PURPOSE: The purpose of this study was to determine the feasibility of the implementation of prehospital advanced life support programs and share in-hospital medical direction center operation experience. METHODS: From Oct. to Dec. 2008, twenty fire safety centers in Seoul metropolitan city took part in a pilot implementation of advanced life support programs with medical services as follow: prehospital 12 lead ECG transmission for patients with chest pain, a prehospital CPAP (continuous positive airway pressure) program for patients with dyspnea, a prehospital stroke scale application for patients with neurologic problems, and real-time audio-visual information transmission for patients with traumatic injuries. RESULTS: A total of 6,741 patients were transported to hospitals by emergency response ambulances to twenty five different safety centers. Of the total number of patients, 304 received advanced life support management. The prehospital use of 12 lead ECG transmission was 57.89%, real-time ECG was 27.45%, continuous positive airway pressure was 20.60%, stroke scale was 25%, and real-time audio-visual information was 5.98%. A Delphi survey using a panel which was expert in prehospital implementation of advanced life support programs concluded that prehospital ECG transmission and stroke scale programs should be implemented. However, they decided against implementation of the continuous positive airway pressure and real-time audio-visual information programs. CONCLUSION: Overall, the feasibility of implementation of a prehospital conventional 12 lead ECG program was good and the Delphi survey concurred that the ECG transmission and prehospital stroke scale programs should be implemented.
Ambulances ; Chest Pain ; Continuous Positive Airway Pressure ; Dyspnea ; Electrocardiography ; Emergencies ; Emergency Medical Services ; Fires ; Humans ; Stroke

PURPOSE: We evaluated the influence of time-related input, throughput, and output factors on ambulance diversions in an urban emergency department (ED). METHODS: Data was prospectively collected in an urban ED for one year. We measured daily input factors (daily number of visit, etc), throughput factors (ED length of stay), and output factors (occupancy rate of adult ward, etc). The duty emergency physician had the authority to declare an ambulance diversion. There was no written protocol for ambulance diversion, and each diversion lasted 4 hours if not extended. We estimated the effect of the potential factors of the same day and the previous day on ambulance diversion with a multivariates logistic regression analysis excluding variables with collinearity RESULTS: The total annual number of visits was 40,863. The number of patients delivered by ambulance was 4,059 (9.9%). Ambulance diversion occurred 29 times during 365 twenty-four hour observation intervals (7.9%). The multivariates logistic regression analyses revealed three significant independent factors of ambulance diversion: the ward occupancy rate of the previous day (odds ratio [OR], 1.278; 95% confidence interval [CI], 1.039-1.573), the elderly proportion for the day (OR, 1.106; 95% CI, 1.005-1.217), the total number of visits of the day (OR, 1.079; 95% CI, 1.039-1.120). CONCLUSION: Daily number of visits, proportion of elderly, and ward occupancy rate of the previous day were found to be factors related with ambulance diversion, with the hospital occupancy rate of the previous day showing the highest OR.
Adult ; Aged ; Ambulances ; Crowding ; Emergencies ; Emergency Service, Hospital ; Humans ; Logistic Models ; Prospective Studies ; Time Factors

Tinnitus-the perception of sound in the absence of an actual external sound-represents a symptom of an underlying condition rather than a single disease. Several theories have been proposed to explain the mechanisms underlying tinnitus. Tinnitus generators are theoretically located in the auditory pathway, and such generators and various mechanisms occurring in the peripheral auditory system have been explained in terms of spontaneous otoacoustic emissions, edge theory, and discordant theory. Those present in the central auditory system have been explained in terms of the dorsal cochlear nucleus, the auditory plasticity theory, the crosstalk theory, the somatosensory system, and the limbic and autonomic nervous systems. Treatments for tinnitus include pharmacotherapy, cognitive and behavioral therapy, sound therapy, music therapy, tinnitus retraining therapy, massage and stretching, and electrical suppression. This paper reviews the characteristics, causes, mechanisms, and treatments of tinnitus.
Auditory Pathways ; Autonomic Nervous System ; Cochlear Nucleus ; Massage ; Music Therapy ; Otoacoustic Emissions, Spontaneous ; Tinnitus

Disulfiram, tetraethylthiuram disulfide, has been used in the clinical treatment of alcoholism since 1948. Aside from the manifestations of a disulfiram-alcohol reaction, disulfiram causes direct toxic side effects including psychiatric, cardiovascular, hematologic and neurologic disorders. The most frequent neurologic side effects are drowsiness, apathy, headache, decreased sexual potency, neuropathy, and optic neuritis. We describe a 26-year-old man who insidiously developed a distal synunetric sensorimotor polyneuropathy after seven years of disulfiram ingestion confirmed by nerve biopsy. He showed nearly complete resolution after the disulfiram was stopped.
Adult ; Alcoholism ; Apathy ; Biopsy ; Disulfiram* ; Eating ; Headache ; Humans ; Nervous System Diseases ; Optic Neuritis ; Polyneuropathies ; Sleep Stages

