Comparison between internal jugular vein access using midline catheter and peripheral intravenous access during cardiopulmonary resuscitation in adults.

Objectives: Vascular access is an important procedure for drug administration during the resuscitation of a patient with cardiac arrest; however, it can be challenging under emergent conditions. This study aimed to investigate the efficiency of ultrasound-guided internal jugular venous access using a midline catheter versus peripheral intravenous access during cardiopulmonary resuscitation. Methods: This was a prospective single-center observational study among patients who received cardiopulmonary resuscitation. The primary outcomes were the success rate of first attempt and the time taken for vascular access via the internal jugular and peripheral veins. We also measured the diameter of the internal jugular and peripheral veins at the access point and the distance from the access point to the heart. Results: In all, 20 patients were included in the study. Internal jugular and peripheral venous access had a first-attempt success rate of 85% and 65%, respectively (p = 0.152). The time to access the internal jugular and peripheral veins was 46.4 ± 40.5 s and 28.8 ± 14.7 s, respectively (p = 0.081). The diameter of the internal jugular and peripheral veins was 10.8 ± 2.6 mm and 2.8 ± 0.8 mm, respectively (p < 0.001). The distance from the vascular access point to the heart was 20.3 ± 4.7 cm and 48.8 ± 13.1 cm for the internal jugular and peripheral veins, respectively (p < 0.001). Conclusions: There was a trend toward higher success rates in the internal jugular vein rather than the peripheral intravenous approach, which was not statistically significant.

Age-specific characteristics of road traffic injuries among children and adolescents in South Korea.

OBJECTIVE: Road traffic injuries (RTIs) are the leading cause of mortality among children and adolescents. This study aimed to identify and compare the age-specific epidemiology, clinical characteristics and factors related to severe RTIs among children and adolescents who had RTIs. METHODS: This multicenter cross-sectional study was conducted using data collected between January 2011 and December 2018 in the Emergency Department-based Injury In-depth Surveillance registry in South Korea. A total of 66,632 participants younger than 19 years who presented with RTIs to emergency departments (EDs) were classified under three age groups: preschoolers (age 0-6 years, n = 18,694), elementary school student (age 7-12 years, n = 21,251), and middle and high school student (age 13-18 years, n = 26,687). Data on demographic and injury-related factors were analyzed, and multivariate logistic regression was used to determine the factors related to severe RTIs, which were defined as the Excess Mortality Ratio-based Injury Severity Score ≥16. RESULTS: RTIs among children and adolescents were more common in boys (71.0%), during weekdays (39.7%), in the summer (31.1%), and between 12 noon and 6 pm (47.9%). The most common type of road users were passengers (preschoolers, 46.4%) and cyclists (age 7-12 years and age 13-18 years, 50.1% and 36.2%, respectively). The proportion of head injury was highest in the preschoolers group (57.3%). The length of ED stay, Excess Mortality Ratio-adjusted Injury Severity Score, and the proportion of intensive care unit admission increased with age. Nighttime (0-6 am), vulnerable road users (motorcyclists, bicyclists, and pedestrians), and use of emergency medical services were significantly associated with severe injury. CONCLUSIONS: The three age groups of patients younger than 19 years with RTIs differed in the types of road user, proportions of injured body regions, and clinical outcomes. In an effort to reduce RTIs to children and adolescents, age-specific focused intervention should be considered. Additionally, the injury severity was found to be associated with nighttime occurrence, vulnerable road users, ED visit through emergency medical services, and nonuse of safety devices across all age group.

Decompression Technique Using Subcutaneous Angiocatheter Insertion to Relieve Extensive Subcutaneous Emphysema: A Case Report.

BACKGROUND: Trauma, pneumothorax, complication of surgery, infection, or malignancy can cause subcutaneous emphysema and although most subcutaneous emphysema cases are self-limited, extensive subcutaneous emphysema can lead to a compromised airway and cardiovascular system. In this report, we described a successful treatment strategy in which subcutaneous angiocatheter insertion was used to relieve the pressure of extensive subcutaneous emphysema. CASE REPORT: An 83-year-old man was received at the emergency department (ED) for recurrent pneumothorax and extensive subcutaneous emphysema. Six 18-gauge angiocatheters were inserted under the thoracic subcutaneous tissue and a noticeable improvement was seen 3 h after angiocatheter insertion. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Subcutaneous angiocatheter insertion may be a safe and uncomplicated decompression technique to relieve extensive subcutaneous emphysema, particularly in the ED.

SARS-CoV-2 molecular diagnostic point-of-care testing based on loop-mediated isothermal amplification: A prospective, single-center validation study.

