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PubMed2006

The ability of paramedics to predict aspiration in patients undergoing prehospital rapid sequence intubation.

One of the purported benefits to invasive prehospital airway management is the prevention of aspiration; however, aspiration events may occur before the arrival of prehospital personnel. We explore the timing of aspiration in patients with severe traumatic brain injury (TBI) undergoing paramedic rapid sequence intubation (RSI). Severely head-injured (Glasgow Coma Scale [GCS] score 3-8) adults were prospectively enrolled into the San Diego Paramedic RSI Trial. As part of the prehospital data collection tool, paramedics prospectively assessed for clinical evidence of aspiration before RSI (pre-intubation), aspiration events occurring during RSI (peri-RSI), and regurgitation of vomitus or blood after intubation (post-intubation). Data were abstracted from work sheets used during the RSI procedure, a telephone debriefing by one of the principal investigators immediately after delivery of the patient, and San Diego County prehospital and trauma databases. The incidence of pre-intubation aspiration, peri-RSI aspiration, and post-intubation regurgitation of vomitus or blood were determined. Patients with and without pre-intubation aspiration were compared with regard to pre- and post-intubation hypoxia and the rate of aspiration pneumonia. Logistic regression was used to explore the association between pre-intubation aspiration and various demographic and clinical factors. The results showed that pre-intubation aspiration was noted by paramedics in 72/269 patients in whom complete data were available. Peri-RSI aspiration was reported in one patient; there were no reported cases of post-intubation regurgitation of vomitus or blood. Patients in the pre-intubation aspiration group required more intubation attempts, had a higher incidence of desaturations and lower pre- and post-intubation SaO(2) values, and were more frequently diagnosed with aspiration pneumonia. Pre-intubation aspiration was associated with severe TBI, GCS score of 3, younger age, and the absence of alcohol intoxication despite controlling for age, gender, GCS, Head AIS (Abbreviated Injury Score), and serum ethanol. It is concluded that paramedics seem to be able to accurately assess for aspiration in patients undergoing prehospital RSI. The vast majority of aspiration events seem to occur before the arrival of prehospital personnel. Alteration in consciousness from TBI may carry a higher risk of aspiration than with other causes, such as alcohol intoxication.

Abbreviated Injury Scale↗

PubMed1998

Naltrexone effects on diazepam intoxication and pharmacokinetics in humans.

The opiate antagonist naltrexone (NTX) blocks relapse drinking in alcoholics and modifies some of the subjective effects of alcohol intoxication. Benzodiazepines have demonstrated cross-dependence and cross-tolerance to alcohol. Furthermore, benzodiazepine intoxication has effects on mood and psychomotor performance that are similar to alcohol intoxication. The effects of NTX on diazepam intoxication were investigated in non-drug abusing individuals. Eighteen men and eight women were randomly assigned to receive either 50 mg NTX or placebo PO, on two different occasions in a within-subjects, crossover, double-blind protocol. Diazepam was taken by mouth, 90 min after NTX. At -90, 45, 75, 135, 210 min, subjects were tested with repeated assessments of several mood and sensation scales and a computer-generated psychomotor test battery (CTB). Blood samples were also obtained and analyzed for serum diazepam levels. Diazepam induced several sensations and mood effects similar to those induced by alcohol. Negative mood states such as sedation, fatigue, and anxiety were higher for NTX than for placebo. Positive mood states such as friendliness, vigor, liking the effects of diazepam, and feeling high from diazepam were all lower for NTX than for placebo. There were no group differences on the CTB performance. NTX delayed the time to reach peak diazepam levels, so that peak levels occurred at 75 min for placebo compared to 135 min for NTX. A sub-analysis was conducted with 14 subjects who were FHP for alcoholism, but no differences were found on these outcome measures.

Adult↗

PubMed2005

Effects of an aqueous extract of Puerariae flos (Thomsonide) on impairment of passive avoidance behavior in mice.

