BACKGROUND AND PURPOSE: The systemic inflammatory response syndrome(SIRS), as defied recently by critical-care specialists, may result from various etiologies including infection, bum, or trauma. The purpose of this study was to determine whether TNF- alpha is associated with the development of systemic inflammatory response syndrome caused by multiple trauma. METHODS: The study population consisted of 21 patients with multiple trauma presented emergency department within 2 hours after insult were enrolled in this study Multiple blood samples were serially drawn to measure seam TNF-alpha level on admission, 12 hours, 24 hours, and every day until 5 days after injury. Serum TNF-alpha was measured by ELISA ("Sandwich type"). Blood samples of fifteen volunteers were used as a reference value far serum TNF-alpha. RESULTS: Serum TNF-alpha. levels of SIRS group were persistency elevated above reference value until 3 days after on admission. Peak seam TNF-alpha level at 12 hours after admission was higher in SIRS group than non-SIRS group(p< 0.05). There was no significant correlation between injury severity score and TNF-alpha levels on regression analysis, all patients with ISS higher than 16 had SIRS. No one had SIRS among patients with ISS less than 16. CONCLUSION: the result of this study suggests that persistent elevation of TNF-alpha and degree of injury severity are associated with the development of systemic inflammatory response syndrome in multiple trauma.
Emergency Service, Hospital ; Enzyme-Linked Immunosorbent Assay ; Humans ; Injury Severity Score ; Multiple Trauma* ; Reference Values ; Specialization ; Systemic Inflammatory Response Syndrome* ; Tumor Necrosis Factor-alpha* ; Volunteers

No abstract available.
Antibody Formation* ; Child* ; Diploidy* ; Humans* ; Immunization* ; Measles ; Measles-Mumps-Rubella Vaccine* ; Mumps ; Rubella ; Vaccination

Spontaneous cervical epidural hematoma (SCEH) is a rare condition that causes paraparesis or quadriparesis. As spontaneous resolution is seldom expected, it usually requires surgical treatment for relieve symptoms. Even if spontaneous resolution occurs, relief from symptoms usually requires several hours to days. In contrast, hemiparesis is the most common symptom of a transient ischemic attack (TIA), and usually resolves over minutes to hours. We report here two patients with SCEH who presented with hemiparesis with severe neck pain. Both patients were taking antiplatelet drugs. Their neurological symptoms recovered spontaneously over a very short time. They were initially misdiagnosed as TIA. These cases show that patients with transient hemiparesis may have SCEH if there is severe neck pain and no cranial nerve involvement.

BACKGROUND: Current guidelines of advanced trauma life support recommend open thoracotomy when pericardiocentesis reveals bloody pericardial effusion in patients with blunt chest trauma. However, open thoracotomy may not be always required for treating patients alive until arriving emergency department, because rapid accumulation of the blood into pericardial space results in immediate death at scene. We report our experiences of treating traumatic pericardial effusion, and discuss the therapeutic modality in patients with traumatic pericardial effusion. METHODS: The study consisted of 37 patients(20 males and 17 females with the mean age 42) sustaining traumatic pericardial effusion. The patients were divided according to treatment modality into 3 groups(group I : patients receiving conservative management, group II : patients treated with pericardiocentesis, group III : patients required emergency thoracotomy). We compared clinical presentations, hemodynamic profiles and echocardiographic findings among three groups. RESULTS: Cardiac tamponade was present in 14 of 37 patients. Pericardiocentesis was performed in 13 patients, and open thoracotomy in 4 patients. Pericardiocentesis was curative in 9 patients. Thoracotomy was performed in only 3(24%) of 13 patients required pericardiocentesis. 3(75%) of 4 patients having moderate or severe pericardial effusion from penetrating injury were required open thoracotomy. CONCLUSION: In selected patients who have traumatic pericardial effusion by blunt chest injury, pericardiocentesis may be curative, and thoracotomy may not be inquired as long as bleeding via indwelling pericardial catheter is not sustained after pericardiocentesis.
Advanced Trauma Life Support Care ; Cardiac Tamponade ; Catheters ; Echocardiography ; Emergencies ; Emergency Service, Hospital ; Female ; Hemodynamics ; Hemorrhage ; Humans ; Male ; Pericardial Effusion* ; Pericardiocentesis ; Thoracic Injuries ; Thoracotomy ; Thorax

