Bentazone is a widely used herbicide considered a moderate hazard. Fatalities associated with its use are rare, with deaths reported only after intake of ≥200 mL. In some studies, bentazone intoxication is accompanied by generalized rigidity. Malignant hyperthermia is a pharmacogenetic disease that presents a hypermetabolic response to anesthetic gases or depolarizing muscle relaxants due to calcium channel dysfunction. The classic symptoms of malignant hyperthermia include hyperthermia and muscle rigidity. We report the case of a 65-year-old man who died 4 hours after presenting to the emergency department after ingesting approximately 75 mL of Basagran M60 (bentazone 33.6%, 25.2 g). This is the smallest dose (364 mg/kg) reported in a fatal case to date. Electrocardiogram changes, including QRS widening and QT prolongation, were present, and hypocalcemia was confirmed. We propose that bentazone intoxication causes patient deterioration by a mechanism similar to that of malignant hyperthermia.
Objective Many studies have examined the July effect. However, little is known about the July effect in sepsis. We hypothesized that the July effect would result in worse outcomes for patients with sepsis. Methods Data from patients with sepsis, collected prospectively between January 2018 and December 2021, were analyzed. In Korea, the new academic year starts on March 1, so the “July effect” appears in March. The primary outcome was 30-day mortality. Secondary outcomes included adherence to the Surviving Sepsis Campaign bundle. Outcomes in March were compared to other months. A multivariate Cox proportional hazard regression was performed to adjust for confounders. Results We included 843 patients. There were no significant differences in sepsis severity. The 30-day mortality in March was higher (49.0% vs. 28.5%, P<0.001). However, there was no difference in bundle adherence in March (42.2% vs. 48.0%, P=0.264). The multivariate Cox proportional hazard regression showed that the July effect was associated with 30-day mortality in patients with sepsis (adjusted hazard ratio, 1.925; 95% confidence interval, 1.405–2.638; P<0.001). Conclusion The July effect was associated with 30-day mortality in patients with sepsis. However, bundle adherence did not differ. These results suggest that the increase in mortality during the turnover period might be related to unmeasured in-hospital management. Intensive supervision and education of residents caring for patients with sepsis is needed in the beginning of training.
Citations
Citations to this article as recorded by
Illness severity modifies the association between sepsis and survival in critically ill patients with acute kidney injury Mahnaz Derakhshan, Mory Ghomshei, Hamid Reza Ansarian Clinical and Experimental Nephrology.2026; 30(4): 581. CrossRef
Objective Accurate interpretation of computed tomography (CT) scans is critical for patient care in the emergency department. We aimed to identify factors associated with an incorrect interpretation of abdominal CT by novice emergency residents and to analyze the characteristics of incorrectly interpreted scans.
Methods This retrospective analysis of a prospective observational cohort was conducted at three urban emergency departments. Discrepancies between the interpretations by postgraduate year-1 (PGY-1) emergency residents and the final radiologists’ reports were assessed by independent adjudicators. Potential factors associated with incorrect interpretation included patient age, sex, time of interpretation, and organ category. Adjusted odds ratios (aORs) for incorrect interpretation were calculated using multivariable logistic regression analysis.
Results Among 1,628 eligible cases, 270 (16.6%) were incorrect. The urinary system was the most correctly interpreted organ system (95.8%, 365/381), while the biliary tract was the most incorrectly interpreted (28.4%, 48/169). Normal CT images showed high false-positive rates of incorrect interpretation (28.2%, 96/340). Organ category was found to be a major determinant of incorrect interpretation. Using the urinary system as a reference, the aOR for incorrect interpretation of biliary tract disease was 9.20 (95% confidence interval, 5.0–16.90) and the aOR for incorrectly interpreting normal CT images was 8.47 (95% confidence interval, 4.85–14.78).
Conclusion Biliary tract disease is a major factor associated with incorrect preliminary interpretations of abdominal CT scans by PGY-1 emergency residents. PGY-1 residents also showed high false-positive interpretation rates for normal CT images. Emergency residents’ training should focus on these two areas to improve abdominal CT interpretation accuracy.
