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1.
Acta Clin Belg ; 64(5): 442-6, 2009.
Article in English | MEDLINE | ID: mdl-19999395

ABSTRACT

OBJECTIVE: We present this case to emphasize the importance of early diagnosis and treatment of an acute severe hypercalcemic syndrome due to primary hyperparathyroidism as a consequence of an undiagnosed adenoma of the parathyroid gland. CASE REPORT: A 50-year-old man presented at another hospital with non-specific symptoms such as anorexia, nausea, vomiting, polyuria, dehydration, abdominal pain, weight loss, fatigue, muscular weakness, irritability and lethargy. Serum levels of calcium and parathyroid hormone (PTH) were markedly increased to 23.6 mg/dL (reference values 8.6-10.2 mg/dL) and > 1900 ng/L (reference values 14-72 ng/L) respectively. After initial treatment, the patient was transferred to the intensive care unit (ICU) of a tertiary care university hospital for further stabilization and treatment because the typical signs of hypercalcemia were not resolving. A parathyroid adenoma was diagnosed and a few days later a parathyroidectomy was performed. The postoperative course was uneventful and the patient could be discharged from the hospital in a good general condition. CONCLUSION: Acute primary hyperparathyroidism, also known as parathyroid storm or parathyroid crisis, is a rare but potentially fatal endocrine emergency if unrecognized and untreated. Appropriate diagnosis and immediate adequate management of hypercalcemia are important in reducing mortality. Nevertheless, mortality remains high, even with surgical treatment which is the cornerstone of the definitive therapy.


Subject(s)
Hypercalcemia/diagnosis , Hypercalcemia/etiology , Hyperparathyroidism, Primary/complications , Acute Disease , Adenoma/complications , Adenoma/diagnostic imaging , Humans , Hyperparathyroidism, Primary/etiology , Hyperparathyroidism, Primary/surgery , Male , Middle Aged , Parathyroid Neoplasms/complications , Parathyroid Neoplasms/diagnostic imaging , Parathyroidectomy , Tomography, X-Ray Computed
2.
Acta Clin Belg ; 61(4): 188-95, 2006.
Article in English | MEDLINE | ID: mdl-17091917

ABSTRACT

Alcohol and illicit drug abuse are major health care problems frequently leading to emergency department admission. The aims of this survey were (1) to determine for the Ghent University Hospital how frequently substance abuse contributed to emergency department admissions, (2) to describe the most important clinical features of these patients and (3) to determine how frequently these patients were referred to appropriate psychiatric services. All 1,941 patients attending the emergency department during the month of September 2003 were registered by the attending emergency department personnel. After exclusion of 8 cases, 1,933 patients were included: 198 (10%) with substance abuse leading to the emergency department admission (= INTOX group) and 1,735 (90%) in the NON-INTOX group. Males and the 21-50 years age group were overrepresented in the INTOX group. Patients with substance abuse were also overrepresented during the night, but not during the weekend. Among the patients from the INTOX group the most frequent reason for the emergency department visit was a psychiatric problem (102/198; 51%). Traumatic lesions related to a fight (n= 19), to a traffic accident (n= 17) and to leisure time activities (n=30) were also frequent. In most patients, only alcohol was abused (144/198; 73%), most frequently chronically (102/144; 71%). In 13% (26/198), there was only illicit drug use, and in 14% (28/198) alcohol abuse was combined with illicit drug use. Among the 54 patients with illicit drug use (with or without alcohol abuse) the most frequently reported drugs were cannabis (54%), cocaine (41%), amphetamines (39%) and opiates (39%). With regard to referral to appropriate psychosocial services it was striking that 53% (19/36) of trauma patients with chronic substance abuse were not offered that type of help. We conclude that abuse of alcohol--and to a much lesser degree illicit drugs--is a frequent cause of emergency department admissions. Our data may help to convince and/or reinforce health care policy makers, emergency department medical directors and the public that alcohol consumption (much more than illicit drugs) is responsible for avoidable morbidity and mortality, and that well-co-ordinated strategies against unhealthy alcohol use are urgently needed. In this respect, the importance of detection and referral of emergency department patients with unhealthy alcohol use should be stressed.