BACKGROUND: Organophosphate insecticides poisoning is one of the most common toxicologic emergencies in Korea. There have been few reports of organophosphate intoxication via parenteral route, although many reports on organophosphate intoxication by oral ingestion were present in the literature. This study aimed to validate the clinical characteristics of organophosphage intoxication according to the route of administration to the body. METHOD: Data were collected retrospectively by the review of the medical records from 49 patients with organophosphate intoxication. Severity of intoxication was classified by the Namba's Classification. Collected data were analysed and compared on the clinical features and laboratory findings between the patient intoxicated by inhalation or contact(parenteral group, n=23) and the other oral ingestion(enteral group, n=26). RESULTS: Severity class by clinical features was higher in enteral group than parenteral group. Severity class by serum cholinestetrase level was not positively correlated with severity class by clinical manifestations. Cholinesterase level tended to overestimate the severity of intoxication in parenteral group. Ventilator therapy and admission to intensive care unit were more frequently needed in enteral group than parenteral group in case that the severity class by clinical features was equal. CONCLUSION: In patients with organophosphate intoxication by parenteral route, serum cholinesterase level of the patient had disparity with clinical severity of intoxication. Considering this disparity, clinical severity should be considered as a more important indicator for treatment of organophosphate intoxication including atropinization, rather than serum cholinesterase level in patients intoxicated by parenteral route.
Cholinesterases* ; Classification ; Eating ; Emergencies ; Humans ; Inhalation ; Insecticides* ; Intensive Care Units ; Korea ; Medical Records ; Plasma* ; Poisoning ; Retrospective Studies ; Ventilators, Mechanical

BACKGROUND: Septic shock is characterized by an abnormal vascular tone that has been related to various factors. Myocardial depression can also occur in septic shock. Various experimental studies have indicated that the myocardial depression could be present early in the course of septic shock. This study aimed to assess hemodynamic characteristics according to outcome of septic shock in emergency department. METHOD: The study population comprised 20 patients admitted to our emergency department for septic shock. All patients with septic shock(prolonged hypotension, signs of tissue hypoperfusion, signs of sepsis, suspected source of infection, or documented bacteremia) had conventional serial hemodynamic evaluations in emergency department to identify early hemodynamic variables that predicted outcome. All patients were monitored with a pulmonary artery catheter and an arterial catheter. Hemodynamic measurements and oxygen profile were obtained. RESULTS: There were 9(53%) survivors and 8(47%) nonsurvivors. There were no significant differences in systolic pressure, pulse rate, mean pulmonary artery pressure, pulmonary capillary wedge pressure, systemic vascular resistance index, and pulmonary vascular resistance index between survivors and nonsurvivors at initial hemodynamic value. However, significant differences were found in cardiac index(4.3+/-0.5 vs. 2.74+/-0.7 L/min/m2), stroke volume index(44+/-10 vs. 23+/-5 ml/beat/m2), left ventricular stroke work index(39+/-11 vs. 15+/-6 gm m/m2), and right ventricular stroke work index(8.1+/-3.0 vs. 5.2+/-2.9 gm m/m2) between survivors and nonsurvivors at initial hemodynamic value. CONCLUSION: Survivors had better myocardial function than nonsurvivors during the early phase of septic shock. This results suggest that myocardial depression during septic shock develops in the early course of septic shock, which is associated with outcome.
Blood Pressure ; Catheters ; Depression ; Emergencies* ; Emergency Service, Hospital* ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Oxygen ; Prognosis* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Sepsis ; Shock, Septic* ; Stroke ; Stroke Volume ; Survivors ; Vascular Resistance

BACKGROUND: M protein, as a marker for monoclonal gammopathy, has been evaluated by protein electrophoresis (PEP) and immunofixation electrophoresis (IFE). Recently a highly sensitive, automated immunonephelometric assay for measurement of free light chains (FLCs) in serum and urine has been developed for the identification and monitoring of patients with monoclonal gammopathy. METHODS: We measured the concentration of kappa and lambda FLCs in 120 healthy individuals aged 20 to 80 years to establish the reference range of kappa and lambda FLCs and kappa/lambda FLC ratio and in 61 serum and 14 urine samples from patients with multiple myeloma (MM) to examine the correlation between the amount of M protein indirectly calculated on PEP and the direct measurement of FLCs. RESULTS: The concentrations of kappa and lambda FLCs and the kappa/lambda FLC ratio in healthy individuals were not significantly related to age or sex. The 95 percentile reference ranges for kappa FLC, lambda FLC, and kappa/lambda FLC ratio were 8.5-23.7 mg/L, 9.5-23.5 mg/L, and 0.67-1.38, respectively. On the PEP performed with MM specimens, 18 cases did not show the evidence of M protein. But, they revealed abnormal FLC concentrations on FLC assay and a significant correlation was found between the amount of M protein and the concentration of kappa and lambda FLC. However, inconsistent results such as the concentra-tion of kappa+lambda FLCs being more than the total protein in urine or M protein in serum were found in 5 of the 14 urine and 1 of the 61 serum samples of MM patients. CONCLUSIONS: FLC assay showed a good correlation with PEP and was more sensitive and accurate than PEP. Therefore, FLC assay is useful for diagnosing and monitoring monoclonal gammopathy at an early stage of the disease and during a remission state after chemotherapy or peripheral blood stem cell transplantation.
Drug Therapy ; Electrophoresis ; Humans ; Multiple Myeloma* ; Paraproteinemias ; Peripheral Blood Stem Cell Transplantation ; Reference Values*

