Effect of transcranial direct current stimulation on neurological injury markers and prognosis in patients with acute and severe carbon monoxide poisoning / 中华劳动卫生职业病杂志

Objective: To observe the effects of transcranial direct current stimulation (tDCS) on nerve injury markers and prognosis in patients with acute severe carbon monoxide poisoning (ASCOP) . Methods: In May 2021, 103 ASCOP patients were treated in the emergency department of Harrison International Peace Hospital of Hebei Medical University from November 2020 to January 2021. The patients were divided into two groups according to whether they received tDCS treatment. The control group (50 cases) were given oxygen therapy (hyperbaric oxygen and oxygen inhalation) , reducing cranial pressure, improving brain circulation and cell metabolism, removing oxygen free radicals and symptomatic support, and the observation group (53 cases) was treated with 2 weeks of tDCS intensive treatment on the basis of conventional treatment. All patients underwent at least 24 h bispectral index (BIS) monitoring, BIS value was recorded at the hour and the 24 h mean value was calculated. Neuron-specific enolase (NSE) and serum S100B calcium-binding protein (S100B) were detected after admission, 3 d, 7 d and discharge. Follow-up for 60 days, the incidence and time of onset of delayed encephalopathy (DEACMP) with acute carbon monoxide poisoning in the two groups were recorded. Results: The NSE and S100B proteins of ASCOP patients were significantly increased at admission, but there was no significant difference between the two groups (P=0.711, 0.326) . The NSE and S100B proteins were further increased at 3 and 7 days after admission. The increase in the observation group was slower than that in the control group, and the difference was statistically significant (P(3 d)=0.045, 0.032, P(7 d)=0.021, 0.000) ; After 14 days, it gradually decreased, but the observation group decreased rapidly compared with the control group, with a statistically significant difference (P=0.009, 0.025) . The 60 day follow-up results showed that the incidence of DEACMP in the observation group was 18.87% (10/53) , compared with 38.00% (19/50) in the control group (P=0.048) ; The time of DEACMP in the observation group[ (16.79±5.28) d] was later than that in the control group[ (22.30±5.42) d], and the difference was statistically significant (P=0.013) . Conclusion: The early administration of tDCS in ASCOP patients can prevent the production of NSE and S100B proteins, which are markers of nerve damage. and can improve the incidence and time of DEACMP.

A case of acute carbon monoxide poisoning with secondary intestinal obstruction and thrombosis / 中华劳动卫生职业病杂志

Acute carbon monoxide poisoning can cause multiple organ damage due to hypoxia. In severe cases, it can be life-threatening and has a high fatality rate. Intestinal obstruction and thrombosis are rare complications of carbon monoxide poisoning. A case of carbon monoxide poisoning was reported. In addition to the central nervous system lesion, intestinal obstruction and lower limb thrombosis were also found. In the treatment of carbon monoxide poisoning patients, the clinician was able to treat the common complications, attention should be paid to gastrointestinal tract, thrombotic disease and other rare complications, so as to avoid missed diagnosis.

Intoxicación aguda con monóxido de carbono (ICO) secundaria a pipa de agua (Narguile). Reporte de un caso / Carbon monoxide poisoning caused by water pipe smoking (Narghile). A case report

Resumen Dentro de las formas alternativas de consumo de tabaco, se describe el uso de pipas de agua (también llamadas hookah, shisha o narguile) como implementos de uso. Esta forma de uso es una forma emergente en nuestro medio, con uso en estudiantes universitarios y secundarios. Debido a que utiliza carbón para quemar el tabaco, junto a largos períodos de uso, presenta riesgo de intoxicación por monóxido de carbono, especialmente si se utiliza en ambientes cerrados. En este artículo presentamos el caso de una paciente femenina de 19 años, quién fue traída al hospital con una intoxicación grave por monóxi do de carbono secundaria a uso de pipa de agua, requiriendo tratamiento con oxígeno en cámara hiperbárica. Realizamos una revisión de la bibliografía.

