Treatment of Amanita phalloides poisoning: I. Retrospective evaluation of plasmapheresis in 21 patients.

Amanita phalloides poisoning is the most common cause of lethal mushroom poisoning (lethality >20% in adults). A specific antidote against the amanitin toxins is not available. This retrospective study reports results in 21 patients (12 males, 9 females; ages 9-59 years) treated for amanita phalloides poisoning between 1984 and 1993. Plasmapheresis was carried out using a commercial plasma protein solution (Biseko, Biotest, Dreieich, Germany) in 17 patients, fresh plasma in 2 patients, and human albumin/Ringer's solution in 2 patients. Ancillary drugs, including penicillin and silibinin, also were used for detoxification, correction of blood-clotting deficiencies, and hepatic protection. One patient died of acute hepatic failure. The results, assessed using mortality (4.8% overall) and frequency of complications, indicate that plasmapheresis is a safe and effective treatment for amanita phalloides poisoning but that further investigations are needed, especially involving measurements of efficacy and the efficiency of toxin removal.     

Management of human and animal bite wounds

One of the most common problems facing the emergency department physician is the management of bite wounds. Therapy for these common injuries is ill-defined and often controversial. This article outlines treatment guidelines for the emergency physician for dog bites, cat bites, rabies, snake bites, and human bites.     

毒蛇咬伤后四肢组织坏死原因临床分析

目的:对毒蛇咬伤后四肢组织坏死的原因进行分析,指导临床治疗。方法:回顾我院收治的毒蛇咬伤246例,统计四肢组织坏死情况、中毒严重程度、伤口切开排毒与否、伤口感染、早期肢体结扎时间并进行相关性统计学分析。结果:本组毒蛇咬伤后四肢组织总体坏死发生率为15%,中毒严重程度、伤口切开、感染、伤口长时间结扎均与组织坏死的发生相关,均P<0.05。结论:毒蛇咬伤后四肢组织坏死的原因复杂,可能与就诊时间、中毒严重程度、伤口切开、感染、早期肢体长时间结扎等因素有关。     

Plasmapheresis in the treatment of hyperthyroidism associated with agranulocytosis: A case report

Plasmapheresis, also known as therapeutic plasma exchange, is used in the treatment of several disorders. Temporary improvement after plasmapheresis in cases with thyrotoxicosis has been reported. A 55-year-old woman presented with agranulocytosis induced by propylthiouracil and clinical signs of heart failure. Three sessions of plasmapheresis were performed. We observed an improvement of thyroid hormone levels and clinical findings as well. Plasmapheresis can be an option when drug treatment of thyrotoxicosis fails.     

血浆置换治疗在儿科危重患者抢救中的经验

目的探讨血浆置换治疗在儿科危重症患者的应用价值和治疗方案。方法应用GAMBR0-PRISMA床旁血滤机和TPE2000膜式血浆分离器对15例危重症患儿（1岁10月～15岁，平均6．8岁）进行39次血浆置换治疗；以新鲜冰冻血浆作置换液，置换量为40-70ml／（kg·次），血泵速度为50～120ml／min，治疗时间2～3h／次：结果39次血浆置换治疗均顺利成功实施，无明显并发症出现；14例在治疗后临床症状及生化指标好转，5例痊愈。结论血浆置换可以应用于多种危重症儿科疾病，治疗方案需根据病情制定。     

急性苯丙胺类药物中毒88例临床分析

目的:观察急性苯丙胺类药物中毒的临床表现特点及治疗效果.方法:回顾性分析2010年1月至2012年6月急诊科诊治的急性苯丙胺类药物中毒患者88例的临床资料.结果:就诊人群以青年患者多见,年龄在25～28岁,78.4％为轻、中度中毒,且21％～41％合并有饮酒史.极重度患者罕见,但死亡率极高.与轻、中度中毒相比,重度中毒患者就诊时间短,但治疗周期延长,有一定死亡风险.发病时间以春夏季为主,而且夜间0点至清晨8点为就诊高峰期.结论:急性苯丙胺中毒以年轻人多见,病情以轻、中度中毒为主,治疗时间较短,预后较好;重度、极重度患者病情恶化快,治疗周期长,死亡率高.     

