BACKGROUND: induction of analgesia is frequently required during undergoing reduction of fractures or dislocation in the emergency department. METHODto induce analgesia should be easy, convenient, and safe because patients are not always in fasting state. Nitrous oxide inhalation has been known as a good method of analgesia in emergency patients. PURPOSE: This study was aimed to evaluate the efficacy and safety of nitrous oxide analgesia in the emergency department. METHOD: We prospectively studied 34 patients undergone reductions of fractures in the emergency department. Nitrous-oxide was the sole source of analgesia. The Visual Analogue Scale(VAS) was rated by the emergency physician before nitrous oxide inhalation,5 minutes after inhalation and reduction procedures. RESULTS: No complication such as vomiting, respiratory depression, or a change in oxygen saturation resulted from the use of nitrous-oxide. Ninety one percent of patients obtained an analgesic effect. However, 9% of patients did not experience any analgesic effect after inhalation of nitrous oxide. In subgroup analysis for analgesic effect of nitrous-oxide, nitrous oxide provided only partial analgesia for acute pain in open fracture group. VAS was significantly lower after inhalation than before inhalation of nitrous oxide in simple fracture group. However, VAS of simple fracture group was increased during closed reductions, which indicated incomplete relief of pain by nitrous oxide. Nitrous oxide inhalation foiled to relieve pain during reduction in patients with open fracture or dislocation. CONCLUSION: Administration of nitrous-oxide, when used as the sole source of analgesia, is not the ideal method of analgesia during reduction of fractures or dislocations.
Acute Pain ; Analgesia ; Dislocations ; Emergencies* ; Emergency Service, Hospital* ; Fasting ; Fractures, Open ; Humans ; Inhalation ; Nitrous Oxide* ; Oxygen ; Prospective Studies ; Respiratory Insufficiency ; Vomiting

Transcutaneous cardiac pacing(TCP) is a rapid, safe, noninvasive and easily utilized form of emergency cardiac pacing, with hemodynamically similar to transvenous cardiac pacing. This paper reports the result of transcutaneous pacing in a series of patients in emergency department.32 patients with bradyanhythmia were enrolled during the study period. TCP was successful in 29(91%) patients. No evidence of electrical capture was seen in two patients in asystole and a patient with ventricular escape rhythm. Mean capture threshold was 66 mA. Transvenous pacemaker was inserted in 18(56%) of the 32 patients during transcutaneous cardiac pacing. Twenty(61%) of the 32 patients survived and eventually discharged. Ten patients(31%) were died of uncorrectable underlying disease in spite of successful ECG capture and palpable pulse by TCP. In conclusion, TCP is a reliable, noninvasive method that offers the possibility to initiate pacing within seconds and can be used by any emergency medical staff. In our opinion, it should be considered as the first choice of emergency treatment of hemodynamically unstable bradyarrhythmia.
Bradycardia* ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Emergency Treatment ; Heart Arrest ; Humans ; Medical Staff ; United Nations

PURPOSE: The purpose of teaching cardiopulmonary resuscitation (CPR) to laypersons is to give them the confidence and willingness to perform CPR in a real cardiac arrest, as well as the basic required knowledge and skills. However, no study has examined laypersons' confidence and willingness to act in a real, life-threatening situation. Therefore, we investigated the effects of CPR education on bystanders' confidence and attitude in performing bystander CPR. METHODS: From March to May 2008, 168 participants receiving 4 hours of CPR education were asked using a questionnaire about their confidence and willingness to perform bystander CPR before the education, after theoretical education, and after practical education. Those who answered that they wouldn't perform bystander CPR were asked for the reasons. RESULTS: Scores in confidence of bystander CPR were 50.4 +/-27.9 before the education, 64.9+/-22.5 after the theoretical education, and 79.5+/-16.1(p<0.001) after the practical education. The 'definitely yes' answer to 'willingness to perform CPR on a strange adult', increased from only 8.3% before the education to 18.5% after the theoretical education and 32.7% after the practical education (p<0.001). Among the reasons for not performing bystander CPR, 'fear of poor knowledge/performance' and 'fear of disease transmission' seemed to decrease as the education was carried on. However, the reasons 'fear of legal liability' and 'reluctance to perform mouth-to-mouth' showed no significant difference. CONCLUSION: Adequate education, including theoretical and practical CPR education, among laypersons significantly increased their confidence and willingness to perform bystander CPR.
Cardiopulmonary Resuscitation ; Heart Arrest ; Surveys and Questionnaires

