Journal Detail Information

1

Cite

Share

The Usefulness of Chest and Abdominal CT in Detection of Thoracolumbar Spine Fracture after Multiple Blunt Trauma.

Jung Min JU ; Yong Su LIM ; Jae Kwang KIM ; Hyuk Jun YANG ; Gun LEE ; Wook JIN ; Seong Youn HWANG

Journal of the Korean Society of Emergency Medicine.2003;14(5):646-652.

PURPOSE: To compare the accuracy of spine plain films with chest and abdominal Computed Tomography (CT) for trauma in detection of spine fractures. METHODS: Patients who sustained multiple blunt injury and required both thoraco-lumbar spine plain films and chest or abdominal CT scans were retrospectively identified. Of these 154 patients had both chest CT for trauma and thoracic spine plain films, and 220 patients had both abdominal CT for trauma and lumbar spine plain films. RESULTS: Of the fractures visible at either chest CT or thoracic spine plain film examination, all were diagnosed on CT and 50% on plain films. Of fractures visible at either abdominal CT or lumbar spine plain films, all were diagnosed on CT and 62% on plain films. CONCLUSION: Evaluation of the scanogram and bone windows when a patient has chest and abdominal CT appears to be as accurate as thoracic and lumbar spine films in the evaluation of spinal trauma. Further study is required to determine whether chest or abdominal CT scans routinely replace conventional radiographs of the thoracic or lumbar spine after blunt trauma.
Humans ; Retrospective Studies ; Spine* ; Thorax* ; Tomography, X-Ray Computed* ; Wounds, Nonpenetrating

2

Cite

Share

Early Aberration Reporting System Modelling of Korean Emergency Syndromic Surveillance System for Bioterrism.

Jae Bong CHUNG ; Moo Eob AHN ; Hee Cheol AHN ; Ki Cheol YOU ; Hyun KIM ; Jun Whi CHO ; Young A CHOI ; Eun Kyeong JEONG

Journal of the Korean Society of Emergency Medicine.2003;14(5):638-645.

PURPOSE: This study were designed to supply the opportunity to make a base of emergency syndromic surveillance warning system to detect the bioterrors through the construction of predictive models which were made by reported patients in 'Emergency Syndromic Surveillance System' who were diagnosed as waterborne contagious diseases. METHODS: On this study, we used the neural network analysis methods among the data mining to analyze the reliable variables which was extracted from the reported data bases in the Emergency Syndrome Surveillance System. RESULTS : In this study, we were using the patients data pools from 13th May 2002 to 13th May 2003 in Emergency Syndrome Surveillance System. So we could get the reliable variables - clinical symptoms, severity of patient, humidity and temperature - to predict the waterborne infections. This study shows the successful predictation rate of 96% in error rate of 0.4 with sensible variables through Chisquare analysis and the construction of one hidden layer which is near linearity. CONCLUSION: Early emergency syndromic surveillance warning models made by the neural network in Emergency Syndrome Surveillance System could make the early detection of waterborne infections, could also stop the transmission of waterborne infections in early stage, and furthermore could be used as the preventive and detective methods of bioterror attacks.
Bioterrorism ; Data Mining ; Emergencies* ; Humans ; Humidity

3

Cite

Share

Six Sigma Quality Improvement Process for Cancellation of Reception in the Emergency Department.

Kyung Won LEE ; Jeong Heon LEE

Journal of the Korean Society of Emergency Medicine.2003;14(5):630-637.

PURPOSE: The rate of Cancellation of Reception (CR) in the emergency department (ED) is one scale to determine the quality of emergency care. We applied the six sigma (6sigma) method to emergency care as a quality improvement activity. 6sigma is a disciplined, data-driven approach and methodology for eliminating defects through DMAIC process (define, measure, analyze, improve, control). In fact, the 6sigma method improved process control and reduced customer dissatisfaction with business department in areas such as quality, cost, and service. We reviewed the availability of the 6sigma method for performing quality improvement activities in the ED. METHODS: We surveyed all patients who visited the ED from Oct. 6, 2001, to Oct. 12, 2001 (Measure period). We calculated the rate of CR and evaluated the causes and processes by using the 6sigma method. From Nov. 5, 2001, to Nov. 25, 2001 (Improve period), we controlled the process in the ED, educated the ED healthcare providers, and co-worked with all hospital healthcare providers to reduce the CR rate. RESULTS: During the Measure period, the mean CR rate was 8.5% (2.938 sigma level). We found that the cause of disease did not influence the CR rate. When the 6sigma method was applied, during the Improve period, the mean CR rate reduced to 6.29% (3.079 sigma level). CONCLUSION: We can implement and evaluate quality improvement activities in the ED more scientifically and systematically by applying the 6sigma method. Although it is necessary to monitor the quality of emergency care continuously, we think the 6sigma method will be a useful way to improve quality in the ED.
Commerce ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Health Personnel ; Humans ; Quality Improvement*

4

Cite

Share

B-Natriuretic Peptide (BNP) Assay for Diagnosis of Congestive Heart Failure.

