The first-line imaging modality used to detect subarachnoid hemorrhage (SAH) is a non-contrast computed tomography (CT) scan. Although a CT scan shows great sensitivity for diagnosis of SAH, especially in the hyper-acute and acute stages, it sometimes shows negative results despite typical symptoms. It is thought that the small amount of blood causing the hemorrage and the delay time of the CT scans were the causes of the negative results. Two patients presented to us with SAH, but initial CT scans were negative. We diagnosed the SAH of these patients using magnetic resonance images.
Humans ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Subarachnoid Hemorrhage

In old age, a traumatic pulmonary pseudocyst is an extremely rare condition that generally develops after blunt chest trauma. It is more common among pediatric and young adult patients. We report three elderly patients who presented with chest symptoms after blunt chest trauma and whose computed tomography showed post-traumatic pulmonary pseudocysts.
Aged ; Humans ; Thoracic Injuries ; Thorax ; Young Adult

Central venous catheterization of a subclavian vein is commonly used in emergency departments for hemodynamic monitoring of patients undergoing shock. Though central venous catheterization has many advantages, it can cause various complications such as bleeding, pneumothorax, infection, or endocarditis. We report a 62-year-old female who had a pericardial effusion complication caused by central venous catheterization of the right subclavian vein. A computed tomography scan revealed a contrast-enhanced pericardium and catheter tubegraphy, which suggested the malpositioning of the catheter tip in the pericardial space. After removing the central venous catheter, pericardial effusion spontaneously resolved and the patient had no further adverse events from hemopericardium.
Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Emergencies ; Endocarditis ; Female ; Hemodynamics ; Hemorrhage ; Humans ; Middle Aged ; Pericardial Effusion ; Pericardium ; Pneumothorax ; Shock ; Subclavian Vein

We experienced a rare case of acute myocardial infarction associated with a coagulopathy-complicating snake bite. A previously healthy 72-year-old Korean woman was bitten on the right thumb by a snake of unknown species. She was admitted to a local medical center for one day and exhibited painful progressive swelling along the entire right arm. She also complained of chest discomfort. She had an ST-elevation and T wave-inversion on an ECG. She was then transferred to our emergency department. We found a regional wall motion abnormality on echocardiography, and elevated cardiac enzymes in a laboratory test. We also observed coagulopathy and a thrombus in the left ventricle on follow-up echocardiography. An acute myocardial infarction was confirmed by percutaneous coronary angiography, which showed the total occlusion and stenosis of several coronary arteries.
Aged ; Arm ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Echocardiography ; Electrocardiography ; Emergencies ; Female ; Follow-Up Studies ; Heart Ventricles ; Humans ; Myocardial Infarction ; Snake Bites ; Snakes ; Thorax ; Thrombosis ; Thumb

PURPOSE: Ocular injury is a significant problem in pediatric patients. The aim of this investigation was to evaluate clinical characteristics of pediatric eye injury for the purpose of offering preventive strategies. METHODS: This retrospective study was carried out by evaluating the records of patients under the age of 15 years who were treated for ocular injury at the Kyungpook National University Hospital emergency medical center, from January 2003 to December 2008. A total of 477 patients were included in the study. Age, sex, date of injury, location where injury occurred, cause of injury, diagnosis, any effects on visual acuity, and any complications, were analyzed. RESULTS: Ocular injury occurred more frequently in boys (72.3%) than in girls, and the highest incidence was seen in ages 11 to 15 years (37.3%). Ocular injury frequently occurred in the home or at school. The most common cause of injury was due to instruments (51.6%). Surgery was necessary in 71 patients (14.9%), complication developed in 48 patients (10.1%), and 40 patients (8.4%) suffered from decreased visual acuity. CONCLUSION: It's important to monitor boys, in particular, who are engaged in physical activities in the home and at school. Appropriate education and application of personal protective equipment are important methods to aid in prevention of pediatric ocular trauma, especially with children in the home and with adolescents engaged in sporting activities.
Adolescent ; Child ; Emergencies ; Eye ; Eye Injuries ; Humans ; Incidence ; Motor Activity ; Organothiophosphorus Compounds ; Pediatrics ; Retrospective Studies ; Sports ; Visual Acuity

