Relation between Inferior Vena Cava Collapsibility and Central Venous Pressure

PURPOSE: For evaluation of volume status in the emergency department, central venous pressure (CVP) measurement is a standard practice. However, this is an invasive method. Measuring inferior vena cava (IVC) size through ultrasound is promising as a non-invasive method. However, few studies have been reported in Korea. Therefore this study measured IVC size and collapsibility in order to examine the clinical usefulness. METHODS: In a prospective study setting, IVC size was measured with ultrasound for patients whose CVP was measured in the emergency department. IVC size of healthy applicants was measured. RESULTS: The healthy group included 100 people: 68 men and 32 women. The average IVC size of men was 1.8+/-0.4 cm and that of women was 1.8+/-0.3 cm. For collapsibility, men were 0.28+/-0.14 and women were 0.23+/-0.14, thus there was no statistical difference in size and collapsibility between men and women. The patient group included 51 people, average age was 59.9+/-18.5, and 28 (54.9%) were men. This group showed a significant negative correlation between CVP and collapsibility. IVC Max was 1.7+/-0.5 cm, IVC Min was 1.2+/-0.5 cm, median collapsibility was 0.26 (0.15-0.38), mean lactate was 6.4+/-4.4 mmol/L, and median CVP was 10.0 (1.0-14.5) cmH2O. CONCLUSION: IVC collapsibility can be used as a reference measure, or even instead of CVP in certain cases.

Different Characteristics of Toxic Substance/poison Exposure Data that Collected from Pre-hospital Telephone Response and Emergency Department

PURPOSE: The purpose of this study is to find differences in the demographics of toxic exposed patients and substance between call based poison information data and hospital based poison information data. METHODS: Seoul 1339 call-response data were used as call based poison data and toxic related injury surveillance data of the Korean center for disease control and prevention (KCDC) were used as hospital based poison data. Age, sex, the kind of exposed substance, reasons for exposure, and exposure routes were compared between two data sets. We analyzed the presence or not of documentation on the name and amount of exposed substance, symptoms after exposure in call based poison data. RESULTS: Seoul1339 poison data included a total of 2260 information related to toxic exposure and KCDC poison data included 5650 poison cases. There was no difference in sexual distribution. Pediatric exposure and accidental exposure were more common in call based poison data. The most common exposed substances were household products in call based poison data and medicines in hospital based poison data, respectively. Documents regarding amount and time of toxic exposure and symptoms after toxic exposure were not recorded exactly in call based poison data. CONCLUSION: There were significant differences in age, reasons for toxic exposure, and the kinds of exposed substances. Poison information data from both pre-hospital and hospital must be considered.

Different Characteristics of Toxic Substance/poison Exposure Data that Collected from Pre-hospital Telephone Response and Emergency Department

PURPOSE: The purpose of this study is to find differences in the demographics of toxic exposed patients and substance between call based poison information data and hospital based poison information data. METHODS: Seoul 1339 call-response data were used as call based poison data and toxic related injury surveillance data of the Korean center for disease control and prevention (KCDC) were used as hospital based poison data. Age, sex, the kind of exposed substance, reasons for exposure, and exposure routes were compared between two data sets. We analyzed the presence or not of documentation on the name and amount of exposed substance, symptoms after exposure in call based poison data. RESULTS: Seoul1339 poison data included a total of 2260 information related to toxic exposure and KCDC poison data included 5650 poison cases. There was no difference in sexual distribution. Pediatric exposure and accidental exposure were more common in call based poison data. The most common exposed substances were household products in call based poison data and medicines in hospital based poison data, respectively. Documents regarding amount and time of toxic exposure and symptoms after toxic exposure were not recorded exactly in call based poison data. CONCLUSION: There were significant differences in age, reasons for toxic exposure, and the kinds of exposed substances. Poison information data from both pre-hospital and hospital must be considered.

