Following are brief statements about the delayed encephalopathy of a patient who recovered without disturbance of consciousness after acute carbon monoxide poisoning. A 72-year-old male was found without consciousness at home and then visited the ER center. Later we learned that the patient was using briquettes as a household heating source. Blood carbon monoxide hemoglobin level was 17.5%. As carbon monoxide poisoning was uncertain after the first interview with the patient, hyperbaric oxygen therapy was not administered at the early stage. After supplying 100% oxygen, the patient recovered consciousness, however, the strength of the lower limb muscle had decreased to class II. The patient showed continued weakening of the lower limb muscle and an increase of CPK; therefore, he was diagnosed as carbon monoxide intoxication and rhabdomyolysis and then admitted to the intensive care unit (ICU) for conservative treatment. During the hospitalization period, continued weakening of the lower limb muscle was observed and he was diagnosed as myopathy after EMG/MCV. However, he suddenly showed altered mentality on the 20th day of hospitalization, and underwent brain MRI. T2 weighted MRI showed typically high signal intensity of both globus pallidus and periventricular white matter; therefore, he was diagnosed as delayed carbon monoxide encephalopathy. This case showed delayed encephalopathy accompanied by rhabdomyolysis and myopathy of a patient who recovered without disturbance of consciousness.
Aged ; Brain ; Carbon ; Carbon Monoxide ; Carbon Monoxide Poisoning ; Consciousness ; European Continental Ancestry Group ; Family Characteristics ; Globus Pallidus ; Heating ; Hemoglobins ; Hospitalization ; Hot Temperature ; Humans ; Hyperbaric Oxygenation ; Intensive Care Units ; Lower Extremity ; Male ; Muscles ; Muscular Diseases ; Oxygen ; Rhabdomyolysis

PURPOSE: Field triage, medical care, and transportation are important and life-saving medical tasks performed at the site of a mass-casualty incident (MCI). We experienced a mass-casualty incident when an express bus fell off the Incheon bridge and conducted an evaluation of problems. We are willing to provide information for equipping an local disaster planning. METHODS: We surveyed the local emergency medical system response time, transportation time, and patients' clinical data using paramedics' records and medical records. We evaluated the adequacy of the order of priority of transportation by field triage used using the simple triage and rapid treatment (START) method. We evaluated field medical care, as well preponderance of transportation. RESULTS: Twenty four people who were on the bus were evacuated, and 2 persons were dead on the scene. Two persons died within one week. There was a transport delay for patients who would benefit significantly from medical intervention because dead persons were transported early. Neither advanced airway nor fluid resuscitation was provided. Sixteen patients (66.7%) were transported to one hospital. CONCLUSION: When we reviewed this mass-casualty incident, there was no appropriate medical control, such as triage, field medical care, and transportation. In construction of the emergency medical service system for preparation for MCI or disasters, we suggest integration and unification of 119 rescue services and emergency medical information centers for effective medical control. Disaster drills should be performed according to guidelines for local emergency medical services.
Disasters ; Emergencies ; Emergency Medical Services ; Humans ; Information Centers ; Mandrillus ; Medical Records ; Reaction Time ; Resuscitation ; Transportation ; Triage

BACKGROUND: To evaluate the post-resuscitation intensive care unit outcome of patients who initially survived out-of-hospital cardiac arrest (OHCA). METHODS: We retrospectively analyzed patients who were admitted to the ICU after OHCA in a tertiary hospital between January, 2005 and December, 2009. We compared the patients' clinical data, the factors associated with admission and the prognosis of patients in cardiac and non-cardiac groups. RESULTS: Sixty-four patients were included in this study. Thirty-four patients were in the cardiac group and thirty patients were in the non-cardiac group. The mean age was 57.3 +/- 15.1 years of age in the cardiac group and 61.9 +/- 15.7 years of age in the non-cardiac group (p = 0.235). The collapse-to-start of the CPR interval was 5.9 +/- 3.8 min in the cardiac group and 6.0 +/- 3.2 min in the non-cardiac group (p = 0.851). The complaint of chest pain occurred in 12 patients (35.3%) in the cardiac group and 1 patient (3.3%) in the non-cardiac group (p = 0.011). The time duration for making a decision for admission was 285.2 +/- 202.2 min in the cardiac group and 327.7 +/- 264.1 min in the non-cardiac group (p = 0.471). The regional wall motion abnormality and ejection fraction decrease were significant in the cardiac group (p = 0.002, 0.030). Grade 5 CPC was present in 8 patients (23.5%) in the cardiac group and 14 patients (46.7%) in the non-cardiac group. CONCLUSIONS: The key symptom that could initially differentiate the two groups was chest pain. The time duration for making an admission decision was long in both groups. The CPC score of the cardiac group was lower than that for the non-cardiac group.
Cardiopulmonary Resuscitation ; Chest Pain ; Dinucleoside Phosphates ; Emergency Medical Services ; Heart Arrest ; Humans ; Critical Care ; Intensive Care Units ; Out-of-Hospital Cardiac Arrest ; Prognosis ; Resuscitation ; Retrospective Studies ; Tertiary Care Centers

