European Resuscitation Council Guidelines for Resuscitation.

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Clinical management of poisoning and drug overdose

Hepatotoxicity is the most common organ injury due to occupational and environmental exposures to industrial chemicals. A wide range of liver pathologies ranging from necrosis to cancer have been observed following chemical exposures both in humans and in animal models. Toxicant-associated fatty liver disease (TAFLD) is a recently named form of liver injury pathologically similar to alcoholic liver disease (ALD) and nonalcoholic fatty liver disease (NAFLD). Toxicant-associated steatohepatitis (TASH) is a more severe form of TAFLD characterized by hepatic steatosis, inflammatory infiltrate, and in some cases, fibrosis. While subjects with TASH have exposures to industrial chemicals, such as vinyl chloride, they do not have traditional risk factors for fatty liver such as significant alcohol consumption or obesity. Conventional biomarkers of hepatotoxicity including serum alanine aminotransferase activity may be normal in TASH, making screening problematic. This article examines selected chemical exposures associated with TAFLD in human subjects or animal models and concisely reviews the closely related NAFLD and ALD.

https://journals.sagepub.com/doi/pdf/10.1177/0192623312468517

Toxicant-associated Steatohepatitis

Neutrophil migration in inflammation: nitric oxide inhibits rolling, adhesion and induces apoptosis

The innate immune system of the lung is a multicomponent host defense system and in addition has an instructing role in regulating the quality and quantity of the adaptive immune response. When the interaction between innate and adaptive immunity is disturbed, pathological conditions such as asthma can develop. It was the aim of the study to investigate the effect of the allergic inflammation of the lung on the innate host defense during bacterial infection. Human bronchial epithelial cells were preincubated with Th2 cytokines and infected with Pseudomonas aeruginosa. The effect of the Th2 cytokines on the mRNA levels of antimicrobial peptides and the antimicrobial activity of HBEC was determined. To investigate the influence of an allergic inflammation on pulmonary host defense in vivo, mice sensitized and challenged with OVA were infected with P. aeruginosa, and the number of viable bacteria in the lungs was determined together with markers of inflammation like cytokines and antimicrobial peptides. Exposure of airway epithelial cells to Th2 cytokines resulted in a significantly decreased antimicrobial activity of the cells and in suppressed mRNA levels of the antimicrobial peptide human β-defensin 2. Furthermore, mice with allergic airway inflammation had significantly more viable bacteria in their lungs after infection. This was consistent with reduced levels of proinflammatory cytokines and of the antimicrobial peptide cathelin-related antimicrobial peptide. These results show that an allergic airway inflammation suppresses the innate antimicrobial host defense. The adaptive immune system modulates the functions of the pulmonary innate immune system.

/pdf/allergic-airway-inflammation-inhibits-pulmonary-345q1rbibp.pdf

Allergic Airway Inflammation Inhibits Pulmonary Antibacterial Host Defense

Inflammatory responses are strictly regulated by coordination of pro-inflammatory and anti-inflammatory mediators. Interleukin-4 (IL-4) and interleukin-10 (IL-10) have typically the biologic anti-inflammatory effects on monocytes, but uncertain effects on polymorphonuclear leukocytes (PMNs). The PMNs are the first line of cellular response for host defense during acute inflammation. To modify hyper-inflammatory reaction with biologic anti-inflammatory mediators, we have determined the biologic anti-inflammatory activities of IL-4 and IL-10 on human PMNs. Human PMNs were pretreated with IL-4 or IL-10 and then stimulated with formyl methionyl leucyl phenylalanine (fMLP) for times indicated. The level of H2O2, interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-alpha) were determined in the each cell free supernatants. fMLP plays the role of a typical pro-inflammatory agent and, at least in determined conditions, down-regulated TNF release. IL-4 acts as an anti-inflammatory mediator but IL-10 did not show its anti-inflammatory activities on fMLP-stimulated human PMNs. IL-4 and IL-10 have different anti-inflammatory mechanisms. Perhaps, IL-10 needs co-factors to act as an anti-inflammatory mediator.

/pdf/anti-inflammatory-effects-of-il-4-and-il-10-on-human-2vqajfttma.pdf

Anti-inflammatory effects of IL-4 and IL-10 on human polymorphonuclear leukocytes.

