Equipment for Difficult Airways in 67 Korean Academic Emergency Departments

PURPOSE: In Korea, there has been no research about the devices that are used for dealing with difficult airways in emergency departments (ED). This study reports the results of the first research of this kind, assessing the equipment in Korean EDs that is used to manage patients with difficult airways. METHODS: We surveyed 92 EDs via the Internet from October 2007 to March 2008. All respondents were asked if they have the following categories of devices in their EDs; alternative intubation devices, alternative rescue ventilation devices, and surgical airway devices. Alternative intubation devices were defined as devices that do not use a direct laryngoscope for tracheal tube insertion. Alternative rescue ventilation devices were defined as ventilation devices that do not use a face mask. Surgical airway devices were defined as devices that use a surgical technique for the placement of endotracheal tube. RESULTS: We obtained data from 67 of the 92 (72.8%) EDs we contacted. Of those, 32 (47.8%) EDs have at least one alternative intubation device, 52 (77.6%) EDs have at least one alternative rescue ventilation device, and 59 (88.1%) EDs have at least one surgical airway device. A total of 30 (44.8%) EDs have equipment in all 3 categories, but 4 (6.0%) EDs do not have any equipment for dealing with difficult airways. The most common alternative intubation device was a flexible fiberscope (29.9%). CONCLUSION: The possession of devices to deal with difficult airways varies across EDs. It seems that not all Korean EDs have enough devices for difficult airways.

Effect of Emergency Auto-Consultation System (EACS) on Length of Stay of Specialty Consultation Patients in the Emergency Department

PURPOSE: The length of stay (LOS) for patients in the emergency department (ED) provides an important measure of both ED overcrowding and patient satisfaction. Specialty consultation is one of the major factors that contributes to longer LOS. The aim of the study was to examine the effectiveness of a computer-based emergency auto-consultation system (EACS) in reducing additional LOS caused by specialty consultation. METHODS: The EACS was developed for use in managing specialty consultation in the ED. Each clinical department provides a daily list of 4 residents and 1 specialist as the doctors on duty. The ED doctors then use the EACS to contact the departments required for a specialty consultation: Clicking the department's name on the computer screen activates the short message service (SMS) calling system, which sends a message with the registration numbers and names of the relevant patients every 10 min to the mobile phones of individuals assigned as doctors on duty, in the order listed. The doctors who receive the SMS are asked to arrive at the ED within 10 minutes. If the the firstlisted doctors on duty do not show up in 10 minutes, an SMS is sent to the next group of doctors on duty on the list. In 50 minutes, therefore, 5 groups of doctors on duty will have received the SMS in the order listed. Each clinical department estimated the response time of doctors on duty 2 months before the adoption of the EACS versus afterward. The LOS of patients admitted to the ED was also compared before and after the adoption of the EACS. A questionnaire was used to survey the health professionals working in the ED about the changes in the intensity of labor and the needs of the EACS. RESULTS: The number of patients participating in the study were 2,035 and 2,216, respectively, before and after the adoption of the EACS. The EACS significantly decreased both the response time of doctors on duty (34.8+/-35.5 min vs. 9.7+/-16.8 min, p=0.000) and the LOS (155.3+/-126.7 min vs. 144.6+/-110.7 min, p=0.003). In the survey, 44.7% of ED health care professionals responded that their intensity of labor were improved, and most of them agreed that the EACS should be required in the ED. CONCLUSION: The computer-based EACS decreased LOS by reducing the response time of doctors on duty, and it also increased satisfaction among the ED health professionals.

Prospective Multi-center Evaluation and Outcome of Cardiopulmonary Resuscitation for Victims of Out-of-Hospital Cardiac Arrest in Seoul

PURPOSE: To evaluate the quality of prehospital CPR (cardiopulmonary resuscitation) performed by 119 rescue personnel and bystanders in Seoul and to recognize the present problems in the pre-hospital emergency medical service system (EMS). METHODS: We enrolled all patients in cardiac arrest visiting the emergency rooms of 9 university hospitals in Seoul via 119 rescue services from 16 October to 26 November 2006, prospectively investigating the environments in which arrest occurred and the factors associated with CPR. RESULTS: Among 73 patients, the most common place of arrest was in the home(45.2%), CPR by bystander was performed in 8 cases(10.7%), endotracheal intubation by EMS personnel was performed in 10 cases(14.1%). Average time from call to CPR was 11.9 minutes and the number of discharges alive was 3 cases(4.1%). CONCLUSION: To improve the rate of alive discharges, development of CPR education program for lay rescue, education in basic and advanced life support, and management of quality for EMS personnel are needed.

Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score II in Predicting Hospital Mortality of Neurosurgical Intensive Care Unit Patients

We study the predictive power of Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) in neurosurgical intensive care unit (ICU) patients. Retrospective investigation was conducted on 672 consecutive ICU patients during the last 2 yr. Data were collected during the first 24 hours of admission and analyzed to calculate predicted mortality. Mortality predicted by two systems was compared and, multivariate analyses were then performed for subarachnoid hemorrhage (SAH) and traumatic brain injury (TBI) patients. Observed mortality was 24.8% whereas predicted mortalities were 37.7% and 38.4%, according to APACHE II and SAPS II. Calibration curve was close to the line of perfect prediction. SAPS II was not statistically significant according to a Lemeshow-Hosmer test, but slightly favored by area under the curve (AUC). In SAH patients, SAPS II was an independent predictor for mortality. In TBI patients, both systems had independent prognostic implications. Scoring systems are useful in predicting mortality and measuring performance in neurosurgical ICU setting. TBI patients are more affected by systemic insults than SAH patients, and this discrepancy of predicting mortality in each neurosurgical disease prompts us to develop a more specific scoring system targeted to cerebral dysfunction.

Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score II in Predicting Hospital Mortality of Neurosurgical Intensive Care Unit Patients

We study the predictive power of Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) in neurosurgical intensive care unit (ICU) patients. Retrospective investigation was conducted on 672 consecutive ICU patients during the last 2 yr. Data were collected during the first 24 hours of admission and analyzed to calculate predicted mortality. Mortality predicted by two systems was compared and, multivariate analyses were then performed for subarachnoid hemorrhage (SAH) and traumatic brain injury (TBI) patients. Observed mortality was 24.8% whereas predicted mortalities were 37.7% and 38.4%, according to APACHE II and SAPS II. Calibration curve was close to the line of perfect prediction. SAPS II was not statistically significant according to a Lemeshow-Hosmer test, but slightly favored by area under the curve (AUC). In SAH patients, SAPS II was an independent predictor for mortality. In TBI patients, both systems had independent prognostic implications. Scoring systems are useful in predicting mortality and measuring performance in neurosurgical ICU setting. TBI patients are more affected by systemic insults than SAH patients, and this discrepancy of predicting mortality in each neurosurgical disease prompts us to develop a more specific scoring system targeted to cerebral dysfunction.

Incidences of Lower Extremity Injuries in Korea

PURPOSE: We conducted this retrospective epidemiological study to assess the incidence and severity of lower extremity injuries in Korea METHODS: For this study, we retrospectively reviewed nationwide lower-extremity injury data compiled from 2001 to 2003 based on the National Injury Database, what included National Health Insurance Corporation (NHIC), Car Insurance, and Industry Insurance data. Data were standardized in terms of demographic characteristics, region, and socioeconomic status by using NHIC data. To assess the degree of the injuries, we used the Modified Abbreviated Injury Scale (MoAIS), what has been changed from the International Classification of Disease-10 (ICD-10) code. By using the Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS), we classified the degree of severity into four categories: mild, moderate, severe and critical. RESULTS: From 2001 to 2003, lower extremity injuries increased slightly, with a yearly average of 2,437,335. Insurance data should that lower-extremity injuries were the most common, followed by upper-extremity injuries. Significant difference were seen in the numbers of lower extremity injuries based on gender and age. As for provinces, Seoul and Gyeongi provinces had the highest numbers of cases. Junlabukdo had the highest rate of 55,282 cases per 1 million people for standardized gender and population. The annual incidence of the insured patients with lower extrimity injuries was higher than the employer's medical insurance contributions to the medical insurance program. Daily cases occur most often in May and June, with the lowest occurrences being in January and February. CONCLUSION: The result of this study shows that lower extremity injuries comprised common cause of all injuries. In addition, differences associated with gender, location and socioeconomic status were observed. Further studies are needed to find reasons and then this knowledge will allow strategies to prevent the lower extremity injuries.

