Amanitin-containing mushroom poisoning is one of the most harmful and lethal types of mushroom poisoning events. Its basic medical and clinical medical knowledge has not been fully understood and mastered, so the basic and clinical diagnosis and treatment of amanitin-containing mushroom poisoning has always been a hot research field of acute mushroom poisoning. This article focuses on the new progress in the epidemiology, toxicological properties, poisoning mechanism, clinical diagnosis and treatment of amanitin-containing mushroom poisoning, in order to provide the basis for further study, diagnosis and treatment of amanitin-containing mushroom poisoning for basic researchers and clinical medical staff.
摘要:目的:探讨有机磷农药中毒患者阿托品使用方法,提高抢救成功率。方法: 对2005年6月至2009年6月我院收治的有机磷农药中毒病人281例进行分组,所有患者均使用阿托品疗法,A组为2007年以后132例序贯阿托品疗法患者,B组2007年以前为常规使用静推继之肌注阿托品疗法149例患者,根据有机磷农药对胆碱酯酶复能剂的疗效分为高效组和低效组,并结合病情严重程度共分为重度有机磷农药中毒胆碱酯酶复能剂高效组、重度有机磷农药中毒胆碱酯酶复能剂低效组,轻度有机磷农药中毒胆碱酯酶复能剂高效组、轻度有机磷农药中毒胆碱酯酶复能剂低效组4组,分别从达到阿托品化时间、维持阿托品化效果、反跳和中间综合征发生率、开始撤药平均时间、总住院费用、总住院平均时间、护士劳动强度进行总结和分析。结果: 维持阿托品化疗效Ａ组与B组间有显著差异,P值lt;0.01,开始撤药平均时间、总住院平均时间、总住院费用、护士劳动强度Ａ组与B组间均有差异,P值lt;0.05,发生反跳和中间综合征发生率、达到阿托品化时间在高效组间比较无差异,低效组间比较无差异,高效组与低效组比较有显著差异,P值lt;0.01,主要与中毒药物种类和病情严重程度有关,其次与阿托品治疗方法有关。 结论: 序贯阿托品疗法治疗有机磷农药中毒优于常规使用静推继之肌注阿托品疗法。Abstract: Objective: To discussion of atropine in organophosphorus pesticide poisoning patients with the use of two different methods to improve the success rate. Methods: For June 2005 to June 2009 inour hospital a total of organophosphorus pesticide poisoning 281 cases were divided into A group and B group, All patients were using atropine therapy, 132 cases of sequential therapy in patients with atropine is divided into A group, 149 cases of routine use of intravenous injection and intramuscular injection of atropine group patients were divided into B group, From the following aspects were analyzed and summarized, They are the maintenance of the effect of atropinization, the average time for the beginning of withdrawal, the total hospitalization costs, the total average time for hospitalization and nurses labor intensity. According to the organic phosphorus pesticide on the efficacy of cholinesterase agents are divided into efficient and inefficient groups groups, From the types of poisons, toxic ways, poisoning performance and Complications for stratified, They were divided into 4 groups, severe organophosphorus pesticide poisoning and cholinesterase reactivator can be highly effective group, severe organophosphorus pesticide poisoning and cholinesterase reactivator Lowefficacy group, mild organophosphorus pesticide poisoning and cholinesterase reactivator can be highly effective group, mild organophosphorus pesticide poisoning and cholinesterase reactivator Lowefficacy group, Correlation analysis Antijumping and the incidence of intermediate syndrome and atropinization time.Results:Maintain the efficacy of atropine of A group and B were significantly different between groups, Plt;0.01, the average time began to withdraw drugs, the total average time for hospitalization, total hospital charges, nursing labor intensity of A group and B are differences between the two groups, P＜0.05. Rebound occurs and the incidence of intermediate syndrome, to atropinization time high between the two groups showed no difference between the two groups showed no differences between inefficient and efficient group and inefficient group were significantly different, Plt;0.01, mainly related to poisoning by drug type and severity of illness, followed with atropine therapy. Conclusion:Atropine sequential therapy is superior to organophosphorus pesticide poisoning by conventional atropine treatmen.
Acute poisoning is characterized by a sudden and rapid onset, most poisons lack specific antidotes. Even with the full use of blood purification, mechanical ventilation, and various drugs, it is often difficult to change the fatal outcome of critically ill patients. In recent years, extracorporeal membrane oxygenation (ECMO) has gradually gained attention and exploratory application in the treatment of acute poisoning due to its significant cardiopulmonary function support, veno-venous ECMO is used for severe lung injury after poisoning, acute respiratory distress syndrome and respiratory failure due to ineffective mechanical ventilation, and it can also be used to assist the removal of residual poisons in the lungs. Veno-arterial ECMO is commonly employed in patients with circulatory failure following poisoning, fatal cardiac arrhythmias, and arrest of cardiac and respiratory. The application of veno-arterio-venous ECMO has also been reported. The mode of ECMO necessitates timely adjustments according to the evolving illness, while ongoing exploration of additional clinical indications is underway. This review analyzes and evaluates the application scope and effectiveness of ECMO in acute poisoning in recent years, with a view to better exploring and rationalizing the use of this technology.
