PURPOSE: The purpose of this article is to analysis undiagnosed HIV-positive patients in the Emergency Room (ER). We expect these analysis to be of help in preventing exposure to HIV and in making a diagnosis effectively. METHODS: A retrospective analysis by chart review was carried out on 8 unrecognized HIV patients who had been admitted to the ward via the ER from December 2000 to August 2002. RESULTS: The results were as follows: 1) The chief complaints were fever with mental change, dyspnea, hemiparesis, dyspnea with fever, chronic diarrhea with fever, abdominal discomfort, and dyspnea with fever and vertigo. 2) The 8 patients all had AIDS as well as other diseases. 3) The reasons for the anti-HIV test were continuous fever of unknown origin (FUO) 33.3%, chest X-ray abnormality 20.0%, VDRL (Venereal Disease Research Laboratory) test positive 13.3%, pre-operation screening blood test 13.3%. The rest were due to MRI (magnetic resonance image) abnormality, intraabdominal tuberculosis, and Cryptococcus in cerebrospinal fluid and comprised 6.7% of the total. CONCLUSION: We recommend that an anti-HIV test be given in the ER for patients who have FUO, infiltration of both lungs in the chest X-ray and a VDRL positive in serum. We also recommend that an anti-HIV test be given in the ER for patients with suspected HIV-related encephalopathy, tuberculosis, Pneumocystis carinii pneumonia, recurrent pneumonia, and progressive multi-focal leukoencephalopathy.
Cerebrospinal Fluid ; Cryptococcus ; Diagnosis ; Diarrhea ; Dyspnea ; Emergencies* ; Emergency Service, Hospital* ; Fever ; Fever of Unknown Origin ; Hematologic Tests ; HIV ; Humans ; Leukoencephalopathies ; Lung ; Magnetic Resonance Imaging ; Mass Screening ; Paresis ; Pneumonia ; Pneumonia, Pneumocystis ; Retrospective Studies ; Thorax ; Tuberculosis ; Vertigo

PURPOSE: Patients with esophageal foreign bodies are difficult to treat in an emergency room. Conventional endoscopic and fluoroscopy guide Foley's catheter removal methods are time consuming, expensive, and often not even possible in an emergency room. To resolve this difficulty, Thus I sought an alternative simple method using Foley's catheter without fluoroscopy. METHODS: I reviewed retrospectively patients with esophageal blunt foreign bodies. The subjects consisted of 40 patients who had been treated with a Foley's catheter without fluoroscopy from May 2000 to December 2002 at the emergency room. RESULTS: Of all 40 cases, 27 patients had foreign bodies lodged in the first esophageal constrictor; 10 patients in the second; and 3 patients in the third. The success rate was 40/40 (100%). In 36 patients, the foreign bodies were removed at the first try. In the remaining 4 patients, they were removed at the second try. Side effects were crying (36 cases), vomiting (18 cases), slightly bloody vomitus (12 cases), sore throat (12 cases), slightly nasal bleeding (6 cases). No serious complications were observed. The average time of removal was 38 minutes. The quickest removal was done in 10 minutes; the longest in 58 minutes. CONCLUSIONS: The simple Foley's catheter removal method is a safe, cost-effective and time-saving method, and does not require the use of endoscopy or fluoroscopy. Moreover, minimal training is required to perform the procedure. Compared to conventional methods, the technique is equally effective and avoids the risk of general anesthesia. The possibility of an esophageal coin foreign body developing into a serious complication may be time-dependent (how fast a patient is treated) rather than the modality-dependent.
Anesthesia, General ; Catheters ; Crying ; Emergency Service, Hospital ; Endoscopy ; Epistaxis ; Esophagus ; Fluoroscopy ; Foreign Bodies* ; Humans ; Numismatics ; Pharyngitis ; Retrospective Studies ; Vomiting

PURPOSE: Inter-arm blood pressure differences of more than 10 mmHg are measured not only in patients who have vascular diseases, such as aortic dissections, and aortic aneurysms, but also in heathy patients. We investigated the degree of and the factors for normal inter-arm blood pressure variations in our country. METHODS: We prospectively studied the cases of 351 patients who visited the Emergency Department of Korea University Hospital between May 1 and July 31, 2001. we collected clinical and demographic data, including age, sex, right/left handedness, and bilateral blood pressure. After we divided the cases into a Normal blood pressure group and a High blood pressure group, we compared the inter-arm blood pressure difference and influencing factors between the two group. RESULTS: The variation in the inter-arm blood pressure was unrelated to age, sex, right/left handedness, and right/left arm in both groups. In the Normal blood pressure group (n=180), the systolic inter-arm blood pressure difference was 3.9+/-0.4 mmHg, and the diastolic inter-arm blood pressure difference was 3.6+/-0.4 mmHg. In the High blood pressure group (n=171), the systolic inter-arm blood pressure difference was 5.2+/-0.5 mmHg, and the diastolic interarm blood pressure difference was 4.8+/-0.5 mmHg. CONCLUSION: The variation in the inter-arm blood pressure was unrelated to age, sex, right/left handedness, and right/left arm. But inter-arm blood pressure difference was significant among subjects without exclusion criteria and was measured as about 5 mmHg in two groups.
Aortic Aneurysm ; Arm* ; Blood Pressure* ; Emergency Service, Hospital ; Functional Laterality ; Humans ; Hypertension ; Korea ; Prospective Studies ; Vascular Diseases

