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Urological emergencies: unmasking massive bladder hematomas. 泌尿科急诊:揭开巨大膀胱血肿的面纱。
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-01-29 DOI: 10.15441/ceem.23.134
Ajay Pawar, Varsha Shinde
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引用次数: 0
Current trends in emergency airway management: a clinical review. 紧急气道管理的当前趋势:临床回顾。
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-03-15 DOI: 10.15441/ceem.23.173
Sangun Nah, Yonghee Lee, Sol Ji Choi, Jeongwoo Lee, Soyun Hwang, Seongmi Lim, Inhye Lee, Young Soon Cho, Hyun Soo Chung

Airway management is a fundamental and complex process that involves a sequence of integrated tasks. Situations requiring emergency airway management may occur in the emergency department, intensive care units, and various other clinical spaces. A variety of challenges can arise during emergency airway preparation, intubation, and postintubation, which may result in significant complications for patients. Therefore, many countries are establishing step-by-step systemization and detailed guidelines and/or updating their content based on the latest research. This clinical review introduces the current trends in emergency airway management, such as emergency airway management algorithms, comparison of video and direct laryngoscopy, rapid sequence intubation, pediatric airway management, prehospital airway management, surgical airway management, and airway management education.

气道管理是一个基本而复杂的过程,涉及一系列综合任务。需要进行紧急气道管理的情况可能发生在急诊科、重症监护室和其他各种场所。急诊气道管理在准备、插管和插管后都可能面临各种挑战,并可能给患者带来严重的并发症。因此,许多国家都在建立逐步系统化和详细的指南,并根据最新研究更新内容。本临床综述介绍了当前急诊气道管理的发展趋势,如急诊气道管理算法、视频喉镜和直接喉镜的比较、快速顺序插管、儿科气道管理、院前气道管理、外科气道管理和气道管理教育。
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引用次数: 0
Update on the pathophysiology and management of acute trauma hemorrhage and trauma-induced coagulopathy based upon viscoelastic testing. 根据粘弹性测试(VET)更新急性创伤出血和创伤诱发凝血病(TIC)的病理生理学和治疗方法。
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-03-15 DOI: 10.15441/ceem.24.202
Marc Maegele

Uncontrolled hemorrhage and trauma-induced coagulopathy (TIC) are the two predominant causes of preventable death after trauma. Early control of bleeding sources and rapid detection, characterization and management of TIC have been associated with improved outcomes. However, recent surveys confirm vast heterogeneity in the clinical diagnosis and management of hemorrhage and TIC from acute trauma, even in advanced trauma centers. In addition, conventional coagulation assays, although still used frequently during the early assessment of bleeding trauma patients, have their limitations. This narrative review highlights the clinical value of rapid point-of-care viscoelastic testing for the early diagnosis and individualized goal-directed therapy in bleeding trauma patients with TIC.

无法控制的出血和创伤诱发凝血病(TIC)仍然是造成创伤后可预防死亡的两个主要原因。早期控制出血源以及快速检测、鉴定和处理 TIC 与改善预后有关。然而,最近的调查证实,即使在先进的创伤中心,急性创伤出血和 TIC 的临床诊断和管理也存在很大的差异。此外,传统的凝血检测方法虽然在创伤出血患者的早期评估中仍被频繁使用,但也有其局限性。这篇叙事性综述强调了快速护理点粘弹性测试(VET)在早期诊断和对 TIC 出血创伤患者进行个体化目标导向治疗方面的临床价值。
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引用次数: 0
Evaluation of the quality of emergency department management for patients with chronic obstructive pulmonary disease. 慢性阻塞性肺病患者 ED 管理质量评估。
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-05-23 DOI: 10.15441/ceem.24.197
Pascale J King, Lana Ramic, Janet Wilson, Shawn Aaron, Ian G Stiell

Objective: Chronic obstructive pulmonary disease (COPD) is associated with exacerbations and high risk of serious outcomes. Our goal was to determine the appropriateness of the emergency department (ED) management of COPD exacerbations.

