Hypertonic saline downregulate the production level of lipopolysaccharide-induced migration inhibitory factor in THP-1 cells / 대한외과학회지

PURPOSE: Macrophage migration inhibitory factor (MIF) may serve as a general marker for systemic inflammation in septic and nonseptic acute critical illness. Additionally, our previous experiment has demonstrated that immunosuppressant Prostaglandin E2 (PGE2) lowered MIF levels and inhibited T-cells proliferation when compared to control levels. The addition of hypertonic saline (HTS) increased MIF production as compared with PGE2-stimulated T-cells in concordance with restore PGE2-suppressed T-cells proliferation. Generally, HTS has been well known for its anti-inflammatory effect so far. Therefore, the experiments were conducted to evaluate MIF after stimulating lipopolysaccharide (LPS) either in the presence or absence of HTS in monocyte, in response to early phase injury. METHODS: Human acute monocytic leukemic cell line (THP-1) cells were cultured in RPMI media, to a final concentration of 1 x 10(6) cells/mL. The effect of HTS on LPS-induced MIF was evaluated in monocyte with 1 microg/mL LPS. HTS at 10, 20 or 40 mmol/L above isotonicity was added. MIF concentrations of the supernatant were determined by enzyme-linked immunosorbent assay, and cell lysates were used for Western blots analysis to determine the MIF expression. RESULTS: MIF concentrations in the cell supernatant increased in LPS-induced cells compared to control cells. Also, levels of MIF protein expression were higher in LPS stimulating cells. However, the addition of HTS to LPS stimulated cell restored MIF concentrations and MIF expression. CONCLUSION: The role of HTS in maintaining physiological balance in human beings, at least in part, should be mediated through the MIF pathway.

Complications of a Tube Thoracostomy Performed by Emergency Medicine Residents

PURPOSE: A tube thoracostomy is an invasive procedure that places patients at risk for complications. Tube thoracostomies are frequently performed by emergency medicine residents. Thus, the purpose of the study was to assess both the complication rate for tube thoracostomies performed by emergency medicine residents and the factors associated with these complications. METHODS: A retrospective chart review of all patients who had undergone a tube thoracostomy performed by emergency medicine residents between January 2008 and February 2009 was conducted at a university hospital. Complications were divided into major and minor complications and into immediate and delayed complications. Complications requiring corrective surgical intervention, requiring the administration of blood products, or involving situations requiring intravenous antibiotics were defined as major. Complications that were detected within 2 hours were defined as immediate. RESULTS: Tube thoracostomies were performed in 189 patients, and 70 patients(37%) experienced some complications. Most complications were immediate and minor. In multiple logistic regressions, BMI, hypotension and resident seniority were significantly associated with complications. CONCLUSION: The prevalence of complications was similar to these in previous reports on the complications of a tube thoracostomy. Most complications from tube thoracostomies performed by emergency medicine residents were immediate and minor complications. Thus, emergency medicine residents should be allowed to perform closed tube thoracostomies instead of thoracic surgeons.

Characteristics of Alcohol-related Injuries in Adolescents Visiting the Emergency Department

Alcohol is frequently a factor affecting emergency department patients, and alcohol consumption is more common among those who are injured. In Korea, the socioeconomic impact of alcohol has been enormous because of traditional permissive attitudes toward alcohol. Juvenile drinking has increased recently; consequently, an increase in alcohol-related injuries is likely in this population. Therefore, we compared the characteristics and severity of alcohol-related injuries in adolescents and adults. All injured patients seen at six EDs throughout 2007 were included. We obtained data from the 'Development of a model for an in-depth injury surveillance system based on the emergency department' surveillance. The proportion of adolescents who drank was 5.0%. No significant alcohol-related difference in injuries was found between male and female adolescents (P = 0.14), whereas in adults, being male was strongly related to alcohol consumption (P < 0.001). Among traffic accidents, motorcycle-related injuries were strongly associated with alcohol use in adolescents (odds ratio [OR] 2.52, 95% confidence interval [CI] 1.09-5.83). Results also indicated that alcohol-related injuries in adolescents showed poor outcomes (OR 2.36, 95% CI 1.47-3.81) as compared with those in adults (OR 1.42, 95% CI 1.26-1.59). Preventive strategy on alcohol-related injuries in adolescents should focus on reducing motorcycle accidents.

