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1.
Article in Korean | WPRIM | ID: wpr-73496

ABSTRACT

PURPOSE: Glyphosate is widely used and its toxic exposures are not rare. Occasionally, glyphosate intoxication can lead to death. The aim of this study is to analyze clinical findings and fatality in glyphosate intoxication. METHODS: Clinical data on acute glyphosate intoxication were prospectively collected at 28 hospitals nationwide between August 2005 and July 2006. The patients' clinical symptoms and characteristics of fatalities were investigated and statistical analysis was performed. RESULTS: Among 105 patients who were finally included, gastrointestinal symptoms(59%) were the most common. A significant difference in the amount ingested was observed between patients with higher systolic blood pressure and those with systolic blood pressure less than or equal to 80 mmHg (p<0.001). The more the patients ingested, the more aggravated their mental status became (p=0.004). Seven patients(6.7%) died, and all of them had ingested greater than or equal to 200 ml. Patients who died had ingested greater amounts than the survivors (p<0.001), and their mental status was worse (p<0.001), and systolic blood pressure was lower (p<0.001). According to the result of logistic regression analysis, relative risk was 24.1-fold higher in the 'poor' mental status group compared with 'good'. CONCLUSION: Patients who ingested large amounts of glyphosate showed poor mental status and lower blood pressure. Statistical difference in amount ingested, mental status, and systolic blood pressure was observed between survivors and patients who died. Ingested amounts and mental status were the most important factor of the prognosis of glyphosate intoxication.


Subject(s)
Blood Pressure , Herbicides , Humans , Logistic Models , Poisoning , Prognosis , Prospective Studies , Survivors
2.
Article in Korean | WPRIM | ID: wpr-65480

ABSTRACT

PURPOSE: The purpose of this study is examine the effects of clinical art therapy on self-esteem, anxiety, and pain of pediatric burn patients. METHODS: Hospitalized pediatric patients, age from 6 to 15, at H specialized burn hospital located in Seoul were chosen as subjects for this study. Total 11 people were participated. An experimental group received 8 sessions of a clinical art therapy program, twice a week with each 40 minutes long. As for measurement tools, a Rosenberg Self-Esteem Scale (RSES) and a State Anxiety Inventory for Children (SAIC) were used. And a Visual Analog Scale (VAS) was implemented before and after each session. Also, a Drawing a Person test was analyzed along with individual characteristics. RESULTS: 1) The self-esteem score after art-therapy was improved from 28.1+/-3.4 to 32.9+/-3.1 (P<0.001), 2) The Anxiety score after art-therapy was decrease from 34.6+/-3.7 to 26.8+/-2.8 (P<0.001), 3) Overall 8 sessions of each art-therapy, there were significant reduction in the pain scale score (least squares means: 2.5 (2.1~2.8), P<0.001). CONCLUSION: The study demonstrate positive effects of clinical art therapy on self-esteem, anxiety, and pain of pediatric burn patients.


Subject(s)
Anxiety , Art Therapy , Burns , Child , Humans
3.
Article in Korean | WPRIM | ID: wpr-219774

ABSTRACT

PURPOSE: As public awareness of medical futility increases, more studies on pronouncement of death and related protocols in the field have been conducted overseas. However, it appears to be hard to declare death in the field in Korea due to a lack of proper treatment procedures for patients with out-of-hospital cardiac arrest (OHCA) under the current emergency medical service (EMS) system. As such, the objective of this study was to establish criteria to determine whether to perform cardiopulmonary resuscitation (CPR) for a patient who visits the ED with OHCA. METHODS: CPR results over an 8-year period, from January 2001 to December 2008, from patients with OHCA at Ewha Womans University, Mokdong Hospital were analyzed. The main factors affecting patients that survived for 24 hours after return of spontaneous circulation (ROSC) were identified retrospectively. RESULTS: A total of 782 patients visited the hospital due to OHCA during the study period. Of these, 752 met the inclusion criteria for our study. Of the 752, 162 (21.5%) survived over 24 hours after ROSC. Of the 752, 38 (5.1%) survived to hospital discharge and 18 (2.4%) survived to hospital discharge with good neurologic function. Among patients who survived over 24 hours after ROSC, factors that predicted survival included the presence of a witness (p<0.001), the implementation of CPR by a bystander (p=0.012), a short time from being found to time of arrival at the hospital (p<0.001) and younger age (p=0.042). Factors that predicted non-survival included no witness at the time of cardiac arrest, a prehospital time longer than 20 minutes, bystander CPR but the initial rhythm was asystole. The positive predict value was 95.6%. CONCLUSION: When an individual has an out-of-hospital cardiac arrest, termination of resuscitation should be considered when there are no witnesses, when there was no bystander to administer CPR, when the initial rhythm was asystole, and when prehospital time was longer than 20 minutes.


