• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.4
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• pp.207-214
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• 2019

Objectives: Medically compromised patients often fear required dental surgical procedures that can increase the risk of medical emergency when combined with reduced tolerance for stress. A stress reduction protocol (SRP) helps doctors minimize treatment-related stress and improves patient management with minimum complications. Diabetes and co-morbid hypertension carry 4-fold risk of aggravation of cardiovascular emergencies and 7.2-fold risk of mortality. Diabetic neuropathy can result in difficult diagnosis of myocardial infarction and reduces chances of surviving a myocardial infarction compared with a non-diabetic person. The aim of the study was to assess the feasibility of a protocol for management of patients having both diabetes and hypertension who required minor oral surgery to minimize the rate of cardiovascular emergencies. Materials and Methods: A prospective study was conducted in 140 patients having both diabetes and hypertension who required minor oral surgical procedures. A systematic approachable protocol was designed for management of such patients. Results: Among 140 patients, 6 patients (4.3%) had cardiovascular complications, while 3 patients (1 with syncope and 2 with hypertension) did not require any intervention other than observation. Two patients were managed with aspirin and nitroglycerin, and 1 patient had possible myocardial infarction (overall incidence 0.7%) with chest pain, S-T segment elevation on electrocardiogram, and troponin level of 0.60 ng/mL. Conclusion: The proposed protocol helps to improve management of patients having both diabetes and hypertension. We recommend that patients with uncontrolled diabetes and uncontrolled hypertension and/or patients having history of cardiovascular complication should be treated in a medical facility with a readily available cardiology unit. This facilitates prompt response to emergency and instant implementation of treatment, helping to reduce morbidity and mortality.

• Journal of Korean Academy of Nursing
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• v.31 no.1
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• pp.68-80
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• 2001

The purpose of this study is to analyze ER patient's Triage and other statistical data. The subjects were 12,618 patients who visited the ER during the year 1998. The study showed the following results; 1. The male vs female ratio was 1.3 : 1.0, the male were in the majority (56.6%), and the age range of 20-29 old was the majority (15.3). The patients who visited ER at 8-10 pm were the majority (11.5%). On Sunday the number of patients who visited the ER were 2,189, and the majority were 17.4%. On Saturday the number of patients was visited the ER were 1,944 patients the second majority (15.4%). Their traffic means : the general passenger cars (75.5%), 119 or hospital ambulance (11.3%). 2.The reasons of visiting ER were : diseases (59.2%), injuries (23.7%). The disease vs injury ratio was 100 : 69. 3. Triage : urgent 40.7%, non-urgent 38.2%, acute 17.8%, and critical 3.2%. 4. The time of waiting and staying in the ER by the Triaget: the average time was 572 minutes (9.53 hrs.). The majority of critical patients (20.5%), acute patients (24.7%) and urgent patients (21.2%) stayed 12-24 hrs., but the majority of non-emergent (27.8%) stayed not longer than one hour. 5. Treatments by the Triage : the 42.9% of critical patients, and 61.3% of acute patients, 57.5% of urgent patients were admitted. But 91.8% of the non-emergents were discharged and 4.7% was admitted. Mortality of total ER visiter were 1.7%. DAA portion was 0.86%. 26.6% of the critical patients were DAA. DAA vs DOA ratio was 1.3 : 1.0. 6. Visiting time, monthly and seasonal distribution by the Triage : the majority of critical patients (12.2%), visited 10-12 am. The majority of acute (12.9%) and urgent (11.7%) visited 4-6 pm, but the majority of non-emergents (15.1%) visited during 8-10 pm. Autumn visiter were the majority (27.6%). The percentage of non-emergent visited in Spring was 41.4% and Autumn was 41.3%. The percentage of urgents who visited in the Summer was 45.3% and the Winter was 40.4%. By clinical departments: the 48.0% of critical patients was NS. The 45.5% of acute and the 33.6% of urgent patients were IM. But the majority of non-emergent patients was PS (21.2%), and the second majority of non-emergent patients was oral Surgery (12.8%).