Effect of hypertonic saline and macrophage migration inhibitory factor in restoration of T cell dysfunction / 대한외과학회지

PURPOSE: Trauma-induced suppression of cellular immune function likely contributes to sepsis, multiple organ dysfunction syndrome and death. T cell proliferation decreases after traumatic stress. The addition of prostaglandin E2 (PGE2), which depresses immune function after hemorrhage and trauma, to T-cells decreases T-cell proliferation; and hypertonic saline restores PGE2-induced T-cell suppression. Recently, it has become apparent that macrophage migration inhibitory factor (MIF) plays a central role in several immune responses, including T-cell proliferation. However, the role of MIF in mediating hypertonic saline (HTS) restoration of T cell dysfunction is unknown. Therefore, we hypothesize that T cell immune restoration by HTS occurs, at least in part, by a MIF-mediated mechanism. METHODS: Jurkat cells were cultured in Roswell Park Memorial Institute media, at a final concentration of 2.5 x 106 cell/mL. The effects of HTS on T-cell proliferation following PGE2-induced suppression were evaluated in Jurkat cells: HTS at 20 or 40 mmol/L above isotonicity was added. MIF levels were determined by enzyme-linked immunosorbent assay and western blot analysis. RESULTS: PGE2 caused a 15.0% inhibition of Jurkat cell proliferation, as compared to the control. MIF levels decreased in PGE2-suppressed cells, as compared to the control. MIF levels were higher in cells treated with HTS than PGE2-stimulated cells. CONCLUSION: The role of HTS in restoring Jurkat cells proliferation suppressed by PGE2, at least in part, should be mediated through a MIF pathway.

Clinical Outcome for High-dose Pralidoxime in Treating Organophosphate Intoxication

PURPOSE: The optimal dose of oximes for use in the treatment of organophosphorus pesticide poisoning has not been conclusively established. In this retrospective study, we assessed the effectiveness of the use of high-dose pralidoxime infusion in treating organophosphorus pesticide poisoning. METHODS: From January 1998 to December 2009, 71 patients visited the hospital Emergency Department (ED) as a result of organophosphate pesticide intoxication. All of these patients received an initial bolus of 2 g of pralidoxime as the first step of treatment. Patients who then received continuous infusion of pralidoxime at a dose of 500 mg/hr were entered into study group 1 (low dose), and those treated by continuous infusion of pralidoxime at a dose of 1000 mg/hr were entered into study group 2 (high-dose). Plasma cholinesterase activities for each patient were evaluated at ED arrival and re-evaluated 24 hours after pralidoxime infusion. The effectiveness of the two treatment modalities was gauged by comparing the required duration of mechanical ventilation, time spent in the intensive care unit (ICU) and total time spent in the hospital. RESULTS: The mean duration of mechanical ventilation was 9.98+/-6.47 days for group 1 and 4.39+/-6.44 days for group 2. The respective mean duration of time spent in ICU and the total number of days in the hospital were 16.38+/-18.84 days and 21.87+/-20.16 days for group 1, and 7.83+/-9.99 days and 11.71+/-13.53 days for group 2. High-dose pralidoxime treatment was associated with shorter required durations for mechanical ventilation, ICU and hospital stay. In addition, plasma cholinesterase reactivation rates were higher for those patients receiving high-dose pralidoxime treatment. CONCLUSION: The results suggest that high-dose pralidoxime treatment has greater efficacy for patients suffering from organophosphorus pesticide poisoning.

Autopsy Results of Out-of-hospital Cardiac Arrest / 대한법의학회지

Mostly of the sudden deaths, except in-hospital death and death within 48 hours of discharge, are declared in the emergency department by emergency physician. The purpose of this study is to review the protocol of cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest by understanding the cause of sudden death from autopsy results. A retrospective analysis was performed by 48 months of medical records from emergency department of a tertiary hospital. The analysis was made from the patient group which gone through autopsy in the main office of National Institute of Scientific Investigation. In the emergency department, 1913 patients were declared death and 43 patients have received autopsy and 19 (1.0%) were natural death. 14 partients received CPR in the natural death group, and 13 were specified as cardiovascular disease. Result of this study represents the importance of prehospital CPR in case of unexpected cardiac arrest patients. However to generalize this result, all dead patients must go through autopsies for medical purpose which the frequency alse should be increased.

