A Clinical Analysis of the Patients Transported by EMS Helicopter - In Gwangju and Jeonnam

PURPOSE: Rapid transport of critically ill patients to advanced medical centers is important in improving the survival rate and prognosis. Helicopter Emergency Medical Services (HEMS) is rapid and fairly accessible, but it is expensive, influenced by weather, and has complications at high altitude. This study was performed to build the basic data for helicopter transportation through an analysis of the patients transported by EMS helicopter in Gwangju and Jeonnam. METHODS: The subjects of this study are patients transported by EMS helicopter from January 2002 to June 2004 in Gwangju and Jeonnam. The analysis focused on the clinical characteristics, including time and purpose of flight, and cause, severity and outcome of the diseases. RESULTS: 1. The 262 cases successfully transported. 162 involved men, and 100 involved women. 2. The mean age was 49.0+/-19.9 years. 3. The regional distribution of the 262 cases was 38 cases in Gwangju and, 224 cases in Jeonnam. There were 164 cases (58.6%) in Sinan, 38 cases in Gwangju, 10 cases in Wando, 10 cases in Youngam, 9 cases in Yeosu and Yeochun, the great majority of which were in island area. 4. Traumatic patients (137 cases) were 52.3% of the total number of patient. The average Injury Severity Score of 115 traumatic patients (except for 6 cases of burn and 16 cases of acute poisoning) was 15.5 +/- 8.6. 5. Non-traumatic patients (125 cases) were 47.7% of the total number of patient. The average Simplified Acute Physiology Score II of 125 non traumatic patients and 6 cases of burn and 16 cases of acute poisoning was 24.4+/-18.2. CONCLUSION: Considerations of the region and the reason for help are needed when assessing the indications for helicopter transport apart from the severity of the diseases. Also, advances in medical control and in the operation of emergency information centers are needed to improve the assessment and treatment of patients from the prehospital, and to allow the transport to the proper institutions.

Effect of High-dose Pralidoxime in Organophosphate Intoxication

PURPOSE: Pralidoxime(2-PAM) is the mainstay of organophosphate intoxication management as an antidote. We investigated the usefulness of high-dose pralidoxime therapy. METHODS: From January 2000 to July 2003, 86 patients presented with organophosphate insecticide intoxication to the emergency medical center of Chonnam National University Hospital. They were randomized into two groups: Group I was given continuous IV infusion of pralidoxime in dose of 500 mg/hr after an initial bolus dose of 2 g and Group II was given continuous IV infusion of pralidoxime in dose of 1000 mg/hr after an initial bolus dose of 2 g. Both groups were given same therapeutic interventions, including the duration of atropine administration. The plasma cholinesterase activites were monitored at admission and at 24 hr and 48 hr after infusion of pralidoxime. The effectiveness of the two treatment modalities were gauged by comparing the durations of mechanical ventilation and intensive care unit (ICU) stay. RESULTS: The mean durations of mechanical ventilation were 9.82+/-6.45 days in group I and 6.51+/-4.50 days in group II. The mean durations of ICU stay were 12.82+/- 7.69 days in group I and 9.15+/-5.38 days in group II. group I showed that longer durations of mechanical ventilation (p=0.03) and ICU stay( p<0.001). The plasma cholinesterase reactivation rate were higher in group II than in group I. CONCLUSION: The results suggest that continuous high-dose pralidoxime therapy may be helpful in the treatment of organophosphate intoxication.

Analysis of Factors Predicting Recurrence and the Result of Treatment in PSVT Patients at the Emergency Department

PURPOSE: The purpose of this research was to evaluate the factors predicting recurrence and the characteristics of patients who recurred after the treatment of spontaneous paroxysmal supraventricular tachycardia (PSVT) with adenosine. METHODS: From January 1999 to December 2001, 62 patients with PSVT were enrolled in this study. The conversion group included patients who had had a therapeutic response, which was defined as the occurrence of a change in the sinus rhythm after adenosine administration. The recurred group consisted of all patients who had not had a therapeutic response. Clinical features, the results of treatment, ECG findings, and the hemodynamic statuses were analyzed. RESULTS: The treatments were vagal maneuver (5 pts, 7.5 %), adenosine 6 mg (37 pts, 55.2 %), adenosine 12 mg (14 pts, 20.9 %), verapamil 5 mg (9 pts, 13.4 %), and cardioversion (2 pts, 3.0 %). Twenty-five of the 62 patients failed to have a therapeutic response, yielding a recurrence rate of 40.3 %. Atrioventricular reentrant tachycardia (AVRT) was more prevalent in the recurred group. The most common symptom at presentation was chest pain. The recurred group had increased heart rate, and increased blood pressure. When patients were monitered after adenosine, unifocal premature ventricular complex was the most common rhythm encountered in the conversion group, but atrial fibrillation, and multifocal premature ventricular complex was the most common rhythm encountered. CONCLUSION: Age, heart rate, difference in systolic blood pressure from presentation to discharge, previous history of heart disease, and rhythms encountered after adenosine administration were factors predicting recurrence.

Clinical and Radiologic Results of Cementless Total Hip Arthroplasty Using Hydroxyapatite - Coated Stem / 대한정형외과학회잡지

From Jan. 1987 to May 1994, we carried out cementless total hip arthroplasties using hydroxyapatite-coated Omnifit system, and among these, 63 cases in 49 patients were followed up more than 24 months. The average Harris Hip Score was 46.3 points preoperatively, 95.4 points at POD 1 year and 96.2 points at POD 2 years. Two patients (3%) complained thigh pain at POD 2 years. On the radiologic findings, endosteal bone formation was noted in 34 cases (53,9 %), radiolucent lines were seen at the non-coating region of distal stem in 41 cases (65.3%), which were less than 2mm and not progressive. Cortical hypertrophy was noted in 5 cases (8.4%), and calcar atrophy was observed in 31 cases (49 %).