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Objective@#Venom-induced coagulopathy (VIC) is a common snakebite complication that can cause life-threatening hemorrhage. Previous studies have shown that snake venom can cause a decrease in the erythrocyte sedimentation rate (ESR), but this has not been investigated in actual clinical practice. This study evaluated the clinical utility of erythrocyte sedimentation rate as a predictive factor for VIC in patients with a poisonous snakebite. @*Methods@#From January 2012 to December 2021, this study performed a retrospective study of patients with venomous snakebites presenting to a tertiary emergency department. The demographic and laboratory data were collected through a chart review. The patients were divided into two groups, VIC and NoVIC groups. Logistic regression analysis was performed to identify the factors that predicted the presence of VIC, and the receiver operating characteristic (ROC) curve was drawn. @*Results@#One hundred and fifty-three patients were enrolled, and 31 patients (20.3%) developed VIC. The VIC group had significantly lower ESR than the NoVIC group (5.1±5.6 vs. 14.8±13.8; P<0.001). Logistic regression analysis showed that the decreased ESR was associated with the occurrence of coagulopathy (odds ratio, 0.957; 95% confidence interval, 0.917-0.999; P=0.045). The area under the curve was 0.701 in the ROC curve, and the cutoff value was set to 4.5 mm/hr. @*Conclusion@#ESR measured upon arrival at the emergency department was available to predict venom-induced coagulopathy in snakebite patients.
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Purpose@#We investigated the current status of imaging studies for pediatric blunt cervical spine injury, and applied 3 clinical decision rules to children with blunt trauma of the head or neck in a pediatric emergency center in Korea. The rules included National Emergency X-Radiography Utilization Study (NEXUS) criteria, Canadian Cervical Spine Rule, and Pediatric Emergency Care Applied Research Network risk factors. @*Methods@#This was a retrospective study conducted on 399 children aged 15 years or younger who visited the center after the blunt trauma, and underwent cervical spine radiographs from January 2020 through December 2021. We examined the clinical characteristics per age groups (0-1, 2-5, 6-12, and 13-15 years). Using the 3 rules, we selected children with a potential need for imaging studies (PNI). For this purpose, we analyzed the absence of low-risk variables and the presence of high-risk variables. Predictive performances of the rules were measured for the imaging-confirmed cervical spine injury. @*Results@#The study population (n = 399) had a median age of 5.0 years (interquartile range, 2.0-9.0) and a 64.2% boys’ proportion. Fall (36.6%) was the most common injury mechanism. Two children had the cervical spine injuries. As per NEXUS criteria, Canadian Cervical Spine Rule, and Pediatric Emergency Care Applied Research Network risk factors, 72 (18.0%), 289 (72.4%), and 74 children (18.5%) were classified as those with PNI, respectively. Resultantly, 291 children (72.9%) were classified as having PNI whereas the other 108 (27.1%) were deemed to undergo unnecessary imaging. The 3 rules had nearly 100% sensitivity and negative predictive value, except a 50% sensitivity of NEXUS criteria. @*Conclusion@#Imaging studies can be minimized for children with blunt trauma of the head or neck who are deemed without PNI per the 3 current clinical decision rules. More elaborate criteria are needed to make a timely diagnosis.
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Objective@#Although accurate diagnosis in neurologic emergencies is critical, the emergency department (ED) suffers from a shortage of neurologists. The purpose of this study was to investigate the effect of a dedicated neurologist on the competence in the management of ED physicians on patients with neurologic abnormalities. @*Methods@#We retrospectively reviewed the medical records of patients with neurologic abnormalities between 1 March 2016 and 30 September 2019. Two periods, including control and intervention periods, were assigned. Neurology consultations were routinely performed by an ED physician in the control period and by a physician of the ED working with a dedicated neurologist in the intervention period. @*Results@#In the control period, the most frequent chief complaints were dizziness (22.45%), focal motor weakness (except the face, 19.62%), altered mental status (9.98%), dysarthria (9.62%), seizures (8.57%), and headaches (6.87%). In the intervention period, the rate of final disposition by the ED physician was significantly increased in patients with dizziness (P<0.001), altered mental status (P=0.003), dysarthria (P<0.001), seizure (P<0.001), headaches (P<0.001), facial palsy (P<0.001), and memory impairment (P=0.043). @*Conclusion@#ED physicians who were educated by a dedicated neurologist could effectively enhance the competence in the management of the patient with neurologic abnormalities. We suggest that the method implemented in this study can be a good alternative for solving the gap in neurology department consultation.
