Uterine rupture in the second trimester is rare, but it is a surgical emergency. Also it results rapid deterioration of patient and high mortality despite of prompt therapy and massive transfusion. Radiologic studies often do not allow definitive diagnosis of it, so clinical judgement is critical for optimizing patient care. We present a case of spontaneous uterine rupture with fetal death in 17 weeks of pregnancy due to placenta percreta with brief review of the literature.
Diagnosis ; Emergencies ; Female ; Fetal Death ; Humans ; Mortality ; Patient Care ; Placenta Accreta ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy* ; Uterine Rupture*

Tetanus is a neurologic disorder, characterized by increased muscle tone and spasms, that is caused by tetanospasmin, a powerful protein toxin elaborated by Clostridium tetani. In the modern society, tetanus is a rare disease, but it has a high mortality on attack and it 's diagnosis depends on the clinical symptoms. The treatment for tetanus is an injection of human tetanus immunoglobulin (HTIG) to neutralize the circulating tetanospasmin, to control breathing, and to provide systemic supportive care. Recently, the 500 unit of HTIG is recommended. We report one case of generalized tetanus that was treated with 500 units of HTIG. The patient was discharged without complications.
Clostridium tetani ; Diagnosis ; Humans* ; Immunoglobulins* ; Mortality ; Nervous System Diseases ; Rare Diseases ; Respiration ; Spasm ; Tetanus*

Superior gluteal artery rupture without pelvic fracture is extremely rare, but the rupture of this vessel is a well-known complication of pelvic fractures. This vessel appears to be at risk at the time of pelvic fracture because of its vulnerable anatomical position in the sacrosciatic notch. The rupture of this vessel causes profound hypotension and compartment syndrome of the gluteal or thigh region. Embolization is the most effective treatment. We report an unusual case of a superior gluteal artery rupture without pelvic fracture in blunt trauma.
Arteries* ; Compartment Syndromes ; Hypotension ; Hypovolemia* ; Rupture* ; Shock* ; Thigh

Hypothermia is not an uncommon condition that emergency physicians meet in their emergency department services. Most cases involve mild hypothermia and are rewarmed well without any complication or sequelae. Hypothermia is well known to be correlated with drug intoxication, such as with alcohol. Since alcohol adds to the suppressive effect on central nervous system due to hypothermia, most intoxicated patients are so deeply drunk that they look comatous. We report the case of a 41-year old male drunk and semi-comatous and who had been left in his car for more than 12 hours on a freezing cold night. He arrived at our emergency department with a body temperature of 27.3degrees C. The patient was warmed with active rewarming, and during the procedure, the patient appeared markedly hypertensive, instead of showing rewarming shock. After initial stabilization the patient was taken for a cerebral CT scan and was found to have a large amount of intracranial hemorrhage. He was treated conservatively in the intensive care unit and was discharged as a hopeless case.
Adult ; Body Temperature ; Central Nervous System ; Cerebral Hemorrhage* ; Emergencies ; Emergency Service, Hospital ; Freezing ; Humans ; Hypothermia* ; Intensive Care Units ; Intracranial Hemorrhages ; Male ; Rewarming ; Shock ; Tomography, X-Ray Computed

Pituitary apoplexy is an acute infarction of the pituitary gland and is a potentially life-threatening condition that may be highly variable in its clinical presentation. As pituitary apoplexy may be fatal in its fulminant state without neurological decompression and corticosteroid, the diagnosis must be made in the emergency department as soon as possible. During its progress, cranial nerves III, IV, V and VI can be compressed. As a result, various degrees of ocular palsy, opthalmoplegia, ptosis, visual field defects, and pupillary defects may be present. However, its diagnosis is very difficult when there are no neurologic symptoms. We report the case of a 58-year-old man presenting to the emergency department with a headache and a febrile sense which had been experienced for 2 days. He had no neurologic symptoms in the initial presentation, but the final diagnosis was pituitary apoplexy. This difficult case is described.
Cranial Nerves ; Decompression ; Diagnosis ; Emergency Service, Hospital ; Headache ; Humans ; Infarction ; Meningitis* ; Middle Aged ; Neurologic Manifestations ; Paralysis ; Pituitary Apoplexy* ; Pituitary Gland ; Visual Fields

