Poisoning

2011 ◽  
Author(s):  
Pawan Gupta
Keyword(s):  
Previous History ◽  
Supportive Therapy ◽  
Initial Assessment ◽  
Junior Doctors ◽  
Acute Overdose ◽  
Life Saving ◽  
Number Of Patients ◽  
History Of ◽  
Gcs Score ◽  
The Uk

EDs in the UK see a significant number of patients (347 per 100 000/year and ever-increasing) with acute overdose of drugs. Most of them are ingested orally, but other modes of intake can be used, such as IV and nasal. Sometimes it is not uncommon to see a patient presenting themselves to the ED feeling unwell after having ingested packets of Class I drugs to transport across continents. Another group of patients include those who present themselves after self-harming with a knife or blade on their wrists, arms, abdomen, or other parts of the body. These patients may have a previous history of drug overdose. Management of situations such as those described above requires both a generalized approach and specific actions against each drug involved. The common antidotes are covered in this chapter and advice is available in all EDs through the NPIS (<WEB>www.toxbase.org) to deal with such emergencies, particularly with the treatments of unusual poisons. I encourage all the junior doctors to use the website for all the poison cases presenting to the ED to help build up confidence while treating them. Readers should note though that the URLs provided in this chapter can be accessed only by foundation and more senior doctors as the NPIS does not provide usernames and passwords to medical students. The priorities in the management of poisoned patients are similar to other ED presentations (ABCDE). Most of these patients require supportive therapy for recovery. Some poisons have specific antidotes which could be life-saving and are to be administered straightway. The initial assessment should be able to indicate whether or not the patient has been exposed to a specific poison for which an antidote is available. Hypoglycaemia must be excluded in every patient who presents with a low GCS score or convulsions by performing a capillary blood glucose by the bedside. A patient with respiratory depression, low GCS, and constricted pupils should be given naloxone while preparations are made to secure the airway. The recognition of such a pattern sometimes may direct the treating clinician towards a specific poison immediately, so that treatment with a definitive antidote can be given without delay.

scholarly journals Predictive factors for developing acute cholangitis and cholecystitis in patients undergoing delayed cholecystectomy: a retrospective study

2019 ◽  
Author(s):  
Takashi Miyata ◽  
Daisuke Matsui ◽  
Yuta Fujiwara ◽  
Hiroto Saito ◽  
Yoshinao Ohbatake ◽  
...  
Keyword(s):  
Risk Factor ◽  
Surgical Outcomes ◽  
Intraoperative Complications ◽  
Acute Cholangitis ◽  
Previous History ◽  
Cell Counts ◽  
Number Of Patients ◽  
History Of ◽  
Group A ◽  
Group B

Abstract Background We evaluated the risk of acute cholangitis and cholecystitis while waiting for cholecystectomy for gallstones. Methods We retrospectively enrolled 168 patients who underwent cholecystectomy for gallstones after a waiting period and conservative therapy between April 2014 and March 2018 at our hospital. We compared the clinical data from 20 patients who developed acute cholangitis and cholecystitis while waiting for cholecystectomy (group A) with data from 148 patients who did not develop cholangitis and cholecystitis (group B). The risk factors for developing acute cholangitis and cholecystitis and all patients' surgical outcomes were investigated. Results Preoperatively, significant differences in age (68.6 years vs 60.7 years; p= 0.004) and the number of patients with a previous history of acute grade II or III cholecystitis (55.0% vs 10.8%; p< 0.001) and biliary drainage (20.0% vs 2.0%; p= 0.004) were observed between group A and group B, respectively. Preoperative white blood cell counts (13500/µL vs 8155/µL; p< 0.001) and serum C-reactive protein levels (12.6 mg/dL vs 5.1 mg/dL; p< 0.001) were significantly increased, and serum albumin levels (3.2 g/dL vs 4.0 g/dL; p< 0.001) were significantly decreased in group A vs group B, respectively. Gallbladder wall thickening (≥ 5 mm) (45.0% vs 18.9%; p= 0.018), incarcerated gallbladder neck stones (55.0% vs 22.3%; p= 0.005), and abscess around the gallbladder (20.0% vs 1.4%; p= 0.002) were seen significantly more frequently during imaging in group A vs group B, respectively. Furthermore, investigating patients' surgical outcomes revealed a higher conversion rate to open surgery (20.0% vs 2.0%; p= 0.004), longer operation time (137 min vs 102 min; p< 0.001), and a higher incidence of intraoperative complications (10.0% vs 0%; p= 0.014) in group A vs group B, respectively. Conclusions Our results suggest that a history of severe cholecystitis is a risk factor for developing acute cholangitis and cholecystitis in patients waiting for surgery, and a risk factor for increased surgical difficulty.