毒蛇伤害126例流行病学分析

目的通过流行病学分析，总结提高毒蛇咬伤的综合防治经验。方法2002—01，2005—12共收治126例毒蛇咬伤患者，对所有蛇伤患者均记录其性别、年龄、职业状况、受伤时间及就诊时间、受伤部位、受伤后的局部症状及全身反应情况、治疗过程及预后，并进行综合分析。结果毒蛇咬伤病例集中于夏秋湿热季节，以青壮年发生率最高（占69．0％），50．8％的病例延迟至受伤6h后就诊，毒蛇种类认知率很低（4．8％），按照Downey系统分类，3、4类重型蛇伤患者所占比重较大（占60．3％）。毒蛇咬伤后，局部可出现伤口感染（7例）、血栓性静脉炎（1例）、横纹肌溶解（3例）、局部坏死伴组织缺失（4例）、骨筋膜室综合征（9例）、截肢或截指（3例）等并发症，也可导致全身并发症如意识障碍（7例）、急性肾衰竭（2例）、心肌损害（6例）、呼吸衰竭（5例）、低蛋白血症（7例）以及凝血功能障碍（2例）；均进行了针对性的综合治疗，无死亡病例。结论加强知识教育，早期诊断，强化监测，早期综合对症处理可有效降低毒蛇咬伤的病残率和死亡率。     

The role of therapeutic plasmapheresis in patients with hyperthyroidism

BackgroundHyperthyroidism is characterized by excess hormone secretion from the thyroid gland. Anti-thyroid drugs (ATDs), surgery, and radioactive iodine can be used in treatment. Plasmapheresis is a rapid and effective treatment option in cases where rapid euthyroidism is needed to be obtained due to complications of thyrotoxicosis and major adverse effects of ATDs.Material and methodWe present patients receiving plasmapheresis to provide immediate euthyroidism due to severe hyperthyroidism, adverse effects of ATDs, or non-thyroid surgery from January 2012 to December 2016.ResultsThis study included 18 patients. The etiology of hyperthyroidism was TDG in seven patients, TDMNG in two, TA in two, TMNG in four, and one patient had AIT. Plasmapheresis was performed to achieve euthyroidism before surgery in two patients. The mean plasmapheresis session was 5.35. The mean number of sessions needed for patients with TDG and TDMNG was 4, whereas it was 6.5 for patients with TA and TMNG (p = 0.07). The decrease of mean free thyroxine and free triiodothyronine were 57 % and 73 %, respectively (p < 0.001). After plasmapheresis, total thyroidectomy was performed in 14 patients. Euthyroidism was achieved with RAI in one patient and with medical therapy in three patients.ConclusionsPlasmapheresis therapy is a reliable and effective treatment option for patients who cannot use ATDs because of their adverse events and those with hyperthyroidism that does not resolve with these drugs, or to achieve euthyroidism before total thyroidectomy, RAI or non-thyroid emergency surgery. However, it cannot be used widely because it is expensive and invasive.     

The effect of plasmapheresis on hemostasis in lung cancer patients

To correct hemostasis, 32 patients with lung carcinoma underwent plasmapheresis with exfusion of 50% the circulating plasma volume one day before surgery. Plasmapheresis was coupled with the conventional drug therapy. As compared with the control group patients (n-32) who did not receive plasmapheresis, the main group patients demonstrated that the use of the multimodality correcting therapy made all the components of hemostasis return to normal and minimized the rate of postoperative thromboembolic complications by 40.6% and the postoperative lethality by 18.7%.     

The lived experience of victims of crime

The focus of this research study was to ascertain the impact of crime on individuals, who presented with an injury to the emergency department. Given the high prevalence of crime in our society today, victims of crime are identified as a growing patient population seeking help in emergency departments. To maximise holistic care for these patients it is important that healthcare professionals gain insight into the experience of being a victim of crime. The study was qualitative in nature and used a phenomenological approach. In-depth, unstructured audio taped interviews were conducted to elicit the essence of the experience of being a victim of crime. The voices of the victims revealed four themes; "Fear, Shock and Disbelief", "Guilt/Self-blame", "Physical and Psychological Scars" and "Lifestyle Changes". The management of victims of crime in the emergency department appears to be concerned exclusively with physical injuries. Unseen is the potential psychological sequelae of the assault. Pivotal to these findings is the absence of psychological follow-up support for these victims of crime. This study affords healthcare professionals working in the emergency department, the opportunity to reflect upon current practice and highlight the value of their role in the provision of optimal care for this patient population.     

