PURPOSE: The collapse-to-advanced life support (ALS) time interval is the most important factor for the survival of and the prognosis for patients suffering from out-of-hospital cardiac arrest. A witness is the key person who decides first response, the mode of transportation, and the activation of the emergency medical service (EMS). Accordingly, the time interval to ED arrival and ALS is mostly influenced by the witness factor. We analyzed the influence of the witness factor and examined how to reduce the collapse-to-ED time interval for cases of out-of-hospital cardiac arrest. METHODS: We retrospectively reviewed 174 out-of-hospital cardiac arrest cases that occurred during a 1-year period. Then, we compared the time to call the EMS and the time to the ED arrival according to the witness' type, the first response, the first place called and the mode of transportation to the ED. RESULTS: The median time to call the EMS and time to ED arrival were 5 (0~30) and 55 (28~120) minutes, respectively. There was a statistically significant correlation between the time to call the EMS and the time to ED arrival. Family/Cohabitant comprised most (80.5%) of the witness and they had a statistically significant delay in the time to call the EMS and the time to ED arrival than other groups. The time to ED arrival was significantly longer for the group who contacted relatives as the first response than it was for other groups who called the EMS or directly transported the victim to the hospital. Among the first places called, the time to call the EMS and the time to ED arrival were significantly shorter for the witness group who called 119 first. As for the mode of transportation, the private ambulance group showed a significant delay in time to ED arrival compared to the 119 ambulance group and other groups. The victims who underwent CPR in the ED had significantly shorter times to call the EMS and to ED arrival than the other victims. CONCLUSIONS: The collapse-to-ED time interval was influenced mainly by the witness. The type of witness, the first response, and the first place called were significant factors that influenced the time to call the EMS and time to ED arrival. To improve the survival rate and the prognosis for out-of-hospital cardiac arrest victims, we need more education for people who might be witnesses of such an event.
Ambulances ; Cardiopulmonary Resuscitation ; Education ; Emergency Medical Services ; Heart Arrest* ; Humans ; Out-of-Hospital Cardiac Arrest ; Prognosis ; Retrospective Studies ; Survival Rate ; Transportation

OBJECTIVE: Tube thoracostomy (TT) is a commonly performed intensive care procedure. Simulator training may be a good alternative method for TT training, compared with conventional methods such as apprenticeship and animal skills laboratory. However, there is insufficient evidence supporting use of a simulator. The aim of this study is to determine whether training with medical simulator is associated with faster TT process, compared to conventional training without simulator. METHODS: This is a simulation study. Eligible participants were emergency medicine residents with very few (≤3 times) TT experience. Participants were randomized to two groups: the conventional training group, and the simulator training group. While the simulator training group used the simulator to train TT, the conventional training group watched the instructor performing TT on a cadaver. After training, all participants performed a TT on a cadaver. The performance quality was measured as correct placement and time delay. Subjects were graded if they had difficulty on process. RESULTS: Estimated median procedure time was 228 seconds in the conventional training group and 75 seconds in the simulator training group, with statistical significance (P=0.040). The difficulty grading did not show any significant difference among groups (overall performance scale, 2 vs. 3; P=0.094). CONCLUSION: Tube thoracostomy training with a medical simulator, when compared to no simulator training, is associated with a significantly faster procedure, when performed on a human cadaver.
Animals ; Cadaver ; Chest Tubes ; Critical Care ; Education ; Emergency Medicine ; Humans ; Methods ; Simulation Training ; Thoracostomy*

