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Purpose: The aim of this study was to compare the effects of hyperbaric oxygen therapy (HBOT) induced hyper-oxygenation and normobaric oxygen therapy (NBOT) on myocardial repolarisation parameters in children with carbon monoxide (CO) poisoning. Materials and Methods: This prospective study included 77 girls and boys aged 0–18 years who were diagnosed and treated for CO poisoning. There were no changes in the routine clinical evaluation and treatment practices of patients. Patients who received NBOT (n=40) and HBOT (n=37) were divided into two groups. These groups were compared in terms of their demographic characteristics, carboxyhaemoglobin, lactate, troponin levels and myocardial repolarisation parameters of electrocardiography (ECG) (Tp-e interval, Tp-e dispersion, QTc and Tp-e/QTc ratio). Results: There were no significant intergroup differences in terms of carboxyhaemoglobin, lactate and troponin levels at the time of admission; admission and post-treatment Tp-e, Tp-e dispersion, corrected QTc and TPe/QTc ratio and post-treatment change rates of each ECG parameter. Conclusion: There was no intergroup difference in terms of repolarisation parameters of ECG in children with CO poisoning. The possible reason for this may be myocardial reperfusion damage due to hyper-oxygenation associated with HBOT therapy.

Purpose: The aim of this study was to compare the effects of hyperbaric oxygen therapy (HBOT) induced hyperoxygenation and normobaric oxygen therapy (NBOT) on myocardial repolarisation parameters in children with carbon monoxide (CO) poisoning. Materials and Methods: This prospective study included 77 girls and boys aged 0–18 years who were diagnosed and treated for CO poisoning. There were no changes in the routine clinical evaluation and treatment practices of patients. Patients who received NBOT (n=40) and HBOT (n=37) were divided into two groups. These groups were compared in terms of their demographic characteristics, carboxyhaemoglobin, lactate, troponin levels and myocardial repolarisation parameters of electrocardiography (ECG) (Tp-e interval, Tp-e dispersion, QTc and Tp-e/QTc ratio). Results: There were no significant intergroup differences in terms of carboxyhaemoglobin, lactate and troponin levels at the time of admission; admission and posttreatment Tp-e, Tp-e dispersion, corrected QTc and TPe/QTc ratio and post-treatment change rates of each ECG parameter. Conclusion: There was no intergroup difference in terms of repolarisation parameters of ECG in children with CO poisoning. The possible reason for this may be myocardial reperfusion damage due to hyper-oxygenation associated with HBOT therapy. [ABSTRACT FROM AUTHOR]

Carbon monoxide (CO) poisoning can cause severe neuropsychiatric disorders. However, no sufficient attention has been paid to this issue in literature. The definition, treatment and clinical course of neuropsychiatric symptoms that occur especially after poisoning are not known exactly. In the studies conducted to date, neurological symptoms, cognitive, mood and personality disorders have been observed in the cases years after CO poisoning. However, the hypotheses regarding the etiopathology of long-term neuropsychiatric findings have not clarified the subject completely. The interaction of environmental and neurobiological complex factors related to the patient's clinical symptomatology may be a risk factor for the emergence of long-term neuropsychiatric disorders. In this study, a 45-year-old female patient who presented to our clinic with late-onset psychotic symptoms and suffered from CO poisoning 15 years ago is presented in the light of literature findings. After CO poisoning, a close follow-up with neuropsychiatric evaluation and regular neuroimaging should be planned. The diagnosis and treatment of neuropsychiatric symptoms and disorders caused by CO poisoning, which is the leading cause of intoxication-related deaths all over the world, is important. Clinicians should be careful about medical evaluations in patients with atypical features and late-onset psychotic complaints and a history of CO poisoning. [ABSTRACT FROM AUTHOR]

