PURPOSE: This study was to explore gender differences on presenting patients with acute myocardial infarction in the emergency department. METHODS: The survey was done with 143 emergency medical charts presented to the emergency department and diagnosed with acute myocardial infarction between January 2005 and December 2006. The collected data were analyzed with frequency, chi-square, and t-test. RESULTS: Significant gender differences were apparent in age, route to the emergency department, elapsed time from onset of symptoms to arrival, and initial heart rate. Women were significantly more likely to report hypertension, diabetes, and congestive heart failure than men, but men were significantly more likely to report smoking. Chest pain was the most common initial symptom in both men and women. Women were significantly more likely to report dyspnea and nausea/vomiting than men. CONCLUSION: Although similarities exist in the associated symptoms of acute myocardial infarction, women might experience different symptoms, compared to men. These findings have implication that patients and health care providers should consider gender difference in presenting symptoms.
Chest Pain ; Dyspnea ; Emergencies ; Female ; Health Personnel ; Heart Failure ; Heart Rate ; Humans ; Hypertension ; Male ; Myocardial Infarction ; Smoke ; Smoking

PURPOSE: The purposes of this study were to investigate medical records and to develop care records for management of patients with chest pain in the emergency department. METHOD: Retrospective review of the 42 medical chart of patients presented to the emergency department with chest pain were used. The collected data were analyzed with a frequency of items in the medical records. RESULTS: In a frequency analysis of recorded items for doctors' chest pain assessment during history taking, the history/risk factors was the highest rank. The following ranks were 'commenced with when/ timing, extra symptoms, place, nature, stay/ radiate, alleviate/aggravate, intensity' in sequence. In a frequency of recorded items in nurse's progress notes according to nursing actions, the 'checking/monitoring' was the highest rank. The following ranks were 'performing, administering/injecting, referring/ arranging, testing, preparing/catheterizing, teaching/informing' in sequence. Chest pain care records for the emergency department was designed, based upon data analysis and literature review. CONCLUSION: The designed records can be a rapid and effective approach tool for assessment and recording of patients with chest pain. Further research is necessary for evaluating the designed chest pain care records.
Chest Pain* ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Medical Records* ; Nursing ; Nursing Records ; Retrospective Studies ; Statistics as Topic ; Thorax*

PURPOSE: This study was designed to evaluate diagnostic accuracy of serial electrocardiograms(ECG), myocardial band of creatinine phosphokinase(CK)(CK-MB/CK ratio) and two dimensional echocardiography(ECHO) for myocardial injury in patients with blunt chest trauma. METHODS: We prospectively investigated 54 patients(male : 38, female : 16, mean age : 41) with severe blunt chest trauma. Presence of myocardial injury was determined by increase(>0.1ug/L) of peak serum troponin T(TnT) concentration from serial mesurements. RESULTS: Among 54 patients with blunt chest trauma, 23 patients(43%) had increased peak TnT level which suggested of myocardial injury. Among 23 patients with increased TnT, abnormal ECG findings were found in 18(78%) and echocardiographic abnormalities were observed in 17(74%). Cardiovascular events in 9(39%) of 23 patients with increase Tnt. There was no cardiovascular events in patients with normal TnT. CONCLUSION: Significant proprotion of patients with blunt chest trauma had elevated TnT value which suggested of myocardial injury. We recommend echocardiagraphy and serial tracing of ECG to verify the clinical significance of elevated TnT in patients with blunt chest trauma.
Creatinine ; Diagnosis* ; Echocardiography ; Electrocardiography ; Female ; Humans ; Prospective Studies ; Thorax* ; Trinitrotoluene ; Troponin ; Troponin T

