Objective: Discriminating between pulmonary embolism (PE) and pneumonia in the emergency department (ED) is one of the fastidious tasks. Elderly patients are at more risk of PE and pneumonia than younger patients. This study aimed to determine whether the ratio of D-dimer to C-reactive protein (CRP) could be used as an adjunctive method to differentiate between PE and pneumonia in elderly patients. Methods: Medical records of patients visiting the ED diagnosed with PE and pneumonia were examined. Cutoff values of D-dimer (μg/mL) and the ratio of D-dimer to CRP ([μg/mL]/[mg/dL]) of subjects with PE or pneumonia were analyzed. Results: There were a total of 60 patients with PE and 152 patients with pneumonia. In addition, 15 patients had both PE and pneumonia. The cutoff value of D-dimer to differentiate between PE and pneumonia was 4.26 μg/mL (4,260 ng/mL) (area under curve [AUC], 0.861; sensitivity, 80.0%; specificity, 80.3%; 95% confidence interval [CI], 0.805-0.917). The cutoff value of the ratio of D-dimer to CRP to differentiate between PE and pneumonia was 1.24 ([μg/mL]/[mg/dL]) (AUC, 0.919; sensitivity, 84.4%; specificity, 84.2%; 95% CI, 0.878-0.960). Conclusion The ratio of D-dimer to CRP can be used as an adjunctive method to determine whether a computed tomography pulmonary angiography or a ventilation-perfusion scan can be performed to differentiate between PE and pneumonia in elderly patients.

PURPOSE: To compare initial CT findings of non-tuberculous mycobacteria (NTM) pulmonary infection between stable and progressed groups and determine whether they could be used to predict disease prognosis and treatment response. MATERIALS AND METHODS: From July 2006 to October 2013, 71 patients with NTM infection were retrospectively reviewed. Lung lesion pattern of CT finding, specific species, disease duration, and follow-up period were analyzed. These patients were classified into NTM stable (n = 46) and progressed (n = 25) groups. RESULTS: The most common CT findings of NTM infection were small nodules (n = 71, 100%) and bronchiectasis (n = 67, 94%). Large consolidation (> 2 cm, n = 34, 48%) and involvement of more than four lobes (n = 49, 69%) were also commonly observed. According to disease prognosis, large consolidation (n = 18, 72%, p = 0.003), cavitary lesion (n = 17, p = 0.002), and involvement of four or more lobes (n = 21, p = 0.044) on CT were significantly more frequent in disease progressed group than that in the stable group. CONCLUSION Among common CT findings of NTM disease, some CT findings such as large consolidation, cavitary lesion, and disease extent are good predictors of response to treatment in NTM pulmonary disease.

An aortoesophageal fistula is one of the very few causes of upper gastrointestinal bleeding but can be fatal if the diagnosis is delayed. This usually occurs secondary to esophageal or aortic surgery. A primary aortoesophageal fistula is rare and less likely to be suspected. Here, we present a case of a primary aortoesophageal fistula that presented as massive upper gastrointestinal bleeding. An 81-year-old man with a history of aortic aneurysm had syncope and bright color hematemesis. The aortoesophageal fistula was not diagnosed early enough and the patient died. Therefore, emergency physicians should consider aortoesophageal fistula as a potential cause when encountering upper gastrointestinal bleeding.
Aged, 80 and over ; Aortic Aneurysm ; Diagnosis ; Emergencies ; Esophageal Fistula ; Fistula* ; Gastrointestinal Hemorrhage ; Hematemesis ; Hemorrhage* ; Humans ; Syncope

