Impact of coronavirus disease 2019 pandemic on pediatric poisoning in a single emergency department in Korea

Purpose@#This study was performed to investigate the coronavirus disease 2019 pandemic-related changes in epidemiological features of pediatric patients with poisoning who visited a local emergency medical center in Incheon, Korea. @*Methods@#We reviewed medical records of the patients (aged ≤ 18 years) who visited the emergency department (ED) from 2015 through 2022 and obtained discharge diagnoses containing "intoxication" or "poisoning," excluding food allergy and game addiction. Time of visit was categorized as pre-pandemic (2015-2019) and pandemic (2020-2022) periods. They were investigated for age, age groups (children [0-9 years] vs. adolescents [10-18 years]), sex, visits during weekend or holiday, exposure-to-ED time, psychiatric history, intentionality, alcohol consumption, substances, therapeutic interventions, and outcomes. The outcomes included need for hospitalization and discharge against medical advice. @*Results@#Among a total of 358 patients with poisoning, 162 (45.3%) visited during the pandemic period, and 220 (61.5%) were adolescents. Compared to the patients who visited during the pre-pandemic period, those who visited during the pandemic period showed significantly higher frequencies of girls (45.9% vs. 81.5%), age of 10-18 years (46.4% vs. 79.6%), intentionality (33.7% vs. 74.7%), alcohol consumption (4.1% vs. 11.7%), need for hospitalization (24.5% vs. 62.3%), and discharge against medical advice (3.1% vs. 25.9%). @*Conclusion@#In the ED, pediatric poisoning became more intentional, female and adolescent-dominant, and severe in their outcomes during the pandemic.

Correlation between hs-CRP and CRP velocity and in-hospital short term prognosis in acute myocardial infarction, which arrived in the ER within 6 hours after symptoms are expressed

Objective@#This study is to measure the high sensitivity C-reactive protein (hs-CRP) value in acute myocardial infarction (AMI) patients who arrive within 6 hours of the symptom manifestation and see how the resulting value affects the short term prognosis in AMI patients. @*Methods@#This study was conducted on 118 patients who had less than 6 hours of onset-to-door time among 149 patients who were diagnosed with myocardial infarction in emergency room and undergo percutaneous coronary intervention (PCI) for 2 years from September 2017. The group including main adverse cardiovascular outcomes were compared in the patients according to the blood test figures (hs-CRP on admission [CRP1], CRP velocity [CRPv], post-PCI hs-CRP [CRP2], and CRP difference values [CRP2-1]). @*Results@#In this study, the average of the hs-CRP values of AMI patients arriving within 6 hours of the symptom manifestation was 2.2±2.3 mg/L. CRP velocity that corrected the CRP value to the elapsed time after the onset of symptoms and N-terminal probrain natriuretic peptide (NT-proBNP) appeared to be significantly correlated with the occurrence of main adverse cardiovascular outcomes (P=0.03). @*Conclusion@#The hs-CRP values of AMI patients arrived within 6 hours of the symptom manifestation showed the mean risk group. CRPv and NT-proBNP showed a significant casual relationship with main adverse cardiovascular outcomes.

A Case of Saponated Cresol Ingestion which Led to Altered Mentality, Chemical Dermal Burn, and Liver Toxicity

Saponated cresol solutions are common household disinfectants worldwide. Their main component, concentrated cresol, is extremely toxic and fatal; however, precise information on the clinical manifestations of cresol intoxication is not available. We report on a case of suicidal poisoning by ingestion of saponated cresol. A 63-year-old male presented with unconsciousness and brownish discoloration on the neck and anterior chest wall after ingesting 100 ml of 50% saponated cresol solution with suicidal attempt. The patient showed a wide range of clinical features of cresol intoxication, including decreased consciousness, respiratory distress, strong carbolic acid odor, dark brown urine, and chemical dermal burns on multiple areas. General treatment of cresol intoxication is intensive supportive care. In addition, reducing systemic absorption is most important in patients with cresol intoxication who present with cresol burns. Because the rate of cresol absorption through the skin is proportional to the size of the area involved and the duration of contact of the chemical with the skin rather than to the concentration of the cresol solution, gross decontamination, including removal of contaminated clothing and vigorous flushing with water, is very important. Quantitative assays for cresol and its metabolites in blood or urine are needed in order to confirm the diagnosis. However, because these analytical methods are time consuming and are not routinely available in most emergency departments, the clinical manifestations of this case may be useful in early diagnosis and treatment.

