Introduction This study aimed to analyze the costs of emergency department (ED) visits among patients aged 65 years and older, with a particular focus on the financial burden of recurrent admissions within a one-year period. Methods A retrospective cross-sectional study was conducted on 143,909 ED visits recorded between January 1, 2014, and December 31, 2014, at the Emergency Department of Ankara Atatürk Training and Research Hospital, Ankara, Turkey. Data for patients aged 65 and older were extracted from the Hospital Information Management System. Cost data were based on the Social Security Institution billing system and converted into US dollars (USD) using the 2014 exchange rate. Patients were categorized by age, gender, diagnosis, and visit frequency. Nonparametric statistical tests were used due to the non-normal distribution of cost variables. A p-value < 0.05 was considered statistically significant. Results A total of 21,458 (15.0%) ED visits were made by patients aged 65 and older. The median cost per visit in this group was $58.16. Costs increased with age: $42.90 for patients aged 65-74, $76.67 for those aged 75-84, and $96.42 for those aged ≥85 (Kruskal-Wallis H = 1,125.3, df = 2, p < 0.001). Among the 19,159 elderly patients who visited the ED, 1,951 (10.2%) had recurrent visits. Within this subgroup, internal medicine diagnoses were most common (1,345 visits, or 68.9%), followed by pulmonary (320, or 16.4%), cardiovascular (211, or 10.8%), and non-specific complaints (231, or 11.8%) as the leading causes. This diagnostic distribution differed significantly from that of single-visit patients (χ² = 42.7, df = 3, p < 0.001). Recurrence rates varied significantly by diagnostic category (χ² = 89.4, df = 5, p < 0.001): the highest recurrence was observed in patients with hematologic conditions (56/355, or 15.8%; adjusted OR = 1.72, 95% CI: 1.28-2.31), followed by psychiatric (8/57, or 14.0%; adjusted OR = 1.45, 95% CI: 0.99-2.12) and pulmonary diagnoses (320/2,358, or 13.6%; adjusted OR = 1.38, 95% CI: 1.22-1.57), all above the overall recurrence rate of 10.2%. The median cost of the first ED visit was significantly higher in the recurrent group ($72.13) compared to the non-recurrent group ($59.76) (Mann-Whitney U = 14.2 × 10⁶, p < 0.001, r = 0.14). Among recurrent cases, the mean cost of the first visit ($101.84) exceeded the average cost of subsequent visits ($93.98) (Wilcoxon T = 2.4 × 10⁵, p < 0.001, r = 0.09). Conclusion Older patients generate disproportionately higher ED costs in Turkey, particularly those with recurrent visits and chronic conditions. These findings support the implementation of geriatric-focused emergency care models and preventive strategies to optimize resource utilization in aging populations.

Moyamoya disease (MMD) is a rare non-inflammatory cerebral vasculopathy characterized by progressive stenosis of the internal carotid arteries, often bilaterally, and the formation of abnormal collateral vascular structures at the cranial base. A patient who underwent elective cesarean section (C/S) twice under spinal anesthesia and was diagnosed with MMD as a result of recurrent intracranial hemorrhage in the postpartum periods is presented. A 41-year-old female patient without any systemic comorbidity, gravida 2, parity 2, had her second cesarean section (C/S) operation under spinal anesthesia and was discharged on the third postoperative day without any problems. The patient had a mild headache that started from the occipital region and spread to the entire cranium on the same day. After applying to the emergency department at different times, she was discharged with conservative treatment. The patient had a severe headache and was admitted to the emergency room on the ninth postoperative day. The patient, who was diagnosed with intracranial hemorrhage after cranial imaging, was referred. Cranial angiography revealed advanced bilateral internal carotid artery symmetric occlusion and the basilar artery was preserved. According to the angiographic image, the patient was diagnosed with moyamoya disease and was followed up in the intensive care unit. The muscle strength of the patient, who had no cranial nerve pathology or lateralization findings, was evaluated as normal. Conservative management was applied in the intensive care unit. The patient was discharged with recommendations for neurosurgery and cardiovascular surgery after 12 days. In the postpartum period, especially in cases of headache that persists for a long time after dural puncture and does not have a postdural feature, intracranial hemorrhage should be considered until proven otherwise, and moyamoya disease also be considered in the differential diagnosis of intracranial hemorrhage. The approach to the patient in the perioperative period should focus on providing normotension, normocapnia, normothermia, and effective analgesia.