The Impact of Early Hyperventilation on Outcome in Intubated Patients with Traumatic Brain Injuries

PURPOSE: We recommend early aggressive airway management with intubation in patients with severe traumatic brain injuries due to prevent hypoxia and aspiration. Reports exist about increased mortality after pre-hospital intubation, which is caused by hyperventilation. Therefore, we studied the impact of hyperventilation on outcome in patients with traumatic brain injuries. METHODS: This was a retrospective study conducted on 865 patients with traumatic brain injuries obtained from the trauma registry between January 2001 and June 2007. Patients >19 years of age with a GCS< or =13 were selected. We analyzed the impact of hyperventilation within 12 hours on outcome as a function of intubation. We also analyzed the predictors for mortality and poor outcome by logistic regression analysis. RESULTS: One hundred sixty-six patients were included with a mean age of 48.7+/-17.9 years. The mortality rate was 25.9%, and the poor outcome rate was 44.6%. In the hyperventilation group, the poor outcome and mortality rates were higher than in the non-hyperventilation group (66.1% vs 37.5%, p=0.012; 47.2% vs 20.0%, p=0.001). The predictors of mortality for intubated patients was hyperventilation within 12 hours (odds ratio [OR], 5.7; 95% of confidence interval [CI], 1.6~20.5). The predictors of poor outcome for intubated patients was a GCS <8 (OR, 3.9; 95% CI, 1.2~13.3). CONCLUSION: Early hyperventilation is a predictor for mortality in intubated patients with traumatic brain injuries. We should monitor and correct early hyperventilation in intubated patients with traumatic brain injuries.

Clinical Characteristics of Acute Zolpidem Intoxication

PURPOSE: The hypnotic effect of zolpidem is comparable to benzodiazepines, but has less abuse and addiction potential than benzodiazepines, so is one of the most commonly prescribed hypnotics. The frequency of acute zolpidem overdose has increased, but clinical analysis and severity predictors are not known in Korea. METHODS: A retrospective evaluation of histories, clinical courses, and laboratory findings of each patient treated from June, 2000, to May, 2006, in a university hospital for acute zolpidem intoxication. RESULTS: We evaluated 30 patients, including 16 co-intoxication cases. Twenty-five patients presented mental alterations but became alert within 2 days. All patients recovered completely. The median zolpidem concentration was 0.9 mg/L (range: 0.2~7.4 mg/L). There was a weak correlation between the amount ingested and zolpidem concentration (r=0.25). None of them presented severe laboratory abnormalities, and these abnormalities did not relate to zolpidem concentration. CONCLUSION: The clinical progress of acute zolpidem intoxication is mild. We could not predict zolpidem concentration or clinical severity from the amount ingested and could not predict the clinical course from laboratory findings in the emergency department.

Rational Use of Antimicrobial Agents in Traumatic Simple Wounds

PURPOSE: The primary goal of wound management is to avoid infection. Wounds in all patients presenting to the Emergency Department are contaminated with bacteria. Despite this, there is a low incidence of infection. Unfortunately, physicians continue to use antimicrobial agents indiscriminately. The authors intended to determine the effect of selective antimicrobial agents and the indications for appropriate antimicrobial agent use in traumatic simple wounds. METHODS: This prospective study was performed from Jul. 2005 to Aug. 2005. A pilot study had been performed from Nov. 2003 to Jul. 2004 at the Ewha Woman's University Mokdong Hospital. Structured data sheets were completed at the times of the patient's visits to the Emergency Department and to the Outpatient Department for follow-up. Infection was determined at the time of follow-up. The indications of antimicrobial agent use are immunocompromised patients, wounds contaminated for 3 hours or longer, devitalized tissue, and extremity wounds except hand wounds caused by sharp objects. RESULTS: The study enrolled 216 injured patients. The general characteristics of patients and wounds between the two groups were not significantly different. The antimicrobial agent use and infection rate of the pilot study were 227 cases (90.4%) and 10 cases (4.0%), and those of this study were 100 cases (46.3%) and 9 cases (4.1%). In this study, antibiotic use was reduced to almost half compared with the previous study, but the infection rate was similar (p<0.001). CONCLUSION: Rational use of antimicrobial agents in simple wounds reduced the use of antimicrobial agents in the Emergency Department without increasing the infection rate.

