Bilateral Primary Psoas Abscess in Heat-stroke Patient: A case report

Psoas abscess is rare condition showing high mortality. Recently, we experienced a case of a bilateral primary psoas abscess in a severely ill heat-stroke patient. This is the first such report as par as we know. A 52-year-old man, construction crew member, was transferred to our hospital, presenting with a comatose mentality and high fever. Two hours before, he had collapsed on the work site, and the patient was diagnosed as having heat stroke with multiorgan failure and possibly aspiration pneumonia. However, the chest CT scan showed no specific abnormality, except swelling on the right psoas muscle. He was transferred to the ICU and underwent cooling. On the morning of the next day, the patient's rectal temperature was down to 37.1degrees C, and he woke up. On the third hospital day, the core temperature was elevated up to 38.4degrees C, and the patient became comatose again. On the 10th day, we performed an abdominal CT scan and found a bilateral psoas abscess. On the 13th day, MRI of the lumbar spine showed no other connection with adjacent organs and a decrease in the horizontal diameter of the abscess of 1 cm in comparison with that in a previous imaging. We continued to follow the medical therapy instead of surgical interventions, and follow-up abdominal CT scans showed complete resolution.

The Risk of Cervical Spine Injuries among Submersion Patients in River

PURPOSE: Recently, the American Heart Association recommended that routine cervical spine protection in submerged patients was not necessary, except in high-energy injury situations. However, until now, this recommendation has few supportive studies and literatures. This retrospective study was performed to demonstrate the risk of cervical spine injury in patients who had been submerged in a river. METHODS: Seventy-nine submerged patients who visited St. Mary's Hospital between January 2000 and December 2005 were included in this retrospective study. We investigated and analyzed the victim's age, sex, activity on submersion, mental status and level of severity at admission, prognosis at discharge, associated injuries, and risk group by using the medical records and cervical spine lateral images. According to the activity on submersion, victims were classified into three groups: high risk, low risk, and unknown risk. The reports of radiologic studies were classified into unstable fracture, stable fracture, sprain, degenerative change, and normal. RESULTS: The patients'mean age was 36.8 yrs, and 54% were males. Of the 79 patients, adult and adolescent populations (80%) were dominant. Jumping from a high bridge (48%) was the most common activity on submersion and accounted for 52% of the high-risk group. The Glasgow coma scale at admission and the cerebral performance scale at discharge showed bimodal patterns. The results of the radiologic studies showed one stable fracture, one suspicious stable fracture, and 18 sprains. The incidence of cervical spine fracture in submerged patients was 2.5% in our study. The incidence of cervical spine injury was higher in the high-risk group than it was in the low-risk group, especially in the jumping-from-high-bridge subgroup; however this observation was not statistically significant. No other factors had any significant effect on the incidence of cervical spine injury. CONCLUSION: Our study showed that even submerged patients in the high risk group had a low incidence of cervical spine fracture and that the prognosis of a patient did not seem to be influenced by the cervical spine fracture itself.

Emergency Ultrasonography for the Detection of a Pneumothorax in Blunt Thoracic Trauma Patients

PURPOSE: This study was conducted to determine the accuracy of ultrasonography (US) in the detection of a traumatic pneumothorax. METHODS: We prospectively evaluated thoracic US for the detection of a pneumothorax in blunt thoracic trauma patients. The presence of "lung sliding"and "comet tail" artifacts were determined in patients by using ultrasound before radiologic verification of a pneumothorax by residents and attending physicians of the emergency department who had been instructed in thoracic ultrasound. Finally, the diagnosis of a pneumothorax was confirmed by using chest computed tomography (CT). RESULTS: Forty nine patients were enrolled in this study. Twenty-five of the 49 patients had a pneumothorax at chest CT, and for 24 patients, the pneumothoraces had been detected at thoracic US and for 13 patients, they were seen at supine chest radiography. The sensitivity and the specificity of US were 96% and 92%, relatively the positive predictive value was 92%, and the negative predictive value was 96%. The sign of disappearance of "lung sliding" had a sensitivity and negative predictive value of 100% and a specificity of 88% for the diagnosis of a pneumothorax. The absence sign of a "comet tail"artifact had a specificity and positive predictive value of 100%, and a sensitivity of 95% for the diagnosis of a pneumothorax. CONCLUSION: In this study, US was more sensitive than supine chest AP view in the detection of a traumatic pneumothorax. Thoracic US is a reliable method for the detection of a pneumothorax and should be added to the currently performed FAST examination in trauma cases.

