Treatment of acute carbon monoxide poisoning with induced hypothermia

OBJECTIVE: The effect of induced hypothermia on severe acute carbon monoxide (CO) poisoning remains to be addressed further. We investigated the effect of induced hypothermia on severe acute CO poisoning. METHODS: Retrospective chart review was conducted for patients who diagnosed as severe acute CO poisoning in emergency department and underwent induced hypothermia from May 2013 to May 2014. Hospital courses with critical medication and major laboratory results were investigated through the chart review. RESULTS: Among total 227 patients with acute CO poisoning during the period of study, patients with severe acute CO poisoning were 15. All patients underwent induced hypothermia with a temperature goal 33°C. Initial and follow-up levels of S100B protein after induced hypothermia were 0.47 μg/L (interquartile range, 0.11 to 0.71) and 0.10 μg/L (interquartile range, 0.06 to 0.37), respectively (P = 0.01). The mean Glasgow Coma Scales at emergency department admission was 6.87 ± 3.36. Except 1 patient who expired after cardiopulmonary resuscitation, Glasgow Coma Scales at 30-day of hospital discharge were 15 in 10 patients (71.4%), 14 in 1 patient (7.1%), 13 in 1 patient (7.1%), and 6 in 2 patients (14.2%). Seven patients (46.7%) developed delayed neurologic sequelae. Four patients showed mild types of delayed neurologic sequelae and 3 showed moderate to severe types of delayed neurologic sequelae. CONCLUSION: Most of patients underwent induced hypothermia had a good recovery from severe acute CO poisoning. Therefore, induced hypothermia may be considered as a possible treatment in severe acute CO poisoning.

Tibia Fracture on Removal of Interlocking Medullary Nail: A report of 3 cases / 대한정형외과학회잡지

Interlocking medullary nails have been widely used in the treatment of long bone fractures especially in tibia and femur. But with increasing use of nails, many preoperative, intra-operative and post-operative complications have been reported. We have experienced 3 cases of very rare complication, fracture of tibia shaft which occurred during removal of interlocking medullary nail after complete healing of original tibial fracture. We report these rare complications with literature review.

Impairment Grading in Orthopedic Certificates / 대한정형외과학회잡지

In orthopedic practice, patients sometimes ask certain kinds of medical documents certifying their disability grading. But many orthopedic surgeons are not accustomed to issue such medical certificates. So we want to review the way of evaluation and grading of disabilities for such different kinds of medical certificates(for examples: disability grading certificate for use in traffic accident, industrial accident, liability of national compensation, private insurance, the handicapped, military service and others) and compare the differences between them.