15 research outputs found
A Diagnostic Utility of Fitz-Hugh-Curtis Syndrome by Using contrast Enhanced Abdominopelvic Computerized Tomography
Purpose: Fitz-Hugh-Curtis (FHC) syndrome is characterized by right upper quadrant pain due to perihepatitis with pelvic inflammatory disease (PID). It is diagnosed by using its typical symptoms, but final diagnosis is made by confirmation of the presence of laparoscopically visualized perihepatic violin string like adhesions. However, laparoscopy is difficult to perform in the emergency department. Recently, on computerized tomography (CT) a linear enhancement of the liver capsule was detected in a patient with FHC syndrome. We present a review of a series of 11 cases in female of FHC syndrome diagnosed by CT.
Methods: We reviewed the medical records and the CT findings of 11 cases of FHC syndrome diagnosed during 7 months in the emergency department. The clinico radiologic criteria of our hospital is as follows: First, right upper quadrant pain. Second, linear enhancement of the liver capsule in the contrast enhancement phase of CT. Third, no pathologic findings for the liver, the gallbladder and the biliary tract in CT.
Results: Eleven patients were diagnosed during 7 months by using criteria. The mean age was 30.2 (range: 16~46) years. Seven patients had a history of PID within 6 months. Seven of the 9 patients who take a pelvic examination were positive in C. trachomatis PCR (polymerase chain reaction), and another patient had a positive N. gonorrhoeae cervix culture. One patient who showed negative in both the C. trachomatis PCR and the N. gonorrhoeae cervix culture had cultured E. coli in urine and blood culture.
Conclusion: CT makes easy the previously difficult diagnosis of FHC syndrome in female patients capable of pregnancy with right upper quadrant abdominal pain.ope
Severe Hypochloremic Metabolic Alkalosis
Chloride is the most abundant negative charge ion in extracellular fluid. In plasma it combines with sodium as sodium chloride and with potassium as potassium chloride. Chloride also is found with hydrogen as hydrochloric acid in the stomach. Although chloride was the first electrolyte to be easily measured, it has been considered often the least important of the major electrolytes because of its attachment to both sodium and potassium. There were lot of research and report about electrolyte imbalance, however it was difficult to find the clinical report about hypochloremia. We recently managed a patient with pyloric stenosis who was admitted to ICU with severe hypochloremic metabolic alkalosis. He was treated with hydration of normal saline and conservative management. Metabolic alkalosis and severe hypochloremia were improved and the patient was discharged on ICU 3 days.ope
How many emergency physicians does Korea need?
Purpose: This research used mathematical modeling to project the supply and demand of emergency physicians over the next decade in Korea.
Methods: A model was used to project the annual emergency physicians (EP) workforce supply and demand through the year 2015. The mathematical equations used were as follows: Supply = number of emergency physicians at the beginning of the year plus annual residency graduates minus annual attrition; Demand formula I = 5.29 fulltime equivalent positions/emergency department (ED) x the number of hospital EDs, Demand formula II = annual ED visits/(4,700visits/EP/year), Demand formula III = (11 to 16 EP per major referral ED) + (6 to 8 EP per urban district/ regional hospital ED).
Results: While the most conservative demand projection was 1,505 EPs in the year 2015, the most aggressive supply estimate with a yearly supply of 120 new EPs and a 1% attrition rate was 1,362 EPs in that year.
Conclusion: In Korea, emergency physicians will remain in short supply for the next ten years, even at the present levels of EM residency output.ope
Comparison of ringer's lactate soultion and normal saline in the treatment of rhabdomyolysis induced by doxylamine
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[μλ¬Έ]The incidence of rhabdomyolysis induced by doxylamine intoxication is reported from 5% to 57%. Early detection and treatment of rhabdomyolysis is necessary to minimize kidney damage. Aggressive intravenous hydration with crystalloid fluids such as normal saline or Ringer's lactate solution and urine alkalization is a recommended treatment. But, large amount of normal saline infusion may induce hyperchloremic metabolic acidosis. The purpose of this study was to compare the effectiveness and side effect of Ringer's lactate solution and normal saline in the treatment of rhabdomyolysis induced by doxylamine intoxication.In this 15-months long prospective randomized single-blind study, after excluding 8 patients among 97 doxylamine-intoxicated patients, 28 patients(31%) developed rhabdomyolysis and were randomly allocated to normal saline group(15 patients) and Ringer's lactate group(13 patients) respectively. After 12 hours' aggressive hydration(300 ml/h), urine/serum pH were significantly higher in Ringer's lactate group, serum Na+/Cl- were significantly higher in normal saline group. There were no significant differences in serum K+ level and the time to CK normalization. The amount of sodium bicarbonate administered and the frequency of diuretics administration were significantly higher in normal saline group.Unlike normal saline group, Ringer's lactate group needed little supplemental sodium bicarbonate and did not develop metabolic acidosis. In conclusion, Ringer's lactate is more useful than normal saline in the treatment of rhabdomyolysis induced by doxylamine intoxication.ope
Analysis on the out-of-pocket money of a university inpatients compensated by workers' compensation insurance
