PURPOSE: The aim of the study was to compare the clinical characteristics in emergency endotracheal intubation procedures between non-elderly and elderly patients. METHODS: Data for airway registry, which were collected in two emergency departments (ED) between April 2006 and March 2010, were retrospectively reviewed. The airway registry data included patient's demographic information and variables such as Cormack-Lehane grade, 3-3-2 finger analysis, success rate, the number of attempts at intubation, complications of intubation, and clinical outcomes after intubation. RESULTS: A total of 1,457 patients were enrolled. The mean age of the patients was 62.2+/-15.7 and 62.1%(n=905) were male. A total of 726(49.8%) patients were classified as being in the elderly intubation group(> or =65 years). Cormack-Lehane grade, 3-3-2 finger analysis, the relationship between the number of attempts and success rate, the relationship between Cormack-Lehane classification and success rate, complications, and clinical outcomes after intubation showed no significant difference between elderly and non-elderly groups. CONCLUSION: Anatomical structures related to endotracheal intubation, the process and clinical outcomes of elderly patients are not different than for non-elderly adult patients. However, considering the lower physiologic reservoir and higher comorbidities of elderly patients, a more vigorous approach to emergency airway management in the elderly is needed.
Adult ; Aged ; Airway Management ; Comorbidity ; Emergencies ; Emergency Treatment ; Fingers ; Humans ; Intubation ; Intubation, Intratracheal ; Male ; Retrospective Studies

Moyamoya is a chronic cerebrovascular disease characterized by progressive stenosis or occlusion of the terminal parts of both intermal carotid arteries with telangiectatic vascular network of collateral circulation at the base of the brain and leptomeningeal arteries. The etiology and pathophysiology of this disease are still unknown. Although the idiopathic presentattion is the commonest, moyamoya disease has also been reported in several hereditary or acquired clinical conditions including neurofibromatosis, sickle cell anemia, tuberculous meningitis, atherosclerosis, and following radiation therapy to the head. The term moyamoya disease should be reserved for those cases in which the characteristic angiogrphic pattern is idiopathic; moyamoya syndrome is used when the underlying condition is known. We have experienced a case of coexistence of moyamoya syndrome and hereditary spherocytosis in a 6-year-8-month-old girl who presented with right-sided hemiparesis and pallor. A cerebral angiogram revealed occlusion of proximal portion of left middle cerebral artery and abnormal collateral network. The peripheral blood smear and osmotic fragility test disclosed hereditary spherocytosis. To our knowledge, the coexistence of moyamoya syndrome and hereditary spherocytosis has not been documented. We report here the case and the brief review of related literatures. Further studies are needed to clarify the intimate relationship between the two diseases.
Anemia, Sickle Cell ; Arteries ; Atherosclerosis ; Brain ; Carotid Arteries ; Collateral Circulation ; Constriction, Pathologic ; Female ; Head ; Humans ; Middle Cerebral Artery ; Moyamoya Disease* ; Neurofibromatoses ; Osmotic Fragility ; Pallor ; Paresis ; Tuberculosis, Meningeal

A specimen of Beauveria bassiana was collected from Yang-yang of Gangwon province, Korea in October 2006. Conidial isolates were prepared from the specimen by the dilution method and inoculated in brown rice medium for fruiting body production. After nearly two months incubation for perithecial stromata developed from single isolates as well as from their combinations. They were determined as Cordyceps bassiana by observing the stromatal characters and their conidial structures. This is the first report of the development of C. bassiana from B. bassiana cultures.
Beauveria ; Cordyceps ; Fruit ; Korea

Streptococcal toxic shock syndrome with myonecrosis is a rapidly progressive process that kills 80% of patients in 72-96 h. Various bullae, hypotension, fever, and evidence of organ failure are late clinical manifestations. The symptoms and signs of myonecrosis can be nonspecific and misleading, not clearly revealing the involvement of deep skeletal muscle. Thus, the challenge to clinicians is to make an early diagnosis and to intervene with aggressive fluid replacement, emergent surgical debridement, and general supportive measures. We describe an presentation of myonecrosis of the lower extremities secondary to group A beta-hemolytic streptococcus infection in a 21-years-old woman. In addition, the patient had no history or evidence of trauma to the affected area.
Debridement ; Early Diagnosis ; Female ; Fever ; Humans ; Hypotension ; Lower Extremity ; Muscle, Skeletal ; Shock, Septic* ; Streptococcal Infections ; Streptococcus*

Pneumomediastinum can result from fractures involving paranasal sinuses, orbits, mandibles, other facial bones. This is a case report of an 25-year-old man who fell from a third floor. He suffered injuries to the maxillofacial region. Initial examination revealed a mandibular complex fracture and tooth loss, but the man developed neck swelling, dyspnea, and dysphagia over the next 3 days. Repeat examination revealed marked pneumomediastinum and subcutaneous emphysema.
Adult ; Deglutition Disorders ; Dyspnea ; Facial Bones ; Humans ; Mandible* ; Mediastinal Emphysema* ; Neck ; Orbit ; Paranasal Sinuses ; Subcutaneous Emphysema ; Tooth Loss