FIBRINOLYTIC ALTERATIONS AS RISK FACTOR IN PATIENTS WITH CORONARY HEART DISEASE

1987 ◽  
Author(s):  
J Aznar ◽  
A Estelles ◽  
G Tormo ◽  
F Espafia ◽  
V Torino
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Plasminogen Activator ◽  
Exercise Test ◽  
Stable Angina ◽  
Previous History ◽  
Control Group ◽  
Number Of Patients ◽  
History Of ◽  
Patient Groups

It has been reported that young survivors of myocardial infarction (MI) have elevated plasminogen activator inhibitor (PAI) levels. We have studied several fibrinolytic parameters (euglobulin lysis time, fibrin-plate lysis, tissue plasminogen activator (t-PA) antigen, t-PA activity, PAI activity, plasminogen, az antiplasmin and FDP/fdp in 55 patients with coronary heart disease (CHD), before and after an exercise test. The patients were classified in 4 groups:A) Patients with unstable angina (n=5); B) Patients with stable angina and previous history of MI (n=13); C) Patients with stable angina without previous history of MI (n=ll) and D) Patients with MI about 3 weeks before this study (n=26). All the groups were similars in age and life habits. Patients suffering from dislipemia and diabetes were excluded from the study. In basal conditions, PAI activity (U/ml) was high in the 4 patient groups (A:2.5±2.8; B:5.2 ± 4.9; C:2.8 ± 2.6; D: 4.6 ± 4.6) ascompared to a group of 10 healthy volunteers (0.46±0.5). In all the clinical groups there were a large number of patients (about 60%) whose PA inhibitor level was > 2 U/ml. t-PA antigen (ng/ml) was slightly elevated in all patient groups (A: 12.4+±4.6; B:12.4±5.6; C:12.5+4.0; D: 13.3+4.3) in comparison with control group (10.1+2.9). The release of t-PA antigen after the exercise test did not differ significantly from one group to another. However, this release was < 3 ng/ml in about 50% of patients in all clinical groups, as compared to the control group, in which the release of t-PA antigen was higher than 3 ng/ml in all the subjects. After the exercise PAI activity remained high in the patient groups. The increased level of t-PA inhibitor activity founded in the patients was partially inhibited by antiserum against PA inhibitor-1 but not by antiserum against PA inhibitor-2. The formation of a complex of about 115,000 daltons between the increased plasma PA-Inhibitor and purified single t-PA was observed by a zymographic fibrin technique. These findings demonstrate that CHD patients have a fibrinolytic hypofunction caused basically by an increase in t-PA inhibitor. This increase in PAI activity is more evident in patient with a previous history of MI.

Suicidal Attempts by Jumping from Heights

1987 ◽  
Vol 15 (3) ◽  
pp. 199-203 ◽  
Author(s):  
Ole M. Böstman
Keyword(s):  
Previous History ◽  
Institutional Care ◽  
Chronic Alcoholism ◽  
Number Of Patients ◽  
History Of ◽  
Investigation Period ◽  
The Mean ◽  
University Department ◽  
One Year

At the Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, an acute accident unit with more than 3000 trauma admissions per year, a protocol was kept over the years 1982–84 of patients who were treated for injuries sustained from intentional falls from heights. The number of patients included in the series was 73. The mean age of the patients was 29.8 (range 15–65) years. The male:female ratio was 1.5:I. In 15 patients (21%) there was a previous history of recorded psychiatric disorder and in a further 11 patients (15%) chronic alcoholism. The 73 patients had a total of 164 serious individual injuries. Thirteen patients died, all except one within the first 24 hours. The median duration of the hospital stay at university department level was 49 days. In a follow-up survey one year after the fall, 19 (32% of the survivors) had returned to work, 29 (48%) were pensioned and 12 (20%) still needed institutional care. Eight had permanent complete paraplegia. The patients injured in suicidal falls amounted to 0.8% of all trauma admissions during the investigation period and to 3.3% of the nursing days. In the intensive care unit, however, these figures were 9.2% and 14.1% respectively, values high enough to warrant increasing attention to this kind of self-inflicted injuries.