Citations
Citations to this article as recorded by
Use of Gallbladder Width Measurement by Computed Tomography in the Diagnosis of Acute Cholecystitis Yong Suk Park, Hee Yoon, Soo Yeon Kang, Ik Joon Jo, Sookyoung Woo, Guntak Lee, Jong Eun Park, Taerim Kim, Se Uk Lee, Sung Yeon Hwang, Won Chul Cha, Tae Gun Shin Diagnostics.2022; 12(3): 721. CrossRef
Objective We evaluated the effect of rapid influenza diagnostic tests (RIDTs) on patient management in an emergency department for 3 years after 2009, and also identified factors associated with the choice of treatment for patients with influenza-like illnesses.
Methods The study period consisted of three influenza epidemic seasons. Patients older than 15 years who underwent RIDTs in the emergency department and were then discharged without admission were included.
Results A total of 453 patients were enrolled, 114 of whom had positive RIDT results and 339 had negative results. Antiviral medication was prescribed to 103 patients (90.4%) who had positive RIDT results, while 1 patient (0.3%) who tested negative was treated with antivirals (P<0.001). Conservative care was administered to 11 RIDT-positive patients (9.6%) and 244 RIDT-negative patients (72.0%) (P<0.001). Symptom onset in less than 48 hours, being older than 65 years, and the presence of comorbidities were not associated with the administration of antiviral therapy.
Conclusion RIDT results had a critical effect on physician decision-making regarding antiviral treatment for patients with influenza-like illnesses in the emergency department. However, symptom onset in less than 48 hours, old age, and comorbidities, which are all indications for antiviral therapy, were not found to influence the administration of antiviral treatment.
Citations
Citations to this article as recorded by
Comparison of rapid nucleic acid amplification tests and rapid antigen tests for influenza in the emergency department Sukyo Lee, Jong-Hak Park, Hanjin Cho, Sungwoo Moon, Sejoong Ahn The American Journal of Emergency Medicine.2026; 99: 25. CrossRef
The “timeless” use of influenza-like illness criteria for influenza detection in the tropics Aung H. Aung, David C. Lye, Lin Cui, Chee K. Ooi, Angela L.P. Chow International Journal of Infectious Diseases.2021; 106: 160. CrossRef
Objective In South Korea, the Gyeonggi Fire Services introduced a multi-tiered dispatch system for out-of-hospital cardiac arrest (OHCA) cases in July 2015. In this study, we investigated whether the multi-tiered dispatch system improved the pre-hospital return of the spontaneous circulation (ROSC) rate.
Methods All non-traumatic adult OHCAs treated and transported by the 119 emergency medical system from July 2015 to December 2015 were included in the study. Demographic and pre-hospital Utstein element-data were collected from the emergency medical system OHCA database. The primary outcome was pre-hospital ROSC as measured at the scene.
Results Of the included OHCAs, 1,436 (89.0%) were categorized to the single-tiered dispatch group and 162 (10.1%) to the multi-tiered dispatch group. The rate of administration of advanced airway ventilation (61.1% vs. 48.0%, P=0.002) and intravenous access (18.5% vs. 12.5%, P=0.037) was higher in the multi-tiered group compared to that in the single-tiered group. The use of epinephrine was higher in the multi-tiered group (4.9% vs. 1.5%, P=0.002). The pre-hospital ROSC rates in the multi-tiered group were higher when compared with the single-tiered group, but the difference was not significant (10.5% vs. 7.5%, P=0.218). The adjusted odds ratio for pre-hospital ROSC rates in the multi-tiered group was 1.29 (95% confidence interval, 0.69 to 2.40).
Conclusion The multi-tiered dispatch system was not associated with a significant increase in the pre-hospital ROSC rate during the early phase of its implementation, even though advanced maneuvers were performed more frequently.
