Outcomes After High-Concentration Peroxide Ingestions.

STUDY OBJECTIVE: In cases of high-concentration peroxide ingestion reported to US poison centers, we describe medical outcomes, examine the role of hyperbaric oxygen, and review the use of endoscopy. METHODS: The study was a retrospective analysis of a structured database, the National Poison Data System. The chart for each poison center case of a high-concentration (>10%) peroxide ingestion was obtained and abstracted in a standardized fashion; 1,054 cases were initially considered and 294 cases met inclusion criteria. The primary outcome of possible embolic event was defined as seizure, altered mental status, respiratory distress, hypoxia, hemodynamic instability, ECG changes, radiographic evidence of cerebrovascular accident, focal neurologic deficit on examination, pulmonary embolism, cardiac emboli, elevated troponin level, physician bedside diagnosis, or rapid improvement after hyperbaric oxygen therapy. Both descriptive statistics and logistic regression models were used to analyze the data. RESULTS: In the 10-year study period, 41 of 294 patients (13.9%; 95% confidence interval 10.2% to 18.4%) with symptoms after high-concentration peroxide ingestion demonstrated evidence of embolic events, and 20 of 294 (6.8%; 95% confidence interval 4.2% to 10.3%) either died or exhibited continued disability when the poison center chart was closed. Improved outcomes were demonstrated after early hyperbaric oxygen therapy. Endoscopy revealed grade 3 or 4 lesions in only 5 cases. CONCLUSION: Symptomatic high-concentration peroxide exposures had a high incidence of associated embolic events in this cohort. Patients with evidence of embolic events had a high rate of death. Early hyperbaric oxygen therapy may be useful, but routine endoscopy is unlikely to be of benefit.

Associations between patient and emergency department operational characteristics and patient satisfaction scores in an adult population.

STUDY OBJECTIVE: Our primary aim is to identify patient and emergency department (ED) characteristics that are associated with patient satisfaction scores. METHODS: This retrospective study reviewed Press Ganey patient satisfaction surveys completed between December 2009 and May 2013 in a single academic ED for all patients aged 21 years and older. Patient and ED operational characteristics were included in the analysis. The outcomes were satisfaction scores for overall experience, likelihood to recommend, and wait time before consulting provider. A linear mixed-effects regression model was used while taking the clustering within patients and physicians into account. RESULTS: Two thousand eighty-three patients were included in the analysis, representing all responses to the survey. A total response rate could not be calculated because Press Ganey does not report the total number of surveys sent out. During this period, 119,244 patients were treated in the ED. The overall mean score was 7.7 (SD 2.7) for overall experience, 78.0 (SD 31.8) for likelihood to recommend, and 70.9 (SD 30.7) for wait time before consulting provider. For all 3 outcomes, white older patients with low door-to-room times had higher scores. Additionally, survey language and payer type were significantly associated with overall experience score, discharge length of stay and time of day by shift were significantly associated with wait time scores, and patients who arrive by ambulance were less likely to recommend the ED. CONCLUSION: Both ED and patient characteristics were associated with satisfaction with care. EDs seeking to increase patient satisfaction scores may consider working on reducing door-to-room times.

Envenomation by the Great Lakes Bush Viper (Atheris nitschei).

INTRODUCTION: We present a case of envenomation by a Great Lakes Bush Viper, Atheris nitschei. Atheris species are a group of snakes that are indigenous to the forested areas of Central Africa. Prior reports of envenomation by Great Lakes Bush Vipers were not found in a Medline search. However, reports of other Atheris species envenomations describe coagulopathy and acute renal failure. CASE DETAILS: A 30-year-old male was bitten by a Great Lakes Bush Viper on his left hand. His left upper extremity was edematous with ecchymoses in the left axilla. There was bleeding from the bite site and from the patient's oral mucosa. Initial laboratory studies demonstrated significant derangement of hematologic parameters including anemia, thrombocytopenia, coagulopathy, and hypofibrinoginemia. There is no antivenom for this species. The patient was treated with blood products. Mucosal bleeding ceased within 12 h of admission. DISCUSSION: Atheris nitschei is an African snake with no available antivenom. In this case, the patient developed coagulopathy with hemolytic anemia, thrombocytopenia, and low fibrinogen. Renal function remained unaffected. Despite the lack of specific antivenom or the use of plasmapheresis, our patient was successfully treated with transfusion of multiple blood products.