Effect of High-dose Pralidoxime in Organophosphate Intoxication

PURPOSE: Pralidoxime(2-PAM) is the mainstay of organophosphate intoxication management as an antidote. We investigated the usefulness of high-dose pralidoxime therapy. METHODS: From January 2000 to July 2003, 86 patients presented with organophosphate insecticide intoxication to the emergency medical center of Chonnam National University Hospital. They were randomized into two groups: Group I was given continuous IV infusion of pralidoxime in dose of 500 mg/hr after an initial bolus dose of 2 g and Group II was given continuous IV infusion of pralidoxime in dose of 1000 mg/hr after an initial bolus dose of 2 g. Both groups were given same therapeutic interventions, including the duration of atropine administration. The plasma cholinesterase activites were monitored at admission and at 24 hr and 48 hr after infusion of pralidoxime. The effectiveness of the two treatment modalities were gauged by comparing the durations of mechanical ventilation and intensive care unit (ICU) stay. RESULTS: The mean durations of mechanical ventilation were 9.82+/-6.45 days in group I and 6.51+/-4.50 days in group II. The mean durations of ICU stay were 12.82+/- 7.69 days in group I and 9.15+/-5.38 days in group II. group I showed that longer durations of mechanical ventilation (p=0.03) and ICU stay( p<0.001). The plasma cholinesterase reactivation rate were higher in group II than in group I. CONCLUSION: The results suggest that continuous high-dose pralidoxime therapy may be helpful in the treatment of organophosphate intoxication.

A Case of Infective Endocarditis in which Cerebral Infarction and Hemorrhage developed together

Risk factors for infective endocarditis include injection drug abusers and patients with structural heart defects undergoing dental procedures. Infective endocarditis is clinically important because it is hard to diagnose it in its early stage owing to its various clinical manifestations, and because its morbidity and mortality increase when neurologic complications occur. This is a case of infective endocarditis in the course of treatment of which complicating cerebral hemorrhage and infarction progressed rapidly and prompted death.

Clinical Analysis of Elevated Serum AST Level in Emergency Patients

PURPOSE: Serum aspartate aminotransferase (AST) is an enzyme widly used in the diagnosis of acute liver disease. It is also highly sensitive in cases of myocardial infarction and muscular injury. This study is designed to ascertain the utility of AST for diagnosis in emergency room. METHODS: From July 2001 to September 2002, 98 patients with AST greater than ten times (400 U/L) the normal range were identified by the biochemistry laboratory in the Emergency Medical Center of Chonnam National University Hospital. The patients 'clinical records were studied to determine the diagnosis, the clinical course, the physical finding on arrival, the past history, other serological and imaging studies, etc. RESULTS: The most common cause of elevated AST level was hepatic in origin (74 cases, 75.5%). Other causes were soft tissue injury (13 cases, 13.3%) and myocardial infarction (11 cases, 11.2%). In group with hepatic causes for raised AST, 21 (28.3%) patients had pancreaticobiliary desease, 20 (27.0%) patients were in conditions producing hepatic ischemia, 18 (24.3%) patients had hepatocellular desease, 6 (8.1%) patients had traumatic liver injury, and 4 (5.4%) patients had malignancy. The hepatic ischemia was caused by sepsis (6 cases, 30.0%), heart failure (6 cases, 30.0%), hypoxia (5 cases, 25.0%), and prolonged hypotension (3 cases, 15.0%). CONCLUSION: The main cause of a notably increased serum AST level is known to be hepatocellular disease, but this study for emergency patients revealed that other causes, such as hepatic ischemia, traumatic liver injury, and muscular disease, were also remarkable. When the level of serum AST is abnormally high, the clinician must consider not only hepatocellular disease but also prolonged hypotension, circulatory collapse, hypoxia, traumatic liver injury, etc.

Clinical Analysis of Hyponatremia in Emergency Patients

PURPOSE: Hyponatremia is the most common electrolyte imbalance encountered in the hospital, there have been few studies about the clinical characteristics of hyponatremia in emergency patients. This study was performed to evaluate the causes and the initial symptoms of hyponatremia in emergency patients, the relationship between their ages and their initial symptoms and the relationship between the causes and the recovery time. METHODS: A total of 42 patients with hyponatremia, who were treated in the Emergency Department of Chonnam National University Hospital from 2000 to 2001, were studied by chart review. RESULTS: The initial symptoms were generalized weakness (33.3%), seizure (28.6%), mental change (21.6%), confusion (9.5%), dizziness (4.8%), and non-specific (2.4%). There was a significant difference in the initial symptoms between children and older. The initial symptom for younger patients was usually seizure. The most common causes of hyponatremia were dehydration and sodium loss (52.4%), other causes were hypothyroidism (11.9%), SIADH (7.1%), heart failure (7.1%), adrenal insufficiency (4.8%), polydypsia (4.8%), CRF (2.4%), nephrotic syndrome (2.4%) and unidentified causes (7.1%). There were significant differences in the recovery times among the causes of hyponatremia. CONCLUSION: The initial symptoms of hyponatremia in emergency patients were usually generalized weakness in older patients and seizure in the young. There were significant differences in the recovery times among the causes of hyponatremia. There were many more incidences of hypovolemic hyponatremia of emergency patients than normovolemic hyponatremia.

