Feasibility of Echocardiographic Evaluation of Ventricular Function After Short-term Course

BACKGROUND: The initial history, physical examination, and ECG assessment should focus on identification of potentially serious noncardiac or cardiac disorders, including coronary artery disease, congestive heart failure, and electrical instability at the emergency room. additionally, it is essential to define disease severity, stability and need for emergency therpy. echocardiography is a useful tool for this purppose. especially Doppler echocardiography may be more sensitive and time-saving diagnostic tool for the evaluation of patients presenting with cardiogenic symptoms. So we evaluate the feasibility of the echocardiographic measurement by emergency physicain after short-term course. METHOD AND RESULTS: Twenty volunteers(10 male, 38.8+/-9.3 years) were included in the study for measurement of myocardial performance index and established parameters of ventricular function using conventional echo-Doppler methods. Myocardial performance index: (ICT+IRT)/ET, was obtained by subtracting ejection time(ET) from the interval between cessation and onset of the mitral inflow velocity to give the sum of isovolumic contraction time(ICT) and isovolumic relaxation time(IRT). The most of mean values of echocardiogrphic parameters were not significantly different between those of cardiologist and those of emergency physicians(p<0.01). The duration for measuring myocardial performance index was shortest among echocardiographic parameters. the validity of echocardiographic parameters measured by emergency physicians was proved relatively good. CONCLUSION: It is proved to be feasible for emergency physician to perform echocardiographic evaluation of ventricular function after short-term course.

Case of Ventricular Tachycardia After Caowu-Ingestion

Aconitum species have been used in western and eastern medicine for centuries. In present, chinese medicine uses the drug to treat weak constitution, poor metabolism, dysuria, cardiac weakness, gout rheumatism in the limbs, neuralgia. Poisoning may occur from intentional or accidental ingestion, and the concentration of the toxic alkaloids - aonitine, mesaconitine, and hypoconitine - varies depending on species, place of origin, time of harvest, and processing procedure. In addition to cardiac arrhythmias, and hypotension, the alkaloids cause GI upset & neurological symptoms, especially numbness of the mouth and parethesia in the extrimities. The alkaloid causes a prolonged sodium current in cardiac muscle with slowed repolarization. The aconitine acts as a agonist of Na-channel receptor. Vaughan-Williams' classification I antiarrhythmic agents which belong to might be the first choice for the therapy of aconitine induced arrhythmias. The modification of the sodium system by aconitine seems to be responsible for the prolongation of the action potential and the appearance of extrasystoles and fibrillation. We experienced a 67-year-old male patient who suffered chest discomfort and palpitation with ventricular tachycardia through to be caused by aconitine. After treatment for 3days he recovered well and discharged. We report this case with literature review.

Abdominal Trauma with Rib Fractures; What is the level of rib fractures we must evaluate intra-abdominal injuries?

Many authors have been reported that the abdominal trauma, especially injury of the liver and spleen, is frequently found with lower rib fractures, below the ninth rib fractures and the incidence was about 20 to 30%. In cases of rib fractures, Intra- abdominal organs may be injured in the higher rib fractures than the ninth because the diaphragm is elevated at the level of filth intercostal space in expiration period and the intra-abdominal lesions are often delayed evaluated due to the pain of the fractures and masked by the other injuries of the head and the extremities. So above reasons, we were often questioned what the level of rib fracture we must evaluate the intra-abdominal injury was? So we investigated 452 patients with rib fractures who visited our emergency medical center from 1995, January to 1996, December and divided into two groups according to the prescience of intra-abdominal organ injuries by each the level of rib fractures. The number of patients with intra-abdominal organ injuries were 75(16.6%) and the most frequently damaged organ was the liver(25 cases, 33.3%). We calculated the statistical values of each level of rib fractures by the Chi-Square method and got a result that the level of rib fracture we must evaluate the intra-abdominal injuries was the sixth rib fracture. Therefore, if we will meet the patients with rib fracture below the sixth, we must have attentions to the intra-abdominal injuries and evaluate the abdomen closely with various diagnostic methods.