BACKGROUND: One of the problem in emergency room(ER) of university hospital is over-crowdedness that causes exhaustion of medical resources (personnel, device, space) and disturbes optimal treatment. METHODS: This is an evaluative research for the purpose of promoting efficient operation system in ER of university hospital. RESULTS: 1) In 387 visitors, mean age was 47.5 years, and male to female ratio 1.21:1. As the specialty in charge, 28.9%f them were internal medicine, 26.6%mergency medicine, 9.9%eurology, and 8.5%eurosurgery. 24%f visitors have come by ambulances. The patients stayed for average 16.1 hours. The admission rate of ER visitors was 33.4 %60.3 %returned home after some management. 2) The visitors had various causes without correlation between the severity of conditions and the choice of high level hospital ER. They perceived their situations emergent in 78.4% but after triage only 25.6%were classified emergent. 48.6%of the visitors were the patients of out-patient department of this hospital due to chronic diseases. 3) The patients were assessed within 9.5 minutes after arrival at ER by nurse and within 34 minutes by doctor. If they were in need of consultation to second/third department, they waited for 141.5/460 minutes respectively to see the doctor. They waited for 59.9/52.7 minutes to get routine laboratory sampling/radiologic examination respectively. 4) Every 2.3 new patients visited this ER per hour. Average 63.2 patients were taken over to next shirt of nurse duty, and 60%of them had chronic degenerative diseases. CONCLUSION: The causes of overcrowding in ER of the university hospital were (1) huge number of patients at out-patient department of the hospital, (2) shortage of beds compared to the number of patients waiting admission, (3) too many kinds of procedures performed in ER, (4) cooperation failure among doctors of different specialty, and (5) no definite criteria of admission/discharge into/from ER. To solve these problems, conversion of ER management policy from complete examination and treatment to more simple and rapid one is necessary.
Ambulances ; Chronic Disease ; Emergencies* ; Emergency Service, Hospital* ; Female ; Hospitals ; Humans ; Internal Medicine ; Male ; Outpatients ; Triage

The educational courses for trauma care are stratified into two classes. The first is the Advanced Trauma Life Support (ATLS) course, which is sponsored by the Committee on Trauma (COT) of the American College of Surgeons (ACS) and whose target learners are the surgeons who treat the victims of major trauma. The second is the Basic Trauma Life Support (BTLS) course, which is sponsored by the American College of Emergency Physicians (ACEP) and whose target learners are the pre-hospital healthcare providers, the nurses in emergency rooms, and the emergency physicians who provide emergency care to the victims of major trauma in the accident scene or in the emergency room before the trauma surgeons. The Emergency Medical Service System (EMSS) of Korea is managing to do its work somewhat well when it functions in the medical emergency situations. However, when it encounters with major trauma patients, it can rarely keep the principles of trauma care, such as the 'Golden Hour' and 'the rapid transportation to an appropriate trauma center directly' due to its systemic failure. Therefore the Preventable Death Rate (PDR) of major trauma patients is presumed to be very high in Korea. To rebuild the EMSS of Korea into a new system suitable for major trauma, the Korean Healthcare Administrations should start to lead the legislation and the support for trauma centers and trauma experts. The spread of the educational courses for trauma care into the emergency medical societies can be a starting point to solve the problem. The BTLS course is one of them.
Advanced Trauma Life Support Care ; Delivery of Health Care ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Health Personnel ; Humans ; Korea ; Mortality ; Societies, Medical ; Transportation ; Trauma Centers

