• Journal of Trauma and Injury
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• v.34 no.3
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• pp.191-197
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• 2021

Renal injuries occur in more than 10% of patients who sustain blunt abdominal injuries. Non-operative management (NOM) is the established treatment strategy for lowgrade (I-III) renal injuries. However, despite some evidence that NOM can be successfully applied to high-grade (IV, V) renal injuries, it remains unclear whether NOM is appropriate in such cases. The authors report two cases of high-grade renal injuries that underwent NOM after embolization in a hybrid emergency room (ER) system with a 24/7 in-house interventional radiology (IR) team. A 29-year-old male visited Wonkwang University Hospital Regional Trauma Center complaining of right abdominal pain after being hit by a rope. Computed tomography (CT) was performed 16 minutes after arrival, and the CT scan indicated a grade V right renal injury. Arterial embolization was initiated within 31 minutes of presentation. A 56-year-old male was transferred to Wonkwang University Hospital Regional Trauma Center with a complaint of right flank pain. He had initially presented to a nearby hospital after falling from a 3-m height. Thanks to the key CT images sent from the previous hospital prior to the patient's arrival, angiography was performed within 8 minutes of the patient's arrival and arterial embolization was completed within 25 minutes. Both patients were treated successfully through NOM with angioembolization and preserved kidneys. Hematoma in the first patient and urinoma in the second patient resolved with percutaneous catheter drainage. The authors believe that the hybrid ER system with an in-house IR team could contribute to NOM and kidney preservation even in high-grade renal injuries.

• The Korean Journal of Blood Transfusion
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• v.23 no.2
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• pp.162-168
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• 2012

Background: Potassium, the most common cation in the intracellular space, plays a critical role in our physiology. Potassium imbalance may cause life-threatening problems, ranging from general weakness to cardiac arrest due to ventricular fibrillation. For emergency physicians, detection of such derangement within a short period of time is of critical importance. In this study, we wanted to determine whether analysis of whole blood samples can be used as a screening tool for potassium imbalance by comparative analysis of whole blood and serum samples. Methods: Two samples were drawn from 227 patients. The whole blood sample was taken from the radial artery and contained in a commercially available arterial blood collection syringe with a lithium-heparin coating. The serum sample was contained in a commercially available vacuum bottle in a non-additive silicone coated tube and transported to the laboratory. The study population was divided into three groups, patients with normal whole blood potassium, patients with decreased whole blood potassium, and patients with elevated whole blood potassium. Potassium levels for each group were coupled with serum potassium levels and compared. Results: No significant difference in potassium values was observed between whole blood and serum samples (P<0.05). Strong associations were observed among the three groups (normal range, hypokalemia, and hyperkalemia group). Compared to the normal group (r=0.851), the hyperkalemia group showed a stronger association between variables (r=0.897), and the hypokalemia group showed a weaker association (r=0.760). Their correlation coefficients were highly significant (P<0.05). Conclusion: Our study illustrates that point-of-care testing using whole blood with whole blood can be a reliable screening tool when treating patients with suspicious potassium abnormality, especially in hyperkalemia patients.

• The Korean Journal of Emergency Medical Services
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• v.6 no.1
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• pp.141-152
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• 2002

