A Clinical Analysis of 179 Cases of Centipede Bite Patients Who Visited the Emergency Department in Korea

PURPOSE: To investigate the epidemiology and clinical characteristics of centipede bite injuries. METHODS: We conducted a retrospective study of clinical manifestations in patients who were identified between April 2005 to April 2007 as having suffered from centipede bites. Factors evaluated included sex, age, location and time of bite, part of body affected, clinical signs and symptoms, treatment modalities and complications. RESULTS: A total of 179 cases of centipede bite were identified. Centipede bites occurred between spring and autumn. 69.3% of bites happened at night. All patients were bitten on an exposed body parts, and the digit of both the handsand feet were the sites most often involved. Pain, swelling, erythema were the most frequent symptoms and signs. Most cases showed minor manifestations but, three patients needed to be admitted because of anaphylaxis. CONCLUSION: Centipede bites are relatively common in the summer season in rural and island areas, especially at night. Though the clinical symptoms of centipede bites are generally minor symptoms, emergency physicians need to possess accurate knowledge of the clinical manifestations in order to properly identify severe cases.

Treatment of Displaced Intra-articular Calcaneal Fractures Using a F-plate

PURPOSE: To evaluate the clinical efficacy of F-plate in displaced intra-articular fractures of calcaneus. MATERIALS AND METHODS: Total 43 cases treated with F-plate and followed up at least six months postoperatively were reviewed. Radiographically, Böhler angle was measured and all cases were subdivided by Sanders classification. Each case was reviewed for the presence of local infection, traumatic arthritis, nonunion, and any breakage of plate or screw. Maryland foot score was used for clinical assessment and factors influencing on clinical results were determined. RESULTS: The mean Böhler angle was improved from 0.5° (range: -24.7~35.5°) preoperatively to 25.8° (range: 14.2~38.6°) postoperatively and the angle at last follow-up was 23.5° (range: 10.2~37.5°), showing about 2.3 degree decline compared to postoperative Böhler angle. There were two cases of F-plate breakage and two cases of screw breakage but the metal breakage did not affect any change in Böhler angle. Other complications were; five cases of traumatic arthritis, one case of varus malunion and one case of deep wound infection. According to Maryland foot score, there were 10 excellent, 22 good, 10 fair and 1 poor result. Furthermore, Age, pre-operative Böhler angle and the patient's expectation on financial compensation had significant influences upon the clinical result. CONCLUSION: F-plate fixation seems to yield firm fixation and satisfactory clinical results in the treatment of displaced intra-articular fractures of calcaneus.

A Case of Tricuspid Regurgitation after Blunt Chest Trauma

Tricuspid regurgitation after blunt chest trauma is rarely seen in the emergency department. A 19-year-old patient visited our emergency department with chest discomfort after collision with his brother while skiing. Recently, Skiing as a winter sports has become popular with the Korean people, so there is an increasing tendency for patients with diverse traumas associated with ski accidents to visit the emergency department. From simple abrasions or contusions to deadly injuries with unstable vital signs, we are seeing many kind of injuries in the emergency department. We present the case report of a patient with tricuspid regurgitation after a blunt chest trauma during the skiing.

A Case of Tricuspid Regurgitation after Blunt Chest Trauma

Tricuspid regurgitation after blunt chest trauma is rarely seen in the emergency department. A 19-year-old patient visited our emergency department with chest discomfort after collision with his brother while skiing. Recently, Skiing as a winter sports has become popular with the Korean people, so there is an increasing tendency for patients with diverse traumas associated with ski accidents to visit the emergency department. From simple abrasions or contusions to deadly injuries with unstable vital signs, we are seeing many kind of injuries in the emergency department. We present the case report of a patient with tricuspid regurgitation after a blunt chest trauma during the skiing.

