BACKGROUND: Trauma is a major cause of death for individuals under the age of 45 years and the third leading cause of death for all ages. So, it has been recognized as an important socioeconomic problem. The purpose of this study was to evaluate the outcome of surgical care of traumatized parients. METHODS: We retrospectively analyzed data of patients who had undergone surgical operation on head, abdomen, or chest trauma from January 1, 1995 to December 31, 1995. TRISS method and W- and Z- statistics were used to evaluate the trauma outcome and the quality assurance of surgical treatment. RESULTS: Two hundred and sixty eight patients were enrolled in this study. Traffic accident in injury mechanisms was the most common(n=185, 69.2%), and severely injured patients with over ISS 16 were 205 of total 268 patients(76.5%). Crude mortality rate was 11.6% (non-survivors/number of patients : 31/268). By TRISS method, predicted mortality rate was 10.1%, excess mortality rate was 14.2%, and W value was - 1.43 indicating less actual survivors than predicted, but absolute Z score was 0.91 and it was statistically not significant. CONCLUSION: These data show that trauma outcome and quality of surgical care in our hospital is adequate. We also suggest that it will provide a valuable data for further studies.
Abdomen ; Accidents, Traffic ; Cause of Death ; Head ; Humans ; Injury Severity Score* ; Mortality ; Retrospective Studies ; Survivors ; Thorax

Basta(R) is one of the Phospho-amino acid group herbicide. It consist of glufosinate ammonium (18.5%), alkylether sulfate as surfactant (30%) and some solvents. Although it's WHO classification is Bade III, the intoxicated patient appears an serious clinical findings and have a 20% mortality rate. Nowadays, in Korea the ingestion of herbicidal agents for suicidal attempts is Sequent. The literature for intoxication of bipyridilium (Gramoxon(R)) as herbicide is varied, but the information for Basta(R) is poor even though the use of it tends to increase. Recently, We experienced six cases of Basta(R) intoxication and found that the patient expressed a gradually progressed depression of mentation, recent memory disturbances, convulsions, hypotension, or bradycardia because of CNS or cardiovascular effects of Basta(R) We report these cases with literature review.
Ammonium Compounds* ; Bradycardia ; Classification ; Depression ; Eating ; Humans ; Hypotension ; Korea ; Memory ; Mortality ; Seizures ; Solvents

BACKGROUND: The current recommendation of rescue breathing techniques in the infant is to blow both the nose and mouth of infants by caregiver's mouth but recent studies suggest some caregivers may have trouble sealing a infant's mouth and nose. The purpose of this study is to estimate the ability of mothers to create a seal to their infants for the provision of rescue breathing according to current recommendation. METHODS: Infants up to 1 year of age(n=98) and their mothers were enrolled from emergency department of Chonbuk National University Hospital. We measured the facial lengths of the infants and the width of mouth in their mothers and compared mouth widths of mothers with their infant's nose-to-mouth lengths. RESULTS: In infants between 0 to 6 months, Mother transverse lengths were significantly larger than mouth, nose and nose-to-mouth lengths of the infants. In infants between 7 to 12 months, Mother transverse lengths were significantly larger than mouth and nose lengths of the infants but there was no statistically significant difference between mother transverse lengths and nose-to-mouth lengths of infants. CONCLUSION: The finding indicate that the present recommendation to cover mouth and nose is partly not possible. We recommend that the mouth-to-nose ventilation of rescue breathing techniques for the infants who have respiratory arrest be taught to mothers.
Caregivers ; Emergency Service, Hospital ; Humans ; Infant* ; Jeollabuk-do ; Mothers ; Mouth ; Nose ; Respiration* ; Ventilation

This case was an acquired aplastic anemia patient who required a major operation for excision of a mediastinal mass. The authors previewed that the coagulation abnormalities would be developed due to major operation. Thus we decided to monitoring the coagulation function using the thromboelastography during the perioperative period and checked the complete blood count, concommitantly. The total blood volume lost during operation was 1800 ml, so we gave him a transfusion of 10 U's of platelet concentrate, 10 U's of pheretic platelet rich plasma and 5 U's of whole blood. The thromboelastography was a good guide that helped us to avoid excessive treatment of the coagulation abnormalities. We concluded that the thromboelastograhy was a reliable and effective monitoring system at the intraoperative coagulation management.
Anemia, Aplastic* ; Anesthesia, General ; Blood Cell Count ; Blood Platelets ; Blood Volume ; Humans ; Perioperative Period ; Platelet-Rich Plasma ; Thrombelastography

