Early Decontamination Research Articles

Synthesis, Characterization and Application of DTPA-Modified Chitosan Hydrogel Dressing for Early Decontamination of Radioactive Contamination in Wounds

Synthesis, Characterization and Application of DTPA-Modified Chitosan Hydrogel Dressing for Early Decontamination of Radioactive Contamination in Wounds

Use of Vacuum in The Treatment of Acute Lung Abscess in Patients with Diabetes

Abstract of acute lung diseases. This problem is of particular importance when considering the growth of patients with diabetes. It should be noted that the emergence of antibiotics is a result of not using antibacterial drugs. Since the implementation. According to various authors, the number of complications in patients remains high, regardless of the rapid development of modern technologies used in the treatment of modern technologies requires the purchase of expensive specialized costs, the economic sector of the lung is also important for diabetes. In the background of appropriate surgical methods, use vacuum therapy in the treatment of acute diabetes and help early decontamination and cleaning of fibrin tissue and fibrin, accelerate the last necrotic tissue and fibrin This allows us to reduce the time of patients

A Narrative Review on Emergency Management of Poisoning

Poisoning cases are coming to the Emergency Department (ED) and cases are increasing day by day due to their easy and vast availability. Clinicians are frequently dealt with to manage critically ill poisoning patients. With the swing of prominence in managing poisoning from in-patient care to early decontamination and early stabilisation, ED physicians are playing a more dynamic role in the care of poisoned patients. The clinical effects encountered by them are dependent on numerous variables, such as the dose, the duration of exposure, the health history of the patient, to provide thorough supportive care, recognition of patients requiring treatment with a specific antidote, and to use the appropriate methods to restrict poison absorption or to increase its elimination, which is the foundation of management. If poisoning in the patient is documented early and appropriate compassionate care is commenced hastily, maximum of patients recover soon. This article is aimed to focus on the more specific issues of emergency management of the poisoned patient.

Ophthalmic Complications and Managements of Sulfur Mustard Exposure: A Narrative Review.

Sulfur mustard (SM) is a lethal chemical agent that affects many organs, particularly the eyes, respiratory system and skin. Even asymptomatic patients with documented SM vapor exposure may develop organ disorder many years later. Patients with even minor signs in the acute stage may experience late complications that necessitate surgery. Early decontamination and conservative measures could help the patients and decrease the complications. Despite decades of research, there is still no effective treatment for either acute or long-term SM-induced ocular complications. Even after multiple medications and surgical procedures, the majority of patients continue to have symptoms. For dry eye, punctual occlusion, autologous eye drops, and aggressive lubrication are used; for persistent epithelial defects (PED), tarsorrhaphy, amniotic membrane transplant, and stem cell transplantation are used; for total limbal stem cell deficiency (LSCD), living-related conjunctivolimbal allograft and keratolimbal allograft are used; for corneal vascularization, steroids, non-steroidal anti-inflammatory drugs, and anti-vascular endothelial growth factor prescribed; and for corneal opacities, corneal transplantation is done. Platelet rich plasma and topical drops containing stem cell transplantation for LSCD, photodynamic therapy paired with subconjunctival or topical anti-vascular endothelial growth factors for corneal vascularization, topical curcumin and topical ciclosporin-A for dry eye, and orbital fat-derived stem cells for PED are all alternative treatments that can be suggested. Despite the experimental and clinical research on the complications of SM exposure over the past decades, there is still no effective treatment for eye complications. However, supportive medical and surgical management has been applied with relatively good outcome.

Combined endoscopic and radiologic intervention for management of acute perforated peptic ulcer: a randomized controlled trial

