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Caustic ingestion can produce a progressive and fatal injuries to esophagus, stomach and other organs. Reported exposure to acetic acid results injuries to gastrointestinal tract, hemolysis and disseminated intravascular coagulation is general, but causing hepatic necrosis by direct injuries are rare. A 47-year-old man visited our emergency medical center complaining odynophagia and abdominal pain after ingesting glacial acetic acid ($99\%$) with suicidal ideation. At the time of arrival, the patient complained mild abdominal pain but a few hours later the patient complained severe abdominal pain with markedly elevated liver enzymes. The Abdominal Computerized Tomography showed diffuse gastric wall edema and density of wedge shaped hypodense area in right hepatic dome showing focal hepatic necrosis without significant inflammation. This seems likely to be a direct effect of the noxious agent on hepatocyte involving the portal circulation.
A 36-year-old female was transferred to our emergency medical center with decreased mental status after a 6.0 g propafenone overdose because of domestic disturbance. She had no previous history of epilepsy, diabetes mellitus, hypertension or psychiatric illness. Before presenting to our center, gastrointestinal decontamination, charcoal administration, and endotracheal intubation due to bradycardia and generalized seizure had been performed. Soon after hospital arrival, at 5 h after ingestion, she collapsed into shock and fatal arrhythmia. We successfully resuscitated the patient with amiodarone, sodium bicarbonate, a large volume of normal saline, calcium, and ventilator care. At 23 h after ingestion, she was fully recovered and had no subjective signs or symptoms. To our knowledge, this is the first case report of intentional propafenone overdose in Korea, which we report with reviews of the previous literature.
경연영 ( Yeon Young Kyong ), 박규남 ( Kyu Nam Park ), 최승필 ( Seung Pill Choi ), 이미진 ( Mi Jin Lee ), 곽태영 ( Thae Young Kwak ), 최경호 ( Kyung Ho Choi ), 최세민 ( Se Min Choi ), 이원재 ( Won Jae Lee ), 김호식 ( Ho Sik Kim ) 대한응급의학회 2006 大韓應急醫學會誌 Vol.17 No.4
Purpose: Marathon running is a unique long-distance sport with respect to injuries because it involves continuous movement allowing for different types of injuries that appear at each distance achieved. We initiated this study to analyze the types of injury patterns associated with marathon running to better predict the types of injuries expected at different points of a marathon course in order to provide more efficient emergency medical care. Methods: The analysis is based on two international marathons that involved 12,356 runners in the 2004 Seoul International Marathon on March 14, 2004, and 3.873 runners in the 2004 Korea Open Marathon on March 28, 2004. We designed medical recording paper and applied it to the patients during the marathon course, and we finally analyzed the different injuries that occurred from the start to finish lines. Results: The results revealed that injuries varied with respect to different distances achieved. From the start line to 10 ㎞, minor contusions and abrasions formed the majority of injuries. However, from the 25 ㎞ area to the finish line, cardiovascular symptoms and heat related disorders manifested. Conclusion: As seen in our study, given that severity of injury patterns differ from point to point during a marathon course, emergency medical care should be also allocate appropriate resources at differing points on a marathon course in anticipation of probable escalating medical needs.
Purpose: To compare the efficacy of inflammatory markers, the Laboratory-score, and a new laboratory combined model for predicting serious bacterial infection (SBI) in young febrile children. Methods: The presence of SBI was reviewed in previously healthy children aged 3 years or younger with fever (> 38。C) who visited the emergency department from 2017 through 2018. Areas under the curves (AUCs) of the receiver operating characteristic curve for SBI were compared with individual inflammatory markers (white blood cells [WBC] count, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], procalcitonin [PCT], and urine WBC count), the Laboratory-score, and a laboratory combined model. The latter model was developed using logistic regression analysis including ESR, CRP, and PCT. Results: Of the 203 enrolled children, SBI was diagnosed in 58 (28.6%). For SBI prediction, the Laboratory-score showed 51.7% sensitivity (95% confidence interval [CI], 38.2%-65.0%) and 83.5% specificity (95% CI, 76.4%-89.1%). The AUC of the Laboratory-score (0.76) was significantly superior to the values of all individual inflammatory markers (WBC, 0.59 [P = 0.032]; ESR, 0.69; and CRP, 0.74 [P < 0.001]) except that of PCT (0.77, [P < 0.001]). The AUC of the laboratory combined model (0.80) was superior to that of the Laboratory-score (0.76) (P < 0.001). Conclusion: In this study, the new laboratory combined model showed good predictability for SBI. This finding suggests the usefulness of combining ESR, CRP, and PCT in predicting SBI.
