Animal bites are a common problem managed by primary physicians and often involve wound infection, neurovascular injury, poor cosmetic outcome, and high medical costs. During clinical assessment, a thorough medical history is acquired, including details of the bite circumstances and the patient's immune status and vaccination history. A meticulous physical examination should be performed in order to identify any injuries to deep structures, in addition to exploring the wound by creating a narrow opening and using diagnostic tools such as radiograph and ultrasound where necessary. Infection is the most problematic complication after a bite injury. Cleaning, irrigation, and debridement are the most important steps in preventing infection. The use of prophylactic antibiotics is controversial, but probably indicated in immunocompromised individuals and in anatomical areas that are more likely to be infected, such as the hand and foot. The decision to close a bite wound must be based on consideration of the benefit of a good cosmetic outcome and the increased risk of infection. In Korea, human rabies has not occurred since 2005, but the transmission of rabies is still a concern with animal bites. The transmission of viral hepatitis, herpes virus and human immunodeficiency virus can occur following human bites. To prevent the transmission of various viruses, healthcare providers should know the guidelines for post-bite exposure prophylaxis.
Animals ; Anti-Bacterial Agents ; Bites and Stings ; Bites, Human ; Debridement ; Foot ; Hand ; Health Personnel ; Hepatitis ; HIV ; Humans ; Immunization ; Korea ; Physical Examination ; Rabies ; Ultrasonography ; Vaccination* ; Wound Infection ; Wounds and Injuries

The survival rate of commotio cordis is low, and there is often associated neurological disability if return of spontaneous circulation (ROSC) can be achieved. We report a case of commotio cordis treated with therapeutic hypothermia (TH) that demonstrated a favorable outcome. A 16-year-old female was transferred to our emergency department (ED) for collapse after being struck in the chest with a dodgeball. She has no history of heart problems. She was brought to our ED with pulseless ventricular tachycardia (VT), and ROSC was achieved with defibrillation. She was comatose at our ED and was treated with TH at a target temperature of 33degrees C for 24 hours. After transfer to the intensive care unit, pulseless VT occurred, and defibrillation was performed twice. She recovered to baseline neurologic status with the exception of some memory difficulties.
Adolescent ; Coma ; Commotio Cordis* ; Emergency Service, Hospital ; Female ; Heart ; Humans ; Hypothermia* ; Intensive Care Units ; Memory ; Survival Rate ; Tachycardia ; Tachycardia, Ventricular* ; Thoracic Injuries ; Thorax

Background: The rate of suicide by carbon monoxide (CO) poisoning is increasing rapidly in Korea. In this study, we aimed to investigate the clinical characteristics of suicide attempters in Korea and to identify risk groups for choosing CO poisoning as a suicide method. Methods: Patients who visited the emergency department after attempting suicide between April 2017 and June 2019 were included in this study. We reviewed the medical records and evaluated the demographic and clinical data of suicide attempters. Cross-tabulation analyses and multivariable logistic regression analyses were performed. Results: Statistically significant risk groups for suicide by CO poisoning were men (odds ratios [OR], 1.71), those who were 25-44 years of age (OR, 7.35), those with no psychiatric history (OR, 2.12), and those who made a suicide plan (OR, 7.70). Among suicide attempters grouped according to psychiatric diagnoses, those with adjustment disorders were most likely and those with psychosis were least likely to choose CO poisoning as the suicide method. Conclusion To prevent a CO poisoning suicide attempt, it seems warranted to develop a tool to screen patients for suicide risk as part of a regular health checkup so that early intervention can be provided.

PURPOSE: As a first step towards reform of the emergency medical service system, we aimed to assess the current status of our emergency department triage systems and illustrated the current status and problems of the Korean emergency department triage system. METHODS: We conducted e-mail and telephone surveys of the triage officers of all 136 emergency medical centers in Korea. RESULTS: All 136 emergency departments responded to the survey. In Korea, a triage scale derived from the 'emergency symptoms based on the requirements of the Emergency Medical Service Act' is the most-used triage scale. We identified factors showing significant association with use of verified triage vs. unverified scales, including level of triage scale, type of hospital, type of emergency department, perception of problems regarding the triage scale, educational performance, and number of annual visits. CONCLUSION: Results of our survey showed that in Korea various kinds of triage scale are in use and the reliability and validity of more than half of them are unverified. Reform of the Korean national triage system is in progress and our survey findings should be helpful in guiding reorganization of the national triage systems of many countries.
Electronic Mail ; Emergencies ; Emergency Medical Services* ; Emergency Service, Hospital* ; Korea ; Patient Safety ; Reproducibility of Results ; Telephone ; Triage* ; Weights and Measures*

No study has examined the effectiveness of backboards and air deflation for achieving adequate chest compression (CC) depth on air mattresses with the typical configurations seen in intensive care units. To determine this efficacy, we measured mattress compression depth (MCD, mm) on these surfaces using dual accelerometers. Eight cardiopulmonary resuscitation providers performed CCs on manikins lying on 4 different surfaces using a visual feedback system. The surfaces were as follows: A, a bed frame; B, a deflated air mattress placed on top of a foam mattress laid on a bed frame; C, a typical air mattress configuration with an inflated air mattress placed on a foam mattress laid on a bed frame; and D, C with a backboard. Deflation of the air mattress decreased MCD significantly (B; 14.74 +/- 1.36 vs C; 30.16 +/- 3.96, P < 0.001). The use of a backboard also decreased MCD (C; 30.16 +/- 3.96 vs D; 25.46 +/- 2.89, P = 0.002). However, deflation of the air mattress decreased MCD more than use of a backboard (B; 14.74 +/- 1.36 vs D; 25.46 +/- 2.89, P = 0.002). The use of a both a backboard and a deflated air mattress in this configuration reduces MCD and thus helps achieve accurate CC depth during cardiopulmonary resuscitation.
Beds ; Cardiopulmonary Resuscitation/*instrumentation/methods ; *Compressive Strength ; Equipment Design ; Heart Massage/*instrumentation/methods ; Humans ; Intensive Care Units ; Manikins ; Prospective Studies

