Analysis of Patients with Acute Industrial Toxic Exposure at an Emergency Department in an Industrial Complex

PURPOSE: Surveys on poisoning usually involves intoxication rather than inhalation, skin contact, etc. Therefore, we examined the characteristics of patients who visited the emergency department in an industrial complex after acute industrial exposure to toxic materials. METHODS: Medical records of patients exposed to toxic materials in the work places from April, 2006, to March, 2008, were analyzed retrospectively. Inhalation patients due to fire were excluded. RESULTS: Subjects included 66 patients, with a mean age of 35.4+/-10.9 years, mostly men (91%). Toxicity occurred in 51 patients (77%) by contact, 15 patients (23%) by inhalation, and none by oral ingestion. For toxic materials, 10 patients were exposed to hydrofluoric acid, 8 to hydrochloric acid, 7 to sodium hydroxide, 7 to metals, and others. The face and hands were the most frequent exposure site by contact. Most exposures were caused by accidents, with 29 cases (42%) exposed because of carelessness or not wearing protective equipment. Most complaints were pain on exposure site, but 7 of the inhalation patients complained of dyspnea. The majority of patients with contact exposure were discharged after wound care or observation. After inhalation exposure, 1 patient died and 5 patients were admitted to the intensive care unit. CONCLUSION: Major causes of workplace exposure were not wearing protective equipment or carelessness. Although contact exposures are usually benign, cautious observation and management are required in patients with inhalation exposure.

The Relationship of Shockable ECG Rhythm During Cardiopulmonary Resuscitation to Outcomes in Cardiac Arrest Patients

PURPOSE: The purpose of this study was to investigate the relationship of ECG change during CPR to outcomes in cardiac arrest patients. METHODS: A total of 170 patients who received cardiopulmonary resuscitation (CPR) in the emergency department from January 2005 to December 2006 were included for analysis. Medical records of study patients were reviewed, retrospectively. Age, sex, cause of arrest, location of arrest, arrest time, CPR time, initial ECG rhythme, changes in ECG during CPR, ROSC, 24 h survival, and number discharged alive were extracted from the medical records. Outcomes studied were ROSC rate and , survival rate at 24 h and at discharge. Student's t-test, the Chi-square test and one-way ANOVA were used for statistical analysis. RESULTS: The patients were divided into three groups according to the initial EKG rhythm. The groups showed no difference in ROSC rate, but the initial VF/VT group and the initial PEA group showed higher survival discharge rates than the initial asystole group (p=0.002). Patients whose rhythm changed from asystole to VF/VT showed significantly higher ROSC and 24 h survival rates but showed no difference in the survival to discharge rate. Patients whose rhythm changed from initial PEA to VF/VT showed no significance difference in ROSC rate, 24 h survival rate, or survival discharge rate. CONCLUSIONS: Although patients whose rhythm changed from initial asystole or PEA to shockable rhythm (VF/VT) showed no significant difference in survival discharge rate compared to those without change to shockable rhythm, in the long run, they may benefit from essential therapies to increase survival because of their higher ROSC rate and 24 h survival rate.

Impact of Initial Helical Abdominal Computed Tomography on the Diagnosis of Hollow Viscus Injury and Blunt Abdominal Traumare

PURPOSE: This study was conducted to examine the clinical significance IV-contrasted helical abdomen computed tomography (CT) as a diagnostic screening tool to evaluate hollow viscus injury in blunt abdominal trauma patients. METHODS: This is a retrospective study encompassing 108 patients, presenting to Korea University Medical Center (KUMC) Emergency Department (ED) from January 2007 to December 2007, with an initial CT finding suggestive of intra-abdominal injury. An initial non-enhanced abdomen CT was taken, followed by an enhanced CT with intravenous contrast. Patients' demographic data, as well as the mechanisms of injury, were inquired upon and obtained, initial diagnosis, as dictated by specialized radiologists, were added to post-operational (post-OP) findings and to additional CT findings acquired during their hospital stays, and all were combined to arrive at final diagnosis. Initial CT findings were further compared with the final diagnosis, yielding values for sensitivity, specificity, and accuracy, as well as positive and negative predictive values. Patients were further divided into two groups, namely, those that underwent operational intervention and those that did not. The initial CT findings of each group were subsequently compared and analyzed. RESULTS: Initial CT scans revealed abnormal findings in a total of 212 cases - solid organ injuries being the most common finding, as was observed in 97 cases. Free fluid accumulation was evident in another 69 cases. Based on the CT findings, 77 cases (71.3%) were initially diagnosed as having a solid organ injury, 20 cases (18.5%) as having a combined (solid organ + hollow viscus) injury, and 11 cases (10.2%), as having an isolated hollow viscus injury. The final diagnosis however, were somewhat different, with only 67 cases (62.0%) attributed to solid organ injury, 31 cases (28.7%) to combined injury (solid + hollow), and 10 cases (9.3%) to hollow viscus injury. The sensitivity (CI 95%) of the initial helical CT in diagnosing hollow viscus injury was 75.6%, and its specificity was 100%. The accuracy in diagnosing hollow viscus injury was also meaningfully lower compared to that in diagnosis of solid organ injury. Among patients initially diagnosed with solid organ injuries, 10 patients (2 from follow-up CT and 8 from post-OP finding) turned out to have combined injuries. A total of 38 patients underwent an operation, and the proportion of initial CT findings suggesting free air, mesenteric hematoma or bowel wall thickening turned out to be significantly higher in the operation group. CONCLUSION: Abdominal CT was a meaningful screening test for hollow viscus injury, but the sensitivity of abdominal CT was significantly lower in detecting hollow viscus injury as compared to solid organ injury. This calls for special consideration and careful observation by the ED physicians when dealing with cases of blunt abdominal trauma.