Abstract Amongst the alternative ways of tobacco use, water pipes (also called hookah, shisha or narghile) have been used as implements. This type of use is an emergent one in our environment, being used by high school and college students. Due to the use of charcoal as a way to burn the tobacco, and the long using times it presents, the users are at risk of being poisoned by carbon monoxide, especially if they smoke in enclosed spaces. In this paper, we present the case of a 19-year-old female patient, who was brought to the hospital with a severe case of carbon monoxide poisoning, requiring treatment with oxygen in a hyperbaric chamber. We make a review of the literature.

Relación Dosis de oxígeno-Celeridad en la oxigenación hiperbárica para intoxicación con monóxido de carbono / Oxygen Dose-Implementation Celerity relationship in hyperbaric oxygenation for carbon monoxide poisoning

Resumen Se realiza una revisión narrativa que plantea una reflexión acerca del rol de la oxigenación hiperbárica en la recuperación de los intoxicados con monóxido de carbono (ICO). La relación presión de tratamiento de oxigenación hiperbárica (TOHB), o sea dosis de oxígeno, y demora en su implementación son descriptas en esta revisión. Se presentan 9 casos de pacientes con ICO tratados con TOHB a 1,45 ATA (Atmósferas absolutas) por falta de acceso a TOHB de alta presión. Si bien es necesario investigación adicional, sugerimos que esta modalidad terapéutica a 1,45 ATA para ICO debe ser elegida frente al oxígeno normobárico, y considerada cuando las instalaciones de alta presión no están disponibles a distancias razonables.

Abstract A narrative review that raises a reflection about the role of hyperbaric oxygenation in the recovery of monoxide carbon (CO) poisoning is carried out. A description of the relationship of the pressure of hyperbaric oxygen therapy (HBOT), oxygen dosage, and the delay in its implementation was done. Nine cases of intoxications treated with HBOT at 1.45 ATA due to lack of access to high-pressure HBOT were presented. While additional research is necessary, we suggest that this therapeutic modality at 1.45 ATA (Absolute Atmospheres) should be chosen instead of normobaric oxygen therapy for CO poisoning, and considered when high pressure facilities are not available at reasonable distances.

Aplicaciones médicas de las cámaras de oxigenación hiperbárica de nueva generación / Medical applications of new generation hyperbaric oxygenation chambers

El uso clínico de la terapia de oxigenación hiperbárica (TOHB) consiste en respirar oxígeno en una concentración cercana al 100% en una cámara presurizada al menos a 1,4 atmósferas absolutas (atm). TOHB actúa produciendo hiperoxia y especies reactivas del oxígeno que desencadenan mecanismos bioquímicos variados. Se presenta una revisión de todas las nuevas aplicaciones emergentes de TOHB en varias especialidades médicas debido a que alcanza beneficios en la cicatrización de heridas, enfermedades inflamatorias y con componente neurológico o isquémico. Las nuevas cámaras realizan el tratamiento a presiones más seguras y con la misma eficiencia demostrada por métodos matemáticos y bioquímicos. El Grupo BioBárica Clinical Research presenta la estadística de las indicaciones en 559 pacientes tratados con estas cámaras en algunos centros médicos y las especialidades médicas implicadas. El uso de TOHB a media presión está en emergencia y podría proveer a futuro evidencia de su efectividad en otras especialidades médicas. (AU)

The clinical use of Hyperbaric Oxygen Therapy (HBOT) consists in breathing oxygen (O2) near to 100% in a pressurized chamber of at least at 1.4 absolute atmospheres (ATA). HBOT acts producing both hyperoxia and reactive oxygen species (ROS) and triggers others biochemical events. The BioBarica Clinical Research Group is developing clinical evidence in diverse pathologies because of accessibility and safety of the new Revitalair hyperbaric oxygen chamber. Because of working at "mild pressure", HBOT performed by these chamber are safer demonstrated by mathematical and biochemical methods. The BioBarica Clinical Research Group presents the statistics of the indications in 559 patients treated with these cameras in some medical centers and the medical specialties involved. Their accessibility to the physicians would become mild pressure HBOT used more frequently proving its effectiveness in other clinical specialties. (AU)