Predictive Value of Serum Procalcitonin in Urinary Tract Infection Patients with Bacteremia

PURPOSE: Urinary tract infection (UTI) is a common disease in the emergency department (ED). In general, UTI could be treated easily without complication. However, UTI with bacteremia can progress to sepsis or severe sepsis and delay of appropriate treatment can result in worse prognosis. Increased serum procalcitonin level in the bacterial infection of ED patients has been proven. The purpose of this study is to examine the clinical utility of procalcitonin as a predictor for bacteremia in UTI patients in the ED setting. METHODS: This is a retrospective cohort study. UTI Patients admitted through the ED of three academic teaching hospitals from January 2010 to December 2012 were enrolled. We investigated demographic characteristics, hemodynamic variables, and laboratory results including serum procalcitonin level at presentation to the ED according to the presence of bacteremia. ROC curve was obtained and multivariate regression analysis was performed to test the predictive value of serum procalcitonin level for bacteremia in UTI patients. RESULTS: A total of 334 patients were enrolled. Bacteremia was proven in 135 UTI patients. UTI patients with bacteremia had significantly higher serum level of procalcitonin (0.830 vs. 6.860, p<0.0001). In multivariable logistic regression analysis, level of procalcitonin and platelet count showed statistical significance (Odds Ratio=1.018, (1.007-1.028), 0.995, (0.992-0.998), 95% CI). Area under the curve for procalcitonin was 0.729, and cut off value was 2.52 ng/ml. CONCLUSION: Serum procalcitonin level could be used as a valuable predictor for the presence of bacteremia in UTI patients visiting the ED.

Comparative Analysis of Acute Toxic Poisoning in 2003 and 2011: Analysis of 3 Academic Hospitals

Social factors may affect the available sources of toxic substances and causes of poisoning; and these factors may change over time. Additionally, understanding the characteristics of patients with acute toxic poisoning is important for treating such patients. Therefore, this study investigated the characteristics of patients with toxic poisoning. Patients visiting one of 3 hospitals in 2003 and 2011 were included in this study. Data on all patients who were admitted to the emergency departments with acute toxic poisoning were retrospectively obtained from medical records. Total 939 patients were analyzed. The average age of patients was 40.0 +/- 20 yr, and 335 (36.9%) patients were men. Among the elements that did not change over time were the facts that suicide was the most common cause, that alcohol consumption was involved in roughly 1 of 4 cases, and that there were more women than men. Furthermore, acetaminophen and doxylamine remained the most common poisoning agents. In conclusion, the average patient age and psychotic drug poisoning has increased over time, and the use of lavage treatment has decreased.

A Case Report of Envenomation and Injury by a Poisonous Spine of A Marble Motoro (Potamotrygon Motoro)

Potamotrygon motoro, also known as the Marble motoro, is a potamodromous freshwater ray native to the basins of the Amazon River. Marble motoros were introduced to South Korea in the 2000s, and, because they are easy to raise, were sold as aquarium fish. The aim of this report is to illustrate a new case involving envenomation by a Marble motoro. A 35-year-old commercial aquarium assistant came to the hospital after being pricked by a Marble motoro. The clinical picture in this case showed acute local pain with minimal systemic manifestations. This patient recovered after receiving symptomatic treatment and wound care. This case of envenomation accentuates the potential for injury among people coming in contact with a venomous Marble motoro.

Hypertonic saline downregulate the production level of lipopolysaccharide-induced migration inhibitory factor in THP-1 cells / 대한외과학회지

PURPOSE: Macrophage migration inhibitory factor (MIF) may serve as a general marker for systemic inflammation in septic and nonseptic acute critical illness. Additionally, our previous experiment has demonstrated that immunosuppressant Prostaglandin E2 (PGE2) lowered MIF levels and inhibited T-cells proliferation when compared to control levels. The addition of hypertonic saline (HTS) increased MIF production as compared with PGE2-stimulated T-cells in concordance with restore PGE2-suppressed T-cells proliferation. Generally, HTS has been well known for its anti-inflammatory effect so far. Therefore, the experiments were conducted to evaluate MIF after stimulating lipopolysaccharide (LPS) either in the presence or absence of HTS in monocyte, in response to early phase injury. METHODS: Human acute monocytic leukemic cell line (THP-1) cells were cultured in RPMI media, to a final concentration of 1 x 10(6) cells/mL. The effect of HTS on LPS-induced MIF was evaluated in monocyte with 1 microg/mL LPS. HTS at 10, 20 or 40 mmol/L above isotonicity was added. MIF concentrations of the supernatant were determined by enzyme-linked immunosorbent assay, and cell lysates were used for Western blots analysis to determine the MIF expression. RESULTS: MIF concentrations in the cell supernatant increased in LPS-induced cells compared to control cells. Also, levels of MIF protein expression were higher in LPS stimulating cells. However, the addition of HTS to LPS stimulated cell restored MIF concentrations and MIF expression. CONCLUSION: The role of HTS in maintaining physiological balance in human beings, at least in part, should be mediated through the MIF pathway.

