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Biomedical subjects

S C Hu

Publications and source records attributed to S C Hu.

At least 37 records · Page 2Linked to original sources
PubMed1996

EMS characteristics in an Asian Metropolis.

A prospective citywide cohort study was conducted from August 1, 1993, through May 31, 1994 to analyze the epidemiological characteristics of emergency medical services (EMS) in an Asian city. Of 5,459 studied cases, the leading 3 causes were trauma (49.7%), alcohol intoxication (8.6%), and altered mental status (AMS) (6.9%). Half of the studied cases needed no prehospital care and 16.4% needed advanced life support (ALS) care. Traffic accidents accounted for 68% of trauma cases. Of 897 cases requiring ALS care, the two most common causes were AMS and dead on arrival (DOA) (32.1% and 21.2% in medical group, 10.1% and 4.5% in trauma group, respectively). The response time, time on scene, and transportation time were 4.6, 4.3, and 9.4 minutes, respectively. This Oriental EMS system experienced very short prehospital times, many traffic accidents, and extremely few DOA cases. Because few patients required ALS care, an emergency medical technician-based EMS system would probably be able to handle the majority of prehospital patients.

Adolescent↗
PubMed1996

Outcomes in severely ill patients transported without prehospital ALS.

Because of the debate regarding the impact of advanced life support (ALS) care on the outcome of prehospital patients, we monitored the influence of lack of sophisticated prehospital treatment in cases of severe illness arriving by ambulance to the emergency department (ED). A prospective cohort study to examine and compare the outcome of trauma- and nontrauma-induced "ALS-eligible" cases in the setting of no prehospital care was carried out from August 1, 1993 through May 31, 1994. On arriving at the ED, patients meeting the criteria for ALS cases and sent by EMS public prehospital personnel were assessed for subjective and objective status and change in severity by triage nurses as well as being followed up for neurological status until discharged from the hospital. Chi-Square method was used to compare the data between two groups and P < .05 was considered statistically significant. Of 667 studied ALS cases (155 trauma and 512 nontrauma), < 20% had their condition change subjectively and < 10% had their condition change objectively; 68% of medical patients and 60% of trauma cases were discharged from the hospital (neurologically intact). However, subgroup analysis showed that objective measures worsened in transit in nearly 18% of trauma victims, a rate nearly 3 times greater than that of medical cases. Moreover, neurological outcome was particularly poor in trauma cases. These results suggest that ALS care may be valuable for severely ill trauma victims.

Ambulances↗
PubMed1996

Assessment of regional deposition of inhaled particles in human lungs by serial bolus delivery method.

Detailed regional deposition of inhaled particles was investigated in young adults (n = 11) by use of a serial bolus aerosol delivery technique. A small bolus (45 ml half-width) of monodisperse aerosols [1-, 3-, and 5-microns particle diameter (Dp)] was delivered sequentially to a specific volumetric depth of the lung (100-500 ml in 50-ml increments), while the subject inhaled clean air via a laser aerosol photometer (25-ml dead volume) with a constant flow rate (Q = 150, 250, and 500 ml/s) and exhaled with the same Q without a pause to the residual volume. Deposition efficiency (LDE) and deposition fraction in 10 local volumetric regions and total deposition fraction of the lung were obtained. LDE increased monotonically with increasing lung depth for all three Dp. LDE was greater with smaller Q values in all lung regions. Deposition was distributed fairly evenly throughout the lung regions with a tendency for an enhancement in the distal lung regions for Dp = 1 micron. Deposition distribution was highly uneven for Dp = 3 and 5 microns, and the region of the peak deposition shifted toward the proximal regions with increasing Dp. Surface dose was 1-5 times greater in the small airway regions and 2-17 times greater in the large airway regions than in the alveolar regions. The results suggest that local or regional enhancement of deposition occurs in healthy subjects and that the local enhancement can be an important factor in health risk assessment of inhaled particles.

Administration, Inhalation↗
PubMed1996

Seasonal variation in the incidence of peptic ulcer and esophageal variceal bleeding in Taiwan.