A Case that Pregnant Woman was Performed Emergency Cesarian Section During CPR

Cardiac arrest during pregnancy is an uncommon event, occurring only about once in every 30,000 late pregnancies. Survival from such an event is exceptional. This case involves sudden cardiac arrest of a 32 weeks pregnant woman. The patient was found at unresponsive state and transferred to emergency center by EMS. At arrival, her EKG rhythm was asystole and we had no patient information. Upon initiation of ACLS, abdominal ultrasonography was done and we detected a fetal heart beat. Timely emergency caesarean section delivery was done and the 1-minute APGAR score of neonate is 0. After endotracheal intubation and respiratory assist, 3-minute APGAR score was recoverd to 3 and neonate was admitted to neonate ICU. The mother did not responsed to resuscitation efforts. Physiologic and anatomic changes occur during normal pregnancy, necessitating a modification of standard BLS and ACLS methods for successful resuscitation. When arrest does occur during the latter part of pregnancy, perimortem caesarean delivery may improve the outcome for both the fetus and the pregnant woman.

Medical error reporting system in the emergency department

PURPOSE: We have evaluated type of medical errors and severity of results in the emergency department (ED). We also analyze the contributory factors of medical errors for the patient's safety and the quality improvement. METHODS: This study the was prospectively performed from May to August 2005. Medical errors that occurred in the ED were reported anonymously by emergency physicians. The type of medical errors and contributory factors were reported. The severity levels of errors were categorized into 5 levels: level 1- life threatening consequences; level 2- potentially life or limbs threatening consequences; level 3- serious failure or delay of diagnosis or treatment; level 4- inappropriate or unnecessary delay or treatment; level 5- no harm. RESULTS: The total number of patients admitted in the ED during the study period was 16,513, and 177 errors (1.5 errors/day) reported in 160 patients (9.7/1,000 patients). The most frequently occurring medical error was order omission (18.0%), but interpretation errors (11.3%) resulted in the most serious consequences (3.6+/-1.2). More than half of medical errors were no harm (51.4%). Educational and environmental (61 errors) factors were the most frequent causes of medical errors. CONCLUSION: Medical errors frequently occur in the ED. Reducing ED errors will require the improvement of ED environments, better communication, and reinforcement of education by supervising faculty members.

Medico-Legal Consideration of Hemopneumothorax : Closing Claim Study / 대한흉부외과학회지

BACKGROUND: The purpose of this study is to describe the characteristics of malpractice claims related to hemopneumothorax and to identify the causes and potential preventability of such claims. MATERIAL AND METHOD: A retrospective study was performed by reviewing the records in the Lawnb website and Lx CD-rom: the records on closed malpractice claims involving hemopneumothorax were abstracted from the files available for analysis. The records were reviewed and were analysed to determine the etiology of hemopneumothorax, patient age, results of lawsuit and indemnity payment, underlying diseases, cause of death or complications, and the factors associated with a successful defense. RESULT: Seven closed claim involving hemopneumothorax were founded in the data for malpractice. Three claims were supreme court decision, one was a high court decision and three claims were district court decision. The most common cause of death was tension pneumothorax. Four of which resulted in indemnity payments. CONCLUSION: While malpractice claims involving hemopneumothorax were uncommon, they resulted in a high rate and amount of indemnity payments. Claims are more common in pediatric patients. In case of iatrogenic hemopneumothorax, post-procedural X-ray can improve patient outcome and is also associated with decreased indemnity risks. Informed consent is also important.

Is the Emergent Endoscopy Necessary for the Patients Who Ingested Liquid Household Bleach Containing Sodium Hypochlorite?