PURPOSE: This study evaluated the characteristics and the prognosis of multiple intraabdominal solid organ injuries, including those to the liver, spleen, and kidney, after blunt trauma. METHODS: From January 2001 to March 2009, 39 patients with multiple intraabdominal solid organ injuries, which had been confirmed by contrast-enhanced computed tomography after blunt trauma, were included in this retrospective study. The injury severity score (ISS), abbreviated injury scale (AIS), revised trauma score (RTS), American Association for the Surgery of Trauma (AAST) injury grade of solid organs, initial hemodynamic status, blood gas analysis, blood transfusion, and the mortality were the main outcome measurements. RESULTS: Injured groups were classified into liver/kidney (n=17), liver/spleen (n=4), spleen/kidney (n=13), and liver/kidney/spleen (n=5) groups. Patients were older in the liver/kidney group than in the liver/kidney/spleen group (43 vs 18 years, p=0.023). The initial systolic blood pressures tended to be lower in the liver/kidney group than in the other groups (84 vs 105, 112, and 114 mmHg, p=0.087). The amounts of 24-hour packed RBC transfusion were 32 units in the liver/kidney group and 4 units in the liver/kidney/spleen group, but the difference was not statistically significant. Differences were found in neither the RTS, ISS, and AIS for head, chest, abdominal, and pelvic injuries nor the AAST injury grade for solid organ, but injuries to the chest were more severe in the liver/spleen group than in the spleen/kidney group (AIS 4.0 vs 2.8, p=0.028). Conservative treatment was the most frequent applied treatment in all groups. There were 6 mortalities : 3 due to hypovolemia, 2 to sepsis, and 1 to brain injury. Mortalities occurred only in the liver/kidney group. CONCLUSION: Patients who had intraabdominal solid organ injuries of the liver and the kidney simultaneously, tended to be transfused more at an early time after trauma, to have lower initial systolic blood pressures, and to have a higher mortality.
Abbreviated Injury Scale ; Abdomen ; Blood Gas Analysis ; Blood Transfusion ; Brain Injuries ; Head ; Hemodynamics ; Humans ; Hypovolemia ; Injury Severity Score ; Kidney ; Liver ; Multiple Trauma ; Prognosis ; Retrospective Studies ; Sepsis ; Spleen ; Thorax ; Wounds, Nonpenetrating

PURPOSE: The aim of this study was to analyze the characteristics and prognosis of intraperitoneal and retroperitoneal solid organ injuries after trauma. METHODS: We analyzed computed tomography (CT) data for 232 patients who had injury to solid abdominal organs between January 2002 and June 2009. The patients who had solid organ injury on CT were categorized into intraperitoneal, retroperitoneal and intra/retroperitoneal injury groups. Medical records were reviewed retrospectively, and data regarding the sex and age of patients, mechanism of injury, initial hemodynamic status, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission rate to intensive care unit (ICU), and mortality were collected and analyzed. Injury severity of solid organs was classified according to the American Association for the Surgery of Trauma (AAST) grading system. RESULTS: The intraperitoneal injury group had 131 patients, the retroperitoneal injury group 49 patients, and the intra/retroperitoneal injury group 52 patients. The intra/retroperitoneal injury group exhibited low blood pressure, a large number of packed red blood cells that were transfused, and high ISS and abdominal AIS. They tended to stay longer in the ICU and showed a higher mortality. Conservative management was the most common therapeutic modality for all 3 groups. CONCLUSION: The intra/retroperitoneal injury group showed higher fall for the mecahnism of injury, a lower initial blood pressure and a larger number of packed red blood cells that were transfused compared with the other groups. Therefore, physicians should rapidly identify those with a poor prognosis at initial presentation and make a decision quickly when they are caring for intra/retroperitoneal injury patients.
Abbreviated Injury Scale ; Abdominal Injuries ; Blood Pressure ; Erythrocytes ; Hemodynamics ; Humans ; Hypotension ; Injury Severity Score ; Intensive Care Units ; Medical Records ; Multiple Trauma ; Peritoneal Cavity ; Prognosis ; Retroperitoneal Space ; Retrospective Studies

