Traumatic spinal injury causes profound changes in blood pressure, pulse rate and cardiac rhythm. Because the cardiovascular system is highly dependent on autonomic influences, acute spinal cord trauma might interfere wit h the complex mechanisms involved in cardiovascular homeostasis. These abnormalities has been generally attributed to autonomic instability. However, relatively little attention has been paid to the acute aspects of autonomic dysfunction in humans. Therefore, this study was performed retrospectively on 62 patients with acute spinal cord injuries to evaluate incidence, time course and severity for cardiovascular instability. In this study, the incidence of persistent bradycardia and hypotension in the cervical injury group was significantly higher than that of the thoracolumbar injury group. These signs occurred earlier in the cervical group than the thoracolumbar group and also lasted longer in the cervical group. This study suggests that there is a direct correlation between the level of spinal cord injury and the incidence of cardiovascular problems.
Blood Pressure ; Bradycardia ; Cardiovascular System ; Heart Rate ; Homeostasis ; Humans ; Hypotension ; Incidence ; Retrospective Studies ; Spinal Cord Injuries ; Spinal Cord* ; Spinal Injuries

PURPOSE: Standard chest compression is useful for cardiopulmonary resuscitation of victims but may be difficult to perform in a confined space if the victim is lying on his side. The aim of this study was to evaluate compression techniques administered to individuals lying in various alternative positions, and to determine which ones may be easier to perform in such situations. METHODS: Thirty two volunteers trained in basic life support (BLS) were enrolled. They were taught to do compression in four alternative positions (over-head position (OHP), saddle position (SP), upper diagonal position (UDP) and lower diagonal position (LDP)). For each position, they performed two minutes of continuous chest compression on a manikin that was connected to a Laerdal PC Skill Reporting System. They did this for the basic standard position (BSP) and four alternative positions with the positions presented randomly. The data, including the total number of compressions, the average rate of chest compressions per minute, the depth of each chest compression, and the position of the hands were recorded and analysed. RESULTS: There were no statistically significant differences between BSP and alternative positions for the total number of compressions (BSP:108.8 min-1; OHP:109.5 min-1; SP:107.8 min-1; UDP:108.5 min-1; LDP:107.7 min-1) of chest compressions. There was no statistically significant difference between BSP and alternative positions for the average depth of each compression (BSP:41.9 mm; OHP:44.4 mm; SP:41.8 mm; UDP:42.9 mm; LDP:41.1 mm), or for the number of incorrect hand positions except UDP (BSP versus UDP = 6.4 versus 32.5). p<0.054 is not normally considered significant. The p value has to be 0.050 or smaller. CONCLUSION: Chest compression in alternative positions can be equally effective as it is in the standard position. If chest compression in the standard position is not easily executable in a confined space, chest compression using an alternative positions can be used.
Cardiopulmonary Resuscitation ; Chest Wall Oscillation ; Confined Spaces ; Deception ; Hand ; Manikins ; Thorax ; Uridine Diphosphate

PURPOSE: Standard chest compression is useful for cardiopulmonary resuscitation of victims but may be difficult to perform in a confined space if the victim is lying on his side. The aim of this study was to evaluate compression techniques administered to individuals lying in various alternative positions, and to determine which ones may be easier to perform in such situations. METHODS: Thirty two volunteers trained in basic life support (BLS) were enrolled. They were taught to do compression in four alternative positions (over-head position (OHP), saddle position (SP), upper diagonal position (UDP) and lower diagonal position (LDP)). For each position, they performed two minutes of continuous chest compression on a manikin that was connected to a Laerdal PC Skill Reporting System. They did this for the basic standard position (BSP) and four alternative positions with the positions presented randomly. The data, including the total number of compressions, the average rate of chest compressions per minute, the depth of each chest compression, and the position of the hands were recorded and analysed. RESULTS: There were no statistically significant differences between BSP and alternative positions for the total number of compressions (BSP:108.8 min-1; OHP:109.5 min-1; SP:107.8 min-1; UDP:108.5 min-1; LDP:107.7 min-1) of chest compressions. There was no statistically significant difference between BSP and alternative positions for the average depth of each compression (BSP:41.9 mm; OHP:44.4 mm; SP:41.8 mm; UDP:42.9 mm; LDP:41.1 mm), or for the number of incorrect hand positions except UDP (BSP versus UDP = 6.4 versus 32.5). p<0.054 is not normally considered significant. The p value has to be 0.050 or smaller. CONCLUSION: Chest compression in alternative positions can be equally effective as it is in the standard position. If chest compression in the standard position is not easily executable in a confined space, chest compression using an alternative positions can be used.
Cardiopulmonary Resuscitation ; Chest Wall Oscillation ; Confined Spaces ; Deception ; Hand ; Manikins ; Thorax ; Uridine Diphosphate

