Two Cases of Poisoning with Veratrum Maackii

Veratrum alkaloids in Veratrum maackii may cause significant gastrointestinal symptoms, bradycardia, hypotension, and arrythmia. We experienced successful outcomes in two patients who were victims of poisoning due to ingestion of Veratrum maackii, which was mistaken for Allium victorialis var. platyphyllum. One patient developed hypotension and prolongation of QT interval in electronicardiogram (ECG) and was treated with administration of vasopressor and magnesium. The other patient developed bradycardia and was treated with administration of atropine. Both patients were kept under close observation, and received supportive care, and both patients were discharged without any symptoms or complications.

Massive Scrotal Hematoma with Active Bleeding Caused by Sparganum

Development of swelling and pain without trauma in a scrotal hematoma is very rare. We report on a case of scrotal hematoma with active bleeding caused by sparganosis. A 75-year-old male patient who presented with left scrotal swelling and moderate pain that started one day ago was admitted to the emergency department. On the computed tomography (CT) scan, a hematoma of greater than 10 cm was observed in the left scrotum and contrast extravasation was observed on the post-enhanced CT scan. Therefore, we concluded massive left scrotal hematoma with active bleeding. The patient underwent immediate surgery, and approximately 200 cc of hematoma was evacuated, and a movable whitish colored sparganum was found and removed. In cases involving development of scrotal hematoma without trauma, confirmed by surgery, sparganosis should be suspected, and should be removed.

Predictive Factors of Re-expansion Pulmonary Edema of Patients with Large Spontaneous Pneumothorax after Chest Tube Insertion

PURPOSE: Reexpansion pulmonary edema (REPE) is rare but sometimes fatal complications can follow chest tube insertion for treatment of pneumothorax. The study assessed the medical records of patients who developed large pneumothroax and searched for the predictive factors and prediction equation for REPE. METHODS: The medical records of patients treated at an emergency department for pneumothorax from January 1, 2008 to December 31, 2009 were reviewed retrospectively. We compared the group that developed REPE with the group that did not develop REPE for clinical and demographic factors. Logistic regression analysis was used to identify predictive factors and prediction equation. We used receiver operator characteristic (ROC) curve analysis to identify optimal cut-off value and assessed the validity of the prediction equation. RESULTS: We screened out 92 large pneumothorax patients among 578 pneumothorax patients. Twenty two cases developed REPE. The calculated prediction equation was 28.955+0.147xsymptom duration before chest tube insertion (days)+0.048xsize of pneumothorax(%)-0.359xSaO2 (%). The results of assessment of the prediction equation using ROC curve analysis were Area under the ROC curve=0.834 and sensitivity 90.9% and specificity 70.0% at the cut-off value 0.210. CONCLUSION: In patients with large pneumothorax, time interval between symptom development and chest tube insertion, size of pneumothorax, and oxygen saturation rate of peripheral artery blood were identified as predictive factors. The prediction equation that we developed for REPE showed good predictability.

The Utility of Bispectral Index Scores for Sedative Intoxication in the Emergency Department

PURPOSE: This study was designed to determine the utility of bispectral index scores (BIS) compared to Glasgow coma scale (GCS) or Observer's Assessment of Alertness/Sedation Scale (OAA/S), in measuring changes in consciousness, prognosis and management of sedative-intoxication patients. METHODS: Sedative intoxication patients, who came to the emergency department with a severe deficit in consciousness, or a GCS less than 12, were analyzed. Patients' consciousness states were evaluated using OAA/S and GCS and compared with BIS scores. Patients' consciousness recovery time and hospitalization were recorded to see if these could be predicted by BIS using regression analysis. BIS, OAS/S and GCS were compared with regard to intubation, admission and ICU admission. Furthermore, usefulness and cut-off values of BIS were evaluated for those intubated. RESULTS: Of 128 sedative intoxication patients, 32 were enrolled for this study. Mean age was 50.94+/-18.01. They took 20.76+/-16.95 times over the average recommended dose. OAA/S and GCS ranged between 1~4 and 4~12, respectively; BIS was 39~88. The Spearman bivariate correlation coefficient was 0.619 between OAA/S and BIS and 0.651 between GCS and BIS, both showing a positive correlation (p0.05). BIS was an effective index for intubation (p=0.012) showing a sensitivity of 91% and a specificity of 50% when the boundary value was set to 65.5. When set to 77.5, sensitivity and specificity were 59%, 100%, respectively. CONCLUSION: In sedative intoxication patients, BIS is useful in determining the degree of sedation, predicting time to recovery of consciousness and as an objective index of intubation.

A Study on Estimating the Blood Pressure by Using the Pulse Wave Transit Time in Shock Patients Who Received Vasopressor Drugs / 대한구급학회지

BACKGROUND: Blood pressure is clinically used for monitoring shock patients and as a therapeutic indicator for them. Non-invasive blood pressure measurement has weak points such as the use of a cuff and it is a discontinuous measurement. A method of measuring the blood pressure by using the PWTT (pulse wave transit time) has been studied to make up for those weak points. If blood pressure monitoring can be done by using the difference of the PWTT between different points in the body, then this method will be a quite useful to monitor the BP of seriously ill patients. This study aimed to verify whether or not the PWTT has a significant correlation with the blood pressure of shock patients who received vasopressor infusion and whether this method is clinically applicable. METHODS: The study subjects were 20 shock patients who were hospitalized in intensive care units and they had received vasopressor, and we measured the PWTT and we analyzed its correlation with the SBP (systolic blood pressure) and DBP (diastolic blood pressure), as measured by non-invasive monitoring. We then determined the effects of the PWTT on the SBP and DBP. RESULTS: From the results of correlation analysis between the PWTT and the SBP and DBP, the SBP displayed a statistically significant negative correlation with the PWTT of 18 patients, while no significant correlation between the PWTT and DBP was observed. At the same time, from the results of the regression analysis of the blood pressures and the PWTT of each patient, it was found that the PWTT had a negative effect on the SBP of all the patients, except two. CONCLUSIONS: The PWTT has a negative correlation with the SBP of the patients who received vasopressor infusion.