PURPOSE: The aim of the study was to compare the clinical characteristics in emergency endotracheal intubation procedures between non-elderly and elderly patients. METHODS: Data for airway registry, which were collected in two emergency departments (ED) between April 2006 and March 2010, were retrospectively reviewed. The airway registry data included patient's demographic information and variables such as Cormack-Lehane grade, 3-3-2 finger analysis, success rate, the number of attempts at intubation, complications of intubation, and clinical outcomes after intubation. RESULTS: A total of 1,457 patients were enrolled. The mean age of the patients was 62.2+/-15.7 and 62.1%(n=905) were male. A total of 726(49.8%) patients were classified as being in the elderly intubation group(> or =65 years). Cormack-Lehane grade, 3-3-2 finger analysis, the relationship between the number of attempts and success rate, the relationship between Cormack-Lehane classification and success rate, complications, and clinical outcomes after intubation showed no significant difference between elderly and non-elderly groups. CONCLUSION: Anatomical structures related to endotracheal intubation, the process and clinical outcomes of elderly patients are not different than for non-elderly adult patients. However, considering the lower physiologic reservoir and higher comorbidities of elderly patients, a more vigorous approach to emergency airway management in the elderly is needed.
Adult ; Aged ; Airway Management ; Comorbidity ; Emergencies ; Emergency Treatment ; Fingers ; Humans ; Intubation ; Intubation, Intratracheal ; Male ; Retrospective Studies

PURPOSE: Benign prostatic hyperplasia (BPH) frequently combines other geriatric diseases, which affect voiding in complicated manner. However, differential diagnosis of BPH attributable to voiding dysfunction in such complicated cases has been difficult. Videourodynamic study, allowing the better correlation of structure and function, have had an important position in the diagnosis of various kind of voiding dysfunction. We compared diagnostic values between traditional pressure-flow study and videourodynamic study in the evaluation of the BPH. MATERIAL AND METHODS: Forty-seven men were subjected to this study, who showed lower urinary tract symptoms (LUTS) secondary to BPH combined with other underlying diseases (cerebrovascular disease, spinal cord injury, diabetes mellitus, Parkinson's disease) which could affect the voiding pattern. Included was patients older than 50 years, with a total International Prostate Symptom Score (IPSS) of 8 points or more. All patients were evaluated with detailed history, physical examination including digital rectal examination, prostate specific antigen (PSA), transrectal ultrasonography (TRUS), and videourodynamic study. Pressure-flow study was additionally performed in 27 patients who had been diagnosed as equivocal or obstructed or unobstructed on videourodynamic findings. RESULTS: The sensitivity of videourodynamic study and pressure-flow procedures was 87% and 55%, respectively, as complete pressure-flow data are not available in 12 patients due to difficult urination by catheterization. The specificity of videourodynamic study and pressure-flow study was 76% and 100%, respectively. Videourodynamic study additionally showed uninhibited bladder contraction and/or detrusor sphincter dyssynergia (internal or external) in 65.1% of the patients, which are not available from pressure-flow study. CONCLUSIONS: To diagnose voiding dysfunction from BPH in complicated case, videourodynamic study showed advantages over pressure-flow study in terms of diagnostic sensitivity, both functional and anatomical informations on lower urinary tract. It is likely that the videourodynamic study is the method of choice for the assessment of voiding dysfunction in BPH combined with other diseases.
Ataxia ; Catheterization ; Catheters ; Diabetes Mellitus ; Diagnosis* ; Diagnosis, Differential ; Digital Rectal Examination ; Humans ; Lower Urinary Tract Symptoms ; Male ; Physical Examination ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia* ; Sensitivity and Specificity ; Spinal Diseases ; Ultrasonography ; Urinary Bladder ; Urinary Tract ; Urination

