• Title/Summary/Keyword: medical accident patients

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Measure of Agreement between Prehospital EMS Personnel and Hospital Staffs using Guidelines for Field Triage of Injured Patients (외상환자의 병원 전 및 병원단계 중증도 평가의 일치도)

  • Kim, Dae Kon;Hong, Ki Jeong;Noh, Hyun;Hong, Won Pyo;Kim, Yu Jin;Shin, Sang Do;Park, Ju Ok
    • Journal of Trauma and Injury
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    • v.27 no.4
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    • pp.126-132
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    • 2014
  • Purpose: The field trauma triage for injured patients is essential for trauma care system. In this study, agreement of patient evaluation between by prehospital EMS personnel and by hospital staffs and the appropriateness of prehospital triage were evaluated. Methods: This observational study was conducted from September to October 2012 for 5 weeks. During this period, EMT evaluated patient's severity according to guideline for field triage and recorded. Same guideline was applied in 26 hospitals for patients with EMS use. Kappa statistics were used to measure agreement for each item of guideline. Finally, over-triage and under-triage rate of EMT were calculated. Results: During study period, total 3,106 patients were transferred to 26 hospital emergency departments with EMS use. Kappa statistics for "vital signs" items were 0.45 for mentality lower than V and 0.44 for systolic blood pressure lower than 90 mmHg as a moderate agreement. In "anatomy of injury" items Kappa statistics were very low. In "mechanism of injury" items Kappa statistics were 0.28 for high-rise fall down and 0.27 for high energy traffic accident but in other items Kappa statistics were very low. 362 patients (12.0%) were over-triaged and 281 patients (9.3%) were under-triaged. Conclusion: Field triage can be applied but need to evaluate and modify in order to become accurate and sensitive for decision of transportation.

The Effects of Herb Extracts in Cerebrovascular Accidental Patient (뇌졸중 치료제인 한약의 효과)

  • Lee, Mi-Hwa;Park, Hyoung-Sook;Choi, Won-Chul
    • The Korean Journal of Rehabilitation Nursing
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    • v.3 no.2
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    • pp.141-153
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    • 2000
  • The several Chinese herbs such as Soon-Ki-Hwal-Hyul-Tang, Bo-Yang-Hwan-O-Tang, Seong-Hyang-Jeong-Ki-San, So-Hap-Hyang-Won and O-Yak-Soon-Ki-San were extracted with water and then lyophilized. For identification of the effect of extracted herbs, they were medicated to 103 patients of cerebrovascular accident for 4 week. They were hospitalized in D-Oriental Medical Hospital from April to August in 1999. The herbs were extracted with water and lyophilized and then, used as samples. The medical history of each patient was detected and analyzed from their medical records. The results were as follows; 1) Each sample (Soon-Ki-Hwal-Hyul-Tang, Bo-Yang-Hwan-O-Tang, Seong-Hyang-Jeong-Ki-San, and O-Yak-Soon-Ki-San) was statistically significant differences of systolic blood pressure(t=4.22, P=0.0004; t=3.44, P=0.0028; t=2.11, P=0.0463; t=3.23, P=0.0052). The statistically significant difference of diastolic blood pressure showed by medicated with Soon-Ki-Hwal-Hyal-Tang, Seong-Hyang-Jeong-Ki-San, and O-Yak-Soon-ki-San (t=2.13, P=0.0459; t=2.68, P=0.0136; t=3.12, P=0.0066). 2) The statistically significant difference of the arm/leg-ROM showed by medicated with Soon-Ki-Hwal-Hyul-Tang, Bo-Yang-Hwan-O Tang, So-Hap-Hyang-Won(t=4.74/4.95, P=0.0002/0.0001; t=2.25/2.44, P=0.0368/0.0248; t=5.85/6.76, P=0.0001/0.0001). 3) In the verbal disorder, Soon-Ki-Hwal-Hyul-Tang, Bo-Yang-Hwan-O-Tang had statistically significant differences(t=4.50, P=0.0002; t=3.32, P=0.0036). 4) In the conscious disorder, Soon-Ki-Hwal-Hyul-Tang, Bo-Yang-Hwan-O-Tang, Seong-Hyang-Jeong-Ki-San, and So-Hap-Hyang-Won had statistically significant differences(t=6.32, P =0.0001; t=8.32, P=0.0001; t=3.74, P=0.0012; t=5.14, P=0.0001). 5) Bovine aortic endothelial cell (BAEC) were cultured in DMEM treating 0.01mg/ml, and 0.1mg/ml of each lyophilized samples for 24 hours. In BAECs were treated by 5 kinds of samples, the effect of So-Hyap-Hyang-Won induced syncytium of adjacent endothelial cells. It may induce the recovering of the damaged blood vessels in cerebrovascular accidental patient by angiogensis of endothelial cells. Therefore, it suggests that the medication of So-Hap-Hyang-Won will help to nursing care for cerebrovascular accidental patients.