The purpose of this study is to provide the basic materials for searching the way of improvement to heighten the emergency medical welfare level by one step further. To achieve this purpose, the subjects of this study were selected 452 college students in Gwangju, using a random sampling method. The statistical analysis methods utilized for analyzing the collected data are frequency analysis, $x^2$ test. The conclusions obtained from these analyses are as following ; 1. In question about necessary optimum number of persons for rescue first aid activity, health and non-health major college students responded by 39.2%, 45.3% respectively that rescue team 15 people, first aid team 3 people is most suitable. But there was no significant difference in major department(p<0.05). 2. In question about security of the public health doctor and the emergency medical technician, all health and non-health major college students are recognizing necessity urgently, but there was no significant difference in major department(p<0.05). 3. In question about 119 rescue first aid team member applying for an examination qualification grant to the department of EMT's graduate, all health and non-health major college students were highest by 52.9%, 52.4% respectively in "necessity" item. But there was no significant difference in major department(p<0.05). 4. Because rescue first aid equipment level appears higher than 41.7% in non-health major college student's case by 54.2% in health major college student's case, health major college students are recognizing that equipment level should be supplemented more but there was no significant difference in major department(p<0.05). 5. In question about equipment supplement, all health and non-health major college students appeared highest by 64.8%, 69.3% in accident type different special equipment. But there was no significant difference in major department(p<0.05). 6. In question about rescue ambulance car size, we could know being thinking that health and non-health major college student each 61.2%, 56.5% is small and narrow that large size of the rescue ambulance amount need. But there was no significant difference in major department(p<0.05). 7. In question about patient's state is worsened, because rescue first aid equipment is inferior, health major college student responded sometimes 55.1%, many 29.5%. very many by 11.5%, while non-health major college student responded 65.8%, 23.1%, 4.0% respectively. There was significant difference in major department(p<0.05). 8. In question about emergency patient must utilize for 119 rescue ambulance car, all health and non-health major college students appeared highest by 38.8%, 41.3% in "not so" item. In question about rescue first aid team's first-aid treatment ability improves more, all health and non-health major college students appeared highest by 58.1% and 58.7% respectively in "improve" item. In question about "119 rescue ambulance car must go more rapidly than now", all health and non-health major college students are recognizing that should be quicker by 58.1%, 60.9% respectively. When called to 119 all health and non-health major college students responded highest by 55.5%, 53.3% respectively that we must receive first-aid treatment direction from a doctor. In question about "119 rescue ambulance car must be made the pay system", all health and non-health major college students responded 74%, 80% respectively in "not so" item. There was significant difference in major department(p<0.05). In conclusions, In oder to provide superior rescue first aid service to people, a public health doctor should be placed in the situation room inside the fire station so that the doctor could instruct the proper emergency treatment suitable for each situation to the rescue first aid team. Also, national education about a first-aid treatment that do to all people is necessarily necessary in emergency delivery system and this should be spread extensively through school education and broadcasting medium and education should be gone side by side, and see that will can save emergency patients' life which is more when these education consists continuously fixed period for public institution of policeman, fire officer etc. specially. And for reinforcement of patient transfer system, public organization must procure special ambulance car so that emergency patient receive first aid treatment while transfer.

• The Journal of Korean Physical Therapy
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• v.27 no.3
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• pp.159-163
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• 2015

Purpose: This study aimed to determine the interaction among the neck, trunk, and lower extremities on the non-paretic side in head rotation along with non-paretic-side weight shifting of stroke patients. To compare stroke patients' ability to control posture through muscle activity variation related to pertubation during head rotation along with the non-paretic limb. Methods: We tested 15 hemiplegic patients and 15 normal individuals. Each group's muscle activity was measured by electromyography in neutral head position and head rotation position. We compared each group's resu lt based on measured values in patients' non-paretic neck muscles, trunk muscles, and lower limbs muscles activation. Results: The study showed that muscle activity increased in the sternocleidomastoid muscle (102.26%, 53.00%), splenius capitis muscle (97.93%, 54.93%), erector spinae muscle (241.00%, 127.60%), external oblique abdominal muscle (256.66%, 152.00%), and internal oblique abdominal muscle (252.80%, 152.6%), peroneus longus muscle (117.53%, 137.13%) and gastrocnemius muscle (119.06%, 137.20%), while the results for the sternocleidomastoid muscle, splenius capitis muscle, erector spinae muscle, external oblique abdominal muscle, internal oblique abdominal muscle, peroneus longus muscle, and gastrocnemius muscle showed a statistically significant difference (p<0.05). Conclusion: It is hard for stroke patients to engage in normal movement control under suggested conditions because of the insufficient movement against gravity on the stroke patient's non-paretic side and impaired cooperative patterns. To solve these problems, patients need their bodies to improve through effective movement, resulting in advanced control of their effective and functional activity.

