Lemierre syndrome is a rare syndrome caused by an acute pharyngitis with secondary septic thrombophlebitis of the internal jugular vein and metastatic infections. Although mortality from Lemierre syndrome is low, it remains a potentially life-threatening disease that requires careful consideration, as its early diagnosis and treatment is essential to prevent metastatic infection. We report a case of a 19-year-old woman who presented with a sore throat and right upper quadrant pain. Abdominal and pelvic computerized tomography (CT) showed acalculous cholecystitis with hepatosplenomegaly. The chest CT showed septic emboli in both lung fields and the neck CT revealed thrombosis in the left internal jugular vein. The patient was treated with antibiotics. After nine days, the chest CT showed a further increase in the size of the septic embolism and the patient was treated with anticoagulants. After 23 days, the size of septic emboli in the lung significantly decreased and the patient was discharged.
Acalculous Cholecystitis ; Anti-Bacterial Agents ; Anticoagulants ; Early Diagnosis ; Embolism ; Female ; Humans ; Jugular Veins ; Lemierre Syndrome ; Lung ; Neck ; Pharyngitis ; Thorax ; Thrombophlebitis ; Thrombosis

PURPOSE: There is a distinct probability of severe complications with stroke unless patients are administered proper treatment at the optimal time. S-100B protein has been reported to be elevated in brain injuries. The current study investigates the efficacy of serum S-100B protein administration during the diagnostic process for patients who have had an acute stroke. METHODS: We prospectively recruited the patients with nonspecific neurological symptoms. Non-specific neurological symptoms were defined as no focal neurological deficits or stroke suspected symptoms with NIHSS score zero. We grouped the patients according to the presence of a brain lesion (positive vs negative group) by computed tomography or magnetic resonance imaging. Using serum S-100B protein together with CT/MRI imaging at the time of diagnosis, the cutoff value, sensitivities, and specificities were calculated in making a diagnosis of acute stroke. RESULTS: Thirty one patients were enrolled. The level of serum S-100B protein was higher in positive group (median 0.201, interquartile range 0.134-0.469) than in negative group (0.085, 0.060-0.106, p=0.001). In diagnosing acute stroke, the sensitivity was 90.9% at a cutoff value for serum S-100B protein of 0.10 microgram/L . At the cutoff level of serum S-100B protein and the specificity was 75.0%. CONCLUSION: The current results suggest that serum S-100B protein may be a useful serologic marker for detecting acute stroke that is suspected with non-specific neurological abnormalities. Further studies are necessary to use the marker as a screening method for acute strokes.
Brain ; Brain Injuries ; Humans ; Magnetic Resonance Imaging ; Mass Screening ; Nerve Growth Factors ; Neurologic Manifestations ; Prospective Studies ; S100 Proteins ; Sensitivity and Specificity ; Serologic Tests ; Staphylococcal Protein A ; Stroke

PURPOSE: Traditional cardiopulmonary resuscitation (CPR) training methods have been gradually replaced by practice-oriented methods such as the American Heart Association (AHA) basic life support (BLS) course for healthcare providers. We attempted to investigate nurses' and other healthcare professionals' retention of BLS skills over time after taking the AHA BLS course for healthcare providers. METHODS: Healthcare providers were screened for their retention of CPR skills at regular intervals up to 1 year after completing the AHA BLS course. Certified BLS instructors administered skills tests. RESULTS: The degree of skills maintained over time decreased, but not significantly (p=0.207, p=0.160). The scores of written tests decreased over time, but not significantly (p=0.082). The degree of CPR knowledge and skills main-tained was higher in the nurse group than in the healthcare professional group; this difference was statistically significant (p=0.02, <0.001, <0.001). However, regarding the degree of knowledge and skills for CPR maintained over time, there was no statistically significant difference between each group. CONCLUSION: After the AHA BLS course for healthcare providers, in-hospital healthcare professionals retain significantly less information after 3 months. We suggest that a skill review is needed within 3 months after CPR training.
American Heart Association ; Cardiopulmonary Resuscitation ; Delivery of Health Care ; Health Personnel ; Hospitals, General ; Humans ; Retention (Psychology)

