Risk Factors for Intracranial Injury Caused by Falls at Home in Korea Using Data from the Emergency Department-based Injury In-depth Surveillance (2011–2018)

Background@#Most unintentional injuries that occur at home are preventable. However, it may be difficult to sufficiently reduce the number of falls occurring at home by only identifying risk factors focused on specific age groups. Therefore, this study aimed to identify the risk factors (especially age and places where injuries occurred at home) for intracranial injury (ICI) caused by unintentional falls at home. @*Methods@#Using the Emergency Department (ED)-Based Injury In-depth Surveillance, we analyzed the data of patients who visited the ED due to unintentional falls at home. Risk factors were identified using multivariable logistic regression according to age groups and interactions between place of injury occurrence and age groups, and sex and age groups were assessed. @*Results@#In total, 232,124 patients were included in the analysis; older adults had a higher adjusted odds ratio (aOR) 14.05 (95% confidence interval [CI], 12.74–15.49) of ICI than infants. The corridor was associated with ICI in the male pediatric group (aOR, 2.71; 95% CI, 1.08–6.84) and the balcony with the female pediatric group (aOR, 2.04; 95% CI, 1.03–4.04). In the adult group, aOR of kitchen was 1.38 (95% CI, 1.02–1.88) in females and 0.56 (95% CI, 0.48–0.66) in males. @*Conclusion@#In this study, we identified the risk factors of ICI caused by falls at home using ED-based injury surveillance data. The risk of ICI was different among places of occurrence in the home depending on the age groups and sex.

Risk Factors for Intracranial Injury Caused by Falls at Home in Korea Using Data from the Emergency Department-based Injury In-depth Surveillance (2011–2018)

Background@#Most unintentional injuries that occur at home are preventable. However, it may be difficult to sufficiently reduce the number of falls occurring at home by only identifying risk factors focused on specific age groups. Therefore, this study aimed to identify the risk factors (especially age and places where injuries occurred at home) for intracranial injury (ICI) caused by unintentional falls at home. @*Methods@#Using the Emergency Department (ED)-Based Injury In-depth Surveillance, we analyzed the data of patients who visited the ED due to unintentional falls at home. Risk factors were identified using multivariable logistic regression according to age groups and interactions between place of injury occurrence and age groups, and sex and age groups were assessed. @*Results@#In total, 232,124 patients were included in the analysis; older adults had a higher adjusted odds ratio (aOR) 14.05 (95% confidence interval [CI], 12.74–15.49) of ICI than infants. The corridor was associated with ICI in the male pediatric group (aOR, 2.71; 95% CI, 1.08–6.84) and the balcony with the female pediatric group (aOR, 2.04; 95% CI, 1.03–4.04). In the adult group, aOR of kitchen was 1.38 (95% CI, 1.02–1.88) in females and 0.56 (95% CI, 0.48–0.66) in males. @*Conclusion@#In this study, we identified the risk factors of ICI caused by falls at home using ED-based injury surveillance data. The risk of ICI was different among places of occurrence in the home depending on the age groups and sex.

Accuracy of high-sensitivity troponin-T in patients visited emergency department with or without symptoms suggestive of acute myocardial infarction

OBJECTIVE: A method of early diagnosis of acute myocardial infarction (AMI) using high-sensitivity cardiac troponin-T (hs-TnT) has been introduced. This study was conducted to evaluate the accuracy of hs-TnT in patients with suspected AMI. METHODS: Patients who were more than 20 years old with symptoms of AMI and who underwent hs-TnT and coronary angiography or echocardiography were included. Risk factors associated with AMI and basic characteristics were collected. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated. The effects of time from symptom onset to emergency department (ED) visit on test accuracy were analyzed. RESULTS: The final analysis included 102 patients, of which 37 were AMI. The sensitivity and specificity of the hs-TnT was 59.5% (95% confidence interval [CI], 42.1% to 75.2%) and 67.7% (95% CI, 54.9% to 78.8%), respectively. In patients with typical chest pain, the sensitivity and specificity of the hs-TnT was 58.1% (95% CI, 39.1% to 75.5%) and 73.2% (95% CI, 57.1% to 85.8%), respectively. The NPV and sensitivity increased, and the PPV and specificity decreased as time from symptom onset to ED visit increased. CONCLUSION: The accuracy of the hs-TnT test was not as good in patients who visited the ED for symptoms suggestive of AMI. Therefore, to rule-in or rule-out AMI by using hs-TnT in ED, it is necessary to consider the electrocardiogram and clinical features, or to check variations by repeated measurement of hs-TnT.

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.

