Overcrowding of emergency department is a serious and growing problem at St. Mary's Hospital. This has motivated the development of short-stay unit(SSU) as an alternative ward to routine hospital admission and ED discharge. In our hospital a SSU begun to admit patients in January 6, 1997. the SSU received 247 patients from the ED during the eight month interval(January 6, 1997 to August 31, 1997). To examine the utilization of the SSU in ED, we retrospectively analyzed 247 patients admired in SSU from the ED, and compared the average hours per patient with acute gastroenteritis spent in the ED doing the 2-month intervals before(July-August 1996) and after(July-August 1997) the establishment of the SSU. The following results were obtained; 1. The total patients consist of EM 92(37.2%), GS 48(19.4%), IM 24(9.7%), PS 21(8.5%), OS 20(8.1%), OBGY 14(5.7%) and others 28(11.3%). 2. The results of EM patients admitted in SSU from ED 1) Sex ratio of male to female was 1:1.1 and the mean age was 37.3+/-16 years. 2) In diagnosis, acute gastroenteritis was 29 cases(31.5%), multiple contusion 14 cases(15.2%), drug intoxication 12 cases(13%), limb laceration 6 cases(6.5%), tendon rupture offhand 6 cases(6.5%), and others 19 cases(20.6%). 3) Mean length of stay in ED was 9.18 hours. 4) Among 92 patients to the SSU, 79 patients(85.9%) were discharged, 11 patients(11.9%) formally admired to hospital and 2 patients(2.2%) transferred to otherhospital. The mean hospital stay time of the patients admitted to SSU was 2.6 days. 3. There was a significant reduction in the average stay time spent in the ED by treat-and-releasing patients with acute gastroenteritis after the establishment of the SSU(from 14.65+/-9.6 to 7.52+/-5.4 hr/patient, p<0.001). Conclusively, the establishment of the SSU can shorten the average stay time that treat-and-releasing patients spend in the ED, and reduce the number of admixed patients waiting in the ED.
Contusions ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Extremities ; Female ; Gastroenteritis ; Humans ; Lacerations ; Length of Stay ; Male ; Retrospective Studies ; Rupture ; Sex Ratio ; Tendons

Phenobarbital is a long-acting barbiturate causing generalized depression of neuronal activity in the brain. Its effect is primarily achieved through enhanced GABA-mediated synaptic inhibition. Its use as an antiepileptic agent was first described in 1912. Before the introduction of phenytoin, phenobarbital is used as sedative-hypnotics. It is used for the treatment of epilepsy and status epilepticus. All barbiturates, including phenobarbital, have a high potential far abuse. They were frequently used for suicide attempts in the past, but they have in large part been replaced by benzodiazepines. the onset of symptoms depends on the drug and the route of administration. Mild to moderate barbiturate intoxication resembles ethanol inebriation with slurred speech, ataxia, and lethargy. Severe acute barbiturate intoxication is life threatening. Early deaths are generally cardiovascular-related. Hypotension, shock, pulmonary edema, and cardiac arrest that occurs with large doses are caused by depression of central sympathetic tone and as well as by direct depression of cardiac contractility. The potentially fatal oral dose of phenobarbital is 6-l0g. We describe an 23-year-old woman with pulmonary edema and cardiac arrest after ingestion of 18 grams of phenobarbital. She was completely recovered by successful cardiopulmonary resuscitation and hemoperfusion. We report a case with literature review.
Ataxia ; Barbiturates ; Benzodiazepines ; Brain ; Cardiopulmonary Resuscitation ; Depression ; Eating ; Epilepsy ; Ethanol ; Female ; Heart Arrest* ; Hemoperfusion ; Humans ; Hypotension ; Lethargy ; Neurons ; Phenobarbital* ; Phenytoin ; Pulmonary Edema* ; Shock ; Status Epilepticus ; Suicide ; Young Adult

