• Journal of The Korean Society of Clinical Toxicology
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• v.11 no.1
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• pp.31-35
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• 2013

Acute organophosphate intoxication is important because of its high morbidity and mortality. The mortality is still high despite the use of atropine as specific antidotal therapy and oximes for reactivation of acetylcholinesterase. Inhibition of acetylcholinesterase by organophosphate can cause acute parasympathetic system dysfunction, muscle weakness, seizure, coma, and respiratory failure. Acute alteration in conscious state or a coma, which may occur following organophosphate intoxication, is an indication of severe intoxication and poorer prognosis. This acute decline in conscious state often reverses when the cholinergic crisis settles; however, it may be prolonged in some patients. We report on a case of a 60-year-old male who showed prolonged decline in conscious state due to of Central Nervous System (CNS) toxicity after a suicide attempt with organophosphate.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.3
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• pp.420-426
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• 2020

In this study, an assistive device for BVM (Bag Valve Mask) was developed. When emergencies occur, rescuers must perform artificial respiration within four minutes utilizing suitable BVM. If not, the patient can suffer serious damage within their brain and body systems. The rescuer must execute artificial respiration until the patient arrives at the hospital. In the process of artificial respiration, the rescuer can feel fatigued in their forearm muscles, particularly those who may have smaller hands or weaker muscle strength. Many products have been developed to solve these problems, but these products are difficult to market and commercialize because of their volume, size, and difficulty of use. In this paper, the BVM assistive device that has been previously manufactured was improved, and an attempt was made to devise a new method that reduces the burden on the user. The BVM assistive device can be divided into three-parts: a head part for compressing the air bag, which can control the amount of air; the body part for coupling with BVM; and finally, the handle that can rotate for better use on various postures of patients. Throughout the experiment, the assistive device could inject an equal amount of air into the patients. As a result, the rescuer could feel less fatigue and inject a suitable amount of air to emergency patients during artificial respiration.

• Journal of The Korean Society of Clinical Toxicology
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• v.6 no.1
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• pp.32-36
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• 2008

Purpose: The major complication of acute organophosphate (OP) poisoning is respiratory failure as a result of cholinergic toxicity. Many clinicians find it difficult to predict the optimal time to initiate mechanical ventilation (MV) weaning, and as a result have tended to provide a prolonged ventilator support period. The purpose of this study is to determine any clinical predictors based on patients characteristics and laboratory findings to assist in the optimal timing of mechanical ventilator weaning. Methods: We reviewed medical and intensive care records of 44 patients with acute OP poisoning who required mechanical ventilation admitted to medical intensive care unit between July 1998 and June 2007. Patient information regarding the poisoning, clinical data and demographic features, APACHE II score, laboratory data, and serial cholinesterase (chE) levels were collected. Base on the time period of MV, the patients were divided into two groups: early group (wean time < 7 days, n = 28) and delayed group (${\geq}$ 7 days, n = 16). Patients were assessed for any clinical characteristics and predictors associated with the MV weaning period. Results: During the study period, 44 patients were enrolled in this study. We obtained the sensitivity and specificity values of predictors in the late weaning group. APACHE II score and a reciprocal convert of hypoxic index but specificity (83.8%) is only APACHE II score. Also, the chE concentration (rho = -0.517, p = 0.026) and APACHE II score (rho = 0.827, p < 0.001) correlated with a longer mechanical ventilation duration. Conclusion: In patients with acute OP poisoning who required mechanical ventilation, the APACHE II scoring system on a point scale of less than 17 and decrements in cholinesterase levels on 1-3 days were good predictors of delayed MV weaning.

• Journal of The Korean Society of Clinical Toxicology
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• v.2 no.2
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• pp.72-76
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• 2004

Purpose: Dealing patients with organophosphate poisoning, cholinesterase level has been used as a diagnostic and prognostic value. But there are some controversies that the cholinesterase level is significantly related to the severity or prognosis of acute organophosphate poisoning. We evaluated the correlation between initial serum level of cholinesterase and APACHE II score as an index for severity, and we assessed cholinesterase levels for predicting value of weaning from mechanical ventilation. Method: From August 1996 to March 2003, 23 patients with organophosphate poisoning who needed ventilatory care were enrolled. Retrospective review was done for the serum level of cholinesterase, APACHE II score, and the duration of ventilatory care. The percentage of measured serum cholinesterase to median normal value was used to standardize cholinesterase levels from different laboratories. Result: There were tendencies that the lower initial serum of cholinesterase, the higher the APACHE II score (r=0.297) and the longer the duration of mechanical ventilation (r=-0.204), but they were not significant (p=0.264 and p=0.351 respectively). In 9 patients whose serum cholinesterase level were checked at the time of weaning, mean of measured cholinesterase level was $10.3\pm7.60\%$ of normal value. Conclusion: There was no significant relationship between initial level of serum cholinesterase and severity or duration of mechanical ventilation. General health status of patient, amount of ingestion, toxicity of agent should be considered as important factors for severity of poisoning. And the decision of weaning should be based not solely on the cholinesterase level but on the consideration of general and respiratory state of individual patients.

