Understanding the status of acute poisoning patients who visited the emergency room in 2018: using sample in-depth survey data

Objective@#This study examined the characteristics of acute poisoning patients who visited the emergency room to use as data for developing the treatment support project of acute poisoning patients. @*Methods@#A total of 2,586 acute in-depth survey data were used for a cross-analysis for poisoning severity, emergency medical treatment result and poisoning reason by age group, and multivariate logistic regression analysis was performed to identify the association of poisoning intentionality and other variables. @*Results@#Poisoning intentionality risk analysis identified that males had a lower risk than females (P<0.001), and young adults (aged 13-29 years) had the highest risk (P<0.001). In addition, the higher poisoning severity patients had a higher risk than patients who had no poisoning symptom (severe P<0.001, death P=0.029). The older patients had the higher poisoning severity proportion, and the poisoning substance of expired patients was mostly pesticides. @*Conclusion@#To develop the appropriate emergency medical response system for acute poisoning patients, it is necessary to provide an integrated system for poisoning treatment information and analysis.

Accuracy and Efficacy of Impedance Cardiography as a Non-Invasive Cardiac Function Monitor

PURPOSE: The most common method of monitoring cardiac output (CO) is thermodilution using pulmonary artery catheter (PAC), but this method is associated with complications. Impedance cardiography (ICG) is a non-invasive CO monitoring technique. This study compared the accuracy and efficacy of ICG as a non-invasive cardiac function monitoring technique to those of thermodilution and arterial pressure contour. MATERIALS AND METHODS: Sixteen patients undergoing liver transplantation were included. Cardiac index (CI) was measured by thermodilution using PAC, arterial waveform analysis, and ICG simultaneously in each patient. Statistical analysis was performed using intraclass correlation coefficient (ICC) and Bland-Altman analysis to assess the degree of agreement. RESULTS: The difference by thermodilution and ICG was 1.13 L/min/m², and the limits of agreement were −0.93 and 3.20 L/min/m². The difference by thermodilution and arterial pressure contour was 0.62 L/min/m², and the limits of agreement were −1.43 and 2.67 L/min/m². The difference by arterial pressure contour and ICG was 0.50 L/min/m², and the limits of agreement were −1.32 and 2.32 L/min/m². All three percentage errors exceeded the 30% limit of acceptance. Substantial agreement was observed between CI of thermodilution with PAC and ICG at preanhepatic and anhepatic phases, as well as between CI of thermodilution and arterial waveform analysis at preanhepatic phase. Others showed moderate agreement. CONCLUSION: Although neither method was clinically equivalent to thermodilution, ICG showed more substantial correlation with thermodilution method than with arterial waveform analysis. As a non-invasive cardiac function monitor, ICG would likely require further studies in other settings.

The effect of warmed inspired gases on body temperature during arthroscopic shoulder surgery under general anesthesia / 대한마취과학회지

BACKGROUND: Perioperative hypothermia can develop easily during shoulder arthroscopy, because cold irrigation can directly influence core body temperature. The authors investigated whether active warming and humidification of inspired gases reduces falls in core body temperature and allows redistribution of body heat in patients undergoing arthroscopic shoulder surgery under general anesthesia. METHODS: Patients scheduled for arthroscopic shoulder surgery were randomly assigned to receive either room temperature inspired gases using a conventional respiratory circuit (the control group, n = 20) or inspired gases humidified and heated using a humidified and electrically heated circuit (HHC) (the heated group, n = 20). RESULTS: Core temperatures were significantly lower in both groups from 30 min after anesthesia induction, but were significantly higher in the heated group than in the control group from 75 to 120 min after anesthesia induction. CONCLUSIONS: In this study the use of a humidified and electrically heated circuit did not prevent core temperature falling during arthroscopic shoulder surgery, but it was found to decrease reductions in core temperature from 75 min after anesthesia induction.

Profound Hypotension after an Intradermal Injection of Indigo Carmine for Sentinel Node Mapping / 한국유방암학회지

Intradermal injections of indigo carmine for sentinel node mapping are considered safe and no report of an adverse reaction has been published. The authors described two cases of profound hypotension in women that underwent breast-conserving surgery after an intradermal injection of indigo carmine into the periareolar area for sentinel node mapping.

Health Needs of the Elderly in Long-term Care Facilities: Using RAI-MDS-FC

PURPOSE: This study was to identify health needs of the elderly at nursing homes by long-term care grade. METHODS: The health needs of 116 elders at two nursing homes in Seoul were measured with resident assessment protocols (RAPs), activities of daily living (ADL), and cognitive performance scale (CPS), and pain and depression were measured by resident assessment instrument (RAI). RESULTS: With regard to RAPs, 11 out of 18 items had different distribution in the 3 groups significantly. The 1st-grade elders had a higher percentage of 9 items than the 2nd- and 3rd-grade ones but the 3rd-grade ones had the highest health needs related with activity. The 2nd-grade elders had similar health needs to the 1st-grade ones. In terms of functional level, the 1st-grade elders had the highest percentage of CPS and ADL but the 3rd-grade ones had the highest score of pain and depression out of the 3 groups. The standardized assessment instrument to identify specific health needs by the 3 groups should be developed. Therefore, care plans to meet health needs of the 3 groups will be made. CONCLUSION: It is suggested that nursing care is required to the elderly of the 1st- and 2nd-grade and safe activity and environment to the 3rd-graded ones.