PURPOSE: The existing triage systems for trauma at prehospital field sites have limitations when applied to various nontraumatic conditions at hospitals and show disagreement in inter- or intra-rater assessments. The purpose of study was to develop a simple and objective triage tool which could be applied to both traumatic and non-traumatic patients and would reduce the rate of disagreement in inter- or intra-rater assessments by using a computerized system. METHODS: A prospective study was designed to evaluate the characteristics and the outcomes of patients who visited Korea University Emergency Medical Center between April 1 and May 31, 2002. The observed parameters were age, sex, AVPU scale, mode of visit, and vital signs including blood pressure, pulse rate, respiratory rate, and body temperature. The patient's outcome, which reflected the severity of condition, was expressed on the basis of progress, including home discharge, admission to general ward, and admission to intensive care unit (ICU) or death. RESULTS: Of the 3,242 patients enrolled in the study, 724 were traumatic patients, and 2518 were non-traumatic patients. The accuracy rate between the actual and the calculated classification of a patient's outcome for all patients was 66.2% for discharge, 64.1% for admission to general ward, 30.6% for admission to ICU or death. The corresponding numbers for non-traumatic patients were 70.3%, 70.6%, 32.1%, and those for traumatic patients were 61.3%, 52.5%, 29.8%. CONCLUSION: The Computerized Triage System provides a useful guideline to classify patients into two groups (discharge vs admission), especially in non-traumatic conditions, but it has limitations for classifying into critically ill patients.
Blood Pressure ; Body Temperature ; Classification ; Critical Illness ; Discriminant Analysis ; Emergencies* ; Emergency Service, Hospital* ; Heart Rate ; Humans ; Intensive Care Units ; Korea ; Patients' Rooms ; Prospective Studies ; Respiratory Rate ; Triage* ; Vital Signs

PURPOSE: The purpose of this study was to observe the success rate, the average of total admininstration doses and the complications associated with a convenient method of adenosine administration for paroxysmal supraventricular tachycardia (PSVT). METHODS: A non-blind, randomized, prospective study was conducted during the 30 months from January 1999 to June 2001. We enrolled 65 cases during this period. The number of cases in the standard method group was 35, and that in the mixed method group was 30. In the standard method group, 6 mg of adenosine was administered intravenously; therefore, 15~20 ml of normal saline was immediately flushed. This method is usually used and recommended. In the mixed method group, 6 mg of adenosine had been previously mixed with 15 ml of normal saline was administered intravenously without any additional manipulation. We evaluated the success rate, the average successful doses, and the complications of each group. RESULTS: The success rate was 80% in the standard method group and 85.7 % in the mixed method group, but this difference was not statistically significant (Chi square test, p=0.39). The average of total admininstration doses were 10.3+/-6.3 mg in the standard method group and 11.0+/-6.5 mg in the mixed method group, but this difference is not statistically significant (student t-test, p=0.07). There was no remarkable complication in the mixed method group. CONCLUSION: The mixed method was effective and more convenient than the standard method. A further, larger study is required.
Adenosine* ; Prospective Studies ; Tachycardia, Supraventricular*

Emergency Medicine is a medical specialty that provides comprehensive emergency care. The spectrum of emergency medicine includes humanity as well as medical care for emergency patients. Since the Korean Society of Emergency Medicine has been established and the training course for emergency residents has begun, quality improvement of the training course still remains to be one of the most important issues in emergency medicine. This report is to understand the current status of training of emergency residents and to improve the quality of training of emergency residents. The survey was performed with questionnaires regarding current status of training and opinions to improve quality of training. The questionnaires were sent to all emergency physicians and emergency residents registered to the Korean Society of Emergency Medicine via an electronic mail or a printed letter. The response rates were 49.6% for emergency physicians and 35.8% for emergency residents. On the basis of the result of this survey, we suggest five proposals for improving the quality of resident training course. These include complete adherence of each institution to training guidelines presented by the Korean Society of Emergency Medicine, development of the education program compatible to each institution, shortening of length of training duration from 4 years to 3 years, promotion of the training environment, and introduction of evaluation examination to the training course.
Education ; Electronic Mail ; Emergencies* ; Emergency Medical Services ; Emergency Medicine ; Humans ; Internship and Residency ; Quality Improvement ; Surveys and Questionnaires

