A case of respiratory failure in a domestic fire victim presenting with 1-3-degree skin burns on 10% of the total body surface, is reported. Forty-eight hours after admission to hospital, the patient ...developed severe respiratory failure that did not respond to mechanical ventilation. Severe obstruction of the airway had resulted from secretions and deposits of soot forming bronchial casts. The patient required repeated bronchoscopies to separate and remove the bronchial secretions and soot deposits. An emergency bronchial endoscopic exam was crucial in the patient’s survival and management. The patient was discharged from the hospital after twenty-four days.
Aim of the study: The management of patients undergoing chronic oral anticoagulation raises concerns regarding the postoperative bleeding risk. In the last few years, new oral anticoagulants were ...released on the market, but the operative protocols for dental surgery interventions are still not well established. The purpose of this review is to summarize the articles` evidence that evaluate the risk of bleeding with the use of Direct Oral Anticoagulants (DOACs). Material and methods: A systematic literature search was conducted from January 2014 to June 2018, in PubMed, Science Direct, Web of Science and Scopus databases. Results: Six articles met the inclusion criteria, all being observational studies. Conclusions showed that dental surgery could be performed without cessation of the DOACs, with a low incidence of bleeding complications, by applying local haemostatic measures (suturing, haemostatic agents, compression with sterile gauzes soaked in 5% tranexamic acid or the use of mouthwash with 5% tranexamic acid).
According to information from the patient's husband that she is a drinker, in the presence of severe high anion gap metabolic acidosis associated with optic neuropathy and ischemic brain CT scan ...lesions, methanol poisoning was suspected. ...the presence of CT findings of bilateral ischemic or necrosis lesions in putamen and cerebral deep white matter, in a patient with severe high anion gap metabolic acidosis, are strong criteria for methanol poisoning diagnosis.
Objectives: The objective of this study was to
assess the pattern and outcome of acute cholinesterase
inhibitors substances (CIS) poisoning cases, in a
cohort from a regional tertiary care hospital. ...Methods:
cases admitted in the Toxicology Clinic of “Sf. Spiridon”
Emergency Clinic Hospital Iasi, Romania between 1983
and 2013 were studied. Results: a total number of 606
patients were included. The reason for exposures was
intentional in 70% of cases and the commonest route of
poisoning was oral in 92.2%. The highest percent of cases
was females (56.4), the age group 20-29 (25.4%) and the
majority (66.7%) coming from rural areas, 28.2% being
agricultural workers. 36.6% of cases were severe clinical
forms. Overall mortality rates were 3.8%, more than half
of the death patients (65.2%) had concomitant alcohol
intake. It was a significant statistical association between
decrease level of serum cholinesterase on admittance and
severe forms (p 0.000) and between survival and deaths
groups (p 0.000). The pattern of poisoning described by
our retrospective study suggests that CIS poisoning are
mainly preventable. The main effective goals for prevention
are restriction in free accessibility to toxic pesticides,
together with sustained efforts in education concerning
the life-threatening danger of pesticide poisoning.
Acute poisonings represent a common cause of morbidity and mortality worldwide. The prognostic utility of the transthoracic echocardiography (TTE) parameters combined with brain natriuretic peptide ...(BNP) in acute poisoning with different xenobiotics, upon admission in the hospital, was not evaluated. This prospective observational cohort study included 229 acutely poisoned non‐diabetic adults, with a median age of 44 years (range 18–90 years), 50.7% women, with an in‐hospital mortality rate of 8.7%. Univariate logistic regression analysis showed that age, the left ventricle kinetic abnormalities, the E‐wave deceleration time (EDT) and BNP correlated significantly with mortality in acutely poisoned patients. Multivariate logistic regression showed that only EDT odds ratio (OR) 3.44, 95% confidence interval (CI) 1.54–7.69, p 0.003, BNP (OR 1.61, 95% CI: 1.02–2.55, p 0.04) and age (OR 2.66, 95% CI: 1.23–5.76, p 0.013) are predictive for mortality. The receiver‐operating characteristic (ROC) analysis proved EDT area under the ROC curve (AUC), 0.85; CI: 0.76–0.94; p 0.001, BNP (AUC, 0.83; CI: 0.75–0.91; p 0.001) and age (AUC, 0.82; CI: 0.74–0.90; p 0.001) as indicators for fatalities. In hospitalized patients acutely intoxicated with undifferentiated poisons, EDT as a parameter of left ventricle diastolic function and BNP are useful to early predict mortality.
