Characteristics and Risk Factors for Delirium in The Surgical Step-Down Unit

Purpose@#This study aimed to investigate the incidence rate, types and risk factors for delirium in patients admitted to the surgical Step-Down Unit (SDU). @*Methods@#This study was a retrospective study of the electronic medical records of patients admitted to a surgical SDU from February 2020 to July 2020. The delirium assessment was conducted using the short Confusion Assessment Method (a tool that allows quick and easy screening of delirium) and the incidence and risk factors for delirium were determined. @*Results@#Among a total of 227 patients in the study, the incidence rate of delirium was 35 cases (16.7%). It predominantly occurred on the first day (n = 16, 45.7%) and the second day of admission (n = 15, 42.8%). The peak occurrence of delirium was between 14:00 and 22:00 (n = 30, 85.7%). The most common type of delirium was hypoactive (n = 19, 54.3%). The results of multiple logistic regression analysis indicated that the factors influencing the occurrence of delirium in the surgical step down unit (SDU) were age, hypertension, stroke, white blood cell count, and the use of restraints. @*Conclusion@#Considering the characteristics of high-risk groups for delirium in the surgical SDU, it is necessary to establish nursing practice guidelines to minimize delirium.

Are the Cardiac Biomarkers in the Emergency Room Sufficient to Predict Adverse Events in Acute Pulmonary Embolism?

PURPOSE: The aim of this study is to determine whether cardiac biomarkers, such as N-terminal-proB-type natriuretic peptide (NT-proBNP), are good predictors of adverse events in acute pulmonary embolism (APE). METHODS: We conducted a retrospective analysis of patients with APE, which was confirmed by a computed tomography in the emergency room. Patients were divided into 2 groups: the major adverse event (MAE) group and the no-MAE group. MAE was defined as one of the following occurrences: in-hospital-death, cardiopulmonary resuscitation, mechanical ventilation, vasopressors, thrombolysis, or surgical embolectomy. Blood samples were obtained during the first hour of presentation to the emergency room. RESULTS: A total of 90 patients were included in this study. Twenty-seven patients had MAE. According to the univariate analysis, NT-proBNP, troponin I, and D-dimer plasma levels were significantly higher in the MAE group than in the noMAE group (919.8 vs. 2,131.0 ng/mL, p=0.032; 0.091 vs. 0.172 ng/mL, p=0.037; 2.43 vs. 3.74 ng/mL, p=0.049, respectively). However, according to the multivariate logistic regression, NT-proBNP was not independently associated with MAE in APE (odds ratio, 1.01; 95% confidence interval, 1.00-1.01). Conversely, troponin I was independently associated with MAE (odds ratio, 1.09; 95% confidence interval, 0.99-1.18). The NT-proBNP plasma level was not significantly different between the right ventricular dysfunction (RVD) group and the no-RVD group (p=0.178). CONCLUSION: The NT-proBNP level, unlike the troponin I level, in the emergency room was not identified as an independent predictor of MAE in acute pulmonary embolism. Further studies of large-scale with controlled timing of blood sampling and echocardiography are required.

Change in Red Cell Distribution Width as Predictor of Death and Neurologic Outcome in Patients Treated with Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest / 대한중환자의학회지

BACKGROUND: The prognostic significance of change in red cell distribution width (RDW) during hospital stays in patients treated with therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) was investigated. METHODS: Patients treated with TH after OHCA between January 2009 and August 2013 were reviewed. Patients with return of spontaneous circulation (ROSC) were assessed according to Utstein Style. Hematologic variables including RDW, hematocrit, white blood cell count, and platelets were also obtained. RDW changes during the 72 hours after ROSC were categorized into five groups as follows: Group 1 (-0.8-0.1%), Group 2 (0.2-0.3%), Group 3 (0.4-0.5%), Group 4 (0.6-0.8%), and Group 5 (>0.8%). RESULTS: A total of 218 patients were enrolled in the study. RDW changes during the 72 hours after ROSC in Group 4 (HR 3.56, 95% CI 1.25-10.20) and Group 5 (HR 5.07, 95% CI 1.73-14.89) were associated with a statistically significant difference in one-month mortality. RDW changes were associated with statistically significant differences in neurologic outcome at 6 months after ROSC (Group 3 [HR 2.45, 95% CI 1.17-5.14], Group 4 [HR 2.79, 95% CI 1.33-5.84], Group 5 [HR 3.50, 95% CI 1.35-7.41]). Other significant variables were location of arrest, cause of arrest, serum albumin, and advanced cardiac life support time. CONCLUSIONS: RDW change during the 72 hours after ROSC is a predictor of mortality and neurologic outcome in patients treated with TH after OHCA.