Purpose: In infants and young children, acute bronchiolitis is a leading cause of hospitalization via emergency departments (EDs). We aimed to investigate factors associated with hospitalization via ED in children with acute bronchiolitis. Methods: We reviewed medical records of children aged 36 months or younger with acute bronchiolitis who visited the ED from January to December 2017. The following clinical data were collected and analyzed: age, sex, premature birth history, symptoms, fever duration, presence of respiratory distress and radiographic lesion, and inflammatory markers. Results: Of 780 children enrolled, 463 (59.4%) were hospitalized via the ED. The factor associated with the hospitalization were age ≤ 12 months (odd ratio [OR], 45.34; confidence interval [CI], 17.50-117.44), fever lasting ≥ 3 days (OR, 13.66; 95% CI, 6.46-28.87), respiratory rate ≥ 24 breaths per minute (OR, 6.88; 95% CI, 4.21-11.26), radiographic lesion (OR, 5.70; 95% CI, 2.62-12.40), and chest retraction (OR, 2.45; 95% CI, 1.11-5.41). Conclusion: In children with acute bronchiolitis who visit EDs, those having younger age, longer fever duration, respiratory distress or radiographic lesion may need hospitalization.
Bupropion, a norepinephrine and dopamine reuptake inhibitor, has been increasingly prescribed for major depressive disorder,attention deficit hyperactivity disorder, and as an adjuvant of cigarette smoking cessation due to its favorable side-effect profile. Annual numbers of bupropion overdose have tended to increase in proportion to this increased prescription. Several cases of severe bupropion overdose have been previously reported worldwide, but these cases are rare in Korea. In this paper, we report two cases of severe bupropion overdose involving seizure: one was fatal; in the other case, the patient recovered.
Background: Incidents of suicide attempts and acute poisonings in the elderly population is rising. This study compared elderly and younger patients to investigate the influence of age on the clinical nature of acute poisoning. Methods: We retrospectively investigated 147 patients with acute poisoning who visited the emergency departm ent within 6 hours of exposure. Patients were divided into two groups, young adult (20-40 yrs) and elderly (≥55 yrs). Information on type of toxic material, age, sex, duration of time to arrive to the emergency departm ent (ED ) after poisoning, cause of poisoning, usage of activated charcoal and gastric lavage, previous suicide attempts, and past psychiatric history were collected. And, the mean arterial pressure, respiratory rate, base excess, aspartate am inotransferase (AST), serum creatinine, rate of discharge against medical advice, intensive care unit (ICU) admission rate, discharge rate, duration in ICU, usage of mechanical ventilator, and death rate were analyzed. Initial and final Poisoning Severity Scores (PSS) of each patient were calculated. Results: The mean age of the young adult group and the elderly group were 30.6±6.1 yrs and 66.6±8.2 yrs, respectively. Cause of poisoning was accidental more often in the elderly group than in the young adult group. AST and creatinine levels were higher and base excess was lower in the elderly group. ICU admission rate, duration in ICU, usage of mechanical ventilator, death rate, and initial and final PSS were all higher in the elderly group as well. Conclusion: This study showed that the PSS and death rate from acute poisoning were higher in the elderly group than in the young adult group. 연구배경: 노인 인구의 증가와 더불어, 응급의료센터에 내원하는 급성 약물 중독 환자 중 노인의 비율도 높아지는것을 임상적으로 흔히 접할 수 있다. 이 연구는 젊은 성인과 55세 이상의 노인의 약물 중독 환자의 임상 양상을 비교 연구하여, 노인 약물 중독 환자의 기초 자료 및 향후 치료 및 예후 평가에 도움이 되고자 계획하였다. 방법: 2004년부터 4년 동안 음독 6시간 이내에 응급의료센터로 내원한 급성 약물 중독 환자 20세 이상 40세까지의 환자 107명과 55세 이상의 환자 40명을 두 군으로 나누어 중독 물질 및 나이, 성별, 음독 후 내원 시간, 두 군의 위세척 및 활성탄 사용의 유무, 자살시도 여부, 과거력상 신경정신과 병력을 조사하였고, 초기 평균 동맥압, 맥박수, 호흡수, 염기 결핍, AST, creatinine 및 환자의 경과 관찰 후 중환자실 입원, 퇴원 및 자의 퇴원율과 중환자실 입원 기간 및 인공호흡기 장착률, 사망률을 비교 분석하였다. 또한 두 군에 따른 초기 중독 중증도 지수 및 최종 중독 중증도 지수를 비교 분석하여 조사하였다. 결과: 대상군의 평균 나이는 젊은 성인군은 30.6±6.1세였으며, 노인군은 66.6±8.2세였다. 음독한 물질로는 젊은 성인군에서는 독실라민이 22명(20.6%)으로 가장 많았고, 노인군에서는 16명(40.0%)이 제초제 및 살충제인 농약류를 음독 후 내원하였다. 노인군에서 사고에 의한 중독이 7명(17.5%)으로 젊은 성인군보다 더 많았으며(p=0.010), AST, creatinine, 중환자실 입원율, 중환자실 입원기간, 인공호흡기 장착률 및 사망률은 노인군에서 의미있게 더 높았다(p<0.05). 또한 초기 및 최종 중증도 지수는 노인군에서 젊은성인군보다 더 높았다(p<0.05). 결론: 노인군 약물 중독 환자에서 평가한 중독 중증도 지수가 젊은 성인군보다 더 높고, 사망률 및 인공호흡기장착률이 더 높아, 노인 약물 중독 환자가 응급의료센터에 내원하는 경우 집중 모니터링 및 치료가 필요하겠다.