Optimal timing for performing percutaneous transhepatic gallbladder drainage to severe acute cholecystitis patients who visit the emergency department

Objective@#Severe acute cholecystitis is an infectious disease that requires immediate gallbladder drainage. Although percutaneous transhepatic gallbladder drainage (PTGBD) is the most common method of gallbladder drainage, the optimal timing remains unclear. @*Methods@#This study is a retrospective analysis of patients diagnosed with severe acute cholecystitis who underwent PTGBD between July 2018 to June 2021. This study investigated the effect of time from emergency department arrival to PTGBD (tPTGBD) on patient prognosis. @*Results@#Totally, 48 patients were included in this study. Based on the cutoff value calculated using the Youden index, the group with tPTGBD of <5.93 hours had a shorter hospital stay (10 vs. 13.5 days, P=0.021), lower portion of progression (27:5 [15.6%] vs. 7:9 [56.3%], P=0.004), even they had a higher initial SOFA score (6 vs. 4.6, P=0.049). However, no statistical difference was obtained for the length of ICU stay between both groups (1 vs. 2, P=0.617). @*Conclusion@#Executing PTGBD to severe acute cholecystitis patients within 5.93 hours after presenting at the emergency department is associated with reduced progression and hospital stay.

Long-term impact of coronavirus disease 2019 pandemic on emergency department utilization in a metropolitan emergency department in Korea

Purpose@#As coronavirus disease 2019 pandemic has been prolonged, it became crucial to analyze the long-term impact of the pandemic on emergency department (ED) utilization for efficient use of emergency medicine resources. @*Methods@#We reviewed the data of children (≤ 18 years) who visited the ED in Daejeon, Korea, from February 2019 through January 2021. This period was dichotomized by February 2020 into the reference and pandemic periods. The latter period was further divided into the early (February-August 2020) and late pandemic periods. Between the reference and pandemic periods, and between the early and late pandemic periods, we respectively compared proportions of children in all patients (including adults), age groups, high acuity (the Korean Triage and Acuity Scale 1-2), diagnostic codes, visits via ambulances, ED length of stay, and ED disposition. @*Results@#Compared to the reference and early pandemic periods, the pandemic and late pandemic periods respectively showed changes as follows: proportion of children in all patients (from 29.8% to 19.0% and from 19.8% to 18.1%; all Ps < 0.001), children younger than 5 years (from 56.7% to 49.9% and from 52.1% to 47.4%; all Ps < 0.001), high acuity (from 12.0% to 7.8% [P < 0.001] and from 8.8% to 6.7% [P = 0.004]), “Injury, poisoning and certain other consequences of external causes (S00-T98; from 30.0% to 49.0% and from 48.3% to 49.8%),” and “Diseases of the respiratory system (J00-J99; from 29.6% to 10.3% and from 12.8% to 7.5%).” Increases in the visits via ambulances, ED length of stay, children undergoing intensive care unit hospitalization or death were noted only in comparison between the reference and pandemic periods. @*Conclusion@#A long-term impact of the pandemic on ED use may be a decrease in the proportion of young or ill children.

Use of Emergency Medical Services and Characteristics of Urgent and Non-Urgent Adult Patients according to the Usual Source of Care: A Korea Medical Expenditure Panel Study

