A Case of Lemierre Syndrome

Lemierre syndrome is a rare syndrome caused by an acute pharyngitis with secondary septic thrombophlebitis of the internal jugular vein and metastatic infections. Although mortality from Lemierre syndrome is low, it remains a potentially life-threatening disease that requires careful consideration, as its early diagnosis and treatment is essential to prevent metastatic infection. We report a case of a 19-year-old woman who presented with a sore throat and right upper quadrant pain. Abdominal and pelvic computerized tomography (CT) showed acalculous cholecystitis with hepatosplenomegaly. The chest CT showed septic emboli in both lung fields and the neck CT revealed thrombosis in the left internal jugular vein. The patient was treated with antibiotics. After nine days, the chest CT showed a further increase in the size of the septic embolism and the patient was treated with anticoagulants. After 23 days, the size of septic emboli in the lung significantly decreased and the patient was discharged.

Direct Medical Direction Performed in an Emergency Medical Information Center

PURPOSE: This study was performed to evaluate the appropriateness of medical direction for the prehospital emergency treatment of 119 rescue services in an emergency information center. METHODS: A total of 4,028 cases requested by 119 rescue services from January 1, 2008 to December 31, 2009 were reviewed retrospectively. Medical direction for requests of 119 rescue services constituted five categories. The appropriateness of medical direction for prehospital emergency treatment of 119 rescue services was evaluated according to area and specialty. RESULTS: The majority of the 119 rescue service requests concerned resource information (72.4%). Medical direction for prehospital treatment comprised a small proportion of the requests (13.2%). The total appropriatenss of medical direction for prehospital treatment was 56.4% and was higher in emergency physician than non-emergency physician. The appropriatenss difference between two areas was not determined. CONCLUSION: The requests for prehospital emergency treatment of 119 rescue services was low. The appropriatenss of medical direction for emergency treatment was low and higher appropriatenss was observed in emergency physician.

Direct Medical Direction Performed in an Emergency Medical Information Center

PURPOSE: This study was performed to evaluate the appropriateness of medical direction for the prehospital emergency treatment of 119 rescue services in an emergency information center. METHODS: A total of 4,028 cases requested by 119 rescue services from January 1, 2008 to December 31, 2009 were reviewed retrospectively. Medical direction for requests of 119 rescue services constituted five categories. The appropriateness of medical direction for prehospital emergency treatment of 119 rescue services was evaluated according to area and specialty. RESULTS: The majority of the 119 rescue service requests concerned resource information (72.4%). Medical direction for prehospital treatment comprised a small proportion of the requests (13.2%). The total appropriatenss of medical direction for prehospital treatment was 56.4% and was higher in emergency physician than non-emergency physician. The appropriatenss difference between two areas was not determined. CONCLUSION: The requests for prehospital emergency treatment of 119 rescue services was low. The appropriatenss of medical direction for emergency treatment was low and higher appropriatenss was observed in emergency physician.

Does the General Public Comply with Hospital Guidance Conveyed at the Emergency Medical Information Center?

PURPOSE: This study investigated the compliance of the general public to the guidance conveyed by hospital emergency medical information centers. METHODS: This study included the incidences of inquiry on hospitals and clinics to Busan Emergency Medical Information Center by the general public for a 2-week period from January 4-17, 2009. Information obtained included general characteristics, time of hospital arrival and departure, length of hospitalization, hospitals visited, and treatment outcome. RESULTS: A total of 939 incidences of hospital guidance to the general public were examined. The degree of compliance was 71.2%, the ratio of the primary and secondary facility that the participants visited were 88.6% and 93.5% of the participants in this study were discharged from hospitals after their visit. Patients who complied with the information received displayed a shorter period of hospitalization than non-compliant patients. CONCLUSION: Emergency medical information centers may help ease the unnecessary use of emergency rooms by providing information on diseases to the general public and effectively distributing medical resources with guidance to proper hospitals according to the degree of symptoms.

Does the General Public Comply with Hospital Guidance Conveyed at the Emergency Medical Information Center?

PURPOSE: This study investigated the compliance of the general public to the guidance conveyed by hospital emergency medical information centers. METHODS: This study included the incidences of inquiry on hospitals and clinics to Busan Emergency Medical Information Center by the general public for a 2-week period from January 4-17, 2009. Information obtained included general characteristics, time of hospital arrival and departure, length of hospitalization, hospitals visited, and treatment outcome. RESULTS: A total of 939 incidences of hospital guidance to the general public were examined. The degree of compliance was 71.2%, the ratio of the primary and secondary facility that the participants visited were 88.6% and 93.5% of the participants in this study were discharged from hospitals after their visit. Patients who complied with the information received displayed a shorter period of hospitalization than non-compliant patients. CONCLUSION: Emergency medical information centers may help ease the unnecessary use of emergency rooms by providing information on diseases to the general public and effectively distributing medical resources with guidance to proper hospitals according to the degree of symptoms.

