PURPOSE: Paraquat is a chemical which causes death in 30~80% of patients even after ingestion of small quantities. In spite of much studies, there are no successful treatment modalities or predictive parameters for determining the prognosis of the poisoning. The aims of this study were to evaluate plasma-paraquat concentration and initial laboratory and clinical data as prognostic parameters in patients with paraquat poisoning. METHODS: A retrospective analysis by chart review was done on 168 patients over three years who had ingested paraquat. The patients were divided into two subgroups based on survival and evaluated for ingested amounts of paraquat, the time between ingestion and treatment, urine dithionite test, and plasma paraquat concentration at the time of emergency department (ED) visit. Other clinical and laboratory factors such as age, sex, serum biochemical parameters, and severity index of paraquat poisoning (SIPP) were also analyzed. RESULTS: The plasma paraquat concentrations in the mortality group were higher than in the survival group (51.59+/-55.07 vs. 1.09+/-3.09 microgram/mL, p<0.001). The SIPP was higher in the mortality group as well (173.87+/-219.67 vs. 5.18+/-13.51 microgram/mL/hour). Among the laboratory data obtained in the ED, s-Potassium, s-Protein, arterial pH, PaCO2, bicarbonate, s-Albumin, s-Amylase, AST, BUN, s-Creatinine, and s-Glucose were significant factors which could affect the prognosis for paraquat poisoning. A Cox regression analysis revealed that plasma paraquat concentration, SIPP, s-Creatinine, s-Protein, s-Potassium and bicarbonate were associated with mortality. In addition, SIPP was more significantly correlated with mortality than plasma paraquat concentration (OR 1.362 vs. 1.011, p<0.001 vs. 0.019). CONCLUSION: Initial laboratory parameters including s-creatinine, s-protein, s-potassium, bicarbonate, plasma Paraquat concentration, and SIPP were significant prognostic factors. In addition, the author suggests that SIPP is a better index than plasma paraquat concentration for predicting the outcome of patients admitted for ingestion of paraquat.
Dithionite ; Eating ; Emergencies ; Humans ; Hydrogen-Ion Concentration ; Paraquat ; Plasma ; Prognosis ; Retrospective Studies ; Severity of Illness Index

PURPOSE: Tetanus is difficult for emergency physician to diagnosis at an early stage because of its low incidence and atypical initial clinical features. Therefore, we reviewed the clinical features of 54 tetanus cases and attempted to identify factors associated with prognosis in order to improve early diagnosis and treatment. METHODS: We carried out a retrospective chart review of 54 adult tetanus patients who presented to the ED of Chonnam National University Hospital between January 1996 and December 2005. We collected information on demographics, SAPS II score, clinical feature, course of infection and prognosis. We divided the patients to two groups according to the survival and compared their data statistically. RESULTS: Fifty four patients, 33 men and 21 women, were included in the study. The mean age was 50.97+/-15.95. The most common initial diagnosis in ED were electrolyte imbalance (n=15), neck and facial dystonia (n=9). The mean incubation period was 10.27+/-6.47 days. The initial SPAS II score 17.29+/-8.45 and the Wood score was 3.12 +/-1.47. Most commonly symptom was dyspnea and dysarthria. Twenty one patients were supported by mechanical ventilation, and the duration of mechanical ventilation was 5.92+/-4.52 days. On multivariate logistic regression analysis, four variables were found to be associated with the prognosis: incubation period, Wood score, Time interval from initial symptom to mechanical ventilation, initial SAPS II. CONCLUSION: Four variables correlated well with the prognosis: Incubation period, Wood score, Time interval from initial symptom to mechanical ventilation, initial SAPS II score.
Adult ; Demography ; Diagnosis ; Dysarthria ; Dyspnea ; Dystonia ; Early Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Incidence ; Jeollanam-do ; Logistic Models ; Male ; Neck ; Prognosis ; Respiration, Artificial ; Retrospective Studies ; Tetanus* ; Wood

PURPOSE: This study was performed to determine the usefulness of blood culture in the management of febrile immunocompetent patients presenting emergency department. METHODS: We prospectively analysed the medical characteristic and the result of blood culture of febrile immunocompetent patients who presented to Chonnam National University Hospital emergency center form April 2005 to October 2005. RESULTS: The study included 182 patients. The characteristic associated with the positive result of blood culture on multivariate analysis was the low initial level of albumin. Of the 182 culture, only 26 were true positive(14.3%). Of them, the result of blood culture influenced management in five patients (2.7%). CONCLUSION: The blood cultures has usually been ordered in febrile immunocompetent patients at emergency department has the limited usefulness. The emergency physician who initially treats them has to consider this limitation of it.
Emergencies* ; Emergency Service, Hospital* ; Fever ; Humans ; Jeollanam-do ; Multivariate Analysis ; Prospective Studies

