Methanol poisoning is an uncommon medical emergency linked with consumption of traditional brews made with methanol and formalin and associated with high-mortality rates.

Healthcare workers will review the latest worldwide trends of methanol poisoning cases, explain the factors perpetuating methanol poisoning in Kenya, describe the pathophysiological concepts associated with methanol intoxication, and discuss the latest measures to combat methanol poisoning in Kenya and their worldwide applicability.

Methanol intoxication is an acute illness resulting from consumption of toxic quantities of methanol. The largest tragedy occurred in September 2006 in Nicaragua. A total of 800 fell ill, 46 were killed. In the US, the last incidence was in 1951. Cases were reported in Africa, Tunisia, Tanzania, Uganda, but Kenya, it runs the most rampant. The majority of victims (79%) are young males, (22–30 years of age). Most are single, childless, and have a low-educational status. Motivating factors for intoxication include stress, idleness, peer-pressure, availability of alcohol, and curiosity.

Toxicity results from liver enzymatic metabolism of methanol to formaldehyde and formic acid causing severe metabolic acidosis. Common features include inebriation, abdominal pains, bilateral blindness, and complications, including severe renal failure and death. The goals of management include comprehensive assessment, laboratory works, and radiography. Ethanol, fomepizole, and folate are the all-important antidotes.

Kenyatta National Hospital, the main recipient of these emergencies established emergency measures other than public awareness campaigns. Nationally, policies embrace an inter-sectoral Approach - Medical Services and Public Health Ministries will avail resources and build health worker capacity in research and continuous education. Recently, local brews were legalized through the Alcoholic Drinks Control Act 2010 for quality control. Ministries of Education and Youth Affairs will coordinate and initiate youth development and support programs to create employment.

Disaster response and emergency preparedness has taken a bigger role in our daily operations since the advent of events of September 11 2001. It is essential that nurses be prepared and trained to respond to disaster incidents. Nonetheless, we are largely unaware of how our nurses feel about their readiness to respond to these disaster incidents. This study aims to understand our nurses' knowledge, skills and perception towards disaster response and emergency preparedness.

A self administered structured questionnaire survey was conducted for the nurses in our hospital. Using a 5 point Likert scale, the questionnaire covered knowledge, skills and perception of institutional and individual preparedness towards a disaster incident. The data was analyzed using SPSS 17.

A convenient sample of 1143 nurses (response rate 95.5%) was studied over a 2-month period from 1st August to 30th September 2010. 55.7% of the surveyed nurses have not attended any training in disaster response. Despite that, more than 50% of them scored correctly in term of their knowledge in different types of disaster incidents. 75.3% of them have not been trained to don the HAZMET suite within the last 2 years. 72.9% do not know where to get the HAZMET suit in the event of a chemical incident. While 80.2% felt that the institution is able to respond to any disaster incident, only 41.3% felt that they were ready. In addition, 83.6% were willing to participate in future disaster incident response training. 77.1% agreed that being able to respond to a disaster incident should be part of their professional competency.

There is a need for the hospital to incorporate disaster preparedness into nursing education curriculum as a clinical core skill to ensure that nurses are ready to respond to disaster incidents.

Inhalant abuse has become less common in Singapore. Awareness of glue sniffing and its complications has decreased among local physicians. Prolonged toluene exposure can result in renal tubular acidosis, with electrolyte and acid-base derangements, and should be considered in the differential diagnosis of any young patient with unexplained hypokalaemic periodic paralysis and normal anion gap metabolic acidosis. We present a typical case to illustrate the abnormalities and to heighten awareness among emergency physicians who may not have laboratory results on hand when evaluating causes of limb weakness.

