A Report for the Research about the Accuracy of a flow Regulator

PURPOSE: The supply of fluids is a major consideration in modern medicine. When fluid is needed, flow regulators are extensively used. But no research or study of flow regulators has yet been performed in Korea. We researched the accuracy of flow regulators that are commonly used in domestic medicine. METHODS: We collected and studied the fluid pumped for an hour through four kinds of flow regulators that are used domestic ally. Infusion rates were 10, 20, 30, 40, 60, 80, 100, 150, and 200 ml/hr. For each rate, the height of the fluid between the point of infusion and the outlet was evaluated in 10 cm increments within the range 30 cm to 120 cm. RESULTS: Among the four products tested, one product injected the fluid three times at the standard height of 80~100 cm, an error of <10%. Two other products injected within the standard range once each, and the fourth product failed to inject within range even once. CONCLUSION: The accuracy of flow regulators in the domestic market was exceedingly low.

An Analysis of Prehospital Care by 119 Rescue Services

PURPOSE: We analysed the prehospital care and property of field triage for quality improvement. METHODS: A retrospective study of 623 case who were selected every five other day(1, 6, 11, 16, 21, 26) and visited emergency center of Hangang Sacred Heart hospital by 119 rescuer from January 2002 to December 2003 was made using triage and management at field and during transport. The research compared 119 transport chart with emergency medical recording. RESULTS: There were 350 male(56.2%) and 273 female(43.8%). Non-triage patient were 432 cases(69.3%). Finding from the crosstabulation analysis between 119 transport chart and emergency medical record reveal that 93 cases were overstimated, and 23 cases were understimated in mental status evaluation by 119 rescuer. Adequate prehospital treatment were 151 cases. CONCLUSION: The property of mental status evaluation by 119 rescuer was nearly correct, but the triage and management were not.

Investigations of the Air Volume for a Tracheal Tube Cuff in a Tracheal Models

PURPOSE: It is recommended that the cuff is inflated with about 10 ml air because cuff pressure is maintained from 25 cmH2O(=18.39 mmHg) to 40 cmH2O(=29.424 mmHg). This study is performed to evaluate the air volume of highvolume and low-pressure cuff during maintaining appropriate pressure. METHODS: The tracheal models are hexahedral structures were made of monomer Cast Polyamide with a whole diameter from 10 mm to 30 mm at 1mm interval each. They were 1/100 with accuracy. Intubation tube were Hi-LoT M (Mallinckrodt, Athlone, Ireland), high-volume low-pressure cuff tube. The diameter of tubes was from 5.0 mm to 8.0 mm at 0.5 mm interval each. Cuff pressure was measured with cuff pressure control (Tracoe(R), Mains, Germany). Inflated cuff volume is measured by plastic syringe (Becton-Dickson Korea, Seoul, Korea) in maintaining recommended cuff pressure. Volume measurements were twice by each different tester. RESULTS: There were considerable volume differences between each tube size and each model. The bigger trachea model diameter was, the more intracuff air volume was. There was the least volume difference in 5.5 mm intubation tube size (3.5~11.5 ml). There was the most difference in 7.5 mm intubation tube size (3.5~19.5 ml). Totally, the maximum air volume was 22.3 ml, the mininum air volume was 1.5 ml. The difference was 20.8 ml. CONCLUSION: The inflated volumes of cuff in proper cuff pressure were considerably different by the diameter sizes of tracheal models and tube sizes. Therefore, it will be more convenient and safe to use device for maintaining cuff pressure properly.

Korean Multicenter Study of Te tanus Antibody Titer (KoMUST)

PURPOSE: We determine the Korean antibody titer and positive rate of tetanus by using a with qualitative test (ELISA) and a quantitative test (TQS(R)). METHODS: This study was prospective collecting study with uncontolled patients who were admitted in 21 Emergency Departments during 3 months in South Korea. We measured TQS(R) and collected the serum with a centrifuge for 5 groups, which was classified with age: 2~10 years (I), 11~20 years (II), 21~30 years (III), 31~40 years (IV), 41~60 years (V), in each hospital. The freezed serum and the protocol with TQS(R) results were taken at the Soonchunhyang University Bucheon hospital to be analyzed. RESULTS: The number of enrolled patients was 1816 (male 58%). The positive rate of TQS(R) was 835 patients (46%), and there was no relation with region or sex. In sex and age, there was a definitive decline in the group III fort males and females. The results of ELISA was showed that 62.8% (> 0.15 IU/ml) and 52.2% (> 0.2 IU/ml) had protective levels of tetanus antibody. The proportion decreased to approximately 43% and 18% among persons 40~60 years of age at each level of antibody titers. By region and population, there was no statistical relationship with TQS(R) and ELISA, but previous military service was associated with a higher prevalence of protective antibodies to tetanus (p<0.001). CONCLUSIONS: A substantial portion of adults in South Korea do not have antibody levels that are protective against tetanus. Also, the mean level of tetanus antibody titers was definitively lower than those of other developed conturies and consistently decreased with aging. Therefore, an adult formulation diphteria and tetanus toxoid every 5 or 10 years is recommended for all adults between 20 and 60 years of age after being tested with TQS(R) in South Korea.

