The survival rate of commotio cordis is low, and there is often associated neurological disability if return of spontaneous circulation (ROSC) can be achieved. We report a case of commotio cordis treated with therapeutic hypothermia (TH) that demonstrated a favorable outcome. A 16-year-old female was transferred to our emergency department (ED) for collapse after being struck in the chest with a dodgeball. She has no history of heart problems. She was brought to our ED with pulseless ventricular tachycardia (VT), and ROSC was achieved with defibrillation. She was comatose at our ED and was treated with TH at a target temperature of 33degrees C for 24 hours. After transfer to the intensive care unit, pulseless VT occurred, and defibrillation was performed twice. She recovered to baseline neurologic status with the exception of some memory difficulties.
Adolescent ; Coma ; Commotio Cordis* ; Emergency Service, Hospital ; Female ; Heart ; Humans ; Hypothermia* ; Intensive Care Units ; Memory ; Survival Rate ; Tachycardia ; Tachycardia, Ventricular* ; Thoracic Injuries ; Thorax

PURPOSE: Arterial hypotension is a recognized complication of emergency intubation, whereas there have been contradicting opinions regarding postintubation hypotension. The aim of this study was to determine the incidence, related factors, and impact on patient outcomes associated with postintubation hypotension (PIH) in intubations performed in the emergency department. METHODS: A structured chart audit of all consecutive adult patients requiring emergency endotracheal intubations over a two-year period (2011.1.1.~2012.12.31.) was performed retrospectively. Patients older than 20 years who had no systolic blood pressure below 90 mmHg at any time before intubation were included. Patients were analyzed in two groups, those with PIH, defined as any recorded systolic pressure less than 90 mmHg within 60 minutes of intubation, and those with no PIH. The primary outcome was in-hospital mortality. RESULTS: Overall, 186 patients intubated in the emergency department were identified, and 18.4% (34 of 186) developed PIH. Advanced age was an independent factor of developing PIH (OR: 3.4, 95% CI: 1.3-9.0, p=0.02). Patients with PIH had significantly higher in-hospital mortality (53% vs 29%; p=0.01), and multiple logistic regression showed that PIH was an independent predictor of in-hospital mortality (OR: 2.5, 95% CI: 1.1-5.5 p=0.03). CONCLUSION: Postintubation hypotension occurs in 18.3% of hemodynamically stable patients before intubation. PIH is independently associated with in-hospital mortality. Advanced age is an independent predicting factor of PIH.
Adult ; Blood Pressure ; Emergencies ; Emergency Service, Hospital* ; Hospital Mortality* ; Humans ; Hypotension* ; Incidence ; Intubation ; Intubation, Intratracheal ; Logistic Models ; Mortality ; Retrospective Studies ; Risk Factors*

The purpose of this study was to evaluate the effects of routine haecho bibimbab (boiled rice with assorted seaweed mixtures) consumption on the bowel habits in humans. Forty free-living adults (female 38, male 2) participated in this study (mean age 41.2 +/- 7.5). After a baseline survey on general characteristics, life style and dietary habits, the participants were asked to consume haecho bibimbab during two-week period for lunch. Habitual bowel movements were checked out every day by a questionnaire and nutrient intake was estimated by a 24-hour recalls before and after the study. After 2 weeks of clinical trial, the bowel habits had improved. Haecho bibimbab increased the number of bowel movements, changed hard stools into softer ones. It also lessen the sense of incomplete evacuation, and abdominal pain during defecation, increased water intake (p < 0.001) and improved gastrointestinal problem. The participants believed that haecho bibimbab was effective in improving their constipation symptoms and bowel habits (p < 0.01). Routine haecho bibimbab consumption tended to increase especially vitamin A, E and folate intake (p < 0.01). The present findings suggest that routine seaweed-based lunch meal (haecho bibimbab) consumption may improve bowel habits without side effects.
Abdominal Pain ; Adult ; Constipation ; Defecation ; Drinking ; Folic Acid ; Food Habits ; Humans ; Life Style ; Lunch ; Male ; Meals ; Surveys and Questionnaires ; Seaweed ; Vitamin A

