Analysis of Cardiopulmonary Resuscitation In Ward of Tertiary Hospital

BACKGROUND: Although cardiopulmonary resuscitation(CPR) is a very effective therapy in cardiac arrest, it is hard to prove the true effectiveness of CPR. Several studies about out-of-hospital and emergency department CPR exist, but only a few reports about in-hospital CPR are available. This study was designed to investigate in-hospital cardiac arrest, to analyze the result of CPR, and to evaluate the problems associated with in-hospital CPR. METHODS: A clinical analysis of 71 cases of in-hospital CPR announcement from January 2000 to August 2000 was performed. The initial rhythm on cardiac arrest, return of spontaneous circulation(ROSC), and the survivals were analyzed in the case of the 46 true cardiac arrest patients. RESULTS: During 8 months, there were 71 cases of in-hospital CPR announcement. Among them, there were 46 cases of true cardiac arrest and 25 cases of non-cardiac arrest. Of the 46 true cardiac-arrest cases, 27(58.7%) experienced ROSC, 15(32.6) survived for over 24 hours, and 7(15.2%) survived to be discharged. The initial rhythms on cardiac arrest were 30 cases(65.2%) of asystole, 14(30.4%) of PEA(pulseless electrical activity), and 2(4.3%) of ventricular fibrillation, with ROSC being 17 cases(56.7%), 9(64.3%) and 1(50.0%) cases and discharged survivors being 4 cases(13.3%), 3(21.4%) and 0(0.0%) cases, respectively. CONCLUSION: Extraordinarily high proportions of asystole and PEA were seen in the initial rhythm of cardiac arrest, and those were associated with high survival rates. Although further study is needed to evaluate the course leading to this high proportion of asystole and PEA, this result suggests that if the EMS system in the hospital is activated promptly and systematically, a better outcome will be achieved in case of cardiac arrest with asystole and PEA.

Post-Traumatic Cerebral Fat Embolism

Post-traumatic fat embolism was first reported by Zenker in 1862, Von Bergmann reported the first clinical diagnosis of the fat embolism syndrome in 1873. Fat embolism has been associated with traumatic or non-traumatic disorders. Fat embolization after long bone trauma is probably common as a subclinical event. The diagnosis of fat embolism syndrome is based on the patient's history, is supported by clinical signs of pulmonary, cerebral, and cutaneous dysfunction, and is confirmed by the demonstration of arterial hypoxemia in the abscence of other disorders. Two different mechanisms cause fat to embolize: direct entry of deposit fat into the blood stream and agglutination of endogenous or exogenous plasma fat. MRI can detect a cerebral fat embolism with a higher sensitivity than cerebral CT. We report a case of post-traumatic cerebral fat embolism without pulmonary involvement, and we present a review of the literature. A 16-year girl had a traffic accident and pelvic bone fracture. Forty eight hours later severe trauma become stuporous without a focal neurological deficit. The patient received supportive therapy, and her condition improved throughout her hospital course. She was discharged with good condition after a 30-day hospital stay.

Clinical Analysis of the Origins of Dizziness in Patients

BACKGROUND: Recently, The number of patients who have been complaining of the vertigo or dizziness has been increasing due to rapid growth of elderly population and senile disease. The differentiation of dizzy patients is not familiar to most emergency physicians. This study was designed to differentiate true vertigo and to investigate the clinical difference among central vertigo, peripheral vertigo, and other causes of dizziness. METHODS: The authors analyzed the cases of 237 dizzy patients who visited the emergency department of Chonnam University Hospital during the recent 2 years. For the base of dizziness, associated past illnesses, severity, nystagmus type, and the causes of central and peripheral vertigo. RESULTS: Female patients were 142(59.9%) and male patients were 95(40.1%). The most common age group was the 6th decade. The origin of dizziness was classified as peripheral cause(25.3%), central cause(32.9%), and others(41.8%). As to nature of the dizziness, the rotatory sense was dominant in peripheral vertigo and the floating sense and blurred vision in central vertigo. Peripheral vertigo was triggered by position change of head and body, and central vertigo by the eye movement. Audiograms I showed that most patients with central vertigo had normal hearing, but 46.7% of thoswith peripheral vertigo had an abnormal hearing disturbance. Nystagmus was more prevalent in peripheral vertigo CONCLUSION: History taking and physical examination played an important role in the diagnosis of dizzy patients. An important part of the diagnosis of a dizzy patient could be to evaluate the peripheral origin, the central origin and others causes. Because central vertigo may be associated with a significant neurological pathology, special radiological studies, including MRI and CT, are mandatory to rule out a devastating brain lesion.

