• Journal of Trauma and Injury
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• v.18 no.2
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• pp.81-86
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• 2005

Background: Cardiac troponin I (cTnI) is a sensitive cardiac marker of myocardial injury. In normal coronary angiogram, positive cTnI values may be detected in various events such as sepsis, stroke, trauma and so on. To investigate characteristics of cTnI positive group in trauma patients, we designed this study between cTnI positive group and cTnI negative group. Method: Trauma patients who visited emergency room within 24 hours after accidents were included. Patients who had renal failure, acute coronary syndrome, sepsis, spontaneous SAH were excluded. Retrospective study of 97 trauma patients was done. We investgated ISS (injury severity score), positive cTnI, EKG abnormality, shock class, ICU admission rate and mortality. Result: In comparing with non chest trauma group, chest trauma group, whose chest AIS (Abbreviated Injury Score) is more than 3 point, had significant values in ISS, positive cTnI, EKG abnormality, shock class and ICU admission rate. Also, in non chest trauma group, we found several patients whose cTnI level was positive. When non chest trauma group was divided into two subgroups, the mortality and shock class of positive cTnI group were higher than that of negative cTnI group. When all trauma patients were divided into two groups, a positive cTnI group had higher values in ISS, shock class, ICU admission rate and mortality than that in a negative cTnI group. Conclusion: We found that cTnI were positive in patients of cardiac contusion but also in various trauma cases. In non chest trauma patients, we assumed that hypotension caused cTnI elevating. The cTnI could play a role in predicting prognosis in trauma patients.

• Journal of The Korean Society of Clinical Toxicology
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• v.13 no.1
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• pp.25-32
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• 2015

Purpose: The aim of this study was to investigate the independent factors associated with the registration rate for the community-based post suicidal care program in the emergency department (ED). Methods: This prospective observational study was conducted between March and December 2013 at the academic ED at the tertiary urban hospital. During the study period, the pre-designed registry was recorded. The variables examined included the following: patients' demographic data (Sex, age, address, type of insurance, marital status, level of education, and history of previous psychiatric disease), suicide-related data (suicidal methods, combined drink of alcohol and number of previous attempts), and management-related data (disposition at ED, physician's training level, etc.). Univariated and multivariated logistic regression analyses were performed for identification of factors affecting the registration rate for the community-based post suicidal care program. Results: A total of 163 suicides were included during the study period. Of these, 33 (20.2%) patients were registered in the post-suicide care program. Factors including a patient's address (OR: 14.92, 95% CI: 3.606-61.711), immediate intervention by psychiatric healthcare center (OR: 5.05, CI: 1.688-15.134), admissions in hospital (OR: 3.69, CI: 1.286-10.605), and history of previous psychiatric disease (OR: 3.52, CI: 1.216-10.201) showed significant association with registration for the program. Conclusion: The community-based post-suicidal care program, which is available 24 hours a day, should be operated in each district in order to increase the registration rate. Emergency physicians should actively consider the inpatient treatment program for suicidal patients and strongly recommend registration to the program, particularly for patients without previous history of psychiatric disease.

• Journal of The Korean Society of Clinical Toxicology
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• v.8 no.1
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• pp.7-15
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• 2010

Purpose: There are an insignificant number of studies done on the demographics of intoxication patients and on the characteristics of toxic exposure on a long term basis in Korea. The objective of our survey is to investigate the epidemiologic characteristics of intoxication in a metropolitan emergency department in order to more efficiently manage intoxication patients. Methods: We retrospectively reviewed the medical records of intoxication patients who visited the emergency department of a high end medical facility between January, 1998 and June, 2009. We investigated the trend of the substances people became intoxicated with during the study period and we analyzed the age, gender, year and distribution of patients and the outcome of the patients. Results: There were 1544 cases of intoxication during the study period, and the cases made up 0.37% of the total visitors to our emergency department, which is a high end medical facility located in the city. Most of the patients were female (70%) in their twenties and thirties. The most commonly ingested intoxication substances were sedatives, analgesics and pesticides. Unlike in the province, antidepressant abuse is on the rise while pesticide abuse is falling. The overall admission rate was 24.8% and the mortality rate was 1.6%. Pesticides intoxication was the most common cause of death (76%). Pesticides intoxication, a male gender and old age were the most significant fatality-related factors. Conclusion: We think that there is a need to investigate the actual conditions of drug intoxication in the city and prepare measures to prevent drug intoxication.

