Tuesday, July 27, 2010

Contents in tobacco smoke

Just have a look at what a tobacco smoke contains and the relevance of those contents in our lives!

The real facts about tobacco

  • Tobacco smoke has negative effects on nearly every organ of the body and reduces overall health.[1]
  • Tobacco smoke contains over 4,000 chemicals, including at least 50 that cause, initiate or promote cancer such as tar, ammonia, carbon monoxide, oxides of nitrogen and benzopyrene.[2]
  • In 2001, over 40 billion cigarettes (42,301 billion) were sold in Canada.[3]
  • Child labour is widespread in all major tobacco producing countries.[4]
  • Smoking in movies is thought to be the most powerful pro-tobacco influence on teens today, accounting for 52% of adolescents who start smoking, an effect even stronger than cigarette advertising.[5]
  • The prevalence of smoking in Canada is declining among youth.  In 2008, across the country, 15% of youth 15 – 19 years old reported that they were regular smokers.  This number has not changed from the same period one year before.[6] 
  • In Ontario, youth are smoking even less.  Only 11.9 % of students in grades 7 – 12 reported that they smoked daily in 2007.  This number is down from 22% in 1999.[7]
  • Breathing in second-hand smoke causes over 1,000 deaths in Canadian non-smokers from lung cancer and heart disease every year.[8]
  • A non-smoker in a smoky room is inhaling the same chemicals as a smoker.[9]
  • The earlier you start smoking, the higher your chances are of becoming addicted to nicotine and continuing to smoke as an adult.[10]
  • Most youth who smoke want to quit but few succeed.[11] One study found that among youth who smoke, 77 percent have made one or more serious quit attempts in the last year but few of these are successful.[12]
  • If you are caught supplying or selling tobacco to youth you can be fined hundreds or even thousands of dollars for breaking the law.
  • Your choice to smoke is affected by factors such as your beliefs and attitudes, your culture, the communities you live in, your friends and family and even whether you are stressed or feel unsafe.[13]
  • Cannabis smoke is potentially carcinogenic in the same way that cigarette smoke is. Cannabis smoke contains over 400 chemicals, many of them carcinogenic.[14]
  • Youth who smoke are more likely to be depressed during their teens and even into their twenties.[15]
  • Teens who smoke cigarettes may be less like­ly to eat a healthy diet and exercise regularly.[16]
  • People who smoke are less likely to exercise.[17]
  • Smokers who want to become more physically active may find it difficult to get past the early stages of exercise because they have trouble breathing.[18]   As a result they often become discouraged and give up.
  • According to researchers at Stanford University if you are next to a person smoking outdoors, you can breathe in smoke that is much more concentrated than normal air pollution levels.  In fact, being within a few feet of a smoker outdoors may expose you to air pollution levels that are similar to levels measured in homes and bars.[19]
  • In 2008, 33% of Canadian youth ages 15-19, tried little cigars or cigarillos and 10% had smoked a little cigar or cigarillo in the past 30 days. [20]
  • A larger number of young adults ages 20-24 (50%) tried little cigars or cigarillos and 13% reported smoking a little cigar or cigarillo in the past 30 days. [20] 
Health Canada Website, Accessed March 15, 2007: http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/body-corps/index-eng.php
Health Canada Website, Accessed March 15, 2007: http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/fact-fait/fs-if/index-eng.php
CCTC Website: Industry Watch FAQs Accessed March 16, 2007. http://www.cctc.ca/cctc/EN/industrywatch/faqs
World Health Organization Website:  Accessed March 16, 2007, http://www.who.int/mediacentre/news/releases/2004/pr36/en/
Dalton, M.A., et.al. (2003). Effect of smoking in movies on adolescent smoking initiation: a cohort study. Published by the Lancet, online June 10, 2003. Accessed March 17, 2007 http://smokefreemovies.ucsf.edu/pdf/Dalton-Lancet.pdf
Canadian Tobacco Use Monitoring Survey: Health Canada Website http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/research-recherche/stat/_ctums-esutc_2008/wave-phase-1_summary-sommaire-eng.php
Centre for Addiction and Mental Health. (2007). Drug Use Among Ontario Students 1977 – 2007. The results of the Ontario Student Drug Use and Health Survey.  Released November 20, 2007.  http://www.camh.net/Research/Areas_of_research/Population_Life_Course_Studies/OSDUS/ OSDUHS2007_DrugDetailed_final.pdf
Makomaski Illing, E.M., & Kaiserman, M.J. (2004). Mortality attributable to tobacco use in Canada and its regions, 1998. Canadian Journal of Public Health, Jan-Feb:95(1):38-44.
United States Environmental Protection Agency. (1992). Respiratory health effects of passive smoking: lung cancer and other disorders (p 3-2). Washington, DC: Indoor Air Division, Office of Atmospheric and Indoor Air Programs, Office of Air and Radiation.
Milton, M.H., Maule, C.O., Yee, S.L., Backinger, C., Melarcher, & A.M., Husten, C.G. (2004) Youth Tobacco Cessation:  A Guide for Making Informed Decisions. Atlanta:  U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.
Sussman S. (2002). Effects of sixty six adolescent cessation use trials and seventeen prospective studies of self-initiated quitting. Tobacco Induced Disease, 1, 35-81.
Hollis J.F., Polen MR, Lichtenstein E, & Whitlock EP. (2003). Tobacco use patterns and attitudes among teens being seen for routine primary care, American Journal of Health Promotion 17(4): 231-9.
Kaczynski AT, Manske SR, Mannell RC, Grewal K. Smoking and physical activity: A systematic review. American Journal of Health Behaviour. 2008;32(1):93-110.
Conwell, L.S., O'Callaghan, M.J., Andersen, M.J., Bor, W., Najman, J.M., & Williams, G.M. (2003). Early Adolescent Smoking and a Web of Personal and Social Disadvantage. Journal of Paediatrics and Child Health, 39, 580-585.
Centre for Addiction and Mental Health (CAMH) Understanding the Effects and Risks of Cannabis Use: Frequently Asked Questions and Answers. http://www.camh.net/About_Addiction_Mental_Health/Child_Youth_Family_Resources/ Cannabisfactsheet4effects.pdf
Chaiton M, Zhang B. Environment modifies the association between depression symptoms and smoking among adolescents. Psychology of Addictive Behaviors 2007 Sep;21(3):420-424. http://www.ncbi.nlm.nih.gov/pubmed/17874894?ordinalpos=1&itool=EntrezSystem2.PEntrez. Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
Larson NI, Story M, Perry CL, Neumark-Sztainer D, Hannan PJ. Are diet and physical activity patterns related to cigarette smoking in adolescents? Findings from project EAT. Preventing Chronic Disease 2007 Jul;4(3):A51. – pdf full text http://www.cdc.gov/pcd/issues/2007/jul/pdf/06_0053.pdf
Costakis CE, Dunnagan T, Haynes G. The relationship between the stages of exercise adoption and other health behaviors. American Journal of Health Promotion. 1999;14:22-30.
Klepeis NE, Ott W, Switzer P. Real-time measurement of outdoor tobacco smoke. Journal of the Air and Waste Management Association 2007 May;57(5):522-34. http://secure.awma.org/journal/pdfs/2007/5/10.3155-1047-3289.57.5.522.pdf See also: http://news-service.stanford.edu/news/2007/may9/smoking-050907.html
Canadian Tobacco Use Monitoring Survey:  Health Canada Website http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/research-recherche/stat/_ctums-esutc_2008/wave-phase-1_summary-sommaire-eng.php Ref:  http://www.smoke-fx.com

