A spontaneous tension hemothorax due to the rupture of an intercostal artery aneurysm is a rare complication of type I neurofibromatosis. Until now, around 23 cases have been reported. The patient reported here presented with a spontaneous tension hemothorax. At the emergency department, we were faced with a rapidly aggravating hemodynamic compromise after chest tubing. An emergent thoracotomy revealed an actively bleeding huge intercostal artery aneurysm. We intended primarily to repair the bleeding aneurysm, but we failed with because of vascular fragility. Thus we present this case to share our terrible experience to other physicians.
Aneurysm* ; Arteries* ; Emergency Service, Hospital ; Hemodynamics ; Hemorrhage ; Hemothorax* ; Humans ; Neurofibromatoses* ; Rupture* ; Thoracotomy ; Thorax

The spleen is the most frequently injured organ following blunt abdominal trauma. However, delayed splenic rupture is rare. As the technical improvement of computed tomography has proceeded, the diagnosis of splenic injury has become easier than before. However, the diagnosis of delayed splenic rupture could be challenging if the trauma is minor and remote. We present a case of delayed splenic rupture in a patient with underlying liver cirrhosis. A 42-year-old male visited our emergency department with pain in the lower left chest following minor blunt trauma. Initial physical exam and abdominal sonography revealed only liver cirrhosis without traumatic injury. On the sixth day after trauma, he complained of abdominal pain and diarrhea after eating snacks. The patient was misdiagnosed as having acute gastroenteritis until he presented with symptoms of shock. Abdominal sonography and computed tomography revealed the splenic rupture. The patient underwent a splenectomy and then underwent a second operation due to postoperative bleeding 20 hours after the first operation. The patient was discharged uneventfully 30 days after trauma. In the present case, the thrombocytopenia and splenomegaly due to liver cirrhosis are suspected of being risk factors for the development of delayed splenic rupture. The physician should keep in mind the possibility of delayed splenic rupture following blunt abdominal or chest trauma.
Abdominal Injuries ; Abdominal Pain ; Adult ; Diarrhea ; Eating ; Emergencies ; Gastroenteritis ; Hemoperitoneum ; Hemorrhage ; Humans ; Liver ; Liver Cirrhosis ; Male ; Risk Factors ; Shock ; Snacks ; Spleen ; Splenectomy ; Splenic Rupture ; Splenomegaly ; Thorax ; Thrombocytopenia

A thyroid cartilage fracture is a rare entity and can be overlooked easily. Such cases are difficult to diagnose, and assessment and treatment guidelines are difficult to determine. CT of the neck region may be useful when acute airway intervention is not required or when more information regarding the neck's anatomy is required for management decisions. We describe a case of a thyroid cartilage fracture with displacement. In the emergency department (ED), neck CT and fiberoptic nasopharyngoscopy were used to assess the status of the patient's (a male) vocal chords immediately. He remained unable to phonate continuously. After an immediate assessment, we decided to use steroid and conservative therapy. The patient had a good recovery and was without symptoms one month after injury. There is no question that early surgical repair of neck injuries affords the best results for airway and voice patency in most cases however, we suspect that surgical repair is not needed in all cases. Early recognition and an accurate therapy plan for a thyroid fracture with displacement are essential. Therefore, the emergency physician's immediate and careful decision based on endoscopy and neck CT is important for the patient's long-term recovery.
Displacement (Psychology) ; Emergencies ; Endoscopy ; Humans ; Neck ; Neck Injuries ; Thyroid Cartilage ; Thyroid Gland ; Voice

PURPOSE: Rural emergency medical service (EMS) is inferior to urban EMS. In creating and providing emergency patient care, in rural areas, it is important to consider resources, patient volumes, geography, technology challenges, volunteer and provider issues, medical oversight, polities, education, communications, and financial concerns. In the current environment in Korea, it is necessary to design tailored and self-supporting rural EMS systems. For the development of a self-supporting model for EMS systems in rural areas, we have studied the EMS system in one rural area, Goheung County. METHODS: We obtained data from a health institute center, the Gwangju emergency medical information center, three emergency medical centers, and the fire station in Goheung county. In order to survey resident's perceptions about the local EMS system, we provided a questionnaire to 324 residents in Goheung County in March 2005. The advisory council for the EMS system analyzed problems at each step or component of the EMS service delivery process and suggested a model for self-supporting EMS service in Goheung County. RESULTS: The status of the EMS system in Goheung County is inferior to urban systems. A lack of appropriately trained emergency personnel at every level of care has been identified in this area. It is hard to find public education programs. There are few communication systems available for emergency medical care and there are extended transport times and distance, both for responding to and transporting patients. Resident's perceptions of the EMS system is unfavorable. The advisory council suggested an optimized plan to address the problems of the EMS system in Goheung County. A self-supporting model is suggested by the council. It is necessary to consider residents' participation and to apply available resources in Goheung County. CONCLUSION: An ideal EMS system in Goheung County will be a self-supporting model requiring participation of residents and wise application of available sources. The first consideration in this model is institution of a public education program and recruitment and education of first responders in every village is suggested. The model recommends integration of the EMS communication system to provide quality emergency medical care.
Emergencies ; Emergency Medical Service Communication Systems ; Emergency Medical Services ; Fires ; First Aid ; Geography ; Humans ; Information Centers ; Korea ; Patient Care ; Surveys and Questionnaires ; Rural Health Services

