The aim of this study was to analyze the general characteristics of children in the pediatric emergency department (PED) who accidentally fall off the crib and to establish useful preventive measures. This prospective research analyzed pediatric patients who accidentally fell off their beds in the observational unit (OU) of the PED from July 2005 to June 2006 (first period). From July 2006 to February 2007 (second period), the causes of children falling off the crib in the first year were analyzed and five related preventive methods were instituted in the OU. From July 2007 to March 2008 (third period), the preventive methods were enhanced to achieve zero-event of accidental falls in the PED. The differences between patients falling off the bed among the three periods were then compared. This study collected 7,281 children admitted to the OU during the first period and recorded 15 cases of accidental falls. After performing the preventive methods in 6,232 patients in the second period, three events of accidental falls were noted. In the third period, there was no accident in the 5,225 patients admitted to the PED. Comparing the occurrences of children falling off the bed among the three periods, accidental falls significantly decreased in the third period (p < 0.001). Effective methods can be instituted to prevent children from falling off the bed, especially in the PED.

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Objective: Myocardial injury used to be considered as one of the major complications associated with sternal fracture, even though recent studies on injuries associated with fracture of sternum are contrary to this belief. Many authors now believe the presence of sternal fracture no longer is indicative of occult injuries to the underlying structure such as the heart. Methods: A case was presented of a 38-year-old female patient transferred to our hospital after being injured in a motor vehicle accident. On arrival, her blood pressure (BP) was 90/50 mmHg but two hours later, it dropped to 60/30 mmHg. Although her chest roentgenography and electrocardiography (ECG) did not reveal any significant findings, chest computerized tomography (CT) scan later revealed a sternal fracture and cardiac tamponade. Results: A diagnosis of cardiac rupture resulting from sternal fracture following blunt chest trauma was made. Under midline sternotomy, her right atrial rupture was repaired. The patient was doing well during a three months postoperative follow-up. Conclusion: Clinicians should maintain a high index of suspicion for the presence cardiac tamponade in cases presented as blunt chest trauma as early diagnosis and surgical intervention is vital to the patient's survival. Prehospital and Disaster Medicine http://pdm.medicine.wisc.edu Vol.17, Supplement 1 https://www.cambridge.org/core/terms. https://doi.Objective: Tetrodotoxin (TTX) is a neurotoxin known to cause food poisoning. It is found in a variety of both freshwater and marine species. Patients with tetrodotoxin intoxication generally have a very typical course of illness involving the cardiovascular, respiratory, peripheral and central nervous systems.Methods: A 59-year-old, male, taxi driver presented to the emergency department with dyspnea and numbness after eating some porridge cooked with Takifugu niphobles. On arrival, he was tachypneic, hypertensive, consciousness clear, and was able to give a coherent history. He immediately was intubated, but respiratory effort ceased several minutes later. About one hour later, he was in deep coma with Glasgow Coma Scale (GCS) Score = 3, had a sinus bradycardia, and became severely hypotensive. Results: During the next two days, he continued to have fluctuating blood pressure, hypothermia, and polyuria. At 36 hours after admission, he regained consciousness and some upper limb motor function, but still had no spontaneous breathing effort. An EEG showed "minor diffuse cortical dysfunction likely to be metabolic in origin". Later in the day his vision recovered spontaneously. Ventilatory function returned and the patient self-extubated on the following day. On day 10, he was discharged after a follow-up EEG that showed "no evidence of focal cortical dysfunction". Tetrodotoxin measured by bioassay was 300 mouse units per gram (MU/g). Conclusion: To our knowledge this is the first report of a human that demonstrated this cortical dysfunction on EEG during tetrodotoxin poisoning.