Vitamin B12 deficiency results in the occurrence of systemic diseases in our nervous system. One of the most common manifestations of Vitamin B12 deficiency is subacute combined degeneration (SCD), which is characterized by paralysis and sensory changes of limbs, and disturbance of gait and position sense. SCD can be caused by the abuse of Happy Balloon, which comprises nitrous oxide and is used as a party hallucinogen. Diagnosis of SCD is achieved by combining the clinical symptoms, laboratory study, electrophysiological study and imaging findings. However, neurological symptoms observed during laboratory examinations are insufficient to diagnose SCD without the characteristic magnetic resonance imaging (MRI) findings. This is due to ambiguity of the symptoms and delayed report time of laboratory results in the emergency department. The ‘Inverted V sign’, observed towards the rear of the cervical and thoracic spine in T2 emphasis MRI images, is the most prominent finding of SCD. In most cases, the T1 image shows the same signal strength as the surrounding tissue. In the current report, we present an SCD case with an enhanced T1 phase of the MRI.

Background: It is important to communicate accurately in the emergency department. Due to COVID-19 pandemic, a mask is mandatory to protect medical staffs and patients from infectious diseases, and the mask is known to disturb speech intelligibility. The objective of this study is to find out if a transparent mask can affect communication. Methods: : We conducted a randomized pre- and post-test trial with 40 participants in a real emergency room environment. The reader puts on a mask and read aloud sentences which are frequently used between medical staffs and patients or among medical staffs. The type of mask was randomly assigned to the reader which was transparent or non-transparent. Frequently used 5 sentences between medical staffs and patients and 5 sentences among medical staffs from prepared 100 sentences were randomly selected and recited. Participants were told to write down the sentences they heard. Each sentence written down was graded 0 or 1. After writing down 10 sentences, reader puts on another type of mask and the same experiment was done. The order of transparenton-transparent mask was randomly allocated to each participant. Results: : In frequently used sentences between medical staffs and patient, average score with a transparent mask was 4.88, and with a non-transparent mask was 4.50(p=0.001). In frequently used sentences among medical staffs, average score with a transparent was 4.77, and with a non-transparent mask was 4.05(p<0.001). Conclusions This study showed the transparent mask improves speech intelligibility when communicating in an emergency room.

Background: Sleep is an important physiological process that is required to perform daily functions. Sleep duration is reported to be correlated withobesity. This study investigated the association between sleep duration and abdominal obesity in Korean adult male. Methods: We used data from the seventh Korean National Health and Nutrition Examination Survey conducted during 2016–2017. In total, 3,997 maleaged >20 years were included. The frequency and weighting percentage of sleep duration were calculated. Chi-square test was performed withRao–Scott calibration. Logistic regression was performed to evaluate the association of sleep duration with abdominal obesity. Results: The overall effect of abdominal obesity on sleep duration was significant. The probability of developing abdominal obesity when the averagesleep duration was below than 5 hours was 1.495 times higher than that when it was 7 hours. Conclusion Sleep duration was related to abdominal obesity in Korean adult male.

Purpose: : Since the era of COVID-19, face-to-face contact has been reduced to prevent the spread of infectious diseases around the world, and hospitals are applying various methods to prevent the spread of infection. However, when writing a consent form essential during the treatment process, it had to be done face-to-face. We developed a non-face-to-face communication device to enable real-time consent writing. This study aims to evaluate the usefulness of the non-face-to-face communication device when writing a consent form. Methods: : From December 28, 2021 to February 2, 2022, electronic medical records of patients visited the severance hospital emergency center and had a central venous catheter inserted were collected retrospectively. There were 56 consent forms included in the study, 43 face-to-face and 13 non-face-to-face. We checked the difference between the details explained in the non-face-to-face consent form and the face-to-face by the average score and the explanation of each item. The score was measured from a minimum of 0 points to a maximum of 13 points, with 1 point for explained items and 0 points for unexplained. Results: : The average score for the face-to-face consent form was 4.3, and for the non-face-to-face was 3.0 (p=0.148). There was no significant difference in the explanation of each item. Conclusion : It was confirmed writing a consent form through the non-face-to-face communication device can perform a similar role compared to the face-to-face. It is expected unnecessary contact can be reduced by applying the device to hospital rooms, and enabling a non-face-to-face rounds system for new infectious diseases.

