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1.
Article in English | WPRIM | ID: wpr-901205

ABSTRACT

Objective@#This study evaluates the general clinico-toxicological characteristics, and determines whether they are varied with toxin source, in patients admitted to the hospital and diagnosed with grayanotoxin (GTX)/mad honey poisoning. @*Methods@#Patients diagnosed with GTX/mad honey poisoning at the University Teaching Hospital emergency department between January 2001 and December 2015 were included in this retrospective study. The clinico-toxicological characteristics were compared by classifying patients into two groups, according to the toxin source: group A, poisoned by the Himalayan mad honey, and group B, poisoned by biologic materials containing GTX other than Himalayan mad honey. @*Results@#Totally, 26 patients were identified with symptomatic grayanotoxin/mad honey poisoning. There were no statistical differences in the clinico-toxicological characteristics, except systolic blood pressure (SBP). At presentation, the SBP was significantly decreased in group B (P=0.013). Although dizziness and blurred vision were statistically not significant symptoms, there was a trend of significance (P<0.1) in group B. Notably, 5 of the 8 patients who consumed Rhododendron brachycarpum complained of blurred vision, and had a relatively low mean SBP (68.6±15.6 mmHg). @*Conclusion@#The general clinico-toxicological characteristics were similar, subsequent to ingestion of Himalayan mad honey and Rhododendron species. However, since blurred vision and hemodynamic instability were relatively more common in poisoning by R. brachycarpum than other Rhododendron species, emergency physicians need to be aware that the symptoms or severity of poisoning may vary according to the Rhododendron species ingested.

2.
Article in Korean | WPRIM | ID: wpr-901193

ABSTRACT

Objective@#This study evaluated the clinical features of acute Phytolacca poisoning and investigated the prognostic factors associated with severe poisoning. @*Methods@#This is a retrospective observational study using the data of patients presenting with acute Phytolacca poisoning. Demographic data, toxicological data, vital signs, laboratory data, and electrocardiographic data were collected. Study patients were divided into mild and severe poisoning patients. After a univariate analysis, binary logistic regression analysis, which used ‘severe poisoning’ as a dependent variable, was performed to figure out the independent variables. In addition, the area under the curve and the cut-off value of independent variables were suggested by using receiver operating characteristics analysis. @*Results@#Most poisonings (80.5%) occurred in winter and spring. Most patients (98.4%) ingested the root of Phytolacca. It took 2 hours from ingestion to the beginning of the symptoms (interquartile range, 1.0-3.0) which included nausea/vomiting (98.4%), abdominal pain (58.6%), or diarrhea (53.1%). Severe poisoning developed in 21 patients (16.4%). For prediction of severe poisoning, the adjusted odds ratio of time from ingestion to the onset of symptoms was 0.18 (95% confidence interval [CI], 0.05-0.61) and that of the amount of ingestion was 1.42 (95% CI, 0.99-2.03). The area under the curve of time from ingestion to the onset of symptoms (≤1 hour) was 0.81 (95% CI, 0.73-0.88) and that of the amount of ingestion (>1.5 knuckles) was 0.75 (95% CI, 0.65-0.83). @*Conclusion@#Acute Phytolacca poisoning has clinical features of acute enterocolitis. Severe poisoning could develop especially in patients with a rapid onset of symptoms (≤1 hour) and ingesting over 1.5 knuckles.

3.
Article in Korean | WPRIM | ID: wpr-916525

ABSTRACT

Objective@#The aims of this study were to determine the prevalence of deep vein thrombosis (DVT) and assess the association of concomitant DVT and unfavorable outcomes in patients with acute symptomatic pulmonary embolism (PE). @*Methods@#We conducted a retrospective analysis of patients with acute symptomatic PE by a computed tomography angiography. Study patients were divided into two groups, including unfavorable and favorable outcome groups. Baseline characteristics and radiologic findings were compared between the two groups. Then, binary logistic regression analysis using the unfavorable outcome as a dependent variable was performed to assess whether concomitant DVT was associated with unfavorable outcomes. @*Results@#Of the 128 patients, 67.2% (86 of 128) had concomitant DVT, and 20.3% (26 of 128) had an unfavorable outcome. The median age was 75.0 years (interquartile range, 63.0-82.0 years), and 76 (59.4%) patients were female. Concomitant DVT and proximal DVT were associated with unfavorable outcomes (P<0.05). In multivariate analysis, proximal DVT (adjusted odds ratio, 7.03; 95% confidence interval, 1.01-49.12) was an independent risk factor of unfavorable outcome. @*Conclusion@#In patients with acute symptomatic PE, about two-thirds of patients had DVT. This study suggests that proximal DVT is significantly associated with unfavorable outcomes.

