PURPOSE: Our medical institute developed an emergency department (ED) cancer unit that specialized in the management of oncologic emergencies; it was named the cancer emergency room (CER). The object of our study was to determine improvements in patient management, especially management of febrile neutropenia (FN). METHODS: This was a retrospective study of 137 febrile neutropenic episodes, including 70 episodes occurring between May 2008 and August 2008, and 67 episodes between May 2009 and August 2009. Episodes were grouped into two categories: those managed in the CER and those managed in the existing ED main treatment area of the main emergency room (MER). The time interval between presentation at the ED and first antibiotic administration, termed the door-to-needle time, clinical outcomes, and length of inpatient hospital stay were analyzed for those admitted. RESULTS: The median door-to-needle time in the CER was 2 hours (0.3-5.1), faster than the time, 3.5 hours (0.9-6.9) in the MER (p=0.000). The length of inpatient hospital stay in the CER was 4 days (1-16), shorter than that, 6 days (1-51), in the MER (p=0.034). Twelve episodes (26.1%) had adverse events in the CER and 42 (46.2%) in the MER (p=0.023). CONCLUSION: Management of FN in a unit specialized for oncologic emergencies showed faster antibiotic delivery time, more favorable outcomes and shorter duration of admission. This specialized cancer unit in the ED enables prompt and relevant management in oncologic emergencies, including events related to chemotherapy toxicity.
Anti-Bacterial Agents ; Emergencies ; Emergency Service, Hospital ; Fever ; Humans ; Inpatients ; Length of Stay ; Neutropenia ; Retrospective Studies

PURPOSE: Body fluid status of patients in an emergency room environment is a very important parameter during clinical evaluation. In this study, we wanted to know the relationship between the diameter of the inferior vena cava and the diameter of the (IVC/Ao index) and central venous pressure (CVP) in hemodynamically unstable patients. METHODS: This study was done prospectively in an emergency medical center of a hospital from January to August, 2009. We compared the diameter of the IVC, the diameter of inferior vena cava/the body surface area index (IVC/BSA index), the IVC/Ao index, and other variables. Before and after hydration of patients with a systolic blood pressure less than 90 mmHg and who had a central venous catheter in place. Then, we calculated the correlation coefficient for DeltaCVP, DeltaIVC/Ao index, and other indexes. RESULTS: Fifty-nine patients were enrolled in the study. The mean IVC diameter before hydration was 14.3+/-2.7 mm; it was 15.6+/-2.7 mm after hydration (p<0.01). The IVC/BSA index before hydration was 8.75+/-1.72 and 9.55+/-1.79 after hydration (p<0.01). The IVC/Ao index before hydration was 1.08+/-0.23; it was 1.16+/-0.25 after hydration (p<0.01). The correlation coefficient for DeltaCVP and DeltaIVC was 0.37 (p<0.01); for DeltaCVP vs. the DeltaIVC/BSA index it was 0.37 (p<0.01); for the DeltaIVC/Ao index it was 0.27 (p=0.04). CONCLUSION: CVP has a higher correlation to IVC diameter and to IVC/BSA index than to the IVC/Ao index. Hence, we should estimate the IVC/Ao index and use that estimate along with other indexes to evaluate body fluid status when dealing with hemodynamically unstable patients.
Blood Pressure ; Body Fluids ; Body Surface Area ; Central Venous Catheters ; Central Venous Pressure ; Emergencies ; Humans ; Hypogonadism ; Mitochondrial Diseases ; Ophthalmoplegia ; Prospective Studies ; Vena Cava, Inferior