A healthy 72-year-old male was referred to the emergency department (ED) for removal of a foreign body (FB) in the right bronchi from a local medical clinic. The FB was a dental part measuring 5×15 mm in size, which had been accidently aspirated into the lung during a dental procedure. On arrival at the ED, he only complained of mild chest discomfort, and there were no abnormal findings in on physical examination. ED physicians prepared bronchoscopic FB removal while the patient rested in bed. During the wait for bronchoscopy, the patient felt discomfort in the chest and epigastric area, and then he coughed forcefully and at the same time, epigastric thrust was performed with his fist. After several strong coughs with epigastric thrusts, the FB was expelled from his mouth. Chest roentgenogram showed no FB, and the patient was discharged from the ED with no complications. Bronchoscopy has been the only treatment option for bronchoscopic FB, and self-removal of FB is rare. This case report may be helpful to understanding a possible mechanism of self-clearance of FB in some healthy adult patients with a small-sized endobronchial FB.
Adult ; Aged ; Bronchi ; Bronchoscopy* ; Cough* ; Emergencies* ; Emergency Service, Hospital* ; Foreign Bodies* ; Humans ; Lung ; Male ; Mouth ; Physical Examination ; Thorax

PURPOSE: Serum creatinine is a late marker of acute kidney injury (AKI). We assessed the diagnostic value of plasma neutrophil gelatinase-associated lipocalin (NGAL) for predicting acute kidney injury in emergency department patients with sepsis. METHODS: This was a prospective observational study of adult sepsis patients. Plasma NGAL levels were measured upon admission to the hospital, and clinical data and serum creatinine were collected daily during the hospital stay. The primary outcome measure was the occurrence of AKI based on criteria from the Acute Kidney Injury Network (AKIN). RESULTS: A total of 178 patients were included, with 13 patients (7.3%) that developed AKI during their hospital stay; 9 and 4 were classified as AKIN stage 1 and 2, respectively. Six patients out of the 13 with AKI died. Mean plasma NGAL levels were 277 ng/mL in patients without AKI and 852 ng/mL in patients with AKI. The area under the receiver operating characteristic curve was 0.883 (95% confidence interval 0.803 to 0.964), the sensitivity was 91.7%, and the specificity was 80.5% for the prediction of AKI (using a cut-off value of 353.5 ng/mL). CONCLUSION: Plasma NGAL is a useful early marker that predicts the development of AKI in adult sepsis patients.
Acute Kidney Injury ; Adult ; Biomarkers ; Creatinine ; Emergencies ; Humans ; Length of Stay ; Lipocalins ; Neutrophils ; Outcome Assessment (Health Care) ; Plasma ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Sepsis

