The reception, admission, and subsequent management of casualties from the Summerland fire are described. A senior member ofthe staff assessed priorities and direceted casualties to different prearranged teams, and a nurse was allocated to each patient to aid continuity of treatment and documentation. Though regular revision and discussion of major accident procedures with all members of the hospital staff and co-ordination with other rescue workers is helpful expensive rehearsals are of limited value in a civilian incident. (+info)
Intimal ultrastructure of human umbilical arteries. Observations on arteries from newborn children of smoking and nonsmoking mothers.
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The umbilical artery was chosen as a possible model for evaluating the vascular injury provoked by tobacco smoking in humans. Cords from newborn children delivered by 15 nonsmoking and 13 smoking mothers were studied in the transmission and the scanning electron microscope. Pronounced intimal changes were seen in the arteries from smoking mothers; the most important findings were degenerative changes of the endothelium such as swelling, blebbing, contraction, and subsequent opening of the endothelial junctions with formation of subendothelial edema. Other observations included dilation of the endoplasmic reticulum in the endothelium and reparative changes such as a considerable widening of the basement membrane. Since similar changes can be induced in arteries of animals by exposure to carbon monoxide or perfusion with nicotine, we conclude that the present study supports the concept that tobacco smoking is harmful to the vascular endothelium. This study also contributes to an understanding of the mechanism through which vascular injury is provoked in heavy smokers. (+info)
Carbon monoxide poisoning: correlation of neurological findings between accident and emergency departments and a hyperbaric unit.
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OBJECTIVES: To investigate and quantify the differences in neurological examination findings in patients acutely poisoned with carbon monoxide, between initial assessment at accident and emergency (A&E) departments and subsequently at a hyperbaric unit. METHODS: Retrospective case note review of all patients referred to the Hull Hyperbaric Unit for treatment of acute carbon monoxide poisoning between August 1998 and August 1999. Patients who were ventilated or less than 16 years old were excluded because of difficulty in assessing their neurological status. RESULTS: Thirty patients were included for analysis. The mean duration from exposure to assessment in A&E was four hours while patients were reviewed on average three hours later at the hyperbaric unit. Referrals came from 14 different hospitals. A history of loss of consciousness accounted for 70% of referrals. A mean of 3.2 neurological signs per patient was documented in A&E compared with 9.2 at the hyperbaric unit. Seventy nine per cent of abnormal neurological signs were not detected at A&E departments compared with 3% at the hyperbaric unit. The major source of discrepancy was in sharpened Rhomberg's test and heel-toe gait, in 13% of patients examined in A&E departments these signs were recorded as abnormal compared with 90% at the hyperbaric unit. CONCLUSION: There is a large discrepancy in neurological findings between assessment in A&E departments and the Hull Hyperbaric Unit. A number of factors may account for this including interobserver variation, patient deterioration during transfer, poor documentation, lack of understanding of the sequelae of carbon monoxide poisoning and inadequate examinations. Further research is required to quantify the impact of the various factors that may contribute to the differences in neurological findings. (+info)
Protective effects of fructose-1,6-diphosphate against cerebral injury induced by subacute carbon monoxide intoxication in mice.
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AIM: To study the effects of fructose-1,6-diphosphate (FDP) on delayed cerebral injury in mice from subacute carbon monoxide (CO) exposure. METHODS: Mice were exposed to CO (100 mL/kg i.p.) once a day, continouUsly for 7 d. After 7-d CO-exposure, mortality of mice, changes in learning ability and memory using passive avoidAnce test, the pathomorphologic observation of brain tissue slices, and changes in monoamine oxide (MAO)-B activities in cerebral tissue were studied. FDP was administrated 30 min before CO-exposure every time. RESULTS: The preadministration of FDP markedly decreased the mortality of mice, almost reversed the impairment of learning and memory function, prevented the cells from delayed death in hippocampal neurons and blunted the rise in MAO-B activity after subacute CO poisoning of mice. CONCLUSION: FDP pretreatment markedly prevented mice from delayed encephalopathy after CO poisoning. (+info)
Relationship of suicide rates to social factors and availability of lethal methods: comparison of suicide in Newcastle upon Tyne 1961-1965 and 1985-1994.