Methods: This observational cohort study incorporated a health records review and included COPD exacerbation cases seen at two large academic EDs. We included all patients with the primary diagnosis of COPD exacerbation. From the electronic medical record, demographic and clinical data were abstracted, and the Ottawa COPD Risk Score (OCRS) was calculated for each. Short-term serious outcomes included intensive care unit admission, intubation, myocardial infarction, noninvasive positive pressure ventilation (NIV), and death at 30 days. Cases were judged for appropriateness of treatment according to explicit indications and standards developed a priori.

Results: We enrolled 500 cases with mean age of 71.9 years, 51.2% female patients, 50.2% admitted, and 4.4% death. The calculated OCRS score was >2 for 70.8% of patients. The treatments provided were inhaled β-agonists (82.6%), inhaled anticholinergics (76.6%), corticosteroids (75.2%), antibiotics (71.0%), oxygen (63.8%), NIV (8.8%), and intubation (0.6%). Overall, 50.0% of cases were judged to have had inadequate management due to missing treatments. Specifically, the proportion of missing treatments were inhaled β-agonist (17.0%), inhaled anticholinergic (22.6%), corticosteroids (24.4%), antibiotics (12.8%), and NIV (2.0%).

Conclusion: Adequate treatment of COPD exacerbation was lacking in 50.0% of patients in these two large academic EDs. Concerning were the number of patients not receiving corticosteroids or antibiotics. Implementation of explicit treatment standards should lead to improved patient care of this common and serious condition.

背景:慢性阻塞性肺病(COPD慢性阻塞性肺病(COPD)与病情恶化和严重后果的高风险有关。我们的目标是确定急诊室对慢性阻塞性肺病加重的处理是否适当:这项观察性队列研究纳入了健康记录审查,包括在两家大型学术性急诊室就诊的慢性阻塞性肺病加重病例。我们纳入了所有主要诊断为慢性阻塞性肺病加重的患者。我们从电子病历中摘录了人口统计学和临床数据,并计算了每位患者的渥太华慢性阻塞性肺病风险评分(OCRS)。短期严重后果(SSO)包括入住重症监护室、插管、心肌梗死、无创正压通气(NIV)和 30 天后死亡。根据事先制定的明确适应症和标准来判断病例治疗的适当性:我们登记了 500 例病例,平均年龄 71.9 岁,女性 51.2%,入院 50.2%,死亡 4.4%。经计算,70.8%的患者 OCRS 评分大于 2 分。提供的治疗包括吸入β-激动剂(82.6%)、吸入抗胆碱能药物(76.6%)、皮质类固醇(75.2%)、抗生素(71.0%)、氧气(63.8%)、NIV(8.8%)和插管(0.6%)。总体而言,有 50.0% 的病例因治疗缺失而被判定为治疗不当。具体而言,缺失治疗的比例为吸入β受体激动剂(17.0%)、吸入抗胆碱能药物(22.6%)、皮质类固醇(24.4%)、抗生素(12.8%)和 NIV(2.0%):结论:在这两家大型学术性急诊室中,50.0%的慢性阻塞性肺疾病恶化患者未得到适当治疗。未接受皮质类固醇或抗生素治疗的患者人数令人担忧。实施明确的治疗标准应能改善对这种常见严重疾病患者的护理。
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引用次数: 0
Optimizing dispatcher-bystander dyadic collaboration in emergency medical communication to improve cardiac arrest response. 优化紧急医疗通信中调度员与旁观者之间的合作,改善心脏骤停响应。
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-09-01 Epub Date: 2024-09-06 DOI: 10.15441/ceem.24.296
Guglielmo Imbriaco, Nicola Ramacciati
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引用次数: 0
A multicenter retrospective cohort study on incidence and diagnostics in emergency department patients with acute vestibular syndrome. 一项关于急诊科急性前庭综合征患者发病率和诊断的多中心回顾性队列研究。
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-07-19 DOI: 10.15441/ceem.24.225
Renske Eveline Henriëtte Maria Bijl, Domenique Wilhelmina Antonia Maria Zaunbrecher, Petra Mathilda de Muynck, Ryanne Eggink, Ronique Timmer, Evian Willems, Sam Koning, Marieke Saskia Sanders, Kim Ellis Jie

Objective: Acute vestibular syndrome (AVS) is a common symptom presented by emergency department (ED) patients. Differentiating peripheral from central etiology poses a challenge and clinical practice lacks a uniform diagnostic approach. This study aims to provide insight on incidence and diagnostics in ED patients presenting with AVS in the Netherlands.

