PURPOSE: Although, urgent intubation is commonly thought to be associated with a high complication rate and poor outcome, early intubation before deterioration and airway compromise is recommended. We designed a study to evaluate the factors associated with the mortality rate of non-traumatic patients intubated in an emergency department (ED). METHODS: Data were retrieved retrospectively from the patient registry for patients >15-years-of-age who had received ED intubation from June 1, 2007 to June 30, 2008. Patient demographic data, clinical and laboratory findings, vital signs, and specific data concerning intubation procedures were included. Acute physiologic and chronic health evaluation (APACHE) II scores were calculated for every patient. RESULTS: From the initial 241 non-traumatic ED intubated patients, 115 were excluded for out-of-hospital arrests, inadequate data, and undetected esophageal intubation. The remaining 126 patients were enrolled in this study. Sixty (47.6%) patients died during hospital treatment. From multivariate logistic regression analysis, respiratory rate and the time from ED arrival to intubation were associated with increased mortality, which showed an odds ratio (95% Cl) of 1.081 (1.026~1.141) and 1.428 (1.066~1.91), respectively. CONCLUSION: The increase in respiratory rate and the time interval of intubation from ED arrival to intubation in non-traumatic patients are related to increased in-hospital mortality.
Emergencies ; Hospital Mortality ; Humans ; Intubation ; Logistic Models ; Odds Ratio ; Respiratory Rate ; Retrospective Studies ; Time Factors ; Vital Signs

PURPOSE: "Stress-induced cardiomyopathy"or "Takotsubo cardiomyopathy", which mimics acute myocardial infarction (AMI), has recently been reported, particularly in Japan. However, little is known about the characteristics of this syndrome. We retrospectively evaluated twenty-three cases of this novel syndrome. METHODS: We analyzed twenty-three patients(7 men and 16 women) who fulfilled the following inclusion criteria: 1) age >18 years old; 2) no previous cardiac disease, especially coronary artery disease; 3) acute onset of symptoms; 4) ST segment elevation or depression and/or T-wave inversion on ECG; 5) cardiac enzyme elevation; 6) regional wall motion abnormality in the echocardiogram or left ventriculogram; 7) no significant stenosis in the coronary angiogram. RESULTS: The most common stressful conditions that preceded the chest pain were: emotional stress (n=8, 34.8%), medical illness (n=7, 30.4%), accident (n=3, 13.1%), and recovery from surgery (n=3, 13.1%). The average initial creatinine kinase MB fraction and cardiac troponin I level were 32.2+/-51.7 ng/ml and 4.11+/-19.7 ng/ml, respectively. ECG changes [ST-segment elevation or depression (n=10, 43.5%) and T-wave inversion (n=19, 82.6%)] were usually found, whereas in contrast a Q wave was rarely found (n=3, 13.4%). The average left ventricular ejection fraction (LVEF) was decreased to 43.2+/-12.2% and regional wall motion abnormality [apex only (n=11, 47.8%), global (n=7, 30.4%)] was found on the initial echocardiograms. Upon follow-up echocardiograms, the average LVEF was improved to 60.6+/-5.8% and regional wall motion abnormality was normalized in all patients. CONCLUSION: Stress-induced cardiomyopathy, mimicking AMI, is triggered by psychologically and physically stressful events. This condition is characterized by a distinctive form of systolic dysfunction and favorable outcomes with medical therapy.
Cardiomyopathies* ; Chest Pain ; Constriction, Pathologic ; Coronary Artery Disease ; Creatinine ; Depression ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Follow-Up Studies ; Heart Diseases ; Humans ; Japan ; Life Change Events ; Male ; Myocardial Infarction* ; Phosphotransferases ; Retrospective Studies* ; Stress, Psychological ; Stroke Volume ; Troponin I

PURPOSE: This study was designed to evaluate the characteristics of exertional heat stroke between the non-survival and the survival groups. METHODS: From January 1996 to December 2002, patients with exertional heat stroke who came to the emergency department of a military hospital were enrolled. Data on individual factors, atmospheric conditions, pre-hospital management, initial vital signs, laboratory findings, presence of seizure attack, and performance of intubation were reviewed retrospectively and compared between the nonsurvival and the survival groups. RESULTS: During the study period, 22 patients were diagnosed as suffering from exertional heat stroke and 5 patients died. Most of the episodes occurred during the summer days with high ambient temperature (mean 30.6+/-3.0 degrees C) and humidity (mean 75.6+/-7.7%), and 13 patients were unacclimatized recruits. The non-survival group showed a lower initial systolic blood pressure, platelet count, arterial pH, and HCO3 - level, and a higher serum creatinine, ALT, and amylase level than did the survival group (p<0.05). However there were no significant differences in individual factors, atmospheric conditions, pre-hospital management, initial pulse rate, temperature, white blood cell count, hemoglobin count, and the sodium, potassium, BUN and AST levels between the two groups. CONCLUSION: Initial systolic blood pressure, platelet count, and arterial pH, as well as HCO3 -, serum creatinine, ALT, and amylase levels seem to be important factors for the prognosis of exertional heat stroke.
Amylases ; Blood Pressure ; Creatinine ; Emergency Service, Hospital ; Heart Rate ; Heat Stroke* ; Hospitals, Military ; Hot Temperature* ; Humans ; Humidity ; Hydrogen-Ion Concentration ; Intubation ; Leukocyte Count ; Military Personnel* ; Platelet Count ; Potassium ; Prognosis ; Retrospective Studies ; Seizures ; Sodium ; Vital Signs