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BACKGROUND: The UK Government's White Paper Saving Lives: Our Healthier Nation included among its targets a reduction in suicide. AIMS: To study causes of change in suicide rate over a 30-year period in Newcastle upon Tyne. METHOD: Suicide rates and methods, based on coroners' inquest records, were compared over two periods (1961-1965 and 1985-1994) and differences were related to changes in exposure to poisions and prescribed drugs, and to socio-demographic changes. RESULTS: Demographic and social changes had taken place which would adversely affect suicide rates. However, a dramatic fall was found in the rate for women, and a modest decline in that for men. Reduced exposure to carbon monoxide and to barbiturates coincided with the fall in rates. CONCLUSIONS: Reduced exposure to lethal methods was responsible for the fall in rate in both genders, while the gender difference in favour of women may be related to their preference for non-violent methods or to their being less affected by the social changes. (+info)
Suicide in children and adolescents in England and Wales 1970-1998.
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BACKGROUND: Suicide rates for England and Wales have been decreasing recently, but rates for young adult males remain high. AIMS: To review changes in suicide rates for children and adolescents in England and Wales between 1970 and 1998. METHOD: Rates for suicide, 'accidental' death by causes similar to suicide and 'undetermined' death for 10-14- and 15-19-year-olds are calculated between 1970 and 1998 using suicide data and estimated mid-year populations obtained from the Office for National Statistics. RESULTS: There has been a substantial increase in suicide rate between the 1970s and the 1990s for males aged 15-19 years. This remains true even when 'undetermined' and 'accidental' death rates for causes similar to suicide are examined. The increase was associated with an increase in self-poisoning with vehicle exhaust gas in the 1980s and an increase in hanging which has continued into the 1990s. Although there was a slight decrease in the official suicide rate for females aged 15-19 years, 'undetermined' deaths increased. There is no indication of a major change in suicide rate in 10-14-year-olds. CONCLUSIONS: The substantial increase in suicide rate in 15-19-year-old males may indicate increased psychosocial stress, particularly affecting this group. (+info)
Carbon monoxide poisoning: systemic manifestations and complications.
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Carbon monoxide (CO) has the toxic effects of tissue hypoxia and produces various systemic and neurological complications. The main clinical manifestations of acute CO poisoning consist of symptoms caused by alterations of the cardiovascular system such as initial tachycardia and hypertension, and central nervous system symptoms such as headache, dizziness, paresis, convulsion and unconsciousness. CO poisoning also produces myocardial ischemia, atrial fibrillation, pneumonia, pulmonary edema, erythrocytosis, leucocytosis, hyperglycemia, muscle necrosis, acute renal failure, skin lesion, and changes in perception of the visual and auditory systems. Of considerable clinical interest, severe neurological manifestations may occur days or weeks after acute CO poisoning. Delayed sequelae of CO poisoning are not rare, usually occur in middle or older, and are clinically characterized by symptom triad of mental deterioration, urinary incontinence, and gait disturbance. Occasionally, movement disorders, particularly parkinsonism, are observed. In addition, peripheral neuropathy following CO poisoning usually occurs in young adults. (+info)
Roles for platelet-activating factor and *NO-derived oxidants causing neutrophil adherence after CO poisoning.
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Studies were conducted with rats to investigate whether platelet activating factor (PAF) and nitric oxide (*NO)-derived oxidants played roles in the initial adherence of neutrophils to vasculature in the brain after carbon monoxide (CO) poisoning. Before CO poisoning, rats were treated with the competitive PAF receptor antagonist WEB-2170 or with the peroxynitrite scavenger selenomethionine. Both agents caused significantly lower concentrations of myeloperoxidase in the brain after poisoning, indicating fewer sequestered neutrophils. Similarly, both agents reduced the concentration of nitrotyrosine, indicating less oxidative stress due to *NO-derived oxidants. There were no alterations in whole brain homogenate PAF concentration measured by immunoassay and bioassay, nor were there changes in phosphatidylcholine concentration. Immunohistochemical imaging showed PAF to be more heavily localized within perivascular zones after CO poisoning. Neutrophils colocalized with both PAF and nitrotyrosine in brains of rats killed immediately after CO poisoning. We conclude that qualitative changes in brain PAF are responsible for neutrophil adherence immediately after CO poisoning and that activated neutrophils trigger the initial rise in brain nitrotyrosine. Persistent PAF-mediated neutrophil adherence required production of *NO-derived oxidants because when oxidants were scavenged, neutrophil adherence was not maintained. (+info)