professional-functional competence (5.21 ± 1.17) in the item of "unsafe conditions” (5.55 ± 1.45). No statistically significant correlation was found between age and experience with moral distress among nurses in the emergency department. From the perspective of nurses in the study, organizational factors including barriers to education were the strongest factor influencing moral distress.
Conclusions: Given that moral distress in nurses participating in the study was very high, it seems that workshops to reduce moral distress in nurses and planning to promote professional-functional competency of nursing practice are essential.

Aim: To evaluate differences between cultivated and wild mushroom poisoning in terms of clinical characteristics, laboratory findings, and complications. we also aimed to determine the differences among patients in regard to presence of complications.
Materials-Methods: We evaluated adults who were diagnosed with mushroom poisoning in a 4-year period between 2014 and 2017. The following characteristics of patients were recorded: age, sex, complaints, time until hospital admittance, time until symptom onset, mushroom source, any interventions until patient arrived to the hospital, laboratory findings, complications, length of stay (LoS) at hospital, and patient discharge status.
Results: A total of 168 patients were enrolled in the study, of which 111 were poisoned by wild mushrooms and 57 were poisoned by cultivated mushrooms. Cultivated mushrooms were more frequently the cause of poisoning in patients who lived in metropolitan and urban areas. Patients who consumed wild mushrooms had higher troponin levels, lower base excess values and longer LoS at hospital.
Conclusions: Studies on MP usually evaluate patients according to mushroom type and onset/severity of complications. We evaluated patients in terms of the source of mushroom (wild/cultivated) and the presence of complications, which is a different approach. We aimed to identify the differences between cultivated and wild MP; however, we ended up finding that these conditions are mostly similar in terms of clinical characteristics, laboratory findings and complications. We also believe that the identification of complications and their severity is an important determinant of their effects on prognosis.

Aim:
About 40 % of patients with trauma, experience chest related injuries. Rib fracture remains the most frequent finding in chest trauma. Some literatures have suggested chest wall ultrasonography as a potential replacement for CXR in detecting rib fractures. The aim of this study is to assess sensitivity and specificity of bedside ultrasonography in detecting rib fractures and related injuries.

Materials and Methods:
Patients between April 2012 and April 2014 were enrolled in our prospective cross-sectional study.
Then emergency medicine specialists performed a bedside ultrasonography to detect any probable fracture and suspected injuries. We took CXRs and an expert radiologist looked for fracture and related injuries. A chest computerized tomography (CT) scan was taken and compared with findings of CXR and ultrasonography.

Results:
Out of 360 patients, 238 met our inclusion criteria and enrolled in the study; where 222 (= 93.3%) were male and 16 (= 6.7%) were female with the average age of 33.78±11.62(±SD). The sensitivity and specificity of two modalities in detecting fracture, pneumothorax, hemothorax and contusion were analyzed.

Conclusion:
Our study showed that bedside ultrasonography could substitute CXR in detecting not only rib fractures but also related comorbidities especially in minor trauma.

Aim: This study aimed to analyze the relationship between platelet, mean platelet volume, C-reactive protein and mortality in ischemic stroke patients who admitted to Okmeydanı Training and Research Hospital Emergency Department with cerebrovascular disease between January 2016- July 2016. The most common encountered neurological disease is cerebrovascular diseases. Of the cerebrovascular diseases, ischemic stroke has a major importance due to its high mortality and morbidity. Ischemic stroke is the third leading reason of death in the world.
Material and Method: This study is a retrospective study and covers 322 patients who admitted to our Emergency Department for cerebrovascular disease between January 2016 and July 2016.
Results: Patient information system was searched as covering the study period. Information of age, sex, platelet, mean platelet volume and C-reactive protein levels at first admission were recorded. Obtained data were recorded in study form. With our analysis we detected meaningful relation between the higher age, higher C-reactive protein levels and mortality in ischemic stroke patients.
Study was performed with 322 patients in Okmeydanı Training and Research Hospital between January 2016 and July 2016.
Quantitative data was reported as average ± standard deviation, categorical data was reported as number or percentage. In all statistical analysis p<0.05 was accepted as statistically meaningful difference. SPSS 10.0 for Windows was used for statistical analysis.
Conclusion: In our study, we detected meaningful relation between the higher age, higher C-reactive protein levels and mortality in ischemic stroke patients similar to the literature.

