Survey of Point-of-Care Testing Devices for Pre-hospital EMS Equipment of Glucometer on Local Area / 農村醫學 地域保健

Objective@#glucometer is one of POCT(point-of-care testing) devices used by EMS. Accurate measurement value is important for patient decision making. Quality control is necessary for this, but most EMS are still using glucometer without quality control it. Therefore, management status and quality control status of glucometers used by 119 paramedics waswere investigated. @*Methods@#6 and 8 of glucometers and blood glucose test strips were submitted from 4 safety centers in 2010 and 8 safety centers in 2012, respectively. Glucometers submitted by local safety centers were analyzed in 2010 and 2012. The control glucometer, which was well managed at A University Hospital, was assumed to be accurate for at blood glucose measurement. Glucose values of various quality control materials control solutions were measured and analyzed using linear regression and Pearson’s correlation test. Error rates were obtained via error tolerance range required by the 2011 ISO(International Organization for Standardization) guideline. For statistics, Excel and MedCalC programs were used. @*Results@#mong 14 safety centers in the region, 4 centers(28.5%) in 2010 and 8 centers(57.1%) in 2012 submitted 6 and 8 glucometers. In the first evaluation in 2010, 2 out of 6(33.3%) glucometers were untestable due to error, and 45 out of 6(66.683.3%) blood glucose test strips' validity were expired. In the second evaluation in 2012, 1 out of 8(13.5%) glucometers were untestable due to lack of battery, and 2 out of 8(25%) blood glucose test strips' validity were expired. All correlation coefficients were above 0.989 in 2010 and above 0.997 in 2012. Error rates were generally high when using expired blood glucose test strips. @*Conclusion@#Among 119 paramedics’ guideline, quantity and operation status of POCT devices are well managed, but quality control is not. Therefore, it is necessary to add management status and quality control status of POCT devices to the EMS’ field work guideline.

A Study on the Disaster Medical Response during the Mauna Ocean Resort Gymnasium Collapse

PURPOSE: To investigate and document a disaster medical response during the collapse of the Gyeongju Mauna Ocean Resort gymnasium, which occurred on February 17, 2014. METHODS: The official records of each institution were verified to select the study population. All the medical records and emergency medical service records were reviewed by an emergency physician. Personal or telephonic interviews were conducted without a separate questionnaire if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent. RESULTS: One hundred fifty-five accident victims, who were treated at 12 hospitals mostly for minor wounds, were included in this study. The collapse killed 10 people. Although the news of the collapse was disseminated in 4 minutes, it took at lease 69 minutes for a dispatch of 4 disaster medical assistance teams to take action; 4.5% of patients were treated on-site, 56.7% were transferred to 2 nearest hospitals, and 42.6% were transferred to hospitals with poor preparation to handle disaster victims. CONCLUSION: In the collapse of the Gyeongju Mauna Ocean Resort gymnasium, the initial triage and distribution of patients were inefficient, with delayed arrival of medical assistance teams. These problems had also been noted in prior mass casualty incidents. Government agencies are implementing improvements, and this study could aid the implementation process.

A study on the disaster medical response during the Mauna Ocean Resort gymnasium collapse

OBJECTIVE: To investigate and document the disaster medical response during the Gyeongju Mauna Ocean Resort gymnasium collapse on February 17, 2014. METHODS: Official records of each institution were verified to select the study population. All the medical records and emergency medical service run sheets were reviewed by an emergency physician. Personal or telephonic interviews were conducted, without a separate questionnaire, if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent. RESULTS: One hundred fifty-five accident victims treated at 12 hospitals, mostly for minor wounds, were included in this study. The collapse killed 10 people. Although the news of collapse was disseminated in 4 minutes, dispatch of 4 disaster medical assistance teams took at least 69 minutes to take the decision of dispatch. Four point five percent were treated at the accident site, 56.7% were transferred to 2 hospitals that were nearest to the collapse site, and 42.6% were transferred to hospitals that were poorly prepared to handle disaster victims. CONCLUSION: In the Gyeongju Mauna Ocean Resort gymnasium collapse, the initial triage and distribution of patients was inefficient and medical assistance arrived late. These problems had also been noted in prior mass casualty incidents.