Patients with ankylosing spondylitis (AS) are at high risk for spinal fracture even after a minor injury. Most spinal fractures with ankylosing spondylitis occur in the cervical spine, whereas spinal fractures in thoracic or lumbar spine are rare. These fractures are often difficult to detect on standard radiographs, because the normal anatomical landmarks are lacking and the abnormal spinal stiffness precludes optimal exposure of the spine. We report on a case of a 12th thoracic spine fracture in ankylosing spondylitis with bamboo spine after a minor injury. In this case, anteroposterior and lateral radiographs of the thoracolumbar spine showed a bamboo spine typical for ankylosing spondylitis with no evidence of fracture. However, computed tomography showed a 12th thoracic fracture with burst. Therefore, this fracture, in a patient with AS involved all three spinal columns, was considered unstable.
Humans ; Spinal Fractures ; Spine* ; Spondylitis, Ankylosing*

Percutaneous needle aspiration biopsy is a relatively simple and safe procedure for the diagnosis of lung and mediastinal lesions. Systemic air embolism during and after percutaneous needle aspiration biopsy of the lung is very rare; however, it is still a complication that can cause fatal outcomes, such as cerebral infarction and myocardial infarction. Here, we report a 72-year-old woman who suffered a change in consciousness immediately after receiving a percutaneous needle aspiration biopsy for the pathologic examination of pulmonary nodules found during a routine health medical examination. She had left side weakness and ST segment elevation on an electrocardiogram. After a high concentration of oxygen, she recovered from neurological symptoms and electrocardiographic abnormalities. The authors report a case of air embolism occurring simultaneously in the brain and coronary arteries after percutaneous needle aspiration biopsy.
Aged ; Biopsy ; Biopsy, Needle* ; Brain ; Cerebral Infarction ; Consciousness ; Coronary Vessels ; Diagnosis ; Electrocardiography ; Embolism ; Embolism, Air* ; Fatal Outcome ; Female ; Humans ; Intracranial Embolism ; Lung* ; Myocardial Infarction ; Needles* ; Oxygen

PURPOSE: Dispatcher-assisted telephone instruction during cardiopulmonary resuscitation (CPR) improves the quality of CPR performed by laypersons. However, in Korea, CPR instruction guidelines for bystanders have not made. We therefore studied the effects of verbal instruction on the quality of chest compression. METHODS: Data from two randomized, double-blinded, controlled trials using identical methodology were combined to obtain 175 records for analysis. Subjects were randomized into either a "push as hard as you can and fast" (n=87) or "push down 5~6 cm, 100~120 rate/min" (n=88), verbal instructions in the 2011 Korea Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). Data were recorded via a Resusci(R) Anne SkillReporter(TM), Laerdal Medical mannequin. Primary outcome measures included chest compression depth and chest compression rate per minute. RESULTS: The average compression depth and speed of chest compressions did not significantly differ between the two verbal instructions. CONCLUSION: The verbal istructions provided by telephone based on the 2011 Korean Guidelines for CPR and ECC are not effective. The instructions for high quality CPR of layperson should therefore be studied.
Cardiopulmonary Resuscitation* ; Emergencies ; Heart Massage ; Korea ; Manikins ; Methods ; Outcome Assessment (Health Care) ; Telephone* ; Thorax ; Verbal Learning

Lead aVR ST segment elevation in patients with clinically suspected acute coronary syndrome strongly suggests the possibility of occlusion of the left main coronary artery (LMCA), and stenosis or occlusion in this area can cause severe life-threatening left ventricular dysfunction or malignant arrhythmias. Thus, it could be a sign suggestive of a poor prognosis for patients. In this study, we report on the case of a 67-year-old male who presented to the emergency department with total occlusion of LMCA with ST-segment elevation in only lead aVR, and without ST-segment elevation in other leads.
Acute Coronary Syndrome ; Aged ; Arrhythmias, Cardiac ; Constriction, Pathologic ; Coronary Vessels ; Electrocardiography ; Emergency Service, Hospital ; Humans ; Male ; Myocardial Infarction* ; Prognosis ; Ventricular Dysfunction, Left

