BACKGROUND: Assessing and securing airway is the beginning of the treatment for emergency patients. Rapid Sequence Intubation is a technique that uses sedatives and neuromuscular blockers to perform endotracheal intubation. This is a basic technique that all emergency physicians must master. Therefore, we investigated the recent circumstance of Rapid Sequence Intubation in patients at the emergency department. METHODS: Ten-item surveys were mailed to the board certified emergency physicians in the emergency department of 45 hospitals. Among the 45 surveys, 37 surveys were returned. The rate of reply was 82.2%. RESULTS: Throughout the hospital, 35/37 of the endotracheal intubation was performed in the emergency department. Anesthesiologists were not called for endotracheal intubation in 34/37 emergency department, and anesthesiologists were not called for the use of neuromuscular blockers in 36/37 emergency departments. 35 emergency departments used sedatives. The sedatives used were as follows : midazolam(48.6%), diazepam(25.7%), thiopental sodium(22.9%), and ketamine(2.9%). 30 emergency departments used neuromuscular blockers. The neuromuscular blockers used were as fallows : succinylcholine(46.7%), vecuronium(43.3%), and pancuronium(10.0%). The rate of Rapid Sequence Intubation was 33.8%. Various monitoring devices were used during Rapid Sequence Intubation ; cardiac monitors 90.5%, pulse oximeters 80.4%, noninvasive blood pressure monitors 64.9% and ETCO2/ 12.8%. Only 6 of 37 hospitals had the assessment program far endotracheal intubations and 60% was the assessment rate in these hospitals, however, there was no proctocol for the quality assurance assessment. CONCLUSION: Emergency endotracheal intubation was performed independently by the physician of the emergency department. The Rapid Sequence Intubation was effective and had low adverse effect. We recommended that Rapid Sequence Intubation should be used more aggressively in patients. Also, applying these assessment proctocol in patients, we could improve the quality of assurance assessment.
Blood Pressure Monitors ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Hypnotics and Sedatives ; Intubation* ; Intubation, Intratracheal ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Postal Service ; Thiopental

BACKGROUND: The fast EMS helicopter was introduced to Korea in 1996 and from Dec. 1. 1997, it was used far transporting emergent patients. Authors, here upon, report the transporting experiences. METHODS: From Dec. 1, 1996 to Dec. 31,1997, Samsung Medical Centers EMS helicopter was used for air evacuation of critically ill patients. The patients data prospectively analyzed. RESULT: A total of 65 patients were transported. Male to female ratio was 1.95 : 1. The mean transport time was 64.1min(10-160 min). Majority of the evacuated patients was surgical patients (General Surgery'16, Orthopedic surgery : 10, Neurosurgery : 6, Infernal medicine 13, Pediatrics : 3, and others : 3). Twenty-one of the 65 patients transported were admitted to ICU and 31 did not require ICU care. During the air evacuation, one physician and one nurse trained for air evacuation amended The patients. No medical problems or deaths developed during the air evacuation period. CONCLUSION: The first EMS helicopter was introduced to Korea in 1996. From Dec. 1, 1996 to Dec. 31, 1997, Samsung Medical Center's EMS helicopter was used for air evacuation of critically ill patients. The patients data reported.
Aircraft* ; Critical Illness ; Emergencies* ; Female ; Humans ; Korea ; Male ; Neurosurgery ; Orthopedics ; Pediatrics ; Prospective Studies

We described 2 patients with Marchiafava-Bignami disease, a neurological disorder associated with chronic alcohol consumption. Patient 1 expressed general weakness and confusion, while patient 2 expressed dysphagia and seizures. Lesions involving the corpus callosum were identified with T2 weighted MR imaging in which there was a hyperintensity in the splenium of patient 1 and in the entire corpus callosum of patient 2. While the conditions of both patients were improved by with nutritional support, they were left with cognitive impairment.
Alcohol Drinking ; Corpus Callosum ; Deglutition Disorders ; Demyelinating Diseases ; Humans ; Magnetic Resonance Imaging ; Marchiafava-Bignami Disease* ; Nervous System Diseases ; Nutritional Support ; Seizures