PURPOSE: After cataracts, eye injuries are the second leading cause of visual impairment worldwide. But most eye injuries are preventable simply by wearing appropriate eye protection. In this study we evaluate factors leading to eye injury in a sample of emergency department (ED) patients. METHODS: This study was conducted with 424 isolated eye injury patients who visited our ED from January to December of 2008. The following data were reviewed; date of visit, characteristics of subjects, existing use of eyewear, relationship of injury to work, causative activity, location where the injury occurred, type of injury, disposition at ED discharge, length of hospital stay, and the existence of sequelae. Severe eye injuries were classified based on the type of injury, disposition at ED, remaining visual loss, and sequelae. RESULTS: Among the total 424 isolated eye injury patients, 411 cases were analyzed. Eye injuries occurred most frequently at home (22.6%), in a factory workplace (21.2%), or an outdoor agricultural workplace (18.2%). The incidence of eye injuries peaked in the fifth decade of life. Among the 306 (74.5%) cases that were workplace unrelated, the main causative activities were assault (18.0%), injury associated with play (14.1%), sports (11.1%), and lawn mowing (9.2%). CONCLUSION: The most common location where the eye injury occurred was at home. Eye injuries prevention in the workplace is well promoted, but in fact, eye injuries were more common at home and during non-occupational activities. We suggest that public education programs which highlight non-occupational eye injury risk and prevention measures should be instituted to reduce preventable eye injuries.
Cataract ; Emergencies ; Eye ; Eye Injuries ; Humans ; Incidence ; Length of Stay ; Risk Factors ; Sports ; Vision Disorders

PURPOSE: The purpose of this study was to investigate current statistics relating to foreigners who visit a Korean emergency department (ED). METHODS: Subjects included in this study were 125,263 patients who visited one Korean ED from January 1, 2008 to December 31, 2010. We divided subjects into two groups, natives (Koreans) and foreigners (non-Koreans). We compared the two groups according to their age, sex, chief medical complaints, department to which they were referred, their final diagnosis, results of treatment applied, ED residence time, mortality rate, total billed cost of treatment, balance of any unpaid bills and method of visiting the ED. RESULTS: Of the total patients included in the study, 119,864 (95.7%) were natives and 5,399 (4.3%) were foreigners. In natives, the majority were 0 to 10 years old (35.1%), while foreigners were mostly 41 to 50 (22.8%) years old. The most common symptom in both natives and foreigners was fever. The most common diagnosis for foreigners was head, face, and neck injury (13.8%). The main referred departments for foreigners were internal medicine (20.1%), pediatric medicine (16.9%), and orthopedics (14.3%). The admission rate for foreigners (13.0%), was lower than that of natives (17.3%). The mortality rate for foreigners (0.5%) was higher than that of natives (0.3%). The ED residence time for foreigners was higher than that of natives. The total billed cost of treatment and balance of unpaid money by foreigners was higher than that of natives. For foreigners, the proportion of medical fees paid from personal accounts and industrial medical insurance were higher than those of natives. CONCLUSION: Medical insurance and policy for the management of foreigners who visit the ED must be improved.
Emergencies ; Emergency Medical Services ; Emigrants and Immigrants ; Fees and Charges ; Fees, Medical ; Fever ; Head ; Humans ; Insurance ; Internal Medicine ; Korea ; Neck Injuries ; Orthopedics ; Population Groups

