Evaluation of Weaning Criteria from Mechanical Ventilatory Support / 대한구급학회지

Introduction: A number of indices have been proposed as accurate predictors of weaning, but several studies have questioned the accuracy of these weaning indices in predicting the capability of independent breathing. The purpose of the study was to assess six standard bedside weaning criteria of mechanically ventilated patients in Surgical intensive care unit (SICM). METHOD: : The study was performed on 72 SICU patients who were mechanically ventilated. According to the outcome of weaning, they were divided into two groups, weaning success (n=62) and weaning failure (n=10) group. All subjects should have PaO2 above 60 mm Hg at an FIO2 of 0.4 and PEEP of 3~5 cm H2O in the extubated patients and no PEEP in the tracheostomy patients. Six bedside weaning criteria were tidal volume above 5 ml/kg, respiratory rate below 25/min, vital capacity above 10 ml/kg, maximum inspiratory pressure below -20 cm H2O, minute volume below 10 L/min and PaO2/FIO2 above 200. Weaning failure was regarded as follows; changes of systolic blood pressure 20 mm Hg or diastolic pressure 10 mm Hg, changes of pulse rate 20 beat per minute, respiratory rate above 30 per minute or increased respiratory rate above 10 per minute, PaO2 below 60 mm Hg or PaCO2 above 55 mm Hg, and presence of paradoxical respiratory pattern. RESULTS: PaO2/FIO2 and minute volume (VE) were showed statistically significant difference between two groups (P=0.048, P=0.003 respectively). Linear discriminant function was D=-1.422-0.005-xPaO2/FIO2+0.336xVE. CONCLUSION: Our study demonstrates that PaO2/FIO2 and minute volume accurately predicts the weaning outcome in the surgical patients with mechanical support.

Clinical survey of the Ocular Trauma Patients visited Emergency Department

The authors analysed statically 420 Cases of the ocular trauma among 35,460 patients who visited to the emergency department, from Jul. 1995 to Jun. 1996. Ocular trauma is one of the commonest causes of eye diseases and blindness, but its patterns and incidences are variable according to the environment. A large number of patients can be readily treated in the emergency department. Prevention is, of course, the best management, but when an ocular injury occurs, proper emergency treatment can often prevent permanent damage.

Pediatric Poisoning: Clinical Analysis and Severity Grading

BACKGROUND: To find out characteristics and classification of toxic agents by clinical analysis of pediatric poisoning and to determine the clinical availability of grading by using MSPC score. METHOD: Subjects were patients under 15 years exposed to toxic agents, who visited Ajou university hospital emergency center from June, 1994 to October, 1997. The study was performed retrospectively. RESULTS: The subjects were 126 cases and male to female sex ratio was 1.2:1. Mean age was 29+/-30 months old. The most common route of exposure was ingestion, following contact, inhalation and bite. The most common reason was mistake by the patient, following mistake by caregiver, suicide attempt and accident. The MSPC score distribution of symptomatic patient was as follows; 1 point: 26 cases(63.4%), 2 point: 12 cases(29.2%), 3 point: 1 case(2.4%), 4 point: 2 cases(4.8%). The classification of exposed poison was as follows; therapeutic drugs: 29 cases(23.0%), non-therapeutic drugs: 97 cases(73.0%). The most common exposed poison was household products: 23 patients(18.3%) were admitted to hospital. CONCLUSION: There was statistically significant difference in the classification of poison, MSPC score, treatment modality at hospital, first follow up period after discharge between admitted group and non-admitted group. There was statistically significant difference in the reason of exposure, route of exposure, MSPC score, admission period according to patient's age. severity grading according to MSPC score is regarded as an available method to determine the modality of management.

Differential Diagnostic Method of Acute Scrotum

Acute scrotum is any pathologic condition of the scrotum or intrascrotal contents that requires emergency medical or surgical management. Management of each disease entity is different, but the differential diagnosis is very difficult. So many testes were lost due to delay of the adequate diagnosis or unnecessary explorations had been taken under the misdiagnosis. A study was done to evaluate the differential diagnostic value of clinical symptoms and signs, physical examinations, laboratory data and radiologic studies including scrotal Doppler ultrasonography on acute scrotum patients. During the two years, thirty patients were visited to emergency medical center of Ajou university. There were 5 patients with testicular torsion, 16 acute epididymitis, 5 orchitis, 3 edema of scrotum, 1 infected hydrocele, the mean age of total patients was 17 years old. Symptoms and signs, laboratory data showed no specific ability to differentiate each disease entities, but radiographic evaluations were useful to differentiate testicular torsion from non-torsion acute scrotum. We could suggest that scrotal Doppler ultrasonography is useful for early differential diagnosis of the acute scrotum, especially in emergency department.