PURPOSE: Recently, the emergency departments of most general hospitals have been overcrowded, and one of the major causes is the increased number of pediatric patients. Therefore, our hospital separated the pediatric emergency room from the emergency department, and we assessed the effect of that separation. METHODS: Pediatric patients below 15 years of age who visited the emergency department from March 1998 to February 1999, which was before the separation, and from March 1999 to February 2000, which was after the separation, were included in this study. RESULTS: The average lengths of stay of pediatric and nonpediatric patients at emergency department before separation were 1.9+/-3.5 and 2.6+/-5 hours, respectively, and declined to 1.6+/-2.4 and 2.3+/-4.7 after separation (p<0.05). The waiting time until admission declined notably from 3.6+/-2.5 hours to 3.3+/-5.6 hours for pediatric patients, in spite of the fact that the number of pediatric admissions increased (p<0.05). In non-pediatric patients, it declined from 3.1+/-3.3 to 2.6+/-3.5 hours (p<0.05). CONCLUSION: The separation of the emergency department into pediatric and non-pediatric departments reduced emergency-department crowding, the length of stay at the emergency department, and, the waiting time until admission. A fundamental solution to the problem of emergency-department crowding requires an independent pediatric emergency department, an increased number of emergency physicians, increased paramedic coverage, and more efficient hospital policies regarding laboratory, radiology, and admission procedures.
Allied Health Personnel ; Crowding ; Emergencies* ; Emergency Service, Hospital* ; Hospitals, General ; Humans ; Length of Stay ; Patient Admission

We describe a rare case of cerebral venous thrombosis and liver infarction with HELLP syndrome in a 25-year-old woman with eclampsia. She had complained of epigastric pain and had visited a local hospital for treatment. Also, signs of fetal distress were presented. After an emergency cesarean section, generalized tonic-clonic seizure occurred twice at a 10-minute interval. The patients was transferred to our emergency room, and the neurologic examination at that time, revealed a deep drowsy mentality and positive Babinski's sign; the deep tendon reflex was two positive. The laboratory findings revealed thrombocytopenia, an elevated liver function test, abnormal coagulation profiles. A bilateral ischemic change with left basal ganglia hemorrhage was seen on brain CT, and multiple foci of ill defined low-density lesions, mainly in the subcapsular portion of the liver and perivascular space, were visible on the abdominal CT. There was a faint showing of the deep venous system on the angiogram of both carotid arteries and a cerebral venous thrombosis was confirmed by using 4-vessel angiography. During the following 2 days, the cerebral hemorrhage and the low-density lesion were resolved through applications of heparin, and the patient returned to a nearly alert mental status. Finally she died of a hemorrhagic shock as a complication of disseminated intravascular coagulation.
Adult ; Angiography ; Basal Ganglia Hemorrhage ; Brain ; Carotid Arteries ; Cerebral Hemorrhage ; Cesarean Section ; Disseminated Intravascular Coagulation ; Eclampsia ; Emergencies ; Emergency Service, Hospital ; Female ; Fetal Distress ; HELLP Syndrome* ; Heparin ; Humans ; Infarction* ; Intracranial Thrombosis ; Liver Function Tests ; Liver* ; Neurologic Examination ; Pregnancy ; Reflex, Babinski ; Reflex, Stretch ; Seizures ; Shock, Hemorrhagic ; Thrombocytopenia ; Tomography, X-Ray Computed ; Venous Thrombosis*