Hypoglycemia is caused by poor oral intake, excessive exercise, alcohol abuse and inaccurate use of a hypoglycemic agent or insulin in patients that have history of diabetes mellitus (DM), especially in the elderly. Severe hypoglycemia has a variety of different symptoms or signs from focal neurologic deficits to severe coma, or death. It can be difficult to differentiate hypoglycemia-induced symptoms or signs, and stroke or cardiovascular disease in acute setting. Transient hypoglycemic hemiparesis is an infrequent case in the emergency department (ED), which is frequently misdiagnosed for stroke. When patients with decreased mental status or hemiparesis are admitted to the ED, a routine blood sugar test is essential. Hypoglycemic hemiparesis if unrecognized can result in permanent neurological damage. Therefore, it is important to detect hypoglycemia early and treat it appropriately.
Aged ; Alcoholism ; Blood Glucose ; Cardiovascular Diseases ; Coma ; Diabetes Mellitus ; Emergencies ; Humans ; Hypoglycemia ; Insulin ; Neurologic Manifestations ; Paresis ; Stroke

PURPOSE: Purpose: We compared the outcomes of training between the use of voice-advisory manikin (VAM) and instructor-led (IL) courses with respect to the acquisition of initial cardio-pulmonary resuscitation (CPR) skills, as defined by the 2010 resuscitation guidelines. METHODS: This study was a randomized, controlled, blinded, parallel-group trial. We recruited 82 first-year emergency medical technician students and randomly distributed them into two groups: the IL group (n=41) and the VAM group (n=37). In the IL group, participants were trained in “single-rescuer, adult CPR” in accordance with the American Heart Association's Basic Life Support course for healthcare providers. In the VAM group, all subjects received a 20-minute lesson about CPR. After the lesson, each student trained individually with the VAM for 1 hour, receiving real-time feedback. After the training, all subjects were evaluated as they performed basic CPR (30 compressions, 2 ventilations) for 4 minutes. RESULTS: The proportion of participants with a mean compression depth ≥50 mm was 34.1% in the IL group and 27.0% in the VAM group, and the proportion with a mean compression depth ≥40 mm had increased significantly in both groups compared with ≥50 mm (IL group, 82.9%; VAM group, 86.5%). However, no significant differences were detected between the two groups in this regard. The proportion of ventilations of the appropriate volume was relatively low in both groups (IL group, 26.4%; VAM group, 12.5%; p=0.396). CONCLUSION: Both methods the IL training using a practice-while-watching video and the VAM training facilitated initial CPR skill acquisition, especially in terms of correct chest compression.
Adult ; Cardiopulmonary Resuscitation* ; Emergency Medical Technicians ; Health Personnel ; Heart ; Humans ; Manikins* ; Resuscitation ; Thorax ; Ventilation ; Voice*

PURPOSE: Many patients complain of pain due to fracture in the emergency department (ED). However, pain management in these patients has not been performed well. The objective of this study is to describe analgesic utilization and assess factors associated with analgesic use in patients with isolated long-bone fractures during the ED visit. METHODS: We retrospectively reviewed electronic medical records of patients presenting to two EDs with an isolated long bone fracture from January to December 2012. A total of 358 patients were enrolled, and sex, age, arrival route, mechanism of injury, fracture type, fracture location, drug used for pain control, arrival time, physician in charge primary care, and disposition were analyzed. RESULTS: Analgesics were administered to 50% of patients between 20~60 years, whereas 11.3% of patients under 20 years old and 38.7% above 60 years old (p<0.01) received analgesics. Better pain control was achieved in females, young adults, patients cared for by emergency medicine residents, and visits made by emergency medical service or at dawn. CONCLUSION: The pain control rate of children is lower than that of adults in patients with an isolated long bone fracture. Active strategies for pain management are necessary by triage physicians from this time forward.
Adult ; Analgesics* ; Child ; Electronic Health Records ; Emergency Medical Services ; Emergency Medicine ; Emergency Service, Hospital* ; Female ; Fractures, Bone* ; Humans ; Pain Management ; Primary Health Care ; Retrospective Studies ; Triage ; Young Adult