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Usefulness of Full-thickness Skin Graft from Anterolateral Chest wall in the Reconstruction of Facial Defects (안면부 재건에서 전외측 흉벽을 공여부로 하는 전층 피부이식술의 유용성)

  • Yoo, Won-Jae;Lim, So-Young;Pyon, Jai-Kyong;Mun, Goo-Hyun;Bang, Sa-Ik;Oh, Kap-Sung
    • Archives of Plastic Surgery
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    • v.37 no.5
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    • pp.589-594
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    • 2010
  • Purpose: Full thickness skin grafts are useful in the reconstruction of facial skin defects when primary closure is not feasible. Although the supraclavicular area has been considered as the choice of donor site for large facial skin defect, many patients are reluctant to get a neck scar and some patients do not have enough skin to cover the defect owing to the same insult occurred to the neck such as burn accident. We present several cases of reconstruction of facial skin defects by freehand full-thickness skin graft from anterolateral chest wall resulting aesthetically acceptable outcome with lesser donor site morbidity. Methods: Retrospective review was performed from March, 2007 to September, 2009. 15 patients were treated by this method. Mean age was 31.5 years. The ethiology was congenital melanocytic nevus in 7 cases, capillary malformation in 5 cases and burn scar contracture in 3 cases. Mean area of lesion was measured to 67.3 cm2 preoperatively. The lesion was removed beneath the subcutaneous fatty tissue layer. The graft was not trimmed to be thin except defatting procedure. For the larger size of defect, two pieces of grafts were harvested from both anterolateral chest wall in separation and combined by suture. Results: The mean follow up period was 9.7 months. All the grafts survived without any problem except small necrotic areas in 4 cases, which healed spontaneously under conventional dressings in 6 weeks postoperatively. Color match was relatively excellent. There were 2 cases of hyperpigmentation immediately, but all of them disappeared in a few months. Conclusion: In cases of large facial skin defects, the anterolateral chest wall may be a good alternative choice of full-thickness skin graft.

A Study on Fall Accident (1개 종합병원 환자의 낙상에 관한 조사)

  • Lee, Hyeon-Suk;Kim, Mae-Ja
    • The Korean Nurse
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    • v.36 no.5
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    • pp.45-62
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    • 1998
  • The study was conducted from November 1995 to May 1996 at the one general hospital in Seoul. The total subjects of this study were 412 patients who have the experience of fall accident, among them 31 was who have fallen during hospitalization and 381 was who visited emergency room and out patient clinic. The purposes of this study were to determine the characteristics, risk factors and results of fall accident and to suggest the nursing strategies for prevention of fall. Data were collected by reviewing the medical records and interviewing with the fallers and their family members. For data analysis, spss/pc+ program was utilized for descriptive statistics, adjusted standardized $X^2$-test. The results of this study were as follows: 1) Total subjects were 412 fallers, of which 245(59.5%) were men and 167(40.5%) were women. Age were 0-14 years 79(19.2%), 15-44 years 125(30.4%), 45-64 years 104(25.2%), over 65 years 104(25.2%). 2) There was significant association between age and the sexes ($X^2$=39.17, P=0.00). 3) There was significant association between age and history of falls ($X^2$=44.41. P= .00). And history of falls in the elderly was significantly associated with falls. 4) There was significant association with age and medical diagnosis ($X^2$=140.66, P= .00), chief medical diagnosis were hypertension(34), diabetis mellitus(22), arthritis(11), stroke(8), fracture(7), pulmonary tuberculosis(6), dementia(5) and cataract(5), 5) There was significant association between age and intrinsic factors: cognitive impairment, mobility impairment, insomnia, emotional problems, urinary difficulty, visual impairments, hearing impairments, use of drugs (sedatives , antihypertensive drugs, diuretics, antidepressants) (P < 0.05). But there was no significant association between age and dizziness ($X^2$=2.87, P=.41). 6) 15.3% of total fallers were drunken state when they were fallen. 7) Environmental factors of fall accident were unusual posture (50.9%), slips(35.2%), trips (9.5%) and collision(4.4%). 8) Most of falls occurred during the day time, peak frequencies of falls occurred from 1pm to 6pm and 7am to 12am. 9) The places of fall accident were roads(22.6%), house-stairs 06.7%), rooms, floors, kitchen (11.2%), the roof-top, veranda, windows(10.9%), hospital(7.5%), ice or snowy ways(5.8%), bathroom(4.9%), playground, park(4.9%), subway-stairs(4.4%) and public-bathrooms (2.2%). 10) Activities at the time of fall accident were walking(37.6%), turning around or reaching for something(20.9%), going up or down stairs09.2%), exereise, working07.4%), up or down from a bed(2.7%), using wheelchair or walking aids, standing up or down from a chair(2.2%) and standing still(2.2%). 11) Anatomical locations of injuries by falls were head, face, neck(31.3%), lower extremities (29.9%). upper extremities(20.6%), spine, thorax, abdomen or pelvic contents(l1.4%) and unspecified(2.9%). 12) Types of injures were fracture(47.6%), bruises03.8%), laceration (13.3%), sprains(9.0%), headache(6.6%), abrasions(2.9%), intracranial hemorrage(2.4%) and burns(0.5%). 13) 41.5% of the fallers were hospitalized and average of hospitalization was 22.3 days. 14) The six fallers(1.46%) died from fall injuries. The two fallers died from intracranial hemorrage and the four fallers died of secondary infection; pneumonia(2), sepsis(1) and cell lulitis(1). It is suggested that 1) Further study is needed with larger sample size to identify the fall risk factors. 2) After the fall accident, comprehensive nursing care and regular physical exercise should be emphasized for the elderly person. 3) Safety education and safety facilities of the public place and home is necessary for fall prevention.

