No abstract available.
Behavior Therapy* ; Self-Injurious Behavior*

No abstract available.
Fetus* ; Humans ; Pregnancy, Twin*

Heat stroke, a medical emergency, occurs when the body's thermal regulation is upset and unable to dissipate adequate amounts of heat with a rise in body temperature. It is characterized by hyperyrexia, with a core temperature of 40degrees C or more, hot dry skin, and central nervous system disturbance and usually results in rhabdomyolysis and multiorgan failure. Our case, a 43-year-old healthy male, was caused by a marathon, half course, on a sunny day in late summer. He suddenly fell down on the road and was delivered to a nearby hospital, where a seizure developed. He was transfered to our hospital and then displayed Central Nervous System disturbance, hot dry skin, acute liver failure, rhabdomyolysis, anuric acute renal failure, and disseminated intravasculular coagulopathy. He was treated with general supportive care and hemofiltration. Despite the aggressive management, he died of shock on the fifth day after admission.
Acute Kidney Injury ; Adult ; Body Temperature ; Central Nervous System ; Emergencies ; Heat Stroke* ; Hemofiltration ; Hot Temperature* ; Humans ; Liver Failure, Acute ; Male ; Rhabdomyolysis ; Seizures ; Shock ; Skin

BACKGROUND: There was a powerful earthquaken(Richter Scale 7.6) in Tiawan, on Sep. 21, 1999. we supported the organized medical services in that area during 5 days. METHODS: We made the protocol and analyzed the results prospecitively. RESULTS: We took care of a total of 708 patients from sep. 23 to sep. 27. Traumatized patients related to the earthquake were 245(34.6%), and most of them had minor injuries. Two hundred thirty-nine(239, 33.8%) patients visited us for medical disease related to living in a group. There were 29(4.1%) patients who complained of neuropsychiatric problems due to the post-earthquake stress. Because the condition of the patients was so bad, 18(2.5%) were transferred to receive more medical services. CONCLUSION: In disaster area, organized medical services have two different roles, especially in the subacute stage. One is responsibility for real emergency medical care, and the other is medical care of non-emergency patients.
Disasters* ; Earthquakes* ; Emergencies ; Humans ; Taiwan*

Twinkling artifact, described by Rahmouni et al in 1996, appears as a rapidly alternating red and blue color Doppler signal behind certain stationary objects, such as stone. It has been reported mainly association with urinary calculi in only a handful of studies, showing the usefulness in equivocal case on sonography. For better visualization of distal ureter and ureterovesical junction(UVJ) on transabdominal sonography, full bladder technique by oral fluid ingestion has been usually performed at radiology department. However, it is time consuming work-up with some limitation, therefore not appropriate with many cases in busy urban ED. For rapid bladder distension on sonography, some authors suggested effective alternative approach, rapid intravenous hydration, rarely reported in related English literatures. I report a case with UVJ stone confirmed by twinkling artifact and alternative quick bladder filling with transabdominal ultrasonography.
Artifacts ; Eating ; Hand ; Ultrasonography ; Ureter ; Urinary Bladder* ; Urinary Calculi

A 45-year-old, alcoholic liver cirrhosis patient presented to the Emergency Department(ED) with complaint of acute intense pain and weakness in the right lower extremity without trauma; hip flexor grade 3/5, knee extensor 2/5, and others normal. Initially, emergency physician diagnosed radiculopathy due to high lumbar disc herniation; however, plain a radiograph and an MRI of the lumbar spine did not revealed definitive compression of the nerve root. On the second hospital day at emergency department, swelling, tenderness of anterior proximal thigh and right inguinal pain were detected and computerized tomography (CT) of the abdomen was performed, which revealed diffuse swelling of right iliacus muscle with acute hematoma. Despite extravasation of contrast for CT imaging, the patient was managed conservatively because of improved neurologic deficit and coagulation abnormality of liver cirrhosis. An early correct diagnosis of femoral nerve palsy caused by iliacus hematoma in the ED is unlikely because of its rare incidence and it is difficult for complete history taking during physical examination involving some special case of severe pain such as this case.
Abdomen ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Femoral Nerve ; Femoral Neuropathy* ; Hematoma* ; Hip ; Humans ; Incidence ; Knee ; Liver Cirrhosis ; Liver Cirrhosis, Alcoholic ; Lower Extremity ; Magnetic Resonance Imaging ; Middle Aged ; Muscles ; Neurologic Manifestations ; Paralysis ; Physical Examination ; Radiculopathy ; Spine ; Thigh