The effects of an aqueous extract of Puerariae flos (Thomsonide) on ethanol-induced learning and memory impairment and scopolamine-induced amnesia were investigated. Thomsonide exerted an ameliorating effect on the impairment of both memory registration and memory retrieval induced by ethanol. These results indicate that Thomsonide has an antiamnesic effect on the central nervous system in alcoholic intoxication and support the traditional use of Puerariae flos for the treatment of alcoholic intoxication. Thomsonide also improved the scopolamine-induced impairment of memory registration in passive avoidance behavior in mice. The results of this study suggest that it may be possible to use Thomsonide for the treatment of age-related memory impairment and dementia.

Alzheimer Disease↗

PubMed1989

Morphometry of terminal hepatic veins. 2. Follow up in chronically alcohol-fed baboons.

Alcohol induced perivenular fibrosis of terminal hepatic veins (THV) is claimed to be a precursor lesion leading to fibrosis development in man and baboon. The nature and significance of the THV lesions found in four baboons chronically fed with alcohol were studied in liver biopsies obtained during a three year period. The surface of THV wall and the number of mesenchymal cells were assessed with a semi-automatic image analyser. Histologically, THV were characterized as (a) phlebitic, in the presence of an inflammatory cell infiltrate involving the venous wall; (b) oedematous, when the connective tissue of the THV wall was disrupted or dissociated and (c) fibrotic, when perivenular scarring appeared as an increased rim. These lesions were present simultaneously and their intensity and distribution were independent of the duration of alcohol intoxication. Morphometric data obtained from these THV confirmed the thickening of the THV wall (WS/IS in: oedematous 1.05 +/- 0.36; phlebitic 1.65 +/- 1.04; fibrotic 1.47 +/- 0.36); and revealed an increased number of mesenchymal cells in fibrotic (439 microns 2/cell; p less than 0.01) and in phlebitic THV (510 microns 2/cell; p less than 0.05). A constant relationship was found between phlebitis and the presence of inflammatory infiltrate within the hepatic acini. Fibrotic THV was a less frequent finding and the lesion disappeared in the sequential biopsies of one of the baboons. In conclusion, THV lesions were heterogeneous and the collagen deposition in the THV wall was potentially reversible during the three year alcohol intoxication period, regardless the inflammatory reaction and, thus, did not indicate early irreversible hapatic fibrosis.

Alcoholic Intoxication↗

PubMed1980

[Effect of alcohol on glial cells].

The reaction of the cerebral cortex glia to alcohol was studied in rats subjected to alcoholic intoxication. Use was made of the Nissl and Golgi method. In 20 days of alcohol intoxication (a 35% solution) the amount of the perineuronal and total glia, as calculated in stratum V of the sensomotor cortex, was found to increase, this increase being statistically significant. This was accompanied by changes of the glia cell metabolism (as was indicated by intensification of the glia impregnation properties) and by formation of compensatory glia-dendrite "contacts", probably, for maintaining the vital activity of the alcohol-affected neurons. Later (in 2, 4, 8, 12, and 15 months), along with the decrease of the number of neurons and the proliferation of the glia, there appeared signs of the latter's dystrophic changes. This is undoubtedly reflected on the cerebral cortex function.

Alcoholism↗

PubMed2000

[Alcohol--forensic aspects].

Alcohol (resp. ethanol) in forensic medicine includes mainly the following areas and fields of problems: analysis (in particular blood- and breath alcohol), ability to drive resp. DUI/DWI, impairment of responsibility, alcohol use, abuse and dependence, intoxication, alcohol as direct and indirect cause of death and organ damage. A short overview presents these problem areas of alcohol use and misuse as well as results of alcohol research ("ethanology") which may be relevant for clinical use.

Alcohol Drinking↗

PubMed1984

Survival after high blood alcohol levels. Association with first-order elimination kinetics.

A patient survived acute alcohol intoxication with an unprecedented blood alcohol level of 1,500 mg/dL. Treatment included peritoneal dialysis and intravenously administered fructose. Alcohol elimination followed first-order kinetics, in which the elimination rate is proportional to concentration, rather than zero order in which the metabolic rate is independent of concentration. The report provides further evidence for first-order elimination kinetics with high blood alcohol levels and for an adaptive increase in alcohol metabolism with long-term alcohol consumption.

Adult↗

PubMed1991

Trauma in cirrhosis: an indicator of the pattern of alcohol abuse in different societies.