Correlation of computed tomography, magnetic resonance imaging and clinical outcome in acute carbon monoxide poisoning / Correlação de tomografia computadorizada, ressonância magnética e resultados clínicos em intoxicação aguda por monóxido de carbono

Abstract Background and objectives: Carbon monoxide is a toxic gas for humans and is still a silent killer in both developed and developing countries. The aim of this case series was to evaluate early radiological images as a predictor of subsequent neuropsychological sequelae, following carbon monoxide poisoning. Case 1: After carbon monoxide exposure, early computed tomography scans and magnetic resonance imaging findings of a 52-year-old woman showed bilateral lesions in the globus pallidus. This patient was discharged and followed for 90 days. The patient recovered without any neurological sequela. Case 2: In a 58-year-old woman exposed to carbon monoxide, computed tomography showed lesions in bilateral globus pallidus and periventricular white matter. Early magnetic resonance imaging revealed changes similar to that like in early tomography images. The patient recovered and was discharged from hospital. On the 27th day of exposure, the patient developed disorientation and memory impairment. Late magnetic resonance imaging showed diffuse hyperintensity in the cerebral white matter. Conclusion: White matter lesions which progress to demyelination and end up in neuropsychological sequelae cannot always be diagnosed by early computed tomography and magnetic resonance imaging in carbon monoxide poisoning.

Resumo Justificativa e objetivos: Monóxido de carbono é um gás tóxico para os seres humanos, além de ser um assassino silencioso tanto em países desenvolvidos quanto em desenvolvimento. O objetivo desta série de casos foi avaliar as imagens radiológicas iniciais como um preditivo de sequelas neuropsicológicas decorrentes de intoxicação por monóxido de carbono. Caso 1: Após exposição ao monóxido de carbono, os achados iniciais em tomografias computadorizadas e ressonâncias magnéticas de uma mulher de 52 anos mostraram lesões em globo pálido bilateralmente. A paciente recebeu alta e foi acompanhada por 90 dias. Recuperou-se sem sequelas neurológicas. Caso 2: Paciente do sexo feminino, 58 anos, exposta ao monóxido de carbono. A tomografia computadorizada mostrou lesões em globo pálido, bilateralmente, e substância branca periventricular. A ressonância magnética inicial revelou alterações semelhantes àquelas em tomografias precoces. A paciente se recuperou e recebeu alta. No 27° dia de exposição, evoluiu com desorientação e perda de memória. Ressonância magnética posterior mostrou hiperintensidade difusa da substância branca cerebral. Conclusão: As lesões da substância branca que progridem para desmielinização e resultam em sequelas neuropsicológicas nem sempre podem ser diagnosticadas em tomografias e ressonâncias iniciais em casos de intoxicação por monóxido de carbono.

Serum neuron-specific enolase and S-100β levels as prognostic follow-up markers for oxygen administered carbon monoxide intoxication cases.

Serum neuron-specific enolase (NSE) and S-100β levels are considered novel biochemical markers of neuronal cell injury. In this study, the initial and post-treatment levels of NSE and S-100β were compared in carbon monoxide (CO) poisoning patients, who received normorbaric oxygen (NBO) or hyperbaric oxygen (HBO) therapy. Forty consecutive patients with acute CO poisoning were enrolled in this prospective, observational study. According to their clinical symptoms and observations, twenty patients were treated with NBO, and the other twenty with HBO. Serum S-100β and NSE levels were measured both at time of admission and 6 h later (post-treatment). Serum NSE and S-100β values decreased significantly in both of the therapeutic modalities. The initial and post-treatment values of NSE and S-100β in NBO or HBO patients were comparable. A clear negative correlation was observed between the decrease of NSE and S-100β levels and initial blood carboxyhemoglobin levels. In conclusion, the present results suggested the use of serum S-100β and NSE levels as indicators for brain injury. Due to the significant increase of their values with oxygen therapy, they may also be useful as prognostic follow-up markers. However, the current findings reflected no difference between the efficacy of NBO or HBO therapy.

