Factors predicting injury severity in driver traffic accidents

Objective@#The factors related to injury severity in accidents in Korea are unclear. This study helps primary physicians treat victims of traffic accidents with a high probability of severe injury during the initial evaluation in the emergency department (ED). @*Methods@#This study was conducted on patients who visited Pusan National University Hospital regional trauma center, Korea, between January 2017 and December 2019 due to involvement in automobile accidents as a driver. Multivariate logistic regression analysis was used to determine the relationship of factors with injury severity. @*Results@#A total of 973 patients were included. Of them, 316 (32.5%) were severely injured. In the multivariate logistic regression analysis, older age was significantly associated with more severe injury (odds ratio [OR], 1.030; 95% confidence interval [CI], 1.017-1.043; P<0.001). A significant difference was noted in injury severity according to the mode of transportation to the ED. Transportation via private ambulance was associated with more severe injury than via public ambulance (OR, 5.853; 95% CI, 3.986-8.594; P<0.001). The severe injury was more likely when the collision involved a large-sized vehicle (OR, 2.369; 95% CI, 1.466-3.826; P<0.001), or a fixed object (OR, 2.077; 95% CI, 1.326-3.254; P<0.001) compared to a small-sized vehicle. The group that did not wear a seat belt had more severe injuries than those who wore a seat belt (OR, 2.218; 95% CI, 1.421-3.463; P<0.001). @*Conclusion@#Injury severity was correlated with age, mode of transportation to the ED, type of collision and seat belt use. These results will help primary physicians assess critically ill patients.

Clinical analysis of endovascular management in blunt thoracic aortic injury

Objective@#Blunt thoracic aortic injury (BTAI) is a rare but fatal injury. BTAI has been treated surgically, but thoracic endovascular aortic repair (TEVAR) is used as a treatment option and has shown good results. The purpose of this study was to analyze the outcomes of patients with BTAI treated using TEVAR. @*Methods@#BTAI patients who had received TEVAR for five years were analyzed. We investigated injury severity score, aortic injury site, computed tomography findings and mortality. @*Results@#We identified 17 patients, and all were diagnosed using computed tomography. Twelve patients received TEVAR as an emergency, and the remaining five patients received TEVAR delayed. The most common injury site was isthmus (82%), and the median injury severity score was 33. There were 15 cases with a BTAI grade of 3 and two cases with a BTAI grade of 4. The mortality rate was 11.8% (n=2). @*Conclusion@#TEVAR is more meaningful because it is easier and faster and has fewer complications than thoracotomy in patients with traumatic aortic injury.

Real-time measurement of changes in cardiac output that occur after raising the lower extremities in a supine position in healthy adults

Objective@#Passive leg raising for treating patients with shock involves the elevation of the legs in the supine position and can also be applied to patients showing sudden aggravation after lying down for a certain period. A study involving healthy adults has reported that this type of passive leg raising is ineffective for those who spend a long time in the supine position. The study measured cardiac output intermittently using echocardiography rather than measuring it continuously in real time, making it impossible to examine the overall trend in cardiac output before and after the leg raise. This study aimed to examine changes and trends in cardiac output using a device that measures cardiac output in real time. @*Methods@#The present study was conducted from January to August 2020 and included healthy adults aged 18 years and above. Cardiac output was measured with a noninvasive cardiac output measuring device (electrical cardiometry, ICON) for 30 minutes in the supine position and for another 30 minutes in the supine position with the legs raised at 45° for 60 minutes. @*Results@#A total of 40 participants were included in the study. Cardiac output increased from 5.13±1.42 L/min to 5.14± 1.64 L/min after the passive leg raise. However, the increase was not statistically significant (P=0.958). @*Conclusion@#No statistically significant change was found between the cardiac outputs before the leg raise and after the leg raise.

Use of succimer as an alternative antidote in copper sulfate poisoning: A case report

Copper sulfate is widely used as a fungicide and pesticide. Acute copper sulfate poisoning is rare but potentially lethal in severe cases. Copper sulfate can lead to cellular damage of red blood cells, hepatocytes, and myocytes. Toxic effects include intravascular hemolysis, acute tubular necrosis and, rhabdomyolysis. A 76-year-old man presented with vomiting and epigastric pain. He had ingested a copper-containing fungicide (about 13.5 g of copper sulfate) while attempting suicide 2 hours prior to presentation. From day 3 at the hospital, laboratory findings suggesting intravascular hemolysis were noted with increased serum creatinine level. He was treated with a chelating agent, dimercaptosuccinic acid (succimer). His anemia and acute kidney injury gradually resolved with a 19-day regimen of succimer. Our case suggests that succimer can be used for copper sulfate poisoning when other chelating agents are not available.