PURPOSE: Hanging is a common method of suicide around the world. The prognosis after hanging injury is highly variable. Some patients die despite intensive treatment, while other patients recover without neurologic sequelae. The purpose of this study was to identify several prognostic factors affecting the outcome in patients with hanging injury. METHODS: Thirty-five patients presented at Gyeongsang National University Hospital between May 2005 and July 2009 following hanging injury. Patients, of whom 30 were unconscious, were classified as being in the initial mental status. For these patients, we investigated several factors and identified correlations between factors and prognosis. We investigated the type of hanging, mental status, presence of pupillary light reflex, glasgow coma scale (GCS), laboratory findings, presence of cardiopulmonary resuscitation (CPR) and intubation, history of psychiatric disease, alcohol use, hanging duration, brain computed tomography (CT), and injury of the spine and neck soft tissue. RESULTS: Factors suggesting a poor prognosis factors were complete hanging, poor mental status, the absence of pupillary light reflex, initial GCS, pH, bicarbonate and excess level of base, the practice of CPR and intubation. In particular, patients who showed GCS scores lower than 4.5 in the emergency room were highly likely to die. CONCLUSION: Patients after hanging injury can recover without neurologic sequelae despite altered mental status. The prognosis of patients who present with hanging injury can be established by the type of hanging, initial mental status, the presence of pupillary light reflex, initial GCS, arterial blood gas analysis (ABGA), and the practice of CPR and intubation. Therefore patients with hanging injury should be treated aggressively with consideration of prognostic factors.
Blood Gas Analysis ; Brain ; Cardiopulmonary Resuscitation ; Emergencies ; Glasgow Coma Scale ; Humans ; Hydrogen-Ion Concentration ; Intubation ; Light ; Neck ; Neck Injuries ; Prognosis ; Reflex ; Spine ; Suicide ; Unconscious (Psychology)

PURPOSE: The bicycle is a clean and future-oriented means of transportation and bicycle usage is growing. The bicycle has been in the spotlight lately with Europe and North America as the center. The purpose of this study was to establish proper prevention strategies for bicycle injuries. METHODS: In this retrospective study, we analysed 148 bicycle-related injury patients who visited our hospital between Feb 1, 2008 and Jan 31, 2009. Information such as age, gender, injury severity score, injury time, injury place, and other characteristics were collected. Data were analysed using SPSS 12.0K. RESULTS: Among the enrollees, 80.4% were male. Patients over 65 years of age accounted for only 18.2% of the group, but average injury severity score (ISS) of this group was the highest. Injuries occurred frequently between 16:00 and 22:00 in the evening, while the severity was higher between 00:00 and 08:00 in the morning. Most of the injuries developed on the roads, which included local roads, national highways, and alleyways. Injuries on the roads were more severe than those that occurred in other places. CONCLUSION: There have been suggestions for using bicycles safely. Legislation on bicycle helmet use already exists. Also, protective apparatus such as knee pads, wrist guards, and protection vests are recommended for use. Construction of more bike trails will be necessary. Above all, bicycle riders' safety consciousness is the most important part.
Accidents, Traffic ; Bicycling ; Consciousness ; Europe ; Head Protective Devices ; Humans ; Hypogonadism ; Injury Severity Score ; Knee ; Male ; Mitochondrial Diseases ; North America ; Ophthalmoplegia ; Retrospective Studies ; Risk Factors ; Transportation ; Wrist

PURPOSE: To achieve early diagnosis of hemorrhagic shock using a survival prediction model in rats. METHODS: We measured heart rate, mean arterial pressure, respiration rate and temperature in 45 Sprague-Dawley rats, and obtained an artificial neural network model for predicting survival rates. RESULTS: Area under the receiver operating characteristic (ROC) curves was 0.992. Applying the determined optimal boundary value of 0.47, the sensitivity and specificity of survival prediction were 98.4 and 96.6%, respectively. CONCLUSION: Because this artificial neural network predicts quite accurate survival rates for rats subjected to fixed-volume hemorrhagic shock, and does so with simple measurements of systolic blood pressure (SBP), mean arterial pressure (MAP), heart rate (HR), respiration rate (RR), and temperature (TEMP), it could provide early diagnosis and effective treatment for hemorrhagic shock if this artificial neural network is applicable to humans.
Animals ; Arterial Pressure ; Blood Pressure ; Early Diagnosis ; Heart Rate ; Humans ; Neural Networks (Computer) ; Rats ; Rats, Sprague-Dawley ; Respiratory Rate ; ROC Curve ; Sensitivity and Specificity ; Shock, Hemorrhagic ; Survival Rate

