A Case of Severe Hypothermia with Cerebral Hemorrhage

Hypothermia is not an uncommon condition that emergency physicians meet in their emergency department services. Most cases involve mild hypothermia and are rewarmed well without any complication or sequelae. Hypothermia is well known to be correlated with drug intoxication, such as with alcohol. Since alcohol adds to the suppressive effect on central nervous system due to hypothermia, most intoxicated patients are so deeply drunk that they look comatous. We report the case of a 41-year old male drunk and semi-comatous and who had been left in his car for more than 12 hours on a freezing cold night. He arrived at our emergency department with a body temperature of 27.3degrees C. The patient was warmed with active rewarming, and during the procedure, the patient appeared markedly hypertensive, instead of showing rewarming shock. After initial stabilization the patient was taken for a cerebral CT scan and was found to have a large amount of intracranial hemorrhage. He was treated conservatively in the intensive care unit and was discharged as a hopeless case.

Survey on Emergency Medicine Specialists in Korea : Working Patterns and Level of Satisfaction

PURPOSE: This research was to investigate and analyze the working conditions and level of satisfaction, to suggest ideal working conditions for emergency medicine specialists, and to propose a future direction for the advancement of emergency medicine. METHODS: Among the 185 doctors who were EM board-certified from 1996 to 2000 in Korea, this survey was sent to 129 emergency medicine specialists; to those 57 answered the questionnaire. The questionnaire was made up of 17 items in the form of short answeres and descriptions. The analysis was done using the SPSS WIN program. RESULTS: From the survey, the level of dissatisfaction was found to be higher than the level of satisfaction and the most prominent cause was the working conditions, including night duty. The most ideal working pattern sought after was an 8-hour workshift and this result did not vary with the specialists the position in the hospital. At present, night duty is not performed by most specialists, but rather extended weekend duty is. The number of specialists employed at most emergency medical centers is under 3 (81.7%). As the ideal number of specialists (more than 4 in 89.5%) is not being reached, 24-hour stationing of a specialist at an emergency medical center is not being achieved. CONCLUSION: This survey was done in order to establish the proper working conditions and a base for improving emergency medicine itself by investigating and studying the present working conditions of emergency medicine specialists, their complaints, and their proposals for advancing of emergency medicine.

Effect of Epinephrine and Vasopressin on Resuscitation in Rat Asphyxia Arrest Model

BACKGROUND: Vasopressin has recently been recognized to have greater effect on improving blood flow to myocardium and brain during cardiac resuscitation than epinephrine and also improves rates of ROSC(return of spontaneous circulation) and survival in pre-hospital and in-hospital prolonged refractory cardiac angst patients who did not respond to the standard epinephrine treatment. This study was designed to investigate the effects of vasopressin on ROSC rates and survival rates in rat asphyxia arrest model. METHOD AND MATERIAL: Thirty male Sprague-Dawley rats were used. Anesthesia was induced with halothane and nitrous oxide and ventilatory cairo was maintained. EtCO2 was adjusted to 30-40mmHg and halothane was maintained. Right infernal carotid artery and right femoral vein were cannulated and EKG electrodes were attached. After 10 minutes of asphyxia, group 1 was treated with 1ml of saline, group 2 with 1ml(0.001mg/100g) of epinephrine and group 3 with 1ml(0.16u/100g) of vasopressin for resuscitation. Statistical significance was an analysed by SPSS with ANOVA and chi-square tests. RESULTS: No significant differences were seen in baseline measurements. Three ROSC and eight 60 minutes survivals were found in group 1, whereas nine ROSC and eight 60 minutes survivals were obtained in group 2 and all of the subjects in group 3 showed ROSC and 60 minutes survival, but no statistical differences were seen between group 2 and 3. CONCLUSION: Vasopressin seems to have similar effect on improving ROSC and survival rates compared to epinephrine in rat asphyxia models.

Evaluation of in-Hospital Cardiac Arrest According to the in-Hospital Utstein Style

BACKGROUND: The in-hospital 'Utstein style' is international recommended guidelines for reporting outcome data from in-hospital resuscitation events. This study was designed to evaluate the current status of in-hospital cardiopulmonary resuscitation(CPR), and to provide basic data far the unified reporting guideline of resuscitation in Korea. METHODS: The patients who had received CPR in a university hospital were searched during one year period from March 1997. The variables according to the Utstein style were evaluated with review of the medical records. RESULTS: During the period, 428 patients had received CPR. Excluding the patients of out-of-hospital arrest and less than 8 years, 242 were enrolled. Their initial ECG rhythms were 55 of asystole, 148 of pulseless electrical activity, and 39 of ventricular fibrillation, The spontaneous circulation was returned in 118(49%, and 48(20% were maintained more than 24 hours. Twenty-two patients(9%) were discharged with spontaneous respiration. Among the survivors, 17 had the Cerebral Performance Category of 1. CONCLUSION: We recommend the Utstein style to report the outcome of in-hospital CPR.

Alteration of Ionized Calcium, Magnesium and Acid-base status in Hyperventilation Syndrome

BACKGROUND: Tetanic spasm is often noted in hyperventilating patients coming in to emergency departments. Classical explanation far this phenomenon was decreased ionized calcium levels due to respiratory alkalosis precipitated by the hyperventilation. Clinically these symptoms were observed in hypocalcemia and were thought as such without doubt. But clinical investigation on the levels of ionized calcium levels have not been clarified. Recent investigations on hyperventilating volunteers have suggested other pathophysiology for tetanic spasm in hyperventilating patients which is the decrement of ionized magnesium level rather than ionized calcium. We wanted to see if these results applied to our hypeventilating patients and see if ionized magnesium level was a factor producing tetanic symptoms. METHOD AND MATERIAL : 35 patients with diagnosis of hyperventilation syndrome by emergency physician were studied retrospectively. Hyperventilating patients arriving at Severance hospital Emergency Center from Jan.1996 to Feb. 1998 were included. Patients with cardiovascular, pulmonary diseases, history of renal or liver disease were excluded. Ion-selective method was used to detect ionized calcium, magnesium levels and arterial blood gas features. Average levels were compared to reference ranges and Wilkoxon-rank. sum test was used to compare hyperventilating patients with tetanic spasm and those with other symptoms such as dyspnea, chest pain and palpitations. RESULTS: 1) Sodium, potassium and chloride levels were 138mmol/L, 3.6mmo1/L, 106mmol/L each which were within a normal range. 2) Degrees of hyperventilation were similar with average of PH 7.54(7.4-7.71), pCO2 23.6mmHg, showing respiratory alkalosis. 3) Ionized calcium and ionized magnesium each showed 0.61mg/dL, 0.16mg/dL lower values than the lowest reference ranges which were 4.5-5.6mg/dL for ionized calcium and 1.19-1.63 for ionized magnesium. 4) No statistical difference points were observed between the tetanic spasm group and group without spasm. Female preponderance were noted in tetanic spasm group. CONCLUSION: We conclude that ogler than decrement of ionized calcium, decrement of ionized magnesium could be a factor far inducing tetanic spasm in respiratory alkalosis caused by hyperventilation.