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Query: UMLS:C0012833 (dizziness)
 9,689 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Three incidences of carbon monoxide poisoning occurred owing to defective heating systems. Twelve persons were affected; of these, three lost their lives. Because the symptoms of carbon monoxide poisoning closely resemble flu and other common illnesses, correct diagnosis was not made as promptly as it might have been. Hemorrhages were found in the nerve fiber layer of the retina in all five of the patients who had been exposed for more than 12 hours. It is our contention, therefore, that complete examination of the patient should always include ohthalmoscopy, and that the finding of retinal hemorrhages, in addition to nausea, headache, and dizziness, should aler the physician to the possibility of carbon monoxide poisoning.
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PMID:Retinal hemorrhages in subacute carbon monoxide poisoning. Exposures in homes with blocked furnace flues. 63 61

Two diving incidents were investigated in which 1) an experienced professional diver (A) lost consciousness during an air dive to 69 meters, and 2) an amateur sports diver (D) lost consciousness during a 40-meter air dive. In subsequent tests both divers' ventilatory responses to inspired carbon dioxide were found to be extremely low. Under simulated diving conditions, Divers A and D exhibited marked carbon dioxide retention during exercise at 30 meters (end-tidal PCO2 = 65 and 57 mmHg, respectively) and at 70 meters, Diver A stopped work in less than 3 min because of severe dizziness. Reduced sensitivity to carbon dioxide, perhaps caused by the interaction of hypercapnia and nitrogen narcosis, is thought to have been partly responsible for these incidents.
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PMID:Observations after loss of consciousness under water. 67 82

Carbon monoxide (CO) poisoning is the commonest single cause of fatal poisoning in the U.K. (Broome & Pearson, 1988). The clinical features are numerous and include headache, fatigue, dizziness, confusion, memory loss, paraesthesia, chest pain, abdominal pain, nausea, and diarrhoea as well as coma, convulsions and death. Without adequate treatment many patients develop neuropsychiatric sequelae including headaches, irritability, memory loss, confusion and personality changes. The diagnosis of CO poisoning is often suggested only by circumstances surrounding the victim, and remains a challenge to the A&E department. Hyperbaric oxygen therapy (HBO) is internationally accepted as the most powerful form of treatment in severe cases (Drug & Therapeutics Bulletin, 1988; Lowe-Ponsford & Henry, 1989). However, in the U.K. treatment with HBO is often not considered due to lack of hyperbaric facilities (Meredith & Vale, 1988; Anand et al., 1988), and due to inadequate awareness on the part of hospital staff. We report a case of a patient deeply unconscious as a result of CO poisoning, in which serial treatments with HBO over a period of 14 days, produced dramatic results.
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PMID:Management of the moribund carbon monoxide victim. 811 Mar 42

Hyperventilation is of little clinical relevance unless it causes symptoms. These are often non-specific. Their threshold for onset and relation to steady level of arterial (or its equivalent, end-tidal PCO2; PETCO2) are uncertain, and it has been suggested that they may relate better to the rate of fall of PCO2 than to the absolute level. We investigated this in nine normal subjects, who breathed to and fro through a pneumotachograph into an open circuit in which the concentration of CO2 could be varied. Tidal volume, respiratory frequency and ventilation was measured on-line by a Compaq computer, and PETCO2 at the mouth was measured by capnograph. Subjects overbreathed at a fixed rate and depth until symptoms consisting of dizziness, paraesthesiae and light headedness occurred. Then, without their knowledge and while they continued to overbreathe, inspired CO2 was increased to restore PETCO2 to normal and abolish symptoms, and was then withdrawn again over either approximately 0.1, 2.5 or 5 min until symptoms were again reported. The PETCO2 at this point was noted. The three protocols were performed in each subject in a random order and the same symptoms were reported each time. When averaged across all subjects, symptoms occurred at mean PETCO2 values of 20.3, 19.2 and 18.6 mmHg (2.71, 2.56 and 2.48 kPa), respectively. These were not significantly different, and it can be concluded that there was no influence of rate of fall of PCO2 on threshold for symptoms. Chest pain only occurred in one subject and may have a different mechanism.
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PMID:Relation of hypocapnic symptoms to rate of fall of end-tidal PCO2 in normal subjects. 144 88