No abstract available.
Adult* ; Fistula* ; Humans

Cat liver fluke (Platynosomum fastosum) was identified upon necropsy of a Felis catus (domestic cat). This trematode has not been reported in domestic cats previously in Korea. Diagnosis of this fluke was made by the presence of eggs in the feces of the cat through the fecal sedimentation method. Flukes in the gallbladder, bile duct, and liver parenchyma were revealed by the necropsy findings. This report describes as the first case of a domestic cat with Platynosomum fastosum in Korea.
Animals ; Bile Ducts ; Cats ; Eggs ; Fasciola hepatica ; Feces ; Gallbladder ; Korea ; Liver ; Ovum ; Trematoda

Cat liver fluke (Platynosomum fastosum) was identified upon necropsy of a Felis catus (domestic cat). This trematode has not been reported in domestic cats previously in Korea. Diagnosis of this fluke was made by the presence of eggs in the feces of the cat through the fecal sedimentation method. Flukes in the gallbladder, bile duct, and liver parenchyma were revealed by the necropsy findings. This report describes as the first case of a domestic cat with Platynosomum fastosum in Korea.
Animals ; Bile Ducts ; Cats ; Eggs ; Fasciola hepatica ; Feces ; Gallbladder ; Korea ; Liver ; Ovum ; Trematoda

BACKGROUND: The purpose of this study was to analyze the endotracheal intubation cases performed in the emergency department. METHODS: We investigated retrospectively 326 cases of endotracheal intubation performed in the emergency department of a tertiary care center from April 1, 1998 to March 31, 1999. We focused on operators, medications used, its success rate and immediate complications, and the relationship between its success rate and medications. RESULTS: Of 326 consecutive intubations, 193 patients(59.2%) were done by emergency medicine residents or attending physician. While 320 patients(98.2%) were successfully intubated, 6 patients could not be intubated and 2 patients underwent tracheostomy. Of 50 cases of intubations(15.3%) attempted with paralyzing agents, 48 cases were done with succinylcholine and 46 cases underwent by emergency physicians. Intubations with neuromuscular paralysis resulted in high success rates at the first attempt. Of 55 immediate adverse events were encountered in 47 patients(desaturation=17, bronchial intubation=15, hypotension=8, bradycardia=4, cardiac arrest=2, others=5). CONCLUSION: At this institution, paralyzing agents were used infrequently, but almost all of them were used by emergency physicians.
Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Humans ; Intubation ; Intubation, Intratracheal* ; Paralysis ; Retrospective Studies ; Succinylcholine ; Tertiary Care Centers* ; Tertiary Healthcare* ; Tracheostomy

BACKGROUND: Triage and transportations are important and life-saving medical task performed at the site of mutiple-casualty incidents(MCIs). We pursued three road traffic accidents victims to find out any problem in triaging and transporting them, and to provide an information for equipping an local disaster planning. METHODS: The medical records of 70 consecutive patients who were transported to five emergency facilities in Kangnung, on three MCIs from 1998 to 2000, were analysed, retrospectively. The intervals and types of transport vehicles were analysed. We compared the prehospital time between severity-based groups, which were graded into 3 groups according to the Triage score(0, 1~8, 9). RESULTS: Among the 70 patients, 33 patients(47.1%), 21 patients(30%), and 16 patients(22.9%) were transported to Level I, Level II, and Level III trauma centers, respectively. The time elapsed from scenes to the Level I trauma center was significantly shorter(p=0.003) than to others, but no differences in the mean Triage score between trauma centers were seen(p>0.05). The 119 rescue services transported 58.6%(41 patients) of victims to emergency facilities, and 58.5%(24 patients) of them was concentrated to Level I. There were no significant differences in the prehospital time between three Triage score groups(p>0.05). CONCLUSION: There was no medical control such as triage and transportation in the cases of three MCIs. In the construction of emergency medical service system(EMSS) preparing MCIs or disasters, we suggest the integration and unification of 119 rescue services and emergency medical information centers for effective medical control. We propose to making a new and simple triage guideline. The prehospital personnel should be educated and disaster drills should be performed under the guideline.
Accidents, Traffic ; Disaster Planning ; Disasters ; Emergencies ; Emergency Medical Services ; Humans ; Information Centers ; Medical Records ; Retrospective Studies ; Transportation* ; Trauma Centers ; Triage*

