Physiological effects of N95 respirators on rescuers during cardiopulmonary resuscitation.

Objectives: There is a lack of evidence in the medical literature reporting the physiological stress imposed by the wearing of N95 respirators during cardiopulmonary resuscitation (CPR) in healthcare providers. The aim of this study is to monitor the changes in hemodynamics and blood gas profiles in rescuers during the performance of CPR while wearing N95 respirators. Methods: Thirty-two healthy healthcare workers performed standard CPR on manikins, each participant conducted 2 min of chest compression followed by 2 min of rest for 3 cycles. A non-invasive blood gas measuring device via a fingertip detector was used to collect arterial blood gas and hemodynamic data. Student t-test was used for comparison of various physiologic parameters before and after each session of chest compression. Results: There were no significant differences in arterial blood gas profiles including partial pressure of arterial carbon dioxide and partial pressure of arterial oxygen before and after each session of chest compression (p > 0.05 for all). Heart rate and cardiac output were significantly higher after CPR (p < 0.05 for all), but no significant changes were found on blood pressure. Conclusions: Our data suggest that healthcare providers wearing N95 respirators during provision of CPR in a short period of time does not cause any significant abnormalities in blood gas profiles and blood pressure. This may provide evidence to reassure the safe use of N95 respirator during performance of CPR.

Rapid detection of non-volatile household pesticides in drained gastric juice by ambient mass spectrometry for emergency management.

In order to provide timely emergency management for the patients accidently or intentionally ingested of household pesticides, it is crucial to develop a point-of-care analytical technique for early ex vivo identification of swallowed pesticides. In this study, probe sampling combined with electrospray laser desorption ionization/mass spectrometry (ELDI/MS) was performed to rapidly detect spiked non-volatile household pesticides in the gastric juice drained from the patients during lavage. Since no sample pretreatment is required, probe sampling is fast, and high thermal energy for analyte desorption is provided; ELDI/MS detects the household pesticides in gastric juice within 30 s. The detection limits of the household pesticides were found to be 0.05-1 mg/L, this makes ELDI/MS combined with probe sampling a novel and efficient analytical tool for providing important toxicological information to ensure an appropriate emergency medical response.

Delayed malposition of a double-lumen hemodialysis catheter that caused hemorrhage and hypovolemic shock: A case report.

RATIONALE: Double-lumen hemodialysis catheters are commonly used as temporary hemodialysis routes. Complications include infection, thrombosis, cardiac arrhythmia, entrapped guide wire, and malposition. We report a rare complication of delayed hemodialysis catheter malposition that caused retroperitoneal hemorrhage and hypovolemic shock during hemodialysis. PATIENT CONCERNS: A 72-year-old female patient who was receiving hemodialysis was referred to our emergency department because of general discomfort and decreased blood pressure (BP) after her regular hemodialysis. She had undergone surgery for a left forearm arteriovenous pseudoaneurysm and received a temporary hemodialysis catheter insertion via the left femoral vein 2 weeks before. The initial blood examination revealed a mildly decreased baseline hemoglobin level (7.2 g/dL) and hyperkalemia (5.9 mmol/L). Her BP recovered after fluid resuscitation. She was administered hemodialysis again, following which her BP reduced and a change in consciousness developed. DIAGNOSIS: Chest and abdominal computed tomographies were performed to exclude acute vascular problems and showed a hemodialysis catheter tip protruding from the left iliac vein and hematoma in the left retroperitoneal space and pelvic cavity. INTERVENTIONS: Intubation, fluid resuscitation, vasopressor administration, and blood transfusion were performed. She was admitted to the intensive care unit. The left femoral hemodialysis catheter was removed. OUTCOMES: Follow-up computed tomography revealed resolution of the retroperitoneal space hematoma. She was transferred to the ordinary ward 18 days later with a stable hemodynamic status. Unfortunately, she developed hospital-acquired pneumonia and arteriovenous shunt infection, and died from respiratory failure and sepsis on the 34th day in our hospital. LESSONS: Femoral double-lumen catheter malposition is rare and potentially fatal. Emergency physicians should be aware of situations wherein a patient's BP declines markedly soon after a hemodialysis initiation.

Foreign body in the thoracic spine due to a nail gun penetrating injury: A case report.

