BACKGROUND: Unexpected deaths of the patients at ED are surprising to the medical staffs as well as the families. It may also increase the possibilities of medico-legal problems. This study was conducted to review the unexpected death in ED and find the predictive factors leading patients to unexpected death. METHODS: A retrospective study with reviewing available medical records of 183 patients who were expired at ED of Shinchon Severance Hospital from Mar. 1997 to Feb. 1998 and 103 patients of Youngdong Severance Hospital from Mar. 1996 to Feb. 1998 was done. Analyses were 4one on 30 variables of physical findings, laboratory results, procedures and therapies. We used univariate analysis, such as t-test and x2-test and multiple logistic regression analysis. RESULTS: Of the total 286 deaths in ED, 153 cases were enrolled in this analysis. The number of unexpected deaths were 76. Age, mental status, fraction of neutrophil count, BUN level, whether endotracheal incubation was done, use of inotropics were the factors with statistical ,significance on the univariate analysis, but only comatose mentality, endotracheal incubated case, and use of the inotropics were significant on logistic regression analysis. The longer the ED length of stay, the higher the rate of mortality and unexpected death. CONCLUSION: This result suggest that medical attention is needed on the patients with comatose decreased mental stylus, endotracheally intubated case and needing inotropic agents to prevent unexpected deaths. Shortening the ED length of stay may also be a factor for decrease the unexpected death rate.
Coma ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Length of Stay ; Logistic Models ; Medical Records ; Medical Staff ; Mortality ; Neutrophils ; Retrospective Studies

BACKGROUND: Methemoglobinemia(MetHb) induced by dapsone overdose is not uncommon in Korea, especially in rural area. For treatment of dapsone-induced methemoglobinemia, methylene blue(MB) and activated charcoal(AC) should be used. To date, no reports have compared the amount of MB used between MB alone with MB & AC combined group(MB+AC). And also between moderate (MetHb<35%) and severe (MetHb>35%) intoxicated group defined by initial MetHb level. Authors hypothesized that less amount of MB can be used if MB and AC was used together and larger amount of MB is necessary to reduce MetHb level to asymptomatic level in severely intoxicated group. METHODS: From Jan 1990 to Dec 1996, a total of 54 patients who received treatment for dapsone intoxication were subject of study, The study was done retrospective chart analysis for initial MetHb level, total amount of MB and AC. Wilcoxon rank sum test and Chi-sqiare test was used to compare the total dosage of MB used for each group. Linear regression analysis was used between initial MetHb and the total amount of MB. Results were considered statistically significant when p<0.05. RESULTS: For MB alone and MB+AC group, the differences in total amount of MB used were statistically significant with mean dosage of 7.14+/-1.1mg/kg and 4.28+/-0.7mg/kg, respectively. And total amount of MB used between moderate and severe intoxicated group, the differences were statistically significant with mean dosage of 5.16+/-1.1mg/kg vs. 10.98+/-1.9mg/kg, respectively. There was significant correlation between initial MetHb level (X) and the amount of methylene blue (Y), Y=0.3X-2.42 (r2=0.41, p=0.0001) in MB alone, Y=0.186X-1.95(r2=0.21, p=0.034) in MB+AC respectively. CONCLUSION: For methemoglobinemia induced by dapsone, total amount of MB can be reduced especially in severe Intoxicated group if AC use was combined in treatment modality. There was significant correlationship between initial MetHb level and total amount of MB used.
Charcoal* ; Dapsone* ; Humans ; Korea ; Linear Models ; Methemoglobinemia ; Methylene Blue* ; Retrospective Studies

Hip arthroscopy has been useful for resolving unexplained pains of the hip joint, despite its clinical applicability came after many other joints. Surgical indications have been increasing recently. Moreover, additional surgical techniques allow both the anatomy and function to return to its normal state. Recently, the concepts and treatments for extra-articular pathologies, such as deep gluteal syndrome, ischiofemoral impingement, subspinal impingement and iliopsoas impingement as well as classic indication, such as femoroacetabular impingement, acetabular labral tear, loose bodies, and synovial osteochondromatosis have been introduced. We present a diagnosis and treatment for diverse indications of hip arthroscopy, preoperative considerations, surgical technique and postoperative rehabilitation.
Acetabulum ; Arthroscopy* ; Chondromatosis, Synovial ; Diagnosis ; Femoracetabular Impingement ; Hip Joint ; Hip* ; Joints ; Pathology ; Rehabilitation ; Tears