Objectives: Rapid and accurate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic tests are crucial for controlling the spread of infections in emergency settings. This study evaluated the diagnostic accuracy of a point-of-care (POC) test based on loop-mediated isothermal amplification (LAMP) that produces rapid results within 30 min. Methods: We prospectively included adult patients (age >19 years) who were diagnosed with SARS-CoV-2 infection within the last 3 days and symptomatic patients who had visited the emergency room. Posterior nasopharyngeal (PNP) swabs and throat swabs collected by physicians were used to test the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and Cohen's Kappa coefficient (k) of the POC index and reference reverse transcription quantitative polymerase chain reaction (RT-qPCR) test devices. Results: Of the 352 participants, 102 (29.0%) tested positive via the RT-PCR-based reference test device; the RT-LAMP-based POC test had a sensitivity of 70.6% and specificity of 98.0%, with 93.5% PPV, 89.1% NPV, 35.5% PLR, and 3.4% NLR. Cohen's k correlation of results from the two devices was 0.74. The cycle threshold value between the positive and negative POC test results differed (17.6 vs. 24.6, p < 0.001). Conclusions: The RT-LAMP POC test in the emergency medical setting has a fair predictive value in high viral load cases in terms of infectivity.

Effects of Occupational Stress and Health Behaviors on Heart Rate Variability in Live-Fire Instructors.

OBJECTIVES: This study aimed to identify the association between the healthrelated characteristics and the subscales of occupational stress of live fire instructors and heart rate variability (HRV). METHODS: We conducted questionnaire survey on a general health checkup for 15 live fire instructors. Occupational stress and HRV parameters were measured to determine the association between health behavior, including smoking, drinking, exercise, and sleep-related disorders, and occupational stress of live fire instructors and HRV parameters using Spearman's rank correlation coefficient. RESULTS: Smoking, insomnia, and job insecurity, a subscale of occupational stress measurement, showed negative Spearman rank correlations with HRV. CONCLUSIONS: Insomnia, smoking, and job insecurity (due to occupational stress) among live fire instructors were associated with decreased HRV.

Two cases of fatal methemoglobinemia caused by self-poisoning with sodium nitrite: A case report.

RATIONALE: Sodium nitrite intoxication reportedly causes severe methemoglobinemia. Recent studies reported that most clinically significant cases resulted from intentional exposure in suicidal attempts. We describe 2 cases of severe methemoglobinemia secondary to intentional sodium nitrite intoxication in suicidal attempts. PATIENTS CONCERNS: A 26-year-old man and 20-year-old woman attempted suicide by taking sodium nitrite, and were brought to the emergency department. DIAGNOSIS: The male patient collapsed at the scene. He ingested approximately 18 g of sodium nitrate, and his methemoglobin level was 90.3%. The female patient was conscious, but was cyanotic. She ingested approximately 12.5 g of sodium nitrite, and her methemoglobin level was 54.6%. INTERVENTIONS: The male patient received advanced cardiac life support in the emergency department. Methylene blue was immediately administered for the female patient. OUTCOMES: The male patient died despite aggressive resuscitation. The female patient's cyanosis resolved, and her methemoglobin level decreased to 1.2% 3 hours later. LESSONS: The immediate administration of methylene blue in severe methemoglobinemia patients prevented fatal consequences. The public should be informed about the accessibility and toxicity of sodium nitrite.

Assessment of novel ICT-EMS systems to improve emergency patient transportation during the COVID-19 pandemic.

OBJECTIVES: This study aimed to examine the usability, feasibility, acceptability, and appropriateness of the information and communication technology for emergency medical services (ICT-EMS) systems to improve the transportation of emergency patients during the COVID-19 pandemic. METHODS: Emergency medical technicians (EMTs) (n = 229) employed at 7 fire stations operated by the North Chungcheong Fire Service Headquarters, South Korea were trained to use ICT-EMS devices prior to a 1-month implementation period. System Usability Scale (SUS), Feasibility of Intervention Measure (FIM), Acceptability of Intervention Measure (AIM), and Intervention Appropriateness Measure (IAM) questionnaires were conducted in the 4th week of the 1-month implementation period to assess the perceived usability, feasibility, acceptability, and appropriateness of the ICT-EMS systems. RESULTS: Among a total of 229 EMTs, 187 EMTs (81.7%) completed the survey. The overall SUS score was significantly low (score of 35.6) indicating an overall negative perception of the ICT-EMS systems. With regard to the feasibility, acceptability, and intervention appropriateness of ICT-EMS, roughly 50 (26.7%) participants agreed that ICT-EMS implementation was possible, appealing, and suitable. CONCLUSION: Many potential areas of improvement were identified within the ICT-EMS systems. System alterations regarding usability, feasibility, acceptability, and appropriateness may be necessary to successfully implement the ICT-EMS systems.

Comparison of the epidemiology and injury profile among injured patients involved in special purpose vehicle-related incidents in South Korea.

Injuries caused by mobile machinery or special purpose vehicles (SPVs) can lead to high socio-medical cost and fatality. In this descriptive study, we compared the epidemiology and injury profile of injured patients involved in SPVs-related incidents. We analyzed a nationwide database of SPV-related injured patients between January 2011 and December 2016. Injured patients were classified into three groups: pedestrian, motor vehicle occupant (MVO), and SPV operator groups. Of 1,419 cases, the highest number of SPV-related injured patients were found in the age group 40-59 years (671 cases, 47.3%) and at transport area (771 cases, 54.3%). The injury was most severe in the SPV operator group. The lower extremities were the most common fracture site, and intrathoracic injury was the most common visceral regions for SPV-related injured patients. SPV operator could lead to fatal intrathoracic injuries.