BACKGROUND: Medical emergency teams (METs) have shown their merit in preventing unexpected cardiac arrest. However, it might be impractical for small- or medium-sized hospitals to operate an MET due to limited manpower and resources. In this study, we sought to evaluate the feasibility of a medical alert system (MAS) that alerts all doctors involved in patient care of patient deterioration via text message using smart-phones. METHODS: The MAS was test-operated from July 2015 to September 2015, in five general wards with a high incidence of cardiac arrest. The number of cardiac arrests was compared to that of 2014. The indication for activation of MAS was decided by the intensive care unit committee of the institution, which examined previous reports on MET. RESULTS: During the three-month study period, 2,322 patients were admitted to the participating wards. In all, MAS activation occurred in 9 patients (0.39%). After activation, 7 patients were admitted to the intensive care unit. Two patients (0.09%) experienced cardiac arrest. Of 13,129 patients admitted to the ward in 2014, there were 50 cases (0.38%) of cardiac arrest (p = 0.009). CONCLUSIONS: It is feasible to use MAS to prevent unexpected cardiac arrest in a general ward.
Emergencies ; Heart Arrest ; Hospital Rapid Response Team ; Humans ; Incidence ; Intensive Care Units ; Mortality ; Patient Care ; Patients' Rooms ; Pilot Projects* ; Text Messaging

BACKGROUND: Medical emergency teams (METs) have shown their merit in preventing unexpected cardiac arrest. However, it might be impractical for small- or medium-sized hospitals to operate an MET due to limited manpower and resources. In this study, we sought to evaluate the feasibility of a medical alert system (MAS) that alerts all doctors involved in patient care of patient deterioration via text message using smart-phones. METHODS: The MAS was test-operated from July 2015 to September 2015, in five general wards with a high incidence of cardiac arrest. The number of cardiac arrests was compared to that of 2014. The indication for activation of MAS was decided by the intensive care unit committee of the institution, which examined previous reports on MET. RESULTS: During the three-month study period, 2,322 patients were admitted to the participating wards. In all, MAS activation occurred in 9 patients (0.39%). After activation, 7 patients were admitted to the intensive care unit. Two patients (0.09%) experienced cardiac arrest. Of 13,129 patients admitted to the ward in 2014, there were 50 cases (0.38%) of cardiac arrest (p = 0.009). CONCLUSIONS: It is feasible to use MAS to prevent unexpected cardiac arrest in a general ward.
Emergencies ; Heart Arrest ; Hospital Rapid Response Team ; Humans ; Incidence ; Intensive Care Units ; Mortality ; Patient Care ; Patients' Rooms ; Pilot Projects ; Text Messaging

PURPOSE: The purpose of this study was to examine nurses' cognition of the diagnosis related group (DRG) in long-term care hospitals and changes in nursing care after application of the DRG system. METHOD: This study was a descriptive survey involving 161 nurses working in 12 long-term care hospitals located in Gwangju city and Chonnam area. Data were analyzed using the SPSS 18.0 version program. Data analyses utilized descriptive test, chi-square test, Fisher's exact probability test, t-test, and one-way ANOVA. RESULT: There was no change in cognition of DRG in 55.3% of the nurses, and 26.1% takes to 'change positively'. More than half of the respondents (57.8%) agreed to the application of DRG. After application of DRG, the nurses responded 'there were changes in nursing care' in 23 of the 25 care items. Two items had an increase in nursing care. CONCLUSIONS: No distinct changes in nursing care were evident after DRG application. Therefore, there is need to provide education programs related to DRG for nurse in long-term care hospitals.
Cognition ; Surveys and Questionnaires ; Diagnosis-Related Groups ; Long-Term Care ; Nursing Care ; Statistics as Topic

PURPOSE: This study was aimed to evaluate the effect of time of surgery for acute appendicitis on surgical outcomes to optimize the timing of appendectomies. METHODS: Medical records of patients who underwent an appendectomy were reviewed to obtain data on time of symptom onset, time of hospital presentation, and start times of surgery. Surgical findings were used to define appendicitis as either uncomplicated or complicated. The uncomplicated group included patients with simple, focal, or suppurative appendicitis, and the complicated group included patients with gangrenous, perforated appendicitis or periappendiceal abscess formation. The 2 groups were analyzed by age, sex, and time. RESULTS: A total of 192 patients were analyzed. The mean time from symptom onset to start of operation showed a significant difference between both groups (1,652.9 minutes vs. 3,383.8 minutes, P < 0.001). The mean time from hospital visit to start of operation showed no difference between both groups (398.7 minutes vs. 402.0 minutes, P = 0.895). Operating within 24 hours of symptom onset had a relative risk of 1.738 (95% confidence interval, 1.319-2.425) for complications. Operating more than 36 hours after symptom onset was associated with an increased risk of postoperative ileus and a longer hospital stay. CONCLUSION: Complicated appendicitis is associated with a delay in surgery from symptom onset rather than a delay at hospital arrival. Surgeons should take into account the time from symptom onset when deciding on the timing of appendectomy. We recommend that appendectomy be performed within 36 hours from symptom onset.
Abscess ; Appendectomy ; Appendicitis* ; Humans ; Ileus ; Length of Stay ; Medical Records ; Surgeons ; Treatment Outcome