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The Influence of Sensory and Upper limb function on Activities of Daily Living of Patients with Chronic Cerebrovascular Accident (만성 뇌졸중 환자의 감각기능과 상지기능에 따른 일상생활활동 수행능력)

  • Song, Won-Il;Cha, Tae-Hyun;Woo, Hee-Soon
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.12 no.12
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    • pp.5731-5740
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    • 2011
  • The aim of this study is to evaluate the relationship between sensory function and performances in the activities of daily living in chronic CVA patients. One-hundred and thirty-eight CVA patients, who experienced their CVA more than 6 months ago, were recruited. Their sensory, motor and cognitive functions, as well as performances in activities of daily living were assessed and analysed. The results indicated that Graphesthesia and proprioception of the affected hand of patients with right hemiplegia showed statistically significant correlation with personal hygiene. The motor functions of the unaffected side in patients with left hemiplegia showed statistically meaningful correlation with ADL performances. The correlation between the motor function of upper limb of the unaffected side and the activities of daily living showed statistical significance in both right and left hemiplegia.

Mental Health Status among Users of Medical Facilities in Mining Area (산업재해 요양기관 이용자의 정신건강에 관한 연구)

  • Cha, Bong-Suk;Park, Jong-Ku
    • Journal of Preventive Medicine and Public Health
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    • v.19 no.2 s.20
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    • pp.233-243
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    • 1986
  • Our study was designed to identify the difference in the mental health status among hospitalized patients due to occupational diseases and accidents and pre-employment physical examinees, and to identify the relationship between mental health status and socio-demographic variables, and to provide information useful to non-psychiatric clinicians in caring of such patients. Samples were comprised of 189 pneumoconiotic patients, 132 industrial accident-induced patients and 122 pre-employment physical examinees who were interviewed with 90-item symptom cheklist (SCL-90). The following results were obtained: 1) Mean scores of symptom dimension on socio-demographic subgroup showed higher tendencies in older aged, male, lower educated, miner, married, mining residence, and pneumoconiotic patients. 2) Mean scores of total samples on all symptom dimensions were as follows in the order of their magnitudes; Depression, Somatization, Obsessive-compulsive, Anxiety, Psychoticism, Interpersonal sensitivity, Phobic-anxiety, Hostility, and Paranoid ideation. 3) The highest mean scores on each socio-demographic subgroup were as follows; Depression in younger aged and Somatization in older aged; Depression in male Somatization in female; Somatization in lower educated and depression in higher educated; Somatization in miners and depression in non-miners; Somatization in married and Depression in unmarried; Depression in all kind of residences; Somatization in patients and Depression in pre-employment physical examinees(normal). 4) In consequence of stepwise multiple regression, the important socio-demographic variables were age, occupation, diagnostic classification, and residence. Age was the most imprtant variable in Somatization, Depression, Obsessive-compulsive, Anxiety, Phobic anxiety, Paranoid ideation, and Psychoticism. Occupation was the most important one in Interpersonal sensitivity and Hostility and also had significant realtionships with all symptom dimensions.