Methods: A multicenter retrospective cohort study on ED patients presenting with AVS in two hospitals during 3 years. Primary endpoints are incidence, diagnostics and diagnosis at ED versus follow-up. A secondary endpoint includes therapy.

Results: 500 AVS cases were included. The annual incidence was 0.1%. 85 ED patients (17.0%) were diagnosed with stroke, 285 (57.0%) with non-stroke and 130 (26.0%) with an unsure etiology. At follow-up, diagnosis was corrected in 145 patients (29.0%), with stroke missed in 29 (5.8%). A triad of clinical tests (HINTS) was reported in 106 (21.2%) patients, a CT in 342 (68.2%) and a MRI in 153 (30.6%). Antiplatelet therapy was prescribed in 135 cases. In 69% of these, initial diagnosis was corrected to non-stroke. For 8 patients who received thrombolysis, initial diagnosis was corrected in 3. Of those patients where stroke was initially not identified, 23 (79%) received suboptimal treatment in lieu of antiplatelet therapy.

Conclusion: The annual incidence of AVS in Dutch ED patients is 0.1%. ED diagnosis is often uncertain, with one-third of diagnoses corrected. This study substantiates clinical practice lacks a uniform diagnostic pathway with an overuse of CT and underuse of HINTS. Further research on optimal diagnostic approach is warranted to improve treatment of AVS.

目的:急性前庭综合征(AVS)是急诊科(ED)患者的常见症状。区分外周病因和中枢病因是一项挑战,临床实践中缺乏统一的诊断方法。本研究旨在了解荷兰急诊科 AVS 患者的发病率和诊断方法:方法:一项多中心回顾性队列研究,对象是 3 年内在两家医院就诊的急诊室 AVS 患者。主要终点是发病率、诊断率以及急诊室诊断与随访的对比。次要终点包括治疗:结果:共纳入 500 例 AVS。年发病率为 0.1%。85名急诊患者(17.0%)被诊断为中风,285名(57.0%)被诊断为非中风,130名(26.0%)病因不明。随访中,145 名患者(29.0%)的诊断得到纠正,29 名患者(5.8%)漏诊为中风。106例(21.2%)患者接受了三联临床检查(HINTS),342例(68.2%)接受了CT检查,153例(30.6%)接受了磁共振成像检查。135例患者接受了抗血小板治疗。其中 69% 的患者的初步诊断被更正为非中风。8 例接受溶栓治疗的患者中,3 例的初步诊断得到纠正。在最初未发现中风的患者中,有 23 人(79%)接受了次优治疗,而不是抗血小板治疗:结论:荷兰急诊室患者的 AVS 年发病率为 0.1%。急诊室的诊断往往不确定,有三分之一的诊断是正确的。这项研究证实,临床实践中缺乏统一的诊断途径,CT 的使用率过高,而 HINTS 的使用率过低。有必要进一步研究最佳诊断方法,以改善 AVS 的治疗。
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引用次数: 0
Is Plasmalyte beneficial in resuscitation of diabetic ketoacidosis patients? A narrative review. 血浆蛋白对糖尿病酮症酸中毒患者的复苏有益吗?综述。
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-07-19 DOI: 10.15441/ceem.24.209
Resshme Kannan Sudha, Kinza Moin, Falaah Abdul Hameed, Hamid Aizaz Chatha