Long-term Prognosis of Localized Lymphoid Hyperplasia of the Rectum

Background/Aims@#Although localized lymphoid hyperplasia (LLH) of the rectum is occasionally observed, its clinical implications are unclear. This study aimed to investigate the clinical course and significance of LLH of the rectum. @*Methods@#We identified 65 patients diagnosed with LLH of the rectum using a histopathologic examination and who received follow-up endoscopies between January 2009 and June 2015. Patients with a history of inflammatory bowel disease, lymphoma, familial adenomatous polyposis, or uncontrolled malignancy and patients who underwent scar biopsy after endoscopic resection or surgery were excluded. Endoscopic findings and clinical courses were analyzed. @*Results@#During the median follow-up of 31 months (interquartile range, 19 to 40 months), 81.5% (53/65) of LLHs of the rectum were resolved. Clinically significant diseases, including ulcerative colitis (UC, n=5) and mucosa-associated lymphoid tissue (MALT) lymphoma (n=1), were diagnosed in 9.2% of patients (6/65). The other six patients showed no significant changes in the lesion (n=3) or a waxing and waning appearance (n=3). According to endoscopic findings, all of the 47 polypoid types showed resolution or waxing and waning patterns. Five of the 11 nodular types (45.5%) developed into UC. One of the seven submucosal tumor (SMT)-like types (14.3%) developed into MALT lymphoma. @*Conclusions@#LLH of the rectum with persistent symptoms or the endoscopic appearance of the nodular or SMT-like type may lead to clinically significant disease. Risk stratification according to endoscopic findings and careful surveillance are required for these lesions.

Factors and Their Correlation with Injury Severity of Elderly Pedestrian Traffic Accidents

PURPOSE@#No previous study has assessed elderly pedestrian traffic accidents based on a nationwide database. This study aimed to help primary physicians who examine patients in emergency departments to determine and make prompt and accurate treatment decisions.@*METHODS@#This study used data from the Emergency Department-based Injury Indepth Surveillance from 2013 to 2017, managed by the Korea Centers for Disease Control and Prevention. Pedestrians aged ≥65 years were included, and using multivariate logistic regression multiple factors were analyzed to determine their relationship with injury severity.@*RESULTS@#Of 227,695 subjects, 6,498 were included, of whom 2,065 (31.8%) were severely injured. There were more female than male patients in all severity groups. Most accidents occurred in the afternoon and on general roads. In the multivariate analysis, the odds ratio (OR) of injury severity for male pedestrians was 1.165 (95% confidence interval: 1.034–1.313, p=0.012). Older age of patients and the use of ambulances were associated with greater injury severity. The accident time affected the degree of injury severity; i.e., compared to dawn, injury severity increased in the morning (OR: 1.246, p=0.047) and decreased at night (OR: 0.678, p<0.001). A significant difference was noted in the correlation between the type of vehicle causing the accident and the accident severity; i.e., motorcycle accidents had lower severity than bicycle accidents (OR: 0.582, p=0.047).@*CONCLUSIONS@#Injury severity was correlated with sex, age, transportation to the ED, TA onset time, and type of vehicle. The study results suggest that injury severity may be positively reflected in initial assessments and overall integrated treatments by physicians and in the related policies.

Hemorrhagic shock caused by closed internal degloving injury: a case report

A closed internal degloving injury is a soft tissue injury, in which the subcutaneous tissue is ripped from the underlying fascia. In rare cases, a closed internal degloving injury can lead to hemorrhagic shock. A 79-year-old woman was brought to the emergency department following an auto-pedestrian accident, in which she was hit by a car. She was in a stupor and was hypotensive. The initial evaluation was unremarkable. During management, the patient required the transfusion of a large volume of blood, and vasoactive agent. Abdominal computed tomography revealed a large hematoma in her lower back and gluteal area and she was diagnosed with a closed internal degloving injury. Missed or delayed diagnosis of this type of injury may result in a significant increase in transfusion requirements and irreversible hemorrhagic shock.

