OBJECTIVE: This study was designed to describe how to develop the 'ASAN-Drug Allergy Alert System' and evaluate the usefulness of this system. METHODS: The drug allergy alert system was developed by a task force that was consisted of emergency physicians, pharmacists, and programmers for ten months. Since this system had been implemented, we compared frequencies with a previous paper based system. RESULTS: This system was implemented with three stages: an input stage, a censorship stage, and an alertness stage. The input of data was done by physicians and nurses as a multidisciplinary team. The censorship of data was charged of an allergist who confirmed whether a suspicious drug had caused life threatening symptoms or not. If the causative drug was confirmed by an allergist, an alert sign changed 'Code Yellow' to 'Code Red' automatically. After that censorship, an alert sign was noticed to clinicians as a yellow or red colored pop-up window. After an alert system, frequencies per month of report were increased from 44.6 to 594. Also, the report ratio of life threatening symptoms was increased from 5.4% to 12.5% (p<0.001). CONCLUSION: We assumed that the Asan-Drug Allergy Alert System could reduce medication errors effectively.
Advisory Committees ; Chungcheongnam-do* ; Drug Hypersensitivity* ; Emergencies ; Humans ; Hypersensitivity ; Medication Errors ; Pharmacists

The traumatic optic neuropathy occurs in 0.5 to 5% of closed head trauma cases. Because it may cause permanent blindness, the early diagnosis and proper treatment are very important. We have treated 6 traumatic optic neuropathy patients among 433 head trauma cases from Sep, 1997 to Aug, 1998. Four patients showed visual recovery with steroid therapy. The diagnosis can be made clinically when the patient suffers from acutely decreased vision, Marcus-Gunn pupil, with its relatively normal fundoscopic finding, is considered as the most sensitive indicator and the first herald of visual tract injury, even though visual acuity is normal at the initial stage. The megadose steroid therapy must be diagnosed for the recovery of incompletely injured axons rather than regeneration. The optic canal decompression surgery must be spared for the delayed onset optic neuropathy patients who do not respond to the steroid therapy. In a case of indirect optic neuropathy, the associated orbital fracture reduction should not be undertaken until the optic neuropathy has stabilized. But severely displaced blow-in fracture of the orbit that decreases orbital volume should repaired early for orbital decompression.
Axons ; Blindness ; Craniocerebral Trauma ; Decompression ; Diagnosis ; Early Diagnosis ; Head Injuries, Closed ; Humans ; Optic Nerve Diseases ; Optic Nerve Injuries* ; Optic Nerve* ; Orbit ; Orbital Fractures ; Pupil Disorders ; Regeneration ; Visual Acuity

PURPOSE: The purpose of this study was to determine the direction for treatment and to evaluate factors influencing improvement by comparison of neurologic and functional outcomes of surgical treatment and conservative treatment for traumatic central cord syndrome. MATERIALS AND METHODS: A total of 28 patients, who were available for follow-up for at least more than one year from January 2005 to December 2008, who were diagnosed as traumatic central cord syndrome were analyzed retrospectively. Fifteen patients underwent surgical treatment (group 1), and 13 patients received conservative treatment (group 2). Maximum canal compromise (MCC), and maximum spinal cord compression (MSCC) were used for radiologic assessment, and American Spinal Injury Association (ASIA) motor score, Japanese Orthopaedic Association (JOA) score, and neck disability index (NDI) were used for assessment of functional outcomes. RESULTS: The mean MCC was 47.2%, mean MSCC was 20.0%, and mean ASIA motor scale was 92.0 (group 1: 92.9, group 2: 90.9) at the final follow-up. The mean JOA score was 12.8 (group 1: 14.0, group 2: 11.4) and mean NDI was 25.0 (group 1: 25.7, group 2: 24.3) at the final follow-up. CONCLUSION: It is concluded that if a patient with traumatic central cord syndrome is young, with a high energy injury combined with fractures, and has severe spinal compression and mild initial neurologic defect, early surgical treatment would be needed as soon as possible.
Asia ; Asian Continental Ancestry Group ; Central Cord Syndrome* ; Follow-Up Studies ; Humans ; Neck ; Retrospective Studies ; Spinal Cord Compression ; Spinal Cord Injuries ; Spinal Injuries ; Treatment Outcome