PURPOSE: Use of emergency rooms (ERs) has increased considerably in Korea. This increase has caused over-crowding and has increased the burden on ER services, created a lack of continuous service provided by ERs, and raised costs. The objective of this study was to examine the characteristics of ER use for urgent and non-urgent cases in 2009-2011. METHODS: In this multivariate analysis, we included data collected from the 2009-2011 Korea Medical Expenditure Panel Survey to assess independent factors associated with ER use in non-urgent settings. We consecutively included patients > or =19 years who had completed the survey until 2011. RESULTS: Among the 10,428 respondents, 19.1% of patients had used ERs. Patients who had used EDs were less likely to have attended graduate school (high school: odds ratio [OR], 0.78 [0.63-0.98]; university: OR, 0.69 [0.54-0.89]) or have chronic disease (OR: 0.68 [0.60-0.78]). In addition, patients who did not have a usual source of care (OR, 0.78 [0.70-0.87]) or those who did not have private insurance (OR, 0.86 [0.74-0.99]) were less likely to use ERs. In the 1,994 cases of ER use, however, the any factors were not affected in the non-urgent ER use group. CONCLUSION: The number of patients who used ERs has increased, and there were no significant differences in ER use between non-urgent and urgent patients. ERs may have been used for non-urgent cases owing to other reasons. Further studies on the reasons for non-urgent ER use and development of urgent patient criteria are required.

Comparison of the Diameter-Dependent Lubricant Effects on Stylet Removal from an Endotracheal Tube

PURPOSE: A stylet aids intubation as a glottis by changing and maintaining the bending inside the endotracheal tube and is used as an auxiliary device in intubation. The aim of this experimental study is to evaluate resistance differences among endotracheal tube sizes and the usefulness of lubricant for stylet removal. METHODS: Depending on endotracheal tube size and lubricant use status, the subjects were divided into the control (n=10, each 7 tube sizes), lidocaine gel (n=70), and saline groups (n=70). Using a tensile strength meter, the work and the peak withdrawal force consumed for retracting a stylet were measured. RESULTS: When the work dependent on the endotracheal tube size and stylet coating was compared, significantly less work was consumed for 6.0-, 6.5-, 7.0-, 8.0-, 8.5 mm stylet group coated with lidocaine gel (p=0.029, p=0.002, p=0.001, p=0.001, p<0.001, p<0.001) or 6.0-, 6.5-, 8.0-, 8.5 mm stylets coated with saline compared to the control group (p=0.002, p<0.001, p<0.001, and p<0.001). In comparison of the peak withdrawal force dependent on the endotracheal tube size and stylet coating, significantly less peak withdrawal force was consumed for the 6.0- or 8.0- mm stylet group coated with lidocaine gel (p=0.004, p<0.001) or 6.0-, 6.5-, 7.5-, or 8.0 mm stylets coated with saline compared to the control group (p=0.025, p=0.001, p=0.008, and p=0.001). CONCLUSION: We found that the effectiveness of lubricant resulted in various sized tubes. Less work was consumed for five tube sizes (6.0-, 6.5-, 7.0-, 8.0-, 8.5 mm) in lidocaine gel groups and four tube sizes (6.0-, 6.5-, 8.0-, 8.5 mm) in saline groups. Less peak withdrawal force was consumed for two tube sizes (6.0-, 8.0 mm) in lidocaine gel groups and four tube sizes (6.0-, 6.5-, 7.5-, 8.0 mm) in saline groups.

Traumatic Liver Injury: Factors Associated with Mortality / 대한구급학회지

BACKGROUND: We postulate that a delay in the implementation of hepatic arterial embolization for traumatic liver injury patients will negatively affect patient prognosis. Our work also seeks to identify factors related to the mortality rate among traumatic liver injury patients. METHODS: From January 2008 to April 2014, patients who had been admitted to the emergency room, were subsequently diagnosed with traumatic liver injury, and later underwent hepatic arterial embolization were included in this retrospective study. RESULTS: Of the 149 patients that underwent hepatic arterial embolization, 86 had the procedure due to traumatic liver injury. Excluding the 3 patients that were admitted to the hospital before procedure, the remaining 83 patients were used as subjects for the study. The average time between emergency room arrival and incidence of procedure was 164 min for the survival group and 132 min for the non-survival group; this was not statistically significant (p = 0.170). The average time to intervention was 182 min for the hemodynamically stable group, and 149 min for the hemodynamically unstable group, the latter having a significantly shorter wait time (p = 0.047). Of the factors related to the mortality rate, the odds ratio of the Glasgow Coma Score (GCS) was 18.48 (p < 0.001), and that of albumin level was 0.368 (p = 0.006). CONCLUSIONS: In analyzing the correlation between mortality rate and the time from patient admission to arrival for hepatic arterial embolization, there was no statistical significance observed. Of the factors related to the mortality rate, GCS and albumin level may be used as prognostic factors in traumatic liver injury.