A Case of Saponated Cresol Ingestion which Led to Altered Mentality, Chemical Dermal Burn, and Liver Toxicity

Saponated cresol solutions are common household disinfectants worldwide. Their main component, concentrated cresol, is extremely toxic and fatal; however, precise information on the clinical manifestations of cresol intoxication is not available. We report on a case of suicidal poisoning by ingestion of saponated cresol. A 63-year-old male presented with unconsciousness and brownish discoloration on the neck and anterior chest wall after ingesting 100 ml of 50% saponated cresol solution with suicidal attempt. The patient showed a wide range of clinical features of cresol intoxication, including decreased consciousness, respiratory distress, strong carbolic acid odor, dark brown urine, and chemical dermal burns on multiple areas. General treatment of cresol intoxication is intensive supportive care. In addition, reducing systemic absorption is most important in patients with cresol intoxication who present with cresol burns. Because the rate of cresol absorption through the skin is proportional to the size of the area involved and the duration of contact of the chemical with the skin rather than to the concentration of the cresol solution, gross decontamination, including removal of contaminated clothing and vigorous flushing with water, is very important. Quantitative assays for cresol and its metabolites in blood or urine are needed in order to confirm the diagnosis. However, because these analytical methods are time consuming and are not routinely available in most emergency departments, the clinical manifestations of this case may be useful in early diagnosis and treatment.

Comparison of Obstetric and Neonatal Outcomes According to Oral Glucose Challenge Test in Korean Pregnant Women / 대한주산의학회잡지

PURPOSE: The purpose of the study was to compare obstetric and perinatal outcomes according to glucose challenge test (GCT) in a single institution. METHODS: One thousand six women, who were underwent antepartum gestational diabetes mellitus (GDM) screening by a GCT in mid-pregnancy and delivered at National Health Service between January 1, 2007 and July 31, 2012, were included in the study. The medical records of patients were analyzed retrospectively. The Subjects were categorized into three groups according to the results of 50 g oral GTC and 100 g oral GTC; normal glucose tolerance (NGT, n=826), less than 140 mg/dL; gestational impaired glucose tolerance (GIGT, n=128), more than 140 mg/dL but non-GDM ; gestational diabetes mellitus (GDM, n=52). Pre-existed maternal DM or hypertension and twin pregnancy were excluded. Obstetric and perinatal outcomes were compared among the three groups. RESULTS: Maternal age, parity, and pre-pregnancy body mass index were higher in the GDM. The preterm delivery and gestational hypertension increased across the groups from NGT to GIGT to GDM (13.9% vs. 18.8% vs. 25.0%, P<0.01, and 1.9% vs.5.5% vs. 13.5%, P<0.01, respectively). Large for gestational age (LGA) and Neonatal Intensive Care Unit admission rate were higher in order in NGT, GIGT, and GDM (6.2% vs. 15.6% vs. 15.4%, P<0.01, and 12.3% vs. 24.2% vs. 38.5%, P<0.01), but other complications requiring intensive care were not different among the groups, including meconium aspiration syndrome and birth asphyxia. CONCLUSION: GDM was a risk factor of cesarean section, preterm delivery, and gestational hypertension. In addition, GIGT was positively correlated with gestational hypertension, preterm labor, cesarean section rate, and LGA. This study suggests that there is a need to develop a guideline for Korean pregnant women who were diagnosed with GIGT.

Serotonin Syndrome After an Overdose of Dextromethorphan and Chlorpeniramine: Two Case Reports

Dextromethorphan and chlorpeniramine are common ingredients of over-the-counter (OTC) cough pills. They are known to be safe when used alone, however, combination with other serotonergic drugs or use of an overdose can cause serotonergic toxicity. We report on a 43-year-old male and a 57-year-old female who ingested an overdose of antitussive drugs containing dextromethorphan and chlorpeniramine. They commonly presented with altered mentality and hyperreflexia on both upper and lower extremities. After conservative therapies, they were discharged with alert mentality. These cases are meaningful in that there are few cases of serotonin syndrome with an overdose of a combination of dextromethorphan and chlorpeniramine. Careful use with medication counseling for OTC cough pills is needed in order to prevent overdose of these ingredients.

