Extracorporeal shock wave lithotripsy (ESWL) has revolutionized the management of urolithiasis since 1980. Although it has proved to be a safe, effective treatment modality, it is not free of complications. As this procedure has become more widely available, complications as a result of injury to the kidney and the surrounding organs are being increasingly recognized. Those reported complications include hepatic hematoma, biliary obstruction, pancreatitis, colonic and splenic injury, bowel perforation, psoas abscess, aortic aneurysm rupture, portal and iliac vein thrombosis, retroperitoneal and brain hemorrhage, gastric erosions, pulmonary contusions and cardiac arrhythmias. Physicians caring for these patients should be mindful of these complications and keep an eye open to spot them. We report here on a case of a young male patient who developed splenic rupture and a pancreatic pseudocyst after undergoing extracorporeal shock wave lithotripsy (ESWL) for treating a left upper ureter stone.
Aortic Aneurysm ; Arrhythmias, Cardiac ; Colon ; Contusions ; Eye ; Hematoma ; Humans ; Iliac Vein ; Intracranial Hemorrhages ; Kidney ; Lithotripsy ; Male ; Pancreatic Pseudocyst ; Pancreatitis ; Psoas Abscess ; Rupture ; Shock ; Spleen ; Splenic Rupture ; Thrombosis ; Ureter ; Urolithiasis

PURPOSE: We wanted to evaluate the actual work patterns of residents and nurses and the effects of controlling visits by relatives on the mortality of patients and their length of stay and on the workload of the residents and nurses. METHODS: We investigated the actual workload of the residents who worked 12 hours shifts and nurses who worked 8 hours shifts in an emergency center for two weeks. We compared the mortality of the patients, the length of their stay and the work patterns between before we controlled visits by relatives and after we controlled visits by relatives. RESULTS: On the average, residents spent 407.01 minutes (56.5%) taking care of patients for a shift (720 min.) and nurses spent 305.29 minutes (63.6%) taking care of patients for a shift (480 min.). Although we controlled visits by relatives, we're unable to reduce the patient mortality and the length of their stay. Yet we were able to reduce the unnecessary repeated explanation-time, the resting time and the nurses and residents were able to better concentrate to explain to patients or their relatives. We were also able to increase the treatment time and description time, and especially for residents. Nurses spent 71.86 minutes (15.0%) to take a rest a shift, and residents spent 166.40 minutes (23.1%) resting a shift (p=0.01). CONCLUSION: To reduce unnecessary repeated explanation-time and the resting time and to allow nurses and residents to better concentrate when explaining to patients or their relatives, and also to increase the treatment and description time, controlling relatives in an emergency center is necessary.
Emergencies ; Humans ; Length of Stay

PURPOSE: The rate of volunteering by emergency residents is currently low in Korea because of the relatively high job stress. We aimed to investigate the job stress and job satisfaction of emergency residents and we wanted to identify the related factors. METHODS: Data was collected by conducting a cross-sectional mail survey. This mail was sent to 397 emergency residents in Korea. Among them, 226 persons answered the questionnaire and 220 responses were analyzed, with excluding 6 incomplete answers. RESULTS: Age, gender, the marriage status and the type of training hospital showed no statistically significant differences in relation to job stress and job satisfaction. XXXXBut the grade of the residents, satisfaction as emergency residents, thoughts of changing their job, thoughts of leaving the emergency department, their social and economic positions and the type of work-shift showed significant differences for job stress and job satisfaction. XXX Among the job stresses, the mean scores of the job factor, the environmental factor and the reward factor were 3.45+/-0.90, 3.63 +/-0.67 and 3.55+/-0, respectively. Among job satisfaction, the mean scores of the job factor, the relationship factor and the reward factor were 3.59+/-0.67, 2.46+/-0.74 and 2.53+/-0.80, respectively CONCLUSION: The job stress of emergency residents is excessive, and especially for the environmental and reward factors, and the degree of job satisfaction is low. Management of crowding, improving the environment by changing the type of work-shift type, eradicating violence in the emergency department and adequate rewards are needed to reduce this job stress. Efforts to increase the treatment capability and positively improve the relationship of residents with other medical specialists should be made to enhance emergency residents' job satisfaction.
Crowding ; Emergencies ; Humans ; Internship and Residency ; Job Satisfaction ; Korea ; Marriage ; Postal Service ; Surveys and Questionnaires ; Reward ; Specialization ; Violence