The Epidemiologic Characteristics of Drowning in Korea

PURPOSE: In spite of preventive measures and excellent prognosis with immediate treatments, drowning and drowning- related injuries remain as one of the leading causes of accidental death in Korea. However, abundant statistical data for drowning has yet to be collected. Thus, this study aimed to describe the epidemiologic characteristics of drowning in terms of demographic characteristics, geopolitical factors and socio-economic status. METHODS: This study was conducted with drowning patients who either visited hospitals or died between January 2001 and December 2003. Of these patients, we enrolled individuals registered for such coverages as automobile insurance, national health service and work injury insurance and we reviewed death records reported to the Korea National Statistical office. NISS (New Injury Severity Scale) and EMR-ISS (the Excessive Mortality Ratio -adjusted Injury Severity Score) values were calculated for each patients and the results were classified 4-into four different severity groups. After analysis, we drew conclusions in terms of year, gender, age, region, insurance type, daily rate of incidences and severity. RESULTS: The incidences of drowning-related injury were 2,486 in 2001, 2,364 in 2002, and 2,595 in 2003 (average of 2,482). The average annual death were 1,954. Victims were more likely to be male and especially high incidence rates were found for two groups: (1) Children aged 5-9 years, (2) Adults aged 40 and older. Seoul and Gyeonggi had the largest total numbers of injury cases, while JeJu had the highest per capita incidence rate (106 per 1,000,000 population). The seasonal distribution of incidence rates showed that predictably, incidents were most frequent between the beginning of July and September. CONCLUSION: The average number of incidents was 55.73 per 1,000,000 population, which constitutes approximately 0.02% of all injuries. Based on this data, we recommand continuing studies and further evaluations in order to develop specific measures to combat drowning.

Ruptured Cerebral Aneurysm without Subarachnoid Hemorrhage: Who needs angiography? / 대한뇌혈관외과학회지

OBJECTIVE: Ruptured intracranial aneurysms usually present as a subarachnoid hemorrhage (SAH), but are sometimes associated with intracerebral hemorrhage (ICH), intraventricular hemorrhage (IVH), or subdural hematoma (SDH). However, the presentation of a ruptured aneurysm without a SAH is quite unusual. We describe nine such cases and highlight some easily overlooked, but important clinical features. METHODS: Among 341 patients diagnosed with ruptured cerebral aneurysms during the past 4 years, 9 patients exhibited non-SAH bleeding on admission, as revealed by brain computed tomograms (CT). On these 9 patients, the characteristic features were reviewed using medical charts, emergency room notes, and radiographic findings. RESULTS: The incidence of aneurysmal rupture without SAH was 2.6%. Eight patients exhibited ICH, and among them, an IVH occurred in one patient and a SDH in two patients. The initial clinical grade was grave in 8 patients, and a favorable outcome occurred in 4 patients. All of these aneurysms arose from the anterior circulation (the circle of Willis in two patients, and distal aneurysms in seven patients). The causes of the aneurysms were spontaneous in four patients, trauma in two patients, infective endocarditis in two patients, and moyamoya syndrome with a history of craniotomy and clipping in one patient. In three patients, additional intervention was required because the initial radiographic images did not reveal a ruptured aneurysm. CONCLUSION: Ruptured aneurysms should be suspected in cases of unexplained intracranial bleeding, even if SAH is not present on the initial CT scan, because most patients exhibit a poor neurologic grade. Therefore, careful interpretation of the clinical and radiologic culprits and timely management should be provided to achieve total occlusion.

