Intussusception after Abdominal Trauma in a Child

Intussusception is the most common abdominal emergency in children younger than 2 years old. It is often considered idiopathic. However, an underlying disease can cause a pathological lead point for the intussusception. Its incidence after trauma is uncommon, and traumatic intussusception in children is even rarer. In Korea, traumatic intussusception in a child has never been reported. We experienced a case of traumatic intussusception in a 3-year-old girl. The patient was injured by a plastic bar while playing, and she soon complained of abdominal pain. We identified an ileo-ileal intussusception on computed tomogram. The intussusception was reduced successfully by air reduction in the emergency department. She was sent to home without complication after three hospital days.

A Case of Seizures after Zolpidem Withdrawal

The imidazopyridine, zolpidem, a non-benzodiazepine hypnotic drug, is widely-prescribed for insomnia. It is regarded as a good alternative to benzodiazepine because of the reduced possibility for abuse and development of dependence. However, more recently, due to the reduced possibility for abuse and development of dependence, it is regarded as a good alternative to benzodiazepine. adverse effects of zolpidem have been recognized. The objective of this report is to provide information on the potential for occurrence of benzodiazepine-like withdrawal seizure in patients who chronically take zolpidem continually. We present and discuss a case of seizure after sudden interruption of the protracted use of an abusively high dose of zolpidem. Zolpidem may not be the ideal drug for long-term pharmacotherapeutic management of insomnia. Clinicians should administer zolpidem at a low-dose for a short period of time for prevention of drug abuse and dependence and the potential for occurrence of benzodiazepine-like withdrawal seizure.

Tissue Adhesive Effectiveness in Laceration Site

PURPOSE: To study tissue adhesive effectiveness in with laceration at various body sites. METHODS: From January 2007 to December 2009, we collected the data of laceration patients treated using tissue adhesive in the emergency department of a university hospital. Data concerning treatment satisfaction were collected twice and analyzed. RESULTS: Of the 8665 patients with laceration, 196 (mean age 23 years, 106 males) were treated using tissue adhesive. Many of the 196 patients were <15-years-of-age. Involved body sites mainly comprised head/neck, followed by the upper extremities. The procedure was the most rapid of all treatments. CONCLUSION: Emergency physicians can reliably use tissue adhesive treatment for various lacerations in the emergency setting.

A Case of Tracheal Compression Caused by a Large Foreign Body in the Esophagus

Foreign bodies that migrate outside the esophagus into the mediastinum or soft tissues usually cause respiratory symptoms. Also, esophageal foreign body granulomas that cause tracheal stenosis, lobar atelectasis, and bronchoesophageal fistulas are reported as complications. Foreign bodies can become lodged above esophageal strictures, and chronically-embedded esophageal foreign bodies can induce stricture formation, although these are less common. This is rare case report that the trachea was directly compressed due to impacted esophagus by foreign body.

Cardiac Tamponade Due to Suture Material and this Manifested as Convulsion

Cardiac tamponade is a potentially acute, life threatening emergency that can cause death if it is not promptly diagnosed and treated. Cardiac tamponade is a comparatively uncommon presentation to the emergency department and it is usually associated with penetrating trauma. We report here on a case of cardiac tamponade due to suture material that was used for colectomy ten years previously. A 17-year-old male was admitted to an emergency department with a complaint of loss of consciousness and convulsion. He also complained of chest pain, dyspnea and hypotension. After a while, he displayed cyanosis and his jugular veins were distended. The emergency echocardiogram showed a large amount of pericardial effusion with features of tamponade. Pericardiocentesis was immediately performed. Although 800 cc of fresh blood was drained from the pericardial cavity, his bleeding wouldn't stop. So, the patient was moved immediately to the operation room, and pericardiectomy and median sternotomy were performed. The surgeon found that the foreign suture material had penetrated the pericardium and he successfully removed it. The removed foreign body was a bundle of thread. The patient was discharged without any complications after 9 days.

A Case of the Symptomatic Bradycardia Treated with Norepinephrine at an ED

Symptomatic bradycardia might be regarded as a serious emergency disease and it requires prompt emergency treatments. The American Heart Association has recommended transcutaneous pacing as a gold standard of treatment and also atropine, epinephrine or dopamine as the first line drugs. We report here on a case of symptomatic bradycardia that was treated with norepinephrine and the patient was not treated with pacing, atropine and dopamine.

Utility of Capnography During Intramuscular Ketamine for Procedural Sedation in Children

PURPOSE: The purpose of this study was to determine whether continuous capnography monitoring detects adverse respiratory and airway events earlier than pulse oximetry and the clinical exam can during intramuscular ketamine for procedural sedation in children. METHODS: This study was a prospective observational study conducted from April 2009 to March 2010 in an urban Korean teaching hospital. Pediatric patients who needed procedural sedation for primary closure were enrolled. After patients received intramuscular ketamine, they were monitored using clinical ventilation assessment, pulse oximetry and capnography. Adverse respiratory and airway events were recorded RESULTS: A total of 91 patients were enrolled. Of the 91 patients, 16 (17%) had adverse respiratory events; 5 had hypoxia. Capnography was 100% sensitive for predicting hypoxia and apnea. CONCLUSION: When intramuscular ketamine is administered for procedural sedation in children, capnography allows early detection of adverse respiratory events.

