Introduction: Accidental carbon monoxide (CO) intoxication is a major cause of unintentional poisoning. This study aimed to determine the value of initial lactate levels in patients with CO poisoning and to evaluate its utilization in the emergency department (ED). Methods: A retrospective cross-sectional study was carried out among patients with CO intoxication, who were admitted to the ED between April 1, 2011 and April 1, 2012. The study data were extracted from a hospital database system using International Classification of Diseases-10 diagnosis codes. The patients were analyzed according to lactate levels, carboxyhemoglobin (COHb) levels, electrocardiographic manifestations, and clinical features at admission to the ED. Results: A total of 74 patients with CO poisoning were enrolled in this study. The average COHb value of the patients was 21.5 ± 13.9%. A total of 50 patients (67.6%) received normobaric oxygen treatment and 24 patients (32.4%) received hyperbaric oxygen (HBO) treatment. The patients who received HBO treatment had increased lactate levels compared with patients receiving normobaric oxygen treatment (2.3 mmol/L vs. 1.0 mmol/L, p < 0.001). The lactate levels were positively correlated with COHb values ( r = 0.738, p < 0.001). We determined that a lactate level of 1.85 mmol/L has a sensitivity of 70.8% and a specificity of 78.0% to predict the HBO treatment needed in CO poisoning. Conclusion: In evaluating patients with CO poisoning, an initial lactate level could be taken into consideration as an adjunctive parameter of severity, together with the clinical criteria and levels of COHb.
Supposedly herbal weight loss pills are sold online and are widely used in the world. Some of these products are found to contain sibutramine by FDA and their sale is prohibited. We report a case of a female patient who presented to the emergency department after taking slimming pills. 17-year-old female patient presented to the emergency room with palpitations, dizziness, anxiety, and insomnia. She stated that she had taken 3 pills named La Jiao Shou Shen for slimming purposes during the day. Her vital signs revealed tachycardia. On her physical examination, she was restless, her oropharynx was dry, her pupils were mydriatic, and no other pathological findings were found. Sibutramine intoxication was suspected. She was given 5 mg IV diazepam for restlessness. After supportive therapy and observation in emergency department for 12 hours there were no complications and the patient was discharged home. Some herbal pills that are sold online for weight loss have sibutramine hidden as an active ingredient, and their sale is prohibited for this reason. For people who use herbal weight loss drugs, sibutramine excessive intake should be kept in mind at all times.
Objective: In this study, our goal was to assess the theoretical levels of knowledge of emergency medicine residents, to determine the subjects that they are more successful and less successful in, and to compare the levels of knowledge of residents in university and training/research hospitals; by evaluating the results of a general examination that was set for the residents of emergency medicine throughout Turkey.
Material and Methods:The examination results of a total number of 30 training/research hospitals and university hospitals that agreed to take the examination were analysed. The results of training/research hospitals and university hospitals were compared regarding distribution of main topics. Results: A total of 320 residents participated in the examination, of whom 207 (64.7%) were working in university hospitals and 113 (35.3%) were in training and research hospitals. According to results, there was statistically significant difference between university hospitals and training hospitals in some subgroups (pediatric emergencies, gynecologic emergencies, internal medicine), however the number of correct answers did not vary. Conclusion: Widespread increase in academic emergency departments necessitate standardization of educational efforts. Emergency medicine residents should be directed according to appropriate guidelines in this area. (JAEM 2013; 12: 30-2)
Energy drinks are increasingly used worldwide inspite of their side effects. These drinks has been linked to case reports that present with ST-elevation myocardial infarction, but in this case we report a case that presents with non-STelevation myocardial infarction after energy drink intake. The patient complained about chest pain after drinking two bottles of energy drink and vodka. Cardiac catheterization subsequently confirmed left anterior descending occlusion in this patient.
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