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Purpose: Traumatic brain injury (TBI) is the most common cause of pediatric trauma patients came to the emergency department. Without guidelines, many of these children underwent repeat brain computed tomography (CT). The purpose of this study was to evaluate the value of repeat brain CT in children with TBI. Methods: We conducted a retrospective study of TBI in children younger than 19 years of age who visited the emergency department (ED) from January 2011 to December 2012. According to the Glasgow Coma Scale (GCS) and Pediatric Glasgow Coma Scale score of the patients, study population divided in three groups. Clinical data collected included age, mechanism of injury, type of TBI, and outcome. Results: A Total 83 children with TBI received repeat brain CT. There were no need for neurosurgical intervention in mild TBI (GCS score 13-15) group who underwent routine repeat CT. 4 patients of mild TBI group, received repeat brain CT due to neurological deterioration, and one patient underwent neurosurgical intervention. Routine repeat CT identified 12 patients with radiographic progression. One patient underwent neurosurgical intervention based on the second brain CT finding, who belonged to the moderate TBI (GCS score 9-12) group. Conclusion: Our study showed that children with mild TBI can be observed without repeat brain CT when there is no evidence of neurologic deterioration. Further study is needed for establish indication for repetition of CT scan in order to avoid unnecessary radiation exposure of children. [ J Trauma Inj 2015; 28: 149-157 ]
김재혁 ( Jae Hyuk Kim ), 조진성 ( Jin Seong Cho ), 임용수 ( Yong Su Lim ), 이수복 ( Soo Bock Lee ), 현성열 ( Sung Youl Hyun ), 김진주 ( Jin Joo Kim ), 이근 ( Gun Lee ), 양혁준 ( Hyuk Jun Yang ), 류일 ( Il Rheu ) 대한응급의학회 2011 大韓應急醫學會誌 Vol.22 No.2
Purpose: Airway management and ventilation at the prehospital stage are essential and very critical to patient welfare. In Korea, however, methods other than the use of a bag valve mask are hardly used at the pre-hospital stage by emergency medical technicians (EMTs). This study survey the current state of airway management and respiratory first aid at the pre-hospital stage. Methods: A questionnaire survey of 356 EMTs was conducted by distributing questionnaires directly to first-class EMTs who participated in clinical training at emergency centers or by sending questionnaires and receiving answers by E-mail. The questionnaire solicited information concerning general characteristics of EMTs, monthly frequency of pre-hospital airway management of patients and the will of EMTs. Subjects were divided into two groups according to governmental subdivision or presence of training within 1-year. Results: Concerning airway management and ventilation at the pre-hospital stage, the use of methods other than nasal prong and simple mask was very rare. As to the reasons, the respondents mentioned the shortage of manpower and lack of knowledge/experience. There was no significant difference in the ratio of pre-hospital airway management between urban and suburban/rural settings. Training within 1-year was not related to increased enforcement of airway management. Conclusion: In Korea, pre-hospital airway management is not well implemented by EMTs. Causes are deficiency of rescuer, less actual patient treatment experience and deficiency of knowledge/experience. Education and work experience can influence pre-hospital airway management. But, most pre-hospital airway management is unaffected by education and work experience.
Purpose: Few data exist regarding cardiopulmonary resuscitation (CPR) education status in relationship to characteristics of socio-economic status and health and medical conditions in Korea. The purpose of this study is to describe the characteristics associated with the CPR educated populationand to develop and analyze a simple predictive model of the CPR education status. Methods: Based on a health survey of Incheon Metropolitan City adults (5,114), differences between a CPR-educated group (n=220) and a CPR non-educated group (n=4,894) were analyzed and a logistic regression analysis of the two groups was performed to evaluate socio-economic status-gender, age, marital status, education level, number of family members, and monthly household income-and health-medical conditions-disease, accidental history, EMS (emergency medical service) experience, and health status. Results: The participation rate in CPR education in Korea is only 4.3% which is vastly lower than in other developed countries, and there are statistically significant differences between the CPR-educated and CPR not-educated in gender (0.000), age (0.000), marital status (0.000), education level (0.000), and diseases (0.003). Similarly, gender (OR: 0.247, 0.000), age (OR: 0.964, 0.000), marital status (OR: 0.463, 0.000), education level (OR: 1.797, 0.000), numbers of family members (OR: 1.231, 0.004), and health status (OR: 0.894, 0.009) are statistically significant predictors of participation in CPR education. Conclusion: Monthly household income, accident history, and EMS experience are not statistically significant factors for participation in CPR education in Korea. It may be necessary to determine the optimal fees of CPR education based on social characteristics and economic conditions, Certain subgroups of lay persons such as high-risk patients and family members need targeted outreach programs.