PURPOSE: In the last 30 years, there has been a markedly increased use of iodinated contrast agents in diagnostic and interventional radiological procedures. Due to the possible side effect of nephrotoxicity of these radiocontrast agents, we investigated the incidence of nephrotoxicity and attempted to identify the patient groups at higher risk for contrast nephrotoxicity among the patients who underwent emergency computerized tomography. METHODS: We reviewed the medical records of 1,572 patients who had undergone contrast computerized tomography at the Emergency Center, Yonsei Medical Center, from January to May 2002. We defined contrast nephrotoxicity as any increase in the creatinine value of more than 0.5 mg/dL (44 micromol/L) or 25% compared to the baseline value. RESULTS: We found 21 patients (1.3%) who met the criterion for contrast nephrotoxicity: 13 patients with normal renal function, and 8 patients with a higher than normal creatinine value before contrast-enhanced computerized tomography. The incidence of contrast nephrotoxicity in the patient group with normal renal function was 0.8% (13/1551), compared to 38.1% (8/21) in the pre-existing renal insufficiency group. There were no statistical differences on the amounts of dye used and the frequencies of risk factors for contrast nephro-toxicity between the patients in pre-existing renal insufficiency group who developed nephrotoxicity and who did not. The renal function of all patients returned to the baseline value without dialysis or renal replacement therapy. CONCLUSION: Pre-existing renal insufficiency is the most important risk factor for contrast nephrotoxicity. We need to take precautions and to have a proper protocol for the prevention of contrast nephrotoxicity in emergency care.
Contrast Media ; Creatinine ; Dialysis ; Emergencies* ; Emergency Medical Services ; Humans ; Incidence ; Medical Records ; Renal Insufficiency ; Renal Replacement Therapy ; Risk Factors ; Tomography, X-Ray Computed*

PURPOSE: We wanted to predict the high risk group that requires urgent airway intervention by using the parameters of the soft-tissue lateral neck radiographs of adult acute epiglottitis patients. METHODS: This retrospective study was conducted in two teaching hospitals. The patients who were diagnosed with acute epiglottitis from June, 2007 to May, 2009 were enrolled and their medical records and x-ray films were reviewed. The width of the epiglottis at the widest point (EW), the width of the arytenoid at the widest point (AW), the prevertebral soft tissue distance at the third cervical spine (PSTD), the shortest distance from the epiglottis to the hypopharyngeal wall (EHD) and the shortest distance from the epiglottic root to the arytenoids'tip (EAD) were investigated and we performed regression analyses of these parameters of the patients in the high risk group that required urgent airway intervention. RESULTS: A total of 42 patients were enrolled. Dyspnea and hoarseness were more frequent in the high risk group that required urgent airway intervention (p=0.008, 0.040, respectively). The EW was significantly longer (p=0.001) in the high risk group. The EHD and EAD were significantly shorter (p=0.012, <0.001, respectively) in the high risk group. Only the EAD showed significant correlation with the percent of airway patency on linear regression analysis (p=0.003) and the EAD was the only significant predictor for the high risk group on multivariate logistic regression analysis (p=0.043). The receiver operating characteristics curve of the EW/EAD for the high risk group was obtained and it showed the best predictive power (AUC: 0.977, p<0.001). CONCLUSION: The EAD noted on soft-tissue lateral neck radiography is an important predictor of high risk patients who require urgent airway intervention. The cut-off value of the EW/EAD for the predicting the high risk group is 2.44 (sensitivity 100%, specificity 85.7%).
Adult ; Airway Obstruction ; Dyspnea ; Epiglottis ; Epiglottitis ; Hoarseness ; Hospitals, Teaching ; Humans ; Linear Models ; Logistic Models ; Medical Records ; Neck ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Spine ; X-Ray Film

