Efficacy and Necessity of the Certification Program for Emergency Medical System Directors on the Actual On-Line Medical Direction

PURPOSE: The purpose of this study is to evaluate the usefulness and necessity of an emergency medical service director program for board certified emergency physicians. METHODS: A retrospective analysis of records of direct medical advice provided by board certified emergency physicians in the Busan area from April 1, 2011 to July 11, 2011 was conducted. The medical and legal validity of the medical direction was evaluated by two independent emergency physicians with experience and certification in the field of medical control. RESULTS: Fifteen emergency physicians provided direct medical control during the study period. Five of them were certified as an emergency medical service (EMS) director by the Korean council of EMS physicians (KCEMSP), and the other 10 were not. An analysis of 992 cases of direct medical direction was performed. No differences in the diagnostic appropriateness and medical validity of medical advice were observed between the two groups. A significant difference was observed in legal validity (p=0.048). However, in multivariate analysis, experience as a certified emergency physician was a significant factor determining legal validity (p=0.02), while certification by the KCEMSP was not significant. CONCLUSION: The current EMS director certification program did not have a significant influence on the appropriateness of direct medical direction. EMS director courses and emergency medicine residency programs are in need of improvement in the legal aspect of prehospital emergency service.

The Usefulness and Difference of Serum Biomarkers BNP, d-dimer, MMP-9, and S100beta for Diagnosing Stroke in Patients with Altered Mental Status

PURPOSE: An altered mental state is a common chief complain at the emergency departments (EDs). But it is difficult to find out the reason for this mental change. Serum biomarkers are an alternative way to diagnose the reason for mental change. We determined the values of four biomarker for diagnosing the mental changes of the patients seen at the ED: BNP, d-dimer, MMP-9 and S100beta. METHODS: From September 2007 to March 2008, we prospectively enrolled 42 adult patients who visited the ED of Hospital because of an altered mental status. We categorized the patient's mental state into 5 steps (alert to coma), and we took samples of blood at the time of visiting the ED. We then measured the 4 serum markers. The clinical records were reviewed to analyze the usefulness of these 4 serum markers. RESULTS: We enrolled 42 patients (24 females and 18 males). Thirty-three people were diagnosed with stroke and 7 people were diagnosed to not have stroke. The measurements of BNP, d-dimer and MMP-9 were on average 136.5+/-231.7 pg/mL, 2052.2+/-2071.8 ng/mL and 294.9+/-311.7 ng/mL, respectively, and S100beta was mostly measured below 100 pg/mL. After statistic analysis, only MMP-9 had diagnostic value for stroke, and BNP & d-dimer had a negative relation to making the diagnosis of stroke. CONCLUSION: MMP-9 is useful for making the different diagnosis of acute stroke in patients with an altered mental status at the ER. There is the probability of metabolic causes for ED patients' depressed mentality when the BNP and ddimer levels are highly elevated, but further study is needed to confirm this.

Young Rabbit Model for Pathophysiologic Study of Acute Lung Injury in Early Childhood / 대한흉부외과학회지

BACKGROUND: Adult respiratory distress syndrome (ARDS) is of particular interest because of its severity of the associated lung injury and its high mortality. However, the pathophysiologies of ARDS in infant and childhood groups are still not well clarified inspite of many previous investigations. To investigate the time course of pathophysiology of ARDS in infant and childhood groups, this study was designed with experimental endotoxin-induced ARDS model using young rabbits (8 week-old). MATERIAL AND METHOD: Rabbits were divided into the control group (n=8) and the endotoxin-treated group (n=32). The endotoxin group was subdivided into 4 groups by the sampling times as 3, 6, 12 and 24 hr-groups (G-E3,6,12,24, each n=8). The experimental ARDS was made by a bolus injection of endotoxin (Escherichia coli serotype O55:B5, 0.50 mg/kg) via rabbit ear vein. For evaluation of the hematologic and inflammatory markers, and superoxide dismutase (SOD) concentrations, the blood samples were taken from the heart. The bronchoalveolar lavage fluid (BALF) were obtained for analysis of the leukocytes and protein concentration. With biopsy of the lung, histopathologic changes of the lung were also evaluated. RESULT: In the endotoxin groups, significant leukopenia (owing to pancytopenia) occurred in 3 and 6-hr groups, which was followed by significant leukocytosis (owing to neutrophilia) in the 12 and 24-hr groups (p<0.05). Serum levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1 beta) in the endotoxin groups were higher than those of control group (p<0.05). Serum levels of superoxide dismutase (SOD) of G-E3 and G-E6 were higher than those of control group, whereas those of G-E12 were lower than those of control groups (p<0.05). Total leukocyte counts and protein concentrations in BALF were significantly elevated in the endotoxin groups compared to the control group (p<0.05). The hemorrhagic pattern of BALF showed occurred in the endotoxin groups. The endotoxin groups (in G-E6) had severe infiltration of inflammatory cells (lymphocyte and monocyte) in the pulmonary interstitium and parenchyma, migrations of neutrophil and eosinophil into alveolar spaces and interstitial widening, which are the evidences of acute lung injury. In the endotoxin groups, there were significant positive correlations between the BALF findings and the immunologic markers (TNF-alpha, IL-1 beta, SOD) (p<0.05). CONCLUSION: Severe acute lung injury occurred in all the endotoxin-treated rabbits. The pathophysiologic findings were so progressive until 6-hr by time dependant pattern, and then recovered slowly. Variable hematologic, immunologic, and pathologic factors were well correlated in the development and progression of endoxin-induced lung injury. The pathophysiologic responses were sensitive and rapid in young rabbit Young rabbit seemed to be a useful experimental animal model for infant and childhood groups.

