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11 th November 2015.  ECG: normal sinus rhythm  Raised Neutrophils (11.9 x 10 9 cells/ml)  CK = 409 IU/l  Normal U&Es  Normal LFTs  Normal Troponin.

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Presentation on theme: "11 th November 2015.  ECG: normal sinus rhythm  Raised Neutrophils (11.9 x 10 9 cells/ml)  CK = 409 IU/l  Normal U&Es  Normal LFTs  Normal Troponin."— Presentation transcript:

1 11 th November 2015

2  ECG: normal sinus rhythm  Raised Neutrophils (11.9 x 10 9 cells/ml)  CK = 409 IU/l  Normal U&Es  Normal LFTs  Normal Troponin I

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4 Justice Keith, R v. Michael Brown [2013] EWCA Crim. 1726

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6 Emerg Med J. 2014; 31: 45-7. Reproduced with thanks from TICTAC, St Georges’ Hospital, London. Ketamine

7 http://www.wedinos.org/db/samples/index/page:3 Health promotion opportunity

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14 N Engl J Med. 2005;352(11):1112-20

15 Hyperpyrexia Kills!

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19 +/- GI Obstruction

20 Urgent Surgical Removal if toxic or obstructed Body packers & body stuffers: Management

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23 Incomplete combustion of hydrocarbons Sources Vehicle emissions Cigarette smoke Gas heaters, fires, boilers Solid fuel heaters Coal fires ConcentrationSource 0.1ppmNatural atmosphere 0.5-5ppmAverage home level 5-15ppmNear gas stoves in homes 100-200ppmExhaust fumes, Mexico City 5000 ppmExhaust home wood fire 7000ppmUndiluted car exhaust, no catalytic convertor

24 1921, Dr William Wilmer, American Journal Ophthalmology Couple c/o headache and fatigue, heard bells and footsteps, saw mysterious figures... Severely damaged furnace 2005, 23 year old saw “ghost in shower”... New gas water heater, improperly installed American Journal Emergency Medicine 2005; 23: 903-904

25 TOXBASE http://www.toxbase.org NPIS helpline 0344 892 0111

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