Hemoperitoneum complicating snake bite: rare CT features

Russelss viper bite victims with systemic poisoning may present with hemorrhagic manifestations, including spontaneous bleeding and incoagulable blood associated with disseminated intravascular coagulation and primary fibrinolysis, two of the most prominent manifestations of the systemic envenoming by this species. Various vascular complications of viperine snake bite have been reported in the literature. We report the computed tomographic findings in a case of snake bite resulting in hemoperitoneum, which, to the best of our knowledge, has not been reported in the literature.     

The incidence of myoglobinuria in patients with pneumatic trousers

The possible association between the use of pneumatic trousers and myoglobinuria was investigated. One hundred and four victims of multiple trauma were entered into a study over a three-month period. Patients who suffered serious injuries to two or more organ systems qualified for entrance into the study. Patients who arrived at the emergency department with inflated pneumatic trousers served as the test population (n = 50), and patients who did not have pneumatic trousers served as the controls (n = 54). Urine specimens were obtained from all patients just before the completion of their treatment in the emergency department. No patients in the control group had myoglobinuria 0%), and only one patient in the test group had myoglobinuria 2%). The results were not statistically significant. Myoglobinuria is not an acute complication of the use of pneumatic trousers. The presence of pneumatic trousers on a multiple-trauma patient is not an indication for routine screening for myoglobinuria in the emergency department.     

早期系统化治疗毒蛇咬伤疗效研究

目的：探讨早期系统化治疗对毒蛇咬伤的疗效。方法：将我院收治的68例毒蛇咬伤病人随机分为对照组与实验组,对照组按蛇毒咬伤的常规处理,实验组按早期系统化治疗;比较两组治疗前和治疗后第3、7天Downey伤口评分、临床病情评分及住院时间。结果：实验组治疗后的评分指标及平均住院时间明显优于对照组（P〈0．05）。结论：早期系统化治疗能提高毒蛇咬伤的疗效。     

Is there an evolution in the epidemiology and follow-up of carbon monoxide poisoning victims?

A retrospective study was conducted to investigate for potential changes in the epidemiology of acute carbon monoxide (CO) poisoning and to evaluate the recommendations within the emergency department (ED) on therapy and neurological and social follow-up of these patients. One hundred and sixty-seven patients with a non-intentional CO poisoning in the time period from 1995 to 1997 were reviewed and compared with data of a similar patient population between 1988 and 1990. Both patient groups were matched for age, sex and comorbidity. Comparing the epidemiological data of the two groups, three main evolutions were observed: (1) there is a global reduction in ED admissions for CO poisoning; (2) the number of young victims has a tendency to decrease; (3) the most common CO source has become an insufficiently functioning stove instead of a defective gas water heater. Regarding treatment and follow-up strategies three conclusions could be drawn: (1) the recommendations for hyperbaric-oxygen therapy were strictly followed; (2) the neurological follow-up was poor and has to be ameliorated and revisited; (3) the systematic follow-up by the social worker on the other hand resulted in immediate actions to prevent a second CO poisoning. This recently elaborated protocol for social evaluation emphasizes the important function of the social worker in the ED and the importance of transmural follow-up organized by the ED.     

Outcome of collagen vascular diseases by treatment with plasmapheresis.

The outcome of collagen vascular diseases after treatment with plasmapheresis was studied in 9 patients with polyarteritis nodosa (PN), in 2 patients with Wegener's granulomatosis (WG), in 1 patient with allergic granulomatous angitis (AGA), and in 20 patients with systemic lupus erythematosus (SLE) associated with antiphospholipid syndrome (APS). Improvement after treatment with plasmapheresis was observed in 41.7% of the patients with PN, WG, and AGA. On the other hand, with the exception of 1 patient with thrombocytopenia and 1 patient with renal failure, all of the clinical manifestations, including thrombocytopenia, central nervous system (CNS) lupus, thrombophlebitis, lung infarction, and recurrent abortions in the SLE patients with APS, improved after plasmapheresis. Plasmapheresis is thought to be an influential strategy of treatment for patients with collagen vascular diseases.     