Subject(s)
Alcoholic Intoxication/epidemiology , Alcoholism/epidemiology , Emergency Service, Hospital/statistics & numerical data , Substance-Related Disorders/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Belgium/epidemiology , Data Collection , Female , Humans , Male , Mental Disorders/epidemiology , Mental Disorders/etiology , Middle Aged , Patient Admission
3.
Resuscitation ; 50(3): 357-61, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11719167

ABSTRACT

Medical supervision of the use of automated external defibrillators (AEDs) is possible by the incorporation of a solid state memory system recording electrocardiography (ECG) tracings and information about the operation of the device. Since a post event report suggested inappropriate AED use erroneously, the information storage and printing processes of the Laerdal AED system were investigated. This analysis strongly suggests (yet unpredictable) incompatibilities between the software built in the solid state memory modules and the different components of the printing system. Although no problems were encountered during the resuscitation attempts, these findings may be clinically relevant because an unreliable post event report from a solid state memory module may lead to erroneous criticism of an AED user.


Subject(s)
Electric Countershock/instrumentation , Equipment Failure/statistics & numerical data , Information Storage and Retrieval , Cardiopulmonary Resuscitation , Electrocardiography , Humans , Male , Middle Aged , Reproducibility of Results
4.
Crit Care Med ; 29(5): 997-9, 2001 May.
Article in English | MEDLINE | ID: mdl-11378611

ABSTRACT

OBJECTIVE: Hypovolemia has been shown to decrease the dose requirement for propofol. This increased effect has been explained partially by an increased end organ sensitivity to the anesthetic effect of propofol. We used the opioid blocking agent naloxone to test the hypothesis that endogenous opioids may be involved in this increased sensitivity. SUBJECTS: Thirty-two chronically instrumented rats were assigned randomly to either the hypovolemia (n = 16) or the control (n = 16) group. INTERVENTIONS: After pretreatment of each rat in the two groups with either intravenous saline (n = 8) or naloxone (3 mg/kg; n = 8), an intravenous infusion of propofol (150 mg x kg(-1) x hr(-1)) was given until 5 secs of electrical suppression of the electroencephalographic signal was observed. Return of righting reflex was used to assess depth of anesthesia, and the propofol blood concentration was determined simultaneously with high-performance liquid chromatography. MEASUREMENTS AND MAIN RESULTS: The mean propofol blood concentrations at the return of righting reflex were significantly lower in the hypovolemic animals compared with the controls within both naloxone-treated (2.1 +/- 0.2 microg/mL vs. 2.9 +/- 0.2 microg/mL; p < .01) and saline-treated (2.2 +/- 0.1 vs. 3.0 +/- 0.2 microg/mL; p < .01) rats. The mean concentrations were not different between the saline- and naloxone-treated rats either within the hypovolemic group or within the control group. CONCLUSIONS: The results of our study indicate that it is unlikely that the increased end organ sensitivity to propofol during hypovolemia is mediated by endogenous opioids, because it was not reversed by naloxone.


Subject(s)
Anesthetics, Intravenous/pharmacology , Hypovolemia/blood , Naloxone/pharmacology , Narcotic Antagonists/pharmacology , Propofol/pharmacology , Reflex/drug effects , Anesthetics, Intravenous/blood , Animals , Dose-Response Relationship, Drug , Drug Interactions , Electroencephalography , Hemodynamics/drug effects , Infusions, Intravenous , Male , Propofol/blood , Rats , Rats, Wistar
5.
J Pharm Pharmacol ; 53(12): 1687-96, 2001 Dec.
Article in English | MEDLINE | ID: mdl-11804399

ABSTRACT

In view of the potential interest in an objective parameter for the depth of coma in intoxications with the recreational drug gamma-hydroxybutyrate (GHB), we have studied the relationship between the plasma concentrations and the electroencephalographic (EEG) changes induced by GHB in the rat. Fifteen rats randomly received either 150 (n = 3), 200 (n = 6) or 300 mg kg(-1) (n = 6) GHB over 5 min, followed by a supramaximal dose of 450 mg kg(-1) over 5 min at the end of the experiment. Plasma concentrations were determined with HPLC. The EEG was continuously recorded and the amplitude in the 15.5-30 Hz frequency band was quantified using aperiodic analysis. The plasma concentration-time profiles were fitted to a two-compartment model with Michaelis-Menten elimination. The pharmacokinetic parameters Vmax, Km and the apparent volume of distribution (Vd) proved to be independent of the dose and the mean pooled values were Vmax 2068 +/- 140 microg min(-1) kg(-1), Km 58 +/- 16 microg mL(-1) and Vd 476 +/- 12 mL kg(-1). The EEG amplitude in the 15.5-30 Hz frequency band displayed a monophasic inhibition and the effect-plasma concentration curve showed hysteresis. This hysteresis between EEG effect and plasma concentrations was minimized by simultaneous calculation of hypothetical effect-site concentrations and fitting the effect vs effect-site concentration curve to a sigmoid inhibitory Emax model. The descriptors of this Emax model (Emax, EC50, k(e,0), gamma and E0) were independent of the dose with an equilibration half-life t1/2k(e,0) of 5.6 +/- 0.3 min (mean value of the pooled results of the 5-min treatment groups). To investigate the origin of this hysteresis, a dose of 600 mg kg(-1) GHB was infused over either 45 or 60 min each in three animals. The hysteresis was much less pronounced with 45 min than with 5 min and was absent with 60-min infusions. This indicated that the hysteresis was due to a distribution delay between the central compartment and the effect site. This study showed that the concentration-effect relationship of GHB could be characterized in individual rats using aperiodic analysis in the 15.5-30 Hz frequency band.