BACKGROUND: Seasonal variation of peptic ulcer and peptic ulcer bleeding has been reported in many western countries. To investigate the seasonal variation of peptic ulcer (PU) and esophageal variceal (EV) bleeding in Taiwan, this retrospective study was conducted. METHODS: Seven hundred and forty-six cases of gastric ulcer (GU) bleeding, 777 cases of duodenal ulcer (DU) bleeding and 264 cases of EV bleeding were recruited from January 1, 1991 to December 31, 1992. Patients were sent to the Medical Emergency Room (MER) for hematemesis and/or melena. Upper gastrointestinal (UGI) endoscopic examinations were completed within 24 hours for all patients. RESULTS: Significant seasonal variation was found in the incidence of PU and EV bleeding. PU bleeding was most often seen in March and EV bleeding was most often seen in February. CONCLUSIONS: The possible mechanism for the cyclic change of PU and EV bleeding is unclear, but clearly more manpower is needed during the months of February and March for better management of the increasing number of cases of PU and EV bleeding.

Aged↗
PubMed1996

Analysis of prehospital ALS cases in a rural community.

BACKGROUND: An Emergency Medical Services (EMS) system containing the advanced life support (ALS) and manned with paramedics, is developing in many countries in view of the importance of prehospital ALS skills on ALS eligible patients, although previous studies have only revealed that a meager need for ALS in urban community. The purpose of this study is to understand the real demand of ALS in a rural community, so that a well organized and cost-effective EMS system can be developed in this country. METHODS: An EMS system with a single tiered response configuration, using firefighters to give basic prehospital care, stored in computer with some necessary informations was established in Ilan County. Cases with ALS from January 1993 through December 1994 were retrieved from the computer. The ones truely eligible for ALS were reconfirmed and analized in terms of neurological outcome while discharging from hospital, sex, age, response time, time spent on scene, transportation time, as well as whether the cases were trauma or medically induced. RESULTS: Of 11352 cases collected during 731 study days, 594(5.28%) ALS eligible cases (including 211 DOA and 383 nonDOA) were studied. Of 211 DOA, 103(48%) were caused by trauma. The response time, time spent on scene and transportation time in ALS and DOA cases were 5.5min., 4.7min., 13.6min., and 5.6min., 5.6min., and 15.7min., respectively. Of 211 cases of trauma (55% of total ALS cases), traffic accident accounted for 46%. Altered mental status and chest pain or tightness made of 90% of medical induced ALS cases. Five percent of patients felt worsening of condition during transit. One third of patients seemed to experience a bad outcome. CONCLUSIONS: Based on the characteristics of low demand for ALS services, more than half trauma-induced ALS cases, acceptable response time, short transportation time, extremely few medically-induced DOA cases, and quite a poor outcome in the setting of limited prehospital care, a unique EMS system different from that in the United States or in the urban area is needed in the rural area.

Adult↗
PubMed1995

Rotating residents' impressions of an ED managed by career emergency physicians.

Rotating residents (RRs) were surveyed to determine their impressions of an emergency department (ED) run by career emergency physicians (EPs), in the hope of generating insights into controversies that occur between the ED and other hospital departments. A questionnaire was distributed to RRs at Taipei Veterans General Hospital in September 1993. The questionnaire inquired about basic data, workload, and ED training and teaching, and also asked respondents for their overall evaluation of emergency medicine and EPs. Of 117 questionnaires issued to residents who had rotated in the ED during the previous 5 years, 60 respondents from the departments of internal medicine, family medicine, chest medicine, neurology, and respiratory therapy completed and returned the questionnaires. Ninety percent believed the workload of the ED to be heavy, and 87% considered two to three months to be an appropriate ED training time. Only 40% were willing to extend their ED training time to achieve a more reasonable workload, and 83% considered their ED residency stressful, with too many patients and long working hours cited as the leading sources of stress. Fear of malpractice suits and difficult interaction with patients and patients' families were also cited as stressful factors. All RRs considered ED training important; self-learning and the accumulation of ED experience, as well as the conference on emergency pitfalls, were the two aspects of training most favored, garnering approval by 92% and 80%, respectively. The overall impression of the RRs on emergency medicine and the performance of EPs was favorable.(ABSTRACT TRUNCATED AT 250 WORDS)

Emergency Medicine↗
PubMed1995

The clinical experience of acute cyanide poisoning.