Incidences of Upper Extremity Injuries in Korea

PURPOSE: This study was conducted to assess the frequency and severity of upper extremity injuries in Korea through a retrospective epidemiological study. METHODS: For this study, we retrospectively reviewed nation-wide upper extremity injury data compiled from 2001 to 2003 from the National Injury Database, which includes the National Health Insurance Corporation (NHIC), Car Insurance, and Industry Insurance. NHIC consists of the medical aid population, the self-employed insured population and the employer-insured population. Data was standardized in terms of demographic characteristics, region and socioeconomic status by NHIC. To assess the degree of the injuries, we used the International Classification of Disease-10 (ICD-10) code and the Modified Abbreviated Injury Scale (MoAIS). Afterwards, we classified the degree of the severity into 4-four categories-mild, moderate, severe and critical- using the Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS). RESULTS: Frequency of cases of upper extremity injuries per 1,000,000 persons was 58,663, and the incidence rate is 26.9% of total injuries. In fact, the incidence rate remained stable. Yet, there was a steady increase in total injuries from 2001 to 2003. Injuries in men outnumbered women regardless of the severity. In terms of severity, mortality was higher for the elderly aged 60 and over. The Seoul and Kyeonggi-areas showed the highest incidence rate while Jeju was the lowest. Furthermore, injuries were more frequent among the medical aid population. The daily incidence rate for non-critical cases was higher in the months of June, September and October. CONCLUSION: The data indicated that upper extremity injuries comprised a major portion of all injuries. Moreover, the result were affected by differences in gender, location and socioeconomic status. All in all, it is critical that sophisticated research and clinical data be compiled in order to develop more effective prevention strategies.

The Study of Accuracy of Death Statistics

PURPOSE: In order to examine the accuracy of death statistics, the present study compared the underlying causes of death on death certificates with the underlying causes of death published by the National Statistical Office. METHODS: A retrospective survey was performed comparing death certificates issued by a university hospital for one year in 2003, the dead patients' medical records, and death statistics for 2003 published by the National Statistical Office. We compared the underlying causes of death on death certificates, the underlying cause of death as classified by the National Statistical Office, and the underlying causes of death in medical records, in order to analyze their degree of coincidence and the causes of any inconsiste RESULTS: The inconsistency rate between the underlying causes of death as listed on death certificates and the underlying causes of death in the published statistics was 26%. The most frequent reason for discrepancies was a switch from one diagnosis name to another (58.7%), and the next most frequent was a change from the general categories of death due to old age or unknown cause to a diagnosis name (41.3%). The inconsistency rate between the actual underlying causes of death and the underlying causes of death on death certificates was 18.9%, with the most frequent reason for inconsistency being the recording of an uncertain cause of death such as old age or unknown cause (53.3%), and next most frequent being the recording of an interim result as the underlying cause of death (38.7%). The inconsistency rate between the underlying causes of death in medical records and the underlying causes of death in statistics was 8.1%: the most frequent reason for inconsistency was a change to a diagnosis name irrelevant to the patient's underlying disease (60.9%). and next most frequent was a change of the patients' underlying disease to one that was not related to the patient's death (34.4%). The proportion of cases with concordance between the underlying cause of death on the death certificate and the actual underlying cause of death, but with discrepancy between the actual underlying cause of death and the underlying cause of death in statistics, was 6.2%. Inconsistency both between the underlying cause of death listed on the death certificate and the actual underlying cause of death and between actual underlying cause of death and the underlying cause of death published in statistics occurred in 11.3% of cases, marking a significant difference. CONCLUSION: The overall accuracy rate of statistics on the causes of death was 91.9%, and the concordance rate between the actual underlying causes of death and the underlying causes of death in published statistics was high whenever death certificates were issued listing the actual underlying causes of death.

Development and Pilot Applications of Simulation-Based Comprehensive Emergency Airway Management Courses

PURPOSE: Adequate training in managing the emergency airway requires a comprehensive learning program and training using an integrated simulator can facilitate such a comprehensive learning experience. This report describes two pilot simulation-based comprehensive emergency airway management (EAM) courses that we developed and ran, primarily for emergency medicine residents and nurses in an emergency department. METHODS: We developed two simulation-based comprehensive EAM courses. Six-hour advanced and full-day basic courses were consisted of pre-test simulations, plenary lectures, small-group hand-on workshops, cadaver workshops, realistic patient simulations using a moderatefidelity integrated simulator, and course evaluations. Participants evaluated the programs using a five-point Likert scale and open comments were also encouraged. RESULTS: Fifteen trainees participated in a pilot advanced course and a total of 48 trainees participated in two pilot basic courses. The evaluation scores of the advanced course were as follow: quality of content, 4.30+/-0.74; clinical utility, 4.63+/-0.56; quality of facility, 4.73+/-0.44; quality of faculty, 4.66+/-0.49; and time allocation, 4.01+/-0.94. For the basic courses, the score were: quality of content, 4.55+/-0.54; clinical utility, 4.50+/-0.59; quality of facility, 4.59+/-0.54; quality of faculty, 4.64+/-0.64; and time allocation, 4.25+/-0.85. Overall response to the courses was very positive with many trainees described the course as filling an important void in their training in EAM. The most common request was for more time for skills training and simulation experiences. CONCLUSION: The simulation-based comprehensive EAM program is a very useful way to integrate individuals' knowledge and skills into the context of managing the emergency airway. Continuous education along with additional efforts to develop various simulation scenarios and performance checklists are recommended.

