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Delvau N, Elens L, Penaloza A, Liistro G, Thys F, Roy P, Gianello P, Hantson P. Carboxyhemoglobin half-life toxicokinetic profiles during and after normobaric oxygen therapy: On a swine model. Toxicol Rep 2024; 12:271-279. [PMID: 38433766 PMCID: PMC10907397 DOI: 10.1016/j.toxrep.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Investigations on acute carbon monoxide (CO) poisoning struggle to highlight a relevant discriminant criterion related to CO poisoning severity for predicting complications, such as delayed neurological syndromes. In this context, it remains difficult to demonstrate the superiority of one method of oxygen (O2) administration over others or to identify the optimal duration of normobaric 100% oxygen (NBO) treatment. Myoglobin, as hemoglobin, are a potential binding site for CO, which could be a source of extravascular CO storage that impacts the severity of CO poisoning. It is not possible in routine clinical practice to estimate this potential extravascular CO storage. Indirect means of doing so that are available in the first few hours of poisoning could include, for example, the carboxyhemoglobin half-life (COHbt1/2), which seems to be influenced itself by the level and duration of CO exposure affecting this store of CO within the body. However, before the elimination of CO can be assessed, the COHbt1/2 toxicokinetic model must be confirmed: research still debates whether this model mono- or bi-compartmental. The second indirect mean could be the assessment of a potential COHb rebound after COHb has returned to 5% and NBO treatment has stopped. Moreover, a COHb rebound could be considered to justify the duration of NBO treatment. On an experimental swine model exposed to moderate CO poisoning (940 ppm for ±118 min until COHb reached 30%), we first confirm that the COHb half-life follows a bi-compartmental model. Secondly, we observe for the first time a slight COHb rebound when COHb returns to 5% and oxygen therapy is stopped. On the basis of these two toxicokinetic characteristics in favor of extravascular CO storage, we recommend that COHbt1/2 is considered using the bi-compartmental model in future clinical studies that compare treatment effectiveness as a potential severity criterion to homogenize cohorts of the same severity. Moreover, from a general toxicokinetic point of view, we confirm that a treatment lasting less than 6 hours appears to be insufficient for treating moderate CO poisoning.
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Affiliation(s)
- N. Delvau
- Department of Emergency Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels 1200, Belgium
| | - L. Elens
- Integrated Pharmacometrics, Pharmacogenomics and PharmacoKinetics (PMGK) Research group, Louvain Drug Research Institute (LDRI), Université Catholique de Louvain, Brussels 1200, Belgium
- Louvain Center for Toxicology and Applied Pharmacology (LTAP), Université Catholique de Louvain, Brussels 1200 , Belgium
| | - A. Penaloza
- Department of Emergency Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels 1200, Belgium
| | - G. Liistro
- Department of Pneumology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels 1200, Belgium
| | - F. Thys
- Emergency Department, GHDC: Grand Hôpital de Charleroi, Charleroi 6000, Belgium
| | - P.M. Roy
- Emergency Department, CHU Angers: Centre Hospitalier Universitaire d’Angers, Angers Cedex 01, Angers 49033, France
| | - P. Gianello
- Department of Health Sciences, Institute for Experimental and Clinical, Experimental Surgery and Transplantation (CHEX), Université Catholique de Louvain, Brussels 1200, Belgium
| | - P. Hantson
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels 1200, Belgium
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2
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Akkan S, Uyanik Ö. Comparing high-flow nasal oxygen therapy and normobaric oxygen therapy on the treatment of carbon monoxide poisoning. Med Klin Intensivmed Notfmed 2024; 119:214-219. [PMID: 37530814 DOI: 10.1007/s00063-023-01044-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/09/2023] [Accepted: 06/25/2023] [Indexed: 08/03/2023]
Abstract
AIM We aimed to investigate whether there is a difference in the rate of decrease in carboxyhemoglobin (COHB) values between high-flow nasal oxygen (HFNO) and normobaric oxygen (NBO) therapy. MATERIAL AND METHOD This retrospective observational study included patients with carbon monoxide poisoning who were treated with HFNO or NBO (control group). All patients were started on NBO therapy with a non-rebreather face mask at a rate of 15 L/min. In the NBO group, NBO treatment was continued until the COHB value fell below 10%. In the HFNO group, as soon as the preparation of the HFNO device was completed, NBO treatment was terminated and HFNO treatment was started and continued until the COHB value fell below 10%. The primary outcome of the study was the difference between HFNO and NBO in terms of COHB half-life rates. RESULTS A total of 81 patients were included in the study, 44 in the HFNO group and 37 in the NBO group. The median of COHB t1/2 values between HFNO and the NBO treatment groups were 47.3 (IQR: 25-75%: 31.5-65.4) and 46 (IQR: 25-75%: 32.3-56.2), respectively, but this difference was not statistically significant (p = 0.81). CONCLUSION The results of this study suggest that HFNO treatment does not have a significant advantage over NBO treatment in the carbon monoxide elimination rate within the first 60 min of treatment.
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Affiliation(s)
- Sedat Akkan
- Elbistan State Hospital, Department of Emergency Medicine, Kahramanmaraş, Turkey.
| | - Ömür Uyanik
- Elbistan State Hospital, Department of Emergency Medicine, Kahramanmaraş, Turkey
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3
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Tekin YK. Optic nerve sheath diameter measurements to predict delayed neurological sequelae after carbon monoxide poisoning. Clin Toxicol (Phila) 2024; 62:88-93. [PMID: 38466623 DOI: 10.1080/15563650.2024.2323092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/20/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES Delayed neurological sequelae are a major complication of carbon monoxide poisoning. However, today there is still no objective screening tool for predicting delayed neurological sequelae in patients with carbon monoxide poisoning. The present study aimed to assess the usefulness of optic nerve sheath diameter measurements in predicting delayed neurological sequelae after carbon monoxide poisoning. METHODS In this retrospective study, patients with a diagnosis of carbon monoxide poisoning in the emergency department from 2010 to 2021 were included in the study. Right and left optic nerve sheath diameters were calculated based on cranial computed tomography scans, and the presence of delayed neurological sequelae was evaluated. RESULTS The mean (± standard deviation) optic nerve sheath diameter in patients who developed delayed neurological sequelae was statistically significantly greater on both the right and left compared to patients who did not develop delayed neurological sequelae (right; 5.02 ± 0.06 mm versus 4.89 ± 0.07 mm, P < 0.001; left; 5.03 ± 0.09 mm versus 4.85 ± 0.10 mm, P < 0.001). A multivariate linear regression analysis revealed that carboxyhemoglobin and both right and left optic nerve sheath diameter were the factors associated with the delayed neurological sequelae. DISCUSSION The present study revealed that optic nerve sheath diameter measurements may be a useful screening tool to predict delayed neurological sequelae after carbon monoxide poisoning. The ability to predict a poor neurological prognosis in carbon monoxide poisoning is important for initiating early rehabilitation interventions and make help future trials. Limitations of this study include that normal optic nerve sheath diameters are not well established, and that not every patient underwent computed tomography. CONCLUSIONS Optic nerve sheath diameters measurements may be a helpful screening tool for predicting delayed neurological sequelae after carbon monoxide poisoning.
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Affiliation(s)
- Yusuf Kenan Tekin
- Department of Emergency Medicine, Sivas Cumhuriyet University, Sivas, Turkey
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Yu J, Lee J, Cho Y, Oh J, Kang H, Lim TH, Ko BS. Correlation between Carboxyhemoglobin Levels Measured by Blood Gas Analysis and by Multiwave Pulse Oximetry. J Pers Med 2024; 14:168. [PMID: 38392600 PMCID: PMC10890311 DOI: 10.3390/jpm14020168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
Carbon monoxide (CO) poisoning is difficult to diagnose owing to its nonspecific symptoms. Multiwave pulse oximetry can be used to quickly screen patients for CO poisoning. However, few studies have analyzed patients with CO poisoning who presented to the emergency department (ED). The primary aim of our study was to determine the correlation between COHb levels measured in blood gas analysis and COHb levels measured in multiwave pulse oximetry. Secondary aims were the sensitivity and specificity of the COHb level cutoff value using multiwave pulse oximetry to predict a 25% COHb level in blood gas analysis. This single-center retrospective observational study included patients with CO poisoning who visited the ED of a university-affiliated hospital in Seoul, Korea between July 2021 and June 2023. COHb poisoning was determined using blood gas analysis and multiwave pulse oximetry. The correlation of COHb levels between the two tests was evaluated using correlation analysis. The area under the receiver operating characteristic curve (AUC) of multiwave pulse oximetry was calculated to predict COHb levels from the blood gas analysis. The optimal cutoff values, sensitivity, and specificity of COHb were determined. A total of 224 patients who had COHb levels measured using both multiwave pulse oximetry and blood gas analysis were included in the analysis. In the correlation analysis, COHb showed a high positive correlation with COHb measured using blood gas analysis (Spearman correlation coefficient = 0.86, p < 0.001). The AUC of COHb measured by multiwave pulse oximetry to predict 25% of the COHb level (which can be an indication of hyperbaric oxygen treatment) measured by blood gas analysis was 0.916. When the COHb levels measured with multiwave pulse oximetry were 20% the sensitivity was 81% and the specificity was 83%, and when the COHb levels were 25% the sensitivity was 50% and the specificity was 95%. The COHb value measured using multiwave pulse oximetry blood gas analysis showed a high correlation. However, additional research using large-scale studies is required for validation.
