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The symptoms of carbon monoxide (CO) poisoning are nonspecific, ranging from dizziness and headache to unconsciousness and death. A German national guideline on the diagnosis and treatment of this condition is lacking at present.This review is based on a selective literature search in the PubMed and Cochrane databases, as well as on existing guidelines from abroad and expert recommendations on diagnosis and treatment.The initiation of 100% oxygen breathing as early as possible is the most important treatment for carbon monoxide poisoning. In case of CO poisoning, the reduced oxygen-carrying capacity of the blood, impairment of the cellular respiratory chain, and immune-modulating processes can lead to tissue injury in the myocardium and brain even after lowering of the carboxyhemoglobin (COHb) concentration. In patients with severe carbon monoxide poisoning, an ECG should be obtained and biomarkers for cardiac ischemia should be measured. Hyperbaric oxygen therapy (HBOT) should be critically considered and initiated within six hours in patients with neurologic deficits, unconsciousness, cardiac ischemia, pregnancy, and/or a very high COHb concentration. At present, there is no general recommendation for HBOT, in view of the heterogeneous state of the evidence from multiple trials. Therapeutic decision-making is directed toward the avoidance of sequelae such as cognitive dysfunction and cardiac complications, and the reduction of mortality. Smoke intoxication must be considered in the differential diagnosis. The state of the evidence on the diagnosis and treatment of this condition is not entirely clear. Alternative or supplementary pharmacological treatments now exist only on an experimental basis.High-quality, prospective, randomized trials that would enable a definitive judgment of the efficacy of HBOT are currently lacking.

Background Adverse drug reactions (ADR) are a common reason for emergency room visits and for hospitalization. An ADR is said to have occurred when the patient's symptoms and signs are considered to be possibly, probably, or definitely related to the intake of a drug. Methods In four large hospital emergency departments, one in each of four German cities ( Ulm, Furth, Bonn, and Stuttgart), the percentage of suspected ADR cases among all patients presenting to the emergency room was determined during a 30-day period of observation. ADRs were ascertained by screening the digital records of all patients seen in the emergency room; causality was assessed as specified by the WHO-UMC (Uppsala Monitoring Center). Results ADR were sought in a total of 10 174 emergency department visits. 665 cases of suspected ADR were found, yielding a prevalence of 6.5%. The prevalence of ADR among patients with documented drug intake was 11.6%. Among the patients with documented suspected ADRs, 89% were hospitalized (in contrast to the 43.7% hospitalization rate in the entire group of 10 174 emergency department visits). A possible causal relationship between the patient's symptoms and signs and the intake of a drug was found in 74-84% of cases. Patients with ADR were found to be taking a median of 7 different drugs simultaneously. Conclusion Adverse drug reactions are a relevant cause of emergency department visits, accounting for 6.5% of the total visits in this study, and often lead to hospital admission. The ADRED (Adverse Drug Reactions in Emergency Departments) study, which is now being conducted, is intended to shed further light on their causes, patient risk factors, and potential avoidability.

The number and proportion of emergency admissions of elderly patients with multiple morbidities and correspondingly extensive medication plans has been increasing continuously in recent years (1, 2). Adverse drug events (ADEs) are common reasons for treatment, but are often not recognized as such (1, 3– 6). Adverse drug events are caused by either conventional adverse drug reactions (ADRs) (7) or medication errors (MEs) (6) that lead to clinical symptoms. Overall, greater attention to drug therapy safety seems to be necessary in elderly patients. To identify and prevent risks more easily, lists of potentially inappropriate medications (PIMs) for elderly patients have been developed on the basis of expert consensus. Well-known examples are the Beers list (8), the STOPP and START criteria (9), and, since 2010 in Germany, the PRISCUS list (10, 11). It is assumed that these potentially inappropriate medications are associated with an increased risk of ADEs in elderly patients. Current studies, however, indicate that PIMs are responsible for only a relatively small percentage of ADEs in elderly patients (1, 12, 13). Moreover, in the international literature on PIMs a substantial percentage of drugs and cases were excluded from analyses, and no distinction was made between MEs and ADRs (1, 14). This raises the question of the extent to which errors caused by methodological shortcomings when data on ADEs were collated led to database bias, causing the potential number of PIMs to be underestimated. There are currently no studies available on the occurrence of such events in acute clinical care for drugs on the PRISCUS list. This study therefore aimed to investigate the effects of PIMs on elderly patients admitted as emergency cases regarding ADEs, involving and not involving MEs.

Increasingly, patients are admitted to hospital as emergency cases beyond the remit of outpatient emergency care. The university medical center in Erlangen has registered annual increases of up to 10%. Thanks to the continuous availability of medical services, a large proportion of patients even present to hospitals independently (1, 2). The organizational structures of emergency departments vary widely, partly—but not entirely—owing to the links with rescue services and the general environment of the hospital. Different organizational approaches range from outpatient admission units with triage systems to special emergency outpatient clinics (“chest pain unit”) or admission units for emergencies where possible referrals/transfers to specialist wards or units are decided only after a time delay—for example, the next morning (1, 3– 6). Although triage instruments have become the quality standard in emergency departments, and time intervals—for example, from the patient’s arrival to initial contact with a doctor/nursing staff—can be measured in a replicable fashion, this does not allow any conclusions about the quality—in the sense of correctness/appropriateness of measures—or about the time it takes to reach a diagnosis. Ultimately, quality indicators are lacking in the heterogeneous area between outpatient care delivered by general practitioners and inpatient care (4, 7). The main requirements for an emergency department are, however, homogenous. They consist of recognizing the acutely life threatening condition of the patient, providing appropriate treatment, or referring the patient for such treatment. This process comprises primary diagnostics and risk stratification on the basis of lead symptoms, initial care, and organization of further specialist diagnostic tests and treatment (1, 2, 6, 8). The present study aims to investigate whether on the basis of data from the hospital information system—data whose documentation is mandatory and that are available in an electronic format—objectifiable numerical parameters of an emergency department can be calculated and used as potential quality indicators.