A sudden break-down of a heat-exchanger in vinyl chloride plant resulted in that 141 °C, 23% concentration of hydrochloric acid spouted out over the workers around it. Eight workers suffered and Ichihara City Fire Department was deployed in response to the call 3 minutes after the onset of the incident, 17 vehicles including 5 fire engines, 6 ambulances, and two helicopters. Finally three severely (> 80% of TBSA) burned, two moderately (20–80%) burned, and three slightly (< 20%) burned victims were identified and triaged. One severely burned was transferred at first to the closest tertiary care hospital (TUCMC) which existed within 2.5 km distance by an ambulance and other two and one moderately burned were transferred by helicopters to the neighboring tertiary care hospitals. Another moderately burned one was sent to TUCMC by an ambulance about 30 minutes later than the first one. Three slightly burned victims were sent to a local hospital and treated as an outpatient. This casualty mission was ended by 120 minutes after the call. Two among the three severely burned patients lost their lives but another severe one and two moderately burned were survived. Conclusions: With these considerations, the management of this multiple burn casualty was successful, partly because of small number of the victims and of that the incident occurred in a weekday morning.

A 20-year-old woman was referred to the emergency department with rapid acceleration of complaints of palpitations, fever, diarrhea, and agitation that had been present for several weeks. During physical examination, the patient was uncomfortable and restless with a tachycardia of 170/minute, and a fever of 38.5 °C. Palpation of the neck revealed a small ventral, painless, solid elastic mass, more prominent on the right side, clinically suspicious for goiter. An electrocardiograph showed an atrial flutter of 150/min. Initial laboratory results showed an erythrocyte sedimentation rate of 35 mm/hour (0–20 mm/hour) and urine analysis tested positive for ketones.

The patient was presumed to be suffering from a thyroid storm. She was treated promptly with Propranolol 160 mg and Thiamazole 30 mg twice daily at the emergency department. She was admitted to the Cardiac Care Unit for observation of the heart rhythm, which slowed down to 110/minute the same day and her condition improved clinically. The following day her laboratory result confirmed the diagnosis with a thyroid-stimulating hormone of < 0.01 mIU/L (0.4–4.0 mIU/L) and a free thyroxine (T4) of > 75 pmol/l (10–22 pmol/l). Eventually, she was diagnosed with Graves Disease.

Thyroid storm is an acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones. The adult mortality rate is high (90%) if early diagnosis is not made and the patient is left untreated. Therefore, in case of clinical suspicion for thyroid storm, it is critical to start prompt treatment with Beta blockade and Thiamazole before the diagnosis can be confirmed biochemically.

Reducible open dorsal dislocation of the single finger's PIP joint is an infrequent case of orthopedic emergencies. The severity of this injury may be underestimated. These injuries are associated with long-term complications such as synovitis, stiffness, degenerative arthrosis, septic arthritis, and loss of the digit if suboptimally treated.

A 90-year-old male came to the emergency department with an open dorsal PIP dislocation due to a fall on his right hand. There was a transverse skin laceration just proximal to the PIP flexion crease of his small and ring fingers. The condyles of his small finger's proximal phalanx protruded through the wound. X-rays showed a dorsal dislocation of the PIP joint without fracture. There was no neurovascular injury determined. The proximal phalanx was hyperextended slightly with gentle axial traction. After irrigation, the skin wound was closed primarily without repair of damaged structures, and systemic antibiotherapy was performed for a week. The PIP joint was immobilized for three weeks by applying the splint dorsally with the joint in 20 degrees of flexion. Active range of motion exercises were then implemented, and the patient regained full digital flexion with only a 10 degree loss of extension within eight weeks.

Forced hyperextension with axial compression causes a dorsal dislocation of the PIP joint. Dorsal PIP dislocations are more common than volar IP dislocation. Open dorsal dislocation of the PIP joint is an infrequent case of orthopedic emergencies. Such injuries can be treated safely in the emergency department by closed reduction and extensor splinting until a definite treatment plan is made by an orthopedic hand surgeon. The complications must be taken into consideration. Early active motion leads to significantly superior results in the range of motion than static splinting, because prolonged immobilization may result in flexion contracture.

Crimean-Congo Hemorrhagic Fever (CCHF) is a fatal zoonotic viral infection. The agent belongs to the Nairovirus of the Bunyaviridae species. The virus naturally recycles in vector-vertebrate-vector. This study aimed to evaluate cases of tick bites admitted to Infectious Diseases and Emergency Departments in 2008, and to develop management recommendations of such cases. Fifty-seven patients who admitted to a hospital due to tick bites in 2008 were included in the study. A 10-day clinical follow-up was performed to assess for symptoms including fever, fatigue, abdominal pain, headache, nausea/vomiting, diarrhea, disseminated somatic pain, and other hemorrhagic signs. During this period, laboratory analyzes, including white blood cells, thrombocytes, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, lactate dehydrogenase, creatinine phosphokinase (CK), and pentylenetetrazol were performed. Personal data of the patients, location of the bite, and the removal of the tick were recorded.