BackgroundPeptic ulcer perforation is a common life-threatening surgical emergency. Graham omental patch is performed for plugging of perforated peptic ulcer. Many endoscopic methods have been used to treat acute perforated peptic ulcer such as over the scope clips, standard endoscopic clips, endoscopic sewing and metallic stents. The main idea in endoscopic management of acute perforated peptic ulcer is early decontamination and decrease sepsis by interventional radiologic drainage.MethodsThis is a prospective randomized controlled clinical trial. This study included patients who were developed acute perforated peptic ulcer manifestations and were admitted to our hospital between December 2019 and August 2021. Sample size was 100 patients divided into 2 equal groups. Endoscopic group (EG): included 50 patients who were subjected to endoscopic management. Surgical group (SG): included 50 patients who were subjected to surgical management.ResultsOne hundred patients were randomized into 2 groups: SG (50) and EG (50). Median age of patients was 36 (range 27:54) and 47 (range 41:50) years-old in SG and EG, respectively. Males constituted 72% and 66% in SG and EG, respectively. Median length of postoperative hospital stay was 1 (range: 1–2) days in EG, while in SG was 7 (range 6–8) days. Postoperative complications in SG patients were 58% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (11%, 5%, 5%, 3%, 2% and 3%, respectively). Postoperative complications in EG patients were 24% in form of fever, pneumonia, leak, abdominal abscess, renal failure and incisional hernia (10%, 0%, 2%, 0%, 0% and 0%, respectively).ConclusionCombined endoscopic and interventional radiological drainage can effectively manage acute perforated peptic ulcer without the need for general anesthesia, with short operative time, in high risk surgical patients with low incidence of morbidity & mortality.

General Approach to Patients Admitted to The Emergency Department with Poisoning

Poisonings are a group of patients that can cause serious mortality and morbidity and are frequently referred to Emergency Departments. Providing an approach to the poisoning phenomenon with predetermined diagnosis and treatment will increase the success rates in treatment. Diagnosing and evaluating poisoned cases in the emergency department at the earliest stage, early decontamination, elimination, and appropriate antidote treatment are life-saving. In this article, it is aimed to compile the general management of poisoning cases admitted to the Emergency Department in line with the current literature.

TREATMENT OF LONG-TERM NON-HEALING PURULENT WOUNDS OF THE LOWER LIMBS USING VAC-THERAPY

Summary. The purpose of the study is - To improve the results of treatment of patients with purulent long-term non-healing wounds of the lower extremities using the method of local negative pressure.in purulent long-term non-healing wounds (PLTNHW).
 Objectives of the research — according to the clinic’s data, to study the features of the course of the wound process and the microbiological characteristics of purulent long-term non-healing wounds of the lower extremities when exposed to the wound surface of local negative pressure.
 Conclusions. The use of the local negative pressure method in the complex treatment of patients with purulent long-term non-healing wounds of the lower extremities helps to reduce the duration of the phases of the course of the wound process, early tissue decontamination and a rapid reduction in the size of wound defects.

Oral potassium overdose: a case series

Objective Severe toxicity from ingestions of oral sustained-release potassium is rare. While acute hyperkalaemia requires urgent intervention given the risk of cardiac toxicity, there is a lack of clinical consensus on optimal management. The aim of this study was to characterise the clinical manifestations of acute potassium overdose and its management approach. Methods This is a retrospective case series of patients presenting following oral potassium overdose of ≥6000mg between January 2009 and December 2020 in Queensland, Australia as recorded in the state’s Poisons Information Centre database and a tertiary Clinical Toxicology Unit database. Patients were identified from prospective databases maintained by both units and data were extracted from these in addition to medical records. Results Thirteen presentations in eleven patients occurred in the twelve-year period. The median age was 35 years (range 14–55 years). The median dose ingested was 6.4 mmol/kg (range 0.9–30.8 mmol/kg). Severe hyperkalaemia >7mmol/L occurred in five patients, four with ingestions ≥60,000mg. All patients with hyperkalaemia received multiple modes of intracellular potassium shifting therapy. Four patients had endoscopic removal of pharmacobezoars. One also underwent whole bowel irrigation. Three presentations were managed with haemodialysis. All patients were discharged home with a median length of stay of 20 h. Conclusion Aggressive medical therapy to shift potassium into cells appears to be the mainstay of treatment in patients with normal renal function. Early decontamination may limit peak potassium concentrations. It is unclear if haemodialysis provides significant additional benefit in patients with normal renal function.

