Usage of Noninvasive Ventilator in the Emergency Department

PURPOSE: A general analysis of patients in the Emergency Department (ED) and the Intensive Care Unit (ICU) was performed to evaluate the effectiveness of a noninvasive ventilator (NIV) for the effective treatment of patients in respiratory distress without using endotracheal intubation. METHODS: The 38 patients who were treated with a NIV from December 1, 2001, to September 31, 2002, were studied. The ER doctors investigated prospectively sex, age, the causes of disease, the main symptoms, the duration of treatment, the mode of ventilation, the vital signs and the arterial blood gas analysis at the time of admission and after 30 minutes of NIV use, adaptation of patients, complications, and the success or failure of the treatment. RESULTS: 1) General features: Out of 38 cases, 25 males and 13 females, the average age was 60.61 years old. In group X (treatment success), the average age was significantly lower than it was in group Y (treatment failures). 2) The causes of disease and symptoms: The causes of disease were as follows: asthma and chronic obstructive pulmonary disease, 13 patients; drug intoxication, 8 patients; pulmonary edema, 8 patients; respiratory failure, 2 patients; lung contusion, 3 patients; pneumonia, 2 patients. 3) Adaptation and complications: 11 patients adapted well, 18 patients adapted normally, and 11 patients failed. Complications were minimal and included gastric distension in 2 patients and xerophthalmia in another 2. 4)Vital signs and arterial blood gas analysis results: The arterial blood gas analysis performed after 30 minutes in treatment showed improved results, but only the pH had any effect on success or failure. CONCLUSION: NIV had a success rate of 72%. The factors influencing success were surveyed according age, pH level before treatment, pH P a C O2 S a O2 30 minutes after treatment, and adaptation.

Perception of Satisfaction with Future of 119 Rescue in the View of the User

PURPOSE: In Korea, 119 rescue plays the largest role in treating emergency patients on the scene and in transferring them to the emergency department. We wanted to find out the perception of and the satisfaction with 119 rescue, as well as its future, in the view of medical service-consumers, that is, patients and their guardians. METHODS: The subjects were patients and their guardians who came to Chosun University Hospital by means of 119 rescue between July 1 and September 31, 2002. Responders were asked their age, sex, academic background and relation to the patient. RESULTS: Perception and satisfaction - They recognized treatment on the scene (66.6%) rather then transport to the hospital (17.2%) as the most important duty of 119 rescue. Seventy percent answered that 119 rescue came to mind right away in an emergency situation, which reflects a high perception of 119 rescue. As to the time to arrive at the scene after a report, many people showed satisfaction (55%), answering that it was fast. Responsibility and rights - As to the question of whether they should hold 119 rescue responsible if the patient's condition is aggravated after treatment by 119, 48.9% answered that they shouldn't because 119 was acting with a good intention. Direction of future development - If the 119 services if to be improved, regular intensive training and testing (39.5%) intensive hospital experience (33.3%) and hiring 1st degree EMTs (27.2%) are believed to be necessary. CONCLUSION: 119 rescue was recognized as a comfortable and reliable means of emergency service. In general, most people were satisfied with the service provided by 119 rescue, but demanded experience with patient care.

Cyanide Poisoning after Consuming a Large Amount of Gingko Nuts

Traditionally, the gingko nut is used for enhancing liver function, skin immunity, pulmonary function, and antitussive action in chronic asthma. However, when overused, it can induce central nervous system dysfunction, and the following symptoms can manifest themselves: vomiting, dizziness, convulsion, insomnia, and confusion. We experienced a case of suspected cyanide intoxication that was manifested by convulsion and metabolic dysfunction after consuming a large number of ginko nuts. We report that case, together with a review of the literature.

Case Report of Tetanus Which is Treated by Human Tetanus Immunoglobulin 500 Unit

Tetanus is a neurologic disorder, characterized by increased muscle tone and spasms, that is caused by tetanospasmin, a powerful protein toxin elaborated by Clostridium tetani. In the modern society, tetanus is a rare disease, but it has a high mortality on attack and it 's diagnosis depends on the clinical symptoms. The treatment for tetanus is an injection of human tetanus immunoglobulin (HTIG) to neutralize the circulating tetanospasmin, to control breathing, and to provide systemic supportive care. Recently, the 500 unit of HTIG is recommended. We report one case of generalized tetanus that was treated with 500 units of HTIG. The patient was discharged without complications.

The Comparative Study of Efficacy in using Midazolam and Propofol in the case of Radiology Examinations for Emergency Patients

PURPOSE: This study was performed to evaluate the usefulness of propofol in radiology studies by comparing propofol sedation with midazolam for patients who do not comply with their doctor's requests and need an injection of a sedative to be treated for a safe and quick recovery without complications. METHODS: Among adult patients who were admitted and checked using CT and MRI in our emergency medical center from February 2001 to August 2001, the patients who required sedation because of the lack of cooperation with ER doctors were studied. Of 49 patients, 23 patients (Group M) were injected with midazolam, and 26 patients (Group P) were injected with propofol. RESULTS: In both groups, the systolic BP and the diastolic BP decreased, but group P's BP decreased more than group M's (p<0.05). In group M, the decrease of SPO2 w a s statistically significant, but neither of the groups required emergency care. Although, Group M didn't require emergency care for SpO2, they did require more emergency care for apnea than Group P did. Group P's time required for an examination to be performed was shorter than group M's. Group P's duration for occurrence of movement was shorter than Group M's, but this difference was not statistically significant. Regardless of which sedative was used, there was no difference in the satisfaction of the radiology technician with regards to group M and group P. CONCLUSION: When the patients were injected with a lowdosage of propofol, they showed effects similar to those observed in patients in injected with midazolam, and there were no complications that required emergency care. The usage of propofol is thought to be a good choice, except for contraindications, for short-time radiology examinations.