Traumatic Liver Injury: Factors Associated with Mortality / 대한중환자의학회지

BACKGROUND: We postulate that a delay in the implementation of hepatic arterial embolization for traumatic liver injury patients will negatively affect patient prognosis. Our work also seeks to identify factors related to the mortality rate among traumatic liver injury patients. METHODS: From January 2008 to April 2014, patients who had been admitted to the emergency room, were subsequently diagnosed with traumatic liver injury, and later underwent hepatic arterial embolization were included in this retrospective study. RESULTS: Of the 149 patients that underwent hepatic arterial embolization, 86 had the procedure due to traumatic liver injury. Excluding the 3 patients that were admitted to the hospital before procedure, the remaining 83 patients were used as subjects for the study. The average time between emergency room arrival and incidence of procedure was 164 min for the survival group and 132 min for the non-survival group; this was not statistically significant (p = 0.170). The average time to intervention was 182 min for the hemodynamically stable group, and 149 min for the hemodynamically unstable group, the latter having a significantly shorter wait time (p = 0.047). Of the factors related to the mortality rate, the odds ratio of the Glasgow Coma Score (GCS) was 18.48 (p < 0.001), and that of albumin level was 0.368 (p = 0.006). CONCLUSIONS: In analyzing the correlation between mortality rate and the time from patient admission to arrival for hepatic arterial embolization, there was no statistical significance observed. Of the factors related to the mortality rate, GCS and albumin level may be used as prognostic factors in traumatic liver injury.

Could One-Hand Compression for a Small Child Cause Intra-abdominal Injuries?

PURPOSE: We examined the question of whether one-hand chest compression for a small child could compress intraabdominal organs. METHODS: We retrospectively examined medical charts and multidirectional computed tomography (MDCT) images obtained from children aged 1 to 18 years who presented to the hospital from March 2002 to March 2012. We measured the length of the sternum (Stotal) and the length of the lower half of the sternum (Stotal/2~X). We also measured the distance from the diaphragm to the midpoint of the sternum (Stotal/2~D) and half the width of an adult hand (Wtotal/2). Finally, we counted the number of instances at each age in which Stotal/2~X and Stotal/2~D were less than Wtotal/2. RESULTS: This study included records and MDCT images for 301 children with a mean age of 12.05+/-5.59 years. We also enrolled 47 adult rescuers (25 men, 53.2%) with a mean age of 23.20+/-2.13 years. The mean Wtotal/2 was 4.62+/-0.46 cm. All 1-year-old children had Stotal/2~X and Stotal/2~D less than Wtotal/2. Among children aged 2 years, six (60.0%) had Stotal/2~X and Stotal/2~D less than Wtotal/2. Among children aged 3 years, four (26.7%) had Stotal/2~X and Stotal/2~D less than Wtotal/2, and among those aged 4 years, two (13.3%) had Stotal/2~X and Stotal/2~D less than Wtotal/2. However, Stotal/2~X and Stotal/2~D were greater than Wtotal/2 in children aged 5 years or more. CONCLUSION: Our measurements indicate that one-hand chest compression for a small child could cause intraabdominal organ injury.

