Nicolau syndrome is a rare adverse reaction at the site of an intramuscular injection, and is characterized by severe pain immediately after the injection and rapid development of distinct skin lesions. As this syndrome is rare, it may be overlooked at the early clinical phase and subsequently, clinical outcomes may be worse due to delay in treatment. We report on a female who developed Nicolau syndrome following intramuscular diclofenac injection, which required surgical reconstruction. Understanding the characteristics of Nicolau syndrome and careful surveillance for relevant clinical features may help physicians to more quickly diagnose and treat this condition.
Diclofenac ; Emergencies ; Female ; Humans ; Injections, Intramuscular ; Skin ; Soft Tissue Injuries

PURPOSE: In-hospital cardiopulmonary resuscitation (CPR) is often performed on patients lying on a bed or stretcher, which involves using a step stool. However, as current CPR training uses mannequins placed on a floor, the quality of CPR in simulated cardiac arrest scenarios on a stretcher versus the floor were analyzed. METHODS: This study was performed during the Objective Structured Clinical Examination (OSCE) for sixth grade medical students. The students were trained using Basic Life Support (BLS) guidelines given by the American Heart Association (AHA) in 2010. Simulated CPR was performed in the 1 rescuer-mode (30:2 compression to ventilation ratio) for 5 cycles, while either standing atop a step stool beside the stretcher or kneeling on the floor, and the position order was randomized. The OSCE score and variables related to CPR quality were compared. RESULTS: Among the 59 students enrolled, 47 students were included for analysis. No significant difference in OSCE scores was found between the groups that performed CPR on a stretcher versus the floor (89.4+/-9.1 vs. 88.1+/-8.4, respectively, p=0.610). In addition, variables related to CPR quality did not differ between the groups that performed CPR on a stretcher versus the floor (following results listed respectively): correct compression rate (%) (54.8+/-42.3 vs. 70.0+/-34.9, p=0.185); compression rate (n/min) (127+/-11.3 vs. 126+/-13.3, p=0.792); correct depth (%) (69.8+/-40.6 vs. 78.6+/-33.6, p=0.429); mean compression depth (mm) (51.1+/-7.2 vs. 53.0+/-6.0, p= 0.337); correct release (%) (99.3+/-2.9 vs. 99.1+/-3.0, p=0.875); correct hand position (%) (83.2+/-32.3 vs. 86.7+/-27.5, p=0.694); total hands off time (sec.) (79.9+/-19.5 vs. 70.4+/-15.6, p=0.077). CONCLUSION: Medical students effectively perform CPR on a stretcher or the floor. Thus, current CPR training methods appear adequate and may be maintained.
American Heart Association ; Cardiopulmonary Resuscitation ; Clinical Competence ; Deception ; Education, Medical ; Hand ; Heart Arrest ; Humans ; Manikins ; Methods ; Students, Medical ; Thorax* ; Ventilation

Purpose: The purpose of this study was to investigate the cause of acute fatal poisoning and the time of death by analyzing the National Emergency Department Information System (NEDIS) of South Korea. Methods: The NEDIS data from 2014 to 2018 excluding non-medical visits were used for this study. The patients with acute poisoning were extracted using diagnostic codes. The toxic substances were classified into pharmaceuticals, pesticides, gases, artificial poisonous substances, and natural toxic substances. Patients were classified according to the time of death, place of death, and region. In each case, the most causative substances of poisoning were identified. Results: There were 380,531 patients including poisoning-related diagnoses, of which 4,148 (1.1%) died, and the WHO age-standardized mortality rate was 4.8 per 100,000. Analysis of 2,702 death patients whose primary diagnosis was acute poisoning, the most common cause of poisoning death was pesticides (62%), followed by therapeutic drugs, gas, and artificial toxic substances. Herbicides were the most common pesticides at 64.5%. The proportion of mortality by time, hyperacute (<6 h) 27.9%, acute (6-24 h) 32.6%, subacute (1-7 d) 29.7%, and delayed period (>7 d) were 9.8%. Conclusion This study suggests that the most common cause of poisoning death was pesticides, and 60% of deaths occurred within 24 hours. The 71% of mortality from pesticides occurred within 6-24 hours, but mortality from gas was mostly within 6 hours. According to the geographic region, the primary cause of poisoning death was varied to pesticides or pharmaceuticals.

Purpose: This study investigated the characteristics and treatment outcomes of patients who visited the emergency department due to intoxication and analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic on their visits. Methods: A retrospective study was conducted using data from the National Emergency Department Information System (NEDIS) on patients who visited the emergency department due to intoxication between January 2014 and December 2020. In total, 277,791 patients were included in the study, and their demographic and clinical data were analyzed. A model was created from 2014 to 2019 and applied to 2020 (i.e., during the COVID-19 pandemic) to conduct a time series analysis distinguishing between unexpected accidents and suicide/self-harm among patients who visited the emergency department. Results: The most common reason for visiting the emergency department was unintentional accidents (48.5%), followed by self-harm/suicide attempts (43.8%). Unexpected accident patients and self-harm/suicide patients showed statistically significant differences in terms of sex, age group, hospitalization rate, and mortality rate. The time series analysis showed a decrease in patients with unexpected accidents during the COVID-19 pandemic, but no change in patients with suicide/self-harm. Conclusion Depending on the intentionality of the intoxication, significant differences were found in the age group, the substance of intoxication, and the mortality rate. Therefore, future analyses of patients with intoxication should be stratified according to intentionality. In addition, the time series analysis of intentional self-harm/suicide did not show a decrease in 2010 in the number of patients, whereas a decrease was found for unintentional accidents.