Seasonal Variation of Renal Colic in the Emergency Department and it Association with Climatic Parameters

PURPOSE: Renal colic is a common disorder with a high rate of recurrence, resulting in a large number of emergency department visits. The aim of this study was to investigate the seasonal variation in renal colic attacks and the association with climatic parameters. METHODS: The time of onset, monthly incidence, and effects of climatic parameters of renal colic were evaluated. Data on climatic parameters were obtained from the Korea Meteorological Administration. Correlation between the number of monthly episodes and climatic parameters was assessed using Pearson's correlation coefficient. RESULTS: A total of 5060 renal colic episodes were retrieved during a period of 84 months (from May 2006 to April 2013). Episodes of renal colic were more common in men (67.4%) than in women(32.6%). The incidence of renal colic showed a circadian variation, with a morning peak (500~1000 h) and an afternoon dip (1500~1900 h). Findings of the current study showed a higher number of renal colic episodes during summer compared with other seasons. Significant positive correlations were observed between the mean monthly temperature and the monthly incidence of renal colic, but not between other climatic parameters (relative humidity, rainfall, sunshine hours, and atmospheric pressure) and incidence of renal colic. CONCLUSION: We conclude that the incidence of renal colic has significant seasonal variation, and only mean monthly temperature showed any consistent association with monthly attack rates.

Effect of Cardiac Arrest Team Training Using Script on the Quality of Simulated Resuscitation / 대한구급학회지

BACKGROUND: The purpose of this study was to compare the quality of simulated resuscitation between the conventional simulation training group and the script based training group. METHODS: This was a retrospective analysis of video clips from a previous study of cardiopulmonary resuscitation (CPR) team simulation training. A total of eighty-four video clips were analyzed. Each video clip belonged to either the conventional group or the script group, of either pre-training or post-training. One of the authors analyzed all the video clips. The qualities of resuscitation team plays were compared in terms of the hands-on compression time, the interval to meaningful measures and the number of utterances of the team leader and members. RESULTS: The hands-on time of the conventional group improved after training whereas that of the script group deteriorated (22.2 vs -7.0 sec, p = 0.009). The time to defibrillation also improved in the conventional group whereas that of the script group deteriorated (-24.0 vs 33.0 sec, p = 0.002). There were no differences in the utterances of team leaders and members between groups and between pre- and post-training. CONCLUSIONS: This study suggested that the effect of script-based training on quality of CPR was less useful than that of conventional training using simulation and debriefing. Therefore, CPR team training using a script alone should not be recommended.

Injury Data Comparison between National and Local Emergency Centers in Korea

PURPOSE: The incidence and severity of injuries differs between each region of Korea due to socioeconomic differences. The comparative analysis between national injury data and the evaluation of regional epidemiologic characteristics is useful in establishing an injury prevention strategy for a regional community. This study was conducted in order to provide basic data for the establishment of an injury prevention strategy by priority through comparison between national injury data collected by National Emergency Department Information System (NEDIS) and injury data from regional emergency centers located in small cities, in Korea. METHODS: The study subjects were the injury patients who visited a total of 117 regional, specialized and local emergency centers from April 2009 to March 2010, as well as those who visited Konkuk University Chungju Hospital during the same period. We collected national data from the Injury Surveillance Report published by Korea Centers for Disease Control and Prevention and compared these with study hospital data collected by our own injury registration system to include gender, ratio, age, and mechanism and severity of patient injury. RESULTS: Of 3,931,573 patients who visited 117 emergency centers and 23,671 patients who visited the study hospital during the study year, the number of injury patients was 786,006 (20.0%) versus 6,177 (26.1%), respectively. 485,521 (62.0%) of the nation-wide subjects versus 4,046 (65.5%) of the study hospital subjects were male, and 298,197 (38.0%) of the nation-wide subjects versus 2,128 (34.5%) of the study hospital subjects were female. The comparison by age of the injury subjects was as follows: below 9 years (22.4% versus 16.8%), twenties (14.5% versus 16.3%) and forties (14.5% versus 15.2%). In the comparison of injury mechanism, blunt injury was higher (20.4%) in nation-wide subjects followed by slip injury (20.0%) and transport accident (19.0%). Transport accidents produced the highest cause of injury (26.0%) in the study subjects followed by slip injury (20.1%) and bunt injury (16.1%). In the severity comparison, 641,344(81.6%) versus 4797(77.8%) were mild injury patients, 139,260(17.7%) versus 1299(21.1%) were severely injured, and 3114 (0.4%) versus 69(1.1%) were fatal injuries. The causes of severe injury nation-wide included intoxication (46.3%), falls (34.8%) and machine accidents (33.3%) versus machine (46.0%), asphyxia (44.4%), intoxication (39.3%) in the study hospital, and the causes of fatal injuries nation-wide were intoxication (5.2%), drowning (4.3%), and asphyxia (4.2%), versus drowning (11.1%), asphyxia (5.6%) and intoxication (4.9%) in the study hospital. CONCLUSION: Through the comparison between study hospital with national injury data, we found that the percentage of severe and fatally injured patients was higher in the nationally with transportation related accidents being highest in terms of mechanism. The construction of a regional injury data system with ongoing comparison with national injury data may be useful in the establishment of a regional injury intervention strategy by priority.

