• Title/Summary/Keyword: coma

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Clinical Characteristics and Prognosis of Heat Stroke (열사병의 임상적 특징 및 예후에 관한 연구)

  • Park, Noh Han;Ryoo, Hyun Wook;Seo, Kang Suk;Park, Jung Bae;Chung, Jae Mung
    • Journal of Trauma and Injury
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    • v.19 no.2
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    • pp.113-120
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    • 2006
  • Purpose: The aim of this study was to evaluate the clinical characteristics of classic heat stroke in Korea and to identify factors of prognosis for heat stroke by comparing a survival group with a non-survival group. Methods: We retrospectively analyzed 27 patients with heat stroke who visited the Emergency Department of Kyungpook National University Hospital from March 2001 to February 2005. First, we divided the patients into two groups, the classic heat stroke group and the exertional heat stroke group, and compared them. Second, we compared the survival group with the non-survival group. Age, sex, cause, place where patients were found, underlying diseases, cooling time, performance of endotracheal intubation, initial Glasgow Coma Scale, initial vital sign, and laboratory findings were reviewed. Results: Five of 27 patients in heat stroke died. The classic heat stroke group had 20 patients. They were old and had more patients in the bathroom than the exertional heat stroke group had. The non-survival group showed lower blood pressure, lower initial GCS score, and higher respiratory rate than the survival group. In laboratory findings, the non-survival group also showed lower$HCO_3-$ level, lower albumin level, lower glucose level, more prolonged PT, and higher CK-MB level than the survival group. Delay in recognition of heat stroke and cooling were poor prognostic factors in heat stroke. Conclusion: The classic heat stroke group had patients who were old and found in the bathroom. Early recognition and treatment of heat stroke is important to reduce mortality. Cooling time, initial GCS score, mean arterial pressure, resipratory rate, $HCO_3-$, PT, CK-MB, and albumin seem to be meaningful when forming a prognosis for heat stroke patients.

Computed Tomographic Evaluation of Three Canine Patients with Head Trauma (개에서 컴퓨터단층촬영을 이용한 두부 외상의 평가 3례)

  • Kim, Tae-Hun;Kim, Ju-Hyung;Cho, Hang-Myo;Cheon, Haeng-Bok;Kang, Ji-Houn;Na, Ki-Jeong;Mo, In-Pil;Lee, Young-Won;Choi, Ho-Jung;Kim, Gon-Hyung;Chang, Dong-Woo
    • Journal of Veterinary Clinics
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    • v.24 no.4
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    • pp.667-672
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    • 2007
  • This report describes the use of conventional computed tomography(CT) for the diagnosis of head trauma in three canine patients. According to physical and neurologic examinations, survey radiography and computed tomography, these patients were diagnosed as traumatic brain injury. Especially, CT is the imaging modality of first choice for head trauma patients. It provides rapid acquisition of images, superior bone detail, and better visualization of acute hemorrhage than magnetic resonance imaging. It is also less expensive and more readily available. Pre-contrast computed tomography was used to image the head. Then, post-contrast CT was performed using the same technique. The Modified Glasgow Coma Scale(MGCS) score was used to predict their probability of survival rate after head trauma in these dogs. Computed tomogram showed fluid filled tympanic bulla, fracture of the left temporal bone and cerebral parenchymal hemorrhage with post contrast ring enhancement. However, in one case, computed tomographic examination didn't delineate cerebellar parenchymal hemorrhage, which was found at postmortem examination. Treatments for patients placed in intensive care were focused to maintain cerebral perfusion pressure and to normalize intracranial pressure. In these cases, diagnostic computed tomography was a useful procedure. It revealed accurate location of the hemorrhage lesion.

Criterion-Related Validity of the Critical Patients' Severity Classification System Developed by the Hospital Nurses' Association (병원간호사회 중환자 중증도 분류도구 준거 타당도 검정: 뇌손상 환자를 대상으로)