PURPOSE: This study was performed to determine the association of symptom recognition with pre-hospital delay in patients with acute coronary syndrome (ACS), and to determine the factors influencing symptom recognition. METHODS: A prospective study from June 1, 2009 to July 31, 2009 was performed. The pre-hospital delay was calculated by subtraction of the hospital-arrival time from the symptom-onset time. The pre-hospital delay of the patients that recognized the symptoms as cardiovascular in origin was compared to the patients that did not recognize the symptoms as cardiac in origin. In addition, the socioeconomic indexes and risk factors were evaluated. RESULTS: Eighty three subjects were enrolled from a total of 205 patients suspected of having an ACS during the study period. No statistical differences were identified in the comparison of the pre-hospital delay by socioeconomic and risk factors of ischemic heart disease. The median pre-hospital delay of the patients that recognized the symptoms as cardiac was 2.9 hours compared to 11.9 hours among the patients that did not recognize the symptoms as cardiac; this difference was statistically significant (p=0.003). There were statistically significant differences in symptom recognition between the patients that had a history of cardiovascular disease and those that did not (p=0.037), and between the patients that took aspirin and those that did not (p=0.014). In addition, the severity of symptoms differed between the patients that recognized their symptoms and those that did not; this difference was statistically significant (p=0.019). Only the severity of symptoms was statistically significant by the logistic regression analysis (p=0.018). CONCLUSION: The pre-hospital delay was shorter, if patients that recognized the symptoms as cardiac in origin. A history of cardiovascular disease, taking aspirin and severity of symptoms were factors influencing the recognition of symptoms.
Acute Coronary Syndrome ; Aspirin ; Attitude to Health ; Cardiovascular Diseases ; Humans ; Logistic Models ; Myocardial Ischemia ; Prospective Studies ; Risk Factors ; Time Factors

PURPOSE: Recent guidelines for sepsis treatment emphasizes the need for early recognition of disease, leading to the development of the MEDS scoring system. However, there has been no prospective validation or comparison against other scoring systems. Therefore, we prospectively validated the MEDS scoring system and compared it withMultiple Organ Dysfunction Score (MODS) and Sepsisrelated Organ Failure Assessment (SOFA) scoring systems. METHODS: MEDS, MODS, and SOFA scores of 288 patients who were suspected to have systemic infection were calculated at the times of their emergency department visits, and clinical data of the patients were reviewed after six months. Results: MEDS, MODS, and SOFA scoring systems were all valid in the prediction of mortality according to logistic regression analysis. The results of probit analysis revealed significant and direct relationships between the scores and the mortality rate and demonstrated the parallelism of the mortality prediction of the three scoring systems. The cut-off values for the MEDS scoring system successfully divided subjects into five groups according to their risk for death. And the MEDS score well predicted the admission to ward or intensive care unit in survived patients. CONCLUSION: MEDS, MODS, and SOFA scor all were good predictors of outcome for patients with suspected sepsis and showed the same degree of predictive power. The MEDS scoring system, however, featured ease of calculation and definite clinical cut-off values which were useful in guiding decisions about treatment options. It also was well correlated with the prognosis of survived patients. We believe it to be the most useful and appropriate clinical prediction tool in cases of suspected sepsis in the emergency department.
Emergencies* ; Emergency Service, Hospital* ; Humans ; Intensive Care Units ; Logistic Models ; Mortality* ; Multiple Organ Failure ; Organ Dysfunction Scores ; Prognosis ; Prospective Studies ; Research Design ; Sepsis*

Anaphylaxis after an animal bite is uncommon. Especially, anaphylaxis after a hamster bite is very rare with only a few reported cases. A 19-year-old previously healthy female arrived complaining of respiratory difficulty, facial swelling and skin rash after her pet hamster bite. Her symptoms started 5 minutes after the bite and arrived 30 minutes after the incidence. Epinephrine, antihistamine and steroid were injected and her symptoms were relieved. She was discharged 3 hours after treatment with no other complications.
Anaphylaxis* ; Animals ; Bites and Stings ; Cricetinae* ; Epinephrine ; Exanthema ; Female ; Humans ; Incidence ; Young Adult