PURPOSE: This study was aimed to develop secondary triage rule for decision of interfacility transfer to higher level of trauma center for patients with traumatic brain injury (TBI). METHODS: In a prospective observational study from August 2006 to December 2007 conducted in an urban tertiary emergency department, data were obtained from patients more than 15 years old and with TBI. Primary outcome was defined as meaningful positive CT findings. Secondary outcome was defined as meaningful intervention. Non-adjusted univariated logistic regression model was derived from result of chi-square test and adjusted model was derived using stepwise selection manner. Hosman-Lemeshow test for the goodness of fit was used. RESULTS: Total number of eligible patients with traumatic brain injury was 653. Primary outcome was positive in 103 patients and secondary outcome was positive in 42 patients. In univariate logistic regression, risk factors were age over 65(OR: 2.40), history of cerebrovascular disease(OR: 7.08), fall over two meter(OR: 6.28), pedestrian struck(OR: 18.5), headache(OR: 2.18), vomiting(OR: 3.03), disorientation(OR: 5.37), any evidence of open fracture(OR: 24.03), Glasgow coma sacle less than 13(OR: 4.97), Racoon's eye sign (OR: 2.50). These 10 risk factors were statistically significant in adjusted model which was derived using stepwise selected manner. Hosman-Lemeshow test for the goodness of fit was used and chi-square was 1.307(p=0.86). This decision rule had a sensitivity of 93.48%, a specificity of 41.13%, and a negative predictive value of 97.32%. CONCLUSION: A sensitive clinical decision rule with high negative predictive value for detection of abnormal CT lesions which need transfer to higher level of trauma center was developed.
Brain Injuries ; Coma ; Emergencies ; Eye ; Humans ; Logistic Models ; Prospective Studies ; Risk Factors ; Sensitivity and Specificity ; Trauma Centers ; Triage

BACKGROUND: Intraperitoneal(IP) vancomycin has been widely used for the treatment of peritonitis or exit-site infection associated with continuous ambulatory peritoneal dialysis(CAPD). However, some previous reports in the literature have suggested that IP administration of certain vancomycin may be associated with chemical peritonitis in CAPD patients. METHODS: Between 1 February 1994 and 1 February 1997, 35 consecutive CAPD patients requiring treatment with intraperitoneal vancomycin for either exit-site infection or peritonitis in the Yeungnam University Hospital were recruited retrospectively into the study. We compared retrospectively the incidence of chemical peritonitis after using two different preparations of vancomycin from different pharmaceutical companies, namely vancocin CP(R) and vancomycin(R). RESULTS: Thirty-three cases(all 26 cases given vancocin CP(R) and 7 out of the 9 cases given vancomycin(R)) showed improvement. None of them developed fever, abdominal pain or cloudy dialysate. Out of the 9 cases given IP vancomycin(R), two who currently did not have abdominal pain and cloudy dialysis effluent develolped these symptom and sign at 5 and 6 hours after administration of IP vancomycin. The chemical peritonitis may be secondary to prolonged contact of the peritoneal membrane with one or more of the impurities present in vancomycin preparation. CONCLUSION: In summary, it is necessary for the nephrologists to be aware of the possible chemical peritonitis which can be caused by the impurities of certain brand of vancomycin.
Abdominal Pain ; Dialysis ; Fever ; Humans ; Incidence ; Membranes ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Retrospective Studies ; Vancomycin*