Radiographic Analysis of the Tibial Axis on the Antero-posterior and Lateral view of Knee

PURPOSE: The purpose of this study is to evaluate the use of plain knee films in assessing the position of tibial component after total knee arthroplasty. MATERIALS AND METHODS: Plain radiological antero-posterior(AP) and lateral view of tibia of 51 adults (mean age: fifty-years old) were taken. On AP view, the medial angles between tibia plateau and mechanical, anatomical and proximal anatomical axis of tibia were measured, and then correlation of each angle and the angle between the tibia plateau and anatomical axis were assessed. On lateral view, the posterior angle formed between the medial tibial plateau and anatomical, proximal anatomical axis, anterior and posterior cortex of proximal tibia were measured, and then correlation of each angle and the angle between the medial tibial plateau and anatomical axis were assessed. RESULTS: On tibial AP view, both axes had significant correlation(p<0.05) with the anatomical axis. The anatomical axis of proximal tibia was closest to it. On lateral view, all three axes had significant correlation(p<0.05) with anatomical axis. Among these, the anterior cortex of proximal tibia was closest to it. CONCLUSION: The position of the tibia component and posterior slope after total knee arthroplasty can be measured on plain knee X-rays using anatomical axis and the anterior cortex line of proximal tibia.

Aspects of Patients Injured While Attending Street Rallies in Seoul During the Period of the 2002 World Cup

PURPOSE: An appropriate emergency medical support system is required at sites of large-scale congregations because different kinds of emergencies may be encountered. My colleagues and I initiated this project to present the information required for the process of devising an onsite plan for large crowds. The basic structure is based on an analysis of patients who were injured while attending large scale street-cheering demonstrations in Seoul during the period of the 2002 World Cup. METHOD: The analysis concentrated on the period from May 31, 2002, to June 30, 2002, during the 2002 Korean-Japan World Cup. Seven soccer games involving the Korean team and 8.91 million people from 116 places were considered. The following report was generated from the supporting schedules and the activity reports of emergency rescue crews from fire departments. It is largely based on rescue activity journals and transportation records. RESULT: There were 796 patients among the in 8.91 million people. Male patients were 383 (42.8%) and female 413 (51.2%). Patients in their 20's were 267, and that was the largest age group. In Korean game against Germany, 183 patients were treated, and that was the largest among the seven games involving Korean's team. There was one patient in every 10,000 people on average. Sicknesses were not that serious, and most of them were headaches, stomachaches and exhaustion. CONCLUSION: The frequency and pattern of generation of patients were affected by the scale of the cheering crowd, the sex and age composition of the crowd, and the weather. In planning future medical support for similar events, the structure of the plan should be based on the site and the size of the crowd, after which the plan can be finalized by considering details such as the importance of the game and the weather.

Korean Multicenter Study of Te tanus Antibody Titer (KoMUST)

PURPOSE: We determine the Korean antibody titer and positive rate of tetanus by using a with qualitative test (ELISA) and a quantitative test (TQS(R)). METHODS: This study was prospective collecting study with uncontolled patients who were admitted in 21 Emergency Departments during 3 months in South Korea. We measured TQS(R) and collected the serum with a centrifuge for 5 groups, which was classified with age: 2~10 years (I), 11~20 years (II), 21~30 years (III), 31~40 years (IV), 41~60 years (V), in each hospital. The freezed serum and the protocol with TQS(R) results were taken at the Soonchunhyang University Bucheon hospital to be analyzed. RESULTS: The number of enrolled patients was 1816 (male 58%). The positive rate of TQS(R) was 835 patients (46%), and there was no relation with region or sex. In sex and age, there was a definitive decline in the group III fort males and females. The results of ELISA was showed that 62.8% (> 0.15 IU/ml) and 52.2% (> 0.2 IU/ml) had protective levels of tetanus antibody. The proportion decreased to approximately 43% and 18% among persons 40~60 years of age at each level of antibody titers. By region and population, there was no statistical relationship with TQS(R) and ELISA, but previous military service was associated with a higher prevalence of protective antibodies to tetanus (p<0.001). CONCLUSIONS: A substantial portion of adults in South Korea do not have antibody levels that are protective against tetanus. Also, the mean level of tetanus antibody titers was definitively lower than those of other developed conturies and consistently decreased with aging. Therefore, an adult formulation diphteria and tetanus toxoid every 5 or 10 years is recommended for all adults between 20 and 60 years of age after being tested with TQS(R) in South Korea.

