Epidemiological Multi-center Study of Blast Injury in Military Centers

PURPOSE: Recently, the incidence of blast injury has been on the increase worldwide. The purpose of this study was to evaluate and analyze blast injuries in South Korea. METHODS: This was a retrospective multi-center study of blast injuries in three tertiary military centers. The medical records of patients with blast injuries from January 2003 to December 2007 were reviewed. The injury severity was evaluated according to the Injury Severity Score (ISS), the Revised Trauma Score (RTS), and the Trauma Score and the Injury Severity Score (TRISS). RESULTS: This study revealed epidemiological data of blast injury in the three tertiary military hospital. A total of 94 cases of blast injury had occurred. Various body regions were involved. The most frequently injured site was the upper extremity (52.1%). The mechanisms for the blast injuries were primary (41.5%), secondary (74.5%), tertiary (7.4%), and quaternary (29.8%). The mean injury-to-hospital arrival time was 3.2+/-1.7 hour. The rate of admission was 88.3%, and the rate of ICU admission was 32.5%. Thirty-six (36) cases required an emergency operation. Most were performed by an Orthopedist (55.6%), an Ophthalmologist (19.4%), or a general surgeon (13.9%). The mortality rate from blast injury was 4.3%. CONCLUSION: This was the first paper to present data on the type of injury, the site of injury, the cause of death, and the mortality from blast injury in South Korea. Chest injury, brain injury, tertiary injury mechanisms, ISS> or = 16, and a Maximal Abbreviated Injury Scale Score (ABI)> or =4 were significantly associated with death.

Surveillance on Hazardous Materials Preparedness in the Emergency Department in Korea: Personal Protection Equipment

PURPOSE: This study was conducted to evaluate the preparedness of personal protective equipment (PPE) against hazardous material (Hazmat) contamination in emergency departments (EDs). METHODS: Among 443 EDs, 118 emergency centers (16 regional centers, 4 specialized centers, 98 local centers) were surveyed either by returned usable surveys or facsimile or telephone communication. The 27 survey questions addressed the ability of EDs to safely decontaminate and treat contaminated patients. RESULTS: Among 118 EDs (100%), 7 EDs (5.9%) have a written plan for decontamination and treatment of Hazmat contaminated patients in the ED, and 36 (30.5%) have a hospital-wide disaster plan that includes contingencies for decontamination and treatment of Hazmat contaminated patients. 11 EDs (9.3%) conducted any Hazmat drill within recent two years. 8 EDs (6.8%) have a specific treatment area for contaminated patients. A stock space of PPE is maintained in 11 EDs (9.3%) and 6 EDs (5.1%) have a responder decontamination shower. While 11 EDs store PPE, most of these involve only gowns, gloves, and surgical masks; only 10 EDs provide any type of respiratory protection. There was no ED fully equipped level A PEE but only 21 EDs have partially equipped. The levels of PPE were level D in 7 EDs (5.9%) according to the guidelines of EPA/OSHA Personal Protection Equipment Levels CONCLUSION: Emergency department preparedness against Hazmat exposure in Korea varies tremendously. A significant proportion of hospitals lack written plan and equipment to allow EDs to safely and effectively handle the Hazmat contaminated patient. This has the meaning of one of preliminary data that was national-wide surveyed in Korea.

Three-dimensional image analysis of the skull using variable CT scanning protocols-effect of slice thickness on measurement in the three-dimensional CT images / 대한구강악안면방사선학회지

PURPOSE: To evaluate the quantitative accuracy of three-dimensional (3D) images by means of comparing distance measurements on the 3D images with direct measurements of dry human skull according to slice thickness and scanning modes. MATERIALS AND METHODS: An observer directly measured the distance of 21 line items between 12 orthodontic landmarks on the skull surface using a digital vernier caliper and each was repeated five times. The dry human skull was scanned with a Helical CT with various slice thickness (3, 5, 7 mm) and acquisition modes (Conventional and Helical). The same observer measured corresponding distance of the same items on reconstructed 3D images with the internal program of V-works 4.0 TM (Cybermed Inc., Seoul, Korea). The quantitative accuracy of distance measurements were statistically evaluated with Wilcoxons' two-sample test. RESULTS: 11 line items in Conventional 3 mm, 8 in Helical 3 mm, 11 in Conventional 5 mm, 10 in Helical 5 mm, 5 in Conventional 7 mm and 9 in Helical 7 mm showed no statistically significant difference. Average difference between direct measurements and measurements on 3D CT images was within 2 mm in 19 line items of Conventional 3 mm, 20 of Helical 3 mm, 15 of Conventional 5 mm, 18 of Helical 5 mm, 11 of Conventional 7 mm and 16 of Helical 7 mm. CONCLUSION: Considering image quality and patient's exposure time, scanning protocol of Helical 5 mm is recommended for 3D image analysis of the skull in CT.

Storage-induced Changes of Plasma Free Hemoglobin, Adenosine Triphosphate, 2,3-Diphosphoglycerate of Cord Blood / 대한임상병리학회지

BACKGROUND: The use of autologous transfusion is gradually increasing since it eliminates transfusion-transmitted viral diseases, and avoids the risk of alloimmunization of red blood cells and posttransfusion graft-versus-host disease. The majority of premature neonates born at less than 1500 g need one or more red blood cell transfusion during the hospitalization and cord blood is considered as the most ideal blood for neonate autologous transfusion. In order to evaluate the adequacy of stored cord blood for autologous transfusion for neonates, the levels of plasma free hemoglobin, red blood cell adenosine triphosphate (ATP) and 2,3-diphosphoglycerate (2,3-DPG) were measured at the time of collection, and then a week interval by 4 weeks. METHODS: The cord blood was collected in a single donor bag with CPDA-1 by aseptic technique from 28 newborns, stored for 28 days at 4degrees C, and changes in the levels of plasma free hemoglobin, red blood cell ATP and 2,3-DPG were measured at the time of collection, and then a week interval by 4 weeks for 26 cord bloods which were not presented with any bacterial growth during the storage. RESULTS: At the time of sampling, hemolysis was 0.11+/-0.16%, and intracellular ATP and 2,3-DPG were 3.74+/-0.99 mumol/g Hb and 11.67+/-1.21 mumol/g Hb, respectively. During the storage, hemolysis gradually increased to 0.61+/-1.09% on 28 days (p<0.05). ATP gradually decreased to 2.98+/-0.92 mumol/g Hb (80% of initial level) on 28 days(p<0.05). The levels of 2,3-DPG were 4.20+/-0.87 mumol/g Hb (about 35% of initial level) on 7 days(p<0.05) and 1.16+/-0.74 mumol/g Hb (less than 10% of initial level) on 28 days (p<0.001). CONCLUSIONS: In conclusion, ATP and 2,3-DPG levels of cord blood that are related to the viability of red blood cells during the storage were similar to those of adults. Thus the cord blood appeared to be an appropriate source for neonate autologous transfusion, however, more intensive studies on the effects of 2,3-DPG and metabolic products in vivo are necessary since physical conditions and physiology of the red blood cells in the neonates are different in many aspects from those of adults and children.