PURPOSE: The aim of the study was to compare the clinical characteristics in emergency endotracheal intubation procedures between non-elderly and elderly patients. METHODS: Data for airway registry, which were collected in two emergency departments (ED) between April 2006 and March 2010, were retrospectively reviewed. The airway registry data included patient's demographic information and variables such as Cormack-Lehane grade, 3-3-2 finger analysis, success rate, the number of attempts at intubation, complications of intubation, and clinical outcomes after intubation. RESULTS: A total of 1,457 patients were enrolled. The mean age of the patients was 62.2+/-15.7 and 62.1%(n=905) were male. A total of 726(49.8%) patients were classified as being in the elderly intubation group(> or =65 years). Cormack-Lehane grade, 3-3-2 finger analysis, the relationship between the number of attempts and success rate, the relationship between Cormack-Lehane classification and success rate, complications, and clinical outcomes after intubation showed no significant difference between elderly and non-elderly groups. CONCLUSION: Anatomical structures related to endotracheal intubation, the process and clinical outcomes of elderly patients are not different than for non-elderly adult patients. However, considering the lower physiologic reservoir and higher comorbidities of elderly patients, a more vigorous approach to emergency airway management in the elderly is needed.
Adult ; Aged ; Airway Management ; Comorbidity ; Emergencies ; Emergency Treatment ; Fingers ; Humans ; Intubation ; Intubation, Intratracheal ; Male ; Retrospective Studies

PURPOSE: The purpose of this study was to evaluate the usefulness of intravenous lipid emulsion as well as adverse events in acute poisoning patients. METHODS: Literature was accessed through PubMed, EMBASE, Cochrane library, Web of science, and KoreaMed. All forms of literatures relevant to human use of intravenous lipid emulsion for acute poisoning were included. Cases reports or letters without description of clinical outcomes for each case were excluded. The literature search was conducted by two investigators in March, 2015, with publication language restricted to English and Korean. The effect, onset time, and adverse event of lipid emulsion and final outcome of each case were analyzed. RESULTS: Eighty-one published articles were included, excluding articles whose title and abstract were not relevant to this study. No articles were classified as high level of evidence. Sixty-eight case reports were identified, consisting of 25 local anesthetics and 43 other drugs, such as tricyclic antidepressants and calcium channel blockers. Although most cases described significant clinical improvements, some of them showed no beneficial effect or worsening of clinical course. Several adverse events including hyperamylasemia and laboratory interference were reported. CONCLUSION: Although there were many case reports illustrating successful use of lipid for various drug poisonings, the effect cannot be estimated due to significant possibility of publication bias. Therefore, lipids might be considered in severe hemodynamic instability resulting from lipophilic drug poisoning, however further studies should follow to establish the use of lipid as the standard of care.
Anesthetics, Local ; Antidepressive Agents, Tricyclic ; Calcium Channel Blockers ; Drug Overdose ; Fat Emulsions, Intravenous ; Hemodynamics ; Humans ; Hyperamylasemia ; Lipid A ; Poisoning* ; Publication Bias ; Publications ; Research Personnel ; Standard of Care

Liposuction is one of the most frequently performed cosmetic surgeries worldwide for reshaping the body contour. Although liposuction is minimally invasive and relatively safe, it is a surgical procedure, and it carries the risk of major and minor complications. These complications vary from postoperative nausea to life-threatening events. Common complications include infection, abdominal wall injury, bowel herniation, bleeding, haematoma, seroma, and lymphoedema. Life-threatening complications such as necrotizing fasciitis, deep vein thrombosis, and pulmonary embolism have also been reported. In this paper, we provide a brief introduction to liposuction with the related anatomy and present computed tomography and ultrasonography findings of a wide spectrum of postoperative complications associated with liposuction.
Abdomen/ultrasonography ; Fasciitis, Necrotizing/etiology ; Hematoma/etiology ; Humans ; Lipectomy/*adverse effects ; Postoperative Complications/*etiology ; Pulmonary Embolism/etiology ; Tomography, X-Ray Computed ; Venous Thrombosis/etiology

PURPOSE: The purpose of this study is to compare the sensitivity, specificity, positive predictive value, and negative predictive value of ultrasonography versus magnetic resonance imaging (MRI) in evaluation of pregnant patients with clinically suspicious acute appendicitis. METHODS: This study was a retrospective cohort study. A total of 60 pregnant patients who presented to the emergency department with suspected appendicitis and underwent ultrasonography or MRI were included. The official interpretation reports and pathologic reports were extracted and analyzed. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for ultrasonography and MRI for diagnosis of acute appendicitis. We also calculated and compared area under the curve (AUC) of both diagnostic tests with the receiver operating characteristic (ROC) curve analysis. RESULTS: Among 60 patients, 43 (71%) underwent ultrasonography, 37 (61%) underwent MRI, and 20 (33%) underwent both diagnostic tests. Twenty patients were confirmed as pathologically-proven acute appendicitis. The sensitivity, specificity, positive predictive value, and negative predictive value of ultrasonography for diagnosing acute appendicitis were 67%, 77%, 53%, and 86%, while those of MRI were 100% for all parameters. In ROC analysis, the AUC was 0.656, respectively, for ultrasonography, and 1.000 for MRI (p value<0.0001). CONCLUSION: This study suggests that MRI is more accurate than ultrasonography for the diagnosis of acute appendicitis in pregnant women, especially when the appendix is invisible with ultrasonography.
Appendicitis* ; Appendix ; Area Under Curve ; Cohort Studies ; Diagnosis ; Diagnostic Tests, Routine ; Emergency Service, Hospital ; Female ; Humans ; Magnetic Resonance Imaging* ; Pregnancy* ; Pregnant Women ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography*