Objective: This study aimed to assess whether the conventional treatments administered in the emergency department (ED) for hypertensive urgencies (observed or peroral [PO]-controlled) in severe high blood pressure (BP) patients with epistaxis increase the incidence of epistaxis recurrence and the mortality rate as compared to immediate BP control using intravenous (IV) antihypertensive medication Methods: A retrospective study over 7 years was conducted at the ED of a tertiary university hospital. Among adult patients with spontaneous epistaxis, subjects with severe high BP (systolic BP ≥180 mmHg or diastolic BP ≥120 mmHg) were included in the study. Participants were divided into three groups determined by the methods used to control BP: non-controlled, PO-controlled, and IV-controlled groups. The incidence of epistaxis recurrence and mortality rate within 6 months were compared. Results: Among the 380 patients enrolled, 238 were discharged from the ED without any pharmacological antihypertensive treatment (non-controlled group), 83 received PO antihypertensive medication (PO-controlled group), and 59 received IV antihypertensive medication (IV-controlled group). Of these, 29 (12.2%), nine (10.8%), and seven (11.9%) patients from the non-controlled, PO-controlled, and IV-controlled groups, respectively, experienced epistaxis recurrence within 24 hours, which was statistically not different among the three groups (P=0.948). The 6-month mortality rates were determined to be 0.8%, 2.4%, and 3.4% in the non-controlled, PO-controlled, and IV-controlled groups, respectively. The difference was also not significant among the groups (P=0.294). Conclusion The conventional treatments of hypertensive urgencies (observed or PO-controlled) in patients with severe high BP with epistaxis in the ED did not increase the incidence of epistaxis recurrence and short-term mortality rate when compared to immediate BP control using IV antihypertensive medication.

Pneumopericardium is defined as the presence of air inside the pericardial space. Usually, it is reported as a complication of blunt or penetrating chest trauma, but rare iatrogenic and spontaneous cases have been reported. Pneumopericardium is relatively stable if it does not generate a tension effect on the heart. However, it may progress to tension pneumopericardium, which requires immediate pericardial aspiration. We report a case of iatrogenic pneumopericardium occurred in a 70-year-old man who presented dyspnea at emergency department. The patient underwent pericardiocentesis for cardiac tamponade due to large pericardial effusion, and iatrogenic tension pneumopericardium occurred due to misuse of the drainage device. After evacuating the pericardial air through the previously implanted catheter, the patient became stable. We report this case to increase the awareness of this fatal condition and to help increase the use of precautions against the development of this condition during emergency procedures.
Aged ; Cardiac Tamponade/etiology ; Drainage ; Dyspnea/diagnosis ; Emergency Medical Services ; Heart Ventricles/physiopathology ; Humans ; Male ; Medical Errors ; Pericardial Effusion/diagnostic imaging/*therapy ; *Pericardiocentesis ; Pneumopericardium/*diagnosis/therapy ; Tomography, X-Ray Computed

PURPOSE: As a first step towards reform of the emergency medical service system, we aimed to assess the current status of our emergency department triage systems and illustrated the current status and problems of the Korean emergency department triage system. METHODS: We conducted e-mail and telephone surveys of the triage officers of all 136 emergency medical centers in Korea. RESULTS: All 136 emergency departments responded to the survey. In Korea, a triage scale derived from the 'emergency symptoms based on the requirements of the Emergency Medical Service Act' is the most-used triage scale. We identified factors showing significant association with use of verified triage vs. unverified scales, including level of triage scale, type of hospital, type of emergency department, perception of problems regarding the triage scale, educational performance, and number of annual visits. CONCLUSION: Results of our survey showed that in Korea various kinds of triage scale are in use and the reliability and validity of more than half of them are unverified. Reform of the Korean national triage system is in progress and our survey findings should be helpful in guiding reorganization of the national triage systems of many countries.
Electronic Mail ; Emergencies ; Emergency Medical Services* ; Emergency Service, Hospital* ; Korea ; Patient Safety ; Reproducibility of Results ; Telephone ; Triage* ; Weights and Measures*