While some morbidities associated with the excessive use of alcohol are related to the total amount of alcohol consumed--cirrhosis being an example--other pathologies, such as trauma and those of psycho-social origin, are mainly related to the frequency of acute alcoholic intoxication rather than to the total amount consumed. The balance between these two types of alcohol-associated morbidities can provide an indication of the relative frequency of intoxication, and thus of the pattern of alcohol abuse in a population. Since trauma is highly associated with acute alcoholic intoxication, the prevalence of bone fractures was determined in cirrhotics in nine countries. The prevalence of rib and vertebral fractures on routine chest x-rays showed a 17-fold variation in the different countries, from 2% and 6% in Spain and Italy to 30% and 34% in Canada and the USA, suggesting marked differences in the pattern of alcohol abuse to intoxication. Conversely, the prevalence of cirrhosis is twice as high in Spain and Italy than in Canada and the USA. A strong positive correlation between per capita consumption and cirrhosis mortality (r = 0.86; p less than 0.01) exists among the nine countries studied, while the correlation between per capita alcohol consumption and the prevalence of trauma is not statistically significant (r = 0.40). Supporting a strong association between trauma and alcoholic intoxication, the prevalence of trauma was found to be highly correlated: r = 0.88, p less than 0.002, with the degree of concern for the psycho-social consequences of alcohol abuse in the different countries. Data indicate that trauma can be used as an objective indicator to assess the pattern of alcohol abuse in a population.

Alcohol Drinking↗

PubMedDate not supplied

Collaborative interventions for physically injured trauma survivors: a pilot randomized effectiveness trial.

Posttraumatic behavioral and emotional disturbances occur frequently among physically injured hospitalized trauma survivors. This investigation was a pilot randomized effectiveness trial of a 4-month collaborative care intervention for injured motor vehicle crash and assault victims. As surgical inpatients, intervention subjects (N=16) were assigned to a trauma support specialist who provided counseling, consulted with surgical and primary care providers, and attempted postdischarge care coordination. Control subjects (N=18) received usual posttraumatic care. For all participants, posttraumatic stress disorder (PTSD) and depressive symptoms, episodic alcohol intoxication, and functional limitations were evaluated during the hospitalization and 1 and 4 months postinjury. Study logs and field notes revealed that over 75% of intervention activity occurred in the first month after the trauma. One-month post-trauma intervention subjects when compared to controls demonstrated statistically significant decreases in PTSD symptoms as well as a reduction in depressive symptoms. However, at the 4-month assessment, intervention subjects evidenced no significant improvements in PTSD and depressive symptoms, episodic alcohol intoxication, or functional limitations. Future larger scale trials of stepped collaborative care interventions for physically injured trauma survivors are recommended.

Adult↗

PubMed1976

Unusually high levels of blood alcohol?

A consecutive three-month study of alcohol-intoxicated patients admitted to the casualty ward showed 24 patients with an initial serum alcohol concentration above 110 millimols/liter. Eight patitents were excluded because of insufficient data. Eight of the remaining 16 patients showed surprisingly slight depression of the central nervous system (CNS).

Adult↗

PubMedDate not supplied

[The dose-dependent effects of a combination of different classes of antioxidants exemplified by dibunol and beta-carotene].

In order to enhance antioxidant protection of the organism in various pathological states, effective combinations of antioxidants have been developed that interact with various types of free radicals. On two experimental models,--acute alcohol intoxication and calcium chloride arrhythmia of rats, the prophylactic activity of antioxidant combinations was established for certain doses, rather then for monotherapy. The possibility of obtaining high protective effects at relatively low concentrations of the components in the complex preparation was shown. Am increase of antioxidant concentration in the preparation could decrease its efficiency. The highest efficiency in the complex preparations, as compared with in each component taken separately, was observed in the case of calcium chloride arrhythmia when dibunol and beta-carotene were combined at concentrations of 10 mg/kg and in the case of acute alcohol intoxication (1 and 0.25 mg/kg, respectively). Enhanced efficiency of combined antioxidant therapy opens up the way to the production of new active complex preparations with minimum toxic side toxic effects and complications.

Alcoholic Intoxication↗

PubMed2004

Suffocation in motor vehicle crashes.

