BACKGROUND: Assessing and securing airway is the beginning of the treatment for emergency patients. Rapid Sequence Intubation is a technique that uses sedatives and neuromuscular blockers to perform endotracheal intubation. This is a basic technique that all emergency physicians must master. Therefore, we investigated the recent circumstance of Rapid Sequence Intubation in patients at the emergency department. METHODS: Ten-item surveys were mailed to the board certified emergency physicians in the emergency department of 45 hospitals. Among the 45 surveys, 37 surveys were returned. The rate of reply was 82.2%. RESULTS: Throughout the hospital, 35/37 of the endotracheal intubation was performed in the emergency department. Anesthesiologists were not called for endotracheal intubation in 34/37 emergency department, and anesthesiologists were not called for the use of neuromuscular blockers in 36/37 emergency departments. 35 emergency departments used sedatives. The sedatives used were as follows : midazolam(48.6%), diazepam(25.7%), thiopental sodium(22.9%), and ketamine(2.9%). 30 emergency departments used neuromuscular blockers. The neuromuscular blockers used were as fallows : succinylcholine(46.7%), vecuronium(43.3%), and pancuronium(10.0%). The rate of Rapid Sequence Intubation was 33.8%. Various monitoring devices were used during Rapid Sequence Intubation ; cardiac monitors 90.5%, pulse oximeters 80.4%, noninvasive blood pressure monitors 64.9% and ETCO2/ 12.8%. Only 6 of 37 hospitals had the assessment program far endotracheal intubations and 60% was the assessment rate in these hospitals, however, there was no proctocol for the quality assurance assessment. CONCLUSION: Emergency endotracheal intubation was performed independently by the physician of the emergency department. The Rapid Sequence Intubation was effective and had low adverse effect. We recommended that Rapid Sequence Intubation should be used more aggressively in patients. Also, applying these assessment proctocol in patients, we could improve the quality of assurance assessment.
Blood Pressure Monitors ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Hypnotics and Sedatives ; Intubation* ; Intubation, Intratracheal ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Postal Service ; Thiopental

No abstract available.
Humans ; Ulsan*

BACKGROUND: The fire victims are affected not only by bum and trauma but also carbon monoxide(CO) and hypoxia. It may be useful to triage mass casualties of fire field that preestimate the victim's injury sevrrities by experiments of measuring the concentration of CO and oxygen according to time progression. METHOD: We prepared one house of apartment as like usual residental environment. The mesuring of concentrations of CO and oxygen was started from firing. RESULT: 3.8 Min. after firing: CO concentration(0.007%) was reached to the level that can give rise to spontaneous headache. 5 Min.: The concentration of CO was incerased. At this level(0.012%), the victims of fire may be suffered severe headache inspite of mild movement. 5.5 Min.: At this time,0.02% of CO concentration that the victims can't escape by themselves was checked. 6 Min.; 0.08% was measured, almost patients may be unconscious and the symptoms will be more severe at this CO concentration because of hypoxia.6.4 Min.: It was absolutly impossible to be survival at this time due to incresing of CO concentration(0.195%) and decreasing of O2 concentration(5%). CONCLUSION: It is within 5.5 Min. that the patient can escape by themselves, and impossible to be survival more than 6.5 Min. in fire field. Rescuers and EMTs must consider time factor as well as sysmtoms of patients.
Anoxia ; Carbon* ; Fires* ; Headache ; Humans ; Mass Casualty Incidents ; Oxygen ; Time Factors ; Triage ; United Nations

No abstract available.
Esophagitis*

Malignant fibrous histiocytoma (MFH) of the heart is a very rare disease. It is difficult to distinguish from myxoma which is most common benign cardiac tumor. Prognosis of malignant fibrous histiocytoma (MFH) of the heart is known to be fatal despite of medical and surgical treatment in contrast to benign tumors. A primary myxoid malignant fibrous histiocytoma of the left atrium was diagnosed in a 58 years old woman. The mass was removed incompletely by operation. The patient did not receive either chemotherapy or radiotherapy. However, the patient is still alive for more than fifteen months after the initial presentation. We report a case of malignant fi brous histiocytoma (MFH) with reviewing the current references.
Drug Therapy ; Echocardiography ; Female ; Heart Atria ; Heart Neoplasms ; Heart* ; Histiocytoma ; Histiocytoma, Malignant Fibrous* ; Humans ; Middle Aged ; Myxoma ; Prognosis ; Radiotherapy ; Rare Diseases

Mixed tumor of the skin (chondroid syringoma) is a rare benign tumor composed of epithelial elements intermingled with myxoid or cartilagenous stroma which is not separated by basement membrane. It had been believed to originate from the eccrine gland but recently, it was described to be of apocrine gland origin in case of showing apparent apocrine secretion. We report on a 63-year-old man with a tumor on the right upper eyelid showing typical microscopic features of mixed tumor of the skin. Many apocrine decapitation secretions were seen in tubular structures and follicular differentiations were also seen, which represents the common origin of folliculo-sebaceous-apocrine unit.
Adenoma, Pleomorphic ; Apocrine Glands ; Basement Membrane ; Decapitation ; Eccrine Glands ; Eyelids ; Humans ; Middle Aged ; Skin

