BACKGROUND: The pediatric CPR is rather uncommon practice than adult CPR in emergency room. Therefore, few interest and studies were focused in pediatric CPR. The object of this study is to make an analysis about pediatric CPR performed within hospital setting. METHOD: From January 1. 1990 to December 31. 1996, a total of 59 patients, less than 15-year-old, who received cardiopulmonary resuscitation were subject of this study. The study was done retrospective chart analysis for sex, age, weight, the place of cardiac arrest, initial EKG rhythms, endotracheal tube size, the causes of arrest, CPR time, ROSC, the amount and types of CPR drugs used during resuscitation. Wilcoxon rank sum test and chi2 test were used to compare the dose of drugs during CPR in each group. RESULTS: There were no statistical difference between ROSC and non-ROSC group in place of arrest, initial EKG rhythms, CPR time, dosage of CPR drugs. CONCLUSION: The uniform reporting guideline of pediatric advanced life support should be used for future pediatric CPR study, such as Utstein style guideline in pediatric CPR.
Adolescent ; Adult ; Cardiopulmonary Resuscitation* ; Electrocardiography ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Resuscitation ; Retrospective Studies

BACKGROUND: Hyperkalemia is a common and potentially life-threatening metabolic disorder. The electrocardiogram(ECG) is known to be a relatively sensitive diagnostic tool hyperkalemia. However many exceptions, in which patients showed normal ECG findings even though hyperkalemic, have been reported. The purpose of this study was to determine the extent of correlation between the ECG findings and hyperkalemia and to determine when the ECG has value for diagnosing hyperkalemia. METHODS: Patients who had been diagnosed as having hyperkalemia at two university hospitals during three years were enrolled in this study. We reviewed the medical records of the patients and evaluated the following 6 ECG abnormalities: tall T waves, narrow T waves, QRS widening, atrioventricular block, loss of P waves, and sine waves. We defined tall T waves and narrow T waves as 20 percentiles of heights and widths of the T waves from the 100 patients with normokalemia. RESULTS: During the study period, there were 100 hyperkalemic patients, and we analyzed 69 available electrocardiograms. Abnormal ECG findings were revealed in 67% of 69 patients. The higher the serum potassium level, the more abnormal ECG findings. The common ECG abnormalities were tall T waves and loss of P waves. The patients with normal ECGs even though hyperkalemic had relatively low potassium levels. And whether chronic renal disease was not correlated to the ECG abnormality. CONCLUSION: The electrocardiogram is a good diagnostic tool for hyperkalemia if it is used with accurate diagnostic criteria. Thus, hyperkalemia should be considered when the ECG shows tall T waves or loss of P waves.
Atrioventricular Block ; Electrocardiography* ; Hospitals, University ; Humans ; Hyperkalemia* ; Medical Records ; Potassium ; Renal Insufficiency, Chronic

BACKGROUND: Methemoglobinemia(MetHb) induced by dapsone overdose is not uncommon in Korea, especially in rural area. For treatment of dapsone-induced methemoglobinemia, methylene blue(MB) and activated charcoal(AC) should be used. To date, no reports have compared the amount of MB used between MB alone with MB & AC combined group(MB+AC). And also between moderate (MetHb<35%) and severe (MetHb>35%) intoxicated group defined by initial MetHb level. Authors hypothesized that less amount of MB can be used if MB and AC was used together and larger amount of MB is necessary to reduce MetHb level to asymptomatic level in severely intoxicated group. METHODS: From Jan 1990 to Dec 1996, a total of 54 patients who received treatment for dapsone intoxication were subject of study, The study was done retrospective chart analysis for initial MetHb level, total amount of MB and AC. Wilcoxon rank sum test and Chi-sqiare test was used to compare the total dosage of MB used for each group. Linear regression analysis was used between initial MetHb and the total amount of MB. Results were considered statistically significant when p<0.05. RESULTS: For MB alone and MB+AC group, the differences in total amount of MB used were statistically significant with mean dosage of 7.14+/-1.1mg/kg and 4.28+/-0.7mg/kg, respectively. And total amount of MB used between moderate and severe intoxicated group, the differences were statistically significant with mean dosage of 5.16+/-1.1mg/kg vs. 10.98+/-1.9mg/kg, respectively. There was significant correlation between initial MetHb level (X) and the amount of methylene blue (Y), Y=0.3X-2.42 (r2=0.41, p=0.0001) in MB alone, Y=0.186X-1.95(r2=0.21, p=0.034) in MB+AC respectively. CONCLUSION: For methemoglobinemia induced by dapsone, total amount of MB can be reduced especially in severe Intoxicated group if AC use was combined in treatment modality. There was significant correlationship between initial MetHb level and total amount of MB used.
Charcoal* ; Dapsone* ; Humans ; Korea ; Linear Models ; Methemoglobinemia ; Methylene Blue* ; Retrospective Studies