PURPOSE: With the very wide range of known toxicants, the correct early management of fatal toxic exposure can be delayed. Past epidemiologic data on fatal toxic exposure would be helpful to emergency physician. The aim of this study was to investigate reports of toxicants on fatal toxicology research during the past two decades in Korea, with a focus on emergency symptoms. METHODS: This study analyzed basic information and abstracts of about 200,000 articles from approximately 500 journals between 1980 to 2003, which were retrieved from Medical Research Information Center and Research Information Center for Health and focused on fatal toxicology related to emergency medicine. The search terms used were the names of toxicants and related terms. RESULTS: A total of 88 toxicants were found to be related to research on fatal toxic exposure. The number of articles increased sharply after 1995. Frequently involved toxicants were carbon monoxide (in 93 articles), followed by paraquat (in 84), and organophosphate pesticide (in 37). Original articles exceeded case reports in number for these three most frequent toxicants. Articles on paraquat were more numerous than those on organophosphate pesticide or carbon monoxide especially after the late 1980s. CONCLUSION: The result suggest that over a 24-year-period, carbon monoxide, paraquat, and organophosphate pesticides have been prominent in both the incidence and severity of fatal toxic exposure in Korea, which underscore the need for review of them.
Carbon Monoxide ; Emergencies ; Emergency Medicine ; Incidence ; Information Centers ; Korea* ; Paraquat ; Pesticides ; Poisoning ; Toxicology

No abstract available.
Fetal Macrosomia*

BACKGROUND AND OBJECTIVES: Exophthalmos from Graves' disease can result in visual disturbance and cosmetic deformity. Surgical treatment of this disorder is possible through a transnasal endoscopic approach or transantral approach. We aimed to evaluate the efficacy of the transnasal endoscopic orbital decompression and transantral orbital decompression in the management of dysthyroid orbitopathy. MATERIALS AND METHODS: Transnasal endoscopic orbital decompression or transantral orbital decompression was performed on 25 orbits in 14 patients for treatment of progressive exophthalmos or visual loss. Transantral orbital decompression was performed on seven patients simultaneously. RESULTS: Proptosis was reduced an average of 2.8 mm (range 0.5 to 6 mm) by transnasal endoscopic decompression alone and of 3.5 mm (range 0.5 to 8 mm) by transnasal endoscopic decompression and transantral decompression. In five patients who complained of visual disturbance, visual acuity was improved in three of them, and stationary in two of them postoperatively. Four patients who had no diplopia preoperatively developed diplopia after the decompression. Among them the diplopia was only temporary in three patients and the remaining one was referred to an ophthalmologist for correction of persistent diplopia. CONCLUSION: Orbital decomprerssion can be performed successfully via the transantral and transnasal endoscopic approach without significant complications and external scar.
Cicatrix ; Congenital Abnormalities ; Decompression* ; Diplopia ; Exophthalmos ; Graves Disease ; Humans ; Orbit* ; Visual Acuity

Benign paroxysmal positional vertigo (BPPV) is a commonly presenting problem at the emergency department. Three types have been recognized based on the pathogenesis of BPPV. The first is posterior-canal canalolithiasis, the second is horizontal-canal canalolithiasis, and the last is horizontal-canal cupulolithiasis. With the first two types of BPPV, an otolith-repositioning manuever can be performed quickly at the bedside with rapid results, often providing much satisfaction to both patient and physician. However, in the case of horizontal-canal cupulolithiasis, no established repositioning maneuver existed until recently. In 2000, Jo et al. developed a new repositioning maneuver and reported excellent results. We report a case of BPPV horizontal-canal cupulolithiasis that immediately responded to the maneuver of Jo et al. and strongly recommend use of this repositioning maneuver at the emergency department.
Emergency Service, Hospital ; Humans ; Semicircular Canals* ; Vertigo