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Affiliation(s)
- Jisu Yu
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Juncheol Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Yongil Cho
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Byuk Sung Ko
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
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5
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Babacan A. Diagnostic accuracy of carboxyhemoglobin saturation with pulse CO-oximetry in patients with carbon monoxide poisoning. Toxicol Res (Camb) 2023; 12:964-969. [PMID: 37915482 PMCID: PMC10615832 DOI: 10.1093/toxres/tfad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/24/2023] [Accepted: 09/09/2023] [Indexed: 11/03/2023] Open
Abstract
Objective Carboxyhemoglobin saturation (SpCO)with pulse CO-oximetry is an alternative method in CO poisoning; however, the correlation of it with blood carboxyhemoglobin level (COHb) is still debated.The study aimed to evaluate the correlation between SpCO and venous COHb level and factors associated with the diagnostic accuracy of SpCO. Material and methods SpCO and venous COHb levels of patients with CO poisoning, according to a COHb level was 3%, were evaluated. The sensitivity, specificity, 95% CI (confidence interval), and the cut-off value of SpCO were calculated using ROC analysis at a 10% threshold for COHb. Agreement levels were calculated with Bland-Altman analysis. Risk factors affecting diagnostic accuracy were analyzed using logistic regression analysis. Results If the 10% threshold of COHb was accepted as the diagnostic threshold for CO poisoning, the sensitivity and specificity of SpCO were 98.4% and 100% (95% CI: 0.996-1.000) at the 6.85 cut-off point of SpCO. The scatter plot of COHb and SpCO showed a strong positive relationship at values of presentation and discharge (r = .979, p<0.001; r = .969, p<0.001). With a bias of 3.1% for the mean difference between-COHb and SpCO, the limits of agreement from Bland- Altman analysis were -0.7 to 7.1. For the 10% threshold, age and male gender have significantly increased false negativity rates (B = .074, p = 0.010, and B = 0.252, p = 0.011, respectively). Conclusion SpCO is a reliable method with high sensitivity and specificity; therefore, a lower cut-off points of SpCO compared to COHb level may be accepted to diagnose and follow-up CO poisoning.
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Affiliation(s)
- Arzu Babacan
- Department of Emergency Service, Ankara Dr Abdurrahman Yurtarslan Oncology Training and Research Hospital, University of Health Sciences, Yenimahalle, Ankara, Turkey
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6
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Papin M, Latour C, Leclère B, Javaudin F. Accuracy of pulse CO-oximetry to evaluate blood carboxyhemoglobin level: a systematic review and meta-analysis of diagnostic test accuracy studies. Eur J Emerg Med 2023; 30:233-243. [PMID: 37171830 PMCID: PMC10306338 DOI: 10.1097/mej.0000000000001043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Abstract
Carbon monoxide (CO) poisoning is one of the most common causes of poisoning death and its diagnosis requires an elevated carboxyhemoglobin (COHb) level. Noninvasive CO saturation by pulse oximetry (SpCO) has been available since 2005 and has the advantage of being portable and easy to use, but its accuracy in determining blood COHb level is controversial. To evaluate the accuracy of SpCO (index test) to estimate COHb (reference test). Systematic review and meta-analysis of diagnostic test accuracy (DTA) studies. Four electronic databases were searched (Medline, Embase, Cochrane Central Register of Controlled Trials, and OpenGrey) on 2 August 2022. All studies of all designs published since the 2000s evaluating the accuracy and reliability of SpCO measurement compared to blood COHb levels in human volunteers or ill patients, including children, were included. The primary outcome was to assess the diagnostic accuracy of SpCO for estimating COHb by blood sampling by modeling receiver operating characteristic (ROC) curves and calculating sensitivity and specificity (primary measures). The secondary measures were to calculate the limits of agreement (LOA) and the mean bias. This systematic review was conducted according to the Preferred Reporting Items for a Systematic Review and Meta-analysis-DTA 2018 guidelines and has been registered on International Prospective Register of Systematic Reviews (PROSPERO, CRD42020177940). The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Twenty-one studies were eligible for the systematic review; 11 could be included for the quantitative analysis of the primary measures and 18 for the secondary measures. No publication bias was found. The area under the summary ROC curve was equal to 86%. The mean sensitivity and specificity were 0.77, 95% confidence interval (CI, 0.66-0.85) and 0.83, 95% CI (0.74-0.89), respectively (2089 subjects and 3381 observations). The mean bias was 0.75% and the LOA was -7.08% to 8.57%, 95% CI (-8.89 to 10.38) (2794 subjects and 4646 observations). Noninvasive measurement of COHb (SpCO) using current pulse CO oximeters do not seem to be highly accurate to estimate blood COHb (moderate sensitivity and specificity, large LOA). They should probably not be used to confirm (rule-in) or exclude (rule-out) CO poisoning with certainty.
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Affiliation(s)
- Mathilde Papin
- Emergency Department, Nantes University Hospital, Nantes
| | - Chloé Latour
- Department of Medicine, Hospital of Pontivy, Pontivy
| | - Brice Leclère
- Department of Medical Evaluation and Epidemiology, Nantes University Hospital
- Cibles et Médicaments des Infections et de l'Immunité, UR1155 IICiMed, Nantes University, Nantes, France
| | - François Javaudin
- Emergency Department, Nantes University Hospital, Nantes
- Cibles et Médicaments des Infections et de l'Immunité, UR1155 IICiMed, Nantes University, Nantes, France
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Williams JM, Ingle CL, Schauer SG, Maddry JK. Prehospital and Emergency Management. Surg Clin North Am 2023; 103:389-401. [PMID: 37149376 DOI: 10.1016/j.suc.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Burn care in the prehospital and emergency settings requires rapid assessment of airway, breathing, and circulation. Intubation (if indicated) and fluid resuscitation are most important in emergency burn care. Total body surface area burned and depth of burn are important early assessments that help guide resuscitation and disposition. Burn care in the emergency department further includes carbon monoxide and cyanide toxicity evaluation and management.
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Affiliation(s)
| | | | - Steven G Schauer
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA; US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Joseph K Maddry
- Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA; US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA; 59th Medical Wing, JBSA Lackland, TX, USA
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8
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Güven D, Sarıcı D. Clinical and Laboratory Characteristics Predicting the Severity of Carbon Monoxide Poisoning in Children: A Single-Center Retrospective Study. Pediatr Emerg Care 2023; 39:207-215. [PMID: 36898143 DOI: 10.1097/pec.0000000000002927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
OBJECTIVES Carbon monoxide poisoning (COP) is extremely common throughout the world. The purpose of this study was to assess the demographic, clinical, and laboratory characteristics predicting the severity COP in children. METHODS The study included 380 children diagnosed with COP between January 2017 and January 2021 and 380 healthy controls. Carbon monoxide poisoning was diagnosed based on the medical history and a carboxyhemoglobin (COHb) level of more than 5%. The patients were classified as mild (COHb 10%), moderate (COHb 10%-25%), or severely (COHb > 25%) poisoned. RESULTS The mean age of the severe group was 8.60 ± 6.30, for the moderate group was 9.50 ± 5.81, for the mild group was 8.79 ± 5.94, and for the control group was 8.95 ± 5.98. The most common place of exposure was at home and all cases were affected accidentally. The coal stove was the most common source of exposure, followed by natural gas. The most common symptoms were nausea/vomiting, vertigo, and headache. Neurologic symptoms such as syncope, confusion, dyspnea, and seizures were more common in the severe group. A total of 91.3% of the children had hyperbaric oxygen therapy, 3.8% were intubated, and 3.8% were transferred to intensive care in the severe group, whereas no death or sequela was observed. Mean platelet volume and red cell distribution width had the highest area under the curve in the receiver operating characteristic analysis (0.659; 0.379). A positive and low statistically significant relationship was found between COHb levels and troponin and lactate levels in the severe group ( P < 0.05). CONCLUSIONS Carbon monoxide poisoning progressed more severely in children presented with neurological symptoms and have elevated red cell distribution width and mean platelet volume. Even in severe COP cases, satisfactory results have been obtained with early and appropriate treatment.
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Affiliation(s)
- Deniz Güven
- From the Department of Pediatrics, University of Health Sciences, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - Dilek Sarıcı
- Department of Neonatology, University of Health Sciences, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
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A pilot study of neuroprotective effect of granulocyte colony-stimulating factor (G-CSF) in patients with carbon monoxide poisoning: a double-blind, randomized, placebo-controlled trial. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2023; 396:1257-1267. [PMID: 36715735 DOI: 10.1007/s00210-023-02395-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023]
Abstract
Although neuroprotective effects of granulocyte colony-stimulating factor (G-CSF) have been shown in rats exposed to carbon monoxide (CO), this pilot clinical trial was performed to assess the feasibility of treatment with G-CSF in patients with acute CO poisoning. A double-blind, randomized, placebo-controlled pilot clinical trial was conducted on twenty-six patients with acute CO poisoning. G-CSF (90 μg/kg) was administered intravenously for 72 h. Demographic data, routine laboratory tests, differential blood counts, venous blood gas, and adverse reactions were recorded. The primary endpoint was brain ischemia improvement based on CT findings and the secondary endpoints examined improvements in the modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), and Barthel Index as well as S-100β concentrations. Fourteen patients received G-CSF, and 12 received a placebo. Twenty-six were followed for 30 days and no one in both groups died during follow-up. Neurological complications, brain ischemic changes, Barthel, and mRS were compared between the two groups on determined days after the onset of therapeutic intervention, and no significant differences were observed between the two groups. Favorable results were achieved for treated patients by different measures; NIHSS was decreased 72 h after treatment (p = 0.046), and S-100β levels were significantly higher in the G-CSF group than in the control group, 12 h and 72 h after the treatment. G-CSF appears to have potential effects on several clinical parameters in patients with acute CO poisoning. The trial was registered at the Iranian Registry of Clinical Trials with the ID: (IRCT201607232083N7).
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DUYAN M, VURAL N. Diagnostic value of systemic immune-inflammation index and red cell distribution width-lymphocyte ratio in predicting troponin elevation in carbon monoxide poisoning. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1171643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose: The aim of our study was to assess the significant value of the systemic inflammatory index (SII) and red cell distribution width/lymphocyte ratio (RLR) in patients with carbon monoxide poisoning (COP).
Materials and Methods: Based on a retrospective cross-sectional study design, this study was conducted among patients 18 years and older who presented to the hospital's emergency department with COP. The patients were separated into troponin positive and negative groups as an outcome of serial troponin measurements. Receiver operating characteristic (ROC) analysis was used to determine the cut-off value of neutrophil/lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), RLR, and SII to predict troponin positivity.
Results: This study included 195 patients with CO exposure, 50 of whom had positive troponin tests. It was discovered that the diagnostic power of NLR, RLR, MLR, and SII was acceptable for identifying troponin positivity (AUC: 0.71-0.77). According to ROC curve comparisons, there was no diagnostic difference between these inflammatory biomarkers. Increased NLR, RLR, MLR, and SII were found to be independent predictors of troponin positivity after CO exposure (Odds ratio respectively: 8.65, 4.31, 7.24, 6.31).