scholarly journals Barriers to access to treatment for mothers with postpartum depression in primary health care centers: a predictive model

2016 ◽  
Vol 24 (0) ◽  
Author(s):  
Pablo Martínez ◽  
Paul A. Vöhringer ◽  
Graciela Rojas
Keyword(s):  
Postpartum Depression ◽  
Predictive Model ◽  
Short Form ◽  
Previous History ◽  
Depression Scale ◽  
Initial Assessment ◽  
P Value ◽  
Access To Treatment ◽  
History Of ◽  
History Of Depression

Objective to develop a predictive model to evaluate the factors that modify the access to treatment for Postpartum Depression (PPD). Methods prospective study with mothers who participated in the monitoring of child health in primary care centers. For the initial assessment and during 3 months, it was considered: sociodemographic data, gyneco-obstetric data, data on the services provided, depressive symptoms according to the Edinburgh Postpartum Depression Scale (EPDS) and quality of life according to the Short Form-36 Health Status Questionnaire (SF-36). The diagnosis of depression was made based on MINI. Mothers diagnosed with PPD in the initial evaluation, were followed-up. Results a statistical model was constructed to determine the factors that prevented access to treatment, which consisted of: item 2 of EPDS (OR 0.43, 95%CI: 0.20-0.93) and item 5 (OR 0.48, 95%CI: 0.21-1.09), and previous history of depression treatment (OR 0.26, 95%CI: 0.61-1.06). Area under the ROC curve for the model=0.79; p-value for the Hosmer-Lemershow=0.73. Conclusion it was elaborated a simple, well standardized and accurate profile, which advises that nurses should pay attention to those mothers diagnosed with PPD, presenting low/no anhedonia (item 2 of EPDS), scarce/no panic/fear (item 5 of EPDS), and no history of depression, as it is likely that these women do not initiate treatment.

scholarly journals Increased deep vein thrombosis cases during the COVID-19 quarantine

2020 ◽  
pp. 026835552097729
Author(s):  
Evren Karaali ◽  
Osman Çiloğlu ◽  
Orhan Saim Demirtürk ◽  
Burak Keklikçioğlu ◽  
İsmail Akçay ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Hospital Admissions ◽  
Previous History ◽  
Vein Thrombosis ◽  
Symptomatic Pulmonary Embolism ◽  
Number Of Patients ◽  
Prophylactic Drug ◽  
History Of ◽  
Deep Vein

Objective The aim of this study was to compare the number of deep vein thrombosis (DVT) cases during the quarantine period for COVID-19 to that of the last year. Methods This study was conducted as a single-center and retrospective study. All hospital admissions during April 2020 and May 2020 were screened from the hospital records, and DVT cases were recorded. Likewise, all hospital admissions during April 2019 and May 2019 were screened, and DVT cases were noted. DVT cases of both years were compared. Results Among 480931 patients admitted to our hospital in April 2019 and May 2019, DVT was detected in 82 patients (0.017%) (47 males, 35 females) with a mean age of 56.99 ± 9.1 years (ranges 39 to 79 years). Besides, among 145101 patients admitted to our hospital in April 2020 and May 2020, DVT was detected in 123 patients (0.084%) (51 males, 72 females) with a mean age of 58.64 ± 8.9 years (ranges 40 to 83 years). Despite the decrease in the total number of patients admitted to the hospital, there was a significant increase in the number of DVT patients. Interestingly, there were only two symptomatic pulmonary-embolism cases in the 2019 period, whereas there were seven symptomatic pulmonary embolisms secondary to DVT in the 2020 period. Unfortunately, one patient died due to pulmonary embolism secondary to DVT in 2020. The previous history of DVT was remarkable in patients admitted during the COVID-19 confinement. Conclusion In conclusion, COVID-19 confinement seems to be associated with increased rates of DVT. Strict preventive measures such as exercise training or prophylactic drug use should be considered to prevent immobility-related DVT during the COVID-19 quarantine.

