PURPOSE: As the lay public indirectly acquires medical knowledge through the mass media, it is desirable to show medically correct care in movies or TV dramas. We evaluated whether the emergency care depicted in Korean boxoffice movies is appropriate and medically sound. METHODS: We selected Korean movies which more than 100,000 peoples had seen in Seoul from 1996 to 2001. We excluded fantasy or historical movies from the list. After searching the emergency situations in videos, including cardiopulmonary arrest, loss of consciousness, injuries, and medical emergencies, we evaluated whether the needed care was provided and properly done and whether the result was medically sound. RESULTS: During the 6-year period, we found 46 emergency situations in 80 movies (0.6 per movie). Loss of consciousness was the most common emergency situation (34.8%), followed by cardiopulmonary arrest (15.7%). Emergency care was provided in 24 situations (52.2%), but was appropriate in only 8 among those 24 situations. Regardless of care, 50% improved and another 36.4% improved without any interventions. There was total of 106 necessary actions in the 46 situations: for instance, EMS system activation, airway maintenance, breathing and circulation support, spinal cord protection, and hemostasis. Only 21 among the 106 necessary actions (19.8%) were done. Hemostasis by external compression was the most common action done (44.4%), and airway maintenance was the least (3.6%). CONCLUSION: We found that emergency care and its result were not properly depicted in Korean box-office movies. Emergency physicians and the medical community should pay attention to this problem and serve as medical advisors to guarantee a medically sound portrayal.
Drama ; Emergencies* ; Emergency Medical Services* ; Emergency Treatment ; Fantasy ; Heart Arrest ; Hemostasis ; Mass Media ; Respiration ; Seoul ; Spinal Cord ; Unconsciousness

Objective: Early prediction of the multiple organ dysfunction syndrome (MODS) and providing early innovative treatment may improve outcomes in patients with severe trauma. Lactate and serum albumin levels, which are widely used markers predicting the severity of critically ill patients, tend to diverge during clinical deterioration. This study aimed to evaluate the clinical utility of the lactate/albumin ratio (LAR) as a predictive factor for MODS and 30-day mortality in patients with severe trauma. Methods: This retrospective, observational cohort study was performed with patients prospectively integrated into a critical pathway for trauma. We analyzed severe trauma patients (Injury Severity Score≥16) admitted to the emergency department (ED), between January 1, 2011, and May 31, 2017. The outcomes were the development of MODS and 30-day mortality. Results: In total, 348 patients were enrolled, of which 18 (5.2%) died within 96 hours of ED admission, and the remaining 330 patients (94.8%) were evaluated for the development of MODS. An increase in the LAR at admission (odds ratio, 1.618; P=0.028) was an independent predictor of MODS development. The area under the receiver operating characteristic curve (0.755) and Harrell's C-index (0.783) showed that LAR could predict MODS and 30-day mortality. Conclusion Initial LAR is an independent predictor of MODS development in patients with severe trauma. Our study results suggest that an elevated LAR can be a useful prognostic marker in patients with severe trauma.

The present study is aimed to assess the effect of antimicrobial photodynamic therapy (aPDT) on Streptococcus mutans biofilm through teeth whitening light emitting diode (LED).
Planktonic and dynamic biofilm state cultures of S. mutans were used. Erythrosine 20 μM/L was used as the photosensitizer. Irradiation was performed by exposing cultures to clinic and homecare whitening LEDs for 15 minutes. The viability was measured through Colony Forming Unit counts and confocal laser scanning microscopy.
aPDT using whitening LEDs and erythrosine significantly decreased the CFU count of S. mutans compared to that in the control group. Dynamic biofilm group showed more resistant features to aPDT compared with planktonic state. Clinic and homecare whitening LED device showed similar antimicrobial effect.
The whitening LED, which could irradiate the entire oral arch, showed a significant photodynamic effect on cariogenic S. mutans biofilm. aPDT mediated by erythrosine and LEDs used for teeth whitening exhibited promising antimicrobial activity.

