Wei-Fong Kao

Taipei Medical University | TMU · Department of Emergency Medicine

Background/purpose: To develop a prediction model for emergency medical technicians (EMTs) to identify trauma patients at high risk of deterioration to emergency medical service (EMS)-witnessed traumatic cardiac arrest (TCA) on the scene or en route. Methods: We developed a prediction model using the classical cross-validation method from the Pa...

Background The diagnosis of acute mountain sickness, which lacks a reliable and objective diagnostic tool, still depends on the clinical symptoms and signs and remains a major threat and unpredictable disease affecting millions of mountaineers. Objectives To record electroencephalography signals with small, convenient, wireless equipment and to te...

Background: Iron is a vital trace element for energy production and oxygen transportation; importantly, it is essential to athletic performance. Maintaining iron balance is tightly controlled at systemic and cellular levels. This study aimed to determine serum iron tests, hepcidin levels, and cellular iron import and export activities in periphera...

Although severe, life-threatening high-altitude pulmonary edema (HAPE) is relatively rare, subclinical or very mild HAPE occurs at altitudes of 2500–3000 m.¹ It is important to determine whether teenagers complaining of chest discomfort while they are on mountains have HAPE and quantify of the severity of illness. Unfortunately, there is a paucity...

Prehospital fluid resuscitation with crystalloids in patients following trauma remain controversial. This study aimed to investigate the association between prehospital fluid resuscitation and outcomes of trauma patients in Asia. We conducted a retrospective cohort study of trauma patients between 2016 and 2018 using data from the Pan-Asia Trauma O...

Prehospital spinal immobilization is a widely used procedure in the emergency medical service (EMS) system worldwide, while the incidence of patients with spinal injury (SI) is relatively low, and unnecessary prehospital spinal immobilization is associated with patient complications. This study aimed to determine the association between prehospital...

PurposeThis study examined the association between lapsed time and trauma patients, suggesting that a shorter time to definitive care leads to a better outcome.Methods We used the Pan-Asian Trauma Outcome Study registry to analyze a retrospective cohort of 963 trauma patients who received surgical intervention or transarterial embolization within 2...

Ultra-marathons are typically held over harsh terrains such as mountains, deserts, or other wilderness, and place severe demands on the physical and psychological capabilities of participants. Adventure-race competitors commonly report hallucinations. The goal of this study was to gain insight into visual hallucinations (VHs) during a mountain ultr...

Completing an ultramarathon leads to an immediate postrace surge of erythropoietin (EPO). Patients with chronic liver disease may have high plasma EPO concentrations. This study aims to explore whether plasma EPO concentrations vary between hepatitis B virus carrier (HBVc) and non-HBVc runners during long distance running. Blood samples were collec...

Our study aimed to (i) utilize novel electrical cardiometry and observe acute changes in cardiac biomarkers among 24-h and 48-h ultra-marathoners, and (ii) examine whether alterations in cardiac responses were associated with the average running speed of these participants. Twenty-four 24-h and sixteen 48-h ultra-marathoners were recruited. Electri...

Atrial fibrillation (AF) is the most common arrhythmia. The most common diagnostic method, 12-lead electrocardiogram (ECG), can record episodes of arrhythmia from which the type and severity can be determined. The Heart Spectrum Blood Pressure Monitor (P2; OSTAR Meditech Corp., New Taipei City, Taiwan) is used to measure cardiovascular pressure cha...

Atrial fibrillation (AF) is the most common arrhythmia. The most common diagnostic method, 12-lead ECG, can record episodes of arrhythmia from which the type and severity can be determined. The Heart Spectrum Blood Pressure Monitor (P2, OSTAR Meditech Corp.) is used to measure cardiovascular pressure change, with fast Fourier transform (FFT) analys...

Blood testing for endogenous small metabolites to determine physiological and biochemical states is routine for laboratory analysis. Here we demonstrate that by combining the commercial direct analysis in real time (DART) ion source with an ion trap mass spectrometer, native cholesterol in its free alcohol form is readily detected from a few hundre...

