1.Fast Track System in Emergency Department of Tertiary Hospital.
Ok Kyoung CHOI ; Won KIM ; Kyoung Soo LIM
Journal of the Korean Society of Emergency Medicine 1998;9(3):380-388
BACKGROUND: In 1996, our emergency department(ED) had 148.4 patients per day and an average time for managing simple and uncomplicated patients was 248 minutes. To relieve congestion, delay and conflict in ED, we have developed Fast Track to treat patients with minor illness rapidly and effectively. The Fast Track area is located in a separate area in front to the main department. The efficiency and effectiveness of new system and patients satisfaction were investigated. METHODS: All ambulatory patients(> 15 years of age) were triaged and treated at Fast Track by emergency physicians. Patients, triaged as severe illness, were moved directly to main ED and the other patients with minor illness were managed in Fast Track. We analysed the patients who were managed at Fast Track from Jan. 1st 1997 through Nov. 30th 1997. The total time staying in Fast Track from beginning of trige to final decision such as discharge or admission was recorded retrospectively. A questionnaire was obtained from random patients in the same period to evaluate the patient's satisfaction. RESULTS: The number of patients who were managed in Fast Track was 13,378, and it was 55.8% of all adult patients who visited ED during the period. The average staying time was decreased significantly with time, (140.9+/-2.9 minutes in June, 125.4+/-2.8 minutes in July, and 97.7+/-1.0 minutes after July). The 75 percentile weighted average time was also decreased significantly; 196 minutes in June, 107 minutes in July, 135 minutes from August to November(p<0.01). The questionnaire were obtained from 107 patients. The results were revealed that 90 of 107 patients(84.1%) were satisfied with emergency care at Fast Track, and the remaining patients expressed unsatisfied comments such as long waiting time(4.7%), overcrowding(1.9%), unsatisfactory care(1.9%). CONCLUSION: The Fast Track system could decrease patient's staying time and improve patient's satisfaction. In addition, the efficiency and effectiveness of the acute care in ED would be enhanced by managing minor illness in Fast Track rapidly and effectively.
Adult
;
Emergencies*
;
Emergency Medical Services
;
Emergency Service, Hospital*
;
Estrogens, Conjugated (USP)
;
Humans
;
Surveys and Questionnaires
;
Retrospective Studies
;
Tertiary Care Centers*
3.Clinical Significance of Gray-scale Ultrasound in the Diagnosis of Ureteral Stone: Need of the New Diagnostic Modalities for the Ureteral Stone in Emergency Room.
Won KIM ; Young Ju LEE ; Kyoung Soo LIM
Journal of the Korean Society of Emergency Medicine 1999;10(4):654-660
BACKGROUND: Ureteral stone(UTS) and acute pyelonephritis are the most common causes of nontraumatic acute flank pain in adults. Urography(IVU) is known as the most ideal diagnostic modality of obstructive uropathy to date. However, it has many practical limitations in overcrowding Korean emergency department to perform IVU as the diagnostic test of UTS. So we have performed prospective analytic study to compare IVU with its alternative diagnostic modalities. METHOD AND RESULTS: Our study was performed at Asan Medical Center from March, 1998 to July, 1999. We performed urinalysis, KUB, grayscale ultrasonography, and IVU in 243 patients, suspected to have UTS, based on histories, physical examination. After excluding patients with undetermined results(n=7) or spontaneous passage of stone before IVU(n=24), 212 patients were enrolled in our study. All of the other diagnostic tests were performed within one hour after emergency room presentation except IVU (53+/-24 hours). Diagnostic agreement among tests are as follows: Urinalysis shows good agreements with KUB(0.53) and IVU(0.62). KUB shows good agreement with IVU(0.48). Ultrasonography shows good agreement with IVU(0.58). Sensitivity(%), specificity(%), positive predicitive value(%), negative predicitive value(%), accuracy(%), and odds ratio of each diagnostic methods are as follows: Urinalysis is 91, 19, 78, 42, 74, 3.88; KUB is 55, 33, 72, 19, 50, 2.49; ultrasonography is 58, 92, 96, 41, 66, 45.61, and IVU is 81, 96, 98, 62, 84, 107.72. CONCLUSION: Although IVU seems to be the most ideal diagnostic modality for the UTS to date, it takes too long time for emergency physicians to confirm the diagnostic using IVU. We can performed other diagnostic modalities within one hour. However, emergency physicians suffer from poor diagnostic accuracy. Therefore, it is concluded that we are in need of more accurate alternative diagnostic modalities for UTS.