BACKGROUND: We designed this study to determine whether trauma history and initial assessment anticipate the injury severity of the free-fall patient. METHODS: Two hundred patients who admitted emergency department of Severance hospital because of the fall from a height were enrolled in this study. The height of fall, the body orientation, and the characteristics of impacted material, and the Injury Severity Score(ISS) were evaluated by retrospective chart reviews. And regression equations were determined for predicting ISS on the basis of clinical parameters using multiple regression analysis. RESULTS: According to the characteristics of impacted material, the ISS was higher in the hard surface(13.7+/-9.5) than the sort surface(10.5+/-8.8)(p<0.05). There were correlations between height of fall and ISS(p<0.01, r=0.5). To the body orientation, the ISS was higher in the head-to-feet orientation(18.211.7) than the feet-to-head(10.9+/- 7.0) or other position(8.5+/-5.8)(p<0.01). The regression equations were as follows, ISS=2 +0.082xage(year)-1.54x(Glasgow Coma Scale)-3x(feet-to-head orientation)+0.65x height of fall(m)+2.7 x (hand surface)(p<0.01, R2=0.53). CONCLUSION: This study suggest that the injury severity of patient with free fall are significancy related to the height of fall, the characteristics of impacted material and the body orientation.
Coma ; Emergency Service, Hospital ; Humans ; Retrospective Studies

BACKGROUND: Vasopressin has recently been recognized to have greater effect on improving blood flow to myocardium and brain during cardiac resuscitation than epinephrine and also improves rates of ROSC(return of spontaneous circulation) and survival in pre-hospital and in-hospital prolonged refractory cardiac angst patients who did not respond to the standard epinephrine treatment. This study was designed to investigate the effects of vasopressin on ROSC rates and survival rates in rat asphyxia arrest model. METHOD AND MATERIAL: Thirty male Sprague-Dawley rats were used. Anesthesia was induced with halothane and nitrous oxide and ventilatory cairo was maintained. EtCO2 was adjusted to 30-40mmHg and halothane was maintained. Right infernal carotid artery and right femoral vein were cannulated and EKG electrodes were attached. After 10 minutes of asphyxia, group 1 was treated with 1ml of saline, group 2 with 1ml(0.001mg/100g) of epinephrine and group 3 with 1ml(0.16u/100g) of vasopressin for resuscitation. Statistical significance was an analysed by SPSS with ANOVA and chi-square tests. RESULTS: No significant differences were seen in baseline measurements. Three ROSC and eight 60 minutes survivals were found in group 1, whereas nine ROSC and eight 60 minutes survivals were obtained in group 2 and all of the subjects in group 3 showed ROSC and 60 minutes survival, but no statistical differences were seen between group 2 and 3. CONCLUSION: Vasopressin seems to have similar effect on improving ROSC and survival rates compared to epinephrine in rat asphyxia models.
Anesthesia ; Animals ; Asphyxia* ; Brain ; Carotid Arteries ; Electrocardiography ; Electrodes ; Epinephrine* ; Femoral Vein ; Halothane ; Humans ; Male ; Myocardium ; Nitrous Oxide ; Rats* ; Rats, Sprague-Dawley ; Resuscitation* ; Survival Rate ; Vasopressins*

BACKGROUND: Activated charcoal has been widely used as an adsorbent for the management of drug intoxicated patients in the emergency department(ED). Although there are several commercial ready-mixed charcoal suspension preparations in the market, we are using custom-made suspension from hospital grade bulk charcoal powder. We designed this study to compare the adsorptive capacity of the Actidose Aqua(R), which is a commercial charcoal product, Fuller's earth, and custom-made activated charcoal used in our ED. METHODS: First, we performed modified USP methylene blue adsorption test which is a standard adsorption test for activated charcoal. Then, the drug adsorption test for phenobarbital, acetaminophen, salicylate, and aminophylline was done. Graded amount of three adsorptives were added to the stock solutions of each drugs. The adsorption test were performed as follows: The vials containing drugs and adsorptives were shaken for 30 minutes to ensure adsorption equilibrium, then the suspension was filtered through in-line filter. The filtrates were analyzed by ultraviolet spectroscopy to determine the residual drug concentrations. Finally we examined and compared the surface area and the structure of activated charcoal and Fuller's earth using scanning electron microscopy. RESULTS: In methylene blue adsorption test, the adsorption rate was 60.1% in Actidose Aqua(R) and 59.0% in custom-made charcoal, and 70.2% in Fuller's earth. For the phenobarbital, acetaminophen, and sallcylate, the adsorption rate of Actidose Aqua(R) and custom-made charcoal was greater than 90% with the ratio o adsorptives to drugs over 10:1. For aminophylline, two charcoal products showed excellent adsorption in 5:1 ratio. But Fuller's earth showed poor adsorption in all rages. CONCLUSION: Custom-made activated charcoal showed a comparable adsorption capacity to Actidose Aqua(R). Fuller's earth showed a poor performance to be used as a substitute for activated charcoal in acute drug poisoning otherwise paraquat.
Acetaminophen ; Adsorption ; Aminophylline ; Charcoal* ; Emergencies ; Humans ; Methylene Blue ; Microscopy, Electron, Scanning ; Paraquat ; Phenobarbital ; Poisoning ; Rage ; Spectrum Analysis

