Epidemiology of Patients Using the Resuscitation Room in an Emergency Department

PURPOSE: The resuscitation room is the hub of intensive care and focused management within the emergency department (ED). For patients with life-threatening conditions, immediate triage and proper treatment using the resuscitation room is important. This study was conducted to assess the epidemiology of patients using the resuscitation room in an emergency department. METHODS:This was a retrospective observational study. Eligible subjects were enrolled through the National Emergency Department Information System from July 2007 to September 2008. All subjects came through a single regional emergency center that logs more than 45,000 patients annually. Pediatric patients less than 15 years of age and those who were dead on arrival at the ED were excluded. The Emergency Severity Index (ESI) version IV was used as a triage tool, and characteristics and ESI levels of patients using or not using resuscitation rooms were compared. RESULTS: The total number of eligible subjects was 40,926 and the male-female ratio was 1:0.92. The numbers of patients using the resuscitation room was 1,050 (2.99%). Patients using the resuscitation room were older than the patients not using the resuscitation room, were more likely to have used an ambulance to visit the ED, and had a higher mortality rate and a higher admission rate. A majority of staff members had the authority to put patients in the resuscitation room. Among them were professors 18.19%, emergency residents 11.43%, certified emergency nurses 40.57%, emergency nurses 19.43%, emergency medical technicians 2.86%, and paramedics 6.19%. Critical care was done in the resuscitation room for cardiopulmonary resuscitation 11.66%, intubation 26.33%, ventilation 1.71%, defibrillation 5.73%, and other 54.57%. The most frequent ESI levels of patients using the resuscitation room was 1 (57.89%); an ESI score of 3 (72.01%) was the most frequent value for patients not using the resuscitation room. CONCLUSION: Patient using the resuscitation room were older, more likely to have used an ambulance, and had a higher mortality rate, admission rate and ESI level.

Replantation of Nose Amputation by Use of Medical Leech

In the microsurgical era, replantation with microvascular anastomosis is considered as the most superior method in aspects of texture, color, shape in case of nose amputation. There are some reported cases of replantation in nose amputation historically, but most of them are composite graft cases rather than microvascular anastomosis. Only a few cases of successful nasal replantation with microvascular anastomosis have been reported due to the reason that the size of vessels is usually very small and identifying suitable vessels for anastomosis is difficult. Microanastomosis of artery and microanastomosis of vein are ideal in replantation, but identifying suitable veins is often difficult. Without venous anastomosis, resolving the venous congestion remains to be a problem. We can carry out arteriovenous shunt if we can find two arteries in amputee. However, the smaller the size of amputee is, the more difficult it is to find two arteries. Instead of arteriovenous shunt, we can try external venous drainage(frequently swab, pin-prick, stab incision, IV or local heparin injection, dropping, apply of heparin-soaked gauze, use of medical leech). Here, we present three cases of replantation with microscopical arterial anastomosis (one angular artery, two dorsal nasal arteries) and external venous drainage (stab incision, application of medical leech and heparin-soaked gauze) even though the size of amputee may be as small as 1.5x1.0 cm. In all cases, surgical outcomes were excellent in cosmetic and functional aspects. This report describes successful replantation by microvasular anastomosis in case that suitable veins are not found.

A Case Report: Fibrous Hamartoma of Infancy in the Buttock

Fibrous hamartoma of infancy is an uncommon, benign, subcutaneous fibrous proliferation and usually found during the first 2 years of life, presenting non- tender, hard and movable soft-tissue mass. This tumor can cause much concern about malignancy because it may be fixed in the underlying tissue and is composed of poorly differentiated mesenchymal cells. The diagnosis is made easily by the characteristic histologic features, treatment is local excision and the prognosis is excellent. Because misdiagnosis of malignancy can lead to unnecessary radical therapy, both surgeon and pathologist must be aware of this entity. We experienced and report a case of a 11 month-old male patient who had a 10x15 cm sized hard, fixed and non-tender mass on the right buttock that manifested characteristic pathology of this disease. We excised the mass widely with safety margin of 1 cm and no recurrence was reported in 12 months.

Conservative Treatment with Silicone Gel Sheet of Aplasia Cutis Congenita: Case Reports

Aplasia cutis congenita represents a congenital absence of all skin layers, and it may occasionally extend through the bone and dura of the skull. Since the first report by Cordon in 1767, over 500 cases have been reported. Eighty percents of all cases are found in the scalp, and 20 percents of these cases involve extremities and trunk and are often bilaterally symmetrical. Histologic examination demonstrates a layer of thin dermal collagen without overlying epithelium or adnexal structures. It has several clinical groups classified by the location and pattern of the skin defect, associated anomalies and the mode of inheritance. Its management is controversial and may be conservative treatment or the surgical option to provide definite skin cover. In 1990, Wexler suggested that conservative treatment using Silvadene was the preferred option. We would like to present 2 cases in which silicone gel sheet as a conservative treatment modality led to favorable outcomes. It was invented for the treatment of hypertrophic scar but has been used and studied for the open wounds in recent years. The use of silicone gel sheet on congenital skin defect has many advantages: the danger of infection is minimized due to frequent washing; prolonged hospitalization is prevented; pain or bleeding is minimized for dressing changes because it doesn't adhere to the wound; and it can be used after the epithelization for the prevention of hypertrophic scar.

Meckel-Gruber syndrome

Meckel-Gruber syndrome is a multiple malformation syndrome featuring occipital meningoencephalocele, multicystic dysplasia of kidney, cystic and fibrotic change of liver, polydactyly, and other characteristics inherited by the autosomal recessive trait. We exprienced a case of Meckel-Gruber syndrome in a newborn male diagnosed clinically and confirmed pathologically. Abnormalities of the fetus were found prenataly by ultrasonogram, and subsequently the baby was terminated by cesarean section delivery at 32 weeks of gestational age. We report this case with brief review of literature.