A Study on Cognitive Attitudes toward Death according to MBTI Personality Types / 한국호스피스완화의료학회지

PURPOSE: The aim of this study was to investigate attitudes toward death according to personality types and to suggest the need to develop related hospice programs. METHODS: Personality types were identified by the Korean version of the Myers-Briggs Type Indicator (MBTI) Form G. A questionnaire with 26 five-point Likert items was used to survey participants' attitudes toward death. RESULTS: The ESFP personality type was most common (20%) among available 100 participants. Significant differences were observed in the attitudes towards death preparation according to personality type s. Participants with personality preference types E, T and J showed positive attitudes (P<0.05) toward death, but no significant differences were shown based on the SN index. CONCLUSION: The attitudes toward death differed by personality types. Therefore, this study points to the need to develop diverse hospice programs based on the personality types.

The Factors Affecting the Registration Rates for Emergency Department Based Post-suicidal Care Program

PURPOSE: The aim of this study was to investigate the independent factors associated with the registration rate for the community-based post suicidal care program in the emergency department (ED). METHODS: This prospective observational study was conducted between March and December 2013 at the academic ED at the tertiary urban hospital. During the study period, the pre-designed registry was recorded. The variables examined included the following: patients' demographic data (Sex, age, address, type of insurance, marital status, level of education, and history of previous psychiatric disease), suicide-related data (suicidal methods, combined drink of alcohol and number of previous attempts), and management-related data (disposition at ED, physician's training level, etc.). Univariated and multivariated logistic regression analyses were performed for identification of factors affecting the registration rate for the community-based post suicidal care program. RESULTS: A total of 163 suicides were included during the study period. Of these, 33 (20.2%) patients were registered in the post-suicide care program. Factors including a patient's address (OR: 14.92, 95% CI: 3.606-61.711), immediate intervention by psychiatric healthcare center (OR: 5.05, CI: 1.688-15.134), admissions in hospital (OR: 3.69, CI: 1.286-10.605), and history of previous psychiatric disease (OR: 3.52, CI: 1.216-10.201) showed significant association with registration for the program. CONCLUSION: The community-based post-suicidal care program, which is available 24 hours a day, should be operated in each district in order to increase the registration rate. Emergency physicians should actively consider the inpatient treatment program for suicidal patients and strongly recommend registration to the program, particularly for patients without previous history of psychiatric disease.

Current Duty Hours of Emergency Resident Physicians in Korea: Multicenter Cross-sectional Study

PURPOSE: This study was conducted in order to determine the current status of duty hours of emergency resident physicians in Korea. METHODS: The training committee of the Korean Society of Emergency Medicine surveyed using a questionnaire on resident training status, which contained the total number of duty hours during four weeks of July (first to 28th day) according to the grades of the resident physician. The proportions of both irregular working hours and independent working hours without supervision of a board certified physician were also evaluated. RESULTS: Responses from 80 hospitals out of 97 training hospitals were analyzed. The average number of duty hours of emergency resident physicians was 63.7+/-10.7 hours/week. The proportion of hospitals for which the average number of duty hours exceeded 80 hours/week was 16.1%. Irregular working hours consisted of 63.9%. Residents in 15(18.7%) hospitals worked 3.7~73.5% of their duty hours without supervision of a board certified physician. The higher grade resident had fewer working hours (p<0.001). No statistical difference was observed in the rate of both irregular work and unsupervised work according to the grade. CONCLUSION: Results of this study showed that nine(11.3%) hospitals had average duty hours above 80 hours/week. In Korea, training hospitals should prepare to minimize the impact of duty hour restriction in the near future, as well as to improve training quality.

