Paraquat a rapidly acting, nonselective herbicide is a leading cause of fatal poisoning in many parts of Asia. After rapid absorption, paraquat is concentrated inside many cells where it undergoes redox cycling. Clinical features are largely due to intracellular effects. Paraquat is actively concentrated into lung tissue leading to pneumonitis and lung fibrosis. Paraquat also causes gastrointestinal, renal, and liver injuries. Activated charcoal and Fuller's earth can minimize further absorption. Gastric lavage is contraindicated. Hemodialysis and hemoperfusion are unlikely to change the clinical course. The use of immunosuppression with dexamethasone, cyclophosphamide, and methylprednisolone evidence for efficacy is weak. Antioxidants such as acetylcysteine and salicylate used as free radical scavenging might be beneficial. The case fatality is very high in this herbicide due to the lack of effective treatment options.

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Background: Skin and soft-tissue infections (SSTIs) vary in presentations, ranging from simple cellulitis to rapidly progressive necrotizing fasciitis. Early diagnosis is vital to reduce the complications. Materials and Methods: This prospective, observational, cohort study conducted between April 1, 2018 and June 30, 2018, in the emergency department (ED) of large tertiary care hospital in South India. In this study, all patients >15 years of age with traumatic or nontraumatic SSTI were enrolled consecutively, and SSTI associated with burns were excluded. The 353 patients were interviewed with a prestructured questionnaire and the statistical analysis was performed using SPSS 25.0. This study was aimed to find the incidence of SSTI and the outcome. Results: The cohort consists of… patients with age group between 40 and 65 years, and there was male predominance. Nonnecrotizing SSTI was the most common presentation. The incidence rate was 1.9%. Diabetes mellitus (DM) was the common risk factor n (%). Lower limbs were the most commonly affected site. The most common organism isolated in the blood and pus culture were Staphylococcus epidermidis and mixed flora. A large number (33.9%) of patients required in-patient care and surgical interventions. The mortality rate in our cohort was n (14%). Conclusion: The incidence of SSTI in patients presenting to the ED remains high. DM was the common risk factor, and many required inpatient care, and surgical intervention including amputation. Despite prompt diagnosis and management, mortality rate was still significant.

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Background: The sickest patients who visit the emergency department (ED) are triaged as priority one based on guidelines. To improve the quality of Emergency medicine (EM) care, a better understanding of patients is needed; hence, this study was done on priority one patients of the ED. Materials and Methods: This retrospective study included all priority one patients during a 4-month period (February, May, September, and December), over 1 year (2017). Demographic details, vital signs at the time of presentation, and details of disposition were noted. Results: Among 2333 priority one patients, majority (89.3%) had non trauma-related diseases, while only 10.7% had trauma as the cause of disease. Males were predominant (64%) and females accounted for 36%. Adults were more than half (59.16%), followed by the geriatric age group. Bradycardia was noted in 6.4% (149) patients, while 52.1% (1212) had tachycardia and 29.7% of the population presented with hypotension. Breathlessness was the most common complaint (44.6%); trauma specialty departments were referred to include neurosurgery (43.1%) and orthopedics (27.5%). Broader specialties such as general medicine and general surgery had majority of their spectrum-related cases referred to them, 44.9% (n = 716) and 39.3% (n = 50), respectively. More than a quarter of patients (27.2%) were discharged from the ED, one-third (68.1%) of the patients were discharged from the hospital overall, and 7.4% succumbed to death. Conclusion: The patient demographics and other characteristics identified by this study help us to guide and shape Indian EM training programs, infrastructure, and faculty development, to more accurately reflect the burden of acute disease in India.

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Formic acid poisoning, especially intentional, carries a high risk of mortality and morbidity. Unavailability of antidote and rapid deterioration after consumption is an important factor in the management of these types of poisoning. Here, we report a case of suicidal formic acid poisoning which presented to our emergency department. Our objective is to review the literature on formic acid poisoning with emphasis on the role and utility of endoscopy in determining its severity and prognosis.

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