A Case of Central Nervous System (CNS) Toxicity in Acute Organophosphate Intoxication

Acute organophosphate intoxication is important because of its high morbidity and mortality. The mortality is still high despite the use of atropine as specific antidotal therapy and oximes for reactivation of acetylcholinesterase. Inhibition of acetylcholinesterase by organophosphate can cause acute parasympathetic system dysfunction, muscle weakness, seizure, coma, and respiratory failure. Acute alteration in conscious state or a coma, which may occur following organophosphate intoxication, is an indication of severe intoxication and poorer prognosis. This acute decline in conscious state often reverses when the cholinergic crisis settles; however, it may be prolonged in some patients. We report on a case of a 60-year-old male who showed prolonged decline in conscious state due to of Central Nervous System (CNS) toxicity after a suicide attempt with organophosphate.

Two Cases of Ethylene Glycol Poisoning

Ethylene glycol poisoning is treated mainly by alcohol dehydrogenase inhibition therapy and hemodialysis. Early recognition and initiation of treatment is important because toxic metabolites increase over time by hepatic metabolism; however, there is no confirmative diagnostic tool in our clinical setting. Therefore, diagnosis is dependent on history, high anion gap acidosis, high osmolal gap, etc.. Diagnosis and treatment are delayed in cases where history taking is not possible, such as a mental changed patient. Authors report on two cases of ethylene glycol poisoning by contrasting clinical outcomes, demonstrating the importance of early diagnosis and treatment for achievement of a good outcome.

A Case of Delayed Carbon Monoxide Encephalopathy

Following are brief statements about the delayed encephalopathy of a patient who recovered without disturbance of consciousness after acute carbon monoxide poisoning. A 72-year-old male was found without consciousness at home and then visited the ER center. Later we learned that the patient was using briquettes as a household heating source. Blood carbon monoxide hemoglobin level was 17.5%. As carbon monoxide poisoning was uncertain after the first interview with the patient, hyperbaric oxygen therapy was not administered at the early stage. After supplying 100% oxygen, the patient recovered consciousness, however, the strength of the lower limb muscle had decreased to class II. The patient showed continued weakening of the lower limb muscle and an increase of CPK; therefore, he was diagnosed as carbon monoxide intoxication and rhabdomyolysis and then admitted to the intensive care unit (ICU) for conservative treatment. During the hospitalization period, continued weakening of the lower limb muscle was observed and he was diagnosed as myopathy after EMG/MCV. However, he suddenly showed altered mentality on the 20th day of hospitalization, and underwent brain MRI. T2 weighted MRI showed typically high signal intensity of both globus pallidus and periventricular white matter; therefore, he was diagnosed as delayed carbon monoxide encephalopathy. This case showed delayed encephalopathy accompanied by rhabdomyolysis and myopathy of a patient who recovered without disturbance of consciousness.

A Case of Fentanyl Toxicity with Misused Durogesic Transdermal Patch

Fentanyl, a synthetic, highly selective opioid micro-receptor agonist, is 50 to 100 times more potent than morphine. The low molecular weight, high potency, great transdermal permeation rate and lipid solubility of fentanyl make it very suitable for transdermal administration. Durogesic is a novel matrix transdermal system providing continuous systemic delivery of fentanyl. In recently, there are many reports that misused or overused fentanyl transdermal patches result in severe intoxication of fentanyl. We present a case of fentanyl toxicity with misused durogesic transdermal patch and discuss the safe and appropriate application of the patches. In conclusion, fentanyl patches should be used in opioid tolerant patients and prescribed at the lowest possible dose and titrated upward as needed. All patients and their caregivers should be educated safe application of fentanyl patches and advised to avoid exposing the patches application site to direct external heat sources, such as heating pads, or electric blankets, heat lamps, sauna, hot tubs, and others. In addition, concomittant medications that affect fentanyl's metabolism should be avoided.