Subject(s)
Cardiopulmonary Resuscitation , Emergencies , Emergency Medical Services , Female , Heart Arrest , Humans , Korea , Medical Futility , Out-of-Hospital Cardiac Arrest , Resuscitation , Retrospective Studies , Wit and Humor as Topic
4.
Article in Korean | WPRIM | ID: wpr-59006

ABSTRACT

PURPOSE: To evaluate the quality of prehospital CPR (cardiopulmonary resuscitation) performed by 119 rescue personnel and bystanders in Seoul and to recognize the present problems in the pre-hospital emergency medical service system (EMS). METHODS: We enrolled all patients in cardiac arrest visiting the emergency rooms of 9 university hospitals in Seoul via 119 rescue services from 16 October to 26 November 2006, prospectively investigating the environments in which arrest occurred and the factors associated with CPR. RESULTS: Among 73 patients, the most common place of arrest was in the home(45.2%), CPR by bystander was performed in 8 cases(10.7%), endotracheal intubation by EMS personnel was performed in 10 cases(14.1%). Average time from call to CPR was 11.9 minutes and the number of discharges alive was 3 cases(4.1%). CONCLUSION: To improve the rate of alive discharges, development of CPR education program for lay rescue, education in basic and advanced life support, and management of quality for EMS personnel are needed.


Subject(s)
Cardiopulmonary Resuscitation , Emergencies , Emergency Medical Services , Heart Arrest , Hospitals, University , Humans , Hypogonadism , Intubation, Intratracheal , Mitochondrial Diseases , Ophthalmoplegia , Out-of-Hospital Cardiac Arrest , Prospective Studies
5.
Article in Korean | WPRIM | ID: wpr-207278

ABSTRACT

PURPOSE: We recommend early aggressive airway management with intubation in patients with severe traumatic brain injuries due to prevent hypoxia and aspiration. Reports exist about increased mortality after pre-hospital intubation, which is caused by hyperventilation. Therefore, we studied the impact of hyperventilation on outcome in patients with traumatic brain injuries. METHODS: This was a retrospective study conducted on 865 patients with traumatic brain injuries obtained from the trauma registry between January 2001 and June 2007. Patients >19 years of age with a GCS< or =13 were selected. We analyzed the impact of hyperventilation within 12 hours on outcome as a function of intubation. We also analyzed the predictors for mortality and poor outcome by logistic regression analysis. RESULTS: One hundred sixty-six patients were included with a mean age of 48.7+/-17.9 years. The mortality rate was 25.9%, and the poor outcome rate was 44.6%. In the hyperventilation group, the poor outcome and mortality rates were higher than in the non-hyperventilation group (66.1% vs 37.5%, p=0.012; 47.2% vs 20.0%, p=0.001). The predictors of mortality for intubated patients was hyperventilation within 12 hours (odds ratio [OR], 5.7; 95% of confidence interval [CI], 1.6~20.5). The predictors of poor outcome for intubated patients was a GCS <8 (OR, 3.9; 95% CI, 1.2~13.3). CONCLUSION: Early hyperventilation is a predictor for mortality in intubated patients with traumatic brain injuries. We should monitor and correct early hyperventilation in intubated patients with traumatic brain injuries.


Subject(s)
Airway Management , Hypoxia , Brain , Brain Injuries , Humans , Hyperventilation , Intubation , Logistic Models , Organothiophosphorus Compounds , Retrospective Studies
6.
Article in Korean | WPRIM | ID: wpr-207275

