SUMMARY Objectives This study aimed to determine the clinical factors that contribute to the admission, management, and outcome of blunt trauma to geriatric patients. Methods This prospective, cross sectional study was conducted at a tertiary Emergency Department (ED) Results The study included 406 geriatric patients (268 (66%) female) with a mean age of all patients being 75.6±7 years (65-102 years). Extremities and head injury were the most common injury sites. The femoral neck was the most common fracture site (24%). Low velocity fall (LVF) was the most common mechanism of blunt trauma (79%). Advancing age was also significantly related with LVF incidence, fracture incidence and ISS ≥9. Five patients died in the hospital (1.2%). Conclusions ÖZET AmaçÇalışmamızın amacı acil servisimize künt travma nedeni ile başvu-ran 65 yaş ve üstü hastaların başvuru, müdahale ve sonlanmasında-ki klinik faktörlerin incelenmesidir. Gereç ve YöntemÇalışmamız Ocak-Nisan 2012 tarihleri arasında, 3. basamak acil servisinde yapılan ileriye yönelik, kesitsel bir çalışmadır. Çalışmaya 65 yaş ve üstü, künt travma nedeni ile başvuran hastalar kabul edildi. Hastaların demografik verileri, yandaş hastalıkları, kullandığı ilaç sayıları, yaralanma mekanizması, son 6 ay içinde travma öyküsü, yaralanma bölgesi, yaralanma ağırlık skoru (ISS), hastane kalım süreleri, hastane sonlanımları veri toplama formuna kaydedildi. BulgularÇalışmaya 406 hasta kabul edildi (n=268, %66 kadın). Yaş ortalaması 75.6±7 (dağılım 65-102 yaş) idi. En sık yaralanma bölgesi ekstremiteler ve baş idi. Femur kırıkları en sık saptanan kırıklardı (%24). Düşük enerjili düşmeler (DED) en sık (%79) travma mekanizması idi. Yaş artışı ile DED, kırık oluşumu ve ISS≥9 olma insidansının arttığı belirlendi. Tüm hastaların 5'i hayatını kaybetti (%1.2). Sonuç DED, geriatrik künt travmada birincil etyolojiyi oluşturdu. En sık yaralanma bölgesi baş ve ekstremitelerdi ve ekstremitelerde en sık femur kırıkları saptandı. İleri yaş ve 5 ve üstü ilaç kullanımı kırık oluşumu için, kadın cinsiyet DED için bağımsız risk faktörleri olarak saptandı. İleri yaş ve inme öyküsü travma ağırlığı ile ilişkili bulundu.Anahtar sözcükler: Acil servis; geriatrik hasta; klinik özellikler; künt travma.

SUMMARYObjectivesBlood ketone (beta-hydroxybutyrate) measurements are suggested instead of urine ketone (acetoacetate) measurements in the diagnosis of diabetic ketoacidosis. Urine ketone examination is difficult and time consuming, and may result in an incorrect interpretation. Studies performed in emergency departments on blood ketones are limited. Our objective is to compare urine ketones and capillary blood ketones in patients whose serum glucose levels were ≥150 mg/dl.MethodsIn our cross-sectional prospective study, finger-stick blood beta-hydroxybutyrate, arterial blood gas and urine ketone measurements of patients whose serum glucose levels were 150 mg/dL and higher were performed in the emergency department.ResultsA total of 265 patients were included in the study. The mean age of the patients was 62.4±14.9 years, and 65.7% of them were female. The mean of the capillary blood ketone levels of the patients was determined to be 0.524±0.9 mmol/L (min: 0 mmol/L, max: 6.7 mmol/L). In 29 (13.1%) of the 221 patients whose urine ketone levels were negative, the finger-stick blood ketone levels were positive. Three of these patients were severely ketonemic, six were moderately ketonemic, and 20 were mildly ketonemic.ConclusionsIn patients admitted to the emergency department with a blood glucose level of 150 mg/dL or higher, performing a capillary blood ketone measurement instead of a urine ketone measurement was a better predictor of ketonemia.

Boerhaave's syndrome is a very rare disease characterised by spontaneous rupture of the oesophagus. Clinical presentation is varied and may depend on the cause, location, size, degree of contamination, and site of injur y. Patients may present with abdominal pain, pneumothorax, hydropneumothorax, and pneumomediastinum. Tension pneumothorax after esophageal perforation has been rarely reported in the medical literature. In our report, a case of tension pneumothorax secondary to Boerhaave's syndrome in a 44-year-old male is presented here.

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