BACKGROUND: Maritime medicine refers to the medical care and education of medical disease which may develop during a cruise. Recently, cruise passengers are increasing around the world and maritime medicine has been initiated in Korea with beginning of the trip to Mt. Kumgang in 1998. Nowadays, there are about 4,000 passengers per week. Therefore, the data were analyzed to promote the understanding of maritime medicine, which was first applied on the Mt. Kumgang cruise, and to help the medical members who will be participation in the maritime medicine in the future. METHODS: From November 1998 to February 1999, all patients who visited to medical cabin of the cruise ship(Hyundai Pongnae) were analyzed retrospectively. RESULT: 2,162 patients excluding 182 patients who re-admitted were analyzed. In each cruise, there were 65.5(9.0%) passengers and 42(13.0%) crews. The male to female ratio was 1.6 : 1, with 709 males and 451 females. The common problems were respiratory and musculoskeletal diseases followed by dematologic and gastrointestinal problems in order of frequency. There were 18 patients who had trauma above 4 points in ISS. Ten patients were confined to the medical cabin. The ship returned to Donghae-port one time, 8 patients were evaluated immediately and 41 patients were referred without urgency. CONCLUSION: Maritime medicine has a particular characteristic of dealing with various cases and treatments including emergencies with limited space, man-power, facilities and equipment. It obviously proposes the participation emergency medical doctors in the maritime medicine because medical personnel must take part in not only medical management but also in education and prevention including CPR. The medical staff in charge of maritime medicine should establish a proper plan depending on the purpose of the cruise and must endeavor to solve the problem.
Cardiopulmonary Resuscitation ; Education ; Emergencies ; Female ; Humans ; Korea ; Male ; Medical Staff ; Musculoskeletal Diseases ; Retrospective Studies ; Ships

BACKGROUND: To determine whether N-acetylcysteine(NAC) reduces methemoglobin. METHOD: We carried out an in vivo experiment in rats, weighed about 300g. Each rat was ingested 200mg of dapsone(4,4'diaminodiphenyl sulphone) to induce methemo- globinemia. After 1 hour, 30 rats were received NAC 160mg(2ml) and another 30 rats, served as control, were received 2ml of normal saline orally,4 times hourly. Serum methemoglobin concentrations were checked 1,6, and 24 hours after dapsone ingestion. RESULT: The methemoglobin concentrations on each time were 27.1+/-5.8%,23.5+/-8.8%, 17.1+/-6.4%(mean+/-SD) in control group and 25.5+/-6.3%, 25.5+/-8.8%, 65.5+/-31.2%(mean+/-SD) in NAC group. There were no differences on methemoglobin concentrations at 1 and 6 hours between two groups(P>.05). At 24 hours, the methemoglobin concentrations of NAC group was significantly higher than those of control group(P<.01). CONCLUSION: NAC had no therapeutic effects on dapsone induced methemoglobinemia in this experimental setting.
Acetylcysteine* ; Animals ; Dapsone ; Eating ; Methemoglobin ; Methemoglobinemia* ; Rats

BACKGROUND: Catheterization of central vein may cause fetal complications such as cardiac arrhythmia, cardiac temponade, atrial perforation etc. For prevention of these complications, tip of central venous catheter should located in superior vena cava. The purpose of this study was to investigate the optimal positioning of central venous catheters. METHOD: From March 1996 to Jun 1996, a total of 50 patients who requiring central venous catheters were involved. First, we evaluate the accuracy of predetermined formula of 'Peres'. Second, we hypothesized that height of patients was correlated with optimal length of central venous catheters and we analysed relationship between height and optimal length of central venous catheters using simple regression analysis by SAS. RESULTS: 1) Predetermined formula of 'Peres' inaccurately predicted required length of central venous catheter. The accuracy was 78%. 2) There were a linear relationships between height and optimal length of central venous catheter. Their relationships was followed, Y=0.09X(Y: optimal length of central venous catheters, X: height, p=0.0001, R2=0.39). CONCLUSION: Using height of patients, we can accurately predict the optimal length of central venous catheters.
Arrhythmias, Cardiac ; Catheterization ; Catheters ; Central Venous Catheters* ; Humans ; Veins ; Vena Cava, Superior