Clinical Significance of Hyperlactatemia and Acidosis in Patients with Suspected Generalized Convulsion

PURPOSE: To determine the clinical usefulness of lactic acidosis in an evaluation of patients with suspected generalized convulsion. METHODS: This was retrospective cohort study. The correlation between the lactate level and the time to blood gas analysis (ABGA) was analyzed in patients who had a final diagnosis of seizure to exclude the time effect on the spontaneous clearance of lactate. The patient's data in the true seizure group and false seizure group was then compared. The receiver operating characteristics (ROC) curve of lactate, pH and base deficit for diagnosing true seizure was drawn. The sensitivity and specificity of the presence of hyperlactatemia or acidosis for a diagnosis of seizure and predicting epileptiform discharge at electroencephalography (EEG) was analyzed. RESULTS: Of the 173 patients suspected of having generalized convulsion, 136 patients were diagnosed with a true seizure on hospital discharge and patients whose ABGA was performed within 60 minutes after seizure showed a significantly higher arterial lactate level, lower arterial pH and base deficit than the patients whose ABGA was performed after 60 minutes of seizure onset. 62 patients whose ABGA was performed 60 minutes after symptom onset were excluded. Finally, of 111 patients, 89 patients with true seizure showed a significantly higher arterial lactate level, lower arterial pH and base deficit than the 22 patients with false seizure. The ROC curve of lactate, pH and base deficit showed a significant area under the curve for diagnosing true seizure. The presence of hyperlactatemia or acidosis showed high sensitivity for diagnosing true seizure and expecting epileptiform EEG when they were measured with 60 minutes after symptom onset. CONCLUSION: In patients with suspected generalized convulsion, upon presentation to the ED within 60 min of symptom onset, the presence of hyperlactatemia or acidosis increased the likelihood of a true seizure and might be an objective indicator for further evaluations of seizure. On the other hand, normal lactate levels and no acidosis could not exclude a true seizure.

Effect of hypertonic saline and macrophage migration inhibitory factor in restoration of T cell dysfunction / 대한외과학회지

PURPOSE: Trauma-induced suppression of cellular immune function likely contributes to sepsis, multiple organ dysfunction syndrome and death. T cell proliferation decreases after traumatic stress. The addition of prostaglandin E2 (PGE2), which depresses immune function after hemorrhage and trauma, to T-cells decreases T-cell proliferation; and hypertonic saline restores PGE2-induced T-cell suppression. Recently, it has become apparent that macrophage migration inhibitory factor (MIF) plays a central role in several immune responses, including T-cell proliferation. However, the role of MIF in mediating hypertonic saline (HTS) restoration of T cell dysfunction is unknown. Therefore, we hypothesize that T cell immune restoration by HTS occurs, at least in part, by a MIF-mediated mechanism. METHODS: Jurkat cells were cultured in Roswell Park Memorial Institute media, at a final concentration of 2.5 x 106 cell/mL. The effects of HTS on T-cell proliferation following PGE2-induced suppression were evaluated in Jurkat cells: HTS at 20 or 40 mmol/L above isotonicity was added. MIF levels were determined by enzyme-linked immunosorbent assay and western blot analysis. RESULTS: PGE2 caused a 15.0% inhibition of Jurkat cell proliferation, as compared to the control. MIF levels decreased in PGE2-suppressed cells, as compared to the control. MIF levels were higher in cells treated with HTS than PGE2-stimulated cells. CONCLUSION: The role of HTS in restoring Jurkat cells proliferation suppressed by PGE2, at least in part, should be mediated through a MIF pathway.