Recently burn care system in Korea has been changing from 'general care' to 'specialized care'. Consequently, most physicians and surgeons who do not work in burn centers could rarely have an opportunity to gain experience in burn care. Before being transferred to a burn center, every burn patient is usually treated primarily by the non-experts. Therefore, all primary physicians need to know the primary care for burns. The main components of the primary care are pre-hospital care, emergency room (ER) care, and decision-making process for the transfer of the patients to a burn center. Pre-hospital care and ER care are on the same spectrum, and composed of the advanced trauma life support (ATLS) primary survey, wound cooling, pain control, fluid therapy, high concentration oxygen therapy, cyanide antidote therapy, and burn wound care including escharotomy. Rapid and proper management for smoke inhalation is essential for acute stage survival of burn patients. Once the patient is stabilized, a decision regarding his/her disposition to a burn center is critical. Inappropriate transfer of minor burn patients to burn centers imposes unnecessary cost and discomfort to the patients. The primary care for burns is very important and medical personnel who are in charge of burn patients should be familiar with it.
Advanced Trauma Life Support Care ; Burn Units ; Burns ; Emergencies ; Fees and Charges ; Fluid Therapy ; Humans ; Inhalation ; Korea ; Oxygen ; Primary Health Care ; Smoke

PURPOSE: We tried to determine whether six-hour fasting before abdominal computed tomography (CT) scan is necessary to prevent aspiration of gastric contents in patients with acute abdominal pain. METHODS: Adult patients with acute abdominal pain who were checked abdominal CT were enrolled. Exclusion criteria were age <15 years, pregnancy, traumatic cause of symptoms, chronic pain(>7 days), renal impairment and hypersensitivity to contrast media. We compared Group-I (<6-hour fasting) with Group-II(> or =6-hour fasting). We collected the demographic and clinical data on the causes of abdominal pain, pain duration, presence of nausea and vomiting, and use of medications before and after abdominal CT. In order to estimate the volume of gastric contents, we measured the area on the CT image which showed the largest volume of gastric contents. RESULTS: Among the 122 patients, Group-I consisted of 38 patients(31.1%) and Group-II included 84(68.9%). The demographic makeups of the two groups were similar, except for gender proportion (more males in Group-I). Group-I showed significantly greater gastric contents compared than Group-II(46.8+/-32.1 vs. 33.7+/-28.3, p=0.024). A slightly negative correlation (r=-0.2313; 95% CI=-0.3929 to -0.0559) was observed between the fasting time and the volume of gastric contents. However, the frequencies of the nausea [13/38 (34.2%) vs. 26/84 (31%), p=0.721] and vomiting [6/38 (15.8%) vs. 18/84 (21.4%), p=0.468] showed no difference between two groups. There were no aspiration events in either groups. CONCLUSION: Six hours of fasting before abdominal CT may not be required to prevent aspiration of gastric contents in patients with acute abdominal pain.
Abdomen, Acute ; Abdominal Pain ; Adult ; Contrast Media ; Fasting ; Humans ; Hypersensitivity ; Male ; Nausea ; Pregnancy ; Tomography, Spiral Computed ; Vomiting

BACKGROUND: Multi-organ failure from sepsis is very lethal disease entity, which is suspected to be caused by activated inflammatory cells. Inflammatory cells activated by endotoxins generate oxidants and cytokines such as TNF-alpha and IL-6, which in turn stimulate macrophages and neutrophils. Augmented inflammation makes an organ-injury deteriorate into an organ-failure, which may progress to multi-organ failure. This study is designed to evaluate the therapeutic effects of vitamin-C, a scavenger of oxidants, in sepsis. METHODS: Male Sprague-Dawley rats were divided into 3 groups : a control group, a group injected intrapetoneally with LPS(lipopolysaccharide), and a group injected intraperitoneally with LPS and vitamin-C. Each eight rats were sacrified 24 hours and 48 hours after injection, and samples of the blood, the liver and the lung were obtained. Biochemical assays of TNF-alpha level in the blood and malondialdehyde(MDA) level, catalase activity and nitric oxide synthase(NOS) activity in the liver and the lung tissues were performed. RESULTS: Serum TNF-alpha level, tissue lipid peroxidation and tissue i-NOS activity were dramatically increased, and tissue catalase activity was exhausted rapidly in sepsis. High dose vitamin-C administration decreased serum TNF-alpha level, tissue lipid peroxidation and tissue i-NOS induction, and protected against catalase exhaustion. CONCLUSION: high dose vitamin-C therapy was proved to have definite antioxidant effect in septic condition.
Animals ; Antioxidants ; Catalase ; Cytokines ; Endotoxins ; Humans ; Inflammation ; Interleukin-6 ; Lipid Peroxidation ; Liver ; Lung ; Macrophages ; Male ; Models, Animal* ; Neutrophils ; Nitric Oxide ; Oxidants ; Rats* ; Rats, Sprague-Dawley ; Sepsis* ; Tumor Necrosis Factor-alpha