Conclusion: SII and RLR, which are simple, inexpensive, and easily accessible parameters, are valuable in predicting troponin positivity in COP cases.
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Affiliation(s)
- Murat DUYAN
- Department of Emergency Medicine, Antalya Training and Research Hospital, Antalya, Turkey
| | - Nafis VURAL
- Department of Emergency Medicine, Ereğli State Hospital
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Xu Q, Rose JJ, Chen X, Wang L, DeMartino AW, Dent MR, Tiwari S, Bocian K, Huang XN, Tong Q, McTiernan CF, Guo L, Alipour E, Jones TC, Ucer KB, Kim-Shapiro DB, Tejero J, Gladwin MT. Cell-free and alkylated hemoproteins improve survival in mouse models of carbon monoxide poisoning. JCI Insight 2022; 7:153296. [PMID: 36173682 PMCID: PMC9675481 DOI: 10.1172/jci.insight.153296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/20/2022] [Indexed: 12/15/2022] Open
Abstract
I.v. administration of a high-affinity carbon monoxide-binding (CO-binding) molecule, recombinant neuroglobin, can improve survival in CO poisoning mouse models. The current study aims to discover how biochemical variables of the scavenger determine the CO removal from the RBCs by evaluating 3 readily available hemoproteins, 2,3-diphosphoglycerate stripped human hemoglobin (StHb); N-ethylmaleimide modified hemoglobin (NEMHb); and equine myoglobin (Mb). These molecules efficiently sequester CO from hemoglobin in erythrocytes in vitro. A kinetic model was developed to predict the CO binding efficacy for hemoproteins, based on their measured in vitro oxygen and CO binding affinities, suggesting that the therapeutic efficacy of hemoproteins for CO poisoning relates to a high M value, which is the binding affinity for CO relative to oxygen (KA,CO/KA,O2). In a lethal CO poisoning mouse model, StHb, NEMHb, and Mb improved survival by 100%, 100%, and 60%, respectively, compared with saline controls and were well tolerated in 48-hour toxicology assessments. In conclusion, both StHb and NEMHb have high CO binding affinities and M values, and they scavenge CO efficiently in vitro and in vivo, highlighting their therapeutic potential for point-of-care antidotal therapy of CO poisoning.
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Affiliation(s)
- Qinzi Xu
- Heart, Lung, Blood and Vascular Medicine Institute
| | - Jason J. Rose
- Heart, Lung, Blood and Vascular Medicine Institute,,Division of Pulmonary, Allergy and Critical Care Medicine, and,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Xiukai Chen
- Heart, Lung, Blood and Vascular Medicine Institute
| | - Ling Wang
- Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, Iowa, USA
| | - Anthony W. DeMartino
- Heart, Lung, Blood and Vascular Medicine Institute,,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | - Qin Tong
- Heart, Lung, Blood and Vascular Medicine Institute
| | - Charles F. McTiernan
- Heart, Lung, Blood and Vascular Medicine Institute,,Division of Pulmonary, Allergy and Critical Care Medicine, and
| | - Lanping Guo
- Division of Pulmonary, Allergy and Critical Care Medicine, and
| | | | | | | | - Daniel B. Kim-Shapiro
- Department of Physics and,Translational Science Center, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Jesús Tejero
- Heart, Lung, Blood and Vascular Medicine Institute,,Division of Pulmonary, Allergy and Critical Care Medicine, and,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark T. Gladwin
- Heart, Lung, Blood and Vascular Medicine Institute,,Division of Pulmonary, Allergy and Critical Care Medicine, and,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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12
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Huang CC, Ho CH, Chen YC, Hsu CC, Lin HJ, Wang JJ, Su SB, Guo HR. Association between carbon monoxide poisoning and adrenal insufficiency: a nationwide cohort study. Sci Rep 2022; 12:16219. [PMID: 36171402 PMCID: PMC9519538 DOI: 10.1038/s41598-022-20584-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 09/15/2022] [Indexed: 12/02/2022] Open
Abstract
Carbon monoxide poisoning may damage the brain and adrenal glands, but it is unclear whether it is associated with adrenal insufficiency. We identified all COP patients diagnosed between 1999 and 2012 in Taiwan using the Nationwide Poisoning Database and selected a reference cohort (participants without COP) from the same database by exact matching of age and index date at a 1:2 ratio. Participants with a history of adrenal insufficiency or steroid use of more than 14 days were excluded. We followed up participants until 2013 and compared the risk of developing adrenal insufficiency between the two cohorts. The 21,842 COP patients had a higher risk for adrenal insufficiency than the 43,684 reference participants (adjusted hazard ratio [AHR] = 2.5; 95% confidence interval [CI]: 1.8–3.5) after adjustment for sex and underlying comorbidities (liver disease, thyroid disease, mental disorder). The risk continued to elevate even after 1 year (AHR = 2.1; 95% CI: 1.4–3.4). The COP patients who had acute respiratory failure had an even higher risk for adrenal insufficiency than those without acute respiratory failure, which may indicate a dose–response relationship. Stratified analyses showed that female patients had an elevated risk (AHR = 3.5; 95% CI: 2.1–6.0), but not male patients. Younger patients (< 50 years) had higher risks, and the AHR reached statistical significance in the age groups 20–34 (AHR = 5.5; 95% CI: 1.5–20.6) and 35–49 (AHR = 4.9; 95% CI: 2.3–10.6) years old. The risk for developing adrenal insufficiency elevated after COP, especially in female and younger patients. Carbon monoxide is the most common gaseous agent causing acute intoxication worldwide. Results of the current study call for monitoring adrenal function of patients with COP.
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Affiliation(s)
- Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan. .,Department of Emergency Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jhi-Joung Wang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Anesthesiology, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Bin Su
- Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Department of Medical Research, Chi Mei Medical Center, Liouying, Tainan, Taiwan.,Department of Occupational Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - How-Ran Guo
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan. .,Occupational Safety, Health, and Medicine Research Center, National Cheng Kung University, Tainan, Taiwan. .,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 704, Taiwan.
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Early predictors of brain injury in patients with acute carbon monoxide poisoning and the neuroprotection of mild hypothermia. Am J Emerg Med 2022; 61:18-28. [PMID: 36029667 DOI: 10.1016/j.ajem.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/13/2022] [Accepted: 08/07/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Carbon monoxide (CO) poisoning can cause serious neurological sequelae. However, there is neither effective treatment strategy nor reliable indicators to determine the prognosis of patients with CO poisoning. The present study aimed to observe the changes of neurological function score, disease severity score, cerebral oxygen utilization (O2UCc), bispectral (BIS) index and neuron-specific enolase (NSE) concentration, and to elucidate the clinical significance of these potential indicators and the neuroprotective effect of mild hypothermia on brain injury in patients with severe acute CO poisoning. MATERIALS AND METHODS A total of 277 patients with acute severe CO poisoning from 2013 to 2018 were enrolled in our hospital. Patients were divided into three groups according to their body temperature on the day of admission and their willingness to treat: a fever group (n = 78), a normal temperature group (NT group, n = 113), and a mild hypothermia group (MH group, n = 86). All patients were given hyperbaric oxygen therapy, while those in the MH group received additional mild hypothermia treatment. The severity of the disease, the neurobehavioral status, the incidence of delayed encephalopathy after acute carbon monoxide poisoning (DEACMP), and other indicators including BIS, O2UCc, NSE were further evaluated in all patients at given time-points. RESULTS Mild hypothermia therapy improved the prognosis of patients with CO poisoning, significantly decreased the value of O2UCc and NSE, and up-regulated BIS. The incidence of DEACMP at 6 months was 27% in the fever group, 23% in the NT group, and 8% in the MH group. The values of Glasgow-Pittsburgh coma scale (G-P score), BIS index and NSE were closely related to the occurrence of DEACMP, the cutoff values were 12.41, 52.17 and 35.20 ng/mL, and the sensitivity and specificity were 79.3%, 77.6%, 79.3% and 67.6%, 89.5%, 88.6% in the receiver operating characteristic curve (ROC), respectively. CONCLUSIONS Early mild hypothermia treatment could significantly reduce the severity of brain injury after CO poisoning, and might be further popularized in clinic. G-P scores, NSE and BIS index can be regarded as the prediction indicators in the occurrence and development of DEACMP. CLINICAL TRIAL REGISTRATION The study protocol was granted from Qingdao University Research Ethics Committee (Clinical trial registry and ethical approval number: QD81571283).
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Yayuan Y, Ling H, Qunli Y, Yongfang G, Hongmei S. Effects of caspase activity of yak meat and internal environment changing during aging. JOURNAL OF FOOD SCIENCE AND TECHNOLOGY 2022; 59:1362-1371. [PMID: 35250061 PMCID: PMC8882741 DOI: 10.1007/s13197-021-05145-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 06/07/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022]
Abstract
The objective of this study was to investigate the protease family caspases in skeletal muscle and their potential contribution to postmortem proteolysis and meat tenderization. Nine yaks were slaughtered, and samples of Longissimus dorsal were injected with AC-DEVD-CHO at a ratio of 1:1 (w/v) and then stored at 4 °C for 2, 6, 12, 24, 72, and 120 h. Results indicate that the morphological changes of the muscle fibers are significantly obstructed, which is not conducive to the subsequent degradation of proteins. After inhibiting the activity of Caspase- 3, the activity of Caspase-8 and 9 and the energy metabolism was affected. In the case of without inhibition of caspase, the pH value decreased and then increased. The meat color and the water retention are better, the muscle fiber skeleton protein degradation is remarkable, the tenderness is improved. Furthermore, yak meat tenderness was improved by apoptotic pathway during aging.