A Preliminary Study of Gender Difference on Clinical Presentation of Acute Ischemic Stroke: A Single Center Study

PURPOSE: To attain improvement in prognosis of patients suffering acute ischemic strokes (AIS), it is crucial to diagnose these swiftly and accurately. It is generally believed that female patients have a less favorable outcome, but there has not yet been sufficient data to confirm this opinion. The authors herein conducted a study to determine whether the symptoms of AIS differ between males and females. METHODS: A retrospective study was conducted on 322 consecutive patients who were diagnosed with AIS on the basis of MRI findings during the last two years. Demographic findings and clinical features were collected from emergency room records in order to evaluate gender differences. RESULTS: There were 148 female patients (45.8% of total) in our study, and the average age of affection for females was significantly higher than males. Our data did not achieve statistical significance; however, we observed the following tendencies: the time from symptom onset to admission was delayed in female group; both traditional and nontraditional symptoms were more prevalent in the male group; and atypical symptoms were observed in the female group. CONCLUSION: No gender difference was observed in the incidence of acute ischemic stroke. However, the proportion of atypical symptoms was relatively higher in female patients. Factors resulting in delay clinical attention and contributing to the observed discrepancy between genders in AIS diagnosis should be validated and investigated further.

Prediction of Endotracheal Tube Size for Korean Children with Broselow Tape

PURPOSE: Broselow Tape was designed to estimate endotracheal tube size on the basis of the body length of emergency pediatric patients. It was validated from the United States. We assess the accuracy of the Broselow Tape method for the prediction of endotracheal tube (ETT) size in Korean children. METHODS: We reviewed pediatric anesthetic charts at a tertiary care hospital for one year, and in addition we collected data on gender, age, height, weight and fifth fingernail width for children visiting two tertiary emergency departments over four months. The inclusion criteria were that patients were American System of Anesthesiology (ASA) grade I or II, and that they were within the measuring range of Broselow Tape. The comparison of two data pairs was by cluster analysis and included stratification based on propensity scores, adjusting, and grouping. RESULTS: Five hundred ninety-seven children and 537 pediatric anesthetic charts were included in this study. The mean ETT size as predicted by the Browslow tape method and as actually intubated were 5.12 mm and 5.11 mm (p=0.3851), respectively. The mean ETT size predicted by the 5th fingernail-width method and the age-based method were 5.48 mm (p<0.0001) and 4.95 mm (p<0.001). CONCLUSION: There was no difference between the ETT size predicted by Browslow tape method and actual tube size. We conclude that Broselow Tape can be used to predict ETT size for Korean children.

Assessment of Cricoid Pressure Application by Emergency Department Personnel

PURPOSE: To assess the knowledge and the accuracy of cricoid pressure applied by emergency department (ED) personnel. METHODS: A prospective, observational study was conducted for 100 ED personnel (57 doctors, 38 nurses, and 5 EMTs) who participated in emergency airway training courses. Each participant was asked to complete a knowledge survey and the accuracy of cricoid pressure applied was evaluated using the training manikin. Three attempts were measured and a mean value was calculated. Subgroup analysis was also performed for specific variables of interest. RESULTS: Only thirty-four participants (34%) applied adequate cricoid pressure, with all participants who were outside of the target range applying less than the target amount. No statistically significant difference was demonstrated for age, qualifications, years of experience, existence of prior instruction, accuracy in knowledge, or ability to apply cricoid force within the target range. Male participants applied correct cricoid pressure within the target range more often than females (p=0.035, odds ratio=6.987, CI:1.145-42.641). CONCLUSION: Both knowledge and the application of adequate cricoid pressure by ED personnel were inadequate. In particular, females more often applied low cricoid pressure in order to guard against regurgitation than did males. Repeated hands-on training is recommended using adequate methods that integrate the concept of force.