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Comparison of Rehabilitation Programs in Traumatic Low Back Injuries with Industrial Accident (산업재해로 발생한 외상성 허리손상에 대한 새로운 재활치료프로그램의 효과 비교)

  • Kim, Young-Bum;Kim, Seung Won
    • Journal of Korean Society of Occupational and Environmental Hygiene
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    • v.29 no.2
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    • pp.236-250
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    • 2019
  • Objectives: The purpose of this study was to investigate the effect of intensive rehabilitation programs on pain, range of motion (ROM), lumbar muscle strength, core muscle endurance, disability, and depression in patients with traumatic low back injuries and to compare the efficacy of this therapy with that of conventional rehabilitation therapy. Methods: The study was performed with a retrospective medical chart review of patients with traumatic low back injury referred to the rehabilitation center at the Daegu Hospital of the Korean Workers Compensation and Welfare Service. Forty-four patients were allocated to either the conventional rehabilitation group (CRG; n = 22) or the intensive rehabilitation group (IRG; n = 22). The CRG group patients, who received 30-min therapist-supervised physical therapy and modality therapy five times per week for four weeks, were compared with the IRG group patients, who received 60-min therapist-supervised physical therapy, 30-min therapist-patient 1:1 matching rehabilitation therapy, and modality therapy five times per week for four weeks. Outcome measures were a numerical rating scale, ROM, lumbar muscle strength, lumbar core muscle endurance, thickness of lumbar deep focal core muscle (transverse abdominis and lumbar multifidus), Oswestry disability index (ODI), and depression (Korean version patient health questionnaire-9). Results: There were statistically significant improvements after treatment in all outcome measures in both groups (p < 0.05). In the intergroup comparison, NRS scores on the activity and thickness of lumbar deep focal core muscles increased significantly more in the IRG than in the CRG (p < 0.05). There were no statistically significant intergroup differences in NRS scores on resting, ROM except left lateral bending, lumbar muscle strength, core muscle endurance, ODI, and depression. Conclusions: We could confirm the superior effectiveness of an intensive rehabilitation program compared to conventional rehabilitation therapy in patients with traumatic low back injuries.

A Clinical Study of Patients with Headache Founded on DongEuiBoGam (동의보감(東醫寶鑑)에 따른 편(偏), 담궐(痰厥) 몇 기궐두통(氣厥頭痛) 환자의 임상적 고찰)

  • Kim, Ji-Yun;Hong, Hyun-Woo;Kim, Jae-Yeon;Kim, Ki-Tak;Heo, Tae-Yool;Park, Dong-Il;Gam, Chul-Woo
    • The Journal of Internal Korean Medicine
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    • v.26 no.4
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    • pp.806-819
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    • 2005
  • Objective : The purpose of this study is to investigate clinical characteristics and remedial value oriental medical therapy for sufferers of severe headache. Methods : On the authority of DongEuiBoCam, patients were classified into three groups: migraine, qi-syncope headache and phlegm-headache. All patients wert treated with acupuncture therapy and herb medicines. After that inquiry was made into the extent of improvement of headache. Results : 1. In accordance with the statistics, 56 cases(50.5%) had phlegm-syncope headache, 28 cases(25.2%) had qi-syncope headache and 27 cases(24.3%) had migraine. 2. The ratio between males and females was about 1:4. Most patients were in their forties. 3. 12 cases(31.6%) with migraine had pain only on the right side of the head, 20 cases(26.3%) with phlegm-syncope and 17 cases(45.6%) with qi-syncope headache suffered from the frontal lobe headache. 4. 8 cases(29.6%) with migraine had been suffering for a week or less, 12 cases(21.4%) with phlegm-syncope headache had been suffering for over six months and under one year and 6 cases(21.4%) with qi-syncupe headache had suffered over one year and under five. 5. Overwork and stress was deemed the main cause of migraine. Phlegm-syncope headache was also attributed to stress and tense situations. Qi-syncope headache was believed to be variously caused by traffic accident, noise, blood pressure and other reasons. 6. 46 cases(30%) felt dull headache and 32 cases(20.9%) felt dizzy. The common associated symptoms of migraine and qi-syncope headache included back, neck and shoulder pain and other pains. Dizziness was an especially prevalent symptom of phlegm-syncope headache. 7. After the oriental medical therapy, 12 cases(10.8%) almost entirely recovered, 50 cases(45%) were in about half as much pain, 45 cases(40.5%) improved little and 4 cases(3.6%) felt no improvement. Conclusions : The results support a role for oriental medical therapy in treatment of headache.