• Journal of The Korean Society of Clinical Toxicology
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• v.5 no.1
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• pp.8-14
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• 2007

Purpose: Organophosphorus insecticides tend to be regarded as a homogeneous single entity. We aimed to determine whether organophosphate poisoning differs by subgroups in clinical features and severity. Methods: We retrospectively reviewed medical records of all patients with acute organophophorus poisoning from January 1998 to December 2006. We investigated clinical features, Glasgow coma scale (GCS), laboratory findings, QTc intervals, management, and outcomes. Results: A total of 109 patients were included. The dimethoxy group experienced significantly longer times than the diethoxy group for ventilation duration (0.6 day vs. 0.2 day, p=0.006), ICU duration (2.0 day vs. 0.8 day, p=0.037), and total admission duration (2.8 day vs. 0.9 day, p=0.008), except in cases of dichlorvos poisoning. Also, the GCS of the dimethoxy group (except with dichlorvos) was significantly lower than for the diethoxy group (dimethoxy, $11.2{\pm}5.2$ vs. diethoxy, $13.8{\pm}2.4$, p= 0.021). QTc intervals for the dimethoxy group (except with dichlorvos) tended to be somewhat greater than for the diethoxy group (dimethoxy, $452.9{\pm}16.1\;msec$ vs. diethoxy, $429.6{\pm}40.9\;msec$). There were 65 patients with dichlorvos ingestion, and 2 of these patients (3%) died. Conclusion: When compared to the diethoxy group, the dimethoxy group of organophosphates (with the exception of dichlorvos) were associated with poorer prognostic value for indicators such as GCS, QTc interval, requirement for intubation, ICU duration, and total admission duration. Within the dimethoxy group, patients with dichlorvos poisoning had relatively better prognoses than for the other dimethoxy group organophosphates studied.

• Journal of The Korean Society of Clinical Toxicology
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• v.4 no.2
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• pp.113-121
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• 2006

Purpose: Previous studies have reported that plasma cholinesterase (AchE) concentration can serve as a useful prognostic parameter in cases of acute organophosphate (OP) poisoning. However, there has been considerable disagreement regarding the degree of its prognostic value. Earlier cross-sectional and one- time point studies were plagued with methodologic flaws, making it difficult to interpret their results. The purpose of this study was to clarify the prognostic value of time-variable cholinesterase levels and their relationship with clinical outcomes in OP poisoning. Methods: We reviewed medical and intensive care records of patients with acute OP poisoning admitted to our emergency department between March 1998 and Sep 2006. We collected patient information regarding poisoning, clinical, and demographic features. Patients were assessed for clinical outcomes and AchE concentrations on days 1, 2, 3, 5, and 7 and on the final day. Results: During the study period, 58 patients were enrolled in this study. There was a statistically significant difference in the AchE differentials on 1-3 days for patients requiring mechanical ventilation and for patients with mild poisoning (p<0.05). Also, the decrease in the log AchE concentration correlated with longer durations of mechanical ventilation (r=-0.411, p=0.002). Conclusion: In severe OP poising, measurements of time-variable AchE concentrations can be helpful in the prediction of mortality, the development of intermediate syndrome, and duration of mechanical ventilation.