PURPOSE: Recently, a new animal model for permanent focal brain ischemia using macrospheres was developed wherein the hypothalamic area was free from ischemic injury. The purpose of this study was to evaluate spatiotemporal changes in the expressions of cFos, pERK, and pAkt proteins in the macrosphere model. METHOD: Three or four macrospheres were injected into the internal carotid artery after ligation of the external carotid artery to induce permanent focal brain ischemic injury. RESULT: Twenty-four hours after macrosphere injection, 2,3,5-Triphenyltetrazlium (TTC) staining showed a marked ischemic injury in the blood supply territory of the middle cerebral artery, for example, the cerebral cortex and striatum. Furthermore, TUNEL staining revealed apoptotic cell death in the ischemic injury region of the cerebral cortex and striatum. Expression of the cFos protein was significant in the penumbral zone, but not in the ischemic core of the cortex and striatum, two and six hours after ischemic insult. A transient prominent expression of the pERK1/2 protein was noted in the penumbral zone of the cortex and striatum two hours after injection of macrospheres. In contrast, there was a strong immunoreactivity for the pAkt protein in the ischemic core, but not in the penumbral zone of the cortex and striatum, six hours after ischemic injury. CONCLUSION: The above results suggest that early expressions of cFos, pERK1/2, and pAkt proteins take part in different signaling cascades for cell survival or death in macrosphere animal model of permanent focal brain ischemic injury.
Animals* ; Brain Ischemia ; Brain* ; Carotid Artery, External ; Carotid Artery, Internal ; Cell Death ; Cell Survival ; Cerebral Cortex ; In Situ Nick-End Labeling ; Ligation ; Middle Cerebral Artery ; Models, Animal*

PURPOSE: Bleaching agents containing sodium hypochlorite are widely used at home to bleach laundry and to disinfect hard surfaces. A retrospective study, with a literature review, was conducted to focus attention on the clinical outcome after accidental or intentional ingestion of sodium hypochlorite. METHODS: The medical records of 67 patients presented to the Inha University emergency department for sodium hypochlorite ingestion between June 1996 and July 2003 were retrospectively examined. RESULTS: The Mean volume of the bleach in the 56 patients who ingested the bleach in a suicide attempt was significantly larger than that of the 11 patients with accidental ingestion (P=0.001). Nausea and vomiting was present in 79% of the patients. The volume of ingestion in patients with vomiting was significantly larger than that in patients without vomiting (P=0.001). Patients with epigastric pain ingested larger volumes of bleach compared to patients without the pain (P=0.01). Endoscopic examinations were performed in seven patient, and normal findings were seen in three patients. Grade 1 caustic injury was observed in two patients, and Grade 2 injuries in the rest. CONCLUSION: The solution of the sodium hypochlorite may cause mild symptoms and seems to be safe after ingestion. However, careful evaluation with endoscopy and hospital admission should be considered if there are symptoms or signs suggesting caustic injury of the esophagus and/or stomach or if the ingested volume is large.
Bleaching Agents ; Caustics ; Eating ; Emergency Service, Hospital ; Endoscopy ; Esophagus ; Family Characteristics* ; Humans ; Medical Records ; Nausea ; Poisons ; Retrospective Studies* ; Sodium Hypochlorite* ; Sodium* ; Stomach ; Suicide ; Vomiting

PURPOSE: Brief myocardial ischemia evokes a cardioprotective response, referred to as "Ischemic Preconditioning", that limits injury caused by a subsequent prolonged ischemic insult. The myocardial ischemic preconditioning effect can be induced by ischemia of "distant" cardiac and noncardiac tissue, implicating the involvement of an as-yet unidentified humoral trigger. The purpose of this study was to prove the protective effect of a preconditioning ischemic trigger (PIT) obtained from coronary effluent to isolated pancreatic cells under hypoxic condition in neonatal pigs. METHODS: Isolated hearts were preconditioned 5 times with 5-min ischemia following 10-min reperfusion. Coronary effluent was collected during reperfusion, filtered by using a Sep-Pak C-18 catridge, and lyophilized after dissolving it with acetonitrile. Isolated pancreatic cells were divided into a PIT-treatment group and a control group, and each group was further divided into time-dependent and dose-dependent groups. Time-dependent groups were incubated under a hypoxic condition for durations of 1, 2, 3, and 4 hrs, and dose-dependent groups were treated with 3 different doses of PIT that had undergone hypoxic incubation for 4 hrs. Viability of the pancreatic cells after the hypoxic incubation period was evaluated by using a confocal microscope. RESULTS: In the control group, the average viability of pancreatic cells after 4 hrs of hypoxia was 60.48 +/- 1.24%, and in the PIT-treated group, the value was 71.88 +/- 1.33%, the difference in the viability between the PIT-treated group and the control group after 4 hrs of hypoxia was statistically significant. In the dose-dependent groups, the viability of pancreatic cells was significantly larger in the groups treated with original PIT and 1/10 PIT than in the control group. CONCLUSION: These data suggest that in the In-vitro pig model, PIT obtained from heart evoked ischemic tolerance to isolated pancreatic cells.
Anoxia* ; Heart* ; Ischemia ; Ischemic Preconditioning ; Ischemic Preconditioning, Myocardial ; Myocardial Ischemia ; Reperfusion ; Swine*