BACKGROUND: Large hospitals should execute the forty-hour workweek from July 2004 as a matter of laws. Some institutes have used this system as the concept of five-day workweek since 2 years ago. To prepare for the forty-hour workweek effectively, all emergency physicians and headquarters of hospitals should make plans from this time. METHOD: We analyzed the emergency patients who visited the ER on two consecutive work-free days and ordinary days of last year. The number of patients, final results, such as admission or home discharge, the clinics participating in emergency care, and other components were analyzed according to two consecutive work-free days and the ordinary days. RESULT: The number of emergency patients who visited ER during the two consecutive work-free days was increased by 39.5~100.8% compared to the ordinary days. Although the number of emergency patients was larger during these days, the admission rate was lowered by 3.8~14.5%. Patients who were cared for by an emergency physician or a pediatric physician were markedly larger during the two consecutive work-free days, and the patients cared by an internal medicine were lower. CONCLUSION: To care for the emergency patients more effectively during the two consecutive work-free days in the forty-hour workweek system, we should increase the number of emergency physicians and pediatric physicians, and space for fast track and pediatric emergency care should be secured.
Academies and Institutes ; Emergencies* ; Emergency Medical Services ; Humans ; Internal Medicine ; Jurisprudence

OBJECTIVES: To investigate the association between abnormal inhibin-A level in Quad test during the 15 and 18 weeks of gestation and adverse pregnancy outcomes. METHODS: From January 2005 to March 2007, women who delivered their babies at our institute after Quad test in second trimester of gestation (N=140) were enrolled. We measured inhibin-A levels (MoM) and other serum markers of the Quad test. And we analyzed the incidence of adverse pregnancy outcomes such as preterm birth, fetal growth restriction, pregnancy induced hypertension, fetal loss, and intrauterine fetal death. RESULTS: When the pregnancy outcomes are hypertensive disorders and fetal losses, the inhibin-A levels are is more elevated with statistically significance. Inhibin-A and hCG levels are elevated with significantly at hypertensive disorders and fetal losses. But inhibin-A levels are more significantly associated with abnormal pregnancy outcomes than hCG. CONCLUSIONS: Measurement of inhibin-A levels may be the most useful among other serum markers of the Quad test in predicting adverse obstetric outcomes.
Adenine ; Biomarkers ; Carbamates ; Deoxycytidine ; Drug Combinations ; Female ; Fetal Death ; Fetal Development ; Humans ; Hypertension, Pregnancy-Induced ; Incidence ; Inhibins ; Organophosphonates ; Pre-Eclampsia ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second ; Premature Birth ; Quinolones ; Thiazoles ; Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination

Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of sterility treatment, such as pharmacological ovulation induction therapy. OHSS is clinically characterized by ovarian enlargement, abdominal distension, electrolyte imbalance, ascites, hypovolemia and hemoconcentration. But, the exact pathophysiology of OHSS is not fully understood. We believe that an increased capillary permeability leading to enhanced fluid extravasation seems to play a major pathogenic role, and also an imbalance in the rennin-angiotensin system is involved. Thromboembolic disease is usually considered to be a rare complication of OHSS. The common factors known to contribute to the risk of thrombosis are hemoconcentration, leukocytosis, thrombocytosis, and alteration in coagulation and fibrinolysis. But the majority of reported cases are venous in origin (75%), the remaining 25% are arterial thromboses. Especially in arterial thromboses, stroke is a rare event and potentially fatal complication. We report that a case of stroke combined with OHSS was received intravenous thrombolytics and recommend that emergency physicians keep in mind that one of possible causes of stroke in young woman who had been ovarian induction therapy is OHSS, and the timely intervention in OHSS with stroke is critical.
Ascites ; Capillary Permeability ; Emergencies ; Female ; Fibrinolysis ; Humans ; Hypovolemia ; Infertility ; Leukocytosis ; Ovarian Hyperstimulation Syndrome* ; Ovulation Induction ; Paresis* ; Stroke ; Thrombocytosis ; Thromboembolism ; Thrombosis

PURPOSE: Bystander cardiopulmonary resuscitation (CPR) and dissemination of its training are essential to improve the survival outcomes of sudden cardiac death. The purpose of this study was to investigate the tri-temporal trend analysis of the national CPR capacity variables and preparedness in a community. METHODS: This nationwide population-based study used structured questionnaire by a telephone survey for CPR in 2007 (n=1,029), in 2011 (n=1,000), and in 2015 (n=1,000). We used stratified cluster sampling to assess the impact of age, gender, and geographic regions. The contents in the questionnaire consisted of CPR awareness, self-efficacy for bystander CPR, prior training status, and willingness of public CPR training. RESULTS: The proportion of CPR awareness and its recent training experience (<2 years) increased from 89.0% and 14.6%, respectively, in 2007 to 88.5% and 18.7% in 2011, and finally to 94.8% and 30.6% in 2015 (both p for trend<0.001). More than 95% of respondents had agreed to mandatory CPR training acquiring a driver's license or CPR education in school. The awareness of Good Samaritan Law was increased from 20.5% in 2011 to 28.7% in 2015; however, the overall values were lower than the other CPR-related awareness and preparedness. CONCLUSION: In Korea, the trends of national CPR capacity index have been increasing during the past decade. However, the public awareness of the Good Samaritan Law was still low. We suggest that promoting the Good Samaritan Law should be the next step in preparing public CPR training in the future.
Cardiopulmonary Resuscitation* ; Death, Sudden, Cardiac ; Education ; Health Services Needs and Demand ; Humans ; Jurisprudence ; Korea ; Licensure ; Surveys and Questionnaires ; Telephone

