Status of functional capacity of the emergency care system in Cambodia: a cross-sectional survey

Objective@#The establishment of a proper emergency care system can significantly decrease the number of deaths and disabilities. However, this is neglected in many low- and middle-income countries, including Cambodia. At present, many Cambodian hospitals lack designated emergency departments, formal triage systems, and staff trained in emergency medicine. This study sought to measure the functional capacity of the Cambodian emergency care system corresponding to each hospital level using the Emergency Care Assessment Tool (ECAT). @*Methods@#We conducted a survey from April 19, 2021, to April 27, 2021, by distributing survey sheets to a total of eight Cambodian medical staff who were invited to a hospital in South Korea for an educational program. The ECAT comprises items evaluating the capability of hospitals to perform signal functions for each of the six emergent sentinel conditions that could occur prior to death. We analyzed the data by categorizing the hospitals into basic, intermediate, and advanced levels. @*Results@#Basic-level hospitals had weaknesses in signal functions related to altered mental status and trauma care. The intermediate-level hospital showed weaknesses in signal functions related to respiratory failure, altered mental status, shock, and trauma care. Advanced-level hospitals had weaknesses in signal functions related to respiratory failure, trauma, and shock. @*Conclusion@#Our survey shows that most Cambodian hospitals lack the capability to perform the emergency signal functions expected at each level. We believe that this gap can be bridged with proper customized education targeting medical staff based on the level of their hospital and ensuring a proper supply of medical devices.

In-Flight Cardiopulmonary Resuscitation and COVID-19 / 항공우주의학회지

As the number of passengers using aircraft increases around the world, there may be more medical measures needed within the aircraft. These medical measures may also include measures against serious situations such as cardiopulmonary resuscitation (CPR). However, since the environment is different from the hospital in the aircraft, it may be difficult to cope with such a situation. Moreover, such in-flight CPR may become more difficult at a time when the proportion of out-ofhospital CPR is decreasing due to the recent COVID-19 pandemic. In this paper, I would like to summarize how in-flight CPR is performed and review the main discussions on CPR in the COVID-19 pandemic, and finally suggest how to perform a safe CPR in the COVID-19 situation.

Characteristics of the bicycle driver accident and factors related to the hospital admission: a multi-center retrospective study between 2011 to 2016

OBJECTIVE@#This study aimed to identify the characteristics of bicycle driver accidents, and investigate the factors related to the admission.@*METHODS@#Adult patients (≥20 years old), who visited the emergency department (ED) after a bicycle driver accident registered in the Korean ED-based Injury In-Depth Surveillance (2011–2016) database, were included. The demographic characteristics, accident-related factors, and patients'disposition after the ED treatment were collected. All included cases were categorized into two groups according to the disposition: discharge versus admission. The characteristics of the two groups were compared, and the factors associated with admission were investigated.@*RESULTS@#Among 25,070 ED visits, admissions were required in 5,963 patients (23.8%). The most frequent age group was the twenties (22.0%), and there were more males (74.7%) than females. Accidents occurred most in the summer (34.4%), and non-bicycle roads (73.5%) were the most common places. The most frequently injured body part was the headeck (43.0%), followed by the upper extremities (21.5%). The odds for admission were lower in females than males (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.78–0.96). The odds for admission were higher in the age group over 40 years than in their twenties. Non-bicycle roads had higher odds for admission than bicycle roads (OR, 1.60; 95% CI, 1.40–1.83). Torso (OR, 2.17; 95% CI, 1.92–2.47), upper extremities (OR, 1.20; 95% CI, 1.07–1.35), and lower extremities (OR, 1.48; 95% CI, 1.31–1.66) had higher odds for admission than the headeck.@*CONCLUSION@#Male sex, old age group, accidents on non-bicycle roads, and torso/extremities injuries were associated with the admission in bicycle driver accidents.

