Background and Objectives: Frontline medical staff usually experience high levels of stress, which could greatly impact their work output. We conducted a survey to investigate the level of stress and its association with job types, work departments, and medical centers among COVID-19 pandemic frontline medical personnel. Materials and Methods: We conducted a cross-sectional survey using a self-administered questionnaire among 307 frontline medical staff who cared for COVID-19 patients in Daegu city. We used a 33-item questionnaire to assess respondents’ general characteristics, job stress, personal effects associated with the COVID-19 pandemic, and their stress level. A general health questionnaire-12 (GHQ-12) was included in our questionnaire. Results: Majority (74.3%) of the respondents were in the stress group. The mean GHQ-12 score was 14.31 ± 4.96. More females (67.4%, p < 0.05) and nurses (73.3%, p = 0.001) were in the stress group compared to males and doctors. Medical staff in the general ward considered the severity of the COVID-19 pandemic situation higher. Nurses perceived work changes (p < 0.05), work burden (p < 0.05), and personal impact (p < 0.05) more serious than doctors. Medical staff in Level 3 emergency department (ED) perceived a lack of real-time information (p = 0.012), a lack of resources, and negative personal impacts associated with the pandemic as more serious than staff in Level 1 and Level 2 EDs. Medical staff in the intensive care unit perceived work changes (p < 0.05), work burden (p < 0.05), and lack of personal protective equipment (p = 0.002) as more serious than staff in the ED and general ward. Conclusion: Providing real-time information and resources for reducing work burden and negative personal impact is central to maximizing the work output of the COVID-19 pandemic frontline medical staff. Supporting their mental health through regular programs and intervention is also imperative.

Background and Objectives: The rise in suicidal attempts has led to an increase in unusual intoxication cases. The ingestion of anhydrous calcium chloride (CaCl₂) causes direct injury to the gastrointestinal wall via a thermal burn. Therefore, previous reports on CaCl₂ ingestion primarily considered the gastrointestinal injury. Severe CaCl₂ intoxication can induce a hypercalcemic crisis, presenting with arrhythmia, acute pancreatitis, and acute kidney injury. This case report details a patient with hematemesis and hypercalcemia following the ingestion of a commercial desiccant. We aimed to report the progression of the case, with a focus on the electrocardiographic manifestations. Case Presentation: A 39-year-old female presented at a regional emergency center with blood in her vomit after the ingestion of a commercial desiccant. Bloody emesis was the initial symptom, and various electrolyte imbalances developed during admission. Electrocardiogram (ECG) changes occurred early after hospitalization and disappeared before the electrolyte levels normalized. The patient was maintained in an NPO (Nil Per Os) state throughout her hospital stay. The bloody emesis and abdominal pain resolved quite early, despite her minimal mention of symptoms, possibly due to her suspected negative psychiatric symptoms. Conclusions: In this case, we observed dynamic and prolonged multiple electrolyte imbalances along with the early-phase ECG changes, all of which responded well to supportive care. This report adds to the understanding of the diverse manifestations and management of CaCl₂ intoxication.

Background Carbon monoxide (CO) intoxication due to suicide attempts or accidental exposure is a critical problem in Korea. Patients with CO intoxication can experience various neurologic and systemic symptoms. Although some of these symptoms may result in severe sequelae, the pathophysiological mechanisms remain unclear. Hyperbaric oxygen (HBO) therapy is the most important treatment for CO poisoning. However, standardized protocols remain unclear, and most related studies focus on the association of HBO therapy with the development of sequelae. Therefore, we intended to conduct studies focusing on the early features of CO intoxication. Methods A retrospective descriptive cross-sectional study was conducted based on an analysis of medical records for patients with CO intoxication treated with hyperbaric oxygenation from January 2020 to March 2023. We excluded patients with a misdiagnosis, duplicate registration, or refusal of treatment. Patients were divided into two groups on the basis of their mental status at the time of presentation, and their demographic, physiological, and environmental characteristics were compared. Chi-square tests and t tests were performed, and 95% confidence intervals were calculated. Results Out of 525 patients identified with CO exposure, 288 patients were included in this study. A total of 186 (64.6%) patients were male, and most were in their mid-forties. Alert patients appeared to visit the hospital earlier compared with other patients (431.82 ± 975.20 vs. 151.78 ± 229.96, p value < 0.001). The proportion of suicide attempts was greater in the nonalert group (94 (56%) vs. 101 (84.2%), p value < 0.001). The frequencies of myocardial damage, shock, and ventilator treatment were 51 (42.5%), 6 (5%), and 13 (10.8%), respectively, and were greater in the unconscious group. Most symptoms usually improved almost completely at the early stage of the HBO therapy protocol. Conclusions In general, patients who are not alert at the time of presentation receive more intensive HBO therapy. According to our study, most intoxication symptoms improve during the early phase of HBO therapy, and delayed neuropsychiatric sequalae can occur in the future, even in initially alert patients. Therefore, physicians should be more careful with patients with neurological symptoms, evidence of myocardial damage, or severely elevated creatine phosphokinase levels, and these patients should be fully administered HBO therapy. Effect of hyperbaric oxygen therapy on early features of carbon monoxide poisoning focusing on neurological symptoms

Streptococcal toxic shock syndrome (STSS), caused by Group A Streptococcus, is a life-threatening condition that can lead to organ failure within several days of symptom onset. Fulminant presentations resulting in death within hours of emergency department arrival are exceedingly rare and have a nearly universally fatal prognosis. Prompt recognition is critical; however, early clinical features may closely mimic those of other surgical emergencies, creating diagnostic challenges. A 75-year-old male was transferred who had posterior neck and bilateral shoulder pain for several days and a suspected cervical epidural abscess. The patient complained of dyspnea at the time of presentation. Despite early endotracheal intubation before the development of overt respiratory failure, the patient rapidly progressed to cardiac arrest and died. Blood cultures obtained at presentation were positive for Streptococcus pyogenes after 3 days, as reported in this case. Although spinal epidural abscesses are not a typical presentation of STSS, they can lead to rapid clinical deterioration in the early phase. Accordingly, a high index of suspicion and early diagnostic evaluation are crucial for timely management.

Background and Objectives: The ingestion of anhydrous calcium chloride (CaCl2) causes direct injury to the gastrointestinal wall via a thermal burn. Severe CaCl2 intoxication can induce a hypercalcemic crisis, presenting with arrhythmia, acute pancreatitis, and acute kidney injury. This case report details a patient with hematemesis and hypercalcemia following the ingestion of a commercial desiccant. We aimed to report the progression of the case and focused on the elec-trocardiographic manifestations. Case presentation: A 39-year-old female presented at a regional emergency center with blood in her vomit after the ingestion of a commercial desiccant. Bloody emesis was the initial symptom, and various electrolyte imbalances developed during admission. Electrocardiogram (ECG) changes occurred early after hospitalization and disappeared before the electrolyte levels normalized. The patient was maintained in an NPO state throughout her hospital stay. Bloody emesis and abdominal pain resolved rather early, despite her minimal mention of symptoms, possibly due to her suspected negative psychiatric symptoms. Conclusions: The rise in suicidal attempts has led to an increase in unusual intoxication cases. Previous reports on CaCl2 ingestion primarily considered the gastrointestinal injury. In this case, we observed the dynamic and prolonged multiple electrolyte imbalances along with the early-phase ECG changes, all of which responded well to supportive care. This report adds to the understanding of the diverse manifestations and management of CaCl2 intoxication.