PURPOSE: In the emergency department (ED), there are many cases of routine emergent endoscopic evaluation for patients who ingest liquid household bleach containing sodium hypochlorite. Many researchers have recommended endoscopic evaluation for caustic injury, but there is much controversy over the indication for emergent endoscopy. Because the clinical course of patients who ingest sodium hypochlorite is commonly mild, we investigated the necessity for routine emergent endoscopy. METHODS: We included patients who visited the ED due to ingestion of liquid bleach containing sodium hypochlorite during the 4 years from June 2001 to May 2005. We retrospectively reviewed the demographic characteristics, ingested amount, symptoms and signs, disposition, and endoscopic results. We also tried to find relationships between the variables and the final endoscopic results. RESULTS: Of the 63 patients included in this study, 47 underwent emergent endoscopy in the ED. The endoscopic results were Grade 1 in 31 patients, Grade 2a in 13, Grade 2b in 2, and Grade 3a in 1. Clinically significant results were observed in only 3 (6.4%) cases. The symptoms and signs was not related to the endoscopic results, but diluted ingestion and the amount of ingestion (<100ml) were significantly related to the endoscopic severity. CONCLUSION: The indications for emergent EGD (esophagogastroduodenoscopy) for caustic injury were discussed. In almost all cases, however, the clinical course of the patients ingesting the sodium hypochlorite was not significant. If the patient ingests a small amount of diluted liquid bleach, < 100 ml, and has few symptoms and signs, we recommend follow up in the outpatient department, which will reduce unnecessary emergent endoscopy.

Outcome in a Tertiary Emergency Department for Cardiopulmonary Resuscitation for Out-of-hospital Cardiac Arrest

PURPOSE: The "Out-of-hospital Utstein Style" is an internationally recommended guideline for reporting outcome data for out-of-hospital resuscitation events. This study was designed to evaluate the current status of out-of-hospital cardiopulmonary resuscitation (CPR) in a tertiary emergency department and to provide basic data for a unified report on guidelines for resuscitation in Korea. METHODS: A clinical analysis of the out-of-hospital cardiac arrest (OHCA) patients, CPR performed in a tertiary emergency department, from July 1995 to December 2002 was conducted. The evaluation was made using Utstein reporting guidelines. RESULTS: Four hundred forty-nine patients were included in this study. The cardiac arrests were caused by non-cardiac medical diseases (41.9%), cardiac diseases (39.6%), unknown (10.0%), and trauma (8.5%). The initial electrocardiogram (ECG) showed asystole in 58.6% of the cases, other rhythms in 29.4%, and ventricular fibrillation/ventricular tachycardia (VF/VT) in 12.0%. Spontaneous circulation was restored (ROSC) in 41.2% of the cases. Twenty-four (5.3%) patients with witnessed and cardiogenic cardiac arrests had VF/VT on initial ECG, and of them, 5 (20.8%) patients were discharged alive. The mean circulatory arrest time was 19.7+/-13.6 minutes, and it was shorter in patients with ROSC (16.9+/-11.6) than in patients without ROSC (22.1+/-14.7, p= 0.003). CONCLUSION: The overall survival rate of OHCA patients was 6.7%, which was poorer than those of western countries. The overall duration from collapse to advanced cardiac life support (ACLS) was 19.7 minutes, which was too long. Major factors contributing to the low survival rate were most likely the lack of bystander CPR, delay in activating the emergency medical system (EMS), and inappropriate CPR by the EMT. We should make every effort to improve these areas.