The authors reviewed the clinical manifestations, complications, and the prognosis affected by Lilly Cyanide Antidote in 21 victims of acute cyanide poisoning over a 10-year period. The clinical signs and symptoms in cyanide poisoning are variable. Among 21 cases, loss of consciousness (15), metabolic acidosis (14), and cardiopulmonary failure (9) were the three leading manifestations of cyanide intoxication. Anoxic encephalopathy (6) was not uncommon in the severely intoxicated victims. Diabetes insipidus (1) or clinical signs and symptoms mimicking diabetes insipidus (3) may be an ominous sign to encephalopathy victims. The major cause of fatal cyanide poisoning is the intentional ingestion of cyanide compounds as part of a suicide attempt. Decrease of arteriovenous difference of O2 partial pressure may be a clue for the suspicion of cyanide intoxication. Although the authors cannot show a statistically significant difference (P = .47) for the Lilly cyanide antidote kit in terms of improving the survival rate for victims of cyanide poisoning, the antidote kit was always mandatory in our study in the cases of severely intoxicated victims who survived. Early diagnosis, prompt, intensive therapy with antidote, and supportive care are still the golden rules for the treatment of acute cyanide poisoning, whether in the ED or on the scene.

Acute Disease↗
PubMed1995

Variability in distribution and populations of gap junctions in ferret trachea during postnatal development.

Immunocytochemical probes have been used to characterize gap junction distribution in the postnatal ferret trachea by epifluorescence and by laser scanning confocal and electron microscopy. A battery of antibodies directed against fragments of different connexins localized beta 1- and beta 2-gap junction antigens (connexins 32 and 26, respectively) at the intercellular borders of the superficial epithelium while alpha 1-gap junction antigen (connexin 43) was localized to the loose connective tissues. Gap junction labeling in the superficial epithelium declined in the first weeks of life but persisted in the developing submucosal glands to the weanling stage. Localization of the alpha- and beta-antigens was specific for connective tissues and epithelial layers, respectively. These observations suggest that communication competence is an important component of early development in the mammalian airways.

Aging↗
PubMed1995

[Results of school children with enterobiasis in Tainan city, treated with mebendazole].

There were 2,471 school children suffering from enterobiasis in six primary schools of Tainan city. The infected children in five primary schools, Po-Ai, Yung-Hua, Fu-Hsiao, Pao-Jeng and Hsin-Nan, were treated with one single dosage of 100 mg mebendazole. In Shih-Men primary school, the sixth, the students were given placebos as a control group. Negative conversion rates of infected children were examined after three weeks of chemotherapy and school children in the six primary schools were surveyed for enterobiasis two months after chemotherapy to obtain infection rates. The method of examination was two consecutive-day adhesive cellophane perianal swabs. With the purpose of evaluating the efficiency of treatment, positive reduction rates were used and calculated according to the infection rates of school children gained before and after chemotherapy. Those rates in Pao-Jeng, Fu-Hsiao, Yung-Hua, Po-Ai and Hsin-Nan were 62.1%, 47.8%, 41.8%, 37.1% and 3.3%, respectively, and in Shih-Men 3.9%. Judging the data obtained from each grade or each class of schools showed that the efficacy of chemotherapy in reducing the rate of infection was variable. Hence, one single dose of mebendazole and education on personal hygiene were not sufficient to reduce the prevalence of enterobiasis in primary schools. This was because the cycle of E. vermicularis was relatively short, cutting out the routes of transmission was very difficult, and the factors involved were very complex. Overall, though the positive reduction rate presented in Hsin-Nan primary school showed nearly no success in reducing the infection, the other four schools showed valuable rates. Whether continue a treatment, of about three-months in duration, can inhibit the prevalence of enterobiasis among children in primary schools or not will need further study.