Carbonmonoxide (CO) intoxication can have serious effects on tissues requiring high oxygen flow such as brain and myocardium. Neurological findings are prominent and cardiotoxic effects are common. Case reports have shown a significant relationship between CO intoxication and myocardial ischemia. In the literature, the number of cases requiring CABG surgery after CO intoxication-induced myocardial infarction (MI) is limited. In the light of literature, we discussed a male patient admittted to the emergency department with the complaint of chest pain without frequently encountered neurological and respiratory system findings, together with elevated troponin and increased carboxyhemoglobulin levels. He was considered to have developed MI after CO intoxication and underwent CABG surgery following an emergency angiography and stenting. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to search if using thiol/disulphide homeostasis together with Neutrophile Lymphocyte Ratio (NLR) which are oxidative stress markers in patients who apply to the emergency service with carbon monoxide intoxication is useful regarding diagnosis or not. Materials and Methods: The study was performed prospectively with 45 patients who applied to the emergency service between 01.01.2014 - 01.03.2015 and who were included in the study and 40 healthy persons who were determined as control group. Thiol/disulphide homeostasis parameters (Thiol, disulphide, disulphide / native thiol, disulphide / total thiol, native thiol / total thiol) and NLR which are oxidative stress markers were studied in the patient and control groups by a method which was developed newly by Erel and Neşelioğlu. Results: In persons with carbon monoxide intoxication, a significant difference was detected in NT, TT, index 3 and NLR rates according to the control group. NT, TT and index 3 were found lower in the patient group, and NLR mean values were found higher in the patient group (p =0.005, < 0.001, = 0.032, < 0.001 respectively). Conclusion: To use NLR together with thiol/disulphide homeostasis parameters in the diagnosis of carbon monoxide intoxication is useful regarding diagnosing in these patients. [ABSTRACT FROM AUTHOR]

Objective: Carbon monoxide (CO) is the main cause of death and morbidity associated with poisoning in developed countries. The most important mortality and morbidity cause of CO poisoning is cerebral hypoxia. Near infrared spectroscopy (NIRS) is a useful method for assessing brain oxygenation. In this study, we aimed to evaluate the brain oxygenation of CO poisoning patients with NIRS and to investigate its benefits in patients follow up and treatment. Methods: The study was conducted as a single-center, prospective clinical trial with 33 patients who were diagnosed by measuring blood carboxyhemoglobin (CO-Hb) level or referred from other hospitals diagnosed with CO poisoning. Patients were divided into two groups as normobaric oxygen therapy (NBOT) group and hyperbaric oxygen therapy (HBOT) group according to the treatment method applied. Results: Although average cerebral saturation (ScO2) levels after treatment were higher in the NBOT group than before treatment, no statistically significant difference was found except the left frontal ScO2 values. In HBOT group, there was no difference between ScO2 values before and after treatment sessions. Conclusions: Our study concluded that NIRS may be useful in assessing brain oxygenation in CO poisoned patients, but not in determining the HBOT start-up, and not in monitoring the effectiveness of HBOT. [ABSTRACT FROM AUTHOR]

Objective: Carbon monoxide (CO) is the main cause of intoxication-related mortality and morbidity in developed countries. It is responsible for more than half of fatal intoxications in many countries. The purpose of this study was to determine the diagnostic value of protein carbonyl (PC), a good marker of oxidative stress, in association with oxidative stress resulting from hypoxia emerging in patients with acute CO intoxication. Methods: Thirty-four patients diagnosed with acute CO intoxication at the Emergency Department and 38 healthy volunteers were included in the study. Patients' PC levels at time of admission and after treatment were compared with those of a control group. Results: No statistically significant difference was observed among PC levels at time of admission in the patient and control groups (p =0.305, patient group 0.025 ± 0.01, control group 0.026 ± 0.01). A significant decrease was determined in post-treatment PC levels in the patient group compared to those at time of admission (p = 0.006, admission 0.025 ± 0.01, post-treatment 0.017 ± 0.008). No significant correlation was determined between patients' carboxyhemoglobin (CO-Hb) levels and PC levels at time of admission (Correlation coefficient = -0.006, p= 0.971). Conclusions: We think that PC is not suitable for use as a biomarker in the acute period in patients with CO intoxication. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The aim of our study is to present the epidemiologic, clinical, laboratory and prognosis differences between the coal stove origin poisoning and natural gas leakages. We also aimed to investigate relationship between the severity of clinical picture, prognosis, complications develop in CO poisoning with neutrophil/lymphocyte ratio (NLR) at the initial admission. Methods: All the acute carbon monoxide cases who applied to Ankara Training and Research Hospital Emergency Medicine Clinic between October 2009 and April 2010 were included to this prospective study. CO poisoning diagnosis was made by the history of CO poisoning with carboxyl hemoglobin (COHb) concentration is over 10%. 100 patients were included to our study. Results: Of the patients, 55(55%) were poisoned from the coal-stove and 45(45%) from natural gas leakage. The mean COHb level of the natural gas group was significantly high (p=0.01). The mean value of GCS of the natural gas group was significantly lower (p=0.018). The number of patients with indication for HBO therapy were 17 and 6 in the natural gas group and coal-stove group, respectively, being significantly higher in the natural gas group(p=0.001). There was no statistically significant relationship between the value of NLR and values of COHb, troponin, and GCS (p=0.872, p=0.470, and p=0.896, respectively). Conclusions: Carbon monoxide poisoning from natural gas leakage is more toxic than that from the coal-stove. There is no relationship between NLR at the time of presentation and the severity of clinical findings, prognosis and complications. [ABSTRACT FROM AUTHOR]

