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

Telemedicine is a health care system that contains new-media techniques and medical special knowledge, using information techniques such as audio, moving picture, and communication provided to patients in distant areas with medical service such as diagnosis, consultation, education. Especially during medical transportation, it is possible that transferred patient can be rapidly taken care of by telemedicine. Our study reports 65 cases between a doctor in a hospital on ground and a patient during medical evacuation by telephone, e-mail and facsimile. Sixteen of 65 cases (25%) were immediately transferred to a hospital by sailing or helicopter. Other 49 cases were successfully taken care of by telemedicine.Telemedicine is economic and reasonable solving medical problems that may occur during medical evacuation where access to medical facilities is impossible.
Aircraft ; Delivery of Health Care ; Diagnosis ; Education ; Electronic Mail ; Humans ; Telemedicine* ; Telephone ; Transportation

Crushing injury is a common in work place and require early judgment and assessment. However during shipping, it is impossible that patient is rapidly taken care in hospital. But in this case, crushed handed patient during shipping was early assessment and sutured by telemedicine. A healthy 28-year-old man had crushed hand during working. But this patient was on the sea, so could not use medical facilities. Using e-mailing and telephone by satellite, report-ed to the doctor that patient status. In order to doctor 's pre-scription, patient hand was sutured and prescribed medicines. So patient preserved good hand function and rapidly recovered. In the future, telemedicine will be useful and economic medical field in isolated areas to medical facilities or shipping.
Adult ; Electronic Mail ; Hand* ; Humans ; Judgment ; Ships ; Telemedicine* ; Telephone ; Workplace

BACKGROUND: Pulmonary contusion is the most common pulmonary parenchymal injury in blunt chest trauma and may constitute a life-threatening thoracic injury. In this study, we evaluated the usefulness of high-frequency chest wall oscillation (HFCWO) therapy in patients with pulmonary contusion. METHODS: Patients with lung contusion either received HFCWO therapy using the Vest system (Vest group; n = 18) or received conventional chest physiotherapy (non-Vest group; n = 23). The physiological parameters of the patients, length of stay in hospital and ICU, and the duration of mechanical ventilation were compared between the two groups. Variables, including pulmonary contusion score, percentage of patients receiving mechanical ventilation therapy, and PaO2/FiO2 ratio, were also analyzed. RESULTS: The pulmonary contusion score was higher in the Vest group (p < 0.01), and mechanical ventilation was used more frequently in the Vest group (p = 0.027). Improvement in the PaO2/FiO2 ratio over the first 48 h did not differ between the Vest and Non-Vest groups. No significant differences in the physiological parameters, hospital and ICU stays, and duration of mechanical ventilation were observed between the two groups. CONCLUSIONS: The therapeutic effect of the Vest system in patients with pulmonary contusion was similar to that of conventional chest physiotherapy. Therefore, the Vest system could be considered as an airway clearance technique in the management of patients with pulmonary contusion.
Chest Wall Oscillation ; Contusions ; Humans ; Length of Stay ; Lung ; Lung Injury ; Respiration, Artificial ; Thoracic Injuries ; Thorax

PURPOSE: This study was conducted in order to determine the characteristics and risk factors of pediatric eye injury patients in the emergency department and to offer strategies for prevention of pediatric eye injury. METHODS: This prospective study was conducted by use of a standardized eye injury survey of patients under the age of 16 years who were treated for ocular injury at nine emergency medical centers, from March to September of 2010. The following data were collected; general characteristics of the study population, type and location of injury, causative activities, and materials of injury. Risk factors associated with open-globe injury were analyzed by logistic regression. RESULTS: A total of 1,151 patients were enrolled in the study; 75% were male. The highest incidence was observed between the age of 11 and 16 years (34.5%); 79.2% of patients had closed globe injury. The most common type of injury was contusion (65.4%) in closed globe injury and penetration (5.1%) in open-globe injury. Eye injury occurred most commonly at home (48.6%), followed by school/institution (19.4%). The most common causative activity and material were play (42.4%) and person/animal/plant (17%). Application of eye protective equipment (odds ratio: 24.33; 95% CI: 11.32~52.29) was found to be a statistically significant factor for occurrence of an open-globe injury. CONCLUSION: Establishment of safety measures considering gender and age is important since characteristics of pediatric eye injury differ based on such risk factors. The risk of open-globe eye injury increased with application of personal protective equipment, therefore, public education and promotion to use protective equipment of adequate level would be considered important.
Contusions ; Cross-Sectional Studies* ; Education ; Emergencies ; Emergency Service, Hospital* ; Eye Injuries* ; Humans ; Incidence ; Logistic Models ; Male ; Pediatrics ; Prospective Studies ; Risk Factors*

