Spontaneous Rupture of Mediastinal Teratoma

Mediastinal teratoma is a rare mediastinal tumor. Patients with mediastinal teratoma are usually asymptomatic and are diagnosed incidentally with chest radiography or CT, but they may develop symptoms via a rupture into adjacent structures, which results in chemical pneumonia, massive hemoptysis, hemothorax, pericardial effusion, or respiratory distress. We report a case of a ruptured teratoma in a 31-year-old female presenting with cough and brown-colored sputum. Chest radiography and computed tomography of the chest showed an inhomogenous anterior mediastinal mass with fat and fluid component. It was successfully treated by surgical resection. Although mature teratomas are rare, we should be familiar with the unique CT features of a ruptured teratoma to make sure of a correct diagnosis.

A Case of Multiple Gastric Mucosa Lacerations in Near Drowning

The causes of complicated upper gastrointestinal bleeding in near-drowning have been known to be stress-induced gastritis, gastric ulcer, Mallory-Weiss syndrome, or Boerhaave syndrome. However, gastric mucosa laceration has often been observed in a drowned body's autopsy. Gastric fundus is the most common site of gastric mucosa lacerations, and the number of lacerations is almost always less than three. Reflex gasping in drowning leads to passive vigorous vomiting, the mechanical force of which causes gastric mucosa laceration. Gastric mucosa laceration is an important forensic clue in autopsy because it means that the victim was drowned alive or was abandoned after being murdered. However, gastric mucosa laceration has rarely been observed in a drowning survivor. We report a neardrowning case of a 9-year-old boy, who had multiple gastric mucosa lacerations treated by endoscopic hemostatic procedure. In our case, we suspect abdominal blunt trauma also to be another cause of gastric mucosa laceration because of uncommon site of the laceration and the large number of lesions. We also present a literature review.

Triage Score as a Predictor of need for Tertiary care Center Transport from Scene by Helicopter

PURPOSE: The number of patients transported by the Helicopter Emergency Medical Service (HEMS) has increased recently. In our review of the Korean HEMS, there was no established helicopter utilization criteria or triage tool on the scene, so many patients with minor injuries were transported to tertiary care centers. The aim of this study is to evaluate the percentage of patients with minor injuries and to propose a more appropriate triage tool for predicting the need for transport to a tertiary care center. METHODS: The subjects of this study were 59 trauma patients transported to Asan Medical Center (AMC) from the scene by Seoul HEMS from January 2004 to December 2005. The Triage score (TS), Injury Severity Score (ISS), and modified Canadian Triage and Acuity Scale (mCTAS) were calculated as severity scales. Patients with minor injuries were defined as those with TS=9, ISS or =3. We evaluated the association of TS, ISS, and mCTAS with the appropriateness of transport. RESULTS: Many of the patients transported to tertiary medical centers were classified as having a minor injury: TS=9 group 35 cases (72.9%), ISS or =3 group 27 cases (56.2%). However, 56.2% (27/59) of the patients were appropriately transported according to need for admission or an operation. The more severely injured patients classified by TS, ISS, and mCTAS were more appropriately transported to a tertiary center (p<0.05). CONCLUSION: Many patients with minor injuries were transported to a tertiary center from the scene directly. The TS can be easily calculated by an emergency medical technician at the scene. Thus, we propose the TS as a useful triage tool for determining the necessity of transport to a tertiary center by helicopter.

Triage Score as a Predictor of need for Tertiary care Center Transport from Scene by Helicopter