Acute Coagulopathy in Non-Traumatic Bleeding

PURPOSE: To find the incidence of acute coagulopathy following non-traumatic bleeding and to evaluate the factors related to the development of coagulopathy. METHODS: Non-traumatic bleeding patients that visited the emergency department of a university teaching hospital from March 2007 to March 2010 were enrolled retrospectively. Patients >18-years-of-age with altered mental status and unstable vital signs, who required resuscitations, transfusion and emergency surgery were included. Patients with liver cirrhosis, chronic renal failure and warfarin medication were excluded. The presence of coagulopathy was defined as prothrombin time (PT) > 18 sec or PT (%) 60 sec. We analyzed the relationship between coagulopathy and age, presence of circulatory shock (systolic blood pressure < 90 mmHg), hypothermia (body temperature (BT) < 36degrees C), acidity of arterial blood (arterial pH < 7.35), tissue hypoperfusion (base deficit < or = -6 mmol/L), thrombocytopenia (< 100000/uL) and sequential organ failure assessment (SOFA) score. Multiple logistic regression analysis was used to find factors that predicted the development of acute coagulopathy. RESULTS: Non-traumatic bleeding patients (n=149) were analyzed. Sixteen patients (10.7%) showed acute coagulopathy. Ten patients (6.7%) expired during hospitalization. There were no significant differences in mortality, age, sex and full term for glasgow coma scale (GCS) according to presence of early coagulopathy. The presence of shock, metabolic acidosis, thrombocytopenia and high SOFA score were risk factors for the development of acute coagulopathy following non-traumatic bleeding. The group that had early coagulopathy received more much fluid and transfusions compared to the group that did not have coagulopathy (p<0.05). CONCLUSION: Acute coagulopathy causes organ dysfunction due to tissue hypoperfusion. Presently, patients who had acute coagulopathy following non-traumatic bleeding required large amounts of fluid and transfusion during acute resuscitation comparison with non-coagulopathy patients. Further study is needed to find whether the correction of coagulopathy improves the outcome of non-traumatic bleeding patients.

Acute Coagulopathy in Non-Traumatic Bleeding

PURPOSE: To find the incidence of acute coagulopathy following non-traumatic bleeding and to evaluate the factors related to the development of coagulopathy. METHODS: Non-traumatic bleeding patients that visited the emergency department of a university teaching hospital from March 2007 to March 2010 were enrolled retrospectively. Patients >18-years-of-age with altered mental status and unstable vital signs, who required resuscitations, transfusion and emergency surgery were included. Patients with liver cirrhosis, chronic renal failure and warfarin medication were excluded. The presence of coagulopathy was defined as prothrombin time (PT) > 18 sec or PT (%) 60 sec. We analyzed the relationship between coagulopathy and age, presence of circulatory shock (systolic blood pressure < 90 mmHg), hypothermia (body temperature (BT) < 36degrees C), acidity of arterial blood (arterial pH < 7.35), tissue hypoperfusion (base deficit < or = -6 mmol/L), thrombocytopenia (< 100000/uL) and sequential organ failure assessment (SOFA) score. Multiple logistic regression analysis was used to find factors that predicted the development of acute coagulopathy. RESULTS: Non-traumatic bleeding patients (n=149) were analyzed. Sixteen patients (10.7%) showed acute coagulopathy. Ten patients (6.7%) expired during hospitalization. There were no significant differences in mortality, age, sex and full term for glasgow coma scale (GCS) according to presence of early coagulopathy. The presence of shock, metabolic acidosis, thrombocytopenia and high SOFA score were risk factors for the development of acute coagulopathy following non-traumatic bleeding. The group that had early coagulopathy received more much fluid and transfusions compared to the group that did not have coagulopathy (p<0.05). CONCLUSION: Acute coagulopathy causes organ dysfunction due to tissue hypoperfusion. Presently, patients who had acute coagulopathy following non-traumatic bleeding required large amounts of fluid and transfusion during acute resuscitation comparison with non-coagulopathy patients. Further study is needed to find whether the correction of coagulopathy improves the outcome of non-traumatic bleeding patients.

Cardiac Toxicity Following a Diphenhydramine Overdose

PURPOSE: This study was designed to analyze the contributing factors, as well as the incidence and nature of the cardiac toxicity, in patients presenting with diphenhydramine overdose. METHODS: We retrospectively reviewed the medical records of the intoxicated patients who presented to the ED of Korea University Anam Hospital from January 2008 to December 2010. Those patients who visited due to a diphenhydramine overdose were selected and the following features were recorded for analysis: the general characteristics, vital signs, the amount of ingested diphenhydramine, the time interval from ingestion to presentation, the coingested drugs (if any), the toxicities and the ECG findings. Cardiac toxicity, while defined mainly in terms of the temporary ECG changes such as QTc prolongation, right axis deviation, QRS widening, high degree AV block and ischemic changes, also encompassed cardiogenic shock, which is a clinical finding. RESULTS: A total of eighteen patients were enrolled. Of the eighteen patients, eight had ingested diphenhydramine only, while ten had ingested other drugs in addition to diphenhydramine. The most commonly observed toxicity following diphenhydramine overdose included cardiac toxicity (78%). Cardiac toxicity was observed in all the patients who presented to the emergency department 2 hours after ingestion. The patients with QTc prolongation turned out to have ingested significantly larger amounts of diphenhydramine. CONCLUSION: QTc prolongation and right axis deviation were common findings for the patients with a diphenhydramine overdose. QTc prolongation was more likely to occur with ingesting larger amounts of diphenhydramine. Close monitoring is mandatory for patients who have ingested large amounts of diphenhydramine to prevent such potentially lethal cardiac toxicity.

