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: Vasopressin has recently been recognized to have greater effect on improving blood flow to myocardium and brain during cardiac resuscitation than epinephrine and also improves rates of ROSC(return of spontaneous circulation) and survival in pre-hospital and in-hospital prolonged refractory cardiac angst patients who did not respond to the standard epinephrine treatment. This study was designed to investigate the effects of vasopressin on ROSC rates and survival rates in rat asphyxia arrest model. METHOD AND MATERIAL: Thirty male Sprague-Dawley rats were used. Anesthesia was induced with halothane and nitrous oxide and ventilatory cairo was maintained. EtCO2 was adjusted to 30-40mmHg and halothane was maintained. Right infernal carotid artery and right femoral vein were cannulated and EKG electrodes were attached. After 10 minutes of asphyxia, group 1 was treated with 1ml of saline, group 2 with 1ml(0.001mg/100g) of epinephrine and group 3 with 1ml(0.16u/100g) of vasopressin for resuscitation. Statistical significance was an analysed by SPSS with ANOVA and chi-square tests. RESULTS: No significant differences were seen in baseline measurements. Three ROSC and eight 60 minutes survivals were found in group 1, whereas nine ROSC and eight 60 minutes survivals were obtained in group 2 and all of the subjects in group 3 showed ROSC and 60 minutes survival, but no statistical differences were seen between group 2 and 3. CONCLUSION: Vasopressin seems to have similar effect on improving ROSC and survival rates compared to epinephrine in rat asphyxia models.
Anesthesia ; Animals ; Asphyxia* ; Brain ; Carotid Arteries ; Electrocardiography ; Electrodes ; Epinephrine* ; Femoral Vein ; Halothane ; Humans ; Male ; Myocardium ; Nitrous Oxide ; Rats* ; Rats, Sprague-Dawley ; Resuscitation* ; Survival Rate ; Vasopressins*

Esophageal hiatal hernia is the hernia of a part of or the whole of stomach to posterior mediastinum through esophageal hiatus. Esophageal hiatal hernia can be classified as sliding hiatal hernia (type I), paraesophageal (type II), combined sliding and paraesophageal (type III), and complex paraesophageal (type IV). Type III and IV are clinically classified as paraesophageal hernia. The authors by chance found cystic mass filled with air in the lower lobe of the right lung during the treatment of mycoplasma pneumonia of 10 month-old patient. It was found to be paraesophageal hernia on the chest computed tomography and treated with the operation. As complex paraesophageal hernia is not usual among infants, the authors report it here with literature review.
Hernia ; Hernia, Hiatal ; Humans ; Infant ; Lung ; Mediastinum ; Mycoplasma ; Pneumonia ; Pneumonia, Mycoplasma ; Stomach ; Thorax

BACKGROUND: Urinalysis is a useful laboratory test in the diagnosis of various diseases. In sampling for the urinalysis, there is much concern about contamination that can lead to misdiagnosis in the mid-stream urine sampling method. We conducted this study to determine, in terms of concordance of results and contamination in culture, whether there was any superiority in mid-stream sampling methods with or without disinfection measures compared to the catheterization method. MATERIALS AND EMTHODS: We used three kinds of urine sampling methods sequentially, mid-stream non-clean catch, mid-stream clean catch, and catheterization, for ambulatory, non-pregnant, non-menstruating female patients who visited NHIC Ilsan Hospital emergency department during a one-week period in September 2001. Each sample was electrophotometrically analyzed for leukocyte esterase, nitrite, and blood by using a reagent strip and was cultured immediately or after overnight refrigeration. RESULTS: Of the 41 patients, 9 had culture-proven urinary tract infections. The concordance rates(kappa) for nitrite, blood, and leukocyte esterase were 0.875, 0.403, and 0.406 between non-clean catch and catheterized samples and 0.875, 0.481, and 0.560 between clean catch and catheterized samples, respectively. The contamination rate of the non-clean catch, the clean catch, and the catheterized samples were statistically different: 51.2%, 29.3% and 0%, respectively. CONCLUSION: We found that cleaning with disinfectant was effective for reducing the contamination rate, even though the best urine sampling method for zero contamination was catheterization. We recommend considering cost, patients' comfort, an acceptable threshold for contamination, and the necessity for a culture before choosing a urine sampling method for women who visit the emergency department.
Catheterization ; Catheters ; Diagnosis ; Diagnostic Errors ; Disinfection ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Leukocytes ; Reagent Strips ; Refrigeration ; Urinalysis ; Urinary Tract Infections

A 40-year-old female patient, known angiocenteric T-cell lymphoma on nasal cavity, was transfered from the department of hemato-oncology for the evaluation of egg sized pinkish-yellow indurated mass with central necrotic tissue on the left medial elbow. Histopathologic findings revealed angiocentric, angioinvasive, and angiodestructive infiltrate containing atypical lymphocytes. The infiltrative cells were positivly stained with antibody to CD45RO, LCA, but not with antibody CD20. The atypical infiltrated perivascular lymphoid cells were positive to Epstein-Barr virus in situ polymerase chain reaction. She was treated with combined chemotherapy and radiation therapy, but she died due to sepsis. We herein report a rare case of angiocentric T-cell lymphoma on the nasal cavity and skin associated with Epstein-Barr virus.
Adult ; Drug Therapy ; Elbow ; Female ; Herpesvirus 4, Human ; Humans ; Lymphocytes ; Lymphoma, T-Cell* ; Nasal Cavity ; Ovum ; Polymerase Chain Reaction ; Sepsis ; Skin ; T-Lymphocytes*

