Kwon O, et al. Healthc Inform Res. 2018 Jul;24(3):198-206. https://doi.org/10.4258/hir.2018.24.3.198

Cho SJ, et al. Healthc Inform Res. 2015 Jul;21(3):196-200. https://doi.org/10.4258/hir.2015.21.3.196

Context. Circulatory shock is a major cause of mortality in glyphosate-surfactant herbicide (GlySH) poisoning, and this condition responds poorly to conventional therapies. We report a case of GlySH poisoning with shock that was refractory to vasopressors but responsive to intravenous fat emulsion (IFE). Case details. A 52-year-old man was brought to the emergency department by ambulance. He was found unconscious in his living room along with an empty bottle of GlySH herbicide, which contained glyphosate, polyoxyethyleneamine (POEA) surfactant, and water. He was drowsy at presentation. His heart rate was 44 beats/min, his blood pressure could not be measured with an arm cuff, but he had a palpable femoral pulse. After about 2.5 h of supportive care after admission, he remained hypotensive, and his systolic blood pressure was 80 mmHg. A 500 mL bottle of 20% IFE product was prepared. As a bolus, 100 mL of IFE was injected, and the remaining 400 mL was then infused. His blood pressure was 100/60 mmHg 1 h after the bolus injection. At 5 h after IFE injection, his blood pressure reached 160/100 mmHg and vasopressors were tapered. Conclusion. IFE should be considered in cases of refractory hemodynamic instability caused by GlySH after aggressive fluid and vasopressor support.

Objective. A nationwide strike that took place from August 21 to September 7, 2020, which was led by young doctors represented by residents and interns, resulted in shortages of manpower at almost all university and training hospitals. This study aimed to identify differences in the process and outcomes of emergency department (ED) patient care by comparing the performance over about 2 weeks of the strike with that during the usual ED operations. Methods. This retrospective observational study evaluated ED flow and performance during the junior doctors’ strike and compared it with the usual period in a single tertiary-care academic hospital. The outcome variables were defined as ED length of stay, crude mortality, and hospital mortality and adjusted for demographic and clinical parameters. The effect of the doctors’ strike on hospital mortality adjusted for demographic and clinical variables was investigated using logistic regression. Results. A total of 1,121 and 1,496 patients visited the ED during the strike and control periods (both 17 days), respectively. The care usually provided by four or six physicians, including one specialist, was replaced with that by one or two specialists at any one time. During the trainee doctors’ strike, EM specialists managed patients with fewer consultations. However, the proportion of patients who underwent laboratory and radiologic tests did not change significantly. The median ED length of stay significantly decreased from 359 minutes (interquartile range, IQR: 147–391) in the control period to 326 minutes (IQR: 123–318) during the strike period . The doctors’ strike was not found to have a significant effect on mortality after adjustments with other variables. Conclusion. During the junior doctors’ strike in 2020 in Korea, EM specialists efficiently managed the care of emergency patients with higher levels of acuity without compromising the survival rate, through fewer consultations and faster disposition.