PURPOSE: The number of patients transported by the Helicopter Emergency Medical Service (HEMS) has increased recently. In our review of the Korean HEMS, there was no established helicopter utilization criteria or triage tool on the scene, so many patients with minor injuries were transported to tertiary care centers. The aim of this study is to evaluate the percentage of patients with minor injuries and to propose a more appropriate triage tool for predicting the need for transport to a tertiary care center. METHODS: The subjects of this study were 59 trauma patients transported to Asan Medical Center (AMC) from the scene by Seoul HEMS from January 2004 to December 2005. The Triage score (TS), Injury Severity Score (ISS), and modified Canadian Triage and Acuity Scale (mCTAS) were calculated as severity scales. Patients with minor injuries were defined as those with TS=9, ISS or =3. We evaluated the association of TS, ISS, and mCTAS with the appropriateness of transport. RESULTS: Many of the patients transported to tertiary medical centers were classified as having a minor injury: TS=9 group 35 cases (72.9%), ISS or =3 group 27 cases (56.2%). However, 56.2% (27/59) of the patients were appropriately transported according to need for admission or an operation. The more severely injured patients classified by TS, ISS, and mCTAS were more appropriately transported to a tertiary center (p<0.05). CONCLUSION: Many patients with minor injuries were transported to a tertiary center from the scene directly. The TS can be easily calculated by an emergency medical technician at the scene. Thus, we propose the TS as a useful triage tool for determining the necessity of transport to a tertiary center by helicopter.

Basic Data for Establishing the Emergency Plan to a Forty-hour workweek

BACKGROUND: Large hospitals should execute the forty-hour workweek from July 2004 as a matter of laws. Some institutes have used this system as the concept of five-day workweek since 2 years ago. To prepare for the forty-hour workweek effectively, all emergency physicians and headquarters of hospitals should make plans from this time. METHOD: We analyzed the emergency patients who visited the ER on two consecutive work-free days and ordinary days of last year. The number of patients, final results, such as admission or home discharge, the clinics participating in emergency care, and other components were analyzed according to two consecutive work-free days and the ordinary days. RESULT: The number of emergency patients who visited ER during the two consecutive work-free days was increased by 39.5~100.8% compared to the ordinary days. Although the number of emergency patients was larger during these days, the admission rate was lowered by 3.8~14.5%. Patients who were cared for by an emergency physician or a pediatric physician were markedly larger during the two consecutive work-free days, and the patients cared by an internal medicine were lower. CONCLUSION: To care for the emergency patients more effectively during the two consecutive work-free days in the forty-hour workweek system, we should increase the number of emergency physicians and pediatric physicians, and space for fast track and pediatric emergency care should be secured.

Diagnostic Value of Elevated Liver Transaminase in Hemodynamically Stable Patients with Blunt Abdominal Trauma

PURPOSE: A patient at the emergency department (ED) with blunt abdominal trauma may still have the possibility of liver injury, even though they are hemodynamically stable. Computed tomography (CT) scanning or ultrasonography (US) is available if they are hemodynamically stable. However ultrasonography (US) has technical differences between physicians depending on their skill and computed tomography (CT) is expensive and time consuming, while liver transaminase is widely available, relatively inexpensive. Therefore, we studied diagnostic value of liver transaminase as a screening test for liver injury in hemodynamically stable patients with blunt abdominal trauma. METHODS: From March 2000 to February 2001, we treated 44 hemodynamically stable patients with suspected blunt abdominal trauma who were patients with elevated liver transaminase. An evaluation protocol including patient's age, sex, injury mechanism, history, physical examination, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Injury Severity Scale (ISS), liver transaminase, abdominal US and abdominal CT was prospectively performed on all patients by residents and the staff of the emergency department. Based on the confirmed diagnosis of abdominal CT, patients were divided into two groups: group I with liver injury and group II without liver injury. We analysed the two groups by using the t-test and the chisquare test, and calculated the sensitivity, the specificity and the predictive value of serum aspartate aminotransferase (AST) and serum alanine aminotransferase (ALT) by using multiple cutoff values. RESULTS: There were 34 male patients (76.3%) and 10 female patients (23.7%) and the average age of all patients was 37 years. Triage RTS and GCS were, respectively, 11.7+/-0.7 and 13.9+/-2.1 in group I, and 11.4+/-1.2 and 13.2 +/-3.5 in group II, the differences between the two groups were statistically insignificant. The ISS was 26.8+/-9.4 in group I and 21.1+/-8.0 in group II, and the differences was statistically significant. AST and ALT were, respectively, 288.0+/-113.7 IU/L and 177.9+/-95.8 IU/L in group I and 148.1+/-84.8 IU/L and 95.1+/-59.8 IU/L in group II. The maximum value of the highest sensitivity and minimal specificity of AST and ALT, calculated using the receiver operator curve, were AST > 256.3 IU/L and/or ALT > 122.0 IU/L, for which the sensitivity and the specificity were 61.1% and 84.6%, and the positive and the negative predictive values were 73.3% and 75.8%, respectively. CONCLUSION: We recommend that all patient with suspected blunt abdominal trauma be evaluated using serum liver transaminase as a screening test for liver injury even though they are hemodynamically stable. If AST > 256.3 IU/L and/or ALT 122.0 >IU/L, they should be evaluated with abdominal CT to confirm liver injury.