Subject(s)
Electroencephalography/drug effects , Illicit Drugs/toxicity , Sodium Oxybate/toxicity , Animals , Dose-Response Relationship, Drug , Male , Rats , Rats, Wistar , Sodium Oxybate/blood
6.
Verh K Acad Geneeskd Belg ; 63(5): 475-80; discussion 480-2, 2001.
Article in Dutch | MEDLINE | ID: mdl-11813504

ABSTRACT

Patients suffering from critical illnesses like cardiac arrest with resuscitation and hypovolemic shock often are in need of medication. Under these conditions pharmacokinetics and pharmacodynamics can be markedly altered. In this paper the results of our experimental work in animals on the pharmacology during resuscitation and hypovolemia is discussed. The data show that during cardiopulmonary resuscitation in the dog the kinetics of epinephrine are changed. The administration of the calcium antagonist nimodipine does not result in a cerebroprotective action in a cardiopulmonary arrest model in the rat. The pharmacokinetics and pharmacodynamics of the anesthetics etomidate and propofol were studied in a model of hemorrhagic hypovolemia in the rat. Changes in plasma concentrations as well as in brain sensitivity occur. It is concluded that animal experiments highlight changes in the action of drugs during critical conditions. Such information can be helpful in view of the practical and ethical problems related to the study of the action of drugs in critically ill patients.


Subject(s)
Cardiopulmonary Resuscitation , Critical Illness/therapy , Heart Arrest/therapy , Pharmaceutical Preparations/metabolism , Shock/metabolism , Adrenergic Agonists/pharmacokinetics , Adrenergic Agonists/pharmacology , Anesthetics, Intravenous/pharmacokinetics , Anesthetics, Intravenous/pharmacology , Animals , Calcium Channel Blockers/pharmacokinetics , Calcium Channel Blockers/pharmacology , Epinephrine/pharmacokinetics , Epinephrine/pharmacology , Etomidate/pharmacokinetics , Etomidate/pharmacology , Humans , Nimodipine/pharmacokinetics , Nimodipine/pharmacology , Pharmacokinetics , Propofol/pharmacokinetics , Propofol/pharmacology
7.
Anesthesiology ; 93(6): 1482-90, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11149444

ABSTRACT

BACKGROUND: Hypovolemia decreases the dose requirement for anesthetics, but no data are available for propofol. As it is impossible to study this in patients, a rat model was used in which the influence of hypovolemia on the pharmacokinetics and pharmacodynamics of propofol was investigated. METHODS: Animals were randomly allocated to either a control (n = 9) or a hypovolemia (n = 9) group, and propofol was infused (150 mg x kg(-1) x h(-1)) until isoelectric periods of 5 s or longer were observed in the electroencephalogram. The changes observed in the electroencephalogram were quantified using aperiodic analysis and used as a surrogate measure of hypnosis. The righting reflex served as a clinical measure of hypnosis. RESULTS: The propofol dose needed to reach the electroencephalographic end point in the hypovolemic rats was reduced by 60% (P < 0.01). This could be attributed to a decrease in propofol clearance and in distribution volume. Protein binding was similar in both groups. To investigate changes in end organ sensitivity during hypovolemia, the electroencephalographic effect versus effect-site concentration relation was studied. The effect-blood concentration relation was biphasic, exhibiting profound hysteresis in both hypovolemic and control animals. Semiparametric minimization of this hysteresis revealed similar equilibration half-lives in both groups. The biphasic effect-concentration relation was characterized by descriptors showing an increased potency of propofol during hemorrhage. The effect-site concentration at the return of righting reflex was 23% (P < 0.01) lower in the hypovolemic animals, also suggesting an increased end organ sensitivity. CONCLUSIONS: An increased hypnotic effect of propofol occurs during hypovolemia in the rat and can be attributed to changes in both pharmacokinetics and end organ sensitivity.