PURPOSE: This study was designed to prove the efficacy of neutralization with weak acid against strong alkali ingestion and to evaluate exothermic reaction of neutralization therapy. METHODS: 30 New Zealand White rabbits were anesthetized with intravenous injection of ketamine and xylazine. After gastric lavage was done, a orogastric catheter and a electric thermometer probe were inserted into stomach. And then the rabbits were divided into six groups. The first group was given 3M NaOH 16.5 mL only. The second and third groups were given 3M NaOH 16.5 mL and then 1M C H3COOH 52.14 mL one and three minutes later, respectively. The fourth and fifth groups were given tap water instead of CH3COOH, and the sixth group was given C H3COOH only. We monitored intragastric temperature continuously, compared arterial pHs before alkali infusion and 15 minutes later, measured gastric pH 15 minutes later, and examined pathologic findings of stomach after sacrificing. RESULTS: There was no significant thermal effect in all groups, and gastric pH of neutralization groups was much lower than alkali alone or dilution groups. Changes of arterial pH after 15 minutes were greater in alkali alone and dilution groups than neutralization groups. In gross and microscopic findings of stomach, only mucosal injuries were observed in neutralization groups, especially in one minute group. But all stomach layers were destroyed in alkali alone and dilution groups. CONCLUSION: Neutralization therapy never makes additional thermal injury, and has protective effects against local tissue destruction and systemic alkalemia. Dilution therapy shows little or no effects.
Alkalies* ; Catheters ; Eating* ; Gastric Lavage ; Hydrogen-Ion Concentration ; Injections, Intravenous ; Ketamine ; Rabbits ; Stomach ; Thermometers ; Water ; Xylazine

PURPOSE: In spite of its high sensitivity, the D-dimer test has a limited role in diagnosis of pulmonary thromboembolism (PTE) due to its low specificity. This study was designed to evaluate the diagnostic accuracy of an index for PTE with addition of C-reactive protein (CRP) in patients showing increased D-dimer level. METHODS: We carried out a retrospective study in a tertiary emergency department and enrolled patients who did blood sampling for D-dimer and CRP at the same time among patients suspected of PTE between December 2000 and October 2008. PTE was confirmed by imaging studies, chest computed tomography and angiography. We analyzed D-dimer and CRP levels and correlated them with PTE. RESULTS: A total of 362 patients were enrolled; 67 had PTE. Areas under the curve (AUC) of the Receiver Operating Characteristic (ROC) curve of D-dimer for PTE were smaller than those for a relative increase in the ratio of D-dimer to CRP (RDDCRP). CONCLUSION: The diagnostic accuracy of D-dimer for PTE can be increased by normalizing D-dimer levels to CRP levels.
Angiography ; C-Reactive Protein ; Emergencies ; Fibrin Fibrinogen Degradation Products ; Humans ; Pulmonary Embolism ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Thorax

PURPOSE: In clinical situations requiring the use or the sputum Gram stain test, the adequacy of specimens is often compromised by improper sample generation by patients. We designed a study to evaluate the effect of good written instruction for sputum expectoration on the outcome of sample adequacy. METHODS: Data were collected from adult patients over age 15 at a tertiary teaching hospital emergency department who had the sputum Gram stain test from October 1 to October 31, 2006. Patients were given carefully written instruction cards for sputum expectoration, together with a bottle of mineral water to gargle before expectoration. Patients' data were compared to a group of patients who visited the same ED during the same month in 2005. RESULTS: The total numbers of sputum tests were 164 in 2006 and 151 in 2005. The number and percentage of adequate specimens increased from 62(44%) in the 2005 patient group to 114(69.5%) in the 2006 patient group (p=0.000). CONCLUSION: By the simple use of properly written instructions for expectoration and of mineral water for oral gargling before sputum expectoration, the adequacy of sputum specimens for testing can be significantly improved.
Adult ; Emergencies* ; Emergency Service, Hospital* ; Hospitals, Teaching ; Humans ; Mineral Waters ; Sputum*

