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.

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.

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.

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.