A Patient with Altered Mental Status During Taking Fluconazole

Fluconazole is a fungistatic agent that is used for treating systemic and superficial fungal infections like onychomycosis and tinea pedis. Various adverse effects of fluconazole have been reported regardless of the total dosage and the duration of treatment. We consider the number of patients who visit the emergency room with nonspecific symptoms that are related to antifungal agents are not inconsiderable. In this case, 44-year-old male patient experienced mental change during taking fluconazole to treat tinea pedis. The understanding of the side effects and the drug interactions with antifungal agents like fluconazole can help to treat patients with nonspecific symptoms that are related to antifungal agents.

A Case of Naematololma Fasciculare Poisoning due to Misidentification as an Edible Mushroom

It is very difficult to discern edible mushrooms such as Naematololma sublateritium from toxic mushrooms such as Naematololma. fasciculare in the natural environment. We experienced a case of a patient who accidentally ingested Naematololma. fasciculare. The patient was admitted to the emergency department with nonspecific abdominal symptoms such as nausea, vomiting, abdominal pain and diarrhea. Treatment involved supportive care instead of gastric lavage and charcoal, since their effectiveness is unproven for relief of mushroom intoxication.

Pain and Paresthesia after Ingestion of Glechoma Longituba: Three Case Reports

Glechoma longituba is a common medicinal plant that is common in wet and sunny land. This plant is used to treat various illnesses including jaundice and edema. But, ingestion of the plant can cause severe pain and swelling on lip and mouth. We experienced three cases that had oral pain and sensory change after ingestion of G. longituba, which we report with a literature review.

The Effect of Decreases in Left Ventricle Volume and Area During Ventricular Fibrillation on Resuscitation Outcomes

PURPOSE: Dynamic changes in the dimensions of the left ventricle (LV) during cardiac arrest might influence the efficacy of CPR. However, the relationship between change in LV dimensions during cardiac arrest and CPR hemodynamics and outcomes have not yet been addressed. In the present study, we investigated changes in left ventricular volume and area during prolonged, untreated ventricular fibrillation (VF); we related those change to coronary perfusion pressure (CPP) during CPR and resuscitation outcomes. METHODS: In 12 domestic male pigs weighing 40+/-3 kg, VF was electrically induced and left untreated for 15 min. CPR was performed for 5 min prior to defibrillation. CPR was continued until the return of spontaneous circulation (ROSC) or for a maximum of 15 minutes. Mean aortic pressure and right atrial pressures were measured and CPP was calculated. LV dimensions were continuously assessed by echocardiographic measurement during the 15 minutes of interval VF. RESULTS: Six animals were successfully resuscitated. During the 15 minute interval of VF, LV area and volume were reduced in all animals. In animals that were not resuscitated, LV dimensions were significantly lower than those in resuscitated animals (p<0.01). These differences were observed after 10 minutes of VF. The animals with greater reduction in LV dimension during VF achieved significantly lower CPP during CPR in contrast to animals with larger LVs during VF. CONCLUSION: Greater decreases in LV volume and area during cardiac arrest are associated with low CPP during CPR and poor resuscitation outcomes. LV dimensions prior to starting CPR might therefore modulate the effectiveness of resuscitation interventions.

A Case of Testicular Torsion in a 57-Year-Old Man

Emergency physicians often have to treat patients suffering from testicular pain. Testicular torsion is a critical disease which can, in the worst situation, require orchiectomy. Testicular torsion is more common among neonates and adolescents than adults, and there are very few adults reported to have testicular torsion. There are several cases of testicular torsion among adults aged 20 to 40. However, there have been almost no reports of patients with testicular torsion over the age of 50. Patients over the age of 50 have a greater possibility of a delayed diagnosis. Therefore, they also have a greater possibility of requiring an orchiectomy. In our case, 57-year-old male patient complained of testicular pain that developed during his sleep after golf practice. After exploratory surgery, he was diagnosed as having testicular torsion. In conclusion, emergency physicians should consider the possibility of testicular torsion when older adults complain of testicular pain. Also, patients who suffer from intermittent testicular pain show higher rates of developing testicular torsion.

Effect of Emergency Department Overcrowding on the Outcome of Patient Care: A pilot study

PURPOSE: This study was designed to evaluate the effect of emergency department (ED) overcrowding on the outcome of patient care. METHODS: A retrospective review of medical records was obtained from Order Communicating System in the adult ED at a tertiary care teaching hospital from September 1, 2001 to November 30, 2001. For the overcrowding index, the length of stay in the ED and the time from registration to order were calculated. The outcome was defined as the result of care done in the ED or during hospitalization. The overcrowding effect on the outcome was tested by using a multivariate logistic regression analysis. Compared with the survival group, the odds ratio (OR) and 95% confidence interval (95% CI) of the death group was calculated with adjustments for gender, age, arrival time in the ED, arrival day of the week, clinical department, operation, hospitalization in the intensive care unit, and injury or disease. RESULTS: The number of total cases was 5,852. Of these, 3,046 was males and 2,806 females. Of these, the number of mortality cases in the ED was 106. A total of 2,025 patients were hospitalized. Of all the hospitalization cases, 161 died on the ward in spite of management. The length of stay in the ED, and adjusted OR were significantly increased in the total death cases and in the death cases on the ward compared to those of the survival cases. For time, from registration to order above 10 minute, compared to those below 10 minute, the adjusted OR for death in the ED was significantly increased. CONCLUSION: The overcrowding indices, such as the length of stay or the time from registration to order, were related with the outcome, that is, total death and death in the ED or on the ward.

Risk factors to consider operation in patients with small bowel obstruction

PURPOSE: There is a continuing debate about whether small bowel obstruction (SBO) is best managed operatively or nonoperatively. There is also no definite criteria for physician to decide to operate patient with SBO. This retrospective study was designed to determine the factors influencing the treatment modality of SBO. METHODS: A clinical analysis was applied to 95 patients with SBO who were admitted to the emergency department of Seoul National University Hospital from January, 2000 to December, 2001. The patients were divided into the operative and non-operative treatment groups according to the treatment modality. We compared parameters such as age, sex, the etiology of SBO, the history of previous SBO, the history of previous operation due to SBO, time period from onset of symptoms to admission, and symptoms and signs between two groups. RESULTS: Among 95 cases, the operative management was performed in 21 cases and the non-operative treatment in 74 cases. There was no significant difference in the distribution of age and sex between two groups. The most common etiology of SBO was adhesion due to previous operation. In the operative treatment group, 12 (57.1%) cases had the history of previous operation because of SBO, which showed a significant difference compared to the non-operative treatment group (p<0.001). The major symptoms and signs were abdominal pain, vomiting, abdominal tenderness, hyperperistalsis, leukocytosis, tachycardia, rebound tenderness and fever. Of these symptoms and signs, rebound tenderness was only more common in the operative group than in the non-operative group (p<0.001). CONCLUSION: At the time of admission to the emergency department, the rebound tenderness in patients with SBO is an important factor to consider the early operative intervention.