BACKGROUND: The present study was performed in order to identify the possible future location of the Department of Emergency Medicine and future demand for and supply of manpower through a survey of the heads of Kwangju City and Chollanam-do hospitals. The survey covered the degrees of recognition and understanding, the necessity, the future prospects, and the direction of development of the Department of Emergency Medicine. METHODS: A total of 33 large-scale general hospitals were selected in county districts having more than 200 sickbeds as of November 1999. Among them, the heads of 29 hospitals responded to the survey. The survey had a total of 31 questions, including 6 questions on the status of the emergency room. Six(6) questions concerned the degree of recognition of the Department of Emergency Medicine. Six(6) questions concerned the degree of understanding of the Department of Emergency Medicine. Six(6) questions concerned the necessity for the Department of Emergency Medicine, and 7 questions concerned the future prospects and direction of development. The results of the survey were analyzed. RESULTS: 1) As to the question of the degree of recognition, the Department of Emergency Medicine was known to all. That is, 50% of the respondents were well aware of the department, and 50% a little. Nineteen(19) respondents(65%) answered that it was convenient to have the Department of Emergency Medicine in a university hospital, among which 16 respondents(55%) answered that it was because of the rapid treatment of emergency patients. 2) As to the question of the degree of understanding, particularly, the areas of medical examination and treatment by the Department of Emergency Medicine, 15 respondents answered that it was for the treatment of patients who needed to receive emergency treatment, while 12 respondents answered that it was for the diagnosis and treatment of all patients who visited the emergency room. Only 7 respondents(24%) answered positively as to the possibility of the Department of Emergency Medicine using thrombolysis medicine. 3) All except for one respondent had a positive view on the necessity for the Department of Emergency Medicine, and all except for 3 respondents wanted to have specialized doctors in emergency medicine work at the corresponding hospital. As to the type of schedule, 10 hospitals(34%) wanted to have only night shifts, and 11 hospitals(38%) wanted to have both day and night shifts. Most hospitals, needed two or more workers in the field. 4) As to the question of the direction of development, many respondents were of the opinion that the hiring of specialized doctors in emergency medicine would not be of greatly help to the finances of the hospital due to increased labor costs. It seems that improvement of the medical system to improve hospital financing is a required prerequisite for the development of the Department of Emergency Medicine. Also, 21 respondents(83%) were of the opinion that it would take a considerable amount of time to activate the Department of Emergency Medicine with respect to the future prospects of the department. CONCLUSION: It was shown in the present survey that the heads of hospitals in Kwangju City and Chollanam-do recognized the Department of Emergency Medicine in a positive way, but it was necessary to establish both a delivery system for emergency medicine and collaboration with and support by other medical areas for its future development. It was estimated that in the future, more than 55 doctors specializing in emergency medicine would be needed as medical manpower for the general hospitals in the districts.
Appointments and Schedules ; Cooperative Behavior ; Surveys and Questionnaires ; Diagnosis ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Emergency Treatment ; Gwangju* ; Head ; Hospitals, General ; Humans ; Jeollanam-do*

