[Special aspects of the emergency medical care of head and neck injuries]

The overall incidence of severe head, face and neck injuries as seen from the German Trauma Registry of the National Association of German Trauma Surgeons is 81.3%. The leading causes of death among these patients are hemorrhage and severe traumatic brain injury. The aim of prehospital emergency medical care is to stabilize vital functions in order to ensure primary survival and to reduce morbidity with appropriate prehospital treatment of the individual injuries within the overall injury pattern. In this review, special aspects as well as pitfalls of the prehospital management of patients with head, face and neck injuries are demonstrated. Prehospital airway management concepts as well as concepts for stopping bleeding in the head, face and neck region are discussed in detail.

Mitochondrial dysfunction in bipolar disorder: evidence from magnetic resonance spectroscopy research

Magnetic resonance spectroscopy (MRS) affords a noninvasive window on in vivo brain chemistry and, as such, provides a unique opportunity to gain insight into the biochemical pathology of bipolar disorder. Studies utilizing proton ((1)H) MRS have identified changes in cerebral concentrations of N-acetyl aspartate, glutamate/glutamine, choline-containing compounds, myo-inositol, and lactate in bipolar subjects compared to normal controls, while studies using phosphorus ((31)P) MRS have examined additional alterations in levels of phosphocreatine, phosphomonoesters, and intracellular pH. We hypothesize that the majority of MRS findings in bipolar subjects can be fit into a more cohesive bioenergetic and neurochemical model of bipolar illness that is both novel and yet in concordance with findings from complementary methodological approaches. In this review, we propose a hypothesis of mitochondrial dysfunction in bipolar disorder that involves impaired oxidative phosphorylation, a resultant shift toward glycolytic energy production, a decrease in total energy production and/or substrate availability, and altered phospholipid metabolism.

Sustained-release potassium chloride overdose

BACKGROUND

Although ingestion of sustained-release potassium supplements can cause life-threatening hyperkalemia in patients with abnormal renal function, only a few previous reports suggest that this may occur in patients with normal renal function. We report 2 cases of hyperkalemia in patients with normal renal function who developed hyperkalemia after ingesting sustained-release potassium preparations and describe the use of radiography and whole-bowel irrigation in their care.

CASE REPORTS

The first patient is a 50-year-old woman who ingested 100 K-Dur tablets (each tablet containing 750 mg KCl or 10 mEq potassium) in a suicide attempt 1 hour prior to presenting to the emergency department. She developed a peak serum potassium level of 9.7 mEq/L and had transient, potentially life-threatening electrocardiographic changes. The second patient was a 17-year-old man who ingested 20 to 30 Klor-Con tablets (each tablet containing 750 mg KCl or 10 mEq potassium) in a suicide attempt 10 hours prior to presentation. Although he developed a peak serum potassium level of 6.1 mEq/L, he had a persistently normal electrocardiogram. In both patients, the tablets were visualized on abdominal radiographs and the gastrointestinal tracts of both were successfully decontaminated using whole-bowel irrigation.

DISCUSSION

Although the sensitivity and specificity are unknown, the abdominal radiograph appears to be useful in detecting sustained-release potassium tablets. Whole-bowel irrigation as a primary method of gastrointestinal decontamination also appears to be effective although its use is not previously reported for sustained-release potassium overdoses.

Aldicarb poisoning by an illicit rodenticide imported into the United States: Tres Pasitos

OBJECTIVE

Although intentional and unintentional rodenticide poisoning is common, most readily available agents are of relatively low acute toxicity. A four-year long epidemic of severe toxicity from rodenticide exposure continues among patients predominantly of Dominican descent living in New York City. This study characterizes the ongoing epidemic of acute cholinesterase inhibitor poisoning due to an illicit rodenticide and identifies its etiology.

METHODS

A prospectively collected case series of poisoned patients referred to the New York City Poison Control Center. The main outcome measures include the clinical characteristics upon presentation, antidotal and other therapeutic requirements, and patient outcome. Product analysis was performed with paper chromatography, gas chromatography/mass spectrometry, and high-performance liquid chromatography. A murine model assessing both clinical effect and cholinesterase activity was also performed.

RESULTS

Thirty-five patients were referred following exposure to Tres Pasitos. Patients developed signs of cholinergic hyperactivity and many required high doses of atropine (>10 mg) to control these symptoms. The source was identified as a rodenticidal compound sold illicitly in local groceries primarily within the Dominican community. Murine cholinesterase activity fell significantly following exposure to the rodenticide. High-performance liquid chromatography identified aldicarb, an extremely potent carbamate-type cholinesterase inhibitor, not licensed for rodenticidal use in this country.

CONCLUSION

Illicit sale of undocumented compounds poses a substantial public health threat. Despite several public health interventions, the epidemic continues.

Frequency of post-poisoning exposure information provided to patients requiring emergency care

Pediatric unintentional poisoning is common despite preventative efforts. Children who have had a poison exposure are at increased risk for subsequent exposure. The purpose of our trial was to determine how often poison prevention information is provided to child care providers in health care facilities (HCF). This was a prospective telephone survey of 100 cases of unintentional poisonings of children ages 1-5 y referred to a HCF. Excluded were cases of patients that had intentional or chronic exposures. Eighty cases received no prevention material; 20 cases received Poison Prevention Information. Ninety-three of the patients were discharged from the emergency department, 6 patients were discharged from a pediatric floor, and 1 was discharged from a Pediatric ICU. Follow up calls to home may be difficult after the patient is referred to a HCF and many families did not receive poison prevention materials. This study indicates the need for a poison prevention discharge packet to be distributed to provide uniform and complete poison prevention education.

[Value of a developmental diagnostic procedure with infants at the age of 12 months with prior perinatal disorders]

68 children after "perinatal distress" and 34 healthy children without perinatal risk factors were examined at 12 months corrected age. The developmental status was determined by "Bayley-Mental-Scale", "Bayley-Infant-Behaviour-Record" and a standardized neurological examination, quantified according to Prechtls optimality concept. Reliability and predication of these instruments has been analysed by variation of clinical criteria in the "high-risk" group and comparison with control children: After excluding children with mental and motor retardation the correlation between "Bayley-Mental-Scale" and the results of the neurological examination decreases, but increases within the control group. Considering rating-scores of the "Infant-Behaviour-Record" it could be shown that this correlation is due to a higher impact of social and interactive patterns in healthy control children. The neurological examination differentiated between children with obvious neurological impairment; in the range of more than 85% optimal conditions it is impossible to detect discrete lesions with the help of optimality-scores. Items of the "Bayley-Mental-Scale" can be related to Piagets stages of development; yet their placement according to stages of difficulty is different from that of the standardization sample.