Hemorrhagic trauma is a major preventable cause of mortality in critically injured patients. Rapid surgical interventions are essential for hemostasis. Comprehensive critical care management before and after surgery significantly enhances the patient survival. Damage control resuscitation (DCR) concept has been adapted from the damage control method of the United States Navy, which outlines immediate temporary measures to prevent a ship from sinking, followed by the definitive repair of the ship at a dock.Current Concepts: DCR combined with damage control surgery focuses on controlling life-threatening hemorrhages and preventing trauma-induced coagulopathy. Key aspects of this strategy are: (1) Permissive hypotension (avoiding excessive fluid resuscitation to reduce re-bleeding risk), (2) restricted fluid and hemostatic resuscitation (limiting fluids and using blood products to promote coagulation), (3) use of antifibrinolytics (administering tranexamic acid to inhibit fibrinolysis and stabilize clots), (4) hypothermia prevention (maintaining normothermia to promote coagulation and mitigate acidosis), (5) calcium maintenance (maintaining normal calcium levels for proper cardiac function and coagulation), and (6) use of vasopressors (for stabilizing blood pressure and tissue perfusion). By integrating these aspects, DCR effectively controls immediate bleeding and overcomes systemic physiological challenges, thereby improving the survival of patients with severe trauma.Discussion and Conclusion: Implementation of DCR with surgical interventions as a bundle of care effectively manages hemorrhagic trauma, possibly saving the patient. Therefore, DCR is a cornerstone strategy to improve the survival of patients with hemorrhagic trauma.

Hemorrhagic trauma is a major preventable cause of mortality in critically injured patients. Rapid surgical interventions are essential for hemostasis. Comprehensive critical care management before and after surgery significantly enhances the patient survival. Damage control resuscitation (DCR) concept has been adapted from the damage control method of the United States Navy, which outlines immediate temporary measures to prevent a ship from sinking, followed by the definitive repair of the ship at a dock.Current Concepts: DCR combined with damage control surgery focuses on controlling life-threatening hemorrhages and preventing trauma-induced coagulopathy. Key aspects of this strategy are: (1) Permissive hypotension (avoiding excessive fluid resuscitation to reduce re-bleeding risk), (2) restricted fluid and hemostatic resuscitation (limiting fluids and using blood products to promote coagulation), (3) use of antifibrinolytics (administering tranexamic acid to inhibit fibrinolysis and stabilize clots), (4) hypothermia prevention (maintaining normothermia to promote coagulation and mitigate acidosis), (5) calcium maintenance (maintaining normal calcium levels for proper cardiac function and coagulation), and (6) use of vasopressors (for stabilizing blood pressure and tissue perfusion). By integrating these aspects, DCR effectively controls immediate bleeding and overcomes systemic physiological challenges, thereby improving the survival of patients with severe trauma.Discussion and Conclusion: Implementation of DCR with surgical interventions as a bundle of care effectively manages hemorrhagic trauma, possibly saving the patient. Therefore, DCR is a cornerstone strategy to improve the survival of patients with hemorrhagic trauma.

Hemorrhagic trauma is a major preventable cause of mortality in critically injured patients. Rapid surgical interventions are essential for hemostasis. Comprehensive critical care management before and after surgery significantly enhances the patient survival. Damage control resuscitation (DCR) concept has been adapted from the damage control method of the United States Navy, which outlines immediate temporary measures to prevent a ship from sinking, followed by the definitive repair of the ship at a dock.Current Concepts: DCR combined with damage control surgery focuses on controlling life-threatening hemorrhages and preventing trauma-induced coagulopathy. Key aspects of this strategy are: (1) Permissive hypotension (avoiding excessive fluid resuscitation to reduce re-bleeding risk), (2) restricted fluid and hemostatic resuscitation (limiting fluids and using blood products to promote coagulation), (3) use of antifibrinolytics (administering tranexamic acid to inhibit fibrinolysis and stabilize clots), (4) hypothermia prevention (maintaining normothermia to promote coagulation and mitigate acidosis), (5) calcium maintenance (maintaining normal calcium levels for proper cardiac function and coagulation), and (6) use of vasopressors (for stabilizing blood pressure and tissue perfusion). By integrating these aspects, DCR effectively controls immediate bleeding and overcomes systemic physiological challenges, thereby improving the survival of patients with severe trauma.Discussion and Conclusion: Implementation of DCR with surgical interventions as a bundle of care effectively manages hemorrhagic trauma, possibly saving the patient. Therefore, DCR is a cornerstone strategy to improve the survival of patients with hemorrhagic trauma.

