Bedside ultrasonographic examination is known to be a quick, noninvasive, cost-effective, repeatable, and harmless diagnostic modality. It can be a powerful tool for clinicians, especially in time-dependent situations including trauma. Focused assessment with sonography in trauma (FAST) has been established as a protocol especially specifically for hemodynamically unstable patients with blunt abdominal trauma. The physiologic priority of airway, breathing, circulation, and disability (ABCD) of injured patients should be assessed using a multi-systemic, multi-focused, problem-based, and point-of-care ultrasound as an extension of physical examination. This ultrasound-enhanced trauma life support, so called FAST-ABCD, can provide a great deal of important information for helping the primary physician in critical decision-making by systemically combining the airway, lung, cardiovascular, abdominopelvic, orbital, and transcranial ultrasound. Additionally, it can provide information on airway patency, guidance of endotracheal intubation and cricothyroidotomy, lung contusion, limited hemodynamics, differential diagnosis of shock, intracranial hypertension, and even more extensively on a secondary survey from head to toe. The indications for the utility of ultrasound in trauma continue to evolve beyond FAST. FAST-ABCD could be incorporated into advanced trauma life support by obtaining more evidence through more studies worldwide.
Advanced Trauma Life Support Care ; Contusions ; Diagnosis, Differential ; Head ; Hemodynamics ; Humans ; Intracranial Hypertension ; Intubation, Intratracheal ; Lung ; Orbit ; Physical Examination ; Respiration ; Shock ; Toes

BACKGROUND: To determine the prognostic value of the initial APACHE II score in the ED compared with the classic APACHE II score in the ICU and to check the usefulness of the MEDS score together for more rapid risk stratification of septic patients admitted to the ICU via the ED. METHODS: We prospectively checked the initial APACHE II and MEDS scores of all the patients who had systemic inflammatory response syndrome in the ED and the classic APACHE II scores after admission to the ICU, as well 6 months later. We enrolled the only sepsis cases in the final diagnosis after reviewing the medical records. We evaluated the predictive abilities of the initial APACHE II and MEDS scores compared with the classic APACHE II score. RESULTS: During 6 months, 58 patients diagnosed with sepsis were enrolled. Twenty-four (41.4%) patients died within 28 days of admission and 34 patients survived. The mortality group had a significantly higher mean classic APACHE II score (19 +/- 6.7 vs. 15 +/- 5.0, p < 0.01) and a higher mean MEDS score (16.67 +/- 2.70 vs. 8.91 +/- 3.11, p < 0.01) than the survivor group. The initial APACHE II score at the ED was not significantly different between the two groups. ROC analysis showed the discriminative power of the MEDS score in predicting mortality was much better than the APACHE II score (areas under the curves of the APACHE II score in the ED and ICU, and the MEDS scores were 0.668, 0.807, and 0.967, respectively; p < 0.01). CONCLUSIONS: The initial APACHE II score in the ED did not predict mortality better than the classic APACHE II score. However, the MEDS score predicted the poor prognosis of septic patients more rapidly and accurately in the ED than the APACHE II model.
APACHE ; Emergencies ; Humans ; Critical Care ; Intensive Care Units ; Medical Records ; Prognosis ; Prospective Studies ; ROC Curve ; Sepsis ; Survivors ; Systemic Inflammatory Response Syndrome

Objective: Arterial blood gas analysis (ABGA) is routinely performed in hyperventilation syndrome (HVS) patients in the emergency department (ED). We tried to substitute end-tidal carbon dioxide (ETCO2) for arterial partial pressure of carbon dioxide (PaCO2) in HVS patients in ED. Methods: It was a prospective observational cohort study of HVS patients from May 2019 to March 2020. Data of age, sex, vital sign, ETCO2 and ABGA were collected. We compared the Pearson correlation between ETCO2 and PaCO2. Results: A total of 135 HVS patients were included in the study. The average value for ETCO2 was 24.9±7.2. It showed a significant linear between ETCO2 and PaCO2. The Pearson correlation coefficient was 0.893 (P<0.001). The linear correlation coefficients of ETCO2 <20 mmHg and ETCO2 20-35 mmHg groups were 0.513 and 0.827, respectively (P<0.001). Conclusion We suggest that ABGA can be replaced by ETCO2 in HVS patients in ED.

