As the elderly population continues to grow, the number of geriatric patients reported to poison centers continues to increase. Older poisoned patients are at an increased risk of death compared to younger adult patients. The purpose of this paper is to report a case of hydrofluoric acid poisoning along with a discussion of poisoning characteristics. A 79 year-old male with dementia visited emergency department presenting epigastic discomfort after ingestion of 50% hydrofluoric acid solution. At admission, he presented with a stable vital sign but progressed to pulseless electrical activity. In spite of advanced resuscitation efforts and administration of calcium gluconate, he rapidly detoriated and died 3 hours after the ingestion.
Adult ; Aged ; Calcium Gluconate ; Dementia ; Eating ; Emergencies ; Gluconates ; Humans ; Hydrofluoric Acid ; Male ; Resuscitation ; Vital Signs

BACKGROUND AND OBJECTIVE: TDI is known to be the most prevalent cause of occupational asthma ( OA ) in Korea. However, the pathogenesis of TDI - induced occupational asthma still remains to be further clarified. So, we evaluated clinical significance of serum specific IgG and IgE antibodies to TDI - HSA conjugate in TDI - induced occupational asthma. Subjects and METHODS: Serum specific IgG and IgE antibodies to TDI - HSA conjugate were measured by enzyme linked immunosorbent assay. Serum was collected from 50 TDI- induced OA patients ( classified as group I ), and was compared with that from 13 asthmatic subjects with negative TDI - bronchoprovocation test ( BPT, group II ), allergic asthmatics ( group III ), and unexposed healthy controls ( group IV ). RESULTS: The prevalence of specific IgG was significantly higher in group I than in group II (p = 0.01) or group III (p <0.01). No significant difference was noted between group II and group III (p> 0.05). However, the prevalence of specific IgE was not different between group I and group II (p> 0.05 ) or group II and group III( p> 0.05 ). There was no significant difference in prevalence of specific IgG according to the asthmatic response during TDI bronchoprovocation test ( p> 0.05 ). No statistical significance was noted between specific IgG and IgE antibodies in group I subjects ( p> 0.05 ). CONCLUSION: These findings demonstrate that presence of specific IgG to TDI - HSA conjugate is closely related to TDI - BPT results and it may contribute to the development of TDI - induced asthma.
Antibodies* ; Asthma ; Asthma, Occupational* ; Enzyme-Linked Immunosorbent Assay ; Humans* ; Immunoglobulin E* ; Immunoglobulin G* ; Korea ; Prevalence ; Serum Albumin* ; Toluene 2,4-Diisocyanate* ; Toluene*

A 47-year-old woman ingested about 12 mg of colchicine with suicidal intent. Colchicine, a highly poisonous alkaloid, is a commonly used treatment for gout, Bechet's disease, and familial Mediterranean fever. Despite the knowledge of its side effects, the risk of a significant overdose is under-appreciated. She suffered from acute multisystem toxicity, including gastrointestinal disorders, bone marrow suppression, alopecia, and probable pancreatitis, but she ultimately recovered with supportive therapy. We report a case of acute colchicine toxicity from a single overdose with a review of the literature.
Alopecia ; Bone Marrow ; Colchicine ; Familial Mediterranean Fever ; Female ; Gastroenteritis ; Gout ; Humans ; Middle Aged ; Pancreatitis

PURPOSE: Chest compression is the corner stone of resuscitation. As a result, many studies insist on the importance of retention of skill performance. But there are weak points. First, a unique characteristic of skill is ignored, "the more practice, the better outcome". Second, no one knows when they have a proficiency in a skill. Learning curve-CUSUM analysis is a good tool to evaluate each trainee's performance. Hence, we designed this study to evaluate each trainee's proficiency in performing chest compression using LC-CUSUM analysis. METHODS: Four medical students were enrolled. We asked them to perform chest compression for two minutes per day without any intervention over six weeks. Data included the depth and rate of chest compression. Eventually, all trainees performed chest compression at least 30 times. We plotted the LC-CUSUM curve according to the results of attempts, successes or failures. RESULTS: According to median values of the depth and rate of chest compression through the 30th attempt, trainees had performances within the acceptable range, 40~49 mm (for depth) and 100~105 beats per minutes (for rate) of chest compression. Nonetheless, LC-CUSUM analysis indicated that two trainees no longer were proficient throughout, and even though the rest of them were once proficient, they appear to have lost that proficiency regarding depth of chest compression. LC-CUSUM analysis of rate of compression showed that all trainees had proficiency during the early phase. CONCLUSION: We propose that instructors can evaluate their trainees' proficiency easily, based on LC-CUSUM analysis.
Cardiopulmonary Resuscitation ; Clinical Competence ; Humans ; Learning ; Resuscitation ; Retention (Psychology) ; Students, Medical ; Thorax ; Training Support