An Analysis on the Patient Transported via 119 System

An analysis was performed to evaluate the problems in Emegency Medical Service System(EMSS) through the review of the 119 transport chart of 1,229 patients who visited to emergency center of Chonnam University Hospital via 119 system during the period from January 1998 to December 1998. The results were obtained as follows: 1) 1,229(4.9%) of the 25,253 patients were transported to emergency center via 119 system. Among 1.229 patients, male were 691(56%) and female 538(44%), and nontraumatic patients were 946(77%) and traumatic patients 283(23%). The peak age was 5th to 6th decades. 2) Mean arrival time to scene(ambulance response time) was 4.8 +/-.8minutes and mean arrival time to hospital 19.6 +/-0.1minutes. In the distribution of the requested place for ambulance, 73% was house and 23% was field. 3) In the severity of patients, 154(12.5%) patients were classified into emergent, 442(36%) into urgent, and 633(51.5%) into non-emergent. Among 1,229 patients, number of patients admitted were 419cases(34.1%), operated 85(6.9%), discharged in emergency department 536(43.6%), dead 70(5.7%), and transferred 119(9.7%), respectively. 4) The assessment of prehospital treatment by Emergency Medical Technician(EMT) revealed that checking the vital sign was only 49.5%, and prehospital care was limited to airway management, O2 inhalation and immobilization. There was no case of the notification to medical institute or the consultation to doctor. These results show that over the half of patients transported to level III emergency center via 119 system were classified into non-emergent and the prehospital management of the patient by EMT was not adequate. This study suggests the need of more simple and objective triage guideline for patient transport, the improvement of prehospital care system, and reconstruction of the computerized communication system.

Proper Depth of Nasotracheal Tube in Korean Adults

BACKGROUND: Nasotracheal intubation is one of techniques of airway management that is essential for the emergency physician to master. It is very important to determine the optimal initial depth of tube in nasotracheal intubation, prior to obtaining a chest radiograph. The average distance from the external naris to the carina is 32cm in the adult male and 27 to 28cm in the adult female in American. We thought that this distance would be inappropriate to Korean adults because of the difference of body habitus. So we studied the proper depth of nasotracheal tube in korean adults and evaluated the factors influencing to that distance. METHODS: A prospective study was performed to determine the distance from the external naris to the carina in 127 Korean adults examined by flexible fiberoptic bronchoscopy from October 1998 to August 1999. In addition, the influence of age, height and weight to that distance was evaluated in korean adults. RESULT:S: The distance from the external naris to the carina in Korean adults was 31.0 +/-1.3 cm in male and 27.6 +/-1.6 cm in female. That distance was positive related to height and weight, but not to age. CONCLUSION: If the tip of the nasotracheal tube be placed at 2cm above the carina, proper depth of nasotracheal tube should be 29cm in male and 26cm in female in Korean adults. And the distance from the external naris to the carina was related to height and weight.

The Eletrocardiographic Analysis of Acute Myocardial Infarction and Non-infarction Syndrome In the Patients with ST Segment Elevation and Chest Pain

BACKGROUND: ST segment elevation in patient with chest pain was seen in acute myocardial infarction and in numerous other non-infarction syndrome. The causes of non-infarction syndrome were left ventricular hypertrophy, BER(benign early repolarization), and left bundle branch block in cardiac origin and were hyperkalemia and hyperventilation syndrome in metabolic origin and were others. Furthermore, the differentiation of electrocardiogram between acute myocardial infarction and non-infarction syndrome was very difficult. So, we compared and analysed characteristics of ST segment elevation of acute myocardial infarction and non-infarction syndrome that suggested the clue of early diagnosis of coronary artery disease. METHOD AND MATERIALS: We retrospectively reviewed the electrocardiogram of 961 patients with chest pain who visited the emergency center from January 1999 to December 1999. Acute myocardial infarction was diagnosed by clinical finding, electrocardiogram, cardiac enzyme, echocardiogram, and myocardial spect. Left ventricular hypertrophy, BER, and left bundle branch block in cardiac origin of non-infarction syndrome were diagnosed by electrocardiographic criteria suggested by William J. Brady. Acute myocarditis, acute pericarditis, and hyperventilation syndrome were diagnosed by clinical finding. RESULTS: Among 961 patients with chest pain, 236(24.6%) patients manifested ST segment elevation who were diagnosed acute myocardial infarction in 162(68.6%) patients and non-infarction syndrome in 74(31.4%) patients. The causes of non-infarction syndrome in 74 patients were left ventricular hypertrophy(32:13.6%), BER(28:11.9%), left bundle branch block(11:4.7%), and others(3:1.3%). Three others were acute myocarditis, acute pericarditis, and hyperventilation syndrome. Electrocardiographic characteristics of ST segment elevation of non-infarction syndrome manifested almost same finding compared to William J. Brady' criteria. CONCLUSION: ST segment elevation in patient with chest with chest pain visited emergency department was seen in acute myocardial infarction(68.6%) and the other non-infarction syndromes(31.4%). Significant number of patients were not associated with acute myocardial infarction. Therefore, we must completely understand characteristics of ST segment elevation in acute myocardial infarction and the other non-infarction syndromes to diagnose fatal early coronary artery disease and to avoid unnecessary thrombolytic therapy.