Fentanyl is a selective and pure agonist to the micron receptor and is about 100 times more potent than morphine. It has been used through intravenously to control acute pain, such as postopreative pain, for a long time. A transdermal fentanyl system, a fentanyl patch, composed of four layers of functional reserviors of fentanyl and one protective layer, delivers a constant amount of fentanyl to systemic circulation thorough passive diffusion for up to 3 days after application on the skin. Due to its pharmacokinetic properties, including delayed onset, relatively constant effect for 3 days, and to the relatively short duration and variable change of acute pain, we recommend that the transdermal fentanyl system should be used to control chronic pain in patients who do not response to lower analgesic agents. However, because of misperception of health care providers, its noninvasive and simple method of administration, and the absence of laws to regulate its usage, abuses of the transdermal fentanyl system have been reported a lot. In conclusion, we reported the cases of two patient who experienced fatal effects after abuse of fentanyl patch, we analyse the pharmacokinetic properties of the fentanyl patch and previous reported cases. We also discuss the appropriate use and regulation of the transdermal fentanyl system by primary health care provider.
Acute Pain ; Analgesics ; Chronic Pain ; Diffusion ; Fentanyl* ; Health Personnel ; Humans ; Jurisprudence ; Morphine ; Primary Health Care ; Respiratory Insufficiency ; Skin

BACKGROUND: More than 90% of acute stroke patients have measurable cardiovascular sequelae, but we have been often overlooked in formal discussions of treatment. If we estimate the incidence of myocardial injury in patient with spontaneous SAH, we may figure the possibility of cardiac dysfunction in such patients. This study was designed to investigate the incidence of myocardial injury in patients with spontaneous SAH using cardiac troponin I(cTnI). METHODS: A prospective single emergency center study was performed to determined preoperative incidence of unrecognized cardiac injury in patients suffering spontaneous SAH. We include the spontaneous SAH patients who underwent serum measurements of the cardic troponin I immediately upon admission last six month period. ECG, CK, CK-MB and myoglobin were also performed at admission. We excluded the spontaneous SAH patients who had past history of myocardial ischemia and ECG abnormality. RESULTS: Fifty-two patients(34 females, 18 males) with spontaneous SAH were studied prospectively. 18 patients(34.6% of the total study population) had cTnI level above 0.5ng/ml. ECG was performed in 52 patients and was abnormal in 15 of the 52 patients(28.8%). CONCLUSION: The measurement of cTnI has provided physicians with a myocardial marker that has a cardiac sensitivity for cardiac injury equal to that of CK-MB yet with greater specificity. So, cardiac troponin I is useful to estimate the incidence of myocardial injury in patients with spontaneous SAH. And we may estimate the possibility of cardiac dysfunction in such patients. This knowledge will hopefully aid in the care and improve the outcome.
Electrocardiography ; Emergencies ; Female ; Humans ; Incidence* ; Myocardial Ischemia ; Myoglobin ; Prospective Studies ; Sensitivity and Specificity ; Stroke ; Troponin I* ; Troponin*

N-acetylcysteine (NAC) is widely recognized as the antidote of choice for acetaminophen overdose. Acetaminophen is a commonly used analgesic and antipyretic agent, and its use is one of the most common causes of poisoning worldwide. Acetaminophen toxicity may occur acutely when supratherapeutic amounts are ingested purposefully or unintentionally. Liver failure may occur in severe toxicity. However, if treated early, patients with acetaminophen poisoning generally recover uneventfully. Acetaminophen is metabolized to N-acetyl-p-benzoquinone imine (NAPQI), which is detoxified by conjugation with glutathione. In overdose, hepatic stores of glutathione are depleted and NAPQI binding to hepatocytes induces cell death and hepatic necrosis. NAC replenishes hepatic glutathione and may also act as a glutathione substitute, combining directly with the toxic metabolite. Intravenous NAC is indicated in patients who present with a history of acetaminophen overdose within the previous 8 to 10 hours, patients unable to tolerate oral NAC, and patients who present with evidence of fulminant hepatic failure. However, caution should be used in patients who have experienced previous hypersensitivity or anaphylactoid reactions to intravenous NAC, as well as in patients with asthma. The most common anaphylactoid reactions include rash, flushing, and bronchospasm. Adults should receive 150 mg/kg administered for 45 minutes, followed by 50 mg/kg administered for 4 hours, followed by 100 mg/kg administered for 16 hours. The total dose is 300 mg/kg delivered over 21 hours. Additionally, caution should always be used when intravenous NAC is prescribed and the amount of diluent is calculated. Monitoring of patients with a should include repeated neurologic and hemodynamic assessment.
Acetaminophen* ; Acetylcysteine* ; Adult ; Antidotes ; Asthma ; Benzoquinones ; Bronchial Spasm ; Cell Death ; Exanthema ; Flushing ; Glutathione ; Hemodynamics ; Hepatocytes ; Humans ; Hypersensitivity ; Imines ; Liver Failure ; Liver Failure, Acute ; Necrosis ; Poisoning*

Sodium hypochlorite is commonly used as a household bleaching agent (for example, the Clorox brand). Sodium hypochlorite poisoning with ingestion of a bleaching agent is often observed in clinical practice.Current Concepts: Ingestion (intentional or accidental) is the most common route of exposure to household bleaching agents. Accidental ingestion of household bleaching agents is rarely clinically important. However, ingestion of a large amount of a dilute formulation or a high-concentration preparation of bleaching agents can result in severe and rarely fatal corrosive injury. Therefore, prompt supportive care is essential because a specific antidote is currently unavailable. Severe poisoning requires hospital admission. Emergency endoscopy and thoracic and abdominal computed tomography are warranted to aid with diagnosis and management of hypochlorite-induced corrosive injury in patients with severe poisoning, who develop clinical features suggestive of corrosive injury.Discussion and Conclusion: Intentional poisoning, which accounts for most cases of household bleaching agent poisonings in Korea, is likely to cause severe corrosive injuries. Therefore, it is necessary to gain deeper and accurate understanding of the clinical aspects and treatment of poisoning by household bleaching agents.