BACKGROUND: This study was designed to describe the current tends of emergency tracheal intubation and predict difficult airway intubations in emergency department (ED) at a teaching hospital in Korea. METHODS: All patients who was taken endotracheal incubation in ED during a 1-year period (Mar 1997 through Feb 1998) were included in the study population. Medical records of the patients were retrospectively reviewed. Among them, 56 patients were prospectively evaluated parameters to predict difficult airway intubations. RESULTS: During the study period, a total of 413 patients(1.5%) required endotracheal intubation. Except far 2 cases, all patients intubated orotracheally, and 298(72%) patients were intubated by emergency medicine resident. Pharmacologic adjuncts were used in 200(48%) patients, the neuromuscular blocking agent(NMBA) was used in 16(3.8%) Commonly used drugs were thiopental and vecuronium. The difficult incubation was not associated with presence of denture, length and circumference of neck, and mental status. The visibility of vocal cord on laryngoscopy significantly correlated to the difficult airway. CONCLUSION: At this institution, the majority of ED incubation were performed by emergency physicians and NMBA was not routinely used. The visibility of vocal cord during the direct laryngoscopy could be a predictor of difficult incubation in ED.
Dentures ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital ; Hospitals, Teaching ; Humans ; Intubation* ; Intubation, Intratracheal ; Korea ; Laryngoscopy ; Medical Records ; Neck ; Neuromuscular Blockade ; Prospective Studies ; Retrospective Studies ; Thiopental ; Vecuronium Bromide ; Vocal Cords

BACKGROUND: Headache is a common complaint in patients presenting to the emergency department(ED). Many patients suffered sustained headache even after presenting to the ED. This study investigate whether the patients were received analgesics and timely adequate. METHOD: We analyzed 131 adolescent and adult patients with non-traumatic headache without any neurologic deficit in two emergency department during 6 months period retrospectively. RESULTS: The positive and negative predictive value according to primary impression were 47% and 74% respectively. The mean time to take brain computed tomography(CT) after ED presentation was 120 minutes. The patients with primary impression of intracranial hemorrhage(mainly SAH) were the most fast(mean time 88+/- 70 minutes). 28(21%) patients were received analgesics before taking brain CT(after ED presentation), and 70(53%) patients after CT, 27(54%) patients after cerebrospinal fluid examination. The mean time interval were 43, 126 and 149 minutes on each group being received the analgesics. CONCLUSION: According to this study many patients suffered sustained headache before being classified to certain type of disorder. It may due to the reasons that there were no definite guidelines treating headache, the pain itself, or the physician treats patients as physician's way.
Adolescent ; Adult ; Analgesics ; Brain ; Cerebrospinal Fluid ; Emergencies* ; Emergency Service, Hospital* ; Headache* ; Humans ; Neurologic Manifestations ; Retrospective Studies