Patients poisoned with drugs and nonpharmaceutical substances are frequently admitted from the emergency department (ED) to a medical or ICU department. We hypothesized that biomarkers of ...inflammation and inflammation-related indexes based on the complete blood cell (CBC) count can identify acutely poisoned patients at increased risk for ICU hospitalization and death. We performed a 6-year prospective cohort study on 1548 adult patients. The demographic data, the levels of hs-CRP (high-sensitivity C-reactive protein), CBC, and inflammation-related indexes based on CBC counts were collected upon admission and compared between survivors and nonsurvivors, based on the poison involved. Both a multivariate logistic regression model with only significant univariate predictors and a model including univariate predictors plus each log-transformed inflammation-related indexes for mortality were constructed. The importance of the variables for mortality was graphically represented using the nomogram. hs-CRP (odds ratio (OR), 1.38; 95% CI, 1.16–1.65, p<0.001 for log-transformed hs-CRP), red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were significantly associated with the risk of ICU hospitalization, after multivariable adjustment. Only RDW, NLR, and monocyte-lymphocyte ratio (MLR) were significantly associated with mortality. The predictive accuracy for mortality of the models which included either NLR (AUC 0.917, 95% CI 0.886-0.948) or MLR (AUC 0.916, 95% CI 0.884-0.948) showed a high ability for prognostic detection. The use of hs-CRP, RDW, NLR, and MLR upon ED admission are promising screening tools for predicting the outcomes of patients acutely intoxicated with undifferentiated poisons.
Organophosphate pesticide (OP) poisoning is quite common and can cause cardiovascular complications and even direct myocardial injury. However, no guideline has included an acute poisoning as a ...potential cause for a type 2 myocardial infarction (MI) so far. Here we present a case of a 61-year-old woman brought by ambulance to emergency department one hour after accidental ingestion of an unknown quantity of a solution she used against flea infestation. The patient presented with dizziness, myosis, excessive sweating, hypersalivation, sphincteric incontinence, muscle fasciculation, tremor of the extremities, pale skin, alcoholic and pesticide breath odour. Even though we had no guidelines to fall back on, we successfully treated the patient with low-molecular-weight heparin, antiplatelets, statin, diltiazem, antidote therapy, and supportive care. Physicians should be aware that OP poisoning can induce type 2 MI as a complication within a few hours since exposure, and emergency management should always include close cardiac monitoring. KEY WORDS: cardiovascular events; organophosphate poisoning; toxicology Otrovanje organofosfatnim pesticidima prilicno je cesto i moze dovesti do komplikacija sa srcem i krvoziljem, a ponekad i izravno ostetiti srcani misic. Do sada, medutim, nije zabiljezen slucaj infarkta miokarda tipa 2. U ovom je radu prikazan slucaj otrovanja 61-godisnjakinje koja je primljena u odjel hitne pomoci jedan sat nakon slucajnoga gutanja nepoznate kolicine otopine koju je upotrebljavala za suzbijanje biljnih usi. Bolesnica je primljena sa znakovima i simptomima osamucenosti, mioze, prekomjernoga znojenja, hipersalivacije, urinarne inkontinencije, misicne fascikulacije, drhtavice u udovima, bljedilom te dahom koji je mirisao na alkohol i pesticide. Premda nije bilo smjernica za lijecenje u takvom slucaju, primjena heparina niske molekulske mase, antitrombotika, statina, diltiazema, antidota i potpornoga lijecenja dovela je do povoljnog ishoda. Svrha je ovoga prikaza ukazati lijecnicima da otrovanje organofosfatima moze uzrokovati infarkt miokarda tipa 2, koji se javlja kao komplikacija unutar nekoliko sati od otrovanja, tako da obrada u odjelu hitne pomoci svakako treba obuhvatiti i strogi nadzor srcane funkcije. KLJUCNE RIJECI: kardiovaskularni dogadaji; pesticidi; toksikologija
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