Carbon monoxide: raising awareness of the silent killer in the emergency department.

Background Carbon monoxide (CO) is an odourless gas produced by the incomplete combustion of carbon containing materials. CO poisoning causes a range of symptoms of which headache is the most common, occurring in up to 90% of patients. An audit in the Emergency Department at University Hospital Aintree, Liverpool, UK found a lack of clinical awareness among healthcare professionals (HCPs) with CO exposure being considered in only 0.8% of patients presenting with non-traumatic headache. This Quality Improvement Project (QIP) aimed to increase this consideration to 50% of presentations. Methods Three separate sequential Plan Do Study Act (PDSA) cycles were instigated. Interventions involved verbal reminders to frontline HCPs (cycle 1), using strategically placed CO posters (cycle 2) and finally designing and introducing a CO sticker education scheme (cycle 3). These stickers, highlighting the approved CO COMA acronym, were placed in patient notes to serve as a physical reminder for HCPs when seeing patients. Rapid cycle sequencing was used with each cycle lasting 2 weeks. Patient notes were analysed for evidence that the HCP considered a diagnosis of CO. Results An average of 61 patients were included in each PDSA cycle. Given baseline findings, each cycle demonstrated positive results with CO awareness being considered in 1.7% and 10.0% of patients with non-traumatic headache following cycles 1 and 2, respectively. The final PDSA cycle demonstrated significant increase in consideration of CO to 42.1% of non-traumatic headache presentations. Conclusion This QIP demonstrated that even small interventions can lead to significant change in awareness of CO exposure. Implementation of a CO sticker education scheme is a feasible way of increasing awareness among emergency care professionals and serves as a low-cost, easy to use, transferable and sustainable solution to address the lack of CO awareness in acute emergency settings. Importantly, this serves to promote improved patient safety

Neurogenic pulmonary oedema as a rare complication of epileptic seizures

Introduction: Neurogenic pulmonary oedema (NPE) is a very rare complication of epileptic seizures, which could potentially increase mortality.Material and methods: The case of a 66-year-old male patient with NPE caused by repeated epileptic seizures is reported. Rapid resolution of pulmonary oedema is well documented by X-ray and computed tomography images.Conclusions: Neurogenic pulmonary oedema could potentially increase mortality, and thus, it is important to perform a chest X-ray in all patients presenting with seizures and dyspnoea

Epicardial fat in patients with chronic obstructive pulmonary disease as a marker of high cardiovascular risk — review

Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases (CVD) are commonly interconnected, and this coincidence negatively influences patients’ mortality and morbidity. On the basis of the current available data originating mainly from cardiovascular studies epicardial fat (EF) has been proposed as a marker of cardiovascular risk. This review is focused on a potential role of epicardial fat as a new biomarker for risk stratification of COPD patients. Epicardial fat may present an important link between chronic obstructive pulmonary disease and cardiovascular diseases, mainly coronary artery disease

Nasierdziowa tkanka tłuszczowa u chorych na przewlekłą obturacyjną chorobę płuc jako wskaźnik wysokiego ryzyka zachorowania na choroby układu sercowo-naczyniowego

Przewlekła obturacyjna choroba płuc (POChP) i choroby układu krążenia (CVD) są ze sobą powiązane i fakt ten powoduje wzrost zachorowalności i umieralności. Na podstawie nowych danych pochodzących głównie z badań nad układem krążenia, nasierdziowa tkanka tłuszczowa (EF) została zaproponowana jako marker ryzyka zachorowania na choroby sercowo-naczyniowe. W przedstawionej pracy poglądowej autorzy skupili się na potencjalnym znaczeniu nasierdziowej tkanki tłuszczowej jako nowego biomarkera stratyfikacji ryzyka chorych na POChP. Nasierdziowa tkanka tłuszczowa może stanowić ważny element łączący przewlekłą obturacyjną chorobę płuc i choroby sercowo- -naczyniowe, a zwłaszcza chorobą wieńcową.Przewlekła obturacyjna choroba płuc (POChP) i choroby układu krążenia (CVD) są ze sobą powiązane i fakt ten powoduje wzrost zachorowalności i umieralności. Na podstawie nowych danych pochodzących głównie z badań nad układem krążenia, nasierdziowa tkanka tłuszczowa (EF) została zaproponowana jako marker ryzyka zachorowania na choroby sercowo-naczyniowe. W przedstawionej pracy poglądowej autorzy skupili się na potencjalnym znaczeniu nasierdziowej tkanki tłuszczowej jako nowego biomarkera stratyfikacji ryzyka chorych na POChP. Nasierdziowa tkanka tłuszczowa może stanowić ważny element łączący przewlekłą obturacyjną chorobę płuc i choroby sercowo- -naczyniowe, a zwłaszcza chorobą wieńcową