The survival rate of commotio cordis is low, and there is often associated neurological disability if return of spontaneous circulation (ROSC) can be achieved. We report a case of commotio cordis treated with therapeutic hypothermia (TH) that demonstrated a favorable outcome. A 16-year-old female was transferred to our emergency department (ED) for collapse after being struck in the chest with a dodgeball. She has no history of heart problems. She was brought to our ED with pulseless ventricular tachycardia (VT), and ROSC was achieved with defibrillation. She was comatose at our ED and was treated with TH at a target temperature of 33degrees C for 24 hours. After transfer to the intensive care unit, pulseless VT occurred, and defibrillation was performed twice. She recovered to baseline neurologic status with the exception of some memory difficulties.
Adolescent ; Coma ; Commotio Cordis ; Emergency Service, Hospital ; Female ; Heart ; Humans ; Hypothermia ; Intensive Care Units ; Memory ; Survival Rate ; Tachycardia ; Tachycardia, Ventricular ; Thoracic Injuries ; Thorax

A 3-month-old female Maltese puppy was hospitalized with persistent diarrhea in a local veterinary clinic. Blood chemistry and hematology profile were analyzed and fecal smear was examined. Diarrheal stools were examined in a diagnostic laboratory, using multiplex real-time polymerase chain reaction (PCR) against 23 diarrheal pathogens. Sequence analysis was performed using nested PCR amplicon of 18S ribosomal RNA. Coccidian oocysts were identified in the fecal smear. Although multiplex real-time PCR was positive for Cyclospora cayetanensis, the final diagnosis was Cystoisospora ohioensis infection, confirmed by phylogenetic analysis of 18S rRNA. To our knowledge, this the first case report of C. ohioensis in Korea, using microscopic examination and phylogenetic analysis.
Animals ; Chemistry ; Cyclospora ; Diagnosis ; Diarrhea ; Dogs ; Female ; Hematology ; Humans ; Infant ; Korea ; Oocysts ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction ; RNA, Ribosomal, 18S ; Sequence Analysis

Objective: The bedside on-site ultrasound examination is a very useful diagnostic test for medically ill elderly emergency patients. However, it is not known whether it is being sufficiently used in the real world scenario. We investigated this aspect in patients with chest pain in two emergency departments in the Seoul metropolitan area. Methods: Elderly patients with chest pain who visited the two emergency departments from January 2019 to December 2019 were recruited using the ‘cardiogenic pain’ code, which is the third step classification of the Korean Triage and Acuity Scale, and their medical records were reviewed to confirm whether an emergency physician-performed ultrasound prescription code was entered. Results: Of the 744 elderly patients with chest pain, 66 were given bedside on-site ultrasound examinations. The rate of examination was 8.8%. Among the emergency departments, the local emergency departments accounted for 33 out of 389 patients (8.5%), and the regional emergency department accounted for 33 out of 355 (9.3%). Conclusion These results raise the need to check the extent of bedside on-site ultrasound examinations that are conducted in the initial care of medically ill emergency elderly patients nationwide.

Objective: The bedside on-site ultrasound examination is a very useful diagnostic test for medically ill elderly emergency patients. However, it is not known whether it is being sufficiently used in the real world scenario. We investigated this aspect in patients with chest pain in two emergency departments in the Seoul metropolitan area. Methods: Elderly patients with chest pain who visited the two emergency departments from January 2019 to December 2019 were recruited using the ‘cardiogenic pain’ code, which is the third step classification of the Korean Triage and Acuity Scale, and their medical records were reviewed to confirm whether an emergency physician-performed ultrasound prescription code was entered. Results: Of the 744 elderly patients with chest pain, 66 were given bedside on-site ultrasound examinations. The rate of examination was 8.8%. Among the emergency departments, the local emergency departments accounted for 33 out of 389 patients (8.5%), and the regional emergency department accounted for 33 out of 355 (9.3%). Conclusion These results raise the need to check the extent of bedside on-site ultrasound examinations that are conducted in the initial care of medically ill emergency elderly patients nationwide.