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The use of high-pressure air instruments has become more common. Consequently, there have been a number of cases of orbital emphysema caused by contact with high-pressure air. In this case, a 62-year-old male patient visited an emergency medical center after his left eye was shot by an air compressor gun that was used to wash cars. Lacerations were observed in the upper and lower eyelids of his left eye. Radiological examinations revealed orbital emphysema, optic nerve transection, pneumocephalus, and subcutaneous emphysema in the face, neck, shoulder, and mediastinum. Canalicular injury repair was performed, and the emphysema resolved. However, there was near-complete vision loss in the patient's left eye. Because most optic nerve transections occur after a severe disruption in bone structure, pure optic nerve transections without any injury of the bone structure, as in the present case, is extremely rare.
Compressed Air ; Emergencies ; Emphysema ; Eyelids ; Humans ; Lacerations ; Male ; Mediastinum ; Middle Aged ; Neck ; Optic Nerve Injuries* ; Optic Nerve* ; Orbit ; Pneumocephalus ; Shoulder ; Subcutaneous Emphysema

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Two cases of incidental Podostroma cornu-damae poisoning.

Hee Nyung KIM ; Han Ho DO ; Jun Seok SEO ; Hee Young KIM

Clinical and Experimental Emergency Medicine.2016;3(3):186-189. doi:10.15441/ceem.16.156

Podostroma cornu-damae is a rare, deadly fungus. However, it can be easily mistaken for antler Ganoderma lucidum. In this case report, two patients made tea with the fungus and drank it over a 2-week period. Both patients presented with bicytopenia, and one patient had desquamation of the palms and soles. Both were treated with prophylactic antibiotics and granulocyte colony-stimulating factor. One patient was admitted to the intensive care unit and received a platelet transfusion. Both patients were discharged without complications. Podostroma cornu-damae infections caused by intoxication were successfully treated using our treatment strategy, which consisted of prophylactic antibiotics, platelet transfusion, and granulocyte colony-stimulating factor. We believe this report can guide future treatment.
Agaricales ; Alopecia ; Animals ; Anti-Bacterial Agents ; Antlers ; Fungi ; Granulocyte Colony-Stimulating Factor ; Humans ; Intensive Care Units ; Pancytopenia ; Platelet Transfusion ; Poisoning* ; Reishi ; Tea

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A fatal case of acute bentazone overdose despite cricothyroidotomy during cardiopulmonary resuscitation.

Kyungwon LEE

Clinical and Experimental Emergency Medicine.2017;4(4):254-257. doi:10.15441/ceem.15.056

Bentazone is classified as a moderately hazardous (class II) herbicide by the World Health Organization. A 53-year-old Korean woman was transferred to the emergency department after a suicide attempt using approximately 500 mL of bentazone one hour prior to admission. Upon admission, she was alert and tachycardia of 125/min was observed. She was treated with gastric lavage and activated charcoal, during which she experienced diarrhea. Two hours after bentazone ingestion, cardiac arrest and muscle rigidity throughout the body occurred. Cardiopulmonary resuscitation was immediately started. Endotracheal intubation after administration of a muscle relaxant (succinylcholine) was unsuccessful because of temporomandibular joint muscle rigidity. Surgical cricothyroidotomy was performed by the emergency physician, but the patient was not resuscitated. For cardiac arrest patients with muscle rigidity caused by bentazone overdose, endotracheal intubation may be challenging because of muscle rigidity, despite appropriate use of muscle relaxants. Early surgical cricothyroidotomy may be the preferred method of airway management in these patients.
Airway Management ; Cardiopulmonary Resuscitation* ; Charcoal ; Diarrhea ; Drug Overdose ; Eating ; Emergencies ; Emergency Service, Hospital ; Fatal Outcome ; Female ; Gastric Lavage ; Heart Arrest ; Humans ; Intubation, Intratracheal ; Methods ; Middle Aged ; Muscle Rigidity ; Suicide ; Tachycardia ; Temporomandibular Joint ; World Health Organization

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Management of right main bronchial rupture with a double lumen endotracheal tube in a patient with blunt chest trauma.

Seung Hwan SEOL ; Woon Jeong LEE ; Seon Hee WOO ; Dae Hui KIM ; Jong Hui SUH

Clinical and Experimental Emergency Medicine.2017;4(4):250-253. doi:10.15441/ceem.16.177