PURPOSE: Mortality in emergency department sepsis (MEDS), sepsis-related organ failure assessment (SOFA), multiple organ dysfunction score (MODS), and serum lactate levels have shown their efficacy in the early detection of patients with a bad prognosis. However, those studies did not consider differences in treatment protocols and could not rule out the interference of these differences in treatment modalities. Hence, we aimed to assess the performance of MEDS, MODS, SOFA, and serum lactate levels for predicting a bad prognosis in patients scheduled for identical, standardized treatment protocols, EGDT. METHODS: Medical records of patients who visited a tertiary level teaching hospital and were enrolled in an EGDT program between October 2009 and May 2010, were retrospectively reviewed. MEDS, SOFA, and MODS scores were calculated and recorded along with serum lactate levels. Receiver operating characteristics (ROC) curves of those predictors of mortality were plotted, Bivariate correlation analyses with overall lengths of admission and ICU lengths of stay were done for surviving patients. RESULTS: None of the diagnostic methods (serum lactate level, MEDS, SOFA, MODS) showed a significant difference on ROC analysis (p=0.819, 0.506, 0.811, 0.873, respectively). Bivariate correlation analyses of MEDS, SOFA, MODS and overall lengths of admission showed significant results (p=0.048, 0.018, and 0.003, respectively. Pearson correlation coefficients were, 0.263, 0.312, and 0.381). Only MEDS showed a significant correlation with intensive care unit (ICU) length of stay (p=0.032, Pearson correlation coefficient = 0.332). CONCLUSION: Neither MEDS, SOFA, MODS, nor serum lactate level can predict mortality in EGDT-enrolled patients. MEDS may be correlated with ICU length of stay.
Clinical Protocols ; Emergencies ; Hospitals, Teaching ; Humans ; Intensive Care Units ; Lactic Acid ; Length of Stay ; Medical Records ; Multiple Organ Failure ; Organ Dysfunction Scores ; Prognosis ; Retrospective Studies ; ROC Curve ; Sepsis ; Severity of Illness Index ; Treatment Outcome

Generally, the occurrence of an esophageal foreign body due to a coin-like material is rare in adults. The Maeksumseok is a kind of rock that is believed to be good for health in Korean folk medicine. Thus, people use a Maeksumseok in various ways, one of which is keeping coin-shaped Maeksum-seok in the mouth. Because of this use, it is easy to swallow a Maeksum-seok coin by accident, and a swallowed Maeksum-seok coin will easily lodge in esophagus. We experienced three cases of an esophageal foreign body caused by a Maeksum-seok coin. The patients swallowed the Maeksum-seok coin accidentally while sleeping with the Maeksum-seok coin in their mouth for health reasons. The problem is that it was hard to detect the Maeksum-seok coin by using a simple radiologic study. However, the patients in these cases complained of a sustained foreign body sensation, so we used endoscopy. The foreign bodies were easily detected and removed by endoscopy in both cases.
Adult ; Endoscopy ; Esophagus ; Foreign Bodies* ; Humans ; Medicine, Traditional ; Mouth ; Numismatics ; Sensation

PURPOSE: The GlideScope video laryngoscope (GL) has been known to help inexperienced health care providers become able to manage even difficult airways. The purpose of this study was to compare foreign body removal efficacies between the Macintosh laryngoscope (ML) and the GL in a setting of airway obstruction. METHODS: Participants were asked to remove the simulated foreign body (2x2 cm rice cake) from the supraglottic area of a freshly embalmed cadaver. This simulated a normal airway and a difficult airway with cervical spine immobilization. Participants performed the removal maneuver 4 times in random order using a Magill forceps with both the ML and the GL. We measured the time to removal (sec) and preference of the participant (5-point scale) and compared results according to the type of laryngoscope. Successful removal was defined as a removal time that was less than 120 sec. RESULTS: Forty participants were enrolled in this simulation experiment. The success rate, time to removal and provider preference were not significantly different betweeh the two types of laryngoscope. In subgroup analysis for experienced providers, the time to removal was significantly shorter in the ML group than the GL group (14 vs 20 sec, p<0.05). The preference of experienced provider was also significantly higher for ML than GL. CONCLUSION: This study suggests that ML has comparable efficacy for foreign body removal to GL and is acceptable to experienced providers.
Airway Obstruction ; Cadaver ; Foreign Bodies ; Health Personnel ; Humans ; Immobilization ; Laryngoscopes ; Spine ; Surgical Instruments