BACKGROUND: This study was designed to describe the current tends of emergency tracheal intubation and predict difficult airway intubations in emergency department (ED) at a teaching hospital in Korea. METHODS: All patients who was taken endotracheal incubation in ED during a 1-year period (Mar 1997 through Feb 1998) were included in the study population. Medical records of the patients were retrospectively reviewed. Among them, 56 patients were prospectively evaluated parameters to predict difficult airway intubations. RESULTS: During the study period, a total of 413 patients(1.5%) required endotracheal intubation. Except far 2 cases, all patients intubated orotracheally, and 298(72%) patients were intubated by emergency medicine resident. Pharmacologic adjuncts were used in 200(48%) patients, the neuromuscular blocking agent(NMBA) was used in 16(3.8%) Commonly used drugs were thiopental and vecuronium. The difficult incubation was not associated with presence of denture, length and circumference of neck, and mental status. The visibility of vocal cord on laryngoscopy significantly correlated to the difficult airway. CONCLUSION: At this institution, the majority of ED incubation were performed by emergency physicians and NMBA was not routinely used. The visibility of vocal cord during the direct laryngoscopy could be a predictor of difficult incubation in ED.
Dentures ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital ; Hospitals, Teaching ; Humans ; Intubation* ; Intubation, Intratracheal ; Korea ; Laryngoscopy ; Medical Records ; Neck ; Neuromuscular Blockade ; Prospective Studies ; Retrospective Studies ; Thiopental ; Vecuronium Bromide ; Vocal Cords

BACKGROUND: The in-hospital 'Utstein style' is international recommended guidelines for reporting outcome data from in-hospital resuscitation events. This study was designed to evaluate the current status of in-hospital cardiopulmonary resuscitation(CPR), and to provide basic data far the unified reporting guideline of resuscitation in Korea. METHODS: The patients who had received CPR in a university hospital were searched during one year period from March 1997. The variables according to the Utstein style were evaluated with review of the medical records. RESULTS: During the period, 428 patients had received CPR. Excluding the patients of out-of-hospital arrest and less than 8 years, 242 were enrolled. Their initial ECG rhythms were 55 of asystole, 148 of pulseless electrical activity, and 39 of ventricular fibrillation, The spontaneous circulation was returned in 118(49%, and 48(20% were maintained more than 24 hours. Twenty-two patients(9%) were discharged with spontaneous respiration. Among the survivors, 17 had the Cerebral Performance Category of 1. CONCLUSION: We recommend the Utstein style to report the outcome of in-hospital CPR.
Cardiopulmonary Resuscitation ; Electrocardiography ; Heart Arrest* ; Humans ; Korea ; Medical Records ; Respiration ; Resuscitation ; Survivors ; Ventricular Fibrillation

BACKGROUND: As the mean life span is prolonged, the concern about health care in postmenopuasal women is now promoted. Expecially, osteoporosis is the serious health problem in postmenopausal women. Bone mineral density in postmenopause is controlled by that in premenopause. Therefore, we searched for the factors which contribute to bone mineral density in premenopause. METHODS: The study subjects who visited the Health Screening and Diagnosis Center in Yeungnam University Hospital from March 1998 to July 1999 was measured BMD at the lumbar spine using Dual Energy X ray Absorptiometry. Subjects were checked past medical history, life style(smoking, drinking, physical activity, exercise etc.), birth history, breast feeding, oral pill intake. The subjects who had disorders known to interfere with bone metabolism and premature menopausal and surgical menopausal women were excluded from the study. And we reviewed the results of the laboratory and radiologic findings which had done in Health Screening and Diagnosis Center. RESULTS: 352 women were included in this study. The number of normal BMD was 228 and the number of osteopenia was 124. Weight, height, BMI, exercise was significant positively correlated with bone mineral density(p<0.05). Previous operation history was significant negatively correlation with bone mineral density(p<0.05). Multiple logistic regression result showed that weight was the most significant factor affecting to BMD and the history of operation and exercise were significant factor affecting BMD(p<0.05). CONCLUSION: In postmenopausal women, who has low weight, past operation history and lack of exercise were need to evaluation of BMD and education for prevention of osteoporosis is needed.
Absorptiometry, Photon ; Bone Density ; Bone Diseases, Metabolic ; Breast Feeding ; Delivery of Health Care ; Diagnosis ; Drinking ; Education ; Female ; Humans ; Logistic Models ; Mass Screening ; Metabolism ; Motor Activity ; Osteoporosis ; Postmenopause ; Premenopause ; Reproductive History ; Spine