Adult
;
Chungcheongnam-do
;
Diagnosis*
;
Diagnostic Tests, Routine
;
Emergencies*
;
Emergency Service, Hospital*
;
Flank Pain
;
Humans
;
Odds Ratio
;
Physical Examination
;
Prospective Studies
;
Pyelonephritis
;
Ultrasonography*
;
Ureter*
;
Urinalysis
4.An experimental study on the regeneration of peripheral nerve through the polyurethane-silicone-haparin composite tube.
Hong Yong PARK ; Byung Gun KIM ; Kyoung Won MINN
Journal of the Korean Society of Plastic and Reconstructive Surgeons 1993;20(3):519-526
No abstract available.
Peripheral Nerves*
;
Regeneration*
5.The effect of histamine on the production of interferongamma and interleukin-12 in peripheral blood mononuclear cells from patients with atopic dermatitis.
Dou Hee YOON ; Eun Kyoung LEE ; Chung Won KIM
Journal of Asthma, Allergy and Clinical Immunology 1999;19(3):459-467
No abstract available.
Dermatitis, Atopic*
;
Histamine*
;
Humans
;
Interleukin-12*
6.Deep Vein Thrombosis after Cementless Total Hip Replacement Arthroplasty Using Doppler Ultrasound.
Kyoung Ho MOON ; Won Hong KIM ; Joung Yoon LEE
The Journal of the Korean Orthopaedic Association 1998;33(6):1553-1559
Venous thromboembolic disease is a frequent complication after total hip arthroplasty. However, in Korea, the low incidence of deep vein thrombosis after total hip arthroplasty was reported. In this study, we present the results of 82 consecutive patients(90 hips) who had a cementless total hip replacement with a Anatomic Medullary Locking Component(AML: Depuy, Warsaw, Indiana, USA) between August 1995 and September 1996 at Inha University Hospital, Korea. Postoperatively, none of the patients were treated with any known prophylatic method for deep vein thrombosis except elastic stockings. Both preoperatively and six weeks after surgery, all patients were studied by an radiologist using a portable Doppler ultrasonic velocity detector with a transmission frequency of 5 megahertz. Contrast phlebography was also done in all patients at the same time as the Doppler ultrasound. In addition, coagulation assays, a complete blood count, blood typing, and serum chemical-profile tests were done for all patients. In comparing the results of these laboratory tests from the DVT group and from the non-DVT group, we found that only eight patients(9.8%) out of eighty-two patients had DVT after total hip arthroplasty. Thrombi were found in the superficial femoral vein in five cases and in the common femoral vein in three cases. Though two(2.4%) patients showed suspicious symptoms of pulmonary embolim, their perfusion lung scans were negative. The DVT group show a significantly shorter activated partial thromboplastin time than did the non-DVT group(P<0.05). In addition, the DVT group showed significantly higher serum total protein than the total protein level of the non-DVT group(P<0.01). In this two groups, there was no difference between the results of Doppler ultrasound and the results of contrast phlebography. Consequently, the incidence of deep vein thrombosis after total hip replacement arthroplasty in Korean patients is significantly lower than incidence in patients from countries other than Korea. Doppler ultrasound was a non-invasive and the most reliable diagnostic technique for deep vein thrombosis.
