Pneumothorax as a complication of dry needling technique.

Post-dry needling pneumothorax is not extremely rare. Patients and referring doctors should be aware of this. Informed consent should mention pneumothorax as a considerable risk of dry needling procedures in the neck, shoulder or chest region. https://bit.ly/49YYNR8.

Foxglove poisoning: diagnostic and therapeutic differences with medicinal digitalis glycosides overdose.

We report a case of a 19-year-old woman who ingested Digitalis purpurea leaves as a suicide attempt. She developed gastro-intestinal symptoms, loss of colour vision, cardiac conduction disturbances as well as an elevated serum potassium. Treatment was initiated in analogy to medicinal digoxin poisoning by means of digoxin-specific Fab-fragments with a good effect. However during the further course we faced difficulties of prolonged intestinal absorption and inability to estimate the ingested dose or half-life of the vegetal cardiac glycoside compounds. To prevent further absorption and interrupt enterohepatic recycling, multi-dose activated charcoal was administered. Because of a relapse of cardiac conduction disturbances and hyperkalemia, two supplementary doses of Fab-fragments were given, up to a total dose of nineteen vials (one vial containing 40 mg). The important diagnostic and therapeutic differences of vegetal digitalis intoxication as compared to medicinal intoxication and the applicability of existing guidelines on medicinal digitalis intoxication in the light of these differences will be discussed here.

First Report on Brorphine: The Next Opioid on the Deadly New Psychoactive Substance Horizon?

New psychoactive substances continue to appear on the drug market. Until recently, new synthetic opioids, which are among the most dangerous new psychoactive substances, primarily encompassed analogs of the potent analgesic fentanyl. Lately, also other new synthetic opioids have increasingly started to surface. This is the first report on the identification and full chemical characterization of brorphine, a novel potent synthetic opioid with a piperidine benzimidazolone structure. A powder, identified as brorphine, was obtained from a patient seeking medical help for detoxification. Brorphine was also found in a serum sample of the patient. Liquid chromatography-high-resolution mass spectrometry (LC-HRMS) identified an exact mass of m/z 400.1020 and 402.1005 for the compound, corresponding to both bromine isotopes. Further chemical characterization was performed by gas chromatography-mass spectrometry, liquid chromatography-diode array detection and Fourier-transform infrared spectroscopy analyses. Finally, the structure was confirmed by performing 1H-NMR and 13C-NMR spectroscopy. In vitro biological activity of brorphine was determined by a cell-based µ-opioid receptor activation assay, resulting in an EC50 of 30.9 nM (13.5 ng/mL) and an Emax of 209% relative to hydromorphone, confirming the high potency and efficacy of this compound. In a serum sample of the patient, brorphine and a hydroxy-metabolite were found using the LC-HRMS screening method. The presence of opioid activity in the serum was also confirmed via the activity-based opioid screening assay. The occurrence of brorphine is yet another example of how the illicit drug market is continuously evolving in an attempt to escape international legislation. Its high potency poses a serious and imminent health threat for any user.

Adequacy of bystander actions in unconscious patients: an audit study in the Ghent region (Belgium).

OBJECTIVE: Early recognition and appropriate bystander response has proven effect on the outcome of many critically ill patients, including those in cardiac arrest. We wanted to audit prehospital bystander response in our region and identify areas for improvement. PATIENTS AND METHODS: We prospectively collected data, including Emergency Medical Services dispatch center audio files, on all patients with a decreased level of consciousness presenting to the Ghent University Hospital prehospital emergency care unit (n = 151). Three trained emergency physicians reviewed the bystander responses, both before and after dispatcher advice was given. Suboptimal actions (SAs) were only withheld if there was 100% consensus. RESULTS: SAs were recognized in 54 (38%) of the 142 cases, and most often related to delayed (n = 35) or inaccurate (n = 12) alerting of the dispatch center. In seven cases, the aid given was considered suboptimal in itself. Importantly, in 21 (25.9%) of the 81 cases where a clear advice was given by the dispatcher, this advice was ignored. In 12 cases, a general practitioner was present at scene. We recognized SAs in 80% of these cases (8/10; insufficient information, n = 2). Cardiopulmonary resuscitation was started in only 29 (43.3%) of the 67 cases of cardiac arrest where dispatcher-assisted cardiopulmonary resuscitation was indicated at the moment of first Emergency Medical Services call. CONCLUSION: We audited bystander response for unconscious patients in our region and found a high degree of suboptimal actions. These results should inform policy makers and healthcare professionals and force them to urgently reflect on how to improve the first parts of the chain of survival.

Patient safety incidents during interhospital transport of patients: A prospective analysis.

INTRODUCTION: Interhospital transport of critically ill patients is at risk of complications. The objective of the study was to prospectively record patient safety incidents that occurred during interhospital transports and to determine their risk factors. METHODS: We prospectively collected data during a fifteen-month period in 2 hospitals. Patient and transport characteristics were collected using a specifically designed tool. Patient safety incidents were appraised for health-care associated harm, and categorized as technical, operational, and communication problems. RESULTS: Our study included 688 patients who were transferred to or from one of both hospitals by physician or nurse led transport, with complete records. A patient safety incident was reported in 16.7% of transports, health-care associated harm was noted in 3.9% of cases. In multivariate analysis, three factors remained significantly associated with an increased risk of healthcare-associated harm: operational incidents (odds ratio=144.93, 95% CI=37.55-767.50, P<0.001), communication incidents (odds ratio=11.05, 95% CI=3.02-52.99, P<0.001) and the Modified Sequential Organ Failure Assessment (M-SOFA) score (odds ratio=1.198, 95% CI=1.038-1.40, P=0.017). CONCLUSIONS: The observed rate of patient safety incidents during interhospital transfers is lower than previously reported in the literature. However, there is limited previous work done on this topic. Operational and communication incidents, and a higher M-SOFA score are significantly associated with increase odds of harmful incident. These findings call for stricter preparation of transfers, with clear and standardized communication.