PURPOSE: Bispectral index (BIS) is a non-invasive parameter that expresses the level of consciousness using a numerical value that ranges from 0-100. It can be easily conducted at the patient bed-side throughout a day. We studied whether BIS could be used as a predictive factor for neurological outcome in patients who undergo hypothermia after cardiopulmonary resuscitation. METHODS: The prospective study enrolled patients who underwent induced hypothermia with post-resuscitated state after cardiac arrest and presented to Chonnam National University Hospital from June, 2010 to October, 2010. BIS monitoring was conducted from admission at the intensive care unit until normal temperature was attained after the induction of hypothermia. The patients were divided into two groups based on neurological outcome at discharge and the values obtained from BIS monitoring were compared. RESULTS: Fourteen patients were included in this study. The mortality rate was 28.6% and five patients were discharged with Glasgow Pittsburgh Cerebral Performance Categories 1 or 2. The value of BIS at the start of rewarming was significantly different between the two groups according to neurological outcome, while the value of BIS upon reaching normal temperature did not differ statistically. The significant difference between the two groups was observed in the value of BIS from 19 hours after starting hypothermia. CONCLUSION: BIS can be used to predict the neurological outcome of patients who undergo resuscitation after cardiac arrest.
Consciousness ; Consciousness Monitors ; Heart Arrest ; Humans ; Hypothermia ; Hypothermia, Induced ; Intensive Care Units ; Prospective Studies ; Resuscitation ; Rewarming

PURPOSE: Bispectral index (BIS) is a non-invasive parameter that expresses the level of consciousness using a numerical value that ranges from 0-100. It can be easily conducted at the patient bed-side throughout a day. We studied whether BIS could be used as a predictive factor for neurological outcome in patients who undergo hypothermia after cardiopulmonary resuscitation. METHODS: The prospective study enrolled patients who underwent induced hypothermia with post-resuscitated state after cardiac arrest and presented to Chonnam National University Hospital from June, 2010 to October, 2010. BIS monitoring was conducted from admission at the intensive care unit until normal temperature was attained after the induction of hypothermia. The patients were divided into two groups based on neurological outcome at discharge and the values obtained from BIS monitoring were compared. RESULTS: Fourteen patients were included in this study. The mortality rate was 28.6% and five patients were discharged with Glasgow Pittsburgh Cerebral Performance Categories 1 or 2. The value of BIS at the start of rewarming was significantly different between the two groups according to neurological outcome, while the value of BIS upon reaching normal temperature did not differ statistically. The significant difference between the two groups was observed in the value of BIS from 19 hours after starting hypothermia. CONCLUSION: BIS can be used to predict the neurological outcome of patients who undergo resuscitation after cardiac arrest.
Consciousness ; Consciousness Monitors ; Heart Arrest ; Humans ; Hypothermia ; Hypothermia, Induced ; Intensive Care Units ; Prospective Studies ; Resuscitation ; Rewarming

PURPOSE: Plasma cholinesterase is a sensitive measure determining the severity of organophosphate intoxication. The author evaluated the usefulness of the plasma cholinesterase level as a prognostic indicator of the severity of organophosphate intoxication. METHODS: From June 1999 to May 2001, 55 patients presented with organophosphate insecticide intoxication to the Emergency Medical Center of the Chonnam National University Hospital, and these were enrolled in this study. The plasma cholinesterase activities of these 55 patients were determined at the time of presentation. The relationships between the plasma cholinesterase level and the clinical variables of organophosphate toxicity, quantity of ingested poison, elapsed time to gastric lavage, and the APACHE score at the time of hospitalization were analyzed. RESULTS: The plasma cholinesterase activity significantly decreased in association with the degree of toxicity of the poison (p<0.001), elapsed time to gastric lavage (p<0.001), and the quantity of organophosphate ingested (p=0.013). In the 55 patients, lower plasma values of cholinesterase were observed in patients with longer durations of mechanical ventilation (r=-0.717, p<0.001) and in patients who developed pneumonia during treatment (r=-0.538, p<0.001). Also, decreased cholinesterase activity correlated with a higher APACHE score (r=-0.672, p<0.001). CONCLUSION: These results suggest that immediate determination of the plasma cholinesterase level at the time of hospitalization may be useful as a prognostic indicator in patients with organophosphate intoxication.
APACHE ; Cholinesterases* ; Eating* ; Emergencies ; Gastric Lavage ; Hospitalization* ; Humans ; Jeollanam-do ; Plasma* ; Pneumonia ; Respiration, Artificial