Is STONE score a useful tool for limiting the use computed tomography in the patients suspected ureter stone? - A single-center retrospective study

OBJECTIVE: The STONE score was developed to gauge the ureter stone probability. On the other hand, it is unclear if the STONE score is also applicable to Koreans. This study evaluated whether the STONE score can identify patients with suspected nephrolithiasis for whom a computed tomography (CT) scan can be obtained in the emergency department, targeting Koreans. METHODS: Patients presenting to the emergency medicine (ED) with flank pain and a suspicion of a ureter stone between January 2016 and December 2016 were reviewed retrospectively. After calculating the STONE score, the enrolled patients were classified into the low, moderate, high score group. In each group, the prevalence of a ureter stone and other clinical diseases on a CT scan were investigated. RESULTS: Among the 156 patients included in the analysis, 124 (79.5%) had a ureter stone and an alternative diagnosis was made in 12 (7.7%). The prevalence of a ureter stone and alternative diseases in the high score group was 87.7% (71/81) and 4.9% (4/81), respectively. The proportion of patients with nephrolithiasis increased significantly (P < 0.001), but the proportion of patients with other clinical diseases did not decrease significantly across the score groups (P=0.196). The area under the receiver operating characteristic curve was 0.711 (95% confidence interval, 0.633–0.780; P=0.001) with a cut off score higher than 8 (sensitivity 82.3%, specificity 50.0%) for the STONE score. CONCLUSION: In this setting, the STONE score had a low specificity and could not accurately assess a ureter stone. More studies aimed at Koreans are warranted before a CT scan can be limited using the STONE score.

Relationship between Pericytes and Endothelial Cells in Retinal Neovascularization: A Histological and Immunofluorescent Study of Retinal Angiogenesis

PURPOSE: To evaluate the relationship between pericytes and endothelial cells in retinal neovascularization through histological and immunofluorescent studies. METHODS: C57BL/6J mice were exposed to hyperoxia from postnatal day (P) 7 to P12 and were returned to room air at P12 to induce a model of oxygen-induced retinopathy (OIR). The cross sections of enucleated eyes were processed with hematoxylin and eosin. Immunofluorescent staining of pericytes, endothelial cells, and N-cadherin was performed. Microfluidic devices were fabricated out of polydimethylsiloxane using soft lithography and replica molding. Human retinal microvascular endothelial cells, human brain microvascular endothelial cells, human umbilical vein endothelial cells and human placenta pericyte were mixed and co-cultured. RESULTS: Unlike the three-layered vascular plexus found in retinal angiogenesis of a normal mouse, angiogenesis in the OIR model is identified by the neovascular tuft extending into the vitreous. Neovascular tufts and the three-layered vascular plexus were both covered with pericytes in the OIR model. In this pathologic vascularization, N-cadherin, known to be crucial intercellular adhesion molecule, was also present. Further evaluation using the microfluidic in vitro model, successfully developed a microvascular network of endothelial cells covered with pericytes, mimicking normal retinal angiogenesis within 6 days. CONCLUSIONS: Pericytes covering endothelial cells were observed not only in vasculature of normal retina but also pathologic neovascularization of OIR mouse at P17. Factors involved in the endothelial cell-pericyte interaction can be evaluated as an attractive novel treatment target. These future studies can be performed using microfluidic systems, which can shorten the study time and provide three-dimensional structural evaluation.

Usefulness of ultrasonography for the evaluation of catheter misplacement and complications after central venous catheterization

OBJECTIVE: To assess whether ultrasonographic examination compared to chest radiography (CXR) is effective for evaluating complications after central venous catheterization. METHODS: We performed a prospective observational study. Immediately after central venous catheter insertion, we asked the radiologic department to perform a portable CXR scan. A junior and senior medical resident each performed ultrasonographic evaluation of the position of the catheter tip and complications such as pneumothorax and pleural effusion (hemothorax). We estimated the time required for ultrasound (US) and CXR. RESULTS: Compared to CXR, US could equivalently identify the catheter tip in the internal jugular or subclavian veins (P=1.000). Compared with CXR, US examinations conducted by junior residents could equivalently evaluate pneumothorax (P=1.000), while US examinations conducted by senior residents could also equivalently evaluate pneumothorax (P=0.557) and pleural effusion (P=0.337). The required time for US was shorter than that for CXR (P < 0.001). CONCLUSION: Compared to CXR, US could equivalently and more quickly identify complications such as pneumothorax or pleural effusion.