Drowning is a significant public health issue, particularly in coastal regions such as Sinop, Turkey, where seasonal variations contribute to a high incidence of cases. However, there is a lack of long-term, population-based studies from the Black Sea region, where distinct environmental factors may influence drowning patterns. This study provides a comprehensive 13-year analysis of seawater drowning cases, including detailed demographic, clinical, and outcome characteristics, to inform prevention strategies and improve emergency response. A retrospective, observational study was conducted on all patients admitted to the regional referral Emergency Department (ED) due to seawater drowning between July 2011 and July 2024. Demographic characteristics, clinical parameters, and outcomes were retrieved from institutional and national health record systems. Descriptive statistical analyses were performed. A total of 198 patients were included, of whom 69.2% were male, with a mean age of 29.6 years. The majority of cases (over 82%) occurred in July and August, and 51% involved tourists. Cardiopulmonary resuscitation (CPR) was performed in 17.7% of patients. Trauma was documented in 7.1% of patients; among these, the most commonly affected regions were the extremities (50.0%) and the head (35.7%). Laboratory analysis showed elevated lactate levels and reduced pH. On admission, most patients had preserved neurological status, while 19.2% presented with severe impairment (GCS ≤8). According to the Szpilman score, 37.9% had mild and 17.7% severe symptoms. The overall mortality was 19.7%, and 22.2% of patients required admission to the intensive care unit (ICU). Notably, 35.9% of all fatal cases (n = 14) involved individuals who drowned while attempting to rescue others. Drowning imposes a substantial burden in coastal regions, disproportionately affecting young males during the summer. Our findings highlight the need for enhanced emergency preparedness and structured clinical response, as well as public education on water safety and safe rescue practices. These findings contribute valuable insight for developing regional and international strategies to mitigate drowning outcomes. Not applicable. This study is a retrospective observational analysis and was not registered as a clinical trial.

Heparin, a naturally occurring polysaccharide belonging to the glycosaminoglycans (GAG) family, is ubiquitously found in mast cells. Unfractionated heparin is the least processed form of natural GAG, purified from animal tissue. In a 67-year-old female patient diagnosed with hypertension and asthma, who suffered a femoral fracture due to a fall, intravenous heparin sodium was administered for thromboembolic treatment in the postoperative period following closed reduction. Subsequently, respiratory distress, loss of consciousness, and cardiac arrest occured following profound hypotension. The patient, whose clinical findings were evaluated as anaphylaxis, was successfully resuscitated with prompt intervention. Despite immune-mediated reactions and Heparin-Induced Thrombocytopenia (HIT) being commonly encountered side effects in clinical practice, it is crucial for all healthcare professionals to recognize that widely used anticoagulant agents such as heparin sodium can lead to fatal complications.

Laparoskopik cerrahide anestezi yönetimi, operasyonun getirdiği fizyolojik değişimlere uyum sağlamayı hedefleyen kapsamlı bir süreçtir. Bu teknik; daha az ağrı, hızlı iyileşme ve kısa hastanede kalış süresi gibi avantajlar sunsa da, karın içine verilen karbondioksit (CO₂) gazı (pnömoperitoneum) ve hastaya verilen cerrahi pozisyonlar ciddi patofizyolojik etkiler yaratır. Pnömoperitoneum; kardiyovasküler sistemde kalp debisinin azalmasına ve tansiyon değişikliklerine, solunum sisteminde ise akciğer kapasitesinin daralmasına ve hiperkapniye yol açabilir. Özellikle obez veya kardiyopulmoner hastalığı olan bireylerde bu riskler daha belirgindir. Anestezi yönetiminde altın standart, endotrakeal entübasyon eşliğinde uygulanan kontrollü genel anestezidir. Operasyon boyunca ETCO₂, EKG, tansiyon ve kas gevşemesi gibi parametreler titizlikle monitörize edilmelidir. Rejyonel anestezi bazı avantajlar sağlasa da, genellikle genel anestezi ile kombine edilerek postoperatif ağrıyı azaltmak amacıyla tercih edilir. Ameliyat sonrası dönemde ise bulantı ve kusma en sık görülen komplikasyonlardır; bu durumun önlenmesi için multimodal analjezi ve uygun antiemetik tedaviler uygulanır. Sonuç olarak laparoskopi, cerrah ve anestezistin yakın iş birliğini gerektiren dinamik bir süreçtir. Anesthetic management in laparoscopic surgery is a comprehensive process aimed at adapting to the physiological changes brought about by the operation. While this technique offers advantages such as less pain, rapid recovery, and shorter hospital stays, the carbon dioxide (CO₂) gas insufflated into the abdomen (pneumoperitoneum) and the surgical positions given to the patient create significant pathophysiological effects. Pneumoperitoneum can lead to decreased cardiac output and blood pressure changes in the cardiovascular system, as well as narrowing of lung capacity and hypercapnia in the respiratory system. These risks are more pronounced, especially in obese patients or those with cardiopulmonary diseases. The gold standard in anesthesia management is controlled general anesthesia performed with endotracheal intubation. Parameters such as ETCO₂, ECG, blood pressure, and muscle relaxation must be meticulously monitored throughout the operation. Although regional anesthesia provides some benefits, it is generally preferred in combination with general anesthesia to reduce postoperative pain. In the postoperative period, nausea and vomiting are the most common complications; multimodal analgesia and appropriate antiemetic treatments are applied to prevent this. Consequently, laparoscopy is a dynamic process that requires close cooperation between the surgeon and the anesthesiologist.