Subject(s)
Anesthesia, Intravenous , Anesthetics, Intravenous/pharmacokinetics , Hypovolemia/metabolism , Propofol/pharmacokinetics , Anesthetics, Intravenous/administration & dosage , Anesthetics, Intravenous/blood , Animals , Electroencephalography , Male , Models, Animal , Propofol/administration & dosage , Propofol/blood , Random Allocation , Rats , Rats, Wistar
8.
Acta Neurol Belg ; 100(4): 221-4, 2000 Dec.
Article in English | MEDLINE | ID: mdl-11233676

ABSTRACT

Clinicians in the emergency department are often confronted with coma patients due to poisoning. A systematic general approach involving early consultation with a neurologist is of paramount importance. A high index of suspicion, a systematic first assessment already in the prehospital phase and early stabilisation of vital functions are the essential first steps. Specific antidotes like hypertonic glucose and thiamine are part of a "coma cocktail". The opiate antagonist naloxone should be used only when clinically indicated and in a titrated way. Flumazenil should only be used with caution and in restricted cases. Clinical neurological evaluation and technical investigations like CT-scan and laboratory tests should make part of a careful diagnostic plan. Toxicological tests deserve their place in the diagnostic work up of a coma patient with suspected poisoning. Knowledge of the possibilities of the toxicology lab and optimal communication with the clinical toxicologist is important for optimal patient care.


Subject(s)
Alcohol-Induced Disorders, Nervous System , Alcoholic Intoxication/complications , Coma/chemically induced , Ethanol/poisoning , Accidental Falls , Alcohol-Induced Disorders, Nervous System/complications , Alcohol-Induced Disorders, Nervous System/diagnosis , Alcohol-Induced Disorders, Nervous System/therapy , Alcoholic Intoxication/diagnosis , Alcoholic Intoxication/therapy , Antidotes/therapeutic use , Brain Injuries/diagnosis , Coma/therapy , Diabetic Coma/diagnosis , Diagnosis, Differential , Diagnostic Tests, Routine , Drug Overdose/diagnosis , Emergencies , First Aid , Flumazenil/therapeutic use , Glucagon/therapeutic use , Glucose/therapeutic use , Humans , Hypoglycemia/complications , Hypoxia, Brain/etiology , Hypoxia, Brain/prevention & control , Monitoring, Physiologic , Naloxone/therapeutic use , Neurologic Examination , Stroke/diagnosis , Thiamine/therapeutic use
9.
J Pharmacol Exp Ther ; 290(3): 1048-53, 1999 Sep.
Article in English | MEDLINE | ID: mdl-10454477

ABSTRACT

The influence of hypovolemia (removal of 30% of the blood volume) on the pharmacokinetics and pharmacodynamics of etomidate was investigated in the rat. Chronically instrumented animals were randomly allocated to either a control (n = 9) or a hypovolemia (n = 9) group, and etomidate was infused (50 mg/kg/h) until isoelectric periods of 5 s or longer were observed in the electroencephalogram. The changes observed in the electroencephalogram were quantified using aperiodic analysis in the 2.5- to 7.5-Hz frequency band and used as a surrogate measure of hypnosis. The righting reflex was used as a clinical measure of hypnosis. The etomidate dose that had to be infused to reach the electroencephalographic endpoint was almost 40% lower (p <.01) in the hypovolemic animals than in the control animals. This difference could be attributed to a decrease in clearance (-20%; p =.06) and distribution volume (-30%; p <.01) of etomidate. Protein binding was similar in both groups. To investigate changes in end organ sensitivity during hypovolemia, the electroencephalographic effect-versus-effect-site concentration relationship was studied. The effect-plasma concentration relationship was biphasic, exhibiting profound hysteresis in both hypovolemic and control animals. Semiparametric minimization of this hysteresis revealed similar equilibrium half-lives in both groups, and the biphasic effect-concentration relationship was characterized nonparametrically by descriptors. With these descriptors, a slightly increased potency of etomidate during hemorrhage was observed. The concentration at the return of righting reflex was 16% (p <.05) lower in the hypovolemic animals. In conclusion, an increased hypnotic effect of etomidate was observed during hypovolemia that is mainly attributed to pharmacokinetic changes. Our data also suggest a small increase in central nervous system sensitivity for etomidate in hypovolemic animals.