• Journal of The Korean Society of Emergency Medicine
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• v.29 no.5
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• pp.485-492
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• 2018

Objective: This paper reports the status of the advanced cardiac life support (ACLS) according to the guidelines by residents belonging to other departments other than the department of emergency medicine. The differences in status between the junior group and senior group was also investigated according to grades of residents. Methods: The ACLS performance for in-hospital cardiac arrest cases of one academic hospital, except for the cases occurring in intensive care unit between November 2015 and October 2017, were analyzed retrospectively. Data included the characteristics of residents, patients' outcomes, ACLS performance, and conventional treatment having discordance with the ACLS guidelines. Leaders during cardiopulmonary resuscitation (CPR) were divided into a junior group and senior group. Results: A total of 152 cases were enrolled in this study. Of these, 131 cases (86.2%) showed at least one treatment with inconsistency from the guidelines and the incidence of discordant treatment was similar in the two groups (55 [85.9%] vs. 76 [88.4%], P=0.657). Implicit use of sodium bicarbonate was more frequent in the senior residents group (odds ratio [OR], 3.04; 95% confidence interval [CI], 1.36-6.81). On the other hand, no use of a defibrillator was less frequent in the senior residents group (OR, 0.14; 95% CI, 0.03-0.81). Conclusion: In both groups, the rate of discordance with the ACLS guidelines during CPR were high. The rate of implicit use of sodium bicarbonate and no use of defibrillator were significantly different in the two groups. A customized education strategy for ACLS is needed for each group.

• Health Policy and Management
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• v.11 no.1
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• pp.1-18
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• 2001

The purpose of the present study was to assess the agreement of survival probability estimated by International Classification of Diseases l0th Edition(ICD-10) based International Classification of Diseases based Injury Severity Score(ICISS) with professional panel's judgment on preventable death. ICISS has a promise as an alternative to Trauma and Injury Severity Score(TRISS) which have served as a standard measure of trauma severity, but requires more validation studies. Furthermore as original version of ICISS was based ICD-9CM, it is necessary to test its performance employing ICD-10 which has been used in Korea and is expected to replace ICD-9 in many countries sooner or later. Methods : For 1997 and 1998 131 trauma deaths and 1,785 blunt trauma inpatients from 6 emergency medical centers were randomly sampled and reviewed. Trauma deaths were reviewed by professional panels with hospital records and survival probability of trauma inpatients was assessed using ICD-10 based ICISS. For trauma mortality degree of agreement between ICISS survival probability with judgment of professional panel on preventable death was assessed and correlation between W-score and preventable death rate by each emergency medical center was assessed. Results : Overall agreement rate of ICISS survival probability with preventable death judged by professional panel was 66.4%(kappa statistic 0.36). Spearman's correlation coefficient between W-score and preventable death rate by each emergency medical center was -0.77(p=0.07) and Pearson's correlation coefficient between them was -0.90(p=0.01). Conclusions : The agreement rate of ICD-10 based ICISS survival probability with of professional panel's judgment on preventable death was similar to TRISS. The W-scores of emergency medical centers derived from ICD-10 based ICISS were highly correlated with preventable death rates of them with marginal statistical significance.

• Journal of Trauma and Injury
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• v.31 no.3
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• pp.159-165
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• 2018

Purpose: Spinning-induced rhabdomyolysis (SIR) has been increasing in recent years and accounts for a large proportion of exercise-induced rhabdomyolysis (EIR). The purpose of this study was to compare the clinical features between SIR and non-spinning exercise-induced rhabdomyolysis (NSIR), and to analyze each of these clinical features. Methods: A retrospective chart review was conducted on patients treated due to EIR from January 2006 to March 2018. Patients were divided into the SIR and NSIR groups, and their clinical factors, outcome, and blood chemistries were compared and analyzed. Results: Sixty-two patients were enrolled in this study, with 23 (37.1%) and 39 (62.9%) patients categorized in the SIR and NSIR groups, respectively. The SIR group were mostly women (78.3% vs. 38.5%, p=0.002), more frequent EIR occurrence in the first exercise class (60.9% vs. 15.4%, p=0.001), and had most complaints of thigh pain (91.3% vs. 43.6%, p=0.001). The SIR group had a higher incidence rate despite its shorter exercise duration (90.5% vs. 62.9%, p=0.024), longer hospital stay (6.0 [4.5-7.0] vs. 5.0 [3.5-6.0] days, p=0.080), and higher rate of peak CPK (15,000 U/L or higher) (91.3% vs. 74.4%, p=0.182) compared to the NSIR group. Conclusions: SIR occurs at a higher rate during the first exercise class in women compared to NSIR, and the incidence rate is higher in SIR than in NSIR despite its shorter exercise duration (less than 60 minutes). It is necessary to recognize these risks during spinning exercises and to perform these exercises sequentially and systematically.

