Unexpected survival after deliberate phosphine gas poisoning: An Australian experience of extracorporeal membrane oxygenation rescue in this setting

Phosphine poisoning is responsible for hundreds of thousands of deaths per year in countries where access to this pesticide is unrestricted. Metal phosphides release phosphine gas on contact with moisture, and ingestion of these tablets most often results in death despite intensive support. A 36-year-old woman presented to a regional hospital after ingesting multiple aluminium phosphide pesticide tablets and rapidly developed severe cardiogenic shock. In this case, serendipitous access to an untested Extracorporeal Membrane Oxygenation (ECMO) service of a regional hospital effected a successful rescue and prevented the predicted death. We discuss the toxicology, management and the evidence for and against using ECMO in this acute poisoning.

Predictive Factors Associated With Methods of Suicide: The Korean National Investigations of Suicide Victims (The KNIGHTS Study)

Background: Because the suicide mortality depends on the lethality of suicide methods, the identification and prediction of suicide methods are important for suicide prevention.Methods: Examination data of suicide decedents were collected based on police reports. Suicide decedents were divided into groups according to the suicide methods (hanging, gas poisoning, pesticide poisoning, jumping, drug poisoning, and drowning) they used. Predictive factors for each suicide method in comparison to other suicide methods were identified.Results: Among 23,647 subjects, hanging was the most common method of suicide. Regarding gas poisoning, the history of previous suicide attempt was a risk factor and being age of 65 or older was a protective factor. Being age of 65 or older showed a highly strong association with suicide by pesticide poisoning. Being age of 18 or younger and the presence of schizophrenia were associated with jumping. A history of psychiatric outpatient treatment was a risk factor for drug poisoning. Regarding suicide by drowning, schizophrenia was a risk factor, while being age of 65 or older was a protective factor.Limitations: Only eight out of a total of 17 regions in South Korea were examined and included in the data of this study. Also, the methods of suicide were defined as one method that directly caused the death, which could undermine other less fatal methods used.Conclusions: There were differences in predictive factors according to the method of suicide. Predicting the method of suicide in people at high risk for suicide stands to be an important strategy for suicide prevention in clinical settings.

Toxic Myocardial Injury in a Patient With Coronary Atherosclerosis, Caused by Acute Poisoning With Gaseous Chlorine

Acute chlorine gas poisoning leads to activation of the sympathetic nervous system and, as a consequence, dysfunction of the cardiovascular system (CVS). We report a clinical case of toxic myocardial injury with gaseous chlorine. In a man with coronary artery disease and polypathy, toxic myocardial injury mimicked acute coronary syndrome (ACS) and was accompanied by a large area of left ventricular microvascular dysfunction, which did not coincide with the areas of blood supply of altered coronary arteries; the dynamics of electrocardiographic changes resembled myocardial stunning in Takotsubo syndrome (TS). The effect of chlorine on CVS, features of clinical and instrumental diagnostics and differentiation of primary / secondary CT and ACS are discussed.

An incident of massive styrene monomer gas poisoning

Following a temporary and partial shutdown of the LG polymers factory for nearly 44 days due to the COVID-19 lockdown, routine maintenance of the plant was affected. At around 3 a.m. on 7May 2020, a failure of the refrigeration system and the inhibitor tank attached to the styrene storage tank, resulted in an auto polymerization reaction that caused nearly half of the 1800 tonnes styrene gas stored to leak into the atmosphere. Since the volatile organic compound detection system was defunct, no alert or alarm was raised and, driven by north easterly winds, a cloud of toxic styrene gas spread over a radius of nearly 3 km, affecting five villages in the vicinity. The pungent smell was initially mistaken by the residents as emanating from a fire accident or a COVID-19 sanitization measure in the vicinity. Following initial triage, over 350 victims were hospitalized in various hospitals. 254 symptomatic adults and 64 children were shifted to the Government King George hospital. The main symptoms were burning sensation of eyes, skin and throat, nausea, vomiting, diplopia, muscle twitching, breathlessness and loss of consciousness. Nearly 10,000 residents from five villages were evacuated to relief camps set up in the perimeter and given first aid and food. There were 11 human and 22 animal fatalities in the immediate vicinity. This incident reports the world’s first fatalities due to massive styrene poisoning

Toxicology

This chapter in the Oxford Handbook of Emergency Medicine encompasses toxicology in the emergency department (ED). It examines poisons in general, including diagnosis, supportive care, reducing absorption, and antidotes. Specific poisoning is explored in detail, through opioid, salicylate, paracetamol, tricyclic antidepressant, benzodiazepine, clomethiazole, phenothiazine, barbiturate, lithium, sulfonylurea, beta-blocker, calcium channel antagonist, digoxin, angiotensin-converting enzyme (ACE) inhibitor, theophylline, salbutamol, iron, ethanol, methanol, ethylene glycol, paraquat, petrol, paraffin, organophosphate, cyanide, carbon monoxide, chlorine, and CS gas (tear gas) poisoning. Chemical incidents are discussed, as well as accidental poisoning from plants, berries, mushrooms, and button batteries. It also examines novel psychoactive substances (NPS), recreational drugs, serotonin syndrome, and body packers.

Rare cases of gas poisoning in the practice of forensic medicine.

Cases of poisoning with gases other than carbon monoxide are rarely reported in forensic medicine. Usually they are associated with an accident, suicidal intoxication, or recreational inhalation to obtain psychoactive effects. The paper presents 2 cases of poisoning with an air freshener aerosol and argon. Both caseswere confirmed after confronting the results of post-mortem examination, additional tests, and the detailed circumstances of the incidents. These cases deserve attention because of both the clinical and scientific aspects.Keywords: air freshener; argon; nitrous oxide; death; poisoning.

Diver Poisoning with Contaminated Compresses Air

The paper describes the case of a military diver who suffered from a complicated poisoning caused by hydrocarbons contained in his breathing air. The hydrocarbons came from a malfunctioning compressor which was used to fill the diving cylinders; the compressor sucked in the exhaust gases of its own motor. Exhaust gas poisoning was further complicated by hypoxia and hypercapnia as the diver spat out the mouthpiece and started to breathe from inside the suit. This resulted in a loss of consciousness. The diver was extracted to the surface and was given oxygen to breathe. The course of treatment was successful. On the same day, symptoms of exhaust gas poisoning occurred in several divers using cylinders filled with the same compressor.