No abstract available.
Arthroplasty* ; Knee*

BACKGROUND: We reviewed retrospectively the clinical features and contrast material-enhanced computed tomography(CT) after blunt abdominal trauma demonstrated a characteristic hypoperfusion complex. Our purpose were to evaluate the hypothesis that children with this 'hypoperfusion complex' CT finding were associated with a tenuous hemodynamic state, severe injury and a poor outcome. METHODS: Between January 1996 and December 1999, 39 consecutive children who sustained blunt trauma and were suspected clinically of having intraabdominal injury underwent CT. Demographic data, blood pressure, indication for CT, pediatric trauma score(PTS) and Glasgow coma score(GCS) were recorded at the time of the initial examination. RESULTS: Three of the 39 children(8%) demonstrated a characteristic finding at CT which was described as the hypoperfusion complex. The 'hypoperfusion complex' was present in the 3 of the 39 traumatized children(8%), but was the main radiographic finding in the 3 of the 14 children with a severe pediatric trauma score(PTS<8) and in the 3 of the 6 children with a Glasgow coma score(GCS<8) who were examined with CT. CONCLUSION: The CT finding in all children with the hypoperfusion complex by definition included marked, diffuse dilatation of the intestine with fluid; abnormally intense contrast enhancement of the bowel wall, mesentery, kidney and/or pancreas; decreased caliber of the abdominal aorta and inferior vena cava(IVC); and moderate to large peritoneal fluid collection. This 'hypoperfusion complex' is a relatively rarely observed in injured children but appears to be associated with severe injury and a poor outcome. The pediatric trauma score provides a useful profile of injury severity in children. Prompt diagnosis of hypovolemic shock is important so that supportive therapy can be instituted to prevent further metabolic abnormalities and their potential cardiotoxic effects. In summary, the intense multiorgan enhancement pattern seen in the hypoperfusion complex indicates tenuous hemodynamic stability and is associated with a poor outcome.
Aorta, Abdominal ; Ascitic Fluid ; Blood Pressure ; Child* ; Coma ; Diagnosis ; Dilatation ; Hemodynamics ; Humans ; Hypovolemia* ; Intestines ; Kidney ; Mesentery ; Pancreas ; Retrospective Studies ; Shock* ; Tomography, X-Ray Computed*

PURPOSE: Generally, if a patient suffers from chest pain and shows a specific EKG pattern, it is easy to determine a clinical diagnosis, thus it is but in many cases, patients show nonspecific chest pain and a nonspecific EKG pattern. So it's important to consider the serological labaratory exam for cardiac enzymes for a definite diagnosis. Until now, cTnI has been considered to be different from CK-MB and cTnT in that it shows a specific elevation in early myocardiac injury and rare nonspecific elevation in renal-failure patients. Therefore, to affirm a sufficient relation between cTnI elevation and myocardiac injury, are carried out this study. METHODS: The number of patients in the study was 58. No one had shown any evidence of myocardiac injury during the recent 2 years or any of the risk factors for AMI, such as smoking, obesity, and hypercholesterolemia. They showed specific symptoms like chest pain or nonspecific ones like dyspnea, indigestion, or a nonspecific EKG abnormality, including nonspecific ST-T change. Their serum creatinine level was above 2.0 mg/dL and qualitative results of cTnI was obtained by using a Troponin I rapid assay kit. The definite diagnosis of AMI was made by a cardiologist based on an intergrated result of EKG, clinical symptoms and signs and regional cardiac wall-motion abnormality on a echocardiogram. RESULTS: The sensitivity of CK-MB, cTnT, and cTnI were 100%, 100%, and 100%, respectively, and the specificities were 75%, 85%, 100%. CONCLUSION: In cases of patients with a high serum-creatinine level, particularly, those with positive serum CK-MB and cTnT, the measurement of cTnI is considered to be significant for the differential diagnosis of AMI as it shows both a high sensitivity and a high specificity in early myocardiac injury.
Chest Pain ; Creatinine ; Diagnosis* ; Diagnosis, Differential ; Dyspepsia ; Dyspnea ; Electrocardiography ; Emergencies* ; Humans ; Hypercholesterolemia ; Myocardial Infarction* ; Obesity ; Renal Insufficiency* ; Risk Factors ; Sensitivity and Specificity ; Smoke ; Smoking ; Troponin I* ; Troponin*