PURPOSE: There have been few studies concerned with the hiccup patients who visit the emergency department. The purpose of this study is to investigate the epidemiology and clinical characteristics of hiccup patients. METHODS: We retrospectively reviewed 60 hiccup patients who visited the emergency departments of Chungbuk National University Hospitals, Chungnam National University Hospital and Chonnam National University Hospital in Korea from January 2005 to December 2007. We categorized the patients into 2 groups of the discharged and the admitted and also into groups of patients who had different types of treatments. We compared clinical outcomes and characteristics of the groups. RESULTS: A total of 60 cases of hiccup patients visited the emergency department from January 2005 to December 2007. There was a significant difference in the recovery rate from hiccups between the discharged group and the admission group (72.4% & 100.0%, p=0.04). The 3 major drugs used for treatment were metoclopramide, chlorpromazine, and benzodiazepine. The patients showed a broad spectrum for the final diagnosis, from the benign hiccups to ischemic stroke in the pons area. CONCLUSION: In this study, the hiccup patients who visited the ED showed simple temporal signs to various severe diseases such as the ischemic stroke in the pons. These findings can be useful reference for the decision making at admission or discharge and for predicting the prognosis of the hiccup patients who visit the emergency department.
Benzodiazepines ; Chlorpromazine ; Decision Making ; Emergencies ; Hiccup ; Hospitals, University ; Humans ; Korea ; Metoclopramide ; Pons ; Prognosis ; Retrospective Studies ; Stroke

PURPOSE: This paper compares a RSS (Rapid Streptococcal Screening) detection test with a throat culture. The RSS detection kit is an easier and faster way to identify the infection of Group A beta-hemolytic streptococcus (GABHS), the most common causal agent of acute bacterial pharyngitis. We also examine the clinical symptoms that are associated with bacterial pharyngitis. METHODS: A throat culture and a RSS detection test were performed simultaneously to all 239 patients who were suspected of having acute pharyngitis, and visited the emergency department between September 1st, 2002, and June 30th, 2003. Then the values of the RSS detection test were analyzed comparatively on a chi square test. The correlation between Centor criteria clinical features and bacterial pharyngitis was examined through a logic regression test. RESULTS: Comparative analysis of the results of a throat culture and RSS detection test showed a test sensitivity of 83.6%, specificity was 97.2%, and the kappa coefficient was 0.83 (95% C.I: 0.75~0.91). This suggests that the RSS detection test is valuable statistically. CONCLUSION: The RSS detection test is more accurate than the diagnosis of bacterial pharyngitis based on clinical features. Assuming that all patients with acute pharyngitis take antibiotics, an RSS detection test reduce of unnecessary antibiotics use.
Anti-Bacterial Agents ; Emergencies ; Humans ; Logic ; Pharyngitis ; Pharynx ; Sensitivity and Specificity ; Streptococcal Infections ; Streptococcus

PURPOSE: In patients with acute neurological symptoms, brain computed tomography (CT) is usually used to exclude hemorrhagic stroke. After CT imaging, there is no rapid, effective biologic marker for differentiating between acute cerebral ischemia and other etiologies, precluding rapid triage for further evaluation. We evaluated the diagnostic value of a panel of biochemical markers. METHODS: We performed the Triage Stroke Panel (Biosite Inc., UK) test using blood samples of patients who were admitted to the emergency department with suspected acute stroke between December, 2007, and March, 2008. The TSP is represented as MMX (multimarker index) compiles from individual biomarker values, based on quantitative measurement of B-type natriuretic peptide (BNP), fibrin degradation products containing D-dimer, matrix metalloproteinase-9 (MMP-9), and S100. All patients were prospectively evaluated with imaging and laboratory tests for final diagnosis. RESULTS: Of 105 patients, 51.4% had ischemic stroke and 48.6% had non-ischemic, non-organic abnormalities, primarily peripheral vertigo. High levels of BNP and MMX were observed in patients with ischemic stroke (both p <0.001). Independent predictors (odds ratio with CIs are given) of ischemic stroke were: female (OR=0.1 [0.2-0.8]), hypertension (OR=5.0 [1.2-21.3]), BNP (BNP >54.7 pg/mL, OR=99.4 [8.5-1,171.0]). A model combining BNP and MMX had 92% specificity and a 91% positive predictive ratio for prediction of acute ischemic stroke. CONCLUSION: Using biomarkers may improve the differential diagnosis of ischemic stroke after initial brain CT imaging for hemorrhagic stroke, rapidly guiding further evaluation and treatment initiation in the emergency department.
Biomarkers ; Brain ; Brain Ischemia ; Diagnosis, Differential ; Emergencies ; Female ; Fibrin Fibrinogen Degradation Products ; Humans ; Hypertension ; Matrix Metalloproteinase 9 ; Natriuretic Peptide, Brain ; Prospective Studies ; Sensitivity and Specificity ; Stroke ; Triage ; Vertigo

PURPOSE: We compared diagnostic accuracy using transverse scans and combined transverse and coronal reformation images in the MDCT diagnosis of acute appendicitis. METHODS: MDCT was performed in 100 patients with acute non-traumatic abdominal pain who visited the emergency department. One half was diagnosed acute appendicitis by radiologic and histologic findings and the other half was not. Transverse scan and combined transverse and coronal reformation images were interpreted by six emergency physicians. Emergency physicians included two board physicians, two senior residents, and two junior residents. For comparison of diagnostic value, the chi-square test and cross tabs test were done. RESULTS: For all emergency physicians except one senior resident, the added coronal reformation images tended to increase the diagnostic accuracy. For board physicians, it increased the diagnostic accuracy from 81.5% to 91% (p=0.003). Senior residents increased from 82.5% to 91.5% (p=0.005), junior residents increased from 75.5% to 87% (p=0.002). The diagnostic accuracy of board physicians and senior residents were higher than junior residents for both image types. CONCLUSION: Coronal reformation images improve the accuracy of emergency physicians in the MDCT diagnosis of acute appendicitis.
Abdominal Pain ; Appendicitis ; Emergencies ; Humans