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Objective@#This study aimed to evaluate the effectiveness of the CRB-65 score as a prognostic predictor in acute heart failure (HF) patients who visited the emergency department (ED). @*Methods@#This study was performed retrospectively on HF patients over the age of 19 years admitted to the ED between August 2018 and July 2020. The patients who met the Framingham criteria, including acute pulmonary edema, were classified by the CRB-65 score and compared with previous HF prognostic predictors (Acute Decompensated Heart Failure National Registry, Get with The Guidelines-Heart Failure and Enhanced Feedback for Effective Cardiac Treatment). We defined the primary outcome as 30-day mortality and secondary outcomes as hospitalization days (HD), admission to intensive care unit (ICU), length of stay (LOS) in the ICU and mechanical ventilation (MV). We conducted linear regression and logistic regression with these outcomes and obtained the area under the receiver-operating characteristics (AUROC) curve to compare the predictive power of the primary outcome. @*Results@#A total of 462 patients were included in the study, and their mean age was 80 years. According to the linear and logistic regression analysis results, the CRB-65 score was significantly correlated with HD (P<0.001), admission to ICU (P=0.014), LOS in ICU (P<0.001) and MV (P=0.004). The AUROC curve of CRB-65 was not higher than the other previous prognostic predictors (AUROC, 0.69), but the result was not different from the predictors. @*Conclusion@#The CRB-65 score is one of the prognostic indicators of acute HF in the ED. However, its prognostic predictive power remains limited.
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Objective@#Triage in the emergency department is important as mistriage leads to inefficient use of resources. The Korean Triage and Acuity Scale (KTAS) was developed in 2012 and has been implemented in emergency departments nationwide since January 2016. The purpose of this study was to determine whether KTAS can predict resource use in a pediatric emergency center. @*Methods@#From October to December 2019, a retrospective analysis was conducted by a review of medical records. Demographic data, KTAS grades, Emergency Severity Index (ESI) as an indicator of resource utilization and details of the use of each resource were collected. Patients were divided into non-trauma and trauma groups. KTAS grades 1 and 2 were defined as the severe group, grade 3 was the moderate group, and grades 4 and 5 were defined as the mild group. We investigated whether triage using KTAS is related to resource utilization. @*Results@#In the non-trauma group, ESI, length of stay in the emergency department, and hospitalization were significantly correlated with the KTAS groups. In the trauma group, there was no significant difference between the moderate and mild groups in the above variables except for hospitalization. This was because there was no significant difference in sedation, procedure, and intravenous injection, in the trauma group. @*Conclusion@#The KTAS triage helped predict resource utilization in the non-trauma group, but not in the trauma group especially between the moderate and mild groups. Additional research will be needed to predict resource utilization in children with trauma.
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Objective@#Triage in the emergency department is important as mistriage leads to inefficient use of resources. The Korean Triage and Acuity Scale (KTAS) was developed in 2012 and has been implemented in emergency departments nationwide since January 2016. The purpose of this study was to determine whether KTAS can predict resource use in a pediatric emergency center. @*Methods@#From October to December 2019, a retrospective analysis was conducted by a review of medical records. Demographic data, KTAS grades, Emergency Severity Index (ESI) as an indicator of resource utilization and details of the use of each resource were collected. Patients were divided into non-trauma and trauma groups. KTAS grades 1 and 2 were defined as the severe group, grade 3 was the moderate group, and grades 4 and 5 were defined as the mild group. We investigated whether triage using KTAS is related to resource utilization. @*Results@#In the non-trauma group, ESI, length of stay in the emergency department, and hospitalization were significantly correlated with the KTAS groups. In the trauma group, there was no significant difference between the moderate and mild groups in the above variables except for hospitalization. This was because there was no significant difference in sedation, procedure, and intravenous injection, in the trauma group. @*Conclusion@#The KTAS triage helped predict resource utilization in the non-trauma group, but not in the trauma group especially between the moderate and mild groups. Additional research will be needed to predict resource utilization in children with trauma.