Background: Prolonged endurance exercise is known to cause elevation of cardiac troponin I (cTnI). Previous studies have reported the correlation of several factors with exercise-induced cTnI release. However, the investigation of the predictors for elevated cTnI and postrace kinetics of cTnI after ultramarathon running is lacking, especially in a...

Background: Sports anemia is a widely observed phenomenon after prolonged running. There are various factors that contribute to sports anemia, including hemodilution, exercise-induced oxidative stress, iron deficiency, gastrointestinal bleeding, hematuria, and hemolysis resulting from foot-strike and/or from compression of contracting muscles on ca...

Background: Several changes in physiological characteristics occur during long-distance and 24-hour ultramarathons, including hyponatremia, skeletal muscle breakdown, plasma volume changes, iron depletion, anemia, and possible hepatic damage. The purpose of this study was to investigate the impact of hepatitis B virus (HBV) carrier status on liver...

Background/purpose: The Modified Early Warning Score (MEWS) reflects the physiological changes of cardiac arrest and has been used in identifying patient deterioration. Physiological reserve capacity is an important outcome predictor, but is seldom reported due to recording limitations in cardiac arrest patients. The aim of the study was to evalua...

Objectives: The outcome of patients after OHCA is poor. Return to spontaneous circulation (ROSC) dramatically decreases with the duration of CPR. Extracorporeal membrane oxygenation has been proposed to assist CPR (ECPR) in OHCA. This study was to investigate the effects and characteristics of ECPR for adult non-traumatic (ANT) OHCA versus Non-ECPR...

Background: Ultramarathon is a high endurance exercise associated with a wide range of exercise-related problems, such as acute kidney injury (AKI). Early recognition of individuals at risk of AKI during ultramarathon event is critical for implementing preventative strategies. Objectives: To investigate the impact of speed variability to identif...

Sports anemia is a widely observed phenomenon after prolonged running. There are various factors that contribute to sports anemia, including hemodilution, exercise-induced oxidative stress, iron deficiency, gastrointestinal bleeding, hematuria, and hemolysis resulting from foot-strike and/or from compression of contracting muscles on capillaries. U...

Background: Rescuers that undergo acute ascent without acclimatization can experience acute mountain sickness. Although performing cardiopulmonary resuscitation (CPR) for a short period requires intensive effort at sea level, performing CPR at high altitude is even more exhausting and can endanger the rescuer. Therefore, we conducted a pilot study...

Objective: To evaluate the prevalence and characteristics of acute kidney injury (AKI) in 100-km ultramarathon runners. Design: Prospective observational study. Setting: The 2011 Soochow University ultramarathon, in which each athlete ran for 100 km. Participants: All Taiwanese entrants who participated in the 100-km race and lived in the no...

To examine the effect of ascent rate on the induction of acute mountain sickness (AMS) in young adults during a climb to Jiaming Lake (3350 m) in Taiwan. Prospective, nonrandomized. Climb from 2370 to 3350 m. Young adults (aged 18 to 26 years) (N = 91) chose to participate in either the fast ascent (3 days; n = 43) or slow ascent (4 days; n = 48) g...

The feasibility of a real-time electrocardiogram (ECG) transmission via satellite phone from Mount Everest to determine a climber's suitability for continued ascent was examined. Four Taiwanese climbers were enrolled in the 2009 Mount Everest summit program. Physiological measurements were taken at base camp (5300 m), camp 2 (6400 m), camp 3 (7100...

Objective: The objective of this study is to determine the association between the duration of high-altitude (>3000 m) pre-exposure and acute mountain sickness (AMS) incidence. Methods: A prospective observational study was conducted on 2 random days each month from April 2007 to March 2008 at Paiyun Lodge (3402 m), Jade Mountain, Taiwan. Demogr...