4.
Article in English | WPRIM | ID: wpr-916517

ABSTRACT

Pyometra is a rare clinical entity, leading to life-threatening complications, such as perforation of the uterus and peritonitis, when the diagnosis is delayed. Emergency department physicians should take into consideration whether older women have a fever and abdominal pain. Early surgical drainage and the diagnosis of pyometra should be confirmed. An 89-year-old woman was admitted to the emergency department because of fever and general fatigue. We reported a clinical case of a postmenopausal woman with a large pyometra, which was misdiagnosed as a distended bladder filled with urine.

5.
Article in English | WPRIM | ID: wpr-893501

ABSTRACT

Objective@#This study evaluates the general clinico-toxicological characteristics, and determines whether they are varied with toxin source, in patients admitted to the hospital and diagnosed with grayanotoxin (GTX)/mad honey poisoning. @*Methods@#Patients diagnosed with GTX/mad honey poisoning at the University Teaching Hospital emergency department between January 2001 and December 2015 were included in this retrospective study. The clinico-toxicological characteristics were compared by classifying patients into two groups, according to the toxin source: group A, poisoned by the Himalayan mad honey, and group B, poisoned by biologic materials containing GTX other than Himalayan mad honey. @*Results@#Totally, 26 patients were identified with symptomatic grayanotoxin/mad honey poisoning. There were no statistical differences in the clinico-toxicological characteristics, except systolic blood pressure (SBP). At presentation, the SBP was significantly decreased in group B (P=0.013). Although dizziness and blurred vision were statistically not significant symptoms, there was a trend of significance (P<0.1) in group B. Notably, 5 of the 8 patients who consumed Rhododendron brachycarpum complained of blurred vision, and had a relatively low mean SBP (68.6±15.6 mmHg). @*Conclusion@#The general clinico-toxicological characteristics were similar, subsequent to ingestion of Himalayan mad honey and Rhododendron species. However, since blurred vision and hemodynamic instability were relatively more common in poisoning by R. brachycarpum than other Rhododendron species, emergency physicians need to be aware that the symptoms or severity of poisoning may vary according to the Rhododendron species ingested.

6.
Article in Korean | WPRIM | ID: wpr-893489

ABSTRACT

Objective@#This study evaluated the clinical features of acute Phytolacca poisoning and investigated the prognostic factors associated with severe poisoning. @*Methods@#This is a retrospective observational study using the data of patients presenting with acute Phytolacca poisoning. Demographic data, toxicological data, vital signs, laboratory data, and electrocardiographic data were collected. Study patients were divided into mild and severe poisoning patients. After a univariate analysis, binary logistic regression analysis, which used ‘severe poisoning’ as a dependent variable, was performed to figure out the independent variables. In addition, the area under the curve and the cut-off value of independent variables were suggested by using receiver operating characteristics analysis. @*Results@#Most poisonings (80.5%) occurred in winter and spring. Most patients (98.4%) ingested the root of Phytolacca. It took 2 hours from ingestion to the beginning of the symptoms (interquartile range, 1.0-3.0) which included nausea/vomiting (98.4%), abdominal pain (58.6%), or diarrhea (53.1%). Severe poisoning developed in 21 patients (16.4%). For prediction of severe poisoning, the adjusted odds ratio of time from ingestion to the onset of symptoms was 0.18 (95% confidence interval [CI], 0.05-0.61) and that of the amount of ingestion was 1.42 (95% CI, 0.99-2.03). The area under the curve of time from ingestion to the onset of symptoms (≤1 hour) was 0.81 (95% CI, 0.73-0.88) and that of the amount of ingestion (>1.5 knuckles) was 0.75 (95% CI, 0.65-0.83). @*Conclusion@#Acute Phytolacca poisoning has clinical features of acute enterocolitis. Severe poisoning could develop especially in patients with a rapid onset of symptoms (≤1 hour) and ingesting over 1.5 knuckles.