Atendimento às vítimas de lesão inalatória por incêndio em ambiente fechado: o que aprendemos com a tragédia de Santa Maria / Assistance of inhalation injury victims caused by fire in confined spaces: what we learned from the tragedy at Santa Maria

Em janeiro de 2013, uma catástrofe ocorrida em Santa Maria (RS), decorrente de um incêndio em ambiente fechado, resultou em 242 mortes, a maioria por lesões inalatórias. Em novembro de 2013, quatro vítimas necessitaram de suporte intensivo após inalação de fumaça em incêndio no Memorial da América Latina, em São Paulo (SP). Este artigo relata a evolução clínica e o manejo dos pacientes com lesão inalatória vítimas de uma catástrofe. Os pacientes ERL e OC apresentaram insuficiência respiratória precoce com broncoaspiração de material carbonáceo e intoxicação por monóxido de carbono. Foi instituído suporte ventilatório com oxigênio a 100%, retirada do material aspirado por broncoscopia, e terapia empírica com nitrito de sódio e tiossulfato de sódio para intoxicação por cianeto. O paciente RP apresentou tosse e queimação retroesternal. Evoluiu com insuficiência respiratória por edema de via aérea alta e infecção pulmonar precoce, manejados com ventilação pulmonar protetora e antimicrobianos. Foi extubado após melhora do edema no seguimento broncoscópico. O paciente MA, asmático, apresentou intoxicação por monóxido de carbono e broncoespasmo, sendo tratado com hiperóxia normobárica, broncodilatadores e corticoterapia. A estadia na unidade de terapia intensiva variou de 4 e 10 dias, e todos os pacientes apresentaram boa recuperação funcional no seguimento. Em conclusão, nos incêndios em ambientes fechados, as lesões inalatórias têm papel preponderante. O suporte ventilatório invasivo não deve ser postergado em caso de edema significativo de via aérea. A hiperóxia deve ser instituída precocemente como terapêutica para intoxicação por monóxido de carbono, bem como terapia farmacológica empírica para intoxicação por cianeto em caso de suspeita.

On January 2013, a disaster at Santa Maria (RS) due to a fire in a confined space caused 242 deaths, most of them by inhalation injury. On November 2013, four individuals required intensive care following smoke inhalation from a fire at the Memorial da América Latina in São Paulo (SP). The present article reports the clinical progression and management of disaster victims presenting with inhalation injury. Patients ERL and OC exhibited early respiratory failure, bronchial aspiration of carbonaceous material, and carbon monoxide poisoning. Ventilation support was performed with 100% oxygen, the aspirated material was removed by bronchoscopy, and cyanide poisoning was empirically treated with sodium nitrite and sodium thiosulfate. Patient RP initially exhibited cough and retrosternal burning and subsequently progressed to respiratory failure due to upper airway swelling and early-onset pulmonary infection, which were treated with protective ventilation and antimicrobial agents. This patient was extubated following improvement of edema on bronchoscopy. Patient MA, an asthmatic, exhibited carbon monoxide poisoning and bronchospasm and was treated with normobaric hyperoxia, bronchodilators, and corticosteroids. The length of stay in the intensive care unit varied from four to 10 days, and all four patients exhibited satisfactory functional recovery. To conclude, inhalation injury has a preponderant role in fires in confined spaces. Invasive ventilation should not be delayed in cases with significant airway swelling. Hyperoxia should be induced early as a therapeutic means against carbon monoxide poisoning, in addition to empiric pharmacological treatment in suspected cases of cyanide poisoning.

Smoke inhalation injury during enclosed-space fires: an update / Lesao por inalacao de fumaca em ambientes fechados: uma atualizacao

In view of the tragic fire at a nightclub in the city of Santa Maria, Brazil, which culminated in the sudden death of 232 young people, we decided to review the literature regarding smoke inhalation injury caused by enclosed-space fires, which can be divided into direct thermal damage, carbon monoxide poisoning, and cyanide poisoning. Such injuries often call for immediate orotracheal intubation, either due to acute airway obstruction or due to a reduced level of consciousness. The diagnosis and the severity of the thermal injury can be determined by fiberoptic bronchoscopy. The levels of gases and gas by-products in the bloodstream should be assessed as rapidly as possible, even while still at the scene of the incident. First responders can also treat carbon monoxide poisoning, with immediate administration of oxygen at 100%, as well as cyanide poisoning, with oxygen therapy and hydroxocobalamin injection.

