Transdermal Methanol Intoxication.

Methanol is a clear liquid with high toxicity. Methanol intoxication may result from accidental exposure, overconsumption of compounds containing methanol with suicidal intent, or following consumption of distilled and contaminated alcoholic beverages. This report describes a case of transdermal methanol intoxication, which is a rare condition. A 58-year-old woman presented with nausea, vomiting, weakness, diplopia and dizziness. On neurological examination, she only had diplopia. On physical examination, a hyperemic lesion with clear borders was found over the right knee. The patient's recent medical history revealed that four days prior to the onset of symptoms, she had covered her knee with a methanol-soaked bandage in an attempt to alleviate her knee pain. She had a high osmolar gap as well as high anion-gap metabolic acidosis (HAGMA). Methanol intoxication was suspected due to HAGMA and high osmolar gap. Serum methanol levels were subsequently measured and found to be 37.9 mg/ dL. The patient was treated with intravenous (IV) bicarbonate, IV ethyl alcohol and hemodialysis. She was discharged with no central nervous system or ophthalmologic sequelae. Methanol poisoning should be kept in mind in patients with diplopia and unexplained metabolic acidosis. Although most methanol intoxication cases occur after oral ingestion, it should be considered that methanol poisoning may occur transdermally.

The efficiency of bedside ultrasonography in patients with wrist injury and comparison with other radiological imaging methods: A prospective study.

STUDY OBJECTIVE: Our aim was to determine the efficiency of ultrasound (US) scanning in patients with wrist trauma admitted to the emergency department and to compare US diagnostic usage with other radiological imaging methods. METHODS: Patients who presented to the emergency department with wrist injury and who met the inclusion criteria and exclusion criteria were eligible. For all patients, US evaluation of the whole wrist was performed by an emergency physician before other radiological imaging methods (radiographies, computed tomography (CT) and magnetic resonance (MR) imaging). All of the patients included in the study underwent US, radiography, CT, and MR. RESULTS: During the study, 122 patients were admitted with a wrist injury. After filtering for the exclusion criteria, 80 patients were included in the study. The sensitivity of US scanning in detecting fractures was 95.31% (95% confidence interval [CI]: 87.1-98.39), the specificity was 93.75% (95% CI: 71.67-98.89), and the positive predictive value was 98.39% (95% CI: 91.72-99.85), and the negative predictive value was 83.33% (95% CI: 72.98-90.41). The sensitivity of US scanning in detecting tendon and ligamentous structural injury was 66.67% (95% CI: 41.71-84.82), the specificity was 100% (95% CI: 94.42-100), the positive predictive value was 100% (95% CI: 94.29-99.89), and the negative predictive was 92.86% (95% CI: 84.25-97.14). CONCLUSION: US scanning is an effective method that can be applied in the emergency department to adult patients to diagnose distal forearm and carpal bones fractures. In soft tissue injuries, US and MR examinations produce similar results.

Independent factors for prediction of poor outcomes in patients with febrile neutropenia.

BACKGROUND: Febrile neutropenia (FN) is a life-threatening condition that requires urgent management in the emergency department (ED). Recent progress in the treatment of neutropenic fever has underscored the importance of risk stratification. In this study, we aimed to determine independent factors for prediction of poor outcomes in patients with FN. MATERIAL AND METHODS: We retrospectively evaluated 200 chemotherapy-induced febrile neutropenic patients who visited the ED. Upon arrival at the ED, clinical data, including sex, age, vital signs, underlying systemic diseases, laboratory test results, estimated GFR, blood cultures, CRP, radiologic examinations, and Multinational Association of Supportive Care in Cancer (MASCC) score of all febrile neutropenic patients were obtained. Outcomes were categorized as "poor" if serious complications during hospitalization, including death, occurred. RESULTS: The platelet count <50 000 cells/mm3 (OR 3.90, 95% CI 1.62-9.43), pulmonary infiltration (OR 3.45, 95% CI 1.48-8.07), hypoproteinemia <6 g/dl (OR 3.30, 95% CI 1.27-8.56), respiratory rate >24/min (OR 8.75, 95% CI 2.18-35.13), and MASCC score <21 (OR 9.20, 95% CI 3.98-21.26) were determined as independent risk factors for the prediction of death. The platelet count <50 000 cells/mm3 (OR 3.93, 95% CI 1.42-10.92), serum CRP >50 mg/dl (OR 3.80, 95% CI 1.68-8.61), hypoproteinemia (OR 7.81, 95% CI 3.43-17.78), eGFR ≤90 ML/min/1.73 m2 (OR 3.06, 95% CI 1.13-8.26), and MASCC score <21 (OR 3.45, 95% CI 1.53-7.79) were determined as independent risk factors for the prediction of poor clinical outcomes of FN patients. Platelet count, protein level, respiratory rate, pulmonary infiltration, CRP, MASCC score, and eGFR were shown to have a significant association with outcome. CONCLUSIONS: The results of our study may help emergency medicine physicians to prevent serious complications with proper use of simple independent risk factors besides MASCC score.

Ionising radiation awareness among resident doctors, interns, and radiographers in a university hospital emergency department.

PURPOSE: In emergency medicine practice, radiological investigations relying on ionising radiation are increasingly used to diagnose a wide range of diseases and injuries. The aim of this study was to investigate the knowledge of radiation exposure doses and risks among interns, resident doctors, and radiographers. MATERIALS AND METHODS: A questionnaire, consisting of 14 questions in multiple choice format, was distributed to 300 participants (100 interns, 100 radiographers, 100 resident doctors) working in the emergency department. The participants were asked to estimate the radiation dose that patients received during the different radiological procedures. The questionnaire was designed to determine the participants' knowledge about radiation-related hazards. RESULTS: None of the radiation doses delivered by the imaging modalities was 100% correctly estimated. A total of 41.4% of all participants and 46.3% of resident doctors underestimated the radiation doses. The frequency of answers underestimating doses was found to be significantly higher (p < 0.001). Resident doctors, with a 39.4% correct answer rate, were found to be significantly less knowledgeable when compared with the interns and radiographers (p = 0.003). Emergency resident doctors had a statistically significantly higher rate of correct answers for the lowest and highest radiation sources for a foetus when compared with other groups (p = 0.001, p = 0.008). CONCLUSION: Our study showed that the resident doctors', interns', and radiographers' knowledge of radiation exposure from radiological investigations and the associated risks was poor. This result could imply that we are not aware of the radiation risks, and we are inattentive in informing our patients about the radiation exposure related to the different imaging modalities.

Septic pulmonary embolism associated with renal abscess: a case report.

BACKGROUND: Septic pulmonary embolism (SPE) is a rare condition that is difficult to diagnose. OBJECTIVES: To describe the clinical course and diagnosis of a patient with SPE. CASE REPORT: We report on a case of SPE diagnosed in the emergency department and review the current literature. CONCLUSION: The diagnosis of SPE can be made using computed tomography scan. Early diagnosis and appropriate antibiotic therapy are important factors for the control of the infection.