Comparison of Instructional Methods for Teaching Cardiopulmonary Resuscitation to School Children: CPR Anytime(R) and Little Anne(R)

PURPOSE: We compared the effectiveness of CPR Anytime(R) and Little Anne(R) for instructing schoolchildren in CPR. METHODS: We gave CPR instructions to 774 school children (24 classes) from the fifth to the eighth grade in 12 schools. We randomly selected two classes of the same grade from each school. Each class was given two hours of CPR instruction using either the Korean version of CPR Anytime(R) or Little Anne(R). The number of CPR Anytime(R) per student was 1:1 and Little Anne(R) was 1:6. The lesson consisted of didactic lecture, skill practice, and skill test. We compared the skill performance of students according to the instruction method. RESULTS: Three hundred ninety-seven (51%) students were taught using CPR Anytime(R) and 377 (49%) with Little Anne (R). There was no difference in the compression depth, hand position, adequacy of chest recoil, volume of ventilation, self-confidence, and willingness to do CPR between the two instructional methods. The average compression depth was less than 40~50 mm. Elementary school students showed more confidence and willingness to do CPR than middle school students. CONCLUSION: There was no difference in CPR skill performance after instruction using either Anytime CPR(R) or Little Anne(R).

Selection of Target Age for School Education of Cardiopulmonary Resuscitation Using Video Self-instruction Program

PURPOSE: The effectiveness of teaching cardiopulmonary resuscitation (CPR) in schools is known to be higher among older students. However, several easier programs have been successful even for primary school children. The purpose of this study is to determine the optimal target age for teaching CPR in schools. METHODS: Six classes from the fifth to the tenth grade were randomly selected. A video-based self-instructional program was presented by health teachers in each school using the Korean version of CPR Anytime(TM) during normal school hours. Questionnaires were given after training to determine their degree of confidence in performing CPR, their willingness to perform CPR on a family, a friend, and a stranger, and at what age the children wanted to learn CPR. Skill tests were administered for several volunteer students. One week after the training, the students were asked to what extent they had shared their knowledge of CPR technique with other people. RESULTS: Two hundred one students were given the CPR instruction. The confidence in performing CPR was lowest among seventh grade children. The willingness expressed by the students to perform CPR on a family member, a friend, and a stranger were 99.5%, 95.7% and 58.8%, respectively, with boys in the tenth grade most willing to perform CPR on a stranger. The students responded that it is most suitable to learn CPR at grade 6.4+/-2.4. The highest average skill score of 9.5/11 was for sixth grade. The average distribution rate was 1.23, and again this was highest in sixth grade at 3.72. CONCLUSION: This study suggests that the optimal target school age for CPR education using video-based self instruction may be at approximately the sixth grade.

