Background: According to the recent coronavirus disease 2019 (COVID-19) pandemic experience, many emergency departments experience difficulties in responding to emerging infectious diseases and this has led to a public health crisis. Our emergency department (ED) is designed to respond to mass outbreaks of infection. Three major preparations were taken to respond to infectious disease; first, to improve the emergency department facilities;second, to created programs to respond to each phase of an epidemic of COVID-19; lastly, to implemented education and training to promote the safety of medical staff. We would like to share the actual responses and statistics of patients visiting emergency department during COVID-19 periods of pandemic. Materials and Methods: This research was conducted through a retrospective chart analysis provided by a public medical center with 502 beds since the first report of a COVID-19 confirmed case on January 19, 2020 to June 15, 2020 in Seoul, the capital of Korea. Our emergency department was designed based on Korean Regional Emergency Center Facility Standards, and modified throughout each phases of COVID-19 outbreak. Patients suspected to be infectious are screened in the triage, separating them from general patients, and then receive isolation treatment in isolated wards. Results: A total of 4,352 patients visited the ED. 3,202 screenings were conducted with 5 confirmed cases. Another 1,150 patients were treated with general emergent symptoms.There were no problems such as closure of the emergency department or isolation of medical staff while managing COVID-19 confirmed patients. Conclusion Improving emergency department facilities, create an operational program to respond to each phase of COVID-19 outbreak and implement educational programs enabled large number of screening tests and hospitalization for COVID-19 suspected patients while maintaining general medical services. Research in emergency department designs and operational programs should increase to combine research data with better ideas to respond not only during regular periods but also during periods of pandemic.

Background: According to the recent coronavirus disease 2019 (COVID-19) pandemic experience, many emergency departments experience difficulties in responding to emerging infectious diseases and this has led to a public health crisis. Our emergency department (ED) is designed to respond to mass outbreaks of infection. Three major preparations were taken to respond to infectious disease; first, to improve the emergency department facilities;second, to created programs to respond to each phase of an epidemic of COVID-19; lastly, to implemented education and training to promote the safety of medical staff. We would like to share the actual responses and statistics of patients visiting emergency department during COVID-19 periods of pandemic. Materials and Methods: This research was conducted through a retrospective chart analysis provided by a public medical center with 502 beds since the first report of a COVID-19 confirmed case on January 19, 2020 to June 15, 2020 in Seoul, the capital of Korea. Our emergency department was designed based on Korean Regional Emergency Center Facility Standards, and modified throughout each phases of COVID-19 outbreak. Patients suspected to be infectious are screened in the triage, separating them from general patients, and then receive isolation treatment in isolated wards. Results: A total of 4,352 patients visited the ED. 3,202 screenings were conducted with 5 confirmed cases. Another 1,150 patients were treated with general emergent symptoms.There were no problems such as closure of the emergency department or isolation of medical staff while managing COVID-19 confirmed patients. Conclusion Improving emergency department facilities, create an operational program to respond to each phase of COVID-19 outbreak and implement educational programs enabled large number of screening tests and hospitalization for COVID-19 suspected patients while maintaining general medical services. Research in emergency department designs and operational programs should increase to combine research data with better ideas to respond not only during regular periods but also during periods of pandemic.

Central venous catheterization is a useful method for monitoring central venous pressure and maintaining volume status. However, it is associated with several complications, such as pneumothorax, hydrothorax, hemothorax, and air embolism. Here we describe a case of iatrogenic tension hydrothorax after rapid infusion of fluid into the pleural space, following the misplacement of an internal jugular vein catheter. Despite ultrasonographic guidance during insertion of the central venous catheter, we were not able to avoid malposition of the catheter. The patient went into hemodynamic compromise during surgery, necessitating chest tube drainage and a mechanical ventilator postoperatively. This case shows that central venous catheter insertion under ultrasonographic guidance does not guarantee proper positioning of the catheter.
Catheterization, Central Venous ; Catheters ; Central Venous Catheters* ; Central Venous Pressure ; Chest Tubes ; Drainage ; Embolism, Air ; Hemodynamics ; Hemothorax ; Humans ; Hydrothorax* ; Jugular Veins ; Methods ; Pneumothorax ; Ventilators, Mechanical