BACKGROUND: Most febrile neutropenic patients are treated in an aggressive manner. However, identification of low-risk patients may enable clinicians to administer risk-based treatment. The object of this study is to certify the factors associated with increased risk at the time of visiting the emergency department. METHODS: This is a retrospective study. We reviewed the medical records of 101 febrile neutropenic patients who had visited the emergency department of Seoul National University Hospital from January 1998 to August 1999. We assumed 22 risk prediction factors that could be assessed at admission to the emergency department and 5 factors that could be assessed during treatment course. To find independent risk-prediction factors, we analyzed these factors respectively by using multiple regression analysis. RESULTS: Tachycardia(aOR=136.5), altered mentality(aOR=28.8), decreased renal function(aOR=20.1), and significant comorbidity(aOR=17.2) are the independent factors associated with higher mortality. Altered mentality(aOR=31.6) and decreased renal function(CCr<75ml/min, aOR=5.4) are those associated with a higher incidence of septic shock. Independent factors associated with persistent(more than 3 days) fever are the early(within 10 days) onset of fever after last chemotherapy(aOR=8.8) and the existence of new pulmonary infiltrates on a simple chest X-ray(aOR=4.3). CONCLUSION: The stability of vital signs, the change of mentality, the renal function, the existence of significant comorbidity, the existence of new pulmonary infiltrates, and the rate of neutropenia are clinically useful risk-predication factors in febrile neutropenia at the time of visiting the emergency department.
Comorbidity ; Emergency Service, Hospital ; Febrile Neutropenia ; Fever ; Humans ; Incidence ; Medical Records ; Mortality ; Neutropenia ; Retrospective Studies ; Seoul ; Shock, Septic ; Thorax ; Vital Signs

BACKGROUND: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates. METHODS: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. RESULTS: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital, 101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). CONCLUSION: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.
Death Certificates* ; Education ; Emergencies ; Mortality ; Retrospective Studies ; Seoul

PURPOSE: Emergency medical service (EMS) providers often care for pregnant women at risk for out-of-hospital delivery and born-before-arrival neonates. As the increase in mortality and morbidity from out-of-hospital delivery is well established, this study sought to determine whether a delivery and neonatal care education program could impact the knowledge and practice of EMS providers. METHODS: EMS providers working in the southeast Gyeonggi province in South Korea received an education program for out-of-hospital delivery and neonatal care. The program consisted of a pretest, didactic, mannequin training, and posttest. Six months after the education program a follow-up survey was administered. A paired t-test was then used to compare pretest and posttest scores. Overall, 56 EMS providers completed the study. RESULTS: The pretest average score was 80.4 and the posttest average score was 92.9 (p<0.001). The percentage of correct answers on each question was relatively and equally elevated in the posttest, regardless of the participant's certification. Participants expressed their satisfaction with the education program and this appraisal was maintained in the 6-month follow-up survey. CONCLUSION: These results suggest that EMS providers can benefit from a didactic and training session regarding out-of-hospital delivery and neonatal care. Further studies are needed, however, to develop the reliability and validity of the test and to determine its clinical applications.
Certification ; Delivery, Obstetric ; Education* ; Emergencies* ; Emergency Medical Services* ; Female ; Follow-Up Studies ; Gyeonggi-do ; Humans ; Infant, Newborn ; Manikins ; Mortality ; Pregnant Women ; Reproducibility of Results ; Republic of Korea

