A 39-year-old man presented to the emergency department after intentionally ingesting 50 tablets of metformin 1,000 mg. The reported time of ingestion was 6 h prior to arrival. Vital signs were: temperature, 37.4°C; pulse, 94 beats per minute; blood pressure, 117/74 mmHg; respirations, 16/min; and oxygen saturation, 96 % on room air. Gastric lavage was performed, and a single dose of activated charcoal was given. His initial serum lactate was 4.3 mmol/L (normal00.67-1.8 mmol/L). The patient had a negative urine drug screen, and acetaminophen and salicylate levels were below detection limits. The patient was admitted for monitoring of lactic acidosis.Twenty hours after arrival, the patient became hypotensive with a blood pressure of 85/45 mmHg. Arterial blood gas analysis revealed a pH of 7.20, pCO 2 19 mmHg, and bicarbonate HCO 3 of 6 mmol/L. A repeat serum lactate at this time was 20 mmol/L, and a basic metabolic panel showed sodium of 134 mmol/L, potassium 3.8 mmol/L, chloride 98 mmol/L, bicarbonate 16 mmol/L, BUN 32 mg/ dL, and creatinine 1.3 mg/dL; the calculated anion gap was 20 mmol/L. A 1-L normal saline bolus was administered, and serum alkalinization was initiated with a sodium bicarbonate drip.
Control of the agitated patient in the emergency department is challenging. Many options exist for chemical sedation, but most have suboptimal pharmacodynamic action, and many have undesirable adverse effects. There are reports of ketamine administration for control of agitation prehospital and in traumatically injured patients. Ketamine is a noncompetitive N-methyl-D-aspartic acid receptor antagonist, making it an effective dissociative agent. We present 5 cases of ketamine administration to manage agitated adolescent patients with underlying psychiatric disease and/or drug intoxication. Ketamine, as a dissociative agent, may be an alternative pharmacological consideration for the control of agitation in patients with undifferentiated agitated delirium.
Ergonomics is an omnipresent and interdisciplinary field of science. It influences the entire environment and, by caring about their comfort and safety and most of all, health, puts humans in the first place. The goal of the research was to evaluate the conditions of hospitalisation in hospital wards from the patient's perspective. 40 patients participated in the research-men and women from Z. Radliński Regional Othopedia and Motor Organ Rehabilitation Centre and Cardiologic Rehabilitation and Internal Medicine Clinic in Lodz, aged 45-80. The research utilised an original questionnaire prepared for this research. Among all of the patients, 31 were satisfied with their stay at the hospital. 9 patients were not satisfied and 5 listed inappropriate fittings in the toilets and bathrooms as one of the reasons. The patients in hospital rooms were particularly satisfied with their hospital beds and room lighting. The biggest concerns were overcrowding of the rooms, insufficient ventilation as well as low number of toilets and bathrooms.
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