PURPOSE: The aim of the study is to evaluate the efficacy of initial red cell distribution width (RDW) levels in the emergency department (ED) in predicting early 28-day mortality and high risk patients for early intervention in patients with upper gastrointestinal hemorrhage (UGIB). METHODS: This is a retrospective clinical study including UGIB patients in the ED. All data were collected through electronic medical records. The two major endpoints were early 28-day mortality and high risk patients. We assessed the relationship between initial RDW level and high risk patients and 28-day mortality. RESULTS: A total of 198 patients were analyzed. There were 160 high risk patients (81.8%) and 12 non-survival patients (6.1%). The mean RDW value in high risk patients was higher than in non-risk patients (15.4+/-2.8 vs. 13.6+/-1.8%; p<0.0001). Area under curve (AUC) in Receiver-operatory characteristic (ROC) curve for RDW in high risk patients was 0.735 (95% Confidence Interval: 0.649-0.821; p<0.001) with an optimal cutoff value of 13.45% with sensitivity of 69.4% and specificity of 73.7%. The mean value of RDW in non-survivals was higher than in survivals (18.0+/- 3.3 vs. 14.9+/-2.6 %; p<0.0001). AUC for RDW in predicting 28-day mortality was 0.793 (95% CI: 0.684-0.902; p<0.001) with an optimal cutoff value of 15.95% with sensitivity of 83.3% and specificity of 71.5%. CONCLUSION: RDW level in initial state might be helpful in predicting high risk patients for early intervention and 28-day mortality in UGIB in the ED.
Area Under Curve ; Early Intervention (Education) ; Electronic Health Records ; Emergency Service, Hospital ; Erythrocyte Indices* ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Humans ; Mortality* ; Retrospective Studies ; Sensitivity and Specificity

PURPOSE: The aim of the study is to evaluate the efficacy of initial plasma D-dimer levels measured in the emergency department (ED) in prediction of early 28-day mortality and high-risk patients for early invasive treatment in patients with Non-ST elevation acute coronary syndrome (NST-ACS). METHODS: This is a retrospective clinical study of NST-ACS patients in the ED. All patients were managed according to the 2010 ACLS guidelines. EKG, cardiac markers, and D-dimer were analyzed. All data were collected via electronic medical records. The two major endpoints were 28-day mortality and high-risk patients who were defined as cases with one of the following: refractory ischemic chest discomfort, recurrent/persistent ST deviation, ventricular tachycardia, hemodynamic instability, and signs of heart failure. We assessed the relationship between initial D-dimer levels, and high-risk patients, and 28-day mortality. RESULTS: A total of 390 patients were analyzed. There were 25 high-risk patients (6.41%) and 10 non-survival cases (2.56%). The median (inter-quartile ranges) D-dimer value was higher in high-risk patients than in non-high risk patients (1.36 [0.57 to 2.30] vs. 0.31 [0.23 to 0.53] ug/dL; p<0.0001). Area under curve (AUC) in Receiver-operatory characteristic (ROC) curve for D-dimer in high-risk patients was 0.834 (95% confidence interval: 0.750-0.920) with the optimum cutoff value of 0.475ug/dL with a sensitivity of 84% and a specificity of 71%. The median value of D-dimer in non-survival cases was higher than in survival cases (1.17 [0.84 to 18.46] vs. 0.33 [0.23 to 0.56] ug/dL; p<0.0001). AUC for D-dimer in predicting 28-day mortality was 0.837 (95% CI: 0.710-0.964) with the optimum cutoff value of 0.98 ug/dL with a sensitivity of 80.0% and a specificity of 86.3%. CONCLUSION: The D-dimer level in the initial state might be helpful in predicting high-risk patients for early invasive treatment or 28-day mortality in patients with NST-ACS in the ED.
Acute Coronary Syndrome* ; Area Under Curve ; Electrocardiography ; Electronic Health Records ; Emergency Service, Hospital ; Heart Failure ; Hemodynamics ; Humans ; Mortality ; Percutaneous Coronary Intervention ; Plasma ; Retrospective Studies ; Sensitivity and Specificity ; Tachycardia, Ventricular ; Thorax