Rhabdomyolysis after SCUBA Diving: A Case Report

Recently, self-contained underwater breathing apparatus (SCUBA) diving's popularity has been increasing tremendously. Most diving injuries are related to the behavior of the gas and to pressure changes during descent and ascent. A scuba diver at depths greater than 7 m may accumulate a tissue partial presure of nitrogen large enough that, on ascent to the surface, nitrogen exist the tissues rapidly, forming bubbles in the blood and other organs, which is known as decompression sickness (DCS). Although both of these bubble disorders can, in theory, cause injury to skeletal muscles (rhabdomyolysis), the case are report here demonstrates the potential for massive muscle necrosis after scuba diving. We report a case of rhabdomyolysis presented with general weakness after scuba diving.

Cardiac Tamponade from Chest Trauma During Snowboarding

As snowboarding has become one of the most popular winter sports, lots of young people enjoy it and they have become the center of this winter sports. However, this increased number of snowboarding lovers results in raising the number of injuries. In the case of severe chest injury caused by snowboarding can be a source of a serious injury such as cardiac tamponade. The development of cardiac tamponade is an acute, life-threatening emergency. To test a cardiac tamponade, a patient with chest trauma should be diagnosed from the information given by a physical examination and simple chest radiography. If the heart is doubted to be wounded, an emergency echocardiography has to be executed. An emergency treatment for the cardiac tamponade patient is to normal saline infusion quickly to augment the capacity of a blood vessel. Extremely, surgeries such as pericardiocentesis or pericardiotomy can be applied to ease the pressure inside the heart. Some patients with chest blunt trauma while snowboarding developed cardiac tamponade and they were successfully recovered through pericardiocentesis. This precedent is reported here with the consideration of the references.

Clinical Investigation of an Acute Allergic Reaction in a Patient Admitted to the Emergency Department of a College Hospital in a Small City

PURPOSE: Emergency department visits for acute allergic reactions are common. However, relatively little is known about the characteristics of patients who visit the emergency department for such reactions. We undertook this study to evaluate the frequency, the cause, the severity, the treatment and the prognosis of patients admitted for allergic reactions to a college hospital in a city. METHODS: We studied 724 patients visiting two emergency departments of college hospitals during the years 2002-2003. Clinical symptoms involved pruritus, dyspnea, hoarseness, nausea, vomiting, abdominal pain, diarrhea, dizziness, and seizure. Physical examinations involved vital signs, urticaria, rash, local edema, angioedema, rhinitis/conjunctivitis, wheezing, stridor, cyanosis, and laryngeal edema. We divided the causative agents into drugs, insects, foods, and others. We classified the treatments of the allergic reaction as antihistamines, corticosteroids, epinephrine, oxygen, and hydration. We divided patients into mild, moderate, and severe acute hypersensitivity groups. RESULTS: In order of frequency, clinical symptoms were pruritus (88.1%), urticaria (72.4%), rash (68.9%), local edema (11.7%), etc. The causative agents were foods (53.0%), unknown origin (29.1%), insects (11.0%), and drugs (6.8%). Antihistamine, corticosteroid, epinephrine were injected in 93.4%, 89.1%, 2.3% of the patients, respectively. The mild, moderate, and severe groups were 87%, 9.8%, and 3.2% of the patients, respectively. CONCLUSION: For patients with allergic symptoms visiting to the university-affiliated teaching hospitals in a small city, foods were the major causative agent, but drugs and insects provoked more severe allergic reactions.

