Predisposing factors for venous thrombosis can be identified in the majority of patients with established venous thromboembolism (VTE). However, an obvious precipitant may not be identified during the initial evaluation of such patients. In the present case, a 47-year-old female presented to the emergency department of our hospital after ingesting multiple drugs. She had no VTE-related risk factors or previous episodes, nor any family history of VTE. After admission to the intensive care unit sudden hypoxemia developed, and during the evaluation cerebral, renal, and splenic infarctions with pulmonary embolisms were diagnosed. However, the sources of the emboli could not be identified by transthoracic echocardiography or computed tomography angiography. Protein C deficiency was identified several days later. We recommend that hypercoagulable states be taken into consideration, especially when unexplained thromboembolic events develop in multiple or unusual venous sites.
Angiography ; Anoxia ; Causality ; Echocardiography ; Emergency Service, Hospital ; Female ; Humans ; Infarction* ; Intensive Care Units ; Middle Aged ; Protein C Deficiency ; Pulmonary Embolism ; Risk Factors ; Splenic Infarction ; Thrombophilia ; Venous Thromboembolism ; Venous Thrombosis

From January 2007 to June 2012, 55 autopsy cases were reviewed, in which death occurred outside the hospital and the patients were declared dead on arrival at the emergency departments, in order to compare the clinical and postmortem examination diagnoses of death-on-arrival patients in tertiary hospitals in Busan, Yangsan and Ulsan city. Of 22 non-traumatic deaths, 21 occurred from natural causes and 1 from unknown cause (sudden infant death syndrome, SIDS). Clinical diagnoses were cardiovascular diseases or "non-traumatic" / "unknown" while autopsy diagnoses were majorly cardiovascular diseases, especially coronary artery diseases (72.7%). Of 33 unnatural deaths, the cause of death was blunt trauma in 4 patients, sharp-force injury in 6, falling in 10, gunshot injury in 1, traffic accidents in 3, asphyxia in 2, drowning in 2, fire-related death in 1, and intoxication in 4. There were no definite discrepancies between clinical and autopsy diagnoses, except for 5 non-traumatic deaths and 2 unnatural deaths. These results suggest that the role of the emergency department may be crucial in postmortem investigations.
Accidents, Traffic ; Asphyxia ; Autopsy ; Cardiovascular Diseases ; Cause of Death ; Coronary Artery Disease ; Drowning ; Emergencies ; Humans ; Infant ; Tertiary Care Centers

BACKGROUND: Severe or massive postpartum hemorrhage (PPH) has remained a leading cause of maternal mortality for decades across the world and it results in critical obstetric complications. Recombinant activated factor VII (rFVIIa) has emerged as a gold standard adjunctive hemostatic agent for the treatment of life-threatening PPH refractory to conventional therapies although it remains off-licensed for use in PPH. We studied the effects of rFVIIa on coagulopathy, transfusion volume, prognosis, severity change in Korean PPH patients. METHODS: A retrospective review of medical records between December 2008 and March 2011 indicating use of rFVIIa in severe PPH was performed. We compared age, rFVIIa treatment, transfusion volume, and Sequential Organ Failure Assessment (SOFA) score at the time of arrival in the emergency department and after 24 hours for patients whose SOFA score was 8 points or higher. RESULTS: Fifteen women with SOFA score of 8 and above participated in this study and eight received rFVIIa administration whereas seven did not. Patients' mean age was 31.7 ± 7.5 years. There was no statistically significant difference in initial and post-24 hours SOFA scores between patients administered rFVIIa or not. The change in SOFA score between initial presentation and after 24 hours was significantly reduced after rFVIIa administration (P = 0.016). CONCLUSIONS: This analysis aimed to support that the administration of rFVIIa can reduce the severity of life-threatening PPH in patients. A rapid decision regarding the administration of rFVIIa is needed for a more favorable outcome in severe PPH patients for whom there is no effective standard treatment.
Emergency Service, Hospital ; Factor VIIa* ; Female ; Humans ; Maternal Death ; Maternal Mortality ; Medical Records ; Organ Dysfunction Scores ; Postpartum Hemorrhage* ; Postpartum Period* ; Prognosis ; Recombinant Proteins ; Retrospective Studies