Change in Red Cell Distribution Width as Predictor of Death and Neurologic Outcome in Patients Treated with Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest / 대한구급학회지

BACKGROUND: The prognostic significance of change in red cell distribution width (RDW) during hospital stays in patients treated with therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) was investigated. METHODS: Patients treated with TH after OHCA between January 2009 and August 2013 were reviewed. Patients with return of spontaneous circulation (ROSC) were assessed according to Utstein Style. Hematologic variables including RDW, hematocrit, white blood cell count, and platelets were also obtained. RDW changes during the 72 hours after ROSC were categorized into five groups as follows: Group 1 (-0.8-0.1%), Group 2 (0.2-0.3%), Group 3 (0.4-0.5%), Group 4 (0.6-0.8%), and Group 5 (>0.8%). RESULTS: A total of 218 patients were enrolled in the study. RDW changes during the 72 hours after ROSC in Group 4 (HR 3.56, 95% CI 1.25-10.20) and Group 5 (HR 5.07, 95% CI 1.73-14.89) were associated with a statistically significant difference in one-month mortality. RDW changes were associated with statistically significant differences in neurologic outcome at 6 months after ROSC (Group 3 [HR 2.45, 95% CI 1.17-5.14], Group 4 [HR 2.79, 95% CI 1.33-5.84], Group 5 [HR 3.50, 95% CI 1.35-7.41]). Other significant variables were location of arrest, cause of arrest, serum albumin, and advanced cardiac life support time. CONCLUSIONS: RDW change during the 72 hours after ROSC is a predictor of mortality and neurologic outcome in patients treated with TH after OHCA.

Disaster Medical Responses to the Shelling of Yeonpyeong Island

PURPOSE: On November 23, 2010, Yeonpyeong Island was under artillery fire and mass civilian casualties developed. Incheon West-sea regional emergency medical center, dispatched a disaster team to deal with the casualties. The purpose of this study was to review the regional disaster response of this team to improve the operations of the National Disaster Medical System, Disaster Medical Assistance Team, and the Mobile Emergency Support Unit in case of future emergencies. METHODS: We retrospectively reviewed the disaster response upon bombardment of the Yeonpyeong Island and analyzed medical records of patients who treated by the disaster team at Yeonpyeong island. RESULTS: The disaster team and EMS were activated after the bombardment. Disaster team included two doctors, three emergency medical technicians, and one ambulance driver. The bombardment occurred at 14:34, and lasted for 30 minutes. The disaster team was dispatched at 16:40, and arrived in Incheon port at 17:07 and departed for Yeonpyeong Island with a fire engine and ambulance at 21:48. Our team reached the island the next morning and started to treat a patient. A total of 30 patients were participated in this study. The mean age of the patients was 49.4(+/-14.2) yrs old. Most of he patients are a mild case. Diagnosis was multiple contusion, acute stress reaction, cerebral concussion, rupture of tympanic membrane. Also: It may help to include data/analyses showing that there were inadequacies and problems with the system (time lag, insufficient medical training or supplies, etc.) CONCLUSION: This article is the first to report on the efficacy of the National Disaster Medical System after bombardment. From our analysis, the National Disaster Medical System contains many problems including access to the island, the equipment of communication, and the security of disaster team. This report shows that a review of our National Disaster Medical System is necessary to plan for future disaster scenarios.

Influences on Formation of Tetanus Antibody after Simultaneous Injection of Tetanus Immunoglobulin with Tetanus Vaccine

The goal of this study was to determine how much the formation of tetanus antibody is influenced after a single injection of tetanus vaccine (Td) and the simultaneous injection of tetanus vaccine with tetanus immunoglobulin (TIG). All of the healthy adult volunteers were divided into two groups: group 1 (Td only) and group 2 (Td plus TIG). Two hundred thirty seven volunteers were enrolled. When the baseline antibody titer, gender and age were adjusted, the geometric mean titers (GMTs) of the tetanus antibody (group 1 vs group 2) was 0.8438 IU/mL vs 0.5684 IU/mL at 4 weeks (P = 0.002), 0.4074 IU/mL vs 0.3217 IU/mL at 6 months (P = 0.072) and 0.3398 IU/mL vs 0.2761 IU/mL at 12 months (P = 0.140) after injection, respectively. The formation of tetanus antibody after tetanus vaccination is not influenced by TIG at the late period and in adults below the age of 50 yr, but there are significant differences between the two groups at the early period of 4 weeks after vaccination and for the patients over 60 yr.

Efficacy of a Program Associated with a Local Community of Suicide Attempters who Visited a Regional Emergency Medical Center

PURPOSE: The number of suicide attempts has increased in Korea. Not only physical therapy, but also psychiatric treatment is important. And urgent follow-up community mental health care is needed. This study reports on a management program associated with community mental health centers for suicide attempters who visited a regional emergency medical center; we suggest establishment of community mental health centers with an emergency department on a national scale. METHODS: We conducted a retrospective analysis of 582 suicide attempters who visited a regional emergency medical center from March 1, 2009 to October 31, 2010. We recorded information on gender, age, patient's identification number, method of suicide attempt, number of previous attempts, past history of psychiatric disease, patient disposition, and Risk-rescue rating scale (RRRS). We analyzed fatality according to gender, age, method of suicide attempt, number of previous attempts, past history of psychiatric disease, and RRRS. We used Pearson's chi-square test and Mann-Whitney test for statistical analysis. RESULTS: Women had more suicide attempts than men and drug intoxication was the most common method of attempted suicide. Significant differences in fatality were observed according to age, gender, methods of attempted suicide, RRRS and no past history of psychiatric disease. Thirty three suicide attempters were registered to community mental health centers and underwent regular follow-up. CONCLUSION: Follow up through community mental health centers is important. However, there is a limitation of low enrollment and a regional medical center. Therefore, government support for community mental health centers is needed. If follow-up studies with community mental health centers are conducted on a national scale, the number of suicide attempters will be reduced.