• Clinical and Experimental Emergency Medicine
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• 제5권4호
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• pp.240-248
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• 2018

Objective Determine differences between faculty, residents, and nurses regarding night shift preparation, performance, recovery, and perception of emotional and physical health effects. Methods Survey study performed at an urban university medical center emergency department with an accredited residency program in emergency medicine. Results Forty-seven faculty, 37 residents, and 90 nurses completed the survey. There was no difference in use of physical sleep aids between groups, except nurses utilized blackout curtains more (69%) than residents (60%) and faculty (45%). Bedroom temperature preference was similar. The routine use of pharmacologic sleep aids differed: nurses and residents (both 38%) compared to faculty (13%). Residents routinely used melatonin more (79%) than did faculty (33%) and nurses (38%). Faculty preferred not to eat (45%), whereas residents (24%) preferred a full meal. The majority (>72%) in all groups drank coffee before their night shift and reported feeling tired despite their routine, with 4:00 a.m. as median nadir. Faculty reported a higher rate (41%) of falling asleep while driving compared to residents (14%) and nurses (32%), but the accident rate (3% to 6%) did not differ significantly. All had similar opinions regarding night shift-associated health effects. However, faculty reported lower level of satisfaction working night shifts, whereas nurses agreed less than the other groups regarding increased risk of drug and alcohol dependence. Conclusion Faculty, residents, and nurses shared many characteristics. Faculty tended to not use pharmacologic sleep aids, not eat before their shift, fall asleep at a higher rate while driving home, and enjoy night shift work less.

• Journal of Trauma and Injury
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• 제25권2호
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• pp.37-43
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• 2012

Purpose: A tube thoracostomy is an invasive procedure that places patients at risk for complications. Tube thoracostomies are frequently performed by emergency medicine residents. Thus, the purpose of the study was to assess both the complication rate for tube thoracostomies performed by emergency medicine residents and the factors associated with these complications. Methods: A retrospective chart review of all patients who had undergone a tube thoracostomy performed by emergency medicine residents between January 2008 and February 2009 was conducted at a university hospital. Complications were divided into major and minor complications and into immediate and delayed complications. Complications requiring corrective surgical intervention, requiring the administration of blood products, or involving situations requiring intravenous antibiotics were defined as major. Complications that were detected within 2 hours were defined as immediate. Results: Tube thoracostomies were performed in 189 patients, and 70 patients(37%) experienced some complications. Most complications were immediate and minor. In multiple logistic regressions, BMI, hypotension and resident seniority were significantly associated with complications. Conclusion: The prevalence of complications was similar to these in previous reports on the complications of a tube thoracostomy. Most complications from tube thoracostomies performed by emergency medicine residents were immediate and minor complications. Thus, emergency medicine residents should be allowed to perform closed tube thoracostomies instead of thoracic surgeons.

• 대한응급의학회지
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• 제29권5호
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• pp.485-492
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• 2018

Objective: This paper reports the status of the advanced cardiac life support (ACLS) according to the guidelines by residents belonging to other departments other than the department of emergency medicine. The differences in status between the junior group and senior group was also investigated according to grades of residents. Methods: The ACLS performance for in-hospital cardiac arrest cases of one academic hospital, except for the cases occurring in intensive care unit between November 2015 and October 2017, were analyzed retrospectively. Data included the characteristics of residents, patients' outcomes, ACLS performance, and conventional treatment having discordance with the ACLS guidelines. Leaders during cardiopulmonary resuscitation (CPR) were divided into a junior group and senior group. Results: A total of 152 cases were enrolled in this study. Of these, 131 cases (86.2%) showed at least one treatment with inconsistency from the guidelines and the incidence of discordant treatment was similar in the two groups (55 [85.9%] vs. 76 [88.4%], P=0.657). Implicit use of sodium bicarbonate was more frequent in the senior residents group (odds ratio [OR], 3.04; 95% confidence interval [CI], 1.36-6.81). On the other hand, no use of a defibrillator was less frequent in the senior residents group (OR, 0.14; 95% CI, 0.03-0.81). Conclusion: In both groups, the rate of discordance with the ACLS guidelines during CPR were high. The rate of implicit use of sodium bicarbonate and no use of defibrillator were significantly different in the two groups. A customized education strategy for ACLS is needed for each group.