PURPOSE: The Surviving Sepsis Campaign recommend initiating broad spectrum antibiotics within the first hour of recognition of septic shock. An unknown proportion of the effectiveness of earlier antibiotics administration will remain in septic shock patients treated with an early quantitative resuscitation in emergency department (ED). We were to compare the 28-day mortality between earlier antibiotic administration (< or =1 hour) and early antibiotic administration (1 hour to 6 hour) in septic shock patients in ED. METHODS: A total of 536 consecutive septic shock patients were prospectively collected from January 2010 to June 2012. We identified 357 patients who were developed shock at initial assessment, and measured the time of initial antibiotics administration. The primary outcome was 28-day mortality. RESULTS: Mean age was 62.8+/-13.7 years old and 222 patients were male (62.2%). The median time from shock recognition-to-antibiotics administration was 94.0 min (IQR 47.0-150.0) and 28-day mortality rate was 20.2%. When the relationship of 28-day mortality between earlier antibiotic administration (< or =1 hour) and early antibiotic administration (1 hour to 6 hour) was compared, no significant difference was shown (19.5% vs. 20.5%, p=0.82). CONCLUSION: Earlier antibiotics administration may have no additional outcome value in septic shock patients treated with an early quantitative resuscitation in ED.
Anti-Bacterial Agents ; Emergency Service, Hospital* ; Humans ; Male ; Mortality* ; Prospective Studies ; Resuscitation ; Sepsis ; Shock ; Shock, Septic* ; Treatment Outcome

BACKGROUND: Coronary artery disease is a major problem and one of the most common cause of death in the elderly. With an increase in technical success rate and a reduction in short-term complication rates for coronary angioplasty, PTCA seems to be an attractive therapy for the elderly. But elderly patients have more extensive coronary artery disease and frequently associated with other disease such as diabetes. So, it was reported that the longterm clinical and angiographic outcome is unfavorable. We examined clinical characteristic and angiographic outcome according to age of patients who underwent balloon angioplasty. METHODS: We studied total 68 patients who underwent balloon angioplasty for the treatment of reversible ischemia and all patients underwent follow-up angiography. Patients were divided into 2 groups according to age; those <65 years (n=49) and those > = or65 years (n=19). Baseline characteristics and angiographic findings, follow-up angiographic findings were compared between two groups. RESULTS: Female sex was more prevalent in the elderly group. Clinical diagnosis and comorbid state were not different. Procedure time was longer in the elderly group (88.1+/-24.5 min vs 75.3+/-21.2 min, p<0.05), but hospital stay was not different. In elderly group, residual stenosis after angioplasty was greater than in younger group (32.9+/-12.7% vs 26.4+/-10.6%, p<0.05). But immediate success and restenosis rate at follow-up angiography had no significant difference between groups. CONCLUSION: PTCA can be done safely and successfully in the elderly and the initial gain is maintained at follow-up angiography. So in symptomatic elderly patients of coronary artery disease, PTCA can play an important role for symptomatic relief.
Aged* ; Angiography ; Angioplasty ; Angioplasty, Balloon ; Angioplasty, Balloon, Coronary* ; Cause of Death ; Constriction, Pathologic ; Coronary Artery Disease ; Diagnosis ; Female ; Follow-Up Studies* ; Humans ; Ischemia ; Length of Stay

CT-guided transthoracic needle biopsy is a common procedure for the evaluation of pulmonary and mediastinal lesions. The most frequent complications include pneumothorax, hemorrhage, and hemoptysis. Air embolism especially cerebral embolism is rare but potentially fatal complication after this procedure. Here, we report a case of cerebral air embolism occurred after CT-guided transthoracic needle biopsy for the peripheral lung mass.
Biopsy, Needle* ; Embolism, Air* ; Hemoptysis ; Hemorrhage ; Intracranial Embolism ; Lung ; Needles* ; Pneumothorax