• Journal of Korean Academy of Nursing Administration
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• v.21 no.3
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• pp.243-253
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• 2015

Purpose: The purpose of this study was to identify the impact of practical communication strategies (PCS) on the reduction of AEs (Adverse Events) in pediatric cardiac ICU (PCICU). Methods: Intra-operative findings and care plans were documented and shared between staff members on a daily basis from the day of operation to the day of general ward transfer. Incidence of AEs was investigated in all patients who were admitted to the PCICU and was compared with incidence of AEs one year after establishment of PCS. Results: The study population consisted of 216 patients in pre-PCS group and 156 patients in post-PCS group. Incidence of readmission decreased from 6.0% (13/216) in pre-PCS group to 0.6% (1/156) in post-PCS group (${\chi}^2=7.23$, p=.010). Incidence of other major complications decreased from 4.2% (9/216) to 0.6% (${\chi}^2=6.66$, p=.012). Minor AEs such as intervention omission, order error, and protocol misunderstanding were reduced from 23.3 cases per 100 patient-days to 7.5 cases per 100 patient-days (${\chi}^2=20.31$, p<.001). Conclusion: Handover protocol is an effective strategy to reduce AEs for critically ill patients after pediatric cardiac surgery. Efforts to develop effective communication strategies should be continued and outcome research about communication strategies for patient safety should be further studied.

• Journal of The Korean Society of Clinical Toxicology
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• v.16 no.1
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• pp.1-8
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• 2018

Purpose: Extremely hazardous pesticides are classified as World Health Organization (WHO) hazard class Ia. However, data describing the clinical course of WHO class Ia OP (organophosphate) poisonings in humans are very scarce. Here, we compare the clinical features of patients who ingested hazard class Ia OPs. Methods: This retrospective observational case study included 75 patients with a history of ingesting ethyl p-nitrophenol thio-benzene phosphonate (EPN), phosphamidon, or terbufos. The patients were divided according to the chemical formulation of the ingested OP. Data regarding mortality and the development of complications were collected and compared among groups. Results: There were no differences in the baseline characteristics and severity scores at presentation between the three groups. No fatalities were observed in the terbufos group. The fatality rates in the EPN and phosphamidon groups were 11.8% and 28.6%, respectively. Patients poisoned with EPN developed respiratory failure later than those poisoned with phosphamidon and also tended to require longer mechanical ventilatory support than phosphamidon patients. The main cause of death was pneumonia in the EPN group and hypotensive shock in the phosphamidon group. Death occurred later in the EPN group than in the phosphamidon group. Conclusion: Even though all three drugs are classified as WHO class Ia OPs (extremely hazardous pesticides), their clinical courses and the related causes of death in humans varied. Their treatment protocols and predicted outcomes should therefore also be different based on the chemical formulation of the OP.

• Journal of the Korean Data and Information Science Society
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• v.27 no.5
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• pp.1361-1373
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• 2016

This study was undertaken to investigate the influence of teamwork skill and decision making competency on nursing work performance. A total of 170 nurses more than one years working experience were recruited from two university hospitals. Data were collected during March, 16 to 25, 2016 using a structured self-report questionnaires. Data were analyzed using the IBM SPSS/WIN 21.0 program. Teamwork skill and decision making competency for nursing work performance showed significant positive correlation. The significant predictors of nursing work performance among nurses were total clinical experience (${\beta}=.23$, p<.001), teamwork skill (${\beta}=.61$, p<.001) and decision making competency (${\beta}=.13$, p=.015). These variables explained 66% of the variance in nursing work performance among nurses. The results indicate that nurses' teamwork skill and decision making competency are factors positively influencing on nursing work performance.

• Journal of The Korean Society of Clinical Toxicology
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• v.3 no.2
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• pp.86-92
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• 2005

Purpose: The main cause of death due to acute organophosphate (OP) poisoning is believed acute respiratory failure caused by cholinergic reactions. Recently, advances in respiratory and intensive care make it possible to maintain the respiratory function of patients with OP poisoning, but the mortality rates remain high. The present study clarified the hemodynamics of patients with acute lethal OP poisoning. The purpose of this study was to analyse the outcomes and predictors of mortality in patients with acute OP poisoning requiring intensive care. Methods: We reviewed medical and intensive care records of patients with acute OP poisoning admitted to emergency department and ICU between March 1998 and Aug 2005. We collected patient information regarding poisoning, clinical, and demographic features. Results: During the study period, 67 subjects treated with intensive care and ventilator management in addition to gastric decontamination standard therapy with atropine and 2-PAM. Of 67 patients, 13 died. Kaplan-Meier survival analysis demonstrated a steep decline in the cumulative survival to $86.6\%$ during the first week. Mean arterial pressure < 60 mmHg within the first 24 hours was recognized as a poor prognostic indicators among mechanical ventilated patients. Conclusion: Most OP poisoning-related deaths occurred within the first week of poisoning. Mean arterial pressure lower than 60 mmHg might be the best predictor of poor outcome. We speculated that the refractory hypotension is the leading cause of death in patients with lethal OP poisoning that receiving mechanical ventilation and maximal supportive care.