Because death from suffocation in traffic fatalities has not been well described, we delineated the clinical, circumstantial, and autopsy findings associated with suffocation in a series of motor vehicle crashes. Medical examiner case files from a 5-year period were reviewed. Scene investigation, autopsy, toxicology, and first-responder reports were examined. Crash descriptions were reviewed, including vehicle type, mechanism of crash, response time, restraint use, occupant ejection, and victim position in cabins of vehicles. Mechanisms of suffocation, including torso compression, inversion, neck flexion, facial occlusion, and blood aspiration, were determined for each case. The files were searched for factors relevant to the diagnosis of suffocation, namely, cerebral concussion, alcohol intoxication, obesity, petechiae, lung weights as a proxy for livor, natural disease, and impact wounds. Twenty-nine traffic fatality cases were identified in which suffocation caused death. In 26, suffocation mechanisms were solely responsible for death. In 3, death was caused by suffocation in combination with other mechanisms. Twenty-five subjects were occupants of vehicles with cabins and 4 were motorcycle riders. The most common mechanism of suffocation was torso compression. Most subjects had either multiple mechanisms of suffocation or a single mechanism acting in concert with concussion or alcohol intoxication. Concussion and intoxication were common, with one or both present in 20 subjects, including all of those with blood aspiration. Petechiae were frequent but were found consistently only among those with inversion. Cutaneous chest petechiae were associated with inversion and torso compression. Lung weights were highest among those with blood aspiration and lowest among those with inversion. Body mass index was highest among those with inversion, suggesting that obesity could be a risk factor for this mechanism.

Accidents, Traffic↗

PubMedDate not supplied

[A fatal outcome of false croup in lacunar angina complicated by peritonsillar abscess].

The paper reports a lethal outcome of false croup in a 62-year-old man. In pathogenetic chain of the disease the leading role belonged to purulent tonsillitis with peritonsillar abscess and epiglottitis with phlegmone of the adjacent soft tissues including the vocal cords. A severe edema of the latter provoked a complete obstruction in the larynx and asphyxia with all its macro- and microscopic morphological features. Chronic alcoholic intoxication seemed to cause immunodeficiency and slow progression of the disease. Tonsillitis, chronic with exacerbation, was alleviated by chronic alcoholic intoxication leading to weak symptoms, delayed reactions and "strange" outcome. Hyperergia could be due to intake of alcohol surrogate.

Croup↗

PubMed1991

[Minor head injuries in a Copenhagen district. 2. Causes, simultaneous lesions, alcohol and economic aspects].

In order to elucidate causes, simultaneous lesions, alcohol intoxication and economic aspects of admission of patients with minor head traumas, the records of 1,961 patients admitted in 1985 and 1986 were reviewed. 35% were admitted after traffic accidents, 18% after assaults and 17% because of home accidents. In the age group 30-39 years, 40% of the males were admitted after assaults. 7% sustained fractures of the extremities, 4% facial fractures and 3% and 1% thoracic and abdominal lesions respectively. At least 28% of all patients, more than 50% of the patients admitted during evening- and night hours and 51% of the males between 14 and 65 years were clinically alcohol intoxicated. 1,876 patients were admitted solely for observation, nine developed an intracranial complication, three were operated upon and one died. The bed day expenditure was 2.7 mill. Dkr. (pounds 225,000), and for the entire nation 64.8 mill. Dkr (pounds 5,400,000). The costs for diagnosing one case of intracranial lesion in Denmark were 925.000 Dkr. (approximately pounds 80,000) and 2.1 mill. Dkr. (pounds 180,000) to find the cases requiring treatment (1985 level).

Accidents, Home↗

PubMed1975

[Acute cerebral circulatory disorders in persons abusing alcohol].

Fifty patients at the age of 29-74 years, being addicted to alcohol for a long time, were investigated in the acute period of brain strokes; in 23 cases the diagnosis was verified on sections. It is established that alcoholic intoxication accelerates the development of strokes. A stroke in intoxicated individuals often develops according to the type of haemorrhage and ends lethally, and in chronic alcoholic intoxication the strokes often develop according to the type of softening. Attention was paid to the frequency of psychomotor exictation, cardiac muscle damage, expressed vascular changes in the eyeground seen already at the young age.

