Clinical characteristics of intentional self-harm inpatient with lethal methods

OBJECTIVE: The aim of this study was to identify the latent class, according to the risk factors, of the patients hospitalized due to intentional self-harm by lethal means. METHODS: The risk factors were derived by categorizing the intentional self-harming measures by lethal (hanging, pesticide poisoning, jumping, and drowning) and non-lethal (drug poisoning and stab) measures and comparing the demographics, diseased state, and suicide-related characteristics. Latent class analysis was performed to identify the type of intentional self-harm. RESULTS: Male (sex), elderly (age), rural (residing location), and comorbid diseases were found to be the risk factors for fatal injuries. For this, four latent classes were modeled. Factors, such as the age group between 20 to 40 years, women, and family conflict were included in the first class. The second class included the age group between 30 to 50 years, men, and financial problems. The third class covered the age group between 60 to 70 years and comorbidity. The fourth class contained the age group of 10 to 50 years, women, and mental problems. The rate of suicide and choice of fatal suicide was ranked in the order of 3 (62.7%, 21.5%), 2 (59.8%, 13.9%), 4 (36.8%, 5.7%), and 1 (29.5%, 5.9%). CONCLUSION: A lethal mean access control policy needs to be established for the high-risk group of self-harm. Moreover, establishing an emergency room-community link prevention policy could help reduce the re-suicide attempt among suffering patients.

The Use of Vapocoolant Spray for the Treatment of Minor Trauma in the Hospital Emergency Department

PURPOSE: Vapocoolant spray is used as an agent to relieve localized pain due to sport injury or intravenous cannulation. The aim of this study was to determine the effectiveness of vapocoolant spray in the treatment of minor trauma in a hospital emergency department. METHODS: We carried out a prospective randomized controlled trial of alert patients with minor trauma who visited our emergency department. The total of 90 participants, all over 14 years old, were divided into 3 groups: a 'NSAIDs IM' group (n=30), 'Vapocoolant spray' group (n=30), and 'NSAIDs IM with Vapocoolant spray' group (n=30). Patients rated their pain and satisfaction of treatment using a 100-mm visual analogue scale (VAS). We assessed pain by VAS 4 times: first upon arrival, and then at 15, 30 and 60 minutes after treatment. We also assessed their treatment satisfaction utilizing VAS at the point of discharge. In addition, we calculated the time between subject arrival and initial treatment. RESULTS: Groups did not differ significantly in terms of age or sex distribution. The mean of the VAS score did not differ significantly among the groups upon their arrival (p=0.885) and were observed as follows: 'NSAIDs IM' group 44.80+/-12.70 mm, 'Vapocoolant spray' group 45.20+/-10.49 mm, and 'NSAIDs IM with Vapocoolant spray' group 46.17+/-9.54 mm. At 15, 30 and 60 min after treatment, the mean reduction in VAS score significantly differed between groups (p<0.05). At 15 min after treatment the results were as follows: 'NSAIDs IM' group 5.27+/-3.26 mm, 'Vapocoolant spray' group 15.17+/-7.17 mm, and 'NSAIDs IM with Vapocoolant spray'group 14.57+/-4.07 mm. At 30 min after treatment the results were: 'NSAIDs IM' group 13.57+/-7.86 mm, 'Vapocoolant spray' group 19.47+/-9.96 mm, and 'NSAIDs IM with Vapocoolant spray' group 21.20+/-6.52 mm. At 60 min after treatment the results were: 'NSAIDs IM' group 25.73+/-8.07 mm, 'Vapocoolant spray' group 20.90+/-9.88 mm, and 'NSAIDs IM with Vapocoolant spray' group 28.93+/-6.66 mm. Satisfaction of treatment and initial treatment time differed between groups (p<0.05). For satisfaction of treatment, the median of VAS significantly differed between the 'NSAIDs IM' group and the 'NSAIDs IM with Vapocoolant spray' group [46.50(41-52) mm vs. 57.00(51-62) mm, p<0.0167]. Initial treatment time significantly differed between the 'NSAIDs IM' group and the other groups [22.50(13-34) min vs. 10.00(7-20) min and 13.00(7-20) min, p<0.0167]. CONCLUSION: Vapocoolant spray is effective in reducing pain with minor trauma in the hospital emergency department. We can simultaneously improve the patient treatment satisfaction and reduce initial treatment time by using the vapocoolant spray.

