Lightning injury can cause systemic deterioration, including neurologic deficits. We present a case of lightning injury with reversible neurologic deficits in a 49-year-old man. Clinical manifestations of neurologic deficits due to lightning injury vary from lightheadedness to paralysis. In order to achieve a favorable outcome, immediate respiratory support and careful neurologic examinations are key elements during initial resuscitation. If secondary injuries due to any type of trauma following lightning were suspected, emergency physicians should make a decision regarding use of advanced diagnostic and therapeutic modalities.
Dizziness ; Emergencies ; Humans ; Lightning Injuries* ; Lightning* ; Middle Aged ; Neurologic Examination ; Neurologic Manifestations* ; Paralysis ; Resuscitation

This report presents a set of identical twins who had recurrent intussusceptions. One twin had intussusception 3 times, and the other had it 7 times. They were usually diagnosed by ultrasonography and reduced by air contrast enema. Manual operative reduction was performed separately for each one due to failure of the enema. Unfortunately, we still could not determine the exact cause. A few cases of intussusceptions in identical twins within a few days of each other have been reported, which may be the result of a congenital predisposition triggered by an acquired agent. We report a rare case of recurrent intussusceptions in identical twins within 4 years.
Emergencies* ; Emergency Service, Hospital* ; Enema ; Humans ; Intussusception* ; Twins ; Twins, Monozygotic* ; Ultrasonography

Spinal cord injury without radiographic abnormality (SCIWORA) is a rare injury and reported less frequently in adults than children. The symptoms and prognosis of SCIWORA are associated with injury level of the spinal cord, neurologic impairment, resolution rate, etc. High level injury of the spinal cord can lead to development of quadriplegia, paraplegia, spinal shock, cardiac dysfunction, and respiratory arrest. However initial presenting cardiac arrest is extremely rare in SCIWORA. Therefore we report on a cardiac arrest patient due to SCIWORA after a motorcycle accident. A 50-year-old male was an out of hospital cardiac arrest in a transferred hospital. At the time of local hospital arrival, he was in cardiac arrest state. Therefore he received endotracheal intubation and cardiopulmonary resuscitation for 5 minutes, and spontaneous circulation returned. In our hospital, he underwent whole body computed tomography and echocardiography. He had a fibular fracture and simple multiple rib fractures without pneumothorax and hemothorax. Magnetic resonance imaging showed spinal cord edema from the cervicomedullary junction to C3 level and ossification of the posterior longitudinal ligament at C2-3 level without bony abnormality. In unknown cause of traumatic cardiac arrest, high level spinal cord injury and further evaluation of the cervical spine may be needed.
Adult ; Cardiopulmonary Resuscitation ; Child ; Death, Sudden, Cardiac ; Echocardiography ; Edema ; Heart Arrest* ; Hemothorax ; Humans ; Intubation, Intratracheal ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Motorcycles ; Out-of-Hospital Cardiac Arrest ; Paraplegia ; Pneumothorax ; Prognosis ; Quadriplegia ; Rib Fractures ; Shock ; Spinal Cord ; Spinal Cord Injuries ; Spine

Pneumomediastinum, a condition in which air is present in the mediastinum, is generally regarded as a benign, self-limited process. Rare life-threatening causes such as esophageal rupture must be excluded. A 26-year-old woman with allergic rhinitis presented with a 3-day history of increasing dyspnea, wheezing, and chest pain. Her high resolution CT (HRCT) showed extensive pneumomediastinum and subcutaneous emphysema without visible airway injury on the CT scan. With application of oxygen through a nasal cannula, bronchodilator inhalation, and systemic steroids, her pneumomediastinum and asthma symptoms were improved. A 30-year-old man with acute exacerbation of newly diagnosed asthma and spontaneous pneumomediastinum was treated with application of oxygen and asthma medication. Here, we reported two cases of newly diagnosed asthma with spontaneous pneumomediastinum during asthma exacerbation.
Adult ; Asthma* ; Catheters ; Chest Pain ; Dyspnea ; Female ; Humans ; Inhalation ; Mediastinal Emphysema* ; Mediastinum ; Oxygen ; Respiratory Sounds ; Rhinitis ; Rupture ; Steroids ; Subcutaneous Emphysema ; Tomography, X-Ray Computed