BACKGROUND: V. vulnificus infection is found between May and October when the man who has hepatic disorder or immunity disorder eats raw shellfish and it causes the systemic symptoms such as sudden fever, chilling, shock and stupor and local skin lesions like blob and necrosis. This disease has 46~61% of fatality rate in spite of intensive treatment. This study conducts the examination of history, epidemic study, ingesting raw fish and bacteriologic investigation in the patients with similar clinical symptoms to the above and examines the diagnostic correlations. METHOD: It is conducted with 31 cases who admitted at emergency medical center of Chosun University Hospital from May of 1995 to September of 1998 and are suspected to have V. vulnificus infection. It analyze bacteriologic examination, the survey of residence, eating raw shellfish, hepatic disorder, alcohol drinking habits and skin lesion. RESULTS: 1)the rate of male and female is 15.5:1 and in the age, 18 cases are in fifties, seven ale in fifties and six are over sixties. 2) Clinically, V. vulnificus is detected in 20 of 31 cases which is suspected to have V. vulnificus i18c1ion and it is not detected in 5 cases. Other bacteria are detected in 6 cases and they include staphylococcus aureus, pseudomonas species, beta hemotytic streptococcus and E-coil. 3) In local distribution, Kohung has 10 cases, Shinan and Mokpo have six, Haenam and Kangjin have aye, Yongkwang and Muan have five, Naju and Yongam have five and Kwangju has one. 4) Eating fishes and raw shellfishes is found in 31 cases. In the kind of shellfishes, eating raw clam is 10 cases, raw thin-shelled surf calm is 8 cases, raw oyster is 5 cases and sliced raw fish is 4 cases and pickled sea floods ate 4 cases. 5) The cases with hepatic disorder are 23 and 15 Gases with heavy alcohol dunking Carrier are included. The cases with Diabetic Mellitus are four and those with pulmonary tuberculosis are two. Two cases have not basal diseases. 6) On the opinion of skin lesion, 20 cases show vesicular necrosis, 7 cases have dendriform erythema, 3 cases have papule and one case doesn't show clear skin lesion. CONCLUSION: When V. vulnificus infection is detected, it is fatal and those who have hepatic disorder or heavy alcohol drinking habit must avoid eating fishes and shellfishes raw in summer. It is important to have emergency treatment for the patient whose V. vulnificus infection is suspected. It is considered that the administration of initial antibiotics is effective by generalizing the clinical symptom, epidemic opinion and patient history even before the results of bacteriologic confirmed.
Alcohol Drinking ; Anti-Bacterial Agents ; Bacteria ; Bivalvia ; Eating ; Emergencies ; Emergency Treatment ; Erythema ; Female ; Fever ; Fishes ; Floods ; Gases ; Gwangju ; Humans ; Jeollanam-do ; Male ; Necrosis ; Ostreidae ; Pseudomonas ; Shellfish ; Shock ; Skin ; Staphylococcus aureus ; Streptococcus ; Stupor ; Tuberculosis, Pulmonary ; Vibrio vulnificus* ; Vibrio*

Endosulfan is an agricultural chemical of organic chlorine, is toxic in both the central nervous system and the cardiovascular system, and causes respiratory system disorder and deaths by status epilepticus, respiratory distress, and so on. The use of this agricultural chemical of organic chlorine is limited by its toxicity. However, it is still used as a common insecticide, so it is readily to available. Four elderly people were admitted with depression of consciousness and convulsions after eating pan-fried food. During their treatment, the patients were diagnosed with endosulfan intoxication, completely by accident. We are reporting these cases of endosulfan intoxication that showed variable clinical findings from mild sequelae to death.
Aged ; Cardiovascular System ; Central Nervous System ; Chlorine ; Consciousness ; Depression ; Eating ; Endosulfan* ; Humans ; Respiratory System ; Seizures ; Status Epilepticus

Chlorophenoxy herbicide poisoning is uncommon, but may produce severe sequelae. It's treatment is primarily the same as that used for poisonings with other drugs; gastric lavage, activated charcoal, etc. However, it's secondary treatment to enhance elimination has two options, alkaline diuresis or hemodialysis. We experienced a patient who had been poisoned with chlorophenoxy herbicide and had severe symptoms like comatose mentation, acute renal failure, rhadomyolysis, etc. The patient was treated by hemodialysis for 5 days and recovered from the acute state.
Acute Kidney Injury ; Charcoal ; Coma ; Diuresis ; Gastric Lavage ; Humans ; Poisoning ; Renal Dialysis*