Two hundred and twenty three cases of acute carbon monoxide poisoning were observed during acute stage and followed-up subsequently for three months. Through single factor and multiple factors analyses, six out of 97 observed factors were demonstrated as risk factors for the development of delayed encephalopathy, namely, elderliness, mental work, previously with hypertension, coma lasting for 2-3 days, long standing dizziness and fatigue after regaining consciousness and mental stimulation during recovery. Based on these factors, a regression equation for predicting the probability of developing delayed encephalopathy in individual patient with acute carbon monoxide poisoning has been established In order to minimize the development of delayed encephalopathy, it is advisable to keep the patients of acute carbon monoxide poisoning with above mentioned related factors under constant monitoring and surveillance.
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PMID:[Related factors for the development of delayed encephalopathy following acute carbon monoxide poisoning]. 160 69

An outbreak of complaints consisting primarily of eye and respiratory tract irritation accompanied by headache, dizziness, fatigue, and nausea occurred among the operating room personnel of a large metropolitan hospital. This initially was attributed to infiltration of diesel exhaust emissions into the ventilation system. However, following correction of this problem and subsequent unrevealing air monitoring, symptoms persisted and were noted in personnel in adjacent areas of the hospital as well. An industrial hygiene and medical evaluation was undertaken. Monitoring for carbon monoxide, formaldehyde, and anesthetic gases and review of medical records and patient examinations were unrevealing, and the problem resolved gradually over several weeks. This outbreak represents a case of building-associated illness among health professionals in a hospital setting that was triggered by a single, identifiable noxious exposure but was sustained despite any apparent ongoing noxious exposures.
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PMID:Sick-hospital syndrome. 186 55

Thyrotropin-releasing hormone (TRH) stimulates pituitary thyrotropin synthesis and release and also regulates autonomic nervous system functions by acting as a neuromodulator and neurotransmitter. In experimental animals a stimulation of ventilation by thyrotropin-releasing hormone was shown when applied at central nervous system sites that affect respiratory motor output. It was the goal of our study to investigate the respiratory properties of thyrotropin-releasing hormone on basal and stimulated (i.e. CO2-rebreathing) conditions following systemic thyrotropin-releasing hormone application in healthy humans. Thyrotropin-releasing hormone (200 micrograms, 400 micrograms intravenous) initiated a rapid short lasting rise of minute volume, ventilatory air-flow and alveolar oxygen tension under steady state breathing (P less than 0.001). Breathing frequency was less affected, heart rate rose concomitantly (P less than 0.001). While breathing with increasing concentrations of carbon dioxide, minute volume was higher under thyrotropin-releasing hormone than under placebo alone. Further effects (e.g. nausea, dizziness, palpitations) mostly appeared later than respiratory changes and thus may not be responsible for their initiation. Our findings prove systemic thyrotropin-releasing hormone to be a strong respiratory stimulant in man. Response in respiratory output was also accompanied by central nervous system-effects (e.g. dizziness, restlessness, augmented vigilance). The mode of thyrotropin-releasing hormone effects on respiration after peripheral administration is still speculative. An augmented sympathetic output or a direct receptor mediated action at central nervous system sites may be responsible, while a peripheral effect cannot be excluded.
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PMID:Thyrotropin-releasing hormone has stimulatory effects on ventilation in humans. 190 74