Background: There have been few studies focusing on the incidence and risk factors for elderly patients undergoing computed tomography (CT) scans with intravascular contrast medium, who develop contrast-induced nephropathy (CIN) in the emergency department (ED). Our objective was to investigate the incidence of and risk factors for, CIN in elderly...

Fewer pauses and better chest compression quality are thought to improve overall survival following cardiac arrest. This study aimed to measure the outcomes of adult nontraumatic out-of-hospital cardiac arrests (OHCAs) treated with 5:1 compressions-to-ventilations (Thumper 1007) or continuous chest compressions with ventilation (Thumper 1008 CCV) m...

This study compares the serological markers between runners who are hepatitis B virus carries (HBVc) and runners who are non-HBVc in a 100-km ultra-marathon race. Blood samples of 8 HBVc and 18 non-HBVc runners were drawn 1 week before, immediately following, and 24 h after the race. Samples were analyzed and compared between the 2 groups for liver...

Objective: To evaluate the use of N-acetylcysteine (NAC), a potent antioxidant, to prevent contrast-induced nephropathy (CIN). Methods: We prospectively studied 209 patients (106 in the NAC group and 103 in the control group) who received contrast-enhanced computed tomography (CECT) in the emergency department (ED). The NAC group received intrav...

  The objective was to explore the incidence, predictors, and prognostic significance of emergency department (ED) neurologic deterioration in patients with spontaneous intracerebral hemorrhage (SICH).   This was a retrospective cohort study conducted at the ED, neurocritical care unit, and general intensive care unit of a university-affiliated med...

The objective is to evaluate the diagnosis of foreign body (FB) ingestion and report on the endoscopic management in Taiwan. This retrospective study enrolled 159 adult patients with confirmed diagnosis of upper gastrointestinal FBs who received endoscopic management in the emergency department. The patients' mean age was 57.0 ± 19.2 years, and 66...

Visual disturbances after high-altitude exposure were first reported in 1969. Manifestations may include retinal hemorrhage, papilledema, and vitreous hemorrhage. We observed a group of 6 experienced climbers who ascended Mt Aconcagua to an altitude of 6,962 m in February 2007. Visual acuity study, intraocular pressure study, visual field study, ne...

This study intended to study the effects of altitude in the high-rise building on the automatic nervous modulation in healthy subjects. Heart rate variability (HRV) analysis was performed to assess the automatic nervous modulation of the subjects at three different altitudes in the air-conditioned high-rise building, i.e., the first basement (4 m b...

Acute mountain sickness (AMS) is a pathophysiological symptom complex that occurs in high altitude areas. The AMS prevalence is reportedly 28% on Jade Mountain, the highest mountain (3952 m) in Taiwan. We conducted this study owing to the lack of annual epidemiological data on AMS in Taiwan. Between April 2007 and March 2008, 1066 questionnaires we...

Elderly persons with acute poisoning in the emergency department (ED) and prognostic factors of outcomes have not been well addressed in previous research. This study aimed to investigate the characteristics of elderly patients with acute poisoning visiting the ED, and to identify the possible predictive factors of mortality. Patients aged > or = 6...

One of the oldest Chinese herbal medicine, bajiaolian is widely used in traditional therapy. In Taiwan, bajiaolian is the fifth highest cause of poisoning among herbal medicines. The diagnosis is difficult because physicians are unfamiliar with this medicine's multiple presentations in different stages of intoxication. The records of 4 major poison...

To determine the change and relationship of spectral components of heart rate variability (HRV) measurements in subjects with or without acute mountain sickness (AMS) at both low and high altitude. A prospective study. A 12-day itinerary by trekking to the Namche Bazaar, 3440 m in Nepal. A total of 32 subjects were recruited. The alternations were...

To understand the urination pattern and to determine the relationships between urine output and performance of ultramarathon runners. Prospective observational study. The 2005 Soochow University international ultramarathon, in which each athlete ran for 12 hours. All entrants in the 12-hour race were invited to participate in the study. None. Athle...