The Report for Emergency Resident's Training Status and Improvement

Emergency Medicine is a medical specialty that provides comprehensive emergency care. The spectrum of emergency medicine includes humanity as well as medical care for emergency patients. Since the Korean Society of Emergency Medicine has been established and the training course for emergency residents has begun, quality improvement of the training course still remains to be one of the most important issues in emergency medicine. This report is to understand the current status of training of emergency residents and to improve the quality of training of emergency residents. The survey was performed with questionnaires regarding current status of training and opinions to improve quality of training. The questionnaires were sent to all emergency physicians and emergency residents registered to the Korean Society of Emergency Medicine via an electronic mail or a printed letter. The response rates were 49.6% for emergency physicians and 35.8% for emergency residents. On the basis of the result of this survey, we suggest five proposals for improving the quality of resident training course. These include complete adherence of each institution to training guidelines presented by the Korean Society of Emergency Medicine, development of the education program compatible to each institution, shortening of length of training duration from 4 years to 3 years, promotion of the training environment, and introduction of evaluation examination to the training course.

In-hospital Utstein-style Evaluation of the CPCR Performed by ACLS Teams on Cardiac-arrest patients in a General Hospital

PURPOSE: This study assessed the results of the cardiopulmonary-cerebral resuscitation (CPCR) performed by advanced cardiovascular life support (ACLS) teams on cardiac-arrest patients in pundang - jeseang general hospital by using the in hospital Utstein style. METHODS: From march 1999 to February 2001, we collected data based on a formatted protocol by using the in hospital utstein style. The subjects were adult patients over the age of 20 years who had not experienced trauma and who had been resusciated in the hospital (the emergency department (ED), the ward, and intensive care unit, etc.) by an ACLS team. We studied three groups: group I (ED), group II (general ward), and group III (ICU). RESULTS: among 100,552 patients who were admitted, we resuscitated 152 patients (23 in group I, 83 group II, 46 group III). The number of male patient was higher than the number of female (78%/22%, 57%/43% and 53%/47%). For group I, II, and III, respectively patients between 50 and 70 years of age were predominant, and in all groups, the most witness of the cardiac arrest was the nurse. Performed CPCR methods were complex (87%, 80% and 100%), compression only (4%, 0%, 0%), defibrillation only (9%, 17% and 0%) and ventilation only (0%, 3% and 0%). Initial EKG rhythms were VT/VF (9pts 39%, 44pts 53% and 22pts 48%), PEA (9pts 39% , 23pts 28% and 19pts41%) and asystol (5pts 22%, 16pts 19% and 5pts 11%). The average intervals (minutes) from arrest to CPCR were 0.4+/-0.4, 3.1+/-2.2, 1.0+/-0.6, from arrest to initial defibrillation were 2.7+/-1.3, 4.0+/-3.2 , 3.0+/-1.1, from arrest to intubation were 0.5+/-0.4, 3.8+/-1.3 and 1.1+/-1.0 and from arrest to initial epinephrine were 1.4+/-0.7, 3.0+/-4.4, 1.5+/-1.1 The durations of resuscitation minutes were 23.1+/-22.1, 29.6+/-13.8, 19.4 +/-14.6 The rates of return of spontaneous circulation were 70% (16/23), 55% (46/83), 77% (34/46). The number of discharged patinets were 3 (13%), 8 (9.6%), 9 (45%). The number of patients alive after 1year were 2 (8.7%), 2 (3.4%), 7 (15.2%). CONCLUSION: The rate of return of spontaneous circulation (ROSC) and the number of patinets after 1 year were higher when the resuscitation was performed quickly, and the ACLS team played a great role in this result. Thus, the resuscitation education and training of nurses are very important and should be pursued continously.