Risk Factors for Infection in Patients with Traumatic Wound

PURPOSE: The ultimate goals of wound management are to avoid infection and to achieve a functional and cosmetically cceptable scar. The authors intended to determine the infection rate, as well as the patients, and the wounds, characteristics, associated with wound infection and with suboptimal appearance after traumatic wound management. METHODS: This prospective study was performed from Dec. 2002 to Aug. 2003 at Ewha Womans University Mokdong Hospital. Structured data sheets were completed at the times of the patient's Emergency Department visit and the Out Patient Department (OPD) follow-ups. Infection was determined at the time of follow-up, and a cosmetic score was determined at the time of suture removal. A multivariate analysis was used to determine the adjusted odds ratio (OR) of infection. RESULT: Of the 401 patients enrolled, infection was developed in 43 patients (10.7%). The characteristics associated with wound infection on multivariate analysis were age (adjusted OR per years, 1.024; 95% CI=1.010 to 1.037) and bite wounds (adjusted OR 8.645; 95% CI=2.753 to 27.150). A wound location on the head was associated with a lower risk of infection (adjusted OR 0.294; 95% CI=0.150 to 0.563). Suboptimal wound appearance increased with infection (p<0.0001). CONCLUSION: Both the patients and the wound's characteristics have influence on the likelihood of infection in cases of traumatic wounds. We found that increasing age, and bite wounds were associated with high risk of infection. Wound on the head were associated with lower risk of infection. Education were provided to patients. Efforts are needed.

Effects of L-Arginine and 7-Nitroindazole in the Gerbil Model of Global Cerebral Ischemia

PURPOSE: This study was performed to determine whether L-Arginine would improve or worsen the neurologic out-come after ischemic brain injury and whether 7- Nitroindazole (7-NI, inhibitors of neuronal nitric oxide (NO) synthase inhibitor) would improve or worsen. METHODS: Five (5) groups (N =11 to 14) of anesthetized gerbils were subjected to 10 min of global cerebral ischemia by means of a bilateral carotid artery occlusion. One group (N =11) was the control group. In a second group (N =12), the animals were pretreated with intraperitoneal L-Arginine (300 mg/kg) one hour before ischemic insult. In a third group (N =12), pretreatment with L-Arginine was performed in the same manner and intraperitoneal 7-NI were given at the time of reperfusion and 2 hours after reperfusion. The animals of a fourth group (N =12) were treated with 7-NI in the same manner without any pretreatment with L-Arginine. The animals in the last group (N =14) underwent sham operations. RESULTS: Compared with control group, concomittent treatment with L-Arginine and 7-NI showed no significant improvement in the neurological cell survival rate. Also, group pretreated with L-Arginine only showed a similar out-come. The group treated with 7-NI at the time of reperfusion and 2 hours after reperfusion showed a significant improvement in the neurological cell survival rate compared with the control group and the other two experimental groups (p<0.05). CONCLUSION: In the ischemia-reperfusion injury of global ischemia in gerbils, NO from endothelial NO synthase has no important role in the neurological outcome.

A Case of Spontaneous Hemoperitoneum Due to Rupture of Visceral Artery Aneurysm

We introduce a case of middle colic artery rupture due to medial degeneration which progressed to hemoperitoneum. Visceral artery aneurysm is an uncommon form of vascular disease that has a significant potential for rupture or erosion into an adjacent viscera, resulting in life-threatening hemorrahge. The case involved a 58-year old man with abdominal pain who admitted to our hospital with a diagnosis of hemoperitoneum due to bleeding of omentum. At surgery, a large amount of hematoma was found in lesser sac which was removed totally. The bleeding focus was middle colic artery. Histological examination showed medial degeneration of unknown origin. The postoperative course was uneventful, and the patient discharged with good condition.

Practical Analysis of Medical Care of Domestic Violence Victims in Emergency Department

PURPOSE: Our society is becoming more interested in domestic violence and proper care of those victims is required. This study was designed to develop a model of countermeasure against domestic violence that can be used in emergency department. METHODS: This prospective, clinical study was performed from Dec. 2000 to Aug. 2001 at the emergency department, Ewha Womans University Mokdong Hospital. Fifty-five patients of the 1665 female trauma patients were found to be victims of domestic violence during study period. We investigated the frequency of domestic violence in the patient's past, whether a weapon had been used, whether the assailant was an alcohol abuser, and whether he assaulted the victim in a drunken state or not. We analyzed correlation between these factors and severity injury of the patients. RESULTS: The average ISS of patients was 2.90+/-2.82, and 14 patients(25.8%) were admitted to hospital for treatment. Eighteen victims were reported to the police. Fourteen patients were injured with weapons, and in those cases, ISS and the hospital admission rates were marginallly higher than those not involving weapons(p=0.099). Police report rates in the weapon-using cases were 64.3%(9 people), which was considerably higher than those of nonweapons cases, 22.0%(p=0.007). No significant correlations exsisted between severity of patient's injury and frequency of domestic violence experienced in her past, assailant's alcohol history, and drunken assaulter. CONCLUSION: When weapons were involved, the police report rates were considerably higher. The medical personnel should immediately evaluate the patients's condition and provide a plan for her safety.