Subject(s)
Blood Volume/physiology , Electroencephalography/drug effects , Etomidate/pharmacology , Etomidate/pharmacokinetics , Shock/physiopathology , Anesthetics, Intravenous/pharmacokinetics , Anesthetics, Intravenous/pharmacology , Animals , Blood Pressure/drug effects , Body Temperature/physiology , Disease Models, Animal , Dose-Response Relationship, Drug , Heart Rate/drug effects , Hypnotics and Sedatives/pharmacokinetics , Hypnotics and Sedatives/pharmacology , Male , Random Allocation , Rats , Rats, Wistar
10.
Pharm Res ; 16(6): 924-9, 1999 Jun.
Article in English | MEDLINE | ID: mdl-10397615

ABSTRACT

PURPOSE: The effect-plasma concentration relationship of etomidate was studied in the rat using electroencephalographic changes as a pharmacodynamic parameter. METHODS: Etomidate was infused (50 mg/kg/h) in chronically instrumented rats (n=6) until isoelectric periods of 5 s or longer were observed in the electroencephalogram (EEG). The EEG was continuously recorded during the experiment and frequent arterial blood samples were taken for determination of etomidate plasma concentrations. The changes observed in the raw EEG signal were quantified using aperiodic analysis in the 2.5-7.5 Hz frequency band. The return of the righting reflex was used as another parameter of anesthesia. RESULTS: A mean dose of 8.58+/-0.41 mg/kg needed to be infused to reach the end point of 5 s isoelectric EEG. The plasma concentration time profiles were most adequately fitted using a three-exponential model. Systemic clearance, volume of distribution at steady-state and elimination half-life averaged 93+/-6 ml/min/kg, 4.03+/-0.24 l/kg and 59.4+/-10.7 min respectively. The EEG effect-plasma concentration relationship was biphasic exhibiting profound hysteresis. Semi-parametric minimization of this hysteresis revealed an equilibration half-life of 2.65+/-0.15 min, and the biphasic effect-concentration relationship was characterized nonparametrically by descriptors. The effect-site concentration at the return of the righting reflex was 0.44+/-0.03 microg/ml. CONCLUSIONS: The results of the present study show that the concentration-effect relationship of etomidate can be characterized in individual rats using aperiodic analysis in the 2.5-7.5 Hz frequency band of the EEG. This characterization can be very useful for studying the influence of diseases on the pharmacodynamics of etomidate in vivo.


Subject(s)
Anesthetics, Intravenous/blood , Electroencephalography/drug effects , Etomidate/blood , Anesthetics, Intravenous/pharmacology , Animals , Etomidate/pharmacology , Male , Rats , Rats, Wistar
11.
Resuscitation ; 38(2): 119-25, 1998 Aug.
Article in English | MEDLINE | ID: mdl-9863574

ABSTRACT

The coincidental print-out by two different Laerdal systems (subsequently called 'system A' and 'system B') of the same medical control module (MCM) for a Laerdal Heartstart 2000 semi-automatic external defibrillator (SAED) led to the discovery of three deficiencies in the information storage and printing processes. First, we noted that the impedance reported via system A was consistently higher. Second, we found the attachment of 'mysterious' ECG samples in the reports from system B, but not from system A. A third problem was the unpredictable (in)ability of system B to print out the information from the MCMs. Further investigations with help from the company suggested that the above-mentioned problems were caused by incompatibilities between the software in the different parts of equipment used (i.e. SAED devices, MCMs, printing systems and a computer program to store the information in a database). These observations demonstrate the need for strict medical supervision on all aspects of a SAED project, and for feed-back from clinicians to manufacturers.


Subject(s)
Electric Countershock/instrumentation , Electrocardiography/instrumentation , Aged , Computer Peripherals/statistics & numerical data , Electric Countershock/statistics & numerical data , Electrocardiography/statistics & numerical data , Equipment Failure/statistics & numerical data , Heart Arrest/diagnosis , Heart Arrest/therapy , Humans , Information Storage and Retrieval/statistics & numerical data , Male
12.
Fundam Clin Pharmacol ; 12(6): 624-30, 1998.
Article in English | MEDLINE | ID: mdl-9818295

