A Case of Gastric Rupture and Pneumoperitoneum after Cardiopulmonary Resuscitation in Acute Myocardial Infarction

Latrogenic gastric rupture is a rarely reported complication of cardiopulmonary resuscitation. Rupture can occur during chest compressions when the stomach is overinflated due to difficult airway management or esophageal intubation. The prognosis of gastric rupture is generally poor, so patients should undergo surgical treatment as soon as possible. We present the case report of a patient with an acute myocardial infarction who experienced gastric perforation and pneumoperitoneum after cardiopulmonary resuscitation.

2 Cases of Alcohol-Induced Rhabdomyolysis with Acute Renal Failure

Rhabdomyolysis is a biochemical and clinical syndrome caused by lysis of skeletal muscle cell and release of muscle cell contents into the Circulation. In addition to traumatic cause, various nontraumatic causes have been reported. Rhabdomyolysis has frequently been associated with seamy aspects of life and society: alcoholic abuse, drug addiction, sadistic drill exercise, war events and attempted suicide. The abuse of alcohol causes many hazards in many organs. One of these is acute alcoholic myopathy that may present as a fulminent syndrome of muscle pain and tenderness associated with rhabdomyolysis and acute renal failure. Because the prognosis of adequately treated rhabdomyolysis is excellent, early recognition and prompt management aye essential in emergency situation. We experienced two typical cases of alcohol-induced rhabdomyolysis with acute renal failure and report these cases with literature review.

Deferoxamine Pretreatment Reduces Infarct Size of Acute Myocardial Infarction in a Rabbit Model

BACKGROUND: Reperfusion of ischemic myocardium has been postulated to result in a specific oxygen radical mediated tissue injury. Iron may liberate during ischemia and we hypothesized that administration of the iron chelator, deferoxamine during ischemia would result in improved recovery after postischemic reperfusion. PURPOSE: To test whether iron-catalyzed processes contribute to myocardial necrosis during ischemia and reperfusion, deferoxamine was administered to block iron catalyzed hydroxyl radical formation in rabbits. METHODS: Eleven rabbits were divided into two groups: control group (n=5) and deferoxamine pretreatment group (n=6). the left circumflex coronay artery was ligated for 30 minutes and reperfused for 180 minutes. Area at risk (AR) was measured by non-stained area with ethylene blue injection into left atrium after left circumflex coronary artery ligation. Infarct size was measured by weighing after tripheyltetrazolium chloride staining. Heart rate was measured using electrocardiographic recording and systemic blood pressure was monitored by pressure transducer connected to the catheter in the left ventricle. RESULTS: 1. There was no significant difference of heart rate and blood pressure in deferoxamine pretreatment group compared with control group. 2. There was significant decrease of serum iron concentration after continuous infusion of deferoxamine compared with serum iron concentration before ligation of coronary artery (P<0.05). 3. There was no significant difference of area at risk between control and deferoxamine pretreatment group. 4. Area at necrosis to area at risk was significantly reduced in deferoxamine pretreatment group compared with control group (P<0.05) The results suggest that deferoxamine infusion prior to coronary artery occlusion has a significant benefit in reducing infarct size in this model.

Patterns of Serum Interleukin-6 Concentration after Initial Successful Cardiopulmonary Resuscitation

OBJECTIVE: To investigate patterns of serial serum interleukin-6(IL-6) concentrations after initial successful cardiopulmonary resuscitation, and to access differences in serum IL16 concentrations in patients with Cerebral Performance Category(CPC, 1-2) and CPC(3-5) at the 5th day after cardiacpulmonary resuscitation(CPR). METHODS: We studied prospectively 12 patients with spontaneous circulation after cardiopulmonary resuscitation. Venous blood samples were taken 2,4,12,24,48 and 72 hours after restoration of spontaneous circulation to measure serum IL-6 levels by the enzyme-linked immunosorbent assay. RESULTS: Serum IL-6 concentrations in the severe neurologically disabled group(CPC, 3-5) were significantly increased at 2, 24 and 48 hours after restoration of spontaneous circulation compared with the less neurolgically disabled group. Also, serum IL-6 concentrations in the severe neurologic disabled group showed dual peak at 4 and 24 hours. CONCLUSION: Our study demonstrates significant incense of seam IL-6 in patients with CPC(3-5) after successful cardiopulmonary resuscitation and the significant correlation between early increase of serum IL-6 and poor neurologic outcome. It suggests that early increase of serum IL-6 can be used as a prognostic marker after successful cardiopulmonary resuscitation.

Correlation Analysis between END-tidal CO2 Tension and Arterial CO2 Tension in Nonintubated Emergency Department Patients with Respiratory Distress

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.

A Clinical Evaluation for The Initial Diagnosis of Renal Infraction in Emergency fdedical Center

To evaluate appropriate diagnostic studies for renal infarction in emergency medical center, we analysed 33 patients of renal infarction treated in this hospital for last 8 years. Eleven patients, 4 trauma associated and 7 aortic disease associated patients were excluded. They are 11 males and 11 females with a mean age of 51 years. Fourteen came to the emergency medical center and seven came to the outpatient department, in the other one patient renal infarction was developed during hospitalization with other disease. On their past history they had hypertension in 9, valvular heart disease in 5, and diabetic mellitus in 4 patients. Abdominal or flank pain was noted in 17 of 22(77%). The other symptoms were vomiting, nausea, fever and so on. On microscopic examination of initial urine in hospital, 5 patients showed more than 10 red blood cells by high power field examination. The mean lactic dehydrogenase level was 1,239 I.U/L(normal range 218-4721.UA), while the mean aspartate aminotransferase and mean alanine aminotransferase were 511.U/L(normal range 13-36 I.U/L) and 44 I.U/L(normal range 5-331.U/L). Abdominal ultrasonography showed positive findings in 5 of 16(31%), of which 3 were confirmed by Doppler ultrasonography In 18, computed topography was done and all those showed positive findings of renal infarction(100%). In conclusion, it is important that identify the elevated lactic dehdrogenase level in case of any suspicion about renal infarction and confirm by computed tomography.

Recovery of Acute Renal Failure Secondaruy to Ethylene Glycol Intoxicity

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.

Level of Emergency Medical care Required in Religious Mass Gathering

STUDY OBJECTIVE: determine the level of medical care required for mass gatherings and describe the types of medical problems encountered in a religious mass gathered ceremony. DESIGN: Standard charts and a four-tiered triage system(minor, moderate, urgent, and emergent) were developed before the event. The triage system was applied to each chart retrospectively by a single emergency physician. SETTING: Medical staff(10 physicians,13 nurses,1 pharmacist, and 54 first-aid attendants) were based in 8 advanced life support (ALS) clinics. INTERVENTIONS: First-aid attendants referred patients to the clinics, where nurses conducted initial assessments and referred patients to physicians at the venue. Three ambulances were stationed at the venues. RESULT: 22 trauma patients were developed and 183 medical complaints were encountered. Only 7 urgent medical problems were encountered.