BACKGROUND AND OBJECTIVES: Antibiotic prophylaxis of infective endocarditis is required before high-risk procedures in patient with high-risk heart diseases. Although guidelines for the prevention of infective endocarditis were proposed by the American Heart Association in 1997, compliance to these recommendations has not been evaluated in Korea. SUBJECTS AND METHODS: This was a retrospective, multicentered study in 8 Korean university hospitals. Patients with high-risk heart diseases, having undergone invasive dental procedures between Jan. 1, 2000 and Dec. 31, 2003, were enrolled. The medical and dental records of the patients were reviewed to evaluate whether the prophylaxis had been appropriate. RESULTS: Of the initial 4,912 patients, 184 that had been treated with invasive dental procedures (255 total episodes, mean 1.4/patient) were evaluated. The most common high-risk heart disease was a prosthetic heart valve (233 procedures), followed by a previous history of infective endocarditis (22 procedures), cyanotic heart diseases (5 procedures) and systemic pulmonic venous shunts (2 procedures). Antibiotic prophylaxis was performed in 231 procedures (90.8%). Amoxicillin was the most common antibiotic used for prophylaxis (88.6%); however, the adequate dosage (2 gm) was administered in only 56% of these cases. Therefore, the appropriate prophylaxis, according to the AHA recommendations, was performed in only 14.1% (36 procedures). The mean duration of prophylaxis and number of antibiotic doses were 2.40 days (2.40+/-2.44) and 7.97 doses (7.97+/-7.18), respectively. A previous history of infective endocarditis (p=0.03) and dental extraction (p<0.01) resulted in a longer duration of prophylaxis. CONCLUSION: Only 14.1% of the high risk group procedures were given appropriate antibiotic prophylaxis according to the AHA recommendations. These data suggest that protocol-based education of both doctors and patients is required for appropriate antimicrobial therapy during high-risk procedures for the prevention of infective endocarditis in patients with high-risk heart disease.
American Heart Association ; Amoxicillin ; Antibiotic Prophylaxis ; Compliance ; Dental Records ; Education ; Endocarditis* ; Heart Diseases ; Heart Valves ; Hospitals, University ; Humans ; Korea ; Retrospective Studies

BACKGROUND: The purpose of this study is to know the healthcare-associated infection (HAI)s in small and medium sized hospitals, less than 400 beds. METHODS: We had web based surveillance for HAIs in 27 hospitals from August to October 2010. The surveillance performed in 1-2 ICUs and 1 general ward in each hospitals by CDC definition. And for the multi-drug resistant organisms (MDROs), we reviewed all of blood culture results. RESULTS: We identified 319 HAIs among 269,436 patients days. The HAIs rate was 1.18 (CI 1.05-1.32)/1,000 patient-days. Urinary tract infection was the most common HAI (52.4%) in this study followed by pneumonia (18.9%), blood-stream infections (14.2%), surgical site infection (7.9%), and others (6.6%). There were 76.5% of device associated infections in UTI, 46.7% in BSI, and 18.3% in pneumonia. The rate of HAIs in ICU was higher than that of in general ward (4.6 vs 0.9/1,000 patient-days). However, the indwelling catheter associated urinary tract infection rate was lower in ICU (2.6 vs 4.4/1,000 device days). There were no significant differences in central line-associated blood stream infection rate (1.5 vs 1.8) and ventilator-associated pneumonia rate (3.0 vs 0.0). The common microorganisms found in HAIs were Escherichia coli (19.8%), Staphylococcus aureus (13.1%), and Pseudomonas aeruginosa (12.7%). Moreover, 90.9% of S. aureus were resistant to methicillin, and 38.2% of P. aeruginosa and 44.4% of Acinetobacter baumannii were resistant to imipenem. Total of 66 MDROs were isolated from blood culture and the result shows that the MRSA was 84.6% (56 case), carbapenmen-resistant Acinetobacter spp. was 10.6% (7 case), and vancomycin-resistant enterococci was 4.6% (3 case). CONCLUSION: The characteristics of HAIs in small and medium sized hospitals will be contributed to the decision making of governance policy for infection control and to provide comparable data for these hospitals.
Acinetobacter ; Acinetobacter baumannii ; Catheters, Indwelling ; Centers for Disease Control and Prevention (U.S.) ; Decision Making ; Escherichia coli ; Humans ; Imipenem ; Infection Control ; Methicillin ; Methicillin-Resistant Staphylococcus aureus ; Patients' Rooms ; Pneumonia ; Pneumonia, Ventilator-Associated ; Pseudomonas aeruginosa ; Rivers ; Staphylococcus aureus ; Urinary Tract Infections

