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Cervical collar makes difficult airway: a simulation study using the LEMON criteria
Moonsu Yuk,Woonhyung Yeo,Kangeui Lee,고정인,Taejin Park 대한응급의학회 2018 Clinical and Experimental Emergency Medicine Vol.5 No.1
Objective Endotracheal intubation is extremely difficult to perform in patients wearing a cervical collar for a head and neck injury. Therefore, we analyzed actual measurements using the look externally, evaluate 3-3-2, Mallampati score, obstruction, and neck mobility (LEMON) criteria before and after cervical collar application to investigate the causes of a difficult airway. Methods This simulation study was performed in 76 healthy volunteers. We measured the mouth opening, modified Mallampati classification, and neck extension before and after cervical collar application. Results The mean inter-incisor distance significantly decreased from 4.3 to 2.6 cm (P<0.001). Fifty-seven participants classified as I and II were newly classified as III and IV according to the modified Mallampati classification after cervical collar application (16% to 91%). The angles of neck extension significantly decreased from 44° to 22° after cervical collar application (P<0.001). Before cervical collar application, our simulations predicted that 14 of 76 participants (18%) would have a difficult airway, whereas after cervical collar application, 76 of 76 (100%) were predicted to have a difficult airway. Conclusion All values for the LEMON criteria (mouth opening, modified Mallampati classification, and neck extension) worsened significantly after cervical collar application. Additionally, a difficult airway was predicted in all participants after cervical collar application.
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Alcohol Intoxication and Glasgow Coma Scale Scores in Patients with Head Trauma
( Jisoo Park ),( Taejin Park ),( Jung-in Ko ),( Woonhyung Yeo ) 대한외상학회 2020 大韓外傷學會誌 Vol.33 No.4
Purpose: Alcohol intoxication is commonly associated with traumatic brain injury (TBI), but the inf luence of alcohol on the Glasgow Coma Scale (GCS) score remains unclear. This study investigates the effects of blood alcohol concentration (BAC) on the GCS score in head trauma patients with alcohol intoxication. Methods: In total, 369 head trauma patients with alcohol intoxication in a 1-year period were retrospectively analyzed. The patients underwent head computed tomography and had a BAC ≥80 mg/dL. Patients were divided into TBI and non-TBI groups. Brain injury severity was further classified using the head Abbreviated Injury Score (AIS). The effects according to 5 BAC groups were examined. Results: The TBI group consisted of 64 patients (16.2%). The mean BAC was significantly higher in the non-TBI group (293.4±87.3 mg/dL) than in the TBI group (242.8±89.9 mg/dL). The mean GCS score was significantly lower in the TBI group (10.3±4.6) than in the non-TBI group (13.0±2.5). A higher BAC showed a significant association with a lower mean GCS score in the TBI group, but not in the non-TBI group. Above ≥150 mg/dL, higher BACs showed significant odds ratios for a lower GCS score. Conclusions: The influence of alcohol in patients with head trauma depended on the presence of a brain injury. An association between a higher BAC and a lower GCS score was only observed in patients with TBI. Therefore, if a severe brain injury is suspected based on a GCS evaluation in patients with alcohol intoxication, prompt diagnosis and intensive care should be performed without delay.
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( Ho-suk Jo ),( Taejin Park ),( Woonhyung Yeo ),( Jung-in Ko ) 대한응급의학회 2020 대한응급의학회지 Vol.31 No.1
Objective: This study examined the frequency of emergency department visits for syncope according to the day, week, and month. The frequency of syncope associated with holidays and the locations was also investigated. Methods: A retrospective study was performed on the frequency of patients discharged from the emergency department with a diagnosis of syncope from July 2016 to June 2017. Each 24-hour period was analyzed in four-hour intervals, and the frequency of occurrence was calculated for weekly and monthly time frames. In addition, the frequency of syncope associated with holidays and the locations where syncope occurred were analyzed for any possible trends. Results: For the 259 patients in this study, the frequency of the reflex syncope was significantly higher between 6 and 10 am (P=0.011), and showed a decreasing trend since that period (P=0.006). The number of reflex syncope visits on Mondays was significantly higher than on the other days (P<0.001) and a decreasing trend after Monday toward the weekend (P=0.023). A significant difference in the frequency of syncope associated with holidays was observed: 0.48 on weekdays, excluding the day after a holiday; 0.37 on a holiday; and 0.92 on the day after a holiday (P<0.001). Almost half of the reflex syncope events (44.3%) occurred in the subway. Conclusion: The frequency of syncope was highest in the morning. In addition, reflex syncope showed a higher frequency on the day after a holiday, and the incidence was higher in the subway.
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Cho Soo Im,Ko Jung-In,Kim Yeonjae,Yeo Woonhyung,Lee Kangeui,Cho Wonjin,Moon Sungwoo,Park Taejin 대한감염학회 2021 Infection and Chemotherapy Vol.53 No.1
Background: According to the recent coronavirus disease 2019 (COVID-19) pandemic experience, many emergency departments experience difficulties in responding to emerging infectious diseases and this has led to a public health crisis. Our emergency department (ED) is designed to respond to mass outbreaks of infection. Three major preparations were taken to respond to infectious disease; first, to improve the emergency department facilities; second, to created programs to respond to each phase of an epidemic of COVID-19; lastly, to implemented education and training to promote the safety of medical staff. We would like to share the actual responses and statistics of patients visiting emergency department during COVID-19 periods of pandemic. Materials and Methods: This research was conducted through a retrospective chart analysis provided by a public medical center with 502 beds since the first report of a COVID-19 confirmed case on January 19, 2020 to June 15, 2020 in Seoul, the capital of Korea. Our emergency department was designed based on Korean Regional Emergency Center Facility Standards, and modified throughout each phases of COVID-19 outbreak. Patients suspected to be infectious are screened in the triage, separating them from general patients, and then receive isolation treatment in isolated wards. Results: A total of 4,352 patients visited the ED. 3,202 screenings were conducted with 5 confirmed cases. Another 1,150 patients were treated with general emergent symptoms. There were no problems such as closure of the emergency department or isolation of medical staff while managing COVID-19 confirmed patients. Conclusion: Improving emergency department facilities, create an operational program to respond to each phase of COVID-19 outbreak and implement educational programs enabled large number of screening tests and hospitalization for COVID-19 suspected patients while maintaining general medical services. Research in emergency department designs and operational programs should increase to combine research data with better ideas to respond not only during regular periods but also during periods of pandemic.
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