Clinical Analysis of Cerebellar Infarctions Diagnosed via the Emergency Department

PURPOSE: Diagnosis of a cerebellar infarct without signs such as weakness, ataxia, or focal neurologic findings is difficult. This study used a clinical review of cerebellar infarctions for the purpose of accurately diagnosing and properly managing such patients. METHODS: We retrospectively studied 94 cerebellar infarct patients who had been admitted to the university hospital via the emergency department from May 1995 to March 2001. We reviewed clinical records and radiologic findings and analyzed risk factors of cerebrovascular disease, chief complaints and associated symptoms, neurologic examinations, electrocardiograms, and brain CT and/or brain MRI findings. RESULTS: Fifty-four (57.4%) of the patients were men and forty (42.6%) were women, and their mean age was 64.1+/- 13.0 years. The most frequent risk factor was hypertension (55.3%), and others were diabetes mellitus (26.6%), cerebrovascular disease (17.0%), ischemic heart disease (10.6%), and atrial fibrillation (6.4%). As to the involved territory, 54 (57.4%) posterior inferior cerebellar artery infarcts, 15 (16.0%) superior cerebellar artery infarcts, 3 (3.2%) anterior inferior cerebellar artery infarcts, and 19 (20.2%) combined-territory infarcts were found. As for symptoms and signs, vertigo (69.1%) and nausea and/or vomiting (64.9%) were the most frequent: others were dysarthria (38.3%), headache (37.2%), ataxia (43.6%), motor weakness (38.3%), nystagmus (30.9%), and so on. Especially, seven (7.4%) patients showed isolated vertigo without paralysis, weakness, or ataxia. CONCLUSION: Vertigo, nausea, and vomiting were frequent clinical findings in 94 cerebellar infarct patients. Nine of these patients showed isolated vertigo. The posterior inferior cerebellar artery was the most frequently involved territory.

Outcome of Cardiopulmonary Resuscitation for In-hospital Cardiac Arrest in a Tertiary Emergency Department

PURPOSE: The "In-hospital Utstein Style" is an internationally recommended guideline for reporting outcome data from inhospital resuscitation events. This study was designed to evaluate the current status of in-hospital cardiopulmonary resuscitation (CPR) in a tertiary emergency department and to provide basic data for a unified report guidelines for resuscitation in Korea. METHODS: A clinical analysis of 249 cases of in-hospital CPR performed in a tertiary emergency department from August 1995 to December 2001 was conducted. The evaluation was made using Utstein reporting guidelines. RESULTS: During the period, 232 patients received 249 resuscitations. The immediate precipitating causes of cardiac arrest were cardiogenic in 61 cases (24.5%), traumatic in 58 cases (23.3%), respiratory in 41 cases (16.5%), and metabolic in 28 cases (11.3%). Initial EKG rhythms were bradyarrhythmia in 115 cases (46.2%), pulseless electrical activity in 69 cases (27.7%), ventricular fibrillation/tachycardia (VF/VT) in 36 cases (14.5%), and asystole in 26 cases (10.4%). The spontaneous circulation was returned in 153 of the 249 resuscitations (61.5%). In 59 of the 249 resuscitations (23.7%), spontaneous circulation was maintained for more than 24 hours. Sixteen of the 232 patients (6.9%) were discharged alive. The VF/VT group of initial EKG rhythm had a better outcome in comparison with non-VF/VT group. The prognosis for respiratory arrest was better (78% probability of survival) than it was for other causes of arrest. Patients suffering from traumatic arrest showed the worst outcomes (9% probability of survival). CONCLUSION: Although the "In-hospital Utstein Style" is very subjective as a report determining the outcome of resuscitation, it has many complementary factors. However, even with the "Utstein Style", new guidelines compatible with the actual circumstances of our emergency department must be developed.