The Validity of the Triage Tool as a Method to Screen Severe Alcoholic Intoxication Patients in the Emergency Department

PURPOSE: Altered mental status is common to alcohol intoxicated patients, resulting in difficulties to perform detailed physical examination and history taking. With this condition, the development of appropriate tools for evaluation was required. This study was conducted to investigate a better method for predicting the prognosis among alcohol intoxicated patients in the emergency department by modifying the Korean Triage Acuity Scale (KTAS). METHODS: We retrospectively reviewed the medical records of 1,155 alcohol intoxicated patients who presented to the ED between January and December of 2013. The correlation between admission and demographical characteristics of patients was analyzed. We applied the clinical values to KTAS (overdose category) and modified KTAS (alcoholic intoxication category). The efficiency of two triage methods was compared by using the receiver operating characteristic (ROC) curve analysis. RESULTS: Among these 1,155 patients, 201 were admitted and 954 were discharged. The sensitivity and specificity of the overdose category were 0.736 and 0.623, respectively. Those of the alcoholic intoxication category were 0.647 and 0.979, respectively. The area under ROC curves for overdose category and alcoholic intoxication category were 0.679±0.020 and 0.813±0.021, respectively (95% confidence interval, p<0.001). CONCLUSION: This study showed that the sensitivities of the overdose category and the alcoholic intoxication category were similar. However, the specificity of the alcoholic intoxication category was higher than that of the overdose category. Therefore, the alcoholic intoxication category was superior to the overdose category in predicting the prognosis among alcohol intoxicated patients.

Comparative Study of Uses and Characteristics of Emergency Medical Service between Islands and Urban Areas

PURPOSE: Despite the development of transportation, accessibility of medical service on islands is still poor. Therefore, providing adequate emergency medical services is becoming more important. The purpose of this study is to measure and describe utilization patterns of emergency medical services for the residents of islands. METHODS: A retrospective cross-sectional observational study of transported patients who live on islands and in urban areas from January 1st, 2011 to December 31th, 2013 was conducted. Through review of emergency medical technician (EMT) transfer records, the demographic information of transferred patients, the frequency of emergency medical services (EMS) activation, and the characteristics of transfer were collected. RESULTS: A total of 31,690 people were included; 29,064 people of urban areas and 2,626 people of islands. The mean age was older in the residents of islands (66+/-19 years old vs. 50+/-24 years old, p<0.001). For the residents of islands, the landline phone is the most common means of EMS activation (36.4% vs 29.9%, p<0.001), and the highest frequency of EMS activation was June (10.9% vs. 9.0% in August, p<0.001). The distance of transfer was longer for islands (5 min, 2-12) compared with urban areas (3 min, 2-4) (p<0.001). CONCLUSION: The above is an important indicator of specificity and form of urban residents and island residents using the EMS. It is our purpose that efficient EMS service be provided depending on each specificity.

Death from Ingestion of beta-fluoroethyl Acetate Rodenticide

The highly toxic sodium monofluoroacetate (SMFA) was banned as a rodenticide in this country in the 1980s. The fluoroacetate metabolite, fluorocitric acid blocks cellular metabolism by inhibiting the Klebs cycle, producing widespread clinical effects including respiratory, neurologic, cardiologic, and fluid-electrolyte abnormalities. We report the case of intentional ingestion of a derivative product, beta-fluoroethyl acetate. A 79-yr-old female was brought to the emergency room without any problem. At 2hours post ingestion, she had a generalized tonic-clonic seizure and then, was unresponsive to painful stimuli. At 6hours post ingestion, she died from refractory ventricular fibrillation. We report this patient to increase awareness of beta-fluoroethylacetate toxicity.

Retroperitoneal Ectopic Pregnancy: A Case Report

A retroperitoneal ectopic pregnancy is a very rare form of extrauterine pregnancy and is a potentially life threatening variation of ectopic gestation within the retroperitoneal cavity. In fact, the clinical history, physical examination, laboratory and vaginal ultrasonographic findings are non specific. It is a surgical emergency because of high maternal and fetal morbidity and mortality. Early diagnosis is essential. Surgical intervention is indicated as soon as the diagnosis is made. We report our experience with one retroperitoneal ectopic pregnancy with a brief review of the literature

Change in the Intrathecal Cytokine level in Hypoxic-ischemic Encephalopathy after Cardiac Arrest

PURPOSE: This study was performed to evaluate the changes in the IL-1beta and the IL-6 concentrations in cerebrospinal fluid (CSF) after initial successful cardiopulmonary resuscitation (CPR), to examine the difference in the IL-1beta and the IL-6 concentrations in CSF between the cerebral performance category (CPC) 1-2 group and CPC 3-5 group after successful CPR, and to identify early makers predicting the outcome after successful CPR. METHODS: We studied prospectively 10 patients with spontaneous circulation after CPR. Samples of CSF were taken at 20 min, 4 hr, 24 hr, and 48 hr after restoration of spontaneous circulation. The control group was consisted of the nonspecific 6 patients in brain computed tomography and CSF finding among the visited patients in emergency department with complaints of headache. The CSF IL-1beta and IL-6 were measured by using enzyme-linked immunosorbent assays. RESULTS: 1) The concentrations of CSF IL-6 for CPC 3-5 were higher in the successful CPR group than in the control group. 2) In the severely neurologically disabled group (CPC 3-5), the concentrations of CSF IL-6 were significantly higher at 20 min 4 hr, 24 hr and 48 hr after successful CPR than they were in the mildly neurologically disabled group(CPC 1-2). 3) The concentrations of CSF IL-6 in the severely neurologically disabled group (CPC 3-5) reached peak levels at 24 hours after successful CPR. 4) The concentrations of CSF IL-1beta did not differ between the two groups. CONCLUSION: Our study indicates that CSF IL-6 is increased more in the severely neurologically disabled group (CPC 3-5) than it is in the mildly neurologically disabled group (CPC 1-2) after successful CPR. We found a significant relationship between the concentration of CSF IL-6 and initial outcome for the CPR patient. Thus, we suggest that CSF IL-6 might play a role in brain ischemic-reperfusion injury and might be used as a prognostic marker after successful CPR.