Comparison of Intubation Success Rate and Times Required for Intubation by Glottic Exposure Methods with Glidescope(R) / 대한구급학회지

BACKGROUND: The glottis can be exposed by a Glidescope(R) during endotracheal intubation using either the epiglottis or valleculae elevation method. We compared the epiglottis and valleculae elevation methods for endotracheal intubations performed with a Glidescope(R) using differences in success rate, time spent for tracheal intubation and percent of glottic opening. METHODS: Forty medical students without experience using a Glidescope(R) participated in this prospective, randomized study in which they intubated a tracheal tube into a manikin. All participants performed tracheal intubation using the 2 forementioned methods. Twenty students exposed the vocal cord by placing the blade tip in the valleculae (valleculae elevation method; VEM). The other 20 students directly elevated the epiglottis with the blade (epiglottis elevation method; EEM). We separated intubating time into 3 parts: turnaround time to exposing the vocal cord, tube passing time and first ventilating time. RESULTS: The success rate of tracheal intubation using VEM (86.7%, 104/120) was higher than that using EEM (65.8%, 79/120) (p < 0.001). VEM resulted in a lower total intubation time (VEM vs. EEM, 23.5 +/- 5.3 vs. 29.0 +/- 8.7, p = 0.001). The key factor of this difference was the tube passing time (VEM vs. EEM, 7.4 +/- 2.5 vs. 12.8 +/- 7.4, p < 0.001). CONCLUSIONS: Exposing the vocal cord by using VEM during tracheal intubation with a Glidescope(R) can increase the success rate of tracheal intubation and shorten the time of endotracheal intubation in novices.

Bibliometric Analysis of the Journal of the Korean Society of Clinical Toxicology

PURPOSE: The purpose of this study was to examine the research characteristics and the trend of the Journal of the Korean Society of Clinical Toxicology by bibliometric analysis. METHODS: This study was a retrospective quantitative literature review of the publications. We collected data from the internet homepage of the Korean Society of Clinical Toxicology. Among 228 publications, a total of 225 articles were included in this analysis. The data were analyzed from different perspectives, including article types, study design, number of authors, type of toxic material, and the top five ranking prolific authors and the affiliated organization were identified. RESULTS: A total of 225 articles were analyzed; 98(43.6%) were original articles, 115(51.1%) were case reports, and 12(5.3%) were reviews. Among the original articles, nine were prospective studies and 89 were retrospective studies, which were assorted according to study design; there were two(2.0%) cross sectional studies, 93(94.9%) cohort studies, and three(3.1%) etc. The median number of authors per article was five and the top five ranking authors and affiliated organizations published 31.1% and 32.8% of total articles, respectively. The most abundant topic was pesticides, followed by natural poisons and poisons encountered in the work place. CONCLUSION: Since its foundation, the Journal of the Korean Society of Clinical Toxicology has published 19 issues and 228 articles and has played a key role in development of toxicology research in Korea. However, low ratio of original articles and a decrease in the number of recent articles indicates that greater effort is needed in clinical research. In addition, further interest of many experts and various institutions is necessary.

Antivenom for snake bite in Korea

In Korea, there are four types of snakes, Glyoidius brevicaudus, G. intermedius (formerly named, saxatilis), G. ussuriensis, Rhabdophis tigrinus. The case-fatality rate in snake bite envenomation is very low. Snake venom is a heterogeneous mixture of pharmacologically active enzymatic, non-enzymatic protein, peptide toxins, other organic and inorganic substances. The pathophysiology evokes a complex series of events that depend on the combined and synergistic action of toxic and non-toxic components. The manifestation includes local and systemic effects. Local tissue effects includes of tissue pain, redness, swelling, tenderness, bullae formation, and necrosis. The major systemic manifestations of snake bite include neurotoxicity, myotoxicity, cytotoxicity, hemolytic, procoagulant, hemorrhagic, and hypotensive effects and interfere in platelet function. General care includes parenteral analgesia, antivenom administration, and serial assessments of limb swelling and laboratory tests. Despite the presence of soft tissue inflammation, prophylactic antibiotics are rarely required, and most patients achieve good outcomes with supportive care and antivenom alone. In the case of mild poisoning do not need to be treated with antivenom. In moderate to severe envenomation, antivenom should be administered. When administered antivenom, adverse reactions are monitored closely and treated early with epinephrine and anti-histamine. In future, we should establish algorithm provides guidance about clinical and laboratory observations, indications for and dosing of antivenom, adjunctive therapies, post-stabilization care, and management of complications from envenomation and therapy.