Emergency Medicine in Disasters / 한양의대학술지

Disaster medicine and emergency medicine are common in many parts, particularly in the acute stage of disaster, so the role of emergency medicine in disaster is very important. For adequate disaster preparation and response, interest and investment to emergency medical care for emergency and safety issues that deal with most important thing, life conservation, must be made in the future. Specifically, support to the emergency medical centers as disaster base hospitals is necessary for emergency medicine to perform adequate roles in disaster, and it is also necessary to assign the role to the hospital in the area that holds the local risk factors. Because of the poor preparedness for nuclear, chemical or biological disaster in Korea, the important things are the preparation and establishment of infrastructure based on equipment and facilities, related to special type disasters. So the government should support the emergency medical system for the adequate response to disasters as well as individual emergency care.

Disaster medicine in Korea

No abstract available.

Principles and system of disaster medicine

For adequate disaster preparation and response, the capacity of various sectors should be integrated harmoniously into a single system. Investment must be made in disaster medical care for emergencies and safety issues that address the most important priority - conservation of life. Specifically, support for disaster base hospital is necessary for a hospital to perform an adequate role in disaster, and it is also necessary to assign the role of disaster base hospital to hospitals in areas that contain local risk factor. Because of the problems for nuclear, chemical or biological disaster preparedness in Korea, important things to consider are the preparation and establishment of an infrastructure based on equipment and facilities, including personal protective equipment, decontamination equipment and facilities. Governments should support the operation of disaster medical assistance teams in order to improve the disaster medical system.

Experiences and lessons of the disaster medical assistance in Korea

In the cases of two important disasters that occurred in Korea in 2014, it was important to spread information early and to respond systematically for rapid utilization of disaster medical resources. Initial response units such as fire and police departments should deliver disaster medical information to disaster medical units and systems to facilitate the rapid response of disaster medical resources. When considering disaster medical situations in Korea, the size of a disaster medical assistance team should be smaller compared to the United States for an effective domestic disaster medical response. In addition, regional disaster manuals or guidelines should be accepted in place of instructions from the central government for detailed disaster medical response in each disaster region, and repeated disaster drills that include related organizations should be performed. The provision of institutional strategy is needed to support the basis of on-site disaster medical assistance activities and the existence of disaster medical assistance team.

Grayanotoxin Poisoning from Honey: A Case Report

Honey is produced by bees from nectar collected from nearby flowers. Sometimes, honey produced from the Rhododendron species is contaminated by Grayanotoxin (GTX) in Nepal and other countries. There have been reports of GTX intoxication, also known as 'mad honey disease', from honey produced in countries other than Korea. The importation of wild honey has been prohibited by the Korean Food and Drug Administration since 2005, yet it is still distributed within Korea by the occasional tourist. We report a case of GTX intoxication from contaminated honey which included the symptoms of nausea, vomiting, general weakness, dizziness, blurred vision, hypotension and sinus bradycardia. By means of infusion with normal saline and atropine sulfate, the patient's condition fully recovered within 8 hours of hospital admission, and she was discharged without any complications.

A Report for the Research about the Accuracy of a flow Regulator

PURPOSE: The supply of fluids is a major consideration in modern medicine. When fluid is needed, flow regulators are extensively used. But no research or study of flow regulators has yet been performed in Korea. We researched the accuracy of flow regulators that are commonly used in domestic medicine. METHODS: We collected and studied the fluid pumped for an hour through four kinds of flow regulators that are used domestic ally. Infusion rates were 10, 20, 30, 40, 60, 80, 100, 150, and 200 ml/hr. For each rate, the height of the fluid between the point of infusion and the outlet was evaluated in 10 cm increments within the range 30 cm to 120 cm. RESULTS: Among the four products tested, one product injected the fluid three times at the standard height of 80~100 cm, an error of <10%. Two other products injected within the standard range once each, and the fourth product failed to inject within range even once. CONCLUSION: The accuracy of flow regulators in the domestic market was exceedingly low.

The Study of an Automated External Defibrillator (AED) Use by 119 Rescuers in Gyeonggi-do