PURPOSE: This study analyzed the characteristics of stable pelvic bone fractures with intra-abdominal solid organ injury. METHODS: Medical records were retrospectively reviewed from January 2000 to December 2009 of patients with stable pelvic bone fractures. A stable pelvic bone fracture according to Young's classification is defined as a lateral compression type I and antero-posterior compression type I. Subjects were divided into two groups, one with (injured group) and one without (non-injured group) intra-abdominal solid organ injury, to evaluate the dependences of the characteristics on the presence of an intra-abdominal solid organ injury. Data including demographics, mechanism of injury, initial hemodynamic status, laboratory results, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission to intensive care unit (ICU), and mortality were analyzed. RESULTS: The subjects were 128 patients with a mean age of 42 years old, of whom were 67 male patients (52.3%). The injured group had 21 patients(16.4%), and the most frequent injured solid organ was the liver. Traffic accident was the most common mechanism of injury and lateral compression was the most common type of fracture in all groups. Initial systolic blood pressure was lower in the injured group, and the ISS was greater in the injured group. Arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. Transfused packed red blood cells within 24 hours were 8 patients(38.1%) in the injured group and 11 patients(10.3%) in the non-injured group. Conservative treatment was the most common therapeutic modality in all groups. Stay in the ICU was longer in the injured group, and three mortalities occurred. CONCLUSION: There is a need to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with stable pelvic bone fractures and for patients with stable pelvic bone fractures along with multiple associated injuries.
Abbreviated Injury Scale ; Abdominal Injuries ; Accidents, Traffic ; Blood Pressure ; Demography ; Emergencies ; Erythrocytes ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Injury Severity Score ; Intensive Care Units ; Liver ; Male ; Medical Records ; Pelvic Bones ; Retrospective Studies ; Shock

PURPOSE: This study compared the characteristics of and the prognosis for intraperitoneal and retroperitoneal/pelvic contrast extravasation, which had been confirmed by enhanced abdominal CT scan, after blunt trauma in patients who had undergone angiographic embolization. METHODS: From January 2001 to March 2009, data were retrospectively collected regarding patients who had undergone contrast extravasation (CE) on CT scanning and arterial embolization after blunt trauma. The study patient group was divided into the intraperitoneal and the retroperitoneal/pelvic groups according to the area of contrast extravasation. We reviewed the initial demographic data, the location of injury, the solid organ injury, the embolized vessel, and the clinical outcome. RESULTS: The mean age of the study subjects was 40.2+/-2.6 years old, and there were 24 male patients. The intraperitoneal group included 10 patients, and retroperitoneal/pelvic group was comprised of 17 patients. The amount of transfusion from presentation to intervention and during the first 24 hours was greater in the retroperitoneal/pelvic group than in the intraperitoneal group. The intraperitoneal group showed a higher frequency and severity of liver injury than the retroperitoneal/pelvic group. Angiography revealed that the hepatic artery (n=4) was the most frequently embolized vessel in the intraperitoneal group, while the internal iliac artery (n=6), followed by the renal artery (n=4), internal pudendal artery (n=3), and the gluteal artery (n=2), were the most frequently injured vessels in the retroperitoneal/pelvic group. CONCLUSION: In patients with intra-abdominal contrast extravasation found on CT scanning and arterial embolization after blunt trauma, the need for transfusion was less in the intra-abdominal group than in the retroperitoneal/pelvic group. Liver injury was also more frequent and severe in the intraperitoneal group than in the retroperitoneal/pelvic group.
Angiography ; Arteries ; Glycosaminoglycans ; Hepatic Artery ; Humans ; Iliac Artery ; Liver ; Male ; Prognosis ; Renal Artery ; Retrospective Studies

PURPOSE: This study was conducted to investigate the characteristics of drug induced anaphylaxis and anaphylactic shock in patients who were admitted to the emergency department. METHODS: We retrospectively collected the data on patients with drug induced anaphylaxis and who were admitted to the emergency department from January 2001 to June 2009. The study group was divided into the non-shock and shock groups according to whether the systolic blood pressure more than 90 mmHg. The initial demographic data, the causes of drug-induced anaphylaxis, the clinical manifestations, the treatment and the prognosis were reviewed for 72 patients. RESULTS: The mean age of the study subjects was 47.9+/-14.2 years old and there were 40 male patients and 32 female patients. There were 26 patients in the non-shock group and 46 in the shock group. The mean age was older in the shock group than in the non-shock group (51.5+/-15.1 vs 42.5+/-10.6, p-0.002). A history of drug allergy was more common in the shock group, but no difference was found for the comorbid chronic diseases between the two groups. Radio-contrast media was the most common cause, followed non-steroidal anti inflammatory drugs and antibiotics, but there is no difference in the causes between the two groups. The symptoms of cyanosis, syncope, sweating and dizziness were more frequently manifested in the shock group. The administration of intravenous fluid and injection of subcutaneous epinephrine at the emergency department were more frequent in the shock group than in the non-shock group. CONCLUSION: For the patients who were admitted to the emergency department with drug induced anaphylaxis, the mean age was older and the symptoms of cyanosis, syncope, sweating, dizziness were more frequent in the anaphylactic shock patients than in the non-shock group. More treatments were given at the emergency department to the anaphylactic shock patients.
Anaphylaxis ; Anti-Bacterial Agents ; Blood Pressure ; Chronic Disease ; Cyanosis ; Dizziness ; Drug Hypersensitivity ; Emergencies ; Epinephrine ; Female ; Humans ; Male ; Prognosis ; Retrospective Studies ; Shock ; Sweat ; Sweating ; Syncope