7.
Article | WPRIM | ID: wpr-834922

ABSTRACT

Objective@#May-Thurner syndrome (MTS) is a condition, in which the left common iliac vein is compressed by the right common iliac artery and spine, resulting in an increased risk of deep vein thrombosis (DVT). This study examined the clinical features of MTS and relationship of MTS with a pulmonary embolism (PE) in acute DVT patients. @*Methods@#This study was a retrospective observational study using the electronic medical records of patients with acute DVT in 2018. Acute DVT patients were divided into the MTS group (n=18, 23.1%) and non-MTS group (n=60, 76.9%) according to the presence of MTS. The following items were compared: demographic data, risk factors of DVT, vital signs, laboratory results, involvement site of vein, incidence of PE, and severity of PE. @*Results@#The presence of risk factors was similar in the two groups. All MTS patients had DVT in the left lower extremity. The ilio-femoral DVT (21.7% vs. 77.8%, P<0.001) and mixed DVT (both ilio-femoral and femoro-popliteal, 10.0% vs. 44.4%; P=0.002) were observed more frequently in the MTS group. The incidence of PE was higher in the non-MTS group (65.0%) than in the MTS group (33.3%) (P=0.017). On the other hand, the severity of PE assessed with main pulmonary artery involvement or hemodynamic instability, and right ventricular dysfunction did not show a significant difference between the two groups. @*Conclusion@#DVT could develop with the presence of risk factors in MTS patients. DVT patients with MTS might reduce the risk of developing PE compared to those without MTS, but the severity of PE was similar in the two groups.

8.
Article in Korean | WPRIM | ID: wpr-758412

ABSTRACT

Procalcitonin (PCT) is commonly employed in medical practice as a diagnostic biomarker of bacterial infection and also as a monitoring biomarker for antimicrobial therapy. There have been a few published reports concerning elevated PCT levels in people with acute liver injury caused by an overdose of acetaminophen. We report here on a case of PCT elevation in an adolescent with acute acetaminophen poisoning without any bacterial infection or liver injury. A 15-year-old girl had deliberately ingested 20 tablets of 650 mg acetaminophen (13 g) and she presented to our emergency department. The PCT level on admission was elevated to 65.64 ng/mL (reference range: 0–0.5 ng/mL). Her PCT level on the second day peaked up to 100 ng/mL and then it gradually decreased. There was no evidence of liver injury or infection on the computed tomography examination and other lab tests. The patient regained her good health and was discharged on the sixth day of hospitalization.


Subject(s)
Acetaminophen , Adolescent , Bacterial Infections , Emergency Service, Hospital , Female , Hospitalization , Humans , Liver , Poisoning , Tablets
9.
Article in English | WPRIM | ID: wpr-758411

ABSTRACT

Dioscorea tokoro has long been used in Korean traditional medicine as a pain killer and anti-inflammatory agent. A 53-year-old male who consumed water that had been boiled with raw tubers of D. tokoro as tea presented with numbness and spasm of both hands and feet. Laboratory results showed hypocalcemia, hypoparathyroidism, and vitamin D insufficiency. During his hospital stay, colitis, acute kidney injury, and toxic encephalopathy developed. The patient received calcium gluconate intravenous infusion and oral calcium carbonate with alfacalcidol. His symptoms improved gradually, but hypocalcemia persisted despite the calcium supplementation. We suggest that ingestion of inappropriately prepared D. tokoro can cause symptomatic hypocalcemia in patients with unbalanced calcium homeostasis.


Subject(s)
Acute Kidney Injury , Calcium , Calcium Carbonate , Calcium Gluconate , Colitis , Dioscorea , Eating , Foot , Hand , Homeostasis , Humans , Hypesthesia , Hypocalcemia , Hypoparathyroidism , Infusions, Intravenous , Length of Stay , Male , Medicine, Korean Traditional , Middle Aged , Neurotoxicity Syndromes , Spasm , Tea , Vitamin D , Water
10.
Article in Korean | WPRIM | ID: wpr-717569