ABSTRACT

PURPOSE: The aim of this study was to examine the diagnostic accuracy and effectiveness of transvaginal ultrasonography (TVUS) performed by emergency physicians (EPs') in the emergency department. METHODS: In this study, female patients with lower abdominal pain who had risks for obstetric and gynecologic diseases were assessed. The accuracy and effectiveness of TVUS performed by emergency physicians was determined by comparing EPs' interpretations of TVUS with the interpretations of TVUS by OGs CT findings, and surgical pathologic results. RESULTS: Forty-one patients were included in the study. The diagnosis was changed in 48.8% of the patients after the TVUS had been performed by an EPs'. When the accuracy of diagnosis was compared pre- and post-TVUS, the accuracy of post-TVUS (80.5%) was higher than the pre-TVUS (39.0%). The agreement between the sonographic findings of EPs' and OGs' was substantial (accuracy=81.3~93.8%; kappa=0.611~0.811; p<0.05). The accuracy of TVUS performed by EPs' in obstetric and gynecologic diseases was 90.6%. The sensitivity and specificity were 100% and 90.9%, respectively, and the positive and negative predictive values were 96.8% and 100%, respectively. CONCLUSION: TVUS performed by EPs' is of considerable help in establishing the correct diagnosis with a high degree of accuracy.


Subject(s)
Abdominal Pain , Diagnosis, Differential , Emergencies , Emergency Medicine , Female , Genital Diseases, Female , Humans , Sensitivity and Specificity , Vagina
7.
Article in English | WPRIM | ID: wpr-84998

ABSTRACT

In South Korea, attempted suicide by paraquat (PQ) intoxication is fairly common, and is lethal by pulmonary fibrosis and hypoxemia. However, the treatment of PQ poisoning is primarily supportive management. To increase the survival rate associated with PQ intoxication, many treatments have been developed. Here, we treated a case of PQ intoxication with steroid pulse therapy. A 23-year-old man was admitted to the hospital because of PQ intoxication. He drank two mouthfuls of Gramoxon (24% commercial paraquat). His vital signs were stable, but he had a throat infection, and navy blue urine in the sodium dithionite test. Standard treatment, including gastric lavage with activated charcoal was performed, and emergent hemoperfusion with a charcoal filter was initiated 11 h after PQ ingestion. Pharmacotherapy was initiated 18 h after PQ ingestion with the administration of 5 mg dexamethasone. On day 10, chest PA showed pulmonary fibrosis. Therefore, we initiated steroid pulse therapy, with 1 g methylprednisolone in 100 mL of D5W administered over 1 h repeated daily for 3 days, and 1g cyclophosphamide in 100 mL of D5W administered over 1 h daily for 2 days. On day 15, dexamethasone therapy was initiated. On day 30, pulmonary fibrosis was improved. Thus, if pulmonary fibrosis becomes exacerbated after dexamethasone therapy during the subacute stage, pulse therapy with methylprednisolone and cyclophosphamide could be helpful.


Subject(s)
Hypoxia , Charcoal , Cyclophosphamide , Dexamethasone , Dithionite , Eating , Gastric Lavage , Hemoperfusion , Humans , Methylprednisolone , Mouth , Paraquat , Pharynx , Pulmonary Fibrosis , Republic of Korea , Suicide, Attempted , Survival Rate , Thorax , Vital Signs , Young Adult
8.
Article in Korean | WPRIM | ID: wpr-91541

ABSTRACT

Purpose: Dichlorvos has been in widespread use as an organophosphate (OP) insecticide compound. The purpose of this study was to access the epidemiology and clinical features of dichlorvos in Korea. Methods: This was a 38 multi-center prospective study of dichlorvos poisoning using surveys, a structural reporting system and review of hospital records from August 2005 to July 2006. A total of 54 patients with acute dichlorvos poisoning on a national basis were enrolled. We analyzed the epidemiologic characteristics and clinical manifestations of dichlorvos poisoning. In addition, the clinical features of dichlorvos poisoning were compared with others OP compounds. Results: During the study period, compounds involving pure OP poisoning were dichlorvos (22.7%), methidathion (8.4%), and phosphamidon (6.7%). In acute dichlorvos poisoning, all ingestion routes were oral. Intentional poisoning involved 74.1% of cases. The common initial complaints involved gastrointestinal (64.8%), systemic (61.1%), central or peripheral nervous system (53.7%), and respiratory symptoms (50.0%). The median arrival time to hospital after dichlorvos poisoning was 2.6 hours and mean hospitalization duration was 7.1 days. 2-PAM was administered in 35 patients in mean doses of 6.3 g/day intravenously. Atropine was administered in 30 patients with a mean dose of 62.8 mg/day (maximal 240 mg/day). Overall mortality rate for dichlorvos poisonings were 14.8% (8/54). Immediate causes for death included sudden cardiac arrest or ventricular dysrhythmias (50%), multi-organ failure (25%), acute renal failure (12.5%), and unknown causes (12.5%). Conclusion: When compared to previous reports, dichlorvos poisoning displayed relatively moderate severity. The presence of a lower GCS score, altered mental status, serious dysrhythmias, systemic shock, acute renal failure, and respiratory complications upon presentation were associated with a more serious and fatal poisoning.