PURPOSE: In this study, we determined the long-term effects of the Independent Capacity Protocol (ICP), in which the emergency department (ED) is temporarily used to stabilize patients, followed by transfer of patients to other facilities when necessary, on crowding metrics. MATERIALS AND METHODS: A before and after study design was used to determine the effects of the ICP on patient outcomes in an academic, urban, tertiary care hospital. The ICP was introduced on July 1, 2007 and the before period included patients presenting to the ED from January 1, 2005 to June 31, 2007. The after period began three months after implementing the ICP from October 1, 2007 to December 31, 2010. The main outcomes were the ED length of stay (LOS) and the total hospital LOS of admitted patients. The mean number of monthly ED visits and the rate of inter-facility transfers between emergency departments were also determined. A piecewise regression analysis, according to observation time intervals, was used to determine the effect of the ICP on the outcomes. RESULTS: During the study period the number of ED visits significantly increased. The intercept for overall ED LOS after intervention from the before-period decreased from 8.51 to 7.98 hours [difference 0.52, 95% confidence interval (CI): 0.04 to 1.01] (p=0.03), and the slope decreased from -0.0110 to -0.0179 hour/week (difference 0.0069, 95% CI: 0.0012 to 0.0125) (p=0.02). CONCLUSION: Implementation of the ICP was associated with a sustainable reduction in ED LOS and time to admission over a six-year period.
Aged ; *Clinical Protocols ; *Crowding ; Efficiency, Organizational ; Emergency Service, Hospital/*organization & administration/utilization ; Female ; Hospital Planning/*methods ; Hospitals, Urban/*organization & administration/utilization ; Humans ; Length of Stay/*statistics & numerical data ; Male ; Outcome and Process Assessment (Health Care) ; Patient Admission/statistics & numerical data ; Patient Transfer/statistics & numerical data ; Regression Analysis ; Time ; Time Factors ; Triage

Proper seat belt use saves lives; however, the use rate decreased in Korea. This study aimed to measure the magnitude of the preventive effect of seat belt on case-fatality across drivers and passengers. We used the Emergency Department based Injury In-depth Surveillance (EDIIS) database from 17 EDs between 2011 and 2012. All of adult injured patients from road traffic injuries (RTI) in-vehicle of less than 10-seat van were eligible, excluding cases with unknown seat belt use and outcomes. Primary and secondary endpoints were in-hospital mortality and intracranial injury. We calculated adjusted odds ratios (AORs) of seat belt use and driving status for study outcomes adjusting for potential confounders. Among 23,698 eligible patients, 15,304 (64.6%) wore seat belts. Driver, middle aged (30-44 yr), male, daytime injured patients were more likely to use seat belts (all P < 0.001). In terms of clinical outcome, no seat belt group had higher proportions of case-fatality and intracranial injury compared to seat belt group (both P < 0.001). Compared to seat belt group, AORs (95% CIs) of no seat belt group were 10.43 (7.75-14.04) for case-fatality and 2.68 (2.25-3.19) for intracranial injury respectively. In the interaction model, AORs (95% CIs) of no seat belt use for case-fatality were 11.71 (8.45-16.22) in drivers and 5.52 (2.83-14.76) in non-driving passengers, respectively. Wearing seat belt has significantly preventive effects on case-fatality and intracranial injury. Public health efforts to increase seat belt use are needed to reduce health burden from RTIs.
Accidents, Traffic/mortality/*prevention & control ; Adult ; Aged ; Craniocerebral Trauma/prevention & control ; Databases, Factual ; Emergency Service, Hospital ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Motor Vehicles ; Odds Ratio ; Republic of Korea/epidemiology ; Seat Belts/*utilization ; Young Adult

No abstract available.
Angiolipoma*

PURPOSES: There have been many efforts to improve the service of emergency centers. In spite of these, no evidence is showing any landmark advancement of emergency services, especially in the hospital stage, exists. We need some efficient standard criteria to evaluate emergency service in the hospital stage, and a useful method might utilize the overcrowding index. We want to know the change in the overcrowding index at a regional emergency center after injury area administration. Injury area means an area in which only an assigned duty physician manages patients with injuries such as those from traffic accidents, falls, assualts, collisions, lacerations, amputations, burns, intoxication, asphyxia, drowning, animal bites, sexual assualts, etc. METHODS: We started to operate an injury area in our emergency department from late 2004, and from January to June in 2004 and in 2005, we collected patients' data, age, sex, assigned department, and result from hospital order communication system to figure out overcrowding indices and result indices. We found the daily number of patients, the turnover rate, the admission rate, the ICU admission rate, the emergency operation rate, the ED stay duration, and the ED patient volume to be overcrowding indices. Also we found the withdrawal rate, the transfer rate, and mortality to be result indices. We compared these indices between 2004 to 2005 by using a t-test. RESULTS: There was a significant increase in the daily number of visiting patients in 2005, overcrowding indices, such as the turnover rate, the admission rate, the ICU admission rate, and the emergency operation rate, also showed statistically significant increases in 2005 (P<0.001). As for the result indices, there was a noticeable decrease in the number of withdrawals (11.77/day in 2004 to 4.53/day in 2005). CONCLUSION: Operating an injury area in a mildly overcrowded local emergency center is beneficial. Evaluating the effect of operating an injury area and it's impact on hospital finances by conducting a similar study analyziing patients for a longer duration would be valuable.
Accidents, Traffic ; Amputation ; Animals ; Asphyxia ; Burns ; Drowning ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Lacerations ; Mortality