BACKGROUND: Peripheral blood stem cells (PBSCs) are mobilized by granulocyte-colony stimulating factor (G-CSF), which causes several side effects in allogeneic donors. We report on side effects of G-CSF administration and determine which side effects could be used in predicting the amount of harvested CD34+ cells. METHODS: Data from the first PBSC collections of 155 healthy donors between 2007 and 2010 were analyzed. Side effects were assessed using adverse event inventory, which was graded from 1 (mild) to 3 (severe) or 4 (disabling). RESULTS: G-CSF administration caused an elevation of WBC counts (mean 44,834/microL) and 86% of them were neutrophils. The mean mononuclear cells in apheresis products was 6.6x10(8)/kg and mean CD34+ cells was 6.0x10(6)/kg. Bone pain was reported by 151 healthy donors (97%) and severe bone pain was related to more CD34+ cells in apheresis products (P=0.041): 39 for grade 1 (5.1x10(6) CD34+cells/kg), 86 for grade 2 (6.0x10(6)), and 26 for grade 3 (7.1x10(6)). In addition, the percentage of collecting more than 5.0x10(6) CD34+cells/kg during the first leukapheresis showed correlation with the severity of bone pain. CONCLUSION: Bone pain was the most common side effect of G-CSF mobilization and more CD34+ cells were harvested in cases of severe bone pain.
Blood Component Removal ; Granulocyte Colony-Stimulating Factor ; Hematopoietic Stem Cell Mobilization* ; Humans ; Leukapheresis ; Neutrophils ; Stem Cells* ; Tissue Donors

Purpose: The purpose of this study is to find out the current status of toxicology laboratory operated by six locations nationwide and to investigate the satisfaction of emergency medical professionals who working at local and regional emergency medical centers. Methods: This survey was conducted prospective. It was conducted on 665 emergency medical professionals working at regional and regional emergency medical centers across the South Korea. Among them, the analysis was conducted with data that 510 emergency medical professionals who respond to this survey. The questionnaire was conducted on an online basis for a month. To ensure statistical significance, consider a dropout rate of 10% based on a minimum response recovery rate of 70%. 506 people were selected for the survey. Results: According to a survey on the status of addiction analysis room usage, the average monthly usage of addiction test rooms among respondents were 406 cases.71.0 cases (17.4%) of toxicology laboratory in Seoul and 71 cases (17.4%) in Gwangju. 32 cases (7.8%), 118 cases (29.0%) requested by toxicology laboratory in Busan, and the toxicology laboratory in Daegu. Eighty two cases (20.1%), Daejeon area 25 cases (6.1%), Wonju area toxicology laboratory was 78 (19.6%). According to a survey on the satisfaction of the addiction analysis room,Seoul (4.9±2.71) and Gwangju (4.8±2.52) showed high satisfaction. Conclusion Due to the limited operation time of the four addiction analysis rooms currently in operation, the satisfaction level of addiction analysis by emergency medical professionals in the area is low due to the delay until the result is notified.

Purpose: This study was conducted to analyze the social factors influencing the ‘authenticity of suicidal ideation’ based post-suicidal care programs in emergency departments (EDs). Methods: This retrospective study was an analysis using the data of patients who had attempted suicide and visited the ED in tertiary urban hospitals from January 1, 2016, to December 31, 2018. The variables examined included gender, age, history of previous psychiatric disease, suicide method, and the number of previous attempts. Univariate and multivariate logistic regression analyses were conducted to identify factors influencing the registration rate for the community-based post-suicide care program. Results: Overall,1,460 suicides were analyzed, 177 (1.16%) showed a high authenticity of suicide. The social factors influencing the authenticity of suicide intent were the unmarried status of men and women, joblessness, history of mental illnesses, more than two previous suicide attempts, the influence of alcohol, and an attempt to commit suicide after midnight more specifically between 24:00 to 6:00 hours in the morning (p<.05). The factors influencing the severity of the condition of high authenticity suicide patients were low Glasgow coma scores (12 points or less), lactate levels, and oxygen saturation observed in the patients who were admitted to the intensive care unit for treatment and died (p<.05). Conclusion The need for evidence-based preventive measures and early assessment tools at the emergency medicine level is emphasized to reduce the rate of suicide attempts. If the results of this study are used in the management of suicide prevention, the evaluation of the authenticity of suicide intent will be more likely to be made at the emergency medicine level, allowing the severity to be assessed earlier.