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease in South Korea with clinical features similar to those of scrub typhus. Infected patients with these two diseases usually visited the emergency department (ED) complaining of fever that was not responsive to treatment in a local clinic. Aggressive management of SFTS is required in order to prevent rapid progression and human-to-human transmission, thus rapid and accurate differential diagnosis of the two diseases in the ED is important. We reported three laboratory confirmed cases of SFTS during 2013-2014 in a single center, with fever, skin lesions, and history of outdoor activities in order to help in differential diagnosis between SFTS and scrub typhus in the ED.
Communicable Diseases, Emerging ; Diagnosis, Differential ; Emergency Service, Hospital ; Fever* ; Humans ; Korea ; Scrub Typhus* ; Skin ; Thrombocytopenia*

PURPOSE: The aim of the study was to determine the factors associated with complicated acute cholecystitis of initial clinical findings during an emergency department (ED) visit, and to use them as a guideline for consideration of early and active surgical intervention, to improve the prognosis of acute cholecystitis. METHODS: Medical records of adult patients diagnosed and treated in the ED as acute cholecystitis were reviewed retrospectively. Clinical findings including demographic data, past medical history, symptoms, physical exam, and laboratory test results were included in the analysis. A case associated with gall bladder empyema, gangrene, perforation, hydrops, or failure of initial laparoscopic approach was defined as complicated acute cholecystitis. Factors showing significance in univariate analyses were included in binary logistic regression analysis for prediction of complicated acute cholecystitis. RESULTS: Age, sex, hypertension history, anorexia, body temperature, white blood cell count (WBC), aspartate aminotransferase, creatinine, total bilirubin, amylase, and lipase were significant in univariate analyses, and included in multivariate analysis. Age (p=0.039), male sex (p=0.004), and WBC (p=0.019) were significant in multivariate analysis. CONCLUSION: Age, sex, and initial WBC of patients diagnosed and treated in the ED as acute cholecystitis were independently associated with complicated acute cholecystitis.
Adult ; Amylases ; Anorexia ; Aspartate Aminotransferases ; Bilirubin ; Body Temperature ; Cholecystitis ; Cholecystitis, Acute* ; Creatinine ; Edema ; Emergencies* ; Emergency Service, Hospital* ; Gangrene ; Humans ; Hypertension ; Leukocyte Count ; Lipase ; Logistic Models ; Male ; Medical Records ; Multivariate Analysis ; Prognosis ; Retrospective Studies

PURPOSE: Electrocardiographic findings such as Tp-Te interval, Tp-Te dispersion, and Tp-Te/QT ratio could be used to predict dysrhythmic events regarding any kind of toxic materials. We investigated the prevalence of cardiac toxicity related to acute carbon monoxide (CO) poisoning and the characteristics of electrocardiographic changes corresponding to the severity of intoxication. METHODS: This retrospective observational study was conducted with 113 patients of acute CO poisoning from May, 2013 to July, 2014. Myocardial injury (MI) was determined based on an elevation of serum troponin T within the first 24 hours of the ED visit. The study population was classified according to Acute Neuropsychiatric Status (ANS) scoring: a mild intoxication group (ANS scores 0 and 1) and a severe intoxication group (ANS scores 2 and 3). RESULTS: Prevalence of MI was higher in the severe intoxication group of acute CO poisoning (p<0.001). QTc was significantly prolonged in the MI group (p=0.007). However, no differences in other electrocardiographic parameters were observed between MI group and non-MI group. CONCLUSION: Myocardial injury was combined more frequently with a severe intoxication group of acute CO poisoning compared to a mild intoxication group. A specific feature of eletrocardiogram in myocardial injury with acute CO poisoning was a QTc prolongation.
Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Electrocardiography* ; Humans ; Observational Study ; Poisoning ; Prevalence ; Retrospective Studies ; Troponin T