  • Oh, Hyun-Soo;Seo, Wha-Sook;Park, Jong-Suk;Bae, Eun-Kyung;Lee, Su-Jing;Chung, Youn-Yee;Choi, Young-Eun;Choi, Hee-Jeong
    • Korean Journal of Adult Nursing
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    • v.21 no.5
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    • pp.489-503
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    • 2009
  • Purpose: This study was conducted to test criterion-related validity of the Critical Patients' Severity Classification System (CPSCS) developed by the Hospital Nurses' Association by examining relationships with brain injury severity measured by Glasgow Coma Scale (GCS), recovery state measured by Glasgow Outcome Scale (GOS), and days of stay in ICU of brain injury patients. Methods: Prospective correlational research design was adopted by including 194 brain injury patients admitted to ICU of one university hospital. Results: The score of CPSCS appeared to significantly discriminate the severity of brain injury. Among nursing activities in CPSCS, Respiratory therapy, IV Infusion and Medication, Monitoring, Activities of Daily Living (ADL), Treatment and Procedure were significant to discriminate the severity of brain injury. Respiratory therapy, Vital Signs, and Monitoring appeared to significantly discriminate the recovery states of 1- and 3-months. Nursing activities significantly contributed to predict the days of ICU stay were Respiratory therapy, ADL, and Teaching and Emotional Support. Conclusion: CPSCS developed by the Hospital Nurses Association appeared to be valid to discriminate or predict brain injury severity, recovery states, and days of stay in ICU for brain injury patients.

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A Monitoring Observation of Comet 17P/Holmes during 2014 Apparition

  • Kwon, Yuna;Ishiguro, Masateru;Hanayama, Hidekazu;Kuroda, Daisuke;Sarugaku, Yuki;Kim, Yoonyoung;Vaubaillon, Jeremie J.;Takahashi, Jun;Watanabe, Jun-Ichi
    • The Bulletin of The Korean Astronomical Society
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    • v.40 no.1
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    • pp.61.1-61.1
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    • 2015
  • We performed a monitoring campaign of a Jupiter-Family comet 17P/Holmes, which underwent the dramatic outburst on 23.3 October 2007 at $r_h=2.44AU$, to investigate the secular change in activity and subsequent physical properties of the inner dust coma before and after the 2014 perihelion passage. The monitoring observation was carried out over two years: from May to July 2013, from July to November 2014, and January 2015 with ~weekly cadence. We conducted photometry monitoring in Rc band using four ground-based telescopes, which are the Ishigakijima Astronomical Observatory 105cm telescope, the Okayama Astrophysical Observatory 50cm telescope, the Nishi-Harima Astronomical Observatory 2m telescope, and the T30 51cm i-telescope, respectively. In order to examine the dust production rate, we put a constraint upon the physical distance from the center of the nucleus as rho=2500km and conducted aperture photometry. We found that the average absolute Rc magnitude over the period between July to November 2014 was mR(1,1,0)~12.29, which was approximately 1.5 magnitudes fainter than those of 2013 data. Accordingly, comet 17P/Holmes seemed to become dormant, although a minor eruption was detected on January 26, 2015. In this presentation, we will introduce our ongoing project for 17P/Holmes and discuss why the nucleus becomes dormant within one orbital period.

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Survival Factors among Medical Intensive Care Unit Patients with Carbapenemas-Producing Enterobacteriaceae (카바페넴분해효소 생성 장내세균속균종(CPE)이 획득된 내과계 중환자실 환자의 생존 영향 요인)

  • Choi, Ji Eun;Jeon, Mi Yang
    • Journal of Korean Biological Nursing Science
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    • v.22 no.4
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    • pp.249-259
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    • 2020
  • Purpose: Carbapenemase-producing Enterobacteriaceae (CPE) are associated with considerable mortality. This study was aimed to identify survival factors among medical care unit patients with CPE. Methods: We conducted a retrospective cohort; data were collected from September 2017 to June 2019 through electronic medical records. The data collected were general characteristics, disease-related characteristics, severity-related characteristics, and treatment-related characteristics. Data were analyzed based on frequency, mean, standard deviation, Chi-square test, Fisher's exact test, t-test, Pearson's correlation coefficient, and Cox proportional hazard model using SPSS/WIN 21.0 program. Results: Seventy-seven patients were included (59 survivors and 18 deceased) in the study. Univariate analysis identified factors for survival associated with acquired CPE as age (t= -1.56, p= .037), simplified acute physiology 3 (SAPS3) score of admission date (t= -2.85, p= .006), Glasgow coma scale (GCS) of CPE acquisition date (t= 2.38, p= .020), artery catheter at CPE acquisition date (χ2= 4.58, p= .032), vasoconstrictor agents use at CPE acquisition date (χ2= 6.81, p= .009), platelet at CPE acquisition date (t= 2.27, p= .025), lymphocyte at CPE acquisition date (t= 2.01, p= .048), calcium at CPE acquisition date (t= 2.68, p= .009), albumin at CPE acquisition date (t= 2.29, p= .025), and creatinine at CPE acquisition date (t= 2.24, p= .028). Multivariate Cox proportional hazard model showed that GCS at CPE acquisition date (HR= 1.14, 95% CI= 1.05-1.22), lymphocyte at CPE acquisition date (HR= 1.05, 95% CI= 1.00-1.10), and creatinine at CPE acquisition date (HR= 1.25, 95% CI= 1.04-1.49) were independent survival factors among medical intensive care unit patients with CPE. Conclusion: Based on the study results, it is necessary to develop nursing interventions that can aid in the management of patients with CPE and identify their effects.