• The Korean Journal of Emergency Medical Services
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• v.12 no.3
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• pp.55-69
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• 2008

Purpose : The purpose of this study was to analyze the prehospital care report prepared by EMS squads of 119 center in Gyeonggi area and to identify the status of prehospital care activities, problems and improvement possibilities of the emergency care. Method : Five hundred copies of prehospital care report prepared by EMS squads in thirty-eight 119 centers under 18 fire stations in Gyeonggi area from March to April in 2008 were randomly chosen for the analysis. Data abstracted according to the purpose of the study were input and the analysis of prehospital care activities were performed using SPSS-WIN(ver. 16) statistics package. Results : 1. Total 500 cases of prehospital emergency care activities were reviewed. By sex, females were 219 (43.8%) and males were 281 (56.2%). The places of reporting were home (57.8%). According to the type of emergency, 281 cases (56.2%) were caused by disease and 291 (43.8%) were from other causes such as traffic accidents or incidental injuries. 2 The average time needed for the 119 EMS squad to arrive at the scene after being reported was 7.29 minutes. The time used at the scene for the emergency care was 7.3 minutes in average and the time to arrive at the hospital was 25.4 minutes in average. 3. In patient evaluation, in 68% of the cases more than two vital signs were measured at one time and emergency patients were 31%, and non-emergency patients were 69%. 4. In one EMS activity, average 2.15 cases of emergency care were provided to a patient. The cases where two kinds of emergency care were given were 14.4%, which is the most frequent cases. When reviewing the details of the emergency cares given to the patient including multiple cares, trivial cards (taking it easy and giving comfort) were the most frequent one as 40.6% and the medical direction of the doctor was given in only one case out of 500 cases. 5. In patient evaluation and emergency care, vital signs were provided to emergency patients at significantly higher rate comparing to the non-emergency patients. The number of emergency care performance was significantly higher in emergency cases. In emergency dispatch, the cases that EMT (1st class) was on board was 86.2%. When comparing the cases when the 1st class EMT was on board and otherwise, the cases with the presence of 1st class EMT showed more vital signs were detected but there was no significant difference in the number of emergency cares provided. Conclusion : It seemed that the on-scene emergency care did not satisfy the expectations. So it is necessary to enforce the cooperation between the elements, the qualifications of the 119 EMS squads and to improve the prehospital working environment in order to provide the better medical service at any time.

• The Korean Journal of Emergency Medical Services
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• v.11 no.3
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• pp.65-79
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• 2007

Purpose : It was to find out demand and supply of EMT from 2007 to 2045 and to expand scope of practice of paramedic in Korea. Methods : This study was conducted by applying a projection formula to the data from admission quota for EMT of the Ministry of Education & Human Resources Development, rate of successful candidates of annual report of the National Health Personnel Licensing Examination Board etc. Results : The number of EMTs were 6,043 paramedics, 5,378 EMT-Bs until 2006 and two produce constants derived from simple estimation were paramedic 0.81, EMT-B 0.86. On the American basis of 5.6 EMTs per 10,000, the number of paramedics under the present act will reach the basis around 2015(5.02), the number of paramedics under the amended act will reach the basis around 2030(5.50). Conclusion : There was relationship between scope of practice of paramedic in the act and demand-supply of paramedic, this necessitates surveys, studies, amendment of the act, legalization for expanded scope of practice of paramedic.

• Journal of The Korean Society of Clinical Toxicology
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• v.5 no.1
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• pp.57-60
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• 2007

Cyanide has been well known from antiquity. Cyanide poisoning causes histotoxic hypoxia--inhibition of mitochondrial cytochrome oxidase with disruption of the ability of cells to use oxygen. The mortality rate is 95% within 30 minutes. Acute cyanide poisoning is mostly the result of attempted suicide, and because of the high doses typically employed it usually is lethal within minutes. Also acute cyanide poisoning leads to a very poor prognosis because medical personnel can't detect cyanide intoxication and so many hospital haven't antidote. We report two cases of cyanide poisoning which responded well to treatment with the Taylor cyanide antidote package.

• The Korean Journal of Emergency Medical Services
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• v.23 no.3
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• pp.111-121
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• 2019

Purpose: Difficult organs or locations or inadequate tube intubations can cause complications. There are some cases in which the tube location changes or the tube is removed due to processing inside the organ while installing the stylet or rapid stylet removal. Thus, this study aimed to evaluate and develop an integrated intubation tube with stylet (IITS) for easier intubation of organs in emergency cases and reduce complications caused by the stylet. Methods: This study used a "Laerdal Airway Management Trainer". For stylet intubation, procedure No. 14 of the national practical test protocol was followed, but the removal step was omitted. In this study, each emergency case was intubated with an IITS, in which the stylet was not inserted or removed separately even though it has the function of an organ intubation stylet. Results: The existing classic ET intubation method had a success rate of 100% and had an average intubation time of 21.75 seconds, The developed IITS method was also successful in all cases and had an average intubation time of 15.78 seconds. Conclusion: Application of an IITS is expected to reduce intubation time and decrease inappropriate depth and intubation failure due to stylet removal, therefore improving the efficiency of airway maintenance.