High-dose Vitamin C therapy in Methemoglobinemia

Methylene blue is the first choice antidote for management of methemoglobinemia, however, some patients are refractory to methylene blue and in most cases, methylene blue cannot be available instantly in Korean emergency departments because of import suspension. A 69-year-old woman visited our emergency department for tachypnea and cyanosis after ingesting 30 tablets of dapsone. Because methylene blue was not available, we intravenously administrated 10 g of vitamin C for symptomatic methemoglobinemia. Repeated i.v. administrations of 10 g of vitamin C in patient without preexisting renal insufficiency successfully treated dapsone-induced methemoglobinemia without causing renal complications. Thus, we recommend that if methylene blue is unavailable or methemoglobinemia is refractory to methylene blue, repeated administrations of 10 g of vitamin C may be considered for the treatment of methemoglobinemia in patients without renal insufficiency.

Usefulness of Blood Cultures in Children Aged Under 3 Years with Fever at the Emergency Department

PURPOSE: Blood cultures are commonly performed in evaluation of febrile children without an obvious source of infection. Pediatric clinicians treat patients with a positive blood culture before final identification of the organism. This study sought to determine the yield and the clinical usefulness of blood cultures in pediatric patients younger than 3 years with fever at the emergency department. METHODS: We conducted a retrospective review of all children between the ages of 1 and 36 months with a body temperature of at least 38.0degrees C who underwent blood culture in the emergency department (ED) from January 2008 to December 2010. RESULTS: Bacteria growth occurred in 126(10.3%) out of 1,219 blood cultures. True positives (TPs), defined as true pathogens, were observed in 2.5% of cultures, representing 23.8% of positives. False positives (FPs), defined as contaminants, were observed in 7.9% of cultures, representing 76.2% of positives. Patients with TP cultures had lower mean pH (7.36+/-0.17 vs 7.41+/-0.08, p=0.031), higher mean base deficit (4.9+/-6.0 mmol/L vs 2.9+/-2.5 mmol/L, p=0.012), and higher mean C-reactive protein (CRP) level (3.3+/-3.7 mg/dL vs 1.8+/-3.2 mg/dL, p=0.034) than those with FP cultures. CONCLUSION: True positive results were observed relatively infrequently in blood cultures of febrile children younger than 3 years in the ED; therefore, changes in treatment of pediatric patients with fever are uncommon. However, bacteria identified by blood cultures are likely to be the true pathogen in a pediatric patient with a large base deficit or a high CRP level.

Effect of a SMS (short message service) System on Emergency Department Overcrowding

PURPOSE: Emergency departments (ED) are always overcrowded. Overcrowding is an important problem associated with emergency department treatment and patient satisfaction. Overcrowding can be caused by specific and complex issues and is affected by multiple influences. In an effort to reduce the degree of overcrowding, we evaluated relationships within the SMS (short message service) specialist's notification system. METHODS: This study involved establishment of a SMS specialist's notification system and other activity for resolution of emergency department overcrowding. We conducted a comparative analysis of ED patients from January 2010 to December 2010, before establishment of the system, and from January 2011 to December 2011, after establishment of the system. Data on ED patients were obtained from electronic medical records and the clinical data warehouse. Data were compared for mean length of stay and patient admission number. RESULTS: Results of comparison showed that the mean length of stay for discharge, admission, operation, and transfer had been effectively reduced. Mean residence time for patients in each administration sector was reduced 80.3, 462.3, 127.3, and 89.3 minutes, respectively, after overcrowding had been diminished. Significant differences for mean residence time were observed in each sector (p<0.001). In addition, comparison of before and after adoption of the SMS specialist's notification system for each clinical department showed that mean length of stay of patients admitted to the emergency department was significantly shorter after its adoption. CONCLUSION: By establishing a SMS specialist notification system, overcrowding can be resolved and length of stay can be shortened, which would result in improved satisfaction of both patients and emergency department professionals.