The American journal of emergency medicine
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Seven cases of hydrogen cyanide gas poisoning which occurred in an industrial building in Hong Kong are presented here. Two of them were more severely injured and required specific antidotal treatment. The other five were mild and responded to supportive treatment alone. ⋯ Cyanide poisoning is relatively uncommon in urbanized area, so high index of suspicion is important for early diagnosis and treatment. We believe that prevention of cyanide poisoning can be achieved by proper storage of chemicals, and by enforcing rescuers to wear special chemical protective clothing to avoid systemic poisoning because of dermal absorption of hydrogen cyanide gas. As there are newer and safer cyanide antidotes available, each emergency department should have a stock of updated products such as hydroxocobalamin.
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The objective of this study was to characterize population-based emergency medical service (EMS) use rates and examine some of the factors associated with usage of prehospital services. The design was a population-based observational study with multiple regression analysis. Transports reported by prehospital services to the Kentucky Emergency Medical Services Information System from Kentucky counties in which all EMS units submit computerized data was the data source. ⋯ In addition, the absence of 911 service (odds ratio [OR] 1.18, 95% confidence interval [CI; 1.14,1.22]) and the absence of a hospital in the county (OR 1.27, 95% CI [1.24,1.30]) were also associated with increasing rates of ambulance use. Rates of use of EMS are most dependent on age and cause, but use is also correlated with increasing levels of poverty. Wide variations in use between communities suggests that point estimates using one community may over- or underestimate EMS usage.
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Ingested foreign bodies can be hard to diagnose but cannot be missed. We report two cases where helical computed tomography (three-dimensional computed tomography) was used for the effective preoperative diagnosis (swallowed fish bone-induced perforation of sigmoid colon and a case of ileus caused by ingested PTP [press-through package]). Other traditional diagnostic methods could not identify the foreign bodies. Three-dimensional computed tomography is useful for the diagnosis of foreign body ingestion and should be used for the difficult cases.