Massive Gasoline Ingestion in a 64-Year-Old Female: An Explosive Situation

Hydrocarbons from gasoline are toxins that can affect a multitude of organ systems based on the route of chemical intoxication exposure, with a majority involving oral ingestion or inhalation. Data is still incomplete concerning the systemic complications of gasoline ingestion due in part to variability in the chemical composition of various gasoline products.A 64-year-old female presented to her local emergency department following the ingestion of gasoline in a suicide attempt with altered mental status, hypotension, shortness of breath, tachypnea, sinus tachycardia, coarse rhonchi bilaterally, and hyperactive bowel sounds. Treatment upon admission included intravenous ampicillin/sulbactam, intubation, an intravenous fluid bolus, and ketamine to address the developing hypotension. The patient developed multiorgan failure and acute toxic encephalopathy despite medical interventions and hemodialysis. After four days, comfort care measures were initiated, and the patient passed away.Gasoline toxicity can have a profound effect on multiple organs based on the chemical properties and the route of exposure. These sequelae can be monitored through patient symptoms as well as radiologic imaging. Early supportive therapy and decontamination are vital in decreasing the morbidity and mortality associated with gasoline ingestion.

ORGANOPHOSPHATE POISONING

Organophosphorus compounds are very commonly available substance especially in agriculture based countries. Its use as a suicidal agent is rampant. Early management of the patient is critical in the final outcome. Use of atropine forms the mainstay of management after early decontamination. The role of oximes has been a matter of controversy. Use of Fresh Frozen Plasma and monitoring the patient using cholinesterase levels is amongst one of the developments in the management of the patient.

A Case of Chemical Injury due to Dichloromethane SuccessfullyTreated by Early Decontamination and Hyperbaric Oxygen Therapy

A Case of Chemical Injury due to Dichloromethane SuccessfullyTreated by Early Decontamination and Hyperbaric Oxygen Therapy

Ambulatory screening and decontamination to prevent Staphylococcus aureus complications in patients undergoing elective surgery (STAUfrei): study protocol for a controlled intervention study

BackgroundSurgical site infections (SSI) are the most common health care associated infections in German acute hospitals and can result in prolonged hospital stays, increased use of antibiotics and utilisation of care. Staphylococcus aureus bacteria (methicillin-resistant S Aureus (MRSA) and methicillin-susceptible S Aureus (MSSA)) are amongst the most prominent causes of SSI. While up to 90% of documented S Aureus colonization is already detectable prior to hospital admission, the majority of hygiene measures in Germany is focused on the hospital setting. It is hypothesized that early detection and decontamination of S Aureus colonization in primary care can prevent health care associated infections and reduce the number of S Aureus isolates in the hospital setting.MethodsThis study is a controlled interventional study (N = 13,260) with a pre-post comparison. The intersectoral intervention (over 2 years) will encompass the following elements: ambulatory detection and decontamination of MRSA and MSSA prior to elective surgery combined with a structured follow-up care. Patients from the control group will be screened in the hospital setting, in accordance with the standard operating procedure (SOP) in routine care. The primary endpoint is the reduction of MRSA and MSSA colonization upon hospital admission. Secondary endpoints are complication rate (SSI), length of stay, recolonization of patients (3 and 6 months after release), patient and provider satisfaction, patient compliance and cost development.DiscussionIn case of positive results, the chance of a widespread uptake and implementation in routine care are considered high. The active involvement of primary care providers in the implementation of screening and decontamination as well as follow-up care is a unique feature of this study. The positive resonance of primary care providers during the recruitment phase highlights the relevance of the topic to the participating actors. These efforts are coupled with patient education and specifically trained medical staff, promising a sustained impact. The STAUfrei care pathway can homogenize current practices in routine care and provide a template for further intersectoral cooperation.Trial registrationGerman Clinical Trials Register (DRKS), DRKS00016615. Registered on April 1st, 2019.