Factors in Delayed Arrival at the Emergency Department in Patients with Suspected Acute Stroke

PURPOSE: Acute stroke is a leading cause of serious, longterm disability and mortality in Korea. Two major refractory problems limiting effective stroke management are patient delays in recognizing stroke symptoms and reluctance to take action. The purpose of this study was to evaluate the actors influencing delayed arrival at the hospital in patients with suspected acute stroke. METHODS: One hundred and seventy-one patients with symptoms of acute stroke who presented to the emergency department (ED) between November 2004 and April 2005 were enrolled in the study. A questionnaire prospectively surveyed by emergency medicine residents was used in evaluating patients for inclusion. RESULTS: Fifty-eight patients (34% of the total) arrived at the hospital within 3 hours of symptom onset. As suggested by univariate analysis, initial symptoms (mental change and speech disturbance), presence or absence of bystanders at the time of symptom onset, utilization of an emergency medical service (EMS) system and inter-hospital transfer all seemed to be associated with the time interval between detection and ED arrival. Further evaluation using multiple linear regression indicated that severity of initial neurologic symptoms, use of EMS transport, the necessity of interhospital transfer, and score on the abnormal Los Angeles Prehospital Stroke Scale (LAPSS) were statistically significant factors affecting arrival time. CONCLUSION: Factors that were associated with earlier ED arrival were severe initial symptoms, utilization of the EMS system, direct arrival from the site of symptom onset, and abnormal LAPSS. Therefore, continuous public education and paramedic training is required to promote early detection and delivery of patients with acute stroke to an appropriate facility.

Effect of a Single Tetanus Toxoid in Korean Adults with Low Tetanus Antibody Titers

PURPOSE: The determination of tetanus prophylaxis according to patients' memories of past immunization is inaccurate. However, by using the Tetanos Quick Stick(R) test, it is possible to select Korean adults with low tetanus antibody titers and to perform tetanus prophylaxis in the emergency department. In 1996, Ha reported that tetanus toxoid injection into healthy Korean adults revealed significant differences between the tetanus antibody titers at the beginning and the tetanus antibody titers after 1 week. Our purpose is to determine the effect of a single tetanus toxoid in Korean adults with low tetanus antibody titers. METHODS: Blood samples were taken from 44 volunteers for a period of 6 weeks. All samples were analyzed using the Tetanus IgG ELISA (enzyme-linked immunosorbent assay) method. RESULTS: The results for tetanus antibody titers at the beginning and after 1 week, 2 weeks, 4 weeks, and 6 weeks were 0.04+/-0.05 IU/mL, 1.22+/-3.63 IU/mL, 4.99+/-7.3 6 IU/mL, 8.36+/-11.10 IU/mL and 6.59+/-9.21 IU/mL respectively. There was a statistically significant defference between the tetanus antibody titers at the beginning and the tetanus antibody titers after 2 weeks. There was no statistically significant defference between the tetanus antibody titers after 2 weeks and 6 weeks. After 4 weeks, all subjects' tetanus antibody titers were at the protective level. CONCLUSIONS: A single tetanus toxoid injection is effective in Korean adults with low tetanus antibody titers.

The Effect of Separation of Prescription and Dispensation of Drugs on Acute Poisoning in Urban Tertiary Emergency Center