Delivery Temperature of Warmed Saline or Blood at Variable Flow Rates

PURPOSE: This study was undertaken to determine the effect of the infusion rate on the temperature of the infusate reaching the distal end of an infusion tubing with active fluid warming. METHODS: One-liter bags of normal saline were warmed to 6 0 degrees C using a microwave oven and were then run through standard infusion tubing at rates of 200, 400, 600, 800, and 1,000 mL/hr. The temperatures at the distal end of the infusion tubing were measured every one minute for the first 10 minutes and then every ten minutes for 1 hour. Subsequently, normal saline and packed red blood cells, which were warmed using a fluid warmer, were infused at rates of 200, 400, 600, 800, and 1,000 mL/hr. Temperatures were recorded when the readings had stabilized within a range of +/-0.1 degrees C. RESULTS: Normal saline warmed by a microwave oven could be delivered through standard infusion tubing at a temperature of more than 37 degrees C if the normal saline had been preheated to 60 degrees C and infused through long tubing (210 cm) at rates of 800 and 1,000 mL/hr. Also, normal saline and packed red blood cells, warmed to 41 degrees C with a fluid warmer, could be delivered at a temperature of or near 3 7 degrees C through relatively short tubing (110 cm) at a rate of 1,000 mL/hr. The fluid composition influenced the infusate temperature (p < 0.05). CONCLUSION: When patients with hypothermia or major trauma are treated by infusing warmed normal saline or packed red blood cells, we should consider appropriate flow rates for the fluid so as to maintain a therapeutic delivery temperature when using practical infusion tubing in the ED setting.

Usefulness of the Syringe Aspiration Technique for Detecting the Position of Endotracheal Tube

PURPOSE: The study was conducted to evaluate the usefulness of syringe aspiration technique (SAT) to correctly differentiate between esophageal and tracheal intubation in emergency department. METHODS: This study, which was comprised of a prospective series of cases, was conducted in the emergency department of an university hospital. A 50 mL catheter-tip syringe was attached to the end of the tracheal tube following intubation. The syringe plunger was then withdrawn or aspirated with 50 mL of air. The ability to withdraw air into the syringe without resistance and without syringe plunger rebound was considered evidence of tracheal intubation. If resistance was met as the syringe was aspirated or if the syringe plunger rebounded following aspiration, esophageal intubation was assumed. RESULTS: Seventy patients were enrolled in the study. Tracheal intubation was performed in 46 patients, and esophageal intubation was performed in 24 patients. Of the 46 tracheal intubations, the SAT correctly indicated tracheal placement in 45 and was indeterminate in 1 case because of blockage of the endotracheal tube by gastric material resulting from aspiration. All 24 esophageal intubation were corrected identified. CONCLUSION: This study suggests that the SAT is a safe and effective device for determining endotracheal tube position in patients with various clinical conditions requiring urgent airway control in the emergency department.

Effect of Low Dose Radiation on Tran: sient Global Cerebral Ischemia in Gerbils

PURPOSE: To date, much research has been performed for amelioration of secondary brain damage after cerebral ischemia and reperfusion. We investigated the antioxidative and anti-inflammatory effects of post-ischemic low-dose total-body irradiation (TBI) on transient global cerebral ischemia. METHODS: The gerbils were divided into six groups (8 gerbils in each group): group I and II, sham operation; group III and IV, 10-minutes ischemia without TBI; group V and VI, 10-minutes ischemia with TBI at 10 minutes after reperfusion. The activity of superoxide dismutase (SOD) and the levels of myeloperoxidase (MPO) and malondialdehyde (MDA) in the brains of group I, III, and V at 4 hours after reperfusion were measured. In the brains of group II, IV, and V, the levels of MPO and MDA were measured and the hippocampal areas were stained with hemotoxylineosin (H-E) and TUNEL at 5 days after reperfusion. RESULTS: The activity of Cu/Zn SOD in group V was significantly increased compared to that in group III, but their activities were significantly lower than that of group I. The MPO and MDA levels in groups V and VI were significantly lower than those in group III and IV. The percent dead neurons found in the hippocampal CA1 region by using H-E staining was significantly lower in group VI than in group IV. The number of TUNEL positive cells in the hippocampal CA1 region was significantly lower in group VI and in group IV. CONCLUSION: Anti-oxidative and anti-inflamatory responses induced by post-ischemic low-dose TBI may reduce secondary neuronal damage following 10 minutes of transient global cerebral ischemia.