ENTERAL INSUFFICIENCY TREATMENT IN PATIENTS WITH GENERALIZED PERITONITIS

Objectives - to improve the treatment results in patients with generalized peritonitis complicated by the enteral insufficiency syndrome. Material and methods. In the period of 2016 -2018 there were 45 patients with a widespread peritonitis admitted to Samara regional clinical hospital named after V.D. Seredavin for treatment. The patients were divided into a control and a main group. The patients of the main group received the intestinal intubation with a specially designed catheter, the intestinal lavage during surgery and in the early postoperative period, the enterosorption, enteral nutrition and bowel decontamination; and in the absence of contraindications - the enteral oxygen therapy. Dynamics of the enteral insufficiency syndrome (EIS) development in both groups were evaluated according to the defined criteria, including laboratory and clinical indicators. Each criterion could weight from 1 to 3 points, their amount reflected the degree of enteral insufficiency. Results. In the main group of patients the small intestinal function was notably restored till the beginning of the third day, what coincided with the transition of the third degree of enteral insufficiency in the second. In patients of the control group the restoration of intestinal function was starting in period of fifth and sixth day after the operation, but the 3d degree of enteral insufficiency remained for 12 hours. Conclusion. The intestinal treatment in combination with the standard therapy allowed to reduce the degree of EIS in the beginning of treatment. This helped to improve the treatment results in general.

Clinical Presentation, Causes, Treatment, and Outcome of Lip Avulsion Injuries in Dogs and Cats: 24 Cases (2001-2017).

Lip avulsions are a common result of orofacial trauma in dogs and cats. Vehicular trauma and bite wounds are common causes. Surgical therapy is highly successful with early decontamination and tension-free closure. This retrospective case series assessed the signalment, causes, lesion location, treatment and outcome of lip avulsion injuries in dogs and cats. A total of 23 patients with 24 lip avulsion injuries were included in the study. They were comprised of 11 dogs and 12 cats. The patients were generally young, with 68.2% under 3 years of age and 36.4% under 1 year of age. The most common known causes were animal bites (26.1%) and vehicular trauma (21.7%). In cats, the most common cause was vehicular trauma (25%). In dogs, the most common cause was an animal bite (45.4%). Bilateral rostral upper lip avulsion was most common in dogs (36.3%), whereas bilateral rostral lower lip avulsion was most common in cats (53.8%). Concurrent injuries were frequent in both species with tooth fractures reported in 34.7%. All lip avulsion injuries were treated via wound debridement and lavage followed by appositional repair with absorbable suture material. The most common short-term complication was wound dehiscence (21.4%). Surgical therapy was highly successful with no significant long-term complications reported. The results suggest that lip avulsion injuries are primarily seen in younger dogs and cats, usually result from vehicular trauma or animal bites, and are successfully managed with surgical repair.

Non-Fatal Amlodipine and Insulin Overdose in an Elderly Person

Background:Amlodipine belongs to the dihydropyridine class of calcium channel blockers (CCB). We present a patient who concomitantly overdosed on amlodipine and subcutaneous insulin. Case Presentation:An elderly man presented within 2 hours to the Emergency department after ingesting 140mg of amlodipine and self-injected 2 cartridges of NovoMix 30/70(600 units) in a suicidal attempt. He developed mild hypotension and had multiple episodes of hypoglycemia but was otherwise asymptomatic. He was managed with activated charcoal, low dose noradrenaline and multiple doses of dextrose for his hypoglycaemia. He was discharged well after 3 days. Discussion:The clinical manifestations of dihydropyridine toxicity are hypotension, hyperglycaemia and metabolic acidosis. Our patient was elderly with multiple medical problems but he was alert and haemodynamically stable on presentation. Activated charcoal is the recommended form of decontamination when the patient presents early. He also developed initial hyperglycemia, which correlates with the degree of the calcium channel blocker overdose. The early coadministration of insulin would correct the patient’s hyperglycemia, acidosis, myocardial function and even provide inotropic support. It may be possible that the subcutaneous route of administering high dose insulin has similar effects as those of intravenous HIET. Our patient’s hypoglycaemia occurred about 12 hours of the overdose, which is expected after an insulin overdose. He required many boluses of dextrose infusions before his blood sugar level stabilised. Conclusion:It is postulated that self-administration of insulin and early decontamination could have resulted in patient’s good outcome despite having ingested a potentially fatal dose of amlodipine.

