Plasma Lactate and Base Deficit: Early Predictors of Morbidity in Burn Patients

PURPOSE: Plasma lactate and base deficit has been used as a marker to determine the status of tissue perfusion in trauma and clinically ill patients and also to predict the outcome of these patients. This study was performed to investigate the effect of plasma lactate and base deficit in predicting burn patients outcome. METHODS: A retrospective review was performed on 102 patients from January 2012 to December 2013 who were admitted as severe burn patients to our burn care unit. Plasma lactate and base deficit were measured upon admission to the hospital and SIRS score, hospital day, ABSI and TBSA were collected after admission. RESULTS: 102 patients were enrolled. Initial base deficit, hospital day, burn surface area and ABSI score showed statistical differences between low SIRS group and high SIRS group. The SIRS score, hospital day and ABSI score showed statistical differences between high base deficit group and low base deficit group (P0.05). CONCLUSION: In this study, initial base deficit but not plasma lactate, was predictor of morbidity following burn injury.

Study of Practical Application of Medical Assistants in Burn Center

PURPOSE: Complications and mortality rate of burn injuries are recently decreasing owing to development of systematic and special burn therapy. Whereas we are suffering from the lack of the medical manpower in burn center. In the future we might need more medical assistants to compensate these shortages. In this study we tried to search the path through these difficulties by considering the practical application of medical assistants. METHODS: We compared Korea's current situation of burn treatment with other countries in various references. Also we studied and compared recent situation of medical assistants in Korea and U.S.A. We took special considerations for Korean emergency medical technician, physical therapist and occupational therapist. RESULTS: Our study showed that we are practically using emergency medical technician, physical therapist and occupational therapist as medical assistants in various fields including burn centers. Emergency medical technician, physical therapist and occupational therapist as medical assistants can be excellent medical substitutes for shortage of manpower in our burn centers. Compared with U.S.A's current situation we are quite lacking of certain certified programs for such medical assistants. Burn therapists can be promoted from medical assistants through certain certified educational programs. CONCLUSION: We think that emergency medical technician, physical therapist and occupational therapist, who have certification concerning certain medical experience, should undergo certified educational program for burn therapy and should be used as a actual burn therapists to overcome the shortage of manpower in our burn centers.

Application of Brain Computerized Tomography to High Voltage Electrical Burns

PURPOSE: High voltage electrical injuries can cause many complications of central nervous system. We tried to define the indication range of brain CT (computerized tomography) in high voltage electrical injuries. METHODS: We performed a retrospective analysis of 51 high voltage electrical injured patients who were confirmed by brain CT, they had visited our emergency department from January 2005 to December 2007. All patients were classified by brain CT findings, presences of combined injuries and neurologic symptoms. RESULTS: 48 patients were confirmed normal in brain CT findings. 3 patients had brain lesions that were associated with secondary trauma. There was no abnormal CT finding in the 23 patients who did not have loss of consciousness, falling and combined injuries. CONCLUSION: If patient with electrical injury did not have neurologic symptoms or sufficient mechanical force, brain CT is not recommended. The results of this study may help emergency physicians to avoid unnecessary brain CT examination in the emergency triage to a high voltage electrical injury patients.

A Retrospective Analysis of 645 Burn Patients Following High Voltage Electrical Injuries - 8 Years of Experience

PURPOSE: High voltage electrical injuries can cause serious complications and sequelae, leading to social and economic costs. We reviewed patients with high voltage electrical injuries experienced over the last 8 years. METHODS: We retrospectively reviewed the medical records of 645 consecutive patients admitted between January, 2000, and December, 2007. We noted demographics, burn type, fasciotomy time after burn injuries, distribution classified by voltage, entrance and exit of burn injuries, type of amputation and amputation rate, associated injuries and complications, death rate, electrocardiogram, and laboratory results. RESULTS: Most injuries occurred in men (99.2%), with a mean age of 38.2+/-9.3 years. Direct contact burns were the most common (62.2%), and the mean burn extent was 14.8+/-15.9%. The right upper extremity was the most common entry point, with the left lower extremity the most common exit point. The amputation rate was 22.2%. Associated injuries and complications occurred in 62.0% of cases. CONCLUSION: This research may influence diagnosis and treatment of high-voltage injuries, reducing the associated injuries and complications. Furthermore, we should protect against high voltage electrical injuries.

A One-Click Paging System in the ED via the Internet

BACKGROUND: The time lag and the difficulty associated with calling clinicians of other departments are major concern in the emergency department(ED). We tried to design a new paging system which was faster, easier, and more accurate. METHOD: We made a web page comprised of paging numbers and then connected a personal computer in the ED to the internet through a dial-up modem, via a web-paging service, and could page persons wearing public pagers. RESULTS: We found that using the internet for paging was faster and more accurate than the hand-operated way. Calls were placed via the internet with only one click of the mouse. CONCLUSION: The One-click paging system is useful for hospital telecommunication. In this way, the internet can be applied to the entire emergency medical service system.

Early Use of Thrombolytics for Massive Pulmonary Embolism by a Comparison of Cases

Pulmonary embolism is a common condition with considerable morbidity and mortality. The diagnosis of pulmonary embolism remains a vexing problem. Prompt and accurate diagnosis is important because the mortality of untreated pulmonary embolism is high and serious complications can occur. Most physicians are inexperienced in the use of thrombolytic agents fo r pulmonary embolism, even though they utilize these agents routinely for acute myocardial infarction. We compared 2 domestic cases with 2 foreign cases. On comparison, we spent a long time in making a definite diagnosis in the domestic cases. Moreover, in the second domestic case, we did not use thrombolytic agents early, in spite of a suspected massive pulmonary embolism and then eventually he died. We conclude that bolus administration of thrombolytic agents during CPR for clinically suspected massive pulmonary embolism in emergency departments may be an acceptable technique.

A Case of Pacemaker-mediated Tachycardia

Pacemaker-mediated tachycardia(PMT) is a circus movement tachycardia that can occur in patients with dual chamber pacemaker with atrial sensing(VDD or DDD), when a ventricular depolarization, either spontaneous or paced, causes retrograde activation of the atrium. Recently, a number of pacemaker manufactures have incorporated in their devices a variety of relatively complex algorithms to prevent PMT. Despite these measures, PMT may still occur because of inappropriate programming or unpredictable variations of ventriculoatrial conduction. We report one case of PMT in a 78-year-old male who received DDD type pacemaker due to sick sinus syndrome. In this case, PMT was disappeared after reprogramming parameters of pacemaker and the application of PMT protection algorithm.

A Case Report and Review of Tetanus

Tetanus is a rare disease in the developed countries, including Korea, as a result of nearly universal active immunization. Because many physicians have little experience with its diagnosis and management, misdiagnosis and therapeutic delay may result in catastrophic consequences. We report one case of generalized tetanus. A previously healthy 35-year-old man was admitted to the emergency department because of stiffness on jaw and neck. board-like abdomen, extended and rigid both legs, chest tightness, and dyspnea. Seven days before admission, he was injured on the right thing at work. In the emergency department, he was given 5,000 units of human tetanus immunoglobulin intramuscularly, as well as diazepam 2 mg/hr intravenously. On the second hospital day, tracheostomy was performed. Ten days later, his condition was improved. Twenty eight days after admission, he was discharged without any complication.