Patterns of Emergency Department Use During the Korean Doctor's Strike

PURPOSE: From June 20, 2000, to June 24, 2000, for five nationwide hospitals and clinics went on strike in opposition to the government 's policy on the separation of dispensaries from medical practice. The present study examined the present state of medical examination and treatment and the management system of the third medical institution to indicate a model for dealing with such strikes ahead in the future. METHODS: The present state of the medical examination and management system in eight hospitals of the nationwide emergency medical centers was examined. The term of strike, June 20, 2000, to June 24, 2000, for five days, was the subject term; Five weekdays of the week just prior to the strikes and two consecutive holidays, January 1, 2000, and January 2, 2000, were chosen as a contrast group. RESULTS: During the term of strike, the number of patients was larger than it was on the weekdays, but was less than it was on consecutive-holidays. In severity triage, the ratio of emergency patients increased but non-emergency and delayed patients decreased than consecutive-holidays, and the number of medical personnel decreased for all types of visits. The attending hospitals in cases of disease increased, and the ratio of internal medicine, general surgery, obstetrics, orthopedics patients increased than consecutive-holidays level, and the ratio of gynecology, phychiatry, opthalmology patients increased than consecutive-holidays and weekdays level. The ratio of cases in CPR decreased, and deliveries was at the same level as it was on the weekdays. Both radiation tests and emergency tests decreased. CONCLUSION: During a strike, carrying out severity triage and operating emergency outpatient care for non-emergency patients, such as outpatients, may be desirable. Adding emergency-treatment manpower to the areas where the number of patients increased, putting additional nursing and assistance manpower in emergency and operation rooms, providing for administration manning at the consecutive-holidays level, and resetting radiation and examination manpower at the consecutive-holidays level should be considered in managing effectively and emergency medical center.

Changes of Splenocyte Proliferative Capacity and Subpopulation of Peripheral Lymphocytes Related to the Hemorrhage Amount in Rats

BACKGROUND: Hemorrhage itself has been shown to produce abnormalities in immunity, particularly depression of the lymphocyte function. In order to better examine the amount of hemorrhage required to suppress the lymphocyte function, we determined the effect of graded fixed-volume hemorrhage on splenocyte proliferation and the lymphocyte subpopulation. METHODS: Male Sprague-Dawley rats(weight, 350~400g) were anesthetized, subjected to hemorrhages of 7.5ml/kg, 15ml/kg, and 22.5ml/kg by percutaneous cardiac puncture with 26G needles. After 1, 2, 4, and 7 days, animals were killed to obtain the blood and spleen. The splenocyte proliferative capacity was measured by using the tritiated thymidine incorporation technique, and the peripheral lymphocyte subpopulation was determined using flow cytometry with the following monoclonal antibodies: T cell(CD3+), T helper cell(CD4+), T cytotoxic cell(CD8+), and B cell(CD45RA+). RESULTS: Hemorrhage of 7.5ml/kg did not induce depression of splenocyte proliferation. However, for hemorrhage greater than 15ml/kg, the splenocyte proliferative capacity was significantly depressed at 2 days after hemorrhage and recovered at 4 days. Hemorrhage induced no changes in the relative percentage of lymphocyte subpopulations and in the number of each cell in peripheral blood. CONCLUSION: This study suggests that cellular immunity is depressed at 48 hrs after a hemorrhage greater than 15ml/kg without any change in the peripheral lymphocyte subpopulation.

Ketamine Use of Pediatric Sedation in Emergency Room

BACKGROUND: Ketamine use in emergency room has been increased. It has rapid onset of action and appropriate duration of action. It does not need endotracheal intubation and produces potent analgesia, sedation, and amnesia. The object of this study is to determine the safety and the degree of physician's satisfaction in relation to ketamine use. MATERIALS AND METHODS: This is a prospective study using protocol. Pediatric trauma patients who need sedation were given IM ketamine(4mg/kg) and atropine(0.01mg/kg) in a same syringe. Monitoring of patients was done by EM residents and complications of ketamine use were recorded. Physician's satisfaction was also recorded after the procedure. RESULTS: Intramuscular ketamine was administered 54 times, mainly for laceration repair. Physicians completed protocol for 51 of treated children. The median time for onset of sedation was 6.5+/-2.4 min, and duration of action was 32.4+/-10.8 min. Hypersalivation occurred in 9.8%(n=5); random movement 3.9%(n=2), emesis during procedure(n=1), emesis at home(n=1), and transient oxygen desaturation(n=1). All were quickly identified and treated without specific airway management and sequelae. Of 84% of physicians was satisfied with ketamine use for pediatric sedation. CONCLUSION: Intramuscular ketamine can be administered safely and satisfactorily in emergency room to facilitate pediatric procedures in conjunction with a defined protocol and appropriate monitoring.

