No abstract available.
Angiotensin II* ; Angiotensins* ; Animals ; Hemorrhage* ; Rats*

BACKGROUND: For the rapid sequence induction of general anesthesia, succinylcholne, a depolarizing muscle relaxant, has been used. But succinylcholine has many side effects, so various efforts using nondepolarizing muscle relaxants have been tried. We have tried and observed the effect of a curonium-lidocaine mixture administration. METHODS: 120 patients who were scheduled for elective surgery were randomly assigned in 6 groups (Group I, II, III, IL, IIL, IIIL). For groups I, II and III vecuronium was administered only 0.10 mg/kg, 0.12 mg/kg, and 0.15 mg/kg, respectively. For each member of groups IL, IIL and IIIL, lidocaine 1.5 mg/kg was added to the dose of vecuronium of groupI, II and III. The vecuronium or vecuronium- lidocaine mixture was injected for 15 seconds and then thiopental sodium was injected for 15 seconds. 90 seconds after the administration of the vecuronium or vecuronium-lidocaine mixture, every patient was intubated. Intubation condition scores, TOF responses of the adductor pollicis of the thumb, arrhythmia, heart rates, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were checked and compared. RESULTS: Intubation condition scores were better in groups IL, IIL and IIIL in comparison with groups I, II and III. The TOF responce of the adductor pollicis of the thumb showed a statistically signifiant difference between the lidocaine groups and the nonlidiocaine groups. The time elapsed before the disappearance of TOF was less in the lidocaine groups. Changes of systolic pressure, diastolic pressure, mean arterial blood pressure and heart rate were no difference in the lidocaine groups and the nonlidocaine groups. CONCULUSIONS: The results suggest that administration of a vecuronium-lidocaine mixture administraion improves the intubation condition score during a rapid sequence induction of general anesthesia and shortens the time of the disapprearance of the TOF response.
Anesthesia, General ; Arrhythmias, Cardiac ; Arterial Pressure ; Blood Pressure ; Heart Rate ; Humans ; Intubation ; Lidocaine ; Neuromuscular Blockade* ; Succinylcholine ; Thiopental ; Thumb ; Vecuronium Bromide*

BACKGROUND: For the rapid sequence induction of general anesthesia, succinylcholne, a depolarizing muscle relaxant, has been used. But succinylcholine has many side effects, so various efforts using nondepolarizing muscle relaxants have been tried. We have tried and observed the effect of a curonium-lidocaine mixture administration. METHODS: 120 patients who were scheduled for elective surgery were randomly assigned in 6 groups (Group I, II, III, IL, IIL, IIIL). For groups I, II and III vecuronium was administered only 0.10 mg/kg, 0.12 mg/kg, and 0.15 mg/kg, respectively. For each member of groups IL, IIL and IIIL, lidocaine 1.5 mg/kg was added to the dose of vecuronium of groupI, II and III. The vecuronium or vecuronium- lidocaine mixture was injected for 15 seconds and then thiopental sodium was injected for 15 seconds. 90 seconds after the administration of the vecuronium or vecuronium-lidocaine mixture, every patient was intubated. Intubation condition scores, TOF responses of the adductor pollicis of the thumb, arrhythmia, heart rates, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were checked and compared. RESULTS: Intubation condition scores were better in groups IL, IIL and IIIL in comparison with groups I, II and III. The TOF responce of the adductor pollicis of the thumb showed a statistically signifiant difference between the lidocaine groups and the nonlidiocaine groups. The time elapsed before the disappearance of TOF was less in the lidocaine groups. Changes of systolic pressure, diastolic pressure, mean arterial blood pressure and heart rate were no difference in the lidocaine groups and the nonlidocaine groups. CONCULUSIONS: The results suggest that administration of a vecuronium-lidocaine mixture administraion improves the intubation condition score during a rapid sequence induction of general anesthesia and shortens the time of the disapprearance of the TOF response.
Anesthesia, General ; Arrhythmias, Cardiac ; Arterial Pressure ; Blood Pressure ; Heart Rate ; Humans ; Intubation ; Lidocaine ; Neuromuscular Blockade* ; Succinylcholine ; Thiopental ; Thumb ; Vecuronium Bromide*