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[μλ¬Έ]This study was performed to analysis out-of-pocket money of patient compensated by Workers' Compensation (Industrial Accident Compensation Insurance; IACI) and to be compared with other insurance types; Automobile Insurance (AI) or National Health Insurance (NHI). The study subjects were 16,252 in-patients in a university hospital from 2005.1.1 ~ 2006.2.28. , Out-of-pocket money of three different insurance types were compare in some different aspects; types of insurance, major diagnosis groups, clinical differences in three high frequent diagnoses.The results were as follows;1. IACI patients paid 26.0% total medical fee as out-of-pocket money while AI and NHI patients paid 22.1% and 50.1% respectively as out-of-pocket money.2. The out-of-pocket money of IACI patients consisted of the ward balance (36.1%), special doctors' fee (34.1%), anesthesia and operation surcharge(16.3%), and injection medication fee(7.0%).3. Clinical characteristics related to severity were compared for the most frequent diseases. The cases with more than 180 minutes operational time was 25.1% in IACI, 14.9% in AI, and 10.7% in NHI, so IACI had more long operation time cases. The number of associated diagnosis more than three was 41.1% in IACI cases, and it was , significantly higher than 27.7% in AI cases or 4.8% in NHI cases. These meant IACI cases was more severe than others.4. The out-of-pocket money was paid by injured workers themselves in most cases (71.9%), by employer (23.3%) or by both injured workers and employer (4.8%).According to the above results, IACI system should be considered to lower the out-of-pocket money.ope
Reactive Airways Dysfunction Syndrome (RADS) from Chlorine Gas Releasing Cleaning Agents
A previously healthy 57-year-old woman with dyspnea and wheezing presented to the emergency department a few minutes after exposure to unknown gas from mixing bleach (sodium hypochlorite) and cleaning agent (hydrochloric acid) at work place. Initial physical examination revealed severe wheezing on both whole lung fields, but the chest radiograph was normal. Arterial blood gas analysis showed only moderate hypoxemia. The patient was treated with oxygen, Ξ²adrenergic bronchodilators, antihistamines and corticosteroids, after then symptoms were improved. And the patient discharged against medical advice. We report a rare case of reactive airways dysfuntion syndrome from chlorine gas exposure.ope
Consent for Emergency Patients: How Far Must We Go?
PURPOSE: The number of medical malpractice suits on violation of informed consent is on the rise. While the medical community can encourage its members on informing their patients, the legal community has a considerable amount of studies on the subject. However, there has not been any systematic debate on the subject for emergency medical situations. The exemption of informed consent in emergency medical situations seems to be the common notion. Nevertheless, the recently enacted Emergency Medical Services Law mandates the provision of informed consent in emergency medical situations by the emergency medical personnel. Therefore, a systematic research focusing on the informed consent in emergency medical service was necessary.
METHOD: This was a qualitative study by survey. The results of the opinions of emergency physicians surveyed was compared to previous studies by the legal community on informed consent.
RESULTS: The legal community view informed consent as a legal duty. But the emergency physicians view it as a part of much professionalized medical act, so the professional ethics should guide the acquisition of informed consent. The legal community and the judicial precedents exempted informed consent in an emergency. But the emergency physicians see informed consent in emergency medical service equal to that of any other medical situation, only that it can be delayed. The emergency physicians have to provide an explanation for each step of the process, but the method varies and the unified form of informed consent provided by the law is not suitable. Informed consent should be acquired even in an emergency like cardiopulmonary resuscitation (CPR), but it can be delayed until the end. Professional ethics should guide the initiation of CPR, but the termination of CPR should be under the informed consent. Non-urgent patients should be informed even in an overcrowded emergency room. The duty is not released or relieved solely on the reason that it is the emergency room.
CONCLUSION: There is a difference in opinion between the legal and the medical community, but for the benefit of the emergency patients a compromise should reached.ope
A Case of Streptococcal Toxic Shock Syndrome with Myonecrosis due toGroup A Ξ²-hemolytic Streptococcus
Streptococcal toxic shock syndrome with myonecrosis is a rapidly progressive process that kills 80% of patients in 72-96 h. Various bullae, hypotension, fever, and evidence of organ failure are late clinical manifestations. The symptoms and signs of myonecrosis can be nonspecific and misleading, not clearly revealing the involvement of deep skeletal muscle. Thus, the challenge to clinicians is to make an early diagnosis and to intervene with aggressive fluid replacement, emergent surgical debridement, and general supportive measures. We describe an presentation of myonecrosis of the lower extremities secondary to group A beta-hemolytic streptococcus infection in a 21-years-old woman. In addition, the patient had no history or evidence of trauma to the affected area.ope
The Clinical Effects of Adjunctive Midazolam During Ketamine Procedural Sedation in Pediatric Emergency Patients
Purpose: Despite widespread use of adjunctive benzodiazepines during ketamine sedation, their efficacy in children has never been studied in Korea. We compared the clinical characteristics and the side effects of as well as the physic i a nβs satisfaction with, ketamine sedation in pediatric patients undergoing procedures involving ketamine with adjunctive midazolam.
Methods: The study was a prospective, randomized, clinical evaluation of the effect of adjunctive midazolam during ketamine sedation. We enrolled 60 children aged 8 months to 8 years. Subjects received either intramuscular ketamine (3 mg/kg) with atropine (0.01 mg/kg) (KA) or intramuscular midazolam (0.05 mg/kg) with ketamine and atropine (KMA). For the two groups, we evaluated the induction time, the recovery time, the sedation efficacy, the adverse effects, and the treating physiciansβ satisfaction.
Results: Forty-two (42) subjects received KMA, and 18 received KA. Potentially confounding variables were similar between the two groups, and the induction times and the recovery times were equivalent. The addition of midazolam led to better sedation efficacy (KA=18.8% versus KMA= 55.0%), more treating physician satisfaction (KA=35.4% versus KMA=69.2%), and a decreased incidence of recovery agitation (KA=27.8% versus KMA= 4.7%).
Conclusion: The incidence of emergence phenomena and satisfaction was affected by the addition of midazolam. The addition of midazolam during ketamine sedation is efficacious and safe with high physician satisfaction for sedation of pediatric patients in the Emergency Department.ope