A Case of Mental Change in a Patient Who Received a Zoletil Injection

Zoletil is a non-opioid, non-barbiturate animal anesthetic and proprietary combination of two drugs, a dissociative anesthetic drug, tiletamine, with the benzodiazepine anxiolytic drug, zolazepam. Zoletil has greater potency than ketamine. Zoletil is abused for recreational purposes, especially by people with easy access to medicine. However, in Korea, it is available over-the-counter. Here we report on a case of an 83-year-old woman who received injection of seven vials of "Zoletil 50" by her daughter and presented with an altered mental change. Her mental state was stupor and vital sign was hypotension, bradycardia. Her blood tests indicated metabolic and respiratory acidosis and hyperkalemia. She was treated with intravenous naloxone and flumazenil but was not responsive. She was admitted to the ICU and treated with supportive therapy. Her mental state showed transient recovery, however, her clinical manifestation worsened and she expired.

Clinical Analysis of Ocular Trauma Induced by Lawn Trimmers

PURPOSE: Lawn trimmers are widely used to cut the weeds around graves in South Korea, but they can cause ocular injury. We investigate at the emergency room the incidence and the clinical features of ocular trauma induced by lawn trimmers. METHODS: The authors analyzed 106 patients who visited Konyang University Hospital's emergency room from March 1, 2007, to October 31, 2011, because of ocular trauma caused by a lawn trimmer. Patients were sorted into two groups, severe ocular injury and mild ocular injury. RESULTS: Over a 5-year period, 106 patients with ocular trauma caused by a lawn trimmer underwent clinical study. Most of the patient (103 patients) were males, and the average age of the patients was 51.75+/-11.66 years. The incidence of ocular trauma peaked in the sixth decade of life. Most injuries occurred between July and September. Severe ocular injury developed in 46.2% of all patients. As age increased, so did the severity of the ocular injury. The impacting object was a small stone in 43.4% of all patients. Nobody wore protective gear. The most common diagnosis were corneal abrasion, followed by intraocular foreign body, corneal laceration, and sclera laceration. Fifty-four patients were followed up, and thirty-six patients of them had severe injury. The most common complication was a traumatic cataract. CONCLUSION: Ocular trauma induced by a lawn trimmer is more severe than general ocular trauma. We suggest that everyone using a lawn trimmer should wear protective gear and follow safety guidelines.

Comparative Study Evaluating the Accuracy of the Urine Sodium Dithionite Test to Predict Plasma Paraquat Concentration in Poisoning Cases

PURPOSE: Plasma Paraquat level is one of the most important prognostic factors used in identifying Paraquat poisoning. Urine sodium dithionite tests are widely used in clinical settings for detecting the presence of Paraquat chemicals and predicting prognosis, but this test is subjective and qualitative. In this prospective study, we evaluated the correlation between sodium dithionite test results as measured by a colorimeter, versus actual plasma or urine Paraquat levels. METHODS: Plasma and urine sample were taken from patients upon arrival at a local emergency center (ED) within 12 hours after Paraquat ingestion. Urine was tested using sodium dithionite reaction and the resulting urine color was measured by colorimeter to result in an L (lightness) value. RESULTS: A total of 23 patients were enrolled in this study with a mean age of 57 years old, mean Paraquat intoxication volume of 94 mL, and mean Paraquat intoxication prior to ED arrival of 3.2 hours. The patients' mean blood Paraquat concentration was 82.23 microg/ml and urine Paraquat concentration was 169.19 microg/ml. Using the sodium dithionite test, 17 patients were diagnosed as beyond 'strong positive'. L values were correlated with intoxication volumes, blood Paraquat concentrations, and urine Paraquat concentrations. Blood Paraquat concentrations showed significant correlation with L value, poison volume, urine Paraquat volume, and creatinine values. CONCLUSION: The greater the intoxicated Paraquat volume, blood Paraquat concentration, and urine Paraquat concentration, the lower the L value.