Posttraumatic Anosmia and Ageusia: Incidence and Recovery with Relevance to the Hemorrhage and Fracture on the Frontal Base

OBJECTIVE: We studied whether frontal skull base fracture has an impact on the occurrence and recovery of anosmia and/or ageusia following frontal traumatic brain injury (TBI). METHODS: Between May 2003 and April 2005, 102 consecutive patients who had hemorrhage or contusion on the frontal lobe base were conservatively treated. Relevant clinical and radiographic data were collected, and assessment of impaired smell and taste sensation were also surveyed up to at least 12 months post-injury. RESULTS: Among 102 patients, anosmia was noted in 22 (21.6%), of whom 10 had ageusia at a mean 4.4 days after trauma. Bilateral frontal lobe injuries were noted in 20 of 22 patients with anosmia and in all 10 patients with ageusia. Frontal skull base fracture was noted in 41 patients, of whom 9 (21.4%) had anosmia and 4 (9.5%) had ageusia. There was no statistical difference in the occurrence of anosmia and ageusia between patients with or without fracture. Of the 22 patients with anosmia, recovery from anosmia occurred in nine (40.9%) at the interval of 6 to 24 months after trauma, of whom six had frontal skull base fracture and three were not associated with fracture. Recovery of anosmia was significantly higher in patients without fracture than those with fracture (p<0.05). Recovery from ageusia occurred in only two of 10 patients at the interval of 18 to 20 months after trauma and was not eminent in patients without fracture. CONCLUSION: One should be alert and seek possibile occurrence of the anosmia and/or ageusia following frontal TBI. It is suggested that recovery is quite less likely if such patients have fractures on the frontal base, and these patients should wait for at least 6 to 18 months to anticipate such recovery if there is no injury to the central olfactory structures.

Preventable Trauma Deaths Rates and Management Errors in Emergency Medical System in Korea

PURPOSE: The objectives of this study were 1) to estimate the preventable death rate in emergency medical system in Korea 2) to determine factors that affect preventability of trauma deaths 3) to identify management errors involved in preventable deaths. METHODS: The records of a 202 patients who died in the emergency departments or shortly after admission due to trauma at nine hospitals in three regions between from July 1, 2003, to June 30, 2004 were retrospectively reviewed by nine board certified physicians in emergency medicine using professional panel study methodology. Each panelist independently reviewed prehospital records, medical records, x-ray films, and inter-hospital transfer records using a structured survey format and preventability was determined by a unanimous agreement rule. The management errors that contributed to a preventable death were determined and classified as "structure-related"and "process-related"errors. RESULTS: Preventable deaths related to all management errors account for 39.6% of all trauma deaths. Whereas, 25.7% of preventable deaths were related to management errors in the studied hospitals. The preventability of trauma deaths were determined by the cause of death and the severity of injury. A total of 389 management errors are identified. Management errors occurred mostly in emergency departments (51.1%) and, in prehospital delivery (21.8%). Most of these errors were found to be processrelated (81.2%) rather then structure-related (18.8%). CONCLUSION: Preventable death rates in Korea are higher than other developed countries, which implies there is much to be improved in the quality of emergency medical services. We found this to be true especially, for processrelated errors, which need to be regularly assessed, and policy established that reduces preventable deaths.