Purpose: This report presents a case of repeated toxic conjunctival necrosis caused by amikacin eye drops in a patient with a corneal ulcer induced by Mycobacterium abscessus (M. abscessus).Case summary: During treatment for herpetic keratitis with complaints of conjunctival hyperemia and eye pain in the right eye for 1 month. Slit-lamp microscopy revealed a circular corneal epithelial defect and stromal infiltration of her right eye. Gram staining and culture were performed, and eye drops were prescribed for empirical treatment. The bacterial culture grew M. abscessus. Antibiotic susceptibility tests showed resistance to quinolone. The patient was prescribed amikacin eye drops and the corneal epithelial defects improved. Two weeks later, circular conjunctival epithelial defects and hyperemia were observed on the inferior conjunctiva. Conjunctival necrosis caused by amikacin was suspected. The amikacin eye drops were discontinued and the conjunctival lesion improved. However, the patient’s corneal ulcer recurred. The amikacin eye drops were restarted, but conjunctival toxicity recurred, so she was treated with topical clarithromycin and moxifloxacin. The eye drops were gradually reduced and the lesion healed leaving mild corneal opacity. Conclusions M. abscessus-induced keratitis resistant to quinolone antibiotics requires long-term combined therapy with multiple drugs. Amikacin eye drops should be used carefully as conjunctival toxicity may occur.

Purpose: Stickler syndrome, a hereditary connective tissue disorder characterized by mutations in collagen genes, presents with progressive ophthalmopathy and diverse systemic manifestations. Here, we present three familial cases of Stickler syndrome, emphasizing the importance of early detection through clinical investigations and genetic testing.Case summary: Two generations of a family, a mother and her two daughters, were evaluated for Stickler syndrome. All three exhibited bilateral retinal lattice degeneration, perivascular retinal degeneration, and vitreous liquefaction. The daughters shared characteristic facial features, including a flattened face, broad nasal bridge, and micrognathia. Clinical symptoms and examination findings led to diagnoses of Stickler syndrome. Subsequent genetic testing in five family members confirmed a COL2A1 mutation in the three affected individuals. Conclusions Stickler syndrome carries a high risk of vision loss from ocular complications, necessitating early detection and intervention. In addition, the presence of systemic manifestations, such as musculoskeletal joint disorders, mitral valve prolapse, hearing loss, and cleft palate, emphasizes the importance of prompt detection through appropriate clinical investigations and genetic testing.

PURPOSE: Extracorporeal elimination of drugs is a critical part of managing poisonings, although the indications and optimal method remain a matter of debate. The aim of this study is to report our clinical experiences with continuous renal replacement therapy (CRRT), as performed by emergency room physicians, as method of extracorporeal drug elimination in patients with poisoning. METHODS: This study was a retrospective study of the consecutive patients who underwent CRRT, as performed by an emergency room physician, for acute poisoning. The patient characteristics, the kinds of drugs and the method of extracorporeal elimination were analyzed by reviewing the patients'charts. RESULTS: During eleven months, 26 patients with acute poisoning underwent extracorporeal elimination (2 patients; intermittent hemodialysis, 24 patients; CRRT). The mean time from the decision to performing extracorporeal elimination was 206.0+/-36.8 minutes for intermittent hemodialysis, 62.9+/-8.5 minutes for continuous venoveno-hemodiafiltration (CVVHDF) and 56.6+/-6.8 minutes for charcoal hemoperfusion. For the patients with CRRT, CVVHDF was conducted in 10 patients (3 patients; valproic acid, 2 patients; Lithium, 1 patient; salicylates, 1 patient; methanol) and charcoal hemoperfusion by using CRRT was done in 14 patients (13 patients; paraquat, 1 patient; dapsone). For the 12 patients who required hemodialysis due to severe poisoning, 7 patients underwent CRRT because of their unstable vital signs. CONCLUSION: CRRT was an effective method of extracorporeal drug elimination in patients with acute poisoning, and especially for the cases with unstable vital sign and for those patients who required an early start of extracorporeal elimination according to the characteristics of the drug. (ED note: the writing of the abstract was not clear. Check it carefully.)
Charcoal ; Emergencies ; Hemoperfusion ; Humans ; Lithium ; Paraquat ; Renal Dialysis ; Renal Replacement Therapy ; Retrospective Studies ; Salicylates ; Valproic Acid ; Vital Signs ; Writing