Availability of Toxicologic Screening Tests in the Emergency Department

PURPOSE: The role of a point of care test (POCT) is currently becoming important when treating patients and making decisions in the emergency department. It also plays a role for managing patients presenting with drug intoxication. But the availability of the test has not yet been studied in Korea. Therefore, we investigated the utility and the availability of POCT for drug screening used in the emergency department. METHODS: This was a retrospective study for those patients with drug intoxication between January 2007 and December 2010 in an urban emergency department. RESULTS: Between the study period, 543 patients were examined with a Triage(R)-TOX Drug Screen. Among those, 248 (45.7%) patients showed negative results and 295 (54.3%) patients showed positive results. The sensitivity of the test for benzodiazepine, acetaminophen and tricyclic antidepressants were 85.9%, 100%, 79.2%, respectively. CONCLUSION: POCT of drug screening in emergency department showed good accuracy especially in patient with benzodiazepine, acetaminophen and tricyclic antidepressant intoxication. Therefore, it can be useful diagnostic tool for the management of intoxicated patients.

Corrosive Injury Due to Edible Vinegar

Vinegar is a very popular ingredient used in many cuisines. It is also known for its beneficial health, beauty and possible weight-loss properties. The authors report on a patient who presented to the emergency department with unstable vital signs complaining of generalized abdominal pain after ingestion of 450 ml of apple cider vinegar. We documented a case of corrosive gastrointestinal injury with persistent metabolic acidosis occurring after ingesting apple cider vinegar with an acetic acid concentration of 12~14%. Toxic damage to the liver and kidney were also observed, peaking on post-ingestion day 3. The patient received supportive care and hemoperfusion for three days without much clinical improvement and died in the seventh day of intensive care due to disseminated intravascular coagulation and multi organ failure. Edible vinegar, when taken in large amounts, is capable of inducing corrosive injuries of the GI tract as well as severe systemic toxicities, such as metabolic acidosis. Safety precautions regarding vinegar deserve more public attention and clinicians also should be astute enough to recognize the potential damage accompanying vinegar ingestion.

Effect of beta-hCG with a Point-of-Care Test in the Emergency Department

PURPOSE: The rapid and accurate diagnosis of pregnancy is important in the emergency department (ED) before evaluation of radiologic tests and medication decisions. Our primary objective was to assess the agreement between whole blood pregnancy tests done in the emergency department and those done in laboratory [serum human chorionic gonadotropin (beta-hCG) and urine beta-hCG]. The secondary objective was to compare turnaround times for tests done in the ED and those done in the laboratory. METHODS: This prospective study enrolled females of childbearing age needing a pregnancy test who visited an ED. Using whole blood, urine and serum from each patient, testing was done in the ED (whole blood - Hubi Quan pro-point of care test, POCT) and in the laboratory using a urine hCG kit (iIexscreen) and in serum (ADVIA centaur). The data included time of each test, beta-hCG result, and urine pregnancy test result. RESULTS: There was a high level of agreement between the POCT using whole blood and the serum beta-hCG as indicated by a kappa value of 0.921(95% confidence interval). The POCT performed in the ED was significantly faster in time to report than tests performed in the laboratory, with mean differences of 20.21+/-2.0 minutes and 36.14+/-20.86 minutes. The sensitivity and specificity of POCT was 98.18% and 93.75%, respectively. CONCLUSION: In ED, the POCT test can perform pregnancy test as accurately as in the laboratory, and can provide results on which to base care much faster than waiting for the laboratory results. POCT may expedite the ED management of patients who require pregnancy tests. Especially, this POCT uses whole blood instead of the urine, since the latter was inconvenient for the test.