The incidence of malignant disease increases in kidney transplant recipients taking immunosuppressive therapy. Extramammary Paget's disease, a very rare dermatologic malignancy, is characterized by frequent recurrences and coexistence with other malignancies. Although skin cancer is the most common malignancy occurring after kidney transplantation, extramammary Paget's disease has not been reported in Korea. In this paper, we report a case of recurrent extramammary Paget's disease after renal transplantation. A 66-year old man, who underwent renal transplantation from a living unrelated donor 15 years ago, was diagnosed to have extramammary Paget's disease 7 years ago. At this admission he was troubled with a pruritic skin lesion in his suprapubic area which previously occurred twice. The recurring Paget's disease was treated with radical resection and coverage. No further recurrences have been developed during the following 12 months until now.
Humans ; Incidence ; Kidney ; Kidney Transplantation ; Korea ; Paget Disease, Extramammary ; Recurrence ; Skin ; Skin Neoplasms ; Unrelated Donors

We report a rare case of acute acalculous cholecystitis (ACC) caused by Salmonella enteritidis infection in a previously healthy 9-year-old boy. Salmonella enteritidis was isolated from stool and bile culture. The diagnosis of ACC was established upon clinical, laboratory, and ultrasonographic findings. The patient was successfully treated using percutaneous transhepaticcholecystic drainage (PTCCD) in combination with antibiotics therapy.
Acalculous Cholecystitis ; Anti-Bacterial Agents ; Bile ; Child ; Drainage ; Humans ; Salmonella ; Salmonella enteritidis

PURPOSE: The Multimarker IndexTM (MMX) is derived from 4 biochemical markers (S100 beta, MMP-9, D-dimer, BNP) and is known to be useful in the early detection of stroke. Assessment of severity in the early stages of stroke is as important as early detection of stroke itself, so that early intensive management can be applied. We evaluated wheather MMX is correlated with stroke severity as measured by NIHSS. METHODS: MRI-confirmed stroke patients were prospectively enrolled for analysis of MMX from their serum, and initial NIHSS was recorded. Patients were divided into three convenient groups according to the time from symptom onset. In each group, correlation of MMX and NIHSS was studied. RESULTS: Fifty-one patients were enrolled, and MMX was found to be positively correlated with NIHSS (p<0.01). In subgroup analysis, group A (presented to ED within 6 hours of symptom onset), and group B (presented to ED from 6-12 hours after symptom onset) showed the same positive correlation between MMX and NIHSS (p=0.017, p<0.001), but in group C (presented to ED after more than 12 hours after symptom onset), there was no correlation (p=0.840). CONCLUSION: MMX positively correlated with stroke severity measured by NIHSS for patients presenting to ED within 12 hours of symptom onset.
Biomarkers ; Cerebral Infarction ; Fibrin Fibrinogen Degradation Products ; Humans ; Prospective Studies ; Stroke ; Triage

PURPOSE: Epidemiologic data on emergency department (ED) patients with systemic inflammatory response syndrome (SIRS) are limited. We examined the prevalence, risk factors, etiologies and outcomes for the various forms of the SIRS, as well as their relationships with infection in ED. METHODS: The subjects were 16,718 non-trauma adult patients who visited a 900- bed university hospital ED between November 2006 and October 2007. ED records were reviewed, and all patients meeting the criteria for SIRS were enrolled retrospectively. SIRS patients were further subdivided into four groups (non-infectious SIRS, sepsis, severe sepsis, septic shock). Baseline characteristics, ED dispositions, and prognoses of patients in each group were analyzed. RESULTS: Among 16,718 patients, there were 2,790 SIRS patients (16.7%). The SIRS patient group was composed of 1,546 non-infectious SIRS patients (55.4%), 1,078 sepsis patients (38.6%), 119 severe sepsis patients (4.3%), and 47 septic shock patients (1.7%). ED patients with SIRS were older on average than non-SIRS patients (52 versus 48, p<0.001). The most common sources of SIRS was the gastrointestinal system (28.3%), followed by the respiratory system (22.9%) and the genitourinary system (11.8%). Pneumonia (18.9%) was the single most common cause of infectious SIRS. The admission rate was higher for SIRS patients than for non-SIRS patients (44% versus 21%). The 28-day mortality rate for non-infectious SIRS, sepsis, severe sepsis, and septic shock patients were 4.5%, 1.3%, 25.2%, and 63.8%. Sepsis severity was correlated with increased rates of both hospital admission and mortality (p<0.001). CONCLUSION: 55% of SIRS patients who visited the ED had a non-infectious cause. SIRS patients were older than non-SIRS patients, and hospital and ICU admission rates were also higher. Sepsis severity was correlated with older age, increased hospital admission rate, increased ICU admission rate, and increased mortality rate.
Adult ; Emergencies ; Epidemiologic Studies ; Hospitals ; Humans ; Pneumonia ; Prevalence ; Prognosis ; Respiratory System ; Retrospective Studies ; Risk Factors ; Sepsis ; Shock, Septic ; Systemic Inflammatory Response Syndrome ; Urogenital System