A Case of an Aortic Arch Aneurysm in which a Fistula Formed Between the Pulmonary Parenchyma

Massive hemoptysis represents a major medical emergency that is associated with high mortality. The causes of hemoptysis are various and include pulmonary and cardiovascular disorders and trauma. The causes of pulmonary disorder are tuberculosis, bronchiectasis, abscess, malignancy, bronchitis, and fungal infection. The causes of cardiovascular disorder are mitral stenosis, pulmonary embolism, and congestive heart failure. A fistula between an aortic aneurysm and the pulmonary parenchyma is one of the causes of hemoptysis, but it is a rare. However, if undiagnosed, it is a uniformly fatal cause of massive hemoptysis. This is a case of bleeding from a fistula between an aortic arch aneurysm and a lung parenchyma in a patient with an aortic arch aneurysm who presented with massive hemoptysis. He had suffered intermittent hemoptysis since he was diagnosed with an aortic arch aneurysm three years before. A high clinical suspicion must be maintained when a history of intermittent hemoptysis is obtained in patients with an aortic aneurysm or prior aortic graft surgery.

Analysis of Factors Predicting Recurrence and the Result of Treatment in PSVT Patients at the Emergency Department

PURPOSE: The purpose of this research was to evaluate the factors predicting recurrence and the characteristics of patients who recurred after the treatment of spontaneous paroxysmal supraventricular tachycardia (PSVT) with adenosine. METHODS: From January 1999 to December 2001, 62 patients with PSVT were enrolled in this study. The conversion group included patients who had had a therapeutic response, which was defined as the occurrence of a change in the sinus rhythm after adenosine administration. The recurred group consisted of all patients who had not had a therapeutic response. Clinical features, the results of treatment, ECG findings, and the hemodynamic statuses were analyzed. RESULTS: The treatments were vagal maneuver (5 pts, 7.5 %), adenosine 6 mg (37 pts, 55.2 %), adenosine 12 mg (14 pts, 20.9 %), verapamil 5 mg (9 pts, 13.4 %), and cardioversion (2 pts, 3.0 %). Twenty-five of the 62 patients failed to have a therapeutic response, yielding a recurrence rate of 40.3 %. Atrioventricular reentrant tachycardia (AVRT) was more prevalent in the recurred group. The most common symptom at presentation was chest pain. The recurred group had increased heart rate, and increased blood pressure. When patients were monitered after adenosine, unifocal premature ventricular complex was the most common rhythm encountered in the conversion group, but atrial fibrillation, and multifocal premature ventricular complex was the most common rhythm encountered. CONCLUSION: Age, heart rate, difference in systolic blood pressure from presentation to discharge, previous history of heart disease, and rhythms encountered after adenosine administration were factors predicting recurrence.

Experience after the Opening of the Gwangju Wide Regional Emergency Medical Center

PURPOSE: As Gwangju Wide Regional Emergency Medical Center was newly opened during February 2001, a comparative analysis was performed of patients who had visited the emergency department before and after the opening in order to measure the difference and to provide basic data for its management. METHODS: The 9,995 patients who had visited between February 1, 1999, and July 31, 1999, before the opening and the 12,457 patients who visited between February 1, 2001, and July 31, 2001, after its opening were compared according to sex, age, non-trauma or trauma, means and form of visit, attending department, length of stay in the emergency department, form of discharge, and time of death verification (dead-on-arrival (D.O.A) versus deadafter-arrival (D.A.A)). RESULTS: The total number of patients increased by 24%. The admission rate was 31.8% before the opening and 40.6% after the opening; the mean length of stay in the emergency department was 15.7 hours before the opening and 12.2 hours after the opening. The mean length of stay of admitted patients decreased from 26.6 hours before the opening to 18.3 hours after the opening. CONCLUSION: The decrease in the mean length of stay in the emergency department from 15.7 hours before the opening to 12.2 hours after the opening is viewed as a positive result, but is still not satisfactory. Accordingly, it is considered urgent that every clinical department take an active part in improving circulation of patients both in the Emergency Intensive Care Unit (EICU) on the second floor and in the emergency ward on the fifth floor, as well as in providing rapid medical care and decisions on treatment strategies in the emergency department on the first floor.