This study is aimed to evaluate and compare the surface roughness and microbial adhesion to alkasite restorative material (Cention N), resin-modified glass ionomer (RMGI), and composite resin. And to examine the correlation between bacterial adhesion and surface roughness by different finishing systems.
Specimens were fabricated in disk shapes and divided into four groups by finishing methods (control, carbide bur, fine grit diamond bur, and white stone bur). Surface roughness was tested by atomic force microscope and surface observation was performed by scanning electron microscope. Colony forming units were measured after incubating Streptococcus mutans biofilm on specimens using CDC biofilm reactor.
Cention N surface roughness was less than 0.2 μm after finishing procedure. Control specimens of resin and Cention N specimens were significantly (p = 0.01) rougher. Pearson correlation coefficient (PCC = 0.13) indicated a weak correlation between surface roughness and S. mutans adhesion to the specimens.
Compared with resin specimens, RMGI and Cention N showed lower microbial adhesion. Surface roughness and bacterial adhesion were not significantly different, regardless of the finishing systems.

BACKGROUND: Patients who survive CPR are profoundly disabled and live with reduced quality of life. Therefore advanced directives are needed to ensure that life sustaining therapies are provided appropriately. This study compared the attitudes of elderly subjects toward advanced directives for CPR before and after receiving CPR education. METHODS: Between January and July 2007, 99 ambulatory persons aged older than 64 years were recruited from six community welfare facilities for the elderly. A questionnaire was distributed to obtain demographic data and their basic understanding and attitudes toward CPR. After providing information and showing a video clip on CPR, we compared whether having received this information influenced the thoughts of our subjects on CPR. RESULTS: None had had previous education on CPR, including prognostic information. Most overestimated the survival chance after CPR. Most wished to be resuscitated. After providing prognostic information on CPR and showing a short video clip, there was a change in their decision and the knowledge of CPR outcome seemed to influence their thoughts on CPR. In particular, the information on CPR prognosis greatly influenced their decision. CONCLUSION: Elderly people rarely have a chance to receive information regarding CPR. As a result, their decision to receive CPR may not accurately reflect the patient's wishes in emergency circumstances. It is important to pro- vide accurate prognostic information to help the elderly in their life-sustaining treatment decisions.
Advance Directives ; Aged ; Cardiopulmonary Resuscitation ; Dietary Sucrose ; Emergencies ; Humans ; Prognosis ; Quality of Life ; Surveys and Questionnaires

PURPOSE: National Emergency X-Radiography Utilization Study (NEXUS) criteria and the Canadian Cervical Spine rule (CCR) are commonly used in cervical trauma patients to determine whether a plain cervical X-ray should be performed. However, plain cervical X-rays are so inaccurate that cervical spine computed tomography (CT) is often considered as a screening test. We studied the usefulness of the NEXUS criteria and the CCR for determining the need for a CT evaluation in the emergency department (ED). METHODS: This prospective observational study was conducted from January 2007 to March 2008. Plain Xray and CT scans of the cervical spine were performed on blunt trauma patients with neck pain. The relevancy of CT was examined using the NEXUS criteria and the CCR. Sensitivity, specificity, positive predicted value, and negative predicted value analyses were performed to diagnose the cervical spine injury. RESULTS: During the study period, 284 patients were enrolled in this study. The sensitivity, specificity, positive predicted value, and negative predicted value of the NEXUS criteria were 87.5%, 1.1%, 5.0%, and 60.0% respectively, while those of the CCR were 87.5%, 8.2%, 5.3%, and 91.6%. There were two missed fracture cases when the NEXUS criteria and the CCR were applied independently, however, no cases were missed when both were applied. CONCLUSION: This study suggests the NEXUS and the CCR in combination can be used as a guide to CT evaluation for cervical spine injury in the ED.
Cervical Vertebrae ; Emergencies ; Female ; Humans ; Mass Screening ; Neck Pain ; Prospective Studies ; Resin Cements ; Sensitivity and Specificity ; Spine

PURPOSE: The purpose of this study is to find differences in the demographics of toxic exposed patients and substance between call based poison information data and hospital based poison information data. METHODS: Seoul 1339 call-response data were used as call based poison data and toxic related injury surveillance data of the Korean center for disease control and prevention (KCDC) were used as hospital based poison data. Age, sex, the kind of exposed substance, reasons for exposure, and exposure routes were compared between two data sets. We analyzed the presence or not of documentation on the name and amount of exposed substance, symptoms after exposure in call based poison data. RESULTS: Seoul1339 poison data included a total of 2260 information related to toxic exposure and KCDC poison data included 5650 poison cases. There was no difference in sexual distribution. Pediatric exposure and accidental exposure were more common in call based poison data. The most common exposed substances were household products in call based poison data and medicines in hospital based poison data, respectively. Documents regarding amount and time of toxic exposure and symptoms after toxic exposure were not recorded exactly in call based poison data. CONCLUSION: There were significant differences in age, reasons for toxic exposure, and the kinds of exposed substances. Poison information data from both pre-hospital and hospital must be considered.
Centers for Disease Control and Prevention (U.S.) ; Dataset ; Demography ; Emergency Service, Hospital* ; Hazardous Substances ; Household Products ; Humans ; Poisoning ; Seoul ; Telephone*