PURPOSE: The separation of prescription and dispensation of drugs starting from July 2000 has led to a reduced exposure to drugs for the general population. Therefore, we hypothesize that the policy of separation the prescribing and the dispensing of drugs has decreased the actual incidence of drug intoxication from drug abuse. METHODS: Patients with acute intentional drug intoxication who were admitted to emergency centers in Seoul were retrospectively studied. The study period was subdivided into three: before, during, and after the launch of the policy of separation of prescription and dispensation, corresponding to the periods January to June, 2000; January to June 2001; and January to June 2002, respectively. RESULTS: Acute drug intoxication was associated with 0.2% of all prescriptions during the studied period. There was no significant difference in the types of intoxicating drugs whereas the most commonly abused drug was Doxylamine succinate. Prescribed medications accounted for 37.0%, 29.2%, and 32.3% of the acute drug intoxication cases in 2000, 2001, and 2002, respectively. There was no significant difference in the treatment outcomes between the three study groups although three patients died of paraquat intoxications in 2001. CONCLUSION: The launch of the policy of separation of prescription and dispension of drugs did not significantly reduce the rate of acute drug intoxication from drug abuse which questions the effectiveness of the policy in decreasing drug abuse. We suggest reassessment of sedatives, in particular, those prescribed medications, in order to decrease the incidence of acute intoxications.

Distribution of Time to Death in Trauma Patients: A Review of 11 years' Experience at a Tertiary Care Teaching Hospital

BACKGROUND: Traumatic death occupies a high ranking in the annual national report on causes of death and causes a significant burden to society. To reduce traumatic death, an area-wide trauma care system is urgently needed, and basic mortality data will be an essential component in designing such a system. The purpose of this study was to review the experience of trauma death in a hospital to determine the pattern of time to death and the effect of the emergency medical services(EMS) system in traumatic death. METHODS: A retrospective analysis of 495 traumatic deaths experienced from 1990 to 2000 was performed. Time to death, mechanism of injury, injury severity, and cause of death were reviewed. The influence of the EMS system before 1995 was compared with its influence after 1995. RESULTS: The mean age of the 495 patients was 41.1+/-18.9 and the mean injury severity score(ISS) was 37.1+/-17.8. The distribution of time to death showed DOA(including found dead) in 39% of the cases, within 48hr in 38.4%, between the 2nd and 7th days in 9.9%, and later than the 7th day in 12.7%. The majority of early deaths occurred within 4 hr of injury, but a minor increase was noted during the 2nd week. After 1995, the ambulance transportation rate increased significantly without any difference in prehospital interventions. CONCLUSION: Our results showed a bimodal distribution of time to death, which reflected geographic, mechanism of injury, and trauma care system differences. We also noted deficiencies in prehospital trauma care in our EMS system. We recommend nationwide trauma registry initiatives to provide basic trauma data and to implement a quality trauma care system.

Maritime Medicine

BACKGROUND: Maritime medicine refers to the medical care and education of medical disease which may develop during a cruise. Recently, cruise passengers are increasing around the world and maritime medicine has been initiated in Korea with beginning of the trip to Mt. Kumgang in 1998. Nowadays, there are about 4,000 passengers per week. Therefore, the data were analyzed to promote the understanding of maritime medicine, which was first applied on the Mt. Kumgang cruise, and to help the medical members who will be participation in the maritime medicine in the future. METHODS: From November 1998 to February 1999, all patients who visited to medical cabin of the cruise ship(Hyundai Pongnae) were analyzed retrospectively. RESULT: 2,162 patients excluding 182 patients who re-admitted were analyzed. In each cruise, there were 65.5(9.0%) passengers and 42(13.0%) crews. The male to female ratio was 1.6 : 1, with 709 males and 451 females. The common problems were respiratory and musculoskeletal diseases followed by dematologic and gastrointestinal problems in order of frequency. There were 18 patients who had trauma above 4 points in ISS. Ten patients were confined to the medical cabin. The ship returned to Donghae-port one time, 8 patients were evaluated immediately and 41 patients were referred without urgency. CONCLUSION: Maritime medicine has a particular characteristic of dealing with various cases and treatments including emergencies with limited space, man-power, facilities and equipment. It obviously proposes the participation emergency medical doctors in the maritime medicine because medical personnel must take part in not only medical management but also in education and prevention including CPR. The medical staff in charge of maritime medicine should establish a proper plan depending on the purpose of the cruise and must endeavor to solve the problem.