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Affiliation(s)
- Yang Yayuan
- College of Food Science and Engineering, Gansu Agricultural University, 1, Yingmen Village, Anning, Lanzhou, 730070 Gansu People's Republic of China
| | - Han Ling
- College of Food Science and Engineering, Gansu Agricultural University, 1, Yingmen Village, Anning, Lanzhou, 730070 Gansu People's Republic of China
| | - Yu Qunli
- College of Food Science and Engineering, Gansu Agricultural University, 1, Yingmen Village, Anning, Lanzhou, 730070 Gansu People's Republic of China
| | - Gao Yongfang
- College of Food Science and Engineering, Gansu Agricultural University, 1, Yingmen Village, Anning, Lanzhou, 730070 Gansu People's Republic of China
| | - Shi Hongmei
- Gannan Tibetan Autonomous Prefecture Institute of Animal Science, No. 43, People East Street, Hezuo, 747000 Gannan Tibetan Autonomous Prefecture People's Republic of China
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Martinez(†) M, Durand M, Jainsky L, Serre P, Vallot C, Jacquet L, Freyssenge J. État de connaissance des médecins urgentistes sur la prise en charge des intoxications au monoxyde de carbone en région Auvergne-Rhône-Alpes. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectif : L’intoxication au monoxyde de carbone (ICO) est un diagnostic souvent difficile en urgence. Son incidence restant faible, les médecins urgentistes (MU) y sont rarement confrontés mais la pertinence de leur prise en charge est essentielle pour limiter la morbi-mortalité. L’objectif principal de cette étude était d’évaluer le niveau de connaissance des MU sur la prise en charge des ICO dans une région française de 8,1 millions d’habitants. L’objectif secondaire était d’individualiser les facteurs associés à une bonne connaissance de la prise en charge en urgence de cette pathologie.
Matériel et méthodes : Étude descriptive multicentrique et déclarative, réalisée auprès de MU travaillant au sein de cette région à l’aide d’un questionnaire en ligne.
Résultat : 246 MU ont répondu à l’enquête, représentant 82 % des structures de médecine d’urgence de la région. Parmi eux, 27 % estimaient prendre en charge moins de deux ICO par an. Le protocole territorial était connu par 59 % des répondeurs. La médiane de réponses justes au questionnaire de connaissance était de 43 [40-47] sur 60. Un taux de réponses justes plus faible (< 70 %) était retrouvé sur les questions traitant du diagnostic (65 %) et des indications et contre-indications de l’oxygénothérapie hyperbare (61 %). Les facteurs associés à un meilleur taux de réponses justes étaient : la connaissance du protocole territorial (63 vs 46 %, p = 0,035), une ancienneté d’exercice ≥ 5 ans (60 vs 40 %, p = 0,014), une formation complémentaire à la médecine hyperbare (85 vs 53 %, p = 0,018), un nombre estimé de prise en charge d’ICO ≥ 2 (60 vs 43 %, p = 0,022) et une auto-évaluation de ses connaissances > 7/10 (68 vs 50 %, p = 0,007).
Conclusion : Cette étude a montré un niveau de connaissance perfectible des MU sur cette pathologie en rapport avec un faible nombre de prise en charge annuel. La création d’un consensus national est à encourager pour améliorer les pratiques.
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Problems Related to Physical Agents. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Jüttner B, Busch HJ, Callies A, Dormann H, Janisch T, Kaiser G, Körner-Göbel H, Kluba K, Kluge S, Leidel BA, Müller O, Naser J, Pohl C, Reiter K, Schneider D, Staps E, Welslau W, Wißuwa H, Wöbker G, Muche-Borowski C. S2k guideline diagnosis and treatment of carbon monoxide poisoning. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2021; 19:Doc13. [PMID: 34867135 PMCID: PMC8607608 DOI: 10.3205/000300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Indexed: 01/20/2023]
Abstract
Carbon monoxide (CO) can occur in numerous situations and ambient conditions, such as fire smoke, indoor fireplaces, silos containing large quantities of wood pellets, engine exhaust fumes, and when using hookahs. Symptoms of CO poisoning are nonspecific and can range from dizziness, headache, and angina pectoris to unconsciousness and death. This guideline presents the current state of knowledge and national recommendations on the diagnosis and treatment of patients with CO poisoning. The diagnosis of CO poisoning is based on clinical symptoms and proven or probable exposure to CO. Negative carboxyhemoglobin (COHb) levels should not rule out CO poisoning if the history and symptoms are consistent with this phenomenon. Reduced oxygen-carrying capacity, impairment of the cellular respiratory chain, and immunomodulatory processes may result in myocardial and central nervous tissue damage even after a reduction in COHb. If CO poisoning is suspected, 100% oxygen breathing should be immediately initiated in the prehospital setting. Clinical symptoms do not correlate with COHb elimination from the blood; therefore, COHb monitoring alone is unsuitable for treatment management. Especially in the absence of improvement despite treatment, a reevaluation for other possible differential diagnoses ought to be performed. Evidence regarding the benefit of hyperbaric oxygen therapy (HBOT) is scant and the subject of controversy due to the heterogeneity of studies. If required, HBOT should be initiated within 6 h. All patients with CO poisoning should be informed about the risk of delayed neurological sequelae (DNS).
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Affiliation(s)
- Björn Jüttner
- German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI)
| | - Hans-Jörg Busch
- German Society of Medical Intensive Care and Emergency Medicine (DGIIN)
| | - Andreas Callies
- Bundesvereinigung der Arbeitsgemeinschaften der Notärzte Deutschlands (BAND)
| | | | - Thorsten Janisch
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | - Guido Kaiser
- GIZ-Nord Poisons Center, University Medical Center Göttingen (GIZ-Nord)
| | | | - Karsten Kluba
- The German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | | | | | - Oliver Müller
- German Society for Diving and Hyperbaric Medicine (GTÜM)
| | - Johannes Naser
- The German Society of Anaesthesiology and Intensive Care Medicine (DGAI)
| | | | - Karl Reiter
- Society for Neonatology and Pediatric Intensive Care Medicine (GNPI)
| | | | | | | | - Holger Wißuwa
- Bundesverband der Ärztlichen Leiter Rettungsdienst Deutschland (ÄLRD)
| | - Gabriele Wöbker
- German Society of NeuroIntensive Care and Emergency Medicine (DGNI)
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Arnaudet I, Montassier E, Javaudin F, Naux E, Le Bastard Q. Prise en charge des brûlures en préhospitalier et aux urgences. ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2021-0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Une brûlure est une lésion de la peau ou d’un autre tissu organique principalement causée par la chaleur ou les rayonnements, la radioactivité, l’électricité, la friction ou le contact avec des produits chimiques. Les plus fréquentes, les brûlures thermiques (dues à la chaleur), surviennent lorsque certaines cellules ou toutes les cellules de la peau ou d’autres tissus sont détruites par des liquides bouillants, des solides chauds (brûlures de contact), ou des flammes. En France, l’incidence des brûlures prises en charge à l’hôpital est environ de 13 pour 100 000 habitants. La prise en charge en urgence du brûlé grave par lésion thermique est bien décrite, une recommandation de pratique professionnelle a été publiée en 2019 par la Société française d’anesthésie et de réanimation, en association avec la Société francophone de brûlologie, la Société française de médecine d’urgence et l’Association des anesthésistes-réanimateurs pédiatriques d’expression française. Pourtant, l’urgentiste va être confronté à de nombreuses brûlures de gravité et de nature différentes. Nous faisons ici une mise au point sur les données connues en termes d’épidémiologie, de manifestations cliniques et des différentes thérapeutiques qui peuvent être proposées dans la prise en charge des brûlures. Nous faisons aussi le point sur les localisations à risque particulier que l’urgentiste doit connaître, ainsi que sur les intoxications qui peuvent être associées aux brûlures. Nous détaillons aussi certains contaminants qui sont à connaître.
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Abstract
Carbon monoxide is a colorless, odorless, highly toxic gas primarily produced through the incomplete combustion of organic material. Carbon monoxide binds to hemoglobin and other heme molecules, causing tissue hypoxia and oxidative stress. Symptoms of carbon monoxide poisoning can vary from a mild headache to critical illness, which can make diagnosis difficult. When there is concern for possible carbon monoxide poisoning, the diagnosis can be made via blood co-oximetry. The primary treatment for patients with carbon monoxide poisoning is supplemental oxygen, usually delivered via a nonrebreather mask. Hyperbaric oxygen can also be used, but the exact indications are controversial.
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Affiliation(s)
- James A Chenoweth
- Department of Emergency Medicine, University of California - Davis, School of Medicine, 4150 V Street, PSSB Suite 2100, Sacramento, CA 95817, USA; Department of Internal Medicine, Mather VA Medical Center, 10535 Hospital Way, Mather, CA 95655, USA.
| | - Timothy E Albertson
- Department of Emergency Medicine, University of California - Davis, School of Medicine, 4150 V Street, PSSB Suite 2100, Sacramento, CA 95817, USA; Department of Internal Medicine, Mather VA Medical Center, 10535 Hospital Way, Mather, CA 95655, USA; Department of Internal Medicine, University of California - Davis, School of Medicine, 4150 V Street, PSSB Suite 3100, Sacramento, CA 95817, USA
| | - Matthew R Greer
- Department of Emergency Medicine, University of California - Davis, School of Medicine, 4150 V Street, PSSB Suite 2100, Sacramento, CA 95817, USA
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21
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Han S, Cho YS. Limitations of the Comparative Study Between Hyperbaric Oxygen Therapy and Normobaric Oxygen Therapy in Carbon Monoxide Poisoning. J Emerg Med 2021; 60:814-815. [PMID: 34147231 DOI: 10.1016/j.jemermed.2021.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Young Soon Cho
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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22
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Ning K, Zhou YY, Zhang N, Sun XJ, Liu WW, Han CH. Neurocognitive sequelae after carbon monoxide poisoning and hyperbaric oxygen therapy. Med Gas Res 2021; 10:30-36. [PMID: 32189667 PMCID: PMC7871936 DOI: 10.4103/2045-9912.279981] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Carbon monoxide (CO) has been the leading cause of poisoning mortality in many countries and hyperbaric oxygen (HBO) is a widely accepted treatment for CO poisoning. However, some patients with CO poisoning will still develop neurocognitive sequelae regardless of HBO therapy, which can persist since CO poisoning or be present days to weeks after a recovery from CO poisoning. HBO has been used in the prevention and treatment of neurocognitive sequelae after CO poisoning, and some mechanisms are also proposed for the potential neuroprotective effects of HBO on the neurocognitive impairment after CO poisoning, but there is still controversy on the effectiveness of HBO on neurocognitive sequelae after CO poisoning. In this paper, we briefly introduce the neurocognitive sequelae after CO poisoning, summarize the potential predictive factors of neurocognitive sequelae, and discuss the use of HBO in the treatment and prevention of neurocognitive sequelae after CO poisoning.