Tracheobronchial disruption is one of the most severe injuries caused by blunt chest trauma. It may cause airway obstruction and resulting life-threatening respiratory deficiency. However, the clinical presentations are variable and frequently difficult to diagnose. We report a case of a previously healthy 16-year-old man with complete right main bronchial transection sustained after a vehicular accident, who had progressive dyspnea, subcutaneous emphysema in the neck and anterior chest wall, and bilateral tension pneumothorax. Prompt chest tube drainage for suspected bilateral tension pneumothorax and a tracheal intubation were performed. Shortly after the positive pressure ventilation, severe subcutaneous emphysema developed and he was at risk for developing shock. Additional chest tubes were inserted. An emergency bronchoscopy showed rupture of the right main bronchus. After changing to a double lumen endotracheal tube, the patient’s condition improved. A surgical closure was performed and postoperative bronchoscopy showed good repair. The patient was discharged without complications.
Adolescent ; Airway Obstruction ; Bronchi ; Bronchoscopy ; Chest Tubes ; Drainage ; Dyspnea ; Emergencies ; Humans ; Intubation ; Neck ; Pneumothorax ; Positive-Pressure Respiration ; Rupture* ; Shock ; Subcutaneous Emphysema ; Thoracic Injuries ; Thoracic Wall ; Thorax*

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Considerations for physicians using ketamine for sedation of children in emergency departments.

Woo Sung KIM ; Ji Yeon KU ; Hanbyul CHOI ; Hyo Jeong CHOI ; Ho Jung KIM ; Bora LEE

Clinical and Experimental Emergency Medicine.2017;4(4):244-249. doi:10.15441/ceem.16.155

OBJECTIVE: Ketamine use in emergency departments (EDs) for procedural sedation and analgesia is becoming increasingly common. However, few studies have examined patient factors related to adverse events associated with ketamine. This study investigated factors for consideration when using ketamine to sedate pediatric ED patients. METHODS: The study included pediatric patients receiving ketamine for laceration repair in the ED. Before sedation, information was collected about upper respiratory tract infection symptoms, allergy history, and fasting time. Patients received 2 mg/kg ketamine intravenously or 4 mg/kg ketamine intramuscularly. The primary outcomes were adverse events due to ketamine. RESULTS: We studied 116 patients aged 8 months to 7 years (2.8±1.5 years). The group with adverse events was significantly younger on average than the group without adverse events (2.5±1.5 vs. 3.1±1.5, P=0.028). Upper respiratory tract infection symptoms were not significant variables affecting ketamine sedation (48.9% vs. 43.7%, P=0.719). There was no significant association between duration of fasting and adverse events (P=0.073 and P=0.897, respectively), or between food type and adverse events (P=0.734). However, the number of attempts to sedate and ketamine dose correlated with adverse events (P<0.001 and P=0.022, respectively). In multiple logistic regression analysis, intravenous injection and ketamine dose were significant factors (odds ratio, 16.77; 95% confidence interval, 1.78 to 498.54; odds ratio, 4.37; 95% confidence interval, 1.59 to 22.9, respectively). CONCLUSION: Emergency medicine physicians should consider injection type and ketamine dose when using ketamine sedation while suturing lacerations.
Analgesia ; Child* ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Fasting ; Humans ; Hypersensitivity ; Injections, Intravenous ; Ketamine* ; Lacerations ; Logistic Models ; Odds Ratio ; Respiratory Tract Infections

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Factors affecting the urologist’s decision to administer ureteral stone therapy: a retrospective cohort study.

Mun Ki MIN ; Ji Ho RYU ; Yong In KIM ; Maeng Real PARK ; Seok Ran YEOM ; Sang Kyoon HAN ; Seong Wook PARK

Clinical and Experimental Emergency Medicine.2017;4(4):238-243. doi:10.15441/ceem.16.187

OBJECTIVE: We aimed to evaluate the factors influencing treatment option selection among urologists for patients with ureteral stones, according to the stone diameter and location. METHODS: We retrospectively reviewed the records of 360 consecutive patients who, between January 2009 and June 2014, presented to the emergency department with renal colic and were eventually diagnosed with urinary stones via computed tomography. The maximal horizontal and longitudinal diameter and location of the stones were investigated. We compared parameters between patients who received urological intervention (group 1) and those who received medical treatment (group 2). RESULTS: Among the 360 patients, 179 (49.7%) had stones in the upper ureter and 181 (50.3%) had stones in the lower ureter. Urologic intervention was frequently performed in cases of upper ureteral stones (P<0.001). In groups 1 and 2, the stone horizontal diameters were 5.5 mm (4.8 to 6.8 mm) and 4.0 mm (3.0 to 4.6 mm), stone longitudinal diameters were 7.5 mm (6.0 to 9.5 mm) and 4.4 mm (3.0 to 5.5 mm), and ureter diameters were 6.4 mm (5.0 to 8.0 mm) and 4.7 mm (4.0 to 5.3 mm), respectively (P<0.001). The cut-off values for the horizontal and longitudinal stone diameters in the upper ureter were 4.45 and 6.25 mm, respectively (sensitivity 81.3%, specificity 91.4%); those of the lower ureter were 4.75 and 5.25 mm, respectively (sensitivity 79.4%, specificity 79.4%). CONCLUSION: The probability of a urologic intervention was higher for patients with upper ureteral stones and those with stone diameters exceeding 5 mm horizontally and 6 mm longitudinally.
Cohort Studies* ; Emergency Service, Hospital ; Humans ; Renal Colic ; Retrospective Studies* ; Sensitivity and Specificity ; Ureter* ; Ureteral Calculi ; Urinary Calculi

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Admission levels of high-density lipoprotein and apolipoprotein A-1 are associated with the neurologic outcome in patients with out-of-hospital cardiac arrest.