Clinical Significance of the Resistive Index of Prostatic Blood Flow According to Prostate Size in Benign Prostatic Hyperplasia / 대한배뇨장애요실금학회지

PURPOSE: The authors evaluated the relationships between the clinical factors and resistive indexes (RIs) of prostate and urethral blood flows by using power Doppler transrectal ultrasonography (PDUS) in men with benign prostatic hyperplasia (BPH). METHODS: The data of 110 patients with BPH and lower urinary tract symptoms (LUTS) treated between January 2015 and July 2015 were prospectively collected. PDUS was used to identify the capsular and urethral arteries of the prostate in order to measure RIs. International Prostate Symptom Score (IPSS), maximal flow rate (Qmax), total prostate volume (TPV), transition zone volume (TZV), transition zone index (=TZV/TPV), presence of intravesical prostatic protrusion (IPP), and the RIs of capsular and urethral arteries were evaluated for all of the patients by one urologist. RESULTS: The 110 patients were categorized according to IPSS (mild symptoms, 0-7; moderate symptoms, 8-19; and severe symptoms, 20-35), Qmax (<10 and ≥10 mL/sec), TPV (<30 and ≥30 mL), and presence or absence of IPP. No significant relationship was found between the mean RI of any artery and IPSS or Qmax. The mean RIs of the urethral artery, and left and right capsular arteries were significantly dependent on prostate size and the presence of IPP. CONCLUSIONS: RI obtained by using PDUS correlated with the presence of IPP and prostate size. The RI of prostate blood flow can be used as a noninvasive diagnostic tool for BPH with LUTS.

Factors Associated with Skeletal Chest Injuries Secondary to Cardiopulmonary Resuscitation of In-Hospital Cardiac Arrest Patients

PURPOSE: Rib and sternal fractures are common complications of chest compressions during cardiopulmonary resuscitation (CPR). The aim of this study is to investigate skeletal chest injuries following chest compressions and factors associated with skeletal chest injuries. METHODS: A retrospective study was conducted for 10 years from January 2005 to February 2015. Skeletal chest injuries in patients who underwent computerized tomography (CT) after return of spontaneous circulation (ROSC) were analyzed. The exclusion criteria were patients with insufficient medical records, under 18 years old, traumatic cardiac arrest, and out-of-hospital cardiac arrest. RESULTS: During the period 106 patients were included. The CT scan after ROSC showed that 47 patients (44.3%) had rib fractures, and 20 patients (18.9%) had sternal fractures. The rib fracture group showed higher age (73 vs 61, p<0.001), longer CPR time (10 vs 6 min, p<0.001), and higher incidence of sternal fracture (34% vs 6.8%, p<0.001). The sternal fracture group showed longer CPR time (10 vs 7, p<0.05) and higher incidence of rib fractures (80% vs 4.7%, p<0.001). In multivariate logistic regression analysis, age (OR 1.087; 95% CI 1.041 to 1.134, p<0.001), CPR time (OR 1.200; 95% CI 1.087 to 1.323, p<0.001), and sternal fracture (OR 4.524; 95% CI 1.259 to 16.697, p=0.021) showed significant association with rib fracture. CONCLUSION: Rib and sternal fractures are frequent complications in patients who underwent CPR. In hospital cardiac arrest patients with older age, longer CPR time, and sternal fracture needed more precaution for rib fractures and other complications.