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Affiliation(s)
- Ke Ning
- Department of Navy Aviation Medicine, Faculty of Naval Medicine, Naval Medical University, Shanghai, China
| | - Yan-Yan Zhou
- Department of Orthopedic Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Ning Zhang
- Department of Navy Aviation Medicine, Faculty of Naval Medicine, Naval Medical University, Shanghai, China
| | - Xue-Jun Sun
- Department of Navy Aviation Medicine, Faculty of Naval Medicine, Naval Medical University, Shanghai, China
| | - Wen-Wu Liu
- Department of Diving and Hyperbaric Medicine, Naval Medical University, Shanghai, China
| | - Cui-Hong Han
- Department of Pathology, the Affiliated No 1 People's Hospital of Jining City, Jining Medical University, Jining, Shandong Province, China
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Multi-analyte calibration and verification of a multi-parameter laser-based pulse oximeter. J Clin Monit Comput 2021; 36:579-586. [PMID: 33871764 DOI: 10.1007/s10877-021-00704-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
Almost since its introduction pulse oximetry was known to overestimate oxygen saturation in cases of carbon monoxide poisoning or elevated methemoglobin (metHb) levels. To eliminate this dangerous behavior some manufacturers have added additional LED emitters to try to increase the number of measured hemoglobin species and to improve measurement accuracy, but have not been very successful. We hypothesized that the use of narrow-band laser light sources would make accurate and precise measurement of the four primary species of hemoglobin possible, even in cases of elevated levels of carboxyhemoglobin (COHb). Calibration and verification studies were performed on a tissue simulator that employed an artificial finger pulsating with whole human blood. This simulator allowed safe generation of 165 different combinations of the levels of oxyhemoglobin (O2Hb), COHb, metHb, and reduced hemoglobin (RHb) for calibration of the laser-based pulse oximeter. A follow-on study used 56 mixed hemoglobin levels for verification and statistical analysis of the performance of this device. This laser-based pulse oximeter measured all four species of hemoglobin accurately and precisely (ARMS ≤ 1.8%) for metHb levels in the clinically normal range. At elevated metHb levels the device continued to provide accurate and precise measurements of metHb and RHb (ARMS ≤ 1.7%). The use of monochromatic laser light sources can create a new generation of highly accurate, multi-parameter, pulse oximeters.
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[Inhalation of Flue Gases - Carbon Monoxide Intoxication]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:69-74. [PMID: 33412605 DOI: 10.1055/a-1023-3116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Most intoxications caused by inhalation are due to carbon monoxide (CO). Usually the reasons are fires in buildings from which people cannot escape quickly enough, open fire places or carbon monoxide emissions from combustion plants. In Germany, there are more than 4000 intoxications and over 600 fatalities resulting from CO poisining every year. Although there is a general awareness of the risks associated with CO, the specific risks and especially methods of protection are not sufficiently known.
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Han S, Nah S, Choi S, Lee YH, Kim GW, Cho YS. Hyperbaric Oxygen Therapy Did Not Prevent Delayed Neuropsychiatric Sequelae in a Prospective Observational Study With Propensity Score Matching in 224 Patients With Acute Carbon Monoxide Toxicity. J Emerg Med 2020; 60:498-505. [PMID: 33298359 DOI: 10.1016/j.jemermed.2020.10.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/24/2020] [Accepted: 10/19/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is important to prevent the development of delayed neuropsychiatric sequelae (DNS) in acute carbon monoxide (CO) intoxication, but no effective treatment has been clearly identified. Hyperbaric oxygen (HBO) therapy is one of the treatment options in acute CO poisoning; however, whether it can prevent the development of DNS is controversial. OBJECTIVES The purpose of this study is to compare the effectiveness of normobaric oxygen (NBO) and HBO in preventing DNS. METHODS This prospective observational study was conducted on all patients with CO poisoning admitted to the emergency department of a tertiary hospital from 2016 to 2019. We followed-up patients to determine whether symptoms of DNS occurred at ≤6 months. We matched the propensity score to an equivalent distribution of potential covariates. RESULTS A total of 224 patients with CO poisoning were enrolled in this study. NBO was used for 26 patients and HBO for 198 patients. DNS occurred in 40 patients. There were significant differences between the NBO and HBO groups in terms of carboxyhemoglobin, loss of consciousness, dizziness, chest pain, hospitalization, and length of hospital stay. The incidence of DNS was 19.2% in the HBO group, which was higher than the 7.7% observed in the NBO group, but the difference was not significant (p = 0.18). After propensity score matching, the incidence of DNS did not differ between the NBO and HBO groups (8.3% vs. 10.4%, p > 0.99). CONCLUSION There was no difference in the incidence of DNS between groups receiving HBO and NBO in acute CO intoxication.
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Affiliation(s)
- Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sangun Nah
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sungwoo Choi
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Young Hwan Lee
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Gi Woon Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Young Soon Cho
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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Costanza A, Ambrosetti J, Spagnoli P, Amerio A, Aguglia A, Serafini G, Amore M, Bondolfi G, Sarasin F, Pignel R. Urgent hyperbaric oxygen therapy for suicidal carbon monoxide poisoning: from a preliminary survey to a proposal for an integrated somatic-psychiatric protocol. Int J Emerg Med 2020; 13:61. [PMID: 33267798 PMCID: PMC7709427 DOI: 10.1186/s12245-020-00321-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 11/21/2020] [Indexed: 01/10/2023] Open
Abstract
A considerable number of patients who made a carbon monoxide (CO) suicidal attempt are treated with urgent hyperbaric oxygen therapy (HBOT). For these patients at potential persistent risk of suicide, the hyperbaric chamber is a dangerous environment and their management a complex challenge for the Emergency Department (ED) and Hyperbaric Medicine Unit (UMH) teams. We aimed to (1) identify cases of intentional CO poisoning treated with urgent HBOT in the UMH of the University Hospitals of Geneva (HUG) during 2011-2018 and (2) test a proposed operational and integrated somatic-psychiatric protocol based on acquired experience. A total of 311 patients with CO poisoning were treated using urgent HBOT, for which poisoning was assumed suicidal in 40 patients (12.9%). This percentage appears greater than in other European countries. Both the excess of cases of intentional CO poisonings and difficulties encountered in their management resulted in the implementation of an operational and integrated somatic-psychiatric protocol addressing the entire patient's clinical trajectory, from the admission at ED-HUG to the treatment at the UMH-HUG. The established institutional protocol includes (1) clinical evaluation, (2) suicide risk assessment, and (3) safety measures. This is the first report-at our best knowledge-of a protocol detailing a practical procedure algorithm and focusing on multidisciplinary and mutual collaboration between the medical-nursing teams at the ED, psychiatric ED, and UMH. Improvements in patient's safety and care team's sense of security were observed. In conclusion, the opportunity to refer to a standardized protocol was beneficial in that it offers both reduced risks for suicidal patients and reduced stress for care teams operating in very acute and complex situations. Further studies are needed.
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Affiliation(s)
- Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland. .,Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
| | - Julia Ambrosetti
- Emergency Department and Psychiatry Department, Emergency Psychiatric Unit (UAUP), Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Philippe Spagnoli
- Emergency Department, Hyperbaric Medicine Unit, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Psychiatry, Tufts University, Boston, USA
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Guido Bondolfi
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland.,Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention (SPLIC), Geneva University Hospitals (HUG), Geneva, Switzerland
| | - François Sarasin
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland.,Emergency Department, Emergency Medicine Unit, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Rodrigue Pignel
- Emergency Department, Hyperbaric Medicine Unit, Geneva University Hospitals (HUG), Geneva, Switzerland
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Abstract
OBJECTIVES This study aimed to describe the epidemiology and clinical burden of unintended carbon monoxide (CO) poisoning among children in the Negev region of southern Israel. METHODS This was a cross-sectional retrospective study of CO poisoning patients admitted to Soroka University Medical Center in 2011 through 2015. RESULTS Overall, 43 cases of CO poisoning were recorded among children younger than 18 years. Five patients died, all upon admission. Poisoning due to smoke "per se" and due to CO emitted from heating devices were responsible for 28 (65.1%) and 14 (32.6%) cases, respectively. Eight (18.6%) patients suffered from convulsions, and 13 (43.3%) of 30 evaluable patients complained of headaches. Twenty-two (51.2%) were found unconscious in the field, and 7 (16.3%) were unconscious at examination at the emergency department. The average carboxyhemoglobin level on admission was 10.5% ± 10.4% (level ranging from 0.1% to 46.2%). Treatment included oxygen in 34 patients (79%) and hyperbaric oxygen therapy in 8 patients (19%). No differences were found between Bedouin and Jewish children in sex, age, residence area, source of CO poisoning, symptoms severity, and need for hyperbaric oxygen therapy. More patients with exposure to water heating devices were older than 4 years, lived in villages, and were diagnosed as having loss of consciousness in the field compared with those exposed to smoke inhalation. CONCLUSIONS Carbon monoxide poisoning in children is frequent in southern Israel. Education about prevention, implementation of safer standards for home heating systems, and government supervision are required management strategies to decrease the CO poisoning incidence in southern Israel.