Paraplegia resulting from the operative treatment of scoliosis is a serious complication feared most by orthopedic surgerns. Scoliosis Research Society reported the incidence of acute neurological complications resulting from the treatment of scoliosis as 0.72% in 1975. Thus, the importance of the development of some form of adequate practical spinal cord monitoring during major corrective surgery of the spine has become increasingly recognized as the surgery in this area has accelerated. In order to reduce the incidence of such neurological complications, intraoperative spinal cord monitoring has introduced since nineteen seventies. Monitoring of cortical somatosensory evoked potentials (CSEP) were applied in surgery of 31 cases of scoliosis and 4 cases of cervical spine lesions at Department of Orthopedic Surgery at Seoul National University Hospital, from Jan. 1982 to May 1985, and the following results were obtained. 1) Quantitative analysis of CSEP was done in 31 cases of scoliosis as grouping into preincision, preinstrumentation, postinstrumentation and skin closure periods. From preincision period, P1 and N1 latencies prolonged significantly across all periods but not from preinstrumentation period to subsequent periods. P1-N1 amplitude and P2-N2 amplitude were decreased significantly between preincision period and other periods but no significant change was noted from preinstrumentation period to skin closure period. (P<0.05) 2) Abnormal CSEP findings were noted during operations in 4 cases, in which acute neurological complications were prevented with CSEP monitoring. 3) We experienced a case in which CSEP was abolished on the concave side of the curve while CSEP was normal on the convex side, during distraction. So it is considered that the ankle electrode should be placed on the concave side of scoliosis to detect neurological complication. 4) Correctibility of deformity in scoliosis surgery was increased from 44.1% to 51.3% with the use of intraoperative CSEP monitoring without acute meurological complications. 5) CSEP monitoring during spine surgery is an effective method to prevent neurological complication.
Ankle ; Congenital Abnormalities ; Electrodes ; Evoked Potentials, Somatosensory ; Incidence ; Intraoperative Complications ; Methods ; Orthopedics ; Paraplegia ; Scoliosis ; Seoul ; Skin ; Spinal Cord ; Spine

14 eyes of 11 patients with chronic angle-closure glaucoma(CACG) undergoing extracapsular cataract extraction(ECCE) with posterior chamber intraocular lens(PCIOL) implantation(group 1) and 14 eyes of 12 patients without glaucoma undergoing ECCE/PCIOL(group 2) were studied to assess the effect on anterior chamber depth, anterior chamber angle, and intraocular pressure (IOP). We measured the anterior chamber depth and angle using the EAS-1000 Scheimpflug camera. Following ECCE/PCIOL in group 1, the anterior chamber depth increased 1.00 +/- 0.25mm(p=0.0001), the anterior chamber angle widened 15.36 +/- 5.61 degrees(p=0.0001), and the postoperative IOP drop of 4.7mmHg(23.9%) showed statistical significance. Group 2 showed the increase of anterior chamber depth 0.22 +/- 0.44mm(p=0.0964), the widening of anterior chamber angle 2.51 +/- 2.65 degrees(p=0.0047), and the decrease of IOP 0.9mmHg(6.2%, p=0.0933). The effects on anterior chamber depth, anterior chamber angle, and rap were statistically significant between the two groups. Based on these results, we recommend that eyes with cataract and CACG may be considered for ECCE/PCIOL implantation as a first procedure rather than combined cataract and filtering surgery.
Anterior Chamber ; Cataract Extraction* ; Cataract* ; Filtering Surgery ; Glaucoma ; Glaucoma, Angle-Closure* ; Humans ; Intraocular Pressure

The neuroleptic malignant syndrome(NMS) results primarily from an imbalance of central neurotransmitters and typically occurs after acute or chronic neuroleptic drug use rather than after neuroleptic overdosage. It is a rare and serious iatrogenic syndrome that is characterized by hyperthermia, muscle rigidity, autonomic dysfunctions and altered mental status. We have observed a case of NMS-like state due to depot of chlorpromazine(CPZ) and have experienced symptomatic and supportive treatment, which including body surface cooling, fluid administration, diuretics, and diazepam. So, in order to provide interests with this clinical situation for emergency physician, pathophysiology is discussed with references to the possibility of NMS in our case and symptomatology and managements are also reviewed.
Chlorpromazine* ; Diazepam ; Diuretics ; Emergencies ; Fever ; Muscle Rigidity ; Neuroleptic Malignant Syndrome ; Neurotransmitter Agents