Subject(s)
Acute Kidney Injury , Atropine , Death, Sudden, Cardiac , Dichlorvos , Eating , Hospital Records , Hospitalization , Humans , Korea , Organothiophosphorus Compounds , Peripheral Nervous System , Phosphamidon , Pralidoxime Compounds , Prospective Studies , Shock
9.
Article in Korean | WPRIM | ID: wpr-91540

ABSTRACT

Purpose: There has been no nationwide surveillance survey of poisoning cases in Korea. This study examined the clinical characteristics of poisoning admissions in order to obtain preliminary data for future planning. Methods: This study retrospectively reviewed the data on poisoning admissions of 150 hospitals based on the hospital discharge injury surveillance data of Center for Disease Control and Prevention in Korea from January to December in 2004. The demographic data, poisons used, causes of poisoning, reasons for attempted suicide and mortality rate was investigated according to the age group. The factors associated with mortality were also evaluated. Results: A total 836 patients admitted for poisoning were analyzed. Their mean age was 46.5+/-19.5 years (male 415, female 421). The most frequent age group was the 4th and 5th decades. The most common poisons involved were pesticides (45%) and medications (23%). The majority (64%) involved intentional poisoning except for those in the 1st decade. The most common reason for the attempted suicide was family problems. However, individual disease was the most common reason in those over 60 years. The overall mortality rate was 8.7% (73/836). Pesticides and being elderly (over 65 years old) were strongly correlated with fatality. Conclusion: The incidence of intentional poisoning increases from the 2nd decade making it a preventable injury. "Overall, the incidence of intentional poisoning increases from the 2nd decade". Therefore, there is a need to frame a prevention policy corresponding to each factor related to fatality, such as an elderly population and pesticides.


Subject(s)
Aged , Female , Humans , Incidence , Korea , Pesticides , Poisons , Retrospective Studies , Suicide, Attempted
10.
Article in Korean | WPRIM | ID: wpr-91539

ABSTRACT

Purpose: Acute organophosphate (OP) poisoning may be monitored by measuring the acetylcholinesterase (AChE). It is important to assess severity and establish prognostic tests in the early stage of OP poisoning. The aim of this study was to look at the relationship between various clinical aspects of the OP poisoning, prognostic indicators of OP poisoning including Simplified Acute Physiology Score (SAPS) 3, and the associated changes in AChE levels. Methods: Clinical data and initial AChE levels from thirty-seven patients with OP poisoning were prospectively reviewed from 12 teaching hospitals in South Korea from August 2005 to July 2006. Clinical manifestations at the time of arrival such as miosis, respiratory abnormality, salivation, urinary incontinence, GCS score, AVPU scale, need for intubation, and mechanical ventilation requirements were recorded. SAPS 3 was calculated using clinical data and laboratory results. Results: The median level of AChE was 9.8 (1.3-53.6) U/gHb. There was no significant difference in AChE levels between the groups with and without cholinergic symptoms. The median level of AChE of the patients who required intubation and those who did not were 3.5 U/gHb and it 19.7 U/gHb respectively (Mann-Whitney test; p<0.001). The AChE levels were also significantly different (p=0.007) in patients who needed mechanical ventilation compared to those who did not with AChE levels found to be 3.1 U/gHb and it was 14.8 U/gHb, respectively. Level of consciousness assessed using the AVPU scale was correlated with AChE levels (Kruskal-Wallis test; p=0.013). GCS score were correlated with AChE levels (p=0.007, Spearman's rho = 0.454). In addition, the lower the level of initial AChE, the longer the ICU stay (p=0.029, Spearman's rho=-0.380). SAPS 3 was inversely correlated with the initial AChE (p<0.001, Spearman's rho=-0.633). Conclusion: In the acute OP poisoning, low AChE levels appear to help indicate the severity of poisoning. The initial AChE level may be a useful prognostic parameter for acute OP poisoning.