PURPOSE: Fitz-Hugh-Curtis Syndrome (FHCS) is a clinical entity characterized by inflammation of the liver capsule associated with genital tract infection. The aim of this study is to provide physicians with clinical suggestions for diagnostic approaches based on a series of patients who were diagnosed with FHCS. MATERIALS AND METHODS: We conducted a retrospective study of patients who were diagnosed with FHCS after presenting to the emergency department (ED). The symptoms, physical examinations, laboratory findings, radiological findings, and progress of the patients were reviewed. RESULTS: During the four-year study period, a total of 82 female patients received a final diagnosis of FHCS in the ED. Chlamydia trachomatis was identified as a pathogen in 89% of the patients. Their clinical characteristics and laboratory findings were described. Fifty-two patients (63.4%) were admitted to the hospital. All of the admitted patients improved after treatment combining antibiotic therapy with conservative care. CONCLUSION: FHCS should be considered as a differential diagnosis for female patients of childbearing age with right upper abdominal pain. Timely diagnosis using biphasic computed tomography (CT) with arterial and portal phases may help ensure adequate medical treatment as well as avoid invasive procedures.
Adolescent ; Adult ; Anti-Bacterial Agents/therapeutic use ; Chlamydia Infections/drug therapy/microbiology/*pathology/radiography ; Chlamydia trachomatis/pathogenicity ; Emergency Service, Hospital ; Female ; Hepatitis/drug therapy/microbiology/*pathology/radiography ; Humans ; Pelvic Inflammatory Disease/drug therapy/microbiology/*pathology/radiography ; Peritonitis/drug therapy/microbiology/*pathology/radiography ; Reproductive Tract Infections/drug therapy/microbiology/pathology/radiography ; Retrospective Studies ; Tomography, X-Ray Computed ; Young Adult

PURPOSE: To evaluate the clinical performance through the Korean Medical Licensing Examination clinical skills assessment (KMLE CSA) this survey was done. METHODS: A survey of 130 interns and residents (46 applicants and 84 non-applicants for the KMLE CSA) at a university hospital in Seoul was conducted in January and February 2012. The data were gathered using a structured and self-administered questionnaire. For the items that assessed the clinical performance of these subjects, we selected 15 items that are mostly frequently used by Delphi's technique, and difficult procedural skills based on the results of medical students' performance. We also used subcomponents of the clinical problems test of the KMLE CSA. RESULTS: The total score on the KMLE CSA improved by 1.33 points (a perfect score is 10), 1.49 points for procedural skills, and 0.84 points for clinical problems by multiple regression analysis. The variables that influenced clinical skills were sex (females had 0.86 more points than males), experience in military or public services (1.04 points higher than persons without experience), and type of school (graduates of medical school had 1.41 more points than graduates of professional graduate school). CONCLUSION: Implementation of the KMLE CSA improved the clinical performance of medical graduates.
Clinical Competence ; Humans ; Licensure ; Military Personnel ; Schools, Medical ; Surveys and Questionnaires

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.

PURPOSE: The bedside lung ultrasound in emergency (BLUE) protocol is an excellent diagnostic tool for acute respiratory failures requiring admission to the intensive care unit. We incorporated cardiac ultrasound in the BLUE algorithm because cardiac origin is also necessary to examine in an emergency setting. We studied the usefulness of the emergency department (ED)-BLUE protocol for patients complaining of dyspnea in an emergency department. METHODS: At first, we assessed lung sliding, artifacts (Alines and B-lines), alveolar consolidation and pleural effusion on stage I and II evaluation. Then, we checked heart to detect 3Es (Effusion, Equality, and Ejection fractions). We divided all the possible conditions into 10 categories. We compared it with final diagnosis and examined the agreements using kappa statistics. We compared the physician's level of confidence for the first impression. The 10 categories were: 1) normal or inconclusive, 2) pulmonary embolism, 3) airway disease (chronic obstructive pulmonary disease or asthma), 4) pneumothorax, 5) large pleural effusion, 6) alveolar consolidation, 7) acute pulmonary edema due to systolic congestive heart failure, 8) acute respiratory distress syndrome, 9) chronic interstitial lung disease with exacerbation, and 10) pericardial effusion with/without tamponade. RESULTS: This prospective study was performed for 172 patients over 18-years-of-age with dyspnea during a 25-month period. Kappa value between the diagnosis after ED-BLUE and final diagnosis was 0.812(p<0.001). The mean of physician's full term for LOC for the first impression before and after ED-BLUE was 3.09+/-0.83 and 4.36+/-0.70 (paired t-test, p<0.001). CONCLUSION: ED-BLUE protocol could help the emergency physician make an accurate diagnosis in patients with dyspnea in the emergent setting.
Artifacts ; Dyspnea ; Emergencies ; Heart ; Heart Failure ; Humans ; Intensive Care Units ; Lung ; Lung Diseases, Interstitial ; Lung Diseases, Obstructive ; Pericardial Effusion ; Pleural Effusion ; Pneumothorax ; Prospective Studies ; Pulmonary Edema ; Pulmonary Embolism ; Respiratory Distress Syndrome, Adult

