Nicolas Delvau

Cyanide poisoning by fire smoke inhalation: a European expert consensus

Smoke inhalation is a common cause of cyanide poisoning during fires, resulting in injury and even death. In many cases of smoke inhalation, cyanide has increasingly been recognized as a significant toxicant. The diagnosis of cyanide poisoning remains very difficult, and failure to recognize it may result in inadequate or inappropriate treatment. Findings suggesting cyanide toxicity include the following: (a) a history of enclosed-space fire; (b) any alteration in the level of consciousness; (c) any cardiovascular changes (particularly inexplicable hypotension); and (d) elevated plasma lactate. The feasibility and safety of empiric treatment with hydroxocobalamin for fire smoke victims have been reported in the literature. On the basis of a literature review and a panel discussion, a group of European experts has proposed emergency management protocols for cyanide toxicity in fire smoke victims.

Multimarker panel in patients admitted to emergency department: a comparison with reference methods.

OBJECTIVES Point of care testing and multimarker panels are rapidly expanding in emergency departments. We determined the reliability of Short-of-Breath SOB panel in patients admitted for acute dyspnea and/or chest pain. DESIGN AND METHODS SOB D-dimer, BNP, cTnI, CK-MB and myoglobin assays were compared with references in 97 outpatients. RESULTS The correlation between SOB and references methods was acceptable, but with limited precision and accuracy. CONCLUSIONS Diagnostic performances and cut-off values should be further validated before clinicians replace traditional cardio-respiratory biomarkers by the new SOB panel.

LETTERS TO THE EDITOR: Emergency department management of exacerbation of chronic obstructive pulmonary disease: low compliance or real world?: Letters to the Editor

Reply Like McCaughan, we are both in the unfortunate position of owning and driving a car in NSW, and have therefore faced the frustration associated with licence renewal. We consequently agree that any system that attempts to provide an opportunity for discussion of organ donation would need to be carefully thought through, systematically organized and appropriately funded. We accept that our paper did not provide the costing and administrative detail that would be necessary for our proposal to be turned into policy. Nonetheless, it is feasible that a model of a 5-min discussion with only those licence holders who refused donation would come in well under the

Emergency department management of exacerbation of chronic obstructive pulmonary disease: low compliance or real world?

13.4 million allocated for public awareness and education in the Australian ‘World’s Best Practice (WBP) Reform Plan’. While in general terms we are supportive of the WBP approach, it is worth pointing out that none of the countries with leading organ donor rates uses the model described by McCaughan; that there are important differences between the ‘Spanish Model’ and what is referred to as WBP (differences that may ultimately compromise the success of reforms of organ donation in Australia); that WBP is modelled after countries who are all, with the exception of the USA, opt-out countries – thereby negating the necessity for registration of donor intention; and that regardless of the approach they have taken very few countries have achieved donor rates of 25–35 p.p.m. (only Spain, Belgium, Portugal and occasionally the USA). That said, we are largely in agreement with McCaughan that increasing consent rates from 45% to 55% to 80% (the rate achieved in Spain) will not bring Australia’s organ donation rate to anywhere near WBP and that it is vitally important that ongoing efforts are made to increase the identification of donors. Our concern however, was that the Australian Organ Donor Register process is neither the best nor most ethical means for increasing consent to organ donation and that alternative approaches, such as the one we outlined in our paper, are necessary to maximize the translation of potential donors into actual donors. Australia needs to increase both the identification of donors and the rate of consent to donation, tasks that require different and complementary strategies. While WBP appears to include some useful strategies to improve donation, it is not a panacea, and therefore thinking about how we can improve consent rates is neither irrelevant nor unethical.

Antidotes for cyanide poisoning

Reply Like McCaughan, we are both in the unfortunate position of owning and driving a car in NSW, and have therefore faced the frustration associated with licence renewal. We consequently agree that any system that attempts to provide an opportunity for discussion of organ donation would need to be carefully thought through, systematically organized and appropriately funded. We accept that our paper did not provide the costing and administrative detail that would be necessary for our proposal to be turned into policy. Nonetheless, it is feasible that a model of a 5-min discussion with only those licence holders who refused donation would come in well under the

LETTERS TO THE EDITOR: Emergency department management of exacerbation of chronic obstructive pulmonary disease: low compliance or real world?