scholarly journals Treatment Adherence Status of the TB Patients Notified from Private Sector and its Associated Factors: Findings of a Secondary Data Analysis from West Bengal, India

2021 ◽  
Author(s):  
Abhijit Dey ◽  
Arista Lahiri ◽  
Sweety Suman Jha ◽  
Vivek Sharma ◽  
Shanmugam Parthiban ◽  
...  
Keyword(s):  
Private Sector ◽  
Treatment Adherence ◽  
Previous History ◽  
Secondary Data ◽  
Strict Adherence ◽  
Number Of Patients ◽  
History Of ◽  
Default Rate ◽  
Adherence Monitoring ◽  
Project Data

Objective: In India, yearly, estimated one million TB cases are missing from notification, mostly from private sector. The large number of patients in private sector has raised concerns for suboptimal quality of care. This study was conducted to find out the treatment adherence status among the private TB patients and factors associated with poor adherence.Data Source: Secondary project data, obtained through adherence monitoring house visit by NGO workers. Data collected by reviewing different records available with the patients &amp; data was entered into the CommCare HQ, an open-source mobile platform designed for data collection.Methods: Descriptive observational study.Results: Default rate among private patients was 5%. Commonest reasons stated for being a defaulter were &lsquo;Medicine is not good&rsquo; (30%), &lsquo;Travel&rsquo; (28.6%), &lsquo;Cost of treatment&rsquo; (21.8%) and &lsquo;Side effects&rsquo; (11.6%). Despite best of efforts only 36.9% defaulter could be retrieved. Higher default rate was associated with 15-59 years age, males, earning member of the family, addiction, DR-TB, continuation phase of treatment, previous history of TB, presence of symptoms and inability to walk.Conclusion: Privately treated TB patients are vulnerable to non-adherence. Once defaulted, it is difficult to retrieve them. Economically productive age group is at higher risk of being defaulter. Strict adherence monitoring for private TB patients and extensive advocacy communication &amp; social mobilization program in the community, workplaces and institutions is a need of hour.

scholarly journals Persufflation—Current State of Play

2021 ◽  
Vol 2 (3) ◽  
pp. 362-378
Author(s):  
Aaron John Buhagiar ◽  
Leo Freitas ◽  
William E. Scott
Keyword(s):  
Gaseous Oxygen ◽  
Multiple Organs ◽  
Current State ◽  
Life Saving ◽  
Number Of Patients ◽  
Organ Quality ◽  
History Of ◽  
Organ Tissue ◽  
Oxygen Perfusion ◽  
To Receive

With the ever-increasing disparity between the number of patients waiting for organ transplants and the number organs available, some patients are unable to receive life-saving transplantation in time. The present, widely-used form of preservation is proving to be incapable of maintaining organ quality during long periods of preservation and meeting the needs of an ever-changing legislative and transplantation landscape. This has led to the need for improved preservation techniques. One such technique that has been extensively researched is gaseous oxygen perfusion or Persufflation (PSF). This method discovered in the early 20th century has shown promise in providing both longer term preservation and organ reconditioning capabilities for multiple organs including the liver, kidneys, and pancreas. PSF utilises the organs own vascular network to provide oxygen to the organ tissue and maintain metabolism during preservation to avoid hypoxic damage. This review delves into the history of this technique, its multiple different approaches and uses, as well as in-depth discussion of work published in the past 15 years. Finally, we discuss exciting commercial developments which may help unlock the potential for this technique to be applied at scale.

scholarly journals A meta-analysis of 2019 novel corona virus patient clinical characteristics and comorbidities

2020 ◽  
Author(s):  
Subodh Sharma Paudel
Keyword(s):  
High Risk ◽  
Clinical Characteristics ◽  
English Language ◽  
Meta Analysis ◽  
Previous History ◽  
Female Ratio ◽  
Number Of Patients ◽  
New Variant ◽  
History Of ◽  
Male To Female