Subject(s)
Acetylcholinesterase , Consciousness , Hospitals, Teaching , Humans , Intubation , Miosis , Organophosphate Poisoning , Prognosis , Prospective Studies , Republic of Korea , Respiration, Artificial , Salivation , Urinary Incontinence
11.
Article in Korean | WPRIM | ID: wpr-91536

ABSTRACT

Metformin which is an oral hypoglycemic agents, acts by enhancing insulin sensitivity, decreasing hepatic glucose production and increasing peripheral utilization of glucose. Deliberate self poisoning with oral hypoglycemic agents is rare. The lactic acidosis associated with metformin toxicity is well described in the medical literature. Metformin overdose even in otherwise healthy patients may produce a profound and life threatening lactic acidosis. We report a case of massive metformin ingestion(75g) in a patient presenting with lactic acidosis and hypotension. She died 24h after presenting to our emergency department despite bicarbonate treatment and hemofiltration therapy.


Subject(s)
Acidosis , Acidosis, Lactic , Emergencies , Glucose , Hemofiltration , Humans , Hypoglycemic Agents , Hypotension , Insulin Resistance , Metformin
12.
Article in Korean | WPRIM | ID: wpr-222667

ABSTRACT

PURPOSE: The hypnotic effect of zolpidem is comparable to benzodiazepines, but has less abuse and addiction potential than benzodiazepines, so is one of the most commonly prescribed hypnotics. The frequency of acute zolpidem overdose has increased, but clinical analysis and severity predictors are not known in Korea. METHODS: A retrospective evaluation of histories, clinical courses, and laboratory findings of each patient treated from June, 2000, to May, 2006, in a university hospital for acute zolpidem intoxication. RESULTS: We evaluated 30 patients, including 16 co-intoxication cases. Twenty-five patients presented mental alterations but became alert within 2 days. All patients recovered completely. The median zolpidem concentration was 0.9 mg/L (range: 0.2~7.4 mg/L). There was a weak correlation between the amount ingested and zolpidem concentration (r=0.25). None of them presented severe laboratory abnormalities, and these abnormalities did not relate to zolpidem concentration. CONCLUSION: The clinical progress of acute zolpidem intoxication is mild. We could not predict zolpidem concentration or clinical severity from the amount ingested and could not predict the clinical course from laboratory findings in the emergency department.


Subject(s)
Benzodiazepines , Emergencies , Humans , Hypnotics and Sedatives , Polymethacrylic Acids , Pyridines , Retrospective Studies
13.
Article in Korean | WPRIM | ID: wpr-19028

ABSTRACT

PURPOSE: Early identification of alcohol use disorder (AUD) among patients coming to the emergency department (ED) for treatment is important in order to facilitate timely intervention and further evaluation. A number of brief screening tools have been developed for identifying patients with AUD. This study compared three brief screening tools for detecting DSM-IV-defined AUD. METHODS: A prospective study was performed from 20th of July 2004 to 20th of October 2004 at a university hospital emergency department (ED). We studied trauma patients including trauma patients who needed administration. Patients were screened by AUDIT, CAGE and RAPS test. Receiver operator characteristic analysis were used to evaluate the performance of the brief screens against the criterion of a DSM-IV AUD. RESULTS: One hundred and thirty-five patients were enrolled in this study. Of the existing screening tools, AUDIT had the best overall performance in identifying AUD (sensitivity 98%. specificity 84%) CONCLUSION: Of the existing screening tools used to identify AUD, AUDIT had the best overall performance in identifying AUD in the ED.


Subject(s)
Alcohol Drinking , Diagnostic and Statistical Manual of Mental Disorders , Emergencies , Humans , Mass Screening , Prospective Studies , Surveys and Questionnaires , Sensitivity and Specificity
14.
Article in Korean | WPRIM | ID: wpr-188891

ABSTRACT

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.


