Risk factors contributing to the incidence and mortality of acute childhood poisoning in emergency department patients in Iran: a hospital-based case-control study

OBJECTIVES Since poisoning is one of the most important preventable factors contributing to the hospitalization and death of children who present to emergency departments, this study was carried out to investigate the risk factors contributing to the incidence and mortality of acute childhood poisoning. METHODS This hospital-based case-control study included 243 cases and 489 controls, drawn from daily admissions to the emergency departments of the included hospitals according to the inclusion and exclusion criteria. RESULTS Gastrointestinal poisoning was the most common poisoning type, found in 87.7% of subjects, and medications were the most common cause of poisoning (49.8%). Multiple logistic regression analysis showed that a history of poisoning (odds ratio [OR], 10.44; 95% confidence interval [CI], 5.58 to 19.51; p<0.001) and the availability of poisonous substances (OR, 8.88; 95% CI, 5.41 to 14.56; p<0.001) were among the most important predictors of childhood poisoning. Respiratory poisoning (OR, 6.72; 95% CI, 1.40 to 32.07; p<0.05) and the presence of addiction in the family (OR, 4.54; 95% CI, 1.10 to 18.68; p<0.05) were the most important predictors of mortality among children with poisoning. CONCLUSIONS Addiction and the presence of physical or psychological disorders in family members, a history of poisoning, and the availability of poisonous substances were significantly associated with the incidence of childhood poisoning and resultant mortality

Intoxication with Low-Dose Baclofen: A Case Report

Background & Objective: One of the most common causes of decreased level of consciousness has many causes, especially in young patients, is drug poisoning. Baclofen is used to reduce muscle spasm and acts through the presynaptic inhibition of motor neurons. Oral intoxication with this drug is not common, if seen, it is due to excessive drug use or underlying renal dysfunction. Case: A 25-year-old woman was brought to our emergency department by her husband with complaining of decreased level of consciousness. The urine sample was sent for toxicology examination and then brain CT scan was done which was normal. After 36 hours she regained consciousness. During a retrospective history taking she stated the baclofen use repeatedly five times a day for two days because of  severe muscle spasms before she came to the hospital. Conclusion: The most common cause of severe baclofen poisoning is arbitrary use of drugs, and accidental use of the drug causes fewer symptoms. Side-effects of baclofen include drowsiness, convulsions, severe cardiac disorder and coma. What is essential for an emergency medicine specialist is to know that, regardless of the underlying cause of the patient's symptoms, the patient must first be stable and pay attention to maintaining the patient's airway

First Seizure Due to a Ruptured Brain Dermoid Cyst

Introduction: first seizure is an unpleasant experience, the underlying cause and probability of recurrence is critical for the patient. Case: A 72 years old female was brought to our emergency department with a complaint of first seizure. Her daughter stated that she had had a tonic colonic generalized seizure that lasted about 10 seconds. She was complaining of a headache at the time of arrival in the ED, and the seizure had ended. The physical examination was normal and she had no past medical history. Spiral axial brain CT scanning demonstrated a sharp, round lesion with peripheral calcification near the pineal gland which compressed the third ventricle. Multiple nodules with fat density were seen in the subarachnoid space. Phenytoin was started for seizure prophylaxis and a neurosurgery consultation was requested. Tumor was completely reacted. Conclusion: This is a rare case of dermoid cyst near the pineal which compressed the third ventricle and caused midline shift and hydrocephaly. The cause of seizure may be the cyst rupturing. Complete cyst resection is the preferred treatment

Rupture of Posterior Urethra without Pelvic Fracture: A Rare Presentation

Rupture of the posterior urethra is a rather uncommon finding in patients with pelvic trauma. It is usually accompanied by pelvic fractures. Herein, we report the case of a 27-year-old man with isolated rupture of the posterior urethra –without pelvic fracture- after falling. The patient was successfully treated with primary suprapubic cystostomy and delayed urethral reconstruction surgery, after which he was discharged in good condition with no urologic complication. The consensus on these cases is either to perform an early realignment or to do late reconstructive surgery

A Rare Manifestation of a Common Disease

Introduction: Ectopic pregnancy (EP) is considered a common disease worldwide. This study is intended to present a case report of ectopic pregnancy presented with syncope, a rare symptom. Case: A 31 years old woman presented in emergency department of an academic trauma center with the chief complaint of head trauma. She was suffering of severe headache following falling down because of syncope. In prices exam she had unstable vital signs and was complaining of abdominal pain and tenderness. Routine laboratory tests including β-hCG, head CT scan, complete abdominal and abdominopelvic sonography were ordered for the patient. Results showed positive β-hCG and abundant free fluid in the abdominal cavity in sonography. After approval of ruptured ectopic pregnancy diagnosis, patient underwent laparotomy, salpingectomy and cystectomy