PURPOSE: Therapeutic hypothermia (TH) has been a standard treatment for ventricular fibrillation (VF) cardiac arrest survivors to improve neurological outcomes. However, there is a lack of evidence that TH has a neuroprotective effect to asphyxial cardiac arrest, which is one of the most prevalent causes of sudden death besides VF cardiac arrest. We studied whether TH improves the neurological outcomes after resuscitation from asphyxial cardiac arrest. METHODS: We included asphyxial cardiac arrest survivors from January 2002 to December 2010. Clinical and neurological outcome data of 24 consecutive patients undergoing TH were compared with 18 patients who did not undergo TH (11 historical controls and seven refusal of TH by patient's next-of-kin). Neurological outcome was assessed at discharge according to the Cerebral Performance Category scale. The incidence of complications after asphyxial cardiac arrest was compared between the two groups. RESULTS: Baseline characteristics except arterial pH after recovery of spontaneous circulation were not different between the TH group and the non-hypothermic group. Good neurological outcome was similar between the TH group and the non-hypothermic group (8.3% vs 0.0%, p=0.498). The TH group included 18 hypokalemic patients, while non-hypothermic group included eight hypokalemic patients (p=0.044). The rate of other complication did not differ significantly between the two groups. CONCLUSION: Therapeutic hypothermia was not associated with good neurological outcome in asphyxial cardiac arrest survivors and was not associated significantly with the incidence of complications after asphyxial cardiac arrest. However, the findings are not conclusive because of a lack of patients, lack of randomization, and uncertainty of appropriateness of therapeutic hypothermia method to asphyxial cardiac arrest.
Asphyxia ; Coma ; Death, Sudden ; Disulfiram ; Heart Arrest ; Humans ; Hydrogen-Ion Concentration ; Hypothermia ; Hypothermia, Induced ; Incidence ; Neuroprotective Agents ; Random Allocation ; Resuscitation ; Survivors ; Uncertainty ; Ventricular Fibrillation

PURPOSE: Compared to urban areas, access to emergency medical services in rural areas is relatively restricted both in quality and quantity. However, based on the aged population model, the need for such services is greater in rural areas, due to accidents and underlying disease. We set out to investigate whether education for emergency medical services would be helpful for utilization of poor resources for emergency medical services in rural areas and how efficient it might be. METHODS: Goheung (n=796) and Haenam (n=819), which appeared to be similar in terms of area, population composition, and quality and quantity of emergency medical services, were selected. While one area received Life Helper for the Village, one of the educational programs for emergency medical services, the other did not. A questionnaire containing items on recognition of emergency medical services and roles of the primary responder was administered. RESULTS: Significant differences were observed in the recognition of emergency medical services and safety awareness in Goheung, to which education for emergency medical services was provided. However, we did not find a relationship between injury or accident development and education for the rural emergency medical service system in two areas. CONCLUSION: Thus, provision of education is needed for development of common residents into primary responders in alienated rural and fishing villages, offering them ongoing and repeating education in order to increase their recognition of emergency medical services and safety awareness, and expand such education to areas that are in a similar situation.
Aged ; Emergencies ; Emergency Medical Services ; Emigrants and Immigrants ; Humans ; Surveys and Questionnaires

PURPOSE: Neurological outcome prediction is an important aspect of post-resuscitation care in cardiac arrest survivors. The appearance of high serum neuron specific enolase (NSE) is known to be associated with ischemic brain injury and poor neurological outcome. The application of therapeutic hypothermia to cardiac arrest survivors has been shown to improve neurological outcomes. As such, we investigated the predictive value of serial serum NSE levels in patients who were resuscitated from cardiac arrest. METHODS: This study included 123 cardiac arrest survivors who were treated by therapeutic hypothermia from January 2008 to June 2011. Blood samples used for evaluating NSE were collected at return of spontaneous circulation (ROSC) at 6, 24 and 48 hours after initiation of therapeutic hypothermia. Neurological outcome was graded as 'good' or 'poor' at discharge and assessed according to the Cerebral Performance Category scale (CPC). A poor outcome was defined as a CPC value of 3-5. RESULTS: Receiver operating characteristic (ROC) analysis revealed NSE cut-off values of 53.9 microg/L (sensitivity 14.6%), 48.5 microg/L (sensitivity 30.6%), 80.0 microg/L (sensitivity 40.0%), and 52.7 microg/L (sensitivity 55.5%) for poor outcomes with a specificity of 100%, measured at ROSC of 6, 24 and 48 hours after initiation of therapeutic hypothermia, respectively. The poor outcome group showed significant change in NSE concentration over time (p=0.002), while the good outcome group did not. CONCLUSION: Detection of NSE at the cut-off value, 48 hr after initiation of therapeutic hypothermia was a specific but moderately sensitive marker of poor outcome at discharge. Single measurements of NSE should be cautiously interpreted, but NSE change over time was helpful in predicting the neurologic outcome.
Brain Injuries ; Dinucleoside Phosphates ; Heart Arrest ; Humans ; Hypothermia ; Hypothermia, Induced ; Neurons ; Phosphopyruvate Hydratase ; Prognosis ; ROC Curve ; Sensitivity and Specificity ; Survivors