The Use of Vapocoolant Spray for the Treatment of Minor Trauma in the Hospital Emergency Department

PURPOSE: Vapocoolant spray is used as an agent to relieve localized pain due to sport injury or intravenous cannulation. The aim of this study was to determine the effectiveness of vapocoolant spray in the treatment of minor trauma in a hospital emergency department. METHODS: We carried out a prospective randomized controlled trial of alert patients with minor trauma who visited our emergency department. The total of 90 participants, all over 14 years old, were divided into 3 groups: a 'NSAIDs IM' group (n=30), 'Vapocoolant spray' group (n=30), and 'NSAIDs IM with Vapocoolant spray' group (n=30). Patients rated their pain and satisfaction of treatment using a 100-mm visual analogue scale (VAS). We assessed pain by VAS 4 times: first upon arrival, and then at 15, 30 and 60 minutes after treatment. We also assessed their treatment satisfaction utilizing VAS at the point of discharge. In addition, we calculated the time between subject arrival and initial treatment. RESULTS: Groups did not differ significantly in terms of age or sex distribution. The mean of the VAS score did not differ significantly among the groups upon their arrival (p=0.885) and were observed as follows: 'NSAIDs IM' group 44.80+/-12.70 mm, 'Vapocoolant spray' group 45.20+/-10.49 mm, and 'NSAIDs IM with Vapocoolant spray' group 46.17+/-9.54 mm. At 15, 30 and 60 min after treatment, the mean reduction in VAS score significantly differed between groups (p<0.05). At 15 min after treatment the results were as follows: 'NSAIDs IM' group 5.27+/-3.26 mm, 'Vapocoolant spray' group 15.17+/-7.17 mm, and 'NSAIDs IM with Vapocoolant spray'group 14.57+/-4.07 mm. At 30 min after treatment the results were: 'NSAIDs IM' group 13.57+/-7.86 mm, 'Vapocoolant spray' group 19.47+/-9.96 mm, and 'NSAIDs IM with Vapocoolant spray' group 21.20+/-6.52 mm. At 60 min after treatment the results were: 'NSAIDs IM' group 25.73+/-8.07 mm, 'Vapocoolant spray' group 20.90+/-9.88 mm, and 'NSAIDs IM with Vapocoolant spray' group 28.93+/-6.66 mm. Satisfaction of treatment and initial treatment time differed between groups (p<0.05). For satisfaction of treatment, the median of VAS significantly differed between the 'NSAIDs IM' group and the 'NSAIDs IM with Vapocoolant spray' group [46.50(41-52) mm vs. 57.00(51-62) mm, p<0.0167]. Initial treatment time significantly differed between the 'NSAIDs IM' group and the other groups [22.50(13-34) min vs. 10.00(7-20) min and 13.00(7-20) min, p<0.0167]. CONCLUSION: Vapocoolant spray is effective in reducing pain with minor trauma in the hospital emergency department. We can simultaneously improve the patient treatment satisfaction and reduce initial treatment time by using the vapocoolant spray.

Comparison of central venous pressure and the inferior vena cava/aorta diameter index for evaluation of body fluid status

PURPOSE: Central venous pressure (CVP) is used almost universally to evaluate patient body fluid status. But historical and more recent data suggest that this approach may be flawed. In this study, we compared the accuracy of CVP versus the inferior vena cava/aorta diameter index (IVC/Ao index), a new approach to assessing body fluid status. METHODS: This study was carried out prospectively with subjects over 18 years of age who visited the emergency department between November 2010 and January 2011. A central venous catheter (CVC) was inserted into patients undergoing computed tomography (CT). IVC and aortic diameter were measured below the renal vein using the CT in axial view. To determine the exact CVP, we measured the distance from the tip of the CVC to the superior vena cava/right atrium (SVC/RA) junction in coronal and axial CT views, and placed the tip of a CVC at the SCV/RA junction. We analyzed the correlation between the CVP, IVC diameter and the IVC/Ao index. RESULTS: A total of 65 patients were enrolled in this study. The mean CVP was 9.25+/-5.99 mmH2O, IVC diameter was 1.456+/-0.568 cm and IVC/Ao index was 0.854+/-0.316. The correlation coefficient for CVP and IVC diameter was 0.625 (p<0.01) and for CVP and IVC/aorta index it was 0.711 (p<0.01). Coefficient of variations (CVs) of the IVC/Ao index was 0.76 at CVP 5 mmH2O and 0.14 at CVP 17 cmH2O. The correlation coefficient for CVP and IVC/Ao index in the group with a CVP result of less than 8 cmH2O was 0.330, and in the group with a CVP result greater than 8 cmH2O, it was 0.660 (p<0.01). CONCLUSION: The CVP results had a higher correlation to the IVC/aorta index than to the IVC diameter. The coefficient of variant (CV) tended to increase as CVP decreased. It is best not to use a single value of CVP or IVC/Ao index to evaluate the body fluid state, as some kind of dynamic parameter should be used.

