The Effect of Head Rotation and Leg Elevation on Skin Depth, Diameter and Relative Position of the Internal Jugular Vein, and its Implications

PURPOSE: The aim of this study was to evaluate the effect of head rotation and leg elevation as it impacts the depth from the skin surface to the internal jugular vein (IJV), the diameter of the IJV, and the relative anatomical location of the IJV to the carotid artery (CA). METHODS: A total of 20 volunteers were enrolled in this study. In a supine position with/without 30degrees head rotation to the left, and with/without 30degrees leg elevation, the depth from skin surface to IJV, the IJV diameters, and the anatomical relationship between IJV and CA were measured using 2-dimensional ultrasound from the right side of the neck. The relative position of the IJV to the CA was depicted as an angle ranging from -180degrees to +180degrees. The measurements observed in each position were compared. RESULTS: As the head was rotated to the left, the depth of the IJV from the skin surface decreased and the anteroposterior IJV diameter increased significantly (all p<0.001). The relative position of the IJV to the CA tended to move in an anterior and medial direction during head rotation. Leg elevation had a significant impact on the transverse diameter of the IJV, but only when the head was rotated (p=0.027). With leg elevation, there was no consistent locational change of the IJV relative to the carotid artery, and there were no significant changes observed for IJV depth relative to the surface of the skin or IJV anteroposterior diameter. CONCLUSION: Our results indicated that head rotation increases the risk of carotid artery puncture by increasing the overlap of the carotid artery and the IJV. To decrease the risk of carotid artery puncture, a neutral head position should be maintained during IJV catheterization, with a central approach.

The Effect of Head Rotation and Leg Elevation on Skin Depth, Diameter and Relative Position of the Internal Jugular Vein, and its Implications

PURPOSE: The aim of this study was to evaluate the effect of head rotation and leg elevation as it impacts the depth from the skin surface to the internal jugular vein (IJV), the diameter of the IJV, and the relative anatomical location of the IJV to the carotid artery (CA). METHODS: A total of 20 volunteers were enrolled in this study. In a supine position with/without 30degrees head rotation to the left, and with/without 30degrees leg elevation, the depth from skin surface to IJV, the IJV diameters, and the anatomical relationship between IJV and CA were measured using 2-dimensional ultrasound from the right side of the neck. The relative position of the IJV to the CA was depicted as an angle ranging from -180degrees to +180degrees. The measurements observed in each position were compared. RESULTS: As the head was rotated to the left, the depth of the IJV from the skin surface decreased and the anteroposterior IJV diameter increased significantly (all p<0.001). The relative position of the IJV to the CA tended to move in an anterior and medial direction during head rotation. Leg elevation had a significant impact on the transverse diameter of the IJV, but only when the head was rotated (p=0.027). With leg elevation, there was no consistent locational change of the IJV relative to the carotid artery, and there were no significant changes observed for IJV depth relative to the surface of the skin or IJV anteroposterior diameter. CONCLUSION: Our results indicated that head rotation increases the risk of carotid artery puncture by increasing the overlap of the carotid artery and the IJV. To decrease the risk of carotid artery puncture, a neutral head position should be maintained during IJV catheterization, with a central approach.

Analysis of Medical Care by Telemedicine / 항공우주의학회지

Telemedicine is a health care system that contains new-media techniques and medical special knowledge, using information techniques such as audio, moving picture, and communication provided to patients in distant areas with medical service such as diagnosis, consultation, education. Especially during medical transportation, it is possible that transferred patient can be rapidly taken care of by telemedicine. Our study reports 65 cases between a doctor in a hospital on ground and a patient during medical evacuation by telephone, e-mail and facsimile. Sixteen of 65 cases (25%) were immediately transferred to a hospital by sailing or helicopter. Other 49 cases were successfully taken care of by telemedicine.Telemedicine is economic and reasonable solving medical problems that may occur during medical evacuation where access to medical facilities is impossible.

Case Report of a Crushing Injury of Hand by Telemedicine

Crushing injury is a common in work place and require early judgment and assessment. However during shipping, it is impossible that patient is rapidly taken care in hospital. But in this case, crushed handed patient during shipping was early assessment and sutured by telemedicine. A healthy 28-year-old man had crushed hand during working. But this patient was on the sea, so could not use medical facilities. Using e-mailing and telephone by satellite, report-ed to the doctor that patient status. In order to doctor 's pre-scription, patient hand was sutured and prescribed medicines. So patient preserved good hand function and rapidly recovered. In the future, telemedicine will be useful and economic medical field in isolated areas to medical facilities or shipping.

