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Öğe Accuracy of emergency physicians’ interpretation of computed tomography for urgent?emergent diagnoses in nontraumatic cases(2022) Karakoyun, Ömer Faruk; Kozaci, Nalan; Avci, Mustafa; Uzunay, HüseyinOBJECTIVE: The aim of this study is to evaluate the accuracy levels of the emergency physicians (EPs) \rmanaging the patient in the interpretation of the urgent?emergent pathological findings in thoracic \rand abdominal computed tomography (CT) scans.\rMETHODS: The EPs interpreted the CT scans of patients who visited the emergency department \rbecause of nontraumatic causes. Then, a radiology instructor made final assessments of these CT \rscans. Based on the interpretation of the radiology instructor, the false?positive rate, false?negative \rrate, sensitivity, specificity, positive predictive value, negative predictive value, and kappa \rcoefficient (?) of the EPs’ interpretations of the CT scans were calculated.\rRESULTS: A total of 268 thoracics and 185 abdominal CT scans were assessed in our study. The \roverall sensitivity and specificity of the EPs’ interpretation of the thoracic CT scans were 90% and 89%, \rrespectively, whereas the abdominal CT interpretation was 88% and 86%, respectively. There was \rexcellent concordance between the EPs and the radiology instructor with regard to the diagnoses of \rpneumothorax, pulmonary embolism, pleural effusion, parenchymal pathology, and masses (?: 0.90, \r?: 0.87, ?: 0.71, ?: 0.79, and ?: 0.91, respectively) and to the diagnoses of intraabdominal free fluid, \rintraabdominal free gas, aortic pathology, splenic pathology, gallbladder pathology, mesenteric artery \rembolism, appendicitis, gynecological pathology, and renal pathology (?: 1, ?: 0.92, ?: 0.96, ?: 0.88, \r?: 0.80, ?: 0.79, ?: 0.89, ?: 0.88, and ?: 0.82, respectively).\rCONCLUSION: The EPs are successful in the interpretation of the urgent?emergent pathological \rfindings in thoracic and abdominal CT scans.Öğe Acil Serviste Odaklanmış Kas-İskelet Ultrasonografisi ile Kas Yaralanmalarının Tanısı: Bir Olgu Sunumu(2020) Kozaci, Nalan; Avcı, MustafaAmaç: Bu sunumda, acil servise yürüme güçlüğü ve bacağında morluk şikâyeti ile başvuran, odaklanmış kas-iskelet ultrasonografisi ile semitendinosus kasında parsiyel rüptür saptanan bir olgu anlatılmıştır.Olgu Sunumu: Otuz bir yaşında erkek hasta sol bacağında ağrı ve morarma şikâyeti ile acil servise başvurdu. Hastanın anamnezinden dansçı olduğu, dans gösterisi esnasında \"spagat pozisyonu\" ismi verilen bir hareket sırasında sol bacağında aniden şiddetli bir ağrı ve yanma hissettiği ve ertesi gün bacağında morluk oluştuğu öğrenildi. Hasta ayrıca, yürüme sırasında ağrısının arttığını ve bu yüzden yürümekte zorluk çektiğini ifade etti. Hastanın fizik muayenesinde sol bacak arka yüzünde orta noktaya yakın bölgede şişlik, ekimoz ve palpasyonda hassasiyet saptandı, bacak ve diz abduksiyonu esnasında tarif edilen lezyon bölgesinde hastanın ağrısı artıyordu. Hastadan sözel ve yazılı onam alındıktan sonra, hastanın sol bacağına acil hekimi tarafından odaklanmış kas-iskelet ultrasonografisi yapıldı. Odaklanmış kas-iskelet ultrasonografisi muayenesi ile sol bacak semitendinosus kas lifleri arasında hematom ile uyumlu sıvı koleksiyonu ve semitendinosus kasında parsiyel rüptür saptandı. Hastaya ait, travmanın onuncu günü manyetik rezonans görüntülerinde semitendinosus kasında antero-posterior çapı 25 mm olarak ölçülen ve kasın %50’sinden fazlasını kapsayan parsiyel rüptür izlendiği, rüptür bölgesinde 1 cm boyutlarında subakut dönemde hematom olduğu ve fasyalar arasında yer yer sıvı birikimleri gözlendiği raporlandı.Sonuç: Sonuç olarak, hastalar kas yaralamaları ile acil servise sıklıkla başvurmaktadırlar. Odaklanmış kas-iskelet ultrasonografisi, semitendinosus kas yaralanmalarının değerlendirilmesi, derecelendirilmesi ve tedavi kararı için alternatif bir görüntüle yöntemi olarak acil serviste kullanılabilir.