RATIONALE: Spinal cord injuries could be catastrophic because they may result in severe neurovascular complications. Here, we present a case of thoracic spine-penetrating injury by a nail-gun. PATIENT CONCERNS: A 60-year-old male presented to our emergency department with complaints of progressive right chest pain for 1 week that was preceded by back pain. He had a medical history of hypertension and denied any trauma history. He had alert consciousness and stable vital signs. He was a carpenter. Upon physical and neurological examination, no obvious wounds or vesicle formation were noted, and the patient was neurologically intact. DIAGNOSIS: Laboratory test results showed abnormally elevated D-dimer levels. Electrocardiography showed normal sinus rhythm. Chest radiography showed no mediastinal widening. Chest computed tomography was performed. The formal radiology report indicated a foreign body in the T4-5 spinal cord and upper back. INTERVENTIONS: A neurosurgeon was consulted with suggestion of operation. We performed T4-5 laminectomy and foreign body removal. The foreign body, stuck to the spinal cord with dural rupture, was removed and found to be a 5 cm-long broken nail. OUTCOMES: The pain resolved immediately post operation. LESSONS: Surgical removal of the foreign body is recommended if neurovascular complications or cerebrospinal fluid (CSF) leak is detected. Obtaining the patient's complete history, including occupation, might be helpful in determining the diagnosis. Careful interpretation of diagnostic imaging is necessary for avoiding medical disputes. Even in the absence of wounds and ecchymosis, trauma-related injury should be considered.

Transient hyperammonemia associated with postictal state in generalized convulsion.

Previous studies revealed that transient hyperammonemia was noted after generalized convulsion. This study was undertaken to analyze the association between postictal state and serum ammonia levels. Adult patients presenting to the emergency department with seizures were included. Serum ammonia and other blood tests were compared between patients with full recovery of consciousness after generalized convulsion and those who had not completely regained consciousness. Patients who had not completely regained consciousness (7 of 7, 100%) had higher rate (p=0.035) of hyperammonemia compared with patients who had fully regained consciousness (4 of 10, 40%) and higher level of serum ammonia (246 ± 96 µg/dL vs. 102 ± 99 µg/dL, p=0.006). All patients who showed postictal consciousness level impairment on arrival at the emergency department had elevated serum ammonia at that time. Transient hyperammonemia is associated with postictal confusion.

Postictal transient hyperammonemia as an indicator of seizure disorder.

BACKGROUND AND PURPOSE: Transient hyperammonemia can occur after episodes of seizure. To verify that transient hyperammonemia is a unique finding in seizure patients, we compared the change in blood ammonia concentration during the postictal period with that of other patients who suffered consciousness disturbances due to other disorders. METHODS: We compared the results of a biochemical examination, including serum ammonia levels, between adult patients sent to the emergency department (ED) with seizure and those with other causes of consciousness disturbance. RESULTS: Nineteen out of 31 patients with generalized epileptic seizures showed hyperammonemia at initial data measurement. Seventeen of these patients showed transient hyperammonemia. Only 10 patients with hepatic encephalopathy showed hyperammonemia, while none of the patients suffering from other causes of consciousness disturbance showed transient hyperammonemia within hours of arrival at the ED. CONCLUSION: Transient hyperammonemia was observed in the majority of generalized tonic-clonic seizure patients examined in this study but not in those with other causes of consciousness disturbance. Because ammonia is checked in patients presenting with transient consciousness disturbance to the ED, with or without witness, transient hyperammonemia could be an indicator of recent epileptic seizure.

Acute quadriparesis caused by spinal arteriovenous malformation: a case report.

Arteriovenous malformations (AVMs) in the spinal cord are relatively rare lesions, especially in the cervical region. Here we report a case of cervical spinal AVM with hemorrhage in a young man who developed acute quadriparesis during exercise. For spinal AVM, emergent spinal magnetic resonance imaging (MRI) is a useful screening tool, and angiography can provide the most important diagnostic information. The emergency physician should have a high index of suspicion for diagnosis and appropriate management of this rare condition. Early diagnosis and management is essential to preserve neurologic functioning.

Subcutaneous emphysema and pneumomediastinum secondary to dental extraction: a case report and literature review.

Here, we present the case of a woman who suffered from acute dyspnea and right cheek and neck swelling during molar extraction. The use of a high-speed dental drill may introduce air into the soft tissue and lead to subcutaneous emphysema and pneumomediastinum. After a review of the literature, we found that subcutaneous emphysema and pneumomediastinum are rare complications secondary to dental extraction. We report this case because physicians in the emergency department may misdiagnose the symptoms as an allergic reaction. Dentists should be more aware of air leak during dental extraction.