Objective: The rate of dropouts by emergency residents is relatively high in Korea, which causes harm to both medicalinstitutions and individuals. This study investigated the dropouts in emergency residents to identify the related factors. Methods: In this retrospective study, data were collected through in-depth individual interviews by telephone after thefirst interview by e-mail for residents who dropped out of emergency medicine training, and thematic analysis was conducted. Results: Three themes were identified from nine subthemes: ‘Overload,’ ‘Disposition dilemma,’ and ‘Occurrence of negativefeeling.’ Conclusion The core themes of dropout in emergency residents are complex, leading to skepticism about emergencymedicine training and a loss of self-esteem as an emergency medicine doctor. Therefore, the guidance specialist shouldexamine the appropriateness of the job of the resident to prevent the dropout in emergency medicine departments, recognizethe ambiguous patient dilemma as a problem of the emergency system, and watch for negative emotions of theresidents.

Heat and moisture exchanger filters (HMEF), used for humidification of patient respiratory gas and filtering microorganisms can cause airway obstruction. We experienced serious airway obstruction in a HMEF after making hydrothorax for high intensity focused ultrasound (HIFU) procedure. The airway obstruction was difficult to differentiate from severe bronchospasm irresponsive to bronchodilator therapy. It was relieved dramatically after we removed the filter from the breathing circuit as soon as we detected air-fluid meniscus in it.
Airway Obstruction ; Bronchial Spasm ; Hot Temperature ; Humans ; Hydrothorax ; Respiration

PURPOSE: This study was designed to evaluate the applicability of optic nerve sheath diameter (ONSD), as measured by a brain CT, in intracranial hemorrhage patients. We assumed that ONSD can be used to make surgical decisions and be considered as a predictive factor for mild intracranial hemorrhage (survival and neurologic outcomes) compared with the Glasgow Coma Scale (GCS) score. METHODS: This retrospective study included 457 patients between January 2016 and September. They were divided into two groups: Those with GCS of between 13 and 15, and those with GCS of below 12. ONSD measurements were taken using a brain computed tomography in the axial view. Using SPSS Statistics ver. 20.0, ONSD was analyzed by a binary logistic regression analysis. Receiver operating characteristics (ROC) curves were used to find the cut-off value that maximized the sum of sensitivity and specificity in both groups to evaluate the feasibility of using ONSD for surgical decision and as a predictive factor (survival and neurologic outcomes). RESULTS: The mean ONSD in mild hemorrhage patients was 5.43 mm. The odd ratio in the mild intracranial hemorrhage group for surgical decision was 5.030. The area under the ROC curve of mean ONSD in mild hemorrhage for surgical decision was 0.789. The cut-off value was 5.46 mm; sensitivity was 81.6% and Specificity was 75.0%. Positive and negative predictive values were 80.7% and 76.4%, respectively. CONCLUSION: The mean ONSD, when compared with the GCS score, is a valuable factor for making surgical decisions in cases of mild intracranial hemorrhage.
Brain* ; Glasgow Coma Scale ; Hemorrhage ; Humans ; Intracranial Hemorrhages* ; Intracranial Pressure ; Logistic Models ; Optic Nerve* ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity

PURPOSE: This study measured the availability of the ‘inferior vena cava (IVC) diameter ratio’ in sepsis or septic shock patients using computed tomography (CT) to determine if it can be used as a predictive factor for the 28-day mortality. METHODS: This retrospective analysis included patients between March 2016 and February 2017. One hundred fortyeight sepsis patients and 62 septic shock patients were included. The patients were divided into 2 groups (28-day survivors and non-survivors). The IVC diameter ratio (maximal transverse-to-maximal anteroposterior diameter immediately below the level of the renal vein) was measured by abdominal CT in the axial view. Using SPSS Statistics ver. 20.0, the IVC diameter ratio was analyzed by logistic regression analysis to identify the predictors of the 28-day mortality. Receiver operating characteristics (ROC) curves were used to determine the cut-off value for the maximum sensitivity and specificity for an evaluation of the availability as a predictive factor (28-day mortality). RESULTS: In the sepsis group, 38 out of 148 patients (25.7%) died. In the septic shock group, 29 out of 62 patients (46.8%) died. The IVC diameter ratio was significantly higher in the non-survivors than the survivors in both the sepsis and septic shock groups. In the sepsis patients, the odds ratio was 8.95. The area under the ROC curve (AUC) of the IVC diameter ratio for the 28-day survival was 0.817; the cut-off value was 1.60:1. The sensitivity and specificity was 73.7% and 75.5%, respectively. The positive and negative predictive value was 50.9% and 89.2%, respectively. In the septic shock patients, the odds ratio was 39.99. The AUC of the IVC diameter ratio for the 28-day survival was 0.831; the cut-off value, sensitivity, and specificity was 1.90:1, 75.9%, and 81.8%, respectively. The positive and negative predictive values were 78.6% and 79.4% respectively. CONCLUSION: The IVC diameter ratio (maximal transverse-to-maximal anteroposterior diameter) is associated with the 28-day mortality in sepsis or septic shock patients who have undergone abdomen CT.
Abdomen* ; Area Under Curve ; Humans ; Logistic Models ; Mortality ; Odds Ratio ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Sepsis* ; Shock, Septic* ; Survivors ; Tomography, X-Ray Computed ; Vena Cava, Inferior*