Timing of surgery is important for prognosis. In patients with acute abdomen, the urgency means timing of surgery is even more important. However early emergency surgery is often logistically daunting because of constraints on resources such as operating room, supporting anesthesiologist, and nurses. Therefore it is worthwhile reviewing the timing of surgery in the patient with acute abdomen. The authors discuss the ideal time to surgery based on their experience and a review of the literature. For appendicitis and for peptic ulcer perforation, the authors recommend surgery within 24 hours from symptom onset. However, for other acute abdomen disease, evidence for a consensus is not as strong. If a surgeon faces a large number of emergent patients, if resources are limited, the surgeon must decide priorities for surgery. Therefore, an emergency triage system is needed, based on expert opinion and evidence. Although several triage systems are described in the literature, there is some controversy. If we follow a triage system, utilization of resources will be more efficient and acute care surgery might be performed within the ideal time.
Abdomen, Acute* ; Appendicitis ; Consensus ; Emergencies ; Expert Testimony ; Humans ; Operating Rooms ; Peptic Ulcer Perforation ; Prognosis ; Time Management ; Time-to-Treatment ; Triage

Objective: : Patients with traumatic brain injury (TBI) commonly exhibit a poor mental health status and can easily develop aspiration pneumonia. Thus, early proper nutrition through oral or tube feeding is difficult to achieve, leading to malnutrition. However, evidence regarding early nutritional support in the intensive care unit (ICU) is lacking. We aimed to assess the effect of early nutrition in patients with TBI admitted to the ICU. Methods: : Data of adult patients with TBI admitted to the trauma ICU of a regional trauma center in Korea between 2022 and 2023 were retrospectively analyzed. Those with ICU stay <7 days, younger than 18 years, and with underlying diseases that could alter baseline metabolism, were excluded. Nutritional support on day 4 of ICU admission was measured. The patients were classified into mortality and survival groups, and risk factors for mortality were evaluated. Subgroup analyses were performed based on TBI severity. Results: : Overall, 864 patients were diagnosed with acute TBI, of whom 227 were included in this study. The mortality rate in the study population was 15% (n=34). Those in the survival group were younger, had longer hospital stays, had a higher initial Glasglow coma scale (GCS) score, and had a higher intake of calorie supplements than those in the mortality group. In a subgroup analysis of patients with non-severe TBI (GCS >8), total calorie intake (751.4 vs. 434.2 kcal, p=0.029), total protein intake (37.5 vs. 22.1 g, p=0.045), and ratio of supplied to target calories (0.49 vs. 0.30, p=0.047) were higher in the survival group than in the mortality group. Logistic regression analysis revealed that calorie intake (B=-0.002, p=0.040) and initial hemoglobin level (B=-0.394, p=0.005) were risk factors for mortality in patients with non-severe TBI. Conclusion : More calories were supplied to the survival group than the mortality group among patients with TBI. Additionally, logistic regression analysis showed that increased calorie supply was associated with reduced mortality in patients with non-severe TBI. The mortality group had low protein intake; however, this did not emerge as a risk factor for mortality. Early sufficient nutritional support improves the prognosis of patients with TBI.

Objective: : Patients with traumatic brain injury (TBI) commonly exhibit a poor mental health status and can easily develop aspiration pneumonia. Thus, early proper nutrition through oral or tube feeding is difficult to achieve, leading to malnutrition. However, evidence regarding early nutritional support in the intensive care unit (ICU) is lacking. We aimed to assess the effect of early nutrition in patients with TBI admitted to the ICU. Methods: : Data of adult patients with TBI admitted to the trauma ICU of a regional trauma center in Korea between 2022 and 2023 were retrospectively analyzed. Those with ICU stay <7 days, younger than 18 years, and with underlying diseases that could alter baseline metabolism, were excluded. Nutritional support on day 4 of ICU admission was measured. The patients were classified into mortality and survival groups, and risk factors for mortality were evaluated. Subgroup analyses were performed based on TBI severity. Results: : Overall, 864 patients were diagnosed with acute TBI, of whom 227 were included in this study. The mortality rate in the study population was 15% (n=34). Those in the survival group were younger, had longer hospital stays, had a higher initial Glasglow coma scale (GCS) score, and had a higher intake of calorie supplements than those in the mortality group. In a subgroup analysis of patients with non-severe TBI (GCS >8), total calorie intake (751.4 vs. 434.2 kcal, p=0.029), total protein intake (37.5 vs. 22.1 g, p=0.045), and ratio of supplied to target calories (0.49 vs. 0.30, p=0.047) were higher in the survival group than in the mortality group. Logistic regression analysis revealed that calorie intake (B=-0.002, p=0.040) and initial hemoglobin level (B=-0.394, p=0.005) were risk factors for mortality in patients with non-severe TBI. Conclusion : More calories were supplied to the survival group than the mortality group among patients with TBI. Additionally, logistic regression analysis showed that increased calorie supply was associated with reduced mortality in patients with non-severe TBI. The mortality group had low protein intake; however, this did not emerge as a risk factor for mortality. Early sufficient nutritional support improves the prognosis of patients with TBI.