Agresiones realizadas con espráis de defensa personal atendidas en el área de descontaminación química de urgencias. A propósito de 15 casos / Injuries from pepper spray used for self defense: analysis of 15 cases managed in an emergency chemical decontamination area

Evalúan las características epidemiológicas, clínicas, terapéuticas y evolutivas, de las asistencias realizadas en el área de descontaminación química (ADQ) del servicio de urgencias, a consecuencia de un ataque con espráis de defensa personal durante un período de 5 años. Se han incluido 15 pacientes con una edad media de 25 años. Trece fueron hombres y el 53% eran personas no nacidas en España. En todos los casos la agresión con el espray se produjo en el curso de una pelea o con ánimo de robo, sobre todo de madrugada (66,7% de los casos entre las 4:30 y las 6:30 h). En el 60% de las atenciones hubo dos o más personas afectadas de forma simultánea. El ataque se produjo en la vía pública en el 73% de las ocasiones y tardaron una mediana de 30 min en llegar a urgencias. Cara y ojos fueron las zonas más afectadas y los síntomas referidos con mayor frecuencia fueron el picor, irritación, quemazón o dolor. El tratamiento aplicado en el hospital fue inmediato (media de demora: 3 min) y se empleó una solución hipertónica, anfótera y quelante en el 80% de los casos, con notable mejoría sintomática, pasando en la escala visual analógica (EVA) del dolor de una puntuación media de 7,2 al ingreso a 3 a la salida (p = 0,009). El tiempo medio de permanencia en el ADQ fue de 40 min. Once de los casos precisaron además asistencia oftalmológica y tratamiento tópico sintomático. La evolución fue favorable y sin secuelas en todos los casos. Concluimos que el uso de espráis de defensa personal con ánimo de robo o agresión es una realidad en nuestro medio. Las medidas de descontaminación son prioritarias y contribuyen a aliviar los síntomas y evitar secuelas (AU)

We analyzed epidemiologic and clinical characteristics, treatment received, and clinical course in cases of pepper spray injury treated in the chemical decontamination area of an emergency department over a 5-year period. A total of 15 patients with a mean (SD) age of 25 (8.3) years were included. Thirteen were men and 53% were foreign-born. All uses of pepper spray occurred during muggings that to place mainly in the early hours of the morning (66.7% between 4:30 and 6:30 AM). Two or more attackers were injured in 60% of the events. Seventy-three percent of the attacks took place on the street and the median delay in reaching the emergency department was 30 minutes. The face and eyes were usually injured, and symptoms included itching, irritation, burning, and pain. On arrival, the patients were treated immediately (mean delay, 3 minutes) with hypertonic saline, an amphoteric surfactant, and a chelating agent in 80% of the cases, in which improvement was substantial as mean pain scale scores changed from 7.2 on admission to 3 on discharge (P=.009). Patients spent an average of 40 minutes in the treatment area. Eleven patients required further care from an ophthalmologist and topical medication for symptoms. Outcomes were good and there were no complications in any of the cases. We conclude that pepper sprays are being used as an aid to self defense in muggings in our community. Decontamination measures have priority as they alleviate symptoms and prevent long-lasting effects (AU)

Sonda nasogástrica, carbón activado y peritonitis / Nasogastric tube, activated charcoal and peritonitis

No disponible

[Injuries from pepper spray used for self defense: analysis of 15 cases managed in an emergency chemical decontamination area]. / Agresiones realizadas con espráis de defensa personal atendidas en el área de descontaminación química de urgencias. A propósito de 15 casos.

EN: We analyzed epidemiologic and clinical characteristics, treatment received, and clinical course in cases of pepper spray injury treated in the chemical decontamination area of an emergency department over a 5-year period. A total of 15 patients with a mean (SD) age of 25 (8.3) years were included. Thirteen were men and 53% were foreign-born. All uses of pepper spray occurred during muggings that to place mainly in the early hours of the morning (66.7% between 4:30 and 6:30 AM). Two or more attackers were injured in 60% of the events. Seventy-three percent of the attacks took place on the street and the median delay in reaching the emergency department was 30 minutes. The face and eyes were usually injured, and symptoms included itching, irritation, burning, and pain. On arrival, the patients were treated immediately (mean delay, 3 minutes) with hypertonic saline, an amphoteric surfactant, and a chelating agent in 80% of the cases, in which improvement was substantial as mean pain scale scores changed from 7.2 on admission to 3 on discharge (P=.009). Patients spent an average of 40 minutes in the treatment area. Eleven patients required further care from an ophthalmologist and topical medication for symptoms. Outcomes were good and there were no complications in any of the cases. We conclude that pepper sprays are being used as an aid to self defense in muggings in our community. Decontamination measures have priority as they alleviate symptoms and prevent long-lasting effects.