Öğe An Innovative Traction-free Drugless Approach to Reduce Anterior Shoulder Dislocation: Axillary Massage Technique(Elsevier Inc., 2025) Islek Yuksel, Ayşegül; Ortadeveci, Abdullah; Kozaci, Nalan; Polat, Osman; Yuksel, SerkanAlthough shoulder dislocation is one of the most common cases encountered in emergency departments, there is still no consensus on the method of reduction. Here, we reported 9 cases in which we used a new technique that did not require any traction, medication, or patient effort. This technique can give results in 20 seconds in some cases and provides high patient satisfaction. Due to its easy applicability and high success rate, we think that the technique will make a significant contribution to the literature and clinical practice. © 2024 The Author(s)Öğe Atrial fibrillation and QTc prolongation associated with hypokalemia and hypomagnesemia: a case report(Science Press, 2025) Kozaci, Nalan; Bayramo?lu, Atıf If; Erenler, Ali Kemal; Aldemir, İlyas; Danış, İhsan[No abstract available]Öğe Comparison of diagnostic accuracy of point-of-care ultrasonography and X-ray of bony injuries of the knee(Springer Heidelberg, 2022) Kozaci, Nalan; Avci, Mustafa; Yuksel, Serkan; Donertas, Eda; Karaca, Adeviye; Gonullu, Gizem; Etli, IbrahimPurpose We aimed to compare the accuracy of point-of-care ultrasonography (POCUS) and X-ray (XR) in the diagnosis of knee bone fractures and fracture characteristics in cases of injuries to the knee. Methods The study was conducted in the emergency department (ED) of a tertiary hospital between March 2017 and March 2019. It included patients who presented to the ED with isolated knee injuries, were suspected to have a bony lesion based on clinical examinations, and were ultimately referred for XR. Five emergency physicians (EPs) who had at least three years of ED experience participated in the study. Before the study, these EPs received training on knee examination and radiographic investigation of the knee joint. They were also trained on how to assess the knee joint using POCUS. The knee bones, patella, femur, tibia, and fibula were evaluated. A POCUS examination of the knee bones was carried out according to the eight-step Kozaci Protocol. Results This study included 92 patients with knee trauma. The mean age of the patients was 34 +/- 16 years (6-55 years). Using POCUS and XR, fractures were detected in 40 (43%) and 32 patients (35%), respectively. Relative to XR, for detecting fractures, POCUS showed sensitivity, specificity, positive predictive value, and negative predictive value of 97%, 85%, 78%, 98%, respectively, and the kappa value was 0.774. POCUS examination revealed hematoma and edema in the soft tissue in 34 (37%) patients and hemarthrosis in 33 patients (36%). Conclusion XR is the first and most widely used imaging modality to identify fractures of the knee bone trauma. However, POCUS examination can successfully diagnose bony lesions of the knee in patients with stable vital signs and without life-threatening injuries. It can also easily diagnose hematoma and hemarthrosis. Therefore, POCUS can be used as a diagnostic tool in emergency situations where XR is not available.Öğe Correlation of Hemoglobin, Hematocrit and Electrolyte Values with Venous Blood Gas Analyzer and Laboratory Auto Analyzers in Patients with Indications for Emergency Hemodialysis(2020) Avcı, Mustafa; Kozaci, NalanAim: The aim the study was to compare the hemoglobin (Hb), hematocrit (Hct) and electrolyte values measured in the venous blood by bedside blood gas analyzer and standard laboratory auto analyzers in patients with emergency hemodialysis indication, to determine the correlation between them and to investigate the accuracy of blood gas analyzer in K abnormalities.Methods: Patients aged 18 years and over who underwent emergency hemodialysis after being diagnosed in the ED between 01 January 2017 and 01 November 2019 were included in the study. Patients whose laboratory test results could not be reached, whose blood samples that analyzed by laboratory auto analyzer and venous blood gas analyzer were not collected simultaneously, whose venous gas results were reported more than 30 minutes after the blood sample was taken, showing hemolysis in laboratory tests and younger than 18-year-old were excluded from the study. The levels of Hb, Hct, sodium (Na), potassium (K) and chloride (Cl) measured by venous blood gas analyzer and laboratory auto analyzers were compared. Results: Two hundred and thirteen patients enrolled in the study. There was a correlation between blood gas analyzer and laboratory auto analyzer results. The correlation coefficient was 0.608 for Na, 