• 한국의료질향상학회지
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• 제10권1호
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• pp.20-27
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• 2003

Background : The doctors' strike was not only a manmade disaster but also a chance to apply a new pattern of emergency medical service for patients. We hope to propose a new pattern of emergency medical service by comparing the patterns of emergency medical service given by resident and staff during the doctors' strike. Methods : We reviewed the medical records of patients who received emergency medical service in the Emergency Department(ED) of Deagu Catholic University Hospital during 3 days a week prior to the residents' strike (July 21-23, 2000) with those of patients receiving emergency medical service during the first 3 days of the residents' strike (July 28-30, 2000). We evaluated the patient's severity, the cause of the ED visit, the performance on the laboratory study, ECG, and radiological study, the disposition, and the length of ED stay. Also, we compared the collected data by presenting doctor and by patient's severity. Results : The staff performed fewer tests admitted fewer emergent and non-emergent patients than the residents. Also, the length of ED stay was shorter in both the emergent (212.76 vs. 321.40 minutes) and the non-emergent groups (117.68 vs. 171.39 minutes) for patients presenting to staff. Conclusion : It is desirable that emergency medical service is given by staff, not by resident.

• Journal of Trauma and Injury
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• 제20권2호
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• pp.130-137
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• 2007

Purpose: Ultrasound is of proven accuracy in abdominal and thoracic trauma and may be useful for diagnosing extremity injury in situations where radiography is not available, such as disasters and military and space applications. However, the diagnosis of fractures is suggested by history and physical examination and is typically confirmed with radiography. As a alternative to radiography, we prospectively evaluated the utility of extremity ultrasound performed by trained residents of emergency medicine (EM) one patient with wrist and ankle extremity injuries. Methods: Initially, residents of EM performed physical examinations for fractures. The emergency ultrasound (EM US) was performed by trained residents, who used a portable ultrasound device with a 10- to 5-MHz linear transducer, on suspected patients before radiography examination. The results of emergency ultrasound and radiography and the final diagnosis were recorded, and correlation among them were determined by using Kappa s test Results: Thirty-nine patients were enrolled in our study. The average age was $36.6\;{\pm}\;19.3$ years. There were radius Fx. (n=21), radius-ulna Fx. (n=1), ulna Fx. (n=1), and contusion (n=2) injuries among the wrist injury and lat.-med. malleolar Fx. (n=13), lat. malleolar Fx. (n=6), and med. malleolar Fx. (n=3) injuries among the ankle injury. Comparing EM US with radiography, we found the sensitivity, specificity, positive predictive value, and negative predictive value of EM US for Fx. diagnosis to be 100%, 66.7%, 97.3%, 100% and those of radiography to be 97.2%, 100%, 100%, and 75%, respectively. Kappa s test for a correlation between the Fx. diagnosis of EM US and the final diagnosis of Fx was performed, and Kappa's value was 0.787 (P = 0.004).Conclusion: EM US for Fx. can be performed quickly and accurately by EM residents with excellent accuracy in remote locations such as disaster areas and in military and aerospace applications. EM US was as useful as radiography in our study and had a high correlation to the final diagnosis of Fx. Therefore, ultrasound should performed on patients with extremity injury to determine whether extremity evaluation should be added to the FAST (focused abdominal sonography trauma) examination.