Therapeutic plasmapheresis as a bridge to liver transplantation in fulminant Wilson disease

Wilson disease is an autosomal recessive disorder of copper metabolism that leads to the accumulation of copper mainly in the liver, cornea, brain, and kidney. Rarely, Wilson disease can present as fulminant hepatic failure with direct antiglobulin test-negative hemolytic anemia and renal failure. In the absence of liver transplantation, this disease is uniformly fatal because medical therapy is ineffective. This report describes the successful use of plasmapheresis for a patient with fulminant Wilson disease as a bridge to transplantation. Five daily therapeutic plasmapheresis procedures using fresh frozen plasma as a replacement fluid were performed over 6 days. Serum copper, urinary copper excretion, and hemolysis were significantly reduced and renal function improved. The patient's clinical status improved and she remained clinically stable until a liver transplant was possible. Plasmapheresis can be a successful medical treatment in fulminant Wilson disease and should be considered as a therapeutic measure to stabilize a patient by decreasing serum copper, reducing hemolysis, and helping to prevent renal tubular injury from copper and copper complexes until liver transplantation is possible.     

依托型急救中心急性中毒流行病学与急救特点分析

目的 研究依托型急救中心急诊内科收治急性中毒患者的流行病学与急救特点.方法 采用回顾性研究方法,对2004-2009年在福建省急救中心内科就诊的各类急性中毒患者的性别、年龄、中毒原因、种类、毒物名称、入侵途径、急诊诊断、急救处置、去向及转归等,进行登记并分析.结果 共收治急性中毒患者2867例,男女比例为1∶1.04,平均33.8岁,其中18～40岁年龄组占76.39%.所有中毒例数以1月份最多,占全部11.33%;中毒类别位居前四位的依次是酒精中毒(54.55%),药物中毒(25.95%),农药中毒(5.65%),毒品中毒(4.88%);毒品中毒大部分为年龄≤25岁(56.44%),平均年龄为28.2岁,明显低于药物中毒和酒精中毒(P＜0.01);69.54%患者经急救处理后离院随诊观察,需要住院者占30.39%,仅4例发生死亡.结论 城市急性中毒以酒精和药物为著;依托型急救中心模式中"院前急救-急诊科-院内救治"的急救绿色通道,对于提高急性中毒的抢救成功率和成活率具有重要意义.     

Thrombolysis for Frostbite: A Case Study and Clinical Considerations

Frostbite injuries are becoming more common in the civilian population and are frequently associated with homelessness, mental illness, and alcohol and drug use and abuse. Taking care of these patients requires a multidisciplinary approach, initially by emergency medicine, the burn service, and interventional radiology, and eventually involving case management, social services, and occupational and physical therapy. Timely and rapid rewarming in conjunction with catheter-directed intravascular thrombolysis interventions can restore adequate perfusion to the patient's compromised digits. To improve patient outcomes, it is essential to obtain proper imaging and, if appropriate, immediately initiate an interventional radiology consultation for urgent thrombolysis treatment. This article presents a clinical case study of a patient who suffered frostbite injuries and underwent intravascular thrombolysis interventions that spanned a 24-hour period and required two interventional radiology procedures. Nursing care considerations and thrombolysis management in the emergency department, radiology department, and intensive care unit are reviewed.     

Capillary electrophoresis for monitoring the effects of plasmapheresis: a feasibility study.

Plasmapheresis is an established method to treat patients with large monoclonal gammopathies (M-components) that increases the blood viscosity. During plasmapheresis the patient plasma is substituted with a mixture of saline, albumin and normal plasma. The treatment results in a reduction of the M-component in the circulation. Plasmapheresis causes changes in several proteins, which makes monitoring by nephelometric or turbidimetric analysis of specific proteins less suitable. Quantification of paraproteins by nephelometric assays are also known to be associated with technical problems. An alternative could be agarose gel electrophoresis but this method is too slow to permit monitoring during the plasmapheresis. Capillary electrophoresis of plasma proteins can be performed in less than 10 min. We have used the CAPILLARYS capillary electrophoresis system (Sebia, Paris, France) to monitor the effect of plasmapheresis treatment on 22 occasions. The mean reduction in M-component size was 51%, range 33-61%. Capillary electrophoresis is a rapid and inexpensive method that could be used to monitor the effect of plasmapheresis during the actual treatment.