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Objective@#Serious bacterial infection (SBI) is a common disease among infants, and it is associated with high morbidity and mortality. Making the diagnosis of SBI is challenging and measurement of various biomarkers is useful. This study examined the utility of lactate at an emergency department for diagnosing SBI patients. @*Methods@#This was a retrospective, observational study of febrile infants less than 90 days old presenting to the emergency department of a tertiary hospital between September 2014 and August 2017. The demographic and laboratory data was collected through a chart review. @*Results@#Laboratory tests such as the white blood cell count, C-reactive protein (CRP), procalcitonin, and lactate showed significant differences on the Student-T test and the Mann Whitney-U test. Multivariabe logistic regression test was done using the variables with significant differences. CRP (P=0.037; odds ratio, 1.01), procalcitonin (P=0.011; odds ratio, 1.02) and lactate (P=0.001; odds ratio, 2.38) shows significant correlation. @*Conclusion@#For febrile infants at the emergency department, the measurement of lactate is expected to be a useful tool to diagnose serious bacterial infection.
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Green tobacco sickness is an illness caused by dermal exposure to nicotine. The common symptoms of the disease include dizziness, headache, nausea, vomiting, severe general weakness, fluctuations of blood pressure or heartbeat, abdominal cramping, chills, increased sweating, salivation, and difficulty breathing. A 79-year-old female arrived at the emergency room for an evaluation of sudden onset dizziness. Magnetic resonance imaging and angiography of the brain did not show any relevant abnormal findings. Four days later, with supportive care, she said that she had harvested green tobacco for six hours on the day of admission and the tobacco harvest was the first time in her life. She sweated excessively during the hot and humid weather and the tobacco leaves were wet from rain the night before. The serum cotinine tested at five days of admission was 16ng/ml. She was diagnosed with acute nicotine poisoning by her clinical symptoms and the half-life of cotinine in the blood.
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PURPOSE: In this single-center, prospective, randomized, cross-over study, we compared the efficiency of oxygen supply between OxyMask and non-rebreather mask (NRM), depending on the position of the mask. METHODS: Either OxyMask or NRM was applied to 33 healthy volunteers, in a random manner, on the upper (that 1 cm upper to it), lower (that 1 cm inferior to it) and lateral malposition (that 1 cm lateral to it). After a 3-minute oxygenation, at a flow rate of 15 L/min, we measured the fractional expired oxygen concentration (F(E)O₂), fractional expired carbon dioxide concentration (F(E)CO₂), and visual analogue scale (VAS) scores for the degree-of-wearing sensation. RESULTS: OxyMask showed a lower level of F(E)O₂ as compared with NRM in all positions. Moreover, OxyMask showed no significant difference between F(E)O₂ and the position of the mask. However, NRM showed a significantly lower F(E)O₂ in the upper and lateral malposition. F(E)CO₂ had no significant difference with the types and position of the mask. The mean VAS scores for the degree-of-wearing sensation were 2.2±1.5 in the OxyMask and 4.3±1.5 in the NRM (p<0.001). CONCLUSION: OxyMask may offer greater benefit in maintaining the concentration of supplied oxygen and provide greater comfort than NRM in patients with difficulty applying the mask on an adequate location and maintaining the seal.
