BACKGROUND: Trauma is a major cause of death for individuals under the age of 45 years and the third leading cause of death for all ages. So, it has been recognized as an important socioeconomic problem. The purpose of this study was to evaluate the outcome of surgical care of traumatized parients. METHODS: We retrospectively analyzed data of patients who had undergone surgical operation on head, abdomen, or chest trauma from January 1, 1995 to December 31, 1995. TRISS method and W- and Z- statistics were used to evaluate the trauma outcome and the quality assurance of surgical treatment. RESULTS: Two hundred and sixty eight patients were enrolled in this study. Traffic accident in injury mechanisms was the most common(n=185, 69.2%), and severely injured patients with over ISS 16 were 205 of total 268 patients(76.5%). Crude mortality rate was 11.6% (non-survivors/number of patients : 31/268). By TRISS method, predicted mortality rate was 10.1%, excess mortality rate was 14.2%, and W value was - 1.43 indicating less actual survivors than predicted, but absolute Z score was 0.91 and it was statistically not significant. CONCLUSION: These data show that trauma outcome and quality of surgical care in our hospital is adequate. We also suggest that it will provide a valuable data for further studies.
Abdomen ; Accidents, Traffic ; Cause of Death ; Head ; Humans ; Injury Severity Score* ; Mortality ; Retrospective Studies ; Survivors ; Thorax

Basta(R) is one of the Phospho-amino acid group herbicide. It consist of glufosinate ammonium (18.5%), alkylether sulfate as surfactant (30%) and some solvents. Although it's WHO classification is Bade III, the intoxicated patient appears an serious clinical findings and have a 20% mortality rate. Nowadays, in Korea the ingestion of herbicidal agents for suicidal attempts is Sequent. The literature for intoxication of bipyridilium (Gramoxon(R)) as herbicide is varied, but the information for Basta(R) is poor even though the use of it tends to increase. Recently, We experienced six cases of Basta(R) intoxication and found that the patient expressed a gradually progressed depression of mentation, recent memory disturbances, convulsions, hypotension, or bradycardia because of CNS or cardiovascular effects of Basta(R) We report these cases with literature review.
Ammonium Compounds* ; Bradycardia ; Classification ; Depression ; Eating ; Humans ; Hypotension ; Korea ; Memory ; Mortality ; Seizures ; Solvents

BACKGROUND: The current recommendation of rescue breathing techniques in the infant is to blow both the nose and mouth of infants by caregiver's mouth but recent studies suggest some caregivers may have trouble sealing a infant's mouth and nose. The purpose of this study is to estimate the ability of mothers to create a seal to their infants for the provision of rescue breathing according to current recommendation. METHODS: Infants up to 1 year of age(n=98) and their mothers were enrolled from emergency department of Chonbuk National University Hospital. We measured the facial lengths of the infants and the width of mouth in their mothers and compared mouth widths of mothers with their infant's nose-to-mouth lengths. RESULTS: In infants between 0 to 6 months, Mother transverse lengths were significantly larger than mouth, nose and nose-to-mouth lengths of the infants. In infants between 7 to 12 months, Mother transverse lengths were significantly larger than mouth and nose lengths of the infants but there was no statistically significant difference between mother transverse lengths and nose-to-mouth lengths of infants. CONCLUSION: The finding indicate that the present recommendation to cover mouth and nose is partly not possible. We recommend that the mouth-to-nose ventilation of rescue breathing techniques for the infants who have respiratory arrest be taught to mothers.
Caregivers ; Emergency Service, Hospital ; Humans ; Infant* ; Jeollabuk-do ; Mothers ; Mouth ; Nose ; Respiration* ; Ventilation

No abstract available.
Tissue Expansion Devices*

BACKGROUND: Nowadays, acute drug intoxication is a important section of emergency medicine. The purpose of this study was to determine what is the best-way to manage acutely intoxicated patients with drug in emergency department setting. METHODS: Clinical assessment were made on 135 cases of drug intoxication visited to emergency center of Hospital during one year from June 1997 to May 1998. RESULTS: 1. The total number of cases of acute drug intoxication was 135 which is 0.5% of total patients presented to emergency center. 2. There was no sexual difference in incidence, but the highest incidence of age group was in 3rd decade(23.7%) and the next was 7th decade(20.0%). 3. High frequency of acute intoxication was observed in autumn. October had the largest portion in monthly distribution. The largest portion of presumed time of poisoning was noon - 4 p.m. and of the time on arrival to emergency center was 8 p.m. -midnight. 4. Suicidal attempt was the most common motive of intoxication (72.6%). 5. The most common drug of intoxication was insecticides (35.7%) and the others were centrally active agents, herbicides in orders. 6. Mental change was observed in 20.7% of patients and the abnormal vital signs were hypertension, tachycardia, and hypotension in order on arrival to emergency center. 7. Mean duration of treatment was 36.1 hours. Mortality rate of the cases was 7.4%. CONCLUSION: The mortality rate was high in patients who ingested relatively fatal drugs (i.e. herbicides, antimicrovials, insecticides), showed mental change on arrival or received mechanical ventilatory care(p<0.05).
Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Herbicides ; Humans ; Hypertension ; Hypotension ; Incidence ; Insecticides ; Mortality ; Poisoning ; Tachycardia ; Vital Signs