Citations
Citations to this article as recorded by
Association between multiple‐ambulance dispatches and clinical outcomes for patients with dispatcher‐unrecognized out‐of‐hospital cardiac arrests Min Seol Seo, Ki Hong Kim, Tae Han Kim, Jeong Ho Park, Joo Jeong, Young Sun Ro, Ki Jeong Hong, Kyoung Jun Song, Sang Do Shin Hong Kong Journal of Emergency Medicine.2026;[Epub] CrossRef
Dual-dispatch protocols and return of spontaneous circulation in patients with out-of-hospital cardiac arrest: a nationwide observational study Seung Hyo Lee, Won Pyo Hong, Young Su Kim, Jeseong Park, Hyouk Jae Lim Clinical and Experimental Emergency Medicine.2024; 11(3): 276. CrossRef
Identification of out-of-hospital cardiac arrest clusters using unsupervised learning Hyung Jun Moon, Yong Jin Shin, Young Soon Cho The American Journal of Emergency Medicine.2022; 62: 41. CrossRef
Effect of team-based cardiopulmonary resuscitation training for emergency medical service providers on pre-hospital return of spontaneous circulation in out-of-hospital cardiac arrest patients Jong-Hak Park, Sungwoo Moon, Hanjin Cho, Eusang Ahn, Tae-kyoung Kim, Bentley J. Bobrow Resuscitation.2019; 144: 60. CrossRef
Objective To assess the learning curve of novice residents in diagnosing acute appendicitis using abdominal computed tomography (CT) scans.
Methods This prospective observational study was conducted within a 4-month period from March 1 to June 30, 2015. After CT scans for right lower quadrant pain or similar acute abdomen were evaluated, postgraduate year 1 (PGY-1) residents completed an interpretation checklist. The primary outcome was evaluation of the learning curve for competent CT scan interpretation under suspicion of acute appendicitis. Secondary outcomes were cumulative numbers of accurate abdominal CT interpretations regardless of initial clinical impression and training period.
Results PGY-1 residents recorded a total of 230 interpretation checklists. There were 53, 51, 46, 44, and 36 checklists recorded by individual residents and 92, 92, 91, 91, and 61 respective training days in the emergency department, excluding rotation periods in other departments. After 16 to 20 interpretations of abdominal CT scans performed under suspicion of acute appendicitis, the residents could diagnose acute appendicitis with more than 95% accuracy. Overall, the sensitivity and specificity for diagnosing acute appendicitis were 97% (95% confidence interval, 94 to 100) and 83% (95% confidence interval, 80 to 87), respectively. After 61 to 80 abdominal CT interpretations regardless of suspicion of acute appendicitis and after 41 to 50 days in training, PGY-1 emergency department residents could diagnose acute appendicitis with more than 95% accuracy.
Conclusion PGY-1 residents require 16 to 20 checklist interpretations to acquire acceptable abdominal CT interpretation. After performing 61 to 80 CT scans regardless of suspicion of acute appendicitis, they could diagnose acute appendicitis with acceptable accuracy.
Citations
Citations to this article as recorded by
Factors affecting incorrect interpretation of abdominal computed tomography in non-traumatic patients by novice emergency physicians Seong Geun Lee, Hanjin Cho, Joo Yeong Kim, Juhyun Song, Jong-Hak Park Clinical and Experimental Emergency Medicine.2021; 8(3): 207. CrossRef
Objective We aimed to determine the incidence, processes of care, and outcomes in out-of-hospital cardiac arrests (OHCA) in Ansan, South Korea. Methods From the Ansan Fire Department’s (1-1-9 emergency call number) Emergency Medical Services (EMS) database, we obtained a list of adult cardiac arrest cases occurring between January 2008 and December 2011. We excluded cases with obvious non-cardiac causes, such as trauma, drowning, hanging, and asphyxia. We matched the EMS data with in-hospital care and outcome data. We analyzed basic demographic variables (age and gender), the time and place of incidence, witnesses, bystander cardiopulmonary resuscitation (CPR), major time variables, CPR instructions during transport, initial cardiac rhythm at the scene, and automated defibrillator use.
Results The overall incidence of OHCA in Ansan was 33.1/100,000 persons per year. Out of 778 adult OHCAs in our study population, bystander CPR was provided in 103 cases (13.2%). Of the 517 OHCAs whose initial rhythms were confirmed, 85 (16.4%) showed shockable rhythms, but only 23 (27.1%) received defibrillation at the scene or during transportation. Of the 106 patients whose spontaneous circulation returned at the hospital, only 6 (5.7%) received mild therapeutic hypothermia. During the study period, 31 patients (4%) survived to discharge from hospitals, and 6 of these discharged patients (19.4%) showed favorable neurologic outcomes. Conclusion While the survival rate from OHCA in Ansan is very low, this study provides basic information needed to create improvements. Our analysis suggests that multiple variables contribute to the low OHCA survival rate. Several of these variables are modifiable; addressing them is a clear first step toward strengthening the chain of survival from OCHA in Ansan.