BACKGROUND: Abdominal pain is one of the most common complaints in the emergency department and the evaluation presents an extraordinary challenge to the emergency physician's skill. C-reactive protein, an acute phase protein which is increased in the presence of inflammation in various clinical conditions, has been proven useful in assessing disease severity, in monitoring the development of complications, and in evaluating the response to specific treatments. So we tried to determine whether CRP offers an advantage over other clinical or laboratory variables for decision-making in the management of acute abdominal pain in the emergency department. METHOD: Patients who came to a University Hospital ED with acute abdominal pain, between september 1, 1998 and November 30, 1998, were included in this study, Data collection included age, sex, duration of symptom, location of pain, and laboratory dta(white blood cell count, portion of neutrophils, ESR, CRP, amylase). RESULT: This study included 85 patients, 34 of whom were men. The mean age was 36.9+/-19.1 years. CRP might be useful to detect the serious condition, sensitivity 81%, but more useful to differentiate normal condition from serious condition in acute abdominal pain patients, specificity 83%. CONCLUSION: CRP is an useful indicator of decision-making to abdominal patients in the emergency department. Hospitalization or operation is very unlikely when CRP value is normal.
Abdominal Pain* ; Acute-Phase Proteins ; Blood Cell Count ; C-Reactive Protein* ; Data Collection ; Emergencies ; Emergency Service, Hospital ; Hospitalization ; Hospitals ; Humans ; Inflammation ; Male ; Neutrophils ; Sensitivity and Specificity

A 16-year old male patient visited the hospital complaining of inguinal pain and internal snapping of right hip joint. In physical examination, the patient was presumed to be diagnosed femoroacetabular impingement (FAI) and acetabular labral tear. In radiologic evaluation, FAI and acetabular labral tear were identified and bony tumor associated with internal snapping was found on the posteromedial portion of the femoral neck. Despite of conservative treatment, there was no symptomatic improvement. So arthroscopic labral repair, osteoplasty and resection of bony tumor were performed. The tumor was pathologically diagnosed as osteochondroma through biopsy and all symptoms improved after surgery. There was no recurrence, complication or abnormal finding during 1 year follow up. Osteochondroma located at posteromedial portion of femoral neck can be a cause of internal snapping hip and although technical demands are challenging, arthroscopic resection can be a good treatment option.
Acetabulum ; Arthroscopy ; Biopsy ; Femoracetabular Impingement ; Femur Neck ; Follow-Up Studies ; Hip ; Hip Joint* ; Humans ; Male ; Osteochondroma* ; Physical Examination ; Recurrence

This is a report of 2 cases that showed dissociation of the acetabular cup liner by acetabular fixation screw among patients who underwent total hip replacement. Screws for fixation of the acetabular cup were used during the primary surgery in both cases. Each patient visited the out patient department complaining of pain and noise from the joint; radiologic finding revealed a collapse of the column shape bone graft area with dissociation of the acetabular cup liner. In both cases, during revision surgery, screw was extruded to the inner side of the acetabular cup, since it migrated superiorly. There has been no report of liner dissociation by extrusion of acetabular cup fixation screw after total hip replacement. Therefore, we report two cases of dissociation of the acetabular cup liner of hip arthroplasty, which occurred due to screw issues after total hip replacement with structural autogenous bone graft.
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Hip* ; Humans ; Noise ; Transplants

PURPOSE: Giant cell tumor is the second most common benign neoplasm in upper extremity. Unlike usual chief complaint of painless mass, an atypical case with giant cell tumor presented a distinguishing characteristics of which accompany pain and tenderness and is histologically giant-cell free. METHODS: A 31-year-old male patient complained of a rapid growing painful mass on the proximal phalanx of the left ring finger. Under microscopic operation, a 1.6 x 1.3cm sized mass was found to be surrounded by areolar tissue and attached to a tendon sheath, encircling the digital nerve and artery. Diagnostic confirmation was assisted by positive finding in histologic immunohistochemical stain-CD68. Characteristic pathologic finding is an atypical distribution of spindle cells & histiocytes without giant cells in fascicular pattern. RESULTS: Giant cell tumor was carefully removed under microscopic approach, while preserving digital nerve & artery. In postoperative 13th month, the patient presented with a 6mm of static two-point discrimination test, similar to that of the adjacent fingers. CONCLUSION: We report an atypical case with painful mass on tendon sheath, surrounding the digital nerve and artery that was diagnosed of giant cell tumor, but without giant cells on pathology. This case provides broader understanding of the giant cell tumor that should not only rely its typical findings of the painless mass and positive sign on H&E stain.
Adult ; Arteries ; Discrimination (Psychology) ; Fingers ; Giant Cell Tumors* ; Giant Cells* ; Histiocytes ; Humans ; Male ; Pathology ; Tendons ; Upper Extremity