Objective To explore the risk factors of nosocomial pulmonary infection in acute pesticide poisoning. Methods The clinical data of patients with acute pesticide poisoning hospitalized in the Emergency Department of the First Affiliated Hospital of Wannan Medical College and the Second Affiliated Hospital of Wannan Medical College between January 1, 2021 and September 30, 2023 were retrospectively analyzed. Patients were divided into pulmonary infection group and non-pulmonary infection group according to whether they had pulmonary infection during hospital. Multiple logistic regression was used to analyze the independent risk factors of nosocomial pulmonary infection in patients with acute pesticide poisoning, and a risk prediction model (nomogram) was constructed. The predictive efficacy of nomogram and independent predictors in nosocomial pulmonary infection were analyzed by using the receiver operating characteristic curve. Calibration curve and decision curve were used to evaluate the differentiation and clinical application value of the model. Results A total of 189 patients with acute pesticide poisoning were included in the study, with an average age of (58.12±18.45) years old, 98 males (51.85%) and 91 females (48.15%). There were 36 cases (19.05%) of pulmonary infection. Multiple logistic regression analysis showed that age [odds ratio (OR)=1.030, 95% confidence interval (CI) (1.001, 1.060), P=0.040], type 2 diabetes mellitus [OR=2.770, 95%CI (1.038, 7.393), P=0.042], ischemic cerebrovascular disease [OR=3.213, 95%CI (1.101, 9.376), P=0.033], white blood cell count [OR=1.080, 95%CI (1.013, 1.152), P=0.019], activities of daily living score [OR=0.981, 95%CI (0.965, 0.998), P=0.024] were independent predicting factors for nosocomial pulmonary infection in acute pesticide poisoning. The area under the curve of nosocomial pulmonary infection in patients with acute pesticide poisoning predicted by nomogram based on the above factors was 0.813 (P<0.001). The calibration curve showed that the prediction probability was consistent with the actual occurrence probability (P=0.912), and the decision curve showed that the nomogram had good clinical application value. Conclusions Age, activities of daily living score, type 2 diabetes mellitus, ischemic cerebrovascular disease, and white blood cell count are independent predictors of nosocomial pulmonary infection in acute pesticide poisoning. The nomogram constructed based on them has good differentiation and consistency, which can provide basis for early identification and intervention of clinical staff.
Objective To construct a nomogram model for predicting delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) in emergency departments. Methods All patients with acute carbon monoxide poisoning who visited the Department of Emergency of Zigong Fourth People’s Hospital between June 1st, 2011 and May 31st, 2023 were retrospectively enrolled and randomly divided into a training set and a testing set in a 6∶4 ratio. LASSO regression was used to screen variables in the training set to establish a nomogram model for predicting DEACMP. The discrimination, calibration, and clinical practicality were compared between the nomogram and Glasgow Coma Scale (GCS) in the training and testing sets. Results A total of 475 patients with acute carbon monoxide poisoning were included, of whom 41 patients had DEACMP. Age, GCS and aspartate aminotransferase were selected as risk factors through LASSO regression, and a nomogram model was constructed based on these factors. The areas under the receiver operating characteristic curves for nomogram and GCS to predict DEACMP in the training set were 0.897 [95% confidence interval (CI) (0.829, 0.966)] and 0.877 [95%CI (0.797, 0.957)], respectively; and those for nomogram and GCS to predict DEACMP in the testing set were 0.925 [95%CI (0.865, 0.985)] and 0.858 [95%CI (0.752, 0.965)], respectively. Compared with GCS, the performance of nomogram in the training set (net reclassification index=0.495, P=0.014; integrated discrimination improvement=0.070, P=0.011) and testing set (net reclassification index=0.721, P=0.004; integrated discrimination improvement=0.138, P=0.009) were both positively improved. The calibration of nomogram in the training set and testing set was higher than that of GCS. The decision curves in the training set and testing set showed that the nomogram had better clinical net benefits than GCS. Conclusion The age, GCS and aspartate aminotransferase are risk factors for DEACMP, and the nomogram model established based on these factors has better discrimination, calibration, and clinical practicality compared to GCS.
