A case series of eight amateur athletes: exercise-induced pre-/syncope during the Zurich Marathon 2023.

Background: Marathon running poses unique cardiovascular challenges, sometimes leading to syncopal episodes. We present a case series of athletes who experienced pre-/syncope during the Zurich Marathon 2023, accompanied by elevated cardiac biomarkers. Case summary: Eight athletes (2 females, 6 males) aged 21-35 years, with pre-/syncope and various additional diverse symptoms such as dizziness and palpitations during the (half-)marathon, were admitted to two emergency departments in Zurich, Switzerland. Clinical evaluations included electrocardiogram, echocardiography, telemetry, coronary computed tomography (CT) scans, and cardiac biomarker assessments. High-sensitive troponin T (hs-cTnT) was elevated in all cases at initial assessment and returned to normal at follow-up. All athletes who received CT scans had normal coronary and brain CT results. None of the eight athletes had underlying cardiovascular disease. Renal function normalized post-admission, and neurological symptoms resolved within hours. Creatinine levels indicated transient acute kidney injury. A common feature was inexperience in running, inadequate race preparation, particularly regarding fluid, electrolyte, and carbohydrate intake, along with pacing issues and lack of coping strategies with heat. Discussion: From a clinician perspective, the case series highlights the challenge in the management of patients with a pre-/syncopal event during strenuous exercise and elevated cardiac biomarkers. Diverse initial symptoms prompted tailored investigations. Adequate training, medical assessments, and awareness of syncope triggers are essential for marathon participants. Caution and pacing strategies are crucial, especially among novices in competitive running. This information is pertinent given the growing popularity of marathon events and prompts a standardized diagnostic approach after these events.

[CME/Answers: Early Recognition and Prevention of a Disulfiram-Ethanol Reaction]. / CME/Antworten: Disulfiram-Ethanol-Reaktion (DER): erkennen und verhindern.

CME/Answers: Early Recognition and Prevention of a Disulfiram-Ethanol Reaction Abstract. Disulfiram is an alcohol-aversive agent for pharmacological relapse prevention in alcohol dependency. When combined with alcohol, disulfiram induces a disulfiram-ethanol reaction (DER), causing mild to severe symptoms. While the anticipated adverse effects should support abstinence, failed abstinence can be potentially lethal. Since there is no specific antidote, early recognition and supportive treatment are vital. The aim of this article is to illustrate the clinical features of DER, to suggest a reasonable diagnostic pathway and to provide a basis for decision-making as to the treatment with disulfiram.

[CME: Early Recognition and Prevention of a Disulfiram-Ethanol Reaction]. / CME: Disulfiram-Ethanol-Reaktion (DER): erkennen und verhindern.

CME: Early Recognition and Prevention of a Disulfiram-Ethanol Reaction Abstract. Disulfiram is an alcohol-aversive agent for pharmacological relapse prevention in alcohol dependency. When combined with alcohol, disulfiram induces a disulfiram-ethanol reaction (DER), causing mild to severe symptoms. While the anticipated adverse effects should support abstinence, failed abstinence can be potentially lethal. Since there is no specific antidote, early recognition and supportive treatment are vital. The aim of this article is to illustrate the clinical features of DER, to suggest a reasonable diagnostic pathway and to provide a basis for decision-making as to the treatment with disulfiram.

[CME: Postexposure Prophylaxis Following Needlestick Injuries and Non-Occupational Exposures]. / CME: Postexpositionsprophylaxe nach Kontakt mit potenziell kontagiösen Körperflüssigkeiten aus notfallmedizinischer Perspektive.

CME: Postexposure Prophylaxis Following Needlestick Injuries and Non-Occupational Exposures Abstract. Occupational exposures following needlestick injuries are far from being uncommon and require a standardised approach in counselling the respective healthcare worker. In addition, non-occupational exposures likewise cause consultations of A & E services. To inform the medical public on state of the art, postexposure prophylaxis following exposures that potentially carry a risk of infection with bloodborne illnesses (HBV, HCV, HIV), we summarized current policies. Special instances may require expert consultation, but will not be discussed here in detail as it would exceed the scope of our article.

Do wearable alcohol-based handrub dispensers increase hand hygiene compliance? - a mixed-methods study.

Background: Hand Hygiene (HH) compliance was shown to be poor in several studies. Improving the availability of alcohol-based hand rub (ABHR) is a cornerstone for increasing HH compliance. Methods: In this study, we introduced wearable dispensers for ABHR in an Emergency Department (ED) well equipped with mounted ABHR dispensers and accompanied this single-modal intervention by a quasi-experimental mixed-method study. The study was performed in the ED of the University Hospital Zurich, Switzerland, a 950-bed tertiary teaching hospital. During a five-week baseline period and a seven-week intervention period, we observed HH compliance according to the WHO 'Five Moments' concept, measured ABHR consumption, and investigated perceived ABHR availability, self-reported HH compliance and knowledge of HH indications by questionnaire. Multivariable logistic regression was used to identify independent determinants for HH compliance. In addition, semi-structured interviews were conducted and thematically analyzed to assess barriers and facilitators for the use of the newly introduced dispensers. Results: Across 811 observed HH opportunities, the HH compliance for all moments was 56% (95% confidence interval (CI), 51-62%) during baseline and 64% (CI, 59-68%) during intervention period, respectively. In the multivariable analysis adjusted for sex, profession, and WHO HH moment, there was no difference in HH compliance between baseline and intervention (adjusted Odds ratio: 1.22 (0.89-1.66), p = 0.22), No significant changes were observed in consumption and perceived availability of ABHR. During intervention, 7.5% ABHR was consumed using wearable dispensers. HCP perceived wearable dispensers as unnecessary since mounted dispensers were readily accessible. Poor ergonomic design of the wearable dispenser emerged as a main barrier, especially its lid and fastening mechanism. Interviewees identified two ideal situations for wearable dispensers, HCP who accompany patients from ED to other wards, and HCP approaching a patient from a non-patient areas in the ED such as the central working station or the meeting room. Conclusion: The introduction of wearable dispensers did not increase observed hand hygiene compliance or ABHR consumption in an ED already well equipped with mounted dispensers. For broader acceptance and use, wearable dispensers might benefit from an optimized ergonomic design.