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*

PURPOSE: Patient delays in seeking treatment of stroke and Emergency Department delays are major factors in preventing the use of thrombolytic therapy for stroke. For the achievement of rapid diagnosis and treatment in the emergency center, a unified and systematic confrontation of symptoms and good team cooperation are essential. METHODS: Various departments involved in the management of acute stroke in the ED conferred to discuss ways to minimize door-to-CT and door-to-drug times in the ED. This team formulated the BEST (Brain salvage through Emergent Stroke Therapy) protocol to optimize the treatment of acute stroke patients. Our study employed the BEST protocol for four month during the period from October, 2004 to February, 2005. Inclusion criteria for the protocol were admission to our Hospital's ED with an acute neurologic symptoms and an onset time of less than 12 hours. RESULTS: Ninety-six patients, including fifty-eight men were enrolled in the study. Reasons for acute neurologic changes were ischemic stroke (66 patients), hemorrhagic stroke (22 patients), and metabolic causes (8 patients). Of the 66 ischemic stroke patients, 11 received tissue plasminogen activator (tPA) and 2 were administered Intraarterial Urokinase (IAUK). Door-to-CT times before and after initiation of the BEST protocol were 47+/-19 minutes and 26+/-12 minutes, respectively (p-value=0.024). And door-to-drug times before and after the BEST protocol were 96+/-16 minutes and 67+/-28 minutes, respectively (pvalue=0.035). CONCLUSION: Assembly of a specific "stroke team"and implementation of a well-designed protocol allows the most efficient evaluation and treatment of patients with acute stroke, thus minimizing both door-to-CT and door-to-drug times.
Cerebral Infarction ; Diagnosis* ; Emergencies ; Emergency Service, Hospital ; Humans ; Male ; Medical Records ; Neurologic Manifestations* ; Stroke ; Thrombolytic Therapy ; Tissue Plasminogen Activator ; Urokinase-Type Plasminogen Activator

OBJECTIVE: It is difficult for emergency residents to attend all the lectures that are required because of the limited labor time. The Google Hangouts program for has been used as a remote videoconference to overcome the limit to provide equal opportunities and reduce the time and costs since 2015. This article reports the authors' experiences of running a residency education program using Google Hangouts. METHODS: From 2015, topics on the emergency radiology were lectured to emergency residents in three different hospitals connected by Google Hangouts. From 2017, electrocardiography analysis, emergency radiology, ventilator application, and journal review were selected for the remote videoconference. The residents' self-assessment score, and a posteducation satisfaction questionnaire were surveyed. RESULTS: Twenty-nine emergency residents responded to the questionnaire after using the Google Hangouts. The number of participants before and after Hangout increased significantly in other two hospitals. All the residents answered that the score on achieving the learning goal increased before and after the videoconference lectures. All the residents answered that the training program is more satisfactory after using the Google Hangouts than before. CONCLUSION: All emergency residents were satisfied and were more confident after the remote videoconference education using the Google Hangouts than before.
Education ; Electrocardiography ; Emergencies ; Emergency Medicine ; Internship and Residency ; Learning ; Lectures ; Running ; Self-Assessment ; Ventilators, Mechanical ; Videoconferencing

Plasmodium vivax is a typically seen infectious disease in Korea. The incidence of Plasmodium vivax malaria has been increasing in recent year despite of worldwide attempts at control. Fever, anemia, thrombocytopenia, and splenomegaly are the most common manifestations seen in Korean patient with P. vivax. Cardiac involvement is thought to be a very rare complication of malaria infection. Cardiac complication seems to be limited to acute infection with Plasmodium falcifarum. However we have experienced cardiac complication such as pericardial effusion, and complete AV block by Plasmodium vivax. Physicians should consider cardiac involvement in patient who present hypotension, fever and arrhythmia in malaria endemic area.
Anemia ; Arrhythmias, Cardiac* ; Atrioventricular Block ; Communicable Diseases ; Fever ; Humans ; Hypotension ; Incidence ; Korea ; Malaria ; Malaria, Vivax ; Pericardial Effusion* ; Plasmodium vivax* ; Plasmodium* ; Splenomegaly ; Thrombocytopenia