ABSTRACT

The influence of hemorrhagic shock (removal of 30% of the blood volume) on the pharmacokinetics and the analgesic effect of morphine was investigated in conscious rats. Plasma concentrations of morphine after a bolus injection (5 mg/kg) are higher in the shock animals, which is attributed to a small decrease in clearance (-22%; P > 0.05) and a significant decrease in distribution volume (-33%; P < 0.05) of the drug. The areas under the plasma concentration-time curve of the metabolite morphine-3-glucuronide (M3G) are significantly higher (+237%; P < 0.01) in the shock rats, which is probably explained by a decreased distribution and renal excretion. The analgesic effect of morphine was evaluated using the tail-flick test during a continuous infusion (10 mg/kg/h) with measurement of the plasma concentrations of morphine and M3G. Data from these experiments show higher plasma concentrations of morphine (+33%; P < 0.05) and M3G (+66%; P > 0.05) during shock, and a significantly increased analgesic effect (+43%; P < 0.05). Our data suggest that the increased analgesic effect of morphine during hemorrhagic shock can most likely be explained by pharmacokinetic changes resulting in higher morphine concentrations.


Subject(s)
Analgesics, Opioid/pharmacology , Analgesics, Opioid/pharmacokinetics , Morphine/pharmacology , Morphine/pharmacokinetics , Shock, Hemorrhagic/metabolism , Analgesia , Analgesics, Opioid/blood , Animals , Injections, Intravenous , Male , Morphine/blood , Morphine Derivatives/blood , Pain Measurement , Rats , Rats, Wistar , Time Factors
13.
Pharmacoepidemiol Drug Saf ; 7(6): 403-10, 1998 Nov.
Article in English | MEDLINE | ID: mdl-15073970

ABSTRACT

Benzodiazepines belong to the most widely prescribed group of drugs and are involved in a large proportion of the acute poisonings seen in emergency departments. The aim of the study was to examine whether a relationship exists between the number of poisonings with different types of benzodiazepines and the number of prescriptions for these benzodiazepines. A significant correlation was found between the type of benzodiazepine in cases of acute poisoning seen in the emergency department and (1) the benzodiazepines used as apparent from a sample of the population of the province of East Flanders (Spearman r=0.70, P=0.002), (2) benzodiazepine prescriptions made during a period of 7 weeks by 131 general practitioners (r=0.66, P=0.039, (3) the number of packages of the different benzodiazepines sold in Belgium (r=0.69, P=0.001) and (4) the number of packages sold in Belgium (expressed in DDD; r=0.58, P=0.047). This correlation was found despite the differences in age and geographic characteristics of the populations we studied. We observed more poisonings with diazepam, flunitrazepam and lormetazepam than would be expected from the data on their use in the population. The reason is unclear but the faster onset of action of the benzodiazepines may have led to more frequent hospitalization.

14.
Resuscitation ; 35(3): 213-8, 1997 Nov.
Article in English | MEDLINE | ID: mdl-10203398

ABSTRACT

In this paper, we assessed the effects of a training course for emergency medical dispatchers on the handling of out-of-hospital cardiac arrest cases in the dispatch center of a two-tiered emergency medical services system. A total of 112 cardiac arrest cases were studied; 64 before and 48 after the training course. Before the course, all relevant information was obtained in 36% of cases, only partial information in 56% and no useful medical information in 8%. The corresponding figures after the training program were 62, 38 and 0%, respectively (2 x 3 chi2 test, P = 0.01). Trends towards an increase in the percentage of cases in which a second-tier team was sent immediately after the initial call (58 vs 75%; chi2 test, P = 0.06) and towards shorter overall intervals between receipt of the call and dispatch of the second-tier team (logrank test, P = 0.10) were noticed. Similarly, the survival rate increased from 2% before, to 8% after the training course (chi2 test with Yates' correction, P = 0.24). We conclude that our training program for emergency medical dispatchers produced some beneficial effects.


Subject(s)
Emergency Medical Services , Emergency Medical Technicians/education , Heart Arrest/therapy , Apnea/therapy , Belgium , Chi-Square Distribution , Communication , Humans , Life Support Care , Prospective Studies , Survival Rate , Time Factors
15.
Eur J Emerg Med ; 2(4): 217-23, 1995 Dec.
Article in English | MEDLINE | ID: mdl-9422210

ABSTRACT

In a prospective study of 4234 patients with acute poisoning in the Emergency Department of the University Hospital of Gent in Belgium between 1983 and 1990, we observed a decline in the number of poisonings from 665 in 1983 to 424 in 1990. This was due to a decrease in the number of deliberate self-poisonings. Fifty-six per cent of patients were female and the most prevalent age group was 20 to 24 years. There was no seasonal variation. The substances most frequently taken were benzodiazepines (55% of the deliberate self-poisonings), ethanol in combination with other substances (35.8%), barbiturates and older hypnotics (18.6%), non-narcotic analgesics (13.3%) and tricyclic antidepressants (11.6%). Carbon monoxide accounted for 65.1% of all the accidental poisonings. With regard to treatment, a reduction in gastric lavage was observed. The patients were transferred to the intensive care unit (29.2%), the psychiatry ward (23.6%) or discharged home (27.8%). Only 0.3% of the patients died in the Emergency Department.