BACKGROUND: Tetanic spasm is often noted in hyperventilating patients coming in to emergency departments. Classical explanation far this phenomenon was decreased ionized calcium levels due to respiratory alkalosis precipitated by the hyperventilation. Clinically these symptoms were observed in hypocalcemia and were thought as such without doubt. But clinical investigation on the levels of ionized calcium levels have not been clarified. Recent investigations on hyperventilating volunteers have suggested other pathophysiology for tetanic spasm in hyperventilating patients which is the decrement of ionized magnesium level rather than ionized calcium. We wanted to see if these results applied to our hypeventilating patients and see if ionized magnesium level was a factor producing tetanic symptoms. METHOD AND MATERIAL : 35 patients with diagnosis of hyperventilation syndrome by emergency physician were studied retrospectively. Hyperventilating patients arriving at Severance hospital Emergency Center from Jan.1996 to Feb. 1998 were included. Patients with cardiovascular, pulmonary diseases, history of renal or liver disease were excluded. Ion-selective method was used to detect ionized calcium, magnesium levels and arterial blood gas features. Average levels were compared to reference ranges and Wilkoxon-rank. sum test was used to compare hyperventilating patients with tetanic spasm and those with other symptoms such as dyspnea, chest pain and palpitations. RESULTS: 1) Sodium, potassium and chloride levels were 138mmol/L, 3.6mmo1/L, 106mmol/L each which were within a normal range. 2) Degrees of hyperventilation were similar with average of PH 7.54(7.4-7.71), pCO2 23.6mmHg, showing respiratory alkalosis. 3) Ionized calcium and ionized magnesium each showed 0.61mg/dL, 0.16mg/dL lower values than the lowest reference ranges which were 4.5-5.6mg/dL for ionized calcium and 1.19-1.63 for ionized magnesium. 4) No statistical difference points were observed between the tetanic spasm group and group without spasm. Female preponderance were noted in tetanic spasm group. CONCLUSION: We conclude that ogler than decrement of ionized calcium, decrement of ionized magnesium could be a factor far inducing tetanic spasm in respiratory alkalosis caused by hyperventilation.
Alkalosis, Respiratory ; Calcium* ; Chest Pain ; Diagnosis ; Dyspnea ; Emergencies ; Emergency Service, Hospital ; Female ; Humans ; Hydrogen-Ion Concentration ; Hyperventilation* ; Hypocalcemia ; Liver Diseases ; Lung Diseases ; Magnesium* ; Potassium ; Reference Values ; Retrospective Studies ; Sodium ; Spasm ; Volunteers

BACKGROUND: Vasopressin has recently been recognized to have greater effect on improving blood flow to myocardium and brain during cardiac resuscitation than epinephrine and also improves rates of ROSC(return of spontaneous circulation) and survival in pre-hospital and in-hospital prolonged refractory cardiac angst patients who did not respond to the standard epinephrine treatment. This study was designed to investigate the effects of vasopressin on ROSC rates and survival rates in rat asphyxia arrest model. METHOD AND MATERIAL: Thirty male Sprague-Dawley rats were used. Anesthesia was induced with halothane and nitrous oxide and ventilatory cairo was maintained. EtCO2 was adjusted to 30-40mmHg and halothane was maintained. Right infernal carotid artery and right femoral vein were cannulated and EKG electrodes were attached. After 10 minutes of asphyxia, group 1 was treated with 1ml of saline, group 2 with 1ml(0.001mg/100g) of epinephrine and group 3 with 1ml(0.16u/100g) of vasopressin for resuscitation. Statistical significance was an analysed by SPSS with ANOVA and chi-square tests. RESULTS: No significant differences were seen in baseline measurements. Three ROSC and eight 60 minutes survivals were found in group 1, whereas nine ROSC and eight 60 minutes survivals were obtained in group 2 and all of the subjects in group 3 showed ROSC and 60 minutes survival, but no statistical differences were seen between group 2 and 3. CONCLUSION: Vasopressin seems to have similar effect on improving ROSC and survival rates compared to epinephrine in rat asphyxia models.
Anesthesia ; Animals ; Asphyxia* ; Brain ; Carotid Arteries ; Electrocardiography ; Electrodes ; Epinephrine* ; Femoral Vein ; Halothane ; Humans ; Male ; Myocardium ; Nitrous Oxide ; Rats* ; Rats, Sprague-Dawley ; Resuscitation* ; Survival Rate ; Vasopressins*