The massive pulmonary thromboembolism is serious illness that can lead to death within an hour after its occurrence. The incidence of cardiac arrest caused by massive pulmonary thromboembolism has been known as about 7%. Invasive therapeutic modalities to treat massive pulmonary thromboembolism during cardiac arrest including thoracotomy or cardiopulmonary bypass have been shown little effect. Administration of a thrombolytic agent is an alternative choice of treating massive pulmonary thromboembolism during cardiac arrest. This report describes our experience of cases with massive pulmonary thromboembolism that were treated with administration of a thrombolytic agent during CPR.
Cardiopulmonary Bypass ; Cardiopulmonary Resuscitation* ; Heart Arrest ; Incidence ; Pulmonary Embolism ; Thoracotomy

PURPOSE: Our society is becoming more interested in domestic violence and proper care of those victims is required. This study was designed to develop a model of countermeasure against domestic violence that can be used in emergency department. METHODS: This prospective, clinical study was performed from Dec. 2000 to Aug. 2001 at the emergency department, Ewha Womans University Mokdong Hospital. Fifty-five patients of the 1665 female trauma patients were found to be victims of domestic violence during study period. We investigated the frequency of domestic violence in the patient's past, whether a weapon had been used, whether the assailant was an alcohol abuser, and whether he assaulted the victim in a drunken state or not. We analyzed correlation between these factors and severity injury of the patients. RESULTS: The average ISS of patients was 2.90+/-2.82, and 14 patients(25.8%) were admitted to hospital for treatment. Eighteen victims were reported to the police. Fourteen patients were injured with weapons, and in those cases, ISS and the hospital admission rates were marginallly higher than those not involving weapons(p=0.099). Police report rates in the weapon-using cases were 64.3%(9 people), which was considerably higher than those of nonweapons cases, 22.0%(p=0.007). No significant correlations exsisted between severity of patient's injury and frequency of domestic violence experienced in her past, assailant's alcohol history, and drunken assaulter. CONCLUSION: When weapons were involved, the police report rates were considerably higher. The medical personnel should immediately evaluate the patients's condition and provide a plan for her safety.
Domestic Violence* ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Police ; Prospective Studies ; Weapons

PURPOSE: To find the factors influencing the immediate and late outcome of replantation and revascularization of the digits, we carried out a prospective study from 1998 to 1999 with at least a 1-year followup. Traumatic total and subtotal amputations with inadequate circulation of the digits distal to the metacarpal head were included in the study. METHODS: This study was carried out as a prospective study from 1998 to 1999 with at least a 1- year followup. The relationship between age, sex, extent of injury, type of injury, ischemic time, regular smoking, level of injury, and survival rate were analyzed. There were 234 patients with 155 males (254 digits) and 79 females (129 digits). RESULTS: Successful operation was found in 203 patients (86.3%), 314 digits (82%). Although male patients seemed to have poorer survival rates than female, it should be noted that male patients had more severe injuries than female patients. All patients who were regular cigarette smokers were males. Cigarette smoking has been shown to cause cutaneous vasoconstriction, decrease the digital blood flow, and impair the wound healing. These two reasons might explain the lower survival rate in males than in females. Type of injury significantly affected the survival rate. The survival rate was very low in extensive crushed amputation (11.1% survival rate), followed by degloving (21.1% survival rate) and avulsion (64.7% survival rate) amputation. The level of injury also seemed to determine the survival rate as injury at Zone I (65% survival rate) resulted in a poor survival rate compared to the injury at Zone II, III, or IV (92%, 97.6%, or 90.9% survival rate). Ischemic time longer than 8 hours might lessen the survival rate. CONCLUSION: All patients who had successful replantation and revascularization were satisfied with the results even though they had rather poor hand movement. In single digital replantation, no patients needed reamputation, but all preferred to have their finger replanted than udergo a primary amputation. All could accommodate and adapt their injured digits to their work.
Amputation ; Female ; Fingers ; Follow-Up Studies ; Hand ; Head ; Humans ; Male ; Prospective Studies ; Replantation* ; Smoke ; Smoking ; Survival Rate ; Tobacco Products ; Vasoconstriction ; Wound Healing