BACKGROUND: The end-tidal carbon dioxide tension(ETCO2) is defied as a partial pressure of carbon dioxide at the end of an exhaled breath.)he purpose of this study is to determine the correlation between ETCO2 and arterial carbon dioxide tension(PaO2) in nonintubated abated patients with respiratory distress in emergency department(ED). METHODS: A prospective non-blind study was performed in ED of our university hospitals. Participants included all nonintubated adult patients with respiratory distress requiring arterial blood gas analysis. ETCO2 was measured with a capnography monitor during tidal volume breathing. ETCO2 were recoreded at the time of arterial blood gas sampling. The correlation between ETCO2 and PaCO2 was analysed in all patients and in subgroups by simple linear regression. RESULTS: Sixty patients were enrolled. In all patients, ETCO2 was 5.72mmHg lower than PaCO2 and correlated well with PaCO 2(r2=0.716). ETCO2 correlated best with PaCO2) in patients who were either acidotic or non-smoking. CONCLUSION: ETCO2 correlate well with PaCO2 in nonintubated patients with respiratory distress in ED. ETCO2 may be sufficient to reflect PaCO2 in selected patients and obviate the need far repeat arterial blood gas determination.
Adult ; Blood Gas Analysis ; Capnography ; Carbon Dioxide ; Emergencies* ; Emergency Service, Hospital* ; Hospitals, University ; Humans ; Linear Models ; Partial Pressure ; Prospective Studies ; Respiration ; Tidal Volume

BACKGROUND: Two major events occurring in the cerebral hemodynamics after successful resuscitation from cardiac arrest are reactive hyperemia and postischemic hypoperfusion. In this study, we examined the effect of Pentoxifylline(PTX) on the rat brain following cardiac arrest. METHODS: Fourteen rats were anesthetized and artificially ventilated. Cardiac angst was produced by chest compression and clamping of tracheal tube far 3 minutes in ketamine anesthetized rats. Circulation was restored by standard cardiopulmonary resuscitation methods. In 7 rats, PTX 10mg/kg was infused at 10min after cardiac angst(PTX group). In the other 7 rats, same amount of normal saline was infused(control group). RESULTS: In both groups, hemodynamic variables, neurologic deficit(ND) score and histopathologic findings of hippocampal CA1 neurons were observed. Hemodynamic variables and ND score were not significandy different between two groups. Delayed ischemic neurons of hippocampal CA1 were decreased in PTX group(2.2+/-2.4%) compared with control group(9.1+/-1.2%). CONCLUSIONS : We conclude that PTX prevented development of delayed ischemic neurons in hippocampal CA1 after cardiac arrest. PTX may be useful in emergency situations following cardiac arrest.
Animals ; Brain* ; Cardiopulmonary Resuscitation ; Constriction ; Emergencies ; Heart Arrest* ; Hemodynamics ; Hyperemia ; Ketamine ; Neurons ; Pentoxifylline* ; Rats* ; Reperfusion Injury* ; Resuscitation ; Thorax

Ethylene glycol is a sweet-tasting liquid with industrial use as a solvent or as a starting reagent in chemical processes. Physicians are familiar with ethylene glycol because it is the major component of many antifreeze solutions and is taken in suicide attempts or, more often inadvertency. its metabolites may cause severe intoxication. Unfortunately, its metabolites are highly toxic and require rapid treatment Treatment involves correction of metabolic acidosis, ethanol administration and enhancement of elimination. The most commonly used elimination technique is hemodialysis We describe an 21-year-old man with acute renal failure due to ingestion of antifreeze that contained ethylene glycol. He was transferred to our hospital because of aggressive management The recovery of our patient with severe ethylene glycol intoxication illustrates that aggressive and early treatment can prevent mortality and morbidity.
Acidosis ; Acute Kidney Injury* ; Chemical Processes ; Eating ; Ethanol ; Ethylene Glycol* ; Humans ; Mortality ; Renal Dialysis ; Suicide ; Young Adult