PURPOSE: It is important to begin a transfusion safely and appropriately as soon as possible in a hemorrhagic shock patient. A group O+ unmatched pack red blood cell (universal O+) transfusion may satisfy that requirement. We report our experiences with universal O+ to compare its usefulness for hemorrhagic shock patients with that of a matched pack red blood cell transfusion in the emergency department (ED). METHODS: This is a retrospective study. Patients who had systolic blood pressure of less than 90 mmHg or a pulse rate of more than 120 beats per minute in the ED were included, and their medical records were reviewed. The collected data were demographic data, vital signs, blood test results, time to transfusion, the amount of transfusion, complications, and diagnoses. We calculated the emergency transfusion score (ETS) based on the patients' medical records. RESULTS: Two hundred thirty-five patients were included. Forty-eight patients (36 trauma and 12 non-trauma patients) were transfused with a universal O+. These patients had less time to transfusion compared with the cross-matched transfusion groups (35+/-42 versus 170+/-187 minutes, p<0.001). There were no differences in complications between groups (p=0.076). Of the patients who were transfused with universal O+, 94.4% got more than 3 ETS. CONCLUSION: The universal O+ transfusion, compared with matched pack red blood cell transfusion, should be a useful treatment for ED hemorrhagic shock patient due to its having a shorter time to transfusion without an increase in complications.
ABO Blood-Group System ; Blood Pressure ; Blood Transfusion ; Collodion ; Emergencies ; Erythrocyte Transfusion ; Erythrocytes ; Heart Rate ; Hematologic Tests ; Humans ; Hypovolemia ; Medical Records ; Retrospective Studies ; Shock ; Shock, Hemorrhagic ; Vital Signs

Objective: The number of elderly people visiting emergency rooms is rapidly increasing. Fever is one of the common complaints of patients who come to the emergency room, and it is often difficult to determine its cause in elderly patients only through basic examinations and tests. This study sought to verify the relationship between computed tomography and emergency department revisits of febrile elderly patients. Methods: This study is a retrospective medical record analysis study. Patients who came to our emergency room between September 2016 and September 2019, aged 65 years or more, and with body temperature higher than 37.8°C at the time of presentation or during their stay in the emergency room were enrolled. Patient age, sex, vital signs at triage, laboratory tests, whether computed tomography (CT) was conducted or not were analyzed. The primary outcome was set as revisits to the emergency department within 72 hours after discharge, due to any reason. Results: Three thousand two hundred and forty patients were enrolled and of these 289 patients revisited the emergency department (ED). In the revisit (-) group, CT was performed on 44.09% of patients and 54.67% of patients in the revisit (+) group thus showing a statically significant difference. Conclusion This study showed that in elderly patients with fever presenting to the ED, patients who underwent a CT had 1.558 higher odds of revisit to the ED compared to patients who did not undergo a CT. From this result, it should be considered that the decision to discharge the febrile elderly patients based on the results of CT examination may not be appropriate.

Objective: The number of elderly people visiting emergency rooms is rapidly increasing. Fever is one of the common complaints of patients who come to the emergency room, and it is often difficult to determine its cause in elderly patients only through basic examinations and tests. This study sought to verify the relationship between computed tomography and emergency department revisits of febrile elderly patients. Methods: This study is a retrospective medical record analysis study. Patients who came to our emergency room between September 2016 and September 2019, aged 65 years or more, and with body temperature higher than 37.8°C at the time of presentation or during their stay in the emergency room were enrolled. Patient age, sex, vital signs at triage, laboratory tests, whether computed tomography (CT) was conducted or not were analyzed. The primary outcome was set as revisits to the emergency department within 72 hours after discharge, due to any reason. Results: Three thousand two hundred and forty patients were enrolled and of these 289 patients revisited the emergency department (ED). In the revisit (-) group, CT was performed on 44.09% of patients and 54.67% of patients in the revisit (+) group thus showing a statically significant difference. Conclusion This study showed that in elderly patients with fever presenting to the ED, patients who underwent a CT had 1.558 higher odds of revisit to the ED compared to patients who did not undergo a CT. From this result, it should be considered that the decision to discharge the febrile elderly patients based on the results of CT examination may not be appropriate.