Child↗
PubMed1995

[Three years' experience of emergency medical services in Ilan County].

The Emergency Medical Services (EMS) aims to improve the survival rate of patients who are dead on arrival (DOA) at hospital, particularly those whose coronary artery disease (CAD) has induced sudden death. Based on the low prevalence of CAD-induced sudden death in Taipei city, as well as the differences between urban and rural communities in Taiwan, an understanding of the characteristics of rural areas is necessary in order to establish a well-organized and cost-effective EMS policy in this country. The data were drawn from a computer database which stored prehospitalization information from Ilan County from 1992 through 1994, including age, sex, response time, time spent on the scene, transportation time, service unit, reasons for emergency call and trauma mechanism. In 1096 study days, 20058 cases (18/day) were collected, of which 16560 (15/day; 83.6%) were transported to hospital. Trauma was responsible for the majority (77%) of these cases, followed by chronic diseases (4.0%), trivial matters (2.6%), drunkenness (2.3%), altered mental status (2.3%), suicide attempt (2.2%), and cardiac arrest (1.8%). Among the trauma cases, traffic accidents were the most common cause (84%); motorcycle accidents comprised 65% of trauma cases. The average response time was 6.6 minutes, time spent on the scene was 3.6 minutes, and transportation time was 17.7 minutes. Trauma and non-trauma accounted for half of the DOA cases, with each making up 0.9% of the total cases transported. In conclusion, it is important that the EMS needs of each community are known for a proper system appropriate to that particular area to be developed.

Adolescent↗
PubMed1994

Rhabdomyolysis in diabetic emergencies.

Rhabdomyolysis (RM) is a clinical and laboratory syndrome resulting from leakage of muscle cell contents into plasma. The increased plasma concentration of the substances released such as creatine kinase (CK) permits the clinician to diagnose this syndrome. Non-traumatic RM has occasionally been reported in patients with diabetic decompensation. We encountered about 44 cases of RM in 265 diabetic emergencies (including DKA or hyperosmolar, or both) during the period from 1984-1 to 1990-6, diagnosed based on (1) serum creatine kinase (CK) > 1000 IU/l and (2) the absence of acute myocardial infarction, stroke and end-stage renal disease. On admission, those who presented with RM had significantly higher concentration of blood urine nitrogen (BUN) (83.3 +/- 5.9 vs. 58.8 +/- 2.4 mg/dl, P < 0.05), creatine (4.45 +/- 0.4 vs. 2.97 +/- 0.1 mg/dl, P < 0.05) and serum osmolarity (386.5 +/- 5.2 vs. 351.6 +/- 2.4 mOsm/kg, P < 0.05). The mortality within 1 week of diabetic emergencies (38.5% for DKA, 35.5% for HHNK) was higher in patients with RM than those without RM (9.7% for DKA, 26.7% for HHNK). There was a correlation (r = 0.49, P < 0.05) between the levels of serum creatinine and CK in patients with RM.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Out-of-hospital cardiac arrest in an Oriental metropolitan city.