Although selective serotonin reuptake inhibitors (SSRIs) have been widely used in both psychiatry and other medicine, few cases have been reported SSRI-related hyperprolactinemia and/or galactorrhea. We experienced one case which showed both galactorrhea and hyperprolactinemia following treatment with paroxetine. In the case, a 37-year-old multiparous woman reported galactorrhea after 8-weeks paroxetine treatment for her depression. After 1 month prescription of bromocriptine, dopamine agonist, as well as switching medication from paroxetine to venlafaxine, serotonin-norepinephrine reuptake inhibitor, both galactorrhea and hyperprolactinemia were disappeared. Both hyperprolactinemia and galactorrhea have not been observed even after the cessation of bromocriptine prescription.
Adult ; Bromocriptine ; Cyclohexanols ; Depression ; Dopamine Agonists ; Female ; Galactorrhea ; Humans ; Hyperprolactinemia ; Paroxetine ; Pregnancy ; Prescriptions ; Serotonin Uptake Inhibitors ; Venlafaxine Hydrochloride

BACKGROUND: Pain is one of the most common presenting complaints in the emergency department(ED) and adequate analgesia for painful conditions is an important goal of emergency medical practice. This study was designed to investigate on the actual condition regarding the use of analgesic injections for traumatized patients in the field of ED and to reconsider the concern and methods of pain management in the future. METHOD: We carried out a prospective, noninterventional observational clinical study of adult patients presenting with acute trauma in the ED. Using a numeric rating scale ranging from 0 to 10, patients quantified their pain intensity on arriving at the ED and on one hour after analgesic administrations in the cases of analgesic use or after initial Assessment in the cases of no analgesic use. They also were interviewed about the level of their satisfaction to pain relief before leaving the ED. RESULTS: Seventy eight percent of all patient received analgesic injections(nonsteroidal antiinflammatory drugs; 62%, opioids; 16%) and the remaining 22 patients(22%) were treated without analgesics. At the time of secondary assessment to pain, initial pain score in the cases of analgesic administration decreased. Patients who are beyond fair in the level of satisfaction were recorded for only 18% of all patient even though 78% of patients received analgesic injections. CONCLUSION: Our data illustrate that the patient of trauma commonly receive analgesic injections in the ED but their levels of satisfaction are under fair. This finding suggests that the concern and methods of pain management have to be reconsidered through the understanding of analgesic pharmacology and pattern of pain relief by analgesics.
Adult ; Analgesia ; Analgesics ; Analgesics, Opioid ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Pain Management* ; Pharmacology ; Prospective Studies

BACKGROUND: Victims of trauma in the emergency room(ER) suffer from kinds of discomforts derived from their physical injury and psychological instability. Although discomforts may be varied by the patient's characteristics and environmental factors such as medical personnel or facilities in ER, an active control for the discomfort should be required because it may affect an outcome of treatment and prognosis of illness. The purpose of this study is to analyze the distressing factors which traumatized patients have been experienced in the ER and to improve the management of trauma patients in the future. METHODS: From January 1, 1996 to June 30, 1996, we tried to interview patients about the painful experiences in ER before the decision of his or her discharge from ER. We analyzed the data on age, sex, religion, educational level, injury severity score(ISS), the most unpleasant experience, sleep deprivation, and friar for death. RESULTS: The 126 patients were enrolled in this study. The patients consisted of 93 male and 33 female, their mean age was 45 years old and mean ISS was 7.86. About seventy one percent of the patients complained unpleasant experiences during the stay in the ER. Of these, pain at the injury sites was the most frequent complaint (66.7%). The sleep deprivation was showed about sixty percent of the total patient and the most common cause of this was also due to pain(40%). Nineteen percent of the patients answered that they have felt the fear for death. There were statistically significant differences in degree of the ISS whether the fear for death and unpleasant experience were or not. When the patients demarked with whether the presence of pain, the occurrence of sleep deprivation, and fear for death were statistically related to the pain. However, the data was denoted no direct relationship with pain according to sex, educational level, or religion. CONCLUSION: The trauma patient admitted to ER suffered from various stressful conditions including not only their physical injury but care personnel or unstable environmental factors in ER. Therefore, emergency medical personnel has to understand some possible distresses of the patients and need to reduce them to provide more careful and proper managements.
Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Sleep Deprivation

The Gerbode shunt, known as the left ventricle to the right atrial communication, is a rather rare finding, following surgical closure of septal defects. Even though the surgical closure is accepted as a treatment of choice, we report a successful percutaneous transcatheter closure of the Gerbode shunt in a 3-months old baby who weighed 3 kilograms.
Heart Septal Defects ; Heart Ventricles ; Humans ; Septal Occluder Device

BACKGROUND: The mechanically ventilated patient's stay in the emergency department (ED) is brief but ventilatory management and intervention must be optimal. Agitation, anxiety, distress, and discomfort are common complications far the ventilated patient. So, sedation is necessary to reduce these complications. METHODS: Patients were monitored and mechanically ventilated. Midazolam was intravenously administered as loading dose(3-5mg), followed by continuous infusion at a rate of 0.06mg/kg/hr, titrated to achieve a predetermined sedation level (Ramsay's sedation score: 2-5 points, Glasgow coma score scathe : 8-11 points). RESULTS: After onset of predetermined sedation, systolic and diastolic blood pressure and heart rate remained stable during continuous infusion when compared with those of the initial state. Arterial blood gas and peak inspiratory pressure remained unchanged but respiratory rate was decreased to allowable ranges. CONCLUSION: A short-term continuous infusion of midazolam was a safe and erective method for sedation of ventilated patients in ED.
Anxiety ; Blood Pressure ; Coma ; Dihydroergotamine ; Emergency Service, Hospital ; Heart Rate ; Humans ; Midazolam* ; Respiratory Rate