summaryIntentional acute toxicity by colchicine is not common but accompanies a high rate of complications and mortality. It is generally assumed to be an emergency in clinical toxicology. Rapid diagnosis and treatment can prevent death. The most common causes of death in this toxicity are acute cardiac failure, shock, and dysrhythmias with hematopoietic complications occurring in later stages. We report three cases of acute colchicine toxicity, two of which expired, with different presenting and ongoing signs and symptoms. We aimed to define the different possible clinical manifestations of the toxicity and review the probable treatments available for these patients.

Background: Carbon monoxide (CO) poisoning results in hundreds of deaths and thousands of emergency department visits all over Iran annually. In this study, we aim to provide an epidemiologic analysis of this poisoning in different consciousness levels. Methods: This single-center retrospective study was conducted at a referral poison center from March 21, 2007 to March 19, 2012 in Tehran, Iran. All CO poisoned children and adults who hospitalized were evaluated based on their on-arrival consciousness level. Results: Two-hundred-sixty patients with pure CO poisoning were enrolled with the majority of males (55.4%). CO exposure was unintentional in 99.6% of cases. The average period between CO exposure and the patients' hospital admission was 6.4 hours (SD = 11.2). Most of the toxicities had occurred at home (73.5%). On arrival acid-base status revealed respiratory acidosis cases in 11.9% of cases. Central nervous system imaging revealed 6.2% abnormal finding. Typically, patients presented with vomiting (25.8%), nausea (22.7%), and dizziness (11.3%). Twenty-nine patients (11.2%) needed intubation and mechanical ventilation. Thirty-six patients admitted to ICU with a median [IQR] hospital stay of 6 [2, 18] days. Ultimately, 202 (78.6%) patients discharged and 47 (18.3%) left the hospital against medical advice, 5 (1.9%) died, and 10 (3.8%) experienced sequellae. Two patients (0.8%), were transferred to other hospitals for specialized care. Conclusions: The incidence and mortality rate of CO poisoning in the current study are still higher than many other parts of the world. Ongoing health prevention strategies are not efficiently working. Hence, constant public education and warning about CO toxicity should be highlighted.

: The current systematic review aimed at investigating different medications commonly used for procedural sedation and analgesia (PSA) in emergency departments (EDs) for adults. The articles related to the subject of interest were searched in five electronic databases, including Google Scholar, PubMed, Medline, Web of Science, Scopus, and Embase, up to 2019. The blinded, randomized, controlled, clinical trials comparing common PSA medications, including midazolam, etomidate, propofol, fentanyl, ketamine, and ketofol, among the adults undergoing PSA in EDs were included in the study. The search process resulted in the inclusion of 35 papers in the study. The main information, including clinical features, sedation duration, recovery time, and incidence of adverse events, was extracted from the selected studies. Based on the reviewed studies, various combinations of medications are used for PSA depending on the hospital protocols and policies; however, there is still controversy over the best choice. As the results of the retrieved articles indicated, propofol is the most common medication used for PSA in EDs due to the shorter time of induction, rapid recovery of consciousness, and fewer side effects. Etomidate and ketamine were also identified as other common sedatives applied for PSA.

Background: Job burnout, defined as a syndrome derived from prolonged exposure to stressors at work, is often observed in health care workers. Shift work and job satisfaction are considered two of the occupational risks for burnout in nurses. Nurses have stress and health complaints. In addition, nurses are likely to job burnout. Objectives: The current study aimed to determine the prevalence of job burnout and its association with work schedules and job satisfaction among Iranian nurses in a public hospital. Methods: This cross-sectional study was conducted in one of the largest Iranian public hospitals among 362 nurses (response rate: 80.44%) in Tehran, Iran. The Maslach burnout inventory (MBI-22) and demographic factors questionnaire were used in the present study. The relationship between job burnout with work schedules and job satisfaction was investigated with multiple logistic regression analysis. Results: The mean age and work experience of the participants were 36.14 ± 8.59 and 15.23 ±9.30 years, respectively. The result indicated a relatively high prevalence of burnout (particularly, personal accomplishment) among the study population. In general, 64.4% of participants reported low personal accomplishment level. The nurses engaged in shift work reported higher levels of emotional exhaustion (odds ratio (OR) = 1.02, 95% confidence interval (CI) = 1.006-1.041, P-value = 0.008); there was no relationship between work schedules with depersonalization and personal accomplishment. The result showed significant relationship between job satisfaction and emotional exhaustion (OR = 0.945, 95% CI = 0.928-0.963, P-value < 0.001) and personal accomplishment (OR = 1.003, 95% CI = 1.014-1.058, P-value = 0.001). Conclusions: The current study revealed that the Iranian nurses are exposed to a considerable risk of personal accomplishment. Also, job burnout is in association with shift working and low job satisfaction level. In this regard, working pressure, type of job and income may affect job burnout. Ergonomic interventional programs are recommended to improve the working conditions.

10.30699/jambs.30.142.407 Background & Objective: Procedural sedation and analgesia (PSA) includes the administration of sedative/dissociative medications with or without the concomitant delivery of analgesic agents. The bispectral index system (BIS) is a modern technology for neurophysiological monitoring that continuously analyzes the patient's electroencephalogram curve during sedation to assess the level of consciousness. This study aimed to compare various PSA protocols, including propofol/fentanyl, propofol/ketamine, and ketamine, based on the BIS and other critical items in adults with anterior shoulder dislocation (ASD) in the emergency department. Materials & Methods: This randomized three-group double-blinded clinical trial was conducted on 150 patients with ASD in Besat General Hospital in Tehran, Iran. The sample size was determined at 50 individuals in each group receiving propofol/fentanyl (group A), propofol/ketamine (ketofol; group B), and ketamine (group C). Before PSA, the sensor of the BIS monitor was attached to the patient, and several items were compared, including the side effects and duration of sedation, as well as BIS values before and 1-5 min after PSA.Results: Visual analogue scale scores before and after the intervention were obtained at 8.1±0.69 and 2.08±0.7, respectively. The BIS values at the 1 st , 2 nd , 3 rd , 4 th , and 5 th min after PSA were not different in the three groups. The comparison between the three groups regarding the patients' satisfaction showed that there was a significant difference between them (P=0.02), which was higher in the ketofol group. Conclusion:The investigation of PSA using propofol/ketamine, ketamine, and propofol/fentanyl showed similar frequencies of BIS values and adverse respiratory events. The use of propofol/fentanyl was associated with a slightly higher incidence of hypotension. Moreover, the frequency of patient satisfaction was higher among the subjects in group B, compared to those in the other groups.