Abstract IntroductionBeing a new variant of coronavirus, detailed information regarding the virulence, its clinical characters, high risk individuals are yet to be defined. This study was done with the objective of finding out clinical features of corona infection and also studies what are the comorbidities that are associated with it.MethodsThis is a single arm meta-analysis in which relevant data were derived from searches in PubMed. It includes study papers which were written in English language and their completely published article is found. Seven articles published from 24th Jan to 16th March, 2020 are included in this study. ResultsThe total number of patients was 1786 with 1044 males and 742 females with male to female ratio of 1.4:1. The median age of patients was 41 years). Fever was present in 88.8% cases. Dry Cough in 68% followed by fatigue in 33%. Hypertension (15.8%) is the most common comorbidity followed by cardio and cerebrovascular condition (11.7%). ConclusionPatients often presented with symptoms of fever, dry cough, lethargy and fatigue, muscle pain, productive cough. Similarly, patients with previous history of HTN, DM, COPD, cardio and cerebrovascular condition, immune-deficient states are at high risk of developing into the severe COVID-19 infection.

Acute asthma exacerbations: tips from the shop floor

2020 ◽  
Vol 81 (12) ◽  
pp. 1-10
Author(s):  
E Lombard ◽  
J Gates ◽  
S Ruickbie
Keyword(s):  
Initial Assessment ◽  
Shop Floor ◽  
British Thoracic Society ◽  
Junior Doctors ◽  
Discharge Process ◽  
Safety Education ◽  
National Review ◽  
Significant Difference ◽  
Significant Burden ◽  
The Uk

Asthma places a significant burden on acute and non-acute services and is frequently encountered in the emergency department and the medical take. The UK has one of the highest asthma mortality rates in Europe. The National Review of Asthma Deaths has identified multiple factors that have contributed to preventable asthma deaths and solutions to these factors, including a better understanding and implementation of asthma guidelines. The British Thoracic Society and Scottish Intercollegiate Guidelines Network have recently updated their guidance on the management of asthma. This article outlines the guidelines for junior doctors managing patients with acute exacerbations of asthma. It highlights key areas of the initial assessment, establishing severity and initiating and escalating treatment. Furthermore, the discharge process from discharge criteria to promoting patient safety, education and ongoing self-management is discussed. This process, in particular education and personalised asthma action plans, can make a significant difference to the patient's outcomes and day-to-day burden of symptoms.

Hot Bathtub, Cold Consequences—Misleading Wounds After Scald Injuries: A Retrospective Analysis

2020 ◽  
Author(s):  
Alperen S Bingoel ◽  
Nicco Krezdorn ◽  
Andreas Jokuszies ◽  
Khaled Dastagir ◽  
Peter Maria Vogt ◽  
...  
Keyword(s):  
Surface Area ◽  
Clinical Presentation ◽  
Previous History ◽  
The Elderly ◽  
Initial Assessment ◽  
P Value ◽  
Significant Difference ◽  
History Of ◽  
Erythematous Skin ◽  
The Mean

Abstract Scalds in the elderly are frequently associated with the use of a bathtub and a disturbed consciousness. Therefore, the total burn surface area is often high. The initial clinical presentation displays a stark erythema of the skin, which frequently does not represent the true depth. The aim of this study was to characterize and assess medical features and outcome of scalds sustained in the bathtub. We conducted a retrospective study at a burn intensive care unit (BICU) between 2011 and 2018. Medical features as well as the treatment in these patients were statistically analyzed. We identified 16 patients and divided them into two groups regarding survival and lethality. The mean total burn surface area was 37.50 ± 19.47%. In 81.25% of the patients, we found a previous history of neurological or psychiatric disorders. Dementia and alcohol abuse were the most common triggers for the trauma. The statistical analysis showed a significant difference for the ABSI-score and the presence of multi organ failure (P-value .0462, respectively, .0004). Erythematous skin areas tended to progress into full thickness burns. We, therefore, coined the term “lobster redness” for these regions. Scalds sustained in the bathtub are devastating injuries. Initial assessment can be misleading and might delay early necrectomy. The wounds request even more attention, if the injuries occurred due to unconsciousness because of the longer exposure to heat. Early necrectomy should be considered. A biopsy with histological workup can be useful. Furthermore, we recommend special safety precautions for neurologically and psychiatrically affected patients.

Sign in / Sign up

Export Citation Format

Share Document