Problems of Emergency Medical Information Exchange

BACKGROUND: To manage the EMS(emergency medical services) system effectively, departments, such as fire stations, emergency information centers, hospitals, and The Ministry of Health and Welfare, should exchange information that they own and/or gather during patient care and/or transportation. Medical records and information are very important for continuing the patient's care and for deciding on a treatment plan, but medical information is not exchanged fully in spite of its importance. METHOD: We analyzed the transfer medical reports that were written by medical doctors who transferred emergency patients to our hospital. The contents and the accuracy of the transfer medical records were analyzed and graded into 4 groups. Group A was fully described and was equipped with diagnosis, laboratory data, X-ray films; group B had a diagnosis and full laboratory data; group C had a diagnosis, but only partial laboratory data; and group D had only a diagnosis. RESULTS: Among 38,214 patients who visited our hospital from Jan. 2001 to Jun. 2001, 7,031 cases were transferred from other hospitals with transfer medical records. According to the accuracy and important contents of the transfer records, Group A occupied 1.9%, group B 5.2%, group C 32.5%, and group D, with only a diagnosis, 60.4%. In the case of our hospital, we delivered all emergency medical information by written paper(transfer note), E-mail, and web-based information system(cyber-AMC) to the doctors concerned with managing the patient. However, 93% of the medical records of patients transferred from other hospital contained insufficient information to adequately care for the emergency patients. In addition, most of the transferred patients had been transorted without prior information about transportation. CONCLUSION: Within the near future, a medical information center equipped with a computerized system should be operated to exchange medical data. As most general hospitals are operating the OCS(order communication system), EMR(electronic medical record), telemedicine, and PACS(picture-archiving communication system), medical information can be exchanged freely in real time if a code standard and HL7(Health Level 7) can be established.

An Analysis of Triage and Transportation on Multiple-Casualty Incidents in Rural Area

BACKGROUND: Triage and transportations are important and life-saving medical task performed at the site of mutiple-casualty incidents(MCIs). We pursued three road traffic accidents victims to find out any problem in triaging and transporting them, and to provide an information for equipping an local disaster planning. METHODS: The medical records of 70 consecutive patients who were transported to five emergency facilities in Kangnung, on three MCIs from 1998 to 2000, were analysed, retrospectively. The intervals and types of transport vehicles were analysed. We compared the prehospital time between severity-based groups, which were graded into 3 groups according to the Triage score(0, 1~8, 9). RESULTS: Among the 70 patients, 33 patients(47.1%), 21 patients(30%), and 16 patients(22.9%) were transported to Level I, Level II, and Level III trauma centers, respectively. The time elapsed from scenes to the Level I trauma center was significantly shorter(p=0.003) than to others, but no differences in the mean Triage score between trauma centers were seen(p>0.05). The 119 rescue services transported 58.6%(41 patients) of victims to emergency facilities, and 58.5%(24 patients) of them was concentrated to Level I. There were no significant differences in the prehospital time between three Triage score groups(p>0.05). CONCLUSION: There was no medical control such as triage and transportation in the cases of three MCIs. In the construction of emergency medical service system(EMSS) preparing MCIs or disasters, we suggest the integration and unification of 119 rescue services and emergency medical information centers for effective medical control. We propose to making a new and simple triage guideline. The prehospital personnel should be educated and disaster drills should be performed under the guideline.

Feasibility of Echocardiographic Evaluation of Ventricular Function After Short-term Course