To investigate the epidemiology of out-of-hospital cardiac arrest in Taipei City, Taiwan, a prospective chart review and follow-up study was conducted by collecting the prehospital cardiac arrest record from 10 designated responsible emergency departments (EDs) from August 1, 1992 through May 31, 1993. Cases with the restoration of spontaneous circulation (ROSC) were followed up until discharged from hospital. The information gathered included age, sex, bystander cardiopulmonary resuscitation, response time (time elapsed from receiving the call to arrival on the scene), advanced cardiac life support (ACLS) time (time elapsed from receiving the call to arrival at the ED), initial cardiac rhythm in the ED, ROSC, survival to discharge from the hospital, underlying disease, past history, personal history, and neurological outcome at discharge. Of 638 out-of-hospital cardiac arrests, 554 (86.7%) were nontraumatic. Response time, ACLS time, ROSC rates, and survival rates were 7.4 minutes, 21.6 minutes, 15.8%, and 1.4%, respectively. In comparing the trauma and nontrauma group, there were significant differences in age, sex, response time, and ACLS time. Between cases of patients who had ROSC and those who died, the data were statistically significant, P = .0143, showing that ACLS time was shorter in the ROSC group (19.5 v 21.9 minutes). In analysis of underlying disease, definite and probable cardiac-origin sudden deaths were found in only 120 patients, which may extend the annual sudden cardiac death rates to be 0.0053%. In conclusion, the low resuscitation and survival rates in this country were because of delayed initiation of both basic life support and ACLS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Longitudinal distribution of ozone absorption in the lung: effects of respiratory flow.

In our previous work, we developed a bolus inhalation apparatus and measured the longitudinal distribution of ozone (O3) uptake in intact human lungs at a quiet respiratory flow of 250 ml/min. The objective of the present study was to determine the effect of alternative respiratory flows between 150 and 1,000 ml/s. Uptake was expressed as the O3 absorbed during a single breath relative to the amount of O3 in the inhaled bolus (lambda). Measurements of lambda were correlated with the penetration volume of the bolus into the respiratory tract (Vp). Vp in the range of 20-70 ml was considered to indicate upper airways (UA), the Vp interval of 70-180 ml was identified as lower conducting airways (CA), and Vp > 180 ml was associated with the respiratory air spaces (RA). During quiet oral breathing at 250 ml/s, lambda increased smoothly as Vp increased, with 50% of the inhaled O3 absorbed in the UAs and the remainder absorbed within the CAs such that no O3 reached the RAs. The effect of increasing the respiratory flow was to shift the lambda-Vp distribution distally such that significantly less O3 was absorbed in the UAs and CAs and some O3 reached the RAs. For example, at 1,000 ml/s, only 10% of the inhaled O3 was absorbed in UAs and 65% was absorbed in the CAs such that 25% reached the RAs.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorption↗
PubMed1994

The role of flumazenil in the management of patients with acute alteration of mental status in the emergency department.

There are a few case reports which suggest that flumazenil can be used as a diagnostic tool in coma of unknown aetiology but no large scale studies have proved its efficacy and cost-effectiveness. Fifty five patients with acute alteration of mental status of unknown aetiology were enrolled prospectively during a time period of one year. Flumazenil was injected intravenously in a regimen of 0.3 mg in the first minute followed by alternate 0.2 mg, 0.3 mg doses every minute until a total dose of 1 mg was given or until the patients responded. Patients were divided into two groups based on their response to flumazenil: Group 1, responders and Group 2, non-responders. The hospital stay was shortened significantly and interventional procedures, such as CT of brain and endotracheal intubation, were rendered unnecessary in several patients in Group 1. The Group 1 patients had a more favourable outcome than that of Group 2. We concluded that flumazenil may serve as a useful tool in diagnosis and management of carefully selected patients with acute alteration of mental status.

Adult↗
PubMed1994

The clinical implication of theophylline intoxication in the Emergency Department.

We reviewed the clinical manifestations of 53 episodes of theophylline intoxication in 50 patients over a one year study period, in order to identify the specific features as they presented to the Emergency Department (ED). There was a trend to an increase in the serum theophylline concentration with increased severity of clinical features, but the difference between the mild and the moderate cases was not statistically significant. The most common symptoms and signs were gastrointestinal complaints, sinus tachycardia, and atrial arrhythmias. Mixed atrial and ventricular arrhythmias, which are rarely mentioned as a specific feature of theophylline intoxication, were found in 16% of our patients and accounted for 29% of the cardiovascular manifestations. Four patients developed rhabdomyolysis, which presumably was secondary to a seizure or profound hypokalaemia. Cases of theophylline intoxication presenting to the ED had higher serum concentrations of theophylline and tended to have more severe toxicity than those patients in the non-ED group. Delayed diagnosis may contribute to the severity of the outcome, since severe cases in the ED were usually suspected to have developed intoxication at some point later in the stay in the ED than at the time of presentation, or after admission to the hospital, thus permitting the occurrence of an additional iatrogenic component to the intoxication. They also complained of symptoms not associated with the theophylline toxicity, which may have diverted the physician's attention from recognizing this concurrent problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Clinical and demographic characteristics of adult emergency patients at the Taipei Veterans General Hospital.