PURPOSE: Biochemical markers can help predict neurological outcome in post-resuscitation patients. This prospective study evaluated the prognostic value of serum S100B protein and neuron-specific enolase (NSE) time courses in predicting unfavorable neurological outcomes. METHODS: We serially measured serum S100B protein and NSE levels 12 times during the 96 h after the return of spontaneous circulation (ROSC) in 40 patients. Neurological outcome was assessed at 6 months after cardiac arrest. Patients were divided into good (CPC 1 to 2) and poor (CPC 3 to 5) neurological outcome groups and assessed for cerebral performance category scores. We compared the two groups at each serum value and calculated cut-off values. RESULTS: Serum S100B protein levels over the study period, except at 4 hours, and NSE levels from 14 hours after ROSC were significantly higher in the poor neurological outcome group (n=32) than the good neurological outcome group (n=8). The most predictive serum S100B protein and NSE times were at 14 hours (cut off value=0.16 microgram/L, sensitivity 81.8%, specificity 100%, AUC=0.938) and 54 hours (cut off value=19.21 microgram/L, sensitivity 86.4%, specificity 100%, AUC=0.932). CONCLUSION: Serum S100B protein and NSE levels are early and useful markers for assessing neurological outcome after successful resuscitation from cardiac arrest.
Biomarkers ; Emergencies ; Heart Arrest ; Humans ; Nerve Growth Factors ; Phosphopyruvate Hydratase ; Prognosis ; Prospective Studies ; Resuscitation ; S100 Proteins ; Sensitivity and Specificity ; Sepsis ; Shock, Septic ; Triage

PURPOSE: Abdominal pain is one of most common complaints in children who visit emergency department (ED), but sometimes it is very difficult in differential diagnosis between medical and surgical disease. This study was performed to collect and analysis of diagnositic scores of children with abdominal pain who could not definitely diagnosed as medical or surgical disease in ED. METHODS: This study reviewed 201 children who were visited for abdominal pain in ED at a tertiary hospital from January 2005 to June 2005. We reviewed the medical records and analysed clinical characteristics, laboratory findings, and radiologic findings retrospectively. We analyzed the diagnostic scores between medical and surgical disease group. RESULTS: The number of medical disease are 125 patients, and the number of surgical disease are 76 patients. Significant predictable factors for surgical diseases are right quadrant pain, vomiting, tenderness, rebound tenderness, leukocytosis and diagnostic score. The mean diagnostic score of medical diseases is 4.55+/-4.10 (mean+/-SD) and the mean score of surgical diseases is 16.22+/-3.48(mean +/-SD). CONCLUSION: For the diagnosis of children with abdominal pain which is uncertain either medical or surgical disease in ED, the diagnostic scores, careful observation and physical examination repeatedly are helpful for correct diagnosis and prompt treatment.
Abdominal Pain* ; Child* ; Diagnosis ; Diagnosis, Differential ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Leukocytosis ; Medical Records ; Physical Examination ; Retrospective Studies ; Tertiary Care Centers ; Vomiting

PURPOSE: The goal of this study was to determine the suitability of ultrasonography for detecting endotracheal tube placement in the emergency department. METHODS: Emergency physicians examined patients immediately following intubation or after intubated patients were transferred. A linear ultrasound transducer was placed transversely on the cricothyroid membrane and suprasternal notch in order to check for the "comet head and tail sign"and "double ring sign", and a sagittal view of the neck was also obtained in order to look for the "bold parallel lines sign". Subsequently, simple thoracic sonography and color doppler sonography were used to check for the "lung sliding sign". The examiner evaluated whether the tube was placed in trachea, the esophagus, or the right main bronchus. The accuracy of ultrasonography was calculated, and the required time for ultrasonography was checked. RESULTS: One hundred ten patients were enrolled in the study. The endotracheal tube was placed in the trachea in 107 patients, in the esophagus in 2 patients, and in the right main bronchus in 1 patient. The sensitivity and specificity of ultrasonography were 100%. The bold parallel lines sign and lung sliding sign proved to be good indicators of endotracheal tube placement. The average required time for ultrasonography was 28.6+/-5.8 seconds. It was difficult to determine tube placement by thoracic ultrasonography in patients with pneumothorax, hemothorax, pleural effusion, or empyema. CONCLUSION: Ultrasonography is well suited for confirming endotracheal tube placement in the emergency department.
Bronchi ; Emergencies* ; Emergency Service, Hospital* ; Empyema ; Esophagus ; Head ; Hemothorax ; Humans ; Intubation ; Lung ; Membranes ; Neck ; Pleural Effusion ; Pneumothorax ; Sensitivity and Specificity ; Trachea ; Transducers ; Ultrasonography*