Citations
Citations to this article as recorded by
Application of the “Plan-Do-Study-Act” Model to Improve Survival after Cardiac Arrest in Korea: A Case Study Joo Yeong Kim, Hanjin Cho, Jong-Hak Park, Joo-Hyun Song, Sungwoo Moon, Hongjae Lee, Hyun Ju Yang, Juliana Tolles, Nichole Bosson, Roger J. Lewis Prehospital and Disaster Medicine.2020; 35(1): 46. CrossRef
Effect of citywide enhancement of the chain of survival on good neurologic outcomes after out-of-hospital cardiac arrest from 2008 to 2017 Dong Eun Lee, Hyun Wook Ryoo, Sungbae Moon, Jeong Ho Park, Sang Do Shin, Corstiaan den Uil PLOS ONE.2020; 15(11): e0241804. CrossRef
Gender disparities in percutaneous coronary intervention in out-of-hospital cardiac arrest Jin Seop Jeong, So Yeon Kong, Sang Do Shin, Young Sun Ro, Kyoung Jun Song, Ki Jeong Hong, Jeong Ho Park, Tae Han Kim The American Journal of Emergency Medicine.2019; 37(4): 632. CrossRef
Implementation of a bundle of Utstein cardiopulmonary resuscitation programs to improve survival outcomes after out-of-hospital cardiac arrest in a metropolis: A before and after study Jeong Ho Park, Sang Do Shin, Young Sun Ro, Kyoung Jun Song, Ki Jeong Hong, Tae Han Kim, Eui Jung Lee, So Yeon Kong Resuscitation.2018; 130: 124. CrossRef
Kardiyopulmoner resüsitasyon eğitimi eğitimsiz kurtarıcıların acil yanıt sistemi görevlisi kılavuzluğunda uyguladığı temel yaşam desteğinin kalitesini arttırmaktadır Afsin Emre Kayipmaz, Cafer Akpinar, Nur Altiparmak, Cemil Kavalci, Helin Gulen Gedik, Cem Aydogdu, Elifsu Unal, Beyza Cinkir, Yigit Temizhan Kırıkkale Üniversitesi Tıp Fakültesi Dergisi.2017; : 55. CrossRef
Availability and use of public access defibrillators in Busan Metropolitan City, South Korea Chang Guk Yoon, Jinwoo Jeong, In Ho Kwon, Jae Hoon Lee SpringerPlus.2016;[Epub] CrossRef
Incidence of Adult In-Hospital Cardiac Arrest Using National Representative Patient Sample in Korea Yuri Choi, In Ho Kwon, Jinwoo Jeong, Junyoung Chung, Younghoon Roh Healthcare Informatics Research.2016; 22(4): 277. CrossRef
Epidemiological and Survival Trends of Pediatric Cardiac Arrests in Emergency Departments in Korea: A Cross-sectional, Nationwide Report Jae Yun Ahn, Mi Jin Lee, Hyun Kim, Han Deok Yoon, Hye Young Jang Journal of Korean Medical Science.2015; 30(9): 1354. CrossRef
Comparison Between 30:1 and 30:2 Compression‐to‐ventilation Ratios for Cardiopulmonary Resuscitation: Are Two Ventilations Necessary? Kyoung‐Chul Cha, Yong Won Kim, Tae Hoon Kim, Woo Jin Jung, Hyun Yook, Eunhee Choi, Yong Sung Cha, Oh Hyun Kim, Hyun Kim, Kang Hyun Lee, Sung Oh Hwang, James E. Olson Academic Emergency Medicine.2015; 22(11): 1261. CrossRef
For how long can two emergency medical technicians perform high-quality cardiopulmonary resuscitation? Chu Hyun Kim, Gi Woon Kim, Won Chul Cha, Bo Ra Kang, Han ho Do, Jun Seok Seo Journal of International Medical Research.2015; 43(6): 841. CrossRef
First
Prev