ABSTRACT

OBJECTIVE: The purpose of this study was to evaluate whether or not the d-dimer level indicating hyperfibrinolysis could be a predictor of early poor outcome (massive transfusion, death within 24 hours) associated with trauma-induced coagulopathy in blunt trauma without significant brain injury. METHODS: This study was a retrospective observational study using 516 blunt trauma patients without significant brain injury. The poor outcome group, including patients receiving massive transfusion and those who died within 24 hours, consisted of 33 patients (6.4%). The variables were compared between the poor outcome group and good outcome group, and logistic regression analysis was performed using statistically significant variables. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the poor outcome prediction ability of the initial d-dimer level. RESULTS: The poor outcome group showed more serious anatomical, physiological, and laboratory data than the good outcome group. In the ROC curve analysis for evaluation of the poor outcome prediction of the d-dimer level, the area under the curve value was 0.87 (95% confidence interval [CI], 0.84–0.90) while the cut-off value was 27.35 mg/L. In the logistic regression analysis, the high d-dimer level was shown to be an independent predictor of poor outcome (adjusted odds ratio, 14.87; 95% CI, 2.96–74.67). CONCLUSION: The high d-dimer level (>27.35 mg/L) can be used as a predictor for the poor outcome of patients with blunt trauma without significant brain injury.


Subject(s)
Blood Transfusion , Brain Injuries , Brain , Humans , Logistic Models , Multiple Trauma , Observational Study , Odds Ratio , Retrospective Studies , ROC Curve , Wounds, Nonpenetrating
11.
Article in Korean | WPRIM | ID: wpr-223866

ABSTRACT

PURPOSE: The serum ammonia level was postulated as a surrogate marker for severe neurotoxicity in glufosinate ammonium (GLA) poisoning. The aim of this study is to evaluate whether the level of serum ammonia can predict delayed neurologic complications in patients with GLA poisoning presented with alert mentality. METHODS: Thirty-six GLA-poisoned patients presented to our emergency department with alert mentality initially were analyzed retrospectively. The baseline characteristics, laboratory findings, ammonia level (initial and second ammonia level, frequency of hyperammonemia, and difference of ammonia level), and clinical outcomes were compared between non-neurologic (n=16) and neurologic complication groups (n=20). RESULTS: Neurologic complications occurred in 20 patients (55.6%) with 14.3 hours (median) of latent period. The initial ammonia level and frequency of initial hyperammonemia did not show any difference between the two groups. However, the difference of ammonia level between the 2nd and 1st samples was an independent predictor of delayed neurologic complication (adjusted odds ratio; 1.184 (95% confidence interval (CI); 1.01-1.387, p=0.037)). The area under the curve and cut-off point of the difference of ammonia level for the prediction of delayed neurologic complication was 0.936 (95% CI; 0.756-0.992) and 15.4 umol/L respectively. CONCLUSION: The difference of ammonia level rather than the initial ammonia level could be used to predict delayed neurologic complication in GLA-poisoned patients presented with alert mentality.


Subject(s)
Ammonia , Ammonium Compounds , Biomarkers , Emergency Service, Hospital , Humans , Hyperammonemia , Odds Ratio , Poisoning , Retrospective Studies
12.
Article in Korean | WPRIM | ID: wpr-136325

ABSTRACT

Some carnivorous gastropods have heat stable tetramine toxins in their salivary glands. This toxin is an autonomic ganglionic blocking agent that enables them to catch the prey easily by paralyzing their targets. Acute tetramine toxin poisoning in humans from eating whelks has been well described based on numerous cases, but is rare in Korea. Symptoms of tetramine poisoning include eyeball pain, blurred vision, headache, dizziness, muscular twitching, tingling of hands and feet, weakness, paralysis and sometimes collapse. Gastrointestinal symptoms, such as abdominal pain, nausea, and vomiting can also occur. However, intoxication is self-limiting and patients will usually recover in about 24 hours. Herein, we report 2 cases of tetramine poisoning after ingestion of Buccinum striatissinum as meat and soup.