Purpose: Trauma is one of the most common causes of death for children, and identifying severely injured children quickly in an overcrowded emergency room (ER) is difficult. Therefore, severe injury must be prevented, and the severity of injuries in children must be determined easily from their general characteristics and pre-hospital factors. Methods: Injured children younger than 15 years of age who visited the ER from June 2011 to May 2013 were enrolled. According to the revised trauma score (RTS) of the patients, the study population was divided in two groups, a severe group (RTS<7) and a mild group (RTS≥7). The general characteristics and the pre-hospital factors were compared between the two groups. Results: Six hundred seventy-three children were enrolled, their mean age was 8.03 (±4.45) years, and 476 (70.73%) patients were male. Of these patients, 22 patients (3.27%) were in the severe group, and 651 patients (96.73%) were in the mild group. Fewer males were in the severe group than in the mild group (50.00% vs. 71.43%, p=0.030), and children in the severe group were younger than children in the mild group (3.50 vs. 8.00 years, p=0.049). In the severe group, toddlers (54.55%, p=0.036) were the most common age group. Severe injuries occurred more often in spring (32.81%) and summer (54.56%) than in autumn (9.09%) and winter (4.55%) (p=0.026). The most common places of injury in the severe group were roads (50.00%, p=0.009), and the most common mechanisms of injury in the severe group were traffic accidents (50.00%), followed by falls (31.82%) (p=0.011). Most severely injured children were transferred by ambulance (72.73%, p=0.000). Conclusion: The results of this study may be helpful for identifying severely injured children quickly in the field and the ER. To prevent severe pediatric injuries, precautions and policies based on these results should be established. [ J Trauma Inj 2014;27:43-49 ]
박원빈 ( Won Bin Park ), 양혁준 ( Hyuk Jun Yang ), 김진주 ( Jin Joo Kim ), 임용수 ( Yong Su Lim ), 김재광 ( Jae Kwang Kim ), 현성열 ( Sung Youl Hyun ), 황성연 ( Sung Youn Hwang ), 이근 ( Gun Lee ), 정호성 ( Ho Sung Jung ) 대한응급의학회 2010 大韓應急醫學會誌 Vol.21 No.1
Purpose: According to the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, unconscious adult patients with ROSC after out-of-hospital cardiac arrest should be cooled to between 32℃ and 34℃ for 12 to 24 hours. Two recent randomized controlled trials that included comatose survivors of cardiac arrest have documented that therapeutic hypothermia improved the neurological recovery. (ED note: Newer cooling devices have recently been introduced, such as endovascular…?)We have introduced newer devices, such as endovascular cooling devices, so we compared endovascular cooling with the previously used surface cooling methods. Methods: This is a cohort study of patients with ROSC (>24hours) after cardiac arrest and who were admitted to the intensive care unit in a tertiary hospital over a twenty-eight month period from September 2006 to December 2008 and they had received therapeutic hypothermia. The patients` baseline characteristics, the mortality, the neurologic outcomes, the side effects during therapeutic hypothermia and other factors were evaluated according to the cooling methods. Results: Seventy-five patients were included over a 28 month period. Surface cooling methods were used in 37 patients, and endovascular cooling methods were used in 38 patients. There were no significant differences of the mortality and the neurologic outcome according to the cooling methods (p=0.973, 0.937). The time from collapse to reaching therapeutic hypothermia was 587.14±384.18 minutes for surface cooling and 496.24±213.83 minutes for endovascular cooling (p=0.105). The rewarming time was 451.09±229.93 minutes and 802.38±209.09 minutes for each cooling method, respectively, and the difference was statistically significant (p=0.002). There were no significant differences of the side effects during therapeutic hypothermia between the surface and endovascular cooling methods. Conclusion: Endovascular cooling methods are useful to maintain the target temperature within a narrower range and these methods have the advantage of automatic feedback control of the temperature and controlled rewarming. There were no significant differences in mortality, the neurologic outcome and other side effects between the surface and endovascular cooling methods during therapeutic hypothermia after cardiac arrest.
A carotid-cavernous fistula (CCF) is a pathologic arteriovenous communication between the carotid artery and the cavernous sinus, and the incidence of CCF as a result of craniofacial trauma is less than 0.2%. Traumatic internal carotid artery dissection (TICAD) is a rare phenomenon, occurring in 0.02 to 0.67% of cervical blunt trauma cases. We report a rare case of CCF associated with ICAD after craniofacial trauma injury, which is very rare. A 23-year-old woman presented with left ptosis on 21 days after a car crash accident. She had suffered from headaches, diplopia, tinnitus, and dizziness. Brain MRI revealed no mass or aneurysmal sac or intracranial hemorrhage, but cerebral angiography showed CCF with ICAD. She was treated with a ICAD percutaneous transarterial stent and endovascular embolization, 1 months after cerebral angiography. clinicians treating patients with craniofacial injuries should have a complete understanding of these patients` entity, because urgent intervention may improve outcome.
