Commotio cordis is induction of sudden cardiac arrest and ventricular fibrillation (VF) by chest blunt trauma and nonpenetrating injury without damage to the rib, sternum, and heart in a person without underlying cardiovascular disease. Commotio cordis has been rarely reported worldwide, and it is particularly rare in the case of traffic accident (TA). We experienced a case of commotio cordis in a healthy 20-year-old man who was involved in a TA. The patient had no other signs of trauma except blunt chest trauma, and the initial electrocardiography (ECG) rhythm checked by the emergency medical technician (EMT) team was VF. They performed defibrillation and cardiopulmonary resuscitation (CPR) during transfer. CPR including defibrillation was performed because VF continued upon arrival at the emergency department, and therapeutic hypothermia (THT) was performed because glasgow coma scale (GCS) score was 3 after return of spontaneous circulation (ROSC). The patient's mental status became alert after performance of THT and cerebral performance category (CPC) score was 1 without neurological symptoms at the time of discharge. In trauma patients who may be have blunt chest trauma, including TA, emergency medical service providers must perform continuous monitoring with commotio cordis in mind, and perform defibrillation and CPR immediately if VF arises. With training in basic CPR and a supply of automated external defibrillators (AED) for application to trauma patients, the survival rate of commotio cordis patients can be increased.
Accidents, Traffic* ; Cardiopulmonary Resuscitation ; Cardiovascular Diseases ; Commotio Cordis* ; Death, Sudden, Cardiac ; Defibrillators ; Electrocardiography ; Emergency Medical Services ; Emergency Medical Technicians ; Emergency Service, Hospital* ; Glasgow Coma Scale ; Heart ; Humans ; Hypothermia ; Ribs ; Sternum ; Survival Rate ; Thoracic Injuries ; Thorax ; Ventricular Fibrillation ; Wounds, Nonpenetrating ; Young Adult

Foreign bodies in the stomach are usually ingested by children under 5 years of age, persons with dentures, alcoholics, mentally disturbed individuals or prisoners with a purpose of secondary gain. Many patients will be asymptomatic and will be brought in by parents with a history of having swallowed something. The ingested foreign bodies are mainly coins, particles of metals, fish bones and etc. A needle or a toothpick in the stomach has been rarely reported in an adult.. We present two cases of patients: one case of patient with needle stuck in the stomach, who swallowed for the purpose of secondary gain, and the other case of patient with toothpick stuck in the stomach, who did not realize having swallowed it. A 23-year-old man, prisoner, was admitted to hospital due to epigastric pain after ingestion of a needle. Endoscopy showed a black needle, 1.2cm long stuck at the prepyloric antrum. It was removed by the endoscopic biopsy forceps through the overtube used in endoscopic variceal ligation and proved to be a needle with a length of 4.9 cm and a diameter of 0.1 cm. A 58-year-old woman developed an acute onset of hematemesis and epigastralgia, and presented to the emergency room. On admission, her blood pressure was 60/40 mmHg. An emergency endoscopy showed a yellowish, thin, stiff material 3.5cm long stuck at the greater curvature of the antrum with meat materials. It was removed by the above method and proved to an wooden tooth pick with a length of 6.5 cm and a diameter of 0.2 cm. No active bleeding was noted from the removed site. She did not realized she had swallowed the toothpick. She was discharged without complication.
Adult ; Alcoholics ; Biopsy ; Blood Pressure ; Child ; Dentures ; Eating ; Emergencies ; Emergency Service, Hospital ; Endoscopy ; Female ; Foreign Bodies ; Hematemesis ; Hemorrhage ; Humans ; Ligation ; Meat ; Metals ; Middle Aged ; Needles* ; Numismatics ; Parents ; Prisoners ; Prisons ; Stomach* ; Surgical Instruments ; Tooth ; Young Adult

Purpose: The study aimed to develop an objectified Korean Triage and Acuity Scale (OTAS) that can objectively and quickly classify severity, as well as a simple age-adjusted OTAS (S-OTAS) that reflects age and evaluate its usefulness. Materials and Methods: A retrospective analysis was performed of all adult patients who had visited the emergency department at three teaching hospitals. Sex, systolic blood pressure, diastolic blood pressure, pulse rate, respiratory rate, body temperature, O 2 saturation, and consciousness level were collected from medical records. The OTAS was developed with objective criterion and minimal OTAS level, and S-OTAS was developed by adding the age variable. For usefulness evaluation, the 30-day mortality, the rates of computed tomography scan and emergency procedures were compared between Korean Triage and Acuity Scale (KTAS) and OTAS. Results: A total of 44402 patients were analyzed. For 30-day mortality, S-OTAS showed a higher area under the curve (AUC) compared to KTAS (0.751 vs. 0.812 for KTAS and S-OTAS, respectively, p<0.001). Regarding the rates of emergency procedures, AUC was significantly higher in S-OTAS, compared to KTAS (0.807 vs. 0.830, for KTAS and S-OTAS, respectively, p=0.013). Conclusion S-OTAS showed comparative usefulness for adult patients visiting the emergency department as a triage tool compared to KTAS.

PURPOSE: Many patients who are acutely poisoned with organophosphorus pesticides have co-ingested alcohol. The purpose of this study was to identify the factors that influence mortality in organophosphate intoxication and the differences between alcohol coingested patients and non-coingested patients, looking at vital signs, length of admission, cholinesterase activity, complications, and mortality. METHODS: All patients visiting one Emergency Department (ED) with organophosphate intoxication between January 2000 and December 2012 were reviewed retrospectively. The patients were divided into two groups, alcohol coingested group and non-coingested group. RESULTS: During the study period, 136 patients (alcohol coingested group, 95 patients; non-coingested group, 41 patients) presented to the ED with organophosphate intoxication. Seventy-one alcohol coingested patients (74.1%) vs. 16 non-coingested patients (39.0%) received endotracheal intubation, with results of the analysis showing a clear distinction between the two groups (p=0.001). Twenty-three alcohol coingested patients (24.2%) vs. 1 non-coingested patient (2.4%) required inotropics, indicating a significant gap (p=0.002). Twenty-eight alcohol coingested patients (29.5%) vs. 2 non-coingested patients (4.9%) died, with results of the analysis showing a clear distinction between the two groups (p=0.002). CONCLUSION: In cases of organophosphate intoxication, alcohol coingested patients tended to receive endotracheal intubation, went into shock, developed central nervous system complications, and more died.
Alcohols ; Central Nervous System ; Cholinesterases ; Emergency Service, Hospital ; Humans ; Intubation, Intratracheal ; Mortality* ; Organophosphate Poisoning ; Pesticides ; Retrospective Studies ; Shock ; Vital Signs

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.

Chronic spontaneous urticaria (CSU) is defined as the occurrence of spontaneous wheals, angioedema, or both for >6 weeks in the absence of specific causes. It is a common condition associated with substantial disease burden both for affected individuals and societies in many countries, including Korea. CSU frequently persists for several years and requires high-intensity treatment; therefore, patients experience deteriorations in quality of life and medication-associated complications. During the last decade, there have been major advances in the pharmacological treatment of CSU and there is an outstanding need for evidence-based guidelines that reflect clinical practice in Korea. The guidelines reported here represent a joint initiative of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Dermatological Association, and aim to provide evidence-based guidance for the management of CSU in Korean adults and children. In Part 1, disease definition, guideline scope and development methodology as well as evidence-based recommendations on the use of antihistamines and corticosteroids are summarized.