Carbon monoxide poisoning: potentially preventable cases.

UNLABELLED: The objective of the study was to describe epidemiological and clinical data regarding acute carbon monoxide (CO) poisoning in an urban area of North Italy. 95 consecutive adult patients admitted to Milan and Turin Poisons Control Centres (PCC) for CO poisoning between October 1993 and March 1995 were enrolled into the study. Epidemiological and medical parameters were recorded in a standardised collection data sheet, which included age, sex, circumstances of poisoning, severity grading (0-3), blood HbCO level upon admission. RESULTS: 86 cases of CO poisoning (90.5%) were due to accidental exposures, 9 to intentional suicide attempts. A majority of cases occurred in late autumn through winter months, from October to February. The highest proportion of accidental CO poisoning cases (92%) occurred in the household setting. In 57 cases the acute severity grading was higher than 1 (median 2); blood HbCO level upon admission was 40% in 16% of the cases (mean 31.6%--median 32.7%). CONCLUSIONS: Carbon monoxide exposure represents a significant cause of severe but potentially preventable accidental poisoning. The study indicates the need for public education campaigns aimed to warn people against the silent killer at home, and to promote preventive measures. The clinical course of CO poisoning is often severe. A standardised collection data system, to record all the cases of acute CO intoxication in Emergency Departments, can help evaluate the real incidence and clinical significance of this poisoning.

Reliability of the vestibulo-ocular reflex as an index of the effects of hypnotic drugs on the central nervous system.

The vestibulo-ocular reflex was tested after the administration of step doses of thiopentone or propanidid in 171 unpremedicated patients. The dose of thiopentone (3 mg kg-1) required to induce loss of nystagmus also abolished the response to verbal command. The dose required to inhibit the reflex in 95% of patients was 7.22 mg kg-1 and prevented adrenergic responses to nociceptive stimulation. The dose of propanidid required to induce loss of nystagmus was greater than that necessary to abolish response to verbal command. The reflex inhibition rate increased proportionally to the dose up to 8 mg kg-1; larger doses exerted a facilitatory effect and reduced the reflex inhibition rate. The vestibulo-ocular reflex is a reliable and sensitive means of demonstrating the different effects exerted by step doses of hypnotic drugs.

Analogue chromatic continuous scale (ACCS): a new method for pain assessment.

A new pain rating scale, Analogue Chromatic Continuous Scale (ACCS), has been developed. The ACCS was tested in fifty consecutive patients suffering from pain of different origins, and compared with a simple descriptive scale (SDS) and a traditional 100 mm visual analogue scale (VAS). VAS and ACCS values showed a highly significant, positive correlation (r = 0.947, P less than 0.001). The means of the VAS and ACCS values, either considered as a whole or stratified according to SDS scores, did not differ significantly. The ACCS proved to be more sensitive than VAS (P less than 0.05), allowing a greater discrimination of grades of pain. Furthermore, the ACCS is very easy to use.