Karbonmonoksit (CO) kokusuz, renksiz, tatsız, irritan özelliği olmayan ve karbon içeren materyalin eksik oksidasyonu ile oluşan bir gazdır. Önemli bir halk sağlığı sorunu olan karbonmonoksit zehirlenmesi ile ülkemizde sık karşılaşılmakta olup özellikle kış aylarında önemli bir morbidité nedenidir. Hem ölümle sonuçlanan, hem de ölümle sonuçlanmayan karbonmonoksit zehirlenmeleri, adli tıp açısından önemlidir. Sunulan olgu, Eskişehir’de bir apartmanda kapıcılık başka bir apartmanda da kalorifercilik yapan dört kişilik bir ailenin, iki hafta arayla, üç bireyinin karbonmonoksit zehirlenmesine maruz kalması ile ilgilidir. Olay, kapıcılık ve kalorifercilik yapan babanın birinci kez 4 yaşındaki kızı ile ikinci kez 12 yaşındaki oğlu ile birlikte, çalıştığı apartmanın kalorifer kazanının önünde baygın bulunması şeklinde gelişmiştir. Olay, baba için çalıştığı iş yerinde ve tekrarlı olması, çocuklar için babanın tedbirsizlik ve dikkatsizliğini gündeme getirmesi nedeniyle sunulmaya ve tartışılmaya değer bulunmuştur. Bu tür olguların sunulmasının adli tıbbi uygulamaya katkı sağlayacağı, düşünülmüştür. Anahtar kelimeler: Karbonmonoksit zehirlenmesi, komplikasyon, adli tıp

