Blunt chest trauma to the heart may produce instantaneous death or, more frequently, congestive heart failure due to myocardial injury or disruption of intracardiac structures. Cardiac injury following by blunt chest trauma is often unsuspected and can range from cardiac contusion to chamber rupture, or to valvular dysfunction. The rate of occurrence of acute traumatic valvular insufficiency is extremely rare. Especially, the tricuspid valve is very rarely injured. Although clinical diagnosis of acute traumatic valvular insufficiency can be difficult to make for trauma patients with multiple injuries, echocardiography can establish diagnosis quickly and accurately. This report describes a patient who developed tricuspid regurgitation and acute heart failure following by an MCV.
Contusions ; Diagnosis ; Echocardiography ; Heart ; Heart Failure ; Humans ; Multiple Trauma ; Rupture ; Thorax* ; Tricuspid Valve ; Tricuspid Valve Insufficiency*

Tetanus is a rare disease in the developed countries, including Korea, as a result of nearly universal active immunization. Because many physicians have little experience with its diagnosis and management, misdiagnosis and therapeutic delay may result in catastrophic consequences. We report one case of generalized tetanus. A previously healthy 35-year-old man was admitted to the emergency department because of stiffness on jaw and neck. board-like abdomen, extended and rigid both legs, chest tightness, and dyspnea. Seven days before admission, he was injured on the right thing at work. In the emergency department, he was given 5,000 units of human tetanus immunoglobulin intramuscularly, as well as diazepam 2 mg/hr intravenously. On the second hospital day, tracheostomy was performed. Ten days later, his condition was improved. Twenty eight days after admission, he was discharged without any complication.
Abdomen ; Adult ; Developed Countries ; Diagnosis ; Diagnostic Errors ; Diazepam ; Dyspnea ; Emergency Service, Hospital ; Humans ; Immunoglobulins ; Jaw ; Korea ; Leg ; Neck ; Rare Diseases ; Tetanus* ; Thorax ; Tracheostomy ; Vaccination

No abstract available.
Emergencies* ; Emergency Service, Hospital* ; Emergency Treatment* ; Humans

No abstract available.
Female ; Ovary* ; Teratoma*

PURPOSE: Fever is the single most common problem in children visiting the emergency department. Fever is treated with a variety of methods, including the recommended combination of tepid massage, and antipyretics. We compared the effects of antipyretics and tepid massage for the management of febrile children. METHODS: We conducted a prospective, randomized, controlled study to assess 49 children who visited to the ED, Kyung Hee Medical Center, with complaints of fever. Ages ranged from 3 to 60 months. Patients were grouped into one of the following three treatment groups: 1) acetaminophen only, 2) tepid massage only, and 3) acetaminophen and tepid massage. We measured body temperature at 0 and 30 minutes after management. RESULTS: The mean temperature at 30 minutes had decreased by initial temperature 0.58degrees C, 0.48degrees C, and 0.90degrees C for groups 1), 2), and 3), respectively. Although body temperature for group 3) decreased to a greater degree than it did in the other groups, the differences were not statistically significant. CONCLUSION: Although tepid massage have been recommended for managing fever, their effect is still uncertain, so they are not recommended, especially in the cases of crowded emergency rooms.
Acetaminophen ; Antipyretics* ; Body Temperature ; Child ; Emergencies* ; Emergency Service, Hospital* ; Fever* ; Humans ; Massage* ; Prospective Studies

Superior gluteal artery rupture without pelvic fracture is extremely rare, but the rupture of this vessel is a well-known complication of pelvic fractures. This vessel appears to be at risk at the time of pelvic fracture because of its vulnerable anatomical position in the sacrosciatic notch. The rupture of this vessel causes profound hypotension and compartment syndrome of the gluteal or thigh region. Embolization is the most effective treatment. We report an unusual case of a superior gluteal artery rupture without pelvic fracture in blunt trauma.
Arteries* ; Compartment Syndromes ; Hypotension ; Hypovolemia* ; Rupture* ; Shock* ; Thigh