OBJECTIVE: We determine the rate of an atypical glandular cells (AGC) on cervical cytology and the incidence of clinical significant lesion on subsequent follow up biopsies. In this study, we attempted to assess the clinical significance of a cytologic diagnosis of atypical glandular cells (AGC). METHODS: A total of 60,174 Pap smears were obtained between January 1st 2000 and December 31th 2005 at Ewha Womans University Mokdong Hospital. Among these smears, 26 patients had a diagnosis of AGC. Follow up was available for 23 patients (88.5%) and these patients had histologic follow up including cervical biopsy, endocervical curettage (ECC), and/or endometrial biopsy (EMB). RESULTS: Among 23 patients with AGC, eight (34.8%) were found to have a clinically significant malignant lesions on subsequent histologic follow up, including 2 endometrial adenocarcinoma cases, 1 cervical adenosquamous cell carcinoma case, 1 endocervical adenocarcinoma case, 2 vault adenocarcinoma cases, 1 MMMT case and 1 squamous cell carcinoma case. We found the differences in incidence of malignant lesions between premenopausal (23.5%) and postmenopausal (66.8%) patients with marginal significance (p=0.057). CONCLUSION: The incidence of AGC in Pap smear was 0.04%. The patients with AGC had a substantial risk of having a significant number of squamous or glandular, premalignant or malignant lesions. This study strongly suggests the need for the close follow up of patients with a diagnosis of AGC, especially in postmenopausal women.
Adenocarcinoma ; Biopsy ; Carcinoma, Squamous Cell ; Curettage ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Incidence

PURPOSE: This study was conducted in order to determine the relationship between the number of portable X-rays and the radiation exposure dose for emergency medical service providers working in the emergency department (ED). METHODS: A prospective study was conducted from February 15, 2013 to May 15, 2013 in the ED in an urban hospital. Six residents, seven emergency medical technicians (EMT), and 24 nurses were enrolled. They wore a personal radiation dosimeter on their upper chest while working in the ED, and they stayed away from the portable X-ray unit at a distance of at least 1.8 m when the X-ray beam was generated. RESULTS: The total number of portable x-rays was 2089. The average total radiation exposure dose of emergency medical service providers was 0.504+/-0.037 mSv, and it was highest in the EMT group, 0.85(0.58-1.08) mSv. The average of the total number of portable X-rays was highest in the doctor group, 728.5(657.25-809). The relationship between the number of portable X-rays and the radiation exposure dose was not statistically significant(-0.186, p=0.269). CONCLUSION: Under the condition of staying away from the portable X-ray unit at a distance of least 1.8 m, the relationship between the number of portable X-rays and the radiation exposure dose was not statistically significant.
Cohort Studies* ; Emergencies* ; Emergency Medical Services ; Emergency Medical Technicians ; Hospitals, Urban ; Humans ; Occupational Exposure ; Prospective Studies ; Radiation Dosage ; Thorax

OBJECTIVE: The aim of this study is as follows; First, to assess knowledge regarding cervical cancer, HPV and the acceptance of HPV vaccination among girls in their late teens in Seoul, Korea. Second, to find out factors affecting the acceptance of HPV vaccination. METHOD: From November to December 2006, we surveyed Ewha Womans University freshmen and third year female students of Keumran High school affiliated with Ewha Womans University. A written questionnaire was sent to 310 students and 275 students responded. The questionnaire was divided into three sections that sought information about the followings : (1) Demographic characteristics; (2) Knowledge regarding cervical Pap smear testing and cervical cancer; (3) Knowledge regarding HPV and HPV vaccines. We scored the questionnaire giving one point for each correct answer. We summed up scores of knowledge on each section and compared the scores according to the acceptance of HPV vaccination in target group. RESULTS: The mean score of knowledge regarding cervical Pap smear testing and cervical cancer, HPV and HPV vaccines were 5.31+/-1.48 and 3.11+/-2.09, respectively. None of the demographic characteristics influenced the acceptance of HPV vaccine. The level of knowledge regarding HPV and HPV vaccines significantly affected the acceptance of HPV vaccine, however, knowledge regarding cervical Pap smear testing and cervical cancer did not. CONCLUSION: This study emphasize the need for further education regarding HPV infection and HPV vaccination for improvement in HPV vaccine acceptance.
Adolescent* ; Education ; Female* ; Humans* ; Korea* ; Papillomavirus Vaccines ; Surveys and Questionnaire ; Seoul ; Uterine Cervical Neoplasms* ; Vaccination*