The Usefulness of the mPTS (modified pediatric trauma score) and Newly Developed Extended mPTS as a High Risk Pediatric Trauma Patients Screening Tool: Support of Two Tiered Trauma Team Activation System

PURPOSE: A secondary triage tool for pediatric trauma patients, “modified pediatric trauma score (mPTS)” was introduced to predict high risk trauma. METHODS: Pediatric trauma patients (≤15 years) presenting to the Pusan National University Hospital trauma center emergency department were analyzed retrospectively. The patients were classified into high risk and low risk groups. The high risk group was assigned an Injury Severity Score ≥12, death, intensive care unit admission, or urgent intervention (intubation, closed thoracostomy, emergency angiography and embolization, emergency surgery). The airway, blood pressure, fractures, level of consciousness, and external wounds were evaluated and the mPTS was calculated. RESULTS: One hundred seventy-seven patients were enrolled in this study. The mPTS had a sensitivity, specificity, positive predictive value, and negative predictive value of 88%, 54%, 60%, and 85%, respectively. Overtriage and undertriage was 39% and 14%, respectively. The mPTS missed 6 high risk patients and all 6 patients were abdominal injury patients. The mPTS was modified to include an abdominal physical examination and/or focused assessment with sonography for trauma. The newly developed scoring system was called the extended mPTS (E-mPTS). The E-mPTS had a sensitivity of 98% and negative predictive value of 98%. The safe level of overtriage (38%) was maintained. CONCLUSION: mPTS was applied to the patients and the undertriage rate was too high. The extended mPTS improved undertriage to 2% while maintaining the overtriage rate at a safe level. The E-mPTS is expected to have a resource saving effect when used as a pediatric trauma team activation standard.

Cardiac Arrest in a Patient with a Severely Distended Colon

Toxic megacolon is a devastating complication of colitis, which is commonly caused by inflammatory bowel disease. Frequently reported complications of toxic megacolon are bleeding, sepsis, colon perforation, and shock. Herein, we report a rare case of cardiac arrest that was likely caused by toxic megacolon in a 49-year-old male, who experienced 3 months of intermittent dyspnea and abdominal distension that abruptly worsened before presentation. Our case suggests that severe colon dilation complicated by toxic megacolon, especially accompanied by cardiopulmonary symptoms and signs, has the potential to progress to an abdominal compartment syndrome, which is a rare but life-threatening complication.

Attempted Suicide by Nitrogen Gas Asphyxiation: A Case Report

Nitrogen is an inert gas that is harmless to humans under normal conditions. While it is not inherently toxic, nitrogen gas becomes dangerous when it displaces oxygen, resulting in suffocation. Herein, we report a case of a 34-year-old man who attempted suicide by nitrogen asphyxiation who presenting with decreased mental function and agitation. Lactic acidosis and hyperammonemia were observed on presentation at the emergency department, but these improved after a few hours. After 2 days, the patient regained full consciousness, and was discharged without any complications. Survival after asphyxiation due to nitrogen gas is very rare, and these patients are more likely to have poorer outcomes. There is a potential for the increasing use of nitrogen gas as a method of committing suicide because of the ease of access to this gas.

Early Predictors of Severe Injury in Motorcycle Crashes

PURPOSE: The severity and mortality of motorcycle accidents are higher than those of other traffic accidents. The majority of risk factors for injury severity identified in previous studies are difficult to apply. This study attempted to identify the clinically useful risk factors for predicting severely injured patients presenting to the emergency department after a motorcycle accident. METHODS: Motorcycle accident patients who visited a Level I trauma center from October 2015 to March 2017 were analyzed. The patients were classified as the severely injured group (Injury Severity Score, ISS≥16) and non-severely injured group (ISS<16). RESULTS: A total of 271 patients were analyzed; 135 (49.8%) patients were included in the severely injured group. Multiple logistic regression analysis was performed with the statistically significant factors between the two groups, including age, systolic blood pressure, heart rate, Glasgow coma scale, alcohol ingestion, and site of injury. The final risk factors predicting severely injured patients were as follows: age (adjusted odds ratio [aOR], 1.023; 95% confidence interval [CI], 1.005– 1.041; p=0.011), systolic blood pressure (aOR, 0.981; 95% CI, 0.970–0.993; p=0.002) and site of injury including abdomen (aOR, 5.785; 95% CI, 2.513–13.316; p<0.001), chest (aOR, 4.567; 95% CI, 2.274–9.173; p<0.001), head and neck (aOR, 5.762; 95% CI, 2.656–12.504; p<0.001), and face (aOR, 2.465; 95% CI, 1.229–4.943; p=0.011). CONCLUSION: Motorcycle accident patients should be assessed promptly for injury to the chest or abdomen by a careful physical examination and focused assessment with sonography for trauma.

