PURPOSE: We wanted to evaluate the actual work patterns of residents and nurses and the effects of controlling visits by relatives on the mortality of patients and their length of stay and on the workload of the residents and nurses. METHODS: We investigated the actual workload of the residents who worked 12 hours shifts and nurses who worked 8 hours shifts in an emergency center for two weeks. We compared the mortality of the patients, the length of their stay and the work patterns between before we controlled visits by relatives and after we controlled visits by relatives. RESULTS: On the average, residents spent 407.01 minutes (56.5%) taking care of patients for a shift (720 min.) and nurses spent 305.29 minutes (63.6%) taking care of patients for a shift (480 min.). Although we controlled visits by relatives, we're unable to reduce the patient mortality and the length of their stay. Yet we were able to reduce the unnecessary repeated explanation-time, the resting time and the nurses and residents were able to better concentrate to explain to patients or their relatives. We were also able to increase the treatment time and description time, and especially for residents. Nurses spent 71.86 minutes (15.0%) to take a rest a shift, and residents spent 166.40 minutes (23.1%) resting a shift (p=0.01). CONCLUSION: To reduce unnecessary repeated explanation-time and the resting time and to allow nurses and residents to better concentrate when explaining to patients or their relatives, and also to increase the treatment and description time, controlling relatives in an emergency center is necessary.
Emergencies ; Humans ; Length of Stay

We experienced a case of transient right-sided heart failure after angioplasty of membranous obstruction of the inferior vena cava confirmed by sonography and an inferior vena cavogram. Angioplasty involved the use of a self-expandable metallic stent, but after successful recanalization of the obstruction , the patient became dyspneic. Chest radiography revealed mild cardiomegaly with pulmonary congestion, but this was resolved spontaneously. For the prevention of serious heart failure, we recommend preprocedural evaluation of cardiac function.
Angioplasty* ; Cardiomegaly ; Estrogens, Conjugated (USP) ; Heart Failure* ; Humans ; Radiography ; Stents ; Thorax ; Vena Cava, Inferior*

Purpose: This study was undertaken to investigate how sedative-hypnotics affect the occurrence and severity of the patient’s symptoms. In addition, we conducted a study to determine the type of patients who reacted severely and required hospitalization;patients were accordingly classified as hospitalized patients and patients discharged from the emergency room. Methods: From January 2017 to December 2019, we investigated the demographics, drug information, history, laboratory tests, and severity of patients who visited our emergency department and were diagnosed with benzodiazepine, zolpidem, and doxylamine succinate overdose. We further compared details of hospitalized patients and discharged patients. Results: Subjects who had overdosed and visited the ED included 120 for benzodiazepine, 147 for zolpidem, and 27 for doxylamine succinate. Comparisons between the three groups revealed differences in their early diagnosis, psychiatric history, and sleep disturbance. Differences between groups were also determined for mental state, poisoning history, treatment received in the intensive care unit, and intubation and ventilator support. In cases of benzodiazepine overdose, we obtained a high hospitalization rate (40.0%), admission to the intensive care unit (24.2%), and intubation rate (18.3%). Comparisons between hospitalized patients and discharged groups showed differences in transferred patients, early diagnosis, and mental state. Conclusion Patients poisoned by sedative-hypnotics are increasing every year. In cases of benzodiazepine and zolpidem, the hospitalization rates were high, and benzodiazepine overdose resulted in hospitalization, intensive care unit admission, and pneumonia in a majority of cases. Therefore, active treatment and quick decisions in the emergency room are greatly required.

Objectives: This study evaluated the effect of adjacent gingival blood flow on detection of pulpal blood flow (PBF) using ultrasound Doppler flowmetry (UDF) through animal study. Materials and Methods: The study included 36 right and left maxillary the third incisors and canines in 9 experimental dogs. The study included 2 main steps: In the first step, the pulse sound level (PSL) was recorded on the cervical part of each tooth without flap elevation (Group 1), with flap elevation (Group 2), and after it was repositioned in place (Group 3). In the second step, the PSL was recorded on the cervical part of each tooth (Group 4), after pulpotomy (Group 5), after partial pulp extirpation (Group 6), after complete extirpation (Group 7), and after canal filling (Group 8). In Groups 5–8, the study was performed with and without flap elevation in the left and right teeth, respectively. The PSL was graded as follows: 0, inaudible; 1, heard faintly; and 2, heard well. The difference between each group was analyzed using Friedman’s test with Wilcoxon signed-rank tests (α = 0.05). Results: In step 1, the PSL results were Group 1 > 2 and 3. In step 2, there was no significant difference between the groups when the flap was not elevated, while PSL results were Group 4 > 5 ≥ 6 and 7 ≥ 8 when the flap was elevated. Conclusions PBF is affected by gingival blood flow when measured with UDF. UDF measurements require isolation of gingiva from the tooth.