Factors Related to Successful Endotracheal Intubations with Glidescope(R)

PURPOSE: The aim of this study was to analyze factors affecting success of endotracheal intubation (ETI) in emergency department (ED) patients, and to investigate usefulness of expected difficult direct laryngoscopy for expectation of a bad Glidescope(R) view. METHODS: ETI data using Glidescope(R) were collected at two EDs over a period of 64 months. We accessed intubator's training level, expected difficulty with laryngoscopy, method, and glottis exposure grade. Based on these variables, we analyzed the intubation success rates. And we examined the correlation between glottis exposure grade using Glidescope(R) and factors for expectation of difficult direct laryngoscopy. RESULTS: A total of 613 ETIs attempts using Glidecope(R) were recorded. The overall success rate was 83.4%. In logistic regression analysis, expected difficult laryngoscopy, intubator's training level, and glottic exposure grade were independent predictive factors for successful ETI using Glidescope(R). The Cormack-Lehane grade I via Glidescope(R) was observed in 89.1% of total ETI attempts. In subgroup analysis, bad glottis exposure status showed a significantly low success rate irrespective of intubator's training level. Among the predicting factors for difficult laryngoscopy, morbid obesity, limited neck extension, and limited mouth opening showed an association with the degree of glottic exposure via Glidescope(R). CONCLUSION: The glottic exposure grade was the most important factor related to successful ETI using Glidescope(R). Morbid obesity, limited neck extension, and limited mouth opening showed a significant association with bad glottis exposure under Glidescope(R), Therefore, we need to identify these findings. Even if in good glottis view, junior physicians showed a lower rate of ETI success using Glidescope, therefore, measurements to improve the ability of junior physicians should be implemented.

Ultrasonography of Suspected Ileocolic Intussusceptions Performed by Emergency Medicine Residents

PURPOSE: The aim of this study was to evaluate the sensitivity and specificity of ultrasonography of suspected ileocolic intussusception performed by emergency medicine (EM) residents who participated in a 2-hour focused ultrasound training program for intussusception. METHODS: This was a 16-month retrospective, observational study. Pediatric patients with suspected ileocolic intussusception who underwent ultrasound performed by second or third year EM residents were included in the study. The gold standard was a diagnostic work-up performed by a radiologist or clinical follow-up, compared with the results of ultrasonography performed by EM residents. RESULTS: A total of 38 patients were enrolled. The sensitivity of ultrasound performed by emergency medicine residents for prediction of ileocolic intussusception was 92.86%(66.13% to 99.82%), the specificity was 91.67%(73.00% to 98.97%), the positive likelihood ratio was 11.14(2.93 to 42.34), and the negative likelihood ratio was 0.08(0.01 to 0.52). CONCLUSION: Emergency residents can identify ileocolic intussusceptions with only minimal training, which could substitute for ultrasonography performed by radiologists when they are not immediately available.

Factors Affecting Cardiopul-monary Resuscitation Hands-off Time in an Emergency Room

PURPOSE: The importance of minimizing hands-off time (HOT) during the performance of cardiopulmonary resuscitation (CPR) is emphasized in the new guidelines. This study analyzes the proportion and effects of each HOT result as observed in an Emergency room (ER). METHODS: We prospectively reviewed 45 video records of CPR performed in an ER resuscitation room from October 2007 to September 2008. We measured the total CPR time, the time to first chest compression (initial assessment time; IAT) and the time required to perform each step of the CPR procedure including pulse check and switchig compressors, echocardiography, efibrillation, X-ray, endotracheal intubation, central venous catheter insertion and needle thoracostomy. RESULTS: The median values recorded included the following: total CPR time was 15.7 min (Interquartile range: 7.51~27.8 min), fractions of HOT (HOTF) in CPR was 11.0% (Interquartile range: 6.9~15.1%), the ratio of IAT in total HOT was 16.8% (Interquartile range: 6.4~34%), pulse check and switching compressors in total HOT were 64.4% (Interquartile range: 52~78%), echocardiography was 13.5% (Interquartile range: 7.7~21.2%), defibrillation was 18.1% (Interquartile range: 8.9~24.6%), endotracheal intubation was 12.2% (Interquartile range: 4.2~17.2%) and X-ray was 15.1% (Interquartile range: 12.7~21.0%). We found that the duration of CPR didn't increase HOTF (HOTF within 15 min of the total CPR time is 7.2% and after 15 min HOFT was counted 6.3%). CONCLUSION: During the year of in-hospital CPR data we observed, the pulse check and switch compressor procedure followed the CPR guideline, but the echocardiography, defibrillation and endotracheal intubation resulted in increased HOT. In order to reduce HOT during the performance of CPR, it is necessary to follow the guideline of each step of the procedure.