Aproveita-se o trágico incêndio ocorrido em uma boate na cidade de Santa Maria, RS, que culminou na morte imediata de 232 jovens, para revisarmos a literatura com relação à lesão por inalação de fumaça em ambientes fechados, que pode ser dividida em dano térmico direito, intoxicação por monóxido de carbono e intoxicação por cianeto. Essas condições frequentemente levam à necessidade de intubação orotraqueal imediata, seja por obstrução aguda de vias aéreas, seja por depressão do nível de consciência. O diagnóstico e a gravidade da injúria térmica podem ser determinados pela fibrobroncoscopia. Quanto aos envenenamentos, a dosagem dos gases ou de seus subprodutos na corrente sanguínea é possível e deve ser realizada ainda na cena do incidente. Da mesma maneira, o tratamento da intoxicação por monóxido de carbono consiste na administração imediata de oxigênio a 100%, enquanto o da intoxicação por cianeto consiste em oxigenoterapia e hidroxicobalamina injetável como antídoto. .

Informe de evaluación rápida de tecnología sobre seguridad y efectividad de la oxigenoterapia hiperbárica / Rapid evaluation report of technology on safety and effectiveness of hyperbaric oxygen therapy

La oxigenación hiperbárica es una modalidad terapéutica no invasiva en la cual el pacientes respira oxígeno puro en el interior de una cámara de acero herméticamente cerrada, a presión atmosférica mayor a la ambiental (cámara hiperbárica). Existen solo dos efectos básicos que describen el mecanismo de acción de la OHB en el cuerpo humano, los cuales son: a. El efecto volumétrico, producido por la presión aumentada a la cual se somete el organismo. Dicho efecto es de fundamental importancia en la reducción del tamaño de las burbujas de gas que pueden contener los tejidos corporales como consecuencia de un accidente de buceo o iatrogenia médica (embolismo gaseoso en las intervenciones quirúrgicas u otros procedimientos terapéuticos invasivos), o el producido por bacterias anaerobias. b. El segundo efecto es solumétrico, debido al incremento de la presión parcial de oxígeno en los tejidos, siendo este multifacético, ya que a las presiones atmosféricas manejadas en este tratamiento el oxígeno se comporta como un fármaco con indicaciones específicas y posibles efectos adversos. Se recomienda cubrir en las siguientes condiciones: enfermedad por descompresión, embolia gaseosa, gangrena gaseosa, intoxicación por monóxido de carbono, fasceitis necrotizante, gangrena de Fournier, lesiones de pie diabético grado IV de Wagner, lesiones de bóveda craneal, parrilla costal, esternón, mandíbula, proctitis y enteritis.(AU)

Revisión de intoxicación por monóxido de carbono / Revision of carbon monoxide intoxication

El monóxido de carbono es un gas muy peligroso que pasa desapercibido en el ambiente. Puede producir cefalea, náuseas, taquicardia, debilidad, convulsines, coma y muerte. El diagnóstico se basa en una historia compatible y el examen físico, en conjunción con el laboratorio. La intervención más importante en el manejo de la intoxicación por el monóxido de carbono es alejar al paciente de la fuente de monóxido de carbono y la terapia con oxígeno, para salvar la vida y prevenir las secuelas

Carbon monoxide is a very dangerous gas that pass unaware in the environment. It can produce headache, nausea, tachycardia, malaise, seizures, coma and death. The diagnosis is based upon a compatible history and physical examination in conjunction with the laboratory. The most important interventions in the management of carbon monoxide poisoning are removal from the source of carbon monoxide and oxygen therapy, to save the life and to prevent secuelae