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Abstract
BACKGROUND Carbon monoxide poisoning affects approximately 5000 children per year and can be challenging to diagnose and treat (Pediatr Emerg Med Pract. 2016;13:1-24). It is in the differential diagnosis of a patient presented with altered consciousness. Patients may look quite "pink" and well perfused, but are often in serious distress. We present the first case in the literature of carbon monoxide poisoning treated with the use of veno-veno extracorporeal membrane oxygenation (ECMO). CASE We report the case of a 10-year-old patient who had carbon monoxide poisoning (carboxyhemoglobin of 18%). She was treated with hydroxocobalamin at 70 mg/kg and was being prepared to transfer to a facility that offered hyperbaric therapy when she suffered a cardiac arrest requiring cardiopulmonary resuscitation. After 11 minutes of resuscitation, she had return of spontaneous circulation and an echocardiogram showed reasonable cardiac function. She was judged too unstable for ambulance transport and the ECMO team was called. Veno-veno ECMO was placed via a single right internal jugular dual-lumen catheter with fluoroscopy in the cardiac catheterization laboratory. There was a rapid improvement in carboxyhemoglobin level, and the ECMO therapy was weaned the next day. The patient eventually made a full recovery. CONCLUSIONS This is the first time that veno-veno ECMO has been reported for the emergent treatment of carbon monoxide intoxication. If emergency physicians are treating such a patient and cannot administer hyperbaric oxygen therapy, ECMO represents a valuable alternative that is not commonly thought of in this situation before.
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Long B, Long DA, Tannenbaum L, Koyfman A. An emergency medicine approach to troponin elevation due to causes other than occlusion myocardial infarction. Am J Emerg Med 2020; 38:998-1006. [DOI: 10.1016/j.ajem.2019.12.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/18/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
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High-Sensitivity Troponin I and Creatinine Kinase-Myocardial Band in Screening for Myocardial Injury in Patients with Carbon Monoxide Poisoning. Diagnostics (Basel) 2020; 10:diagnostics10040242. [PMID: 32326299 PMCID: PMC7235999 DOI: 10.3390/diagnostics10040242] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022] Open
Abstract
Myocardial dysfunction due to acute carbon monoxide (CO) poisoning is common and associated with poor outcomes. The role of cardiac markers, including creatine kinase-myocardial band (CK-MB), high-sensitivity troponin I (hsTnI), and brain natriuretic peptide (BNP), in identifying patients with CO-induced cardiomyopathy were evaluated. This single-center, retrospective cohort study included 905 consecutive adult patients in the CO poisoning registry from February 2009 to December 2019. Cardiomyopathy was defined as any abnormality on transthoracic echocardiography (TTE), including left ventricular systolic and diastolic dysfunction, right ventricular dysfunction, and wall motion abnormalities. The areas under receiver operating curves (AUCs) for biomarkers were compared. Of the 850 included patients, 101 (11.9%) had CO-induced cardiomyopathy. Initial and peak hsTnI and CK-MB concentrations, and initial BNP concentrations were significantly higher in patients with than without cardiomyopathy (all P-values < 0.01), but the AUCs were higher for hsTnI (0.894) and CK-MB (0.864) than for BNP (0.796). Initial TnI > 0.01 ng/mL and CK-MB > 1.5 ng/mL each had 95% sensitivity and 97% negative predictive value for CO-induced cardiomyopathy. Higher hsTnI or CK-MB levels on admission can identify patients at high-risk of CO-induced cardiomyopathy and can be a screening tool for CO poisoning.
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Su C, Zhao N, Zou J, Yan X. TDZD-8 alleviates delayed neurological sequelae following acute carbon monoxide poisoning involving tau protein phosphorylation. Inhal Toxicol 2020; 32:79-85. [PMID: 32188325 DOI: 10.1080/08958378.2020.1741739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: Acute carbon monoxide (CO)poisoning can cause delayed neurological sequelae (DNS). Glycogen synthase kinase 3β (GSK-3β) /Tau protein pathway is reported to play a key role in neurological abnormalities. In the present study, we aimed to determine the role of GSK-3β/Tau in DNS following acute CO poisoning.Methods: 4-benzyl-2-methyl-1,2,4-thiadiazolidine-3,5-dione (TDZD-8), a specific non-competitive inhibitor of GSK-3β, was used to inhibit GSK-3β. Twenty-four male Sprague-Dawley rats were randomly assigned to the three groups: Control group, CO group and CO-TDZD-8 group. Rats breathed 1000 ppm CO for 40 minutes and then 3000 ppm for up to 20 minutes until they lost consciousness. TDZD-8 (1 mg/kg) was administered intravenously three times after the end of CO exposure at 0, 24, 48 hours late. Learning and memory abilities were observed using the Morris Water Maze (MWM). Brain histological changes were evaluated by hematoxylin-eosin staining. Moreover, the expression levels of Tau and GSK-3β were detected after acute carbon monoxide poisoning.Results: TDZD-8 significantly attenuated the learning and memory dysfunction induced by acute CO poisoning, ameliorated the histology structure of damaged neural cells in cortex and hippocampus CA1 area. TDZD-8 clearly decreased p-Tau expression, reversed the reduction of p-GSK-3β induced by acute CO poisoning.Conclusions: The therapeutic effect of TDZD-8 in alleviating DNS caused by acute CO poisoning is related to the inactivation of Tau by intensifying the level of GSK-3β phosphorylation.
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Affiliation(s)
- Chenglei Su
- Department of Emergency Medicine Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Ningjun Zhao
- Department of Emergency Medicine Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jianjiao Zou
- Department of Emergency Medicine Center, Lanling Hospital, Linyi, Shandong, China
| | - Xianliang Yan
- Department of Emergency Medicine Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Martínez-Sánchez L, Ferrés-Padró V, Martínez-Millán D, Fernández-Calabria C, Amigó-Tadín M, Jiménez-Fàbrega FX, Nogué-Xarau S. Prehospital emergency care of patients exposed to poisoning: Assessment of epidemiological, clinical characteristics and quality of care. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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33
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Problems Related to Physical Agents. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_170-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sarı Doğan F, Güneysel Ö, Gökdağ E, Güneş M, Sümen SG. Demographic characteristics and delayed neurological sequelae risk factors in carbon monoxide poisoning. Am J Emerg Med 2019; 38:2552-2556. [PMID: 31889577 DOI: 10.1016/j.ajem.2019.12.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/01/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022] Open
Abstract
AIM Carbon monoxide (CO) is a colorless, odorless gas and tasteless. CO poisoning (COP) is one of the most frequently encountered inhalation poisonings. The most common cause of morbidity in COP is delayed neurological sequelae (DNS). DNS is the occurrence of neuropsychiatric findings within 2-240 days after discharge of patients with COP and there are no definitive diagnostic criteria. The aim of our study is; to determine the risk factors and incidence of DNS. METHOD Our study is a retrospective, observational study. Patients with the diagnosis of COP in the emergency department between 2015 and 2016 were included in the study. Patients age, gender, findings in the initial physical examination (PE) and neurological examination (NE), blood carboxyhemoglobin (COHb) level, relation between hyperbaric oxygen (HBO) treatment and DNS were assessed. RESULTS Total of 72 patients were included in the study. Mean age was 33.43 ± 20.89. It was determined that pathological findings in the initial NE are a significant predictive factor for DNS (Odds ratio 18.600, p:0.004). Significant relation between NE and HBO treatment was present (p:00.1). There was no statistically significant relationship between initial COHb level and receiving HBO treatment (p:0.9). Median COHb level of patients with DNS was 30 (min:10, max: 43), median COHb level of patients without DNS was 25 (min:10, max:44) and there was no statistically significant relationship between the two groups according to COHb levels (p:0.7). CONCLUSION Pathological findings in the initial neurological examination had a predictive value for delayed neurological sequelae in patients with carbon monoxide poisoning.
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Affiliation(s)
- Fatma Sarı Doğan
- Emergency Medicine Clinic, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey.
| | - Özlem Güneysel
- Emergency Department, Maltepe University Faculty of Medicine, Istanbul, Turkey
| | - Eren Gökdağ
- Emergency Department, Yeditepe University Faculty of Medicine, Istanbul, Turkey
| | - Merve Güneş
- Anesthesia and Intensive Medicine, Vivantes Klinikum am Urban, Berlin, Germany
| | - Selin Gamze Sümen
- Underwater and Hyperbaric Medicine, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
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Cho Y, Kang H, Oh J, Lim TH, Ryu J, Ko BS. Risk of Venous Thromboembolism After Carbon Monoxide Poisoning: A Nationwide Population-Based Study. Ann Emerg Med 2019; 75:587-596. [PMID: 31759754 DOI: 10.1016/j.annemergmed.2019.08.454] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/19/2019] [Accepted: 08/26/2019] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE Few studies have investigated the association between carbon monoxide (CO) poisoning and risk of venous thromboembolism. We aim to identify the risk of pulmonary embolism and deep venous thrombosis after CO poisoning. METHODS We conducted a nationwide cohort-crossover study using administrative claims data in Korea. We compared the risk of venous thromboembolism (pulmonary embolism or deep venous thrombosis) in the cohort period after CO poisoning to that of the same period 1 year later (crossover period), using conditional logistic regression analysis. RESULTS We included 22,699 patients with a diagnosis of CO poisoning during the study period between 2004 and 2015. The risk of venous thromboembolism was significantly elevated during days 0 to 90 after CO poisoning (odds ratio 3.96; 95% confidence interval 2.50 to 6.25). However, this risk was not significantly elevated during subsequent postexposure periods through 360 days. During days 0 to 30 after CO poisoning, the risks of pulmonary embolism (odds ratio 22.00; 95% confidence interval 5.33 to 90.75) and deep venous thrombosis (odds ratio 10.33; 95% confidence interval 3.16 to 33.80) were significantly elevated. CONCLUSION We found that the risk of venous thromboembolism persisted for up to 90 days after CO poisoning. The risk was increased 22-fold for pulmonary embolism and 10-fold for deep venous thrombosis, especially in the first month after CO poisoning. Patients should be monitored for venous thromboembolism risk after CO poisoning.
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Affiliation(s)
- Yongil Cho
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Jiin Ryu
- Biostatistical Consulting and Research Laboratory, Medical Research Collaborating Center, Hanyang University, Seoul, Republic of Korea
| | - Byuk Sung Ko
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea.