Subject(s)
Adult , Humans , Carbon Dioxide , Cross-Over Studies , Healthy Volunteers , Masks , Oxygen , Prospective Studies , SensationABSTRACT
PURPOSE: The incidence of glufosinate poisoning is gradually increasing, and it can be fatal if severe poisoning occurs. However, factors useful for predicting the post-discharge neurological prognosis of patients who have ingested glufosinate have yet to be identified. Our objective was to evaluate the utility of the acute physiology and chronic health evaluation (APACHE) II score measured in the emergency department for predicting the neurological prognosis. METHODS: From April 2012 to August 2014, we conducted a retrospective study of patients who had ingested glufosinate. The outcome of the patients at discharge was defined by the Cerebral Performance Category Score (CPC). The patients were divided into a good prognosis group (CPC 1, 2) and a poor prognosis group (CPC 3, 4, 5), after which the APACHE II scores were compared. The Hosmer-Lemeshow test and the area under the receiver operating characteristic (ROC) curve from patients determined calibration and discrimination. RESULTS: A total of 76 patients were enrolled (good prognosis group: 67 vs poor prognosis group: 9). The cut-off value for the APACHE II score was 12 and the area under the curve value was 0.891. The Hosmer and Lemeshow C statistic χ2 was 7.414 (p=0.387), indicating good calibration for APACHE II. CONCLUSION: The APACHE II score is useful at predicting the neurological prognosis of patients who have ingested glufosinate.
Subject(s)
Humans , APACHE , Calibration , Discrimination, Psychological , Emergency Service, Hospital , Herbicides , Incidence , Poisoning , Prognosis , Retrospective Studies , ROC CurveABSTRACT
PURPOSE: Glufosinate-containing herbicides intoxication causes mild to severe complication, depending on patients' factors. However, it is not clearly known whether there are factors affecting glufosinate-containing herbicides intoxicated patients who develop complications. Thus, we sought to identify independent factors comparing the complicated group with the non-complicated group and to predict which patients will develop subsequent medical complication. METHODS: The medical records of patients with exposure to Glufosinate-containing herbicides at a tertiary academic university hospital in Korea from January 2012 to April 2015 were reviewed retrospectively. Demographic and clinical data of 75 patients were then analyzed by univariate and multivariate stepwise logistic regression analyses to identify potential predictors of significant complications following acute Glufosinate-containing herbicides poisoning for comparison of complicated patients with non-complicated patients. RESULTS: Of 75 patients, 44 (58.6%) had medical complications and 6 (8%) were dead. Neurologic complications (n=26, 35%) were the most common including seizure (n=18), delirium tremens (n=5), and amnesia (n=4). The results of univariate analysis showed that an advanced age (>60 years old), higher ingested amount of the herbicide (>100 mL), vomiting at arrival, medical history of hypertension, metabolic acidosis, and systemic inflammatory response score (SIRS)> or =2 were significant factors. However, the results of multivariate analysis showed that an advanced age (p60 years, and amount ingested>100 mL were significant predictive factors for significant medical complications in patients with Glufosinate-containing herbicides poisoning.
Subject(s)
Humans , Acidosis , Alcohol Withdrawal Delirium , Amnesia , Herbicides , Hypertension , Korea , Logistic Models , Medical Records , Multivariate Analysis , Poisoning , Retrospective Studies , Seizures , VomitingABSTRACT
With increasing users of SNS (Social Network Service), the video known as 'couple play' has been popular recently. People imitate the scene of couple play in the video. However, some of them failed to reproduce some actions. We report a case of cervical spine fracture with 'couple play'. A 14-year-old female presented to the emergency department complaining of posterior neck pain. She had a history of trauma with 'couple play' three days ago. She had no neurologic deficit. Cervical spine x-ray and computed tomography showed spinous process fracture of the seventh cervical spine (clay-shoveler fracture). This case demonstrates the need for heightened awareness concerning videos containing dangerous actions that may be harmful when imitated. The authors believe that an institutional strategy for notification of the risks is needed.