Fluid resuscitation is vital in the resuscitation of diabetic ketoacidosis patients. The purpose of this narrative review is to analyze the role of Plasmalyte in fluid resuscitation of adult diabetic ketoacidosis patients. A thorough search was conducted in PUBMED, EMBASE and MEDLINE. Studies conducted between 1st January 2010 and 31st March 2023 were collected. Of 123 results, 5 pertinent randomized controlled trials were included. The close resemblance of Plasmalyte's electrolyte composition to human plasma and its role in the prevention of hyperchloremic metabolic acidosis are some of its vital benefits in patients with diabetic ketoacidosis. Results on the role of Plasmalyte in length of stay, time to resolution of diabetic ketoacidosis and mortality in diabetic ketoacidosis patients are varied. Hence, further research on these topics is needed.

液体复苏对糖尿病酮症酸中毒患者的复苏至关重要。本综述旨在分析血浆蛋白在成年糖尿病酮症酸中毒患者液体复苏中的作用。我们在 PUBMED、EMBASE 和 MEDLINE 中进行了全面检索。收集了 2010 年 1 月 1 日至 2023 年 3 月 31 日期间进行的研究。在 123 项结果中,包括了 5 项相关的随机对照试验。胰岛素血浆的电解质成分与人体血浆非常相似,在预防高胆酸血症代谢性酸中毒方面发挥着作用,这是它对糖尿病酮症酸中毒患者的一些重要益处。有关血浆电解质对糖尿病酮症酸中毒患者的住院时间、糖尿病酮症酸中毒缓解时间和死亡率的作用的结果各不相同。因此,需要对这些课题进行进一步研究。
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引用次数: 0
Short-term Functional Outcomes and Treatment Trends between Branch Atheromatous Disease and Lacunar Infarction: Retrospective Cohort Study of the Nationwide Multicenter Registry. 动脉粥样硬化性疾病与脑干梗死之间的短期功能结果和治疗趋势:全国多中心登记处的回顾性队列研究。
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-07-19 DOI: 10.15441/ceem.24.220
Gaku Fujiwara, Hideki Oka, Akihiro Fujii

Background: Branch atheromatous disease (BAD) is a form of ischemic stroke that presents with imaging findings similar to those of lacunar infarction, but has a different pathogenesis and is known to cause progressive paralysis. Due to regional variations, the epidemiology of BAD is not wellunderstood, and its relationship with functional prognosis remains unclear. Using a comprehensive Japanese stroke database, we investigated its epidemiological characteristics and associations with functional outcomes.

Methods: In this multicenter cohort study, we retrospectively analyzed data from the Saiseikai Stroke Database (2013-2021) including 27 hospitals. We used multivariable logistic regression to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of BAD compared with LI for functional outcomes at discharge. Ischemic stroke caused by BAD or LI was included and demographic characteristics and clinical data were evaluated and contrasted between BAD and LI.

Results: Of the 5,966 analyzed patients, 1,549 (25.9%) had BAD and 4,434 (74.1%) had LI. BAD was associated with worse functional outcomes (adjusted OR of 2.77, 95%CI: 2.42-3.17, relative to LI) and extended hospital stays (median 19 days for BAD vs. 13 days for LI). Moreover, aggressive treatment strategies, including the use of argatroban and dual antiplatelet therapy, were more common in BAD patients.

Conclusions: BAD presented worse functional outcomes and longer hospital stays than LI, necessitating treatment plans that take into account its progression and prognosis.