Adult↗

PubMed1998

Clinically relevant concentrations of ethanol attenuate primed neutrophil bactericidal activity.

BACKGROUND: Acute alcohol intoxication is associated with an increased risk of infection in the injured patient. The impact of clinically relevant levels of ethanol (ETOH) on neutrophil (PMN) bactericidal activity remains ill-defined. PMN priming optimizes microbicidal activity by enhancing oxygen radical production, degranulation, and adhesion molecule up-regulation. We hypothesized that clinically relevant levels of ETOH attenuate these primed PMN responses critical to eradicate infection. METHODS: After incubation with ETOH (0-1.0%), isolated human PMNs were primed with beta-acetyl-gamma-O-alkyl and activated with N-formyl-methionyl-leucyl-phenylalanine. Superoxide generation was measured by cytochrome c reduction, elastase release was measured by cleavage of methoxysuccinyl-ala-ala-pro-val-p-nitroanilide, and CD11b was measured by fluorescent monoclonal antibody staining. Bactericidal activity was assessed by Staphylococcus aureus killing. RESULTS: ETOH attenuated superoxide production dose-dependently with significance at 0.3% ETOH. Elastase release was attenuated starting at 0.2% ETOH, and CD11b expression was reduced starting at 0.4% ETOH. S. aureus killing was impaired dose-dependently with significance at 0.3% ETOH. CONCLUSION: Clinically relevant concentrations of ETOH attenuate PMN functions critical in host defense against invading pathogens. These results provide direct in vitro evidence consistent with previous in vivo data that acute alcohol intoxication is important in the pathogenesis of trauma-related infections.

Alcoholic Intoxication↗

PubMed1998

Reduction in BOLD fMRI response to primary visual stimulation following alcohol ingestion.

The physiology of alcohol's effects on brain function is poorly understood. Emission tomographic imaging has revealed both acute and chronic alterations in resting cerebral hemodynamics and metabolism following alcohol ingestion. However, cerebral functional integrity under these conditions has received less attention. Functional magnetic resonance imaging (fMRI) offers a non-invasive method for assessing brain functional activation. In order to assess its utility for studying the effect of alcohol on brain function, we performed fMRI with photic stimulation before and after administration of either 0.7 mg/kg alcohol (N = 12) or placebo (N = 5), resulting in peak breath alcohol levels averaging 0.069 g/dl. We found that the amplitude of visual cortical activation in response to photic stimulation was significantly reduced by approximately 33% following alcohol administration (4.0 +/- 1.7% vs. 2.7 +/- 1.3%, P = 0.02), but not following placebo (4.2 +/- 1.5% vs. 4.1 +/- 1.4%, P = 0.7). The results also suggest that the baseline right hemispheric predominance of activation in response to photic stimulation may be reduced following alcohol, suggesting a greater effect on the right hemisphere, consistent with previous studies and alcohol's known effects on visuospatial processing. In addition, through the course of each activation session, there was a progressive reduction in response following alcohol. These data demonstrate that the cerebral effects of alcohol intoxication can be studied with fMRI, and that the effects on brain function of even moderate alcohol intoxication may be widespread, may be lateralized, and may include the visual system.

Adult↗

PubMed1993

Alcoholism.

Several medications may help improve treatment of alcoholic patients. Medications that effectively and specifically reverse symptoms of alcohol intoxication or coma currently are lacking. Benzodiazepines remain the most effective medications for the treatment of alcohol withdrawal and for the prevention of withdrawal seizures and delirium, even though the adrenergic agents clonidine or atenolol may hasten resolution of withdrawal symptoms and facilitate outpatient detoxification. Psychosocial rehabilitation of alcoholics may be improved by judicious addition of the alcohol-sensitizing agents disulfiram and carbimide, the serotonergic drugs fluoxetine and buspirone, the opiate antagonist naltrexone, and, for primarily depressed alcoholics, tricyclic antidepressants. As in psychosocial alcohol rehabilitation, patient-treatment matching may improve results of pharmacotherapeutic intervention.

Alcohol Withdrawal Delirium↗