Cases of iatrogenic coronary artery fistulas draining into the left ventricle after surgical myectomy for hypertrophic obstructive cardiomyopathy have been published as sporadic reports. However, its management scheme and prognosis are not clear because of the low incidence. A 46-yr-old woman was hospitalized for evaluation of chest pain and shortness of breath for 3 months. Transthoracic echocardiographic examination showed typical hypertrophic obstructive cardiomyopathy with a peak pressure gradient of 71 mmHg across the left ventricular outflow tract. The patient underwent surgical septal myectomy. Postoperative color Doppler imaging revealed a diastolic blood flow from the interventricular septal myocardium to the left ventricular cavity, i.e. iatrogenic coronary artery fistula to the left ventricle. Ten days later, the fistula closed spontaneously which was diagnosed by transthoracic echocardiography and confirmed by coronary angiography.
Vascular Fistula/diagnosis/*etiology ; Middle Aged ; *Iatrogenic Disease ; Humans ; Heart Ventricles/*abnormalities ; Heart Septum/*surgery ; Female ; Coronary Vessel Anomalies/diagnosis/*etiology ; Cardiovascular Surgical Procedures/*adverse effects ; Cardiomyopathy, Hypertrophic/complications/*surgery

BACKGROUND: The purpose of this study was to identify the factors that influence mortality in organophosphate intoxication and the differences between the elderly (> or =65 years) and younger adults (18-64 years) looking at vital sign, length of admission, cholinesterase activity, complications, and prognosis. METHODS: All patients visiting one Emergency Department (ED) with organophophate intoxication between January 2000 and December 2011 were reviewed retrospectively. We divided the patients into two groups, geriatric adults (> or = 65 years) and nongeriatric adults (18-64 years). RESULTS: During the study period, 155 patients (45 patients, > or =65 years; 110 patients, 18-64 years) presented to the ED with organophosphate intoxication. Thirty-six elderly patients (80.0%) vs. 63 younger adult patients (57.3%) were intubated endotracheally, with the analysis showing a clear distinction between the two groups (p=0.026). Twenty-two elderly patients (48.9%) vs. 23 younger adult patients (20.9%) went into shock, displaying a significant gap (p=0.008). Thirtyfive elderly patients (81.4%) vs. 62 younger adult patients (59.0%) developed respiratory complications and 20 elderly patients (46.5%) vs. 19 younger adult patients (18.1%) developed central nervous system complications, with obvious differences seen in each of the comparison at (p=0.031) and (p=0.005), respectively. Comparing plasma cholinesterase levels at 1st, 3rd, 5th, 10th, 15th, and 20th days, the rate of increase was faster in the younger adults (p=0.022). CONCLUSION: With organophosphate intoxication, elderly patients tended to be intubated endotracheally, went into shock, developed central nervous system complications, were more severe, and showed a slower increase in cholinesterase level.
Adult ; Aged ; Central Nervous System ; Cholinesterases ; Emergencies ; Humans ; Mortality ; Organophosphate Poisoning ; Plasma ; Prognosis* ; Retrospective Studies ; Shock ; Vital Signs

In vivo 31P NMR spectra were obtained in eight infant brain at 4.7T. Each phosphorus metabolite and its ratio were analyzed to evaluate the brain damage and maturity, and compared with the reported data obtained at the lower field strength. Measurement of T1 relaxation time at 4.7T was done in an infant and a cat brain in vivo. PCr/Pi and PCr/β-ATP ratio were used as a marker of brain damage. PME/PDE revealed higher values than those of the reported data obtained at the lower field strength and the difference was partly attributed to the long T1 relaxation time of PME rather than the brain immaturity. Although the resolution of the spectrum was improved at 4.7T, a long repetition time is recommended to minimize T1difference of phosphorus metabolites of brain at 4.7T.
Animals ; Brain* ; Cats ; Humans ; Infant ; Magnetic Resonance Spectroscopy* ; Phosphorus ; Relaxation