Point-of-care ultrasound (POCUS) is a rapidly developing technology that has the potential to revolutionize emergency and critical care medicine. The use of POCUS can improve patient care by providing real-time clinical information. However, appropriate usage and proper training are crucial to ensure patient safety and reliability. This article discusses the various applications of POCUS in emergency and critical care medicine, the importance of training and education, and the future of POCUS in medicine.

Objective This study aimed to evaluate the change in length of stay (LOS) in the emergency department (ED) and outcomes during the coronavirus disease 2019 (COVID-19) pandemic.Methods This is a single-center, retrospective observational study. We compared ED LOS and outcomes in patients aged ≥19 years who presented to the ED of Soonchunhyang University Bucheon Hospital, a single tertiary university hospital, between January and December in 2018, 2019, and 2020. We included patients who were diagnosed with fever, pneumonia, and sepsis in the ED, based on the International Statistical Classification of Diseases and Related Health Problems 10th Revision. We also compared the LOS and outcomes of overall ED patients in 2019 (before COVID-19) and in 2020 (after COVID-19).Results A total of 5,061 patients with fever, pneumonia, and sepsis were analyzed. The LOS in the ED in 2020 significantly increased compared with 2018 and 2019 (177.0±115.0 minutes in 2018, 154.0±85.0 minutes in 2019, and 208.0±239.0 minutes in 2020). The proportion of patients who were transferred to other hospitals in 2020 (2.1%) increased compared with 2018 (0.8%) and 2019 (0.7%). Intensive care unit admission significantly increased in 2020 (13.7%) compared with 2019 (10.3%). Among all ED patients, ED LOS in 2020 was longer than in 2019, particularly in patients who were admitted and then transferred to another hospital. Intensive care unit admission (4.4% vs. 5.0%), transfer rate (0.7% vs. 0.9%), and ED mortality (0.6% vs. 0.7%) also significantly increased.Conclusion The ED LOS, time to intensive care unit admissions, time to transfer to other hospitals, and ED mortality significantly increased during the COVID-19 pandemic.

South Korean studies on coronavirus disease-2019 (COVID-19) treatment have described the use of community treatment centers (CTCs), which combine elements of the home and hospital, to isolate and treat mild COVID-19 patients. While the number of South Koreans diagnosed with COVID-19 cases has varied greatly by season, the number of confirmed cases in foreign nationals has shown no seasonality, with an average of around 25 to 30 per day. For foreign patients, accommodation arrangements and travel routes may be difficult; they may also have difficulty accessing medical care, so require careful management. We discuss our experience in operating and managing a CTC for foreign COVID-19 patients arriving in South Korea with mild symptoms. We also propose guidelines for efficient use of resources with respect to treating these patients in CTCs. We present the clinical findings of patients treated at the CTC between 7 October and 22 November 2020, and make some recommendations. We quarantined and treated foreign patients with mild symptoms of COVID-19 at the Ansan CTC. Discharge is determined based on clinical symptoms rather than polymerase chain reaction results. Medical and administrative staff use building A, while building B is used for isolating patients. Medical rounds are in the form of twice-daily video calls. Three kinds of foods with medication are served according to the patient's country of origin. In total, 315 patients were admitted to the Ansan CTC between 7 October and 22 November 2020; 145 of them were discharged from the CTC and 26 were transferred to other hospitals. To utilize medical resources efficiently during the pandemic, it is desirable to reserve CTCs exclusively for foreign patients.