Sulfoxaflor is the first insecticide belonging to the sulfoximine class and is efficient against sap-feeding insects that are resistant to other insecticides. Sulfoxaflor acts as a neurotoxin to the central nervous system of insects compared with very low toxicity to mammalian. We report on a case of a 67-year-old male who ingested insecticide and received conservative treatment for mild metabolic acidosis and gastrointestinal symptoms.
Acidosis ; Aged ; Central Nervous System ; Humans ; Insecticides ; Insects ; Male ; Poisoning*

Education and training of disaster medicine are the most important part of disaster management. There are so many training and education curriculum all over the world. However education courses based upon core competencies of disaster medicine are lacking. There is still a need to define the specific knowledge, skills, and attitudes that must be mastered by specialized professionals. Standardized core competencies for acute care medical personnel such as emergency department nurses, emergency physicians, and out-of-hospital emergency medical services personnel are needed to ensure that effective emergency medical response can be provided efficiently during all types of disasters. Therefore education and training curriculum of other countries were reviewed in this article.
Curriculum ; Disaster Medicine* ; Disasters* ; Education* ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Mental Competency

BACKGROUND: This study quantitatively and qualitatively analyzed the characteristics and trends of papers published in the Journal of the Korean Geriatrics Society. METHODS: Original articles, case reports, review articles published from 2006 to 2013 were retrospectively examined. All of the article research topics, paper-specific corresponding author's affiliations and number of authors were investigated. Original articles were separated and grouped according to research designs. Using the Korean Citation Index, impact factor of this journal was examined and compared with four related journals. RESULTS: Of the 276 articles analyzed, 159 (57.6%) were original articles, 145 (91.2%) were analytic studies, and 36 (22.6%) were experimental studies. The proportion of original articles accounted for about 60% until 2007 but decreased to 41.0% in 2013. By clinical study topics, 37 studies (13.4%) addressed the understanding of geriatric diseases and 45 studies (16.3%) were focused on nervous system diseases. The median number of authors for the 276 studies was 6. Internal medicine accounted for the largest proportion of corresponding author's affiliation (109 studies, 39.5%) studies. Impact factor of the journal increased from 0.05 (4th position) in 2009 to 0.48 (3rd position) in 2011. CONCLUSION: Articles published in the Journal of the Korean Geriatrics Society increasingly included experimental studies based on evidence-centered medicine, with the proportion of original articles decreasing. The impact factor increased annually along with the journal ranking, compared with other journals. Journal of the Korean Geriatrics Society is judged to be qualitatively improving.
Bibliometrics* ; Geriatrics* ; Internal Medicine ; Nervous System Diseases ; Publications ; Research Design ; Retrospective Studies

PURPOSE: This study was conducted to assess the satisfaction, and factors influencing the satisfaction, of patients and guardians with the internal environment and safety of ambulances in Korea. METHODS: Participants were patients and guardians who were transported by public emergency medical service ambulance to an emergency medical center in June 2015. Data were collected using self-administered questionnaires. The degree of satisfaction with the ambulance was categorized as satisfaction (Likert scale 4 or 5) or dissatisfaction (Likert scale 1 or 2). The questionnaires comprised 3 categories: 1) demographics, 2) internal environment (space, light, temperature, humidity, soundproof, and odor), and 3) safety (vibration, leaning of body, and falling objects). RESULTS: Among 84 cases, 80.5% of patients and 83.7% of guardians gave positive responses regarding general satisfaction with the internal environment of the ambulance, but these percentages were lower regarding adequacy of space and light. Four factors had a statistically significantly influence on the degree of satisfaction: 1) sex of guardian regarding adequacy of space, 2) number of guardians regarding general satisfaction, 3) severity of patient regarding guardian's satisfaction with space, 4) diagnosis of patient (trauma vs non-trauma) regarding vibration during transport (all p<0.05). CONCLUSION: Overall, patients and guardians were satisfied with the internal environment and safety of ambulances except for adequacy of space and light.
Ambulances* ; Demography ; Diagnosis ; Emergencies* ; Emergency Medical Services* ; Humans ; Humidity ; Korea* ; Patient Satisfaction ; Pilot Projects* ; Vibration

In Korea, the national evaluation program for emergency medical centers (EMCs) was introduced in 2003. EMCs in Korea have three levels of emergency centers including regional emergency centers, local emergency centers, and local emergency rooms. The evaluation system assesses the performance of EMCs at all three levels. The role of both regional emergency centers and local emergency centers administer the final treatment for severe emergency patients, although the definition of severe emergency patients is unclear. These factors may aggravate crowding at the emergency department. The national evaluation system aims to reduce the length of stay in the emergency department. However, reduction of the length of stay at emergency department may cause a conflict with the administration of final treatment for critically ill emergency patients owing to a lack of in-hospital beds. Crowding of the emergency department is not a problem of EMCs but that of the health system. In 2019, the Korean Society of Emergency Medicine performed a study to improve the national evaluation program for EMC and the performance of EMC. Here, we have summarized the results.