ABSTRACT
PURPOSE: In pediatric intubation, it is difficult to select the correct tracheal tube size and proper depth. Children have as many different tube size as they have ages. This study was performed to evaluate the Pediatric Advanced Life Support (PALS) guideline for intubation in Korean children. METHODS: We studied pediatric patients who were admitted with intubation from 1996 to 2001 at our hospital. We selected 33 Korean patients under 15 years of age for evaluation in this study. Their medical records and chest radiographs were compared. The distance of the tracheal tube tip from the carina on the postintubation chest X-ray was determined. RESULTS: Thirty-three patients were enrolled in the study. The depth of tracheal intubation was proper in 12 patients (36.3%), too deep in 16 patients (48.4%) and too shallow in 5 patients (15.1%). The reasons for intubation were respiratory failure (24.2%), mental change (57.6%) and status epilepticus (18.1%). CONCLUSION: We conclude that the PALS guideline for tracheal intubation is not suitable for Korean children. Determination of the proper depth of tracheal intubation for Korean children is needed through further study.
Subject(s)
Child , Humans , Intubation , Medical Records , Radiography, Thoracic , Respiratory Insufficiency , Status Epilepticus , ThoraxABSTRACT
Foreign bodies in the gastrointestinal (GI) tract can be seen in all age groups and is not uncommon to see in the emergency department. Most are pediatric, edentulous, incarcerated and/or psychiatric patients. Since ingested objects are expected to pass spontaneously in 80% to 90% of patients with normal anatomy, direct foreign body removal using surgical intervention is rarely required. However, an ingested toothpick is of surgical interest as a cause of significant morbidity and even mortality. This is due to the difficulty in preoperative diagnosis resulting from a lack of history of ingestion of the toothpick and to the toothpick's radiolucent qualities. We report the case of a patient with peritonitis due to perforation of the sigmoid colon, a complication of accidental ingestion of a toothpick, that was diagnosed at the surgical field. Related literature is reviewed together.
Subject(s)
Humans , Colon , Colon, Sigmoid , Diagnosis , Eating , Emergency Service, Hospital , Foreign Bodies , Mortality , PeritonitisABSTRACT
BACKGROUND: To the emergency physician, issuing a death certificate is becoming a burden as the DOAs(Deaths on Arrival) have increased in recent years. We analyzed the agreement on the causes of death issued by emergency physicians and attempted to find out whether emergency physicians complied with the guidelines for issuing death certificates. MATERIAL AND METHOD: A survey questionnaire containing twelve pre-selected DOA cases which were supplemented with relevant past medical history and physical examination was used. The cases, with varying causes of death, were chosen from the medical records of DOA patients who presented to the emergency department at Severance Hospital, Yonsei University College of Medicine, from January 1997 to December 2000. The questionnaires were sent to 60 emergency physicians(22 specialists and 38 residents) at 22 university-affiliated teaching hospitals and 2 general hospitals across the nation. They were asked to identify the most probable direct cause of death for each of the 12 cases. The same questionnaire was sent to medical examiners at the National Institute of Scientific Investigation and to a Korean emergency physician at Albert Einstein College of Medicine in New York, USA. We also included an open question about the optimal age for the use of 'senility' as a cause of death. RESULTS: All 60 emergency physicians responded to the survey. The average number of causes of death per case was 9.7(7~14). The range of concordance of causes of death was 23.3% to 66.6%. Out of a total of 720 causes of death given by the emergency physicians, 35(4.9%) failed to adhere to the death certification guidelines. Also, 210 causes of death were not listed in the Korean classification of standard causes of death. Interestingly, the medical examiner answered 'unknown etiology' and the emergency physician in the USA answered 'cardiopulmonary arrest' or 'respiratory arrest' in most cases. Regarding 'senility' as a cause of death, 22 physicians(36.7%) thought the optimal age was over 80 years. CONCLUSION: A significant lack of agreement exists in determining the cause of death for the DOA patients arriving at emergency departments. Therefore, an all-out effort is essential to find ways to improve and resolve this situation. As the death certificate is a legal document and a basis for vital statistics, emergency physician should seek a rational consensus to improve and resolve these inconsistencies.
Subject(s)
Humans , Cause of Death , Certification , Classification , Consensus , Coroners and Medical Examiners , Death Certificates , Emergencies , Emergency Service, Hospital , Hospitals, General , Hospitals, Teaching , Medical Records , Physical Examination , Surveys and Questionnaires , Specialization , Vital StatisticsABSTRACT
To raise the quality of research, medical articles which are feasible and objective must be continuously published and be continuously monitored. All articles published in the Journal of the Korean Society of Emergency Medicine from November, 1990 to November, 1995 were compared with a foreign emergency medical journal, the American Journal of Emergency Medicine(AJE). Classifying the articles in the Journal of the Korean Society of Emergency Medicine, there were 15 (8.4%) review articles, 145 (81.0%) original articles and 19 (10.6%) case reports. In the AJE, there were 103 (15.1%) review articles, 304 (44.4%) original articles and 277 (40.5%) case reports. Classifying the original articles in the Journal of the Korean Society of Emergency Medicine, there were 13 (9.0%) experimental articles, 88 (60.7%) descriptive articles and 44 (30.3%) analytic articles. In the AJE, there were 40 (13.2%) experimental articles, 59 (19.4%) descriptive articles and 205 (67.4%) analytic articles. The classification of original articles according to frequency in the Journal of the Korean Society of Emergency Medicine is trauma, resuscitation, toxicology and medical emergency, where as the AJE is medical emergency, trauma, toxicology and EMS. For statistical methods used in original articles, 90 (62.1%) case did not do any statistical analysis or where only descriptive statistics were used. In 6 (4.1%) cases the statistical level was described but statistical methods were nonmentioned. By simple classification study, there were 44 (30.3%) cases of original articles in the Journal of the Korean Society of Emergency Medicine, and 6 (2.0%) cases in the AJE. Because the development of Emergency Medicine as a special department is based on logical articles, organization of articles have study design, make hypothesis, sample gathering, statistical analysis and feasibility of conclusion. For this, the emergency training course needs a course on research methodology.