The relief of acute pain is a key link in modern emergency medicine. Procedural sedation and analgesia is a necessary technique for emergency physicians. This article summarizes its application in emergency therapy.
Analgesia ; adverse effects ; instrumentation ; methods ; Emergency Medicine ; methods ; Humans

Hemodynamic monitoring is important for critically ill patients in emergency medicine. While the conventional static hemodynamic monitoring may not accurately reflect the hemodynamic status, functional hemodynamic monitoring can dynamicly and individually monitor the hemodynamic status, and thus becomes a valuable supplementation for conventional static hemodynamic monitoring. This article reviews the limitations of conventional hemodynamic monitoring and introduces the methodology of functional hemodynamic monitoring.
Emergency Medicine ; methods ; Hemodynamics ; physiology ; Humans ; Monitoring, Physiologic ; methods

Competency-Based Education ; Curriculum ; Education, Medical, Graduate ; methods ; Emergency Medicine ; education ; Humans ; Internship and Residency ; methods ; Singapore

PURPOSE: The purpose of this study was to evaluate the predictive value of the measured factors that can be used in an emergency department to assess patients with blow-out fractures (BOFs) who are expected to undergo surgical management. METHODS: This study was conducted on patients with BOFs who attended an emergency department in a tertiary teaching hospital from December 2013 to November 2016. The medical records and radiology findings, such as facial computed tomography (CT), were reviewed retrospectively. The depth of floor displacement (DFD) and cranial-caudal dimension (CCD), which were measured using facial CT, were evaluated to determine the power of the CT parameters as predictors expecting surgical management in BOF patients. Statistical analysis was conducted with SPSS statistics ver. 23.0. RESULTS: The final 44 BOF patients were included in the study. Among them, 21 patients had undergone surgery. From this study, using a threshold DFD value of 0.5 cm, the accuracy of DFD was 86.36%, and the sensitivity and specificity in predicting surgery in BOF patients was 100% and 73.91%, respectively. Using a threshold CCD value of 0.4 cm, the accuracy of CCD was 88.64%, and the sensitivity and specificity in predicting surgery in BOF patients was 100% and 78.26%, respectively. CONCLUSION: With the aid of DFD and CCD, which was measured from facial CT, BOF patients who may require surgical management can be detected easily and more promptly by emergency physicians in emergency settings.
Emergencies ; Emergency Medicine ; Emergency Service, Hospital ; Hospitals, Teaching ; Humans ; Medical Records ; Methods* ; Orbital Fractures* ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity

INTRODUCTIONSingapore experienced its second riot in 40 years on 8 December 2013, in the area known as Little India. A retrospective review of 36 casualties treated at the emergency department was conducted to evaluate injury patterns.

METHODSCharacteristics including the rate of arrival, injury severity, type and location, and disposition of the casualties were analysed.

RESULTSThe injuries were predominantly mild (97.2%), with the most common injuries involving the head (50.0%) and limbs (38.9%). 97.2% of the casualties were managed as outpatient cases.

CONCLUSIONThe majority of the injuries in this incident were mild and could be managed as outpatient cases. Important lessons were learnt from the incident about the utilisation of manpower and safety of staff in the emergency department.

Adult ; Emergency Medical Services ; Emergency Medicine ; methods ; Emergency Service, Hospital ; Female ; Humans ; Injury Severity Score ; Male ; Patient Safety ; Retrospective Studies ; Riots ; Singapore ; Triage

Adolescent ; Cardiac Surgical Procedures ; methods ; Cardiac Tamponade ; surgery ; Emergency Medicine ; methods ; Emergency Service, Hospital ; Humans ; Male ; Sternum ; surgery ; Thoracotomy ; methods ; standards

The Emergency Medicine Recipes in Local Medicinals (鄕藥救急方, Hyang'yak Kugŭpbang) (c. 14th century) is known to be one of the oldest Korean medical textbooks that exists in its entirety. This study challenges conventional perceptions that have interpreted this text by using modern concepts, and it seeks to position the medical activities of the late Koryŏ Dynasty 高麗 (918–1392) to the early Chosŏn Dynasty 朝鮮 (1392–1910) in medical history with a focus on this text. According to existing studies, Emergency Medicine Recipes in Local Medicinals is a strategic compromise of the Korean elite in response to the influx of Chinese medical texts and thus a medical text from a “periphery” of the Sinitic world. Other studies have evaluated this text as a medieval publication demonstrating stages of transition to systematic and rational medicine and, as such, a formulary book 方書 that includes primitive elements. By examining past medicine practices through “modern” concepts based on a dichotomous framework of analysis — i.e., modernity vs. tradition, center vs. periphery, science vs. culture — such conventional perceptions have relegated Emergency Medicine Recipes in Local Medicinals to the position of a transitional medieval publication meaningful only for research on hyangchal 鄕札 (Chinese character-based writing system used to record Korean during the Silla Dynasty 新羅 [57 BC–935 AD] to the Koryŏ Dynasty). It is necessary to overcome this dichotomous framework in order to understand the characteristics of East Asian medicine. As such, this study first defines “medicine 醫”, an object of research on medical history, as a “special form of problem-solving activities” and seeks to highlight the problematics and independent medical activities of the relevant actors. Through this strategy (i.e., texts as solutions to problems), this study analyzes Emergency Medicine Recipes in Local Medicinals to determine its characteristics and significance. Ultimately, this study argues that Emergency Medicine Recipes in Local Medicinals was a problem-solving method for the scholar-gentry 士人層 from the late Koryŏ Dynasty to the early Chosŏn Dynasty, who had adopted a new cultural identity, to perform certain roles on the level of medical governance and constitute medical praxis that reflected views of both the body and materials and an orientation distinguished from those of the so-called medicine of Confucian physicians 儒醫, which was the mainstream medicine of the center. Intertwined at the cultural basis of the treatments and medical recipes included in Emergency Medicine Recipes in Local Medicinals were aspects such as correlative thinking, ecological circulation of life force, transformation of materiality through contact, appropriation of analogies, and reasoning of sympathy. Because “local medicinals 鄕藥” is understood in Emergency Medicine Recipes in Local Medicinals as referring to objects easily available from one's surroundings, it signifies locality referring to the ease of acquisition in local areas rather than to the identity of the state of Koryŏ or Chosŏn. As for characteristics revealed by this text's methods of implementing medicine, Korean medicine in terms of this text consisted largely of single-ingredient formulas using diverse medicinal ingredients easily obtainable from one's surroundings rather than making use of general drugs as represented by materia medica 本草 or of multiple-ingredient formulas. In addition, accessible tools, full awareness of the procedures and processes of the guidelines, procedural rituals, and acts of emergency treatment (first aid) were more important than the study of the medical classics, moral cultivation, and coherent explanations emphasized in categorical medical texts. Though Emergency Medicine Recipes in Local Medicinals can be seen as an origin of the tradition of emergency medicine in Korea, it differs from medical texts that followed which specializing in emergency medicine to the extent that it places toxicosis 中毒 before the six climatic factors 六氣 in its classification of diseases.
Asian Continental Ancestry Group ; Ceremonial Behavior ; Classification ; Emergencies ; Emergency Medicine ; Emergency Treatment ; Far East ; Humans ; Korea ; Materia Medica ; Medicine, East Asian Traditional ; Methods ; Publications ; Thinking ; Writing