Won KIM ; Won Young KIM ; Yong Taeg JUNG ; Kyoung Soo LIM ; Yun Kyung PARK

Journal of the Korean Society of Emergency Medicine.2003;14(5):624-629.

PURPOSE: Rapid diagnosis of congestive heart failure (CHF) is important for prompt and appropriate treatment, but is often difficult. The B-type natriuretic peptide (BNP) has been described as a powerful diagnostic test for heart failure. The goal of this study was to determine the diagnostic cutoff values of BNP, to evaluate useful factors for the diagnosis of CHF, and to develope a diagnostic algorithm for CHF with acute dyspnea patients. METHODS: BNP levels were obtained in 721 patients presenting to the emergency medical center with acute dyspnea from January 2001 to December 2002. With the use of inclusion criteria, 305 patients were excluded. Blood samples were collected by venipuncture and were analyzed by using Triage BNP assay. Included patients underwent echocardiography to evaluate the left ventricular (LV) dysfunction. RESULTS: The mean BNP concentration was higher in patients with CHF (n=214) than in those with other diagnose (517.31+/-37.70 pg/mL vs 75.53+/-11.25 pg/mL, p<0.001). At a blood concentration of 100 pg/mL, BNP showed a sensitivity of 79 %, a specificity of 83 %, a positive predictive value of 83%, and a negative predictive value of 79%. CONCLUSION: The BNP measurement is a useful tool in the diagnosis of CHF in patients presenting with dyspnea. We propose a diagnostic algorithm for CHF based on the BNP assay.
Diagnosis* ; Diagnostic Tests, Routine ; Dyspnea ; Echocardiography ; Emergencies ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Humans ; Natriuretic Peptide, Brain ; Phlebotomy ; Sensitivity and Specificity ; Triage

5

Cite

Share

The Clinical Analysis on the Altered Mental Status in the ED.

Hon Chol JIN ; Jun Young ROH ; Suk Jin CHO ; Sang Rae LEE ; Sung Jun KIM ; Seok Yong RYU ; Hong Yong KIM

Journal of the Korean Society of Emergency Medicine.2003;14(5):615-623.

PURPOSE: Altered mental status (AMS) is a collective phrase that describes an undifferentiated assortment of disorders of mentation including impaired cognition, attention, awareness, and level of consciousness. Although AMS is a common chief complaint and a frequent issue in the emergency department (ED), the clinical surveys of AMS have not been conducted in Korea. We analyzed the AMS patients on the clinical basis. METHODS: From march 2002 to may 2002, we had enrolled prospectively 256 adult patients who visited the ED of Sanggye Paik Hospital because of AMS. The patients accompanied by AMS clinically were included, excluding patients caused by trauma, cerebrovascular accident with alert mentality. The clinical records were reviewed to analyze the clinical features of AMS, 9 months after discharge from ED. RESULTS: AMS was found in 256 patients which comprised the 2.2% of the ED patients during the test period, and 112 patients were admitted. The most commonly encountered mental status was drowsiness(36.3%), and the overall mortality rate 10.2%. The AMS was caused by neurogenic, metabolic, alcohol-related, psychogenic disorders in frequency accounting for most of AMS etiologies. CONCLUSION: This survey shows that the incidence of AMS is 2.2%, old age increases the rate of admission, and the common etiologies are neurogenic, metabolic, alcohol-related disorders. It seems prudent to approach the patients with AMS on the basis of etiologies and age.
Adult ; Alcohol-Related Disorders ; Cerebrovascular Trauma ; Cognition ; Consciousness ; Delirium ; Emergency Service, Hospital ; Humans ; Incidence ; Korea ; Mortality ; Prospective Studies ; Seizures

6

Cite

Share

Sonography of the Pediatric Acute Abdomen in the Emergency Center.

Tae Kyung KIM ; Kyung Hwan KIM ; Dae Kon SOHN ; Ah Jin KIM ; Hong Yong KIM

Journal of the Korean Society of Emergency Medicine.2003;14(5):610-614.