• Clinical and Experimental Pediatrics
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• 제51권10호
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• pp.1058-1064
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• 2008

목적: 심정지 등 중증 소아 환자에서 빠른 정맥로 확보를 통한 수액과 약물의 투여는 매우 중요한 술기이다. 저자들은 중증 소아 환자를 주로 담당하는 소아과와 응급의학과 전공의들의 골강내 주사 교육 경험 정도를 알아보고 이들에게 골강내 주사의 이론과 실습 교육을 시행하여 골강내 주사에 대한 기본 지식과 수행도, 자신감 정도를 교육 전후로 평가하여 전공과별 교육 효과의 차이를 알아보고자 하였다. 방법: 2008년 5월에서 6월까지 세 개 대학병원의 소아과와 응급의학과 전공의를 대상으로 골강내 주사에 대한 이론 및 실습 교육을 실시하였다. 실습은 반자동 드릴 형태의 EZ-IO 제품을 이용하여 이루어졌으며 교육 전후 골강내 주사에 대한 지식, 수행 경험, 골수 천자 검사 경험 및 수행 자신감 등에 대한 설문을 시행하였다. 실습 후 골강내 주사 삽입 술기를 평가하였다. 결 과: 소아과와 응급의학과 전공의 각각 45명과 22명이 골강내 주사 교육에 참여하였다. 교육 전 설문 결과 응급의학과 전공의들이 통계적으로 유의하게 골강내 주사 교육 경험이 풍부했으며(P<0.001) 소아과 전공의들이 통계적으로 유의하게 골수 천자 검사 경험이 많았다(P<0.001). 교육 전후 골강내 주사의 기본 지식에 대한 질문의 정답률을 비교하였을 때 교육 후 유의한 정답률이 유의하게 상승하였다(P<0.001). 골강내 주사 1차 시도 시 전체 전공의의 성공률은 88.7%였으며 두 군 간에 성공률의 차이는 없었으나 소아과 전공의들의 골강내 주사 총 수행 시간이 응급의학과에 비해 유의하게 짧았다(P=0.001). 두 군 모두에서 교육 후 골강내 주사 수행에 대한 자신감이 상승하였으며 두 군 간의 유의한 차이는 없었다. 결 론: 전공의 대상의 비교적 짧은 시간의 골강내 주사 이론 및 실습 교육을 통해 교육 후 골강내 주사에 대한 지식 정도와 골강내 주사 수행 시 자신감에서 유의한 교육 효과가 관찰되었다. 중증 소아 환자를 주로 담당하는 소아과 및 응급의학과 전공의들에게 골강내 주사 교육의 기회가 더 많이 주어져야 할 것으로 생각한다.

• 대한임상독성학회지
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• 제11권2호
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• pp.101-105
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• 2013

Purpose: This study was conducted in order to determine the relationship between the number of portable X-rays and the radiation exposure dose for emergency medical service providers working in the emergency department (ED). Methods: A prospective study was conducted from February 15, 2013 to May 15, 2013 in the ED in an urban hospital. Six residents, seven emergency medical technicians (EMT), and 24 nurses were enrolled. They wore a personal radiation dosimeter on their upper chest while working in the ED, and they stayed away from the portable X-ray unit at a distance of at least 1.8 m when the X-ray beam was generated. Results: The total number of portable x-rays was 2089. The average total radiation exposure dose of emergency medical service providers was $0.504{\pm}0.037$ mSv, and it was highest in the EMT group, 0.85(0.58-1.08) mSv. The average of the total number of portable X-rays was highest in the doctor group, 728.5(657.25-809). The relationship between the number of portable X-rays and the radiation exposure dose was not statistically significant(-0.186, p=0.269). Conclusion: Under the condition of staying away from the portable X-ray unit at a distance of least 1.8 m, the relationship between the number of portable X-rays and the radiation exposure dose was not statistically significant.