Wang, Shih-Hao(1,2) Tai-Yi Hsu,(1,2) Jen-Tse Kuan,(1,2) Jih-Chang Chen,(1,2) Wei-Fong Kao,(3) Te-Fa Chiu,(1,2) Yu-Cheng Chen,(1,2) and Hang-Cheng Chen.(1,2) Medical problems requiring mountain rescues from 1985 to 2007 in Yu-Shan National Park, Taiwan. High Alt. Med Biol. 10:77-82, 2009.-Medical problems requiring mountain rescue in densely populat...

The femoral vein is the most popular location for temporary catheterization during emergency hemodialysis. Common complications are infection, thrombosis, arterial puncture, and groin hematoma. We report herein a patient with femoral vein perforation and prevesical hematoma.

The principal objective of this study was to evaluate serial weight changes in athletes during 12- and 24-hour ultra-marathons and to correlate these changes with athletic performance, namely the distance covered. This was a prospective study. The 2003 Soochow University international ultra-marathon. Fifty-two race participants. 12- or 24-hour ultr...

Bajiaolian (Dysosma pleianthum), a species in the Mayapple family (Podophyllum pelatum), has been widely used as a traditional Chinese herbal medication for the remedies of snake bite, tumor growth, post-partum recovery, and acne. It has also been used in western medicine, especially topically for various skin lesions. Both oral ingestion and derma...

To investigate clinical features and outcomes in patients with acute cholecystitis with gall bladder perforation receiving open cholecystectomy or percutaneous transhepatic gall bladder drainage in the emergency department. From 1996 through 2005, 33 patients with non-traumatic gall bladder perforation, among 585 patients with acute cholecystitis,...

Our objective was to investigate the risk factors and prognostic predictors of unexpected intensive care unit (ICU) admission within 3 days after emergency department (ED) discharge. From January 1, 2001, through December 31, 2005, patients admitted to the ICU unexpectedly within 3 days after being discharged from the ED were enrolled. Medical reco...

The objective of the study was to investigate initial clinical characteristics that can suggest an early diagnosis of patients with acute renal infarction presenting with flank and/or abdominal pain in the emergency department (ED). From January 1, 1996, through December 31, 2005, 20 adult patients with renal infarction diagnosed by contrast-enhanc...

The immediate and long-term impact of severe acute respiratory syndrome (SARS) outbreak on emergency department (ED) visits and hospital expenditures for these visits has not been thoroughly investigated. The objectives of this retrospective observational study investigated the impact of SARS outbreak on ED visits and the cost of these visits in a...

Clinical cases of renal infarction are rarely seen and often either misdiagnosed or initially treated as something else. In most circumstances, renal infarctions are discovered accidentally, not due to a consideration of the diagnosis. A review of the literature reveals that we ought to search for the entity in patients with risk factors such as at...

Abdominal pain is one of the most common chief complaints of patients presenting to the emergency department and, among the diagnoses of abdominal pain, appendicitis is the most common surgical disorder. Traditionally, the diagnosis of appendicitis is based on well-established clinical criteria combined with physician experience. However, appendici...

The purpose of this study was to determine the initial clinical characteristics of acute mesenteric ischemia and identify variables associated with adverse outcomes in the emergency department (ED). The charts of 124 consecutive patients with surgically and pathologically identified acute mesenteric ischemia from September 1990 to September 2000 we...

The impact of the severe acute respiratory syndrome (SARS) outbreak in 2003 on the emergency department (ED) medical needs of adult patients has not been elucidated. The purpose of this study was to investigate the demographic and clinical characteristics of ED adult patients before, during and after the SARS epidemic in a SARS-dedicated hospital....

To rapidly establish a temporary isolation ward to handle an unexpected sudden outbreak of severe acute respiratory syndrome (SARS) and to evaluate the implementation of exposure control measures by healthcare workers (HCWs) for SARS patients. Rapid creation of 60 relatively negative pressure isolation rooms for 196 suspected SARS patients transfer...

