Search In this Thesis
   Search In this Thesis  
العنوان
Investigating Deaths among Mechanically
Ventilated Acutely Poisoned Patients Admitted to Poison Control Center of Ain Shams University Hospitals from January to December 2013 /
المؤلف
Mohammed, Noran Mohammed.
هيئة الاعداد
باحث / Noran Mohammed Mohammed
مشرف / Gamal Nasser Eid
مشرف / Nabil Nassif Rezk
مناقش / Ayman Mohamed Abdelfattah
تاريخ النشر
2016.
عدد الصفحات
P. 215. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
علم الأمراض والطب الشرعي
تاريخ الإجازة
1/1/2016
مكان الإجازة
جامعة عين شمس - كلية الطب - الطب الشرعى والسموم
الفهرس
Only 14 pages are availabe for public view

from 215

from 215

Abstract

Mechanical ventilation is a cornerstone in the rescue and maintenance of patients with acute poisoning (Rosengart and Pinsky, 2014).
In Egypt, the reports published by the Poison Control Center of Ain Shams University Hospitals (PCCA) during the year 2012 showed that 42% of overall acutely poisoned mechanically ventilated patients died, but it did not clarify whether deaths were related to the mechanical ventilation or not (El Masry and Tawfik, 2013).
This gave us imptus to investigate deaths among poisoned mechanically ventilated patients to recognize actual causes of these deaths. This study was designed so that files of mechanically ventilated acutely poisoned patients who were reported dead on discharge were meticulously examined . Retrieved data were tabulated and statistically analyzed.
As regard age of affected patients , no specific age prediction was observed. This study revealed that the highest incidence of died acutely poisoned mechanically ventilated admitted to ICU was observed in patient ranging between4 months to73 years, with mean age less than 25 years of whom male sex represented the majority with percentage 57.1% of cases. Attempting suicide was the main etiology of these cases. Majority of patients consumed the poison through oral route. In the majority of cases delay time to clinical presentation was less than 6 hours.
The study also revealed that unemployment among middle aged males was prevailing among the died poisoned mechanically ventilated patients a matter which could be explained by their despirate attempts of suicide by taking serious toxic doses of the poison.
Solving the problem of unemploymed by arrangement of some sort of social and psychological support and offering job opportunities for people suffering from unemployment may help reducing numbers of these deaths .
Organophosphorus compounds (41.3%) and tramadol (23.8%), were the most frequently encountered agents of died acutely poisoned mechanically ventilated patients.
OPI represented the majority of cases and this could be attributed to the fact that OPI is widely available and is used as insecticides in agriculture as well as for house-hold purposes and many OPC in the market are unknown or not registered or license.
Accordingly substitution of the harmful insecticides by more safe or natural compounds and limitation of their use may be crucial.
Besides, drug addiction especially tramadol was a factor increasing deaths among poisoned mechanically ventilated patients .
So regulation of access to pharmaceuticals may be helpful in limiting poisoning and its fatal consequences .Obtaining drugs must be through written prescriptions and the doses and duration of treatment should be clear in order to limit the amount obtained.
Also, Overcrowdedness and traffic jam played a role in increasing deaths among mechanically ventilated patients as it results in delay in hospital presentation.
Acute hypoxemia as well as ARDS represented 30.2% of cases; besides, pneumonia in 11.1% of cases and pneumothorax in 3.2% of cases.
It could be concluded that the majority of cases died because of complications related to mechanical ventilation (pneumonia , ARDS and pneumothorax) which were reported in 44.5% of cases .
Also there was a considerable percentage of cases suffered from cardiac arrthymia, hypotension and sudden arrest . This also could be attributed and exaggerated by the effect of mechanical ventilation induced hypotension.
The occurrence of re-institution of mechanical ventilation after weaning in acutely poisoned mechanically ventilated admitted to ICU of PCCA weaning trial was observed in 11 cases (17.5%) all failed and reinstitution of mechanical ventilation was done & it occurred within24h.
Significant positive correlation between failureweaning of mechanical ventilation and duration of mechanical ventilation as well as mortality was evident .
The results of this study revealed that (65.1 %) of patients received vasopressor and inotropic therapy. Also we concluded that vasopressor use is associated with increased mortality and increased duration of MV.
Regrettably exact cause of death, mechanism of death, and manner of death was not reported in patients sheets.
This current study prevealed that avoiding chest complication and proper infection control measures may play a significant role in reducing mortalities among the poisoned MV patients.
We’ve got to stop killing the people by improper use of MV. It is intended to help recovery not to produce serious fatal complications.