Wandering Spleen: An Unusual Association with Gastric Volvulus

Gastric volvulus is a rare disease; only 700 cases have been reported since Berti first described autopsy findings of a patient in 1866. Its symptoms are non-specific and therefore it is difficult to diagnose it early. Acute gastric volvulus has a poor prognosis because it may cause shock and strangulation. Perforation or gastric hemorrhage can also result from ischemia when diagnosis is delayed. Therefore, it requires rapid diagnosis and an emergency operation. Wandering spleen is a rare condition characterized by the absence or underdevelopment of one or all of the ligaments that hold the spleen in its normal position in the abdomen. Wandering spleen and gastric volvulus have a common cause lack of intraperitoneal visceral ligaments. The authors now report a case of wandering spleen accompanying gastric voluvulus, which resulted in wandering spleen and perforation.

The Impacts of Helmet Use on Injuries in Motorcycle Crash Patients in Korea

PURPOSE: To determine the helmet use rate, factors affecting helmet use in Korea, and the effects of helmet use on injuries. METHODS: This is a prospective study with patients who visited two emergency centers in Seoul during 7 months due to accidents that they had while riding a motorcycle. We examined the patients' general characteristics, whether to wear a helmet, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) on admission, and whether to be hospitalized. In addition, factors such as the patients' position, accident season, day of the week, hour and whether to drink were analyzed to see if they affect helmet use and injuries. RESULTS: A total of 178 patients participated in this study, and 57.3% wore a helmet. Around 20% of patients had head injuries. Head injuries were more frequent in those who did not wear a helmet. According to the result of analyzing factors affecting helmet use, the helmet non-use rate was high in patients whose age was 30 or less and drinkers. For the two groups, the odds ratios for helmet non-use were 2.3 (95% CI 1.2~4.5) and 4.2 (95% CI 1.2~ 15.2), respectively. CONCLUSION: This study shows that helmet use can prevent head injuries in motorcycle patients. Thus, in order to prevent head injuries, helmet use should be increased and, for this, education and regulation on helmet use should be reinforced, particularly for those aged 30 or younger and drinkers.

Definition and Analysis of Overcrowding in the Emergency Department of Ten Tertiary Hospitals

PURPOSE: In this research, a definition of overcrowding in emergency department (ED) was proposed, and the actual state of overcrowding in ED was measured by surveys and extensive statistical analysis of data using objective variables. METHODS: The emergency physicians (EP) of 10 arbitrarily selected hospitals were questioned about the definition and cause of overcrowding in ED. The hospitals were divided into two groups (high-feeling and low-feeling) in accordance with the survey results. Admission/discharge records of the patients including arrival/departure date and time, were also collected for the duration of 4 weeks with consideration of seasonal variations, from March 2002 to March 2003. Four parameters, the bed ratio (BR), the provider ratio (PR), the acuity ratio (AR), and the demand value (DV), which were used for the evaluation of overcrowding, were calculated for each hospital. A statistical analysis was carried out to see whether any difference existed in the BR, the PR, the AR and the DV between weekends and weekdays. Also, a similar statistical method was used to analyze the differences between the high-feeling group and the low feeling group. RESULTS: In the survey, 83 physicians were asked to answer the questions. The most preferred answers (>70%) for the definition of overcrowding were "saturation of the beds in the ED for more than 6 hours a day."For the cause of overcrowding, the popular answers were "delay in the consultation and the disposition decision" (74.7%), "use of the ED by non-urgent patients"(74.7%), and "lack of inhospital beds"(65.1%). Among the 10 hospitals, 5 hospitals were categorized the high-feeling group, and the rest fell into the low-feeling group. The average BR and AR were higher in high-feeling group than those of low-feeling group (p<0.01, p<0.01). However, average PR of low-feeling group was higher than that of high-feeling group (p<0.01). Average DV did not exhibit any difference between the two groups (p=0.31). CONCLUSION: The definition of overcrowding in the ED should include not only the lack of beds in the ED but also patient's acuity and the lack of providers. Certain aspects of overcrowding are clearly different between the high-feeling and the low-feeling groups.

Discussion on Expansion and Establishment of Home Nursing Care / 간호학회지

PURPOSE: The purpose of study is to develop a home nursing care project model suitable for Korea's heath care system and policy directions for expansion and establishment of home nursing care. METHOD: The first, status of home nursing care program in medical institution and public health center was evaluated respectively in view of structure, process and performance. And then, issues of the program were analyzed in view of accessibility, safety, and sufficient supply. The second, demand projection of home nursing care according to income level and technical level of service that is needed to the subject was tried. In addition, the level of supply for home nursing care at present was estimated. The third, home nursing care program in advanced countries (Japan and U.S.A.) was examined. RESULT AND CONCLUSION: Community-based home nursing care program is developed into public-operation model and private-operation model from above the sub-subject result. Functional network for referral system among related institutions is built up to meet various needs, regardless of accessibility to distance and economy. And prior settlements and policy directions for expansion and establishment of home nursing care are suggested.