BACKGROUND: This study was designed to describe the current tends of emergency tracheal intubation and predict difficult airway intubations in emergency department (ED) at a teaching hospital in Korea. METHODS: All patients who was taken endotracheal incubation in ED during a 1-year period (Mar 1997 through Feb 1998) were included in the study population. Medical records of the patients were retrospectively reviewed. Among them, 56 patients were prospectively evaluated parameters to predict difficult airway intubations. RESULTS: During the study period, a total of 413 patients(1.5%) required endotracheal intubation. Except far 2 cases, all patients intubated orotracheally, and 298(72%) patients were intubated by emergency medicine resident. Pharmacologic adjuncts were used in 200(48%) patients, the neuromuscular blocking agent(NMBA) was used in 16(3.8%) Commonly used drugs were thiopental and vecuronium. The difficult incubation was not associated with presence of denture, length and circumference of neck, and mental status. The visibility of vocal cord on laryngoscopy significantly correlated to the difficult airway. CONCLUSION: At this institution, the majority of ED incubation were performed by emergency physicians and NMBA was not routinely used. The visibility of vocal cord during the direct laryngoscopy could be a predictor of difficult incubation in ED.
Dentures ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital ; Hospitals, Teaching ; Humans ; Intubation* ; Intubation, Intratracheal ; Korea ; Laryngoscopy ; Medical Records ; Neck ; Neuromuscular Blockade ; Prospective Studies ; Retrospective Studies ; Thiopental ; Vecuronium Bromide ; Vocal Cords

BACKGROUND: Recent evidences suggest that anesthetic action within the spinal cord is important in suppressing somatic responses to painful stimuli. Intrathecal endothelin-1 (ET-1) is known to have antinociceptive effect. The purpose of this experiment was to determine whether intrathecal ET-1 may influence the minimum alveolar concentration (MAC) of isoflurane in rats and access the role of the spinal cord as the sites of anesthetic action in blocking somatic responsiveness. METHODS: In Sprague-Dawley rats fitted with an indwelling intrathecal catheter, we determined the MAC of isoflurane using a tail-clamp technique as a painful stimulus, combined with end-tidal anesthetic sampling. In experiment 1, the control MAC was determined and changes of control MAC were observed after intrathecal ET-1 (4x10-2 nmol, 4x10-3 nmol) administration. In experiment 2, we observed the effects of L or N type Ca++ channel blocker such as verapamil (50 g) or W-conotoxin (0.5 g) on the MAC after measurement of the control MAC. In experiment 3, after measurement of the control MAC, ET-1 (10-2 nmol) was administered intrathecally and the MAC was determined again. Next, intrathecal verapamil (50 g) or W-conotoxin (0.5 g) was injected. After that, the MAC was determined again. RESULTS: In experiment 1, ET-1 decreased the MAC of isoflurane and its effect was sustained over 2 hours. In experiment 2, the MAC, determined following administration of verapamil or W-conotoxin, was not different from that of the control. In experiment 3, the MAC was decreased after ET-1 administration and then increased following injection of verapamil or W-conotoxin. CONCLUSIONS: These results suggested that ET-1, in relation to calcium, might play an important role in determining the MAC of isoflurane in the spinal cord.
Animals ; Calcium ; Catheters ; Endothelin-1* ; Isoflurane* ; Rats* ; Rats, Sprague-Dawley ; Spinal Cord ; Verapamil

Significant traumatic disruption of the ligaments about the knee can occur in a child. Recently several reports have described knee ligament, injuries with open growth plates. And these reports contradict the notion that complete tears of knee ligaments occur only after growth plates have closed. The youngest patient with medial collateral ligament injury reported before was a 4-year-old boy by Joseph and Pogrund in 1978. But authors experienced a case of ruptured medial collateral ligament of the knee in a 2-year and 1-month old boy, who seemed to be youngest with the ligament injury.
Child ; Child, Preschool ; Collateral Ligaments ; Growth Plate ; Humans ; Infant, Newborn ; Knee ; Ligaments ; Male ; Rupture ; Tears