PURPOSE: Diagnosis of acute abdomen in infants and children is difficult. The aim of this study is to evaluate the usefulness of sonography in the children suffering from acute abdominal pain. METHODS: From January 2001 through July 2002, abdominal sonography was carried out in 265 children who had abdominal pain, vomiting, or irritability. The suspected diagnosis were acute appendicitis, intussusception, congenital pyloric obstruction, inguinal hernia, and illeocolitis. Medical records were reviewed retrospectively for age, sex, sonographic diagnosis, and the impact of the sonography in the treatment was evaluated by comparing the sonographic diagnosis with the final diagnosis (guidance for treatment). RESULTS: Among 265 patiens, the sex ratio (male:female) was 1.7:1. According to the findings of sonographic studies, mesenteric lymphadenitis (40.8%) was the most common diagnosis and was followed by acute appendicitis (21.9%), normal abdomen (19.2%), intussusception (14.3%), ileus (3.4%), and epididymitis (0.4%). In 259 of the 265 patients, sonography helped guideline for treatment (97.7%). CONCLUSION: Sonography is very useful in the diagnosis and establishing the treatment guideline of pediatric patients with acute abdomen.
Abdomen ; Abdomen, Acute* ; Abdominal Pain ; Appendicitis ; Child ; Diagnosis ; Emergencies* ; Epididymitis ; Hernia, Inguinal ; Humans ; Ileus ; Infant ; Intussusception ; Male ; Medical Records ; Mesenteric Lymphadenitis ; Retrospective Studies ; Sex Ratio ; Ultrasonography ; Vomiting

7

Cite

Share

Usage of Noninvasive Ventilator in the Emergency Department.

Seong Kuk KIM ; Soo Hyeong CHO ; Nam Soo CHO ; Meung Ryong KIM

Journal of the Korean Society of Emergency Medicine.2003;14(5):604-609.

PURPOSE: A general analysis of patients in the Emergency Department (ED) and the Intensive Care Unit (ICU) was performed to evaluate the effectiveness of a noninvasive ventilator (NIV) for the effective treatment of patients in respiratory distress without using endotracheal intubation. METHODS: The 38 patients who were treated with a NIV from December 1, 2001, to September 31, 2002, were studied. The ER doctors investigated prospectively sex, age, the causes of disease, the main symptoms, the duration of treatment, the mode of ventilation, the vital signs and the arterial blood gas analysis at the time of admission and after 30 minutes of NIV use, adaptation of patients, complications, and the success or failure of the treatment. RESULTS: 1) General features: Out of 38 cases, 25 males and 13 females, the average age was 60.61 years old. In group X (treatment success), the average age was significantly lower than it was in group Y (treatment failures). 2) The causes of disease and symptoms: The causes of disease were as follows: asthma and chronic obstructive pulmonary disease, 13 patients; drug intoxication, 8 patients; pulmonary edema, 8 patients; respiratory failure, 2 patients; lung contusion, 3 patients; pneumonia, 2 patients. 3) Adaptation and complications: 11 patients adapted well, 18 patients adapted normally, and 11 patients failed. Complications were minimal and included gastric distension in 2 patients and xerophthalmia in another 2. 4)Vital signs and arterial blood gas analysis results: The arterial blood gas analysis performed after 30 minutes in treatment showed improved results, but only the pH had any effect on success or failure. CONCLUSION: NIV had a success rate of 72%. The factors influencing success were surveyed according age, pH level before treatment, pH P a C O2 S a O2 30 minutes after treatment, and adaptation.
Asthma ; Blood Gas Analysis ; Contusions ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Hydrogen-Ion Concentration ; Intensive Care Units ; Intubation, Intratracheal ; Lung ; Male ; Pneumonia ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive ; Pulmonary Edema ; Respiratory Insufficiency ; Ventilation ; Ventilators, Mechanical* ; Vital Signs ; Xerophthalmia

8

Cite

Share

Effect of Standard Cardiopulmonary Resuscitation on Cerebral Blood Flow and Coronary Perfusion Pressure in the Canine Model of Simulated Ventricular Tachycardia.

Yong Soo JANG ; Sung Oh HWANG ; Hyun KIM ; Han Joo CHOI ; Sung Bum OH ; Kyung Cheol CHA ; Sun Hyu KIM ; Ho Jin JI ; Kang hyun LEE ; Seo Young LEE

Journal of the Korean Society of Emergency Medicine.2003;14(5):597-603.