• The Korean Journal of Emergency Medical Services
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• v.13 no.1
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• pp.61-72
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• 2009

Purpose : This study was conducted to understand the unforeseen phone calls placed through the 1339 emergency medical communication system by residents of the Gwangju/Jeonnam area during the Lunar New Year and Chuseok holidays. Methods : A descriptive research method was implemented using SPSS to analyze 9,047 reported and received consultation phone calls made during the 2008 Lunar New Year holiday (February 6-10) and the 2008 Chuseok holiday (September 13-15) for frequency and percentages. Results : Among the general characteristics of subjects during the Lunar New Year and Chuseok holidays, an examination of the distribution for gender showed more men than women and the distribution for age showed most subjects were thirties, followed by forties, and finally under ten years of age. According to the status of situational calls during the Lunar New Year holiday most were used for in the following order : providing resource information, misdialing and prank calls, and additional consultations. According to the status of situational calls during the Chuseok holiday most were used for in the following order : providing resource information, additional consultations, misdialing and prank calls. According to region most came from Gwangju Metropolitan City Bukgu, followed by Yeosu, Suncheon, and Mokpo in Jeonnam. According to callers, the majority were non-medical persons. According to time most were made between 9:01 and 12:00, while the fewest were made during 3:01 and 6:00. According to treatment department most were made in the following order : internal medicine, pharmacy, and pediatrics. Most medical resource information provided regarded areas outside the callers location. Conclusion : Emergency medical technician will play a central role in the emergency medical information system in the near future.

• Journal of Convergence for Information Technology
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• v.10 no.12
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• pp.126-131
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• 2020

This study analyzed the inflow and outflow patterns of emergency department patients, to identify changes in regional types in cities, counties, and districts in Jeonlado, Korea. Data of areas in Jeonlado for 2014 to 2018 were extracted from the National Emergency Department Information System. The extracted data includes the patients' and emergency medical institution addresses, which were used to calculate the relevance index (RI) and commitment index (CI). The calculated indices were classified into regional types by applying cluster analysis. A non-parametric method, Kruskal-Wallis test, was employed to examine the differences between years for RI and CI by regional types. The results of cluster analysis using the relevance and commitment indices revealed three regional types. Regions in cluster 1 were classified as outflow type, in cluster 2 as inflow type, and in cluster 3 as self-sufficient. RI and CI were calculated for each cluster or regional type. There were no significant differences between years in cluster 2 (inflow type) and cluster 3 (self-sufficient type). In cluster 1 (outflow type), there were no significant differences in CI between the years; however, there were significant differences in RI between 2014 and 2017, and 2014 and 2018. It is difficult to see that the emergency medical environment has improved due to the increased concentration of emergency medical care.

• Proceedings of the Korea Institute of Fire Science and Engineering Conference
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• 2003.04a
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• pp.248-254
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• 2003

According to the analysis of the patient transport in the fire disaster occuring at Taegu Subway Jungangro Station February 18th, 2003, authors concluded as follows. Patients were transported mainly to medical institutes which were larger and that had shorter distance. Because of non-emergenct patient's transport to larger and nearer institutes, some critical patients should be transported to more distant institutes. Dead patients before arrival were transported relatively evenly. An adequate transport according to adequate triage should be performed in the future. Early mitigation and response, correlation with the method of transport, regional guide line of disaster transport and correlation between disaster information and emergency medical information should be corrected and need research in the future.