OBJECTIVES: In most retrospective studies, the clinical performance of restorations had not been considered in survival analysis. This study investigated the effect of including the clinically unacceptable cases according to modified United States Public Health Service (USPHS) criteria into the failed data on the survival analysis of direct restorations as to the longevity and prognostic variables. MATERIALS AND METHODS: Nine hundred and sixty-seven direct restorations were evaluated. The data of 204 retreated restorations were collected from the records, and clinical performance of 763 restorations in function was evaluated according to modified USPHS criteria by two observers. The longevity and prognostic variables of the restorations were compared with a factor of involving clinically unacceptable cases into the failures using Kaplan-Meier survival analysis and Cox proportional hazard model. RESULTS: The median survival times of amalgam, composite resin and glass ionomer were 11.8, 11.0 and 6.8 years, respectively. Glass ionomer showed significantly lower longevity than composite resin and amalgam. When clinically unacceptable restorations were included into the failure, the median survival times of them decreased to 8.9, 9.7 and 6.4 years, respectively. CONCLUSIONS: After considering the clinical performance, composite resin was the only material that showed a difference in the longevity (p < 0.05) and the significantly higher relative risk of student group than professor group disappeared in operator groups. Even in the design of retrospective study, clinical evaluation needs to be included.
Acrylic Resins ; Glass ; Humans ; Longevity ; Retrospective Studies ; Silicon Dioxide ; United States Public Health Service

The present study was designed to establish comparatively the inhibitory effects of cilnidipine (CNP), nifedipine (NIF), and omega-conotoxin GVIA (CTX) on the release of CA evoked by cholinergic stimulation and membrane depolarization from the isolated perfused model of the rat adrenal medulla. CNP (3 micrometer), NIF (3 micrometer), and CTX (3 micrometer) perfused into an adrenal vein for 60 min produced greatly inhibition in CA secretory responses evoked by ACh (5.32 x 10(-3) M), DMPP (10(-4) M for 2 min), McN-A-343 (10(-4) M for 2 min), high K+ (5.6 x 10(-2) M), Bay-K-8644 (10(-5) M), and cyclopiazonic acid (10(-5) M), respectively. For the CA release evoked by ACh and Bay-K-8644, the following rank order of potency was obtained: CNP > NIF > CTX. The rank order for the CA release evoked by McN-A-343 and cyclopiazonic acid was CNP > NIF > CTX. Also, the rank orders for high K+ and for DMPP were NIF > CTX > CNP and NIF > CNP > CTX, respectively. Taken together, these results demonstrate that all voltage-dependent Ca2+ channels (VDCCs) blockers of cilnidipine, nifedipine, and omega-conotoxin GVIA inhibit greatly the CA release evoked by stimulation of cholinergic (both nicotinic and muscarinic) receptors and the membrane depolarization without affecting the basal release from the isolated perfused rat adrenal gland. It seems likely that the inhibitory effects of cilnidipine, nifedipine, and omega-conotoxin GVIA are mediated by the blockade of both L- and N-type, L-type only, and N-type only VDCCs located on the rat adrenomedullary chromaffin cells, respectively, which are relevant to Ca2+ mobilization. It is also suggested that N-type VDCCs play an important role in the rat adrenomedullary CA secretion, in addition to L-type VDCCs.
(4-(m-Chlorophenylcarbamoyloxy)-2-butynyl)trimethylammonium Chloride ; 3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethyl-5-nitro-4-(2-(trifluoromethyl)phenyl)-, Methyl ester ; Adrenal Glands ; Adrenal Medulla* ; Animals ; Calcium Channels ; Calcium Channels, L-Type ; Calcium Channels, N-Type ; Chromaffin Cells ; Dimethylphenylpiperazinium Iodide ; Membranes ; Nifedipine* ; omega-Conotoxin GVIA* ; omega-Conotoxins* ; Rats* ; Veins