Arthroplasty*
;
Arthroplasty, Replacement, Hip*
;
Blood Cell Count
;
Blood Grouping and Crossmatching
;
Femoral Vein
;
Humans
;
Incidence
;
Indiana
;
Korea
;
Lung
;
Partial Thromboplastin Time
;
Perfusion
;
Phlebography
;
Stockings, Compression
;
Ultrasonics
;
Ultrasonography*
;
Venous Thromboembolism
;
Venous Thrombosis*
7.SURGICAL REPAIR OF COMPLETE 80NY BILATERAL CHOANAL ATRESIA VIA TRANSPALATAL APPROACH
Kyoung Won KIM ; Yong Seok CHO ; Soo Nam YANG
Journal of the Korean Association of Maxillofacial Plastic and Reconstructive Surgeons 1998;20(2):133-138
Catheters
;
Choanal Atresia
;
Diagnosis
;
Emergencies
;
Hand
;
Membranes
;
Nasal Cavity
;
Nasopharynx
;
Nose
;
Operative Time
;
Parturition
;
Rubber
8.Clinical Characteristics of Elderly Patients in Emergency Department .
Kyoung Soo LIM ; Young Soo LEE ; Won KIM ; Ok Kyoung CHOI
Journal of the Korean Geriatrics Society 1998;2(2):38-45
BACKGROUND : The proportion and absolute number of older patients admitted through the emergency department (ED) are increasing yearly. As people getting older, they are more likely to suffer from emergency situation of disease, disability, and trauma. Combining with the decrease in physiologic reserve, these added burdens make the elderly more vulnerable to any of the additional situations. Understanding the implications of these facts is crucial to one who is providing optimal triage and emergency care to elderly (aged 65 years or older) and adults (between 15year of age and 64 years of age). METHODS : We conducted an observational survey of emergency patients age 15 or older who admitted to emergency department of Asan Medical Center. A convenience sample of 3,481 were divided into 2 groups by 65 years of age, and final results (admission vs. discharge) after emergency care was compared. The admission rate according to between two groups. We calculated odds ratios of important outcomes by pooling data from individual trials using logistic regression analysis. RESULTS : Admission rate of elderly was higher than adults as 59.2% versus 36.4% (odds ratio=2.32) 95% CI=1.21~3.24). Although vital signs were within normal ranges, admission rate of elderly was significantly higher than adults as follows; normal range of systolic blood pressure (56.0% vs. 35.5%), normal range of respiration rate per minute (55.4% vs. 36.4%), alert status of mentality (34.2% vs. 54.7%). CONCLUSION : We could not define the severity of emergency patients only by using vital signs and/or clinical symptoms, especially to the elderly patients. Even though the vital signs of elderly patients. emergency physician should manage them carefully because of the high severity of clinical condition in elderly then we expected. Emergency Geriatric Assessment tools must be developed differently from general triage tools.
Adult
;
Aged*
;
Blood Pressure
;
Chungcheongnam-do
;
Emergencies*
;
Emergency Medical Services
;
Emergency Service, Hospital*
;
Geriatric Assessment
;
Humans
;
Logistic Models
;
Odds Ratio
;
Reference Values
;
Respiratory Rate
;
Triage
;
Vital Signs
9.Spontaneous Intracranial Hypotension.
