Electrocardiographic findings of carbon monoxide intoxication; two cases

IntroductionCarbon monoxide (CO) poisoning is a life threatening emergency. Oxygen delivery to tissues is reduced and hypoxia develops. Most affected systems are the central nervous system and cardiovascular system. For the diagnosis of CO poisoning, first poisoning should be suspected and then blood carboxyhaemoglobin (COHb) levels should be measured. For cardiovascular evaluation ECG is required.Case 1A 56-year-old male patient admitted to ED with complaints of syncope, headache, dizziness and blurred vision. Patient was mentally confused and on ECG sinus tachycardia was present (Fig. 1). On blood gas analysis COHb value was measured 33.3%. Due to syncope and ECG changes hyperbaric oxygen (HBO) therapy initiated. After the treatment, COHb value was measured 4.5% and ECG showed normal sinus rhythm. Patient was discharged with recommendations.Case 2An unconscious 36-year-old female patient admitted to ED with a diagnosis of CO poisoning. ECG revealed ST depression on DII-DIII-AVF leads (Fig. 2) and elevated troponin I (0.1ng/ml) and CK-MB (47U/L) values were determined. On blood gas analysis, COHb value was measured 39.8%. HBO therapy initiated. After HBO therapy patient was conscious and for further follow-up patient was admitted to intensive care unit.Discussion and ConclusionAlthough there is no classic ”carbon monoxide” ECG pattern, sinus tachycardia and ST-T depressions are the most common ECG findings. Even a small amount of exposure to CO can cause myocardial infarction, especially in patients with coronary artery disease. Patients admitting to ED with chest pain and ECG changes may be considered as a possible CO poisoning and patients with CO poisoning must be carefully evaluated for cardiovascular disease

Bullous myringitis: A cause of hearing loss

Bullous myringitis is defined by the presence of blisters on the tympanic membrane which has generally a severe otalgia as a first symptom of presentation. This clinical picture sometimes may be accompanied by sensori-neural hearing loss. In this study, we aimed to share visual content of a patient with Bullous myringitis admitted to the emergency department. Case presentation: A 24-year-old male patient complained of a right severe pain in the right ear and hearing loss was admitted to the emergency department. On physical examination the right tympanic membrane was oedematous, hyperaemic and blisters were seen. The patient was referred to ENT department for evaluation of hearing loss. Bullous myringitis with sensori-neural hearing loss in the right ear was diagnosed. For treatment, pain control and warm compression was recommended. Antibiotic therapy has been also planned for middle ear infection. ENT follow-up were planned for the assessment of hearing loss. Results and discussion: Many microorganisms, especially viruses, m.pneumoniae, chlamydia may cause Bullous myringitis. In the literature bullous myringitis cases that admitted to ED with sensori-neural hearing loss have been reported. Diagnosis is made by clinical examination. Pain control and mild compression may be sufficient for treatment. If concomitant otitis media is present, antibiotics should be added to treatment

A different trauma, a different fracture

Pelvic apophysis avulsion fractures in adolescent athletes are rare injuries and these fractures occur on the growth cartilage on the apophysis plates. Case presentation: A 17-year-old male patient admitted to ED suffering from sharp pain in the right hip and difficulty in walking after kicking ball severely during playing football. On physical examination, there was tenderness in the right thigh consistent with spina iliaca anterior superior (SIAS). Hip movements were within normal range except pain during movement. Neurovascular examination was within normal range. On Pelvic X-ray revealed a crescent shaped avulsion fracture of the right SIAS. The patient was treated conservatively and discharged with recommendations. Discussion and conclusion: The epiphyses and the apophyses are the weakest part of all the skeletal system. In these regions, avulsion fractures may occur with sudden and severe spasm of the muscles. Avulsion fractures of SIAS are mostly treated conservatively unless there is more than 2 cm fragment separated and non-union case in which case surgery is recommended. This type of injuries can be easily overlooked or misdiagnosed due to history of trauma free. It may also effect

Analysis of traumatic mortality cases

In this study we aimed to analyse the trauma cases admitted to hospital and died in the 3-month follow-up. Methods: The cases that admitted to various departments due to trauma in one year period and died in 3 month follow-up were analysed retrospectively. Demographics, causes of trauma, type of arrivals, arrival vital signs and admitted clinic data were saved. The data obtained were evaluated. Results: For one year period 551 cases were admitted to hospital and 35 of them (6.35%) were died in follow up period. The mean age was 54.38 (min:11–max:90) and male/female ratio was 1,7. The most common causes were fall (n = 14), firearm wounds (n = 7) and traffic accidents (n = 4). 15 (42.35%) cases were brought by ambulance. 16 (45.7%) cases were unstable at arrival and it is identified that 11 (68.75%) of them were died in early period. The most common admitted services were neurosurgery (n = 14), orthopaedics (n = 9) and intensive care unit (n = 8). It is determined that 7 (20%) cases were died in early period (1 week) and other 24 (68.5%) cases were died in first one month period. Discussion and conclusion: It is observed that early period mortality proportion was low in all trauma mortalities and more patients were died due to late complications. It can be considered as this result is an indirect indicator of the effectiveness of early resuscitation applications

Overweight/obesity and respiratory and allergic disease in children: International study of asthma and allergies in childhood (ISAAC) phase two

Background: Childhood obesity and asthma are increasing worldwide. A possible link between the two conditions has been postulated. Methods: Cross-sectional studies of stratified random samples of 8-12-year-old children (n=10 652) (16 centres in affluent and 8 centres in non-affluent countries) used the standardized methodology of ISAAC Phase Two. Respiratory and allergic symptoms were ascertained by parental questionnaires. Tests for allergic disease were performed. Height and weight were measured, and overweight and obesity were defined according to international definitions. Prevalence rates and prevalence odds ratios were calculated. Results: Overweight (odds ratio=1.14, 95%-confidence interval: 0.98; 1.33) and obesity (odds ratio=1.67, 95%-confidence interval: 1.25; 2.21) were related to wheeze. The relationship was stronger in affluent than in non-affluent centres. Similar results were found for cough and phlegm, rhinitis and eczema but the associations were mostly driven by children with wheeze. There was a clear association of overweight and obesity with airways obstruction (change in FEV1/FVC, 20.90, 95%-confidence interval: 21.33%; 20.47%, for overweight and 22.46%, 95%-confidence interval: 23.84%; 21.07%, for obesity) whereas the results for the other objective markers, including atopy, were null. Conclusions: Our data from a large international child population confirm that there is a strong relation of body mass index with wheeze especially in affluent countries. Moreover, body mass index is associated with an objective marker of airways obstruction (FEV1/FVC) but no other objective markers of respiratory and allergic disorders. © 2014 Weinmayr et al

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

•We report INICC device-associated module data of 50 countries from 2010-2015.•We collected prospective data from 861,284 patients in 703 ICUs for 3,506,562 days.•DA-HAI rates and bacterial resistance were higher in the INICC ICUs than in CDC-NHSN's.•Device utilization ratio in the INICC ICUs was similar to CDC-NHSN's. Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN