Comparison of radiation exposure by area before and after emergency center remodeling

OBJECTIVE: Radiation is used extensively in emergency centers. Computed tomography and X-ray imaging are used frequently. Portable X-rays, in particular, cause a significant amount of indirect radiation exposure to medical personnel. The authors' emergency center was remodeled, and a comparative study of radiation exposure was carried out in certain places that had experienced radiation for a long time. METHODS: The cumulative radiation dose was measured 20 times in the 24 hours prior to remodeling, and the cumulative radiation dose was measured again 20 times across the 24-hour period. The measurement points were fixed at the emergency doctor's seat (Zone A), charge nurse's seat (Zone B), and section nurse's seat (Zone C). During the 24-hour cumulative radiation measurement period, the number of portable X-ray shots was recorded in the emergency center. RESULTS: The mean of the 24-hour cumulative radiation measurements in zone A was 3.36±0.07 µSV and 4.54±0.07 µSV before and after remodeling, respectively (P<0.001). Regarding the number of portable X-rays performed during the measurement, a higher number of trials in the Pearson correction correlated with a higher radiation measurement. CONCLUSION: In an emergency medical center, there is a higher level of low-dose radiation exposure compared to that experienced from natural radioactivity. Regarding the number of portable X-rays, the cumulative radiation dose measured 24 hours after remodeling increased and can be assumed to be related to the environment.

Improvement of Night Pharmacy Service by Automated Dispensing Cabinet System Implementation in Emergency Medical Center

OBJECTIVE: An automated process for medication preparation and dispensing is essential to improve the quality of work. To reduce night pharmacy workload, a new automated dispensing cabinet system was implemented in a hospital emergency medical center. The purpose of this study is to verify that implementation of an automated dispensing cabinet system will influence the efficiency of night pharmacy work. METHODS: To evaluate the new system implementation, a retrospective study and survey was performed in the Ewha Womans University medical center. We compared the dispensing and near-miss error rates between the automated dispensing cabinet system and a night pharmacy. The degree of satisfaction of night shift workers with the new system was surveyed. RESULTS: This study showed significantly reduced dispensing rates of night medications (56.1% and 37.3%; p < 0.01) and near-miss night medications (0.27% and 0.17%; p < 0.01). Thirty-two persons responded to the survey, and the satisfaction score for the new system was 4.0 (±0.8). The scores were high in order of efficiency, management, and convenience. Time requirement was also reduced because of the simple step of only reviewing in the pharmacy with the new system. CONCLUSION: Due to system implementation, workload was reduced and time was saved for not only night shift workers but also patients receiving emergency discharge medicine. It was suggested that this will have a positive effect on pharmacist medical service and patient safety.

A prototype interactive seminar on pediatric emergency practice in Yokohama / 医学教育

  We describe a prototype seminar, inspired by the problem-based learning tutorial system, on pediatric emergency practice for young physicians working in 7 pediatric emergency centers in Yokohama. The seminar was received favorably by the participants, especially as an opportunity for individual learning. We expect that the seminar will contribute to the standardization of emergency practice in these pediatric centers and the establishment of an interhospital network.

Epidemiology and characteristics of acute poisoning treated at an emergency center / 世界急诊医学杂志（英文）

BACKGROUND:Acute poisoning is frequently encountered at emergency department. This study was to investigate the epidemiology and characteristics of patients with acute poisoning who were treated at the Emergency Center, Fujian Provincial Hospital, China. METHODS:We retrospectively analyzed the gender, age, causes of poisoning, types of poisons, poisoning route, emergency diagnoses, outcomes, and prognoses of these patients. RESULTS:Altogether 2867 patients with acute poisoning were treated from January 2004 to December 2009. The ratio of male to female was 1:1.04, and their average age was 33.8 years. Of the 2867 patients, 76.39％ were between 18 and 40 years old. The incidence of acute poisoning was as high as 11.33％ in January each year. The incidence of poisoning was in a descending order:alcohol poisoning (54.55％), medication poisoning (25.95％), pesticide poisoning (5.65％), and drug poisoning (4.88％). Most (56.44％) of the patients with drug poisoning were under 25 years and their mean age was significantly lower than that of patients with medication poisoning or alcohol poisoning (P < 0.01). Approximately 69.54％ of the patients were followed up after emergency treatment, 30.39％ were hospitalized, and four patients died. CONCLUSIONS:Acute poisoning is largely alcohol poisoning and medication poisoning in a city. The emergency green channel "pre-hospital emergency care-emergency department-hospital treatment"can significantly improve the survival rate of patients with acute poisoning.