On September 18th, 2023, the American Heart Association published clinical management guidelines for patients with poisoning-induced cardiac arrest and critical cardiovascular illness in Circulation. Considering the important role of the guidelines in clinical practice, our team has divided them into three sections for detailed interpretation based on the different toxic effects of the drugs. This article is the second part of the interpretation, which combines the literature to interpret the recommendations related to cardiotoxic substance poisoning in the guidelines, mainly involving the clinical management of beta blockers, calcium channel blockers, digoxin and other cardiac glycosides, as well as sodium channel blocker poisoning, aiming to assist colleagues in their clinical practice through a detailed explanation of the key recommendations in the guidelines.
Objective To formulate an optimal treatment for patients with acute organophosphorus pesticide poisoning through the evidence-based approach. Methods Based on the clinical questions raised from a real-life patient of acute organophosphorus pesticide poisoning (OP poisoning) in Emergency ICU (EICU), we searched ACP journal club (1991-April, 2006), The Cochrane Library (Issue 1, 2006), MEDLINE (1966-May 2006) and Chinese Biological Medical Database(1978-May 2006) for systematic reviews , clinical randomized controlled trials, cohort and case-control studies using the keywords of “organophosphorus compounds, poisoning, insecticides, oximes, cholinesterase reactivators, and intermediate syndrome”. The quality of the included studies was assessed. Results One Cochrane systematic review and one meta-analysis were included. These two studies concluded that there was no clear evidence on the benefits of oximes for acute organophosphorus pesticide poisoning. Based on the current evidence, integrated with clinical expertise and the patients’ values, the oximes were not used for this patient, only low-dose atropine was administered with other supportive therapies. After one week of treatment, the patient was discharged since her vital signs were stable and clinical symptoms were relieved. Conclusions The appropriate management for acute organophosphorus pesticide poisoning has been formulated with the approach of evidence-based medicine. Large-scale, methodologically-sound trials are required.
Acute carbon monoxide poisoning is a common and frequently occurring disease in winter and spring in China, with high disability and mortality. Delayed encephalopathy is a serious sequela after the pseudo-convalescence. Its mechanism is complex, including environmental and genetic factors, hypoxia and energy metabolism disorder, cytotoxicity and oxygen free radical damage, immune disorder and inflammatory activation, neurotransmitter disorder, brain parenchymal changes, vascular and hemorheological abnormalities, calcium overload, and cell apoptosis. At present, methods for predicting delayed encephalopathy in acute carbon monoxide poisoning include detailed inquiry of medical history, laboratory examination of relevant indicators, electrophysiological examination, brain imaging examination, and evaluation scale prediction. This review summarizes the research status of the pathogenesis and early prediction methods of delayed encephalopathy in acute carbon monoxide poisoning, with a view to providing reference for future research directions.
ObjectiveTo explore the effects of small dose and low pressure lavage on gastrointestinal hemorrhage induced by acute poisoning. MethodsWe collected the clinical data of all the patients diagnosed as gastrointestinal hemorrhage induced by acute poisoning treated between January 2011 and December 2012. The patients were divided into two groups: control group and treatment group, according to the different treatments they underwent. The control group received traditional treatment only, while the treatment group received small dose and low pressure lavage as well as the traditional treatment. After recording the ages, poisoning dose, pretreatment time, shock and complications, we evaluated the risk of death by calculating ROCKALL scores. ResultsThe differences of ages, sexes, and poisoning dose between these two groups were not significant. However, the death rate in high and middle risk patients of the treatment group was significantly lower than that of the control group (P<0.05). ConclusionThe small dose and low pressure lavage can improve the prognosis of the gastrointestinal hemorrhage induced by acute intoxication.
Objective To explore the treatment methods for group Amanita exitialis poisoning, and summarize the treatment strategies for group Amanita exitialis poisoning. Methods A group of Amanita exitialis poisoning patients admitted to the Department of Emergency Medicine of the Affiliated Hospital of Yunnan University on July 31, 2023 were retrospectively included. We graded the patients’ condition and analyzed their clinical data, treatment methods, and blood purification selection modes. Results A total of 6 patients with Amanita exitialis poisoning were included, with an average age of 52 years. There were 2 patients with grade Ⅰ, 2 patients with grade Ⅱ, 1 patient with grade Ⅲ and 1 patient with grade Ⅳ. Grade Ⅰ patients choosed single one mode hemoperfusion (HP), grade Ⅱ patients choosed single multiple mode HP, grade Ⅲ patient choosed multiple mode HP combined with plasma exchange, and grade Ⅳ patient choosed multiple mode HP combined with plasma exchange, double plasma molecular adsorption system and continuous renal replacement therapy. After individualized comprehensive treatment, 5 patients were cured and discharged, and 1 patient died. Conclusions In the treatment of group Amanita exitialis poisoning, in addition to basic drug treatment, it is necessary to first consider factors such as the side effects of blood purification and the economic conditions of the patient. Then, according to the different disease grades of the patient, single or combined blood purification, single or multiple treatment modes can be choosed. Early selection of appropriate individualized blood purification modes can effectively buy time for poisoning patients.