PURPOSE: Ethanol is the most common toxic substance encountered clinically and is becoming increasingly important in forensic medicine. Generally, pre-treatment with an alcohol disinfectant such as isopropyl alcohol for blood sampling could influence evaluations and affect legal evidence. This study was performed to determine whether isopropyl alcohol affects the serum ethanol level. METHODS: Volunteers were prohibited from drinking alcohol and taking medication for 48 hours prior to participating. Pregnant volunteers and volunteers with abnormal liver enzymes or abnormal kidney function were excluded. Enrolled subjects had their blood collected from each arm to measure the alcohol concentration, one side was disinfected with povidone iodine and the other with isopropyl alcohol. After waiting one hour, they ingested 20g of alcohol and waited. After one hour, the serum ethanol levels were measured using the same method as the first sampling. RESULTS: Ten volunteers enrolled for this study. Without the alcohol intake, all serum ethanol levels were in the nondetectable range(<3 mg/dL) for both samples with either isopropyl alcohol or povidone iodine. After drinking alcohol, the serum ethanol level varied among individuals; the mean value of the serum ethanol levels in the alcohol preparation group was 21.08+/-4.85 mg/dL, which was significantly greater than that of the povidone iodine preparation group (19.71+/-5.47 mg/dL) (p=0.006). However, the Bland-Altman analysis showed that the precision of both groups was 1.230 mg/dL, which was less than the measurement error of the equipment (3.48 mg/dL). Therefore, there was no significant difference between the two groups with regard to the measurement error. CONCLUSION: Before alcohol intake, there was no influence on the blood alcohol concentration from the alcohol disinfection, and the result was reliable. After alcohol intake, the possible influence of pre-treatment alcohol on the serum ethanol level was less than the measurement error of the equipment used.
2-Propanol ; Alcohol Drinking ; Arm ; Disinfection ; Drinking ; Ethanol ; Forensic Medicine ; Kidney ; Liver ; Povidone-Iodine

PURPOSE: This study was designed to investigate the time delay in the prehospital and inhospital course of acute ischemic stroke patients at an emergency department (ED). METHODS: We collected data from medical records retrospectively, including baseline characteristics, mode of arrival, arrival time, and neurological symptoms, from January 2006 to October 2008. Time data were also collected; from symptom onset to ED visit (prehospital delay), ED visit to brain imaging (imaging delay), and from ED visit to treatment (treatment delay). We designed multivariate Cox-regression models to predict factors influencing prehospital and ED time for ischemic stroke. RESULTS: In total, 946 ischemic stroke patients were enrolled. Diabetes mellitus was associated with a longer prehospital delay. Heart disease, hyperlipidemia, and use of an emergency medical service (EMS) were associated with a shorter prehospital delay. Female gender, night time visits, and abnormal speech were associated with a longer imaging delay. Hypertension, use of EMS, multiple symptoms, and prehospital delay within 3 hours were associated with a shorter delay. Abnormal speech was also a significant factor for a longer treatment delay. Tingling sense or numbness, multiple symptoms, and a prehospital delay within 3 hours were related to a shorter treatment delay. CONCLUSION: The time delay in the prehospital and ED course of acute ischemic stroke patients was associated with multiple factors including gender, comorbidities, use of EMS, arrival time, acute symptom onset within 3 hours, neurological symptoms, and multiple neurological symptoms.
Cerebral Infarction ; Comorbidity ; Diabetes Mellitus ; Emergencies ; Emergency Medical Services ; Female ; Heart Diseases ; Humans ; Hyperlipidemias ; Hypertension ; Hypesthesia ; Medical Records ; Neuroimaging ; Retrospective Studies ; Stroke

No abstract available.
Classification* ; Female ; Hydatidiform Mole* ; Pregnancy

PURPOSE: This study was performed to evaluate factors affecting the decision to operate in orbital fracture patients. METHODS: This study included 396 orbital fracture patients who visited an urban tertiary teaching hospital emergency room from January 1, 2002 to December 31, 2005. We reviewed medical records of the patients. Data collected included a patient's sex, age, mechanism of trauma, wall fractures, associated other facial bone fracture, visual disturbance and ocular motility disturbance. The Chi-square test, t-test were applied in order to evaluate the factors associated with the decision to operate in orbital fracture cases. Multinomial logistic regression was applied to those factors which achieved significance in Chi-square test. RESULTS: As seen in other studies, orbital fractures were frequent in young males ages 10 through 40. The most common cause of orbital fractures was violence (41.0%). In the Chi-square test, medial, lateral and inferior wall fractures; skull vault fracture; nasal septum fracture; diplopia; ocular motor dysfunction; and fractures involving more than two walls were found to be statistically significant in the decision to operate compared to other factors. Diplopia, lateral wall fracture, ocular motor dysfunction, skull vault fracture, and inferior wall fracture were confirmed by multinominal logistic regression analysis as positive predictors of a decision to operate in orbital fracture. CONCLUSION: Orbital wall fracture patient with diplopia, lateral or inferior wall fracture, ocular motor dysfunction, and skull vault fracture are likely to result in surgical intervention.
Diplopia ; Emergency Service, Hospital ; Facial Bones ; Forecasting ; Hospitals, Teaching ; Humans ; Logistic Models ; Male ; Medical Records ; Nasal Septum ; Orbit* ; Orbital Fractures* ; Patient Education as Topic ; Skull ; Violence