Clinico-Toxicological Characteristics of Patients with Acute Organophosphate Intoxication Requiring Mechanical Ventilation

PURPOSE: The purpose of this study is to investigated the clinico-toxicological characteristics of patients with acute organophosphate intoxication requiring Mechanical Ventilation. METHODS: We reviewed retrospectively the medical records of patients with acute organophosphate intoxication in our emergency center from January 2002 to December 2003. We compare to toxicologic characteristics, laboratory findings, patients managements, complications, and outcomes between Mechanical Ventilation group (MV group) and non-Mechanical Ventilation group (non MV group) RESULTS: Thirty-six patients are investigated. Twelve patients were the MV group and twenty-four patients were non MV group. In the MV group, patients had more CNS symptoms(83%), higher SAPS II(43.5) and also had abnormal laboratory findings (leukocytosis, high glucose level, high Pco2, and lower pH). Cholinesterase level at presentation was not significant difference between MV group and non MV group, but total amount and administration time of atropine and 2-PAM was significantly different. Respiratory complication and intermediate syndrome were common in the MV group. CONCLUSION: We suggest that the patients having CNS and/or nicotinic symptoms following organophosphate intoxication, is a potential patient group requiring intensive care with mechanical ventilation. Additionally we think that hypercarbia due to respiratory weakness or paralysis and mental status change is important factors to decide the application of mechanical ventilation.

Visual Analogue Scale in Acute Pain measurement: Its Usefulness as a Pain Measurement Tool in an Emergency Setting

PURPOSE: The Visual Analogue Scale (VAS), as a pain measurement tool, has been shown to be a reliable measurement for chronic pain. However, the reliability and the validity of the VAS have not been demonstrated in an acute setting where pain fluctuations might be greater than they would be for chronic pain. This study assessed the usefulness of the VAS in an emergency setting. METHODS: Patients 16 years of age or older who presented with acute pain resulting from trauma or non-traumatic diseases were enrolled in this prospective, observational study. A 100-mm non-hatched, horizontal visual analogue scale was used to measure the pain severity. VAS measurements were obtained 1 minute apart at admission, 30 minutes after admission, and 1 hour after treatment. Intraclass correlation coefficients (ICCs) with 95% confidence intervals (95% CIs) and a Bland-Altman analysis were used to assess the reliability and the validity of the VAS measurements. RESULTS: The ICCs for paired VAS scores at admission, 30 minutes after admission, and 1 hour after treatment were 0.988 (95% CI=0.98 to 0.99), 0.968 (95% CI=0.95 to 0.98), and 0.989 (95% CI=0.98 to 0.99), respectively. The Bland-Altman analysis showed that 95% of the paired measurements at admission, 30 minutes after admission, and 1 hour after treatment were within 7 mm. CONCLUSION: The VAS appears to be a highly reproducible instrument for measurement of acute pain in the emergency department. This study suggests that the VAS is sufficiently reliable to be used to assess acute pain.