Subject(s)
Abdominal Pain , Dizziness , Eating , Foot , Ganglia, Autonomic , Gastropoda , Hand , Headache , Hot Temperature , Humans , Korea , Meat , Nausea , Paralysis , Poisoning , Salivary Glands , Vomiting
13.
Article in Korean | WPRIM | ID: wpr-136324

ABSTRACT

Some carnivorous gastropods have heat stable tetramine toxins in their salivary glands. This toxin is an autonomic ganglionic blocking agent that enables them to catch the prey easily by paralyzing their targets. Acute tetramine toxin poisoning in humans from eating whelks has been well described based on numerous cases, but is rare in Korea. Symptoms of tetramine poisoning include eyeball pain, blurred vision, headache, dizziness, muscular twitching, tingling of hands and feet, weakness, paralysis and sometimes collapse. Gastrointestinal symptoms, such as abdominal pain, nausea, and vomiting can also occur. However, intoxication is self-limiting and patients will usually recover in about 24 hours. Herein, we report 2 cases of tetramine poisoning after ingestion of Buccinum striatissinum as meat and soup.


Subject(s)
Abdominal Pain , Dizziness , Eating , Foot , Ganglia, Autonomic , Gastropoda , Hand , Headache , Hot Temperature , Humans , Korea , Meat , Nausea , Paralysis , Poisoning , Salivary Glands , Vomiting
14.
Article in Korean | WPRIM | ID: wpr-217700

ABSTRACT

PURPOSE: Acute endosulfan poisoning is rare but causes significant morbidity and mortality. The aim of our study is to describe complications and features of seizure and determine factors associated with mortality in acute endosulfan poisoning. METHODS: Twenty-eight adult patients with acute endosulfan poisoning admitted to our emergency department during a 15-year period were studied retrospectively. The clinical features of seizure, use of antiepileptic drugs during seizure, and hospital courses were evaluated. Clinical factors between survived group and non-survived group were compared for identification of factors associated with mortality. RESULTS: Of the 28 patients with endosulfan poisoning, 4 patients (14.3%) died and 15 (53.6%) patients developed generalized tonic-clonic seizure. Thirteen patients (46.4%) and 5 patients (17.9%) progressed to status epilepticus (SE) and refractory status epilepticus (RSE), respectively. SE and RSE were associated with mortality. Almost all significant complications including shock, acute renal failure, hepatic toxicity, rhabdomyolysis, and cardiac injury developed in SE and RSE patients. CONCLUSION: SE and RSE were important contributors to death in endosulfan poisoning. Emergency physicians treating endosulfan poisoning should make an effort not to progress seizure following endosulfan poisoning to SE and RSE using a rapid and aggressive antiepileptic drug.


Subject(s)
Acute Kidney Injury , Adult , Anticonvulsants , Emergencies , Emergency Service, Hospital , Endosulfan , Humans , Mortality , Poisoning , Retrospective Studies , Rhabdomyolysis , Seizures , Shock , Status Epilepticus
15.
Article in English | WPRIM | ID: wpr-727682

ABSTRACT

Nausea and emesis are a major side effect and obstacle for chemotherapy in cancer patients. Employ of antiemetic drugs help to suppress chemotherapy-induced emesis in some patients but not all patients. Ginger, an herbal medicine, has been traditionally used to treat various kinds of diseases including gastrointestinal symptoms. Ginger is effective in alleviating nausea and emesis, particularly, for cytotoxic chemotherapy drug-induced emesis. Ginger-mediated antiemetic effect has been attributed to its pungent constituents-mediated inhibition of serotonin (5-HT) receptor activity but its cellular mechanism of action is still unclear. Emetogenic chemotherapy drugs increase 5-HT concentration and activate visceral vagal afferent nerve activity. Thus, 5-HT mediated vagal afferent activation is essential to provoke emesis during chemotherapy. In this experiment, water extract of ginger and its three major pungent constituent's effect on 5-HT-evoked responses were tested on acutely dispersed visceral afferent neurons with patch-clamp methods. The ginger extract has similar effects to antiemetic drug ondansetron by blocking 5-HT-evoked responses. Pungent constituents of the ginger, [6]-shogaol, [6]-gingerol, and zingerone inhibited 5-HT responses in a dose dependent manner. The order of inhibitory potency for these compounds were [6]-shogaol>[6]-gingerol>zingerone. Unlike well-known competitive 5-HT3 receptor antagonist ondansetron, all tested ginger constituents acted as non-competitive antagonist. Our results imply that ginger and its pungent constituents exert antiemetic effects by blocking 5-HT-induced emetic signal transmission in vagal afferent neurons.