PURPOSE: The purpose of this study was to investigate the use of an AED by 119 rescuers in prehospital cardiac arrest. METHODS: 132 patients who experienced prehospital cardiac arrest and was defibrillated by 119 rescuers using AED from January 2003 to December 2004 were included in this study. They were reviewed retrospectively based on 119 rescue service records and ECG. We analyzed patients' general characteristics, types of ECG rhythm, time intervals from EMS activation to arrival and from EMS activation to the first defibrillation, numbers of defibrillation, and return of spontaneous circulation (ROSC). RESULTS: The mean age was 57.33+/-17.84 years with 92 males and 40 females. 68 patients showed shockable rhythms (coarse ventricular fibrillation 41, fine ventricular fibrillation 24, pulseless ventricular tachycardia 3) and 39 patients showed unshockable rhythms (pulseless electrical activity 19 , asystole 18, normal sinus rhythm 2) as an initial rhythm at EMS arrival. Unshockable rhythms were changed to shockable rhythms after cardiopulmonary resuscitation. 25 patients had no ECG rhythms on 119 rescue service records. In the patients with shockable rhythms initially (68 patients), 18 patients experienced ROSC, whereas only 1 patients experienced ROSC in the patients with unshockable rhythms initially (39 patients). The patients with shockable rhythms initially had higher ROSC rates than the patients with unshockable rhythms initially (26.1% vs 2.6%, p=0.001) and received less defibrillation than the patients with unshockable rhythms initially (1.37+/-0.60 vs 2.49+/-1.87, p=0.016). There were no significant differences in the time intervals from EMS activation to arrival (5.74+/-2.13 minutes vs 7.12+/-4.33 minutes, p=0.529) and from EMS activation to the first defibrillation (14.20+/-7.97 minutes vs 13.75+/-7.30 minutes, p=0.542) between ROSC group & non-ROSC group. There was no significant difference in ROSC between male and female (13% vs 17.5%, p=0.164). CONCLUSION: The patients with shockable rhythms initially had higher ROSC rates than the patients with unshockable rhythms initially (26.1% vs 2.6%, p=0.001) and received less defibrillation than the patients with unshockable rhythms initially (1.37+/-0.60 vs 2.49+/-1.87, p=0.016).

Characteristics of the Early Electrocardiographic Findings and Their Relations h i p with the Location of the Lesion and Its Severity in Acute Ischemic Stroke

PURPOSE: Like a hemorrhagic stroke, an acute ischemic stroke can produce abnormal ECG (electrocardiography) findings. This study was carried out to evaluate the incidences and the types of abnormal ECG findings in patients with acute ischemic stroke and to find the relationship between an abnormal ECG and a cerebral ischemic lesion. METHODS: One hundred two patients admitted through the ED with acute ischemic stroke from January 1, 2001, to December 31, 2001, were studied. The first ECG checked in the ED, the brain MRI, 4-vessel angiography, and medical records were reviewed. RESULTS: Abnormal ECG findings were found in 89.2% of the patients with acute ischemic stroke. The most common abnormal ECG finding was QTc interval prolongation (52.8%). Other common findings were an abnormal PR interval (47.3%), left ventricular hypertrophy (31.9%), and sinus bradycardia (25.3%). The abnormal ECG findings were not related with the location of the cerebral ischemic lesion. In addition, the abnormal ECG findings were not related to the neurological severity of the stroke. CONCILUSION: The incidence of abnormal ECG findings in patients with acute ischemic stroke was higher than that of previous studies. However, this study showed no significant relationship between abnormal ECG findings and a particular ischemic area of the brain. The causality of abnormal ECG findings and acute ischemic stroke was not definite. Therefore, further study to find that causality has to be carried out.

Introduction of Geriatric Emergency Medicine

No abstract available.

Analysis of Transportation of Victims of the Subway Fire in Daegu

PURPOSE: The purpose of this study was to improve transportation and distribution of mass-casualty patients by reviewing the subway fire that occurred in Daegu on 18 February 2003. METHODS: We used the reports of the Daegu Emergency Medical Information Center and the medical records of each hospital to analyze retrospectively 199 patients who were transported to 22 initial receiving hospitals. We evaluated the appropriateness of transportation based on the distances of transportation, the capability of the receiving hospitals, and the severity of patients. Using the SAS program(version 6.12), the collected data was analyzed by frequency and x(2) test. RESULTS: The more severe the patients were, the nearer and larger the receiving hospitals were. There was no accurate triage at the scene, but the distribution of patients was good because members of Daegu Emergency Medical Information Center were dispatched to the scene and because communications between the scene and receiving hospitals were continuous. CONCLUSION: We do not expect disasters, but they happen. All we can do is plan and prepare appropriate responses for disasters. Appropriate transportation and distribution of patients based on triage is an important aspect of early disaster response.

Geriatric Trauma

No abstract available.

Analysis of Early Results from the Emergency Department Syndromic Surveillance System for Bioterrorism

PURPOSE: This study reviewed the development of and analyzed the early results from syndromic surveillance based on emergency departments, which was developed to detect bioterrorism attacks, especially during the 2002 FIFA Korea-Japan World Cup games. METHOD: Data from homepages and server computers were analyzed from May 13 2002, to August 5 2002. The data were gathered everyday from 121 emergency departments in Korea via the internet by using PC or PDA. Some data gathered via telephone or FAX were also digitalized. RESULTS: The daily report rate was 82.5% on average. Most of the cases were acute respiratory syndrome (63.4%) and acute sporadic diarrheal syndrome (34.8%). No bioterrorism was confirmed during this period. The peak times and distributions of sporadic and cluster cases of acute diarrheal syndrome are not equivalent. In the case of level 2 reports, there was an average of 12 cases per one institute and 32.8 cases per institute of level 1 and 2 reports totally. CONCLUSIONS: The emergency department syndromic surveillance system for bioterrorism is the first everyday reporting system based on the clinical basis in emergency depart-ments. It has been and is functioning without large problems, but exact knowledge of and more participation by reporting institutes are required. It is necessary to survey the results for a longer period and to correct the early problems if we want to know the ultimate usefulness of this system.