Investigations of the Amount of Air and the Pressure for a Tracheal Tube Cuff

PURPOSE: After intubation, it is recommended that, to sustain airway patency, about 10ml of air be infused to seal the airway and to prevent complications. At this step, sustaining a proper pressure level (18~24 mmHg) is most important because excessive pressure can cause diverse complications. We carried out a series of investigations to find a way to sustain a constant pressure level. METHODS: We gathered the cases of intubated patients for 6 randomly selected days during 2003 at HanGang Sacred Heart Hospital. Included were cases from emergency room, the intensive care unit, and the operating rooms; 30 cases were enrolled for this investigation. We used a cuff pressure control REF 701 (Tracoe(r), Mainz, Germany) to trace the cuff pressure. First, we measured the amount of air that was infused into the cuff and the cuff pressure. Then, we measured the amount of air after a proper level of cuff pressure had been achieved. RESULTS: We have found that out of the 30 cases investigated the recommended pressure level was maintained in 4 cases. The average cuff pressure was 40.9 mmHg with 10.2 cc of air and 69.0 mmHg, the largest value, was reported in one case. However, when recommended pressure level was maintained (18 mmHg), the average amount of air was reduced to 7.9 cc. CONCLUSION: The results reveal that it may not be possible to sustain the recommended pressure level by "infusing about 10 ml of air,"and that may cause complications.

Investigation of the Tracheal Luminal Diameter in Koreans by using Chest Computed Tonography

PURPOSE: It is important that the internal pressure of a cuff be sustained at a constant level (18~25 mmHg). If not, complications may result. Because the space for the intrusion of the cuff is limited, the pressure should be determined by the amount of air in the cuff and the tracheal luminal diameter. Since very limited studies of the tracheal luminal diameter in Korea exist, in this study, we report the relationships between the tracheal luminal diameter and other variables such as age, gender, pulmonary disease, and chronic obstructive pulmonary disease. METHODS: This study was based on chest CT cases at HanGang Sacred Heart Hospital in 2002. We retrospectively reviewed the charts of the 102 patients included in this study. The mean luminal diameter of the anterior-posterior(AP) and the transverse diameters were our dependent variables, and those diameters were checked by two investigators in each case. RESULTS: The average mean luminal diameter was 17.0mm, and the range of the mean luminal diameter was from 9.0 mm to 27.5 mm. The mean value for men was 18.3mm, and that for women was 15.1 mm, and the difference proved to be statistically different from zero (p<0.01). The luminal diameter is significantly different between COPD (m=19.0 mm) and non-COPD (m=17.0 mm) cases and the difference was statistically different from zero for all the statistics adopted in this study. CONCLUSION: This study found that the size of the luminal diameter was significantly different between two groups: men and women, and COPD and non-COPD cases. Despite the seminal findings of the present study, this study has several limitations.

A Case of Delayed Airway Obstruction Associated with Prevertebral Hematoma and Cervical Vertebra Fracture

Neck trauma can result in a spectrum of injuries and complications ranging from incidental to life threatening, including hemorrhagic shock, acute neurologic injury, and airway obstruction. A prevertebral hematoma associated with a cervical vertebra fracture is not a common condition, moreover, in such cases, airway obstruction is rare. If this condition occur, it may very fatal that can producing hypoxia, cyanosis, acidemia, hypoxic brain damage, and then death. For this reason, the attending physitian must careful observation and protect the airway until the hematoma is reduced and other complications relieved. Recently, we experienced a case of airway obstruction induced by cervical vertebra teardrop fracture (C5). The hematoma progressed slowly and then progressively; Finally it compressed the airway. So we present this case with a reviews of the literature.

Analysis of Victims of the Fire that Broke Out at a Beer Bar in Inchon

PURPOSE: This study was conducted to develop field triage, transportation, distribution, and prehospital care at a fire disaster by analyzing the victims of the fire that broke out at a bar in Incheon. METHOD: We analyzed the cases of the victims of a fire in Incheon in Oct. 1999. We determined the primary care hospital, the arrival time, the burn size, the outcome, and the injury type from the medical records, the concerned organ records, and interviews with concerned persons. RESULT: The total number of victims was 137: 56 prehospital deaths, 1 hospital death, and 80 survivals. The Pearson correlation coefficient between the burn size and the severity was -0.175. There were 121 (89.6%) cases of inhalation injury, 59 (43.7%) cases of flame burns, 66 (48.9%) cases of hypoxic brain damage, and 16 (11.9%) cases involving other types of injury. CONCLUSION: The causes of death of the fire victims were inhalation injury and hypoxic brain damage due to CO poisoning and other toxic inhalants. We propose the use of a simple triage and rapid treatment (START) system and a reassessment the delayed category in fire disasters.