PURPOSE: We evaluated a method to distinguish group A (abscess) from group B (cellulitis, pharyngitis, tonsillitis, epiglottis) through clinical variables in patients with a deep neck infection. METHODS: This was a retrospective chart review study consisting of the evaluation of CT scans or surgical diagnoses on adult patients (18 or more years of age). CT scans were reviewed by a radiologist. We evaluated several clinical variables in order to distinguish group A from group B. We also evaluated the ability of these clinical variables to distinguish group A from group B by a receiver operating characteristic curve. RESULTS: Sixty-three patients were enrolled in this study. Several clinical variables (swelling, odynophagia, tenderness, trismus, age>50years) differed between group A and group B. A AUC which was obtained by adding the number of variables (swelling, odynophagia, tenderness, trismus, age>50years) was 0.87 (p<0.01). The sensitivity and specificity of these clinical variables were 0.96 and 0.6 respectively, when the cut off value for adding the number of variables was set as 1.5. When the sum of these number of variables are more than two, the sensitivity is 0.958 (95% C.I:0.901~0.987) and the specificity is 0.600 (95% C.I:0.417~0.693). CONCLUSION: Five clinical variables (age>50, swelling, odynophagia, tenderness, trismus) were able to distinguish group A from group B.
Abscess ; Adult ; Area Under Curve ; Humans ; Neck ; Palatine Tonsil ; Pharyngitis ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Soft Tissue Infections ; Tonsillitis ; Trismus

PURPOSE: To evaluate the utility of ultrasound-assisted lumbar puncture in the emergency department. METHODS: This was a prospective randomized controlled trial. We enrolled patients who were 18 years of age or older from May to August 2007. Patients were divided into a classic lumbar puncture group (group A) and an ultrasoundassisted lumbar puncture group (group B). We compared the frequency of attempting the procedure, the procedure time, the failure rate of lumbar puncture, and the traumatic lumbar puncture between groups. RESULTS: Sixty-one patients were enrolled in the study. Thirty-two patients were in group A and 29 patients were in group B. There were 6 cases of failed lumbar puncture in group A and one case in group B (p=0.07), and there were 3 cases of traumatic lumbar puncture in group A, and one case in group B (p=0.35). It took 8.6+/-8.4 minutes to accomplish lumbar puncture in group A compared to 8.2+/-6.4 minutes in group B (p=0.85). Overall, the frequency of attempting the procedure was 2.3+/-1.8 in group A and, 1.6 +/-1.1 in group B (p=0.66). In elderly patients (age> or =60 years) the frequency of attempting the procedure was 4.0+/-2.5 in group A and 1.6+/-0.5 in group B (p=0.03). There were 4 cases of failed lumbar puncture in group A but none in group B. CONCLUSION: Emergency physicians did not generally attempt ultrasound-assisted lumbar puncture in the emergency department. For elderly patients(> or =60 years), however, it was an available tool for emergency physicians and employed more frequently.
Adult ; Aged ; Emergencies ; Humans ; Prospective Studies ; Spinal Puncture

Rapid ammonia elevation in blood with accompanying mental change should be considered as a true medical emergency. In such a case, action leading to immediate diagnosis and the earliest possible treatment must occur in order to minimize permanent brain damage. Hyperornithinemia- Hyperammonemia-Homocitrullinuria (HHH) syndrome is a rare inborn errors of metabolism and autosomal recessive metabolic disorder caused by a deficiency of the mitochondrial ornithine transporter at the cellular level. Emergency physicians should take account of the possibility of HHH syndrome in patients with unreasonable hyperammonemia coupled with altered mental status. We report a case of a 59-year old man who presented with headache, nausea, vomiting and altered mental status. His serologic test showed hyperornithinemia, hyperammomemia, and homocitrullinuria. He was treated with fluid therapy and hemodialysis. His clinical manifestation improved and he was discharged after hemodialysis
Amino Acid Transport Systems, Basic ; Ammonia ; Brain ; Emergencies ; Fluid Therapy ; Headache ; Humans ; Hyperammonemia ; Metabolism, Inborn Errors ; Nausea ; Ornithine ; Renal Dialysis ; Serologic Tests ; Urea Cycle Disorders, Inborn ; Vomiting