Comparison between an instructor-led course and training using a voice advisory manikin in initial cardiopulmonary resuscitation skill acquisition

OBJECTIVE: We compared training using a voice advisory manikin (VAM) with an instructor-led (IL) course in terms of acquisition of initial cardiopulmonary resuscitation (CPR) skills, as defined by the 2010 resuscitation guidelines. METHODS: This study was a randomized, controlled, blinded, parallel-group trial. We recruited 82 first-year emergency medical technician students and distributed them randomly into two groups: the IL group (n=41) and the VAM group (n=37). In the IL-group, participants were trained in “single-rescuer, adult CPR” according to the American Heart Association's Basic Life Support course for healthcare providers. In the VAM group, all subjects received a 20-minute lesson about CPR. After the lesson, each student trained individually with the VAM for 1 hour, receiving real-time feedback. After the training, all subjects were evaluated as they performed basic CPR (30 compressions, 2 ventilations) for 4 minutes. RESULTS: The proportion of participants with a mean compression depth ≥50 mm was 34.1% in the IL group and 27.0% in the VAM group, and the proportion with a mean compression depth ≥40 mm had increased significantly in both groups compared with ≥50 mm (IL group, 82.9%; VAM group, 86.5%). However, no significant differences were detected between the groups in this regard. The proportion of ventilations of the appropriate volume was relatively low in both groups (IL group, 26.4%; VAM group, 12.5%; P=0.396). CONCLUSION: Both methods, the IL training using a practice-while-watching video and the VAM training, facilitated initial CPR skill acquisition, especially in terms of correct chest compression.

The effect of preemptive intravenous ketamine on postoperative pain in patients undergoing arthroscopic rotator cuff repair with intra articular ropivacaine injection

BACKGROUND: A low dose of ketamine can be an effective preemptive analgesic by preventing central sensitization when administered before surgical trauma. In this study, we assessed the preemptive analgesic effect of low-dose ketamine administered intravenously to patients undergoing arthroscopic rotator cuff repair with intra articular ropivacaine injection. METHODS: This randomized, double-blinded study included fifty-six patients scheduled for elective arthroscopic rotator cuff repair. Normal saline (group C) or 0.5 mg/kg of ketamine (group K) was injected intravenously before the skin incision. An intra articular injection using 20 ml of 0.75% ropivacaine was performed in both groups just before wound closure by the surgeon at the end of the surgery. Postoperative pain was assessed by the numeric rating scale (NRS) in the post-anesthesia care unit (PACU) and at 12, 24, and 48 hours postoperatively. The total dose of fentanyl consumption and side effects were recorded. RESULTS: There were no significant differences between the C and K groups for the NRS of pain in the PACU and at 12, 24, and 48 hours after the surgery. In addition, there was also no significant difference in total fentanyl consumption between the two groups. CONCLUSIONS: Preemptive ketamine did not reduce preemptive pain scores and fentanyl consumption in patients who underwent arthroscopic rotator cuff repair with intra articular local anesthetic injection. Therefore, more aggressive and multimodal pain control is required in patients undergoing arthroscopic shoulder surgery regardless of the use of preemptive intravenous ketamine injection.

Expression of Nestin on Endothelial Cells and Pericytes During Retinal Vascular Development in Mouse

PURPOSE: Nestin, a marker of neural stem cells, is expressed in Müller cells during retinal development. However, the role of nestin in retinal vascular development is not well established. Thus, we investigated the expression of nestin in developmental mouse retina and identified which retinal cells are related to the expression of nestin during the retinal vascular development. METHODS: Eyes were enucleated from C57BL/6 mice on postnatal day (P) 4, P8, P12, P16 and P26. Immunofluorescence was used to evaluate nestin expression in relation to endothelial cells (isolectin B4), pericytes (neural/glial antigen 2) and astrocytes (glial fibrillary acidic protein). RESULTS: Nestin was strongly expressed from the ganglion cell layer to retinoblast layer at P4. At P8, P12 and P16, the expression of nestin was observed from the upper border of the ganglion cell layer, and vertically penetrating to outer nuclear layer. At P26, the expression of nestin was decreased and confined to the ganglion cell layer and inner nuclear layer. Interestingly, there was strong vascular shape expression of nestin at all stages. The superficial, deep and intermediate vascular plexus was completely merged with nestin expression at P4, P8, P12 and P16. In addition, the nestin expression merged with pericytes but not with astrocytes. CONCLUSIONS: Nestin was expressed in endothelial cells and pericytes during retinal vascular development in the retina. These results suggest that nestin could play an important role in developmental angiogenesis via interplay with endothelial cells and pericytes.