Comparison on the adsorptive capacity of Fuller's earth, Actidose Aqua(R) and activated charcoal

BACKGROUND: Activated charcoal has been widely used as an adsorbent for the management of drug intoxicated patients in the emergency department(ED). Although there are several commercial ready-mixed charcoal suspension preparations in the market, we are using custom-made suspension from hospital grade bulk charcoal powder. We designed this study to compare the adsorptive capacity of the Actidose Aqua(R), which is a commercial charcoal product, Fuller's earth, and custom-made activated charcoal used in our ED. METHODS: First, we performed modified USP methylene blue adsorption test which is a standard adsorption test for activated charcoal. Then, the drug adsorption test for phenobarbital, acetaminophen, salicylate, and aminophylline was done. Graded amount of three adsorptives were added to the stock solutions of each drugs. The adsorption test were performed as follows: The vials containing drugs and adsorptives were shaken for 30 minutes to ensure adsorption equilibrium, then the suspension was filtered through in-line filter. The filtrates were analyzed by ultraviolet spectroscopy to determine the residual drug concentrations. Finally we examined and compared the surface area and the structure of activated charcoal and Fuller's earth using scanning electron microscopy. RESULTS: In methylene blue adsorption test, the adsorption rate was 60.1% in Actidose Aqua(R) and 59.0% in custom-made charcoal, and 70.2% in Fuller's earth. For the phenobarbital, acetaminophen, and sallcylate, the adsorption rate of Actidose Aqua(R) and custom-made charcoal was greater than 90% with the ratio o adsorptives to drugs over 10:1. For aminophylline, two charcoal products showed excellent adsorption in 5:1 ratio. But Fuller's earth showed poor adsorption in all rages. CONCLUSION: Custom-made activated charcoal showed a comparable adsorption capacity to Actidose Aqua(R). Fuller's earth showed a poor performance to be used as a substitute for activated charcoal in acute drug poisoning otherwise paraquat.

Effect of Epinephrine and Vasopressin on Resuscitation in Rat Asphyxia Arrest Model

BACKGROUND: Vasopressin has recently been recognized to have greater effect on improving blood flow to myocardium and brain during cardiac resuscitation than epinephrine and also improves rates of ROSC(return of spontaneous circulation) and survival in pre-hospital and in-hospital prolonged refractory cardiac angst patients who did not respond to the standard epinephrine treatment. This study was designed to investigate the effects of vasopressin on ROSC rates and survival rates in rat asphyxia arrest model. METHOD AND MATERIAL: Thirty male Sprague-Dawley rats were used. Anesthesia was induced with halothane and nitrous oxide and ventilatory cairo was maintained. EtCO2 was adjusted to 30-40mmHg and halothane was maintained. Right infernal carotid artery and right femoral vein were cannulated and EKG electrodes were attached. After 10 minutes of asphyxia, group 1 was treated with 1ml of saline, group 2 with 1ml(0.001mg/100g) of epinephrine and group 3 with 1ml(0.16u/100g) of vasopressin for resuscitation. Statistical significance was an analysed by SPSS with ANOVA and chi-square tests. RESULTS: No significant differences were seen in baseline measurements. Three ROSC and eight 60 minutes survivals were found in group 1, whereas nine ROSC and eight 60 minutes survivals were obtained in group 2 and all of the subjects in group 3 showed ROSC and 60 minutes survival, but no statistical differences were seen between group 2 and 3. CONCLUSION: Vasopressin seems to have similar effect on improving ROSC and survival rates compared to epinephrine in rat asphyxia models.

