Objective: Traumatic brain injury (TBI) is an important public health concern due to its high prevalence and mortality rate among young people. We investigated the clinical and social characteristics of patients who visited the emergency department due to TBI in whom brain computed tomography, was performed by age. Methods: We retrospectively analyzed 15,567 TBI patients who received a brain computed tomography evaluation at the emergency department of Korea University Hospital from March 2013 to February 2016. We divided patients into age groups by decade and analyzed factors such as sex, trauma mechanism, need for operation, hospitalization, and results of treatment. Results: The mean age was 42.0±22.8 years; the most common age group was the 50s (16.5%). Except for the age group over 70 years, males predominated. Under 9 years of age, public ambulance usage rate was lower than in other age groups. Regarding severity based on the Glasgow Coma Scale score, the proportion of mild cases was higher in those under 9 years of age (99.3%) and the proportion of severe cases was higher in those in their 20s (4.6%). The most common injury mechanism was blunt trauma, followed by car accidents. For those under 9 years of age, falls were more common than in other age groups. Only 20.5% of TBI patients were hospitalized and 11.9% were treated surgically, while 70.6% of patients were discharged home after treatment. Conclusion TBI may present with different characteristics depending on the age of the patients, thus prevention policies and clinical practice should be tailored to age.

Lemierre syndrome is a rare syndrome caused by an acute pharyngitis with secondary septic thrombophlebitis of the internal jugular vein and metastatic infections. Although mortality from Lemierre syndrome is low, it remains a potentially life-threatening disease that requires careful consideration, as its early diagnosis and treatment is essential to prevent metastatic infection. We report a case of a 19-year-old woman who presented with a sore throat and right upper quadrant pain. Abdominal and pelvic computerized tomography (CT) showed acalculous cholecystitis with hepatosplenomegaly. The chest CT showed septic emboli in both lung fields and the neck CT revealed thrombosis in the left internal jugular vein. The patient was treated with antibiotics. After nine days, the chest CT showed a further increase in the size of the septic embolism and the patient was treated with anticoagulants. After 23 days, the size of septic emboli in the lung significantly decreased and the patient was discharged.
Acalculous Cholecystitis ; Anti-Bacterial Agents ; Anticoagulants ; Early Diagnosis ; Embolism ; Female ; Humans ; Jugular Veins ; Lemierre Syndrome ; Lung ; Neck ; Pharyngitis ; Thorax ; Thrombophlebitis ; Thrombosis

Repeated surgery of the lumbar spine after lumbar discectomy was not uncommon. Total 817 cases of lumbar disorders were carried out surgical intervention in author's clinic from Jan. 1993. to May 1997. Among them, 82 cases were reoperated cases after lumbar disc surgery. The causes, methods and outcome of reoperation were reviewed. The most common causes of reoperation was epidural adhesion, and the most frequent method of reoperation was the interbody fusion with adhesiotomy. Epidural fibrosis was the major problem and must be studied forward for preventing reoperaion.
Diskectomy ; Fibrosis ; Reoperation* ; Spine

Tuberculosis is still remains an important cause of morbidity and mortality throughout the world. Calvarial tuberculosis is a rare entity and when the primary lesion is in the calvarium without any detectable pulmonary lesion, it is even exeedingly rare. The authors present a case of a 60-year-old female patient presenting with headache and an area of painful protrusion in the left parietal scalp. Plain skull radiographs, computerized tomography(CT) scan and magnetic resonance(MR) image of the brain revealed an osteolytic lesion in the left parietal bone with an outward growth of the outer table. Chest radiograph was normal. At operation, the osteolytic lesion of the skull and the abnormal soft tissue were removed completely. Histopathological report on the surgical specimen confirmed the tuberculosis of the calvarium.
Brain ; Female ; Headache ; Humans ; Middle Aged ; Mortality ; Parietal Bone ; Rabeprazole ; Radiography, Thoracic ; Scalp ; Skull ; Tuberculosis*