No abstract available.
Heart Septal Defects, Atrial* ; Mitral Valve Insufficiency* ; Myxoma*

No abstract available.
Anesthesia, Spinal*

OBJECTIVES: This study was conducted to evaluate the association between workplace violence and depression METHODS: In total, 2236 employees who were providing services at hotels, casinos and amusement halls were used in this study. A structured questionnaire was used to assess exposures to violence, which was classified into physical violence, verbal violence, sexual harassment and bullying together with jobs and sociodemographic factors. Depressive symptoms were assessed using the Korean Beck depression inventory-II (BDI-II). Those with total BDI-II score over 22 points were defined as people with depression. RESULTS: Prevalence of depression among subjects exposed to any violence was higher than those who were not exposed to violence. After adjusting covariates, the odds ratio of depression was 2.47 (95% CI;1.13~5.39) for sexually harassed male subjects (n=72, 4.90%), 3.22 (95% CI; 1.51~6.87) for bullied male subjects (n=570, 38.83%), and 2.57 (95% CI; 1.52~4.32) for bullied female subjects (n=447, 58.20%). CONCLUSIONS: The results of this study suggest that depression can be an important psychological issue to those exposed to workplace violence in Korea. First of all, acknowledgement of the problem should be made in the workplace. Exalting public awareness and transforming work ethics and culture is cardinal to making this a social rather than an individual problem.
Bullying ; Depression ; Female ; Humans ; Korea ; Male ; Odds Ratio ; Prevalence ; Questionnaires ; Sex Offenses ; Violence

Objective: There has been a consistent import of Plasmodium falciparum malaria into South Korea. As artesunate has been shown to reduce malaria related mortality in other countries, we sought to evaluate the treatment outcomes of P. falciparum malaria with artesunate. Methods: We retrospectively reviewed demographic (age, sex, travel history, and year of admission) and clinical data (sign and symptoms, laboratory findings, complications, treatment outcome) of patients with imported P. falciparum malaria diagnosed between 2014 and 2019. Results: A total of 55 patients with P. falciparum malaria were included, of which 36.4% had severe P. falciparum malaria. Their mean (±standard deviation) age was 42.6 (±12.8) years. Overall, the median length of hospital stay was 6 days (interquartile range, 4-9; range, 3-36) and 21.8% of the patients needed intensive care unit (ICU) care. The overall mortality rate was 3.6%. In patients with severe P. falciparum malaria, half of the patients (50.0%) needed ICU care and the mortality rate was 10.0%. Conclusion This is the first study to report the outcomes of imported P. falciparum malaria treated with artesunate. The mortality rate for severe P. falciparum malaria in this study was higher than that in other non-endemic countries. Further studies are needed to evaluate the effect of treatment of P. falciparum malaria with artesunate.

Background: Differences in the effects of propofol and dexmedetomidine sedation on electroencephalogram patterns have been reported previously. However, the reliability of the Bispectral Index (BIS) value for assessing the sedation caused by dexmedetomidine remains debatable. The purpose of this study is to evaluate the correlation between the BIS value and the Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) scale in patients sedated with dexmedetomidine. Methods: Forty-two patients (age range, 20–80 years) who were scheduled for elective surgery under spinal anesthesia were enrolled in this study. Spinal anesthesia was performed using 0.5% bupivacaine, which was followed by dexmedetomidine infusion (loading dose, 0.5–1 μg/kg for 10 min; maintenance dose, 0.3–0.6 μg/kg/h). The MOAA/S score was used to evaluate the level of sedation, and the Vital Recorder program was used to collect data (vital signs and BIS values). Results: A total of 215082 MOAA/S scores and BIS data pairs were analyzed. The baseline variability of the BIS value was 7.024%, and the decrease in the BIS value was associated with a decrease in the MOAA/S score. The correlation coefficient and prediction probability between the two measurements were 0.566 (P < 0.0001) and 0.636, respectively. The mean ± standard deviation values of the BIS were 87.22 ± 7.06, 75.85 ± 9.81, and 68.29 ± 12.65 when the MOAA/S scores were 5, 3, and 1, respectively. Furthermore, the cut-off BIS values in the receiver operating characteristic analysis at MOAA/S scores of 5, 3, and 1 were 82, 79, and 73, respectively. Conclusion The BIS values were significantly correlated with the MOAA/S scores. Thus, the BIS along with the clinical sedation scale might prove useful in assessing the hypnotic depth of a patient during sedation with dexmedetomidine.