Incidence and Prediction of Rhabdomyolysis Following Doxylamine Overdose

BACKGROUND: Doxylamine, an antihistamine with sleep inducing property, is the most commonly intoxicated drug in the urban ED. This drug is relatively safe but is known to induce rhabdomyolysis in rare occasion. The purpose of this study is to determine the incidence of rhabdomyolysis after doxylamine overdose and prognostic factors that contributes to this complication. METHOD: This study was conducted from 26 patients admitted to our hospital after doxylamine intoxication during the period from April 1999 to June 1999. Using the protocol made beforehand, the amount ingested, past history, laboratory results were recorded. Rhabdomyolysis was defined as serum myoglobin over 300 ng/mL or serum creatine phosphokinase(CK) over 1,000 IU/L. Data were analyzed using SPSS program with t-test, Fisher's exact test and discriminant analysis. RESULTS: The rhabdomyolysis was diagnosed in 57.7% of patients. The amount ingested per body weight, prehospital vomiting and low arterial pCO2 predicted occurrence of rhabdomyolysis. The sensitivity of serum CK and myoglobin were 67% and 80% respectively and specificity was 100% for both. The diagnosis was possible for CK after an average of 14hr 20min time after ingestion and 8hr 12min for myoglobin. CONCLUSION: Rhabdomyolysis is a common complication of doxylamine intoxication and if the amount ingested was more than 1 tablet(25mg) per body weight, the incidence of rhabdomyolysis was higher. So, CK measurement after 14 hour postingestion and myoglobin after 8 hour is recommended to decide whether rhabdomyolysis occur.

Short-term Revisit to the Emergency Department

BACKGROUND: When patients return to the emergency department shortly after being seen, it is generally assumed that their initial evaluation or treatment was inadequate. But in other aspects many short term revisits may be unnecessary in the aspect of emergency care because it is known that substantial numbers of patients use emergency department for nonemergency problems. So we analysed the tendency and the cause of short term revisit patients, determined the rates and the associated demographic, clinical, disease variables as a tool of quality assurance. METHODS: We carried out a chart review of patients seen in the emergency department, who revisited within 72 hours, of Young Dong Severance Hospital retrospectively between January 1, 1998 and September 30, 1999 (period 2), and compared with result between April 1, 1990 and March 31, 1991 (period 1) respectively. RESULTS: In the period 1, the total revisits patients were 204/21,025(0.97%), in that period scheduled revisits were 15.2%, the unscheduled were 84.8%, and the frequent revisits (more than 3 times) were 6.4%. In the period 2, the total revisit patients were 4,722/72,802 (6.49%), in that period scheduled revisits were 86.3%, the unscheduled were 13.7%, and the frequent revisits were 24.8%. The most common cause of revisit during the period 2 is a drug addictor (31.2%) that frequently used the emergency room for seeking drug. CONCLUSIONS : The scheduled revisit patients for dressing, medication, re-evaluation were increased enormously, so the medical care of these patients might be a part of job that performed in emergency department. And if the health care system could support the adequate nursing care facility, the portion of avoidable revisits of emergency department can be decreased. We also found that the emergency department is an important points for the early identification and referral for the treatment of patients who revisited emergency room for seeking drug, and the analysis of physician related factor in revisits patients may be used as a tool of quality assurance in the emergency department.

The Clinical Application of C-Reactive Protein in Acute Abdominal Pain

BACKGROUND: Abdominal pain is one of the most common complaints in the emergency department and the evaluation presents an extraordinary challenge to the emergency physician's skill. C-reactive protein, an acute phase protein which is increased in the presence of inflammation in various clinical conditions, has been proven useful in assessing disease severity, in monitoring the development of complications, and in evaluating the response to specific treatments. So we tried to determine whether CRP offers an advantage over other clinical or laboratory variables for decision-making in the management of acute abdominal pain in the emergency department. METHOD: Patients who came to a University Hospital ED with acute abdominal pain, between september 1, 1998 and November 30, 1998, were included in this study, Data collection included age, sex, duration of symptom, location of pain, and laboratory dta(white blood cell count, portion of neutrophils, ESR, CRP, amylase). RESULT: This study included 85 patients, 34 of whom were men. The mean age was 36.9+/-19.1 years. CRP might be useful to detect the serious condition, sensitivity 81%, but more useful to differentiate normal condition from serious condition in acute abdominal pain patients, specificity 83%. CONCLUSION: CRP is an useful indicator of decision-making to abdominal patients in the emergency department. Hospitalization or operation is very unlikely when CRP value is normal.