Gyu Chong CHO ; Won KIM ; Ok Kyoung CHOI ; Kyoung Soo LIM
Journal of the Korean Society of Emergency Medicine 1999;10(4):628-635
BACKGROUNDS: Headache is one of the common symptoms complained by patients at the emergency department. Postural headache is the characteristic symptom that is aggravated at upright position and relieved at recumbent position. This postural headache is associated with low cerebrospinal fluid (CSF) pressure. Spontaneous intracranial hypotension(SIH) is an unusual syndrome of postural headache and low CSF pressure without a precipitating event. The diagnosis of SIH is confirmed by 60mmH2O or less CSF opening pressure on lumbar puncture. However, the cases of SIH with normal CSF opening pressure have been reported. so it is needed to complement the diagnostic criteria of SIH. METHODS: A retrospective descriptive study with reviewing medical records of 10 patients who had been admitted at Asan Medical Center from Apr. 1995 to Jul. 1999 was done. Analyses were done on 22 variables of age, sex, clinical symptoms, spinal analysis findings, radiologic findings and therapeutic modality. Fisher's exact test and Mann-Whitney test were applied for statistical analysis (p-value < 0.05). RESULTS: 1. The male to female ratio was 3 : 7, and the mean age was 37.30+/-5.96 years. 2. Postural headache was characteristic symptom & complained by all patients. 3. The mean CSF pressure was 22.8+/-30.8 mmH2O. 4. Brain MRI demonstrated the pachymeningeal enhancement in all patients. 5. Radioisotope cisternography demonstrated slow ascent of tracer to the cerebral convexity in 88.9% patients, early soft tissue uptake suggestive of CSF leakage & rapid urinary accumulation of tracer in 66.7% patients, respectively. 6. 90.0% of all patients were recovered with autologous epidural blood patches, and 10.0% were recovered with conservative management. CONCLUSION: The SIH is an unusual syndrome. but we can diagnose the SIH in the patient, complains of a postural headache, if any following two or more criteria are present. 1. 60mmH2O or less CSF opening pressure on lumbar puncture. 2. Brain MRI finding : the pachymeningeal enhancement. 3. Cisternography findings : slow ascent of tracer to the cerebral convexity, early soft tissue uptake suggestive of CSF leakage & rapid urinary accumulation of tracer.
Blood Patch, Epidural
;
Brain
;
Cerebrospinal Fluid
;
Chungcheongnam-do
;
Complement System Proteins
;
Diagnosis
;
Emergency Service, Hospital
;
Female
;
Headache
;
Humans
;
Intracranial Hypotension*
;
Magnetic Resonance Imaging
;
Male
;
Medical Records
;
Retrospective Studies
;
Spinal Puncture
10.New Index of Combined Systolic and Diastolic Cardiac Performance Using Echo-Dopple Methods: The Utility of Cardiac Performance Index in the Screening Test of Cardiac Dysfunction due to Acute Myocardial Infarction.
Won KIM ; Kyoung Soo LIM ; Young Ju LEE ; Ok Kyoung CHOI ; Jeong Min JEON
Journal of the Korean Society of Emergency Medicine 1999;10(4):587-598
BACKGROUND: Because systolic and diastolic dysfunction frequently coexist in acute myocardial infarction(AMI), we hypothesize that a combined measure of ventricular performance using Doppler echocardiography may be more sensitive and time-saving diagnostic tool for the evaluation of patients presenting with cardiogenic chest pain. METHOD AND RESULTS: Seventy-one patients with AMI (47 male, 59+/-11 years) and 45 patients with normal coronary artery (29 male, 52+/-11 years) were included in the study for measurement of cardiac performance index and established parameters of ventricular function using conventional echo-Doppler methods. a new derived index of cardiac performance: (ICT+IRT)/ET, was obtained by subtracting ejection time(ET) from the interval between cessation and onset of the mitral inflow velocity to give the sum of isovolumic contraction time(ICT) and isovolumic relaxation time(IRT). The mean value of the index was significantly different between normal and AMI(p<0.01). The degree of inter-group overlap was smaller for the index compared to other parameters. within functional groups, the value of the index did not appear to be related to heart rate, mean arterial pressure and the degree of mitral regurgitation. CONCLUSION: cardiac performance index is a conceptually new, simple and reproducible Doppler index of combined systolic and diastolic myocardial performance, and it is useful as screening test for patients with cardiac dysfunction due to AMI.
Arterial Pressure
;
Chest Pain
;
Coronary Vessels
;
Echocardiography, Doppler
;
Heart Rate
;
Humans
;
Male
;
Mass Screening*
;
Mitral Valve Insufficiency
;
Myocardial Infarction*
;
Relaxation
;
Ventricular Function