Pneumocephalus is defined as "the presence of air or gas within the cranial cavity." Intracranial air may represent an incidental finding of no clinical significance or more aggressive, life-threatening disease. It is usually associated with head trauma and surgery, tumor, brain abscess, postradiation necrosis, or diagnostic procedures. In the absence of head trauma or surgery, meningitis due to gas-forming organisms is an extremely rare cause of pneumocephalus. We report an unusual case of a localized spontaneous pneumocephalus caused by pneumococcal meningitis in the absence of head trauma, surgery, and brain abscess.
Abscess ; Brain Abscess ; Brain Neoplasms ; Craniocerebral Trauma ; Incidental Findings ; Meningitis ; Meningitis, Pneumococcal* ; Necrosis ; Pneumocephalus* ; Streptococcus pneumoniae

Although thrombolytic therapy is one of the most effective therapeutic option for acute ischemic stroke, hemorrhagic complication still remains major concern about its application. A patient with hemoperitoneum, who previously underwent thrombolytic therapy(intraarterial urokinase infusion, IAUK) for acute ischemic stroke was treated successfully with emergency transarterial embolization for rupture of hepatocellular carcinoma. We present a rare case of rupture of hepatocellular carcinoma after intraarterial urokinase infusion for acute ischemic stroke with brief review of the literature.
Carcinoma, Hepatocellular ; Emergencies ; Hemoperitoneum* ; Humans ; Rupture ; Stroke* ; Thrombolytic Therapy ; Urokinase-Type Plasminogen Activator*

Most currently available statins are associated with an increase with risk of myositis, including rhabdomyolysis. Myopathy is believed to be caused by interference in the cytochrome P450 3A4 enzyme system, which results in a marked increase in reductase activity. Cerivastatin, a new synthetic HMG-CoA reductase inhibitor, is a safe, well-tolerated effective drug for the treatment of patients with dyslipidemia. The drug is metabolized by the cytochrome P450 3A4 and cytochrome P450 2C8 hepatic isoenzymes. Because of this dual metabolic pathway, it has been suggested that cerivastatin is less subject to drug-todrug interactions. We describe a 60-year-old woman with rhabdomyolysis and localized myositis, after she had taken cerivastatin(lipobay, 0.3 mg/day) and gemfibrozil(lopid, 500 mg/day) for 1month.
Cytochrome P-450 Enzyme System ; Dyslipidemias ; Female ; Gemfibrozil ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Isoenzymes ; Metabolic Networks and Pathways ; Middle Aged ; Muscular Diseases ; Myositis ; Oxidoreductases ; Rhabdomyolysis*

BACKGROUND: The prevalence and prognostic value of overt disseminated intravascular coagulation (DIC) in patients with septic shock presenting to emergency departments (EDs) is poorly understood, particularly following the release of a new definition of septic shock. The purpose of this study was to investigate the prevalence and prognostic value of DIC in septic shock. METHODS: We performed retrospective review of 391 consecutive patients with septic shock admitting to the ED of tertiary care, university-affiliated hospital during a 16-month. Septic shock was defined as fluid-unresponsive hypotension requiring vasopressor to maintain a mean arterial pressure of 65 mmHg or greater, and serum lactate level ≥ 2 mmol/L. Overt DIC was defined as an International Society on Thrombosis and Hemostasis (ISTH) score ≥ 5 points. The primary endpoint was 28-day mortality. RESULTS: Of 391 patients with septic shock, 290 were included in the present study. The mean age was 65.6 years, the 28-day mortality rate was 26.9%, and the prevalence of overt DIC was 17.6% (n = 51) according to the ISTH score. The median DIC score was higher in non-survivors than in survivors (5.0 vs. 2.0, p = 0.001). Significant higher risk of mortality was observed in overt DIC patients compared to those without (28.2% vs. 13.7%, p = 0.005). Multivariable logistic regression analysis identified DIC to be independently associated with 28-day mortality (odds ratio, 2.689 [95% confidence interval, 1.390-5.201]). CONCLUSIONS: Using the ISTH criteria of DIC, overt DIC in septic shock was found to be common among patients admitting to the ED and to be associated with higher mortality when it is accompanied with septic shock. Efforts are required to identify presence of overt DIC during the initial treatment of septic shock in patients presenting the the ED.
Arterial Pressure ; Consensus* ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Emergencies* ; Emergency Service, Hospital* ; Hemostasis ; Humans ; Hypotension ; Lactic Acid ; Logistic Models ; Mortality ; Prevalence* ; Retrospective Studies ; Shock, Septic* ; Survivors ; Tertiary Healthcare ; Thrombosis