Accidental Injuries from Explosion of a Compressed Natural Gas Bus

PURPOSE: During August 2010, a natural gas fuel cylinder on a bus exploded in downtown Seoul, injuring 20 citizens. This kind of blast injury has never been reported in Korea before. Thus, the goal of this study was to review the clinical features of these victims to help physicians manage similar cases and to understand the risk factors associated with blast injuries in everyday life. METHODS: Twenty (20) victims who visited nearby emergency departments, and 3 peoples left hospital without care. Seventeen (17) victims were included in this study, and the following factors were investigated: age, sex, type of hospital, diagnosis of injury, injury mechanism, position of victim (in-bus/out of bus), classification of injury severity with START (simple triage and rapid treatment), and classification of injury according to the mechanism of the blast injury. RESULTS: The victims included 8 males (47%), 9 females (53%). The mean age was 37.5+/-12. Thirteen (13) victims were transferred to two tertiary hospitals, and 4 were transferred to two secondary hospitals. The types of injury were 3 fractures, 2 ligaments injuries, 6 contusions, 4 abrasions, and 3 open wounds (one of them was combined fracture). According to START classification, 17 victims were 1 immediate, 11 minor, 5 delayed, and no death. Classifications according to the mechanism of the blast injury were 1 primary injury, 6 secondary injuries (2 of them combined other mechanism), 3 tertiary injuries and 9 quaternary injuries. CONCLUSION: Trauma care physicians should be familiar with not only the specific types of injuries from blast accidents, but also the potential accidents that may occur in public facilities.

Adequacy of Direct Laryngoscope Brightness in 26 Emergency Rooms

PURPOSE: To determine adequacy of brightness and proper brightness of the direct laryngoscope in emergency departments. METHODS: We investigated blade and handle in 26 hospitals in Seoul and made 110 combination. We excluded malfunction and non-fixed combination, and measured the lux of each combination. We divided results into two groups (bulb type and fiber type) in two ways (adult type and pediatric type). RESULTS: In the 110 combinations, the median lux value was 836.25. The number of laryngoscopes in which brightness exceeded International Organization for Standardization (ISO) recommended value of the 700 was 67. There was no statistically significant difference in median lux between fiber type and bulb type (847.5 vs 802.0; p=0.870), while the brightness of the pediatric type was brighter than the adult type. A questionnaire of laryngoscope management revealed no regular basis of use, and complete absence of awareness of brightness criteria. CONCLUSION: An improved laryngoscope managing system is essential including regular criteria for laryngoscope management.

The Effect of Personal Protection Equipment Level C on Airway Management with Advanced Airway Devices: A Manikin Study

