[Acute carbon monoxide poisoning after water pipe tobacco smoking].

Carbon monoxide poisoning is potentially lethal, and early recognition and treatment is essential. An 18-year-old man was admitted due to syncope and a carboxyhaemoglobin level of 17% after water pipe tobacco smoking. He received normo- and hyperbaric oxygen as treatment and was discharged after two days without neurological sequelae. This case is the first in Denmark, but recently seven similar cases have been reported. The number of young people smoking water pipe tobacco is increasing, and we fear that more cases like this will occur in the future.

[Assessment of the prognosis in patients who remain comatose after resuscitation from cardiac arrest]. / Vurdering af prognose hos patienter med manglende opvågning efter hjertestop

In Denmark there are around 3,500 unexpected cardiac arrests (CA) out of hospital each year. There is an unknown number of CA in hospitals. The survival rate after CA outside a hospital in Denmark is 10% after 30 days. There are varying data for the neurological outcome in this group of patients. The purpose of this work is to disseminate new knowledge and to help standardizing the treatment in the group of patients who remain comatose after being resuscitated from CA. Assessment of the prognosis for a patient in this group can be made after 72 hours and a multi-modal approach to the patient is required.

Effect of head rotation on cerebral blood velocity in the prone position.

Background. The prone position is applied to facilitate surgery of the back and to improve oxygenation in the respirator-treated patient. In particular, with positive pressure ventilation the prone position reduces venous return to the heart and in turn cardiac output (CO) with consequences for cerebral blood flow. We tested in healthy subjects the hypothesis that rotating the head in the prone position reduces cerebral blood flow. Methods. Mean arterial blood pressure (MAP), stroke volume (SV), and CO were determined, together with the middle cerebral artery mean blood velocity (MCA V(mean)) and jugular vein diameters bilaterally in 22 healthy subjects in the prone position with the head centered, respectively, rotated sideways, with and without positive pressure breathing (10 cmH(2)O). Results. The prone position reduced SV (by 5.4 ± 1.5%; P < 0.05) and CO (by 2.3 ± 1.9 %), and slightly increased MAP (from 78 ± 3 to 80 ± 2 mmHg) as well as bilateral jugular vein diameters, leaving MCA V(mean) unchanged. Positive pressure breathing in the prone position increased MAP (by 3.6 ± 0.8 mmHg) but further reduced SV and CO (by 9.3 ± 1.3 % and 7.2 ± 2.4 % below baseline) while MCA V(mean) was maintained. The head-rotated prone position with positive pressure breathing augmented MAP further (87 ± 2 mmHg) but not CO, narrowed both jugular vein diameters, and reduced MCA V(mean) (by 8.6 ± 3.2 %). Conclusion. During positive pressure breathing the prone position with sideways rotated head reduces MCA V(mean) ~10% in spite of an elevated MAP. Prone positioning with rotated head affects both CBF and cerebrovenous drainage indicating that optimal brain perfusion requires head centering.

[Intraabdominal hypertension and abdominal compartment syndrome]. / Intraabdominal hypertension og abdominalt kompartmentsyndrom.

Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are rare conditions with high mortality. IAH is an intraabdominal pressure (IAP) above 12 mmHg and ACS an IAP above 20 mmHg with evidence of organ dysfunction. IAP is measured indirectly via the bladder or stomach. Various medical and surgical conditions increase the intraabdominal volume. When the content exceeds the compliance of the abdominal wall, the IAP rises. Increased IAP affects the functioning of the brain, lungs, circulation, kidneys, and bowel. The treatment of ACS is a reduction of IAP.

[Severe metabolic acidosis in an alcoholic]. / Svaer metabolisk acidose hos en kronisk alkoholiker.

Severe metabolic acidosis is associated with poor prognosis. We present a patient with profound alcohol and starvation-related combined lactic and keto acidosis (lactate = 29 mM; pH = 6.83) who made a good recovery following 18 hours of intensive care therapy. A brief summary of the proposed mechanism by which these metabolic derangements develop is presented.

[Measurement of intraabdominal pressure and abdominal compartment syndrome in surgical and intensive care units]. / Måling af intraabdominalt tryk og abdominalt kompartmentsyndrom på kirurgiske og intensiv terapi-afdelinger.

INTRODUCTION: Over the past number of years, there has been an increasing interest in the pathophysiological phenomena intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Foreign studies have shown considerably national differences in the interpretation of the two phenomena. The purpose of this questionnaire study was to survey which group of patients is examined for IAH and ACS, how the examination is carried out and how the two conditions are treated in surgical and intensive care units in Denmark. MATERIALS AND METHODS: A questionnaire was sent to all relevant surgical and intensive care units in Denmark. RESULTS: The response rate was 81%. 74% intensive care units and 31% surgical wards measured IAP. 100% used the intravesical method. International guidelines were followed in 11% of surgical wards and 18% of the intensive care units regarding how often IAP should be measured and 44%/ 32% regarding at what IAP level surgical intervention should be considered. 78% of the wards and 79% of the intensive care units that measured IAP had celiotomy as a treatment modality. There were major differences between both surgical wards and intensive care units regarding which group of patients should have IAP measured. CONCLUSION: Considering the differences in clinical practice and the discrepancy to international guidelines interdisciplinary national guideline might contribute to a more uniform evaluation and treatment of patients with IAH or ACS.

[Adverse reactions to anthrax vaccination in Danish military personnel deployed to Iraq]. / Bivirkninger ved anthraxvaccination i forbindelse med udsendelse af danske soldater til Irak.

INTRODUCTION: On Denmark's decision to join the war in Iraq, it was decided to immunise all personnel to be deployed there with anthrax vaccine. This paper describes the types and frequency of adverse reactions to the vaccine. MATERIALS AND METHODS: Between March 2003 and February 2004, 1,899 immunisations against anthrax in 755 personnel were registered at the health care facilities of the Danish Defence. RESULTS: No serious or life-threatening adverse reactions were reported. The data showed a statistically significant decrease in adverse reactions between the four immunisation series. For males, adverse reactions after the second immunisation depended on possible adverse reactions to the first immunisation. In females, this correlation was not found. No differences in the frequency of adverse reactions between males and females were found. DISCUSSION: None of the vaccinated persons suffered serious or life-threatening adverse reactions. Compared to other studies on self-reported adverse reactions, the overall frequency was low. The data showed a statistically significant decrease in adverse reactions between the four immunisation series. This has been described in comparable studies. The correlation between adverse reactions in the second immunisation being dependent on adverse reactions to the first immunisation has been partly confirmed by other studies. No differences between the sexes were found, probably because only a few females were included in the study. In case of a significant level of threat concerning biological weapons, immunisation against anthrax is considered appropriate.