Subject(s)
Craniocerebral Trauma , Education , Emergencies , Glasgow Coma Scale , Head Protective Devices , Humans , Injury Severity Score , Korea , Motorcycles , Odds Ratio , Prospective Studies , Seasons , Seoul
15.
Article in Korean | WPRIM | ID: wpr-35214

ABSTRACT

Cardiac arrest during pregnancy is an uncommon event, occurring only about once in every 30,000 late pregnancies. Survival from such an event is exceptional. This case involves sudden cardiac arrest of a 32 weeks pregnant woman. The patient was found at unresponsive state and transferred to emergency center by EMS. At arrival, her EKG rhythm was asystole and we had no patient information. Upon initiation of ACLS, abdominal ultrasonography was done and we detected a fetal heart beat. Timely emergency caesarean section delivery was done and the 1-minute APGAR score of neonate is 0. After endotracheal intubation and respiratory assist, 3-minute APGAR score was recoverd to 3 and neonate was admitted to neonate ICU. The mother did not responsed to resuscitation efforts. Physiologic and anatomic changes occur during normal pregnancy, necessitating a modification of standard BLS and ACLS methods for successful resuscitation. When arrest does occur during the latter part of pregnancy, perimortem caesarean delivery may improve the outcome for both the fetus and the pregnant woman.


Subject(s)
Apgar Score , Cardiopulmonary Resuscitation , Cesarean Section , Death, Sudden, Cardiac , Electrocardiography , Emergencies , Female , Fetal Heart , Fetus , Heart Arrest , Humans , Infant, Newborn , Intubation, Intratracheal , Mothers , Pregnancy , Pregnant Women , Resuscitation , Ultrasonography
16.
Article in Korean | WPRIM | ID: wpr-89854

ABSTRACT

PURPOSE: In the ED, alcohol ingestion in trauma patients is highly relevant both to the occurrence of an injury and its severity. Thus assessment of alcohol ingestion in trauma patients is very important in emergency practice. To date the most accurate diagnostic method for detecting alcohol ingestion is the blood alcohol concentration (BAC) test. However, it is impractical to administer this test to all patients in every ED. The aim of this study is to evaluate the accuracy of self-reporting and physician's diagnoses in assessing alcohol ingestion in trauma patients. METHODS: For three months, we collected self-reports and measured BAC for trauma patients 15 years of age or older who required admission. We excluded patients who were injured more than six hours previously or who drank alcohol after their injury. Patients were classified on the basis of BAC, and we recorded the patients' answers regarding alcohol ingestion and the physicians' diagnoses based on the smell of alcohol. The accuracy of the self-reports and the physicians' diagnoses were assessed in terms of their sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: Of 361 patients, 105 were BAC-positive and 256 were BAC-negative, respectively. For the assessment of alcohol ingestion, self-reporting was 89.5% sensitive and 94.4% specific, and physicians' diagnoses based on the smell of alcohol were very similarly 90.5% sensitive and 94.9% specific. CONCLUSION: Self-reporting and physician's diagnosis based on the smell of alcohol are both relatively accurate methods for assessing alcohol ingestion for patients in the ED.


Subject(s)
Diagnosis , Eating , Emergencies , Humans , Sensitivity and Specificity , Smell
17.
Article in Korean | WPRIM | ID: wpr-89846

ABSTRACT

Failure of automatic control of ventilation (Ondine's curse syndrome) is a rare syndrome that sometimes occurs following localized brainstem dysfunction. In this report, we present a case of a 52-year-old male who was admitted to the hospital with sudden-onset nausea. On examination, no lateralization signs were presented. After one hour, his consciousness was altered and he became apneic. After endotracheal intubation and mechanical ventilation, his mentality improved and he was able to ventilate spontaneously. Cranial magnetic resonance imaging demonstrated acute infarction in both cerebellar inferior aspects involving the right side of the medulla. Eleven hours later, the patient's consciousness altered again. Computed tomography demonstrated newly developed hydrocephalus and emergent craniotomy, and extraventricular drainage were performed. The patient improved in both consciousness and respiratory status but complained of mild ataxia and left arm weakness. We recommend cautious examination and early diagnosis and therapeutic decisions in cases of patients with atypical presentation of stroke.


Subject(s)
Arm , Ataxia , Brain Infarction , Brain Stem , Brain Stem Infarctions , Consciousness , Craniotomy , Drainage , Early Diagnosis , Humans , Hydrocephalus , Infarction , Intubation, Intratracheal , Magnetic Resonance Imaging , Male , Middle Aged , Nausea , Respiration, Artificial , Sleep Apnea, Central , Stroke , Ventilation
18.
Article in Korean | WPRIM | ID: wpr-38197