Comparison between an Instructor-led Course and Training Using a Voice Advisory Manikin in Initial Cardiopulmonary Resuscitation Skill Acquisition

PURPOSE: Purpose: We compared the outcomes of training between the use of voice-advisory manikin (VAM) and instructor-led (IL) courses with respect to the acquisition of initial cardio-pulmonary resuscitation (CPR) skills, as defined by the 2010 resuscitation guidelines. METHODS: This study was a randomized, controlled, blinded, parallel-group trial. We recruited 82 first-year emergency medical technician students and randomly distributed them into two groups: the IL group (n=41) and the VAM group (n=37). In the IL group, participants were trained in “single-rescuer, adult CPR” in accordance with the American Heart Association's Basic Life Support course for healthcare providers. In the VAM group, all subjects received a 20-minute lesson about CPR. After the lesson, each student trained individually with the VAM for 1 hour, receiving real-time feedback. After the training, all subjects were evaluated as they performed basic CPR (30 compressions, 2 ventilations) for 4 minutes. RESULTS: The proportion of participants with a mean compression depth ≥50 mm was 34.1% in the IL group and 27.0% in the VAM group, and the proportion with a mean compression depth ≥40 mm had increased significantly in both groups compared with ≥50 mm (IL group, 82.9%; VAM group, 86.5%). However, no significant differences were detected between the two groups in this regard. The proportion of ventilations of the appropriate volume was relatively low in both groups (IL group, 26.4%; VAM group, 12.5%; p=0.396). CONCLUSION: Both methods the IL training using a practice-while-watching video and the VAM training facilitated initial CPR skill acquisition, especially in terms of correct chest compression.

Correlation between Tissue Oxygen Saturation and Global Oxygenation Parameters in Emergency Patients: A Pilot Clinical Study

PURPOSE: Near-infrared spectroscopy (NIRS) can noninvasively assess changes in tissue oxygen saturation (StO₂). The primary concern of the current study is to determine whether StO₂ can be used as a surrogate for global oxygenation parameters such as central venous oxygen saturation (ScvO₂), lactic acid, and base deficit (BD) in patients presenting to the emergency department (ED). METHODS: This was a prospective, observational study in patients requiring central venous catheter placement, admitted to the ED with complaints classified as infectious and non-infectious etiology. The NIRS sensor (15 mm probe) was applied on the thenar eminence for at least 3 minutes and ScvO₂, arterial lactic acid, and BD were measured during insertion of a central venous catheter. Data were analyzed using a simple correlation and Bland-Altman plot. RESULTS: A total of 120 patients were enrolled in the study and further classified as an infection (n=39) and a noninfection (n=81) group. Lactic acid BD showed significant correlation with StO₂ in total and in non-infection patients but the degree of correlation was weak and these correlations were not observed in infection patients. Approximately 94% of the difference between StO₂ and ScvO₂ was placed within limit of agreement but there was a risk that StO₂ may overestimate ScvO₂ when ScvO₂ becomes lower. When patients were assigned to two groups according to laboratory results (lactic acid 4.0 mmol/L; BD > 3.0 mmol/L; ScvO₂> 65% or 75%), no significant difference in StO₂ was observed between the two groups. CONCLUSION: In ED patients suspected of having systemic hypoperfusion, StO₂ showed a weak correlation with lactic acid and BD in non-infection patients and no correlation in infection patients. In addition, as ScvO₂ decreased, the difference between StO₂ and ScvO₂ showed a tendency to increase, and StO₂ was much higher than ScvO₂ at low ScvO₂ level. Therefore, before using StO₂ as surrogate for ScvO₂, lactic acid and BD in critically ill patients presenting to the ED, further investigation should be conducted to overcome the limitations of NIRS addressed in this study.

Acute Colchicine Poisoning Treated with Granulocyte Colony Stimulating Factor and Transfusion / 대한구급학회지

Colchicine poisoning is rare but can cause potentially life-threatening toxic complications such as hypovolemic shock, cardiovascular collapse and multiple organ failure. In this case report, we describe a case of a 20-year-old female who presented to the emergency department after suicidal ingestion of a toxic dose of colchicine. She developed thrombocytopenia, neutropenia and acute respiratory distress syndrome that required blood transfusion and administration of granulocyte colony stimulating factor for the prevention of infectious complications. With regard to the clinical manifestations of colchicine toxicity, we discussed suggested mechanisms.