Of the 57 patients, 37% were from the city, and 63% were from rural areas. The tick was removed by health staff in 25 (44%) of the cases. The bites occurred on body areas including the head/neck, trunk, upper extremities, and lower extremities in 14%, 24%, 27%, and 13% of the cases, respectively. During the follow-up period, none of the patients exhibited any of the signs or symptoms listed above. Laboratory tests did not reveal any abnormalities, except for high levels of CK in 15 patients. Thus, 57 cases did not develop CCHF.

Since 2002, CCHF has caused an increased mortality in Turkey, and has resulted in high anxiety and concern among the Turkish public regarding tick bites. This has resulted in a rise in the number of patients admitting to emergency departments with tick bites. Due to CCHF's incubation period, patients with tick bites should be evaluated for 10 days using a multidisciplinary approach involving both clinical and laboratory evaluations in order to prevent the unnecessary administration of ribavirine.

Violent incidents (VI) in emergency departments (EDs) are under-reported concerns for emergency care providers (ECP). There are limited data from EDs in India.

This is a study of pattern and factors associated with VIs in the ED of a Level-1 Trauma Center.

A qualitative survey questionnaire was distributed to 42 ECPs who worked in the ED of the All India Institute of Medical Sciences. Responses of ECPs were compiled and analyzed.

A total of 78.6% of nurses, 19.1% doctors, and 2.4% registration clerks participated in the study. A total of 54.8% were female. A total of 85.7% had five years of work experience in the ED. A total of 59.5% witnessed and experienced verbal abuse; 19.04% witnessed and experienced physical abuse. The remaining experienced and witnessed verbal abuse as well as physical abuse. A total of 57.1% had experienced VI multiple times in last six months. Of these, 88.2% faced the incident between 8 pm and 8 am. The ECP reported the incident to hospital authority's 54.8% of the time, 19.1% reported it to the police, and 14.29% did not report, while 7.1% reported to police and hospital administration. Eighty-five percent experienced insecurity & emotional disturbance. Patient-related factors included intoxication and anxiety. Healthcare system-related factors included delay in investigations, non-availability of beds, overcrowding of ED, and lack of staff. A total of 47.7% of participants felt that there was improper communication between healthcare workers and 40.1% felt that non-availability of senior doctor were the system deficiency factors. A total of 16.6% of ECPs had formal training regarding communication skills, and 11.9% had grief counseling. All respondents felt that steps should be taken to decrease and mitigate the VIs in the ED.

Verbal and physical abuse of emergency care workers is common.

Manual documentation has an inherent problem of improper communication, manipulation, and validity. An electronic medical record (EMR) is a computerized medical record created in an organization that delivers care, such as a hospital. EMRs tend to be a part of a local, stand-alone, health information system that allows for storage and retrieval.

The objective of this study was to assess the perception of emergency care providers toward the implementation of an EMR System in the emergency department of a Level-1 Trauma Center.

A qualitative survey was conducted among consenting doctors and nurses in the emergency department of the All India Institute of Medical Sciences February to October 2010. Data were collected from a sample of 22—eight doctors and 14 nurses. The collection tool was a structured, closed-ended questionnaire of 12 questions based on usability, applicability, and security, of EMR. A Likert scale (LS) was used (1 = worst, 4 = best). Surveys were done on Day 20, Day 45, and after nine months of implementation of. Responses of emergency care providers were compiled and analyzed using SPSS version 16.

Three surveys consisted of 22 participants in each survey. The survey domain of usability improved on Survey 3 (LS = 2.57), Survey 2 (LS = 2.46), Survey 1 (LS = 2.24). Application of EMR improved from Survey 1 to Survey 3. The data regarding perception of security concerns such as manipulation of data, transparency, and accountability were comparable among Survey 1, Survey 2, and Survey 3. Initial satisfaction was strongly associated with perception of usefulness of data mining for research purposes.