PURPOSE: This study was performed to investigate whether therapeutic hypercapnia could attenuate systemic inflammatory responses in hemorrhagic shock in rats. METHODS: Male Sprague-Dawley rats were mechanically ventilated and underwent pressure-controlled (mean arterial pressure: 38+/-1 mmHg) hemorrhagic shock. At 10 minutes after the induction of hemorrhagic shock, the rats were divided into the normocapnia (PaCO2=35-45 mmHg, n=10) and the hypercapnia (PaCO2=60-70 mmHg) groups. The PaCO2 concentration was adjusted by using the concentration of inhaled CO2 gas. After 90 minutes of hemorrhagic shock, rats were resuscitated with shed blood for 10 minutes and were observed for 2 hours. The mean arterial pressure (MAP) and the heart rate were monitored continuously, and the results of arterial blood gas analyses, as well as the plasma concentrations of interleukin (IL)-6, IL-10, and nitrite/nitrate were compared between the normocapnia and the hypercapnia groups. RESULTS: The MAP and the heart rate were not different between the two groups. The plasma concentration of IL-6 was significantly lower in the hypercapnia group than in the normocapnia group (p<0.05). The IL-10 concentration was not different and the IL-6 to IL-10 ratio was significantly lower in the hypercapnia group compared to the normocapnia group. The plasma nitrite/nitrate concentration of the hypercapnia group was lower than that of the normocapnia group. CONCLUSION: Therapeutic hypercapnia attenuates systemic inflammatory responses in hemorrhagic shock.
Animals ; Arterial Pressure ; Blood Gas Analysis ; Cytokines ; Heart Rate ; Humans ; Hypercapnia ; Inflammation ; Interleukin-10 ; Interleukin-6 ; Interleukins ; Male ; Nitric Oxide ; Plasma ; Rats ; Rats, Sprague-Dawley ; Shock, Hemorrhagic

The pathogenesis of sepsis is not clearly understood. In animal models, the association of a high plasma TNF-alpha level with the frequent development of adult respiratory distress syndrome in septic conditions suggests that TNF-alpha plays a major role in the pathogenesis of the lung injury. Also, oxygen free radicals are known to participate in the pathogenesis of multiorgan failure. However, the relations between those factors have not been elucidated clearly. In pharmacological dosage, growth hormone (GH) promotes positive nitrogen balance and anabolic metabolism. There have been many studies about the therapeutic effects of GH in sepsis; However, the exact mechanism is not known. The purpose of this study is to evaluate the mechanism of the therapeutic action of GH in sepsis induced by intraperitoneal injection of Zymosan-A in an animal model. The experimental animals were female Sprague-Dawley rats which were devided into three groups: a control group, a group injected intraperitoneally with Zymosan-A, and a group injected intraperitoneally with Zymosan-A and intramurally with growth hormone. After the lapse of time of 6, 12, 24, 48, and 72 hrs., the rats were sacrificed; then the histopathologic findings for the lung tissue were examined, and the levels of malondialdehyde(MDA) in the lung tissue and TNF-alpha in the blood were measured. In the Zymosan-A-injected group, an increment of infiltration by lymphocytes and neutrophils was observed, the MDA levels in the lung tissue were remarkably increased and reached a peak level 24 hrs. after Zymosan-A injection, and the TNF-alpha levels in the plasma were markedly increased. In the Zymosan-A-plus GH-injected group, there were less infiltration of inflammatory cells and less interstitial edema, and significantly suppressed increments of TNF-alpha and MDA. It can be concluded that GH inhibits the production of TNF-alpha and MDA in sepsis and protect against systemic tissue injury. However, the mechanism for the inhibition of the TNF-alpha production was not elucidated by this study. Further experiments are required.
Animals ; Edema ; Female ; Free Radicals ; Growth Hormone* ; Humans ; Injections, Intraperitoneal ; Lung ; Lung Injury ; Lymphocytes ; Metabolism ; Models, Animal ; Neutrophils ; Nitrogen ; Oxygen ; Plasma ; Rats ; Rats, Sprague-Dawley ; Respiratory Distress Syndrome, Adult ; Sepsis ; Tumor Necrosis Factor-alpha* ; Zymosan*