Amaç: Karbonmonoksit (CO) organik bileşiklerin yanması sonucu oluşan, irritan olmayan, renksiz, kokusuz bir gazdır. Toksisitesi, ısınma amaçlı kullanılan kömür sobaları, yangınlar ve yeterli havalandırma sağlanmamış kapalı alanlarda çalıştırılan jeneratör, araçlar ve şofbenlere bağlı sık görülmektedir. CO zehirlenmesi ülkemizde ve dünyada sık görülen toplumsal sağlık sorunları arasındadır. CO’nun kardiyak mitokondriler üzerinde de doğrudan toksik etkileri vardır. Bu yazıda, koroner arter hastalığı (KAH) öyküsü olan, CO zehirlenmesiyle sekonder miyokard enfarktüsü (MI) geçiren bir olguyu sunmayı amaçlıyoruz. Olgu: Özgeçmişinde HT, DM, KOAH, KAH (6 yıl önce koroner bypass, 2 ay önce koroner anjiyografi) öyküsü olan 74 yaşında erkek hasta, evinde çıkan yangında dumandan etkilenerek acil servise getirilmiş. Fizik muayenesinde; genel durumu iyi, bilinci açık, oryante, koopere imiş. Kan basıncı: 170/80 mmHg, kalp hızı: 87 atım/dk, solunum sayısı: 30/dk, SpO2 : %95 (oksijensiz) ve EKG’de ST segmentlerinde depresyon ve T-dalgasında anormallikler görülmüş. Kan gazında; ph: 7,48, pCO2 : 29,8 mmHg, pO2 : 107,4 mmHg, HCO3 : 23,3 mmol/L, COHb: %16,2, sO2 : %89,6 ve biyokimya sonuçları normal olarak tespit edilmiş. Yoğun bakım ünitemize yatırılan hastaya nazal kanülle 10 lt/dk oksijen tedavisine başlandı, takipnesinin düzeldiği görüldü. Öykü ve EKG bulgusu nedeniyle kardiyoloji bölümüne konsülte edildi, yatak başı yapılan transtorasik ekokardiyografide; duvar ve kapak hareketleri normal, ejeksiyon fraksiyonu %50 olarak belirlendi, intrakardiyak trombüs izlenmedi. Hastaya ikili antiagregan ve düşük molekül ağırlıklı heparin tedavisi başlandı. Kan gazı, kardiyak marker ve EKG takibi yapıldı (Tablo 1, 2). Üç günlük yatışın ve tedavinin ardından kardiyak enzim ve arteriyel kan gazı değerleri normale döndü ve taburcu edildi. Sonuç: CO; intoksikasyonuyla çeşitli organ sistemlerini etkileyebilen, mortal sonuçlara yol açan bir gazdır. Ülkemizde ölümle sonuçlanan zehirlenme olgularında CO zehirlenmesi yaklaşık %31 oranında en sık neden olarak bildirilmiştir. Oksijene kıyasla CO’nun hemoglobin afinitesi 200-250 kez daha fazla olduğundan zehirlenmedeki morbidite ve mortalitenin doku hipoksisi zemininde geliştiği, ayrıca CO’nun hücre üzerinde kardiyak mitokondriler üzerinde olduğu direkt toksik etkilerinin de olduğu belirtilmektedir. CO zehirlenmesi akut veya kronik olarak gelişebilir. Etkilenme hipoksiye duyarlı kalp kası, beyin hücreleri, böbrek hücreleri öncelikle olmak üzere bütün hücrelerde olur. CO’nun %10- 15’i iskelet ve kalp kası myoglobinine bağlanır. Miyokardiyal depresyon ve doku hipoksisi birlikteliği koroner spazm, aritmi ve kardiyak arreste yol açar. Hastalar, klinikte genellikle karşımıza santral sinir sistemi ait bulgularıyla başvurmalarına rağmen, belirgin ve fatal kardiyak anormallikler görülebilir. Kardiyak tutulum, CO ile karşılaşmadan hemen sonra oluşabileceği gibi, birkaç gün sonra da gerçekleşebilir. Çarpıntı, sinüs taşikardisi ve atriyal fibrilasyon, ventriküler ekstrasistol gibi aritmiler gözlenebilir. Şiddetli olgularda, bradikardi ve atrioventriküler tam blok görülebilir. İskemik kalp hastalığı olanlarda, anjina pektoris ve MI tetiklenebilir. Elektrokardiyografik ST segment ve T-dalga değişiklikleri sık olarak görülebilir. Geçici sağ ve/veya sol ventrikül duvar hareket bozuklukları mevcut olabilir. Bizim olgumuzda iskemik kalp hastalığı mevcut idi. EKG’de ST segmentinde depresyon, T-dalgasında anormallikler gözlemlendi. Kardiyak enzimlerinde kısa sürede belirgin artış mevcut idi. Hastanın tedavisinde verdiğimiz antiagregan ve %100 oksijen den sonra hızlı yanıt aldık. Hastanın semptom ve kliniğindeki düzelmeyle kardiyak enzimlerinde ve EKG değişikliklerinde düzelme gözlemlendi. Sonuç olarak CO zehirlenmesiyle başvuran tüm hastalarda kardiyak hasar ve sekonder MI açısından kardiyak enzim ve elektrokardiyografi takibi yapılmalı. Özellikle kardiyovasküler hastalığı olan ve ileri yaş hastalarda aralıklı seri kardiyak enzim ve elektrokardiyografi takiplerinin dikkatlice yapılması gerektiği kanaatindeyiz. [ABSTRACT FROM AUTHOR]