Takayasu's arteritis is a non-specific inflammatory process that involves the aorta and its main branches, the etiology of which remains unknown. This arteritis occurs predominantly in young Asian women, although there have been many documented cases in males and non-Asians. Criteria for the diagnosis of Takayasu's arteritis were developed by The Subcommittee on Classification of Vasculitis of the American College of Rheumatology in 1990, of which a modified version is shown in Table 1. The presence of three or more of the six criteria shown demonstrated a diagnostic sensitivity of 90.5% and a specificity of 97.8%. Takayasu's arteritis is known as 'pulseless disease,' and this non-specific inflammatory arteriopathy typically produces segmental arterial narrowing and occlusion with resultant end-organ ischemic consequences, including upper extremity digital necrosis, stroke, visceral ischemia and renal failure. Previously reported sites of aneurysm formation include the thoracic and abdominal aorta, as well as the innominate, the carotid and the superior mesenteric arteries, but rarely the subclavian artery. A 26-year-old man presented with a progressively enlarging and tender pulsatile mass at the base of the left neck, intermittent Claudication of the upper limbs in association with a decreased brachial artery pulse and a bruit over the subclavian artery. Computed tomography and aortography demonstrated a 4 cmX5 cm aneurysm of the left subclavian artery. There was no evidence of occlusive disease. An aneurysmectomy with 8 mm hemashield graft interposis was performed . Pathology revealed a chronic, active inflammatory process. Aneurysm formation is an unusual complication of Takayasu's arteritis. Emergency department physicians must carefully observed patiens with symptomatic upper extremity pain and paresthesia and must consider whether those symptoms might be due to the formation of a subclavian artery aneurysm due to Takayasu's arteritis
Adult ; Aneurysm* ; Aorta ; Aorta, Abdominal ; Aortography ; Arteritis ; Asian Continental Ancestry Group ; Brachial Artery ; Classification ; Diagnosis ; Emergency Service, Hospital ; Female ; Humans ; Intermittent Claudication ; Ischemia ; Male ; Mesenteric Artery, Superior ; Neck ; Necrosis ; Paresthesia ; Pathology ; Renal Insufficiency ; Rheumatology ; Sensitivity and Specificity ; Stroke ; Subclavian Artery* ; Takayasu Arteritis* ; Transplants ; Upper Extremity ; Vasculitis

BACKGROUND: Tsutsugamushi disease is an acute, rashed febrile disease that shows widely varying prognoses from unsymptomatic infection to death. Early diagnosis and treatment lead to speedy recovery. Otherwise, many complications develop. This research was carried out to analyze the factors that affect the development of complications by comparing Tsutsugamushi patients with complicaions with those without complications. METHODS: Among the acute febrile disease patients who visited the emergency center of Chosun University Hospital from January to December 2000, 41 patients were clinically and serologically confirmed as having Tsutsugamushi disease. They were divided into two groups; 14 patients with complications and 27 patients without complications. We analyzed the two groups for correlations between complications and sex, age, period of occurrence, transfer or not, vital signs, laboratory findings, period before treatment, and checks for the existence of underlying disease, eschar, eruption, chest Xrays, and early diagnosis. RESULTS: 1) The aged have a high incidence of the disease, but there was no correlation between age and complications. Also, there was no correlation based on sex. 2) Although fall has a high incidence of the disease, the other seasons have higher complication rates. 3) The complication incidence rate has no correlation with either blood pressure or heart rate, also it does no correlate with eschar and skin rashes. 4) In the laboratory findings, hemoglobin and platelet, and Bun/Cr correlate with the complicaton incidence rate, but the white blood cell count and AST/ALT do not. 5) The complication incidence rate was high when treatment was started 10 days after the onset of Tsutsugamushi disease and no early diagnosis had been given. CONCLUSION: Early diagnosis and treatment are most important in preventing complications of Tsutsugamushi disease because the factors that affect the developement of complications of Tsutsugamushi disase are found during early diagnosis. Patients with doubtful clinical symptoms and abnormal lab findings should be started on a program of antibiotic treatment.
Blood Platelets ; Blood Pressure ; Early Diagnosis ; Emergencies ; Exanthema ; Heart Rate ; Humans ; Incidence ; Leukocyte Count ; Prognosis ; Scrub Typhus ; Seasons ; Thorax ; Vital Signs

No abstract available.
Glomerulonephritis, IGA* ; Immunoglobulin A* ; Nephrotic Syndrome*