PURPOSE: Delayed transfer to an appropriate emergency room has been the primary reason that patients with acute ischemic stroke do not receive thrombolytic therapy. Therefore, it is crucial to develop a catchphrase system to easily recognize acute ischemic stroke. In the course of developing catchphrases for public education or campaigns, we collected and analyzed actual expressions from patients with acute ischemic stroke or their witnesses. METHODS: From January 2007 to May 2009, we enrolled 1452 patients with acute ischemic stroke who were admitted to a neurology department via an emergency room. Subjective expressions of 3 domains, which consisted of temporal characteristics at onset, body-spatial location and neurologic symptoms, were classified and the frequencies of "words" or "short phrases" were evaluated. RESULTS: In the expressions of patients with transient ischemic attack or mild stroke, "sudden" (71.1%) was the most frequent in terms of temporal characteristics at onset and was followed by "after awakening" (42.7%) and "as unusual" (7.4%). When expressing body-spatial location, "one-side arm" (51.5%), "one-side leg" (42.5%) or "onesided face" (12.5%) followed, with frequent expression of neurological symptoms of motor-parts (13.4%), speechparts (7.1%) and sensory-parts (6.7%). Patients with NIHSS > or =6 showed the same rank of expressions related to temporal and body-spatial domains. Regarding neurological symptoms, however, motor-part (74.2%), consciousness-part (50.1%) and speech-part (50.0%) were more frequent. CONCLUSION: We propose a novel Korean catchphrase, "Sudden Side Symptoms", based on a 3-dimensional system (Cubic S model) for public education so people will more easily recognize acute ischemic strokes.
Cerebral Infarction ; Emergencies ; Health Promotion ; Humans ; Ischemic Attack, Transient ; Neurologic Manifestations ; Neurology ; Stroke ; Thrombolytic Therapy ; Wit and Humor as Topic

PURPOSE: We examined the utility of biochemical markers in the diagnosis of acute cerebral infarction and the relationship between panel results and the extent and severity of the infarct. METHODS: Group-wise comparisons were made between a group (Group 1) consisting of 38 subjects who were shown through medical screening between April 2007 and March 2008 to have no past history of cerebral disorders and a group (Group 2) consisting of 55 subjects who had visited the ER (during the same period) within 24 hours after the onset of neurologic symptoms and who were diagnosed with stroke through magnetic resonance imaging. Tests were carried out using the Multimarker Index, which is based on the principle of immunofluorescence. B-type natriuretic peptide, D-dimer, matrix metalloproteinase-9, and S100beta were examined, and the Multimarker Index (MMX) was derived. The extent of the infarct lesion was assessed using a volumetry program. RESULTS: The average MMX value was 2.27 in group I and 4.14 in group II, and the difference was statistically significant (p<0.05). For group II, the MMX value had a statistically significant correlation with both the extent of infarct lesion (r=0.46, p<0.001) and its severity (r=0.39, p<0.001). CONCLUSION: We believe that biomarker tests using the MMX should provide useful data in diagnosing strokes, and be of utility in making decisions regarding additional diagnostic tests and early treatment.
Biomarkers ; Cerebral Infarction ; Diagnostic Tests, Routine ; Fibrin Fibrinogen Degradation Products ; Fluorescent Antibody Technique ; Magnetic Resonance Imaging ; Mass Screening ; Matrix Metalloproteinase 9 ; Natriuretic Peptide, Brain ; Neurologic Manifestations ; Prospective Studies ; Stroke

PURPOSE: The 2005 guidelines for cardiopulmonary resuscitation (CPR) caution that effective compression is essential (Class I) and chest compression (CC) by rescuers should be switched every 2 minutes to avoid rescuer's fatigue. It is controversial how long effective CC by a single individual can be provided. There are few reports about CPR quality, especially when rescuers perform CC for more than 10 minutes. The mean CPR period was about 30 minutes in Korea. We investigated the quality of CC and rescuer's fatigue after about 30 minutes. METHODS: From April 2009 to July 2009, health care providers (HCPs) were recruited into this study. The study simulated 2 person, in-hospital CPR. On the test day, which had been randomly assigned, each participant performed 7 CCs for about 30 minutes. The period of each CC was 2 minutes, and the period of each circulation check was 5 seconds. Participants' heart rates (HR) and visual analogue scale (VAS) scores for fatigue were obtained before and after each CC. Data for each 2 minutes CC was obtained with the use of Resusci Anne(R) with the Laerdal(R) PC skill reporting system. We used one-way repeated measures ANOVA for comparison of quality and fatigue of each CC and multiple linear regression for finding the predictors for correct CC. SPSS 17.0 was used for analysis. RESULTS: Among a total of 30 HCPs, data from 27 were analyzed. All participants were certified as a BLS provider and some were certified as BLS instructors. The rate of effective compression was 83.8+/-24.3%. Despite 2 min CC tasks were repeated alternatively for about 30 minutes, there were no differences in the number of correct CCs, depth and velocity of compression, and the number of incorrect CCs. CONCLUSION: During in-hospital CPR, HCPs may provide effective chest compressions on shifts with minimal effect of fatigue, even if they provide CC for 30 minutes.
Cardiopulmonary Resuscitation ; Fatigue ; Health Personnel ; Heart Rate ; Humans ; Korea ; Linear Models ; Manikins ; Thorax