PURPOSE: The purpose of this study was to evaluate the hemodynamic effects of external chest compression in state of the heart's beating. METHODS: Ten mongrel dogs were used in this study. Ventricular tachycardia was simulated by using a rapid ventricular pacing and ventricular rate was adjusted and maintained at the rate necessary to achieve a 50-mmHg fall in the baseline systolic aortic pressure. External chest compression was initiated after 4 minutes of simulated ventricular tachycardia and was continued for 4 minutes. Hemodynamic measurements, including the systolic and the diastolic aortic pressure, the right atrial pressure, the carotid blood flow, and the end tidal CO2 tension, were done at baseline, during the simulated ventricular tachycardia (VT), and during the simulated ventricular tachycardia with external chest compression (VT+ECC). RESULTS: The systolic aortic pressure, the diastolic aortic pressure, and the mean right atrial pressure were higher during VT+ECC than during VT (99+/-12 vs 92+/-8 mmHg, p=0.157, 59+/-8 vs 55+/-12 mmHg, p=0.140, and 23+/-8 vs 8+/-2 mmHg, p<0.001, respectively). The carotid blood flow was higher during VT+ECC than during VT (273+/-203 vs 136+/-76 mL/min., p=0.011). The calculated coronary perfusion pressure was lower during VT+ECC than during VT ( 26+/-8 vs 40+/-9 mmHg, p<0.001). The end tidal CO2 tension was not different between VT+ECC and VT. CONCLUSION: In the canine model of simulated ventricular tachycardia, external chest compression had a contradictory hemodynamic effect, including an increase in the cerebral blood flow and a decrease in the coronary perfusion pressure.
Animals ; Arterial Pressure ; Atrial Pressure ; Cardiopulmonary Resuscitation* ; Dogs ; Hemodynamics ; Perfusion* ; Tachycardia, Ventricular* ; Thorax

9

Cite

Share

Clinical Value of BNP (B-type natriuretic peptides) in Patients with Acute Myocardial Infarction.

Mi Ran KIM ; Sung Chan OH ; Sang Lae LEE ; Seok Jin CHO ; Seok Yong RYU ; Hong Yong KIM ; Sung Jun KIM

Journal of the Korean Society of Emergency Medicine.2003;14(5):588-596.

PURPOSE: This study evaluates the roles and the clinical effects of BNP (B-type natriuretic peptides) in patients with AMI (acute myocardial infarction). METHODS: We prospectively analyzed the cases of 20 patients with AMI who visited the Emergency Department, Sanggye Paik Hospital, during the 3 months from Dec.1 to Feb. 28,2003. We measured the BNP and the cardiac enzyme (CK-MB) at admission and at 1 day, 3 days, and 5 days after admission. The patients were divided according to LV (left ventricular) systolic function, site of infarction, infarct-related artery, 6-hour vascular patency, and pattern of BNP change. We compared the values for the BNP for parameters such as sex, age, risk factors, onset time, cardiac enzymes, ejection fraction, hospital days, and etc. RESULTS : BNP at each time was higher in cases with LVSD (LV systolic dysfunction) than it was in cases without LVSD, but no statistically significant difference etistied among the subgroup. BNP is correlated with the onset time, the hospital days, the ejection fraction, and the presence of LVSD, but not with cardiac enzyme (CK-MB) or with necrotic severity. CONCLUSION: the BNP level of a patient with AMI is a predictive marker of LVSD at any measurement time and reflects the hospital course. Thus, we can use BNP as a prognostic factor of LVSD and stratify the risk of heart failure.
Arteries ; Emergency Service, Hospital ; Heart Failure ; Humans ; Infarction ; Myocardial Infarction* ; Prospective Studies ; Risk Factors ; Vascular Patency

10

Cite

Share

Analysis of Injuries Following the Crash of Chinese Passenger Flight B767-200 During Its Approach to Kimhae Airport.

Sung Kwun KIM ; Jun Young CHUNG ; Seok Ran YEOM ; Suck Ju CHO ; Sun Sik MIN

Journal of the Korean Society of Emergency Medicine.2003;14(5):581-587.

PURPOSE: These days, airline traffic is so developed that the globe has become much smaller and interest in fear of passenger-flight crashes is increasing. Using the opportunity offered by the Kimhae airline disaster, the author studied the relation of the injury mechanism & the seat-position to the injury severity in order to provide helpful information for use in other situations. METHODS: The author performed a retrospective analysis and compared survivors (37 persons) with deaths (129 persons) in the crash of Chinese passenger-flight B767-200 approaching Kimhae airport on April 15, 2002. RESULTS: Most of the survivors were seated in the rear of the airplane while most of those who died were in the front. Thus, a definite correlation exists between seat position in the aircraft and the injury severity. The deceleration force generated during a flight crash is sufficient to induce fatal injury. CONCLUSION: Most flight crashes are due to CFIT (controlled flight into terrain) accidents which are caused by the pilot being insensible to safety. This time, it was also the case. The author wishes it not to be the case next time.
Aircraft ; Airports* ; Asian Continental Ancestry Group* ; Deceleration ; Disasters ; Gyeongsangnam-do* ; Humans ; Retrospective Studies ; Survivors

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share