Five patients presented to the emergency department (ED) following exposure in an enclosed space to methylene chloride (dichloromethane), used for removing paint. Two workers and three rescuers were involved. Two rescuers complained only of dizziness and mild nausea, and were subsequently discharged from the ED. One rescuer was asymptomatic. Worker no. 1 arrived in cardiac arrest and eventually died in the ED despite resuscitation efforts. Worker no. 2 also presented to the ED in cardiac arrest, and was successfully resuscitated to pulse and blood pressure. However, he never regained consciousness or spontaneous respirations, and died on the fourth day. Of interest is that worker no. 2's carboxyhemoglobin level increased from 2% to 8% over the 9 hours following admission, despite administration of 40% to 50% oxygen by endotracheal tube. Among the conclusions that can be drawn are (1) the cause of death in these patients was not carbon monoxide poisoning, but solvent-induced narcosis; (2) carboxyhemoglobin levels may continue to rise following cessation of exposure, despite administration of high flow oxygen; (3) rescuers can easily become victims if proper protective clothing and respirators are not worn.
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PMID:Methylene chloride: report of five exposures and two deaths. 222

To investigate occult carbon monoxide poisoning in patients with neurologic illness, we prospectively studied 168 patients who presented to the emergency department between December 1987 and February 1988 with neurologic symptoms for evidence of carbon monoxide exposure. Patients with known carbon monoxide poisoning were excluded. The mean carboxyhemoglobin level was 3.1 percent; there were no significant differences in carboxyhemoglobin between categories of neurologic illness (F(5,162) = 1.35; p less than 0.25). Five patients (3 percent) had a carboxyhemoglobin greater than 10 percent, with levels ranging from 11.7 percent to 29.5 percent. After controlling for the effects of active and passive exposure to cigarette smoke, problems with the home heating system (odds ratio 9.6; p less than 0.03) and the presence of cohabitants with concurrent headache or dizziness (odds ratio 21.6; p less than 0.0001) were associated with an increased risk of a carboxyhemoglobin greater than 10 percent. A rule for obtaining carboxyhemoglobin tests only on patients who used gas stoves for heat or who had symptomatic cohabitants would have correctly identified all patients with carboxyhemoglobins greater than 10 percent, correctly excluded 77 percent of patients with lower levels, and eliminated the need for testing in 75 percent of cases. We conclude that unrecognized carbon monoxide poisoning occurs in a small but important fraction of patients with wintertime neurologic illness and can be identified by a characteristic risk factor profile.
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PMID:Occult carbon monoxide poisoning in patients with neurologic illness. 238 Oct 21

This clinical study was preceded by two laboratory experiments. The first experiment compared temperature changes in the vestibule while vaporizing a 0.6-mm stapedotomy with Argon, KTP-532, and CO2 lasers. Data demonstrated that the CO2 laser possesses superior tissue characteristics for stapedotomy. In the second experiment safe energy parameters were established for various Sharplan CO2 laser models. Using these safe power settings, 153 consecutive CO2 laser stapedotomies were performed under local anesthesia. No patient experienced intraoperative dizziness during or immediately following the application of the CO2 laser to the stapes footplate. Long-term postoperative hearing results demonstrated that 87% of the patients maintained an air/bone gap to within 10 dB and 94% maintained an air/bone gap to within 15 dB (mean follow-up 32 months). No patient incurred a significant sensorineural hearing loss (greater than 10 dB) in the speech range. Four patients developed a perilymph fistula (three immediate and one delayed) and fluctuating sensorineural hearing loss, but all were successfully repaired without significant permanent nerve deafness. At 4,000 Hz, five patients lost 20 dB and two patients dropped 40 dB compared with preoperative levels. Postoperative complications included four perilymph fistulas, two prostheses displaced from the stapedotomy opening, one fixed prosthesis, and one fixed incus. Seven of eight of these complications were successfully revised. At the time of this writing, 6/153 patients have a persistent conductive hearing loss greater than 20 dB and have not been revised. Using appropriate energy parameters, the CO2 laser provides a safe, efficient microsurgical tool for performing stapedotomy simply and with minimum inner ear trauma.
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PMID:CO2 laser stapedotomy. 229 97


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