Analysis of the Clinical Features and Prognostic Factors in Sea Water Drowning Patients

PURPOSE: Drowning is a common preventable cause of accidental death. Although many studies about drowning injuries have been conducted, most are related to freshwater drowning. The aim of this study was to analyze the clinical features and prognostic factors in seawater drowning patients. METHODS: This study was performed retrospectively with sea water drowning patients who visited the emergency department at Pusan National University Hospital between January 2005 and December 2009. RESULTS: In total, 51 sea water drowning patients presented at the emergency department with a mean age of 48.65+/-15.40 years. The survival group included 42(82.4%) patients, and the death group was comprised of nine patients(17.6%). Fifteen patients arrested in the field, and cardiopulmonary resuscitation (CPR) was performed. Median immersion time in the death group was 15.0 minutes (range, 9.5~22.5 minutes). Among the death group, five patients had respiratory acidosis and nine showed pulmonary edema on a chest X-ray. Initial sodium level in the survival group was 146.30 mEq/L (range, 142.38~152.60 mEq/L), but the level was normalized with isotonic saline. CONCLUSION: Most drowning injuries occurred at night and in relatively young aged patients. CPR in the field did not result in good outcomes because of the longer immersion time. The death group had respiratory acidosis. Because the survival group did not show significant hypernatremia, isotonic saline as an initial fluid was thought to be appropriate. Drowning injuries occur differently based on geographic and social characteristics; therefore, local characteristics should be considered to establish preventive measures.

The Effectiveness of Antivenin in Treating Snake Bites Resulting in Minimal Clinical Symptoms

PURPOSE: Serious complications from snake bite envenomization are relatively rare in Korea. According to standrad treatment guidelines for local and systemic injuries, antivenin is not recommended for snake bite cases when victims show minimal clinical symptoms. However, there are no published stidies about the effectiveness of antivenin treatment in such cases in Korea. In order to provide actual documentation to support a standard for treatment, we evaluated the effectiveness of antivenin use by comparing clinical outcomes in snake bite patients exhibiting minimal clinical symptoms (traditional snake bite severity grades 0 and I). METHODS: We retrospectively reviewed 140 snake bite cases of patients with minimal clinical symptoms who visited the emergency departments of Chungnam National University Hospital, Cheonan Medical Center, and Chungnam Seosan Medical Center in Korea from January 2000 to December 2006. We categorized the patients into antivenin (group 1) and non-antivenin (group 2) treatment groups. We compared clinical outcomes and characteristics of the two groups. RESULTS: Neither demographic factors nor clinical outcomes showed statistical significance between the groups. CONCLUSION: In case of snake bite victims in Korea, antivenin treatment should not generally recommended as treatment for victims exhibiting minimlal clinical symptoms.

Estimate the Cuff Inflation Volume to Maintain Safe Intracuff Pressure of an Endotracheal Tube

PURPOSE: The cuff of an endotracheal-tube is used to prevent air leak and pulmonary aspiration. Although high cuff pressure may result in mucosal complications, such as tracheal stenosis, endotracheal-tube cuff pressures are not routinely measured in emergency settings in Korea. We designed this study to estimate the cuff inflation volume (Vcuff) required to maintain appropriate intracuff pressure of the endotracheal tube. METHODS: We measured the cuff pressure for adult patients on whom endotracheal intubation was performed in the emergency department. The cuff pressure was measured by using a VBM(R) control inflator, and a Mallinckrodt Hi-Lo(R) endotracheal tube was used. The maximum and the minimum Vcuff were defined as Vcuff, producing a recommended maximum and minimum cuff pressure of 32 and 22 c m H2O, respectively. We performed multiple regression analysis to estimate the maximum Vcuff from age, gender, tube size, neck circumference, artificial ventilation, and peak inflation pressure. RESULTS: The maximum Vcuff was 7.1+/-1.9 ml, and the minimum Vcuff was 5.5+/-1.8 ml, with a difference of 1.6+/- 0.8 ml. The value of Vcuff in male patients were significantly higher than they were in female patients. The following regression equations for maximum Vcuff were calculated: "8.2-2xfemale "for a 7.5-mm tracheal tube and "5.5+0.04 x age-1.7 x female "for a 7.0-mm tube. CONCLUSION: We have proposed equations to calculate the Vcuff for 7.5- and 7.0-mm Mallinckrodt tubes. However, this study suggests that the difference between the maximum and the minimum Vcuff is small, so the routine use of a cuff pressure gauge is required for accurate cuff pressure maintenance.