The Incidence of Myocardial Injury in Patients with Spontaneous Subarachnoid Hemorrhage(SAH) Using Cardiac Troponin I

BACKGROUND: More than 90% of acute stroke patients have measurable cardiovascular sequelae, but we have been often overlooked in formal discussions of treatment. If we estimate the incidence of myocardial injury in patient with spontaneous SAH, we may figure the possibility of cardiac dysfunction in such patients. This study was designed to investigate the incidence of myocardial injury in patients with spontaneous SAH using cardiac troponin I(cTnI). METHODS: A prospective single emergency center study was performed to determined preoperative incidence of unrecognized cardiac injury in patients suffering spontaneous SAH. We include the spontaneous SAH patients who underwent serum measurements of the cardic troponin I immediately upon admission last six month period. ECG, CK, CK-MB and myoglobin were also performed at admission. We excluded the spontaneous SAH patients who had past history of myocardial ischemia and ECG abnormality. RESULTS: Fifty-two patients(34 females, 18 males) with spontaneous SAH were studied prospectively. 18 patients(34.6% of the total study population) had cTnI level above 0.5ng/ml. ECG was performed in 52 patients and was abnormal in 15 of the 52 patients(28.8%). CONCLUSION: The measurement of cTnI has provided physicians with a myocardial marker that has a cardiac sensitivity for cardiac injury equal to that of CK-MB yet with greater specificity. So, cardiac troponin I is useful to estimate the incidence of myocardial injury in patients with spontaneous SAH. And we may estimate the possibility of cardiac dysfunction in such patients. This knowledge will hopefully aid in the care and improve the outcome.

Indication of Evaluation and Hospitalization in Patients of Alert Mental state who Visit Emergency Department due to Headache

BACKGROUND: Headache is a common symptom. It has not proved useful methods that the physician evaluated the alert patient who had headache. It needs the presence of predictors of intracranial pathology(ICP) which serves as influential factors in the indication of evaluation and hospitalization of patients. METHOD: So, in order to identify such factors, patient records were retrospectively analysed. 168 patients with the chief complaint of headache presented to the Emergency Department of Chonnam University Hospital during the period from January 1, 1995 to December 31, 1997. All were in an alert mental state and had no evidence of trauma and intoxication. RESULTS: 14 cases(8.3% revealed ICP. 41 cases(24.4% revealed systemic disease. The remainder of cases were divided among unclassified headaches(61 cases, 36.3%, tension headaches(30 cases, 17.9%, and migraine(22 cases, 13.1%. Comparison of ICP-positive and ICP-positive cases revealed that ICP-Positive Patients could be categorized by the following findings: (1) Presence of the focal sign through neurological examination, (2) age greater than 55 years, (3) presence of associated symptoms, (4) acute headache. These four manifestations were proven to be statistically significant as predictors of ICP. CONCLUSION: Although the positive predictive value of the above criteria is not perfect for the prediction of ICP, they are worthy of clinical consideration in alert patients presenting with headache.

Two cases of Anticholinergic Toxicity After Jimson weed Ingestion

Jimson weed, also known as Datura stramonium, is a member of the Solanaceae family. Jimson weed was used by American Indians for medicinal and religious purposes. All parts of the Jimson weed plant are poisons, containing the alkaloids atropine, hyoscyamine and scopolamine. So, it is caused by these components to make a anticholinergic toxicity within 6h after ingestion. Initial manifestations include dry mucus membrane, blurred, vision, thirst, difficulty swallowing and speaking, and photophobia, and may be followed by hyperthermia, confusion, agitation, combative behavior, hallucination, urinary retention, seizure and coma. We experienced two patients who developed combative behavior and agitation with pupil dilation caused by Jimson weed. They discharged with improvement after supportive for 2days.

Idiopathic Bilateral Diaphragmatic Paralysis Combined with Acute Pancreatitis

Bilateral diaphragmatic paralysis(BDP) is a rare disorder, which can be secondary to spinal cord injury, motor neuron disease, myopathy, noninfectious polyneuropathy, infection, iced saline cardioplegia performed during cardiac surgery, or idiopathic causes. there may be typical presentations such as dyspnea, paradoxical respiratory movement, and hypercapnic respiratory failure. It needs to exclude above secondary causes to consider idiopathic bilateral diaphragmatic paralysis. We report a 51-years-old man who presented with idiopathic bilateral diaphragmatic paralysis combined with acute pancreatitis. We couldnt, find out the association of these two clinical conditions. The patient was improved by mechanical ventilation.