背景:动脉粥样硬化性脑卒中(BAD)是缺血性脑卒中的一种,其影像学表现与腔隙性脑梗死相似,但发病机制不同,已知可导致进行性瘫痪。由于地区差异,BAD 的流行病学尚不清楚,其与功能性预后的关系也不明确。我们利用日本卒中综合数据库研究了 BAD 的流行病学特征及其与功能预后的关系:在这项多中心队列研究中,我们回顾性分析了包括 27 家医院在内的 Saiseikai 卒中数据库(2013-2021 年)的数据。我们使用多变量逻辑回归法计算了 BAD 与 LI 在出院时功能预后方面的调整后几率比(OR)及 95% 置信区间(CI)。BAD或LI导致的缺血性中风也包括在内,并对BAD和LI的人口统计学特征和临床数据进行了评估和对比:在分析的 5966 名患者中,1549 人(25.9%)患有 BAD,4434 人(74.1%)患有 LI。BAD与较差的功能预后(相对于LI,调整后OR值为2.77,95%CI:2.42-3.17)和较长的住院时间(BAD的中位住院时间为19天,而LI为13天)相关。此外,积极的治疗策略,包括使用阿加曲班和双联抗血小板疗法,在BAD患者中更为常见:结论:与LI相比,BAD的功能预后更差,住院时间更长,因此有必要制定考虑其进展和预后的治疗方案。
{"title":"Short-term Functional Outcomes and Treatment Trends between Branch Atheromatous Disease and Lacunar Infarction: Retrospective Cohort Study of the Nationwide Multicenter Registry.","authors":"Gaku Fujiwara, Hideki Oka, Akihiro Fujii","doi":"10.15441/ceem.24.220","DOIUrl":"https://doi.org/10.15441/ceem.24.220","url":null,"abstract":"<p><strong>Background: </strong>Branch atheromatous disease (BAD) is a form of ischemic stroke that presents with imaging findings similar to those of lacunar infarction, but has a different pathogenesis and is known to cause progressive paralysis. Due to regional variations, the epidemiology of BAD is not wellunderstood, and its relationship with functional prognosis remains unclear. Using a comprehensive Japanese stroke database, we investigated its epidemiological characteristics and associations with functional outcomes.</p><p><strong>Methods: </strong>In this multicenter cohort study, we retrospectively analyzed data from the Saiseikai Stroke Database (2013-2021) including 27 hospitals. We used multivariable logistic regression to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of BAD compared with LI for functional outcomes at discharge. Ischemic stroke caused by BAD or LI was included and demographic characteristics and clinical data were evaluated and contrasted between BAD and LI.</p><p><strong>Results: </strong>Of the 5,966 analyzed patients, 1,549 (25.9%) had BAD and 4,434 (74.1%) had LI. BAD was associated with worse functional outcomes (adjusted OR of 2.77, 95%CI: 2.42-3.17, relative to LI) and extended hospital stays (median 19 days for BAD vs. 13 days for LI). Moreover, aggressive treatment strategies, including the use of argatroban and dual antiplatelet therapy, were more common in BAD patients.</p><p><strong>Conclusions: </strong>BAD presented worse functional outcomes and longer hospital stays than LI, necessitating treatment plans that take into account its progression and prognosis.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Simulation intervention related to family presence during resuscitation for physicians and medical students: A scoping review. 为医生和医科学生提供与复苏期间家属在场相关的模拟干预:范围综述。
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-07-19 DOI: 10.15441/ceem.24.224
Kyung Hye Park, Jannet J Lee-Jayaram, Melissa K Kahili-Heede, Benjamin W Berg

Objective: Family presence during resuscitation (FPDR) is known as part of family-centered care. However, it is unknown or how physicians are educated for FPDR. We aim to review the current status of simulation related FPDR for physicians and medical students.

Methods: A scoping review of literature published from 1999 to May 5 2023 and written in English was undertaken. The articles were searched for using keyword combinations of the following words; family, resuscitation, and simulation-related words.

Results: Eight articles were included in the final review. This review of FPDR simulation for physicians and medical students revealed findings in three categories; measuring CPR quality, investigating participant responses after FPDR simulation, and extracting exemplar good communication elements. First, in four studies measuring resuscitation quality, physicians participated in adult resuscitation, and resuscitation quality was reduced with overt reaction family presence. Second, in three studies investigating the response to simulation training, interprofessional teams participating in pediatric resuscitation had negative responses to FPDR simulation. Third, in one study, good communication elements during FPDR were found in infant simulation, in which interprofessional teams participated. FPDR simulation training for medical students has not been reported.