• Quality Improvement in Health Care
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• v.2 no.1
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• pp.58-67
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• 1995

Background: This paper describes an effort to provide baseline informations for appropriate utilization of emergency room in a tertiary hospital. Methods: Authors have evaluated that the admissions in the emergency room were medically necessary by objective criteria, Appropriateness Evaluation Protocol(AEP), for one month in a tertiary hospital. Data were analysed by chi-square test and multiple logistic regression to exmaine statistical significances at the level of 0.05. Results: The prevalence of inappropriate decisions for admission was found to be 47.8%(154/322). Whether the physician decided the patient to admit or not was affected by type of services, number of departments involved, patients' medical condition, route of visit, and a day of the week visited. Level of appropriateness of admission is significantly related to patients' age, type of services, and a day of the week visited. Conclusion: We found that substantial proportion of admissions through emergency room are medically unnecessary and that non-medical factors are related to physician's for admission decisions and level of appropriateness of admission. This suggests that policy measures be required to relieve the overcrowding problem and to reduce non-emergent utilization of emergency room in a tertiary hospital.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.7
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• pp.3427-3430
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• 2012

Aim: The significance of the mucinous adenocarcinoma in TNM staging and prognosis for colorectal tumor patients is still controversial. The aim was to provide a meta-analysis for TNM staging and prognostic features of colorectal tumors. Methods: 30 individual case-control studies were finally included into this meta-analysis, involving a total of 444,489 cancer cases and 45,050 mucinous adenocarcinomas, of relations with TNM staging and prognostic features. Results: Compared to non-mucinous adenocarcinoma patients, the TNM IV stage accounted for a larger percentage of mucinous adenocarcinomas (OR=1.48, 95%CI 1.28-1.71, POR<0.001) and the prognosis was significantly poor (HR=1.06, 95%CI 1.04-1.08, P<0.001). After heterogeneity testing, the results was similar to the holistic approach outcome (HR=1.48, 95%CI 1.35-1.62, P<0.001). Conclusion: Compared to patients with non-mucinous adenocarcinomas, mucinous adenocarcinoma patients with later TNM staging make up a big percentage, and mucinous adenocarcinoma is an independent risk factor for poor prognosis.

• Journal of Trauma and Injury
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• v.21 no.1
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• pp.28-35
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• 2008

Purpose: This study was conducted to examine the clinical significance IV-contrasted helical abdomen computed tomography (CT) as a diagnostic screening tool to evaluate hollow viscus injury in blunt abdominal trauma patients. Methods: This is a retrospective study encompassing 108 patients, presenting to Korea University Medical Center (KUMC) Emergency Department (ED) from January 2007 to December 2007, with an initial CT finding suggestive of intra-abdominal injury. An initial non-enhanced abdomen CT was taken, followed by an enhanced CT with intravenous contrast. Patients' demographic data, as well as the mechanisms of injury, were inquired upon and obtained, initial diagnosis, as dictated by specialized radiologists, were added to post-operational (post-OP) findings and to additional CT findings acquired during their hospital stays, and all were combined to arrive at final diagnosis. Initial CT findings were further compared with the final diagnosis, yielding values for sensitivity, specificity, and accuracy, as well as positive and negative predictive values. Patients were further divided into two groups, namely, those that underwent operational intervention and those that did not. The initial CT findings of each group were subsequently compared and analyzed. Results: Initial CT scans revealed abnormal findings in a total of 212 cases - solid organ injuries being the most common finding, as was observed in 97 cases. Free fluid accumulation was evident in another 69 cases. Based on the CT findings, 77 cases (71.3%) were initially diagnosed as having a solid organ injury, 20 cases (18.5%) as having a combined (solid organ + hollow viscus) injury, and 11 cases (10.2%), as having an isolated hollow viscus injury. The final diagnosis however, were somewhat different, with only 67 cases (62.0%) attributed to solid organ injury, 31 cases (28.7%) to combined injury (solid + hollow), and 10 cases (9.3%) to hollow viscus injury. The sensitivity (CI 95%) of the initial helical CT in diagnosing hollow viscus injury was 75.6%, and its specificity was 100%. The accuracy in diagnosing hollow viscus injury was also meaningfully lower compared to that in diagnosis of solid organ injury. Among patients initially diagnosed with solid organ injuries, 10 patients (2 from follow-up CT and 8 from post-OP finding) turned out to have combined injuries. A total of 38 patients underwent an operation, and the proportion of initial CT findings suggesting free air, mesenteric hematoma or bowel wall thickening turned out to be significantly higher in the operation group. Conclusion: Abdominal CT was a meaningful screening test for hollow viscus injury, but the sensitivity of abdominal CT was significantly lower in detecting hollow viscus injury as compared to solid organ injury. This calls for special consideration and careful observation by the ED physicians when dealing with cases of blunt abdominal trauma.