Blue nevus is a benign melanocytic neoplasm and represents itself usually as a solitary blue or blue-black papule. It rarely occurs as multiple lesions grouped in a circumscribed area. How-ever, non-grouped disseminated blue nevi are exceedingly rare. We report a patient with acquired multiple blue nevi that was distributed over the entire body discretely and showed an increase in the number of the nevi without any causal factors.
Humans ; Nevus ; Nevus, Blue*

Variant angina is characterized by episodic angina due to spasm of an epicardial coronary artery at rest and concomitant transient ST elevation on electrocardiogram. While long-term survival of coronary spasm is usually excellent, but serious complications can be developed such as disabling pain, myocardial infarction, ventricular tachyarrhythmias, atrioventricular block and sudden cardiac death. We experienced 40 year-old man with intractable chest pain due to coronary artery spasm, who suffered from ventricular fibrillation and acute anterior myocardial infarction at the first admission. The patient underwent coronary angiogram, which revealed spontaneous focal spasm at the proximal left anterior descending coronary artery (LAD). He was treated by the combination of nitrate and calcium channel blocker. However, he complained of severe chest pain despite intensive medical therapy and visited emergency room 5 times during 8-month follow-up. We performed ergonovine coronary angiogram and intracoronary ultrasound, which revealed focal spasm at same site of proximal LAD with small amount of localized eccentric atheromatous plaque. Thus we placed coronary artery stent (3.0 x 24 mm GFX stent) at proximal LAD and his symptom was resolved after stenting. We performed follow-up coronary angiogram at 9 months after stenting and stent was patent without any stent recoil and in-stent restenosis.
Adult ; Atrioventricular Block ; Calcium Channels ; Chest Pain ; Coronary Vessels ; Death, Sudden, Cardiac ; Electrocardiography ; Emergency Service, Hospital ; Ergonovine ; Follow-Up Studies ; Humans ; Myocardial Infarction ; Spasm* ; Stents* ; Tachycardia ; Ultrasonography ; Ventricular Fibrillation

BACKGROUND: Reciprocal ST-segment depression in precordial leads is a common finding in acute inferior myocardial infarction. The responsible mechanism and the significance of this finding, however, are still controversial. METHODS: Clinical characteristics, serial eletrocardiograms, angiographic findings of coronary artery and left ventricle were reviewed in 33 patients with acute inferior myocardial infarction. Reciprocal ST-segment depression was defined as ST-segment depression > or =1.0mm in two or more adjacent chest leads, I and aVL in patients with acute inferior myocardial infarction showing ST-segment elevation in II, III, aVF. Coronary angiography and left ventriculography were performed 15,2+/-16.9 hours after arrival. RESULTS: Eleven patients did not have reciprocal ST-segment depression(group A) and 22 patients had reciprocal ST-segment depression(group B). There was no significant difference in the demographic data of the patients except age and peak CK-MB, which were significantly higher in group B than group A. Left anterior descending coronary artery(LAD) stenosis was significantly more frequent in group B than group A(54.5% vs 18.2%, p<0.05). However the distribution of left ventricular regional wall motion abnormality and global ejection fraction showed no difference between two groups. In addition, there was no difference in in-hospital complications. CONCLUSIONS: These results suggest that reciprocal ST-segment depression in acute inferior myocardial infarction can be explained by anterior ischemia due to concomitant LAD stenosis in some cases, but its clinical significance is limited at least in terms of in-hospital complications.
Constriction, Pathologic ; Coronary Angiography ; Coronary Stenosis* ; Coronary Vessels* ; Depression* ; Heart Ventricles ; Humans ; Inferior Wall Myocardial Infarction* ; Ischemia ; Thorax

BACKGROUND: Trimetazidine(Vastinan(R)) is a new antianginal agent of different action mechanism specifically targeted at the metabolic cellular consequences of myocardial ischemia. The clinical efficacy of the Trimetazidine in angina pectoris is still to be defined. METHOD: To determine the antianginal effect of trimetazidine in the treatment of ischemic heart disease, 15 patients with stable angina(12 male, 3 female, mean age : 59.3 years) were studied. In 6 cases as a single agent and in 9 cases as an additive regimen to conventional antianginal medications. Trimetazidine(20mg 3 times daily) was given for 30 days or more to evaluate the clinical effect. Graded exercise tests were carried out before the trial of Trimetazidine and on the 30th day of the treatment period. RESULTS: 1) The number of episodes of anginal attacks decreased from 4.2+/-2.7 to 2.0+/-0.5 a week(p<0.05) after treatment with Trimetazidine. 2) Trimetazidine also significantly increased the duration of total exercise from 12.1+/-4.7 min to 14.5+/-3.3 min(p<0.05), and the time to 1mm ST segment depression from 7.7+/-5.9 min to 11.7+/-5.2 min(p<0.05) on treadmill exercise by modified Bruce protocol. 3) Total workload (METs) and rate pressure double product(heart rate x systolic blood pressure) slightly increased, but the differences were not significant statistically. 4) No serious clinical side effects were observed during the treatment. CONCLUSION: These results suggest that the Trimetazidine is an effective and safe as an antianginal drug in the treatment of stable angina patients as a single agent and as an additive regimen when the patients are refractory to conventional drugs.
Angina Pectoris ; Angina, Stable* ; Depression ; Exercise Test ; Female ; Humans ; Male ; Myocardial Ischemia ; Trimetazidine