Fractures in the subtrochanteric region of the femur present more formidable problems in treatment than do other trochanteric fractures, because such severe stresses exit at the fracture site. Therefore, as a rule we prefer to treat subtrochanteric fractures by operative means if possible. Many internal fixation devices have been recommanded for use in subtrochanteric fractures and each of these devices have advantages in certain types of subtrochanteric fractures, and their selection should be based on the individual fracture anatomy. A total of 20 patients with fracture of the subtrochanteric region of the femur, who were treated by internal fixation with Judet plate between January 1982 and December 1988 have been reviewed. Our conclusions were as follows; 1. Average age was 38 years old and most common cause of injury was traffic accident. 2. Cast immobilization was done after Judet plate fixation. Partial weight bearing ambulation was enabled from POD 10 weeks and full weight bearing ambulation was enabled from POD 16 weeks. 3. 18 in 20 cases, primary bony union was happened and the mean duration of radiological bony union was 24 weeks. 4. 3 cases of complications, metal failure with refracture (2 cases) and screw loosening (1 case), were occured due to early weight bearing in the post operative course. 5. Judet plate fixation was gave satisfactory result in uncomminuted subtrochanteric fracture, especially Seinsheimer's type I, II-A,B,C or Fieldings type I, II. 6. From a consideration of these series, Judet plate showed easy to use, perfect adaptation and rigid fixation. We thought Judet plate is one of a good implants for rigid fixation of subtrochanteric fracture without severe medial cortical disruption.
Accidents, Traffic ; Clinical Study ; Femur ; Hip Fractures ; Humans ; Immobilization ; Internal Fixators ; Walking ; Weight-Bearing

PURPOSE: The purpose of this study was to analyze research trends and to suggest future directions for research on families of patients with chronic disease. METHOD: The method used was a review of 83 dissertations and articles related to these families published in Korea between 1980 and 2002. Analysis included design of the study, sources of data, interventions for experimental research and main concepts for non-experimental research. RESULT: It was found that 80.7% of the studies were non-experimental research and 85.1% of these were descriptive surveys. In 79.5% of research studies, data were collected at a hospital. Nursing interventions in the experimental studies included stress management, education, strengthening functional communication among family members and nursing management. The major concepts were family burden, family stress and coping, and family experience. CONCLUSION: It is necessary that research on the family-as-a-client be more focused and that the results of family related research be applied to the family as a unit. Development of research instruments to measure the phenomena of Korean families of patients with chronic disease is also needed.
Chronic Disease* ; Education ; Humans ; Korea ; Nursing Research* ; Nursing*

PURPOSE: This study was done to suggest policies for nurse workforce based on patient safety. METHODS: The two steps in developing the items were items related to what would be desirable policies and items on how the policies should be developed for patient safety regarding nurse workforce. A literature review was done and suggestions from experts through two rounds using the Delphi technique were outlined. The fifteen experts who participated in this study were six representatives of service consumers and nine representatives of service providers (four medical doctors and fives nurses). RESULTS: To guarantee patient safety, accreditation of nursing practice and nursing education were found to be necessary, and to prevent medical and nursing accidents in clinical practice, the professional judgement of the nurses was found to be pivotal to the provision of safe nursing services. CONCLUSION: Polices on nursing for the nurse workforce based on patient safety in clinical settings should be established to ensure that nursing care is provided according to the nurses' clinical judgements based on their professional knowledge and assessment skills.
Accreditation ; Delphi Technique* ; Education, Nursing ; Nursing ; Nursing Care ; Nursing Services ; Patient Safety*

