To identify and analyse the characteristics of carbon monoxide (CO) poisoning due to burning charcoal in our locality. Methods: This was a 3-year retrospective study. All patients presenting with CO poisoning by burning charcoal from August 1999 to December 2002 were recruited. The demographic data, initial vital signs, blood results, treatment regimens and outcomes were collected. Association between clinical outcomes and parameters were calculated. Results: The study identified 148 patients (mean age 34.7 years) suffering from CO poisoning by burning charcoal. One hundred and forty-six cases (98.6%) were suicidal. Twenty-five patients (16.9%) were unconscious (GCS ≤ 8) on arrival. The mean initial carboxyhaemoglobin (COHb) level was 21.0%. The mortality rate was 5.4%. Fifteen cases (10.1%) required intensive care. Twelve cases (8.1%) had neurological complications and five (3.4%) suffered from delayed neurological sequelae. Initial blood results showing hyperkalemia and acidosis were associated with likelihood of unconsciousness on arrival (p = 0.007, p = 0.019 respectively). Hyperkalemia and unconsciousness on arrival were associated with longer hospital stay (p < 0.001, p < 0.001 respectively) as well as likelihood of systemic complication (p < 0.001, p < 0.001 respectively). There was no relationship between co-ingestion, age, initial COHb level, initial systolic and diastolic blood pressure with consciousness level on arrival (p = 0.188, p = 0.846, p = 0.264, p = 0.224, p = 0.755 respectively). Age, initial COHb level, acidosis, initial systolic and diastolic blood pressure did not correlate with the duration of hospital stay (p = 0.679, p = 0.176, p = 0.501, p = 0.313, p = 0.868 respectively). Conclusion: Suicide almost accounted for all the CO poisonings by burning charcoal in our study group. It caused significant mortality and morbidity. Hyperkalemia, unconscious state and acidosis had prognostic values.
There has been a vast difference in the reported value for carboxyhaemoglobin (COHb) half-life (COHbt 1/2) in carbon monoxide (CO) poisoning patients breathing 100% normobaric oxygen (O 2). This could be due to the fact that all previous studies were performed on heterogeneous groups of patients with different aetiology. We wished to determine the COHbt 1/2 in a homogenous group of acute CO poisoning patients who attempted suicide by burning charcoal and were treated with normobaric high flow oxygen. Methods: It was a retrospective descriptive cohort study for a period of 60 months (January 2001 to December 2005). Setting: Accident and Emergency Department of Tuen Mun Hospital, serving a population of 1.5 millions. Population: We recruited all cases of CO poisoning by burning charcoal for suicidal attempt and we excluded the cases if (1) there was only one COHb measurement; (2) the patient had not received high flow O 2 therapy via tightly fitting facial mask with O 2 reservoir, given before the first blood sample or throughout the period until a second blood sample was taken; (3) the first COHb was <10%; (4) the second COHb was <2%; (5) there was significant co-poisoning; (6) the patient was haemodynamically unstable; or (7) the time of blood sampling was not documented. We believed that the elimination of COHb under 100% normobaric O 2 was constant and followed a simple exponential decay. Results: Forty-three (27.4%) cases met all of the selection criteria and the mean COHbt 1/2 was 78±9 minutes. Conclusion: We believed that our patients (i.e. CO poisoning patients who committed suicide by burning charcoal) represented a homogenous group of acute CO poisoning of unique aetiology. The estimated COHbt 1/2 would be useful in deciding the length of normobaric oxygen therapy for this group of patients.
Noisy belching in front of other people, often considered to be an impolite manner, may not be as harmless as it seems. We report on a patient who had spontaneous pneumomediastinum after intentional induction of noisy belching by rapid excessive intake of carbonated drinks (imitating the game played in a popular local television program “The Super Trio Continues…”). The clinical features, investigations and management of spontaneous pneumomediastinum are discussed.
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