A Study on the Triage and Statitical Data of Patients in the Emergency Room, PNU / 간호학회지

The purpose of this study is to analyze ER patient's Triage and other statistical data. The subjects were 12,618 patients who visited the ER during the year 1998. The study showed the following results; 1. The male vs female ratio was 1.3 : 1.0, the male were in the majority (56.6%), and the age range of 20-29 old was the majority (15.3). The patients who visited ER at 8-10 pm were the majority (11.5%). On Sunday the number of patients who visited the ER were 2,189, and the majority were 17.4%. On Saturday the number of patients was visited the ER were 1,944 patients the second majority (15.4%). Their traffic means : the general passenger cars (75.5%), 119 or hospital ambulance (11.3%). 2. The reasons of visiting ER were : diseases (59.2%), injuries (23.7%). The disease vs injury ratio was 100 : 69. 3. Triage : urgent 40.7%, non-urgent 38.2%, acute 17.8%, and critical 3.2%. 4. The time of waiting and staying in the ER by the Triaget: the average time was 572 minutes (9.53 hrs.). The majority of critical patients (20.5%), acute patients (24.7%) and urgent patients (21.2%) stayed 12-24 hrs., but the majority of non-emergent (27.8%) stayed not longer than one hour. 5. Treatments by the Triage : the 42.9% of critical patients, and 61.3% of acute patients, 57.5% of urgent patients were admitted. But 91.8% of the non-emergents were discharged and 4.7% was admitted. Mortality of total ER visiter were 1.7%. DAA portion was 0.86%. 26.6% of the critical patients were DAA. DAA vs DOA ratio was 1.3 : 1.0. 6. Visiting time, monthly and seasonal distribution by the Triage : the majority of critical patients (12.2%), visited 10-12 am. The majority of acute (12.9%) and urgent (11.7%) visited 4-6 pm, but the majority of non-emergents (15.1%) visited during 8-10 pm. Autumn visiter were the majority (27.6%). The percentage of non-emergent visited in Spring was 41.4% and Autumn was 41.3%. The percentage of urgents who visited in the Summer was 45.3% and the Winter was 40.4%. By clinical departments: the 48.0% of critical patients was NS. The 45.5% of acute and the 33.6% of urgent patients were IM. But the majority of non-emergent patients was PS (21.2%), and the second majority of non-emergent patients was oral Surgery (12.8%).

A Study on the Triage and Statitical Data by the 5 Developmental Stages of the Children in Emergency Room, PNU / 아동간호학회지

The subjects, under 18 old, 2,694 children who visited ER during 199H, were surveyed by the Triage and other statical data. The results were as follows : 1. The male to female ratio was 1.7 : 1, and the toddler(1-4 old) was the majority. 2. Triage : critical 1.3%, acute 14.6%, urgent 29.5%, nonemergent 54.6%. 3. The reasons of visiting ER : 1) The children had diseases(46.5%), injury (36.9%), TA(5.6%) and toxication(1.0%). 2) In diseases, male to female ratio was 1.5 : 1 and in injury, male to female was 2 : 1. 3) Among the children having in TA, 12-18 old groups was the majority(34.9%). 4. The time of visiting ; the 20 : 00-22 : 00 was the majority(16.9%). 5. By monthly and seasonal distribution ; Jan. (9.7%?), Mar. and May(9%) respectively, Dec. and July(6.7%) respectively. The children who visited ER in spring and autumn showed higher portion than those of summer and winter. 6. Results : admission(27.4%), discharge(68.4%), operations(2.8%), and DOA and DAA(0.4%). The mortality of the infancy and toddler groups was 83.3%. The infancy group showed the highest rate of admission. 7. The time of staying in ER : 1-2 hrs was the major group(23.3%) and the average was 4.6 hours. 8. By clinical departments ; Ped, was 34.4%, PS was 20.8.%, Dental Surgery was 10.3% and Dermatology was 0.9%. 9. The types of visiting : the group who visited by themselves was 80%, transfer from the primary and secondary clinic was 17% and OPD was 3.0%. 10. The traffic means ; by the own cars and taxi were 87.6%, by hospital ambulance was 6.1% and by 119 ambulance was 4.3%.

A CLINICAL STUDY OF FOREIGN BODY INGESTION

We analyzed records at Chonnam university hospital from Sep. 1. 1993 to Aug. 31. 1996 to assess clinical significance of the foreign body in the gastrointestinal tract. There were 133 episodes consisting of 79 pediatric and 54 adult patients as possible to review. In the pediatric patients, the coin was the most common cause of foreign body ingestion, while adult patients were usually caused by bones and meat. We removed foreign bodies in the oral cavity and oropharynx in 12 cases using direct laryngophanmgoscpy and forcep. Endoscopy was performed successfully in 47 of 51 patients in which was attempted; there were two complications composed of an aspiration pneumonia and a mediastinitis due to esophageal perforation. There were spontaneous passage of foreign bodies in 48 cases. We observed complications in 6 cases in which 4 cases needed operations due to complications. Foreign bodies which pass into the stomach can be observed for development of complications, as 94% of foreign bodies which reach the stomach spontaneously pass. Only 4 patients required interventions, which was done without mortality.