BACKGROUND: The initial history, physical examination, and ECG assessment should focus on identification of potentially serious noncardiac or cardiac disorders, including coronary artery disease, congestive heart failure, and electrical instability at the emergency room. additionally, it is essential to define disease severity, stability and need for emergency therpy. echocardiography is a useful tool for this purppose. especially Doppler echocardiography may be more sensitive and time-saving diagnostic tool for the evaluation of patients presenting with cardiogenic symptoms. So we evaluate the feasibility of the echocardiographic measurement by emergency physicain after short-term course. METHOD AND RESULTS: Twenty volunteers(10 male, 38.8+/-9.3 years) were included in the study for measurement of myocardial performance index and established parameters of ventricular function using conventional echo-Doppler methods. Myocardial performance index: (ICT+IRT)/ET, was obtained by subtracting ejection time(ET) from the interval between cessation and onset of the mitral inflow velocity to give the sum of isovolumic contraction time(ICT) and isovolumic relaxation time(IRT). The most of mean values of echocardiogrphic parameters were not significantly different between those of cardiologist and those of emergency physicians(p<0.01). The duration for measuring myocardial performance index was shortest among echocardiographic parameters. the validity of echocardiographic parameters measured by emergency physicians was proved relatively good. CONCLUSION: It is proved to be feasible for emergency physician to perform echocardiographic evaluation of ventricular function after short-term course.

Vascular Reactivity by Purinoceptor Activation in Rat Inferior Vena Cava

BACKGROUND: Extracellular ATP, released from platelets and nerve endings, plays significant roles in the regulation of circulation. The effects of ATP depend on the location of the vessels and the species of experimental animals. Until now, studies were limited to arteries, so we compared the effects of ATP in rat vena cava with those in the aorta and attempted to identify the characteristics of their receptors. METHODS: Vascular rings were isolated from the rat inferior vena cava and descending thoracic aorta. Endothelial cells were preserved or removed by gentle rubbing. The isometric contractions were recorded on polygraph using a force transducer. RESULTS: In the vena cava ring precontracted by 100 nM norepinephrine (NE), ATP elicited relaxations in a dose-dependent manner. These effects were abolished by removal of the endothelium or pretreatment with a nitric oxide synthase inhibitor. Relaxations to ATP in the vena cava (EC50 :9.9 microM) were less potent than those in the aorta (1.7 microM). The relative order of potencies was ADP>ATP>AMP>adenosine, but the maximal relaxation to ADP was smaller than to ATP. ATP-induced vasorelaxation was blocked by suramin, a nonselective antagonist for P2 purinoceptor and reactive blue-2, a P2Y blocker. At basal tension, ATP contracted the vena cava dose-dependently and these effects were potentiated by endothelium-removal. Contractions in the vena cava were also less potent than in the aorta, and the order of potencies was alpha, beta-MeATP>UTP>ATP>ADP>AMP=adenosine. ATP-induced vasoconstriction was blocked by suramin and alpha, beta-MeATP, a desensitizing antagonist of P2X purinoceptor, and potentiated by pretreatment with UTP. CONCLUSION: These results suggest that ADP and ATP acts on P2Y1- and P2Y2-purinoceptor in the endothelium, respectively and induces vasorelaxation of the vena cava, which is mediated by nitric oxide. Since ATP and UTP induced vasoconstriction in endothelium-denuded condition, it may be mediated by the activation of the P2X and P2Y4, 6 purinoceptor on smooth muscles, respectively.

Depression of L-type Ca2+ and transient outward K+ currents in endotoxin-treated rat cardiac myocytes

Decreased cardiac contractility occurs in endotoxicosis, but little is known about the ionic mechanism responsible for myocardial dysfunction. In this study, we examined the changes in Ca2+ and K+ currents in cardiac myocytes from endotoxin-treated rat. Ventricular myocytes were isolated from normal and endotoxemic rats (ex vivo), that were treated for 10 hours with Salmonella enteritidis lipopolysaccharides (LPS; 1.5 mg/kg) intravenously. Normal cardiac myocytes were also incubated for 6 hours with 200 ng/ml LPS (in vitro). L-type Ca2+ current (ICa,L) and transient outward K+ current (Ito) were measured using whole cell patch clamp techniques. Peak ICa,L was reduced in endotoxemic myocytes (ex vivo; 6.00.4 pA/pF, P<0.01) compared to normal myocytes (control; 10.90.6 pA/pF). Exposure to endotoxin in vitro also attenuated ICa,L (8.40.4 pA/pF, P<0.01). The amplitude of Ito on depolarization to 60 mV was reduced in endotoxin treated myocytes (16.51.5 pA/pF, P<0.01, ex vivo; 20.00.9 pA/pF, P<0.01, in vitro) compared to normal myocytes (control; 24.71.0 pA/pF). There was no voltage shift in steady-state inactivation of ICa,L and Ito between groups. These results suggest that endotoxin reduces Ca2+ and K+ currents of rat cardiac myocytes, which may lead to cardiac dysfunction.

