Antidotes Stocking and Delivery for Acute Poisoning Patients at 20 Emergency Departments in Korea 2015–2017

PURPOSE: The National Emergency Medical Center has been running a project for the storage and delivery of antidotes for acute poisoning patients of the Department of Health and Welfare, Korea. This study analyzed the results of this project over the past two years. METHODS: The requests received by the National Emergency Medical Center and the data on the delivery process were analyzed. RESULTS: This study analyzed a total of 121 patients with acute poisoning, who were requested to receive an antidote reserved at 20 key hospitals in 2015–2017, and whose age was 52.3±23.5 years; old; 54 were women. Intentional poisoning were 58.7%, and the home was the most common place of exposure (66.9%). The toxic substances were chemicals (32.2%), pesticides (27.3%), medicines (24.8%), and snake venom (4.1%). The patient's poison severity score was 2.4±0.7 (median 3) indicating moderate-to-severe toxicity. Antidote administration was the cases treated in key hospitals 67.8% (82/121), in which transferred patients accounted for 57.3% (47/82). After receiving an antidote request from a hospital other than the key hospitals, the median was 75.5 minutes (range 10 to 242 minutes) until the antidote reached the patient, and an average of 81.5 minutes was required. The results of emergency care were intensive care unit (70.3%), general wards (13.2%), death (10.7%), and discharge from emergency department (5.0%). CONCLUSION: This study showed that the characteristics of acute poisoning patients treated with an antidote were different from previous reports of poisoned patients in the emergency department, and basic data on the time required for delivery from key hospitals was different.

The Risk Factors Affecting Ultra-Early Rebleeding In Patients with Spontaneous Subarchnoid Hemorrhage

Spontaneous subarachnoid hemorrhage(SAH) is a cause of high mortality and morbidity in the emergency department. Rebleeding has been well investigated, and it is now recognized that early operation can prevent rebleeding. However, ultra-early rebleeding, which may occur prior to early operation(within 24 hours after admission), worsens the clinical outcome of patients with SAH. To determine the risk factors of ultra-early rebleeding in patients with spontaneous SAH before early operation, we analyzed the cases of 383 patients admitted within 24 hours after their last attack of SAH between 1994 to 1996. In this analysis, diagnosis of rebleeding before admission was defined only if the patients experienced a definite clinical deterioration once more after an attack suggesting SAH. After admission patients who observed a sudden neurological deterioration were subject to repeat CT scanning and rebleeding was diagnosed only when new hemorrhage was observed on the CT scan in comparison with the previous scan. 45 cases(11.7%) of 383 patients had ultra-early rebleeding. The incidence of ultra-early rebleeding significantly increased in the patients who admitted hospital within 2 hours after attack. The incidence of ultra-early rebleeding also increased in the old-age group(70 years or more), patients with high systolic blood pressure, those who underwent angiography within 6 hours of the last SAH, and patients who had poor neurological condition.