Subject(s)
Adolescent , Female , Humans , Computer Communication Networks , Emergency Service, Hospital , Neck Pain , Neurologic Manifestations , Social Media , Spinal Fractures , SpineABSTRACT
PURPOSE: Traumatic brain injury (TBI) occurs frequently in patients with facial injuries. In patients with facial injuries without neurologic deficit, it is a challenging decision for emergency physicians whether brain computed tomography (CT) is necessary or not. Our objective is to evaluate the availability of optic nerve sheath diameter (ONSD) measured by facial CT in predicting TBI. METHODS: From January, 2010, to December, 2012, we conducted a retrospective study of patients with head or facial injuries who underwent both facial CT and brain CT simultaneously in the emergency department. Patients with obvious orbital trauma or ocular disease were excluded. We analyzed correlation between ONSD measured by facial CT and the brain CT findings of TBI. RESULTS: A total of 229 patients were enrolled. Ninety six patients without TBI on facial CT showed mean ONSD of 5.11+/-0.44 mm, and 82 patients with TBI showed mean ONSD of 5.89+/-0.78 mm. The sensitivity and the specificity compared with the presence of TBI findings on brain CT were 78.05% and 82.29%, respectively, when the cut-off value was set to 5.5 mm. The area under the curve (AUC) was 0.826 in the receiver operating characteristic curve (ROC curve). CONCLUSION: ONSD measured on facial CT is available for predicting TBI in patients with facial injuries.
Subject(s)
Humans , Brain , Brain Injuries , Emergencies , Emergency Service, Hospital , Facial Injuries , Head , Intracranial Hypertension , Neurologic Manifestations , Optic Nerve , Orbit , Retrospective Studies , ROC Curve , Sensitivity and Specificity , Tomography, X-Ray ComputedABSTRACT
Aconitine, found in the Aconitum species, is highly extremely toxic, and has been known to cause fatal cardiac arrhythmias and cardiovascular collapse. Although several reports have described treatment of aconitine intoxication, management strategy for the patient in a hemodynamically compromised state who experienced cardiopulmonary collapse is unknown. We report here on a case of a successful cardiopulmonary resuscitation and therapeutic hypothermia in an aconitine-induced cardiovascular collapsed patient. A 73-year-old male who presented with nausea, vomiting, chest discomfort, and drowsy mental state after eating an herbal decoction made from aconite roots was admitted to the emergency department. He showed hemodynamic compromise with monomorphic ventricular tachycardia resistant to amiodarone and lidocaine. After 3 minutes on admission, he collapsed, and cardiopulmonary resuscitation was initiated. We treated him with repeated cardioversion/defibrillation of 51 times, 10,150 joules and cardiopulmonary resuscitation of 12 times, 69 minutes for 14 hours and therapeutic hypothermia for 36 hours. He recovered fully in 7 days.
Subject(s)
Aged , Humans , Male , Aconitine , Aconitum , Amiodarone , Arrhythmias, Cardiac , Cardiopulmonary Resuscitation , Eating , Emergency Service, Hospital , Hemodynamics , Hypothermia , Hypothermia, Induced , Lidocaine , Nausea , Resuscitation , Shock , Tachycardia, Ventricular , Thorax , VomitingABSTRACT
PURPOSE: Although Pokeweed intoxication is relatively less severe, thereis little data onthe clinical presentation ofPokeweed intoxication in Korea. This study examined the clinical aspectsto providebasic data for evaluating Pokeweed intoxication. METHODS: A retrospective study by a chart review was performedon 19 patients who ingested Pokeweed and presented to anacademic emergency department with an annual census of 40,000 between March 2012 and May 2012. RESULTS: Nineteen patients were identified. All patients wereintoxicated unintentionally. The most common symptoms were vomiting with diarrhea and abdominal pain. The onset time varied, but occurs 30 minutes to 5 hours post ingestion of Pokeweed. All patients were discharged without fatal complications. CONCLUSION: Compared to previous reports, mostpokeweed poisoning patients complain of gastrointestinal symptoms. Supportive care is the mainstay of the management of pokeweed intoxication. All symptoms were resolved over a 24 to 48 hour period.