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The Efficacy of Ultrasound Diagnosis of a Partial Tendon Injury by Emergency Doctors: Using a Swine Model.

Jeong Ryel PARK ; Chun Song YOUN ; Byung Hak SO ; JI Hoon KIM ; Hyung Min KIM ; Kyu Nam PARK ; Hyeon Woo YIM

Journal of the Korean Society of Emergency Medicine.2010;21(1):82-87.

PURPOSE: To evaluate the efficacy of ultrasound for the detection of a partial tendon injury of the dorsum of the hand by emergency doctors using a swine model. METHODS: Fifteen swine feet were used for the study. Two tendons from each foot were examined using a 10 MHz hocky stick scan head. A 0%, 10%, 50% and 90% incision was made in each extensor tendon at the proximal site of the skin incision. Four emergency physicians and five senior emergency residents were blinded to the injuries and evaluated the samples for a partial tendon rupture. RESULTS: The difference between the results for the emergency physicians and the emergency senior residents were not statistically significant.The diagnostic sensitivity for all participants was more than 10%; more than a 50% tendon injury was identified in 69.2% and 77.0%, respectively. The specificity was 51.4% and 53.5% for each case. The sensitivity and specificity showed no significant differences. (sensitivity p=0.243, specificity p=0.992) CONCLUSION: The results of this study confirm that ultrasound was useful in the detection of a partial tendon rupture by emergency doctors. The findings of this study have implications for the training of emergency room doctors.
Benzeneacetamides ; Emergencies ; Foot ; Hand ; Head ; Piperidones ; Rupture ; Sensitivity and Specificity ; Skin ; Swine ; Tendon Injuries ; Tendons

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Influence of Military Service on Tetanus Antibody Titer in Korean Adults.

Jong Whan SHIN ; Jin Joo KIM ; Joong Sik JEONG ; Kyoung Jun SONG ; Jin Seong CHO

Journal of the Korean Society of Emergency Medicine.2010;21(1):73-81.

PURPOSE: Most Korean veterans receive a tetanus immunization as part of military service. Both tetanus toxoid and immunoglobulin are given to injured patients that present to the emergency department, regardless of their tetanus antibody titer and history of military service. The goal of this study was to determine the tetanus antibody titer and history of military service among patients presenting to the emergency room. METHODS: Seven hundred and seventy patients visited the emergency department after an injury from April 2008 to June 2009. The samples obtained were tested using a Tetanus Immunoglobulin G ELISA (enzyme-linked immunosorbent assay) method. The tetanus antibody titer was analyzed according to time, five years after entrance into military service and also between veterans and nonveterans. RESULTS: Subjects that had safe antibody titers that were protective against tetanus up to 20 years after entrance into military accounted for 60%. Those with a history of military service were more likely to have protective antibody levels (> or =0.1 IU/ml, odds ratio 2.41, 95% CI 1.613-3.596) and mean antibody titers (p<0.001). In the subjects between 20 and 45 years of age those with a history of military service were more likely to have statistically significant antibody titers. In addition, male veterans were more likely to have significant antibody titers compared to the males and females that were not veterans (p=0.015 and p<0.001); however, there were no significant differences between the males and females that were not veterans. CONCLUSION: The results of this study showed that until about 20 years after entrance into military service, 60% of the subjects had protective tetanus antibody titers. The history of military service influenced tetanus antibody titers until about 45 years of age.
Adult ; Emergencies ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunization ; Immunoglobulin G ; Immunoglobulins ; Male ; Military Personnel ; Odds Ratio ; Tetanus ; Tetanus Toxoid ; Veterans

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Non-invasive Hemoglobin Measurement in Emergency Patients.

Jin Woo CHUNG ; Jun Seok PARK ; Ah Jin KIM ; Dong Wun SHIN ; Jun Young ROH ; Kyung Hwan KIM ; Kyung Mi LEE

Journal of the Korean Society of Emergency Medicine.2010;21(1):67-72.

PURPOSE: At present, the hemoglobin count is one of the most commonly performed clinical laboratory tests in the emergency department. However, the conventional method is invasive and permits only intermittent assessments. The aim of this study was to determine whether non-invasive hemoglobin measurements (SpHb) produce comparably accurate results to laboratory hemoglobin tests (tHb) in patients presented to the emergency department. METHODS: From May to July 2009, 217 patients who required hemoglobin tests after presenting to the emergency department of a hospital were enrolled. We measured hemoglobin values using the conventional method (tHb), and the non-invasive method (SpHb). The study population was classified into two groups: 'non-bleeding' and 'bleeding'. The concordance between tHb and SpHb was analyzed by the Pearson's correlation coefficient. RESULTS: A total of 217 data pairs were collected from 217 subjects, 193(88.9%) non-bleeding patients, 24(11.1%) bleeding patients. A total of 114 subjects were male (52.5%). The Pearson's correlation coefficient between tHb and SpHb was 0.814(p=0.000). In the 'non-bleeding' and 'bleeding' groups, the Pearson's correlation coefficients between tHb and SpHb were 0.779(p=0.000) and 0.788(p=0.000) respectively. CONCLUSION: Non-invasive SpHb measurement provides clinically acceptable accuracy compared to the conventional laboratory method (tHb) in the setting of the emergency department.
Emergencies ; Emergency Medicine ; Hemoglobinometry ; Hemoglobins ; Hemorrhage ; Humans ; Male