Subject(s)
Antiemetics , Drug Therapy , Ginger , Herbal Medicine , Humans , Nausea , Neurons , Neurons, Afferent , Ondansetron , Receptors, Serotonin, 5-HT3 , Serotonin , Visceral Afferents , Vomiting , Water
16.
Article in Korean | WPRIM | ID: wpr-73492

ABSTRACT

PURPOSE: The aim of this study is to estimate one mouthful volume in a single swallow and average volume per swallow (AVS) in multiple swallows in the situation of toxic liquid poisoning. METHODS: Thirty five men and 35 women were included in this study. Each subject was asked to drink one swallow and three consecutive swallows from bottle containing water and a bottle containing saline separately. We calculated one mouthful volume in a single swallow and AVS in three swallows. One mouthful volume and AVS were compared according to sex and content, respectively. One mouthful volume of water and saline was then compared with AVS of each. RESULTS: Sixty seven adults(34 men; 26.9+/-3.2 years, 33 women; 25.6+/-2.4 years) completed the study. Men had larger one mouthful volume of water(49.1+/-19.9 ml vs 39.7+/-10.2 ml, p=0.02) and saline(20.7+/-10.9 ml vs 14.0+/-4.6 ml, p=0.004) and AVS of water(28.5+/-11.9 ml vs 21.5+/-5.9 ml, p=0.004) and saline(11.9+/-6.3 ml vs 7.9+/-2.0 ml, p=0.001) than women. One mouthful volume and AVS of saline swallow were lower than those of water swallow. AVS of three consecutive swallows was lower than one mouthful volume in water and saline swallow. CONCLUSION: We suggest that one mouthful volume in a single swallow is 21 ml in men and 14 ml in women and AVS in multiple swallows is 12 ml in men and 8 ml in women. AVS in multiple swallows is two-threefold lower than reference values(20~30 ml) commonly used in poisoning study.


Subject(s)
Adult , Deglutition , Female , Humans , Male , Mouth , Poisoning , Swallows , Water , Young Adult
17.
Article in Korean | WPRIM | ID: wpr-59133

ABSTRACT

PURPOSE: The large disparity in outcomes of out-of-hospital cardiac arrest (OHCA) between communities makes it important determine pre-hospital factors associated with outcome of OHCA. The study evaluated pre-hospital care performed by 119 rescuers in OHCA and investigated pre-hospital factors that influenced return of spontaneous circulation (ROSC) and automated external defibrillator (AED) use. METHODS: We retrospectively analyzed 119 OHCA patients with presumed cardiac origin admitted to our emergency department transported by 119 rescuers from May 2007 to April 2010. Patients were divided according to achievement of ROSC and AED use prior to comparative analysis. RESULTS: Twenty six patients (21.8%) experienced ROSC and only five patients (4.2%) survived to discharge. In the study area, scene-to-hospital arrival time was significantly shorter in the ROSC group (15.0+/-5.8 minutes) than the non-ROSC group (19.4+/-9.1 minutes) (p=0.02) and electrocardiography (ECG) application was associated with non-AED use. CONCLUSION: Cooperation of emergency medical services and hospitals in the community to reduce hospital arrival time is needed to improve ROSC in OHCA patients. AED use on scene prior to ECG application will be encouraged and higher level training and continuous education of 119 rescuers for AED use will be needed to enhance AED application.


Subject(s)
Achievement , Defibrillators , Electrocardiography , Emergencies , Emergency Medical Services , Humans , Out-of-Hospital Cardiac Arrest , Retrospective Studies
18.
Article in Korean | WPRIM | ID: wpr-166248

ABSTRACT

BACKGROUND: D-dimer testing is widely applied as a first step in the diagnostic work-up of pulmonary embolism (PE). Although this is the most sensitive assay for ruling out PE, the prognostic implications of D-dimer testing in patients with normotensive PE are not well known. The aim of this study was to determine if D-dimer testing on admission predicts major adverse cardiac events (MACE) in patients with normotensive PE. METHODS: A total of 180 consecutive patients with normotensive PE admitted between January 2003 and June 2009 were included. The group was divided into quartiles on the basis of their D-dimer levels. We compared the frequency of MACE by quartile of D-dimer level and estimated sensitivity, specificity, and predictive values for MACE in the first and fourth quartile. RESULTS: In the 37 (20.6%) patients with MACEs, the median D-dimer level (7.94 [IQR: 4.03~18.17] microgram/mL) was higher than in patients with a benign course (5.29 [IQR: 2.60~11.52] microgram/mL, p<0.01). The occurrence of MACEs was increased with increasing D-dimer level (p=0.017). In the first quartile (D-Dimer <2.76 microgram/mL) sensitivity, specificity, and positive and negative predictive values for predicting MACEs were, respectively, 91.9%, 29.4%, 25.2%, and 93.3%. CONCLUSION: Patients with D-dimer levels below 2.76 microgram/mL have a low risk of MACEs. Our study suggest that D-dimer level may be used to identify low risk patients with normotensive PE.