Satisfaction with an EMR system at its implementation generally persisted through the first year of use. Implementation plans must include positive reinforcement regarding EMR among emergency care providers.

In Singapore, the H1N1 outbreak lasted 108 days. The study emergency department (ED) was designated as Singapore's H1N1 screening centre for the borders and the country's primary care centers. Our aim was to determine the psychological morbidity among ED physicians, nurses, administrative and ancillary staff during the H1N1 outbreak.

We conducted a survey on all ED healthcare worker (n = 305) using the 12-item General Health Questionnaire (GHQ-12). The bimodal scoring of GHQ-12 was dichotomised into non-cases (score 0 – 2) and potential cases (score ≥ 3). Participation was strictly voluntary.

The overall response rate was 273 (89.5%). Most respondents were females (73.3%); the mean age was 33 (SD 10.6) years. The mean GHQ score was found to be 1.9 (SD 2.7) with no gender-related differences. A comparison of the dichotomised GHQ-12 scores, found psychological morbidity to be more common in administrative staff (40%) and physicians (38.1%) than ancillary (24.2%) and nurses (19%) (p = 0.011). The average prevalence of psychological morbidity among ED staff was 25.3%. When we considered the 12 items of the GHQ separately and analyzed them by occupational group, we found physicians scoring the worst on item 6 - “Could not overcome difficulties” - than nurses, administrative and ancillary staff (p < 0.001). Physicians and administrative staff alike felt constantly under strain and were unable to concentrate compared to nurses and ancillary staff (p = 0.001).

Healthcare workers in an emergency setting unlike those in the rest of the hospital, face a wide range of risks on the job and this has a substantial effect on their mental well-being and job satisfaction.

Although bile leaks are emerging as frequent complications of non-operative management of liver injury, the best method to use to diagnose intrahepatic biliary injury (IHBI) has not been established.

Fifteen patients with a blunt liver injury admitted to the hospital during a two-year period, were diagnosed by computed tomography as having a grade 3–4 injury, and underwent DIC-MDCT intended to diagnose IHBI in its early stages. These 15 patients included 11 with a grade 4 (Group A: five patients who underwent TAE; Group B: six patients who did not undergo TAE) and four with a grade 3.

In Group A, all of the patients were found to have some signs of IHBI in DIC-CT. Of these patients, two were found to have extrahepatic leakage and underwent local drainage; one also underwent ENBD. Three patients were not found to have extrahepatic leakage even though they had signs of IHBI; these three underwent conservative therapy with no other care, and had a satisfactory course. In Group B, only one patient was found to have IHBI. However, all of the patients, including those not found to have signs of IHBI in DIC-CT, recovered. Patients with grade 3 did not have signs of IHBI. Compared to Group B, Group A had a high Injury Severity Scale Score of 38.5 ± 11.2, and a higher incidence of IHBI.

DIC-MDCT may, in cases of severe liver injury that might require TAE, help to diagnose IHBI in its early stages, and help to determine if additional treatment is needed based on the site and extent of the injury and whether extrahepatic bile leakage is present.

A systematic search and narrative review of existing literature on the medium- and long-term impacts of injuries was conducted to provide context for a primary research study.

Searches were undertaken in MEDLINE, CINHAL and Science Citation Index using a combination of free text and Medical Subject Heading (MeSH) terms. Studies were included if they assessed outcomes following injury at least six months post-injury and reported morbidity-related outcomes. A standardized data extraction form was developed, and studies were assessed for quality using standard quality assessment criteria. The main characteristics of included studies were presented in structured tables and synthesized using a narrative summary.

The search strategy identified 4,969 abstracts and/or titles, of which 125 appeared relevant. Following a detailed reading of the material, 32 studies met the inclusion criteria of this review. Summarizing the results of the studies was difficult, as they were of moderate quality and used many different methods. The main findings were that at 12 months post-injury a proportion of injured patients continue to suffer from physical, psychological, and social problems and this proportion doesn't decline over the next few years. In the medium term (12 months–5 years) about 10–25% of casualties continue to report a variety of health problems associated with their injuries.