Eosinophilic peritonitis is defined as when there are more than 100 eosinophils present per milliliter of peritoneal effluent, of which eosinophils constitute more than 10% of its total WBC count. Most cases occur within the first 4 weeks of peritoneal catheter insertion and they usually have a benign and self-limited course. We report a patient of eosinophilic peritonitis that was successfully resolved without special treatment. An 84-year-old man with end stage renal disease secondary to diabetic nephropathy was admitted for dyspnea and poor oral intake. Allergic history was negative. and physical examination was unremarkable. Complete blood count showed a hemoglobin level of 11.1 g/dL, WBC count was 24, 500/mm3 (neutrophil, 93%; lymphocyte, 5%; monocyte, 2%), platelet count was 216, 000/mm3, serum BUN was 143 mg/dL, Cr was 5.7 mg/dL and albumin was 3.5 g/dL. Creatinine clearance was 5.4 mL/min. Three weeks after peritoneal catheter insertion, he was started on peritoneal dialysis with a 6-hour exchange of 2L 1.5% peritoneal dialysate. After nine days, he developed turbid peritoneal effluents with fever (38.4degrees C), abdominal pain and tenderness. Dialysate WBC count was 180/mm3 (neutrophil, 20%; lymphocyte, 4%; eosinophil, 76% [eosinophil count: 136/mm3]). Cultures of peritoneal fluid showed no growth of aerobic or anaerobic bacteria, or of fungus. Continuous ambulatory peritoneal dialysis (CAPD) was commenced, and he was started on intraperitoneal ceftazidime (1.0 g/day) and cefazolin (1.0 g/day). After two weeksr, the dialysate had cleared up and clinical symptoms were improved. Dialysate WBC count decreased to 8/mm3 and eosinophils were not detected in peritoneal fluid. There was no recurrence of eosinophilic peritonitis on follow-up evaluation, but he died of sepsis and pneumonia fifteen weeks after admission.
Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Cefazolin/therapeutic use ; Ceftazidime/therapeutic use ; Diabetic Nephropathies/complications ; Eosinophilia/drug therapy/*etiology ; Humans ; Kidney Failure, Chronic/etiology/therapy ; Male ; Peritoneal Dialysis, Continuous Ambulatory/*adverse effects ; Peritonitis/drug therapy/*etiology

A 71-year-old woman with minimal change disease visited our clinic complaining of pleuritic chest pain. Cefepime was given under the impression that she had pneumonia. Three days after cefepime administration, she became unconscious. A brain MRI scan was non-revealing and an EEG showed triphasic waves. As there was no evidence of septic, uremic or hepatic encephalopathy, we suspected cefepime-induced neurotoxicity. Cefepime was stopped and she underwent hemodialysis to decrease the blood levels of the drug. Following hemodialysis, she regained consciousness.
Aged ; Brain ; Cephalosporins ; Chest Pain ; Consciousness ; Electroencephalography ; Female ; Hepatic Encephalopathy ; Humans ; Magnetic Resonance Imaging ; Nephrosis, Lipoid ; Neurotoxicity Syndromes ; Pneumonia ; Renal Dialysis ; Unconscious (Psychology)

A 13-year-old male and a 15-year-old female presented with optic disc edema associated with chronic recurrent uveitis. While the ocular inflammation responded to high doses of oral prednisolone, the disc edema showed little improvement. After oral administration of methotrexate, the disc edema and ocular inflammation were resolved, and the dose of oral corticosteroid could be reduced.
Administration, Oral ; Adolescent ; Chronic Disease ; Female ; Glucocorticoids/administration & dosage ; Humans ; Immunosuppressive Agents/administration & dosage ; Male ; Methotrexate/administration & dosage ; Papilledema/drug therapy/*etiology ; Prednisolone/administration & dosage ; Recurrence ; Uveitis/*complications/drug therapy