Analysis of Emergency Department Patients Transferred from Geriatric Hospitals: Case Series Descriptive Study

PURPOSE: Nursing homes continue to increase in number, and more residents are being transferred to emergency departments (EDs). The objective of this study was to investigate the overall characteristics of residents who were transferred to the ED and follow-up their course of treatments. METHODS: We identified nursing home residents aged 65 years and older who had been transferred to the ED of a regional tertiary university medical center from January 2008 to December 2009. Further attention was paid to those who had been diagnosed with sepsis. Meantime, a separate cohort of sepsis patients was collected, made up of geriatric patients aged 65 years or older who had visited the ED voluntarily from home or through medical institutions other than nursing homes during the same period. We then compared the two cohorts of sepsis patients. RESULTS: A total of 321 patients aged 65 years or older were transferred from nursing homes during the study period. Their mean age was 77.6+/-7.2 years, and 172 (54.8%) were females. Seventy six (24.2%) patients whose caregivers did not comply with the necessary procedures or refused aggressive management were discharged home or were retransferred to nursing homes. A total of 41 sepsis patients had been transferred from nursing homes, whereas 64 patients had visited the ER voluntarily or through medical institutions other than nursing homes. Even though the difference between the two groups was not significant statistically, patients transferred from nursing homes tended to be discharged or retransferred to nursing homes with inadequate treatment. CONCLUSION: A considerable number of patients transferred from nursing homes were found to be discharged or retransferred to nursing homes during acute care due to refusal of aggressive treatments. Likewise, the comparison of sepsis patients between the two arms showed a greater portion being retransferred with inadequate treatment as well as a greater rate of mortality among patients transferred from nursing homes.

Early Traumatic Deaths

PURPOSE: In Korea, trauma is the 3rd most common cause of death. The trauma treatment system is divided into pre-hospital and hospital stages. Deaths occurring in the pre-hospital stage are 50% of the total death, and 20% of those are deaths that are preventable. Therefore, the purpose of our study is to calculate the preventable death rates caused by trauma in our current pre-hospital system, to analyze the appropriateness of the treatment of traumatized patients and to draw a conclusions about the problems we have. METHODS: The study was done on traumatized patients who expired at the emergency department from January 1, 2005, to December 31, 2009, at the Korea University Medical Centers in Anam, Guro and Ansan. The data on the patients were reviewed retrospectively based on characteristics, conditions on admission and trauma severity. The patient's RTS (revised trauma score) and ISS (injury severity score) was calculated. Preventable death rate was calculated by TRISS (the trauma score-injury severity score). RESULTS: A total of 168 patients were enrolled. All patients were intubated and underwent CPR. Of the total, 72% patients were male, and traffic accidents were the most common form of trauma (52.4%), falls being second (28.6%). Head injury, solitary or multiple, was the most common cause of death (55.4%). Thirty-eight (38, 22.6%) deaths were preventable. The 22.6% preventable death rate consisted of 15.5% potentially preventable and 7.1% definitely preventable deaths. Based on a logistic regression analysis, the relationship between the time intervals until transfusion and imaging and death was statistically significant in the hospital stage. In the pre-hospital stage, transit time from the site of the injury to the hospital showed a significant relationship with the mortality rate. CONCLUSION: One hundred sixty-eight (168) patients died of trauma at the 3 hospitals of Korea University Medical Center. The TRISS method was used to calculate the preventable death rate, with a result of 22.6%. The only factor that was significant related to the preventable death rate in the pre-hospital stage was the time from injury to hospital arrival, and the time intervals until transfusion and imaging were the two factors that showed significance in the hospital stage. Shortening the time of treatment in the field and transferring the patient to the hospital as quickly as possible is the most important life-saving step in the pre-hospital stage. In the hospital stage, the primary survey, resuscitation and diagnosis should proceed simultaneously.