Epidemiological analysis of acute poisoning in emergency center affiliated to general hospital / 中华急诊医学杂志

Objective Acute poisoning is frequently encountered at emergency department. This study was to investigate the epidemiology and characteristics of patients with acute poisoning who were treated at the Emergency Center, Fujian Provincial Hospital, China. Method We retrospectively analyzed the gender, age, causes of poisoning, types of poisons, poisoning route, emergency diagnoses, outcomes, and prognoses of these patients.Results Altogether 2867 patients with acute poisoning were treated from January 2004 to December 2009. The ratween 18 and 40 years old. The incidence of acute poisoning was as high as 11.33% in January each year. The incidence of poisoning was in a descending order: alcohol poisoning (54.55%), medication poisoning (25.95%), pesticide poisoning (5.65%), and drug poisoning (4.88%). Most (56.44%) of the patients with drug poisoning were under 25 years and their mean age was significantly lower than that of patients with medication poisoning or alcohol poisoning ( P ＜ 0.01 ). Approximately 69.54% of the patients were followed up after emergency treatment, 30.39% were hospitalized, and four patients died. Conclusions Acute poisoning is largely alcohol poisoning and medication poisoning in a city. The emergency green channel "pre-hospital emergency care-emergency department-hospital treatment" can significantly improve the survival rate of patients with acute poisoning.

Clinical Analysis of the Pediatric Patients Seen in the Emergency Medical Center / 소아과

PURPOSE: We studied a clinical analysis of pediatric patients who visited the emergency medical center of Yeungnam University Hospital to compare the characteristics of pediatric emergency patients after year 2000 with the previous studies. METHODS: We reviewed 7, 034 children under the age of 15 years who visited the emergency medical center of Yeungnam University Hospital during the 2 year period from January 2001 to December 2002, and then we performed a clinical and statistical analysis. We analyzed the pediatric patients according to gender, age, season, day of the week, time of the visit, the disease classification and the final disposition of the patients. RESULTS: Among the patients who visited the emergency room, 15.6% of the total emergency patients were under the age of 15. The male to female ratio was 1.6: 1. Among the 7, 034 pediatric patients, the most common age group was between 1 year and under 3 years of age (26.9%). The peak seasonal incidence was early summer and spring, especially during June (11.2%) and May (10.6 %). The peak incidence day of the week was Sunday (24.8%) and the peak time when the emergency pediatric patients visited the emergency room was between 20 and 24 o'clock (28.8%). The distribution of diseases, according to ICD-10 system, were injury and poisoning (30.4%), diseases of the respiratory system (22.8%), and diseases of the digestive system (14.6%). 30% of total pediatric patients were admitted to the hospital. CONCLUSION: After year 2000, as compared with the previous studies, the proportions of emergency pediatric patients has decreased. The distribution of diseases was not much different from the previous studies and the proportions of non-urgent diseases, such as acute nasopharyngitis or acute gastroenteritis, were still high. These result have come about due to the declining birth rate and changes of the medical system in Korea.

Implementation of a Critical Pathway to the Dizzy Patients in the Emergency Center

BACKGROUND AND OBJECTIVES: Dizziness and vertigo are frequent causes of presentation in the emergency center. Nevertheless, the practice guideline for the primary care doctor in the emergency center has not been reported yet. Considering its complex approach for diagnosis, we developed critical pathway for dizzy patients who visited emergency center. We performed this study to show the process of development and the result of implementation of critical pathway. MATERIALS AND METHOD: A critical pathway was developed following the analysis of dizzy patients visiting emergency center by retrospective chart review and in the basis of questionnaire for knowing the needs for critical pathway to the primary care doctor in emergency center. Specialists for caring dizzy patients joined to make the flow sheet and practice guideline for dizzy patients and also made educational materials for doctors in emergency center. The critical pathway was then implemented and its results were analyzed by estimating the practice time and the degree of satisfaction of the patients and doctors. RESULTS: Most of the primary care doctors in emergency center reported the difficulty in diagnostic approach for dizzy patients and the need for critical pathway. More than half of the dizzy patients were diagnosed as peripheral vertigo and the commonest disease was benign paroxysmal positional vertigo. All of the patients with vertigo diagnosed as central origin showed the neurologic deficit. After the implementation of critical pathway, practice time was significantly decreased and many of the dizzy patients and doctors were satisfied. CONCLUSION: Development and implementation of a critical pathway for dizzy patient in emergency center was possible, valuable and effective for the patients and doctors, though the process was not easy and needed interdisciplinary cooperation of involving departments.

Clinical Analysis of Pediatric Death Patients Visiting Emergency Center / 소아과

PURPOSE: We analyzed pediatric death patients who visited Dong-Kang Hospital emergency center, in order to minimize unexpected pediatric deaths. METHODS: The authors analyzed retrospectively the medical records of 110 pediatric patients who died before and within 24 hours after admission to the emergency center of Ulsan Dong-Kang General Hospital from January 1997 to December 2002. RESULTS: We classified three categories by the cause of death, accident group(AG) 46 cases(41.8%), disease group(DG) 37 cases(33.6%), unknown cause group(UG) 27 cases(24.6%) respectively. The most common age was between two and five years of age(50.0%) in AG, under one month (40.5%) in DG, between one month and one year(51.9%) in UG respectively. The most common season was summer(37.0%) in AG, winter(51.4%) in DG, spring(37.1%) in UG respectively. The most common time on arrival was from 13:00 to 18:00(37.0%) in AG, from 7:00 to noon(43.2%) in DG, from midnight to 6:00(29.6%) and from 7:00 to noon(29.6%) in UG respectively. The most common type of accident was traffic accident(47.8%). The most common cause of death in DG was respiratory disorder(40.5%). Sudden infant death syndrome was the most common(37.1%) in unknown cause of death. CONCLUSION: Accidental injuries and severe chronic illnesses are the major cause of unexpected pediatric death. Legislation related to accidents and a parents teaching program for emergency situations are necessary to decrease cases of unexpected pediatric death.

Clinical Review of Acute Hepatitis A in a Emergency Center

PURPOSE: We conducted this study to evaluate the clinical manifestations of acute hepatitis A in an emergency center. METHODS: All hepatitis A patients who visited the emergency center of Seoul National University Hospital from October 1999 to March 2002 were analyzed using a retrospective medical record review. Variables included in the data analysis were age, sex, clinical symptoms and signs, and laboratory findings on initial presentation and their peak values. RESULTS: A total of 31 patients showed positive for the anti-HAV IgM antibody, and 29 patients had apparent hepatitis A. The number of hepatitis A cases per month in 1999, 2000, 2001, and 2002 were 1.33, 0.25, 0.92, and 4.3, respectively. Among the 29 patients, 15 were brought to the emergency center and constituted the study group. The mean age were 22.3 years old. The most common symptoms were nausea and vomiting (100%), followed by fever (86.7%), anorexia (66.7%). Common signs were jaundice (53.3%) and hepatomegaly (46.7%). Seven patients admitted via the outpatient department were older and had a longer duration of symptoms from onset to diagnosis than the study group. The mean values of the initial laboratory tests were serum aspartate aminotransferase (AST) of 3,044 IU/L, alanine aminotransferase (ALT) of 3,521 IU/L, and a total bilirubin of 4.15 mg/dL. The peak mean values of those variables were 4,067 IU/L, 4,662 IU/L and 7.35 mg/dL, respectively. All patients recoverd without complications. CONCLUSION: Patients with hepatitis A showed benign clinical features. This study revealed a trend of increasing incidence of hepatitis A in adults and suggested the possibility of an outbreak. Further effort to prevent the propagation of the disease is warranted.

The Severity of the Pediatric Patients Visiting Emergency Center / 아동간호학회지

This study was attempted to help in explore new direction about classification of the severity of the pediatric patients visiting emergency center. Data were collected from 276 patients who visited emergency center of E University Hospital during 3 months period from March 1, to May 31,1999. The results were as follows: 1. The degree of severity of the pediatric patients visiting emergency center shown ranged 0-18 and averaged .87. 2. With the respect to the severity of the pediatric patients visiting emergency center, there were statiscally significant difference in patients' visiting time(F=2.607, p=.025), disease classification(F=9.606, p=.000), consciousness level(F=71.499, p=.000), period of symptom manifestation (F=2.262, p=.030), pediatric patients protector's thinking about pediatric patients state (F=16.833, p=.000), treatment outcome (t=5.362, p=.000), duration of stay at emergency center(F=23.944, p=.000).

The degree of Satisfaction with Nursing Care of Pediatric patients visiting Emergency Center / 아동간호학회지

The purpose of this study was to provide qualified nursing care to examine the degree of satisfaction with nursing care of pediatric patients visiting emergency center. Data were collected from March, 8 to June, 5, 1999 from 304 subjects including 2 University hospitals located in Seoul. Using the 23 item questionnaire, which made out by Davis CHECSS tool through modification and supplement by researchers. The collected data were scored by use of means and standard deviations according to the degree of satisfaction with nursing care of pediatric patients visiting emergency center and each item as an independent variable was analysed by t-test and ANOVA test. The results are as follows. 1. The degree of satisfaction with the nursing care of pediatric patients visiting emergency center showed as an average of 3.69. 2. With the resept of general characteristics related to pediatric patients visiting emergency center, there were statiscally significant difference in duration of stay at emergency center(F=2.908, p=.014), type of disease(F=1.777, p=.046). The degree of satisfaction with the nursing care of pediatric patients of examiners showed relatively high, but emotional care and information supply are required.