PURPOSE: Neurological outcome prediction is an important aspect of post-resuscitation care in cardiac arrest survivors. The appearance of high serum neuron specific enolase (NSE) is known to be associated with ischemic brain injury and poor neurological outcome. The application of therapeutic hypothermia to cardiac arrest survivors has been shown to improve neurological outcomes. As such, we investigated the predictive value of serial serum NSE levels in patients who were resuscitated from cardiac arrest. METHODS: This study included 123 cardiac arrest survivors who were treated by therapeutic hypothermia from January 2008 to June 2011. Blood samples used for evaluating NSE were collected at return of spontaneous circulation (ROSC) at 6, 24 and 48 hours after initiation of therapeutic hypothermia. Neurological outcome was graded as 'good' or 'poor' at discharge and assessed according to the Cerebral Performance Category scale (CPC). A poor outcome was defined as a CPC value of 3-5. RESULTS: Receiver operating characteristic (ROC) analysis revealed NSE cut-off values of 53.9 microg/L (sensitivity 14.6%), 48.5 microg/L (sensitivity 30.6%), 80.0 microg/L (sensitivity 40.0%), and 52.7 microg/L (sensitivity 55.5%) for poor outcomes with a specificity of 100%, measured at ROSC of 6, 24 and 48 hours after initiation of therapeutic hypothermia, respectively. The poor outcome group showed significant change in NSE concentration over time (p=0.002), while the good outcome group did not. CONCLUSION: Detection of NSE at the cut-off value, 48 hr after initiation of therapeutic hypothermia was a specific but moderately sensitive marker of poor outcome at discharge. Single measurements of NSE should be cautiously interpreted, but NSE change over time was helpful in predicting the neurologic outcome.
Brain Injuries ; Dinucleoside Phosphates ; Heart Arrest ; Humans ; Hypothermia ; Hypothermia, Induced ; Neurons ; Phosphopyruvate Hydratase ; Prognosis ; ROC Curve ; Sensitivity and Specificity ; Survivors

BACKGROUND: Flood is the most common natural disaster in our country. Lots of victims occurred during the period of flood in the northern territory of Kyoungkido on August 5, 1998. We tried to describe the characteristics of the flood-related injury and illness, management and medical requirements. METHODS: We interviewed the patients admitted to 8 hospitals in Ujungbu and reviewed medical records from aug 5 to Aug 14, 1998. RESULTS: There were total 102 patients, male were 52%and women were 48% Most of patients were between 30's and 60's. Most of them were minor, and less than 3%of them needed critical care. The diagnosis were laceration(39.2%, contusion(22.5%, fracture(13.7%, infectious disease(7.8%, ligament rupture(7.8%, aggravation of chronic illness(5.9%, dermatitis(2.0% and traumatic hyphema(1.0%. The laceration occurred in the foot(37.9%, lower leg(27.0%, thigh(16.2%, hand(10.8% and head(8.1%. The location of ligament injury were achilless tendon(62.5%, hand(25% and knee(12.5%. The 67.5%of flood-related laceration patients progressed cellulitis, especially in sutured wound and a typical tetanic patient was developed. Of hospitalized patients, 2 patients showed evidence of post-traumatic stress disorder(PTSD). CONCLUSION: During flood, civils have better to be educated about prevention of injury, such as wearing of shoes and clothes. Although laceration was minor, lacerated wounds should be thoroughly irrigated, debrided the margin and considered delayed closure, tetanus immunization. Reportedly, there is an increased prevalance of PTSD and depression after disasters. Therefore mental health care will be required in the future.
Cellulitis ; Critical Care ; Depression ; Diagnosis ; Disasters ; Female ; Gyeonggi-do ; Humans ; Immunization ; Lacerations ; Ligaments ; Male ; Medical Records ; Mental Health ; Northern Territory ; Shoes ; Stress Disorders, Post-Traumatic ; Tetanus ; Wounds and Injuries

Calcifying aponeurotic fibroma (CAF) is an uncommon benign tumor and a locally aggressive fibroblastic lesion. It commonly affects the palmar side of the hand and fingers, and the soles of the feet. The typical clinical manifestations are known as a poorly circumscribed, slow-growing, and asymptomatic firm mass. Most CAFs usually reveal low to intermediate or isointensity on T1-weighted images, and strong heterogeneous enhancement. However, various signal intensities on T2-weighted images have been reported depending on the degree of hypocellularity or the amount of calcification or collagen within the tumor. This report provides the radiographic and MRI finding of CAF arising in uncommon site, the knee region, of a 19-year-old male who presented with a painful and palpable mass.
Collagen ; Fibroblasts ; Fibroma* ; Fingers ; Foot ; Hand ; Humans ; Knee* ; Magnetic Resonance Imaging* ; Male ; Young Adult