BACKGROUND: This study was designed to review the cases of patients who had undergone diffusionweighted magnetic resonance imaging(DWI) in the emergency department(ED), and to investigate its clinical usefulness and current indications. METHODS: We analyzed the cases of 152 consecutive patients who underwent DWI in the ED from Jan to Mar 2001. DWI was obtained with the use of a multislice, single-shot, spin-echo plana imaging technique(GE Signa(R)). Imaging time was less than one minute. The medical records, the DWI films and the computed tomography results were reviewed. We investigated the chief complaint, initial findings of physical examination, final diagnosis, decision-making department, interval from admission to imaging, and DWI findings. RESULTS: DWI showed positive findings of high signal intensity in 84 patients(55.3%). Among the 68 patients who yielded a negative result, false negative occurred with 12 patients(17.6%): 10 lacunar infarctions, a pons infarction, and a brainstem infarction. Eleven patients were determined as having a cerebral hemorrhage, all of whom showed the abnormal finding of a mixed signal in DWI. The sensitivity and the specificity of DWI to rule out stroke were 85.5% and 98%, respectively. Current indications for DWI in our ED are age older than 60, alert mental status, and one of the symptoms or signs among lateralyzing sign, language disturbance, and dizziness/vertigo. CONCLUSION: DWI was highly specific to rule out stroke, so emergency care professionals should be familiar with this new technology. Further prospective study is required to determine the proper indications and clinical usefulness of DWI in the ED.
Brain Stem Infarctions ; Cerebral Hemorrhage ; Diagnosis ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Humans ; Infarction ; Magnetic Resonance Imaging* ; Medical Records ; Physical Examination ; Pons ; Sensitivity and Specificity ; Stroke ; Stroke, Lacunar

BACKGROUNDS: The mortality of geriatric trauma patients is higher than that of other age groups. However, little research has been done the methods or criteria of triage for geriatric trauma patients. This study evaluated a clinical significance of the triage-revised trauma score(t-RTS) for triage of geriatric trauma patients. METHODS: We retrospectively analyzed clinical data on 528 trauma patients over 65 years of age who were treated from Jan 1999 to Dec 2000. The t-RTS was calculated utilizing the RR(respiratory rate), SBP(systolic BP), and GCS scores and the ISS was abstracted from the final diagnosis. The obtained t-RTS and ISS were evaluated using the measures of sensitivity, specificity, accuracy, and AUC curve. RESULTS: The overall mortality rate was 9%, and there was no significant differences between the survival group and the mortality group according to age and sex. The mean scores of SBP, RR and GCS of the survival group were significantly higher than those of mortality group(p=0.001). The mean of t-RTS and RTS of the survival group were also significantly higher(p=0.001), but the ISS was significantly higher in the mortality group(p=0.001). The t-RTS, RTS, and ISS showed good prediction rates on the ROC curve(p=0.001), and the AUC value was higher in the ISS than in the t-RTS and the RTS. The sensitivity and the accuracy were high in the t-RTS and the RTS, and the specificity was high in the ISS. The t-RTS is less than 10 for a survival probability of 50% or less CONCLUSONS: Implementation of the t-RTS in the triage of geriatric trauma patients in the field and in emergency room would be very useful. The probability of death in geriatric trauma patients is high when the t-RTS is less than 10.
Area Under Curve ; Diagnosis ; Emergency Service, Hospital ; Humans ; Mortality ; Retrospective Studies ; Sensitivity and Specificity ; Triage*

Caowu (aconite) is derived from the roots of certain aconitum species (Racunculaceae), which are widely distributed both in China and Korea. Aconitine, an extremely toxic ingredient present in aconite, has pharmacological effects including anti-inflammatory, analgesic, and positive inotropic actions. Due to its relatively low safe dose, we sometimes encounter cases of serious Caowu intoxication. A group of women visited our emergency department with various symptoms after drinking home-brewed alcohol together on a sightseeing tour. The fifteen affected individuals were admitted to our hospital. We checked the home-brewed alcohol and found about 7 aconites in the liquor bottle, indicating that the patients were experiencing aconitine poisoning. We report the characteristics of an outbreak of aconitine intoxication resulting from drinking alcohol mixed with aconites.
Aconitine ; Aconitum ; China ; Drinking ; Emergencies ; Female ; Humans ; Korea

PURPOSE: To evaluate the quality of the emergency medical care during doctors' strike at a hospital in Korea. METHODS: During a period of 7 consecutive days, from 20th to 26th June 2000, the training physicians in Korea were on strike against medical reform and the emergency medical care was provided by medical staffs without training physicians. We drew out convenient samples by systematic allocation method and reviewed the medical records. We evaluated the patients' severities, the number of diagnostic tests and therapeutic procedures, the admission rates, and the lengths of stay at emergency department(ED) in the strike period(SP) compared to control period(NSP) from 20th to 26th June, 1999. RESULTS: The two groups(SP: 191 vs NSP: 202 patients) showed significant differences in the proportion of emergent patients(17.3 vs 32.7%), ED length of stay(1.98 vs 4.47 hours), the number of diagnostic tests(1.47 vs 3.92), the injection rates(17.3 vs 35.1%), and the adverse event rates(4.5 vs 6.5%). CONCLUSION: This study suggested that the ED administration by medical staffs without training physicians improves medical quality of emergency care.
Diagnostic Tests, Routine ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Humans ; Korea ; Medical Records ; Medical Staff ; Strikes, Employee*