Amaç: Karbonmonoksit (CO) zehirlenmesi özellikle kış aylarında önemli bir mortalite/morbidite nedenidir. COHb, hemoglobin katabolizmasında ortaya çıktığından çok düşük düzeylerde (%0-5) her bireyde tespit edilmekte olup hemoglobine afinitesi oksijenden 250 kat daha fazladır. Reaksiyon sonucunda Hb-O2 eÄŸrisi sola kayar ve hücrelerde hipoksi ortaya çıkar. Ancak zehirlenmelerde klinik bulgular; özellikle nörolojik anormallikler ile COHb düzeyleri arasında korelasyon saptanmamaktadır. Bu olguda nörolojik geç sekel geliÅŸen bir hastamızı sunmayı amaçladık. Olgu: Elli yaşında erkek hasta soba zehirlenmesi ile acil servise getirildi. GKS: 5 olması üzerine entübe edilen hasta yoÄŸun bakıma devir alındı. Hiperbarik oksijen tedavisine baÅŸlanıldı. Yapılan diffüzyon MRG’de saÄŸ parietal bölgede ve ayrıca bilateral bazal ganglionlar düzeyinde kısıtlanmış diffüzyon alanı görüldü. Ä°lk deÄŸerlendirmede pupiller normoizokorik, IR +/+, gözler orta hatta ve aÄŸrılı uyarana fleksiyon yanıt saptandı. Hastanın geliÅŸindeki kan gazında Ph: 7,41, PaCO2 : 36 mmHg, PaO2 : 102 mmHg, COHb: 5,6 saptandı. Hemodinamik bulguları stabildi. Hastanın yatışının 9. gününde bilinç açık, tek basamaklı emirlerle koopere olduÄŸu gözlenerek ekstübe edildi. Hiperbarik tedavisi 12 güne tamamlandıktan ve hastanın bilincinin tamamen açılması üzerine durduruldu. Fakat yatışının 16. gününde bilinçte gerileme gözlendi ve kontrol kraniyal MR çekildi. Kontrol MR’de yeni geliÅŸen bulgu saptanmadı. Hiperbarik tedavisine 5 seans daha devam edilen hastada bilinç durumunda bir deÄŸiÅŸiklik olmadı. Solunum sıkıntısı olmayan hasta 1. basamak yoÄŸun bakım ünitesine devredildi. Sonuç: CO zehirlenmelerinin akut evresinden sonra günler içinde (3-240 gün) hastalarda geç nörolojik sekel görülebilmektedir. Hastaların %10-30’unda demans, kiÅŸilik deÄŸiÅŸiklikleri, öğrenme güçlüğü, konsantrasyon bozuklukları, psikoz, paralizi, korea, periferal nöropati ve inkontinans gibi nöropsikiyatrik bozukluklar görülmektedir. Geç nörolojik sekeli olan hastaların çoÄŸu akut zehirlenme sırasında bilinç kaybı olan, kraniyal BT ve MRG’de beyaz cevher zedelenmesi saptanan olgulardır. Bir yıl sonra geç nöropsikiyatrik bulguları olan bu hastaların %50-75’inde iyileÅŸme gözlenmektedir. Kraniyal BT bulgularının normal olması, uzun dönemde hastaların prognozunun iyi olacağını düşündüren bir bulgudur. Ancak yine de hastaların kognitif fonksiyonlar açısından yakın ve uzun süreli izlenmeleri gereklidir. Amaç: Karbonmonoksit (CO) zehirlenmesi özellikle kış aylarında önemli bir mortalite/morbidite nedenidir. COHb, hemoglobin katabolizmasında ortaya çıktığından çok düşük düzeylerde (%0-5) her bireyde tespit edilmekte olup hemoglobine afinitesi oksijenden 250 kat daha fazladır. Reaksiyon sonucunda Hb-O2 eğrisi sola kayar ve hücrelerde hipoksi ortaya çıkar. Ancak zehirlenmelerde klinik bulgular; özellikle nörolojik anormallikler ile COHb düzeyleri arasında korelasyon saptanmamaktadır. Bu olguda nörolojik geç sekel gelişen bir hastamızı sunmayı amaçladık. Olgu: Elli yaşında erkek hasta soba zehirlenmesi ile acil servise getirildi. GKS: 5 olması üzerine entübe edilen hasta yoğun bakıma devir alındı. Hiperbarik oksijen tedavisine başlanıldı. Yapılan diffüzyon MRG’de sağ parietal bölgede ve ayrıca bilateral bazal ganglionlar düzeyinde kısıtlanmış diffüzyon alanı görüldü. İlk değerlendirmede pupiller normoizokorik, IR +/+, gözler orta hatta ve ağrılı uyarana fleksiyon yanıt saptandı. Hastanın gelişindeki kan gazında Ph: 7,41, PaCO2 : 36 mmHg, PaO2 : 102 mmHg, COHb: 5,6 saptandı. Hemodinamik bulguları stabildi. Hastanın yatışının 9. gününde bilinç açık, tek basamaklı emirlerle koopere olduğu gözlenerek ekstübe edildi. Hiperbarik tedavisi 12 güne tamamlandıktan ve hastanın bilincinin tamamen açılması üzerine durduruldu. Fakat yatışının 16. gününde bilinçte gerileme gözlendi ve kontrol kraniyal MR çekildi. Kontrol MR’de yeni gelişen bulgu saptanmadı. Hiperbarik tedavisine 5 seans daha devam edilen hastada bilinç durumunda bir değişiklik olmadı. Solunum sıkıntısı olmayan hasta 1. basamak yoğun bakım ünitesine devredildi. Sonuç: CO zehirlenmelerinin akut evresinden sonra günler içinde (3-240 gün) hastalarda geç nörolojik sekel görülebilmektedir. Hastaların %10-30’unda demans, kişilik değişiklikleri, öğrenme güçlüğü, konsantrasyon bozuklukları, psikoz, paralizi, korea, periferal nöropati ve inkontinans gibi nöropsikiyatrik bozukluklar görülmektedir. Geç nörolojik sekeli olan hastaların çoğu akut zehirlenme sırasında bilinç kaybı olan, kraniyal BT ve MRG’de beyaz cevher zedelenmesi saptanan olgulardır. Bir yıl sonra geç nöropsikiyatrik bulguları olan bu hastaların %50-75’inde iyileşme gözlenmektedir. Kraniyal BT bulgularının normal olması, uzun dönemde hastaların prognozunun iyi olacağını düşündüren bir bulgudur. Ancak yine de hastaların kognitif fonksiyonlar açısından yakın ve uzun süreli izlenmeleri gereklidir. [ABSTRACT FROM AUTHOR]