PURPOSE: In managing acutely dyspneic patients, differentiating the underlying disease rapidly is important but not easy. Although B-type natriuretic peptide (BNP) is generally accepted as a useful marker, inconclusive results require an emergency physician (EP) to have something more confirmative. We evaluate whether Tissue Doppler Echocardiography (TDE) performed by an EP can better discriminate between heart disease and lung disease than can BNP in the emergency department (ED). METHODS: For enrolled ED patients with acute dyspnea and unclear pathology, initial BNP level and TDE performed by EP were checked prospectively. The ratios of peak early diastolic transmitral blood flow velocity (E) versus the peak early diastolic tissue velocity over mitral annulus (Ea) on TDE were recorded. The sensitivity and specificity of tissue Doppler parameters and BNP levels for diagnosing acute heart failure were calculated and we compared the discriminatory ability of the two tools. RESULTS:49 patients (39 heart failure, 10 respiratory disease) were enrolled. The area under the ROC curves for BNP and E/Ea were 0.946 and 0.888 (p<0.001) respectively. Cutoff values were 350 pg/ml for BNP (sensitivity and specificity of 82.1% and 100%) and 9.0 for E/Ea (89.2% and 100%). Especially in the group with low BNP (<350), BNP was a poor discriminator of the underlying disease, whereas E/Ea was still effective (AUC: 0.943, p=0.021). CONCLUSION: TDE by EP is a useful tool for diagnosing acute heart failure in ED and could easily and rapidly discriminate the underlying disease of acutely dyspneic patients, especially in patients with inconclusive BNP levels.
Blood Flow Velocity ; Diagnosis, Differential ; Dichlorodiphenyldichloroethane ; Dyspnea ; Echocardiography ; Echocardiography, Doppler ; Emergencies ; Heart Diseases ; Heart Failure ; Humans ; Lung Diseases ; Natriuretic Peptide, Brain ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity

PURPOSE: To evaluate the utility of ONSD (optic nerve sheath diameter) measured by US (ultrasonography) in detecting the presence of increased intracranial pressure. METHODS: This prospective study was done from October, 2007, to March, 2008. Patients who were 18 years or younger, had a recent ocular or periocular disease, had an abnormal Q test (Queckenstedtis test), or were uncooperative were excluded. The patients were divided into group A (increased CSF pressure group > or =200 mmCSF) and group B (normal CSF pressure <200 mmCSF). The ONSDs were measured using a 3~12 MHz ultrasonographic probe on the closed eyelids. We analyzed the correlation between the CSF (cerebrospinal fluid) pressure and the ONSD. RESULTS: There were 21 patients in group A and 70 patients in group B. The mean for binocular ONSDs in group A was 5.1+/-0.6 mm and 4.5+/-0.4 mm in group B (plt;0.01). The CSF pressure correlated with the ONSD (Correlation Coefficient=0.54) (plt;0.01). In the ROC curve (Receiver operating characteristic curve) for ONSD to distinguish group A from B, the AUC was 0.8 (95% confidence interval 0.7~0.9) with a sensitivity of 81.0%, and a specificity of 75.7% when the cut off value was set at 4.7 mm. CONCLUSION: The ONSD was related to the CSF pressure, with a difference in the ONSD between group A and group B. The ONSD, as measured by US, can be used to detect the presence of high ICP.
Adult ; Area Under Curve ; Eyelids ; Humans ; Intracranial Pressure ; Optic Nerve ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Telescopes

PURPOSE: High voltage electrical injuries can cause serious complications and sequelae, leading to social and economic costs. We reviewed patients with high voltage electrical injuries experienced over the last 8 years. METHODS: We retrospectively reviewed the medical records of 645 consecutive patients admitted between January, 2000, and December, 2007. We noted demographics, burn type, fasciotomy time after burn injuries, distribution classified by voltage, entrance and exit of burn injuries, type of amputation and amputation rate, associated injuries and complications, death rate, electrocardiogram, and laboratory results. RESULTS: Most injuries occurred in men (99.2%), with a mean age of 38.2+/-9.3 years. Direct contact burns were the most common (62.2%), and the mean burn extent was 14.8+/-15.9%. The right upper extremity was the most common entry point, with the left lower extremity the most common exit point. The amputation rate was 22.2%. Associated injuries and complications occurred in 62.0% of cases. CONCLUSION: This research may influence diagnosis and treatment of high-voltage injuries, reducing the associated injuries and complications. Furthermore, we should protect against high voltage electrical injuries.
Amputation ; Burns ; Demography ; Electrocardiography ; Humans ; Lower Extremity ; Male ; Medical Records ; Retrospective Studies ; Upper Extremity