In vitro permeation of palladium powders through intact and damaged human skin

The use of palladium (Pd) has grown in the last decades, commonly used in automotive catalytic converters, jewellery and dental restorations sectors. Both general and working population can be exposed to this metal, which may act as skin sensitizer. This study investigated in vitro palladium powders permeation through excised intact and damaged human skin using the Franz diffusion cell method and the effect of rapid skin decontamination using sodium laureth-sulphate. 1 mL of a 10 min sonicated suspension made of 2.5 g of Pd powder in 50 mL synthetic sweat at pH 4.5 and room temperature was applied to the outer surface of the skin membranes for 24 h. Pd permeation, assessed by ICP-MS, was higher when damaged skin was used (p = 0.03). Final flux permeation values and lag times were 0.02 ± 0.01 μg cm−2 h−1 and 6.00 ± 3.95 h for intact, and 0.10 ± 0.02 μg cm−2 h−1 and 2.05 ± 1.49 h for damaged skin samples, respectively. Damaged skin protocol enhances Pd skin penetration inside dermal layer (p = 0.04), thus making the metal available for systemic uptake. Pd penetration (p = 0.02) and permeation (p = 0.012) through intact skin decreased significantly when a cleaning procedure was applied. This study demonstrates that after skin exposure to Pd powders a small permeation of the metal happen both through intact and damaged skin and that an early decontamination with a common cleanser can significantly decrease the final amount of metal available forsystemic uptake.

RSDL decontamination of human skin contaminated with the nerve agent VX

Dermal exposure to low volatile organophosphorus compounds (OPC) may lead to penetration through the skin and uptake in the blood circulation. Skin decontamination of toxic OPCs, such as pesticides and chemical warfare nerve agents, might therefore be crucial for mitigating the systemic toxicity following dermal exposure. Reactive skin decontamination lotion (RSDL) has been shown to reduce toxic effects in animals dermally exposed to the nerve agent VX. In the present study, an in vitro flow-through diffusion cell was utilized to evaluate the efficacy of RSDL for decontamination of VX exposed to human epidermis. In particular, the impact of timing in the initiation of decontamination and agent dilution in water was studied. The impact of the lipophilic properties of VX in the RSDL decontamination was additionally addressed by comparing chemical degradation in RSDL and decontamination efficacy between the VX and the hydrophilic OPC triethyl phosphonoacetate (TEPA). The epidermal membrane was exposed to 20, 75 or 90% OPC diluted in deionized water and the decontamination was initiated 5, 10, 30, 60 or 120min post-exposure.Early decontamination of VX with RSDL, initiated 5–10min after skin exposure, was very effective. Delayed decontamination initiated 30–60min post-exposure was less effective but still the amount of penetrated agent was significantly reduced, while further delayed start of decontamination to 120min resulted in very low efficacy. Comparing RSDL decontamination of VX with that of TEPA showed that the decontamination efficacy at high agent concentrations was higher for VX. The degradation mechanism of VX and TEPA during decontamination was dissected by 31P NMR spectroscopy of the OPCs following reactions with RSDL and its three nucleophile components. The degradation rate was clearly associated with the high pH of the specific solution investigated; i.e. increased pH resulted in a more rapid degradation. In addition, the solubility of the OPC in RSDL also influenced the degradation rate since the degradation of VX was significantly faster when the NMR analysis was performed in the organic solvent acetonitrile compared to water.In conclusion, we have applied the in vitro flow-through diffusion cell for evaluation of skin decontamination procedures of human epidermis exposed to OPCs. It was demonstrated that early decontamination is crucial for efficient mitigation of epidermal penetration of VX and that almost complete removal of the nerve agent from the skin surface is possible. Our data also indicate that the pH of RSDL together with the solubility of OPC in RSDL are of primary importance for the decontamination efficacy.

Selection of decontaminants for experimental phenol burn wounds

To investigate the effect of the decontaminants frequently used for phenol burn wounds. The central part of the dorsal skin of adult male Sprague-Dawley rats were burned with 90% (W/V)phenol solution for 2 min, and water, 75% ethanol, polyethylene glycol 400 (PEG400), and Diphoterine were applied for decontamination for 15 min. The changes in wounds were observed, and the depth of skin burns at 24 hours after treatment and changes in six indicators of organ injuries, i.e., serum levels of total bilirubin (TBil), creatinine (Crea), alanine aminotransferase (ALT), alanine aminotransferase (AST), creatine kinase (CK), and lactate dehydrogenase (LDH), at 6 hours after treatment were compared. After phenol burns, the Diphoterine group had a significantly better effect and significantly lower degrees of skin and organ injuries compared with the water group (P<0.05). The effect of decontamination and degrees of skin and organ injuries were similar between the 75% ethanol group and the PEG400 group, and both groups had a better effect of decontamination compared with the water group; the 75% ethanol group had significantly lower serum levels of CK and LDH than the water group (P<0.05). Among these four groups, the water group had the worst effect, the deepest wounds, and the most severe organ injuries. After phenol burns, early decontamination with water has a poor effect, while Diphoterine can reduce the depth of phenol burns and the degrees of injuries of vital organs, and has a good effect of decontamination.