Objectives Carbon monoxide poisoning (COP) is one of the causes ofhypoxic encep-halopathy. The Mini-Mental Status Examination Scale (MMSES) is useful for evaluating the severity of hypoxic encephalopathy. The aim of this study was to investigate the relationship between the severity of poisoning, carboxyhemoglobin (CoHb) levels, and the MMSES among patients admitted to the emergency department with carbon monoxide poisoning. Methods Patients who were diagnosed with acute COP between February 2006 and February 2007 at Ondokuz Mayıs University Faculty of Medicine Emergency Department were evaluated prospectively. According to the severity of poisoning, patients were subdivided into three groups: mild, moderate, and severe. Results Fifty-one patients were included in our study. The ratio of females to males was 1.125. The average patient age at admission was 38.4± 16.5 years. The frequency of carbon monoxide poisoning among all admissions was 0.35%, and the frequency among all poisoning cases was 7.89%. Headache, nausea, dizziness, and weakness were the most frequent symptoms. Twenty of the patients (39.2%) had mild poisoning, 25 (49%) had moderate poisoning, and 6 (11.7%) had severe poisoning. While the relationship between severity of poisoning and COHb level was not significant, the relationships between MMSES and COHb level and between MMSES and poisoning severity were significant. Conclusions The MMSES scores of the patients admitted to the emergency department were negatively correlated with the severity of poisoning and CoHb levels. [ABSTRACT FROM AUTHOR]