Aims: To determine the clinical characteristics of Syrian immigrant children admitted to the emergency department (ED) with trauma with respect to their frequency, socio-demographic characteristics such as living conditions, education of family, not to go to kinder-garden and corresponding high-risk injury.
Materials and Methods: This is a retrospective observational study. All records for children aged between 0-17 years were retrospectively evaluated and only patients admitted to the ED with trauma were included in the study. The data of interest investigated from patient records were age, sex, location, and timing of injury occurrence, as well as the family and education data of parents.
Results: Totally 200 children with a Interestingly, in this study, among 200 children included, 51 (25.5%) were Syrian immigrants. The mean age of Syrian immigrants was younger than that of Turkish children (p: 0.002). age of 8.29 ± 4.85 years (range: 1-17 years) were included in the study. Falloffs were the most common cause in all age groups.
Conclusion: In that study, we have determined approximately one-quarter of the children with trauma are Syrian immigrants. Children between the ages of 1-3 years and 6-9 years, and boys were at a higher risk. Syrian immigrants cannot deal with their children enough because of living difficulties for them in Turkey. The living and educational conditions of the Syrian immigrant children who escaped from the war and took refuge should be made better and the sensitivity of the families should be increased.

Aim
The aim of our study is to compare the efficiency of fentanyl and tramadol as analgesics in renal colic patients.
Materials and Methods
Our research is a prospective, randomized, double-blind study. We administered intravenous(iv) non-steroid anti-inflammatory drugs as first line treatment. Then, “iv Fentanyl” and “iv Tramadol” were administered to the patients whose pain did not relieve. The outcomes of the analgesic efficacy in our study are the difference between VAS0-VAS 60 values and the score less than 4 in VAS 60.
Results
A total of 912 renal colic patients were admitted during the study period. When the exclusion criteria were applied, the study is completed with 143 patients. The difference between VAS0 and VAS 60 values-which is the primary outcome in the evaluation of analgesic efficiency in our study is 6,11±2,49 in Fentanyl and 5,94±2,40i n Tramadol group. In the fentanyl group, 16 patients responded to the treatment and in the tramadol group 18 patients responded to the treatment.
Conclusions
Our study is concluded that both drugs are effective on renal colic pain and they do not have a significant advantage over each other.

Paint thinner is an organic solvent which includes aromatic hydrocarbons and is widely used in the paint, varnish, and plastic products industries. Regular inhalation of such solvents is known to cause chronic intoxication. Oral thinner over-exposure is rare but quite fatal. Volatile liquids can cause pulmonary complications even with oral ingestion. Therefore, in patients with oral volatile liquid thinner intake, emergency physicians should be aware of local complications as well as the systematic effect even with initial normal physical or radiological findings. In this report, we present a patient with chemical pneumonia due to self-vomiting after accidentally drinking paint thinner.

Introduction:
Open bone fractures are frequently seen in fingers (45%) and in long bones such as tibia and fibula (11,2%). Open fractures of the thorax due to rib fracture rarely result in antagonism. Rib fracture treatment is often conservative, but fracture-related complications may require surgical intervention. We presented a case report of a child who had open rib fracture in the left hemithorax after falling from a donkey and who was followed up by the family for a long period of time falsely, considering that it was a piece of wood.
Case report:
There was a story of a 9 year old female patient falling from a donkey 20 days ago. After the trauma, a hard, creamy colored piece of ribextending out about 2 cm from the surface of the skin in the patient's left hemithorax was thought to be a foreign bodyby the family. After the tetanus vaccination was performed, the necessary antibiotic treatment was started and the rib piece about 6 cm in length was removedunder local anesthesia. Follow-ups were normal and no complications are encountered yet.
Discussion and Conclusion:
As a result, chest wall should be intervened early to reduce or eliminate morbidity in compound rib fractures. Although initiation of treatment in the late period may reduce the chances of success of treatment, morbidity can be reduced by appropriate surgical intervention.

Warfarin is the most widely used anticoagulant in the world. Patients who need more than 15 mg per day should be considered warfarin-resistant. Nearly 30 genes have been reported in association with warfarin pharmacogenetics but genetic polymorphisms in the genes encoding CYP2C9 and VKORC1 have been shown to act as major determinants of drug dosage requirements. The main enzyme responsible for the metabolism of S-warfarin, the more potent of warfarin’s two stereoisomers, is CYP2C9. Vitamin K [ep]oxide reductase (VKOR) is the enzyme that warfarin inhibits. A 30-year-old woman was referred to our clinic for pulmonary embolism. She was treated with low molecular weight heparin. The warfarin dose was titrated up to 15 mg daily but after one week, the INR (international normalized ratio) was still subtherapeutic level at 1.8. In this paper, we discuss underlying genetic polymorphisms about warfarin resistance.

Not Applicable.