Clinicopathological effects of pepper (oleoresin capsicum) spray.

Pepper (oleoresin capsicum) spray is one of the most common riot-control measures used today. Although not lethal, exposure of pepper spray can cause injury to different organ systems. This review aimed to summarise the major clinicopathological effects of pepper spray in humans. MEDLINE, EMBASE database, and Cochrane Database of Systematic Reviews were used to search for terms associated with the clinicopathological effects of pepper spray in humans and those describing the pathophysiology of capsaicin. A phone interview with two individuals recently exposed to pepper spray was also conducted to establish clinical symptoms. Major key words used for the MEDLINE search were "pepper spray", "OC spray", "oleoresin capsicum"; and other key words as "riot control agents", "capsaicin", and "capsaicinoid". We then combined the key words "capsaicin" and "capsaicinoid" with the major key words to narrow down the number of articles. A search with other databases including EMBASE and Cochrane Database of Systematic Reviews was also conducted with the above phrases to identify any additional related articles. All article searches were confined to human study. The bibliography of articles was screened for additional relevant studies including non-indexed reports, and information from these was also recorded. Non-English articles were included in the search. Fifteen articles were considered relevant. Oleoresin capsicum causes almost instantaneous irritative symptoms to the skin, eyes, and respiratory system. Dermatological effects include a burning sensation, erythema, and hyperalgesia. Ophthalmic effects involve blepharospasm, conjunctivitis, peri-orbital oedema, and corneal pathology. Following inhalation, a stinging or burning sensation can be felt in the nose with sore throat, chest tightness, or dyspnoea. The major pathophysiology is neurogenic inflammation caused by capsaicinoid in the pepper spray. There is no antidote for oleoresin capsicum. Treatment consists of thorough decontamination, symptom-directed supportive measures, and early detection and treatment of systemic toxicity. Decontamination should be carefully carried out to avoid contamination of the surrounding skin and clothing. Pepper (oleoresin capsicum) spray is an effective riot-control agent and does not cause life-threatening clinical effects in the majority of exposed individuals. Early decontamination minimises the irritant effects.

Use of a human skin in vitro model to investigate the influence of ‘every-day’ clothing and skin surface decontamination on the percutaneous penetration of organophosphates

Organophosphates (OPs) are widely used in agriculture. Many studies have investigated the capability of personal protective equipment (PPE) to reduce chemical exposure; however, investigations into the protective effect of ‘every-day’ clothing are rare. The purpose of this study was to investigate the protective effect of ‘every-day’ clothing against dermal exposure and to measure early decontamination of skin following exposure to chlorpyrifos and dichlorvos.Using human skin in vitro, absorption of 14C-labelled chlorpyrifos (500ng/cm2), was shown to be significantly reduced when applied to clothed skin (cotton shirt), regardless of application vehicle (isopropanol (IPA) or propylene glycol (PG)). The majority of applied dose was retained within the clothing after 4h exposure. Significant reduction in absorption of chlorpyrifos (in PG) was seen through clothed skin when supplemented with skin decontamination at 4h, compared with clothed skin decontaminated after 24h, however, this was not observed with IPA.Absorption of dichlorvos (5μg/cm2) was greater through unclothed skin than chlorpyrifos for all vehicles (IPA, isopropyl myristate (IPM) and PG). Significant reduction in absorption was observed when decontaminating clothed skin at 30min, compared with decontamination at 24h (post-exposure) for all vehicles. Resultindicate that ‘every-day’ clothing is effective at reducing exposure to chemicals in contact with skin. Washing the skin surface immediately following removal of exposed clothing can further reduce exposure, depending on the properties of the chemical and vehicle applied.