OBJECTIVE: Stroke volume (SV) measurements have been used to guide fluid management. Noninvasive, indirect, and convenient measurements of the SV for fluid therapy are required for most patients during spontaneous breathing (SB). On the other hand, the preferred method for an indirect prediction of the SV is unclear. This study examined the best of the indirect and predictable parameters responding to a SV variation during SB. METHODS: Hemodynamic parameters, such as collapsibility of the inferior vena cava (cIVC), peak velocity variation in the common carotid artery (pvvCCA), collapsibility of the internal jugular vein (cIJV), and end-tidal carbon dioxide (ETCO₂) were measured 180 times (6 different positions each in 30 normal subjects). The variables changed with the SV at the upper body elevation of 60°and 30°, in the supine position, at the lower body elevation of 60°and 30°, and lumbar elevation. RESULTS: The SV showed the highest value at 30°of lower body elevation. Following fixed position changes, the ETCO₂ during SB was the factor most correlated with the SV when compared to cIVC, cIJV, and pvvCCA (β coefficient, 2.432 vs. −0.41, −0.033, and −0.654; P=0.004). The adjusted ETCO₂ showed a significant change with the SV, even though the change in ETCO₂ was not large. CONCLUSION: ETCO₂ was less influenced by the SB than cIVC, pvvCCA, and cIJV because the ETCO₂ change was in accordance but the variations of the other blood vessels did not coincide with a SV change. Therefore, ETCO₂ monitoring for predicting the SV would be more important than the variations in the vessels during SB.
Blood Vessels ; Carbon Dioxide ; Carbon ; Cardiac Output ; Carotid Artery, Common ; Fluid Therapy ; Hand ; Hemodynamics ; Humans ; Jugular Veins ; Methods ; Respiration ; Stroke Volume ; Stroke ; Supine Position ; Ultrasonography ; Vena Cava, Inferior

PURPOSE: Interhospital transfers are necessary to meet the needs for emergency medical care with limited resources. 1339 emergency medical information centers are responsible for arranging interhospital transfers. We analyzed the requests for transfer received by an emergency medical information center to explore ways to improve the effectiveness and appropriateness of interhospital transfers. METHODS: We retrospectively analyzed 830 requests for interhospital transfers received by the Busan 1339 Emergency Medical Information Center from Aug 1, 2002, to Oct 31, 2002, by using record from the Center's computer system. RESULTS: Among the total 830 requests, 271 requests were due to trauma, 242 requests were due to acute diseases, 212 were due to chronic diseases, and 39 were due to intoxication. The center managed 647 requests (78.0%) successfully, but 183 requests (22.0%) were impossible to arrange. Transport from a tertiary care facility to a secondary care facility accounted for the majority of requests (305 requests: 36.7%). Over half of the requests were because of temporarily unavailable resources (483 requests: 58.2%). CONCLUSION: Interhospital transfers mediated by the Emergency Medical Information Center are helpful to alleviate emergency department overcrowding and to effectively utilize emergency medical resources.
Acute Disease ; Busan ; Chronic Disease ; Computer Systems ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital ; Information Centers* ; Retrospective Studies ; Secondary Care Centers ; Tertiary Healthcare

Fenfluramine is an amphetamine-derived substance first developed in the late 1960s for appetite control. Because of its known side effects at therapeutic doses, it is now controlled by the government and has been withdrawn from the market, but the underground market is still big. When over-dosed, it can produce a wide range of neurologic and cardiovascular symptoms, and even death, when a large amount is ingested. We report two cases of acute fenfluramine overdose: a fatal case with generalized seizure and pulseless electrical activity, and a case of relatively mild intoxication.
Appetite ; Fenfluramine* ; Seizures

PURPOSE: We postulated that the success rate for subclavian venous catheterization could be enhanced by improving body positioning. The purpose of this study was to determine the optimal positioning. The ideal position should result in the largest antero-posterior diameter of the subclavian vein and the shortest depth from the skin to the subclavian vein. METHODS: We used 7.5MHz linear probe. Eighteen adult volunteers underwent ultrasound imaging of the right subclavian vein while supine in the following eight positions: NP/PO/AT, NP/PO/AN, NP/PX/AT, NP/PX/AN, LP/PO/AT, LP/PO/AN, LP/PX/AT, LP/PX//AN (neutral head position, NP; head turned to left, LP; on pillow, PO; off pillow, PX; arm traction, AT; neutral arm position, AN). We checked the antero-posterior diameter of the subclavian vein and the depth from skin to the subclavian vein in each position. Statistical significance was determined using Wilcoxon's signed rank test. RESULTS: The antero-posterior diameter of the subclavian vein in NP/PX/AN position is largest and in LP/PO/AN position is smallest (p=0.01). The difference of the depths from skin to the subclavian vein in each positions is not significant statistically. CONCLUSION: There was no statistically significant effect of head position on the antero-posterior diameter of the subclavian vein or on the depth from the skin to subclavian vein. Arm traction did not result in an increase in the anteroposterior diameter. Positioning on the pillow likewise conferred no advantage in the antero-posterior diameter. The most optimal position for subclavian venous catheterization was the neutral head position without pillow between the scapulas and without the arm retracted position.
Adult ; Arm ; Catheterization* ; Catheterization, Central Venous ; Catheters* ; Head ; Humans ; Scapula ; Skin ; Subclavian Vein ; Traction ; Ultrasonography ; Volunteers