PURPOSE: This study was designed to correlate the size and position of ureteral stones to their clinical manifestation. METHODS: This study was a retrospective review of medical records of 201 patients who visited the emergency department complaining of renal colic and diagnosed with ureteral stone(s) by use of computed tomography from July to December 2011. The size and position of a stone and the corresponding ipsilateral hydronephrosis, as well as the number and type of administered analgesics, were evaluated. RESULTS: Ureteral stones were located at the ureteropelvic junction in 2.0% of cases, at the proximal ureter between the ureteropelvic junction and the iliac vessels in 41.8% of cases, at the ureter crossing external iliac vessels in 1.0% of cases, at the distal ureter between the iliac vessels and the ureterovesical junction in 12.9% of cases, and at the ureterovesical junction in 42.3% of cases. Where the ureter crossed external iliac vessels, the mean size of stones was significantly larger in the upper ureter, as 5.3+/-2.3 mm, than in the lower ureter, as 4.2+/-1.8 mm. Pain duration and stone size were significant factors associated with hydronephrosis by logistic regression analysis. Ketorolac was selected as the first-line analgesics in 169 patients (94.9%). The factor affecting the response to analgesic treatment was stone size. Patients needing analgesic administration three times or more, had smaller stones. CONCLUSION: Most of the ureteral stones observed were located in the proximal ureter and at the ureterovesical junction. Hydronephrosis occurred more often in patients who had longer periods of pain and larger stones. Patients with smaller stones needed more frequent administration of pain killers.
Analgesics ; Emergencies ; Humans ; Hydronephrosis ; Ketorolac ; Logistic Models ; Medical Records ; Renal Colic ; Retrospective Studies ; Ureter ; Ureteral Calculi

PURPOSE: This study provided a sample of self-reported turnover rates and their causes for emergency medicine physicians. METHODS: A questionnaire was distributed to 47 emergency physicians practicing in private clinics via post or e-mail. Self-reported demographic data, workload, causes of turnover, psychosocial and job related stress were collected. 27 emergency physicians participated in this study by completing and returning the questionnaire. RESULTS: Turnover rate for emergency physician was 14.3%. The mean age of the participants was 45.19+/-3.43, and 25 of the 27 participants were male. The length of time working in a private clinic was 7.14+/-4.02 years. Years since acquisition of emergency board certification was 3.38+/-2.97 years. Work hours per week were 52.70+/-8.99. Income satisfaction and personal well-being were higher than compared to their time practicing medicine as emergency physicians. The average scores for APGAR and psychosocial stress were 5.63+/-2.71 and 2.19+/-0.85, respectively. Reported causes of turnover in emergency clinical practice included negative impacts to quality of life, impact of aging, negative effects of shift work, negative "fishbowl" work environment, etc. CONCLUSION: The causes of turnover for emergency physicians include concerns regarding health impacts due to shift work, negative impact on quality of life, and concerns related to job security. In order to decrease emergency physician turnover rates, administrative considerations should be put in place to include a decrease in night shift hours per physician, and frequency for senior emergency physician is most important. Investigation into causes of turnover for physicians should not be limited to private clinic operations but should also include administration, research, teaching, and other duties.
Aging ; Certification ; Electronic Mail ; Emergencies ; Emergency Medicine ; Humans ; Hypogonadism ; Male ; Mitochondrial Diseases ; Ophthalmoplegia ; Quality of Life ; Surveys and Questionnaires

PURPOSE: We evaluated the differences between the clinical characteristics, procedure and results of real life cardiopulmonary resuscitation versus how CPR is portrayed in Korean medical dramas. METHODS: We watched 58 episodes of Korean television medical dramas including , and , broadcast during the period 2007 to 2010. We identified all occurrences of CPR in each episode and collected the fictional patients' age, sex, location, presumed cause of cardiac arrest, and return of spontaneous circulation rate for the CPR performed, and then compared these with actual, published resuscitation statistics. Whether or not the procedure employed in a fictional CPR scene adhered to current CPR guidelines was also evaluated. RESULTS: There were 39 occurrences of CPR in the 58 television episodes viewed, with the most common cause being cardiac arrest. The fictional ROSC rate after CPR (71.8%) differed significantly from published real life figures (p=0.072). The resuscitation process did not appear to follow current guidelines in 64.1% of the cases. Contrary to reality, the average age of patients was 41.3 years. CONCLUSION: The CPR provided to fictional patients in medical dramas televised in Korea is generally different than what would be provided to a patient in reality. In addition, the ROSC rate appears higher on television than what can be expected in the real world.
Cardiopulmonary Resuscitation ; Drama ; Heart Arrest ; Humans ; Korea ; Resuscitation ; Television