Subject(s)
Emergency Service, Hospital/statistics & numerical data , Poisoning/epidemiology , Acute Disease , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Belgium/epidemiology , Female , Hospitals, University , Humans , Incidence , Male , Middle Aged , Poisoning/diagnosis , Risk Factors , Sex Distribution , Survival Rate , Utilization Review
16.
J Toxicol Clin Toxicol ; 33(3): 253-6, 1995.
Article in English | MEDLINE | ID: mdl-7760451

ABSTRACT

Although poisoning with calcium channel blocking agents is frequent, to our knowledge no cases involving amlodipine have been published. We describe here a case of amlodipine intoxication, in which protracted hypotension did not respond to vasopressor therapy alone. After the addition of continuous calcium chloride and glucagon infusion, blood pressure was restored and vasopressor therapy could be tapered off substantially. When calcium and glucagon were interrupted because of severe hypercalcemia and hyperglycemia, the patient developed irreversible hypotension and died. Either glucagon or calcium or both, and to some extent vasopressors, seem to have constituted effective treatment of hypotension in this case.


Subject(s)
Amlodipine/poisoning , Fatal Outcome , Female , Humans , Hypotension/chemically induced , Middle Aged , Oxazepam/poisoning
17.
Resuscitation ; 26(1): 47-52, 1993 Aug.
Article in English | MEDLINE | ID: mdl-8210731

ABSTRACT

Incorrectly performed bystander CPR might compromise survival of the cardiac arrest patient. We therefore evaluated the outcome in 3306 out-of-hospital primary cardiac arrests of which 885 received bystander CPR. bystanders performed CPR correctly in 52%, incorrectly in 11%, 31% performed only external chest compressions (ECC) and 6% only mouth-to-mouth ventilation (MMV). The initial ECG in cases without bystander CPR was ventricular fibrillation in 28% (95% confidence interval: 27-30%); 45% (41-50%) and 39% (29-48%), respectively when bystander CPR was performed correctly or incorrectly; 43% (37-49%) when only ECC was applied and 22% (11-33%) when only MMV was practiced. Long term survival, defined as being awake 14 days after CPR, was 16% (13-19%) in patients with correct bystander CPR; 10% (7-14%) and 2% (0-9%), respectively when only ECC or only MMV was performed; 7% (6-8%) when no bystander was involved; 4% (0-8%) when bystander CPR was performed incorrectly. Bystander CPR might have a beneficial effect on survival by maintaining the heart in ventricular fibrillation by ECC. A negative effect of badly performed bystander CPR was not observed compared to cases which had not received bystander CPR.


Subject(s)
Cardiopulmonary Resuscitation/standards , Heart Arrest/therapy , Belgium/epidemiology , Cardiopulmonary Resuscitation/adverse effects , Cardiopulmonary Resuscitation/education , Emergency Medical Services , Health Personnel , Heart Arrest/mortality , Humans , Risk Factors , Survival Rate , Time Factors , Treatment Outcome , Ventricular Fibrillation/mortality , Ventricular Fibrillation/therapy
18.
Resuscitation ; 25(1): 59-71, 1993 Feb.
Article in English | MEDLINE | ID: mdl-8446788

ABSTRACT

In view of our negative results with the calcium antagonist nimodipine as a cerebroprotective agent in a cardiopulmonary resuscitation model in the rat, we examined the protective effects of nimodipine in the four-vessel (carotid and vertebral) occlusion model, a model of global brain ischemia without important cardiovascular depression. Survival and neurological status were monitored and after 72 h the hippocampus was resected and examined for histological evaluation. The animals were treated blindly and randomly with either nimodipine, its solvent or saline given subcutaneously. In two separate studies, high doses (total dose: 5 mg/kg) or low doses of nimodipine (total dose: 1.6 mg/kg) were administered. In the high dose series, the survival rates at 72 h in the nimodipine group, the saline group and the solvent group were 4% (2/44), 19% (7/37) and 20% (8/41), respectively; in the low dose series, the figures were 26% (13/50), 34% (15/44) and 39% (18/46), respectively. The differences between nimodipine, solvent and saline were not statistically significant. Likewise, no differences in neurological status or histological brain damage were found. These data suggest that nimodipine offers no cerebral protection in global brain ischemia and may even be toxic, especially when given in high doses.


