During examination of the vocal cords (VC) using transcutaneous laryngeal ultrasonography (TLUSG), 3 sonographic landmarks (namely, false VC [FC], true VC [TC], and arytenoids [AR]) are often seen. However, it remains unclear which landmark provides a more reliable assessment and whether seeing more landmarks improves the diagnostic accuracy and reliability. We evaluated prospectively 245 patients from 2 centers. One assessor from each center performed all TLUSG examinations and their findings were validated by direct laryngoscopy. All 3 sonographic landmarks were routinely visualized whenever possible. The rate of visualization and diagnostic accuracy between the 3 landmarks were compared. Eighteen patients suffered postoperative VC palsy (VCP). Both centers had comparable visualization or assessability rate of ≥ 1 sonographic landmark (94.9 and 95.3%; P = 1.000) and 100% sensitivity on postoperative TLUSG. The rates of FC, TC, and AR visualization were 92.7%, 36.7%, and 89.8%, respectively. The sensitivity, specificity, and diagnostic accuracy and the proportion of true positives, false positives, and true negatives between using 1, 2, landmarks and 3 landmarks were comparable (P > .05). Each sonographic landmark had similar reliability and diagnostic accuracy. Identifying all 3 sonographic landmarks was not mandatory and visualizing normal movement in one of the sonographic landmarks would be sufficient to exclude VCP.

A 46-year-old woman demonstrated refractory Kounis syndrome (KS) after induction of anesthesia. Despite conventional management of anaphylaxis and advanced cardiac life support, her cardiovascular function continued to deteriorate until she had a cardiac arrest, and after extracorporeal membrane oxygenation (ECMO) therapy, electrical cardiac activity reappeared. A large number of patients with KS—“allergic angina syndrome”—has been known to recover well with vasodilators; however, this patient showed antibiotics-induced refractory KS during general anesthesia. Severe bronchospasms with desaturation appeared as initial anaphylactic features; however, these did not respond to conventional treatment for anaphylaxis. Patient’s hemodynamic signs eventually worsened, leading to cardiac arrest despite ephedrine administration and chest compressions. During cardiopulmonary cerebral resuscitation, the central line was secured, and epinephrine, atropine, as well as sodium bicarbonate were administered repeatedly; nevertheless, cardiac arrest was sustained. After initiation of veno-arterial ECMO, atrial fibrillation was observed, which was later converted to sinus tachycardia by electrical cardioversions and amiodarone. Coronary angiography was performed before the patient was admitted to the intensive care unit; there were no indications of an impending cardiac arrest. The patient was discharged uneventfully owing to early use of ECMO despite the emergence of KS symptoms that were initially masked by anesthesia but later worsened abruptly.

Purpose: In February 2024, a nationwide resident walkout in Korea caused a temporary shortage of medical professionals. This study investigated whether the walkout influenced trauma care, with a particular focus on scene-to-door time and patients’ in-hospital course.Methods: Trauma patients transported by emergency medical services between June 1, 2022, and March 31, 2025, were included if trauma team activation occurred upon emergency department arrival. Patients were divided into two groups: group 1 (post–COVID-19 normalization period) and group 2 (post–resident walkout period). The primary outcome was scene-to-door time.Results: A total of 271 patients were analyzed: 117 in group 1 and 154 in group 2. The proportion of patients originating outside the primary service area increased from 16.7% to 31.3%. Intensive care unit admission rates decreased (65.0% vs. 22.1%), while interhospital transfers directly from the emergency department increased (7.7% vs. 18.8%). The median scene-to-door time rose from 28 to 44.5 minutes. Spline regression and locally estimated scatterplot smoothing analyses revealed no consistent temporal trend but showed greater variability during the walkout period. According to the generalized linear model, scene-to-door time was 42% longer during this period.Conclusions: The resident walkout was associated with marked delays in scene-to-door time and shifts in in-hospital patient flow. These findings suggest that even temporary workforce shortages can disrupt both prehospital and in-hospital trauma care, underscoring the importance of response planning and adaptable system operations during workforce disruptions.

The corresponding author of this paper is Keun Won Ryu.