The American journal of emergency medicine
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Acute carbon monoxide (CO) poisoning due to smoking hookah has been reported and may present similarly to other causes of acute carbon monoxide poisoning with nausea, headache, and loss of consciousness [1]. In the acute poisoned patient, immediate removal from the carbon monoxide source is paramount in addition to administration of oxygen and possible hyperbaric oxygen therapy (HBO) in certain situations. However, cases of chronic CO poisoning, treatment options, and long-term adverse health effects are far less reported but may include atherosclerosis and vague neurologic symptoms [2]. ⋯ While being seen in the hematology clinic, he was found to have a blood carboxyhemoglobin of level 33.6% despite being asymptomatic. This is the highest recorded hookah-related carboxyhemoglobin concentration in the medical literature; and the significant chronic carboxyhemoglobinemia explained his polycythemia. This case illustrates that a social history is crucial when assessing the patient with severe carboxyhemoglobinemia as HBO is not indicated in chronic CO poisoning in an asymptomatic patient.
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Syncope is a common presenting symptom in the pediatric emergency department (PED). The etiology of pediatric syncope is generally benign. However, differentiating cardiac and other serious causes from benign causes of syncope are crucial. The aim of this study was to evaluate the change of physicians' behavior after introduction of an institutional protocol designed to act as a guide in the assessment and management of syncope patients in the PED. ⋯ The introduction of the syncope approach protocol in PED has enabled an evidence-based and systematic evaluation and management of syncope patients, and reduced the rates of low-yield investigations. Sustained implementation of this protocol can have long-term benefits in the care of children with syncope at the emergency department.
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Bradycardia is an under-studied manifestation of hyperkalemia potentially associated with adverse outcomes. We sought to systematically describe emergency department (ED) patients that present with severe bradycardia (heart rate < 50) associated with severe hyperkalemia (potassium ≥6.0 mEQ/L) and identify factors associated with the receipt of hemodynamic support. ⋯ Patients presenting with severe bradycardia represent a unique phenotype of ED patients with hyperkalemia that may require significant resuscitation and critical care resources. Further research on the treatment of this uncommon, but potentially life-threatening condition is needed.
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Published evidence regarding the effect of gender on outcome after out of hospital cardiac arrest (OHCA) is inconsistent. We aimed to investigate the association of gender to outcome and resuscitation characteristics in OHCA patients admitted to the cardiac arrest center. ⋯ Women admitted for OHCA to a cardiac center had a different cause of arrest that had a different treatment and outcome compared to men. Survival and good neurological outcome were lower in women, however, after adjusting for baseline characteristics, gender was not associated with survival nor neurological outcome.