Comparison of central venous pressure and the inferior vena cava/aorta diameter index for evaluation of body fluid status

PURPOSE: Central venous pressure (CVP) is used almost universally to evaluate patient body fluid status. But historical and more recent data suggest that this approach may be flawed. In this study, we compared the accuracy of CVP versus the inferior vena cava/aorta diameter index (IVC/Ao index), a new approach to assessing body fluid status. METHODS: This study was carried out prospectively with subjects over 18 years of age who visited the emergency department between November 2010 and January 2011. A central venous catheter (CVC) was inserted into patients undergoing computed tomography (CT). IVC and aortic diameter were measured below the renal vein using the CT in axial view. To determine the exact CVP, we measured the distance from the tip of the CVC to the superior vena cava/right atrium (SVC/RA) junction in coronal and axial CT views, and placed the tip of a CVC at the SCV/RA junction. We analyzed the correlation between the CVP, IVC diameter and the IVC/Ao index. RESULTS: A total of 65 patients were enrolled in this study. The mean CVP was 9.25+/-5.99 mmH2O, IVC diameter was 1.456+/-0.568 cm and IVC/Ao index was 0.854+/-0.316. The correlation coefficient for CVP and IVC diameter was 0.625 (p<0.01) and for CVP and IVC/aorta index it was 0.711 (p<0.01). Coefficient of variations (CVs) of the IVC/Ao index was 0.76 at CVP 5 mmH2O and 0.14 at CVP 17 cmH2O. The correlation coefficient for CVP and IVC/Ao index in the group with a CVP result of less than 8 cmH2O was 0.330, and in the group with a CVP result greater than 8 cmH2O, it was 0.660 (p<0.01). CONCLUSION: The CVP results had a higher correlation to the IVC/aorta index than to the IVC diameter. The coefficient of variant (CV) tended to increase as CVP decreased. It is best not to use a single value of CVP or IVC/Ao index to evaluate the body fluid state, as some kind of dynamic parameter should be used.

Survey of Emergency Medical Ethics in Korea

PURPOSE: Ethical problems are common in the emergency department (ED)- much more common than is usually recognized. However, the difficult ethical dilemmas and unique aspects of ethics in emergency medicine have not been thoroughly discussed in the context of Korean emergency medicine. The purpose of this study is to evaluate the degree of general recognition of emergency medical ethics, as well as attitude toward several difficult ethical dilemmas among emergency physicians. METHODS: This is a qualitative study by survey. By using a questionnaire, we surveyed on emergency physicians working in teaching- hospitals in Korea in August 2007. RESULTS: The survey response rate was 30%, and there were 192 total respondents to the questionnaire. The results are as follows. Eighty-one percent of respondents said that they had trouble with difficult ethical dilemmas, 74% of respondents said that they need to be educated or trained to improve ethical decision-making capacity, and 58% of respondents said that they will use emergency ethical guideline actively if they are established. The ethical values that emergency physicians must possess, according to the survey responses, are agility, a sense of vocation, and prudence. With respect to questions about ending a patient's life, we found that emergency physicians have a tendency to ignore a patient's desires not to start CPR. Finally, in relation to colleagues and other professionals, many respondents said that they will take action to correct their medical errors. CONCLUSION: Study and development of emergency medical ethics will be greatly helpful to many emergency physicians. Further study and discussion must be pursued in order to establish ethical guideline.