Neuroprotective Effects of Intraischemic(1 hour) Moderate Hypothermia in Gerbil Brain Global Ischemic Model

BACKGROUND: In animal models of cerebral ischemic-reperfusion has been shown to have a beneficial effect. The object of this study is to compare the effect of pathologic findings between normotheimic and moderate hypothermic group. METHODS: We investigated the effect of moderate hypothermia induced 1 hour after transient(10 min) both carotid artery occlusion on the extent of ischemic-reperfusion cell damage in Mongolian Gerbil model. The terminal deoxyribonucleotidyl transferase (TdT) -mediated biotin-16-dUTP nick-end labelling(TUNEL staning) are used to detect apoptosis. RESULTS: 1. We suggest that Core body temperature is down to moderate hypothermia(30-32degrees C) beyond 10 minite by selective bain cooling method in Mongolian Gerbil model. 2. By light microscopy, ischemic-reperfusion damage were detected in the hippocampal CA1 pyramidal layer on the 3 day after transient ischemic insult, which showed chrosomal condensation and cytoplasmic eosinophilia. Ischemic-reperfusion cells were increased in the CA1 region on the 5 day. Apoptotic cells of the CA1 neurons seen by TUNEL staining than ischemic neurons seen by Hematoxylin-eosin staining were investigate 3 and 5 days after ischemic-reperfusion insult. CONCLUSION: We suggest that is not neuroprotective effects of Intraischemic(1 hour) moderate hypothermia in Gerbil brain global ischemic-reperfusion model.

ANALYSIS OF ARTICLES PUBLISHED IN THE JOURNAL OF THE KOREAN SOCIETY OF EMERGENCY MEDICINE

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.

The Analysis of Motorcycle Accident

In Korea, there are about 8 million motor vehicles and one-fourth of it is motorcycle. Last year Korean government report on the motor vehicle accidents claimed 12,781 cases of motorcycle accidents and it account for 5.1% of all of motor vehicle accidents occurred in Korea. But this is too broad analysis and lack of statical values. In general, most of people think motorcycle rider will suffer or die from head injuries sustained with motorcycle accident. Even though mandatory law on wearing helmet during motorcycle ride, but we see too many motorcycle riders not wearing helmet, especially in teenagers. The loss of young person by accident is great loss for family, society and economy of nation. No one will doubt the effectiveness of helmet on reduced incidence of head injuries. And multiple studies from United States of America have clearly demonstrated the benefit of helmets in motorcycle accidents. The following study was undertaken to determine the relationship between head injuries and helmet use in motorcycle accident, as well as analysis of general motorcycle accident.

Comparison of Accuracy of Radiological Diagnostic Tools for Thoracolumbar Bursting Fracture

As regard to the treatment modality and its prognosis following the treatment, there are some differences between the thoracolumbar compression fracture and bursting fracture. If bursting fracture is accompanied by nerve injury, especially if the fracture fragment is compressing the spinal cord, it is reported that decompression with early surgical intervention would achieve a much better prognosis. Therefore, the authors tried to suggest an overall statistics on the patient's age, mechanism of injury and injured site and to compare the sensitivity of tools used in diagnosing bursting fracture radiologically, as well as the sensitivity of posterior vertebral body angle, which is used in diagnosing subtle bursting fracture. Three hundred forty three patients admitted to emergency center of Yongdong Severance Hospital with a thoracolumbar fracture from 1992. Jan. to 1994. Dec. Of the 343 patients, minor fracture and those with insufficient X-ray films and clinical notes were excluded from the study. The study was done with 199 patients in retrospective method. All the 199 patients had plain X-ray and computed tomography taken. the results were as follows 1. The male to female ratio was 114 to 85 with average age being 47.1 years old(14-93 years old). 2. The mechanisms of injury were falling down, traffic accident, slipped down, sprain and confusional injury in the order written. 3. There were 67 cases of compression fracture and 132 cases of bursting fracture. 157 cases had I level injury in the order of Ll, T12, and L2, 33 cases had 2 level injury, and 8 cases were injured in 3 level of the spine. 4. Of the factors determining the radiological diagnosis of bursting fracture, the disruption of posterior cortical line had the highest sensitivity. 5. Of the 45 cases of 1 level injured subtle bursting fracture, those with posterior vertebral body angle of more than 100 degree radiographically had a sensitivity of 82%. Of the thoracolumbar fractured patient admitted to the emergency room, searching for disruption of posterior cortical line in plain film helped in diagnosing bursting fracture, and calculating the posterior vertebral body angle helped in determining whether further computed topography was needed in subtle bursting fracture.

The analysis of discharge against medical advice in the emergency department

No abstract available.

Anti-tetanus antibody titers in Korean

No abstract available.

Emergency department violence

No abstract available.

Overcrowding in emergency department

No abstract available.

Revisit patrients in emergency department

No abstract available.