Analysis of Transportation of Victims of the Subway Fire in Daegu

PURPOSE: The purpose of this study was to improve transportation and distribution of mass-casualty patients by reviewing the subway fire that occurred in Daegu on 18 February 2003. METHODS: We used the reports of the Daegu Emergency Medical Information Center and the medical records of each hospital to analyze retrospectively 199 patients who were transported to 22 initial receiving hospitals. We evaluated the appropriateness of transportation based on the distances of transportation, the capability of the receiving hospitals, and the severity of patients. Using the SAS program(version 6.12), the collected data was analyzed by frequency and x(2) test. RESULTS: The more severe the patients were, the nearer and larger the receiving hospitals were. There was no accurate triage at the scene, but the distribution of patients was good because members of Daegu Emergency Medical Information Center were dispatched to the scene and because communications between the scene and receiving hospitals were continuous. CONCLUSION: We do not expect disasters, but they happen. All we can do is plan and prepare appropriate responses for disasters. Appropriate transportation and distribution of patients based on triage is an important aspect of early disaster response.

Aneurysm of Splenic Artery: A Case Report

Aneurysm of the splenic artery are the third most common intra-abdominal aneurysm, following aneurysms of the infrarenal aorta and iliac arteries. Splenic artery aneurysms (SAA) are the most frequent visceral artery aneurysms and account for more than two thirds of all lesions. Incidence of SAA are rare clinical entities(0.01-0.2%) that carry risk of rupture and fatal hemorrhage(35-100%). Fibroblastic dysplasia and atherosclerosis is fecund in the majority, and the fact that these aneurysms developes more commonly in female. Most patients are asymptomatic and the diagnosis is generally made incidentally. The treatment of patient with known SAA is dictated by several factors, including location, age, sex, present of symptom, size, pregnancy. We report ruptured splenic artery aneurysm with hemoperitoneum and review of the literature.

The Risk of Aspiration in Laryngeal Mask Airway: Laryngeal Mask Airway vs Endotracheal Tube

BACKGROUND: There were several studies for the incidence of gastroesophageal reflux associated with the laryngeal mask airway(LMA), but the results of those studies were much different much different from one another. The aim of this study was to compare the incidence of gastroesophageal reflux and regurgitation of gastric contents between the LMA and the endotracheal tube(ETT). METHOD: Ninety patients scheduled for elective orthopedic surgery with a standardized general anesthetic technique were randomly allocated to receive either a LMA(n-49) or a ETT(n=41) for airway management. The esophageal manometry was carried out for the exclusion of esophageal motility disorders and the 24-hour ambulatory pH metry was done from one day before the operation. A methylene blue(50mg) capsule was swallowed just before the induction and the simultaneous recordings of pH were maintained during anesthesia. At the end of anesthesia, the episodes of regurgitation of gastric contents above hypopharynx were analyzed by the pharyngeal blue staining and the pH metric data were analyzed for the detection of gastroesophageal relux episodes during anesthesia. RESULTS: There was no significant difference in the incidence of gastroesophageal relux(pH< or =4) between two groups; only two patients in LMA and three patients in ETT had reflux episodes during the removal or arousal phase. There was no episode of the pharyngeal blue staining in both group. All of the gastroesophageal reflux patients in both group developed a cough or straining during those phases. There was no clinical evidence of aspiration of gastric contents in both group. CONCLUSION: In comparison with ETT, use of LMA does not appear to increase the incidence of gastroesophageal reflux and regurgitation above hypophryngeal level in positive pressure ventilating patients during long surgical procedures. Therefore, the risk of aspiration in LMA will not be much more than ETT.