PURPOSE: The purpose of this study is to find differences in the demographics of toxic exposed patients and substance between call based poison information data and hospital based poison information data. METHODS: Seoul 1339 call-response data were used as call based poison data and toxic related injury surveillance data of the Korean center for disease control and prevention (KCDC) were used as hospital based poison data. Age, sex, the kind of exposed substance, reasons for exposure, and exposure routes were compared between two data sets. We analyzed the presence or not of documentation on the name and amount of exposed substance, symptoms after exposure in call based poison data. RESULTS: Seoul1339 poison data included a total of 2260 information related to toxic exposure and KCDC poison data included 5650 poison cases. There was no difference in sexual distribution. Pediatric exposure and accidental exposure were more common in call based poison data. The most common exposed substances were household products in call based poison data and medicines in hospital based poison data, respectively. Documents regarding amount and time of toxic exposure and symptoms after toxic exposure were not recorded exactly in call based poison data. CONCLUSION: There were significant differences in age, reasons for toxic exposure, and the kinds of exposed substances. Poison information data from both pre-hospital and hospital must be considered.
Centers for Disease Control and Prevention (U.S.) ; Dataset ; Demography ; Emergency Service, Hospital* ; Hazardous Substances ; Household Products ; Humans ; Poisoning ; Seoul ; Telephone*

PURPOSE: Geographic problems can make it difficult for rescue teams to access emergency patients in the mountains. We developed the aeromedical relief program in conjunction with fire department helicopter EMS teams. This study describes the clinical experience of patients transported from the mountains in this program. METHODS: We reviewed the employed protocols and the medical records of patients transported to our hospital from the mountains by the aeromedical transport system from June 2006 to June 2007. RESULTS: Thirty-one patients were transported by helicopter during the study period, most of them (84%) from Mt. Bukhan. The time interval from call for help to hospital arrival was 80+/-56 min, and rescue time alone was 30+/-24 min. Eleven patients (36%) were pronounced dead on arrival, and 11 patients were admitted for management. The number of trauma patients were 24 (77%), who had an average RTS score (excluding the 11 patients who expired before arrival) of 11.7+/-0.6. When the ground team and the aeromedical team were dispatched at the same time, the total transport time was 54.0+/-22.8 min, compared to 133.0 +/-75.7 min when the aeromedical team was dispatched only upon the request of the ground team, a large and statistically significant difference. CONCLUSION: This study suggests that the helicopter transport system can be successfully employed to achieve early access to patients in the mountains. To optimize the current program, cooperation between hospital and the regional helicopter EMS is required.
Aircraft* ; Emergencies ; Emergency Medical Services ; Fires ; Humans ; Medical Records ; Mountaineering ; Seoul*

The occurrences of subcutaneous emphysema or pneumomediastinum after a dental procedure are rare, but they are potentially life-threatening complications. These complications are reported to occur mainly in patients after dental procedures on the third molar, in particular during mandibular extractions and treatment on the right side. A 22-yearold woman visited the emergency department with neck swelling and chest pain after a right lower third molar extraction. She had a subcutaneous emphysema on the face and neck. Her chest x-ray and computed tomography of the chest showed a pneumomediastinum. She was discharged 6 days later without serious complications. Many cases of subcutaneous emphysema are of limited severity, resulting in minor, localized swelling, and require nothing more than observation and reassurance. However, early recognition of these problems is essential in preventing lifethreatening complications such as airway obstruction, mediastinitis, deep neck infection, and cardiac failure. We review the pathophysiology and clinical course of this disease.
Airway Obstruction ; Chest Pain ; Emergency Service, Hospital ; Female ; Heart Failure ; Humans ; Mediastinal Emphysema* ; Mediastinitis ; Molar, Third ; Neck ; Subcutaneous Emphysema* ; Thorax