Characteristics of Bicycle and Motorcycle Injured Patients in a University Hospital and in an Edited National Injury Surveillance Report

PURPOSE: To study characteristics of bicycle and motorcycle injured patients in a university hospital and in an edited national injury surveillance report. METHODS: Between July 2007 and January 2010, we collected data on bicycle and motorcycle injured patients in a university hospital. First, we compared the characteristics of each group. Second, we analyzed injury severity using their injury severity score (ISS) and their revised trauma score (RTS). We compared the categories of an edited national injury surveillance report with our university-acquired data. RESULTS: The total number of patients in traffic accidents was 4,111 (including 204 bicycle riders and 165 motorcycle riders). For those in bicycle accidents, a large fraction was 51 years old. For those in motorcycle accidents. Those in motorcycle accidents had an increased proportion of liver cirrhosis and of previous experience with a similar accident. Bicycle accidents had a higher proportion of cases where just the driver or just the passenger was injured. Just falling was the most cause of injury. Others were injured by collision with a car or by both. Motorcycle riders who wore helmets were better protected. Most accidents occurred after 19:00: motorcycle accidents most frequently between 0:00 and 7:00 and between 13:00 and 18:00 hours. Injury severity score were not different. Admission to the hospital and fatalities were highest for motorcycle accidents. The place of injury and alcohol intoxication status were reported for traffic accidents. CONCLUSION: Bicycle and motorcycle injuries were already considered as important factors in traffic accidents included in the injury surveillance report. More factors, including age, time, past history, etc. should be added.

Clinical Characteristics and History of Patients with Hemoperitoneum due to Ovarian Cyst Rupture

PURPOSE: To evaluate and analyze the clinical characteristics and history of patients with hemoperitoneum due to ovarian rupture. METHODS: Subjects were fertile females who visited the emergency department between January 2006 and December 2008. We did retrospective chart reviews only for patients diagnosed with hemoperitoneum. We investigated the characteristics and history of enrolled patients. RESULTS: A total of 76 females (mean age = 28 years) were enrolled. Of the 76, 32 (41.8%) were initially checked for coitus history by emergency physicians (EP). Of the 76, 52 (68.4%) were operated on and the remaining 24 (31.6%) were only observed. Only 4 patients had knowledge of a history of ovarian cysts. CONCLUSION: Coitus history and ovarian cyst history should be done by EPs during the initial examination of fertile females who complain of lower abdominal pain.

A Clinical Analysis of the Delirium Tremens

PURPOSE: We performed this study to identify the clinical characteristics of delirium tremens in Korea. METHODS: We reviewed the charts of patients suffering from delirium tremens who visited the Emergency Department of Keimyung University Hospital during the period of Jan. 2001 through Jun. 2002. RESULTS: All patients were mail, and the number was 28. The age distribution was 40~49, and the most common duration of drinking (15 cases) was between 11 and 20 years. The abstinence period before development of Delirium Tremens was, in most cases, less than 4 days, and the average period of symptoms of Delirium Tremens was less than 6 days. Various abnormal laboratory finding were noted: increased bilirubin level in 50%, prolonged pro-thrombin time in 14.3%, increased amylase level in 19.9% and electrolyte imbalance in 25%. CONCLUSION: During the study period, there was no mortalities. The author believes that sufficient vitamins and fluid supplement contributed to the results.

Outcome of Nontraumatic Prehospital Cardiac Arrest

PURPOSE: There has been an increase in the number of nontraumatic prehospital cardiac arrests due to increases in both cardiovascular diseases and the average age of the population. We performed this study to identify the proper resuscitation technique to be used to increase the survival rate in nontraumatic, prehospital cardiac arrest. METHODS: We reviewed the charts of patients with nontraumatic, prehospital cardiac arrest who visited our Emergency Department of Keimyung University Hospital during the period of May 2001 through April 2002. RESULTS: Out of 60 cases of nontraumatic, prehospital cardiac arrest, 27 (45%) experienced no ROSC, 15 (25%) experienced transient ROSC, 6 (10%) died after 24 hours, and 12 (20%) alived and were discharged. Among those discharged, 10 had visited our emergency department for cardiac causes and 2 for non-cardiac causes. EKG findings were VF in 8, PEA in 2, and bradycardia in 2. In the discharged survival cases, the cardiac arrest had been witnessed. CONCLUSION: We failed to find significant statistical survival differences based on the causes of cardiac arrest, the initial EKG monitoring, or the method of visit. Witnessed cases of cardiac arrest had a higher survival rate than nonwitnessed cases (p<0.05).

CLINICAL ANALYSIS OF THE MUSHROOM POISONING

BACKGROUND: Mushroom poisonings are infrequent but potentially fatal. Most fatalities are due to the amatoxin containing species, particularly Amanita phalloides, Amanita virosa, Amanita verna which cause fulminant hepatic failure often with encephalopathy. METHODS: We experienced twenty two patients with acute mushroom poisoning admitted to Dong San hospital, Keimyung University through emergency department between January 1990 and September 1997. RESULTS: Mean age of the patients was 40.0 years and the ratio of male to female was 1 : 0.83. Seasonal distribution is 10 patients in July, 3 in August and 9 in September. The mean interval between ingestion and early symptom onset was 9.7 hours. Most of the patients had early gastrointestinal symptoms; abdominal pain, nausea, vomiting and diarrhea. except for a patient with associated mental change. The subsequent symptoms and signs follow up admission were fulminant hepatic failure(72.7%), renal failure(31.8%), mental change(27.3%), acute pancreatitis(9.1%), pericardial effusion(4.5%) and erythematous rash(4.5%). The outcomes of the patients were recovery(72.7%), death(18.2%) and hopeless discharge(9.1%). CONCLUSION: The patients who have mushroom poisoning are misdiagnosed as having viral gastroenteritis and are discharged frequently. The doctors and people should be educated not to overlook the severity of mushroom poisoning.