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( Yo Huh ) 대한응급의학회 2014 대한응급의학회 학술대회초록집 Vol.2014 No.2
Acute transverse myelitis (ATM) is characterized by motor weakness, sensory change and autonomic dysfunction. However, it would be difficult for emergency physicians not only to diagnose ATM just using clinical features at early clinical stage, but also to clarify the cause of disease, owing to low incidence rate. We retrospectively analyzed ATM cases for providing high suspicion index of clinical clues for the early identification of ATM to emergency physicians All the records of the patients who visited emergency medical center with a final diagnosis of ATM from January 2005 to February 2013 were reviewed. Data including demographics, clinical findings, and radiographic findings were reviewed. A total of 46 patients were included in the present study. Among the patients (mean age 43.4 years), sensory changes were identified in 45 patients (97.8%), motor weakness in 33 patients (71.7%), and autonomic dysfunctions in 35 patients (76.1%). Thirty patients (65.2%) showed high signal intensity at T2-weighted MR image and thoracic spine was most common lesion in MRI (56.7%). There were discrepancy between sensory changes and levels of MRI lesions. Thirty five patients (76.1%) were diagnosed as idiopathic ATM. Referral impressions from ED were 1) herniated intervertebral disc (38.7%), 2) stroke (19.4%), 3) Guillain-Barre syndrome (12.9%), 4) cauda equine syndrome and ATM (9.7%, respectively), 5) others (9.7%). ATM should be initially considered as an exclusion diagnosis when a patient represents any symptoms of motor weakness, sensory changes, or autonomic dysfunction, unless impressions after initial evaluation are clear.
Huh Yo,Kwon Junsik,Moon Jonghwan,Kang Byung Hee,Kim Sora,Yoo Jayoung,Song Seoyoung,Jung Kyoungwon 대한의학회 2021 Journal of Korean medical science Vol.36 No.22
Background: This study examined the impact of the performance improvement and patient safety (PIPS) program implemented in 2015 on outcomes for trauma patients in a regional trauma center established by a government-led project for a national trauma system in Korea. Methods: The PIPS program was based on guidelines by the World Health Organization and American College of Surgeons. The corrective strategies were proceeded according to the loop closure principle: data-gathering and monitoring, identification of preventable trauma deaths (PTDs), evaluation of preventable factors, analysis of findings, and corrective action plans. We established guidelines and protocols for trauma care, conducted targeted education and peer review presentations for problematic cases, and enhanced resources for improvement accordingly. A comparative analysis was performed on trauma outcomes over a four-year period (2015–2018) since implementing the PIPS program, including the number of trauma team activation and admissions, time factors related to resuscitation, ventilator duration, and the rate of PTDs. Results: Human resources in the center significantly increased during the period; attending surgeons responsible for trauma resuscitation from 6 to 11 and trauma nurses from 85 to 218. Trauma admissions (from 2,166 to 2,786), trauma team activations (from 373 to 1,688), and severe cases (from 22.6 to 33.8%) significantly increased (all P < 0.001). Time to initial resuscitation and transfusion significantly decreased from 120 to 36 minutes (P < 0.001) and from 39 to 16 minutes (P < 0.001). Time to surgery for hemorrhage control and decompressive craniotomy improved from 99 to 54 minutes (P < 0.001) and 181 to 135 minutes (P = 0.042). Ventilator duration and rate of PTDs significantly decreased from 6 to 4 days (P = 0.001) and 22.2% to 8.4% (P = 0.008). Conclusion: Implementation of the PIPS program resulted in improvements in outcomes at a regional trauma center that has just been opened in Korea. Further establishment of the PIPS program is required for optimal care of trauma patients.
강병희,최동환,조자윤,권준식,Yo Huh,문종환,김영환,정경원,John Cook-Jong Lee 대한의학회 2017 Journal of Korean medical science Vol.32 No.12
A new blood bank system was established in our trauma bay, which allowed immediate utilization of uncross-matched type O packed red blood cells (UORBCs). We investigated the efficacy of UORBC compared to that of the ABO type-specific packed red blood cells (ABO RBCs) from before the bank was installed. From March 2016 to February 2017, data from trauma patients who received UORBCs in the trauma bay were compared with those of trauma patients who received ABO RBCs from January 2013 to December 2015. Propensity matching was used to overcome retrospective bias. The primary outcome was 24-hour mortality, while the secondary outcomes were in-hospital mortality and intensive care unit (ICU) length of stay (LOS). Data from 252 patients were reviewed and UORBCs were administered to 64 patients. The time to transfusion from emergency room admission was shorter in the UORBC group (11 [7–16] minutes vs. 44 [29–72] minutes, P < 0.001). After propensity matching, 47 patients were included in each group. The 24-hour mortality (4 [8.5%] vs. 9 [13.8%], P = 0.135), in-hospital mortality (14 [29.8%] vs. 18 [38.3%], P = 0.384), and ICU LOS (9 [4–19] days vs. 5 [0–19] days, P = 0.155) did not differ significantly between groups. The utilization of UORBCs resulted in a faster transfusion but did not significantly improve the clinical outcomes in traumatic shock patients in this study. However, the tendency for lower mortality in the UORBC group suggested the need for a large study.