The support systems for the Emergency Medical Services (EMS) at mass gatherings, such as the local marathon or large international baseball games, are underdeveloped. The purposes of this study were to extend well-developed, triage-based, EMS Personal Digital Assistant (PDA) support systems to cover pre-hospital emergency medical services and onsit...

The purpose of this study was to investigate the initial clinical features and subsequent outcomes in patients with adult leukemia with typhlitis or neutropenic enterocolitis. A retrospective review of 10 episodes of neutropenic enterocolitis in nine patients (age range, 21-71 years) with acute leukemia from March 1, 1990, through February 28, 2002...

To examine the efficacy and safety of administration of calcium and magnesium orally and intraperitoneally to treat severe sodium fluoride intoxication. Mice were initially gavaged a lethal dose of sodium fluoride (NaF) or water. Then, mice were treated with water or varying concentrations of calcium chloride (CaCl2) or magnesium sulfate (MgSO4) vi...

Objective: To investigate the incidence of ill or injured persons utilizing emergency medical services (EMS) during long distance foot/races, as well as the planning of EMS in such types of mass gatherings. Materials and Methods: We conducted a prospective study from January through December 2002. We planned the EMS for and participated in 7 mass g...

Percutaneous dilatational tracheostomy has gained popularity, but its superiority to open tracheostomy is unclear. The object of this study was to compare procedure time, complication, safety and cost-effect between the percutaneous dilatational tracheostomy (PDT) and the conventional open tracheotomy (OT). A prospective randomized clinic trial was...

Objective: To describe the demographics of emergency medical care at a summer rock concert in Taipei. Materials and Methods: The medical care for a summer Taipei rock concert festival, which was held in an outdoor stadium in Taipei, was coordinated by emergency physicians of a medical center. About 70,000 attendees participated in the concert over...

Objective: To examine the characteristics of disease patterns in high mountain recreational area, and to investigate the prevalence of high altitude syndrome. Materials and Methods: The study was conducted from November 2000 to June 2001 in three travel spots (Ho-Hwan Mountain-3,050 meters meter, Yu Mountain-2,600 meters, and Tai-Ping Mountain-1,92...

Objective: To explore the current status of emergency medical services (EMS) in high mountain and remote recreational areas, and to help the government establish a well organized EMS in these areas, as well as the main goallowering the resuscitative rate of prehospital cardiac deaths. Materials and Methods: This study was conducted from November 1,...

Although there are more than 200 peaks higher than 3000 m in the Taiwan Alps, no data on the incidence of acute mountain sickness (AMS) are available. This study investigated the incidence of AMS in Jade Mountain climbers. The study was performed at the entrance of Jade Mountain, the highest peak (3952 m) in Taiwan. A standardized form was used to...

Background: Although there are more than 200 peaks higher than 3000 m in the Taiwan Alps, no data on the incidence of acute mountain sickness (AMS) are available. This study investigated the incidence of AMS in Jade Mountain climbers. Methods: The study was performed at the entrance of Jade Mountain, the highest peak (3952 m) in Taiwan. A standardi...

For understanding the feasibility of full computerization of an emergency department (ED), we investigated the completion rate performed by doctors, nurses, or registration clerks since the implementation of full computerization in our ED. We evaluated the changing style of chart-recording, from hand-writing pattern to full computer recording, by r...

Objective: To describe the patient characteristics at a marathon at high altitude in Taiwan, and to provide data for planning future events. Materials and Methods: Medical care was provided for 600 runners, about 400 workers and more than ten thousand spectators at the 1999 Lishan Marathon (altitude 1,700 m to 2,600 m), coordinated by the Emergency...

Objective: To understand the characteristics of Emergency Medical Services (EMS) and the performance of prehospital care by Emergency Medical Technicians (EMTs) in Hualien. Patients and Methods: A prospective study was conducted from Jan. 1, 2000 through Dec. 31, 2000. Patients sent to the Emergency Department (ED) of Tzu Chi General Hospital-Huali...