A 20-year-old woman, who was found unconscious in the bed by the morning, was brought to emergency department. Her carboxyhemoglobin level was 20.2%. The portable chest X-ray showed bilaterally alveolar and interstitial infiltration. Initial pO2/FIO2 ratio was calculated as 119 mmHg. Acute lung injury due to carbon monoxide intoxication was considered. She was intubated and mechanical ventilation was applied. In the second day of hospitalization, a clear improvement was observed on the chest X-ray. She was discharged without any complication on the seventh day of hospitalization. Early diagnosis and treatment may prevent progression of ARDS and progression of permanent damage, and may lead to complete recovery. [ABSTRACT FROM AUTHOR]

AIM: In Turkey, studies about frequency of carbon monoxide (CO) poisoning are rare. In this study, it is aimed to determine the frequency of the CO poisoning cases occurring all around the country. METHOD: This study was planned as a descriptive study covering Turkey in general as stage. In this study, the CO poisoning case records of Ministry of Health Treat Services General Directorate in 2010 have been examined. The distribution of cases among regions-provinces, mortality rates, types of CO sources, seasonal and monthly dispersions have been examined. RESULTS: According to the records, totally 10.154 cases of CO poisoning were detected in Turkey in 2010 and only 39 of them were ended with death. It is determined that the frequency of cases is 0.0137% (approximately 14 in every 100.000) and mortality rate is about 5 in every 10 million. Poisoning cases have been occurred mostly in Marmara Region (3.426 cases, 33.7%). When it is evaluated in regard to the population, cases are mostly seen in Kilis (0,1998%). As of mortality rates, Bursa has the most number of cases ending with death (18 cases). CONCLUSION: Compared to studies in other countries, according to our data, Turkey was faced with more frequent cases of CO poisoning. The number of cases has increased, especially during the winter months. [ABSTRACT FROM AUTHOR]

Due to climate and socio-economic issues in Turkey, the incidence of carbon monoxide (CO) poisoning is high, especially in winter. Clinical manifestations may vary depending on the type of CO source, concentration and duration of exposure. The symptoms of CO poisoning predominantly manifest in lots of organs and systems with high oxygen utilization, especially the brain and the heart. The primary aim in oxygen therapy is to eliminate CO and to reduce its toxic effects. In this context, normobaric and hyperbaric oxygen therapy are used to achieve these goals. Normobaric oxygen (NBO) treatment is an easily accessible and relatively not expensive modality, where hyperbaric oxygen (HBO) therapy requires specific equipment, certified staff and is available only in some centers. Additionally, HBO treatment has several additional advantages over NBO treatment. Despite its benefits, it is compulsory to search for some criteria in selecting patients to be treated because of the limited availability and access of hyperbaric facilities. For an effective evaluation and an optimal treatment, advanced education of the healthcare professionals on the use of oxygen delivery modalities in the management of CO poisoning is imperative. In this review, it has been aimed to outline the significance of oxygen treatment modalities and to determine patient selection criteria for HBO treatment in the management of CO poisoning which continues to be an important threat to community health care. [ABSTRACT FROM AUTHOR]

Objective: Carbon monoxide (CO) poisoning is known to cause myocardial toxicity and life threatening arrhythmias. QT interval measured from electrocardiogram is an indirect measure of the heterogeneity of ventricular repolarization, which may contribute to ventricular arrhythmias. The purpose of the study was to investigate whether the carboxyhemoglobin (COHb) level may be related to the changes of QT, corrected QT (QTc), QT dispersion (QTd), corrected Qtd (QTdc) and cardiac enzymes during carbon monoxide poisoning. Methods: We conducted an observational study; 104 patients who had been diagnosed with CO intoxication were included in the study. Measurement of QT, QTc, QTd and QTdc intervals were performed form electrocardiogram on admission, 24 and 48 hours after admission. Cardiac enzymes were measured at each time-point. The myocardial perfusion scan was determined in all patients 1 week after admission. Results: The QT interval level in 24h was significantly higher than admission level (p<0.001), additionally QTc interval levels in 24h and 48h were significantly lower than admission levels (p<0.001 and p<0.001, respectively). Carboxyhemoglobin level only significantly correlated with QT intervals (r=-0.288 ; p=0.019), troponin T (r=-0.297; p=0.007), and creatine kinase MB levels (r=0.262; p=0.020). As a result of ROC analysis the QT interval level was significantly powerful parameter to predict COHb (p=0.022). Conclusion: Our data indicate COHb level correlated with QT intervals and cardiac enzymes. Clinicians should possibly avoid QT prolonging drugs and carefully monitor the QT, QTc, QTdc intervals in patients at high risk of cardiac disability due to high levels of COHb after CO poisoning. [ABSTRACT FROM AUTHOR]