• Journal of Trauma and Injury
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• 제20권1호
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• pp.6-11
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• 2007

Purpose: Gaining vascular access is difficult and time-consuming in critically ill children, so nowdays, in many countries, intraosseous vascular access is frequently used for rapid vascular access in critically ill children. Its pharmacokinetics is close to that of the peripheral intravenous route, but its infusion flow rate is faster. The purpose of this study was to determine how widely the intraosseous infusion technique was being used in Korean emergency departments. Methods: We telephoned forty-two (42) randomly selected university-affiliated hospitals. We asked physicians if they use the intraosseous infusion technique. Responders were emergency and pediatric residents and emergency faculty. If they responded that they were not using the intraosseous infusion technique, we asked the reason. Also, we asked about their experiences with the intraosseous infusion technique. Results: Forty-two (42) hospitals were enrolled in this study. No hospital used the intraosseous infusion technique on a regular basis. However, 8 hospitals used the intraosseous infusion technique occasionally. None of the responders had experience with the intraosseous infusion technique. Conclusion: The intraosseous infusion technique is currently underrepresented at emergency departments in Korea.

• 대한응급의학회지
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• 제29권5호
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• pp.529-550
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• 2018

Objective: This study investigated the most common errors on death certificates written by resident trainees of the emergency department and evaluated the effects of education on how to write a death certificate. Methods: A casebook of 31 deaths was prepared based on actual death cases in the emergency room in 2016. Ten residents completed 31 death certificates for the death casebook without any prior notice and then received education on 'How to write the death certificate.' They completed the death certificates again for the same casebook after receiving the education and the number of errors on all death certificates was again determined and divided into major and minor errors. The average number of error types was compared before and after the education. Results: Major errors occurred in 55% of all death certificates, but decreased to 32% after education. Minor errors decreased from 81% before education to 54% after education. The most common major error was 'unacceptable cause of death' (mean${\pm}$standard deviation [SD], $10.2{\pm}8.2$), and the most common minor error was 'absence of time interval' (mean${\pm}$SD, $24.0{\pm}7.7$), followed by 'absence of other significant conditions' (mean${\pm}$SD, $14.6{\pm}6.1$) before education. Conclusion: Education on 'how to write a death certificate' can help reduce errors on death certificates and improve the quality of death certificates.

• Investigative Magnetic Resonance Imaging
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• 제22권1호
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• pp.10-17
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• 2018

Purpose: To evaluate interpretation errors involving spine MRIs by residents in their second to fourth year of training, classified as minor, intermediate and major discrepancies, as well as the types of commonly discordant lesions with or without clinical significance. Materials and Methods: A staff radiologist evaluated both preliminary and final reports of 582 spine MRIs performed in the emergency room from March 2011 to February 2013, involving (1) the incidence of report discrepancy, classified as minor if there was sufficient description of the main MR findings without ancillary or incidental lesions not influencing the main diagnosis, treatment, or patients' clinical course; intermediate if the correct diagnosis was made with insufficient or inadequate explanation, potentially influencing treatment or clinical course; and major if the discrepancy affected the main diagnosis; and (2) the common causes of discrepancy. We analyzed the differences in the incidence of discrepancy with respect to the training years of residents, age and sex of patients. Results: Interpretation discrepancy occurred in 229 of the 582 cases (229/582, 39.3%), including 146 minor (146/582, 25.1%), 40 intermediate (40/582, 6.9%), and 43 major cases (43/582, 7.4%). The common causes of major discrepancy were: over-diagnosis of fracture (n = 10), missed cord lesion (n = 9), missed signal abnormalities associated with diffuse marrow (n = 5), and failure to provide differential diagnosis of focal abnormal marrow signal intensity (n = 5). No significant difference was found in the incidence of minor, intermediate, and major discrepancies according to the levels of residency, patients' age or sex. Conclusion: A 7.4% rate of major discrepancies was found in preliminary reporting of emergency MRIs of spine interpreted by radiology residents, probably related to a relative lack of clinical experience, indicating the need for additional training, especially involving spine trauma, spinal cord and bone marrow lesions.