Hydrofluoric acid is a colorless gas or fuming liquid with a strong, irritating odor. Hydrofluoric acid burns are uncommon; however, if severe burn occur, they caused death from systemic effects, such as fatal cardiac arrthmia. We experienced two cases of hydrofluoric acid chemical burns on digits. These patients had typical clinical features of hydrofluoric acid chemical burns, such as pulsating pain at the burn site, as well as ischemic and necrotic skin changes. The hydrofluoric acid chemical burn was confirmed by a history of exposure. Subsequently, we made a calcium gluconate gel by mixing 20% calcium gluconate, an antagonist against hydrofluoric acid, with lubricant, and we injected 10% calcium gluconate subcutaneously when they complained of pain rated at higher than 5 on the pain scale. Simultaneously, we monitored the patients' electrocardiographs and checked their serum total calcium, ionized calcium, and magnesium levels serially. Clinical presentations and the emergency management of hydrofluoric acid chemical burns were reviewed along with the current literature. These patients were discharged without any significant complications.
Burns ; Burns, Chemical* ; Calcium ; Calcium Gluconate ; Electrocardiography ; Emergencies ; Humans ; Hydrofluoric Acid* ; Magnesium ; Odors ; Skin

Hydrofluoric acid is a colorless gas or fuming liquid with a strong, irritating odor. Hydrofluoric acid burns are uncommon; however, if severe burn occur, they caused death from systemic effects, such as fatal cardiac arrthmia. We experienced two cases of hydrofluoric acid chemical burns on digits. These patients had typical clinical features of hydrofluoric acid chemical burns, such as pulsating pain at the burn site, as well as ischemic and necrotic skin changes. The hydrofluoric acid chemical burn was confirmed by a history of exposure. Subsequently, we made a calcium gluconate gel by mixing 20% calcium gluconate, an antagonist against hydrofluoric acid, with lubricant, and we injected 10% calcium gluconate subcutaneously when they complained of pain rated at higher than 5 on the pain scale. Simultaneously, we monitored the patients' electrocardiographs and checked their serum total calcium, ionized calcium, and magnesium levels serially. Clinical presentations and the emergency management of hydrofluoric acid chemical burns were reviewed along with the current literature. These patients were discharged without any significant complications.
Burns ; Burns, Chemical* ; Calcium ; Calcium Gluconate ; Electrocardiography ; Emergencies ; Humans ; Hydrofluoric Acid* ; Magnesium ; Odors ; Skin

Pericardial tamponade is a life-threatening condition, as accumulated fluid in the pericardial sac can ultimately lead to fatal shock. The clinical identification of cardiac tamponade can be difficult to determine. Accurate diagnosis and prompt intervention are important to prevent adverse outcomes. Unexplained hypotension, enlarged cardiac silhouette, chest pain or dyspnea in a patient with underlying comorbidities, such as cancer, uremia or trauma history, constitute a high-risk population for pericardial effusions. The identifying cause of pericardial effusion and the understanding of the disease process are also important to prevent recurrent pericardial effusions. We report a case of malignant pericardial effusion with tamponade as an initial presentation in a patient with lung adenocarcinoma. The patient had typical features of tamponade such as neck vein distension, hypotension, tachycardia, tachypnea, muffled heart sound and cardiomegaly on chest X-ray. The pericardial effusion was confirmed by bedside echocardiography. Subsequently, ultrasound guided pericardiocentesis was performed and malignant cells were detected in the effusion by cytology. Eventually, lung adenocarcinoma was detected by CT-guided tissue biopsy. Hemodynamic changes, associated underlying causes, clinical presentations, radiologic findings, and the emergency management of cardiac tamponade were reviewed with the current literature.
Adenocarcinoma* ; Biopsy ; Cardiac Tamponade ; Cardiomegaly ; Chest Pain ; Comorbidity ; Diagnosis ; Dyspnea ; Echocardiography ; Emergencies ; Heart Sounds ; Hemodynamics ; Humans ; Hypotension ; Lung Neoplasms ; Lung* ; Neck ; Pericardial Effusion* ; Pericardiocentesis ; Shock ; Tachycardia ; Tachypnea ; Thorax ; Ultrasonography ; Uremia ; Veins