PURPOSE: Purpose: We compared the outcomes of training between the use of voice-advisory manikin (VAM) and instructor-led (IL) courses with respect to the acquisition of initial cardio-pulmonary resuscitation (CPR) skills, as defined by the 2010 resuscitation guidelines. METHODS: This study was a randomized, controlled, blinded, parallel-group trial. We recruited 82 first-year emergency medical technician students and randomly distributed them into two groups: the IL group (n=41) and the VAM group (n=37). In the IL group, participants were trained in “single-rescuer, adult CPR” in accordance with the American Heart Association's Basic Life Support course for healthcare providers. In the VAM group, all subjects received a 20-minute lesson about CPR. After the lesson, each student trained individually with the VAM for 1 hour, receiving real-time feedback. After the training, all subjects were evaluated as they performed basic CPR (30 compressions, 2 ventilations) for 4 minutes. RESULTS: The proportion of participants with a mean compression depth ≥50 mm was 34.1% in the IL group and 27.0% in the VAM group, and the proportion with a mean compression depth ≥40 mm had increased significantly in both groups compared with ≥50 mm (IL group, 82.9%; VAM group, 86.5%). However, no significant differences were detected between the two groups in this regard. The proportion of ventilations of the appropriate volume was relatively low in both groups (IL group, 26.4%; VAM group, 12.5%; p=0.396). CONCLUSION: Both methods the IL training using a practice-while-watching video and the VAM training facilitated initial CPR skill acquisition, especially in terms of correct chest compression.
Adult ; Cardiopulmonary Resuscitation* ; Emergency Medical Technicians ; Health Personnel ; Heart ; Humans ; Manikins* ; Resuscitation ; Thorax ; Ventilation ; Voice*

OBJECTIVE: We compared training using a voice advisory manikin (VAM) with an instructor-led (IL) course in terms of acquisition of initial cardiopulmonary resuscitation (CPR) skills, as defined by the 2010 resuscitation guidelines. METHODS: This study was a randomized, controlled, blinded, parallel-group trial. We recruited 82 first-year emergency medical technician students and distributed them randomly into two groups: the IL group (n=41) and the VAM group (n=37). In the IL-group, participants were trained in “single-rescuer, adult CPR” according to the American Heart Association's Basic Life Support course for healthcare providers. In the VAM group, all subjects received a 20-minute lesson about CPR. After the lesson, each student trained individually with the VAM for 1 hour, receiving real-time feedback. After the training, all subjects were evaluated as they performed basic CPR (30 compressions, 2 ventilations) for 4 minutes. RESULTS: The proportion of participants with a mean compression depth ≥50 mm was 34.1% in the IL group and 27.0% in the VAM group, and the proportion with a mean compression depth ≥40 mm had increased significantly in both groups compared with ≥50 mm (IL group, 82.9%; VAM group, 86.5%). However, no significant differences were detected between the groups in this regard. The proportion of ventilations of the appropriate volume was relatively low in both groups (IL group, 26.4%; VAM group, 12.5%; P=0.396). CONCLUSION: Both methods, the IL training using a practice-while-watching video and the VAM training, facilitated initial CPR skill acquisition, especially in terms of correct chest compression.
Adult ; Cardiopulmonary Resuscitation* ; Education ; Emergency Medical Technicians ; Health Personnel ; Heart ; Humans ; Manikins* ; Resuscitation ; Teaching Materials ; Thorax ; Ventilation ; Voice*

OBJECTIVE: To assess whether ultrasonographic examination compared to chest radiography (CXR) is effective for evaluating complications after central venous catheterization. METHODS: We performed a prospective observational study. Immediately after central venous catheter insertion, we asked the radiologic department to perform a portable CXR scan. A junior and senior medical resident each performed ultrasonographic evaluation of the position of the catheter tip and complications such as pneumothorax and pleural effusion (hemothorax). We estimated the time required for ultrasound (US) and CXR. RESULTS: Compared to CXR, US could equivalently identify the catheter tip in the internal jugular or subclavian veins (P=1.000). Compared with CXR, US examinations conducted by junior residents could equivalently evaluate pneumothorax (P=1.000), while US examinations conducted by senior residents could also equivalently evaluate pneumothorax (P=0.557) and pleural effusion (P=0.337). The required time for US was shorter than that for CXR (P < 0.001). CONCLUSION: Compared to CXR, US could equivalently and more quickly identify complications such as pneumothorax or pleural effusion.
Catheterization, Central Venous* ; Catheters* ; Central Venous Catheters* ; Diagnostic Imaging ; Observational Study ; Pleural Effusion ; Pneumothorax ; Prospective Studies ; Radiography ; Subclavian Vein ; Thorax ; Ultrasonography*