Analysis of Operational Results of the 1339 Emergency Medical Information Center

PURPOSE: The purpose of this research is to estimate the recent function and the correct situation of the 1339 Emergency Medical Information Center and to recommend a future direction. METHOD: The operational results from the Taegu 1339 Emergency Medical Information Center from January 1, 1992, to December 31, 2001, were analyzed and compared retrospectively to the operational results from three other 1339 Emergency Medical Information Centers. The results were analyzed according to the numbers of phone calls for various purposes, numbers per population, numbers per bed, and numbers per square kilometer in the area. Answers to five questions obatained by phone calls to personnel working at 1339 Emergency Medical Information Centers in various areas in Korea were anaylzed, too. RESULTS: In the case of Taegu 1339 Emergency Medical Information Center, simple telephone inquiry is accounted for 66.8% of the calls, requests for hospital information 27.1%, consultations for diseases 4.6%, and connection to ambulances 1.5%. Seoul 1339 Emergency Medical Information Center had the highest rate of first aid consultations (42%) and the lowest rate of requests for hospital information (38.5%). Seoul center had the highest numbers of total phone calls per population, per bed, and per square kilometer in the area. Rate of connections to ambulance per bed was the highest at Busan center. In the phone call survey of personnel working at 1339 Emergency Medical Information Centers, 65% answered that the extent of use of the Information Center was low. The main reason was the lack of assistance from hospitals and 119. No personnel opposed to the integrated information management of all 1339 Emergency Medical Information Centers. CONCLUSIONS: The functions of the 1339 Emergency Medical Information Centers should be rebuilt to respect the characteristics of specific regions and should be harmonized with integrated management. A correct, useful, realtime supply of information is required, and the mutual confidence between Emergency Medical Information Centers and related institutes is essential.

Acute Myocardial Infarction after the Use of Sildenafil Citrate(Viagra(R))

Erectile dysfunction(ED) is defined as the inability to achieve and/or maintain an erection which is sufficient for satisfactory sexual activity. Risk factors for ED include many of the same risk factors for cardiovascular disease: hypertension; lipid abnormalities, including low high-density lipoprotein cholesterol; diabetes; and smoking. Therefore, some patients with ED will have ischemic heart disease. Viagra(R), an oral therapy for ED, is the citrate salt of sildenafil, a selective inhibitor of cyclic guanosine monophosphate(cGMP)-specific phosphodiesterase 5(PDE5). The adverse effects of sildenafil include headache, flushing, dyspepsia, nasal congestion, visual disturbance, and cardiovascular complications. A general impression exists that cardiovascular complications of sildenafil occur mainly when the drug is taken concomitantly with nitrate. We report the case of a 52-year-old man who developed an acute myocardial infarction shortly after taking one tablet of sildenafil without sexual activity. The patient had not been using nitrates. Physicians treating patients with chest pain should be aware of the potential consequences of giving nitrates to patients taking sildenafil. We suggest that before initiating therapy, the history of sildenafil ingestion be obtained from patients with suspected myocardial infarction.

A Preliminary Survey of Emergency Medicine in 12 Asian Countries

BACKGROUND: To assess the current level of development of emergency medicine (EM) systems in Asia. METHOD: Survey of EM professionals from 12 Asian countries during a 90-day period from August to November 1998. 12 EM professionals from 12 Asian countries completed the survey. All participants were physicians. 7 participants (58%) gave presentations at an international EM conference during the study period. Respondents completed a 103 question questionnaire about the status of EM specialty, academic, patient care, information and management systems and the factors influencing the future of EM in their countries. RESULTS: 92% of respondents stated that their countries have hospital-based emergency departments (ED). More than 80% of respondents reported that their countries have EMS systems and ED systems for trauma care and patient transfer. More than 70% stated that their countries have national EM organizations, EM research, national EMS activation phone numbers, ED systems for pediatric emergency care, emergency physician (EP) training in ACLS and ATLS and peer review. More than 60% reported official recognition of EM as an independent specialty status, ED triage systems and systems for customer service. More than 50% reported EM residency training programs, EM journals and EP ability to perform rapid sequence intubation (RSI). 50% reported EP ability to perform thrombolysis for acute MI and 33% reported EP ultrasonography. 92% felt that a lack of funding posed a moderate or great obstacle to the future development of EM in their countries. CONCLUSION: Many essential systems of EM now exist throughout Asia. In the systems of administration and emergency medical information in many countries, there are some parts to be developed further.