• The Journal of Korean Academic Society of Nursing Education
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• v.24 no.4
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• pp.347-357
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• 2018

Purpose: The purpose of this study was to identify patient safety awareness and emergency response ability and affecting factors perceived by nursing homes and home visiting caregivers. Methods: This study was a descriptive study that conveniently extracts nursing caregivers who care for elderly patients in S and G provinces, Korea. Data collection was done by structural questionnaires from April to May 2018. A total of 204 responses consisting of 103 nursing homes and 101 home visiting caregivers were used for data analysis in SPSS Win 22.0. Results: Patient safety awareness and emergency response ability of nursing homes caregivers with each $4.24{\pm}0.50$, $74.26{\pm}09.57$ was each higher than that of the home visiting caregivers with $3.68{\pm}0.49$, $68.02{\pm}12.12$ (p<.001). The affecting factors of the patient safety awareness were working place, safety education, and daily average working hours with 12 or more (F = 27.30, p<.001) and that of emergency response ability were number of patients per personnel with 9 or more and emergency situation experience (F=14.00, p<.001). Conclusion: These results suggest that it is necessary to develop a safety education program that can share indirectly experience emergency situations that occur on the job site.

• The Korean Journal of Emergency Medical Services
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• v.9 no.1
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• pp.79-87
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• 2005

Purpose: Investigates the results of CPR operation in visited patients with arrest state, and element to affect the results, and it is checks a problem, and it is made to promote. Methods: As for this study, analysis studied the results that operation CPR with the object arrest patients of 69 visited Jecheon Seoul hospital emergency center for during the period from January 2002 to February 2005. It was played writing partly changed In-hospital Utstein Style, and to stick a record in it. Paramedic which participated in CPR directly did the record of a variable, As for the data processing, use SPSS Version 12.0 for Windows. Results: It was male 68.1% female 31.9% for 69 people, and the sex ratio didn't affect return of spontaneous circulation, with female 8 people to male 16 people for ROSC(Return of spontaneous circulation) 24 people. with female 14 people to male 31 people for NROSC(Non-return of spontaneous circulation) 45 people(p>0.05). The initial EKG rhythm was asystole 34.8%, VF 31.9%, The case that initial EKG was VF compared it to a patient of asystole, and a survivor had a lot of VF and there were a lot of survivors(p<0.05). The wasn't relativity between VF and PEA(p>0.05), The CPR lead time was short in ROSC with NROSC $25.0{\pm}15.0$ minutes, ROSC $11.9{\pm}10.7$ minutes(p<0.01). Epinephrine administer time was NROSC $3.0{\pm}4.1$ minutes, ROSC $2.1{\pm}1.9$ minutes(p>0.05). It was survivor 18 people(21.1%) than 24 hours and the PAM Index affected in ROSC. with $9.0{\pm}1.2$ points NROSC, with $1.6{\pm}1.7$ points ROSC(p<0.01). A correlation was high between a CPR lead time and PAM Index(p<0.02), a correlation was examined by being high between ROSC and a CPR lead time, PAM Index(p<0.01).

• Journal of The Korean Society of Clinical Toxicology
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• v.17 no.2
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• pp.102-107
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• 2019

Purpose: Acute carbon monoxide (CO) poisoning is one of the most common types of poisoning and a major health problem worldwide. Treatment options are limited to normobaric oxygen therapy, administered using a non-rebreather face mask or hyperbaric oxygen. Compared to conventional oxygen therapy, high-flow nasal cannula oxygen (HFNC) creates a positive pressure effect through high-flow rates. The purpose of this human pilot study is to determine the effects of HFNC on the rate of CO clearance from the blood, in patients with mild to moderate CO poisoning. Methods: CO-poisoned patients were administered 100% oxygen from HFNC (flow of 60 L/min). The fraction of COHb (fCOHb) was measured at 30-min intervals until it decreased to under 10%, and the half-life time of fCOHb (fCOHb t_1/2) was subsequently determined. Results: At the time of ED arrival, a total of 10 patients had fCOHb levels ≥10%, with 4 patients ranging between 10% and 50%. The mean rate of fCOHb elimination patterns exhibits logarithmic growth curves that initially increase quickly with time (HFNC equation, Y=0.3388*X+11.67). The mean fCOHbt_1/2 in the HFNC group was determined to be 48.5±12.4 minutes. Conclusion: In patients with mild to moderate CO poisoning, oxygen delivered via high flow nasal cannula is a safe and comfortable method to treat acute CO toxicity, and is effective in reducing the COHb half-life. Our results indicate HFNC to be a promising alternative method of delivering oxygen for CO toxicity. Validating the effectiveness of this method will require larger studies with clinical outcomes.