PURPOSE: The purpose of this study was to report medical care activities of Disaster Medical Assistance Team (DMAT) and medical facilities that responded to the Goyang Bus Terminal fire on May 26, 2014, and to draw improvement of the current disaster medical response system. METHODS: We retrospectively reviewed emergency medical service (EMS) run sheet and medical records of patients who visited the emergency department the day of the fire. We also interviewed the officials involved in disaster response. RESULTS: A total of 73 patients participated in this study. Among them, 9 were classified as Emergency, 60 as Non-Emergency, and 4 as Death on arrival (DOA). Fifty one patients visited the nearest hospital, and 17 patients were transported by EMS. DMAT arrived at the scene in 58 minutes, however there was little medical activity. CONCLUSION: Initial Triage and distribution of patients was rather inadequate and DMAT arrived late. For the future, we recommend constant training of the paramedics and leaders of 119, and to mend DMAT requesting and response system.
Allied Health Personnel ; Disasters* ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Fires* ; Humans ; Mass Casualty Incidents ; Medical Assistance ; Medical Records ; Retrospective Studies ; Triage

PURPOSE: Community-Acquired Pneumonia (CAP) is a common cause of mortality and serious morbidity. Regardless of the condition of the patients, almost all are hospitalized. And it seems to be a standard procedure to obtain blood cultures before the administration of antibiotics in suspected pneumonic patients. Recent studies show that the blood cultures don't affect the treatment of the patients with CAP. Accordingly, this study was designed to examine the usefulness of the blood cultures routinely performed and to evaluate the stratification of the patients with CAP by Pneumonia Severity Index (PSI) in the Emergency Department (ED). METHODS: Research subjects were patients over 16 years old who had been diagnosed with CAP in a general hospital between January and December 2008 and were admitted by way of the ED. We evaluated their records retrospectively. RESULTS: A total of 261 patients were diagnosed with CAP. According to the PSI, 155 (59%) of the 261 were classified as being in the low risk group and 106 (41%) in the high risk group. Blood cultures were positive in 13 of 261 (5%). Three of 13 patients belonged to the low risk group, and 10 to the high risk group. Antibiotics were changed in 43 of 261 patients. Nineteen of those belonged to the low risk group and 24 to the high risk group. Of the 13 bacteremic patients, blood cultures results altered therapy for 4 patients. CONCLUSION: Most often, blood cultures performed in the ED do not alter the therapy of patients with CAP. But we do recommend blood cultures for the high risk group.
Anti-Bacterial Agents ; Community-Acquired Infections ; Emergencies ; Hospitals, General ; Humans ; Pneumonia ; Research Subjects ; Retrospective Studies ; Severity of Illness Index

No abstract available.

Mondor's disease, thrombophlebitis of the subcutaneous veins, is an uncommon condition. It has clinical features of sudden development of localized pain to be followed by a palpable and visible tender, linear, branching cutaneous groove. The patient was a 43-year-old man who showed two cord like tender subcutaneous grooves on the left lower quadrant of the abdomen. He had done vigorous weightlifting for one month prior to his visit. Histopathologic finding showed occlusion of vessels by organized thrombus.
Abdomen ; Adult ; Humans ; Thrombophlebitis ; Thrombosis ; Veins

PURPOSE: In 2000, the American Heart Association and International Liaison Committee on Resuscitation published guidelines for CPR (Cardiopulmonary Resuscitation), and these guidelines were revised in 2005. Many physicians perform CPR differently than suggested by these guidelines. We investigated guideline conformation rates for CPR by non-emergency physicians. METHODS: From January 1st, 2005, to December 31st, 2005, and from January 1st, 2007, to September 30th, 2007, 103 in-hospital CPR cases were enrolled. We separated the 103 cases into two groups: 2005 patients and 2007 patients. Fifty-two cases in the 2005 group and 51 cases in the 2007 group were enrolled. The defibrillation method, defibrillation energy, epinephrine use, and atropine use were analyzed. RESULTS: Nineteen cases (82.6%) in the 2005 group and three cases (21.4%) in the 2007 group were performed using the appropriate defibrillation method (p=0.0002). Seventeen cases (73.9%) in the 2005 group and four cases (28.6%) in the 2007 group received the appropriate defibrillation energy (p=0.0069). Seven cases (14.0%) in the 2005 group and 16 cases (32.0%) in the 2007 group used the appropriate epinephrine dose (p=0.0325). Fourteen cases (28.0%) in the 2005 patient group and 14 cases (29.2%) in the 2007 patient group used the appropriate atropine dose (p=0.8983). CONCLUSION: Although CPR guidelines were renewed in 2005, many physicians do not follow these guidelines. We suggest that adequate information, education, feedback, and further study are needed for guideline conformation.
American Heart Association ; Atropine ; Cardiopulmonary Resuscitation ; Electric Countershock ; Epinephrine ; Humans ; Resuscitation