Recurrent croup is a good indicator of underlying paediatric airway issues: A 10-year retrospective cohort study of airway endoscopy

Objective Children with a history of recurrent croup alert the ENT clinician to the potential for underlying laryngotracheal pathology. There is equipoise about the likelihood of identifying any underlying structural issues or subglottic stenosis in those children who undergo airway assessment. Methods A retrospective cohort study in a tertiary UK paediatric hospital of a decade of children with recurrent croup who underwent a rigid laryngo-tracheo-bronchoscopy (airway endoscopy). Main Outcome(s) airway pathology seen on endoscopy and need for further airway surgery. Results In ten years, 139 children underwent airway endoscopy for recurrent croup. Operative findings were abnormal in 62 (45 %) cases. Twelve cases (9%) had subglottic stenosis. Although recurrent croup was more common in males (78% of cases), this was not found to predispose them to operative findings. Children with previous intubations had >2 times the risk of abnormal findings and children born prematurely (<37 wks) had a trend towards abnormal operative findings versus children with no airway findings in our cohort. Even in those patients with abnormal findings, none necessitated further airway surgery. Conclusions Surgeons and parents can be reassured that rigid airway endoscopy for children with recurrent croup demonstrated high diagnostic utility but will rarely lead to further surgical intervention. Greater understanding about recurrent croup may require consensus clarification about definitions of recurrent croup and/or a universal adoption of a minimum standard operative record or grading system after rigid endoscopy for recurrent croup

Dapagliflozin for the treatment of type 2 diabetes mellitus - an update.

IntroductionDiabetes is a global health concern with a prevalence of 463 million people. Importantly, despite the availability of numerous antidiabetic medications, type 2 diabetes mellitus (T2DM) is still associated with significant morbidity and mortality worldwide. One particular drug of interest is dapagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor that is commonly used in the treatment of Type 2 Diabetes Mellitus (T2DM).Areas coveredThis review outlines the current use and pharmacology of dapagliflozin, with a specific focus on recent evidence regarding benefits in patients with cardiovascular and chronic kidney disease. The article includes an overview of the efficacy and safety of this drug and provides the reader with the expert opinion and perspectives of the authors.Expert opinionIncreasing evidence of the beneficial effects on morbidity and mortality in patients with Type 2 diabetes and concurrent heart failure, acute MI and renal failure are likely to see the usage of dapagliflozin in patients with these comorbidities increase over the next 5 years

Adherence of obstructive sleep apnoea syndrome patients to positive airway pressure therapy - 10-year follow-up

Purpose. Continuous positive airway pressure (CPAP) is the most effective therapy for obstructive sleep apnoea syndrome (OSAS). Long-term adherence is necessary; however, it may be widely variable based on current literature, where the predicting factors are also not well defined. The aim of this study was to assess ten-year adherence to CPAP and to define factors influencing it. Methods. In total, 107 patients (91 males) were enrolled in this study, with an average age of 53.5 years (SD 10.1), with CPAP therapy being indicated (Apnoea-Hypopnoea Index - AHI > 15). Anthropometric and social status data have been obtained as well as the average use of CPAP through device memory. Results. Sufficient adherence (> 4 h per night) was found in 57% of patients in the first year with no subsequent significant change during the next ­9 years. Adherence correlated significantly with the severity of OSAS - AHI (r = 0.321 over 5 years) and Epworth Sleepiness Scale (r = 0.317 over ten years) but did not correlate with the pressure used or the age of the patient. No statistically significant differences have been found between the sexes, the different mask groups, or the social status groups. Conclusion. Good adherence to CPAP therapy in OSAS patients is essential. According to our results, patients with more severe OSAS or more severe sleepiness seem to have better adherence

Mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock

Patients with acute myocardial infarction (MI) complicated by cardiogenic shock (CS) have poor prognosis. Over the last two decades, there has been some improvement in mortality rates associated with CS. Initial measures to stabilise patients should follow a shock protocol, including therapies such as volume expansion, inotropes/vasopressors, and early coronary revascularisation. The use of mechanical circulatory support (MCS) devices demonstrated better haemodynamic and metabolic profiles for patients with CS. However, these benefits have not been consistently translated into significant reductions in cardiovascular adverse events. This review aims to discuss emerging concepts related to CS including an update on its classification and pathophysiology. The focus is on recent evidence regarding the use of MCS and the timing of initiating in patients with CS