Aims: Clinical forensic medicine deals with cases involving both the legal and medical aspects of patient care, such as motor vehicle trauma or poisoning. In this study, we aimed to draw attention to the forensic issues by retrospective investigation of 13823 emergency cases and to share our experiences on this topic. Materials and Methods: This retrospective study was conducted in a university Emergency Department (ED) in Ankara, Turkey. The data were collected from official hospital police sheets. Results: Between 2000 and 2005, 13823 legal cases (3.66% of all ED patients) were examined, and 58.23% of them were male. The mean age was 28.03±16.42 years. The main injury patterns were motor vehicle trauma (43.84%), physical assault (19.04%), suicide attempts (17.10%), and carbon monoxide (CO) poisoning (6.62%). Most of the cases were in the 20-29 years of age group (30.01%). Suicide attempts, CO poisoning and sexual assault victims were mostly female. 46.47% of the cases were admitted to the ED between 16:00 and 23:59. Forensic cases were mostly reported in May (9.92%). Two hundred and forty-two forensic cases died in the ED and 42 died outside the ED previously; 71.53% of them were male. The main cause of death was motor vehicle trauma (62.50%). [ABSTRACT FROM AUTHOR]

Carbon monoxide intoxication is an important public health problem, which may result in death. A 46-year-old male patient was found in an unconscious state at home and was transported to the emergency service by the patient's relatives. Relatives of the patients were indicated that there was gas leak from the stove. At first it was considered that the patient might be poisoned with carbon monoxide. The laboratory findings were, creatinine 2.5 mg/ dL and creatinine kinase 88.15 U/L. Carboxy hemoglobin level was 30.9%. Hyperbaric oxygen therapy was commenced with the diagnosis of carbon monoxide intoxication. The laboratory values in the 2nd day of admission were, creatinine 5.8 mg/ dL, creatinine kinase 88.42 U/L. Then the patient underwent a hemodialysis. Hemoglobin levels decreased to 7.3 g/dL, platelet count dropped to 11.000/mm³. Peripheral blood smear showed erythrocyte fragmentation. Thrombotic thrombocytopenic purpura was considered and methylprednisolone and plasmapheresis was started. After the 10th session of plasmapheresis, platelet value was over 150.000/mm³ and plasmapheresis was discontinued. Platelet value was 285.000/mm³ and creatinine 0.7 mg/dL. The patient was discharged. Thrombotic thrombocytopenic purpura which might have complication should be kept in mind in patients with carbon monoxide intoxication. [ABSTRACT FROM AUTHOR]

Objective: Carbon monoxide (CO) poisoning is one of the most important toxicological global causes of morbidity and mortality. Carbon monoxide poisoning causes myocardial damage and arrhythmias by impairing the transport of oxygen. In the literature, there have been few cases of CO poisoning-induced atrial fibrillation (AF) reported. In this case, we report a successful conversion of sinus rhythm into a female patient by providing high flow oxygen (to intubate) to the atrial fibrillation caused by CO toxicity. Case: We report a 53-year-old female patient who had atrial fibrillation due to carbon monoxide poisoning and was given sinus rhythm after removal of hypoxia. Conclusion: The patient was intubated and hypoxia was removed after high flow oxygen. After 12 hours, the patient was extubated on the improvement of the blood gas parameters. Normal sinus rhythm was detected on the control ECG. [ABSTRACT FROM AUTHOR]

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Carbon monoxide (CO) is a colorless, odorless gas which is a leading cause of accidental deaths during winter months. It's toxic effect occurs by binding to hemoglobin or directly at cellular level. Electrocardiographic findings due to CO intoxication are ST- segment changes, premature contractions, sinus tachycardia, bundle blocks and atrial fibrillation (AF). We report a 33-year-old man who presented with AF due to CO poisoning. The patient was treated with anti-ischemic drugs and oxygen therapy. [ABSTRACT FROM AUTHOR]