Analysis of overcrowding indices of isolation beds at a single regional emergency department in the COVID-19 pandemic era

Objective@#Emergency department (ED) overcrowding is a global issue that negatively impacts the clinical outcome. Through the coronavirus disease 2019 (COVID-19) pandemic era, overcrowding of ED isolated territory (isolation bed) was aggravated. This study analyzed overcrowding indices of ED isolation beds during the COVID-19 pandemic. @*Methods@#This study was a single-center, retrospective, observational study. The study analyzed 34,925 patients who visited the ED during the COVID-19 pandemic from April 2021 to August 2022. Patients who were treated in isolation beds and regular beds were compared. Among the patients using isolation beds, patients who stayed longer than 720 minutes were also classified and analyzed. @*Results@#During the analysis period, 4,479 and 34,943 patients were treated in the ED isolation bed and ED regular bed, respectively. The overcrowding indices (general ward admission rate, intensive care unit admission rate, ED-length of stay, transfer rate, mortality rate, prolonged ED stay patient ratio) of the isolation beds were significantly higher than those of the ED regular bed (P<0.05). The prolonged ED stay-patient ratio of isolation beds and regular beds was affected by the number of COVID-19 patients (regular bed, r=0.617 and P=0.01; isolation bed, r=0.525 and P=0.03). The average ED-length of stay of isolation beds was longer than that of the ED regular beds. One hundred and forty-five patients were classified as prolonged ED stay patients. Their time from the decision point to the discharge point comprised a higher rate with an average of 76.52%. @*Conclusion@#ED isolation beds are more vulnerable to infectious disease outbreaks. A proper medical policy and arrangement management system that can flexibly deal with disaster emergencies are required

A Study of Facial Fracture and Associated Injuries

PURPOSE: This study is to analyze the frequency and pattern of associated injuries in patients with facial fractures. METHODS: A retrospective method was used to study facial fracture patients visiting our emergency room from May 2002 to April 2003. The patient's age, sex, injury mechanism, location of facial fracture, and associated injuries, as well as the records of emergency procedures and emergency operations were examined. RESULTS: During the research, a total number of 206 patients with facial fractures were examined. As for the injury mechanism, traffic accidents were the primary cause with 40.3%. Orbital fracture was the most common overall facial fracture (44.7%). Ninety-seven (47.1%) patients had associated injuries. Fifty-nine of those patients had head injuries, 48 had extremity injuries, 17 had chest injuries, 14 had abdominal injuries, and 13 had spine injuries. Among the facial-fracture patients, patients with maxillary fractures had the most associated injuries (95.3%). Of those associated injuries, head injuries were the most commonly reported ones (48.3%). The emergency procedures used were intubations (9) and thoracostomies (4). The emergency operations performed were craniotomies (5) and exploratory laparotomies (2). Four patients died due to brain injuries. CONCILUSION: Associated injuries often occur in patients with facial fractures. Head and extremity injuries are the most common associated injuries. We believe emergency physicians can maximize the effectiveness of their treatment of patients with facial fractures and their associated injuries through a coordinated team approach, while minimizing the complications and sequelae.

Educational Effect on Prehospital Personnel for Prehospital Stroke Management

PURPOSE: If optimal neurologic recovery of stroke patients is to be achieved, thrombolysis and intervention must be initiated within hours from the onset of stroke symptoms. The prehospital personnel play a vital role in prehospital stroke management, including rapid recognition of stroke and rapid transport of the victim to the treating facility. The fact is, however, education and assessment of prehospital personnel's knowledge and practice in recognizing stroke are lacking. In this study, we assessed the prehospital personnel's knowledge of stroke; then, we performed an analysis to determine if that knowledge proved to have an impact on stroke management. METHODS: The study was conducted from March to August 2001 at 9 fire stations in Seoul and other regional areas, and included 164 prehospital personnel. In order to conduct a before-and-after comparative study, we first investigated the prehospital personnel's current knowledge of stroke; then, we administered our own educational training which was taught by an emergency physician. RESULTS: One hundred sixty-four prehospital personnel participated in the educational training program. Most of them (63.4%) were educated at the National Fire Academy. The most frequently listed stroke risk factor was hypertension (98.2%). The most frequently listed stroke symptom and sign was abnormal speech (91.5%). The level of knowledge about the prehospital stroke scale was very low (facial palsy: 10.8%, arm drift: 7.9%, dysarthria: 17.7%). Before the education, their knowledge about the definition of stroke, its risk factors, symptoms and signs, the goal of prehospital management, and the therapeutic window for thrombolysis was not satisfactory. However, there was a significant improvement after the education(p<0.001). The extent of knowledge about stroke varied with the characteristics of the prehospital personnel. The prehospital personnel's knowledge was relatively higher if they were EMP-P certified; from the Department of Emergency Medical Service; worked in Seoul; had been educated for stroke; or had been less than 2 years on the job. CONCLUSION: Presently, the prehospital personnel 's knowledge about prehospital stroke management has proven to be insufficient. However, there was a significant improvement in stroke knowledge after education by an emergency physician