Background: Prehospital return of spontaneous circulation (ROSC) is a widely used intermediate endpoint in out-of-hospital cardiac arrest (OHCA), but its downstream clinical meaning may differ according to when ROSC is achieved. Methods: We conducted a retrospective registry-based cohort study of adult non-traumatic OHCA patients treated with Smart Advanced Life Support (SALS) from 2015 to 2023 who achieved prehospital ROSC. The primary exposure was the low-flow interval, defined as the interval from CPR initiation to first prehospital ROSC, categorized a priori as <10, 10–14, 15–19, 20–24, 25–29, and ≥30 min. Multivariable logistic regression models estimated associations with good neurological recovery, prehospital rearrest, survival to hospital admission, and survival to discharge, adjusting for age, sex, witnessed arrest, bystander CPR, initial shockable rhythm, transport time interval, and region. Results: Among 19,156 adult SALS-treated OHCA patients, 4195 achieved prehospital ROSC; 3760 had valid low-flow interval values from 0 to 60 min and were included in the primary analysis. Good neurological recovery decreased from 582/1004 (58.0%) in the <10 min group to 17/249 (6.8%) in the ≥30 min group, while prehospital rearrest increased from 194/488 (39.8%) to 136/174 (78.2%). Compared with <10 min, the adjusted odds ratios for good neurological recovery were 0.368, 0.164, 0.135, 0.099, and 0.081 across progressively later ROSC categories. The adjusted odds ratio for rearrest in the ≥30 min group was 5.024. Conclusions: In this selected SALS-treated ROSC-positive OHCA cohort, later low-flow interval was associated with substantially lower odds of favorable neurological recovery and survival and higher odds of prehospital rearrest. These findings suggest that prehospital ROSC timing may serve as a prognostic marker but should not be interpreted as a standalone criterion for treatment termination or transport decisions.

Objective: Effective child abuse intervention requires understanding its prevalence. While obtaining a comprehensive national estimate of child abuse cases is challenging, sentinel injuries—minor yet unusual injuries like bruises or wounds in pre-cruising-age children—can provide an indicative measure. Using the National Emergency Department Information System (NEDIS) data, this study aimed to gauge the prevalence of sentinel injuries using diagnostic codes in children under 12 months who visited emergency centers in South Korea and to evaluate the extent of child abuse screening in these cases. Methods: This cross-sectional study used diagnostic codes indicative of sentinel injuries previously defined using the Delphi method. This study, using NEDIS data, included children under 12 months who visited emergency centers nationwide from 2014 to 2021 for reasons of injury. Children injured in car accidents were excluded. Independent variables included patient demographics, the injury mechanism, intentionality, the route of arrival, the emergency center level, the triage level, and specialist consultation. Dependent variables were the presence of a sentinel injury code, and whether diagnostic tests for child abuse were conducted. Results: Based on NEDIS and national statistical data, the frequency from 2014 to 2021 averaged 2501 per 100,000 of the population. Of the 186,065 patients studied, 63,131 (33.9%) had a diagnostic code corresponding to a sentinel injury. The proportion of patients undergoing diagnostic tests for suspected child abuse was 36.9% for those with sentinel injuries and 43.8% for those with other codes. The percentage of children with sentinel injuries receiving diagnostic tests increased annually, from 32.4% in 2014 to 54.4% in 2021. By institution, the rates were 36.4% for regional emergency centers, 38.4% for local emergency centers, and 20.0% for local emergency institutions. Conclusions: A significant proportion of children presenting to emergency departments had sentinel injury codes. However, the rate of diagnostic tests conducted for suspected child abuse in these cases remains suboptimal. Although there has been an upward trend in testing rates in recent years, there is a pressing need for increased attention to and enhancement in screening for child abuse among children with sentinel injury codes.

Maxillofacial trauma occasionally presents a serious challenge for physicians, and an orofacial injury can be considered life-threatening. It is difficult to control the bleeding and prevent airway obstruction simultaneously with conventional treatment. Herein, we share two cases in which we managed massive orofacial bleeding using a King laryngeal tube, a supraglottic airway device equipped with an inflatable balloon. Both patients had uncontrolled orofacial bleeding. In one of the patients, endotracheal intubation was possible; however, bleeding continued, and vital signs became unstable. The second patient had failed endotracheal intubation due to uncontrolled bleeding. We deployed the King laryngeal tube in both patients and achieved bleeding control and airway maintenance. Both patients were discharged without complications after 3 to 4 weeks. The King laryngeal tube method can be considered a useful management option for addressing massive orofacial bleeding that is uncontrollable with conventional treatment.