Objective: This study evaluated the accuracy of the pre-hospital shock index multiplied by the AVPU scale (PSIAVPU) as a predictor of massive transfusion (MT) and traumatic coagulopathy. Methods: This research was a retrospective single-center study that included patients consecutively presenting to a trauma center between 2017 and 2020. The predictive value of the PSIAVPU for MT, in-hospital mortality, and traumatic coagulopathy was measured using the area under the curve (AUC) of the receiver operating characteristic curve. The AUC of the PSIAVPU was compared with the Reverse Shock Index multiplied by the Glasgow Coma Scale (rSIG) measured at the trauma center presentation. Results: One thousand seven hundred and ninety-two patients were included, of which 163 patients (9.09%) received MT and 195 patients (10.88%) died during their hospital stay. Traumatic coagulopathy was observed in 245 patients. The AUC values for the PSIAVPU in terms of predicting MT, hospital mortality, and traumatic coagulopathy were 0.755, 0.752, and 0.736, respectively. Conclusion In patients with trauma, the predictive power of the PSIAVPU was higher than that of the prehospital shock index and was comparable to that of the rSIG. The PSIAVPU is a useful indicator that can be used easily and quickly for trauma patients at the prehospital stage.

Objective: Alcohol consumption is a frequent risk factor for trauma. The shock index is widely used to predict the prognosis of trauma, and alcohol can influence the shock index in several ways. This study investigated the usefulness of the shock index in trauma patients who had ingested alcohol. Methods: This was a retrospective, observational, single-center study. We performed a logistic regression analysis to assess the association between alcohol consumption and massive transfusions. A receiver operating characteristic (ROC) curve was constructed to determine the predictive value of the shock index for patients who had ingested alcohol. Results: A total of 5,128 patients were included in the study. The alcohol-positive group had lower systolic blood pressure and higher heart rate; consequently, the shock index in this group was higher. There was no significant difference between the proportion of the alcohol-positive and alcohol-negative groups who underwent massive transfusions and suffered hospital mortality compared to the overall proportion of patients who underwent massive transfusion based on the shock index. In the logistic regression analysis, the alcohol-negative group showed higher odds ratios for massive transfusions compared to the alcohol-positive group. The area under the ROC curve for predicting massive transfusion was 0.831 for the alcohol-positive group and 0.825 for the alcohol-negative group. However, when a cutoff value of 1 was used, the false positive rate was significantly higher in the alcohol-positive group. Conclusion The shock index is a useful tool for predicting outcomes in patients with trauma. However, in patients who have ingested alcohol, the shock index should be interpreted with caution.

Objective: This study assessed the characteristics of medical utilization by analyzing the pathway of severe emergency patients visiting emergency departments in the three regions. Methods: The study was conducted based on the National Emergency Department Information System, which collected information from 43 local governments from 2017 to 2019. Severe emergency patients were classified according to the Korean Triage and Acuity Scale level. A map was produced based on the results of connectivity centrality analysis, and groupings were performed using the R program. The relevance index was calculated to confirm medical utilization within and among regions. Results: Medical utilization within the region for severe emergency patients was concentrated in major cities. With the opening of local emergency medical agencies in underserved areas of emergency medical services, medical utilization within the region has increased compared to three years ago. Severe emergency patients in the western region of Gyeongsangnam-do mainly visit the emergency department in Jinju city. In contrast, in western county areas, they mainly visit the emergency department in Busan city. In Ulsan city, which belongs to Ulju county and Jung-gu, many patients frequently visit the emergency department in Yangsan city. Patients from Geochang, Changnyeong, Hamyang, and Hapcheon counties in Gyeongnam Province frequently visit the emergency department in Daegu city. Conclusion The intersection and cooperation of health resources within and between regions of the emergency medical system are no longer a task that can be postponed, and regionalization has been proposed as an alternative concept.