Diagnosis of Myocardial Injury in Blunt Chest Trauma

PURPOSE: This study was designed to evaluate diagnostic accuracy of serial electrocardiograms(ECG), myocardial band of creatinine phosphokinase(CK)(CK-MB/CK ratio) and two dimensional echocardiography(ECHO) for myocardial injury in patients with blunt chest trauma. METHODS: We prospectively investigated 54 patients(male : 38, female : 16, mean age : 41) with severe blunt chest trauma. Presence of myocardial injury was determined by increase(>0.1ug/L) of peak serum troponin T(TnT) concentration from serial mesurements. RESULTS: Among 54 patients with blunt chest trauma, 23 patients(43%) had increased peak TnT level which suggested of myocardial injury. Among 23 patients with increased TnT, abnormal ECG findings were found in 18(78%) and echocardiographic abnormalities were observed in 17(74%). Cardiovascular events in 9(39%) of 23 patients with increase Tnt. There was no cardiovascular events in patients with normal TnT. CONCLUSION: Significant proprotion of patients with blunt chest trauma had elevated TnT value which suggested of myocardial injury. We recommend echocardiagraphy and serial tracing of ECG to verify the clinical significance of elevated TnT in patients with blunt chest trauma.

Training Nurses, Trainee for Emergency Medical Technitinan, and Firefighters to use Automated External Defibrillator

BACKGROUND: Automated external defibrillator(AED) represent a major breakdown to permit more widespread application of the principle of early defibrillation. Many recent efforts to improve emergency medical services(EMS) and increase survival rates are simply efforts to get defibrillation to patients as rapidly as possible. AED is major innovation for the prehospital care of ventricular fibrillation cardiac arrest patients. The purpose of this study is to evaluate the course of initial training to three different groups(nurses, firefighters, and EMT trainee) to use AED. METHOD: We studies the efficacy of education of AED to 33 nurses, 15 EMT trainee, and 16 firefighters. Training lasted 75 mins and included 45 mins an overview of defibrillation, protocols for using the AED, and operation of the AED(Laerdal Heartstart 3000),15 mins demonstraion.4 check list was used to grade the performance of cardiopulmonary resuscitation, operation of the AED, and the time required to deliver the first three defibrillations. RESULT: There were no statistically significant differences in performance and time required to deliver an electrical countershock among the groups(p=0.4). To the second test 92fo of all group completed all steps successfully. The step most often foiled was the preparing of the AED for defibrillation. CONCLUSION: In nurses, EMT trainee, and firefighters, it is both feasible and effective to train AED use irrespective of the degree of the trainee.

Utility of Emergency Transesophageal Echocardiography in the Diagnosis of Thoracic Aortic Disease

BACKGROUND: Early recognition of thoracic aortic disease is critical for managing the patients to reduce morbidity and mortality. In emergency department(ED), transesophageal echocadiography(TEE) has recently challenged traditional diagnostic modality for assessing thoracic aortic disease such as computed tomogram(CT) scan, aortography and magnetic resonance imaging(MRI) because of it's safety, rapid acquisition time, high sensitivity and portability. The purpose of this study was to evaluate the diagnostic role of TEE as the first imaging modality in nontraumatic and traumatic thoracic aortic disease in emergency department. METHODS: From May 1993 to Feburary 1995, twenty six patients(nontrauma : 13 cases, trauma : 13 cases) who were suspicious of thoracic aortic disease and received tee as the first diagnostic tool in emergency department were enrolledd. Indications of emergency TEE in the suspicious thoracic aortic disease were typical chest pain, mediastinal widening or massive left side hemothorax. RESULTS: Of the 26 patients undergoing TE, CT scan were performed sequentially in patients(except 4 patients who died immediately in ED). Aortic pathology was detected in 18 patients (65%). Aortic pathology of nontraumatic patients were as followings : DeBakey type I dissction was in 4 cases(36%), type II dissection in 3 cases (28%), and type III dissection in 4 cases(36%). Six of 13 traumatic patients (46%) had thoracic aortic injury. Findings of aortic injury were aortic tear(2 cases), aortic aneurysm and aortic dissection in each. Of six traumatic thoracic aortic lesions which were detected by TEE, 4 lesions (2 aortic tear, subintimal hematoma, and aortic aneurysm) were not detected dby CT scan. Only 4 cases(15%) underwent emergency operation after TEE. There was no significant hemodynamic deterioration or procedure-related dddeath during TEE. CONCLUSION: In emergency department, TEE may be considered as the first diagnostic tool in detecting acute thoracic aortic disease. In considering of it's high sensitivity, no contrast injection, short procedure time and portability at bedside, TEE should be prefered in patients with suspected thoracic aortic disease from trauma.