Research of Acute Poisoning on a Local Emergency Medical Facility in an Urban-Rural Area / 農村醫學 地域保健

OBJECTIVES: The aim of this study was to investigate the characteristics of acute poisoning cases admitted to a local emergency department in an urban-rural area. METHODS: This retrospective study included all patients with acute poisoning who admitted the emergency department between June 2004 and May 2005. We analyzed the medical records for etiological and demographical characteristics of the acutely poisoned patients. RESULTS: There were 155(1.0%) poisoning cases among 15,457 admitted to the emergency department. Of the admitted cases, 51.0% were female and 49.0% male. The poisoning made a peak in the age range of 30-39 and over 60. The seasonal distribution in poisoning patients suggested a peak in spring(38.1%) and summer(24.5%). The majority of exposures(95.5%) occurred in patient's home, 81.8% were deliberate. The most common agents of acute poisoning in deliberate causes were drugs(p<0.01). All of deliberate cases were suicidal attempts. The most common poisoning cases were pesticides in male, but in female were medications(p<0.01). Overall mortality rate of total cases were 12.9%. The overall mortality rate was higher in male(p<0.05), increasing age(p<0.05) and intentional ingestion(p<0.05), pesticides poisoning(p<0.05). CONCLUSIONS: The study forms a foundation for future work on poisoning epidemiology which hopefully will facilitate the allocation of preventive services in order to reduce the incidence as well as morbidity and mortality of toxic exposures.

Up-regulation of PSD-95 in the Rat Hippocampal Formation after Chronic Renal Failure / 대한해부학회지

The mechanism of central nervous system (CNS) dysfunction in uremia are multifactorial and only partially characterized. Studies using hippocampal formation (HF) evaluate the relationship between the uremia and memory impairment. Immunoblots with calcium permeable NMDA (N-methyl-D-aspartate) and AMPA (2-amino-3-hydroxy-5-methylisoxazole-4-propinoic acid) receptors and their associated PSD-95 proteins after chronic renal failure (CRF) provided significant new informations. CRF rats induced by 5/6 nephrectomized had significant effects on up-regulation of PSD-95 protein rather than those of calcium permeable NMDA and AMPA receptor subunits. Up-regulation of PSD-95 after CRF might be associated with the enhanced activity of NMDA and/or AMPA receptors, thereby leads to the intracellular Ca2+ accumulation and functional neuronal cell damage subsequently. Degradation of intermediate filament 200 (NF200) in the axon after CRF may induce an impairment of intracellular transport and eventual cellular dysfunction through destruction of the neuronal cytoarchitecture. These data suggest that up-regulation of PSD-95 in CRF may increase the functional derangement between the nerve cells and ultimately lead to memory impairment.

Clinical Analysis of Pediatric Patients visiting our Emergency Center with Gastrointestinal Hemorrhage

PURPOSE: Gastrointestinal hemorrhage is one of the common pediatric and surgical emergencies for infants and children in Korea. Even though the causes and the appearance of gastrointestinal tract lesions vary with age, attention has seldomly been focused on infancy and childhood. This study aimed to provide, as basic material, experience with and an approach to gastrointestinal hemorrhage in infants and children. METHOD: A retrospective review of the medical records of 90 patients, 45 males and 45 females who visited the emergency center of Keimyung University Dong-San Hospital from January 1 to December 31 2003 was conducted. RESULT: Pediatric patients account for 6.5% of the total number of patients visiting the emergency center. The most common ages were between one month and one year of age (30%). The majority of the patients in this study presented with upper gastrointestinal bleeding and with small hemorrhage. The major symptom was hematemesis. Almost 95.6% of our patients required medical intervention. Four patients died, for an overall mortality of 3.3%. CONCLUSION: According to the literature, gastrointestinal bleeding is uncommon in children, but is sometimes serious and life-threatening. A knowledge of age-dependent diagnoses in pediatric patients should be helpful in establishing a specific source of bleeding. Early diagnosis and prompt treatment are necessary to preclude undue morbidity.