PURPOSE: Shift work is inherent to emergency medicine practice. However, the intershift handoff between emergency physicians has been identified as a high-risk area for medical errors. We evaluated the current handoff processes in an emergency department in Korea and the attitudes of emergency medicine residents toward the need for standardized guidelines. METHODS: A questionnaire survey was conducted on emergency medicine residents working in training hospitals (one resident per hospital) in Korea. The questionnaire asked about the current handoff method, whether there was a standardized handoff format, and asked residents on their experiences and opinions about the handoff practice. RESULTS: A total of 29 emergency medicine residents responded to the survey. A majority of hospitals were found to have no uniform handoff format in their emergency department (26 hospitals, 90%). In addition, only a small number of hospitals had an educational program for intershift handoff (7 hospitals, 24%). A large majority of responders (97%) reported experiencing medical errors related to handoff. CONCLUSION: There is currently a significant lack of handoff format or educational programs on intershift handoff in Korean emergency medicine training hospitals. Further research and effort for the establishment of effective standardized handoff and training programs are strongly needed.
Education ; Emergencies* ; Emergency Medicine* ; Korea* ; Medical Errors ; Methods ; Patient Handoff ; Surveys and Questionnaires

PURPOSE: This study analyzed the effects of the hospitalization decisions made by emergency physicians (EP) on the emergency department length of stay (ED-LOS). METHODS: From March 2016, the hospitalization decisions of six internal medicine departments were made by EP, which has been implemented gradually since 2015. Through a retrospective electronic record review, the ED-LOS between EP hospitalization decision departments (group A) and others (group B) was analyzed and the ED-LOS before and after the hospitalization decision method change was compared (2014 vs. 2016). RESULTS: Compared to 2014, in 2016, the ED-LOS in departments that hospitalization decision made by EP was reduced significantly (median with interquartile range; 478.0 minutes [319.0 to 900.5 minutes] vs. 259.0 minutes [177.0 to 384.0 minutes]; p < 0.001). In addition, the ED-LOS in Group A was reduced more than in Group B (219.0 minutes (45.8%) vs. 30.0 minutes (10.2%). CONCLUSION: ED-LOS can be reduced by the EP hospitalization decisions.
Emergencies* ; Emergency Service, Hospital* ; Hospitalization* ; Internal Medicine ; Length of Stay* ; Methods ; Retrospective Studies

OBJECTIVE: Tube thoracostomy (TT) is a commonly performed intensive care procedure. Simulator training may be a good alternative method for TT training, compared with conventional methods such as apprenticeship and animal skills laboratory. However, there is insufficient evidence supporting use of a simulator. The aim of this study is to determine whether training with medical simulator is associated with faster TT process, compared to conventional training without simulator. METHODS: This is a simulation study. Eligible participants were emergency medicine residents with very few (≤3 times) TT experience. Participants were randomized to two groups: the conventional training group, and the simulator training group. While the simulator training group used the simulator to train TT, the conventional training group watched the instructor performing TT on a cadaver. After training, all participants performed a TT on a cadaver. The performance quality was measured as correct placement and time delay. Subjects were graded if they had difficulty on process. RESULTS: Estimated median procedure time was 228 seconds in the conventional training group and 75 seconds in the simulator training group, with statistical significance (P=0.040). The difficulty grading did not show any significant difference among groups (overall performance scale, 2 vs. 3; P=0.094). CONCLUSION: Tube thoracostomy training with a medical simulator, when compared to no simulator training, is associated with a significantly faster procedure, when performed on a human cadaver.
Animals ; Cadaver ; Chest Tubes ; Critical Care ; Education ; Emergency Medicine ; Humans ; Methods ; Simulation Training ; Thoracostomy*