PURPOSE: The purpose of this study is to determine for upper abdominal pain, the accuracy of emergency abdominal ultrasonography (EAU) performed by emergency physicians with limited training. METHODS: Two PGY-3 emergency physicians, who had received 2 hours of hands-on training, including the normal anatomy of a biliary system, liver, kindney, spleen, and pancreas, and who had studied the pathologic findings for another month were the subjects of this study. They used a Sonosite 180 R to perform EAU on patients with upper abdominal pain within 2 months after training. We determined the agreement between the radiologist 's abdominal ultrasonography(RAU) and EAU by using Kappa statistics. RESULTS: A total of 59 patients were enrolled. The agreement between the EAU and the RAU findings was 0.97, 0.88, 0.79, 0.73, 0.62, and 0.57 for gall bladder (GB) distension, cholelithiasis, GB wall thickening, duct dilatation, choledocholithiasis, and pericholecystic fluid, respectively (p<0.05). CONCLUSION: The results of EAU, performed by emergency physician with limited training on patients suffering from upper abdominal pain had a significant agreement with the RAU. However, more educations and cautions are warranted for diagnosing pericholecystic fluid and choledocholithiasis.
Abdominal Pain ; Biliary Tract ; Choledocholithiasis ; Cholelithiasis ; Dilatation ; Emergencies* ; Humans ; Liver ; Pancreas ; Spleen ; Ultrasonography* ; Urinary Bladder

PURPOSE: This study was designed to investigate the predictors of long-term admission in patients with acute diarrhea at an early stage of their emergency department (ED) visit. METHODS: We retrospectively analyzed clinical data of 125 patients who visited our ED with complaints of acute diarrhea and abdominal pain and underwent a stool test during one year (Jan. to Dec. 2001). We excluded patients who were transferred out or were self-discharged and those with another illness. We checked the numbers of cases of diarrhea, the presence of fever and abdominal pain, the stool cell counts, the blood cell counts, platelets, blood urea nitrogen, and creatinine on admission. We also counted the length of stay and defined a stay of over 4 days in the hospital as a long-term admission. We tried to find parameters that could predict long-term admission at an early stage. RESULTS: A total of 125 patients were enrolled (men : 56 ; women : 69), and their mean age was 44 +/- 0.25 years. The mean length of stay was 3.0 +/- 0.02 days. The length of stay had a statistically significant correlation with the stool WBC (p<0.01, R=0.361). Only the stool WBC a the discriminative variable for long-term admission (p<0.01). CONCLUSION: The stool WBC was a statistically significant predictive variable to determinate the long-term admission and the severity of acute diarrhea, and we think it could be used to make an early decision for the close medical attention.
Abdominal Pain ; Blood Cell Count ; Blood Platelets ; Cell Count ; Creatinine ; Diarrhea* ; Emergency Service, Hospital ; Female ; Fever ; Humans ; Length of Stay ; Nitrogen ; Retrospective Studies ; Urea

PURPOSE: We hypothesized that a new scoring system that included emergency ultrasound (EUS) and clinical or laboratory predictors for diagnosing acute appendicitis (AA) in patients with right lower quadrant (RLQ) pain could decrease the false negative rate when EUS is performed alone. METHODS: During a 10 month period, patients with RLQ pain were evaluated with EUS just after history taking and physical examination. We also checked the 17 well-known predictors of AA. Univariate analyses for each predictor including EUS findings identified 11 predictors. We then tested those predictors with logistic regression analysis. RESULTS: A total 397 patients (mean age=31.13+/-18.25 years: 196 males, 201 females) were enrolled in this study. Among the 397, 247 underwent an operation, but 14 turned out to have normal appendices. Among 233 patients with appendicitis, 75 had a perforated appendix. Four independent correlates of AA (constant pain, aggravated pain, male sex, and positive EUS findings) were identified with logistic regression analysis. We developed a novel scoring system using regression coefficients as follows: 6 points for a positive EUS, 3 points for aggravated pain, 2 points for constant pain, and 2 points for being male. We named the new scoring system "CAMUS" for "Constant or Aggravated pain, Male sex, and UltraSound score". The area under the receiver-operating characteristic curve (ROC) for the CAMUS score for AA was 0.93(95% confidence interval: 0.871 to 0.959). CONCLUSION: Our new CAMUS scoring system can help emergency physicians diagnose AA accurately and rapidly.
Appendicitis ; Appendix ; Benzeneacetamides ; Diagnosis, Differential ; Emergencies ; Humans ; Logistic Models ; Male ; Physical Examination ; Piperidones