PURPOSE: This study analyzed the prognostic factors affecting admission in acute alcohol-intoxicated traumatic brain injury (TBI) patients visiting the emergency room. METHODS: A multicenter, retrospective observational study was conducted on 821 acute alcohol-intoxicated adult trauma patients, who visited 10 university hospital emergency centers from April to November 2016. The primary outcome was hospital admission. The secondary outcome was in-hospital mortality. RESULTS: One hundred sixty-eight patients diagnosed with acute alcohol-intoxicated TBI were analyzed. The increase in blood alcohol concentration was associated significantly with a mild decrease in admission (adjusted odds ratio, 0.993; 95% confidence interval, 0.989 to 0.998; p=0.01). Moderate to severe TBI patients showed a significant increase in admission compared to mild TBI patients (adjusted odds ratio, 12.449; 95% confidence interval, 3.316 to 46.743; p < 0.001). CONCLUSION: This study showed that the admission was inversely correlated with the blood alcohol concentration and is correlated directly with the increase in the severity in TBI. Therefore, emergency physicians may be required to identify the severity of TBI rapidly and accurately in acute alcohol-intoxicated trauma patients visiting the emergency room.
Adult ; Alcohol Drinking ; Blood Alcohol Content ; Brain Injuries* ; Emergencies* ; Emergency Service, Hospital* ; Hospital Mortality ; Humans ; Observational Study ; Odds Ratio ; Patient Admission ; Prognosis ; Retrospective Studies

The efficacy and safety of ertapenem, 1 g once daily, were compared with that of ceftriaxone, 2 g once daily, for the treatment of adults with acute pyelonephritis (APN) and complicated urinary tract infections (cUTIs) in a prospective, multicenter, double-blinded, randomized study. After > or = 3 days of parenteral study therapy, patients could be switched to an oral agent. Of 271 patients who were initially stratified by APN (n = 210) or other cUTIs (n = 61), 66 (48.9%) in the ertapenem group and 71 (52.2%) in the ceftriaxone group were microbiologically evaluable. The mean duration of parenteral and total therapy, respectively, was 5.6 and 13.8 days for ertapenem and 5.8 and 13.8 days for ceftriaxone. The most common pathogen was Escherichia coli. At the primary efficacy endpoint 5-9 days after treatment, 58 (87.9%) patients in the ertapenem group and 63 (88.7%) in the ceftriaxone had a favorable microbiological response. When compared by stratum and severity, the outcomes in the two groups were equivalent. The frequency and severity of drug-related adverse events were generally similar in both treatment groups. The results indicate that ertapenem is highly effective and safe for the treatment of APN and cUTIs.
Acute Disease ; Anti-Bacterial Agents/*therapeutic use ; Ceftriaxone/*therapeutic use ; Double-Blind Method ; Humans ; Odds Ratio ; Pyelonephritis/complications/*drug therapy ; Republic of Korea ; Risk Factors ; Urinary Tract Infections/complications/*drug therapy ; beta-Lactams/*therapeutic use

Neutralizing antibodies targeted at the receptor-binding domain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein have been developed and now under evaluation in clinical trials. The US Food and Drug Administration currently issued emergency use authorizations for neutralizing monoclonal antibodies in non-hospitalized patients with mild to moderate coronavirus disease 2019 (COVID-19) who are at high risk for progressing to severe disease and/or hospitalization. In terms of this situation, there is an urgent need to investigate the clinical aspects and to develop strategies to deploy them effectively in clinical practice. Here we provide guidance for the use of anti-SARS-CoV-2 monoclonal antibodies for the treatment of COVID-19 based on the latest evidence.