Current Trends in Emergency Tracheal Intubation and Prediction of Difficult Intubation in ED

BACKGROUND: This study was designed to describe the current tends of emergency tracheal intubation and predict difficult airway intubations in emergency department (ED) at a teaching hospital in Korea. METHODS: All patients who was taken endotracheal incubation in ED during a 1-year period (Mar 1997 through Feb 1998) were included in the study population. Medical records of the patients were retrospectively reviewed. Among them, 56 patients were prospectively evaluated parameters to predict difficult airway intubations. RESULTS: During the study period, a total of 413 patients(1.5%) required endotracheal intubation. Except far 2 cases, all patients intubated orotracheally, and 298(72%) patients were intubated by emergency medicine resident. Pharmacologic adjuncts were used in 200(48%) patients, the neuromuscular blocking agent(NMBA) was used in 16(3.8%) Commonly used drugs were thiopental and vecuronium. The difficult incubation was not associated with presence of denture, length and circumference of neck, and mental status. The visibility of vocal cord on laryngoscopy significantly correlated to the difficult airway. CONCLUSION: At this institution, the majority of ED incubation were performed by emergency physicians and NMBA was not routinely used. The visibility of vocal cord during the direct laryngoscopy could be a predictor of difficult incubation in ED.

Alteration of Ionized Calcium, Magnesium and Acid-base status in Hyperventilation Syndrome

BACKGROUND: Tetanic spasm is often noted in hyperventilating patients coming in to emergency departments. Classical explanation far this phenomenon was decreased ionized calcium levels due to respiratory alkalosis precipitated by the hyperventilation. Clinically these symptoms were observed in hypocalcemia and were thought as such without doubt. But clinical investigation on the levels of ionized calcium levels have not been clarified. Recent investigations on hyperventilating volunteers have suggested other pathophysiology for tetanic spasm in hyperventilating patients which is the decrement of ionized magnesium level rather than ionized calcium. We wanted to see if these results applied to our hypeventilating patients and see if ionized magnesium level was a factor producing tetanic symptoms. METHOD AND MATERIAL : 35 patients with diagnosis of hyperventilation syndrome by emergency physician were studied retrospectively. Hyperventilating patients arriving at Severance hospital Emergency Center from Jan.1996 to Feb. 1998 were included. Patients with cardiovascular, pulmonary diseases, history of renal or liver disease were excluded. Ion-selective method was used to detect ionized calcium, magnesium levels and arterial blood gas features. Average levels were compared to reference ranges and Wilkoxon-rank. sum test was used to compare hyperventilating patients with tetanic spasm and those with other symptoms such as dyspnea, chest pain and palpitations. RESULTS: 1) Sodium, potassium and chloride levels were 138mmol/L, 3.6mmo1/L, 106mmol/L each which were within a normal range. 2) Degrees of hyperventilation were similar with average of PH 7.54(7.4-7.71), pCO2 23.6mmHg, showing respiratory alkalosis. 3) Ionized calcium and ionized magnesium each showed 0.61mg/dL, 0.16mg/dL lower values than the lowest reference ranges which were 4.5-5.6mg/dL for ionized calcium and 1.19-1.63 for ionized magnesium. 4) No statistical difference points were observed between the tetanic spasm group and group without spasm. Female preponderance were noted in tetanic spasm group. CONCLUSION: We conclude that ogler than decrement of ionized calcium, decrement of ionized magnesium could be a factor far inducing tetanic spasm in respiratory alkalosis caused by hyperventilation.

Optima Positioning of Central Venous Catheters

BACKGROUND: Catheterization of central vein may cause fetal complications such as cardiac arrhythmia, cardiac temponade, atrial perforation etc. For prevention of these complications, tip of central venous catheter should located in superior vena cava. The purpose of this study was to investigate the optimal positioning of central venous catheters. METHOD: From March 1996 to Jun 1996, a total of 50 patients who requiring central venous catheters were involved. First, we evaluate the accuracy of predetermined formula of 'Peres'. Second, we hypothesized that height of patients was correlated with optimal length of central venous catheters and we analysed relationship between height and optimal length of central venous catheters using simple regression analysis by SAS. RESULTS: 1) Predetermined formula of 'Peres' inaccurately predicted required length of central venous catheter. The accuracy was 78%. 2) There were a linear relationships between height and optimal length of central venous catheter. Their relationships was followed, Y=0.09X(Y: optimal length of central venous catheters, X: height, p=0.0001, R2=0.39). CONCLUSION: Using height of patients, we can accurately predict the optimal length of central venous catheters.