PURPOSE: Triage is the initial clinical evaluation process in a hospital emergency department (ED). The Korean Triage and Acuity Scale-based triage system (KTAS) has been developed and used in Korean EDs as a triage tool. However, there has been limited evidence of its reliability and validation in KTAS. The aim of this study was to validate KTAS by comparing the Emergency Severity Index (ESI). METHODS: This was a prospective study. All adult patients over the age of 18 years who visited our ED during the study period were included. Patients were independently triaged by a primary triage nurse using KTAS and emergency physician by ESI. The total admission rate (TAR) and length of stay (LOS) were analyzed by comparing KTAS and ESI according to acuity levels. RESULTS: A total of 2919 patients were enrolled in our study. With KTAS, 0.8%, 9.3%, 41.6%, 39.7%, and 8.6% were assigned to the levels 1, 2, 3, 4, and 5, respectively. With ESI, 1.8%, 15.7%, 38.4%, 42.5%, and 1.6% were assigned to levels 1, 2, 3, 4, and 5, respectively. The percentage of each level using KTAS was similar to using ESI. Significant consistency existed in TAR and LOS compared with KTAS and ESI. CONCLUSION: KTAS seems preferable to triaged patients according to severity. It is helpful to order of priority in utilization for ED.
Adult* ; Emergencies* ; Emergency Service, Hospital ; Humans ; Length of Stay ; Prospective Studies ; Tertiary Care Centers* ; Triage*

PURPOSE: The predisposition infection response organ failure (PIRO) score has been developed to be used in the emergency department (ED) to risk stratify sepsis case but has not been well studied domestically. The aim of this study was to compare the usefulness between the PIRO score and the mortality in emergency department sepsis (MEDS) score in predicting the mortality of septic patients admitted to the intensive care unit (ICU). METHODS: We conducted a retrospective study of patients who were suspected to have sepsis and were admitted to the ICU via the ED during a period between January 2013 and June 2015. PIRO and MEDS scores were calculated from the ED data. A comparative analysis was performed the evaluate the areas under the receiver operator characteristic (ROC) curves for 28-day mortality. RESULTS: During the 30-month period, a total of 199 patients diagnosed with sepsis were enrolled. Fifty-seven patients (28.6%) died within 28 days of presentation. The PIRO score showed increasing mortality with higher scores. The area under the ROC curve (AUC) for mortality was 0.890 (95% confidence interval [CI]=0.830 to 0.950) for PIRO and 0.705 (95% CI=0.609 to 0.801) for MEDS score. CONCLUSION: The MEDS score in the ED did not predict mortality better than PIRO score. The PIRO score was a good predictor of the outcome for patients with suspected sepsis. We believe that the PIRO score may be the most useful and appropriate clinical prediction tool for patients with suspected sepsis in the ED.
Critical Care* ; Emergencies* ; Emergency Service, Hospital* ; Hospital Mortality ; Humans ; Intensive Care Units* ; Mortality* ; Organ Dysfunction Scores* ; Prognosis* ; Retrospective Studies ; ROC Curve ; Sepsis*

PURPOSE: The aim of this study was to determine whether there are monthly and seasonal variations of incidence of subarachnoid hemorrhage (SAH) in Seoul. METHODS: We conducted a cross-sectional, retrospective study on the incidence of SAH using the National Emergency Department Information System (NEDIS) of Korea, a nationwide electronic emergency medical care database. Meteorological data (daily and monthly mean sea level air pressure, daily and monthly mean air temperature, daily temperature range) between January 2010 and December 2010 in Seoul were acquired from the Korea Meteorological Administration. The incidence of SAH in patients visiting the ED was defined as those assigned the following codes of the Korea Standard Classification of Disease, 6th Revision (KCD-6codes): I600-I609. RESULTS: The diurnal variation of the onset of SAH showed two broad peak times from 10 a.m. to 2 p.m. and from 4 p.m. to 7 p.m. There was a clear seasonal variation in the occurrence rate of SAH, which was higher in winter than in any other season. Daily temperature (mean, maximum, and minimum) and mean sea-level barometric pressure were not associated with the occurrence rates of SAH. Univariate analysis showed no significant difference between bleeding days and non-bleeding days for the number of SAH patients. In multivariate analysis, the monthly mean temperature showed significant correlation with the occurrence of SAH. CONCLUSION: This study showed seasonal variation in the onset of SAH. Conduct of further population-based study would be required in order to obtain more precise and valuable information.
Air Pressure ; Classification ; Climate* ; Emergencies ; Emergency Service, Hospital ; Epidemiology ; Hemorrhage ; Humans ; Incidence ; Information Systems ; Korea ; Multivariate Analysis ; Retrospective Studies ; Seasons* ; Seoul ; Subarachnoid Hemorrhage*