PURPOSE: Facial scars are a main complaint of patients who had undergone suture in the emergency department. Therefore, effective techniques for minimizing scar formation are required. W-plasty, a widely used method of scar correction, has been performed to change the scar direction or divide it into multiple segmented scars. This method can be applied in the initial stage of wound repair in the emergency department. The aim of this study was to investigate the effectiveness of direct application of W-plasty to the wound in simultaneously accomplishing the aforementioned objectives. METHODS: This was a prospective study, from June 2012 to June 2014. Either simple debridement or W-plasty for facial laceration was performed in 31 patients. In patients in the simple debridement group, the excision was made along the laceration margin. In patients in the W-plasty group, the excision was made within the W-form predesigned margin of the laceration. The prognosis was evaluated using the Stony Brook scar evaluation scale (SBSES). RESULTS: Among 31 patients, 15 underwent simple debridement and 16 underwent W-plasty. In procedure time, there was no significant difference between the two groups. No complications were observed in either group. The median SBSES score was 4 (IQR, 3-4) in the simple debridement group and 5 (IQR, 5-5) in the W-plasty group, indicating a significant difference between the two groups (p<0.001). CONCLUSION: We achieved good results of direct W-plasty application to wound lacerations in terms of minimal scar formation. Thus, for patients with facial lacerations, we suggest that application of W-plasty to the wound debridement is more effective than the classic simple debridement.
Cicatrix* ; Debridement ; Emergencies* ; Emergency Service, Hospital* ; Follow-Up Studies* ; Humans ; Lacerations ; Prognosis ; Prospective Studies ; Suture Techniques ; Sutures ; Wounds and Injuries

PURPOSE: Occupational stress can have a negative effect on the worker such as physical, emotional, and psychological health. Although it is well reported that health service staff tend to have a high level of minor psychiatric disorder, only a few studies have been reported in Korea. Intern and Residency (residents) are very vulnerable periods of stress and other psychiatric disorders. In this study, we describe occupational stress of interns and residents and relationship between occupational stress and depression. METHODS: The participants of this study were interns and residents trained in a tertiary hospital in Korea. The occupational stress scale was used for measurement of occupational stress. In addition, the Korean version of the Beck depression scale was used to evaluate the prevalence of depression. Statistical analyses were performed using SPSS v. 18.0; p-value less than 0.05 was considered statistically significant. RESULTS: Female doctors showed higher occupational stress than male. Interns and chief residents demonstrated higher occupational stress than other grades. Astonishingly, most participants showed depressive mood. Compared with the general population, job demand and culture of the workplace are in the first upper quartile. It is indicated that compared with general populations, physicians have a higher workload and patience is required in order to cope with the harsh culture of the workplace. Depressive mood was evaluated with various factors and only occupational stress was statistically significant. CONCLUSION: Overwhelming occupational stress of residents could result in both medical and social problems. Therefore, recognition of occupational stress is essential and aggressive interventions are required.
Burnout, Professional ; Depression ; Female ; Health Services ; Humans ; Internship and Residency ; Korea* ; Male ; Prevalence ; Seoul* ; Social Problems ; Tertiary Care Centers*

PURPOSE: The purpose of this study was to investigate the current status of post-traumatic stress (PTS), job satisfaction, and associated factors with job satisfaction among 119 rescue crews. METHODS: The study subjects were 507 rescue crews who worked in G Metropolitan City and J province. General characteristics, job-related characteristics, PTS, and job satisfaction were collected by self-reported questionnaires via official e-mail. Job satisfaction by subjects' characteristics was tested using t-test, ANOVA, and multiple linear regression analysis. RESULTS: Of 507 rescue crews, the overall PTS scores and job satisfaction score were 13.58+/-12.99 and 85.19+/-13.37, respectively. In multiple linear regression analyses, job satisfaction scores were significantly lower in subjects with fair (beta=-3.53, 95% CI=-5.89~-1.17) or poor (beta=-7.69, 95% CI=-11.67~-3.71) self-rated health and with longer duration of career (beta=-3.53, 95% CI=-6.62~-0.44). Regarding rescue field related characteristics, witness injury of co-workers (beta=-3.02, 95% CI=-5.61~-0.44), obvious dead treatment (beta=-3.60, 95% CI=-6.37~-0.83), and PTS (beta=-4.21, 95% CI=-7.56~-0.88) showed association with lower job satisfaction. CONCLUSION: Job satisfaction showed association with general characteristics, field related factors, and PTS. Risk reduction of rescue field and management of PTS will help to increase the job satisfaction of 119 rescue crews.
Electronic Mail ; Emergency Medical Services ; Job Satisfaction* ; Linear Models ; Risk Reduction Behavior