0.821 for K, 0.548 for Cl, 0.738 for Hb and 0.771 for Hct. The highest correlation was in K. The formulas were designed to calculate laboratory analyzer values from venous blood gas analyzer values. Each of these formulas designed was applied to the patients included in the study and the results were found reliable. Conclusion: The values of Na, K, Cl, Hb and Hct measured by blood gas analyzer in venous blood sample are correlated with those measured in laboratory auto analyzers in patients with emergency hemodialysis indication in emergency department. Especially, K abnormalities have the highest correlation coefficient. The values of Na, K, Cl, Hb and Hct measured by blood gas analyzer in venous blood sample can be used in daily practice. Furthermore, formulas were able to be produced to calculate the value measured by a laboratory automatic analyzer from the value measured by a blood gas analyzer. These formulas can be useful in case of urgent decisions.Öğe Diagnosis of Diffuse Pulmonary Hemorrhage by Ultrasonography: A Case Report(2024) Kozaci, Nalan; Aydın, İsmail Erkan; Erşahin, Tuğçe; Taşkıran, BüşraA 72-year-old male patient was admitted to the emergency department with a complaint of a rash covering his entire body and shortness of breath. Aside from the petechial rash covering his body, the patient was also found to have bleeding in the mouth and gums, and tachypnea. A bedside point-of-care ultrasound (POCUS) revealed multiple and confluent B lines, a pleural line abnormality, the disappearance of A-lines, a subpleural hypoechoic area, hepatization, shred sign and pleural effusion, predominantly in the 3rd, 4th and 5th zones of the right lung and the 3rd and 4th zones of the left lung. A stratosphere sign was detected in M Mode. The patient was diagnosed with diffuse pulmonary hemorrhage with POCUS and clinical findingsÖğe Diagnosis of Pulmonary Hydatid Cyst with Point of Care Ultrasound in an Emergency Department: A Case Report(2020) Kozaci, Nalan; Avci, MustafaUltrasonography is widely used for diagnostic and invasive purposes in emergency departments. We present here a case with acquired immune deficiency syndrome who was diagnosed with a hydatid cyst and pneumonia in the lung parenchyma during a pointof-care-ultrasonography examination.Öğe Diagnostic accuracy of point-of-care ultrasonography in physeal fractures(W B Saunders Co-Elsevier Inc, 2026) Gurkan, Onur; Kozaci, Nalan; Colak, Songul; Aydin, Ismail ErkanObjective: The aim of this study was to compare the accuracy of Point of Care Ultrasound (POCUS) with X-ray (XR) in the diagnosis of physeal fractures and Salter-Harris classification in pediatric patients. Methods: The study was conducted in a university hospital emergency department between January 1, 2024 and June 30, 2025. Pediatric patients aged 0-18 years who were admitted to the emergency department due to extremity trauma, had stable vital signs, and presented with suspected physeal fractures on physical examination were included in this prospective study. Results: A total of 117 patients were included in the study. Fractures were detected on XR in 73 % of patients. Compared with XR, POCUS demonstrated a sensitivity (Sn) of 97 %, specificity (Sp) of 94 %, positive predictive value (PPV) of 98 %, negative predictive value (NPV) of 91 % (AUC: 0.951, 95 % CI: 0.90-1.00), and a kappa value of 0.894 for fracture detection. For physeal fractures, POCUS showed Sn 93 %, Sp 95 %, PPV 74 %, NPV 99 % (AUC: 0.942, 95 % CI: 0.87-1.00) and kappa = 0.794. For detecting the extension of the fracture into the joint space, POCUS showed Sn 62 %, Sp 100 %, PPV 54 %, NPV 100 % (AUC: 0.810; 95 % CI: 0.68-0.94) and a kappa value of 0.727. Moderate concordance was observed between POCUS and XR for Salter-Harris classification (kappa = 0.673). Conclusion: POCUS demonstrates high sensitivity in detecting traumatic extremity fractures and physeal fractures in pediatric patients. However, only moderate concordance was observed between POCUS and XR in assessing the extension of the fracture into the joint space and in applying the Salter-Harris classification. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.