Acrylonitrile is most commonly used aliphatic nitrile compounds characterized by the structural formula R-C=N and used mostly to make acrylic fibers, plastics, synthetic rubber, and wall coverings In recent, because of its extensive usage and the rapid expansion of the chemical industry, many poisonings have been reported and many studies on its health effects have been performed Acute toxicity resembles cyanide poisoning and results mainly in effects on the nervous system High exposure also can cause temporary damage to red blood cells and the liver and can cause lead to death Because long-term occupational exposure to the acrylonitrile has been with cancer in humans, the U.S EPA dassifies acrylonitrile as probable carcinogen For this reason, The federal govemment has developed regulations and advisories to protect individuals from the potential health effects of aaylonitrile in the enviroment, but there are few studies, case reports and regulations of the govemment in our country We experienced acute poisoning caused by acrylonitrile inhalation that occurred in an industrial accident. So, we report this case with literature reveiw
조진성 ( Jin Seong Cho ), 임혁기 ( Hyuk Kee Lim ), 이근 ( Keun Lee ), 양혁준 ( Hyuk Jun Yang ), 이승철 ( Seung Chul Lee ), 염석란 ( Suk Ran Yeum ), 박주옥 ( Ju Ok Park ), 이경원 ( Kyung Won Lee ) 대한응급의학회 2012 大韓應急醫學會誌 Vol.23 No.1
Purpose: We investigated current dispatcher education requirements and proposed how to further improve and develop the EMD education curriculum in Korea. Methods: The contents of EMD training programs from the US were used in the development of the questionnaire used to investigate the status of EMD education in Korea. The Delphi method was used to obtain expert consensus on which specific training objectives to include, how many hours would be required, who was qualified to receive the training, and how to confirm their successful qualification. Results: A consensus of the experts was made for core educational objectives, the appropriate number of education hours, qualifications for trainers, passing marks for the exams, and the format of re-education as follows: The didactic education time requirement was 18 hours and the experiential education time requirement was 10 hours. The target qualification requirement for trainees was EMT level 1, and they were required to have an experience of firstaid as a prerequisite. The minimum annual re-education time was 8 hours (61.1%). The passing mark for examinations was 70.0 (median, IQR: 65.0 - 70.0) for the didactic test and 70.0 (median, Interguatile range [IQR]: 60.0 - 80.0) for the experiential test. The format of the required re-education included both comprehensive and individual forms. Conclusion: We propose the core contents of EMD education should be based on the results of the expert consensus.
박웅 ( Woong Park ), 박철현 ( Chul Hyun Park ), 전양빈 ( Yang Bin Jeon ), 이재익 ( Jae Ik Lee ), 최창휴 ( Chang Hu Choi ), 박국양 ( Kook Yang Park ), 김진주 ( Jin Joo Kim ), 현성렬 ( Sung Youl Hyun ), 양혁준 ( Hyuk Jun Yang ), 김은영 ( Eu) 대한응급의학회 2012 大韓應急醫學會誌 Vol.23 No.6
Purpose: Acute aortic dissection is a rare and life-threatening disease, requiring an immediate evaluation and treatment. In 2010, the American College of Cardiology/American Heart Association suggested a new risk score system for the detection of an acute aortic dissection. This system was applied to our known patients with acute aortic dissection. Methods: 155 patients with acute aortic dissection regardless of the types from January 2000 to June 2012 were examined. The known risk factors and 12 newly proposed risk factors were compared, based on the new guidelines, after dividing them into a delayed diagnosis group and early diagnosis group. The impact of the aortic dissection detection (ADD) risk score on the diagnostic process was assessed. Results: The abrupt onset of pain was the most frequent symptom (65.2%) and only had an impact on an early diagnosis (p=0.021). 83 patients (53.5%) showed a widened mediastinum in the chest X-rays. The diagnosis was delayed in 21 patients (13.8%). According to the new guideline, 149(96.1%) were identified by 1 or more of the 12 clinical markers. 6(3.8%), 88(56.8%) and 61(39.3%) patients were classified as low, intermediate and high risk, respectively. Three of the 6 low risk patients showed mediastinal widening. Conclusion: The clinical risk markers and the ADD risk score system in the 2010 guidelines detected patients with high sensitivity. The new risk score system appears to be a valuable diagnostic index at the initial presentation.