Characteristics of Korean Poisoning Patients: Retrospective Analysis by National Emergency Department Information System

PURPOSE@#The study examined the poisoned patients' characteristics nationwide in Korea by using data from the National Emergency Department Information System (NEDIS).@*METHODS@#Among the patients' information sent to NEDIS from January 1, 2013 to December 31, 2015, the included subjects' main diagnosis in ED showed poisoning according to the 7th edition of the Korean Standard Disease Classification (KCD-7). We analyzed the patients' gender, age, initial vital signs, visit time, stay time of staying in ED, results of ED care, main diagnosis in ED, length of hospitalization, and results of hospitalization.@*RESULTS@#A total of 106,779 ED visits were included in the analysis. There were 55,878 males (52.3%), which was more than the number of females. The number of intentional poisoning was 49,805 (59.6%). 75,499 cases (70.8%) were discharged, and 25,858 cases (24.2%) were hospitalized. The numbers of poisoning patients per 1,000 ED visits were 14 in Chungnam and 11.9 in Jeonbuk. The most common cause of poisoning, according to the main diagnosis, was venomous animals. It was the same for hospitalized patients, and pesticide was next. Pesticide was the most common cause of mortality in ED (228 cases, 46.1%) and after hospitalization (584 cases, 54.9%). The incidence of poisoning by age group was frequent for patients in their 30s to 50s, and mortality in ED and post-hospitalization were frequent for patients in their 60s to 80s.@*CONCLUSION@#This study investigated the characteristics of poisoning patients reported in the past 3 years. Pesticide poisoning had a high mortality rate for patients in ED and in-hospital. For mortality, there was a high proportion of elderly people over 60. Thus, policy and medical measures are needed to reduce this problem. Since it is difficult to identify the poison substance in detail due to nature of this study, it is necessary to build a database and monitoring system for monitoring the causative substance and enacting countermeasures.

Emergency Airway Management Using a Glidescope Video Laryngoscope in Trauma Patients

PURPOSE: To describe the current status of airway management for trauma patients in the emergency department (ED) and to evaluate the success rate and associated factors for selecting the Glidescope video laryngoscope. METHODS: This was a retrospective observational study of prospectively collected data from the Koran Emergency Airway Management Registry in two university hospitals between April 2006 and March 2010. The study population included all trauma patients presenting at the ED who required emergency airway management. Demographic and airway related parameters were collected. The success rate was compared between the Glidescope and the direct laryngoscope. Factors associated with selecting the Glidescope were analyzed using multiple logistic regression. RESULTS: Among the 1,974 patients who received airway management in the ED during the study period, 341 were identified as trauma patients. The Glidescope was used in 130 (38%) of the patients. Difficult airway was identified in 46.9% of the Glidescope group compared with 22.6% in the direct laryngoscope group (p<0.001). Success rate on the first attempt was not different between the direct laryngoscope and the Glidescope. The Glidescope was selected in favor of cervical immobilization, difficult airway, and senior grade resident. CONCLUSION: Among intubated patients in the ED, trauma patients accounted for 17.6%. The Glidescope video laryngoscope was selected in 38% of cases. It was usually used in cases of difficult airway such as cervical immobilization by senior grade residents.

A Lethal Case of Sodium Azide Ingestion

Sodium azide (NaN3) is a white to colorless, crystalline powder that is highly water soluble, tasteless, and odorless. It is used mainly as a preservative in aqueous laboratory reagents and biologic fluids and also as an automobile airbag gas generant. Although it has caused deaths for decades, the toxic properties and effects of sodium azide in humans remains unknown. A 31-year-old comatose female was transported to the emergency department with an empty bottle labeled sodium azide. She developed cardiac arrest 15 minutes after arrival and expired in spite of 30 minutes of resuscitative effort. Subsequently, resuscitation team members incidentally suffered from sodium azide's exposure and developed eye discomfort, skin rashes parasthesias, pruritus, sore throat, and headache.