Carbon monoxide poisoning

Many people are poisoned by carbon monoxide [CO] with potentially devastating outcomes. CO is the leading cause of fatal poisoning in the industrialized world as well as being endemic in many parts of the developing world. CO poisoning is a serious threat that people need to get informed about. Diagnosis can be difficult because, the early symptoms are quite nonspecific, resemble those of influenza, motion sickness or heat exhaustion, and are often misinterpreted. Those suffering from CO poisoning may initially complain of vague symptoms but the symptoms can rapidly progress to coma and even death, so called silent death. It is therefore critical that CO be eliminated from the body as soon and quickly as possible. Unless patient dies, recovery occurs as CO is removed from the circulation, accelerated by breathing O[2]

Series clínicas de Medicina de Urgencia: intoxicación por monóxido de carbono, el gran simulador / Clinical series of emergency medicine: carbon monoxide poisoning, the great simulator

El monóxido de carbono (CO) es un gas incoloro, inodoro e insípido que se produce durante la combustión incompleta de materiales orgánicos que contienen carbono. La intoxicación por este gas es una causa frecuente de muerte por intoxicación involuntaria durante el período de otoño-invierno. El cuadro clínico suele ser inespecífico, simulando cuadros banales como las virosis hasta episodios graves con compromiso neurológico y alteración de conciencia. El diagnóstico exige al clínico conocer los factores de riesgo epidemiológicos y las distintas variedades de presentación clínica. Se presenta el caso clínico de una paciente que consulta por segunda vez en el Servicio de Urgencia por compromiso de conciencia transitorio, con un estudio inicial negativo. El antecedente anamnéstico de una mascota con síntomas similares permitió buscar probables fuentes de monóxido de carbono en su hogar, confirmándose el diagnóstico por niveles de carboxihemoglobina elevados. El diagnóstico de esta intoxicación suele estar basado en la sospecha clínica considerando los antecedentes epidemiológicos, el cuadro clínico y los factores de riesgo del caso individual.

Treatment with hyperbaric oxygen

Hyper baric oxygen therapy [HBO therapy] is a medical treatement that allows patients to breathe pure oxygen inside pressurized chamber. Although the primary role of the hyper baric medicine unit is to provide emergency treatement for decomperssion illness and Carbon Monoxide poisoning certrain other conditions benefit from the use of elective HBO therapy like specific types of infections wounds, burns and tissues damage caused by osteo radionecrosis

Some usual and unusual poisonings due to carbon monoxide

Carbon monoxide poisoning is a frequent occurrence in both developed and under developed countries of the world. Carbon monoxide can be produced in fires, automobile engine exhausts and the incomplete combustion of organic matter. It is a [quot ]silent killer[quot ] that initially produces a mild progressive frontal headache, drowsiness and sleep that is usually ignored as common place. Continued low-level CO exposure for a long period of time in a confined space is cumulative and these accidental deaths are frequent but should be avoidable. Several usual and unusual poisonings are reported to illustrate its various forms of exposure. It all began many years ago when a bolt of lightening hit a fallen tree and produced a fire. Early cave man later learned to enjoy some of the benefits of this new discovery. They could now see at night, they could keep warm, keep the predators at bay, cook their food and make it taste better and be more gentle to their teeth. Also meat could be preserved and eaten at a later date especially if it were dried and smoked. They learned by trial and error that it was dangerous to bring their fire deep into their cave without a chimney. Carbon monoxide (CO) also can be easily produced by many other sources besides fire. Very common today is the incomplete combustion of gasoline in the engine of an automobile which can produce about 6 carbon monoxide

Intoxicación por monóxido de carbono / Carbon monoxide toxicity

La intoxicación por monóxido de carbono (CO), constituye un problema de alta mortalidad. En Estados Unidos alrededor de 10.000 personas pierden al menos 1 día de trabajo debido a una intoxicación por CO, y se produce alrededor de 3.000 muertes al año por esta causa. La incidencia de intoxicación por CO en nuestro país no es bien conocida, debido en parte a que es una condición subdiagnosticada, sin embargo estaría dentro de las primeras causas de intoxicación en la población general. En los últimos años esta intoxicación ha despertado mayor preocupación y difusión por medios periodísticos, por lo que se han adoptado medidas de fiscalización más rigurosas