PURPOSE: Chronic use of topical hypotensive agents induces several side effects caused by preservatives. The purpose of this study was to evaluate the effects of prostaglandin analogs with varying concentrations of benzalkonium chloride (BAC), preservative-free (PF), and alternative preservatives on mouse corneal tissue. METHODS: Thirty-five, 8- to 10-week-old female C57BL/6 mice (five mice for each group) were used for this study. To the control group, we applied normal saline, and to each drug-treated group we applied 0.02% BAC, bimatoprost 0.01% (with BAC 0.02%), latanoprost 0.005% (with BAC 0.02%), travoprost 0.004% (with 0.001% polyquad) or tafluprost 0.0015% with/without 0.001% BAC, once a day (9 p.m.) for 4 weeks. Corneal fluorescein staining was evaluated in all groups. After harvest, the corneal tissues were embedded in paraffin and then Hematoxylin-Eosin stain was performed for histopathological examination. Immunofluorescence staining was done against TNF-alpha, IL-6, HLA DR, pJNK, and pAkt. RESULTS: In corneal fluorescein staining, severe punctate epithelial keratitis was seen in the groups of 0.02% BAC, 0.02% BAC containing bimatoprost 0.01% and latanoprost 0.005%. The surface desquamation, irregular surface, loss of cell borders, anisocytosis and stromal shrinkage were observed in the groups of BAC-containing eye drops. Moreover, the groups treated with BAC-containing eye drops have high inflammatory markers, significantly decreased cell viability-related signal, pAkt, and higher apoptosis-inducing signal, pJNK, than the control group. On the other hand, travoprost 0.004% and PF tafluprost 0.0015% have less cellular morphologic changes, lower inflammation, and higher cellular viability than BAC-containing formulations. CONCLUSIONS: Corneal damage, increased inflammation and apoptosis and low cell viability were observed in BAC-containing groups. PF or alternatively preserved glaucoma medications seem to be a reasonable and viable alternative to those preserved with BAC.
Animals ; Cell Survival ; Conjunctiva/drug effects/*pathology ; Disease Models, Animal ; Epithelium, Corneal/drug effects/*pathology ; Female ; Glaucoma/*drug therapy/pathology ; Mice ; Mice, Inbred C57BL ; Microscopy, Fluorescence ; Ophthalmic Solutions ; Preservatives, Pharmaceutical ; Prostaglandins, Synthetic/*administration & dosage

OBJECTIVE: Whether to perform cardiopulmonary resuscitation (CPR) or do-not-resuscitate (DNR) is not only a medical problem but also a decision that should be made carefully with self-autonomy in accordance with life values. We conducted a retrospective observational study to identify the characteristics of current CPR and DNR at a practical level. METHODS: We retrospectively analyzed data from medical records with regard to the clinical status of DNR decision in 356 patients with cancer who expired between October 2014 and September 2015 in Soonchunhyang University Bucheon Hospital. RESULTS: DNR was decided significantly more frequently in patients with solid cancers than in patients with hematological cancer (87.7% vs. 71.4%, P=0.003). No other significant factor influenced the DNR decision in this study. The main persons who signed the DNR consent form were mostly sons or daughters (60.7%), never the patients themselves. The median time from the DNR order to death was longer in the ward than in the intensive care unit (ICU; 3.0 days vs. 1.0 days). The mean time from the DNR order to death was 6.6 days (median, 2 days). Among the patients with a DNR order, 110 (36.7%) were hospitalized in the ICU and 73 (24.3%) were treated with ventilator support. CONCLUSION: Most patients expired 6.6 days after DNR permission was given and could not decide their treatment plan by themselves. For better end-of-life care, the sensitive DNR decision with consideration of the individualized environment of the patient for life-sustaining treatment should be settled in Korea.
Cardiopulmonary Resuscitation* ; Consent Forms ; Gyeonggi-do ; Humans ; Intensive Care Units ; Korea ; Medical Records ; Nuclear Family ; Observational Study ; Resuscitation Orders ; Retrospective Studies* ; Terminal Care ; Ventilators, Mechanical