1 5 ; 2 0 ( 3 ) : 1 7 2 -1 7 4 . ÖzetÇinko fosfür rodentisit olarak kullanılan toksik kimyasal bir ajandır. Etkileri kalp, akciğer, böbrek ve gastrointestinal sistem üzerinedir. Metabolik asidoz, amilaz yüksekliği, karaciğer hasarı, hipotansiyon, şok ve kardiyak aritmi görülmektedir. Kırkbir yaşında erkek hasta özkıyım amacıyla çinko fosfür içeren fare zehiri alımı hikayesiyle değerlendirildi. Solunum sıkıntısı, aritmi, istemsiz yaygın kas kasılması, metabolik asidoz, koagülasyon bozukluğu, amilaz, AST ve LDH yüksekliği tespit edildi. Yoğun bakım takibi sonrası iyilik haliyle taburcu edildi. Bu yazıda, özkıyım amacıyla çinko fosfür alan olgunun yoğun bakım ünitesindeki takip-tedavi sürecinde yaşadığımız tecrübenin genel bilgiler eşliğinde paylaşılması amaçlanmıştır.Anahtar kelimeler: Fare zehiri, Çinko fosfür, İntihar, Metabolik asidoz, Yüksek amilaz. AbstractZinc phosphide is a toxic chemical agent used as a rodenticide. The effects are on heart, lung, kidney and gastrointestinal tract. Metabolic acidosis, high amylase, liver damage, hypotension, shock and cardiac arrhythmia is observed. Forty-year-old male patient evaluated with a history of taking zinc phosphide containing rat poison in order to commit suicide. Respiratory distress, arrhythmias, commonly involuntary muscle contraction, metabolic acidosis, coagulation disorders, amylase, AST and LDH levels were determined. Term follow-up after intensive care unit and was discharged favor. In this paper, for the purpose of suicide zinc phosphide our experiences in the field of public information in the cases of ICU follow-up treatment process is intended to share the accompaniment.
Objective: To compare the use of propofol and thiopental in children undergoing MRI.
Perioperative anaphylaxis is a type I hypersensitivity reaction, which rapidly develops with severe and variable clinical findings and can be fatal even in previously healthy patients. Early diagnosis and appropriate treatment are required but identifying the responsible agent is difficult. After anaphylaxis developed in our case, we did not have a healthy and adequate knowledge about the following questions. When should we get the blood sample, how much blood and to which tubes? Which tests can we work for detection of the responsible agent, where and in which laboratories? When we were communicating with the centers and laboratories which are given as references, we could not reach to standard information. Therefore, when perioperative anaphylaxis develops, it would be beneficial to have a set of perioperative anaphylaxis management guideline, including contact information of a national center for feedback and a reference anesthetic allergy testing center that could identify the responsible agent.
A 32-year-old woman was referred to us for a routine pacemaker (PM) control procedure. A DDDR (dual chamber) PM was implanted in 2010 and an elective replacement indicator (ERI) alert was given 2 months and 21 days ago. Before battery replacement, a temporary PM lead was implanted through the right subclavian vein under the guidance of bedside echocardiography and the pacing threshold was found to be 1 Volt. When the ventricular lead of the permanent battery was removed from the generator, it resulted in cardiac arrest. On fl uoroscopic view, the lead of the temporary PM was found in the right atrium. However, a wide QRS and a left bundle-branch block (LBBB) pattern rhythm was observed during a threshold test before the surgery. The activity of the atrium was sensed by the atrial lead of the permanent PM that worked on the atrial-sensed ventricular-(As/Vp) mode. Thus, there was a wide QRS and LBBB pattern and at the rate of equal to temporary PM's rate rhythm had been occurred during the threshold testing.In the absence of adequate intrinsic cardiac activity, if battery replacement is performed on DDDR-mode devices, the temporary PM lead must be implanted under fl uoroscopic control and it must be ensured that it is in the ventricle.Key Words: Pacemaker replacement; fl uoroscopy; complication; DDDR devices Pacemaker Batarya Replasmanında Floroskopi Gereksinimi ÖZETOtuz iki yaşında kadın hasta rutin pacemaker (PM) kontrolü için başvurdu. 2010 yılında DDDR (çift odacıklı) PM implante edilmiş ve 2 ay 21 gün önce "Elektif Pacemaker Indikatör (ERI)" uyarısı verdiği tespit edildi. Batarya replasmanı öncesi geçici kalp pili leadi yatak başı ekokardiyografi eşliğinde sağ subklavian ven yoluyla takıldı ve uyarı eşiği 1 Volt olarak bulundu. Ne zaman ki kalıcı kalp pilinin ventrikül leadi bataryadan çıkarıldığında kardiyak arrest gelişti. Bunun üzerine fl oroskopi yapıldı ve geçici kalp pili leadinin sağ atriyumda olduğu tespit edildi. Oysa eşik testi esnasında geniş QRS ve sol dal bloğu paterninde ritm oluşturduğundan geçici kalp pili etkin bulunmuştu. Atrial aktivite kalıcı kalp pilinin atriyum leadi tarafından algılanarak ventrikülü kalıcı kalp pilinin ventriküler leadi stimüle etmekteymiş.Yani kalıcı kalp pili As/Vp modunda çalıştığından geçici kalp pilinin eşik testi yapılırken geniş QRS, sol dal bloğu paterninde ve aynı geçici kalp pilinin hızı ile eşit bir ritm oluşmaktaydı.Şayet hastanın yeterli hızda kendine ait ritmi yoksa ve replasmanı yapılacak olan cihaz DDDR modunda ise geçici kalp pili leadi mutlaka fl oroskopi altında yerleştirilmelidir. Ayrıca leadin atriyumda değil de ventrkülde olduğundan emin olunmalıdır.
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