Tips for avoiding common mistakes in out-of-hospital diagnosis of carbon monoxide poisoning.

Acute carbon monoxide poisoning is the leading cause of intoxication from exogenous substances in the world. It is also a major cause of morbidity and mortality due to poisoning in the USA. In the USA, it determines to 50,000 visits per year in emergency departments with a mortality ranging from 1 to 3%. Although prevalence and incidence data reveal the large impact of carbon monoxide poisoning on public health, some studies have shown that errors in its diagnosis have a high incidence (30%) and that awareness campaigns have allowed the reduction of the same to 5%. In addition, many diagnostic and/or therapeutic errors were found both in small first aid situations and in the context of rescue units belonging to prestigious hospitals. To formulate a diagnosis, the collection of clues from the environment in which the patient is found is essential. Especially when the routine use of environmental gas detectors or handheld CO-oximeters is not possible, the emergency doctor, in addition to concentrating on the clinical presentation of the case, will have to give a quick overview of the patient and his environment. In addition to age, sex, and already known comorbidities, it is not irrelevant to evaluate socio-economic and cultural characteristics, hygiene conditions, habits, etc.The purpose of this study is to provide useful information to the doctor who comes first to the site of intoxication to reduce diagnostic and therapeutic errors in the pre- and intra-hospital phase as much as possible.

Can hyperbaric oxygenation therapy (HOT) modify the blood testosterone concentration?

INTRODUCTION: Testosterone has a modulating effect on inflammatory and healing processes. In this study, we evaluate whether hyperbaric oxygenation therapy (HOT) modifies the blood concentration of total testosterone (TT) in patients treated for different pathologies. MATERIALS AND METHODS: Fourteen male patients (23-72 years old) were treated with 90-min HOT sessions (range 4 to 23 sessions) as an adjuvant to the following conditions: leg fractures, osteonecrosis, diabetic foot, firearm injuries, complicated arthroprosthesis and underwater diving embolism. As controls, six healthy male volunteers (37-51 years old) were subjected to 10 HOT sessions. Testosterone plasma levels were determined immediately before the first HOT session and the day after the last session. RESULTS: At the end of treatment, 12 patients fully recovered and 2 (diabetic foot patients) showed a marked improvement. Testosterone significantly increased after hyperbaric oxygenation therapy in both patients and controls (ANOVA, p<0.004). DISCUSSION: We conclude that hyperbaric oxygenation therapy increases the blood concentration of total testosterone in patients as well as in healthy men. This finding raises new questions and indicates the need to investigate the causes of this increase and its therapeutic significance. Since testosterone modulates inflammation and healing processes, it is possible that hormonal changes are the mechanisms affected by hyperbaric oxygenation therapy.

Guiding principles in choosing a therapeutic table for DCI hyperbaric therapy.

Hyperbaric therapy is the basis of treatment for pervasive development disorders. For this reason, the choice of the right therapeutic table for each case is critical. Above all, the delay in recompression time with respect to the first symptoms and to the severity of the case must be considered. In our experience, the use of low-pressure oxygen tables resolves almost all cases if recompression takes place within a short time. When recompression is possible almost immediately, the mechanical effect of reduction on bubble volume due to pressure is of remarkable importance. In these cases, high-pressure tables can be considered. These tables can also be used in severe spinal-cord decompression sickness. The preferred breathing mixture is still disputed. Heliox seems to be favored because it causes fewer problems during the recompression of divers, and above all, because nitrox can cause narcosis and contributes nitrogen. Saturation treatment should be avoided or at least used only in special cases. In cases of arterial gas embolism cerebral injury, it is recommended to start with an initial 6 ATA recompression only if the time between symptom onset and the beginning of recompression is less than a few hours.