Follow up Study about Health-Related Quality of Life in Injury Patients

PURPOSE: The purpose of this study is to assess healthrelated quality of life (HRQOL), to compare HRQOL of 3 months after injury with 10 days after injury, and to offer the result of this study to basic data of HRQOL in Korean patients with injury. METHODS: Between November 1, 2003, and March 2, 2004, 100 eligible injury patients who had visited emergency center were enrolled in the study. HRQOL was measured by Korean EuroQol 5 dimensions (KEQ-5D), and assessed in 10 days and 3 months after injury. The severity of injury was measured by Injury Severity Score (ISS). RESULTS: Of the 100 subjects, 54 (54%) were men and 46 (46%) were women, with mean (+/-SD) age of 43.7 (+/-15.2) and mean ISS (+/-SD) of 4.45 (+/-4.38). The KEQ-5D utility index and 5 subdimensional scores of 3 months after injury were significantly higher than those of 10 days after injury. The KEQ-5D utility indexes of 3 months after injury of each group by the ISS, age, sex, educational status and marrital status had significant higher than those of 10 days after injury. CONCLUSION: In this study, we observed that HRLOQ in patients with 3 months after injury was higher than those with 10 days after injury. However, to define the more definite feature of HRLOQ in patients with injury, the study with more and large epidemiologic controlled injury group and detailed variable adjustment should be done.

A Study Assessing the Knowledge and Attitude of First Responders about Cardiopulmonary Resuscitation

PURPOSE: This study was performed to improve cardiopulmonary resuscitation(CPR) training strategies for occupational groups, through the analysis of first responders' characteristics, knowledge and attitudes concerning CPR. METHODS: The occupational groups expected to have some training on rescue and emergency care in Korea were regarded as the first responders. In particular, this study focused on nurse-teachers, traffic policemen, and industrial safety supervisors, taxi drivers and restaurant workers as potential first responders, clerical workers comprised the control group. The subjects were given a questionnaire to answer over the internet. RESULTS: First responders' knowledge on CPR was significantly higher than that of the control group. First responders' attitude on CPR was more affirmative compared with the control group. In first responder group, nurse-teachers, traffic policemen and industrial safety supervisors had a higher fund of knowledge and more positive attitudes when compared to taxi drivers and restaurant workers. CONCLUSION: More training for first responders in CPR and emergency care is required given the likelihood of medical emergencies arising while on duty. Taxi drivers and restaurant workers' knowledge on CPR were found to be inadequate based on our survey questionnaire. Thus, it is necessary to strengthen CPR training for these individuals and groups.

A Case of Transient Cortical Blindness after Cardiopulmonary Resuscitation

Cortical Blindness is loss of vision due to injury of geniculocalcarine visual tract, usually caused by cerebrovascular disease. Cardiac arrest leads to global brain hypoxia or to more focal neurologic deficits. Cortical blindness is one form of these focal neurologic deficits. The severity of visual disturbance in cortical blindness is variable, so the diagnosis can be made later unless emergency physicians are familiar with it. We report a case of transient cortical blindness following hypoxic episode caused by coronary vasospasm.

Health-related Quality of Life in Patients with Injury in the Emergency Department

PURPOSE: The purpose of this study is to assess healthrelated quality of life (HRQOL) in patients with injury in the Emergency department, to compare that HRQOLs with normal control group, and to offer the results of this study as basic data on the HRQOL in Korean patients with injury, in the Emergency department. METHODS: Between November 1, 2003, and March 2, 2004, 266 eligible injury patients who had visited our emergency center were enrolled in the study. The HRQOL was measured by using the Korean Short Form Health Survey-36 (KSF-36)and the Korean EuroQol 5 dimensions (KEQ-5D). The HRQOL was assessed at 10 days after injury. The severity of injury was measured by using the Injury Severity Score (ISS). RESULTS: Of the 266 subjects, 164 (61.7%) were men and 102 (38.3%) were women, with a mean (+/-SD) age of 42.8 (+/-15.2) and mean ISS (+/-SD) of 4.54 (+/-3.98). The KSF- 36 and KEQ-5D scores in patients with injury were significantly lower than those in the normal control group. The HRQOL scores of each group by cause of injury had significant differences in the KSF-36 MCS and the KEQ-5D utility index, but they had no significant differences in the KSF-36 PCS. Women were more likely to have poor HRQOLs than men, but no statistical significance was found. Patients with non-intentional injury and hospitalized were more likely to have poor HRQOLs than patients with intentional injury and discharged, but the statistical significance varied with the measurement tool. CONCLUSION: In this study, we observed that the HRLOQs in patients with injury were lower than those in healthy subjects. However, if more definite feature of HRLOQ in patients with injury are to be defined, a study with a large epidemiologic controlled injury group and with detailed adjustments of the variable is needed.