Toxic benzyl alcohol inhalation: Altered mental status with metabolic acidosis and hyperammonemia.

This report presents the case of a patient whose inhalation exposure to benzyl alcohol led to clinical manifestations similar to toluene intoxication, including sudden altered mental status, metabolic acidosis, hypokalemia, hypophosphatemia, and hyperammonemia. Toxicity from benzyl alcohol inhalation is quite rare, and hyperammonemia associated with renal tubular dysfunction in poisoning cases has not been reported in the past.

Epidemiology and outcomes of pregnant trauma patients in Japan: a nationwide descriptive study.

PURPOSE: Trauma during pregnancy is the leading indirect obstetric cause of death, and its management is challenging owing to its characteristics. We aimed to describe the epidemiology of pregnant trauma patients and explore their characteristics by comparing them with those of non-pregnant patients. METHODS: Using the Japan Trauma Data Bank data collected between January 2004 and May 2019, we identified pregnant and non-pregnant female trauma patients between the ages of 15-45 years. We described patient characteristics, prehospital information, in-hospital management, and clinical outcomes. We also investigated the differences in the information between pregnant and non-pregnant patients. RESULTS: In total, 165 pregnant trauma patients were identified (0.7%). Motor vehicle collisions were the most frequent mechanism of injury (64.6%) in pregnant patients. The time from call to the arrival of emergency medical services at the hospital was similar for both pregnant and non-pregnant patients. The use of abdominal computed tomography (CT) scans was lower and injury to the abdomen was more frequent in pregnant than non-pregnant patients. In-hospital mortality was 7.2% in pregnant patients and 10.9% in non-pregnant patients. No significant differences in mortality after adjustment for confounding factors were found (adjusted odds ratio: 0.78, 95% confidential interval: 0.35-1.75, p = 0.548). CONCLUSION: Transport time and mortality were similar between pregnant and non-pregnant trauma patients. Abdominal trauma and surgery were more common in pregnant relative to non-pregnant patients, while the number of CT scans was less. Further research is required to investigate the effects of trauma on the course of pregnancy and the fetus.

[Successful airway management using a Cook airway exchange catheter as an emergent dilator for life-threatening neoplastic stenosis of the trachea: a case report].

A 68-year-old male patient was referred to our hospital for his intractable and progressive dyspnea. Chest roentgenography and computerized tomography revealed severe lower tracheal stenosis due to neoplastic invasion. The tumor completely surrounded his trachea for 5 cm length and the remaining internal diameter of the trachea was less than 5 mm. To avoid fatal asphyxia, emergency airway security was required. After placing both femoral arterial and venous cannulae for percutaneous cardiopulmonary support system, we dilated the stenotic trachea using a Cook airway exchange catheter (CAEC), and then an armored tube of 7 mm inner diameter was introduced through the CAEC. The maneuver was smoothly completed within one minute without any complications. His dyspnea was completely relieved. Following chemotherapy and radiotherapy were so effective that the endotracheal tube was extubated two weeks later uneventfully. After several series of chemotherapy and 50 Gy irradiation, the patient was discharged three months later without symptoms. We concluded that CAEC could be one of the life-saving instruments for emergent airway management in case of severe organic tracheal stenosis.