Conclusion: It highlighted a gap in FPDR simulations involving physicians and/or medical students. Physicians were more concerned with resuscitation quality than supporting families during resuscitation simulations. Medical students should be considered as the main participants for FPDR simulation. More high-evidence studies with interprofessional teams including physicians and/or medical students are needed to evaluate curriculum design and participant response changes following FPDR simulation.

目的:众所周知,复苏期间家属在场(FPDR)是以家庭为中心的护理的一部分。然而,医生如何接受 FPDR 教育尚不得而知。我们旨在回顾医生和医学生模拟相关 FPDR 的现状:方法:我们对 1999 年至 2023 年 5 月 5 日期间发表的英文文献进行了范围界定。检索文章时使用了以下关键词组合:家庭、复苏和模拟相关词:结果:八篇文章被纳入最终综述。这篇针对医生和医学生的 FPDR 模拟综述揭示了三类研究结果:测量心肺复苏术质量、调查 FPDR 模拟后参与者的反应以及提取示范性良好沟通要素。首先,在四项测量复苏质量的研究中,医生参与了成人复苏,复苏质量随着明显反应的家属在场而降低。其次,在三项调查模拟培训反应的研究中,参与儿科复苏的跨专业团队对 FPDR 模拟反应消极。第三,在一项研究中发现,在跨专业团队参与的婴儿模拟中,FPDR 期间存在良好的沟通要素。针对医学生的 FPDR 模拟培训尚未见报道:结论:该研究强调了有医生和/或医科学生参与的 FPDR 模拟中存在的不足。在模拟复苏过程中,医生更关注复苏质量,而不是对家属的支持。医学生应被视为 FPDR 模拟的主要参与者。需要对包括医生和/或医学生在内的跨专业团队进行更多高证据研究,以评估课程设计和参与者在 FPDR 模拟后的反应变化。
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引用次数: 0
Mortality case due to minimal bentazone intoxication. 因轻度苯达松中毒而死亡的病例。
IF 1.9 Q2 EMERGENCY MEDICINE Pub Date : 2024-07-19 DOI: 10.15441/ceem.24.217
Yumin Jeon, Sejoong Ahn, Jong-Hak Park, Hanjin Cho, Sungwoo Moon, Sukyo Lee

Bentazone is a widely used herbicide and is considered a moderate hazard. Fatalities are rarely reported, with reports of deaths occurring in doses of 200 ml or more. In some literature, it is accompanied by generalized rigidity. Malignant hyperthermia (MH) is a pharmacogenetic diseases that presents a hypermetabolic response to anesthetic gases or depolarizing muscle relaxant due to calcium channel dysfunction. The classic symptom of MH include hyperthermia and muscle rigidity. In this article, we report a case of a 65-year-old man who died 4 hours after presenting to the emergency department after taking approximately 75 ml of Basagran M60 (bentazone 33.6%, 25.2 g). This is the smallest dose (364 mg/kg) reported in a fatal case to date. Electrocardiogram changes, including QRS widening and QT prolongation, were present, and hypocalcemia was confirmed. We propose the possibility that bentazone intoxication causes patient deterioration by a mechanism similar to malignant hyperthermia.

本草酮是一种广泛使用的除草剂,被认为具有中等危害。很少有致死的报道,但有报道称剂量达到或超过 200 毫升时会导致死亡。在一些文献中,它还伴有全身僵硬。恶性高热(MH)是一种药物遗传性疾病,由于钙通道功能障碍,患者会对麻醉气体或去极化肌肉松弛剂产生高代谢反应。MH 的典型症状包括高热和肌肉僵硬。在本文中,我们报告了一例 65 岁男子的病例,他在服用了约 75 毫升 Basagran M60(苯达宗 33.6%,25.2 克)后,在急诊科就诊 4 小时后死亡。这是迄今为止在死亡病例中报告的最小剂量(364 毫克/千克)。出现了心电图变化,包括 QRS 增宽和 QT 间期延长,并确诊为低钙血症。我们认为,苯达松中毒导致患者病情恶化的机制可能与恶性高热症类似。
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引用次数: 0
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Clinical and Experimental Emergency Medicine
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