Hemobilia caused by pancreatic disease is very rare. The most common cause is a splenic artery pseudoaneurysm caused by acute and chronic inflammation of the pancreas. We experienced a case regarding as hemobilia as a complication of chronic relapsing pancreatitis in a 14 year-old boy. He was admitted with chief complaints of abdominal pain and hematemesis. Two years prior to admission, intermittent attacks of abdominal pain and vomiting began to develop. Recently he suffered a weight loss of 7.8kg due to poor oral intake but regain his usual weight after management by one month of total parenteral nutrition. On the day of admission abrupt onset of abdominal pain and massive hematermesis brought him to the emergency room of our hospital, and the area of active bleeding was on the 2 nd portion of duodenum proven by endoscopic examination. Bleeding control was failed with conservative management including blood transfusion, so whipple's operation was done on the 4 th day of admission. Ffter then bleeding was controlled, but he died of sepsis and cerebral infartion on the 20 th postoperative day.
Abdominal Pain ; Adolescent ; Aneurysm, False ; Blood Transfusion ; Duodenum ; Emergency Service, Hospital ; Hematemesis ; Hemobilia* ; Hemorrhage ; Humans ; Inflammation ; Male ; Pancreas ; Pancreatic Diseases ; Pancreatitis ; Pancreatitis, Chronic* ; Parenteral Nutrition, Total ; Sepsis ; Splenic Artery ; Vomiting ; Weight Loss

PURPOSE: This research used mathematical modeling to project the supply and demand of emergency physicians over the next decade in Korea. METHODS: A model was used to project the annual emergency physicians (EP) workforce supply and demand through the year 2015. The mathematical equations used were as follows: Supply = number of emergency physicians at the beginning of the year plus annual residency graduates minus annual attrition; Demand formula I = 5.29 fulltime equivalent positions/emergency department (ED) x the number of hospital EDs, Demand formula II = annual ED visits/(4,700visits/EP/year), Demand formula III = (11 to 16 EP per major referral ED) + (6 to 8 EP per urban district/ regional hospital ED). RESULTS: While the most conservative demand projection was 1,505 EPs in the year 2015, the most aggressive supply estimate with a yearly supply of 120 new EPs and a 1% attrition rate was 1,362 EPs in that year. CONCLUSIONS: In Korea, emergency physicians will remain in short supply for the next ten years, even at the present levels of EM residency output.
Emergencies* ; Emergency Medicine ; Hospitals ; Internship and Residency ; Korea* ; Models, Theoretical ; Referral and Consultation

BACKGROUND: Teamwork and leadership training have been shown to improve subsequent resuscitation performance in a variety of clinical situations. Critical care nurses, in addition to those who may be part of resuscitation team leaders and members, have also the need for such training. This study examines the teamwork and leadership skills of critical care nurses and their perceptions of the need for teamwork and leadership training. METHODS: We developed a pilot, interactive 3-hour teamwork, and the leadership training program based on the objectives and teaching methods of the Advanced Life Support (ACLS) course. Participants completed a 1-hour lecture, and discussion for team roles and obstacles, 30 min of script-based role play in resuscitation team training, and finally, a 2-hour simulation-based team training program. Before the completion of the course, participants were anonymously surveyed on the perceived educational value of the teamwork and leadership program. Expert raters reviewed videos of simulated resuscitation events in the course, and scored each video by two existing checklist for the team dynamic. RESULTS: Fifty-one nurses voluntarily participated and six videotaped simulation were rated by an expert rater. Most of the students believed the course was delivered at an appropriate level for them, and that it is a necessary training in their continuing professional education. The video rated average scores were from 68.5 to 72.9 according to the checklists. CONCLUSIONS: Critical care nurses can learn teamwork and leadership skills from appropriately designed programs, and believe it is a necessity in their training.
Anonyms and Pseudonyms ; Cardiopulmonary Resuscitation ; Checklist ; Critical Care ; Education, Professional ; Humans ; Leadership ; Pilot Projects ; Resuscitation ; Teaching

Single ascospore isolates of Cordyceps bassiana were observed for their colony pigmentation on Sabouraud Dextrose agar plus Yeast Extract (SDAY) plates and were inoculated in a brown rice medium for production of fruiting bodies. Colony pigmentation did not show any relationship with perithecial stromata formation. The isolates were also grown on opposite sides of SDAY agar plates and were observed for vegetative compatibility. Neither vegetative compatibility nor perithecial stromata could be found to be related to each other. It was concluded that fertile fruiting body production was independent of colony pigmentation and vegetative compatibility. Synnemata formation was found to be more common than perithecial stromata formation. This might be due to its highly conidiogenous anamorphic stage, i.e., Beauveria bassiana.
Agar ; Beauveria ; Cordyceps ; Cultural Characteristics ; Fruit ; Glucose ; Pigmentation ; Yeasts

Thyrotoxic periodic paralysis (TPP) is rare in white Caucasian but a few in Asian. A 36-year-old man presented with suddenly developed paraparesis was brought by ambulance. He got some medications and injection for the upper respiratory infection in the morning of admission day. On admission he revealed bilateral proximal muscle weakness without pain. He didn't have any specific medical history of himself and his family. The laboratory results on admission revealed severe hypokalemia (2.1 mM/l). Potassium replacement was immediately started and his symptom was gone. We found TSH was extremely decreased (<0.005 microIU/ml) but T3 and T4 were within normal level. We guess TPP was induced by some drugs to the patient with sub-clinical hyperthyroidism. Hyperthyroidism is not always clinically apparent and then may be easily missed. However just a single medication or injection that is usually prescribed can induce critical progressive hypokalemia.
Adult ; Ambulances ; Asian Continental Ancestry Group ; Humans ; Hyperthyroidism* ; Hypokalemia ; Muscle Weakness ; Paralysis ; Paraparesis ; Potassium