PURPOSE: Personal protection equipment (PPE) is compulsory for the safety of physicians and patients in the presence of biological hazards. In particular, such equipment is required for airway management of patients with highly contagious respiratory diseases. However, there are only a few studies about the effect of PPE on airway management with various advanced airway devices including the newly developed video-laryngoscope. We conducted a study on the effect of PPE level C on airway management with five different types of advanced airway devices including the laryngeal mask airway (LMA), direct laryngoscope (DL), airwayscope (AWS), video-laryngoscope made by Stortz (DCI), and the Levitanscope (LE). METHODS: Twenty-two emergency physician and residents in two emergency centers were trained to do trials with PPE and without PPE while performing airway management with five different airway devices. The procedures were done on two types of manikins. We compared the time from the start of the procedure to the first successful ventilation for each device and for each type of manikin. A short questionnaire was used to examine participants' subjective experiences. RESULTS: For both types of manikin, there were no significant differences in performance time between the group not wearing PPE and the PPE wearing group for any device. However, when compared with the other devices, the performance time for the LMA was faster than the other devices, and the Levitanscope(R) took a significantly longer time in both groups. According to the questionnaires, the most comfortable & uncomfortable airway devices were the LMA and the Levitanscope(R). CONCLUSION: When PPE level C was compared with the no protection state, there were no significant statistical time differences for performing advanced airway management with any particular airway device.

Comparison of Cervical Spine Movement by Airway Equipment during Orotracheal Intubation: A Manikin Pilot Study / 대한구급학회지

BACKGROUND: In patients with limited cervical spine movement, equipment for orotracheal intubation should achieve sufficient laryngeal exposure with the least cervical spine movement. This study was designed to compare movement of the cervical spine during the orotracheal intubation with various intubating equipment. METHODS: Twelve emergency physicians & residents with a total experience of >50 cases of endotracheal intubation in two emergency centers were assigned to perform orotracheal intubation with four different airway devices, including the Macintosh laryngoscope (ML), DCI video laryngoscope (DCI), Airway Scope (AWS) and Levitan Scope (LS), using the same manikin (Ambu(R) airway management trainer) in random sequences. Movement of the C-spine was examined by measuring the angle formed by two lines which are parallel to the anterior surface of the C2 and C7 vertebrae bodies. The angle was measured when Cormack-Lehane grade II glottis exposure was achieved during intubation. RESULTS: Mean cervical spine movements were 37.6 +/- 9.2degrees, 32.2 +/- 14.2degrees, 32.2 +/- 6.45degrees and 17.4 +/- 10.0degrees with the ML, DCI (p = 0.347), AWS (p = 0.094), and LS (p < 0.001), respectively, compared to that of ML. Cervical spine movement by LS was 54% less than that by ML. LS produced less cervical spine movement in comparison to DCI (p = 0.013) and AWS (p = 0.001). CONCLUSIONS: The Levitan Scope produced less movement of the cervical spine when compared to the Macintosh laryngoscope, DCI video-laryngoscope and Airway Scope during orotracheal intubation in a single airway training manikin model.

Exposure to Power Frequency Magnetic Fields in the Emergency Department

PURPOSE: We use many electronic devices for treating patients in our emergency department. Several studies have reported an association between electromagnetic field exposure and risk of cancer and other diseases. Our purpose was to measure the intensity of power-frequency magnetic fields in the emergency department and evaluate the conditions exceeded regulation guidelines for power-frequency magnetic fields. METHODS: Extremely low frequency magnetic fields were measured at 78 ordinary working spots in our tertiary hospital's emergency department (ED) and evaluated according to national regulatory guidelines and SWEDAC. Each spot was measured four times. During measurement, every electrical device in the emergency department was turned on. RESULTS: The average intensity of the magnetic fields in our emergency department was 0.99+/-1.27 mG. The maximum intensity was 8.3 mG, which was found in the pediatric section. CONCLUSION: The power-frequency magnetic field intensities of the various sections of our ED did not exceed national regulatory guidelines. However, pediatric and the minor emergency section showed magnetic fields intensities far above 2 mG. We found these high values outside the pediatric and waiting sections, where the electrical cabinet panel was located. We conclude that the electrical cabinet panel should be shielded and that similar studies are needed for other emergency departments.

