Zoletil is a combination of tiletamine hydrochloride and zolazepam hydrochloride used as a veterinary anesthetic. Although zoletil abuse is widely known, zoletil poisoning for the purpose of suicide is very rare. We present a case of a 39-year-old man who attempted suicide by intravenously injecting a large amount of zoletil, resulting in decreased mental status and severe respiratory depression. Intubation and mechanical ventilation were applied. After 30 hours in the hospital, all symptoms of poisoning improved. Because zoletil can cause severe respiratory depression, close observation and aggressive securement of an airway is mandatory
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Soo Hyun Kim, Kyu Nam Park, Chun Song Youn, Minjung Kathy Chae, Won Young Kim, Byung Kook Lee, Dong Hoon Lee, Tae Chang Jang, Jae Hoon Lee, Yoon Hee Choi, Je Sung You, In Soo Cho, Su Jin Kim, Jong-Seok Lee, Yong Hwan Kim, Min Seob Sim, Jonghwan Shin, Yoo Seok Park, Young Hwan Lee, HyungJun Moon, Won Jung Jeong, Joo Suk Oh, Seung Pill Choi, Kyoung-Chul Cha, Korean Hypothermia Network investigators
Clin Exp Emerg Med 2020;7(4):250-258. Published online December 31, 2020
Objective High-quality intensive care, including targeted temperature management (TTM) for patients with postcardiac arrest syndrome, is a key element for improving outcomes after out-of-hospital cardiac arrest (OHCA). We aimed to assess the status of postcardiac arrest syndrome care, including TTM and 6-month survival with neurologically favorable outcomes, after adult OHCA patients were treated with TTM, using data from the Korean Hypothermia Network prospective registry.
Methods We used the Korean Hypothermia Network prospective registry, a web-based multicenter registry that includes data from 22 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TTM between October 2015 and December 2018 were included. The primary outcome was neurological outcome at 6 months.
Results Of the 1,354 registered OHCA survivors treated with TTM, 550 (40.6%) survived 6 months, and 413 (30.5%) had good neurological outcomes. We identified 839 (62.0%) patients with preClinsumed cardiac etiology. A total of 937 (69.2%) collapses were witnessed, shockable rhythms were demonstrated in 482 (35.6%) patients, and 421 (31.1%) patients arrived at the emergency department with prehospital return of spontaneous circulation. The most common target temperature was 33°C, and the most common target duration was 24 hours.
Conclusion The survival and good neurologic outcome rates of this prospective registry show great improvements compared with those of an earlier registry. While the optimal target temperature and duration are still unknown, the most common target temperature was 33°C, and the most common target duration was 24 hours.
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Objective To analyze the differences in characteristics and outcomes between public bath (PB)- related and non-PB-related out-of-hospital cardiac arrest (OHCA) patients in South Korea.
Methods We performed a retrospective observational analysis of collected data from the Smart Advanced Cardiac Life Support (SALS) registry between September 2015 and December 2018. We included adult OHCA patients (aged >18 years) with presumed OHCA of non-traumatic etiology who were attended by dispatched emergency medical services. SALS is a field advanced life support with smartphone-based direct medical direction. The primary outcome was the survival to discharge rate measured at the time of discharge.
Results Of 38,995 cardiac arrest patients enrolled in the SALS registry, 11,889 were included in the final analysis. In total, 263 OHCAs occurred in PBs. Male sex and bystander cardiopulmonary resuscitation proportions appeared to be higher among PB patients than among non-PB patients. Percentages for shockable rhythm, witnessed rate, and number of underlying disease were lower in the PB group than in the non-PB group. Prehospital return of spontaneous circulation (11.4% vs. 19.5%, P=0.001), survival to discharge (2.3% vs. 9.9%, P<0.001), and favorable neurologic outcome (1.9% vs. 5.8%, P=0.007) in PB patients were significantly poorer than those in non-PB patients.
Conclusion Patient characteristics and emergency medical services factors differed between PB and non-PB patients. All outcomes of PB-related OHCA were poorer than those of non-PB-related OHCA. Further treatment strategies should be developed to improve the outcomes of PBrelated cardiac arrest.
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