Abstract Glyphosate-based herbicides (GlyBH) are widely used worldwide and are generally considered to have low acute toxicity in humans. However, increasing evidence suggests that exposure to concentrated formulations, especially those containing surfactants such as polyoxyethylene amine, can result in severe systemic toxicity. Gastrointestinal manifestations are usually limited to mucosal injury, and bowel gangrene following glyphosate ingestion has not been previously described in the literature. We report a fatal case of acute GlyBH poisoning in a 17-year-old male who presented 14 h after ingestion with severe abdominal pain and metabolic acidosis. Clinical examination and radiological findings were suggestive of peritonitis, prompting emergency exploratory laparotomy. Intraoperatively, extensive gangrene of the small bowel was identified, with patchy involvement of the cecum and spleen. The patient underwent damage control bowel resection followed by a relook surgery with ileocolic resection and end ileostomy. Although initially stabilized postoperatively, he subsequently developed acute respiratory distress syndrome, acute kidney injury, severe thrombocytopenia, hospital-acquired pneumonia, and mixed septic and cardiogenic shock. Echocardiography revealed severe left ventricular dysfunction. Despite aggressive intensive care management and supportive therapy, the patient showed progressive clinical deterioration and died on postoperative day 20. This case highlights bowel gangrene as an exceptionally rare and previously unreported complication of GlyBH poisoning. It emphasizes the potential for catastrophic gastrointestinal and multisystem toxicity following ingestion and the importance of early recognition, aggressive supportive treatment, and close intensive monitoring in severe cases.
Abstract Introduction: Acute kidney injury (AKI) frequently complicates acute respiratory distress syndrome (ARDS) and leads to poor outcomes. Although prone ventilation in moderate-to-severe ARDS improves oxygenation and survival, AKI may offset these benefits and contribute to mortality. Furthermore, multiple factors have been implicated in AKI risk in ARDS, but have not been comprehensively synthesized. Methods: This review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines. PubMed, Embase, Scopus, and the Cochrane Library were searched. Observational studies reporting AKI prevalence and mortality in ARDS patients were included. Risk ratios (RR), prevalence estimates, and mean differences were pooled using random-effects models. Results: Twenty-one studies ( n = 5631) were included with 13 supine-and 8 prone-ventilated cohorts. AKI was associated with increased mortality (RR 2.40, P < 0.00001), with a numerically higher risk observed with prone than supine ventilation. Subgroup analysis revealed a significantly higher mortality risk in coronavirus disease 2019 (COVID-19)-ARDS compared to non-COVID-19 (RR 2.88 vs. 1.72; P < 0.0001). The AKI-mortality association remained robust regardless of ECMO ( P < 0.0001) or vasopressor use ( P < 0.0001), with no significant subgroup differences. AKI prevalence was high in both prone (47%) and supine (43%) groups. Meta-analysis identified older age, diabetes, obesity, higher serum lactate levels, lower PaO 2 /FiO 2 , and ECMO use as risk factors for AKI. Conclusion: AKI is highly prevalent in ARDS and is associated with a more than two-fold increase in mortality risk, irrespective of prone or supine ventilation. This association is consistent across COVID-19 and non-COVID-19 patients, as well as those requiring ECMO or vasopressors, highlighting AKI as a critical prognostic indicator in ARDS care.
Abstract Introduction: According to the World Health Organization, traffic accidents are a leading cause of fatalities, particularly among young adults aged 5–29, with hemorrhage being the primary cause of death in traumatic incidents. The average time from the onset of shock to death is approximately 2 h, illustrating the need for rapid assessment, timely intervention, and prompt transport to a trauma centre. EEmergency Medical Professional (EMP), are typically the first on the scene to attend to patients with traumatic injuries and play a crucial role in determining patient outcomes; they must be on their toes in the management of these emergencies. Methods: Our aim was to assess the proficiency of Emergency Medical Professionals (EMPs) in handling hemorrhagic shock in a simulated scenario. The simulation study comprised 300 Emergency Medical Professionals, both new and experienced across India, and was conducted over a period of 6 months. The participants were scored on a checklist with a maximum of 10 points. High-fidelity manikins were used, and participants were divided into 30 groups for 45-min sessions, which included pre-briefing, simulation, and debriefing. Results: The results demonstrate strong proficiency among EMPs in initial trauma assessment skills but reveal critical gaps in recognizing life-threatening conditions like exsanguinating hemorrhage and “Load and Go” situations. Despite exhibiting technical proficiency in the International Trauma Life Support ITLS primary survey, participants struggled to translate assessments into life-saving interventions. There was a significant failure to recognize exsanguinating hemorrhage (46.7%), declare “load-and-go” situations (36.3%), and administer tranexamic acid (0%). In the Indian context of prolonged transport times, this lack of situational awareness is concerning. Bridging this gap requires targeted, simulation-based experiential learning to help EMPs evolve from simply completing checklists to executing rapid, critical prioritization in real-world emergencies. Conclusion: The study highlights a notable proficiency gap among EMPs in key shock management skills, emphasizing the importance of continuous training to enhance patient outcomes and elevate care standards in trauma care.
Abstract Introduction: Acute Respiratory Distress Syndrome (ARDS) results in severe hypoxemia and decreased lung compliance due to alveolar–capillary damage, often requiring mechanical ventilation. Ketamine has bronchodilatory and anti-inflammatory properties, suggesting a potential therapeutic role in ARDS. This study evaluated the clinical effects of nebulized ketamine in ventilated ARDS patients. Methods: A randomized, double-blind controlled trial was conducted on 40 mechanically ventilated adults with ARDS, divided into two equal groups. Group K received nebulized ketamine (0.75 mg/kg) three times daily, whereas Group C served as control. Daily Sequential Organ Failure Assessment (SOFA) scores and P/F ratios were recorded, and Murray scores and Interleukin 6 (IL-6) levels were measured on Days 1, 3, and 5. Additional outcomes included 28-day mortality and sedative and vasopressor requirements. Results: Group K demonstrated significant improvement in P/F ratio on Days 2 and 3. Murray scores improved earlier and remained superior in Group K from 24 h through Day 5. SOFA scores showed a significant reduction from Day 3 onward, accompanied by decreased IL-6 levels on Days 3 and 5. No major adverse effects were noted, and mortality and hemodynamic support needs were comparable between groups. Conclusion: Nebulized ketamine appears to be a safe and beneficial adjunct in ARDS management, improving oxygenation and reducing inflammatory response. Larger, multicenter trials with extended follow-up are needed to validate these findings and determine the optimal administration strategy.