PURPOSE: Ethical problems are common in the emergency department (ED)- much more common than is usually recognized. However, the difficult ethical dilemmas and unique aspects of ethics in emergency medicine have not been thoroughly discussed in the context of Korean emergency medicine. The purpose of this study is to evaluate the degree of general recognition of emergency medical ethics, as well as attitude toward several difficult ethical dilemmas among emergency physicians. METHODS: This is a qualitative study by survey. By using a questionnaire, we surveyed on emergency physicians working in teaching- hospitals in Korea in August 2007. RESULTS: The survey response rate was 30%, and there were 192 total respondents to the questionnaire. The results are as follows. Eighty-one percent of respondents said that they had trouble with difficult ethical dilemmas, 74% of respondents said that they need to be educated or trained to improve ethical decision-making capacity, and 58% of respondents said that they will use emergency ethical guideline actively if they are established. The ethical values that emergency physicians must possess, according to the survey responses, are agility, a sense of vocation, and prudence. With respect to questions about ending a patient's life, we found that emergency physicians have a tendency to ignore a patient's desires not to start CPR. Finally, in relation to colleagues and other professionals, many respondents said that they will take action to correct their medical errors. CONCLUSION: Study and development of emergency medical ethics will be greatly helpful to many emergency physicians. Further study and discussion must be pursued in order to establish ethical guideline.
Cardiopulmonary Resuscitation ; Surveys and Questionnaires ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital ; Ethics ; Ethics, Medical* ; Korea* ; Medical Errors ; Medical Futility ; Occupations

Objective: Although several studies have been conducted on the use of ultrasound to assist in arterial punctures, its utility is controversial and it is also inconvenient to use the equipment in the emergency room. Therefore, we developed a radial artery puncture assistive device for use in the emergency room and evaluated its utility. Methods: The operator attempted the procedure on a mannequin, both with and without the device. We recorded the first-attempt success rate, the number of punctures, the time to success, and the failure rate. We conducted a survey to assess pre-experiment expectation and post-experiment satisfaction. Results: The first-attempt success rate was 78% with no device and 66% with the device (P=0.105). The failure rate was 5% both when the device was not worn and worn (P>0.99). The number of attempts was 2.18 with no device and 2.10 with the device (P=0.765). The time to success was 40.81 seconds without the device and 54.08 seconds with the device (P=0.307). The responses to the pre-experiment survey were 5% for ‘Not wearing the device seems to be more helpful’, 75% for ‘Wearing the device seems to be more helpful’, and 20% for ‘There seems to be no difference’. In the postexperiment survey, the responses were 30% for ‘Not wearing the device was more helpful’, 55% for ‘Wearing the device was more helpful’, and 15% for ‘There was no difference’. Conclusion There were no significant results from the experiments. But respondents felt that wearing the device was better in both the pre-experiment and post-experiment survey.

Objective: Although several studies have been conducted on the use of ultrasound to assist in arterial punctures, its utility is controversial and it is also inconvenient to use the equipment in the emergency room. Therefore, we developed a radial artery puncture assistive device for use in the emergency room and evaluated its utility. Methods: The operator attempted the procedure on a mannequin, both with and without the device. We recorded the first-attempt success rate, the number of punctures, the time to success, and the failure rate. We conducted a survey to assess pre-experiment expectation and post-experiment satisfaction. Results: The first-attempt success rate was 78% with no device and 66% with the device (P=0.105). The failure rate was 5% both when the device was not worn and worn (P>0.99). The number of attempts was 2.18 with no device and 2.10 with the device (P=0.765). The time to success was 40.81 seconds without the device and 54.08 seconds with the device (P=0.307). The responses to the pre-experiment survey were 5% for ‘Not wearing the device seems to be more helpful’, 75% for ‘Wearing the device seems to be more helpful’, and 20% for ‘There seems to be no difference’. In the postexperiment survey, the responses were 30% for ‘Not wearing the device was more helpful’, 55% for ‘Wearing the device was more helpful’, and 15% for ‘There was no difference’. Conclusion There were no significant results from the experiments. But respondents felt that wearing the device was better in both the pre-experiment and post-experiment survey.