PURPOSE: The purpose of this study was to use a review of the regional disaster that occurred on April 15, 2002, to improve the National Disaster Medical System and to operate the Disaster Medical Assistance Team and the Mobile Emergency Support Unit better. METHODS: We retrospectively analyzed 39 survivors among the 167 victims of the Air China aircraft crash, Kimhae, Korea, on April 15, 2002, by using reports of the on-site disaster medical assistance team members, recordings of notifications to the Busan and the Kyoungnam 1339 Emergency Information Centers from the scene of accident, and medical records of the victims transported to hospitals. RESULTS: On the date of accident, April 15, 2002, 27 of the 39 survivors were transported to 5 hospitals in Kimhae and 12 were transported to 8 hospitals in Busan. On the next day, April 16, two patients who had been transported to hospitals in Kimhae were transferred to medical centers in Busan. One of them expired, and the other was subsequently transferred to a medical center in Seoul and expired on May 2, 2002. CONCLUSION: Still now, our National Disaster Medical System contains many problems, especially lack of cooperation between related parts, and insufficient communications. This study shows that we should recheck our National Disaster Medical Dystem and construct a cooperative Police, Fire defense organization, 1339 Emergency Medical Information Center, and regional medical service system.
Aircraft* ; Airports* ; Busan ; China* ; Disasters* ; Emergencies ; Fires ; Gyeongsangnam-do* ; Humans ; Information Centers ; Korea ; Medical Assistance ; Medical Records ; Police ; Retrospective Studies ; Seoul ; Survivors

This paper discusses the future development of air ambulance operations in Korea. Helicopter emergency medical services are a useful means of transporting critically ill patients to the right hospital, at the right time. It is an important element of the emergency medical system to treat acute diseases at the scene, or in transit. For more efficient operations of the emergency medical helicopters (air ambulances or the so-called ‘Doctor Helgi’ in Korea), various challenges are faced. These include, the expansion of air ambulance bases, proper placement of rendezvous points (landing point), increase of field transport requests, and the operation of night missions. First, it is necessary to reduce the disparity in the benefits of emergency medical care for critically ill patients through the expansion of helicopter bases. Second, through the advancement of joint operations of the pan-ministerial emergency medical helicopters, the time from dispatch to helicopter take-off should be minimized, and a quality improvement program for air transportation should be carried out. Third, it is necessary to increase the number of insufficient rendezvous points and ensure the safety of the helicopters during takeoff and landing, to activate field transportation. Finally, the safety of patients and medical staff should be secured through the systematic preparation of the air transport system for future night missions. To solve these tasks, an appropriate legal system for helicopter emergency medical service is required. Based on the improved system, it is expected that everyone will enjoy equal rights for health, regardless of the regions.

PURPOSE: These days, airline traffic is so developed that the globe has become much smaller and interest in fear of passenger-flight crashes is increasing. Using the opportunity offered by the Kimhae airline disaster, the author studied the relation of the injury mechanism & the seat-position to the injury severity in order to provide helpful information for use in other situations. METHODS: The author performed a retrospective analysis and compared survivors (37 persons) with deaths (129 persons) in the crash of Chinese passenger-flight B767-200 approaching Kimhae airport on April 15, 2002. RESULTS: Most of the survivors were seated in the rear of the airplane while most of those who died were in the front. Thus, a definite correlation exists between seat position in the aircraft and the injury severity. The deceleration force generated during a flight crash is sufficient to induce fatal injury. CONCLUSION: Most flight crashes are due to CFIT (controlled flight into terrain) accidents which are caused by the pilot being insensible to safety. This time, it was also the case. The author wishes it not to be the case next time.
Aircraft ; Airports* ; Asian Continental Ancestry Group* ; Deceleration ; Disasters ; Gyeongsangnam-do* ; Humans ; Retrospective Studies ; Survivors