Subject(s)
Fibrin Fibrinogen Degradation Products , Humans , Prognosis , Pulmonary Embolism , Resin Cements
19.
Article in Korean | WPRIM | ID: wpr-46265

ABSTRACT

PURPOSE: The aim of our study was to examine the discrepancies between the Pneumonia Severity Index (PSI) score, the CURB-65 [confusion, blood urea nitrogen, respiratory rate and blood pressure with age (65 years)] and the clinical judgment for making admission decisions, and we also wanted to evaluate the value of the PSI and CURB-65 as the indicators for detecting inappropriate hospitalization among the patients with low risk CAP. METHODS: The medical records of 286 patients who visited the emergency department with CAP were identified by their PSI and their CURB-65, and we reviewed whether there existed a clinical basis to justify their hospitalization. RESULTS: Of a total 286 patients, 225 patients were admitted to the hospital. Sixty five patients with a PSI of I or II, and 117 patients with a CURB-65 of 0 or 1 were admitted by clinical judgment. The factors that justified admission of a lower risk CAP group were medical conditions other than CAP (56.9% vs 70.1%; PSI vs CURB-65), failure of outpatient therapy (24.6% vs 19.6%), social needs (6.2% vs 2.6%) and hypoxemia in 1 patient (1.5% vs 0.9%, respectively). Of the patients in the low risk group according to the CURB-65, one five patient was hospitalized for suspicion of sepsis. The positive predicted values of the PSI and CURB- 65 for inappropriate hospitalization of low risk CAP patients were 10.8% and 5.9%, respectively. CONCLUSION: The PSI and CURB-65 had unacceptably low positive predictive values and this was due to the comorbid conditions that required in-hospital care for the patients with low risk CAP. These indices did not supersede clinical judgment for making the decision to hospitalize low risk patients with CAP.


Subject(s)
Hypoxia , Blood Pressure , Blood Urea Nitrogen , Community-Acquired Infections , Emergencies , Hospitalization , Humans , Judgment , Medical Records , Outpatients , Pneumonia , Respiratory Rate , Sepsis , Severity of Illness Index
20.
Article in Korean | WPRIM | ID: wpr-52180

ABSTRACT

PURPOSE: Various electrocardiogram (ECG) changes can occur in patients with acute organophosphate poisoning (OPP) and may be associated with the clinical severity of poisoning. The present study aimed to evaluate the extent and frequency of ECG changes and cardiac manifestations, and their association with acute OPP clinical severity. METHODS: Seventy-two adult patients admitted to our emergency department with a diagnosis of acute OPP were studied retrospectively. ECG changes and cardiac manifestations at admission were evaluated. ECG changes between respiratory failure (RF) group and no respiratory failure (no RF) groups were compared. RESULTS: Prolongation of QTc interval (n=40, 55.6%) was the most common ECG change, followed by sinus tachycardia (n=36, 50.0%). ST-T wave changes such as ST segment elevation or depression and T wave change (inversion or non-specific change) were evident in 16 patients (22.2%). Prolongation of QTc interval was significantly higher in the RF group compared with the no RF group (p=0.03), but was not an independent predictor for RF in acute OPP (OR; 4.00, 95% CI; 0.70-23.12, p=0.12). CONCLUSION: While patients with acute OPP can display ECG changes that include prolongation of QTc interval, sinus tachycardia, and ST-T wave changes at admission, these changes are not predictors of respiratory failure.


Subject(s)
Adult , Depression , Electrocardiography , Emergencies , Humans , Organophosphate Poisoning , Phenylpropionates , Respiratory Insufficiency , Retrospective Studies , Tachycardia, Sinus
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