PURPOSE: Chlorine gas is a common irritant that usually causes mild respiratory symptoms. One severe symptom, RADS (Reactive Airway Dysfunction Syndrome), is not well known to physicians. We analyzed the clinical features of chlorine gas exposure. METHODS: We prospectively collected 25 cases of chlorine gas exposure near our emergency center on January 10th, 2007, and analyzed demographic data, event-to-ER interval, symptoms, and laboratory results based on medical records. RESULTS: Only 2 patients out of 25 were admitted because of severe symptoms, the rest were discharged without complications. Sixty percent of them visited the ER within 12 h of exposure. The most common symptoms were chest discomfort (60%), headache (40%), nausea (40%), throat irritation (26%), and cough (32%). Two out of eight dyspnea cases showed abnormal pulmonary function, but only one case was diagnosed as RADS. CONCLUSION: Most symptoms after chlorine gas exposure can be treated conservatively. However, patients with chlorine exposure should be followed up long term for delayed complications.
Chlorine ; Cough ; Dyspnea ; Emergencies ; Environmental Exposure ; Follow-Up Studies ; Headache ; Humans ; Hypersensitivity ; Nausea ; Pharynx ; Prospective Studies ; Thorax

OBJECTIVE: This study was designed to describe how to develop the 'ASAN-Drug Allergy Alert System' and evaluate the usefulness of this system. METHODS: The drug allergy alert system was developed by a task force that was consisted of emergency physicians, pharmacists, and programmers for ten months. Since this system had been implemented, we compared frequencies with a previous paper based system. RESULTS: This system was implemented with three stages: an input stage, a censorship stage, and an alertness stage. The input of data was done by physicians and nurses as a multidisciplinary team. The censorship of data was charged of an allergist who confirmed whether a suspicious drug had caused life threatening symptoms or not. If the causative drug was confirmed by an allergist, an alert sign changed 'Code Yellow' to 'Code Red' automatically. After that censorship, an alert sign was noticed to clinicians as a yellow or red colored pop-up window. After an alert system, frequencies per month of report were increased from 44.6 to 594. Also, the report ratio of life threatening symptoms was increased from 5.4% to 12.5% (p<0.001). CONCLUSION: We assumed that the Asan-Drug Allergy Alert System could reduce medication errors effectively.
Advisory Committees ; Chungcheongnam-do* ; Drug Hypersensitivity* ; Emergencies ; Humans ; Hypersensitivity ; Medication Errors ; Pharmacists

Dimethylformamide (DMF) is a major solvent predominately used in synthetic leather and electrical equipment production. The effects of DMF exposure in humans are not well known or documented in the medical literature. We present a case of an electrical factory worker who underwent frequent exposure to DMF while making film. The patient complained of abdominal pain, nausea, vomiting and presented with hepatotoxicity serologic evaluation consistent with prior reports in people exposed to DMF. The possibility of viral, drug induced and alcoholic hepatitis were ruled out from his history and serological studies. The patient was eventually diagnosed as having a DMF induced toxic hepatitis and was managed with supportive care and hepatotonics. The clinical presentation and management of DMF induced toxic hepatitis were reviewed with the current literature.
Abdominal Pain ; Dimethylformamide* ; Drug-Induced Liver Injury* ; Hepatitis, Alcoholic ; Humans ; Nausea ; Vomiting