Prognostic Factors for the Hyperosmolar Nonketotic State

BACKGROUND: A hyperosmolar nonketotic state has been known to have a high mortality, and even now, despite this high mortality, only a few studies of this disease have been performed. We studied the prognostic factors for the hyperosmolar nonketotic state. METHODS: We retrospectively studied the cases of 40 patients who were in a hypersomolar nonketotic state when admitted to Sanggye Paik Hospital during the 6-year period from 1995 through 2000. We divided the hyperosmolar nonketotic patients into two groups, the complete recovery group and the incomplete recovery group, and compared the clinical features, the laboratory findings, and the precipitating factors between two groups. RESULTS: 1) A total of 40 patients were studied: 24 in the complete recovery group and 16 patients in the incomplete recovery group. The mortality rate was 32.5%. 2) No significant statistical difference existed among the clinical features of the two groups, except for the sex(p<0.01). 3) Among the laboratory findings of both groups, analysis revealed that the effective osmolarity was significantly higher among those in the incomplete recovery group(p<0.01). Serum sodium concentration was also significantly higher among those in the incomplete recovery group(p<0.01). Serum creatinine was also significantly higher among those in the incomplete recovery group(p<0.05). Serum bicarbonate concentration, on the other hand, was significantly lower among those in that group(p<0.05). 4) Infection was identified as the most common precipitating factor(62.5%). Among the precipitating factors of the two groups, there were significant statistical difference in pneumonia, UTI, and inappropriate glucose control. 5) A significant statistical difference existed among the initial level of onsciousness of both groups(p<0.05). 6) The only significant independent factor responsible for prognosis of nonketotic hyperosmolar state patients was the sex. CONCLUSION: The sex was only significant independent prognostic factor of nonketotic hyperosmolar state patients.

Factors Influencing the Survival of the Patients with Prehospital Cardiac Arrest

BACKGROUND AND OBJECT: The survival rate of the patients with prehospital cardiac arrest in Korea is lower than that in other developed countries. The main cause of this low survival rate is that prehospital emergency medical service systems are not yet well established in Korea. This study was undertaken to obtain a fundamental data for the development of prehospital emergency medical service systems. MATERIALS AND METHOD: We retrospectively analized 104 patients with prehospital cardiac arrest on whom cardiopulmonary resuscitation (CPR) had been attempted in Sanggye Paik Hospital from January 1998 through December 1999. RESULTS: As to the CPR results, 43 patients (41.3%) showed no return of spontaneous circulation (ROSC), 22 patients (21.2%) died within 24 hours, 28 Patients (26.9%) survived over 24 hours but eventually died during admission, and 11 patient (10.6%) survived and were discharged. The mean time of the arrest-to-CPR interval was 19.69.0 min. Patients with ROSC and patients who had survived over 24 hours had shorter the arrest-to-CPR interval than patients without ROSC and patients who died within 24 hours, respectively (p<0.01, p<0.01). The cutting point of the arrest-to-CPR interval for ROSC was 21.3 minutes. CONCLUSION: The arrest-to-CPR interval is important to improve the survival rate of the patients with prehospital cardiac arrest. And CPR should be attempted aggresively in prehospital cardiac arrests when the arrest-to-CPR interval is within 21.3 minutes, considering the possibility of ROSC.

A Study about IgG Subclasses Concentration of Chronic Cough Patient and Changes of Immunoglobulin Levels after RU 41.740 Administration

PURPOSE: People who suffer from chronic or recurrent respiratory disease have immunoglobulin deficiency due to hypofunction of B cell. Among these immunoglobulin deficiency, it has been reported that only one or two subclass of IgG are deficient with normal quantity of IgG and IgA. Therefore it is necessary to measure IgG subclasses in chronic or recurrent respiratory infection for diagnosis. The purpose of this study is to measure IgG subclass in children with chronic respiratory disease and administration of RU 41.740 which was obtained from Klebsiella pneumonia, K2O strain(it has proven role in control of immunity) comparing the changes of immunoglobulin levels and IgG subclasses with the control group. So that better therapeutic approaches can be made for these diseases. Subjectsand METHODS: Thirty-six patients who visited to Konkuk university hospital due to chronic and recurrent coughing from January 1993 to June 1994, were selected for this research. Their age ranged from 2~13 year old and patients with evident history of allergy or tuberculosis were excluded. RU 41.740 with antibiotics were given to 31 subjects and 5 subjects were given placebo with antibiotics. For all subjects IgG, A, M, E, IgG1, G2, G3, G4 were measured. Immunoglobulins were remeasured from 15 subjects who received RU 41.740 and from 5 subjects who received placebo. Results : 1) Five subjects out of 36 were low or low-normal IgG group and all combined with IgG subclass deficiency, and all of low or low-normal IgG group had IgG3 deficiency. Eighteen subjects out of 31 normal IgG group accompanied IgG subclass deficiency and 12 subjects had IgG3 deficiency, which is most common IgG subclass deficiency. 2) Four subjects out of 36 were IgA deficiency group. Three subjects from 4 accompanied IgG subclass deficiency and had IgG4 subclass eficiency. 3) After the RU 41.740 administration, the levels of IgG and IgG subclasses increased significantly in study group. There were no significant change in IgG and IgG subclasses levels in placebo group CONCLUSIONS: In patients with chronic or recurrent respiratory disease, it is necessary to measure IgG subclass. These diseases tend to be chronic and recurrent and can be severely complicated causing bronchiectasis and incurable otitis media. Generally these diseases are not responsive to antibiotics. Therefore therapies should be directed to increasing immunological function for better results.

Clinical experiences of open heart surgery / 대한흉부외과학회지

No abstract available.