Clinical Bilateral Poplitear Artery Entrapment Syndrome Caused by a Anomalous Origin of the Gastrocnemius Muscle / 대한스포츠의학회지

Popliteal artery entrapment syndrome can result from abnormal branching patterns of the popliteal artery or the anatomically abnormal placement of nearby muscles and tendons leading to a sustained compression of the popliteal artery. This compression leads to chronic capillary damage and early arteriosclerosis and embolism that can lead to distal ischemia. Thus early treatment is required to prevent harm to the lower limb. This is a rare congenital disease that mostly affects young adults, usually presenting with intermittent claudication of the leg, coldness and edema. A case where a 16-year-old female presented with pain and coldness in the lower right limb that started 1 year ago will be discussed. In this case, magnetic resonance imaging and arterial angiography lead to a diagnosis of popliteal artery entrapment resulting from an abnormal origin of the medial head of Gastrocnemius.

An Evaluation of the Disaster Medical System after an Accident which Occurred after a Bus fell off the Incheon Bridge

PURPOSE: Field triage, medical care, and transportation are important and life-saving medical tasks performed at the site of a mass-casualty incident (MCI). We experienced a mass-casualty incident when an express bus fell off the Incheon bridge and conducted an evaluation of problems. We are willing to provide information for equipping an local disaster planning. METHODS: We surveyed the local emergency medical system response time, transportation time, and patients' clinical data using paramedics' records and medical records. We evaluated the adequacy of the order of priority of transportation by field triage used using the simple triage and rapid treatment (START) method. We evaluated field medical care, as well preponderance of transportation. RESULTS: Twenty four people who were on the bus were evacuated, and 2 persons were dead on the scene. Two persons died within one week. There was a transport delay for patients who would benefit significantly from medical intervention because dead persons were transported early. Neither advanced airway nor fluid resuscitation was provided. Sixteen patients (66.7%) were transported to one hospital. CONCLUSION: When we reviewed this mass-casualty incident, there was no appropriate medical control, such as triage, field medical care, and transportation. In construction of the emergency medical service system for preparation for MCI or disasters, we suggest integration and unification of 119 rescue services and emergency medical information centers for effective medical control. Disaster drills should be performed according to guidelines for local emergency medical services.

Surgical Treatment of Muller-Weiss Disease: A Case Report / 대한족부족관절학회지

Muller-Weiss disease is a rare disease presenting severe deformity of navicular with osteoarthritis. This disease can be confused with Kohler's disease, but has a different entity. A 68 years-old male with painful mid-foot deformity had diagnosed as Muller-Weiss disease, and triple arthrodesis with autogenous iliac bone graft had been performed on his left foot. Here is a report of our case with brief review of this disease.

Outcome of Pediatric Out-of-Hospital Cardiac Arrest

PURPOSE: We analyzed the characteristics and outcome of pediatric out-of-hospital cardiac arrest. METHODS: Pediatric out-of-hospital cardiac arrest from January 2000 to December 2005 at two tertiary hospitals were described and evaluated using the Utstein style. We reviewed the records retrospectively and analyzed the outcome variables which were any return of spontaneous circulation (ROSC), sustained ROSC, survived event, and survival to hospital discharge. Neurologic outcome was assessed by the Pediatric Cerebral Performance Category (PCPC) scale. RESULTS: The study included 62 children with out-of-hospital cardiac arrest. Any ROSC was achieved in twenty patients (32.3%). Sustained ROSC of any ROSC group was achieved in sixteen patients (80.0%). Of the sustained ROSC group, fourteen patients (87.5%) were admitted to hospital, and only four patients (28.6%) of survived event group survived to hospital discharge. The prevalent etiology were injuries. Although 35 children (56.5%) of the arrests occurred at home with family members present, only 1 patients received bystander CPR. Nonshockable rhythm (96.8%) were showed more than shockable rhythm (3.2%). In any ROSC group, time to initiation of CPR was 9.3 minutes,duration of total CPR was 20.4 minutes. CONCLUSION: Mortality of pediatric out-of-hospital cardiac arrest was high and neurologic outcome was poor. Factors that increased survival rate were prevention of injuries, enhanced education programs of bystander CPR, rapid initiation of CPR.