ES: Evalúan las características epidemiológicas, clínicas, terapéuticas y evolutivas, de las asistencias realizadas en el área de descontaminación química (ADQ) del servicio de urgencias, a consecuencia de un ataque con espráis de defensa personal durante un período de 5 años. Se han incluido 15 pacientes con una edad media de 25 años. Trece fueron hombres y el 53% eran personas no nacidas en España. En todos los casos la agresión con el espray se produjo en el curso de una pelea o con ánimo de robo, sobre todo de madrugada (66,7% de los casos entre las 4:30 y las 6:30 h). En el 60% de las atenciones hubo dos o más personas afectadas de forma simultánea. El ataque se produjo en la vía pública en el 73% de las ocasiones y tardaron una mediana de 30 min en llegar a urgencias. Cara y ojos fueron las zonas más afectadas y los síntomas referidos con mayor frecuencia fueron el picor, irritación, quemazón o dolor. El tratamiento aplicado en el hospital fue inmediato (media de demora: 3 min) y se empleó una solución hipertónica, anfótera y quelante en el 80% de los casos, con notable mejoría sintomática, pasando en la escala visual analógica (EVA) del dolor de una puntuación media de 7,2 al ingreso a 3 a la salida (p = 0,009). El tiempo medio de permanencia en el ADQ fue de 40 min. Once de los casos precisaron además asistencia oftalmológica y tratamiento tópico sintomático. La evolución fue favorable y sin secuelas en todos los casos. Concluimos que el uso de espráis de defensa personal con ánimo de robo o agresión es una realidad en nuestro medio. Las medidas de descontaminación son prioritarias y contribuyen a aliviar los síntomas y evitar secuelas.

¿Qué hacer en las quemaduras oculares o cutáneas por productos químicos? / No disponible

No disponible

La tierra de Fuller y otras medidas de descontaminación digestiva en el tratamiento de las intoxicaciones / The Fuller's earth and other digestive decontamination measures in the treatment of poisoning

No disponible

Raves, consumo de drogas y asistencia en urgencias / Raves, drugs use and emergency assistance

No disponible

Carbón activado en 575 casos de intoxicaciones agudas. Seguridad y factores asociados a las reacciones adversas / Use of activated charcoal in acute poisonings: Clinical safety and factors associated with adverse reactions in 575 cases

Fundamento y objetivo: Identificar el patrón de utilización del carbón activado como tratamiento de las intoxicaciones, evaluar la prevalencia y la gravedad de sus reacciones adversas y definir los factores de riesgo asociados a su presentación. Pacientes y método: Estudio prospectivo y observacional realizado en urgencias durante un período de 7 años. Inclusión de pacientes que recibieron carbón activado como método de descontaminación digestiva. Se han investigado variables epidemiológicas, toxicológicas, terapéuticas y evolutivas. La variable dependiente fue la aparición de efectos secundarios relacionados con el uso del carbón activado. Resultados:Se incluyó a 575 pacientes. La media (desviación estándar) de edad fue de 37,8 años (14,8) y el 65,7% fueron mujeres. El carbón se administró por vía oral al 88% de los pacientes y por sonda gástrica tras el lavado al 12% de los pacientes. El 2,4% de los casos había recibido carbón antes de su llegada al hospital. Se presentaron reacciones adversas en 41 casos (7,1%), en forma de náuseas o vómitos (36 pacientes), broncoaspiración (6 pacientes) y neumonía (2 pacientes). La presencia de vómitos espontáneos antes de dar el carbón (p<0,001), la administración prehospitalaria de carbón (p<0,05) o en dosis repetidas (p<0,01) y la necesidad de tratamiento sintomático del intoxicado (p<0,05) resultaron factores de riesgo independientes para la presentación de reacciones adversas al carbón, mientras que la edad superior o igual a 40 años (p<0,05) y haberse intoxicado con benzodiacepinas (p<0,01) se asociaron de forma independiente a una menor presentación de reacciones adversas. La estancia media en urgencias fue de 10,2h (18,6), y se prolongó de forma significativa (p<0,05) en los pacientes que presentaron reacciones adversas. El 75,4% de los casos se dio de alta a su domicilio, el 20,5% requirió ingreso psiquiátrico y el 3,9% ingresó por las consecuencias clínicas de la intoxicación (AU)

