S2k guideline diagnosis and treatment of carbon monoxide poisoning.

Carbon monoxide (CO) can occur in numerous situations and ambient conditions, such as fire smoke, indoor fireplaces, silos containing large quantities of wood pellets, engine exhaust fumes, and when using hookahs. Symptoms of CO poisoning are nonspecific and can range from dizziness, headache, and angina pectoris to unconsciousness and death. This guideline presents the current state of knowledge and national recommendations on the diagnosis and treatment of patients with CO poisoning. The diagnosis of CO poisoning is based on clinical symptoms and proven or probable exposure to CO. Negative carboxyhemoglobin (COHb) levels should not rule out CO poisoning if the history and symptoms are consistent with this phenomenon. Reduced oxygen-carrying capacity, impairment of the cellular respiratory chain, and immunomodulatory processes may result in myocardial and central nervous tissue damage even after a reduction in COHb. If CO poisoning is suspected, 100% oxygen breathing should be immediately initiated in the prehospital setting. Clinical symptoms do not correlate with COHb elimination from the blood; therefore, COHb monitoring alone is unsuitable for treatment management. Especially in the absence of improvement despite treatment, a reevaluation for other possible differential diagnoses ought to be performed. Evidence regarding the benefit of hyperbaric oxygen therapy (HBOT) is scant and the subject of controversy due to the heterogeneity of studies. If required, HBOT should be initiated within 6 h. All patients with CO poisoning should be informed about the risk of delayed neurological sequelae (DNS).

[Injuries caused by acids and bases - emergency treatment]. / Verletzungen durch Säuren und Laugen - Versorgung im Rettungsdienst.

Emergency medical care for injuries caused by acids and bases is challenging for rescue services. They have to deal with operational safety, detection of the toxic agent, emergency medical care of the patient and handling of the rescue mission. Because of the rareness of such situations experience and routine are largely missing. This article highlights some basic points for the therapy and provides support for such rescue missions.

Of pills, plants, and paraquat: the relevance of poison centers in emergency medicine.

The organization and work of a poisons center are demonstrated on the basis of GIZ-Nord Poisons Center Annual Report for 2011. In a short summary the basic principles of clinical toxicology are elucidated: the indications for gastric lavage and the application of activated charcoal. Moreover the means of enhanced elimination are presented: hemodialysis, hemoperfusion, multi-dose activated charcoal and molecular absorbent recirculating system (MARS). Gastric lavage is indicated within one hour after ingestion of a life-threatening dose of a poison. In intoxications with CNS penetrating substances gastric lavage should be performed only after endotracheal intubation due to the risk of aspiration. The basic management of the intoxicated patient by emergency medicine personnel out of hospital and on the way into the hospital is presented. The "Bremen List", a compilation of five antidotes (atropine, 4-DMAP, tolonium chloride, naloxone, activated charcoal) for the out of hospital treatment by emergency doctors is introduced.

Structures and solution dynamics of pseudorotaxanes mediated by alkali-metal cations.

Kinetic stability studies of a series of pseudorotaxanes formed from electron-rich crown ethers (hosts 1 and 2) and naphthalene diimide (guest A) in the presence of alkali salt templates MX (where M+ = Li+ and Na+, and X- = Cl-, Br-, I-, NO3- and CF3SO3-) were performed by 1H NMR. The switching between the (bound) host 1 and its linkage isomer host 2 (free) was monitored in solution in the presence and absence of alkali salts, to establish the relative thermodynamic stabilities in the series. We also report here six new crystal structures, for pseudorotaxanes of type: [1.A], [M2.1.A]2+ and [M2.2.A]2+. Their solution-phase structures are in good agreement with the solid-state structures determined by X-ray crystallography.