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Eichhorn L, Thudium M, Jüttner B. The Diagnosis and Treatment of Carbon Monoxide Poisoning. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:863-870. [PMID: 30765023 DOI: 10.3238/arztebl.2018.0863] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/04/2018] [Accepted: 09/24/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The symptoms of carbon monoxide (CO) poisoning are nonspecific, ranging from dizziness and headache to unconsciousness and death. A German national guideline on the diagnosis and treatment of this condition is lacking at present. METHODS This review is based on a selective literature search in the PubMed and Cochrane databases, as well as on existing guidelines from abroad and expert recommendations on diagnosis and treatment. RESULTS The initiation of 100% oxygen breathing as early as possible is the most important treatment for carbon monoxide poisoning. In case of CO poisoning, the reduced oxygen-carrying capacity of the blood, impairment of the cellular respiratory chain, and immune-modulating processes can lead to tissue injury in the myocardium and brain even after lowering of the carboxyhemoglobin (COHb) concentration. In patients with severe carbon monoxide poisoning, an ECG should be obtained and biomarkers for cardiac ischemia should be measured. Hyperbaric oxygen therapy (HBOT) should be critically considered and initiated within six hours in patients with neurologic deficits, unconsciousness, cardiac ischemia, pregnancy, and/or a very high COHb concentration. At present, there is no general recommendation for HBOT, in view of the heterogeneous state of the evidence from multiple trials. Therapeutic decision-making is directed toward the avoidance of sequelae such as cognitive dysfunction and cardiac complications, and the reduction of mortality. Smoke intoxication must be considered in the differential diagnosis. The state of the evidence on the diagnosis and treatment of this condition is not entirely clear. Alternative or supplementary pharmacological treatments now exist only on an experimental basis. CONCLUSION High-quality, prospective, randomized trials that would enable a definitive judgment of the efficacy of HBOT are currently lacking.
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Affiliation(s)
- Lars Eichhorn
- Department of Anaesthesiology and Intensive Care University Hospital Bonn (UKB), Bonn Clinic for Anesthesiology and Intensive Care Medicine, Hannover Medical School
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Carbon Monoxide and Cyanide Poisoning in the Burned Pregnant Patient: An Indication for Hyperbaric Oxygen Therapy. Ann Plast Surg 2019; 80:S106-S112. [PMID: 29461288 DOI: 10.1097/sap.0000000000001351] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Carbon monoxide (CO) is a small molecule poison released as a product of incomplete combustion. Carbon monoxide binds hemoglobin, reducing oxygen delivery. This effect is exacerbated in the burned pregnant patient by fetal hemoglobin that binds CO 2.5- to 3-fold stronger than maternal hemoglobin. With no signature clinical symptom, diagnosis depends on patient injury history, elevated carboxyhemoglobin levels, and alterations in mental status. The standard of care for treatment of CO intoxication is 100% normobaric oxygen, which decreases the half-life of CO in the bloodstream from 5 hours to 1 hour. Hyperbaric oxygen (HBO2) is a useful adjunct to rapidly reduce the half-life of CO to 20 minutes and the incidence of delayed neurologic sequelae. Because of the slow disassociation of CO from hemoglobin in the fetus, there is a far stronger indication for HBO2 in the burned pregnant patient than in other burn patient populations.Cyanide intoxication is often a comorbid disease with CO in inhalation injury from an enclosed fire, but may be the predominant toxin. It acts synergistically with CO to effectively lower the lethal doses of both cyanide and CO. Diagnosis is best made in the presence of high lactate levels, carboxyhemoglobin concentrations greater than 10%, injury history of smoke inhalation from an enclosed fire, and alterations in consciousness. While treatment with hydroxocobalamin is the standard of care and has the effect of reducing concomitant CO toxicity, data indicate cyanide may also be displaced by HBO2.Carbon monoxide and cyanide poisoning presents potential complications impacting care. This review addresses the mechanism of action, presentation, diagnosis, and treatment of CO and cyanide poisonings in the burned pregnant patient and the use of HBO2 therapy.
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Carbon monoxide poisoning at a Florida Hospital following Hurricane Irma. Am J Emerg Med 2019; 37:1800-1801. [DOI: 10.1016/j.ajem.2019.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 11/22/2022] Open
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Life-Threatening Acute Pulmonary Thromboembolism Following Severe Carbon Monoxide Poisoning. JACC Case Rep 2019; 1:208-212. [PMID: 34316786 PMCID: PMC8301243 DOI: 10.1016/j.jaccas.2019.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/09/2019] [Indexed: 11/21/2022]
Abstract
A 57-year-old man admitted with severe carbon monoxide (CO) poisoning suffered life-threatening pulmonary embolism (PE) after hyperbaric oxygen therapy, in the absence of other risk factors for thromboembolism, and was successfully treated with thrombolysis. CO is a thrombophilic condition predisposing to PE and active surveillance is advisable. (Level of Difficulty: Advanced.)
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40
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Exposure Duration and History of Hypertension Predicted Neurological Sequelae in Patients with Carbon Monoxide Poisoning. Epidemiology 2019; 30 Suppl 1:S76-S81. [DOI: 10.1097/ede.0000000000001000] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Inhalationstrauma durch Rauchgas bei Bränden. Notf Rett Med 2019. [DOI: 10.1007/s10049-018-0450-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Eichhorn L, Kieback M, Michaelis D, Kemmerer M, Jüttner B, Tetzlaff K. [Treatment of carbon monoxide poisoning in Germany : A retrospective single center analysis]. Anaesthesist 2019; 68:208-217. [PMID: 30789991 DOI: 10.1007/s00101-019-0544-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 12/04/2018] [Accepted: 01/11/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The symptoms of acute carbon monoxide (CO) poisoning are unspecific, ranging from headaches to unconsciousness and death. In addition to acute symptoms, delayed severe neurological sequelae may occur. While a total of 440 deaths by CO poisoning were registered in Germany in 1999, a total of 594 patients died (0.73 per 100,000 inhabitants) in 2014 and in 2015 the number even increased to 648 deaths. A national database on clinical symptoms, course of illness or quality of care concerning CO poisoning does not yet exist. METHODS The treatment data of patients admitted to the Hyperbaric Emergency Centre Wiesbaden (HEC) from 2013 to 2017 with CO poisoning formed the basis of the study. This was a comparative evaluation of patient demographics, poisoning sources, symptom spectrum, course of treatment and time intervals registered on the preclinical and clinical levels. RESULTS From 2013 to 2017 a total of 476 patients (282 men and 194 women) with an average non-invasively measured CO-Hb of 15% (Q0.25 = 7.6%, Q0.75 = 22.3%) were treated with hyperbaric oxygen. Heaters (n = 131), charcoal barbecues (n = 93), fires (n = 90), hookahs (n = 78) and combustion engines (n = 37) were the most frequent CO sources identified. Headaches, vertigo, nausea and syncope were the most prevalent symptoms. A median of 91 min (Q0.25 = 53 min; Q0.75 = 147 min) passed between first medical contact and BGA-validated diagnosis. In total, 151 patients were transferred directly to the HEC, whereas 325 patients were secondarily transferred. The delay in this subgroup took 183 min (median Q0.25 = 138 min; Q0.75 = 248 min). After receiving the first hyperbaric treatment, 80% were free of symptoms. Remaining symptoms included headache (10%), fatigue (8%), vertigo (5%) and nausea (3%) and 45 patients terminated further treatment. Of the patients 417 received a second hyperbaric treatment and 370 patients were treated 3 times. After the third treatment, 89% were free of symptoms and 5% still reported headaches, 3% vertigo and 2% fatigue. In total, 6 patients died and 430 patients were symptom-free after treatment. CONCLUSION Commonly known sources (fire, charcoal grills) aside, many poisonings by smoking a hookah were observed. This study highlights the importance of considering CO poisoning as a differential diagnosis when encountering patients, especially of younger age, with non-specific neurological symptoms, as well as the importance of early initiation of treatment. A direct correlation between CO-Hb values (whether measured noninvasively or by invasive BGA) and the initial symptoms could not be demonstrated. In total, substantial time expired between the diagnosis and start of treatment of patients transported to a primary care hospital compared to those transported directly to the HEC. Although analysis showed adequate treatment with oxygen in the preclinical interval, administration of oxygen during primary hospital stay showed room for improvement. Introducing a national CO poisoning register and uniform treatment guidelines could improve in-house clinical processes. Multicenter studies are needed to close the gaps identified in the quality of care in Germany.
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Affiliation(s)
- L Eichhorn
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn (AöR), Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland.
| | - M Kieback
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn (AöR), Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland
| | - D Michaelis
- Druckkammerzentrum Rhein Main Taunus GmbH, Wiesbaden, Deutschland
- Paulinen Klinik Wiesbaden, Wiesbaden, Deutschland
| | - M Kemmerer
- Druckkammerzentrum Rhein Main Taunus GmbH, Wiesbaden, Deutschland
| | - B Jüttner
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - K Tetzlaff
- Abteilung Sportmedizin - Medizinische Klinik, Universitätsklinikum Tübingen, Tübingen, Deutschland
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Jüttner M, Körner-Göbel H, Starke H, Enax S, Eismann H, Göbel V, Eichhorn L, Jüttner B. [Evaluation and assessment of the health care process in patients with carbon monoxide poisoning in Germany]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2019; 140:1-13. [PMID: 30598287 DOI: 10.1016/j.zefq.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Carbon monoxide poisoning (COP) is the most common cause for poisoning by inhalation in Germany. In the past 8 years, a marked increase in the number of COP-related deaths has been registered nationwide. A national German guideline is missing. METHODS The national and international literature was screened systematically. Existing international guidelines and expert recommendations for the diagnosis and treatment of COP were compared and evaluated. Furthermore, quality of health care was analyzed by a prospective preclinical dataset of emergency rescue services and retrospective analysis of routine data from 2014 to 2016 in Germany. RESULTS There is not a single evidence-based guideline worldwide. We determined 8 key performance indicators based on the five recommendations available for treatment of COP. These indices were subdivided into prehospital terms, hospital facilities, and diagnostic and therapeutic measures performed; they act as indicators for quality of care. In particular, the key figure "start oxygen" revealed that up to 41 % of the patients had not been treated with inhaled oxygen. In summary, data capture showed considerable incompleteness that is mainly due to missing time stamps. CONCLUSION In order to achieve a consistent treatment of patients with COP which meets the standard of recommended care, there is an urgent need for a consented national guideline. Another objective is to establish a nationwide prospective registry evaluating the treatment of carbon monoxide poisoning.