Mitral “Hole-in-one Embolus” Detected by Transesophageal Echocardiography During Cardiopulmonary Resuscitation: A Cases Report

Mass detached partially or completely from left atrial wall, may produce systemic embolus. If embolus is too large and mitral stenosis is coincidentally present, emblous may obstruct inflow tract of the left ventricle and result in rapid decrease of cardiac output and sudden death subsequently. We experienced a 59-year-old male victim with sudden cardiac arrest from obstruction(“hole-in-one embolus”) of stenotic mitral valve by left atrial mass(ball thrombus). which was detected by transesophageal echocardiography during cardiopulmonary resuscitation.

Emergency Transvenous Cardiac Pacing without Fluoroscopy in Patients with Impending Brady-Asystolic Cardiac Arrest

Not infrequently, we meet urgent situations that emergency cardiac pacing is inevitable. Paricularly, in patients with impending brady-asystole cardiac arrest, we cannot but introduce pacing cartheter without fluroscopic guidance in emergency department if transcutaneous pacing is not available. There is little report about emergency transvenous cardiac pacing without fluoroscopic guidance in patients with impending cardiac arrest in korea. We report our experiences of temporary transvenous pacing by blind approach performed in patients with impending bradyasystolic cardiac arrest in emergency department. Among 10 patients who blind pacing were performed. 7 were successfully paced and 3 were not. 5 of 7 patients with successful pacing died of underlying diseases. 2 patients wiere alive. A hematoma around the puncture site was developed in a patient receiving thrombolytic therapy. We concluded that temporary transvenous pacing withoup fluoroscopy should be tried in the emergency situations if fluoroscopy or transcutaneous pacemaker is not avialable.

Outcome of Resuscitation Attempts in Victims with Non Traumatic Out-of-Hospital Cardiac Arrest

BACKGROUND: In korea, significant proportion of victims with out-of-hospital cardiac arrest have no change to survive because some physicians regard the victim with cardiac arrest outside the hospital as the dead and they do not attempt cardiopulmonary resuscitation(CPR). And we cannot expect bystander-initiated CPR and emergency medical system in resuscitating the victims with cardiac arrest. We studies the outcome of resuscitation attempts and the factor associated with survival in patients with out-of-hospital cardiac arrest in current situation of emegency medical system. Method: We attempted cardiopulmonary resuscitation(by standard guidelines) in 74 consecutive victims with non-traumatic out-of-hospital cardiac arrest in emergency department. RESULTS: Of 74 victims with cardiac arrest 35(47%) had no any restoration of spotaneous circulation(ROSC), 26(35%) had transient ROSC but died within 24 hours,6(8%) survived over 24 hours but died in the hospital, and 7(10%) discharged alive. Factors associated with survival were cardiac origin as a cause of cardiac arrest, ventricular fibrillation as a initial ECG rhythm, and short circulatory arrest time. CONCLUSION: Survival rate of victims with non-traumatic out-of-hospital cardiac arrest was 10%. Considering the feasibility to survive, CPR should be attempted in patients with out-of-hospital cardiac arrest if do-no-resusciate(DNR) is not indicated.

'Do-no-resuscitate' dicisions in the emergency department

No abstract available.