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The Clinical Utility of Blood Cultures by Pneumonia Severity Index for Patients with Community-Acquired Pneumonia in the Emergency Department.

Jae Hoon ROH ; Jong Han JUN ; Shin Ho LEE ; Won Nyung PARK ; Hong Du GU

Journal of the Korean Society of Emergency Medicine.2010;21(1):61-66.

PURPOSE: Community-Acquired Pneumonia (CAP) is a common cause of mortality and serious morbidity. Regardless of the condition of the patients, almost all are hospitalized. And it seems to be a standard procedure to obtain blood cultures before the administration of antibiotics in suspected pneumonic patients. Recent studies show that the blood cultures don't affect the treatment of the patients with CAP. Accordingly, this study was designed to examine the usefulness of the blood cultures routinely performed and to evaluate the stratification of the patients with CAP by Pneumonia Severity Index (PSI) in the Emergency Department (ED). METHODS: Research subjects were patients over 16 years old who had been diagnosed with CAP in a general hospital between January and December 2008 and were admitted by way of the ED. We evaluated their records retrospectively. RESULTS: A total of 261 patients were diagnosed with CAP. According to the PSI, 155 (59%) of the 261 were classified as being in the low risk group and 106 (41%) in the high risk group. Blood cultures were positive in 13 of 261 (5%). Three of 13 patients belonged to the low risk group, and 10 to the high risk group. Antibiotics were changed in 43 of 261 patients. Nineteen of those belonged to the low risk group and 24 to the high risk group. Of the 13 bacteremic patients, blood cultures results altered therapy for 4 patients. CONCLUSION: Most often, blood cultures performed in the ED do not alter the therapy of patients with CAP. But we do recommend blood cultures for the high risk group.
Anti-Bacterial Agents ; Community-Acquired Infections ; Emergencies ; Hospitals, General ; Humans ; Pneumonia ; Research Subjects ; Retrospective Studies ; Severity of Illness Index

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Factors Associated with In-hospital Mortality of Emergency Department Intubation for Non-traumatic Patients.

Sung Yeon HWANG ; Ik Joon JO

Journal of the Korean Society of Emergency Medicine.2010;21(1):55-60.

PURPOSE: Although, urgent intubation is commonly thought to be associated with a high complication rate and poor outcome, early intubation before deterioration and airway compromise is recommended. We designed a study to evaluate the factors associated with the mortality rate of non-traumatic patients intubated in an emergency department (ED). METHODS: Data were retrieved retrospectively from the patient registry for patients >15-years-of-age who had received ED intubation from June 1, 2007 to June 30, 2008. Patient demographic data, clinical and laboratory findings, vital signs, and specific data concerning intubation procedures were included. Acute physiologic and chronic health evaluation (APACHE) II scores were calculated for every patient. RESULTS: From the initial 241 non-traumatic ED intubated patients, 115 were excluded for out-of-hospital arrests, inadequate data, and undetected esophageal intubation. The remaining 126 patients were enrolled in this study. Sixty (47.6%) patients died during hospital treatment. From multivariate logistic regression analysis, respiratory rate and the time from ED arrival to intubation were associated with increased mortality, which showed an odds ratio (95% Cl) of 1.081 (1.026~1.141) and 1.428 (1.066~1.91), respectively. CONCLUSION: The increase in respiratory rate and the time interval of intubation from ED arrival to intubation in non-traumatic patients are related to increased in-hospital mortality.
Emergencies ; Hospital Mortality ; Humans ; Intubation ; Logistic Models ; Odds Ratio ; Respiratory Rate ; Retrospective Studies ; Time Factors ; Vital Signs

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Predicting the Airway Patency using the Parameters of Soft-tissue Lateral Neck Radiography in Adult Patients with Acute Epiglottitis.

Jae Don SOHN ; Sun Wook KIM ; Min Joung KIM ; Tae Nyoung CHUNG ; Yoo Seok PARK ; In Cheol PARK

Journal of the Korean Society of Emergency Medicine.2010;21(1):48-54.