Yong Soo SON ; Kyung Su KIM ; Gil Joon SUH ; Woon Yong KWON ; Min Ji PARK ; Jung In KO ; Taegyun KIM

Clinical and Experimental Emergency Medicine.2017;4(4):232-237. doi:10.15441/ceem.16.164

OBJECTIVE: To investigate whether serum levels of high-density lipoprotein (HDL) and apolipoprotein A-1 (ApoA1), after the return of spontaneous circulation, can predict the neurologic outcome in patients with out-of-hospital cardiac arrest (OHCA). METHODS: This was a retrospective observational study conducted in a single tertiary hospital intensive care unit. All adult OHCA survivors with admission lipid profiles were enrolled from March 2013 to December 2015. Good neurologic outcome was defined as discharge cerebral performance categories 1 and 2. RESULTS: Among 59 patients enrolled, 13 (22.0%) had a good neurologic outcome. Serum levels of HDL (56.7 vs. 40 mg/dL) and ApoA1 (117 vs. 91.6 mg/dL) were significantly higher in patients with a good outcome. Areas under the HDL and ApoA1 receiver operating curves to predict good outcomes were 0.799 and 0.759, respectively. The proportion of good outcome was significantly higher in patients in higher tertiles of HDL and ApoA1 (test for trend, both P=0.003). HDL (P=0.018) was an independent predictor in the multivariate logistic regression model. CONCLUSION: Admission levels of HDL and ApoA1 are associated with neurologic outcome in patients with OHCA. Prognostic and potential therapeutic values of HDL and ApoA1 merit further evaluation in the post-cardiac arrest state, as in other systemic inflammatory conditions such as sepsis.
Adult ; Apolipoprotein A-I* ; Apolipoproteins* ; Cholesterol, HDL ; Heart Arrest ; Humans ; Intensive Care Units ; Lipoproteins* ; Logistic Models ; Observational Study ; Out-of-Hospital Cardiac Arrest* ; Prognosis ; Retrospective Studies ; Sepsis ; Survivors ; Tertiary Care Centers

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Learning curve and period of experience required for the competent diagnosis of acute appendicitis using abdominal computed tomography: a prospective observational study.

Ju Hyun SONG ; Hajin CHO ; Jong Hak PARK ; Sungwoo MOON ; Joo Yeong KIM ; Su Jin KIM ; Sung Hyuk CHOI

Clinical and Experimental Emergency Medicine.2017;4(4):222-231. doi:10.15441/ceem.17.209

OBJECTIVE: To assess the learning curve of novice residents in diagnosing acute appendicitis using abdominal computed tomography (CT) scans. METHODS: This prospective observational study was conducted within a 4-month period from March 1 to June 30, 2015. After CT scans for right lower quadrant pain or similar acute abdomen were evaluated, postgraduate year 1 (PGY-1) residents completed an interpretation checklist. The primary outcome was evaluation of the learning curve for competent CT scan interpretation under suspicion of acute appendicitis. Secondary outcomes were cumulative numbers of accurate abdominal CT interpretations regardless of initial clinical impression and training period. RESULTS: PGY-1 residents recorded a total of 230 interpretation checklists. There were 53, 51, 46, 44, and 36 checklists recorded by individual residents and 92, 92, 91, 91, and 61 respective training days in the emergency department, excluding rotation periods in other departments. After 16 to 20 interpretations of abdominal CT scans performed under suspicion of acute appendicitis, the residents could diagnose acute appendicitis with more than 95% accuracy. Overall, the sensitivity and specificity for diagnosing acute appendicitis were 97% (95% confidence interval, 94 to 100) and 83% (95% confidence interval, 80 to 87), respectively. After 61 to 80 abdominal CT interpretations regardless of suspicion of acute appendicitis and after 41 to 50 days in training, PGY-1 emergency department residents could diagnose acute appendicitis with more than 95% accuracy. CONCLUSION: PGY-1 residents require 16 to 20 checklist interpretations to acquire acceptable abdominal CT interpretation. After performing 61 to 80 CT scans regardless of suspicion of acute appendicitis, they could diagnose acute appendicitis with acceptable accuracy.
Abdomen, Acute ; Appendicitis* ; Checklist ; Diagnosis* ; Emergency Service, Hospital ; Learning Curve* ; Learning* ; Observational Study* ; Prospective Studies* ; Sensitivity and Specificity ; Tomography, X-Ray Computed

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