Background and objective: To identify the pattern of use of activated charcoal in the treatment of poisonings, and to evaluate the prevalence and severity of adverse reactions and define the risk factors associated with them. Patients and method: Observational, prospective 7-year study. Patients receiving activated charcoal for gut decontamination were included. Epidemiological, toxicological, therapeutic and evolutionary variables were studied. The dependent variable was the appearance of secondary effects related to the use of charcoal.Results: A total of 575 patients were included. The mean age was 37.8 (14.8) years and 65.7% were women. Activated charcoal was administered orally in 88% of the patients and by gastric tube after lavage in 12%, and 2.4% of patients received charcoal before hospital arrival. Adverse reactions occurred in 41 cases (7.1%) and included nausea or vomiting (36 patients), bronchoaspiration (6 patients) and pneumonia (2 patients). Spontaneous vomiting before administration of charcoal (p<0.001), pre-hospital administration of charcoal (p<0.05), repeated doses (p<0.01) and the need for symptomatic measures to treat intoxicated patients (p<0.05) were independent risk factors for adverse reactions, whereas age ≥40 years (p<0.05) and intoxication with benzodiazepines (p<0.01) were independently associated with a smaller risk of adverse reactions. The mean emergency department stay was 10.2 (18.6) hours, and was significantly longer (p<0.05) in patients suffering adverse reactions. A total of 75.4% of patients were discharged to home, 20.5% required psychiatric admission and 3.9% were admitted due to the clinical consequences of the poisoning. The prevalence of non-psychiatric admission to general hospital or intensive care was greater in patients suffering adverse reactions. No patient died (AU)

[Use of activated charcoal in acute poisonings: clinical safety and factors associated with adverse reactions in 575 cases]. / Carbón activado en 575 casos de intoxicaciones agudas. Seguridad y factores asociados a las reacciones adversas.

BACKGROUND AND OBJECTIVE: To identify the pattern of use of activated charcoal in the treatment of poisonings, and to evaluate the prevalence and severity of adverse reactions and define the risk factors associated with them. PATIENTS AND METHOD: Observational, prospective 7-year study. Patients receiving activated charcoal for gut decontamination were included. Epidemiological, toxicological, therapeutic and evolutionary variables were studied. The dependent variable was the appearance of secondary effects related to the use of charcoal. RESULTS: A total of 575 patients were included. The mean age was 37.8 (14.8) years and 65.7% were women. Activated charcoal was administered orally in 88% of the patients and by gastric tube after lavage in 12%, and 2.4% of patients received charcoal before hospital arrival. Adverse reactions occurred in 41 cases (7.1%) and included nausea or vomiting (36 patients), bronchoaspiration (6 patients) and pneumonia (2 patients). Spontaneous vomiting before administration of charcoal (p < 0.001), pre-hospital administration of charcoal (p < 0.05), repeated doses (p < 0.01) and the need for symptomatic measures to treat intoxicated patients (p < 0.05) were independent risk factors for adverse reactions, whereas age ≥ 40 years (p < 0.05) and intoxication with benzodiazepines (p < 0.01) were independently associated with a smaller risk of adverse reactions. The mean emergency department stay was 10.2 (18.6) hours, and was significantly longer (p < 0.05) in patients suffering adverse reactions. A total of 75.4% of patients were discharged to home, 20.5% required psychiatric admission and 3.9% were admitted due to the clinical consequences of the poisoning. The prevalence of non-psychiatric admission to general hospital or intensive care was greater in patients suffering adverse reactions. No patient died. CONCLUSIONS: Adverse reactions to charcoal are infrequent and rarely severe, but are associated with a greater emergency department stay and a trend to greater hospital admission. Predisposing factors are vomiting before administration of charcoal and administration of repeated doses. Age ≥ 40 years and ingestion of benzodiazepines are protective factors.