A Clinical Study of the Pediatric Patients Visiting Emergency Center / 아동간호학회지

The purpose of this study was to provide basic data of nursing intervention through understanding disease pattern of pediatric patients. Data were collected from 3,016 patients who visited emergency center of E university Hospital during one year period from January to December, 1997. The results were as follows : 1. The most common type of disease was respiratory disease(26.7%). 2. According to the developmental age, toddler (35%) ranked first followed by preschooler(22.1%), infant(18.5%), schooler(16.0%), adolescent (5.6%), neonate(2.7%). 3. The proportion of males to females, male patients(59.8%) outnumbered female(40.2%) by the ratio of 1.48 : 1. 4. Visiting patients were seasonally more frequent in spring(29.8%) and summer(29.3%) than fall or winter. 5. Comparing weekly distribution, week end involing holiday outnumbered week day(48.5%). 6. The visiting time predominattly high from 8 : 00 PM to 0 : 00 AM (29.8%) during a day. 7. The majority duration of stay at Emergency center was 1-6 hours. 8. Most patients discharged from the emergency center in good condition(76.5%).

The Clinical Characteristics of Urologic Patients Who Visited Emergency Center / 대한비뇨기과학회지

PURPOSE: This study was performed to analyze the clinical characteristics of urologic patients who visited emergency center and provide a fundamental data for further study, and to add some help in the management of the patients. Materials and Methods: Among the total 99,935 patients who visited the emergency center from July 1, 1993 to June 30, 1995, the clinical data of 3,063 urologic patients was reviewed retrospectively. RESULTS: The most common group of age was 4th decade, and male predominated over female by 2.6 : 1. The peak time of patient's entrance to emergency center was between 20 : 00 and 24 : 00 (24.4%) and second peak was 00 : 00 and 04 : 00 (18.5%). Flank pain (57.5%) was the most common symptom and urinary retention (10.3%), gross hematuria (9.7%), irritative voiding symptoms (7.5%) followed that. The common diseases or injury were urinary stone (56.4%) and benign prostatic hyperplasia (8.0%), renal injury (4.0%), acute cystitis (3.7%) respectively. The admission rate was 23.3% and the ratio between urologic department and other departments was 4 : 1. Trauma was occupied 12.5% in all urologic patients and common disease or injuries that needed emergent operation were bladder rupture (23.5%), testicular torsion (18.5%), and renal trauma (16.0%). 7 patients with multiple injury were expired due to 1 urologic cause (renal trauma) and 6 non-urologic causes. CONCLUSIONS: The most common cause that brings the urologic patients to the emergency center is flank pain associated with urinary stone and the factors related to increased occurrence are male, age of 4th decades and midnight.

Performance Evaluation of Emergency Medical Center / 예방의학회지

Currently, there are 100 community emergency centers which expect to provide professional emergency care like Level 1 trauma centers in U.S.A. To evaluate Performance of emergency center, most studies have been widely adopted death rate based methods such as Trauma and Injury Severity Score(TRISS) and A Severity Characterization of Trauma(ASCOT). However, these methods are only applicable in situation where registration process of trauma patients is well established. Therefore, an alternative method should be applied to evaluate performance of emergency centers in Korea which does not have well-developed registration scheme. This study aims to develop new performance measures which are applicable to Korea and evaluate performance of 35 community emergency centers through new measures. The new measures are included that 'W-statistic' ; death rate calculated on the basis of International Classification based Injury Severity Score(ICISS), and 'the degree of severity' ; rate of severe trauma patients of each emergency medical centers. The study results can be summarized as follows. First, about 34% of sample emergency centers show they provide proper care in terms of their function. Second, tertiary hospitals, university hospitals, and hospitals located in Seoul show higher severity degree of patients and lower severity-adjusted death rate.

Discussion on integrated treatment of multiple trauma in the emergency center / 中华创伤杂志

Objective To explore the effective countermeasures for treatment of multiple trauma. Methods The clinical data of 135 cases with multiple trauma admitted into the emergency center of Zhongshan City from June 2002 to June 2003 were applied to study the mode and the key point of integrated treatment for multiple trauma. Results Of 135 cases,107 survived with a success rate of 79.3% and 28 died with a mortality of 20.7%. Conclusions (1)The integrated treatment in the emergency center is an effective way to improve the curative rate of multiple trauma as well as a development trend in treatment of multiple trauma. (2) The mode to make integrated diagnosis and treatment includes the following parts: set up wound center in emergency center,build a united rescue system and train high quality professional personnel. The diagnosis and treatment of multiple trauma must be organized and carried out by doctors in the emergency center. (3)The key treatment points for serious multiple trauma include firstly,active pre-hospital medical care and in-hospital medical care to save the lives;secondly,timely surgical operation to repair the damaged organ and eliminate the factors of lethality and cripples;and thirdly,necessary intensive care to treat the original damage further,protect various function of organs,promote recovery of body and prevent the complications.