PURPOSE: The aim of this study was to determine the relationships between weather and calendar variables and the admission volume at the emergency center in Daejon city. PATIENTS AND METHODS: Daily patient volume from January to November 2003 was matched with calendar and weather variables. Calendar variables included season, day of the week, holidays, and the day after a holiday. Weather variables included daily maximum, minimum, and average temperatures and other factors such as snowfall and rainfall. RESULTS: The average daily admission volume was 282 +/- 54 persons (187~605), and the most highly significant calendar and weather variables related with admission volume were holidays and maximal temperature, respectively. A regression model was calculated as follows: the daily patient volume = 214 + 2 x (maximal temperature) + 113 x (holiday) + 26.8 x (day after a holiday). This equation could estimate about 62.6% of the daily patient volumes. CONCLUSION: This study suggests that the temperature and a holiday may influence the number of visiting patients. Thus, the staffing level should be set appropriately by considering the estimated patient volume.
Daejeon ; Emergencies* ; Holidays ; Humans ; Meteorological Concepts ; Patient Admission ; Seasons ; Weather

PURPOSE: In patients with acetaminophen poisoning, clinical severities are partly based on the prothrombin time. In several conditions, N-acetylcysteine (NAC) infusion has been shown to lower the prothrombin index. Thus, we studied the effect of NAC on the prothrombin time in patients intoxicated with acetaminophen without hepatotoxicity. METHODS: From March 2000 to Aug 2004, we reviewed the medical records of 149 patients with a diagnosis of acetaminophen poisoning. After 88 patients had been excluded (29 had hepatocellular injury, 14 had a probable risk based on their normogram, and 45 had a missing prothrombin index value), 61 patients were included in the analysis. The prothrombin time was recorded before and serially during NAC treatment. RESULTS: The mean baseline prothrombin time was 99.1%, 99.3% after intravenous NAC infusion, and 74.0% at 8 hrs after initiation of NAC infusion. It decreased rapidly at 16 hrs, and reached a steady baseline state between 16 to 24 hrs. A rapid increase in the baseline time occurred after 2-3 days when the NAC infusion was stopped. After oral NAC treatment, it decreased rapidly from 8 to 16 hrs, and reached a steady baseline after 2 days. There was a rapid increase after 3~4 days when the NAC infusion was stopped. CONCLUSION: In patients with uncomplicated acetaminophen poisoning, the decrease in the prothrombin index might be misinterpreted as a sign of liver failure, leading to a prolonged treatment.
Acetaminophen* ; Acetylcysteine* ; Diagnosis ; Humans ; Liver Failure ; Medical Records ; Poisoning* ; Prothrombin Time* ; Prothrombin*

PURPOSE: Non-blood transfusion is of increasing interest as more patients are refusing a blood transfusion because of religious belief, infection, or fear of a blood-transmitted disease such as AIDS. This study analyzed clinical findings to help the treatment and management of patients who want a non-blood transfusion. METHODS: Of the 83 patients who visited the non-blood transfusion center in Chosun University Hospital from June 2001 to December 2003, 59 patients had a sufficient clinical record, and these were reviewed retrospectively. We investigated sex, age, the reason for the visit, the reason for refusing a blood transfusion, the degree of anemia, the necessity of the blood transfusion, the histories of transfusion and attempted non-blood transfusion, and the histories of visits to emergency departments and the outcomes. RESULTS: The male-to-female ratio was 1:2.93, and the most prevalent ages of the patients were in the forties (26 patients) and thirties (10 patients). The reasons for refusing a blood transfusion were religion (48 patients, 81.4%), risk of infection (1 patients, 1.7%), and other (10 patients, 16.9%). Among the specialty departments, the proportions of patients from the departments of obstetrics and gynecology, internal medicine, general surgery and orthopedics were 40.7% (24 patients), 25.4%, 11.9%, and 6.8%, respectively. Of the patients, 28 patients (47.5%) were admitted directly to the emergency department, and 39 patients (66.1%) were operated on. A blood transfusion was considered to be necessary for 16 patients (27.1%), but only a 2 patients (3.4%) actually received a blood transfusion. Of those 14 patients, 3patients (21.4%) died. After admission, 17 patients (29.8%) received a non-blood transfusion. CONCLUSIONS: Most of the patients visited the non-blood transfusion center for religious reasons, and the majority of the patients were admitted from the Department of Obstetrics and Gynecology. Many of the patients medically should have received blood transfusion, but only a few actually did.
Anemia ; Blood Transfusion* ; Emergency Service, Hospital ; Gynecology ; Humans ; Internal Medicine ; Obstetrics ; Orthopedics ; Religion ; Retrospective Studies