• The Korean Journal of Emergency Medical Services
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• v.24 no.2
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• pp.123-131
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• 2020

Purpose: This study aimed to find out the effectiveness of gum elastic bougies for intubation in comparison to stylet according to airway type using a manikin. Methods: The study subjects were 52 paramedic students who intubated using a Macintosh laryngoscope and compared stylet and gum elastic bougie use in a 7.5 mmID endotracheal tube, on a manikin with either normal or difficult airway. Difficult airway was made Philadelphia neck collar. Collected data included intubation time, accuracy and ease of intubation, later analyzed by frequency analysis, descriptive analysis, independent t-test, chi square test, paired t-test, and McNemar test using SPSS Statistics 18.0. Results: There was a significant difference in intubation time according to intubation device and airway type (p=.000). There was no significant difference in accuracy of intubation according to intubation device or airway type (normal airway p=1.000, difficult airway p=.052). There was a significant difference in ease of intubation scale according to intubation device and airway type (p=.000, p=.000). Conclusion: Based on the speed and ease of intubation, gum elastic bougie is recommended for intubation in patients with difficult airways such as those with cervical injury.

• Quality Improvement in Health Care
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• v.7 no.2
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• pp.138-155
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• 2000

Background: Factors related to waiting and staying time for patient care in emergency care center (ECC) were examined during 1 month from Apr. 1 to Apr. 30, 1997 at an ECC of Yeungnam university hospital in Taegu metropolitan city, to obtain the baseline data on the strategy of effective management of emergency patients. Method: The study subjects consisted of the 1,742 patients who visited at ECC and the data were obtained from the medical records of ECC and direct surveys. Results: The mean interval between ECC admission time and initial care time by each ECC duty residents was 83.1 minutes for male patients and 84.9 minutes for female patients, and mean ECC staying time (time interval between admission and final disposition from ECC) was 718.0 minutes in men and 670.5 minutes in women. As the results, the mean staying time in ECC was higher in older age, and especially the both of initial care time and staying time were highest in patients of medical aid, and shortest in patients of worker's accident compensation insurance. The on admission or not, previously endotracheal-intubation state of patient. The ECC staying ti initial care time was much more delayed in patients of not having previous medical records and the ECC staying time was higher in referred patients from out-patient department, in transferred patients from the other hospitals and patients having previous records, and in patients partly used the order-communicating system. The factors associated with the initial care time were the numbers of ECC patients and the existence of any true emergent patients, being cardiopulmonary resuscitation (CPR) statusme was much more longer in patients of drug intoxication, in CPR patients, in medical department patients, in transfused patients and in patients related to 3 or more departments. And according to the numbers of duty internships, the ECC staying time for four internships was more longer than for five internships and after admission ordering was done, also-more longer in status being of no available beds. As above mentioned results, the factors for the ECC staying time were thought to be statistically significant (P<0.01) according to the patient's age and the laboratory orders and the X-ray films checked. And also the factor for the ECC staying time were thought to be statistically significant (P<0.01) according to the status being of no available beds, the laboratory orders and/or the special laboratory orders, the X-ray films checked, final disposing department, transferred to other hospital or not, home medication or not, admission or not, the grades of beds, the year grades of residents, the causes of ECC visit, the being CPR status on admission or not, the surgical operation or not, being known personells in our hospital. Conclution: Authors concluded that the relieving method of long-staying time in ECC was being establishing the legally proved apparatus which could differentiate the true emergency or non-emergency patients, and that the methods of shortening ECC staying time were doing definitely necessary laboratory orders and managing beds more flexibly to admit for ECC patients and finally this methods were thought to be a method of unloading for ECC personnels and improving the quality of care in emergency patients.