PURPOSE: In this study, we created a questionnaire and collected answers concerning actual conditions of vaccination and parents' knowledge of vaccination issues, in order to find false knowledge of patients. We tried to give correct information and suggested the role of the pediatrician. METHODS: We made questionnaires and collected answers from 466 parents from March 2004 to June 2004. RESULTS: Places of vaccination were pediatric clinics(49.4 percent), health centers(27.7 percent), general/university hospitals(15.0 percent) and other clinics(4.9 percent). We found 38.8 percent of parents thought that the reason for vaccination at pediatric clinics was a belief of speciality, even though there is no difference in the vaccination itself. We also found 15.0 percent of parents thought that there were no differences between pediatricians and other physicians, but 52.0 percent of parents wanted to receive vaccination at pediatric clinics in the future. Our study also found that 62.4 percent of parents wanted to make out a preliminary questionnaire for vaccination. Many parents got vaccination information from vaccination record books(57.9 percent), and 52.6 percent of parents incorrectly believed that Hib vaccination could prevent all kinds of meningitis. CONCLUSION: Our study suggests that pediatricians need to make efforts to give out correct information. It is necessary to use preliminary questionnaires for vaccination and correct vaccination information should be written on the vaccination record book. Also, there needs to be counselling with parents about weaning, growth and development at the time of vaccination, and to point out the differences between pediatricians and other physicians.
Growth and Development ; Haemophilus influenzae type b ; Humans ; Meningitis ; Parents* ; Surveys and Questionnaires ; Vaccination* ; Weaning

BACKGROUND: Ski injuries depend on many factors which involve the skier's skill, the skiing environment, and skier's equipment. The purpose of this study was to determine the factors associated with fractures by skiing accident. SUBJECT: We evaluated 566 patients with ski injuries who visited to the emergency post located in the YongPyong Ski Resorts from Nov. 1996 to Feb. 1997. Among the patients,379 patients had no fracture(group I) and 187 patients had fracture(group II). RESULT: There was no differences in mean age and sex ratio between two groups. Fractures of the lower extremities were more common than the upper extremities. Slipping was the most common injury mechanism. arming-up was done in 40% of group I and in 17% of group II. The fracture injuries were more common in the skier with intermediate(45%) skill than the beginner(29%) and the ones with advanced skill(12%). The slope with intermediate difficulty was the most frequent site of fracture accidents. The fracture group tended to choose the slope beyond their skiing ability. CONCLUSION: Our results suggest that fracture during skiing can be prevented if skiers do warming-up prior to skiing and choose slope appropriate to their skiing skill.
Emergencies ; Health Resorts ; Humans ; Lower Extremity ; Sex Ratio ; Skiing ; Upper Extremity

Transcutaneous cardiac pacing(TCP) is a rapid, safe, noninvasive and easily utilized form of emergency cardiac pacing, with hemodynamically similar to transvenous cardiac pacing. This paper reports the result of transcutaneous pacing in a series of patients in emergency department.32 patients with bradyanhythmia were enrolled during the study period. TCP was successful in 29(91%) patients. No evidence of electrical capture was seen in two patients in asystole and a patient with ventricular escape rhythm. Mean capture threshold was 66 mA. Transvenous pacemaker was inserted in 18(56%) of the 32 patients during transcutaneous cardiac pacing. Twenty(61%) of the 32 patients survived and eventually discharged. Ten patients(31%) were died of uncorrectable underlying disease in spite of successful ECG capture and palpable pulse by TCP. In conclusion, TCP is a reliable, noninvasive method that offers the possibility to initiate pacing within seconds and can be used by any emergency medical staff. In our opinion, it should be considered as the first choice of emergency treatment of hemodynamically unstable bradyarrhythmia.
Bradycardia* ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Emergency Treatment ; Heart Arrest ; Humans ; Medical Staff ; United Nations