Bo Seung Kang

An assessment of the iPad 2 as a CT teleradiology tool using brain CT with subtle intracranial hemorrhage under conventional illumination.

We examined the potential of the iPad 2 as a teleradiologic tool for evaluating brain computed tomography (CT) with subtle hemorrhage in the conventional lighting conditions which are common situations in the remote CT reading. The comparison of the clinician’s performance was undertaken through detecting hemorrhage by the iPad 2 and the clinical liquid crystal display (LCD) monitor. We selected 100 brain CT exams performed for head trauma or headache. Fifty had subtle radiological signs of intracranial hemorrhage (ICH), while the other 50 showed no significant abnormality. Five emergency medicine physicians reviewed these brain CT scans using the iPad 2 and the LCD monitor, scoring the probability of ICH on each exam on a five-point scale. Result showed high sensitivities and specificities in both devices. We generated receiver operating characteristic curves and calculated the average area under the curve of the iPad 2 and the LCD (0.935 and 0.900). Using the iPad 2 and reliable internet connectivity, clinicians can provide remote evaluation of brain CT with subtle hemorrhage under suboptimal viewing condition. Considering the distinct advantages of the iPad 2, the popular out-of-hospital use of mobile CT teleradiology would be anticipated soon.

Nationwide online social networking for cardiovascular care in Korea using Facebook.

To examine the use of online social networking for cardiovascular care using Facebook. All posts and comments in a Facebook group between June 2011 and May 2012 were reviewed, and a survey was conducted. A total of 298 members participated. Of the 277 wall posts, 26.7% were question posts requesting rapid replies, and 50.5% were interesting cases shared with other members. The median response time for the question posts was 16 min (IQR 8-47), which tended to decrease as more members joined the group. Many members (37.4%) accessed the group more than once a day, and more than half (64%) monitored the group posts in real time with automatic notifications of new posts. Most members expressed confidence in the content posted. Facebook enables online social networking between physicians in near-real time and appears to be a useful tool for physicians to share clinical experience and request assistance in decision-making.

Can the new McGrath laryngoscope rival the GlideScope Ranger portable video laryngoscope? A randomized manikin study

PURPOSE We hypothesized that novices would be able to use the McGrath MAC (Aircraft Medical Ltd, Edinburgh, UK) equally as well as the GlideScope Ranger (Verathon, Inc, Bothell, WA) for intubation in regular simulated airways. METHODS We performed a prospective, randomized crossover study of 39 medical students using the McGrath MAC, GlideScope Ranger, and Macintosh in a manikin with 2 normal airways. The primary outcome was the intubation time. Secondary outcomes included the success rates and the overall glottic view of the 3 laryngoscopes. RESULTS The mean intubation times for each attempt with the McGrath MAC were 30.8 ± 16.9 seconds or less and did not differ significantly from those obtained with the GlideScope Ranger or the Macintosh in both airway scenarios (P = .18; P = .49). The mean success rates at each attempt with the McGrath MAC were 82.0% ± 38.8% or more, equal to the Macintosh and the GlideScope Ranger in both scenarios (P = .026; P = .72) except during the first intubation attempt in a normal airway (P = .008). The median grades of the glottic view visible at each intubation attempt with the McGrath Mac were Cormack-Lehane grade 1 (scenario 1: interquartile range, 1-1; scenario 2: interquartile range, 1-2), which was significantly better than the Macintosh laryngoscope in both scenarios. However, the McGrath Mac did not produce a better glottic view than the GlideScope Ranger with either scenario. CONCLUSIONS The intubation performance of novices using the McGrath MAC was equal to their performance using the GlideScope Ranger in regular simulated airways.

Variation of availability and frequency of emergency physician-performed ultrasonography between adult and pediatric patients in the academic emergency department in Korea

Objective This study investigates the availability and frequency of emergency physician-performed ultrasonography (USG) in the emergency department (ED) and the status of USG training programs in emergency medicine residencies in academic EDs in Korea. Methods In spring 2014, a link to a 16-question, multiple-choice, and rating scale web-based survey was e-mailed to all 97 academic ED residency training directors in Korea. Results The response rate was 83.5% (81/97). All respondents had their own USG machines in the ED. In total, 82.7% of respondents reported that emergency physician-performed adult USGs were usually conducted daily, whereas only 23.6% performed pediatric USGs daily. Moreover, 55.5% performed pediatric USG fewer than once a week. 74.1% of respondents had education programs for adult USG in residency training, but only 21.0% had programs for pediatric USG. There was a high association between the presence of education programs and the use of USG in both groups. The faculty members who most commonly participated in teaching ED residents how to perform USG were emergency physicians (67.9%). Only 17.3% of respondents reported that they always supported a quality assurance process. The training directors generally agreed with the advantages in emergency physician-performed USGs. Conclusion The availability of ultrasound machines was high both for adult and pediatric EDs. Nevertheless, the frequency of Emergency physician-performed USG for pediatric patients was low, which was related to the lack of the training programs for treating pediatric patients.

Ultrasound-guided regional anesthesia for the pain management of elderly patients with hip fractures in the emergency department

Objective We examined the pain-relieving effect of ultrasound-guided regional anesthesia performed by emergency physicians on elderly hip fracture patients. Methods This study is a prospective, non-randomized, case-control study. The subjects were patients older than 65 years who visited the emergency department with a hip fracture. After we obtained informed consent, two emergency physicians performed an ultrasound-guided three-in-one femoral block using 20 mL of 0.5% bupivacaine. The pain score was measured just before regional anesthesia, and 0.25, 0.5, 1, 2, 3, and 4 hours after the procedure. Another group of patients was given multiple doses of morphine to control the pain. We compared the change in pain score and the development of adverse reactions between the two groups. Results A total of 47 patients were enrolled in this study, of which 25 were given regional anesthesia. Successful pain control (pain score<4) was significantly higher in the regional anesthesia group (96.0% vs. 40.9%; P<0.001). The decrease in pain score was significantly higher in the regional anesthesia group (7 [interquartile range, 6 to 7] vs. 4 [interquartile range, 3 to 5]; P< 0.001). The only adverse reaction observed was mild nausea in 4 patients (1 out of 25 from the regional anesthesia group and 3 out of 22 from the morphine group). Conclusion Ultrasound-guided regional anesthesia administered by emergency physicians treating elderly hip fracture patients provided faster pain relief and a larger decrease in pain than conventional intravenous injections of morphine.