Clinical Features of Acute Acetanilide Herbicide Poisoning

PURPOSE: Acetanilide has been in widespread use as an amide herbicide compound. However, available data regarding acute human poisoning is scarce. The aim of this study was to analyze the clinical characteristics of acetanilide poisoning in order to identify the risk factors associated with severity. METHODS: We conducted a retrospective observational study encompassing the period January 2005 to December 2010, including adult ED patients suffering from acetanilide intoxication. Toxicological history, symptoms observed, clinical signs of toxicity, and laboratory test results were collected for each patient. The patients were classified into two groups for analysis, according their poisoning severity score (PSS). Resulting clinical data and prognostic variables were compared between mild-to-moderate poisoning (PSS 1/2 grades), and severe poisonings and fatalities (PSS 3/4 grades). RESULTS: There were a total of 37 patients, including 26 alachlor, 6 s-metolachlor, 4 mefenacet, and 1 butachlor cases. The majority of patients (81.1%) were assigned PSS 1/2 grades. Changes in mental status and observation of adverse neurologic symptoms were more common in the PSS 3/4 group. The median ingested volume of amide herbicide compound was 250 ml (IQR 200-300 ml) in the PSS 3/4 group, and 80 ml (IQR 50-138 ml) in the PSS 1/2 group. Also, the median GCS observed in the PSS 3/4 group was 13 (IQR 10-14), which was markedly low as compared to a median GCS of 15 in the PSS 1/2 group. Overall mortality rate was 5.4%, and profound cardiogenic shock was observed prior to death in all fatalities. CONCLUSION: When compared to previous reports, acute acetanilide poisoning resulted in relatively moderate severity. The presence of neurologic manifestations, hypotension, lower GCS score, and larger ingested volumes was associated with more serious effects and mortalities.

Pneumatization Pattern of the Frontal Recess: Relationship of the Anterior-to-Posterior Length of Frontal Isthmus and/or Frontal Recess with the Volume of Agger Nasi Cell

OBJECTIVES: We analyzed the pneumatization pattern of the frontal recess (FR) in a Korean population. We also determined the correlation between the volume of the agger nasi cell (ANC) and the anterior-to-posterior (A-P) length of the frontal isthmus (FI) and FR. METHODS: Multiplanar paranasal sinus computed tomography (CT) images from 105 patients who underwent endoscopic sinus surgery were reviewed. The prevalence of frontal recess cells (FRCs), thickness of the frontal beak (FB), volume of the ANC, A-P length of the FI, and FR were evaluated. RESULTS: The ANC was identified in 96% of the patients and frontal cells (FCs) in 32% (FC type 1, 24.2%; type 2, 4.2%; type 3, 3.1%; and type 4, 0%). The prevalences of frontal bullar, suprabullar, supraorbital ethmoidal, and interfrontal sinus septal cells were 10%, 7.8%, 3.6%, and 6.8%, respectively. The A-P lengths of the FR and FI were 10.1+/-3.1 and 8.4+/-2.9 mm, respectively. The thickness of the FB was 7.8+/-1.8 mm and the volume of the ANC averaged 394.1+/-240.5 mm3. The thickness of the FB did not correlate with the volume of the ANC. In contrast, the A-P length of the FI and FR were positively correlated with the volume of the ANC. CONCLUSION: ANCs and FCs were found in 96% and 32% of the cases in this series. FC type 4 was not seen. What appeared to be FC4 on conventional CT was identified as FBC from reconstructed parasagittal images. A large ANC increased the A-P length of the FI and FR, regardless of the thickness of the FB.

Comparative Analysis of Overdose with Common Sleep-aid Medications: Doxylamine vs Diphenhydramine