It is difficult to synthesize injury outcome studies because of the varying methodological approaches, study populations, follow-up periods, and outcome measures used. The evidence that exists suggests that many casualties demonstrate good early recovery but a significant proportion still show significant social, physical, and psychological sequelae one to five years post-injury.

A variety of models, methods, and computer-aided systems have been used to predict and analyze disasters and emergencies, and manage a pertinent medical response effectively. The list of these instruments traditionally comprises: computerized databases, geographic information systems (GISs), graph theory, complex networks, mathematical programming, simulation, and agent-based modeling. As a rule, each type of those is applied asunder. It makes sense to put in one silo diverse instruments to get multidisciplinary solution with its synergy effect for problems of disaster and emergency medicine.

Within this study, an original, agent-based model was developed. The model combines the advantages of the principal computer-aided instruments and considers all the types of information: semantic, topographical, metric, and topological. The model is severely dynamic, fits to real actors and principally covers all the disaster situation.

In line with the model, a so called Topometric Agent-Based System (TABS) with its key visualization component has been designed. A TABS-specific simulation to investigate behavior of the attacked network of vulnerable actors has been conducted leading to critical findings. It has been shown a severe significance of order within combination of threats: man-made + natural or those of natural + man-made. A well-balanced financial distribution to protect actors of diverse status also has been found.

A TABS similar to GIS focuses on mapping. Topometric Agent-Based System mapping brings an efficient and clear language for information sharing not only within national emergency medical services but between experts from different fields and countries.

Radiography is the standard observation tool for examining orthopedic injuries. Bedside Ultrasound (BUS) may be a faster, non-invasive alternative to effectively identify bone fractures in the emergency department (ED) setting. The study compares the diagnostic utilities of BUS and radiography for identifying long bone fractures.

Prospective observation study with convenience sampling was conducted in ED in patients > 5 years, with post-traumatic upper and lower limb injuries requiring standard radiological examination after informed consent. The BUS examinations were performed by a emergency physician (EP) who had a brief training session to detect fractures. For every subject, radiographs were taken and reviewed for the presence of fracture by blinded orthopedic specialist. Statistical analysis was done by SPSS.

A total of 133 patients were enrolled in the study. Only 42 had fracture, out of which 36 were picked up by BUS. The overall sensitivity of the BUS in detecting fracture was 85.7% with a confidence interval (CI) of 0.70–0.94 and specificity of 100% with a CI = 0.95–1.00. The positive predictive value (PPV) of USG was 100% with a CI = 0.86–1.00 and negative predictive value (NPV) of 93.8% with a CI = 0.86–0.97. There were six additional fractures which were recognized on x-ray and were not picked up by ultrasound.

BUS can be utilized by EP after brief training to accurately identify long-bone fractures. It may gain a more prominent role in pregnant and pediatric population as well as in mass-casualty scenarios.

Ultrasonography of optic nerve sheath diameter (ONSD) may be useful in detecting raised intracranial pressure (ICP) in head injury (HI). There is limited data from India.

The objective of this study was to evaluate the utility of measuring ONSD for diagnosis of raised intracranial pressure in HI victims in the emergency department.

Fifty-two HI patients presenting between February to August 2009 were included, A CT head scan was performed and simultaneous ocular ultrasound was done by an emergency physician who had underwent goal-directed training in ophthalmic sonography by a linear probe of 10 MHz. An ONSD greater than > 5 mm for patients > 15 years of age, 4.5 mm for 1–15 years of age, and 4 mm for infants were considered abnormal. The two modalities of diagnosis were compared.

The median age was 30 years (Range = 0.25–72 years). A total of 90.4% were male and 9.6% were female. A total of 71.2% had severe HI, 19.2% had moderate HI, and 9.6% had mild HI. A raised ICP based on CT findings was present in 42 (80.8%) patients. Mean optic nerve diameter in patients with raised ICP was 5.11 + 1.56 mm compared to 5.04 + 1.6 mm in patients with no features of raised ICP. Sensitivity and specificity of ONSD as a screening test for detection of raised intracranial pressure were 57.1% and 40%, respectively with a positive predictive value and negative predictive value of 80% and 18.1%, respectively.

The evaluation of the ONSD diameter is a simple and non-invasive potential tool in initial assessment of raised intracranial pressure.