Öğe Evaluation of The Effects of Laboratory Values, Oxidation Parameters, Scoring Systems, and Ventricular Diameter Measurements on Prognosis in Patients Diagnosed with APE in The Emergency Department(2025) Avcı, Mustafa; Kozaci, NalanObjective: This study aimed to investigate the role of oxidant and antioxidant levels in the diagnosis of acute pulmonary embolism (APE). Materials and Methods: Participants diagnosed with APE were included in group 1, and healthy volunteers were included in Group 2. In addition, Group 1 was divided into two groups according to 30-day mortality. Results: Sixty-five participants diagnosed with APE were included in Group 1. A total of 52 healthy volunteers were included in Group 2. The total antioxidant capacity (TAC) levels of Group 1 were lower than those of Group 2, and the total oxidant capacity (TOC), oxidative stress index (OSI), and ischemia-modified albumin levels were higher. When receiver operating characteristic analysis was performed for TAC, TOC, OSI, and ischemia-modified albumin, the highest area under the curve was found for OSI, TOC, and ischemia-modified albumin, respectively. Fifteen (23%) participants in Group 1 died within 30 days of admission to the emergency department (Group 1A), and 50 (77%) survived after 30 days (Group 1B). Conclusion: The oxidant-antioxidant balance is impaired in APE. Therefore, oxidants and antioxidants can be used to diagnose and exclude patients with suspected APE.Öğe Relationship between internal carotid artery stenosis grade and optic nerve sheath diameter measured by transorbital ultrasonography(Wiley, 2021) Komut, Erdal; Murat, Muammer; Buyuksireci, Mehmet; Komut, Seval; Kozaci, NalanPurpose To assess the consequence of the presence, grade, and asymmetry of carotid artery stenoses on the optic nerve sheath diameter (ONSD) measured by ultrasonography. Methods ONSD was measured with B-mode ultrasonography in 129 patients referred for duplex and color Doppler imaging of the carotid arteries. Internal carotid artery stenosis was graded on the basis of peak systolic flow velocity. Results The mean ONSD was 3.04 +/- 0.38 mm in the patients without or with 70% stenosis. There was an average difference of 0.58 mm between the ONSD of the patients with 70% stenosis. Conclusion ONSD is lower in patients with carotid artery stenosis. Carotid arteries should be investigated, especially in patients with cardiovascular risk factors or diseases, before interpreting ONSD values.Öğe The Relationship Between Depression, Anxiety, and Stress Levels and Eating Behavior in Emergency Service Workers(Cureus Inc, 2023) Erden, Selime Celik; Yilmaz, Banu Karakus; Kozaci, Nalan; Uygur, Abdullah Burak; Yigit, Yavuz; Karakus, Kadir; Aydin, Ismail ErkanIntroduction It is seen that shift work causes various biological, psychological, and behavioral problems in individuals. This study aimed to determine the eating attitudes and behaviors of health workers working in shifts in a stressful environment such as the emergency service and to examine the relationship between depression, anxiety, and stress levels and eating behaviors (emotional eating, restrictive eating, and external eating) in terms of sociodemographic and clinical characteristics. Material and Methods Sociodemographic data form; Depression, Anxiety, and Stress Scale (DASS); and Dutch Eating Behavior Questionnaire (DEBQ) were used. The study sample consisted of 92 employees (doctor, nurse, emergency medical technician (EMT), medical secretary, and security, staff) who were actively on duty in the emergency department of Alanya Alaaddin Keykubat University Medical Faculty Training and Research Hospital. Results In our study, when the eating behavior of emergency service workers was evaluated in terms of emotional, external, and restricted eating sub-dimensions, depression (p=0.043), anxiety (p=0.017), increased stress levels (p=0.002), being female (p=0.022), nurse-emergency medical technician profession (p=0.001), working in 24-hour shifts (p=0.001), and diet history (p=0.013) were associated with emotional eating. In addition, an increase in depression levels (p=0.048), being single (p=0.015), working in 24-hour shifts (p=0.005), a decrease in age (p<0.001) with extrinsic eating, an increase in body mass index (BMI) (p=0.020) and waist circumference (p=0.049), and diet history (p<0.001) were associated with restricted eating. Conclusions In our study, among the