Development of Assessment Tools for Performance and Leadership of a Cardiopulmonary Resuscitation Team / 대한구급학회지

BACKGROUND: The assessment tools for leadership and performance of resuscitation teams are have not been developed. We evaluated the checklists for resuscitation team performance and teamwork. METHODS: We developed two checklists for team dynamics (D1, D2) and two checklists for team performances (P1, P2). The videotaped mock resuscitation before and after a 2-hr Advanced Cardiovascular Life Support (ACLS) training were also evaluated by two emergency physicians and two nurses using the four checklists. The validity and agreement between assessors were determined. Internal consistency was determined using Cronbach-alpha. RESULTS: There were no significant differences in scores by expert consensus and the checklist score. The average scores between different assessors were different except for the D1 and D2 between doctors. The Cronbach-alpha for internal consistency were within acceptable ranges in the checklists D2 and P2. CONCLUSIONS: This study suggests that the D2 and P2 checklists are provisionally acceptable due to relatively high validity, agreement, and internal consistency. However, further research is needed to develop validated checklists for resuscitation teams.

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.

Comparison of Impedance Cardiography with Thermodilution of Hemodynamic Parameters in Critically Ill Patients / 대한구급학회지

BACKGROUND: To evaluate the feasibility of noninvasive hemodynamic monitoring (impedance cardiography, ICG) in critically ill patients, we compared this technique with simultaneous invasive monitoring with a pulmonary artery thermodilution catheter. METHODS: A prospective observational study was done comparing invasive monitoring and noninvasive monitoring in 12 critically ill patients. The cardiac output (CO), the stroke volume (SV) and the systemic vascular resistance (SVR) measured by using a standard thermodilution pulmonary artery catheter technique were compared with the corresponding measurements simultaneously using an ICG. RESULTS: The value of CO, SV and SVR measured by ICG were closely correlated to those by the thermodilution methods [r: 0.659 (p<0.01), 0.536 (p<0.01), 0.738 (p<0.01)]. CONCLUSIONS: ICG can provide hemodynamic information previously available only by invasive monitoring with a thermodilution catheter.

Effects of Octreotide on Small Bowel Obstructions in Rats / 대한소화기학회지

BACKGROUNDS/AIMS: Gastrointestinal decompression by nasogastric or intestinal tubes developed in 1930s has been the only treatment modality for inoperable intestinal obstruction. We hypothesized that the octreotide, a potent inhibitor of intestinal secretion, has a therapeutic potential in intestinal obstruction. METHODS: Forty Sprague-Dawley rats were randomly assigned to four groups. The rats were subjected to complete or partial ileal obstruction. The treated rats received octreotide (100 microgram/kg) while the controls received the same quantity of saline every 12 hours for 24 or 48 hours. After 24 or 48 hours, the volumes of the small bowel contents were measured. The volumes of supernatant and the concentrations of electrolytes in the small bowel contents after centrifugation were also analyzed. The ileal segments proximal to obstruction were harvested, fixed, and stained, and the pathological changes were evaluated with mucosal damage scores. RESULTS: There were no statistical differences in the volume and the electrolyte composition of intestinal fluid among the 4 groups. In the 48 hour complete obstruction group, the octreotide-treated rats showed statistically lower mucosal damage scores than the control rats (p<0.05). CONCLUSIONS: Octreotide exerts mucosal protecting effect on the complete intestinal obstruction rat model.

Proper Depth of Tracheal Intubation in Korean Children

PURPOSE: In pediatric intubation, it is difficult to select the correct tracheal tube size and proper depth. Children have as many different tube size as they have ages. This study was performed to evaluate the Pediatric Advanced Life Support (PALS) guideline for intubation in Korean children. METHODS: We studied pediatric patients who were admitted with intubation from 1996 to 2001 at our hospital. We selected 33 Korean patients under 15 years of age for evaluation in this study. Their medical records and chest radiographs were compared. The distance of the tracheal tube tip from the carina on the postintubation chest X-ray was determined. RESULTS: Thirty-three patients were enrolled in the study. The depth of tracheal intubation was proper in 12 patients (36.3%), too deep in 16 patients (48.4%) and too shallow in 5 patients (15.1%). The reasons for intubation were respiratory failure (24.2%), mental change (57.6%) and status epilepticus (18.1%). CONCLUSION: We conclude that the PALS guideline for tracheal intubation is not suitable for Korean children. Determination of the proper depth of tracheal intubation for Korean children is needed through further study.