PURPOSE: We aimed to investigate the clinical characteristics and their relationship with the onset age of wheeze in school-age children and adolescents with asthma. METHODS: Three hundred twenty-six patients, aged 6 to 19 years, diagnosed with asthma at 6 hospitals from Seoul, Gyeonggi, Daegu, and Busan were enrolled. They were categorized into 3 groups by the onset age of wheeze: group A, early onset (age <3 years); group B, preschool onset (age 3-6 years); group C, late onset (age > or =6 years). Clinical characteristics including atopic sensitization, family history, combined allergic diseases, severity of asthma, and influence of asthma on daily life were examined. A history of hospitalization for early lower respiratory infection (LRI) and environmental tobacco smoking were studied and lung function tests were also performed. RESULTS: There was no difference in demographics, prevalence of atopy, combined allergic diseases, and family history of allergy between 3 groups. A history of sever LRI in early life was more common in groups A and B compared with group C. Sensitization to Dermatophagoides pteronyssinus was more prevalent in groups A and B than in group C. Forced expiratory flow between 25% to 75% (FEF(25%-75%)) was lower in groups A and B than in group C, and methacholine PC20 (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second) was lowest in group B. Significantly lower FEF(25%-75%) and methacholine PC20 were observed in the patients who had been hospitalized with LRI in early life. CONCLUSION: Our study shows significant difference in lung function and atopic sensitization in relation to the onset age of wheeze in school-age children and adolescents with asthma, and suggests that early LRI might contribute to the development of asthma in early life.
Adolescent* ; Age of Onset* ; Asthma* ; Busan ; Child* ; Daegu ; Demography ; Dermatophagoides pteronyssinus ; Forced Expiratory Volume ; Gyeonggi-do ; Hospitalization ; Humans ; Hypersensitivity ; Lung ; Methacholine Chloride ; Prevalence ; Respiratory Function Tests ; Seoul ; Smoking

PURPOSE: To investigate the educational needs and attitudes of homemakers regarding emergency situations in the home and to compare differences in perceptions about emergency situations according to the general characteristics of homemakers and differences between homemakers and emergency physicians METHODS: Using a written survey of a randomly selected sample, we questioned 69 emergency physicians and 450 homemakers over a 5 month period from November 2008 to March 2009. The survey consisted of 8 medical conditions and 16 injury-related conditions. It contained questions (using a Likert scale) about the need for education about each condition (the higher the score, the greater the need). We also determined homemakers' general characteristics: their age, educational background, number of children, gender of their children, age of their children, the existence of older families, and prior training in the process of resuscitation. RESULTS: A total of 346(77%) homemakers responded. For most conditions, the average scores were higher (greater need) among homemakers than among emergency physicians. There were significant differences between these two groups, especially for seizure, fever, dyspnea, bleeding, contusions (of the head, face, extremities, cervical spine and other areas), wounds (of the head, face, oral cavity and extremities), amputated tissue control, injury to teeth, burns, foreign body ingestion, intoxication, and electrical shock. According to the general characteristics of homemakers, the educational background affected the educational needs for homemakers for dyspnea, and for contusions of the head, face, and cervical spine. CONCLUSION: The need for education regarding emergency conditions in the home are higher in the eyes of homemakers than in the eyes of emergency physicians. General characteristics of homemakers affects educational needs. The subject of educational program about first aid will be chosen according to general characteristics of homemakers. according to general characteristics of homemakers.
Accidents, Home ; Burns ; Child ; Contusions ; Dyspnea ; Eating ; Emergencies ; Extremities ; Eye ; First Aid ; Foreign Bodies ; Head ; Hemorrhage ; Housekeeping ; Humans ; Mouth ; Resuscitation ; Seizures, Febrile ; Shock ; Spine ; Tooth