PURPOSE: The previous studies on H1 antihistamine overdose have generally been limited to cases of acute doxylamine succinate (DS) poisoning, yet there have been some studies on diphenhydramine (DPH) overdosing. But many clinicians consider the two drugs to be very similar and to have similar ingredients. The purpose of this study was to clarify the toxicologic characteristics and clinical outcomes between DS and DPH poisoning/overdose. METHODS: We reviewed the medical and intensive care records of the patients with acute DS or DPH poisoning and who admitted to our emergency department from January 2008 and April 2010. We collected patient information regarding the features of the poisoning and the clinical and demographic characteristics. The patients were assessed for the clinical outcomes, the GCS, the PSS (Poisoning Severity Score) and the SOFA (Sequential Organ Failure Assessment). RESULTS: Fifty seven patients (45 cases of DS poisoning and 12 cases of DPH poisoning) were enrolled. Compared with the DS group, the DPH group had higher incidences of intubation, serious mental change, QTc prolongation and ECG conduction abnormality (p=0.041, <0.001, 0.014 and 0.044, respectively). The DPH group had a higher PSS and a longer ICU stay. The peak CPK time and the CPK normalization time were longer for the patients with rhabdomyolysis due to DS poisoning. CONCLUSION: Two common H1 antihistamines, doxylamine and diphenhydramine, are in the same ethanolaminestructural class, but the toxico-clinical outcomes are different according to many aspects. Therefore, clinicians could take a careful approach for the differential diagnosis and management between DS and DPH poisoning.

A Case of Electrocardiographic and Mental Change in a Patient with a Diphenhydramine Overdose

The antihistaminic drug diphenhydramine is mainly used as a sedative, hypnotic and antiemetic. In many countries it is available over-the-counter, very common, and generally regarded as a harmless drug. However, diphenhydramine overdose can result in cardiotoxicity due to its ability to block fast sodium channels in a manner analogous to classic Vaughan-Williams type IA antidysrhythmic agents. As such, cardiotoxicity from diphenhydramine resembles that of the tricyclic antidepressant agents. Here we report a case of a 52 year old man who ingested 2,000 mg of diphenhydramine and presented with an altered mental state and an electrocardiographic change. His electrocardiogram showed sinus tachycardia with a rate 145 beat/min, a QRS interval of 88 ms, and a QTc of 556 ms. He had a wide anion gap metabolic acidosis. He was treated with intravenous sodium bicarbonate and supportive therapy. His clinical manifestations waned and he was transferred to another hospital nearby his hometown.

Application of Perifix(R) LOR (Loss of Resistance) Syringe for Obtaining Adequate Intracuff Pressures of Endotracheal Tubes

PURPOSE: The management of cuffed endotracheal (ET) tubes is routine practice for emergency physicians. Although various cuff inflation techniques are used, there is no standard technique identified in the literature as the method for cuff inflation or intracuffed pressure (ICP). A loss of resistance (LOR) syringe has been used for years and this is located in the epidural space. The purpose of this study was to measure the actual ICP obtained by a new estimation technique. METHODS: Using a manikin simulation model, we assessed how physicians inflated the cuff in 5.5, 6.5, 7.5 mm inner diameter ET tubes. We measured the inflated air volumes and the ICPs obtained by the conventional technique (A group), by the commercial 10-ml syringe + passive release technique (B group), and by a LOR syringe + PRT (C group). Subsequently, a manometer was used to measure the actual ICP (normal: 16 to 40 cmH2O). RESULTS: We sampled 90 participants. They were classified into three groups: those who underwent the conventional inflation technique (A group, n=30), those who underwent the commercial syringe technique (B group, n=30) and those who underwent the Perifix(R) LOR syringe technique (C group, n=30). In the control group, the mean recorded ICPs were 78.2+/-30.7 cmH2O (A group) and 56.1+/-16.0 cmH2O (B group). The initial cuff pressures were greater than 40 cmH2O in 25 (83.3%) cases. For the experimental group, the mean recorded ICP was 19.1+/-1.8 cmH2O. With respect to the rate of optimal cuff inflation, the LOR syringe technique was significantly higher than the conventional method or the PRT + 10-ml syringe method (100% vs. 16.7 and 23.3%, respectively, p<0.001). CONCLUSION: Using conventional syringe technique, most cuff pressures exceeded a safe pressure and they required correction. Ultimately, PRT using the Perifix(R) LOR syringe is a useful alternative cuff inflation method when direct intracuff pressure measurement is not available.