PURPOSE: Due to its rapidity and easy accessibility, the fingerstick blood glucometer has been used in almost all hospitals and private clinics, and even by patients themselves. We also have used it even in shock patient care, but shock shows global tissue hypoperfusion, especially in peripheral tissue. The changes of peripheral circulation have an influence on the results for fingerstick glucose. To evaluate the accuracy of the glucometer for patients with poor peripheral perfusion, we designed this study. METHODS: A prospective, nonrandomized comparison group study was done. A hypotensive group and a normotensive group were compared. We obtained three data from each patient: venous blood glucose level (clinicopathologic laboratory), venous blood glucose level (by glucometer) and fingerstick glucose level (by glucometer). RESULTS: We saw a significant difference between the fingerstick glucometer results and the laboratory glucose levels in hypotensive patients: 131.67+/-55.33 mg/dl vs. 1 4 7 . 2 3+/-62.06 mg/dl (paired t-test, p<0.05). There was no significant difference between fingerstick and laboratory glucose in normotensive patients: 101.75+/-20.14 mg/dl vs. 1 0 5 . 6 0+/-21.95 mg/dl (paired t-test, p>0.05). There was no significant difference between the results of venous glucometer and laboratory test in either group: 142.37+/-61.27 mg/dl vs. 147.23+/-62.06 mg/dl (paired t-test, p>0.05) and 102.98+/-17.02 mg/dl vs. 105.60+/-21.95 mg/dl (paired t-test, p>0.05). Although some statistical differences existed between the results, all of the error rates were in an acceptable range (within 15%, accepted by American Diabetes Association consensus). CONCLUSION: These results suggest that the blood glucose level of the glucometer with venous blood is more accurate than that with peripheral blood in patients with poor peripheral circulation.
Blood Glucose* ; Glucose ; Humans ; Patient Care ; Perfusion ; Prospective Studies ; Shock

PURPOSE: Paraquat (1,1-dimethyl-4,4'-bipyridylium chloride) is widely a used non- selective herbicide. In spite of efforts to improve the outcome in patients poisoned with paraquat, the mortality rates still remains high. The purpose of this study is to identify initial stat laboratory parameters which can affect the survival rate of these patients. METHODS: A retrospective analysis by chart review was done on 67 patients who had ingested paraquat and who had presented to the Emergency Medical Center of Chonnam University Hospital from June 1997 to July 2001. RESULTS: The results were as follows: 1) Survivors were significantly younger than the nonsurvivors (38 years vs 44 years, p=0.03). The volume of paraquat ingested by survivors was significantly smaller than that ingested by the deceased (1 mouthful vs 3 mouthfuls, p<0.001). 2) The WBC count and the levels of serum AST, BUN and serum creatinine in the deceased were significantly higher than those in the survivors. The levels of serum potassium and bicarbonate, arterial pH, and base excess in survivors were significantly higher than those in the deceased. 3) A multivariate analysis revealed that serum creatinine, serum potassium, and arterial base excess were associated with the fatality rate. CONCLUSION: Initial stat laboratory parameters including arterial blood gas analysis, renal function test, and serum electrolytes could be used to predict the outcome of patients poisoned with paraquat. However, the development of readily applicable and reliable indices predicting outcome is desired for the future.
Blood Gas Analysis ; Creatinine ; Electrolytes ; Emergencies ; Humans ; Hydrogen-Ion Concentration ; Jeollanam-do ; Mortality ; Mouth ; Multivariate Analysis ; Paraquat* ; Potassium ; Retrospective Studies ; Survival Rate* ; Survivors