A Study on Organophosphate Poisoning Patients: Comparison of the Survivor Group and Dead Group

PURPOSE: Organophosphate insecticide poisoning is common in Korea, but there is no definitive guideline for determining the severity of the poisoning and the predictive factors. Therefore, we evaluated the organophosphate poisoned patients and we divided them into two groups, the survivors and the dead, and the results might be useful for treating organophosphate poisoning patients. METHODS: We performed a retrospective analysis of 68 organophosphate poisoned patients who visited the Chosun University Hospital Emergency Medical Center during a 24-month period from January, 2007 to December, 2008. We made a work sheet of the patients' characteristics and the collected data was analyzed and we compared this data between the survivor group and the dead patient group. RESULTS: There were significant differences between the survivor group and the dead patient group for the mean age, the alcohol intake state and the typically expressed signs. The dead patients had lower blood pressure, tachycardia and a lower Glasgo Coma Score (GCS) score than the survivor group. On the arterial blood gas analysis, the dead patients had more severe acidemia and they had lower saturations. Increased serum amylase levels were found in the dead patients. The survivors' initial and follow up serum pseudocholinesterase activity (after 6~8 days) was significantly higher than that of the dead group. The total amount of atropine injected to patient was less in the survivors than that in the dead patients. CONCLUSION: Old age and expressing the typical intoxication signs, a lower GCS score and blood pressure, showing acidosis on the gas analysis and low serum cholinesterase activity may be useful as poor prognostic indicators for patients with organophosphate poisoning. We suggest that physicians must pay careful attention to the signs and prognostic factors of organophosphate insecticide poisoned patients.

A Study on the Effect of the Depressive Disorder in Suicidal Attempt Aspect

PURPOSE: The number of suicide attempts has increased in Korea. Depressive disorders are a major cause. This study investigated the clinical characteristics and outcomes of attempted suicide victims who had been admitted to the emergency department based on a psychiatric disorder. METHODS: We performed a retrospective analysis of 168 suicide attempters who visited the Chosun University hospital emergency medical center between June 1st, 2007 and May 31st, 2008. From chart reviews, we divided the victims into three groups by psychiatric histories, especially depressive disorder. We analyzed the effect of various factors including age, sex, previous suicide attempts outcome of suicide attempts. We used Pearson's chi-square test to chart the statistical data. RESULTS: Depressive patients had significantly more suicide attempts than other psychiatric patients and more than those who had no psychiatric history. Repeated attempts were also more frequent in depressive patients (64%). Sixty percent of depressive patients were admitted into our hospital or local clinic and eight percent of depressive suicide attempters died. Compared to other national statistics, there were fewer persons who consulted with a psychiatrist, but depressive patients had more interviews with psychiatrists (62.9%) than did the other groups. CONCLUSION: Even if the depressive disorder patient group shows a high recurrence rate, it also shows a high psychiatric interview acceptance rate and a relatively low rank on physical and psychiatric severity. Therefore, it is possible to prevent the recurrence of suicide attempts for the depressive group and to reduce the fatality rate. This can be done through on-going educational opportunities and psychiatric interviews. The rate of psychiatric consultations in Korea are significantly lower than in other countries. This situation requires more active psychiatric consultations and interviews later on.

A Case of Toxic Epidermal Necrolysis (TEN) Induced by Nonsteroidal Anti-Inflammatory Drug (NSAID)

A patient who was transferred to our Emergency Medical Center from a local clinic with a dermatologic disorder of unknown origin presented to us with TEN with a 40% skin slough. The patient was a 53-year-old women with complaints of erythematous rash and blisters on her trunk and both proximal extremities. She had taken NSAIDS, 1300 mg per oral, every 8 h for 5 days. Five days after administration of NSAIDS began, the doctors at the local clinic noted that a rash with blisters had begun on her back and progressed to her extremities. After 4 days of that progression she came to us. On physical examination, she had asymptomatic multiple clear filled bullae and erosion with brown- to black-colored hyperpigmentation on her trunk and proximal extremities involving 40% of the body surface. She was admitted to a private room to prevent secondary infections, and her management included fluid replacement, third-generation cephalosporin and corticosteroid administration, and intensive wound care. Fifteen days after admission, no further treatment was required, and only a small scar and a mild dispigmentation lesion could be seen. Emergency department physicians should think about TEN if the patient has extensive exfolating skin lesions. Treatment of patients with suspected TEN must be directed at minimizing fluid and electrolyte loss and preventing secondary infection, and an effort should be made to identify the suspicious drug and to educate patient to avoid the drug.