Bleeding and perforation are serious and commonly observed complications of colonofibroscopy. Pneumoretroperitoneum and pneumomediastinum are also infrequently reported as complications of colonofibroscopy. Clinical symptoms of pneumomediastinum are variable, with chest pain being the most common symptom, and a definitive diagnosis can be made by chest X-ray. Most cases can be successfully managed with only conservative treatment. Infrequently surgical managements are required. We report an unusual case of pneumoretroperitoneum and pneumomediastinum as a complication of colonofibroscopy. Pneumomediastinum was treated successfully and simply with only antibiotics and fasting.
Anti-Bacterial Agents ; Chest Pain ; Colon* ; Colonoscopy ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Fasting ; Hemorrhage ; Humans ; Intestinal Perforation ; Mediastinal Emphysema* ; Retropneumoperitoneum ; Thorax

A 20-year-old male was admitted to our hospital due to a cosmetic problem of gynecomastia. He received a surgical resection of subcutaneous fat through an incision in the periareolar area under general anesthesia. On the postoperative fifth day, he complained of intraoral pain due to an oral ulcer. He was prescribed benoxinate at 4 mL (12 mg) for use by gargling, but instead he injected it intravenously by himself. He experienced severe tremors in the extremities, chest discomfort, and palpitation immediately after injection, and sinus tachycardia was noted on the electrocardiogram. We managed his symptoms by hydration with normal saline and oxygen supplementation. Seven hours later, his symptoms had subsided, and no further complications were observed.
Anesthesia, General ; Anesthetics ; Electrocardiography ; Extremities ; Gynecomastia ; Humans ; Male ; Oral Ulcer ; Oxygen ; Subcutaneous Fat ; Tachycardia, Sinus ; Thorax ; Tremor ; Young Adult

PURPOSE: To evaluate the usefulness of ultrasonography (US) as a disposition tool in emergency care centers for categorizing urolithiasis patients who present with acute flank pain and microscopic hematuria. METHODS: We enrolled patients who presented with acute flank pain and microscopic hematuria from January to August 2006 in the Emergency Care Center of Chungnam National University Hospital. We categorized patients into four groups according to their hydronephrosis and urinary complications, respectively, and retrospectively reviewed their charts relative to patients' disposition. RESULTS: One hundred eighty-two patients met the criteria and were enrolled in the study. Patients who were classified as group D (without complication or hydronephrosis) had 100% negative predictive value for invasive procedures (ureteroscopy or double J catheterization), hospital admission, extracoporeal shock wave lithotripsy (ESWL), and prescription of antibiotics. CONCLUSION: It is reasonable for emergency department residents to route patients without complication or hydronephrosis to the outpatient department after pain control and simple therapeutic education.
Anti-Bacterial Agents ; Chungcheongnam-do ; Education ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Flank Pain* ; Hematuria* ; Humans ; Hydronephrosis ; Lithotripsy ; Outpatients ; Prescriptions ; Retrospective Studies ; Shock ; Ultrasonography* ; Urolithiasis

PURPOSE: Some studies indicate that vital signs such as blood pressure, heart rate, respiration rate, body temperature correlate with each other. However, no study has rigorously confirmed the correlations between vital signs due to study limitations. The aim of this study is to determine the relationship of pain to vital sings and to assess its clinical utility in ureter stone patients. METHODS: All 371 patients with ureter stone admitted to the Emergency Department (ED) at Kyung Hee University Hospital from September 1, 2005 to August 31, 2006 were prospectively involved in our study. We recorded vital signs of all patients 3 times every 10 minutes before analgesic injection and determined mean values. We analyzed the data by using the SPSS 13.0 statistics program. RESULTS: The means for systolic and diastolic blood pressure, heart rate and respiration rate were significantly different in pain score (p<0.05), but were not different by body temperature. Correlations of pain grade to vital signs were calculated, and blood pressure, heart rate and respiration rate showed positive correlation with pain grade (p<0.05). In multivariate analysis by general linear analysis, only systolic blood pressure and respiration rate were significantly associated with pain scores (p<0.05). CONCLUSION: In general, we have a tendency to underestimate the importance of the respiration rate relative to blood pressure, heart rate, and body temperature except in special circumstances, such as COPD or asthma exacerbation. Self-reported pain scores of patients correlate with vital signs, especially blood pressure and respiration rate.
Asthma ; Blood Pressure ; Body Temperature ; Emergency Service, Hospital ; Heart Rate ; Humans ; Multivariate Analysis ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive ; Respiratory Rate ; Ureter* ; Urinary Calculi ; Vital Signs*