PURPOSE: We wanted to predict the high risk group that requires urgent airway intervention by using the parameters of the soft-tissue lateral neck radiographs of adult acute epiglottitis patients. METHODS: This retrospective study was conducted in two teaching hospitals. The patients who were diagnosed with acute epiglottitis from June, 2007 to May, 2009 were enrolled and their medical records and x-ray films were reviewed. The width of the epiglottis at the widest point (EW), the width of the arytenoid at the widest point (AW), the prevertebral soft tissue distance at the third cervical spine (PSTD), the shortest distance from the epiglottis to the hypopharyngeal wall (EHD) and the shortest distance from the epiglottic root to the arytenoids'tip (EAD) were investigated and we performed regression analyses of these parameters of the patients in the high risk group that required urgent airway intervention. RESULTS: A total of 42 patients were enrolled. Dyspnea and hoarseness were more frequent in the high risk group that required urgent airway intervention (p=0.008, 0.040, respectively). The EW was significantly longer (p=0.001) in the high risk group. The EHD and EAD were significantly shorter (p=0.012, <0.001, respectively) in the high risk group. Only the EAD showed significant correlation with the percent of airway patency on linear regression analysis (p=0.003) and the EAD was the only significant predictor for the high risk group on multivariate logistic regression analysis (p=0.043). The receiver operating characteristics curve of the EW/EAD for the high risk group was obtained and it showed the best predictive power (AUC: 0.977, p<0.001). CONCLUSION: The EAD noted on soft-tissue lateral neck radiography is an important predictor of high risk patients who require urgent airway intervention. The cut-off value of the EW/EAD for the predicting the high risk group is 2.44 (sensitivity 100%, specificity 85.7%).
Adult ; Airway Obstruction ; Dyspnea ; Epiglottis ; Epiglottitis ; Hoarseness ; Hospitals, Teaching ; Humans ; Linear Models ; Logistic Models ; Medical Records ; Neck ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Spine ; X-Ray Film

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The Optimal Length of a CVC Inserted via the Right Internal Jugular Vein during Computed Tomography.

Byuk Sung KO ; Seung Mok YOU ; Youn Sun LEE ; Jae Ho LEE ; Bum Jin OH ; Won KIM ; Kyoung Soo LIM ; Won Young KIM

Journal of the Korean Society of Emergency Medicine.2010;21(1):44-47.

PURPOSE: The aim of this study was to investigate the optimal length of a central venous catheter (CVC) inserted through the right internal jugular vein METHODS: During a 4-month period, we prospectively studied 374 patients who required a CVC. We enrolled 39 patients who underwent chest computed tomography (CT). The skin was punctured at the anterior border of the sternocleidomastoid muscle and at mid-distance between the angle of the mandible and the sternoclavicular junction. We measured the distance from catheter insertion to the superior vena cava/right atrium (SVC/RA) junction and calculated the recommended depth. RESULTS: The optimal length of a CVC inserted via the right internal jugular vein was 15 cm, this was based on the mean distance from the CVC insertion point to the distal SVC. By using these guidelines, the initial placement of a CVC in the distal SVC was more accurate than using other formulas (92.3% vs. 76.9%). CONCLUSION: To increase the likelihood of optimal tip location within the SVC on the first attempt and elimination of reposition, we suggest using the recommended depth instead of a formula to guide catheter placement.
Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Humans ; Jugular Veins ; Mandible ; Muscles ; Prospective Studies ; Skin ; Thorax ; Tomography, X-Ray Computed

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The Utility of the Inferior Vena Cava/Aorta Diameter Index in Trauma Patients.

Kang Ho SON ; Mi Ran KIM ; Yang Weon KIM ; Yoo Sang YOON

Journal of the Korean Society of Emergency Medicine.2010;21(1):35-43.

PURPOSE: An accurate assessment of body fluid status is a significant challenge during every clinical examination. In many disorders, the therapy and its effectiveness depend on appropriate evaluation of body fluid state, especially in the trauma patient. The purpose of this study was to evaluate the clinical significance of the IVC/aorta diameter index on abdominal CT scans and to determine whether? The IVC/aorta diameter index was useful for predicting the outcome of trauma patients in the emergency department. METHODS: This study was a retrospective analysis of data acquired between December 2008 and April 2009. We included 108 trauma patients who received abdominal CT in the emergency department. Persons who had a major medical problem such as liver cirrhosis, or who were transferred from other hospitals for ICU care, or who were younger than 15 years, were excluded. IVC and aorta were measured below the infrarenal vein in the abdominal CT in an axial view. Clinical assessment included the patient's final diagnosis, blood pressure, heart rate, weight and whether he was dead or not. Receiver operating characteristic (ROC) curves were used to find the value of the IVC/aorta diameter index that maximized the sum of the sensitivity and specificity. Statistical analysis was performed using SPSS 17.0. RESULTS: We studied 135 patients (trauma 108 and non trauma 27). The mean IVC/aorta diameter index of nontrauma patients was 1.26+/-0.17; for trauma patients it was 0.80+/-0.33. The average IVC/aorta index in the shock group at arrival were significantly smaller than in the non shock group (0.57+/-0.27 versus 0.89+/-0.3). CONCLUSION: The inferior vena cava/aorta diameter index in trauma patients is useful in assessment of injury severity and prognosis.
Aorta ; Blood Pressure ; Body Fluids ; Emergencies ; Heart Rate ; Humans ; Liver Cirrhosis ; Prognosis ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Shock ; Veins ; Vena Cava, Inferior

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Diagnostic Usefulness of a Relative Increase in the Ratio Between D-dimer and C-reactive Protein in Pulmonary Thromboembolism Disorder.