BACKGROUND: The mechanically ventilated patient's stay in the emergency department (ED) is brief but ventilatory management and intervention must be optimal. Agitation, anxiety, distress, and discomfort are common complications far the ventilated patient. So, sedation is necessary to reduce these complications. METHODS: Patients were monitored and mechanically ventilated. Midazolam was intravenously administered as loading dose(3-5mg), followed by continuous infusion at a rate of 0.06mg/kg/hr, titrated to achieve a predetermined sedation level (Ramsay's sedation score: 2-5 points, Glasgow coma score scathe : 8-11 points). RESULTS: After onset of predetermined sedation, systolic and diastolic blood pressure and heart rate remained stable during continuous infusion when compared with those of the initial state. Arterial blood gas and peak inspiratory pressure remained unchanged but respiratory rate was decreased to allowable ranges. CONCLUSION: A short-term continuous infusion of midazolam was a safe and erective method for sedation of ventilated patients in ED.
Anxiety ; Blood Pressure ; Coma ; Dihydroergotamine ; Emergency Service, Hospital ; Heart Rate ; Humans ; Midazolam* ; Respiratory Rate

The diurnal variation of introcular pressure was measured in 40 eyes of 20 healthy Koreans and in 50 eyes of 25 patients with chronic open angle glaucoma and ocular hypertension with and without levobunolol and dipivefrine. The intraocular pressure was measured every 1 hour from 8:00 o'clock by the same examiner using with Goldmann applanation tonometry. The levobunolol, a new beta-adrenoceptor antagonist effective in the long-term treatment of glaucoma and the dipivefrine, a prodrug of epinephrine which is alpha-and beta-adrenergic agonist, both decrease intraocular pressure despite of opposite pharmacologic actions. Several clinical studies have demonstrated additional effect when an epinephrine compound is added to timolol, a beta-blocker antagonist, theraphy. It is the most important issue that determination of the time of instillatiolt related to the time of maximum effec: of the drugs and the time of the highest intraocular pressure in a day in every each patient. The authors obtained the following results; 1) In the control group, the mean intraocular pressure was 15.3 +/- 1.377 mmHg, the highest was 17.3 +/- 0.924 mmHg at 10 o'clock AM and the lowest was 13.7 +/- 1.764 mmHg at 3 o'clock PM. The diurnal variation was 3.60 +/- 1.743 mmHg.(p=0.002). 2) In the patient group, the mean intracular pressure was 28.5 +/- 1.606 mmHg, the highest was 31.4 +/- 2.986 mmHg at 10 o'clock AM and the lowest was 26.1 +/- 0.836 mmHg at 4 o'clock PM. The diurnal variation was 5.31 +/- 1.101 mmHg.(p=0.0001). 2) The lowering effect of intraocular pressure by the instillation of 0.5% levabunolol and 0.1% dipivefrine was statistically significant(p=0.0001) both in the control group and patient group. In the patient group, the maximum effect was made at 5 hours after instillation of the drugs with 28% decrease. 4) The distribution of the highest intraocular pressure in the patient group was as following: 23 eyes at 10 o'clock AM, 11 eyes at 9 AM, 9 eyes at 11 AM, 3 eyes at 8 AM, 3 eyes at noon and 1 eye at 4 o'clock PM.
Adrenergic beta-Agonists ; Epinephrine ; Glaucoma ; Glaucoma, Open-Angle* ; Humans ; Intraocular Pressure ; Levobunolol* ; Manometry ; Ocular Hypertension ; Pharmacologic Actions ; Timolol

BACKGROUND: Victims of trauma in the emergency room(ER) suffer from kinds of discomforts derived from their physical injury and psychological instability. Although discomforts may be varied by the patient's characteristics and environmental factors such as medical personnel or facilities in ER, an active control for the discomfort should be required because it may affect an outcome of treatment and prognosis of illness. The purpose of this study is to analyze the distressing factors which traumatized patients have been experienced in the ER and to improve the management of trauma patients in the future. METHODS: From January 1, 1996 to June 30, 1996, we tried to interview patients about the painful experiences in ER before the decision of his or her discharge from ER. We analyzed the data on age, sex, religion, educational level, injury severity score(ISS), the most unpleasant experience, sleep deprivation, and friar for death. RESULTS: The 126 patients were enrolled in this study. The patients consisted of 93 male and 33 female, their mean age was 45 years old and mean ISS was 7.86. About seventy one percent of the patients complained unpleasant experiences during the stay in the ER. Of these, pain at the injury sites was the most frequent complaint (66.7%). The sleep deprivation was showed about sixty percent of the total patient and the most common cause of this was also due to pain(40%). Nineteen percent of the patients answered that they have felt the fear for death. There were statistically significant differences in degree of the ISS whether the fear for death and unpleasant experience were or not. When the patients demarked with whether the presence of pain, the occurrence of sleep deprivation, and fear for death were statistically related to the pain. However, the data was denoted no direct relationship with pain according to sex, educational level, or religion. CONCLUSION: The trauma patient admitted to ER suffered from various stressful conditions including not only their physical injury but care personnel or unstable environmental factors in ER. Therefore, emergency medical personnel has to understand some possible distresses of the patients and need to reduce them to provide more careful and proper managements.
Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Sleep Deprivation