BACKGROUND: We hypothesized that the direction of the J-tip of the guidewire during insertion into the internal jugular vein (IJV) might determine its ultimate location. METHODS: In this study, 300 patients between the ages of 18 and 99 years who required central venous catheterization via IJV in the emergency department enrolled for randomization. IVJ catheterization was successful in 285 of 300 patients. An independent operator randomly prefixed the direction of the J-tip of the guidewire to one of three directions. Based on the direction of the J-tip, patients were allocated into three groups: the J-tip medial-directed group (Group A), the lateral-directed group (Group B), or the downward-directed group (Group C). Postoperative chest radiography was performed on all patients in order to visualize the location of the catheter tip. A catheter is considered malpositioned if it is not located in the superior vena cava or right atrium. RESULTS: Of the total malpositioned catheter tips (8 of 285; 2.8%), the majority (5 of 8; 62.5%) entered the contralateral subclavian vein, 2 (25.0%) were complicated by looping, and 1 (12.5%) entered the ipsilateral subclavian vein. According to the direction of the J-tip of the guidewire, the incidence of malpositioning of the catheter tip was 4 of 92 in Group A (4.3%), 4 of 96 in Group B (4.2%), and there were no malpositions in Group C. There were no significant differences among the three groups (p = 0.114). CONCLUSIONS: The direction of the J-tip of the guidewire had no statistically significant effect on incidence of malpositioned tips.
Catheterization ; Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Emergency Service, Hospital ; Heart Atria ; Humans ; Incidence ; Jugular Veins* ; Radiography ; Random Allocation ; Subclavian Vein ; Thorax ; Vena Cava, Superior

Corpus callsoum (CC) is the largest commissural fiber connecting the cerebral hemispheres. The gender difference in the size or the shape of CC is a long standing dispute. Some reported that adult female CC had more bulbous splenium and larger area considering brain size, but others failed to replicate this findings. There is no definite consensus on sexual dimorphism of CC yet, although extensive studies on sexual dimorphism has been expected to provide a clue to explain sociopsychological differences between male and female. This variable results are attributed to limited number of subjects, measured parameters, and method of measurement. We have employed comprehensive analytic parameters with large subjects to understand gender differences on CC of healthy Korean adults. We have analyzed the magnetic resonance image (MRI) in adults free from neurological disorders. The subjects were composed of 108 young people (3rd decade; male : 51, female : 57). Total area, its 5 sub-areas, linear parameters including height, length, and width and five specific angles of the CC were measured on the midsagittal MR images with NIH Image program (R) (Ver 1.6). The gender differences were observed in the area of splenium and length in the group. The male CC have larger splenium and longer length than female. The angle between neural axis and base of corpus callosum in female was significantly larger than that of male. This study reports not only gender difference of adult CC, but Korean adult standard morphometric data of CC research. These results might serve a useful basic data for various research in the fields of neuroanatomy, neuroradiology, and neuropsychiatry.
Adult* ; Axis, Cervical Vertebra ; Brain ; Cerebrum ; Consensus ; Corpus Callosum* ; Dissent and Disputes ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Nervous System Diseases ; Neuroanatomy ; Neuropsychiatry

PURPOSE: Fournier's disease is polymicrobial necrotizing fasciitis of the perineal, perianal, or genital areas. The objective of this study was to investigate patients with Fournier's gangrene and to determine risk factors that affect mortality. METHODS: This study was a retrospective clinical study. Clinical presentations and outcomes of surgical treatments were evaluated in 27 patients with Fournier's gangrene that were treated in a single institution from January 2000 to March 2009. RESULTS: The mean age of patients was 52.8+/-14.4 yr, and the male-to-female ratio was 25:2. Among the predisposing factors, diabetes mellitus was the most common (n=8, 29.6%). The most common infection source was anorectal (n=16, 59.3%). Sepsis on admission was detected in 16 cases (59.3%). Four patients died during treatment, for an overall mortality of 14.8%. A logistic regression test showed a Fournier's gangrene severity index greater than 9 and sepsis on admission to be prognostic factors. CONCLUSION: The mortality rate was higher in patients with sepsis on admission and with a Fournier's gangrene severity index greater than nine.
Diabetes Mellitus ; Fasciitis, Necrotizing ; Fournier Gangrene ; Humans ; Logistic Models ; Retrospective Studies ; Risk Factors ; Sepsis