BACKGROUND: Organophosphate insecticides poisoning is one of the most common toxicologic emergencies in Korea. There have been few reports of organophosphate intoxication via parenteral route, although many reports on organophosphate intoxication by oral ingestion were present in the literature. This study aimed to validate the clinical characteristics of organophosphage intoxication according to the route of administration to the body. METHOD: Data were collected retrospectively by the review of the medical records from 49 patients with organophosphate intoxication. Severity of intoxication was classified by the Namba's Classification. Collected data were analysed and compared on the clinical features and laboratory findings between the patient intoxicated by inhalation or contact(parenteral group, n=23) and the other oral ingestion(enteral group, n=26). RESULTS: Severity class by clinical features was higher in enteral group than parenteral group. Severity class by serum cholinestetrase level was not positively correlated with severity class by clinical manifestations. Cholinesterase level tended to overestimate the severity of intoxication in parenteral group. Ventilator therapy and admission to intensive care unit were more frequently needed in enteral group than parenteral group in case that the severity class by clinical features was equal. CONCLUSION: In patients with organophosphate intoxication by parenteral route, serum cholinesterase level of the patient had disparity with clinical severity of intoxication. Considering this disparity, clinical severity should be considered as a more important indicator for treatment of organophosphate intoxication including atropinization, rather than serum cholinesterase level in patients intoxicated by parenteral route.
Cholinesterases* ; Classification ; Eating ; Emergencies ; Humans ; Inhalation ; Insecticides* ; Intensive Care Units ; Korea ; Medical Records ; Plasma* ; Poisoning ; Retrospective Studies ; Ventilators, Mechanical

BACKGROUND: Septic shock is characterized by an abnormal vascular tone that has been related to various factors. Myocardial depression can also occur in septic shock. Various experimental studies have indicated that the myocardial depression could be present early in the course of septic shock. This study aimed to assess hemodynamic characteristics according to outcome of septic shock in emergency department. METHOD: The study population comprised 20 patients admitted to our emergency department for septic shock. All patients with septic shock(prolonged hypotension, signs of tissue hypoperfusion, signs of sepsis, suspected source of infection, or documented bacteremia) had conventional serial hemodynamic evaluations in emergency department to identify early hemodynamic variables that predicted outcome. All patients were monitored with a pulmonary artery catheter and an arterial catheter. Hemodynamic measurements and oxygen profile were obtained. RESULTS: There were 9(53%) survivors and 8(47%) nonsurvivors. There were no significant differences in systolic pressure, pulse rate, mean pulmonary artery pressure, pulmonary capillary wedge pressure, systemic vascular resistance index, and pulmonary vascular resistance index between survivors and nonsurvivors at initial hemodynamic value. However, significant differences were found in cardiac index(4.3+/-0.5 vs. 2.74+/-0.7 L/min/m2), stroke volume index(44+/-10 vs. 23+/-5 ml/beat/m2), left ventricular stroke work index(39+/-11 vs. 15+/-6 gm m/m2), and right ventricular stroke work index(8.1+/-3.0 vs. 5.2+/-2.9 gm m/m2) between survivors and nonsurvivors at initial hemodynamic value. CONCLUSION: Survivors had better myocardial function than nonsurvivors during the early phase of septic shock. This results suggest that myocardial depression during septic shock develops in the early course of septic shock, which is associated with outcome.
Blood Pressure ; Catheters ; Depression ; Emergencies* ; Emergency Service, Hospital* ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Oxygen ; Prognosis* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Sepsis ; Shock, Septic* ; Stroke ; Stroke Volume ; Survivors ; Vascular Resistance