Intravenous lidocaine has been used for attenuating cardiovascular responses to endotracheal intubation. To determine the optimal time of administration of lidocaine for attenuating hemodynamic changes induced by intubation, 100 patients were allocated randomly to a control group (without lidocaine) or four treated groups (with lidocaine). Lidocaine 1.5 mg/kg was administered intravenously at 60 (Group 2), 90 (Group 3), 120 (Group 4) and 180 seconds (Group 5) before intubation. Arterial pressure (systolic, mean and diastolic), heart rate and rate-pressure product (RPP) were measured before induction, after lidocaine injection, immediatly before intubation, immediately and 5 minutes after intubation. After intubation, arterial pressure, heart rate and RPP increased significantly in every study groups. In group 2 and 3, however, such changes were attenuated significantly, Postintubation elevation of systolic blood pressure, mean arterial pressure and RPP were effectively prevented in group 2 and 3. Lidocaine effect on diastolic pressure was observed only in group 3. Changes of heart rate were not affected with lidocaine adminiistration. In Group 4 and Group 5, this effect was not observed. In diastolic pressure, suppressive effect of lidocaine in increasing of blood pressure and RPP was observed in Group 3 significantly, but not in Group 2, Group 3 and Group 5. Changes of heart rate show that in all groups injected lidocaine (Group 2,3,4,5) significantly suppressive effect was not observed as compared with control group. These results suggest that intravenous lidocaine (1.5 mg/kg), 60-90 second prior to intubation attenuate hemodynamic responses induced by intubation.
Arterial Pressure ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Intubation, Intratracheal* ; Lidocaine*

BACKGROUND: There are only a few studies regarding the causes of treatment failure for tuberculosis. Therefore, this study aimed to determine the causes of intractable tuberculosis. METHODS: M.tuberculosis, differentiated MOTT (Tycobacterium Other Than Tuberculosis) were isolated, and the RFLP (Restriction fragments length polymorphisms) pattern was analyzed from 204 patients with pulmonary tuberculosis and 53 suffering from neck tuberculosis. The IL-1β, IL-12, *1 IFNγ and *2 TNFαblood levels were measured. All patients were regularly followed for 18 months after treatment. RESULTS: There was no correlation between the RFLP patterns of M.tuberculosis treatment failure. From the 204 cases, 31.9% were intractable. The characteristics of patients with intractable tuberculosis were old age, being male and recurrent cases. The causes of treatment failure were identified as follows ; a decrease in the IL-12(59.4%) concentration, drug resistant strain(54.7%), irregular medication(15.4%), MOTT(6.2%) and a heavy infection(4.6%). The causes of all cases of intractable tuberculosis could be investigated. The IL-12 concentration in the blood was significantly lower in the intractable cases, where it disclosed a maximum sensitivity(64.7%) and specificity(75.4%) at 165.0 pg/ml. Most of the 53 cases on neck node tuberculosis were treated successfully. Therefore, we were unable to analyze the cause of treatment failure. CONCLUSION: A decrease in the blood IL-12 concentration and drug resistant strains were identified as the most significant causes of treatment failure for tuberculosis. In Korea, infection by clusters were prevalent, but no difference in the clinical course between clusters and non-clusters could be found.
Humans ; Interleukin-12 ; Korea ; Male ; Neck* ; Polymorphism, Restriction Fragment Length ; Treatment Failure* ; Tuberculosis* ; Tuberculosis, Pulmonary

No abstract available.

When antagonism to neuromuscular block is needed, glycopyrrolate is the new anticholinergic drug emplyed to counteract the muscarinic action of neostigmine. To know the effect on heart rate after an injection of glycopyrrolate and neostigmine mixture, we observed the changes in heart rate after injection of the mixtures and changing the ratio of glycopyrrolate(0.2mg/vial) to neostigmine(0.5mg/smpul) using 2 to 1, 2 to 1.5, 1 to 1, 1.5 to 2 and 1 to 2 during halothane anesthesia. The result of this study showed that the heart rates were more stable in the group given the ratio of glycopyrrolate 1 vial(0.2mg) to neostigmine 1 ampule(0.5mg) than any other gorups.
Anesthesia ; Glycopyrrolate* ; Halothane ; Heart Rate* ; Heart* ; Neostigmine* ; Neuromuscular Blockade