Burn Size Estimation and Fluid Resuscitation In the Emergency Department

PURPOSE: Assessment of the burn size in the Accident and Emergency Department is one of the most important aspects in the initial care of a burn victims. The purpose of this study was to examine in the Emergency Department the accuracy of burn size estimates and the adequacy of burn-patient fluid resuscitation in relationship to the Parkland formula. METHODS: A retrospective study was conducted of 52 adult burn patients who visited the Emergency Department of Keimyung University Dongsan Medical Center during 2003 year. A substratification of the data was undertaken to compare total burn surface area as estimated by the Emergency-Department staff with that determined by the Burn-Care-Unit staff. RESULTS: The average length of stay in the Emergency Department was 394.04 minutes (range: 150~1055 minutes). The average total body surface area evaluated by the Emergency-Department staff was 33.31% compared with the Burn-Care-Unit staff's average of 29.77%, and the difference was statistically significant (p<0.05). During their stays in the Emergency Department, burn patients were underresuscitated based on the fluid volume calculated by using the Parkland formula. CONCLUSION: Early communication with the Burn-Care-Unit staff in the Emergency Department and better education of Emergency-Department physicians will markedly improve the overall care of burn patients.

High Flow Priapism After Perineal Trauma: A Case Report

Priapism is the pathologic prolongation of penile erection, accompanied by pain and tenderness but not by sexual exitement and not relieved orgasm. Priapism is a urologic emergency and treatment should not be delayed. The overall incidence and prevalence of priapism are unknown. Priapism can be classified as high flow or low flow depending on the status of th penile arterial blood flow. The initial evaluation of the priapic patient should attempt to differentiate the high from low flow state. A complete history should be obtained. Early determination of the state of corporal oxygenation is essential and will define the optimal management approach. Early intervention and prompt, appropriate therapy improves outcome. Through greater understanding of the pathophysiology of priapism, the clinician may become armed with etiology specific medical alternatives providing timely detumescence for men with prolonged erections. The authors report the experience of case of high flow priapism after perineal trauma with review of the literature.

Acute Ammonium Dichromate Poisoning: A Case Report

Soluble compounds of chromium are widely used in industrial processes, including printing, photography, pyrotechnics, dyeing, electroplating, aircraft, shipbuilding, and leather tanning. Exposure in industry is generally via the inhalation of dusts and fumes. Ingestion of chromium (chromate or dichromate salt) has occurred accidentally in suicide attempts and during drug experimentation and may causes ulceration of the bowel, diarrhea, hemorrhagic diathesis, acute renal failure, and hepatic damage. Ingestion of hexavalent chromium com-pounds is considered to be one hundred times more toxic than the trivalent compounds. Chromium poisoning in children is an uncommon, potentially lethal form of poisoning which could possibly increase in incidence because of the resumed greater domestic distribution of dichromate in Korea. We report a case of ammonium dichromate inges-tion by a child that resulted in a healthy discharge.

Outcome of Nontraumatic Prehospital Cardiac Arrest

PURPOSE: There has been an increase in the number of nontraumatic prehospital cardiac arrests due to increases in both cardiovascular diseases and the average age of the population. We performed this study to identify the proper resuscitation technique to be used to increase the survival rate in nontraumatic, prehospital cardiac arrest. METHODS: We reviewed the charts of patients with nontraumatic, prehospital cardiac arrest who visited our Emergency Department of Keimyung University Hospital during the period of May 2001 through April 2002. RESULTS: Out of 60 cases of nontraumatic, prehospital cardiac arrest, 27 (45%) experienced no ROSC, 15 (25%) experienced transient ROSC, 6 (10%) died after 24 hours, and 12 (20%) alived and were discharged. Among those discharged, 10 had visited our emergency department for cardiac causes and 2 for non-cardiac causes. EKG findings were VF in 8, PEA in 2, and bradycardia in 2. In the discharged survival cases, the cardiac arrest had been witnessed. CONCLUSION: We failed to find significant statistical survival differences based on the causes of cardiac arrest, the initial EKG monitoring, or the method of visit. Witnessed cases of cardiac arrest had a higher survival rate than nonwitnessed cases (p<0.05).