Objective: Urgent upper endoscopy is performed to achieve acute hemostasis in patients with high-risk bleeding sources. Emergency physicians must identify patients who require urgent endoscopic treatments. This study assessed the performance of blood urea nitrogen (BUN) for predicting severe bleeding that necessitates urgent endoscopic hemostasis compared to the risk assessment scores in patients with acute non-variceal upper gastrointestinal bleeding (ANVUGIB). Methods: The presumed ANVUGIB patients were classified into endoscopic and non-endoscopic hemostasis groups. Data including historical features, symptoms, signs, and routine laboratory tests were collected and compared. Results: Three hundred and ninety-one patients were analyzed, including 116 patients in the endoscopic hemostasis and 275 patients in the non-endoscopic hemostasis group. In the area under curve (AUC) of the receiver operator characteristic curve, BUN (AUC 0.733; 95% confidence interval [CI], 0.681-0.785) and BUN/creatinine (AUC, 0.727; 95% CI, 0.672-0.783) were superior to total protein, Glasgow-Blatchford score (GBS), modified GBS (AUC, 0.649, 0.623 and 0.646, respectively) for predicting endoscopic hemostasis. Pre-endoscopy Rockall score and AIMS65 were statistically insignificant. The same results were obtained when the patients with liver and chronic kidney diseases were excluded. Conclusion The current results suggest that BUN was an independent predictor of endoscopic hemostasis in patients with ANVUGIB. Further studies will be needed to determine if BUN can be used in clinical practice.

Objective: The factors related to injury severity in accidents in Korea are unclear. This study helps primary physicians treat victims of traffic accidents with a high probability of severe injury during the initial evaluation in the emergency department (ED). Methods: This study was conducted on patients who visited Pusan National University Hospital regional trauma center, Korea, between January 2017 and December 2019 due to involvement in automobile accidents as a driver. Multivariate logistic regression analysis was used to determine the relationship of factors with injury severity. Results: A total of 973 patients were included. Of them, 316 (32.5%) were severely injured. In the multivariate logistic regression analysis, older age was significantly associated with more severe injury (odds ratio [OR], 1.030; 95% confidence interval [CI], 1.017-1.043; P<0.001). A significant difference was noted in injury severity according to the mode of transportation to the ED. Transportation via private ambulance was associated with more severe injury than via public ambulance (OR, 5.853; 95% CI, 3.986-8.594; P<0.001). The severe injury was more likely when the collision involved a large-sized vehicle (OR, 2.369; 95% CI, 1.466-3.826; P<0.001), or a fixed object (OR, 2.077; 95% CI, 1.326-3.254; P<0.001) compared to a small-sized vehicle. The group that did not wear a seat belt had more severe injuries than those who wore a seat belt (OR, 2.218; 95% CI, 1.421-3.463; P<0.001). Conclusion Injury severity was correlated with age, mode of transportation to the ED, type of collision and seat belt use. These results will help primary physicians assess critically ill patients.

Copper sulfate is widely used as a fungicide and pesticide. Acute copper sulfate poisoning is rare but potentially lethal in severe cases. Copper sulfate can lead to cellular damage of red blood cells, hepatocytes, and myocytes. Toxic effects include intravascular hemolysis, acute tubular necrosis and, rhabdomyolysis. A 76-year-old man presented with vomiting and epigastric pain. He had ingested a copper-containing fungicide (about 13.5 g of copper sulfate) while attempting suicide 2 hours prior to presentation. From day 3 at the hospital, laboratory findings suggesting intravascular hemolysis were noted with increased serum creatinine level. He was treated with a chelating agent, dimercaptosuccinic acid (succimer). His anemia and acute kidney injury gradually resolved with a 19-day regimen of succimer. Our case suggests that succimer can be used for copper sulfate poisoning when other chelating agents are not available.

Carbon monoxide (CO) can cause a variety of electrocardiogram (ECG) changes. The Brugada ECG patterns are very rare in CO poisoning cases. We detected a patient with a CO-induced type 1 Brugada ECG pattern with chest pain. The panel genetic test and echocardiogram revealed normal findings. The Brugada phenocopy gradually improved over 3 days. We reviewed the literature and suggested possible mechanisms.