OBJECTIVE: This study examined the characteristics of suicidal attempters, including pre-hospital patients and those who visited the emergency department. METHODS: Suicidal attempters who had been reported to the 119 call center were selected between July 2015 and June 2016. Sex, age, place, methods of suicidal attempt, season, time, and suicide success rate were reviewed in the fire center records. RESULTS: A total 961 suicide attempters were enrolled. Among them, 53.6% were males who had an approximately 2.6 times higher mortality than that of females (9.2%). The most preferred place to commit suicide was the home in both sexes (68.0% in male, 82.8% in female) and the most preferred methods was drug intoxication, particularly pesticide. The method with the highest mortality was hanging and the lowest was self-harm. The season of the highest mortality was spring. The success of suicide and the time variation were similar. Most of the un-transferred patients also selected fatal suicide attempts compared to transfer patients. CONCLUSION: Unlike previous studies, this study includes information on un-transferred patients. Overall, the probability of death was highest as more than 50 years men chose hanging as a method, which had an influence on the un-transferred patients group.
Emergency Medical Services ; Emergency Service, Hospital ; Female ; Fires ; Gangwon-do* ; Humans ; Male ; Methods ; Mortality ; Seasons ; Suicide* ; Treatment Refusal

Objective: Predicting the incidence of emergency patients can be very important for the efficient use of emergency medical resources and the deployment of 119 centers in a pre-hospital setting. The study was conducted to analyze the occurrence of emergency patients using geographic information systems in a pre-hospital setting in Korea. Methods: The basic data used in this study were collected from the 119 centers in Chuncheon-si, Korea, under the firefighting headquarters in Gangwon-do from January 2012 to December 2016. Results: The total number of patients transferred by 119 paramedics was 72,362. Of these, 9,904 (14.7%) were emergency patients; 519 (0.7%) had cardiovascular diseases; 383 (0.5%) had cerebrovascular diseases; 3,043 (4.2%) were trauma patients; 58,413 (80.7%) were non-emergency patients. The occurrence of emergency diseases was slightly lower in the Hyoja-dong area, and it was slightly higher in the area of the outskirts of the city. The incidence of heart disease was low in the Hyoja-dong and Nam-myeon areas, but the incidence of heart disease was highly observed in other areas. The number of trauma patients was 1,265 (41.6%) in the outskirts of the city, a suburban area, showing a relatively higher incidence than other emerging diseases. Conclusion The deployment of ambulances in Chuncheon-si should be carried out considering demographic characteristics and patient occurrence.

Objective: The number of elderly patients in Korea has been on the rise recently, and hence the number of out-of-hospital cardiac arrest (OHCA) elderly patients is also rising. The causes of cardiac arrest for the elderly vary, and, it is difficult to predict the recovery of spontaneous circulation (ROSC) in OHCA patients. Therefore, the purpose of this study was to ascertain the predictive value of arterial blood gas analysis (ABGA) results in achieving ROSC in the elderly. Methods: A retrospective analysis of emergency department patients with OHCA was performed at the Kangwon National University Hospital, Korea from 1 January 2016 to 31 December 2019. The initial ABGA results were compared between two patient groups, those who had achieved a return of spontaneous circulation and those who had not. Univariate and multivariable analyses were performed to elucidate the factors associated with ROSC. Results: Overall, 229 OHCA patients were included in the final analysis. The lactate level was independently related to ROSC. A receiver operating characteristics (ROC) curve was plotted to obtain the best cutoff value. The lactate level <9.85 mmol/L showed the largest area under the ROC curve (AUC) to predict ROSC (AUC, 0.666; 95% confidence interval, 0.588-0.743). Multiple regression analysis was performed using the cutoff value, which was a lactate level of 9.85 (odds ratio, 2.907; 95% confidence interval, 1.432-5.902; P=0.003). Conclusion The ABGA results during the cardiopulmonary resuscitation of OHCA patients, showed that the lactate level was an independent factor associated with ROSC. The lactate cutoff value was 9.85 mmol/L.