Background: This clinical trial was conducted to determine whether combined use of magnesium sulfate and vitamin C more significantly reduced postoperative fentanyl consumption and pain than magnesium sulfate or vitamin C alone. Methods: The prospective, double-blinded, randomized controlled study enrolled 132 patients scheduled for laparoscopic gynecologic surgery. The patients were randomly allocated to one of the four groups (n = 33 for each group; Group M [magnesium sulfate 40 mg/kg], Group V [vitamin C 50 mg/kg], Group MV [magnesium sulfate 40 mg/kg and vitamin C 50 mg/kg] and Group C [isotonic saline 40 ml]). Cumulative postoperative fentanyl consumption (primary endpoint measure), postoperative pain score by numeric rating scale, and postoperative nausea and vomiting were recorded at 1, 6, 24, and 48 h after discharge from the postanesthesia care unit. Results: Cumulative postoperative fentanyl consumption was significantly less in Groups M, V, and MV than in Group C at all time points. Group MV showed significantly less cumulative postoperative fentanyl consumption than Group M at postoperative 24 h (mean ± standard deviation, 156.6 ± 67.5 vs. 235.6 ± 94.6 μg, P = 0.001), as well as significantly less consumption than Groups M and V at postoperative 48 h (190.8 ± 74.6 vs. 301.0 ± 114.8 or 284.1 ± 128.6 μg, P < 0.001, P = 0.003, respectively). Conclusions Combined use of magnesium sulfate and vitamin C provides an additional benefit in postoperative pain management after laparoscopic gynecologic surgery in comparison to single administration of magnesium sulfate or vitamin C.

BACKGROUND: Dexmedetomidine has been widely used during spinal anesthesia to provide sedation. However, dexmedetomidine frequently causes significant bradycardia. This study was designed to evaluate whether fluid loading could reduce the incidence of bradycardia after intravenous dexmedetomidine infusion in patients under spinal anesthesia. METHODS: A total of 99 patients, 18 to 65 years of age, with American Society of Anesthesiologists physical status 1 or 2, who were scheduled for elective total knee replacement or internal fixation of lower leg fracture under spinal anesthesia were enrolled. The patients were randomly assigned into one of the three groups, and fluid was loaded as follows: group LOW - 4 ml/kg, group MID - 8 ml/kg, and group HI - 12 ml/kg. After fluid loading and spinal anesthesia, dexmedetomidine was infused as follows: 1 μg/kg of loading dose for 10 minutes, thereafter continuous infusion at 0.4 μg/kg/h. RESULTS: The heart rate of group HI was significantly higher than that of group LOW (P = 0.049). The dosage of atropine administration was significantly lower in group HI than in group LOW (P = 0.003). The change in thoracic fluid contents was significantly higher in group HI than in group LOW (P = 0.018). CONCLUSIONS: Fluid loading during spinal anesthesia can reduce the incidence and extent of bradycardia after intravenous dexmedetomidine infusion.
Anesthesia, Spinal* ; Arthroplasty, Replacement, Knee ; Atropine ; Bradycardia* ; Dexmedetomidine* ; Fluid Therapy ; Heart Rate ; Humans ; Incidence ; Leg