sociodemographic factors, being female, being single, working in 24-hour shifts, diet history, nurse-EMT profession, and undergraduate education level were found to increase the tendency to develop eating behavior problems. An increase in depression levels, being single, working in 24-hour shifts, and a decrease in age were associated with extrinsic eating. There is a correlation between depression, anxiety, and stress scores and emotional eating scores. Additionally, we found significant correlations between body mass index, waist circumference, diet history, and restricted eating scores. In the approach to eating behavior problems, it is important to determine the individual eating behavior disorder. Due to the increased risk of eating behavior disorder in those who work in long shifts such as 24 hours, it will be possible to organize work programs and increase the quality of service.Öğe The Role of Optic Nerve Sheath Diameter in Differential Diagnosis in Patients with Headache, A Prospective, Randomized Controlled Study(2025) Yüksel, Ayşegül; Selvi, Fatih; Yüksel, Serkan; Avcı, Mustafa; Günay, Gülsüm Çalışkan; Kozaci, NalanObjective: This study aimed to evaluate the usability of the optic nerve sheath diameter (ONSD) in the differential diagnosis of headache. Materials and Methods: This study included non-traumatic patients with headache. Patients were divided into three groups. Primary headache was assigned to group 1, secondary headache to group 2, and healthy volunteers to group 3. ONSD was measured by ultrasonography before computed cranial tomography imaging. Results: A total of 50 patients in groups 1 and 2 and 50 healthy volunteers in group 3 were included. The mean ONSD of healthy volunteers was 4.2 mm, and the mean ONSD difference between eyes was 0.2 mm. The mean ONSD for the primary headache was 4.5 mm, and the mean ONSD difference for both eyes was 0.2 mm. The ONSD of the secondary headache was measured as 6.2 mm, and the ONSD difference between the eyes was 0.3 mm. The ONSD difference in both eyes and the ONSD of patients with secondary headache were higher than those in groups 1 and 3 (p<0.001). The ONSD cutoff value, which was positive on CT imaging, was 5.2 mm. Conclusion: The ONSD and difference in ONSD can be used in the differential diagnosis of primary and secondary headache.Öğe Tr ansient Complete Right Bundle Branch Block Due _ to _ Lung _ Contusion: Case Re port(Emergency Medicine Physicians Assoc Turkey, 2024) Kozaci, Nalan; Aydin, Ismail Erkan; Ersahin, Durmus Ali; Yuksel, YavuzRight bundle branch block (RBBB) may occur in lung diseases and cardiovascular diseases. A 25-year-old male patient was admitted to emergency department after a motorcycle accident. Contusion was detected in bilateral lungs, and pneumothorax with laceration were detected in the right lung. ECG revealed103 bpm, right axis deviation, and complete RBBB. ECGrevealed 83 bpm, complete RBBB continued at the 6th hour after tube thoracostomy, andhigh sensitive TnI was normal. Chest X-ray wasnormal on the 4th day of hospitalization, and ECG revealed74 bpm, normal sinus rhythm. In thoracic trauma, ECG changes may develop as a result of lung contusion. ECG findings improve as the lung contusion heals.Öğe Utility of POCUS in the Diagnosis of Drowning-related Noncardiogenic Pulmonary Edema: A Case Report(2024) Aydın, İsmail Erkan; Kozaci, NalanRespiratory complications such as noncardiogenic pulmonary edema, acute respiratory distress syndrome and pneumonia are frequently seen in drowning. No additional disease was noted in the history of a 37-year-old male patient who was brought to the emergency department with cardiopulmonary arrest after drowning at sea. Spontaneous circulation returned following 12 minutes of cardiopulmonary resuscitation. Bedside point-of-care ultrasound (POCUS) revealed multiple and confluent B lines, an irregularity on the pleural line, disappearance in the A-lines, and subpleural hypoechoic areas predominantly in the 2nd, 3rd, 4th and 6th zones of the right lung and the 3rd, 4th and 6th zones of the left lung. The ventilator mode and settings were adjusted according to the POCUS findings, being a safe option in emergency departments for the diagnosis of noncardiogenic pulmonary edema due to drowning and for the management of such patients.