Tuesday, July 13, 2010



Fat embolism
It is a common pathological finding following long bone fracture especially with lower limb fractures e.g. Femur and Pelvis. It is common in fractures that have not been immobilized.
It can also occur after:
- Prosthetic joint replacement
- Cardiac massage
- Liver trauma
- Burns
- Marrow transplant
- Marrow biopsy
- Rapid high altitude decompression and liposuction
- Non traumatic etiology: Fatty liver, prolonged corticosteroid therapy, acute pancreatitis, osteomyelitis, conditions causing bone infarcts such as sickle cell disease.
It may occur in previously young and healthy individuals. More common 24 – 72 hours post fracture.


Marrow fat enters the circulation and lodges in the lungs causing mechanical obstruction.

Clinical features:
1. Hypoxia
2. Coagulopathy with transient petechial rash on neck, axilla and skin folds.
3. Neuro disturbance: confusion, disorientation, coma.
4. Clinically stable patients may deteriorate with low grade fever, petechial rash, hypoxia and confusion.
5. Jaundice and renal dysfunction are possible.

GURD’S criteria for diagnosis of Fat pulmonary embolism:
1. Axillary or subconjunctival petechial
2. Hypoxemia (PaO2<60 mm Hg, FiO2 110/min)
2. Pyrexia (Temperature >38.5 degree celcius)
3. Emboli present in retina on fundus examination
4. fat present in urine
5. Sudden unexplained drop in hemotocrit or platelet values
6. Fat globules present in sputum
7. Increasing sedimentation rate
Diagnosis requires at least 4 major and 1 minor criteria.

-Clinical suspicion in patients with lower limb fractures presenting with tachypnoea and hypoxia.
-Fat globules in urine.
Chest radiograph: Bilateral alveolar infiltrates. ARDS can develop.

CT Thorax: ground glass opacities / nodular opacities- centrilobular, subpleural
V/Q SCAN: perfusion scan shows multiple peripheral subsegmental defects.
Echocardiographic findings: Fat embolism can be identified in real time during orthopedic procedure.
Imaging recommendations:
Chest radiograph is usually adequate for detection of lung disease and monitoring disease course.

ARDS, Hydrostatic pulmonary edema, neurogenic pulmonary edema, Infection, Pulmonary hemorrhage, Acute venous thrombo embolic disease, Pulmonary contusion, Aspiration.

1. Immobilization of fracture site.
2. Fluid replacement
3. Oxygen
4. Supportive care.

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