Phentermine has been widely used as an appetite suppressant since 2004 in Korea. The authors experienced two cases of acute phentermine overdose and report with the literature review. A 36-year-old man and a 24-year-old woman presented together to the emergency department with taking 13 tablets (390 mg) of phentermine 16 hours ago. They had tachycardia, hypertension and complained visual symptoms, nausea, insomnia and anxiety. These symptoms were resolved by conservative management.
Adult ; Anxiety ; Appetite ; Drug Overdose ; Emergency Service, Hospital ; Female ; Humans ; Hypertension ; Korea ; Nausea ; Phentermine* ; Sleep Initiation and Maintenance Disorders ; Tablets ; Tachycardia ; Young Adult

We report on a patient who developed acute hepatic failure despite intravenous N-acetyl cysteine therapy who was treated with the Molecular Adsorbents Recirculating System (MARS). She presented 20 hours after the ingestion of 13 g of acetaminophen. The MARS is based on albumin dialysis principle which can be applied for patients with acute poisoning from drugs that have high protein-binding capacity because of its ability to selectively remove from circulation protein-bound toxins. The clinical toxicologist should be consider this technology when treating patients with hepatic failure following acetaminophen poisoning.
Acetaminophen* ; Cysteine ; Dialysis ; Eating ; Humans ; Liver Failure ; Liver Failure, Acute* ; Mars ; Poisoning

Phentermine has been widely used as an appetite suppressant since 2004 in Korea. The authors experienced two cases of acute phentermine overdose and report with the literature review. A 36-year-old man and a 24-year-old woman presented together to the emergency department with taking 13 tablets (390 mg) of phentermine 16 hours ago. They had tachycardia, hypertension and complained visual symptoms, nausea, insomnia and anxiety. These symptoms were resolved by conservative management.
Adult ; Anxiety ; Appetite ; Drug Overdose ; Emergency Service, Hospital ; Female ; Humans ; Hypertension ; Korea ; Nausea ; Phentermine* ; Sleep Initiation and Maintenance Disorders ; Tablets ; Tachycardia ; Young Adult

We report on a patient who developed acute hepatic failure despite intravenous N-acetyl cysteine therapy who was treated with the Molecular Adsorbents Recirculating System (MARS). She presented 20 hours after the ingestion of 13 g of acetaminophen. The MARS is based on albumin dialysis principle which can be applied for patients with acute poisoning from drugs that have high protein-binding capacity because of its ability to selectively remove from circulation protein-bound toxins. The clinical toxicologist should be consider this technology when treating patients with hepatic failure following acetaminophen poisoning.
Acetaminophen* ; Cysteine ; Dialysis ; Eating ; Humans ; Liver Failure ; Liver Failure, Acute* ; Mars ; Poisoning

PURPOSE: The aim of this study was to validate the Glasgow-Blatchford score and the pre-endoscopic Rockall score to assess their ability to predict the presence of active bleeding in emergency department patients with suspected upper gastrointestinal bleeding. METHODS: We reviewed and extracted data from electronic medical records on patients presenting with a suspicion of acute upper gastrointestinal bleeding at our emergency department from January 1, 2012 to December 31, 2012. For each patient we calculated the Glasgow-Blatchford score and the pre-endoscopic Rockall score. Discriminative ability of the scoring systems for predicting active bleeding was evaluated by receiver operator characteristic (ROC) curve analysis. RESULTS: We identified 636 patients with upper gastrointestinal bleeding. There were 118 (18.6%) patients with active bleeding and 520 (81.8%) patients with need for intervention. The ROC curve analysis showed poor discriminative ability of the Glasgow-Blatchford score and the pre-endoscopic Rockall score for determining the presence of active bleeding (area under the curve (AUC)=0.546, 95% confidence interval (CI) 0.490-0.602 vs. 0.576, 95% CI 0.523-0.630; p=0.34). The sensitivity and the specificity of the two scoring systems were suboptimal. However, the Glasgow-Blatchford score outperformed the pre-endoscopic Rockall score in predicting the need for clinical intervention (AUC=0.867, 95% CI 0.831-0.903 vs. 0.698, 95% CI 0.643-0.754; p<0.001). CONCLUSION: The Glasgow-Blatchford score was superior in predicting the need for intervention in emergency department patients with suspected gastrointestinal hemorrhage. However, these clinical decision rules may be insufficient to predict the presence of active bleeding.
Electronic Health Records ; Emergency Service, Hospital* ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Hemostasis ; Humans ; ROC Curve ; Sensitivity and Specificity ; Upper Gastrointestinal Tract

Nicotine-poisoning related to the electronic cigarettes (e-cigarette) is increasing worldwide. Moreover, the American Association of Poison Control Centers has advised the public to use caution with e-cigarette devices and highly concentrated liquid nicotine after a surge in related poisonings. We report here the first case of nicotine poisoning from self-injected e-cigarette fluid in Korea. A 17-year-old male patient subcutaneously injected himself with 0.5 ml of nicotine solution for an electronic cigarette via the dorsum of his hand, after which he complained of nausea, vomiting, dizziness and dyspnea. His vital signs were within the normal range, but his mental status was drowsy. He was admitted for observation and the symptoms disappeared the following day. Sinus bradycardia with a rate of 45/min was observed on the third hospital day, but improved after 6 hours. He was discharged without complications.
Adolescent ; Bradycardia ; Dizziness ; Dyspnea ; Electronic Cigarettes* ; Hand ; Humans ; Injections, Subcutaneous* ; Korea ; Male ; Nausea ; Nicotine* ; Poison Control Centers ; Poisoning* ; Reference Values ; Vital Signs ; Vomiting