Indicadores de calidad para la asistencia urgente de pacientes con intoxicaciones agudas (Calitox-2006) / Quality indicators for emergency health care of patients with acute poisoning (Calitox, 2006)

Se presenta un mapa de 24 indicadores para medir la calidad de la asistencia dada a los pacientes con intoxicaciones agudas que son atendidos en los servicios de urgencias. Se incluyen indicadores estructurales (disponibilidad de protocolos, stock de antídotos, técnicas analíticas, sondas de lavado gástrico), indicadores de proceso (adecuación de las técnicas de descontaminación digestiva, indicaciones de depuración renal y de depuración extrarrenal, uso de antídotos, indicación de análisis toxicológicos, práctica de electrocardiograma, demora asistencial, consulta psiquiátrica, parte judicial), indicadores de resultado (mortalidad, cumplimentación de un conjunto mínimo de datos del intoxicado, formación continuada del personal) e indicadores administrativos (publicaciones)

We present a map of 24 indicators to measure the quality of care given to patients with acute poisoning attended in the emergency department. These include structural indicators (availability of protocols, stocks of antidotes, analytical tests, gastric lavage tubes), process indicators (correct indication of gut decontamination techniques, indications for renal and extra-renal purification, use of antidotes, indication of toxicological analyses, ECG, delays in care, psychiatric referrals, judicial notifications), indicators of results (mortality, compliance with minimum basic data set of poisonings, continuing staff education) and administrative indicators (publications)

[Not Available]. / Indicadores de calidad para la asistencia urgente de pacientes con intoxicaciones agudas (Calitox-2006).

We present a map of 24 indicators to measure the quality of care given to patients with acute poisoning attended in the emergency department. These include structural indicators (availability of protocols, stocks of antidotes, analytical tests, gastric lavage tubes), process indicators (correct indication of gut decontamination techniques, indications for renal and extra-renal purification, use of antidotes, indication of toxicological analyses, ECG, delays in care, psychiatric referrals, judicial notifications), indicators of results (mortality, compliance with minimum basic data set of poisonings, continuing staff education) and administrative indicators (publications).

[Efficacy and safety of gut decontamination in patients with acute therapeutic drug overdose]. / Eficacia y seguridad de la descontaminación digestiva en la intoxicación medicamentosa aguda.

BACKGROUND AND OBJECTIVE: Gut decontamination (GD) may be used as a treatment for acute therapeutic drug overdose (ATDO) to reduce the absorption of the drug and thereby avoid the presence or worsening of signs and symptoms of intoxication. The objective of this study was to assess the efficacy and safety of GD in ATDO patients. PATIENTS AND METHOD: A 4-month prospective observational study was designed to include all patients admitted to the emergency department due to an ATDO. On admission, epidemiological data, vital signs and physical examination results were all recorded and a blood sample was taken for toxicological analysis. An algorithm was used to determine the GD method to be applied. A clinical reassessment was made at 3-6 hours and a further sample was taken for toxicological analysis. Patients were followed until hospital discharge, with all possible adverse events due to GD being recorded. RESULTS: Ninety-four patients were included. GD was indicated in 60 patients (63.8%): 3.3% received ipecacuana syrup, 8.3% gastric lavage, 21.6% gastric lavage followed by activated charcoal and 71.6% oral activated charcoal alone. The clinical state worsened in 19.1% of patients, usually on the basis of a diminished consciousness. Adverse events attributable to GD were observed in 8.3% of patients. A toxicological analysis was made in 50 patients and in 42% of them, drug concentrations were higher at 3 or 6 hours than on admission. An analysis of the method of decontamination used showed that the procedure recommended by the algorithm was applied in 70 patients (group A) while in the remaining 24 (group B) another decontamination technique was used. Clinical deterioration was seen in 14.3% of patients in group A and 33.3% in group B (p = 0.041). There was a favourable evolution of the analytic curve in 63.9% patients in group A and 42.9% in group B (p = NS); severe adverse events attributable to GD were suffered by 2.4% patients in group A and 11.1% in group B (p = NS). CONCLUSIONS: The efficacy and safety of GD in ATDO increases in patients in whom the decision-making algorithm is applied. However, this does not prevent clinical deterioration or continued drug absorption in all cases and may be accompanied by adverse events.