Background: : Effective communication between doctors and patients is very important not only for diagnosis and treatment but also for building trust. Although teaching communication skills is very important in medical schools, there are limitations such as the number of students and the uncertainty of the patient population. Therefore, this study evaluates the effect of Fishbowl method to teach communication skills to medical students, which involves the medical students communicating with standardized patients in front of a large classroom and being observed by rest of the students. Methods: : This study involves 10 weeks of educating 126 fourth grade medical students and graduates. During this period, total 8 classes were taken by subjects, where each class lasts 2 hours and is conducted by observing treatments of the standardized patients on 14 clinical topics by randomly selected medical students and giving feedback on the communication skills of the selected medical students. The educational effect was evaluated based on the scores of the clinical performance examination before and after the classes. Results: : The scores assessed for medical history taking before and after the training are increased by 2.45 (p<0.001) and the scores for patient-doctor relationship is increased by 7.56 (p<0.001). Conclusions : It is expected to improve the communication skills of medical students by large scale lectures with standardized patients.

PURPOSE: National Emergency X-Radiography Utilization Study (NEXUS) criteria and the Canadian Cervical Spine rule (CCR) are commonly used in cervical trauma patients to determine whether a plain cervical X-ray should be performed. However, plain cervical X-rays are so inaccurate that cervical spine computed tomography (CT) is often considered as a screening test. We studied the usefulness of the NEXUS criteria and the CCR for determining the need for a CT evaluation in the emergency department (ED). METHODS: This prospective observational study was conducted from January 2007 to March 2008. Plain Xray and CT scans of the cervical spine were performed on blunt trauma patients with neck pain. The relevancy of CT was examined using the NEXUS criteria and the CCR. Sensitivity, specificity, positive predicted value, and negative predicted value analyses were performed to diagnose the cervical spine injury. RESULTS: During the study period, 284 patients were enrolled in this study. The sensitivity, specificity, positive predicted value, and negative predicted value of the NEXUS criteria were 87.5%, 1.1%, 5.0%, and 60.0% respectively, while those of the CCR were 87.5%, 8.2%, 5.3%, and 91.6%. There were two missed fracture cases when the NEXUS criteria and the CCR were applied independently, however, no cases were missed when both were applied. CONCLUSION: This study suggests the NEXUS and the CCR in combination can be used as a guide to CT evaluation for cervical spine injury in the ED.
Cervical Vertebrae ; Emergencies ; Female ; Humans ; Mass Screening ; Neck Pain ; Prospective Studies ; Resin Cements ; Sensitivity and Specificity ; Spine

PURPOSE: This study was designed to evaluate the educational effects of cardiopulmonary resuscitation (CPR) instruction to elementary school children and the perspectives of students and teachers about such instruction. METHODS: A total of 34,232 5th and 6th grade students from 998 elementary schools were instructed using a two-hour CPR lesson from each school teacher using CPR Anytime(R). The school teachers also were instructed by the same lesson from BLS instructors. Survey questionnaires were distributed to students involved. CPR skills were tested using a checklist during the class. We calculated the multiply effect that how many people were instructed CPR secondarily by student after the lesson and analyzed results by grade and gender. RESULTS: Most students (82%) said that CPR was easy to learn; 81% indicated a willingness to do CPR on a stranger. CPR skills were tested in 11,529 students (34%), and 10,269 (89%) passed. Assessment of respiration was the most commonly omitted procedure. The multiply effect was 1.54, and was higher in the 5th grade and among girls. CONCLUSION: This study suggests that the CPR instruction to 5th or 6th grade students in an elementary school setting is feasible and effective. Although the quality of instruction may be low, the children performed CPR on their family and friends.
Cardiopulmonary Resuscitation ; Checklist ; Child ; Friends ; Health Education ; Heart Arrest ; Humans ; Manikins ; Surveys and Questionnaires ; Respiration