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Affiliation(s)
- Marieke Jüttner
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Hella Körner-Göbel
- HELIOS Universitätsklinikum Wuppertal, Institut für Notfallmedizin, Wuppertal, Deutschland
| | - Henning Starke
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Sascha Enax
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Hendrik Eismann
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Volker Göbel
- Berufsfeuerwehr Wuppertal, Wuppertal, Deutschland
| | - Lars Eichhorn
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Björn Jüttner
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland.
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Ozturan IU, Yaka E, Suner S, Ozbek AE, Alyesil C, Dogan NO, Yilmaz S, Pekdemir M. Determination of carboxyhemoglobin half-life in patients with carbon monoxide toxicity treated with high flow nasal cannula oxygen therapy. Clin Toxicol (Phila) 2019; 57:617-623. [DOI: 10.1080/15563650.2018.1540046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Ibrahim Ulas Ozturan
- Brown Advanced Emergency Medicine Academies, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Elif Yaka
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Selim Suner
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Asim Enes Ozbek
- Department of Emergency Medicine, University of Health Science, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Cansu Alyesil
- Department of Emergency Medicine, Mersin State Hospital, Mersin, Turkey
| | - Nurettin Ozgur Dogan
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Serkan Yilmaz
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Murat Pekdemir
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Tomruk O, Karaman K, Erdur B, Armagan HH, Beceren NG, Oskay A, Bircan HA. A New Promising Treatment Strategy for Carbon Monoxide Poisoning: High Flow Nasal Cannula Oxygen Therapy. Med Sci Monit 2019; 25:605-609. [PMID: 30663634 PMCID: PMC6350449 DOI: 10.12659/msm.914800] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background High-flow nasal cannula (HFNC) is an alternative to conventional normobaric oxygen therapy (NBO) for hypoxemic patients. Since nothing is known about its effect on carbon monoxide (CO) poisoning, we hypothesized that HFNC might be a useful device in the treatment of CO poisoning victims. Material/Methods We retrospectively reviewed the medical records of patients who were admitted consecutively to the emergency department with CO intoxication. Patients were divided into 2 groups: patients treated with HFNC and patients treated with conventional face mask (CFM). Demographic data, pretreatment, and control (after 1 hour) arterial blood gas analyses values of the patients were evaluated. Results Sixty-eight patients (mean age 35.8±18.7 years) were included in this study. NBO was given via HFNC to 38 patients (55.9%), and via CFM to 30 patients (44.1%). The demographic characteristics and pretreatment values of carboxy-hemoglobin (COHb) were similar in the 2 groups. The mean COHb value of the HFNC group at the first hour was found significantly lower than the CFM group: 9.5±4.7 and 12.0±5.1, respectively (P=0.041). Improvement of COHb level was significantly higher in the HFNC group compared to the CFM group: 12.5±4.5 versus 6.7±3.7, respectively (P=0.001). Conclusions HFNC was superior than CFM in alleviating COHb levels in the victims of CO poisoning. We believe that using HFNC will increase patient comfort by shortening the duration of treatment in emergency department settings, especially in patients who have mild clinical findings of CO poisoning.
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Affiliation(s)
- Onder Tomruk
- Department of Emergency Medicine, Medical Faculty, Suleyman Demirel University, Isparta, Turkey
| | - Kıvanç Karaman
- Department of Emergency Medicine, Medical Faculty, Suleyman Demirel University, Isparta, Turkey
| | - Bulent Erdur
- Department of Emergency Medicine, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - Hamit Hakan Armagan
- Department of Emergency Medicine, Medical Faculty, Suleyman Demirel University, Isparta, Turkey
| | - Nesrin Gökben Beceren
- Department of Emergency Medicine, Medical Faculty, Suleyman Demirel University, Isparta, Turkey
| | - Alten Oskay
- Department of Emergency Medicine, Medical Faculty, Suleyman Demirel University, Isparta, Turkey
| | - Haci Ahmet Bircan
- Department of Chest Diseases, Medical Faculty, Suleyman Demirel University, Isparta, Turkey
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Moon JM, Chun BJ, Lee SD, Shin MH. The impact of hyperthermia after acute carbon monoxide poisoning on neurological sequelae. Hum Exp Toxicol 2018; 38:455-465. [PMID: 30545252 DOI: 10.1177/0960327118814151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigated whether hyperthermia within the first 24 h after presentation was associated with long-term neurological outcomes after acute carbon monoxide (CO) poisoning. This retrospective study included 200 patients with acute severe CO poisoning. Hyperthermia (≥ 37.5°C) developed during the first 24 h after presentation in 55 (27.5%) patients, and poor long-term neurological sequelae assessed at 23 months after acute CO poisoning developed in 19.5% of the patients. The incidence of poor long-term neurological outcomes was significantly higher in the hyperthermia group than in the normothermia group. Patients with poor long-term neurological outcomes had higher maximum temperatures than patients with good outcomes. No significant difference was found in the time of hyperthermia onset within the first day according to the neurological outcomes. Hyperthermia (adjusted odds ratio (aOR) 5.009 (95% confidence interval (CI) 1.556-16.126)) and maximum temperature (aOR 2.581 (95% CI 1.098-6.063)) within the first 24 h after presentation to the emergency department were independently associated with poor long-term neurological outcomes. Body temperature measurements, which are easily and noninvasively recorded at the bedside in any facility, help to predict the risk for poor long-term neurological outcomes. This study carefully emphasizes fastidious control of pyrexia, particularly during the early period after acute CO poisoning.
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Affiliation(s)
- J M Moon
- 1 Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - B J Chun
- 1 Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - S D Lee
- 1 Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - M H Shin
- 2 Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea
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Fujita M, Oda Y, Kaneda K, Kawamura Y, Nakahara T, Todani M, Yagi T, Koga Y, Tsuruta R. Variability in Treatment for Carbon Monoxide Poisoning in Japan: A Multicenter Retrospective Survey. Emerg Med Int 2018; 2018:2159147. [PMID: 30627443 PMCID: PMC6304618 DOI: 10.1155/2018/2159147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/07/2018] [Accepted: 11/22/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The aim of this study was to identify practice differences in the treatment of carbon monoxide (CO) poisoning with or without hyperbaric oxygen (HBO2) therapy in Japan. MATERIALS AND METHODS Using an online survey website (Google form), we created a questionnaire and invited interested institutions to join the COP-J Study, a prospective observational study of CO poisoning in Japan. RESULTS Forty-eight (63%) of 76 institutions replied to the questionnaire. Thirty-three institutions (69%) administered HBO2 therapy to patients with CO poisoning, and 15 institutions (31%) did not. Consciousness disturbance on arrival, exposure to CO for a long time, and elevation of arterial carboxyhemoglobin (CO-Hb) were the major indications for HBO2 therapy. The maximum therapeutic pressures were 2.0, 2.5, and 2.8 atmospheres absolute (ATA) at 19 (58%), 6 (18%), and 8 (24%) institutions, respectively. The number of HBO2 sessions on the first day was 1-3, and 1-7 sessions were administered on days 2-7. Seventeen (35%) institutions treated patients with delayed neurological sequelae (DNS) and 15 of them used HBO2 therapy for DNS. CONCLUSIONS This survey indicates that HBO2 therapy for CO poisoning was varied in both the indications and practice regimens used in Japan.
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Affiliation(s)
- Motoki Fujita
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Yasutaka Oda
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Kotaro Kaneda
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Yoshikatsu Kawamura
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Takashi Nakahara
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Masaki Todani
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Takeshi Yagi
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Yasutaka Koga
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Ryosuke Tsuruta
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
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Ng PC, Long B, Koyfman A. Clinical chameleons: an emergency medicine focused review of carbon monoxide poisoning. Intern Emerg Med 2018; 13:223-229. [PMID: 29435715 DOI: 10.1007/s11739-018-1798-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 02/01/2018] [Indexed: 12/21/2022]
Abstract
Carbon monoxide (CO) is a colorless, odorless gas that is found in the environment, in the home, and in the human body as a normal part of mammalian metabolism. Poisoning from CO, a common exposure, is associated with significant morbidity and mortality if not recognized and treated in a timely manner. This review evaluates the signs and symptoms of CO poisoning, conditions that present similar to CO poisoning, and an approach to the recognition and management for CO poisoning. CO poisoning accounts for thousands of emergency department visits annually. If not promptly recognized and treated, it leads to significant morbidity and mortality. CO poisoning poses a challenge to the emergency physician because it classically presents with non-specific symptoms such as headache, dizziness, nausea, and vomiting. Due to nonspecific presentations, it is easily mistaken for other, more benign diagnoses such as viral infection. The use of specific historical clues such as exposure to non-conventional heat sources or suicide attempts in garages, as well as the use of targeted diagnostic testing with CO-oximetry, can confirm the diagnosis of CO poisoning. Once diagnosed, treatment options range from observation to the use of hyperbaric oxygen. CO poisoning is an elusive diagnosis. This review evaluates the signs and symptoms CO poisoning, common chameleons or mimics, and an approach to management of CO poisoning.
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Affiliation(s)
- Patrick Chow Ng
- Medical Toxicology, Rocky Mountain Poison and Drug Center, Denver Health and Hospital, 1391 Speer Blvd, Denver, CO, 80204, USA.
| | - Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Alex Koyfman
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
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Mass Casualty Triage in the Case of Carbon Monoxide Poisoning: Lessons Learned. Disaster Med Public Health Prep 2017; 12:373-378. [PMID: 28994363 DOI: 10.1017/dmp.2017.65] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTCarbon monoxide (CO) can cause mass intoxication, but no standard triage algorithm specifically addresses CO poisoning. The roles of some recent diagnostic tools in triage as well as treatment with hyperbaric oxygen are controversial. We describe a mass casualty case of CO poisoning involving 77 patients, with a focus on the triage and treatment options decided on-site. The reasons for choosing these options are reviewed, and the pitfalls that occurred and the lessons learned from this major incident are described. We discuss the potential to improve the management of such an event and strategies to accomplish this, including simplifying triage and administering oxygen to all exposed persons for 6 h. (Disaster Med Public Health Preparedness. 2018; 12: 373-378).
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Predicting Cardiotoxic Effects of Carbon Monoxide Poisoning Using Speckle Tracking Echocardiography. Cardiovasc Toxicol 2017; 18:175-183. [DOI: 10.1007/s12012-017-9428-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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