PURPOSE: Chest compression is the corner stone of resuscitation. As a result, many studies insist on the importance of retention of skill performance. But there are weak points. First, a unique characteristic of skill is ignored, "the more practice, the better outcome". Second, no one knows when they have a proficiency in a skill. Learning curve-CUSUM analysis is a good tool to evaluate each trainee's performance. Hence, we designed this study to evaluate each trainee's proficiency in performing chest compression using LC-CUSUM analysis. METHODS: Four medical students were enrolled. We asked them to perform chest compression for two minutes per day without any intervention over six weeks. Data included the depth and rate of chest compression. Eventually, all trainees performed chest compression at least 30 times. We plotted the LC-CUSUM curve according to the results of attempts, successes or failures. RESULTS: According to median values of the depth and rate of chest compression through the 30th attempt, trainees had performances within the acceptable range, 40~49 mm (for depth) and 100~105 beats per minutes (for rate) of chest compression. Nonetheless, LC-CUSUM analysis indicated that two trainees no longer were proficient throughout, and even though the rest of them were once proficient, they appear to have lost that proficiency regarding depth of chest compression. LC-CUSUM analysis of rate of compression showed that all trainees had proficiency during the early phase. CONCLUSION: We propose that instructors can evaluate their trainees' proficiency easily, based on LC-CUSUM analysis.
Cardiopulmonary Resuscitation ; Clinical Competence ; Humans ; Learning ; Resuscitation ; Retention (Psychology) ; Students, Medical ; Thorax ; Training Support

PURPOSE: Many studies have shown that therapeutic hypothermia (TH) administration to non-ventricular fibrillation (Vf) cardiac arrest survivors or non-cardiac origin arrest survivors leads to good neurological outcomes. Therefore, TH has been regarded as a standard therapy for cardiac arrest survivors. Our study was designated to analyze predictors of neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors throughout the duration of the event, from the detection of arrest to the end of TH. METHODS: We retrospectively reviewed the cases of sixty OHCA survivors treated with TH between January 2006 and December 2008. We divided the patients into two groups according to the Cerebral Performance Categories scale at discharge and statistically compared the factors associated with neurological outcomes. RESULTS: Younger age, absence of diabetes mellitus, Vf of initial rhythm, and cardiac origin of cardiac arrest were associated with good neurological outcomes. The frequency of witnessed arrest was higher in the good outcomes group. The time intervals from detection of arrest to emergency department arrival (EDA) and performance of advanced cardiac life support were shorter in the good outcomes group. Mean blood pressure at implementation of TH and the frequency of hypomagnesemia were higher in the poor outcomes group. Logistic regression revealed that an independent predictor of good outcomes was the time interval from the detection of arrest to EDA (95% CI, 0.792-0.988). CONCLUSION: An independent predictor of good neurological outcomes is the time interval from detection of arrest to EDA. Improvable components of TH were early implementation of TH, avoiding hypomagnesemia, and slow rewarming.
Advanced Cardiac Life Support ; Blood Pressure ; Cardiopulmonary Resuscitation ; Diabetes Mellitus ; Emergencies ; Heart Arrest ; Humans ; Hypothermia ; Hypothermia, Induced ; Logistic Models ; Out-of-Hospital Cardiac Arrest ; Prognosis ; Retrospective Studies ; Rewarming ; Survivors ; Wit and Humor as Topic