• Journal of Korean Academy of Nursing Administration
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• v.19 no.4
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• pp.437-448
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• 2013

Purpose: This study was a retrospective survey to examine economic feasibility of home care services for patients with diabetic foot. Methods: The participants were 33 patients in the home care services (HC) group and 27 in the non-home care services (non-HC) group, all of whom were discharged early after inpatient treatment. Data were collected from medical records. Direct medical costs were calculated using medical fee payment data. Cost-effectiveness ratio was calculated using direct medical costs paid by the patient and the insurer until complete cure of the diabetic foot. Effectiveness was the time required for a complete cure. Direct medical costs included fees for hospitalization, emergency care, home care, ambulatory fees, and hospitalization or ambulatory fees at other medical institutions. Results: Mean for direct medical costs was 11,118,773 won per person in the HC group, and 16,005,883 won in the non-HC group. The difference between the groups was statistically significant (p=.042). Analysis of the results for cost-effectiveness ratio showed 91,891 won per day in the HC patients, and 109,629 won per day in the non-HC patients. Conclusion: Result shows that the cost-effectiveness ratio is lower HC patients than non-HC patients, that indicates home care services are economically feasible.

• Journal of Trauma and Injury
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• v.34 no.1
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• pp.57-60
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• 2021

Warfarin is used as part of the treatment of various diseases, and laboratory monitoring of its effects is required. Airway hematoma secondary to warfarin is rare, but can be fatal because of potential airway obstruction. Rapid definitive airway establishment is crucial if airway obstruction is suspected. This complication is more likely to occur in those with elevated coagulation laboratory values. However, we experienced a patient in whom a massive retropharyngeal hematoma caused airway obstruction after a non-severe motor vehicle collision. The patient had been taking warfarin, and had coagulation parameter values within the normal ranges. A major fracture or hemorrhage was not anticipated. Upon examination, a massive retropharyngeal hematoma was noted. Orotracheal intubation failed due to an airway obstruction. Emergency tracheostomy and an operation for hematoma removal were performed. Physicians must always consider the possibility of airway hematoma in warfarin-taking patients with normal coagulation values regardless of the severity of mechanism of injury.

• The Korean Journal of Emergency Medical Services
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• v.27 no.2
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• pp.91-111
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• 2023

Purpose: This study aims to compare 119 emergency medical services (EMS) in South Korea and Japan to provide essential data for EMS improvement in South Korea. Methods: Recent data and regulations on firefighting and EMS in South Korea and Japan were analyzed and compared. Results: South Korea follows a centralized approach to EMS, whereas Japan operates with autonomous bodies that establish their own criteria. Japan considers more regional variables than South Korea. In South Korea, there are shortages in fire station deployment among the 119 emergency medical resources in certain regions, leading to significant regional disparities. South Korea has a larger population served by its 119 emergency medical resources with a higher workload and dispatch numbers than Japan. The percentage of non-transported patients among the total number of dispatches was higher in South Korea. Conclusion: Increasing the number of medical professionals and ambulances per population to the level of Japan to reflect local conditions and include various underlying variables such as daytime population, aging, and emergency dispatch conditions in the deployment of 119 emergency resources, and to reduce the deployment gap between regions, will contribute to improving the performance of the South Korea EMS system.