PURPOSE: In most areas of the world, transfers between emergency centers are performed through direct communication between physicians of transferring and receiving hospitals. The emergency medical information center "1339" (or 1339, for short), which had mediated inter-hospital transfers for about 10 years, was recently discontinued. This study aimed to survey the stance of physicians at transferring and receiving hospitals on the importance of 1339 functions. METHODS: In May 2012, before the discontinuation of 1339 as a mediator, a questionnaire was distributed to emergency-related physicians at several hospitals on the level of emergency care in Busan. RESULTS: There were 202 answers. Physicians of high level emergency centers had a higher tendency to transfer patients without pre-contact for transfer (p=0.019). The physicians at each level of care thought that direct communication between physicians was more accurate (69.9%), but mediation through 1339 was more convenient (53.6%). Mediation through 1339 was the most frequent resource used for pre-contact of inter-hospital transfers (58.1%). CONCLUSION: Physicians at each level of care tended to find pre-contact between physicians more accurate for inter-hospital transfers; however, they also thought mediation through 1339 was more convenient and it was the most frequently used resource for pre-contact of inter-hospital transfers.
Community Networks ; Emergencies ; Emergency Medical Services ; Hospital Information Systems ; Humans ; Information Centers ; Negotiating ; Surveys and Questionnaires

PURPOSE: This study was conducted to evaluate the correlations among pulmonary contusion severity, trauma score and cardiac troponin I (cTnI) level. METHODS: We prospectively evaluated patients with multiple injuries who had been admitted to the emergency department (ED) from July 2007 to July 2008. We first measured the total creatinine kinase (CK), the MB fraction of CK (CK-MB), TnI, and myoglobin within 2 hours after the injury. We then checked the electrocardiogram, x-ray, and computed tomography (CT) results. Finally, we assessed the injuries as variables and then compared the results for patients with elevated TnI levels (group A) and patients whose TnI levels fell within the normal range (group B). RESULTS: Eighty-six of the 92 patients admitted to the ED were enrolled. The pulmonary contusion score (PCS) was well correlated with PaO2/FiO2. TnI levels were correlated with PCS. When TnI levels were above 0.86 ng/ml, the mortality was estimated with 100% sensitivity and 86.1% specificity. CONCLUSION: Pulmonary contusion severity is correlated with TnI level. When the PCS is high and the cTnI level is elevated in multiple-injury patients, we recommend continuous cardiac monitoring and further evaluation.
Contusions ; Creatinine ; Electrocardiography ; Emergencies ; Humans ; Injury Severity Score ; Multiple Trauma ; Myoglobin ; Phosphotransferases ; Prospective Studies ; Reference Values ; Troponin I

PURPOSE: Drowning is a common preventable cause of accidental death. Although many studies about drowning injuries have been conducted, most are related to freshwater drowning. The aim of this study was to analyze the clinical features and prognostic factors in seawater drowning patients. METHODS: This study was performed retrospectively with sea water drowning patients who visited the emergency department at Pusan National University Hospital between January 2005 and December 2009. RESULTS: In total, 51 sea water drowning patients presented at the emergency department with a mean age of 48.65+/-15.40 years. The survival group included 42(82.4%) patients, and the death group was comprised of nine patients(17.6%). Fifteen patients arrested in the field, and cardiopulmonary resuscitation (CPR) was performed. Median immersion time in the death group was 15.0 minutes (range, 9.5~22.5 minutes). Among the death group, five patients had respiratory acidosis and nine showed pulmonary edema on a chest X-ray. Initial sodium level in the survival group was 146.30 mEq/L (range, 142.38~152.60 mEq/L), but the level was normalized with isotonic saline. CONCLUSION: Most drowning injuries occurred at night and in relatively young aged patients. CPR in the field did not result in good outcomes because of the longer immersion time. The death group had respiratory acidosis. Because the survival group did not show significant hypernatremia, isotonic saline as an initial fluid was thought to be appropriate. Drowning injuries occur differently based on geographic and social characteristics; therefore, local characteristics should be considered to establish preventive measures.
Acidosis, Respiratory ; Aged ; Cardiopulmonary Resuscitation ; Drowning ; Emergencies ; Fresh Water ; Humans ; Hypernatremia ; Immersion ; Prognosis ; Pulmonary Edema ; Retrospective Studies ; Seawater ; Sodium ; Thorax