Clinical Significance of Prolonged QTc Dispersion in Spontaneous Intracerebral Hemorrhage

PURPOSE: QTc dispersion is a quantitative measure of myocardial repolarization and is a new important prognostic factor for many diseases. We have analyzed the admission ECGs of 53 patients with spontaneous intracerebral hemorrhage (ICH) for QTc dispersion. This study was performed to investigate the value of QTc dispersion as a prognostic factor in ICH patients. METHODS: ECGs done within 24 hours from attack onset were analyzed for abnormalities and QTc. The QTc dispersion is the QT duration of the longest minus the shortest rate-corrected QT interval. We studied the differences in QTc dispersions on the initial ECGs in the ED between a favorable group and an unfavorable group. RESULTS: We found that patients had less chance for a good recovery if they had a lower Glasgow Coma Scale (GCS) score on admission, a larger volume hematoma, a prolonged QTc dispersion, or a longer maximal QTc interval of the 53 patients with ICH, 16 (30.2%) patients demonstrated ECG abnormalities. The QTc dispersion was extremely prolonged in both groups. The favorable group included patients with a mean QTc dispersion=70.6 ms, whereas the unfavorable group included patients with a QTc dispersion= 117.6 ms. CONCLUSION: A prolonged QTc dispersion and a lower GCS score were significant predictors of a poor prognosis for spontaneous ICH patients. An increased QTc dispersion on the initial ECG is an important prognostic factor for ICH patients. More attention should be given to the disposition and intensive care of such patients.

Relationship Between the Methemoglobin Level and Oxygen Saturation on a Pulse Oximeter in Cases of Acute Methemoglobinemia

PURPOSE: Methemoglobinemia is a disorder caused by over accumulation of methemoglobin in the red blood cells of circulating blood, prohibiting adequate supply of oxygen to organs. The seriousness of its clinical symptoms and its treatment methods are determined by the blood methemoglobin level. Therefore, we revealed the clinical relation between the blood methemoglobin level and oxygen saturation on a pulse oximeter. Then we tried to indirectly measure the blood methemoglobin level by using their relation, instead of checking its level through blood sampling. METHODS: The medical records of 39 patients who were admitted to the Chonnam University Hospital Emergency Medical Center due to acute methemoglobinemia between January 1, 2001, and June 30, 2005, underwent a prospective analysis. RESULTS: Among the total of 39 cases, there were 25 males (64.1%) and 14 females (35.9%). There were 15 cases (38.5%) of dapsone overdosage, 18 cases (46.1%) of aniline- type pesticide intoxication, and 6 cases (15.4%) of aniline gas inhalation. As for the main symptoms for admission to the emergency center, there were 8 cases involving on altered mental state, 7 involving dizziness, 3 involving cyanosis, 7 involving dyspnea; and 14 cases were nonsymptomatic. Relational analyses of arterial blood gas analysis results, pulse oximetry saturation levels, and blood methemoglobin levels of the admitted patients revealed that only the pulse oximetry saturation level was related to the blood methemoglobin level (p<0.001). CONCLUSION: When in doubt about the possibility of acute methemoglobinemia, differences in the oxygen saturation level on the pulse oximeter level can be used instead of repeated co-oximetry examinations, can be used to judge treatment responses.

Evaluation of Prognostic Factors in Acute Renal Failure at the Emergency Department

PURPOSE: This study intended to identify prognostic factors influencing recovery, progressing chronic renal failure (CRF) and mortality in acute renal failure (ARF) patients at the emergency department. METHODS: We retrospectively analyzed 104 patients with ARF and with serum creatinine (Cr) level above 2 mg/dL and glomerular filtration rate (GFR) 60 years, underlying disease, cause of ARF, urine volume, existence of oliguria, duration of oliguria, proteinuria, GFR, serum BUN, serum Cr, BUN/Cr ratio, arterial pH, PaO2, S a O2, serum Na+, serum K+, serum albumin, serum total bilirubin, serum osmolarity, serum AST, serum ALT, serum creatine kinase, and serum myoglobin were all significant factors discriminating between recovery patients and nonrecovery patients (progressing CRF, mortality). Based on a multivariate analysis, sex, existence of oliguria, duration of oliguria, GFR, BUN/Cr ratio, PaO2, serum K+, SaO2, serum bilirubin, and serum osmolarity were useful factors which might affected non-recovery. CONCLUSION: In ARF, the prognostic factors were serum K+, S a O2, duration of oliguria, and BUN/Cr ratio. The higher serum K+, the lower SaO2, the longer the duration of oliguria, and the lower the BUN/Cr ratio are for ARF patients at the emergency department, the more the intensive care emergency physician must perform.

Clinical Analysis of CPR in Infants with Out-of-Hospital Cardiopulmonary Arrest

PURPOSE: Since 1960 pediatric advanced life support (PALS) has been studied and applied to clinical situations, ILCOR guidelines 2000 for CPR and ECC was achieved. Pediatric cardiopulmonary arrest differs from adult arrest in etiologies, mechanisms, and managements. This study was performed to identify the clinical manifestations and real picutre of CPR to recognize the need of standard CPR method that increases the survival in infants with out-of hospital arrest. METHODS: This study was planned by retrospectively reviewed the records of all children who arrived without spontaneous respiration and palpable pulse at the emergency room of the three Hospitals from January 1996 to July 2003. RESULTS: During that period, 45 infants presented with out of-hospital cardiopulmonary arrest. Overall, there was a return of vital signs in 15 of the 45 patients; 6 survived to discharge from hospital. 1. Out-of-hospital arrest in infants demonstrated that 60% were male, mean age was 133.4 days. Of these, 71.1% of the arrests occurred in the home with family members presents, those family members didn't perform basic CPR in only 1 case. 2. In any ROSC group, the interval between the arrest and arrival at the hospital was 14.4 minutes. In ROSC never achieved group, the interval was 32.0 minutes. 3. Two of the 15 patients with SIDS(13.3%) and four of the 13 patients with respiratory arrest(30.8%) survived to hospital discharge. CONCLUSION: Factors that predicted survival to discharged alive included a death caused by respiratory disease, a short interval between the arrest and arrival at the hospital, and a short duration of resuscitation efforts in the ER. We found that need of standard guideline and commonly applied CPR techniques.

A Case of Locked-in Syndrome with Hypoglycemia

Locked in syndrome (LIS) is a state of tetraplegia and lower cranial nerve palsies in which vertical eye movement and blinking are the only means of communication, but consciousness is preserved. LIS is most frequently a sequelae of a basilar artery thrombosis lesion and may be caused by trauma, hemorrhage, a tumor, infection, etc., which results in a ventral pontine lesion or bilateral midbrain lesion. Early diagnosis and treatment must be a priority because the recovery of patients with locked in syndrome caused by a basilar artery occlusion is exceptional, with a 65~75% mortality. Although an improved clinical outcome can be achieved in patients with a basilar artery occlusion by early recanalization after the use of thrombolytic therapy or angioplasty, early diagnosis and treatment of this state is difficult, for the neurologic deficits develope gradually. The diagnosis of LIS in patients who present with hypoxia, metabolic disorder, endocrine disorder, central nerve system disorder, acute alcohol intoxication, acute drug intoxication, etc may be missed. At the emergency department, closer attention and frequent neurologic examinations must be given to patients who complain of altered mental state. We report a case of LIS which was misdiagnosised as hypoglycemic encephalopathy and review the literature.