BACKGROUND: In recent years, there has been increasing interest in the use of capnometry, the noninvasive, continuous measurement of end-tidal carbon dioxide(ETCO2) in expired air during CPR. The purpose of this study is to determine the significance of ETCO2 monitoring according to immediate cause of arrest during CPR as a prognostic indicator of successful resuscitation and survival. METHODS: A prospective, clinical study was performed from May 1997 to December 2000 at the Department of Emergency Medicine, Ewha Womans University Mokdong Hospital. The study included 220 patients(231cases). All patients were immediately connected to a mainstream capnometer sensor between the tube and the bag after endotracheal intubation using an infrared capnometer. RESULTS: The 107 patients(46.3%) with return of spontaneous circulation(ROSC) had higher maximal ETCO2 during CPR than the 113 patients without ROSC(31.0+/-19.4 vs 11.7+/-9.4 mmHg, P=0.000). The ETCO2 was not significantly different in relation to age, initial rhythm, and survival time after ROSC, but there was a significant difference in the immediate cause of arrest in the ROSC group(respiratory arrest: 4 0 . 2+/-23.5 mmHg, P=0.000). In case of cardiac arrest due to trauma, maximal ETCO2 was not significant in the ROSC group compared with the non-ROSC group(18.2+/-16.6 vs 10.8+/-7.5 mmHg, P=0.208). When maximal ETCO2 was less than 10 mmHg, we observed a sensitivity of 94.4% and a specificity of 39.5% in predicting ROSC. There were 6 patients with ROSC even though the maximal ETCO2 was less than 10 mmHg. CONCLUSION: Continuous ETCO2 monitoring during CPR may be noninvasive and valuable predictor of successful resuscitation and survival from cardiac arrest. However, ETCO2 should not be used as a single indicator for either cardiac arrest due to trauma or withdrawal of CPR.
Carbon ; Cardiopulmonary Resuscitation* ; Emergency Medicine ; Female ; Heart Arrest ; Humans ; Intubation, Intratracheal ; Prospective Studies ; Resuscitation* ; Sensitivity and Specificity

PURPOSE: We have evaluated type of medical errors and severity of results in the emergency department (ED). We also analyze the contributory factors of medical errors for the patient's safety and the quality improvement. METHODS: This study the was prospectively performed from May to August 2005. Medical errors that occurred in the ED were reported anonymously by emergency physicians. The type of medical errors and contributory factors were reported. The severity levels of errors were categorized into 5 levels: level 1- life threatening consequences; level 2- potentially life or limbs threatening consequences; level 3- serious failure or delay of diagnosis or treatment; level 4- inappropriate or unnecessary delay or treatment; level 5- no harm. RESULTS: The total number of patients admitted in the ED during the study period was 16,513, and 177 errors (1.5 errors/day) reported in 160 patients (9.7/1,000 patients). The most frequently occurring medical error was order omission (18.0%), but interpretation errors (11.3%) resulted in the most serious consequences (3.6+/-1.2). More than half of medical errors were no harm (51.4%). Educational and environmental (61 errors) factors were the most frequent causes of medical errors. CONCLUSION: Medical errors frequently occur in the ED. Reducing ED errors will require the improvement of ED environments, better communication, and reinforcement of education by supervising faculty members.
Anonyms and Pseudonyms ; Diagnosis ; Education ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Extremities ; Humans ; Medical Errors* ; Prospective Studies ; Quality Improvement