Correlation Analysis of Injection Cannula's Diameter and Fat Cell Viability in Autologous Fat Grafts

Autologous fat graft is a common procedure in cosmetic and reconstructive plastic surgery. However, a resorption is the limitation of fat graft, and there have been numerous attempts to find appropriate methods for long-term graft survival. The purpose of this study was to determine an optimum injection cannula that gave the highest numbers of viable fat cells. Fat tissue harvested from the periumbilical area of 5 patients was injected through 17G, 18G and 19G microcannulas. Injected fat tissue was then separated to mature adipocytes and preadipocytes, and cellular viability was quantitatively evaluated by XTT reduction assay. Results showed no significant difference in viability of both mature adipocytes and preadipocytes between groups. Based on these results, we concluded that there is no relationship between the size of injection cannula and the viability of fat cells. To support our conclusion, further in-vivo study is required.

The Influence of Rotation Order on Medical Students' BLS Performance during the OSCE Examination

PURPOSE: An objective structured clinical examination (OSCE) is an examination made up of a series of stations through which the candidate rotates to test clinical skill performance. This study was conducted to evaluate whether the testing ability changed and the basic life support (BLS) performance was influenced during the OSCE as a function of the time elapsed during the rotations. METHODS: Candidates rotated around the 10 stations in 6 groups lasting 6 minutes each, for a total examination period of approximately 1 hour. For our analysis, 58 third-year medical students were divided into four groups by testing order; early, early-middle, late-middle, and latter. BLS performance scoring consisted of 50 points with 13 question items. We also analysed their objective BLS performance by Resusci(R) Anne Skill Report TM scoring results. RESULTS: The total OSCE scores of each group were 404.8 +/-28.5, 395.8+/-18.7, 386.0+/-20.9, and 386.3+/-39.5 (p=0.187), respectively. The station scores were as follows: 40.8+/-5.4, 36.6+/-7.2, 34.2+/-6.1, and 33.7+/-6.2 for total BLS examination score (p=0.008), respectively; 2.5+/-2.6, 5.0+/-0.0, 4.7+/-1.2, and 5.0+/-0.0 for performance of sequence (p=0.000), respectively; 43.0+/-23.7%, 47.2+/- 17.6%, 12.7+/-2 2.0%, and 16.8+/-21.4% for adequate ventilation (p=0.000), respectively; and 77.3+/-21.5%, 62.8+/- 46.1%, 52.4+/-22.4%, and 31.3+/-36.1% (p=0.003) for adequate compressions, respectively. The general performance- related variables were lesser points in the early group. As the test progressed, accuracy decreased conspicuously in the middle groups. However, accuracy rose again, but fatigue-related scores were deteriorated in the latter group. CONCLUSION: According to our study, the rotating order has exerted a strong influence on medical students' BLS performance and examination scores. Therefore, we should consider score distribution in the performance evaluation and accuracy of items to according to the rotation order during the OSCE examination.

Severe Traumatic Intraocular Injuries Related to Blowout Fractures

PURPOSE: Blunt trauma can cause a wide range of ocular injuries. This study was performed to describe the prevalence of severe intraocular injuries (SIOI) and their correlation with the severity of blunt orbital trauma. METHODS: We retrospectively analyzed 117 eyes of 107 patients with orbital wall fractures who visited the emergency room at Konyang University Hospital from July 2006 to June 2008. Clinical features such as age, sex, causes of injury, revised trauma score (RTS), type of orbital wall fractures were recorded. The patients were divided into two groups: blowout fracture with severe intraocular injuries (SIOI) and blowout fracture without SIOI. We compared the clinical and the injury-related characteristics between two groups and analyzed the SIOS-related factors. RESULTS: Among the 107 patients (117 eyes) with blowout fractures, 29 (27.1%) patients with 32 eyes (25.6%) had complicated severe intraocular injuries. Retrobulbar hemorrhage (14.5%), hyphema (13.7%), traumatic optic nerve injury (4.3%), and sustained loss of visual acuity (4.3%) were the most common SIOI disorders. A logistic regression analysis revealed that loss of visual acuity (odds ratio = 4.75) and eyeball motility disorder (odds ratio=7.61) were significantly associated with SIOS. CONCLUSION: We suggest that blowout fracture patients with loss of visual acuity or eyeball motility disorder are mostly likely to have severe intraocular injuries, so they need an ophthalmologic evaluation immediately.