Dong Woo LEE ; Min Seob SIM ; Ik Joon JO ; Hyoung Gon SONG

Journal of the Korean Society of Emergency Medicine.2010;21(1):28-34.

PURPOSE: In spite of its high sensitivity, the D-dimer test has a limited role in diagnosis of pulmonary thromboembolism (PTE) due to its low specificity. This study was designed to evaluate the diagnostic accuracy of an index for PTE with addition of C-reactive protein (CRP) in patients showing increased D-dimer level. METHODS: We carried out a retrospective study in a tertiary emergency department and enrolled patients who did blood sampling for D-dimer and CRP at the same time among patients suspected of PTE between December 2000 and October 2008. PTE was confirmed by imaging studies, chest computed tomography and angiography. We analyzed D-dimer and CRP levels and correlated them with PTE. RESULTS: A total of 362 patients were enrolled; 67 had PTE. Areas under the curve (AUC) of the Receiver Operating Characteristic (ROC) curve of D-dimer for PTE were smaller than those for a relative increase in the ratio of D-dimer to CRP (RDDCRP). CONCLUSION: The diagnostic accuracy of D-dimer for PTE can be increased by normalizing D-dimer levels to CRP levels.
Angiography ; C-Reactive Protein ; Emergencies ; Fibrin Fibrinogen Degradation Products ; Humans ; Pulmonary Embolism ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Thorax

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The Efficacy of Surface and Endovascular Cooling Methods During Therapeutic Hypothermia after Cardiac Arrest.

Won Bin PARK ; Hyuk Jun YANG ; Jin Joo KIM ; Yong Su LIM ; Jae Kwang KIM ; Sung Youl HYUN ; Sung Youn HWANG ; Gun LEE

Journal of the Korean Society of Emergency Medicine.2010;21(1):19-27.

PURPOSE: According to the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, unconscious adult patients with ROSC after out-of-hospital cardiac arrest should be cooled to between 32degrees C and 34degrees C for 12 to 24 hours. Two recent randomized controlled trials that included comatose survivors of cardiac arrest have documented that therapeutic hypothermia improved the neurological recovery. (ED note: Newer cooling devices have recently been introduced, such as endovascular...?)We have introduced newer devices, such as endovascular cooling devices, so we compared endovascular cooling with the previously used surface cooling Methods. METHODS: This is a cohort study of patients with ROSC (>24hours) after cardiac arrest and who were admitted to the intensive care unit in a tertiary hospital over a twentyeight month period from September 2006 to December 2008 and they had received therapeutic hypothermia. The patients'baseline characteristics, the mortality, the neurologic outcomes, the side effects during therapeutic hypothermia and other factors were evaluated according to the cooling methods. RESULTS: Seventy-five patients were included over a 28 month period. Surface cooling methods were used in 37 patients, and endovascular cooling methods were used in 38 patients. There were no significant differences of the mortality and the neurologic outcome according to the cooling methods (p=0.973, 0.937). The time from collapse to reaching therapeutic hypothermia was 587.14+/-384.18 minutes for surface cooling and 496.24+/-213.83 minutes for endovascular cooling (p=0.105). The rewarming time was 451.09+/-229.93 minutes and 802.38+/-209.09 minutes for each cooling method, respectively, and the difference was statistically significant (p=0.002). There were no significant differences of the side effects during therapeutic hypothermia between the surface and endovascular cooling methods. CONCLUSION: Endovascular cooling methods are useful to maintain the target temperature within a narrower range and these methods have the advantage of automatic feedback control of the temperature and controlled rewarming. There were no significant differences in mortality, the neurologic outcome and other side effects between the surface and endovascular cooling methods during therapeutic hypothermia after cardiac arrest.
Adult ; American Heart Association ; Brain ; Cardiopulmonary Resuscitation ; Cohort Studies ; Coma ; Emergencies ; Heart Arrest ; Humans ; Hypothermia ; Imidazoles ; Intensive Care Units ; Nitro Compounds ; Out-of-Hospital Cardiac Arrest ; Rewarming ; Survivors ; Tertiary Care Centers ; Unconscious (Psychology)

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