BACKGROUND: Activated charcoal has been widely used as an adsorbent for the management of drug intoxicated patients in the emergency department(ED). Although there are several commercial ready-mixed charcoal suspension preparations in the market, we are using custom-made suspension from hospital grade bulk charcoal powder. We designed this study to compare the adsorptive capacity of the Actidose Aqua(R), which is a commercial charcoal product, Fuller's earth, and custom-made activated charcoal used in our ED. METHODS: First, we performed modified USP methylene blue adsorption test which is a standard adsorption test for activated charcoal. Then, the drug adsorption test for phenobarbital, acetaminophen, salicylate, and aminophylline was done. Graded amount of three adsorptives were added to the stock solutions of each drugs. The adsorption test were performed as follows: The vials containing drugs and adsorptives were shaken for 30 minutes to ensure adsorption equilibrium, then the suspension was filtered through in-line filter. The filtrates were analyzed by ultraviolet spectroscopy to determine the residual drug concentrations. Finally we examined and compared the surface area and the structure of activated charcoal and Fuller's earth using scanning electron microscopy. RESULTS: In methylene blue adsorption test, the adsorption rate was 60.1% in Actidose Aqua(R) and 59.0% in custom-made charcoal, and 70.2% in Fuller's earth. For the phenobarbital, acetaminophen, and sallcylate, the adsorption rate of Actidose Aqua(R) and custom-made charcoal was greater than 90% with the ratio o adsorptives to drugs over 10:1. For aminophylline, two charcoal products showed excellent adsorption in 5:1 ratio. But Fuller's earth showed poor adsorption in all rages. CONCLUSION: Custom-made activated charcoal showed a comparable adsorption capacity to Actidose Aqua(R). Fuller's earth showed a poor performance to be used as a substitute for activated charcoal in acute drug poisoning otherwise paraquat.
Acetaminophen ; Adsorption ; Aminophylline ; Charcoal* ; Emergencies ; Humans ; Methylene Blue ; Microscopy, Electron, Scanning ; Paraquat ; Phenobarbital ; Poisoning ; Rage ; Spectrum Analysis

BACKGROUND: Traumatic death occupies a high ranking in the annual national report on causes of death and causes a significant burden to society. To reduce traumatic death, an area-wide trauma care system is urgently needed, and basic mortality data will be an essential component in designing such a system. The purpose of this study was to review the experience of trauma death in a hospital to determine the pattern of time to death and the effect of the emergency medical services(EMS) system in traumatic death. METHODS: A retrospective analysis of 495 traumatic deaths experienced from 1990 to 2000 was performed. Time to death, mechanism of injury, injury severity, and cause of death were reviewed. The influence of the EMS system before 1995 was compared with its influence after 1995. RESULTS: The mean age of the 495 patients was 41.1+/-18.9 and the mean injury severity score(ISS) was 37.1+/-17.8. The distribution of time to death showed DOA(including found dead) in 39% of the cases, within 48hr in 38.4%, between the 2nd and 7th days in 9.9%, and later than the 7th day in 12.7%. The majority of early deaths occurred within 4 hr of injury, but a minor increase was noted during the 2nd week. After 1995, the ambulance transportation rate increased significantly without any difference in prehospital interventions. CONCLUSION: Our results showed a bimodal distribution of time to death, which reflected geographic, mechanism of injury, and trauma care system differences. We also noted deficiencies in prehospital trauma care in our EMS system. We recommend nationwide trauma registry initiatives to provide basic trauma data and to implement a quality trauma care system.
Ambulances ; Cause of Death ; Emergencies ; Hospitals, Teaching* ; Humans ; Mortality ; Retrospective Studies ; Tertiary Healthcare* ; Transportation

PURPOSE: Renal colic is a common disorder with a high rate of recurrence, resulting in a large number of emergency department visits. The aim of this study was to investigate the seasonal variation in renal colic attacks and the association with climatic parameters. METHODS: The time of onset, monthly incidence, and effects of climatic parameters of renal colic were evaluated. Data on climatic parameters were obtained from the Korea Meteorological Administration. Correlation between the number of monthly episodes and climatic parameters was assessed using Pearson's correlation coefficient. RESULTS: A total of 5060 renal colic episodes were retrieved during a period of 84 months (from May 2006 to April 2013). Episodes of renal colic were more common in men (67.4%) than in women(32.6%). The incidence of renal colic showed a circadian variation, with a morning peak (500~1000 h) and an afternoon dip (1500~1900 h). Findings of the current study showed a higher number of renal colic episodes during summer compared with other seasons. Significant positive correlations were observed between the mean monthly temperature and the monthly incidence of renal colic, but not between other climatic parameters (relative humidity, rainfall, sunshine hours, and atmospheric pressure) and incidence of renal colic. CONCLUSION: We conclude that the incidence of renal colic has significant seasonal variation, and only mean monthly temperature showed any consistent association with monthly attack rates.
Climate ; Emergency Service, Hospital* ; Humans ; Humidity ; Incidence ; Korea ; Male ; Recurrence ; Renal Colic* ; Seasons* ; Sunlight ; Urolithiasis