A Case of Acute Lung Injury Caused by Inhalation of Industrial Acetic Acid

Industrial exposure to toxic agent may produce a wide variety of respiratory damage. Acetic acid is a colorless liquid with a pungent vingar-like odor. It is a rare case that acute lung injury is caused by inhalation of acetic acid. Acetic acid is miscible with water, and may directly produce damage to mucosa of respiratory tract due to its irritant quality. The outcome of the reaction is dependent on the intensity and duration of exposure and varies from death or pulmonary edema in acute phase to resolution or bronchiolitis obliterans or bronchiectasis. We experienced a rose of acute lung injury due to accidental inhalation of acetic acid. The patient was a 31-year-old male who had developed progressive chest discomfort, chilling sense, and mild dyspnea after accidental inhalation of acetic acid. He had severe hypoxemia and chest radiograph showed diane bilateral alveolar edema. He responded to conservative treatment with oxygen inhalation and was discharged with improved condition on the 7th hospital day.

A Case of Dichloromethane Intoxication Following Ingestion

The Dichloromethane(methylene chloride) is a highly volatile liquid used as a solvent, extraction medium, and paint remover. The most significant route of intoxication to dichloromethane is generally inhalation at work site or home, but ingestion is rare. The main toxicological harvard insults from in vivo conversion of dichloromethane to carbon monoxide. We present a case of dichloromethane intoxication following ingestion. A 71 years old male patient ingested 60-70cc of dichloromethane was brought to emergency department after stomach washout via nasogastric tube at other hospital. On arrival at emergency department(approximately 19 hours after ingestion), he was stuporous with a blood pressure 140/90mmHg, heart rate of 92 beats/min, dyspneic, respiratory rate of 24/min and body temperature 36.8 degrees C. His Pupils were isocoric, miotic, and sluggishly reactive. There were mucosal bums and significant secretion in oral cavity. On auscultation, breathing sound was coarse without role on both lung field. The COHb levels were 6.3%at 32 hours after ingestion and normalized to 0.6%at 44 hours after ingestion. Patient was transfered to intensive care unit and supportive care was started with 100% oxygen. On ingestion 4th day, chest X-ray showed pulmonary edema and acute respiratory distress syndrome developed. Patient regained the consciousness on the 11th day. On the 30th day, respiratory function improved and the ventilator was removed. Alveolitis and mild pulmonary fibrosis developed and mild dyspnea was continued. On the 36th day, gastroscopic examinations showed ulceration of esophagus and stomach. On the 76th day, patient was discharged after pulmonary rehabilitation.

An Analysis of The Patients with Non-Traumatic Chest Pain Patients in Emergency Department according to Goldman's Algorithm

BACKGROUND: It is important to evaluate the patient presenting with non-traumatic chest pain in emergency department, and it is also difficult to classify appropriately. The purpose of this study is to predict probability of acute myocardial infarction(AMI) and assess the group for low probability of AMI that is target for observation-unit of chest pain in emergency department. METHODS: A prospective, clinical study was performed from March 1998 to August 1998 at the department of emergency medicine, Ewha Womans University Mokdong hospital. We classified high-probability group and low-probability group of AMI according to Goldman's algorithm and then compared with the final diagnosis. RESULTS: The study included 218 patients. 84 patients(39%) was the high-probability group and 134 patients(61%) was the low-probability group of AMI. As compared with final diagnosis, AMI was 47 patients(56%) among the high-probability group and 1 patient(0.7%) among the low-probability group. We observed sensitivity of 98%, specificity of 78% in predicting AMI. CONCLUSION: The classification according to Goldman's algorithm may be useful predictor of AMI and improve triage for emergency department patient with chest pain. It is also helpful for management of observation-unit of chest pain in emergency department.