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Characteristics of Injured Pregnant Women by the Traffic Accidents (교통사고로 수상한 임산부의 특성)

  • Kim, Duk-Hwan;Cho, Young-Duck;Kim, Jung-Youn;Yoon, Young-Hoon;Lee, Sung-Woo;Moon, Sung-Woo;Choi, Sung-Hyuk
    • Journal of Trauma and Injury
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    • v.25 no.4
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    • pp.132-138
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    • 2012
  • Purpose: Trauma is one of the major causes of maternal and fetal mortality, and the most common cause of maternal trauma is a traffic accident. In Korea, data about traffic accidents in pregnant women are not widely collected and classified so far. Hence, we studied and analyzed the characteristics of injured pregnant women by the traffic accidents. Methods: From January 2002 to August 2011, pregnant women who were in traffic accidents visiting Emergency Department were studied. Pregnancy out come and the degree of the damage were determined through the retrospective analysis of the medical records. Results: The pregnant women who visited after traffic accidents were total 204 patients. Among them, 176 patients had no complication related to the traffic accidents, 28 patients had complications. The incidence of the complications in the 3rd trimester pregnants was statistically significant higher than that in the other trimesters. The analysis based on the mechanism shows more complications in the pedestrian injury. In the survey by the type of the vehicles, the complications from the trauma associated with a car had lower incidence. The patients arrived at the emergency center by walking had greater numbers than who arrived by an ambulance in the groups occurred the complications. The patients suffered complications who complained pain in trunk especially in abdomen and pelvis than in extremities and complained vaginal discharge, and those showed a statistically significant greater incidence. Conclusion: When pregnant women were injured by the traffic accidents, the factors related to the poor pregnant prognosis were trimester of pregnancy, means of visiting the emergency center, trauma mechanism, and complaining symptoms. Therefore, these factors may be used as a prognostic tool to predict an incidence of complications, length of hospital stay and rate of complications and can be used to plan for treatments.

A Study on the Stress of Family-Caregivers and Level of Daily Living Performance with Patients of Cerebra Vascular Accident(CVA) (뇌졸중환자의 일상생활 수행수준과 가족원의 스트레스)

  • Cho, Young-Hee
    • Research in Community and Public Health Nursing
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    • v.10 no.2
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    • pp.372-386
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    • 1999
  • The purpose of this study was to explore the degree of stress in caregivers caring for CVA patients and the level of daily living performance of CVA patients. The subjects for the study were caregivers of 112 CVA patients who enter a hospital or out-patient-department (OPD) at two Oriental medical hospital in Jeonbuk province. The survey instruments used in this study were Kang's ADL check list for daily living performance of patients and Choi's 4 sore scale for stress of caregivers. The survey was conducted from July 4th to August 30th in 1999. The survey results were analyzed with the Statistical Package for Social Science(SPSS) program and can be summarized as follows: 1. The level of daily living performance for the CVA patients was: 1) complete dependence (M=14.9, 13.1%), 2) complete independence (M=23.6, 20.9%), 3) incomplete independence (M=23.9, 21.0%), 4) incomplete dependence (M=26.6, 25%), 5) dependence and independence (M=23.0, 20.0%). The items for with there was a high level daily living performance were: 1) drinking (M=3.62), 2) eating(M=3.25). 3) position returning (M=3.18) : and the items for which there was a low level of daily living performance were: 1) ascending and descending stairs (M=2.08), 2) walking (M=2.47), 3) dressing and undressing trousers (M=2.55). 2. Degree of caregiver stress was: Mean=2.39 at 40 score. The items for which was a high level caregiver stress were: 1) medical fee (M=3.25), 2) being handicapped or recurrence (M=3.02) : and the items for which there was a low level of caregiver stress were: 1) discontinuity of patient's treatment (M = 1.98). 2) change of home atmosphere caused by patient's disease (M = 1.98), 3) desire of patient's knowing about disease (M= 1.99). 3. There was statistically significant difference in the degree of caregiver stress according to the following caregiver's demographic characteristics: education level (F=3.52, P=0.03). change of caregiver (F=5.41. P=0.02). 4. There was a statistically signifiant difference in the level of daily living performance according to the CVA patients demographic characteristics: patient's paralytic status (F=4.48, P=0.01), duration of disease (t=2.76, P=0.03). 5. There was significant difference in degree of caregiver stress according to the CVA patient's demographic characteristics: CVA status (F=4.75, P=0.01). 6. There was statistically significant difference in the degree of caregiver stress according to the level of daily living performance in CVA patients(r=-0.482, P<0.00).

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