In order to establish a database dealing with the clinical and demographic characteristics of an emergency department (ED) in a large teaching hospital, a prospective chart review study was conducted from April to September 1991. Attendance charts for the medical emergency room (MER) and surgical emergency room (SER) were checked and necessary information was entered in the computer. The information headings were triage classification, registration time, time to be seen, patient disposition, and impression. Of the 7,086 patients tracked in MER and 4,545 in SER, 3.5% vs 1.5% were classified as triage 1; 14.69% vs 9.48%, triage 2; 69.42% vs 79.22%, triage 3; and 12.41% vs 9.79%, triage 4. There were two peak hours (09:00 to 12:00 and 19:00 to 21:00) in MER, and one (16:00 to 17:00) in SER. The driving force behind these peak times was considered. The leading 15 diseases or chief complaints in MER and 20 in SER were described, showing that ED overcrowding was caused by the number of chronic diseases presented in MER. The broad based clinical and demographic characteristics of emergency patients were analyzed. A further study is warranted in order to improve the quality of care of patients visiting this unique ED.

Adult↗
PubMed1994

Noninvasive determination of respiratory ozone absorption: the bolus-response method.

Morphometric studies in animals exposed to ozone (O3), and mathematical simulations of O3 transport in human lungs indicate that O3 toxicity is focal in nature, causing tissue damage that is more pronounced in the proximal alveolar region (the proximal end of the respiratory airspaces in our compartment models) than in other airways. These findings suggest that the internal distribution of O3 uptake must be known in order to assess health risk reliably. In previous work (Ultman and Ben-Jebria 1990), we developed a fast-responding chemiluminescent O3 analyzer and a small-scale O3 generator, both of which are suitable for respiratory measurements. The objective of the current research was to integrate these instruments into a bolus inhalation system capable of noninvasively measuring the longitudinal distribution of O3 absorption in intact human lungs. With this system we aimed to carry out baseline experiments in healthy men during quiet oral breathing at a respiratory flow rate of 250 mL/sec, determine the effect of alternative respiratory flow rates between 150 and 1,000 mL/sec, compare the absorption distribution during quiet oral breathing with that during quiet nasal breathing, and ascertain the influence of a peak inspired concentration between 0.3 and 4.0 parts per million (ppm). Ozone uptake (lambda) was expressed as the amount of O3 absorbed during a single breath relative to the amount in the inhaled bolus. Measurements of lambda were correlated with the penetration volume (VP) of the bolus into the respiratory tract. Values of VP less than 70 mL were considered to be associated with the upper airways, values between 70 and 180 mL were associated with the lower conducting airways, and values greater than 180 mL were associated with the respiratory airspaces. During quiet oral breathing, lambda increased smoothly with VP, with 50% of the inhaled O3 absorbed in the upper airways and the balance absorbed within the lower conducting airways. This compares favorably with the results of direct-sampling methods, which have indicated that 40.4% of continuously inhaled O3 is removed by the extrathoracic airways (Gerrity et al. 1988). The effect of increasing the respiratory flow, which occurs when people exercise, was to shift the lambda-VP distribution distally so that significantly less O3 was absorbed in the upper airways and more reached the respiratory airspaces. Compared with oral breathing, nasal breathing caused a proximal shift in the lambda-VP distribution to the extent that absorption in the upper airways increased from 50% to 80%.(ABSTRACT TRUNCATED AT 400 WORDS)

Absorption↗