Subject(s)
Brain Damage, Chronic/prevention & control , Brain Ischemia/drug therapy , Hippocampus/pathology , Nimodipine/therapeutic use , Animals , Brain Damage, Chronic/pathology , Brain Ischemia/complications , Male , Nimodipine/administration & dosage , Rats , Rats, Wistar
19.
Arch Toxicol ; 67(2): 79-84, 1993.
Article in English | MEDLINE | ID: mdl-8481105

ABSTRACT

We measured in nine patients, poisoned by organophosphorus agents (ethyl parathion, ethyl and methyl parathion, dimethoate, or bromophos), erythrocyte and serum cholinesterase activities, and plasma concentrations of the organophosphorus agent. These patients were treated with pralidoxime methylsulphate (Contrathion), administered as a bolus injection of 4.42 mg.kg-1 followed by a continuous infusion of 2.14 mg.kg-1/h, a dose regimen calculated to obtain the presumed "therapeutic" plasma level of 4 mg.l-1, or by a multiple of this infusion rate. Oxime plasma concentrations were also measured. The organophosphorus agent was still detectable in some patients after several days or weeks. In the patients with ethyl and methyl several days or weeks. In the patients with ethyl and methyl parathion poisoning, enzyme reactivation could be obtained in some at oxime concentrations as low as 2.88 mg.l-1; in others, however, oxime concentrations as high as 14.6 mg.l-1 remained without effect. The therapeutic effect of the oxime seemed to depend on the plasma concentrations of ethyl and methyl parathion, enzyme reactivation being absent as long as these concentrations remained above 30 micrograms.l-1. The bromophos poisoning was rather mild, cholinesterases were moderately inhibited and increased under oxime therapy. The omethoate inhibited enzyme could not be reactivated.


Subject(s)
Cholinesterase Reactivators/blood , Insecticides/poisoning , Organophosphate Poisoning , Pralidoxime Compounds/blood , Adult , Aged , Cholinesterase Inhibitors/blood , Cholinesterases/blood , Dimethoate/blood , Dimethoate/poisoning , Erythrocytes/enzymology , Female , Humans , Insecticides/blood , Male , Methyl Parathion/blood , Methyl Parathion/poisoning , Middle Aged , Organophosphorus Compounds/blood , Organothiophosphates/blood , Parathion/blood , Parathion/poisoning
20.
Ann Emerg Med ; 21(10): 1179-84, 1992 Oct.
Article in English | MEDLINE | ID: mdl-1416293

ABSTRACT

STUDY OBJECTIVES: To study whether age of the cardiac arrest patient is related to prognostic factors and survival. STUDY DESIGN: Retrospective analysis of a prospective registration of cardiac arrest events in the mobile ICUs of seven participating hospitals. STUDY POPULATION: Two thousand seven hundred seventy-six out-of-hospital cardiac arrests in which advanced life support was initiated. Cardiac arrests with a precipitating event requiring specific therapeutic consequences and with specific prognosis were not included in the analysis (eg, trauma, exsanguination, drowning, sudden infant death syndrome). RESULTS: Neither resuscitation rate (23%) nor mortality caused by a neurologic reason (9%) was significantly different between age groups. Mortality after CPR of non-neurologic etiology was significantly higher in the elderly patient (younger than 40 years, 16%; 40 to 69 years, 19%; 70 to 79 years, 30%; 80 years or older, 34%; P less than .005) and had a negative effect on survival in resuscitated elderly patients (P less than .05). Elderly patients more frequently had a dependent lifestyle before the arrest (P less than .025), an arrest of cardiac origin (P less than .001), electromechanical dissociation as the type of cardiac arrest (P less than .025), and a shorter duration of advanced life support in unsuccessful resuscitation attempts (r = -.178, P less than .0001). CONCLUSION: Because survival two weeks after CPR was not significantly different between age groups, we suggest that decision making in CPR should not be based on age but on factors with better predictive power for outcome and quality of survival.


Subject(s)
Cardiopulmonary Resuscitation , Heart Arrest/mortality , Adult , Age Factors , Aged , Aged, 80 and over , Heart Arrest/etiology , Heart Arrest/therapy , Humans , Middle Aged , Prognosis , Resuscitation Orders , Retrospective Studies , Survival Rate
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