Objective: In the Emergency Department, it would be worthwhile to treat pneumothorax patients on an outpatient basis by utilizing a smallcalibre catheter and Heimlich valve insertion. We evaluated this treatment and compared it with the closed thoracostomy. Methods: In this comparative study, the success rate, complications and recurrence rate of treating spontaneous pneumothorax patients by using a small-calibre catheter and Heimlch valve were compared with those of a similar-sized group treated by closed thoracostomy. Results: Pneumothorax was successfully treated on an ambulatory basis by using the small-calibre catheter and Heimlch valve in 20 patients (47%); this was less than the 42 patients (89%) who were successfully treated by closed thoracostomy. While no complications were encountered in the group treated using the small-calibre catheter and Heimlich valve, 11 patients in the group treated by closed thoracostomy developed complications. The medical expenses for the treatment involving the small-calibre catheter and Heimlich valve were less than those for closed thoracostomy. Conclusion: Prior to the treatment, the patients should be fully informed of the success rate of this treatment and the possibility of requiring closed thoracostomy in the event of treatment failure. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Can spontaneous pneumothorax patients be treated by ambulatory care management

Background: Diagostic imaging can help in the management of toxicologic emergencies. The authors report on a patient who presented to the emergency department with coma and suppressed respirations after ingestion of an unknown substance. Methods: Ingestion of chloroform with radiopaque material in the bowel on abdominal radiograph was documented. The patient was treated with haemoperfusion, activated charcoal, and laxatives to decrease the toxicities. Results: Hepatotoxicity occurred on post-ingestion day 3 and elevation of liver enzymes reached peak levels on post-ingestion day 5. The patient received N-acetylsystein and supportive care during hospitalisation. The patient improved from hepatic dysfunction and was discharged without complication on post-ingestion day 11. Conclusion: Radiographic studies in toxicology may confirm a diagnosis and assist in therapeutic intervention.

/pdf/diagnostic-radiopacity-and-hepatotoxicity-following-2zrshzszro.pdf

Diagnostic radiopacity and hepatotoxicity following chloroform ingestion: a case report

High-rise buildings present unique challenges to providing high-quality CPR. We investigated the effect of using a mechanical compressor and supraglottic airway on flow time and CPR quality in simulated cardiac arrests occurring within a high-rise building. Twelve teams of EMS providers performed CPR according to 4 scenarios: manual compression and ventilation through bag-valve-mask (MAB) or supraglottic airway (MAS); mechanical compression and ventilation through bag-valve-mask (MEB) or supraglottic airway (MES). Chest compression indices did not differ significantly among the groups. The mechanical compression groups had a higher flow time fraction from exiting the elevator until the manikin was loaded into the ambulance than the manual compression groups. The supraglottic airway groups had higher flow time fractions from entering the elevator until the end of the scenario than the bag-valve-mask groups. The total flow time fraction was lowest in the MAB group and was highest in the MEB group (P < 0.001). In simulated cardiac arrest in a high-rise building, the use of a supraglottic airway maintained flow time at a level similar to that observed with the use of a mechanical compressor. Moreover, the use of a mechanical compressor and a supraglottic airway increased the flow time most effectively.

/pdf/the-effect-of-a-mechanical-compression-device-and-1snitwqilx.pdf

The Effect of a Mechanical Compression Device and Supraglottic Airway on Flow Time: A Simulation Study of Out-of-Hospital Cardiac Arrest in a High-Rise Building

Background The poor prognosis of acute stroke may be largely attributed to delays in treatment. Emergency medical services (EMS) usage is associated with a significant reduction in the delay in stroke treatment. The aims of this study were to identify factors associated with the delay in EMS activation for patients with acute stroke. Methods This study was conducted at 26 Fire Safety Centers in five districts of Seoul, Korea. Patients with acute stroke transferred by EMS and admitted to a tertiary referral hospital from January 2014 to December 2018 were enrolled. In this cross-sectional study, the dependent variable was the time from stroke onset to EMS activation time. Patients were divided into two groups, onset-to-alarm time ≤ 30 min and onset-to-alarm time > 30 min, and previously collected patient data were analyzed. We performed logistical regression analyses of characteristics differing significantly between groups. Results Out of 480 patients, 197 (41%) had onset-to-alarm times > 30 min. Significant variables in the logistical analysis were alert mental state (adjusted odds ratio [aOR]: 2.77; 95% confidence interval [CI]: 1.31–6.13), pre-stroke mRS ≥ 2 (aOR: 2.46; 95% CI: 1.26–4.95), onset occurrence at private space (aOR: 2.31; 95% CI: 1.23–4.41), recognizing symptoms between 0 and 8 am (aOR: 2.30; 95% CI: 1.25–4.31), ischemic stroke (aOR: 1.88; 95% CI: 1.04–3.43), and witnessed by others (aOR: 0.32; 95% CI: 0.18–0.55). Conclusions Delay in EMS activation for acute stroke cases is possibly related to difficult situations to recognize stroke symptoms, such as alert mental state, pre-stroke mRS ≥ 2, onset occurrence at private space, recognizing symptoms between 0 and 8 am, and unwitnessed by others.

Jun-Dong Moon

Papers

Anti-inflammatory effects of IL-4 and IL-10 on human polymorphonuclear leukocytes.

Can spontaneous pneumothorax patients be treated by ambulatory care management

Diagnostic radiopacity and hepatotoxicity following chloroform ingestion: a case report

The Effect of a Mechanical Compression Device and Supraglottic Airway on Flow Time: A Simulation Study of Out-of-Hospital Cardiac Arrest in a High-Rise Building

Factors Associated with Delay of Emergency Medical Services Activation in Patients with Acute Stroke.