Emergency Care and Disposition of Prisoners in the Emergency Department

PURPOSE: Most emergency departments (EDs) treat prisoners; however, in so doing, there is often a disruption in the normal routines of the ED and associated problems for the treating physician. The current study was conducted to describe the use of emergency medical care by the prison population in an effort to better understand the needs of prisoners and to plan specific services to care for prisoners. METHODS: We retrospectively analyzed 220 ED admissions involving 188 prisoners at Konyang University Hospital between August 2004 and January 2009. The medical records of all prisoners admitted to the ED were collected and analyzed from the ED computerized database. The following data were extracted for each prisoner: time and reason for admission, age, gender, Emergency Severity Index (ESI), final diagnosis, and disposition. RESULTS: The 220 admissions (188 prisoners; mean age, 42.3 years; range, 20-78 years) consisted of the following: medical illnesses (64.1%), self-injuries (16.8%), surgical conditions (7.7%), injuries sustained from violence (6.4%), accidental injuries (3.6%), sports injuries (0.9%), and miscellaneous (0.5%). Eighty ED admissions (36.4%) had significant medical histories, including hypertension, diabetes, myocardial infarctions, and seizure disorders. Ninety-six ED admissions (43.6%) were subsequently admitted to the hospital as inpatients. Twenty prisoners visited the ED more than 1 time (a total of 52 times), including 2 prisoners who were admitted to the ED 5 times each. There were 19 ED admissions for ingestion of foreign objects by 15 prisoners. The most common foreign body was a metal wire. The overall mortality rate was 6.9%. CONCLUSION: Prisoners referred to the ED have serious medical conditions with a high mortality rate that require specific emergency management. In rendering care for a confined prison population, the ED staff should be aware of the increased risk of sudden cardiac death.

Clinical Characteristics of Patients with Acute Organophosphate Poisoning Requiring Prolonged Mechanical Ventilation

Purpose: The major complication of acute organophosphate (OP) poisoning is respiratory failure as a result of cholinergic toxicity. Many clinicians find it difficult to predict the optimal time to initiate mechanical ventilation (MV) weaning, and as a result have tended to provide a prolonged ventilator support period. The purpose of this study is to determine any clinical predictors based on patients characteristics and laboratory findings to assist in the optimal timing of mechanical ventilator weaning. Methods: We reviewed medical and intensive care records of 44 patients with acute OP poisoning who required mechanical ventilation admitted to medical intensive care unit between July 1998 and June 2007. Patient information regarding the poisoning, clinical data and demographic features, APACHE II score, laboratory data, and serial cholinesterase (chE) levels were collected. Base on the time period of MV, the patients were divided into two groups: early group (wean time or =7 days, n = 16). Patients were assessed for any clinical characteristics and predictors associated with the MV weaning period. Results: During the study period, 44 patients were enrolled in this study. We obtained the sensitivity and specificity values of predictors in the late weaning group. APACHE II score and a reciprocal convert of hypoxic index but specificity (83.8%) is only APACHE II score. Also, the chE concentration (rho = -0.517, p = 0.026) and APACHE II score (rho = 0.827, p < 0.001) correlated with a longer mechanical ventilation duration. Conclusion: In patients with acute OP poisoning who required mechanical ventilation, the APACHE II scoring system on a point scale of less than 17 and decrements in cholinesterase levels on 1-3 days were good predictors of delayed MV weaning.