BACKGROUND: The purpose of this study was to determine that the assessment of serum neuron specific enolase(NSE) could provide a reliable early predictor of neurologic outcome after cardiac arrest. METHODS: Prospective, observational study was performed from April 1996 to March 1998 at a university teaching hospital ED. Serum NSE concentrations were analysed twice at 24 and 48 hours after return of spontaneous circulation(ROSC). Neurologic outcome was categorized using cerebral performance category(CPC). RESULTS: Twenty-nine patients(16 were men) were enrolled during the study period. The mean age was 50.8 years. Nine(31%) of them showed good outcome defied as CPC 1-3, and 20(69%) patients showed bad outcome defied as CPC 4-5. In the good outcome group, the serum NSE was revealed 33.8+/-9.3 ng/ml at 24 hours, 34.0+/-4.73 ng/ml at 48 hours. While in the bad outcome group, it was 99.5+/-11.7 ng/ml and 114.6+/-15.8 ng/ml. The NSE at 48hr after ROSC was more prescise than that of 24hr. When the cutoff value of 50 ng/ml at 48 hr, the sensitivity was 82%, and specificity was 93%. CONCLUSION: This study suggest that the serum NSE may represent a valuable, noninvasive, and useful clinical tool for prediction of neurologic outcome after cardiac arrest.
Heart Arrest* ; Hospitals, Teaching ; Humans ; Neurons* ; Observational Study ; Phosphopyruvate Hydratase* ; Prospective Studies ; Sensitivity and Specificity

Acetaminophen (AAP) overdose can result in potentially serious hepatotoxicity. The ingested dose and time from ingestion to presentation are important prognostic factors. Toxic dose in adult is thought to be at least 10 g or 200 mg/kg. However, early management of acute overdose should be guided by the plasma AAP concentration. The antidote for AAP poisoning is N-acetylcysteine (NAC). It provides complete protection against hepatotoxicity if given within 8 h of acute overdose. If the concentration is above the possible toxicity line as predicted by the Rumack-Matthew nomogram, either the 72-hr oral or the 20-hr intravenous NAC regimen should be administered. NAC is also effective if started late in patients with established hepatic failure. This article summarizes the current consensus of clinical assessment and management for acute AAP overdose.
Acetaminophen ; Acetylcysteine ; Adult ; Consensus ; Eating ; Humans ; Liver Failure ; Nomograms ; Oligopeptides ; Plasma

The calcium alginate matrix, which has been used as a delivery vehicle for autogenous transplantation of the human chondrocytes, should provide a suitable environment for chondrocyte survival and for generation of new cartilage-like tissue. To optimize calcium alginate condition for human chondrocytes, the viscosity and concentration of sodium alginate and the CaCl2 concentration were varied during manufacture of the alginate discs. Human rib cartilage was dissected, enzymatically dissociated, and the chondrocytes were collected by centrifugation. Chondrocyte viability measured after fourteen days of culture by quantification of the DNA content per alginate discs. Sodium alginate concentrations were tested at four different levels varying from 0.5% to 3 percent using both low and moderate viscosity alginates. The DNA content was highest at 0.5% percent and lowest at 3 percent with both alginates. Varying the CaCl2 concentrations for polymerization from 50 to 200 mM produced no difference in DNA content. These data demonstrate that sodium alginate concentration rather than CaCl2 concentration is a critical factor for successful encapsulation of human cartilage cells in a calcium alginate matrix.
Alginates ; Calcium* ; Cartilage ; Centrifugation ; Chondrocytes* ; DNA ; Humans* ; Polymerization ; Polymers ; Ribs ; Sodium ; Viscosity

BACKGROUND: Activated charcoal has been widely used as an adsorbent for the management of drug intoxicated patients in the emergency department(ED). Although there are several commercial ready-mixed charcoal suspension preparations in the market, we are using custom-made suspension from hospital grade bulk charcoal powder. We designed this study to compare the adsorptive capacity of the Actidose Aqua(R), which is a commercial charcoal product, Fuller's earth, and custom-made activated charcoal used in our ED. METHODS: First, we performed modified USP methylene blue adsorption test which is a standard adsorption test for activated charcoal. Then, the drug adsorption test for phenobarbital, acetaminophen, salicylate, and aminophylline was done. Graded amount of three adsorptives were added to the stock solutions of each drugs. The adsorption test were performed as follows: The vials containing drugs and adsorptives were shaken for 30 minutes to ensure adsorption equilibrium, then the suspension was filtered through in-line filter. The filtrates were analyzed by ultraviolet spectroscopy to determine the residual drug concentrations. Finally we examined and compared the surface area and the structure of activated charcoal and Fuller's earth using scanning electron microscopy. RESULTS: In methylene blue adsorption test, the adsorption rate was 60.1% in Actidose Aqua(R) and 59.0% in custom-made charcoal, and 70.2% in Fuller's earth. For the phenobarbital, acetaminophen, and sallcylate, the adsorption rate of Actidose Aqua(R) and custom-made charcoal was greater than 90% with the ratio o adsorptives to drugs over 10:1. For aminophylline, two charcoal products showed excellent adsorption in 5:1 ratio. But Fuller's earth showed poor adsorption in all rages. CONCLUSION: Custom-made activated charcoal showed a comparable adsorption capacity to Actidose Aqua(R). Fuller's earth showed a poor performance to be used as a substitute for activated charcoal in acute drug poisoning otherwise paraquat.
Acetaminophen ; Adsorption ; Aminophylline ; Charcoal* ; Emergencies ; Humans ; Methylene Blue ; Microscopy, Electron, Scanning ; Paraquat ; Phenobarbital ; Poisoning ; Rage ; Spectrum Analysis