PURPOSE: A 12-lead ECG is only 50% sensitive for the detection of an acute myocardial infarction (AMI). The majority of leads for optimal classification of an AMI probably lie outside the area covered by the 6 precordial leads. Thus, body surface potential mapping (BSPM) may be more helpful in diagnosing AMI, because a large thoracic area is sampled. METHODS: Two hundred sixty-eight consecutive patients with ischemic-type chest pain, who visited our emergency medical center from August 2002 to January 2003, were recruited prospectively. A 12-lead ECG and an 80-lead BSPM were recorded at presentation. Cardiac markers were measured. Acute myocardial infarction was defined as 1) chest pain with a duration greater than 20 minutes and, 2) elevated cardiac enzyme. The diagnoses of the 12-lead ECGs and the BSPM algorithms were categorized into two subgroups, AMI and non-AMI, and were compared. RESULTS: Of the 268 patients, 81 patients (30.2%) were confirmed as having an acute myocardial infarction. The 12-lead ECGs identified 32 patients with AMI (sensitivity 39.5%, specificity 93.0%), and the BSPM algorithm identified 56 patients with AMI (sensitivity 69.1%, specificity 85.6%). Patients with a positive BSPM diagnosis were much more likely to have AMI (odds ratio 13.3, 95% Confidence interval 7.1~24.8) than patients with a positive 12-lead ECG diagnosis. Thirty AMI patients that had not been detected with 12-lead ECGs were detected with 80-lead BSPMs (sensitivity 61.2%, specificity 87.9%). CONCLUSION: When compared with the 12-lead ECG, the BSPM algorithm has a higher sensitivity for detection of AMI, particularly in patients presenting with chest pain and nondiagnostic ECG changes. The use of the BSPM algorithm in such patients may lead to earlier detection of an AMI.
Body Surface Potential Mapping* ; Chest Pain ; Classification ; Diagnosis* ; Electrocardiography ; Emergencies ; Humans ; Myocardial Infarction* ; Prospective Studies ; Sensitivity and Specificity

PURPOSE: This study was done to evaluate patients' and physicians' attitude toward emergency physician's professional appearance in the ED. METHODS: By way of a survey, the patients and guardians of 87 patients presenting to the Emergency Department of Seoul National University Hospital (patients' group) were shown 6 photographs of physician's dress style and asked questions related to their preference for each physician's dress style. The same questions were also given to 52 medical personnel (medical group: physicians, nurses, and paramedics of the emergency department). RESULTS: There was no preference for formal suit or casual suit without white laboratory coat in either group. Fifty-eight (73.4%) of the patients' group preferred a formal suit with white coat whereas 22(44.0%) of the medical group preferred a formal suit with white coat (p=0.008). As to surgical scrubs with or without a white coat, there was a preference in both group. However, the medical group liked 'scrubs+white coat' more than the patients' group (p=0.003). Of 12 other items, 4 items (dyed hair, no tie, a Tshirt, and sports shoes) were preferred and 7 items (longhair/ponytail (man), mustache/beard, blue jeans, sportswear, mini-skirt, earrings (man) and bracelets) were not preferred by the either group. However, there is a disconcordance about slippers/sandals between the patients' group and the medical group (27.8% vs 56.8% preferred them; p=0.003). CONCLUSION: Patients and their guardians preferred emergency department doctors to be dressed in formal dress with a white coat, but also accepted surgical scrubs whereas medical personnel preferred scrub with white coat.
Allied Health Personnel ; Clothing ; Ear ; Emergencies* ; Emergency Service, Hospital ; Hair ; Humans ; Seoul ; Sports