Predicting Factors for the Development of Rhabdomyolysis in the Carbon Monoxide Poisoning

PURPOSE: Carbon monoxide (CO) poisoning can cause rhabdomyolysis and acute kidney injury (AKI). However, until recently, studies regarding CO-induced rhabdomyolysis were rarely reported. This study was conducted in order to determine the risk factors for prediction of development of CO-induced rhabdomyolysis. METHODS: We retrospectively reviewed the medical records of 70 CO poisoned patients who presented to an emergency department from January 2010 to December 2012. CO poisoning related parameters, patient demographics, and laboratory data were analyzed. RESULTS: Rhabdomyolysis and AKI were observed in 11 patients (15.7%) and six (8.6%) patients, respectively. Time of exposure to CO, age, Glasgow coma scale, and leukocyte count differed significantly between patients who developed rhabdomyolysis and patients who did not. Exposure time to CO was the only risk factor for predicting development of rhabdomyolysis (odds ratio, 1.365; 95% confidence interval, 1.014-1.836; p=0.040). CONCLUSION: The frequency of rhabdomyolysis in CO poisoning was 15.7% and fluid therapy was very effective in treatment of CO-induced rhabdomyolysis and prevention of AKI progression. An exposure time to CO of over 5 hours was a factor with high potential for predicting development of CO-induced rhabdomyolysis. Along with patients' symptoms and signs, this factor should be considered in assessment of patients with CO poisoning.

Direct Medical Direction Performed in an Emergency Medical Information Center

PURPOSE: This study was performed to evaluate the appropriateness of medical direction for the prehospital emergency treatment of 119 rescue services in an emergency information center. METHODS: A total of 4,028 cases requested by 119 rescue services from January 1, 2008 to December 31, 2009 were reviewed retrospectively. Medical direction for requests of 119 rescue services constituted five categories. The appropriateness of medical direction for prehospital emergency treatment of 119 rescue services was evaluated according to area and specialty. RESULTS: The majority of the 119 rescue service requests concerned resource information (72.4%). Medical direction for prehospital treatment comprised a small proportion of the requests (13.2%). The total appropriatenss of medical direction for prehospital treatment was 56.4% and was higher in emergency physician than non-emergency physician. The appropriatenss difference between two areas was not determined. CONCLUSION: The requests for prehospital emergency treatment of 119 rescue services was low. The appropriatenss of medical direction for emergency treatment was low and higher appropriatenss was observed in emergency physician.

Direct Medical Direction Performed in an Emergency Medical Information Center

PURPOSE: This study was performed to evaluate the appropriateness of medical direction for the prehospital emergency treatment of 119 rescue services in an emergency information center. METHODS: A total of 4,028 cases requested by 119 rescue services from January 1, 2008 to December 31, 2009 were reviewed retrospectively. Medical direction for requests of 119 rescue services constituted five categories. The appropriateness of medical direction for prehospital emergency treatment of 119 rescue services was evaluated according to area and specialty. RESULTS: The majority of the 119 rescue service requests concerned resource information (72.4%). Medical direction for prehospital treatment comprised a small proportion of the requests (13.2%). The total appropriatenss of medical direction for prehospital treatment was 56.4% and was higher in emergency physician than non-emergency physician. The appropriatenss difference between two areas was not determined. CONCLUSION: The requests for prehospital emergency treatment of 119 rescue services was low. The appropriatenss of medical direction for emergency treatment was low and higher appropriatenss was observed in emergency physician.

Effect of the Emergency Trauma Team's Management on the Treatment of Patients with Multiple Severe Trauma

PURPOSE: We performed this study to determine how the emergency trauma team affects the treatment of patients with multiple severe trauma and to discuss the effect and the direction of the emergency trauma team's management. METHODS: We performed a retrospective analysis of 518 patients who visited our emergency department with severe trauma from August 2006 to July 2008. We divided the severe trauma patients into 2 groups : patients before and after trauma team management (Group 1 and Group 2). Then, we compared demographic characteristics, mechanisms of injury, and treatment outcomes (lengths of stay in the ED, admission ratio, and in-hospital mortality) between the 2 groups. In the same way, patients with multiple severe trauma were divided into 2 groups, that are patients before and after trauma team management (Group 3 and Group 4) and analyzed. RESULTS: There was no significant difference, except mean age, between groups 1 and 2. In group 4 patients, compared to group 3 patients, the lengths of stay in the ED were lower (p value < 0.001), and the admission ratio were higher (p value = 0.017), but there was no significant difference in the in-hospital mortality between the groups 3 and 4. CONCLUSION: When patients with multiple severe trauma visit the ED, the emergency trauma team's management can decrease the lengths of stay in the ED and increase the admission ratio, but does not produce a decrease in the in-hospital mortality rate. Further investigations of emergency trauma team management are needed to improve treatment outcomes for patients with multiple severe trauma.