OBJECTIVE: We compared training using a voice advisory manikin (VAM) with an instructor-led (IL) course in terms of acquisition of initial cardiopulmonary resuscitation (CPR) skills, as defined by the 2010 resuscitation guidelines. METHODS: This study was a randomized, controlled, blinded, parallel-group trial. We recruited 82 first-year emergency medical technician students and distributed them randomly into two groups: the IL group (n=41) and the VAM group (n=37). In the IL-group, participants were trained in “single-rescuer, adult CPR” according to the American Heart Association's Basic Life Support course for healthcare providers. In the VAM group, all subjects received a 20-minute lesson about CPR. After the lesson, each student trained individually with the VAM for 1 hour, receiving real-time feedback. After the training, all subjects were evaluated as they performed basic CPR (30 compressions, 2 ventilations) for 4 minutes. RESULTS: The proportion of participants with a mean compression depth ≥50 mm was 34.1% in the IL group and 27.0% in the VAM group, and the proportion with a mean compression depth ≥40 mm had increased significantly in both groups compared with ≥50 mm (IL group, 82.9%; VAM group, 86.5%). However, no significant differences were detected between the groups in this regard. The proportion of ventilations of the appropriate volume was relatively low in both groups (IL group, 26.4%; VAM group, 12.5%; P=0.396). CONCLUSION: Both methods, the IL training using a practice-while-watching video and the VAM training, facilitated initial CPR skill acquisition, especially in terms of correct chest compression.
Adult ; Cardiopulmonary Resuscitation* ; Education ; Emergency Medical Technicians ; Health Personnel ; Heart ; Humans ; Manikins* ; Resuscitation ; Teaching Materials ; Thorax ; Ventilation ; Voice*

OBJECTIVE: To assess whether ultrasonographic examination compared to chest radiography (CXR) is effective for evaluating complications after central venous catheterization. METHODS: We performed a prospective observational study. Immediately after central venous catheter insertion, we asked the radiologic department to perform a portable CXR scan. A junior and senior medical resident each performed ultrasonographic evaluation of the position of the catheter tip and complications such as pneumothorax and pleural effusion (hemothorax). We estimated the time required for ultrasound (US) and CXR. RESULTS: Compared to CXR, US could equivalently identify the catheter tip in the internal jugular or subclavian veins (P=1.000). Compared with CXR, US examinations conducted by junior residents could equivalently evaluate pneumothorax (P=1.000), while US examinations conducted by senior residents could also equivalently evaluate pneumothorax (P=0.557) and pleural effusion (P=0.337). The required time for US was shorter than that for CXR (P < 0.001). CONCLUSION: Compared to CXR, US could equivalently and more quickly identify complications such as pneumothorax or pleural effusion.
Catheterization, Central Venous* ; Catheters* ; Central Venous Catheters* ; Diagnostic Imaging ; Observational Study ; Pleural Effusion ; Pneumothorax ; Prospective Studies ; Radiography ; Subclavian Vein ; Thorax ; Ultrasonography*

PURPOSE: Drowning is a common preventable cause of accidental death. Although many studies about drowning injuries have been conducted, most are related to freshwater drowning. The aim of this study was to analyze the clinical features and prognostic factors in seawater drowning patients. METHODS: This study was performed retrospectively with sea water drowning patients who visited the emergency department at Pusan National University Hospital between January 2005 and December 2009. RESULTS: In total, 51 sea water drowning patients presented at the emergency department with a mean age of 48.65+/-15.40 years. The survival group included 42(82.4%) patients, and the death group was comprised of nine patients(17.6%). Fifteen patients arrested in the field, and cardiopulmonary resuscitation (CPR) was performed. Median immersion time in the death group was 15.0 minutes (range, 9.5~22.5 minutes). Among the death group, five patients had respiratory acidosis and nine showed pulmonary edema on a chest X-ray. Initial sodium level in the survival group was 146.30 mEq/L (range, 142.38~152.60 mEq/L), but the level was normalized with isotonic saline. CONCLUSION: Most drowning injuries occurred at night and in relatively young aged patients. CPR in the field did not result in good outcomes because of the longer immersion time. The death group had respiratory acidosis. Because the survival group did not show significant hypernatremia, isotonic saline as an initial fluid was thought to be appropriate. Drowning injuries occur differently based on geographic and social characteristics; therefore, local characteristics should be considered to establish preventive measures.
Acidosis, Respiratory ; Aged ; Cardiopulmonary Resuscitation ; Drowning ; Emergencies ; Fresh Water ; Humans ; Hypernatremia ; Immersion ; Prognosis ; Pulmonary Edema ; Retrospective Studies ; Seawater ; Sodium ; Thorax

Gastric rupture after cardiopulmonary resuscitation (CPR) is a rare complication. In most cases, it is associated with bystander-provided CPR, bag-mask ventilation, and difficult airway management. To the best of our knowledge, there has been only one previous case report in the literature regarding gastric rupture after CPR via supraglottic airway. We present a case of a gastroesophageal junction rupture secondary to CPR with supraglottic airway. Healthcare providers should consider that gastric rupture can be a complication from performing CPR.
Airway Management ; Cardiopulmonary Resuscitation* ; Esophagogastric Junction* ; Health Personnel ; Humans ; Laryngeal Masks ; Pneumoperitoneum* ; Rupture* ; Stomach Rupture ; Ventilation