13.4 million allocated for public awareness and education in the Australian ‘World’s Best Practice (WBP) Reform Plan’. While in general terms we are supportive of the WBP approach, it is worth pointing out that none of the countries with leading organ donor rates uses the model described by McCaughan; that there are important differences between the ‘Spanish Model’ and what is referred to as WBP (differences that may ultimately compromise the success of reforms of organ donation in Australia); that WBP is modelled after countries who are all, with the exception of the USA, opt-out countries – thereby negating the necessity for registration of donor intention; and that regardless of the approach they have taken very few countries have achieved donor rates of 25–35 p.p.m. (only Spain, Belgium, Portugal and occasionally the USA). That said, we are largely in agreement with McCaughan that increasing consent rates from 45% to 55% to 80% (the rate achieved in Spain) will not bring Australia’s organ donation rate to anywhere near WBP and that it is vitally important that ongoing efforts are made to increase the identification of donors. Our concern however, was that the Australian Organ Donor Register process is neither the best nor most ethical means for increasing consent to organ donation and that alternative approaches, such as the one we outlined in our paper, are necessary to maximize the translation of potential donors into actual donors. Australia needs to increase both the identification of donors and the rate of consent to donation, tasks that require different and complementary strategies. While WBP appears to include some useful strategies to improve donation, it is not a panacea, and therefore thinking about how we can improve consent rates is neither irrelevant nor unethical.

Effect of continuous positive airway pressure combined to nebulization on lung deposition measured by urinary excretion of amikacin

However, we disagree that sodium thiosulphate adds to the effectiveness of hydroxocobalamin. We especially disagree that it improves outcome for severe cyanideinduced toxicity. We compared hydroxocobalamin to hydroxocobalamin with sodium thiosulphate and did not find a difference on group comparisons of vital signs, cyanide levels, other laboratory values and mortality [2]. In addition, on the basis of previous animal and human studies, if the patient does not respond to the vasopressor or the antidotal effects of hydroxocobalamin, the patient is unlikely to benefit from sodium thiosulphate, a drug that may take up to 30 min to take effect and is poorly transported into the mitochondrial membrane [2,5].

Emergency orthopaedic surgery under noninvasive ventilation after refusal for general anaesthesia.

Reply Like McCaughan, we are both in the unfortunate position of owning and driving a car in NSW, and have therefore faced the frustration associated with licence renewal. We consequently agree that any system that attempts to provide an opportunity for discussion of organ donation would need to be carefully thought through, systematically organized and appropriately funded. We accept that our paper did not provide the costing and administrative detail that would be necessary for our proposal to be turned into policy. Nonetheless, it is feasible that a model of a 5-min discussion with only those licence holders who refused donation would come in well under the

Saturomètre en médecine générale

13.4 million allocated for public awareness and education in the Australian ‘World’s Best Practice (WBP) Reform Plan’. While in general terms we are supportive of the WBP approach, it is worth pointing out that none of the countries with leading organ donor rates uses the model described by McCaughan; that there are important differences between the ‘Spanish Model’ and what is referred to as WBP (differences that may ultimately compromise the success of reforms of organ donation in Australia); that WBP is modelled after countries who are all, with the exception of the USA, opt-out countries – thereby negating the necessity for registration of donor intention; and that regardless of the approach they have taken very few countries have achieved donor rates of 25–35 p.p.m. (only Spain, Belgium, Portugal and occasionally the USA). That said, we are largely in agreement with McCaughan that increasing consent rates from 45% to 55% to 80% (the rate achieved in Spain) will not bring Australia’s organ donation rate to anywhere near WBP and that it is vitally important that ongoing efforts are made to increase the identification of donors. Our concern however, was that the Australian Organ Donor Register process is neither the best nor most ethical means for increasing consent to organ donation and that alternative approaches, such as the one we outlined in our paper, are necessary to maximize the translation of potential donors into actual donors. Australia needs to increase both the identification of donors and the rate of consent to donation, tasks that require different and complementary strategies. While WBP appears to include some useful strategies to improve donation, it is not a panacea, and therefore thinking about how we can improve consent rates is neither irrelevant nor unethical.