Early Aberration Reporting System Modelling of Korean Emergency Syndromic Surveillance System for Bioterrism

PURPOSE: This study were designed to supply the opportunity to make a base of emergency syndromic surveillance warning system to detect the bioterrors through the construction of predictive models which were made by reported patients in 'Emergency Syndromic Surveillance System' who were diagnosed as waterborne contagious diseases. METHODS: On this study, we used the neural network analysis methods among the data mining to analyze the reliable variables which was extracted from the reported data bases in the Emergency Syndrome Surveillance System. RESULTS : In this study, we were using the patients data pools from 13th May 2002 to 13th May 2003 in Emergency Syndrome Surveillance System. So we could get the reliable variables - clinical symptoms, severity of patient, humidity and temperature - to predict the waterborne infections. This study shows the successful predictation rate of 96% in error rate of 0.4 with sensible variables through Chisquare analysis and the construction of one hidden layer which is near linearity. CONCLUSION: Early emergency syndromic surveillance warning models made by the neural network in Emergency Syndrome Surveillance System could make the early detection of waterborne infections, could also stop the transmission of waterborne infections in early stage, and furthermore could be used as the preventive and detective methods of bioterror attacks.

Rhabdomyolysis following Frostbite

No abstract available.

Clinical Review In Geriatric Trauma Patients

PURPOSE: This study was conducted to examine various clinical factors for their ablity to predict mortality in geriatric patients following trauma. METHODS: In this retrospective study, medical records from Chun Cheon Sacred Heart hospital were reviewed for patients 65 years and older who sustained trauma. The following variables were extracted and examined, independently and in combination, for their ablity to predict death: age, gender, mechanism of injury, blood pressure, and respiration, pulse rate, as well as Glasgow Coma Score, Revised Trauma Score, and Injury Severity Score. These patients had entered the hospital following trauma during a 2-year period (1999-2000). RESULTS: the Injury Severity Score (more than 28), the Glasgow Coma Score (less than 9), and the Revised Trauma Score (less than 8) were variables that correlated with mortality. Mortality rates were higher for men than for women. Admission variables associated with the highest risks of death included hypotension (mean blood pressure < 78 mmHg); pedestrian and motorcycle traffic accident; skull fracture, subdural hemorrhage, and diffuse axonal injury; and hemothorax and lung contusion. CONCLUSION: Admission variables in geriatric trauma patients can be used to predict the outcome and may also be useful in making decisions about triage, and treatment of the patient.

A Case of Delayed Airway Obstruction Associated with Prevertebral Hematoma and Cervical Vertebra Fracture

Neck trauma can result in a spectrum of injuries and complications ranging from incidental to life threatening, including hemorrhagic shock, acute neurologic injury, and airway obstruction. A prevertebral hematoma associated with a cervical vertebra fracture is not a common condition, moreover, in such cases, airway obstruction is rare. If this condition occur, it may very fatal that can producing hypoxia, cyanosis, acidemia, hypoxic brain damage, and then death. For this reason, the attending physitian must careful observation and protect the airway until the hematoma is reduced and other complications relieved. Recently, we experienced a case of airway obstruction induced by cervical vertebra teardrop fracture (C5). The hematoma progressed slowly and then progressively; Finally it compressed the airway. So we present this case with a reviews of the literature.

Analysis of Victims of the Fire that Broke Out at a Beer Bar in Inchon

PURPOSE: This study was conducted to develop field triage, transportation, distribution, and prehospital care at a fire disaster by analyzing the victims of the fire that broke out at a bar in Incheon. METHOD: We analyzed the cases of the victims of a fire in Incheon in Oct. 1999. We determined the primary care hospital, the arrival time, the burn size, the outcome, and the injury type from the medical records, the concerned organ records, and interviews with concerned persons. RESULT: The total number of victims was 137: 56 prehospital deaths, 1 hospital death, and 80 survivals. The Pearson correlation coefficient between the burn size and the severity was -0.175. There were 121 (89.6%) cases of inhalation injury, 59 (43.7%) cases of flame burns, 66 (48.9%) cases of hypoxic brain damage, and 16 (11.9%) cases involving other types of injury. CONCLUSION: The causes of death of the fire victims were inhalation injury and hypoxic brain damage due to CO poisoning and other toxic inhalants. We propose the use of a simple triage and rapid treatment (START) system and a reassessment the delayed category in fire disasters.