Early Prognostic factors and New Approach to Organophosphate Poisoning

BACKGROUND: Definite criteria for determining severity of organophosphate poisoning have not been made. Discovery of the third neuromuscular syndrome, the intermediate syndrome, have made it more complicating then ever. Objectives of this study is to determine early prognostic factors of outcome and development of a new treatment algorithm. METHOD: 74 patients admitted to Severance hospital with acute organophosphate poisoning during 5 years were included. We made a protocol concerning the initial consciousness level, QTc interval, PVC, serum cholinesterase, the intermediate syndrome, total hospital, ICU day, length of ventilator support, disposition and have done a study retrospectively. Multiple regression and Chi-square was used as statistical analysis. Significant statistical P-value was 0.05. RESULTS: The total hospital days were prolonged as serum cholinesterase levels were lower, the age was older and mental status graver.(p<.05) The length of ventilatory support was prolonged when patient's serum cholinesterase level was very low, they were unconscious and serum cholinesterase level not recovered to 500 IU/ml within initial 3 days. The intermediate syndrome was significantly related to the prolonged cholinesterase inhibition. CONCLUSION: As an early prognostic factor for the length of ventilatory support in organophosphate poisoning, 1) level of concsiousness and 2) serum cholinesterase level at admission, 3) recovery to more than 500 IU/ml within initial 3 days are useful. Especially when the serum cholinesterase level is not recovered to more than 500 IU/ml within initial 3 days, it is essential to observe closely for the possibility of an intermediate syndrome.

Effect of N-acetylcysteine on Dapsone-Induced Methemoglobinemia

BACKGROUND: To determine whether N-acetylcysteine(NAC) reduces methemoglobin. METHOD: We carried out an in vivo experiment in rats, weighed about 300g. Each rat was ingested 200mg of dapsone(4,4'diaminodiphenyl sulphone) to induce methemo- globinemia. After 1 hour, 30 rats were received NAC 160mg(2ml) and another 30 rats, served as control, were received 2ml of normal saline orally,4 times hourly. Serum methemoglobin concentrations were checked 1,6, and 24 hours after dapsone ingestion. RESULT: The methemoglobin concentrations on each time were 27.1+/-5.8%,23.5+/-8.8%, 17.1+/-6.4%(mean+/-SD) in control group and 25.5+/-6.3%, 25.5+/-8.8%, 65.5+/-31.2%(mean+/-SD) in NAC group. There were no differences on methemoglobin concentrations at 1 and 6 hours between two groups(P>.05). At 24 hours, the methemoglobin concentrations of NAC group was significantly higher than those of control group(P<.01). CONCLUSION: NAC had no therapeutic effects on dapsone induced methemoglobinemia in this experimental setting.

The Patients With Headache in Emergency Department

BACKGROUND: Headache is a common complaint in patients presenting to the emergency department(ED). Many patients suffered sustained headache even after presenting to the ED. This study investigate whether the patients were received analgesics and timely adequate. METHOD: We analyzed 131 adolescent and adult patients with non-traumatic headache without any neurologic deficit in two emergency department during 6 months period retrospectively. RESULTS: The positive and negative predictive value according to primary impression were 47% and 74% respectively. The mean time to take brain computed tomography(CT) after ED presentation was 120 minutes. The patients with primary impression of intracranial hemorrhage(mainly SAH) were the most fast(mean time 88+/- 70 minutes). 28(21%) patients were received analgesics before taking brain CT(after ED presentation), and 70(53%) patients after CT, 27(54%) patients after cerebrospinal fluid examination. The mean time interval were 43, 126 and 149 minutes on each group being received the analgesics. CONCLUSION: According to this study many patients suffered sustained headache before being classified to certain type of disorder. It may due to the reasons that there were no definite guidelines treating headache, the pain itself, or the physician treats patients as physician's way.