Clinical Evaluation of Abdominal Stab Wound Patients in the ED

PURPOSE: In Korea, most abdominal penetrating wounds are caused by stab wounds rather than gun-shot wounds. However, not many studies have been performed on stab injuries and their epidemiologic characteristics. Disagreements of opinions of obligatory surgical exploration and conservative treatment exist, and this subject is still being debated. Therefore, the authors studied the epidemiologic characteristics of abdominal stab wound patients visiting the emergency department and reviewed the proportion of patients that received non-therapeutic surgery and conservative treatment. METHODS: This study included patients visiting the emergency department with abdominal stab wounds. A retrospective chart review was done on the abdominal stab wound patients. Sex, age, cause of injury, location of wound, initial vital signs, operation results, injured organs and CT & LWE results were reviewed. RESULTS: The median age of the 121 patients was 40.9 years, of these patients, 88 were males, of which 52 (43.0%) were drunken. Of the patients that received non-therapeutic operations, only 3 patients (15.0%) were drunken, significantly lower than the therapeutic operation group. For the location of the wound, most patients were injured in the right and left upper quadrants, 27 patients each. The most common injured organ was the small bowel; 13 patients were injured in the small bowel. With abdominal CT scans and local wound explorations together, the results exhibited a sensitivity of 97%, a specificity of 44%, a positive predictive value of 56%, and a negative predictive value of 95%. CONCLUSION: In our study, the sensitivity was 97% when CT & LWE were performed together; thus we can conclude that CT and LWE can be used together to select the treatment method. Although in our study, the surgical indications in abdominal stab wound patients is not sufficient, our results showed a higher rate of non-therapeutic surgery compared to previous studies. Therefore, more research is needed to prevent unnecessary laparotomies in hemodynamically-stable patients without symptoms.

Feasibility of Extracorporeal Life Support for Out-of-Hospital Cardiac Arrest Patients who are Unresponsive to Conventional Cardiopulmonary Resuscitation

PURPOSE: To determine the feasibility of using extracorporeal life support (ECLS) for out-of-hospital cardiac arrest (OHCA) patients who are unresponsive to conventional cardiopulmonary resuscitation (CPR) techniques. METHODS: This study was a case series of consecutive nontraumatic OHCA patients aged 18~75 years who received ECLS in the emergency department (ED) of a university teaching hospital. We analyzed outcomes, physiologic effects, and complications associated with ECLS. To compare outcomes of ECLS and conventional CPR, we selected a conventional CPR subgroup, those who were aged 18 to 75 years, who experienced cardiac arrest with pre-hospital CPR, who had no terminal illness, and who had CPR for more than 40 minutes. RESULTS: Of 14 attempts to initiate ECLS, 13 patients received ECLS and one patient failed catheterization. Nine patients achieved return of spontaneous circulation (ROSC) more than 20 minutes later; 4 of the 9? patients survived more than 24 hours; 2 patients were successfully weaned off ECLS; 1 patient was discharged alive without neurologic complications. Median (minimum-maximum) duration of CPR before ECLS (pre-hospital and in-hospital) was 84(41 to 167) minutes. Blood gas parameters obtained 3 hours after the start of ECLS were significantly improved compared with those obtained pre-ECLS. Four patients who arrested from acute myocardial infarction received intervention as during ECLS support to correct the causes of the arrest. Serious complications of ECLS causing mortality were catheterization failure, intracranial hemorrhage, and massive hemothorax. The ECLS group showed a higher ROSC rate than patients who received conventional CPR without ECLS (64.3% vs. 7.1%, p=0.002). CONCLUSION: ECLS in the ED is feasible for OHCA patients who are unresponsive to prolonged CPR. ECLS provides a bridge to evaluation and definitive care in refractory OHCA by improving early hemodynamic and physiologic status. Earlier application of ECLS and reduction of complications associated with ECLS may improve the survival of OHCA patients.

Lactate Clearance as a Prognostic Factor of Organ Failure in Sepsis

PURPOSE: To understand the prognostic value of initial lactate level and initial lactate clearance rate in severe sepsis and septic shock patients. We analyzed the Sequential Organ Failure Assessment (SOFA) score to determine the relationship with organ failure. METHODS: This was a prospective observational study on severe sepsis and septic patients. We calculated the SOFA score on admission (0), and at 4, 24, 48, and 72 hours. We divided the patients into four groups by lactate level of 4 mmol/L and initial lactate clearance rate of 10%. We compared the 28-day mortality rate and the SOFA score. RESULTS: Initial lactate level and initial lactate clearance rate on admission showed significant difference in the SOFA score, 28-day survival rate and survival curves (p<0.05). The initial serum lactate level according to the SOFA score of the renal system showed no significant difference at any time period. However, the lactate clearance rate was correlated with the renal system at 24, 48, and 72 hours. In addition, the group with high initial lactate level and low lactate clearance rate showed a significantly low 28-day survival rate (p<0.05) and the SOFA score was also high. CONCLUSION: We confirmed that the initial lactate level and the initial lactate clearance rate were closely related with the prognosis and SOFA score of severe sepsis and septic shock patients. According to each organ, the renal system was not significantly correlated with the initial lactate level but did show a significant relationship with the initial lactate clearance rate.