ABSTRACT

PURPOSE: The primary goal of wound management is to avoid infection. Wounds in all patients presenting to the Emergency Department are contaminated with bacteria. Despite this, there is a low incidence of infection. Unfortunately, physicians continue to use antimicrobial agents indiscriminately. The authors intended to determine the effect of selective antimicrobial agents and the indications for appropriate antimicrobial agent use in traumatic simple wounds. METHODS: This prospective study was performed from Jul. 2005 to Aug. 2005. A pilot study had been performed from Nov. 2003 to Jul. 2004 at the Ewha Woman's University Mokdong Hospital. Structured data sheets were completed at the times of the patient's visits to the Emergency Department and to the Outpatient Department for follow-up. Infection was determined at the time of follow-up. The indications of antimicrobial agent use are immunocompromised patients, wounds contaminated for 3 hours or longer, devitalized tissue, and extremity wounds except hand wounds caused by sharp objects. RESULTS: The study enrolled 216 injured patients. The general characteristics of patients and wounds between the two groups were not significantly different. The antimicrobial agent use and infection rate of the pilot study were 227 cases (90.4%) and 10 cases (4.0%), and those of this study were 100 cases (46.3%) and 9 cases (4.1%). In this study, antibiotic use was reduced to almost half compared with the previous study, but the infection rate was similar (p<0.001). CONCLUSION: Rational use of antimicrobial agents in simple wounds reduced the use of antimicrobial agents in the Emergency Department without increasing the infection rate.


Subject(s)
Anti-Infective Agents , Bacteria , Emergency Service, Hospital , Extremities , Follow-Up Studies , Hand , Humans , Immunocompromised Host , Incidence , Outpatients , Pilot Projects , Prospective Studies , Wounds and Injuries
19.
Article in Korean | WPRIM | ID: wpr-202581

ABSTRACT

Emphysematous cholecystitis is an uncommon but life-threatening form of acute cholecystitis that is caused by gas- forming organisms such as Clostridia species, Escherichia coli, Klebsiella, and anaerobic streptococci. Emphysematous cholecystitis frequently affects elderly men, and is associated with diabetes mellitus. The risk of gangrene and perforation of the gallbladder is relatively high in emphysematous cholecystitis patients, and there is a 15% mortality compared with the 4% for acute cholecystitis. We report here a case of emphysematous cholecystitis in a 56-year-old woman, who had diabetes for 10 months. The patient presented with right upper abdominal pain and chills. The abdominal plain film showed a mottled gas pattern in the right upper quadrant. The laboratory value revealed massive intravascular hemolysis. The patient deteriorated rapidly during the course of the evaluation and required cardiopulmonary resuscitation. Despite the attempts to resuscitate the patient, she died 9 hours after the onset of symptoms.


Subject(s)
Abdominal Pain , Aged , Cardiopulmonary Resuscitation , Chills , Cholecystitis, Acute , Diabetes Mellitus , Emphysematous Cholecystitis , Escherichia coli , Female , Gallbladder , Gangrene , Hemolysis , Humans , Klebsiella , Male , Middle Aged , Mortality , Sepsis
20.
Article in Korean | WPRIM | ID: wpr-190340

ABSTRACT

PURPOSE: We have evaluated type of medical errors and severity of results in the emergency department (ED). We also analyze the contributory factors of medical errors for the patient's safety and the quality improvement. METHODS: This study the was prospectively performed from May to August 2005. Medical errors that occurred in the ED were reported anonymously by emergency physicians. The type of medical errors and contributory factors were reported. The severity levels of errors were categorized into 5 levels: level 1- life threatening consequences; level 2- potentially life or limbs threatening consequences; level 3- serious failure or delay of diagnosis or treatment; level 4- inappropriate or unnecessary delay or treatment; level 5- no harm. RESULTS: The total number of patients admitted in the ED during the study period was 16,513, and 177 errors (1.5 errors/day) reported in 160 patients (9.7/1,000 patients). The most frequently occurring medical error was order omission (18.0%), but interpretation errors (11.3%) resulted in the most serious consequences (3.6+/-1.2). More than half of medical errors were no harm (51.4%). Educational and environmental (61 errors) factors were the most frequent causes of medical errors. CONCLUSION: Medical errors frequently occur in the ED. Reducing ED errors will require the improvement of ED environments, better communication, and reinforcement of education by supervising faculty members.


Subject(s)
Anonyms and Pseudonyms , Diagnosis , Education , Emergencies , Emergency Medical Services , Emergency Service, Hospital , Extremities , Humans , Medical Errors , Prospective Studies , Quality Improvement
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