TREATMENT OF SELF-INJURIOUS LIP BITING WITH POSTERIOR BITE BLOCK APPLIANCE IN A BRAIN LESION PATIENT (교합 거상판을 이용한 뇌병변장애 환아의 자해성 구강 손상의 치료)

  • Jun, Hyelim;Song, Je-Seon;Lee, Jae-Ho;Lee, Hyo-Seol
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.10 no.2
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    • pp.93-96
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    • 2014
  • Brain disorder disability is assessed when organic brain lesion such as cerebral palsy, traumatic brain injury, or stroke causes physical impairment which limits daily activites substantially according to its level and range of paralysis or the presence of involuntary movement. According to the disabled person welfare law in Korea, grade I brain disorder is assessed when one is in continuous irreversible state of coma without the ability to prolong one's life without other's help. Self-injurious behavior is defined as the non-suicidal intentional or unintentional injury to one's own body which can occur repetitively temporarily or chronically. People with decreased consciousness often exhibit increased self-injurious behavior which is most commonly associated with tongue or lip biting. This report documents a successful self -injurious lip biting treatment of a brain lesion patient within a short time by applying a removable acrylic resin appliance including posterior bite block.

The Significance of Clinical Examination for Brain Lesion Differentiation of Patients with Head Trauma after Alcohol Intoxication

  • Jung, Yoon Hyun;Jeong, Dong Kil;Lee, Jung Won;Moon, Hyung Jun;Choi, Jae Hyung;Song, Jun Hwan
    • Journal of Trauma and Injury
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    • v.29 no.4
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    • pp.99-104
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    • 2016
  • Purpose: There are many patients visited to ED in an alcohol intoxicated state. For these patients, it is difficult to predict by only clinical examination whether he/she would have brain lesion. The purpose of this study is to research whether it is possible to predict brain lesion by only clinical examination findings, with comparing patients with/without actual brain lesions. Methods: A retrospective study was performed at a university hospital for the period 11 months with the medical records. As for the inclusion group, head trauma patients with objectively proved drunk, judging by their blood ethanol concentration, and performed the brain CT were selected. In terms of medical record, Glasgow coma scale (GCS), the presence of neurologic abnormalities, the presence of lesion on brain CT of the patients, were examined. From laboratory results, blood ethanol concentration, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT) and glucose concentration were identified. Results: For this study, there were total 80 patients of inclusion group. There was no statistically significant difference in terms of GCS score and neurological examination abnormalities, between the group with brain lesion and the group without brain lesion on brain CT. Conclusion: Alcohol intoxicated patient with head trauma visits the ED, it is not possible to distinguish or determine whether brain lesion exists or not by only clinical findings. In order to check the lesion existence, the image examination, therefore, should be considered and performed.

Low Plasma Insulin Level Prolonged Hypoglycemia after High dose Insulin Lispro Injection (고용량 Insulin lispro 피하 주사 후 저 인슐린 혈증을 보인 지속적 저혈당성 혼수 환자 1례)

  • Kang, Jeong Ho;Park, Hyun Soo
    • Journal of The Korean Society of Clinical Toxicology
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    • v.14 no.2
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    • pp.151-154
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    • 2016
  • Increased plasma insulin levels are often observed in exogenous insulin overdose patients. However, plasma insulin level may decrease with time. We report a case of low plasma insulin level hypoglycemia after insulin lispro overdose. The patient was a 37-year-old man with no previous medical history who suspected insulin lispro overdose. Upon arrival, his Glasgow coma scale was 3 points and his blood sugar level (BSL) was 24 mg/dl. We found five humalog-quick-pen (insulin lispro) in his bag. There was no elevation of glucose level, despite an initial 50 ml bolus of 50% glucose and 150 cc/hr of 10% dextrose continuous intravenous infusion. He also suffered from generalized tonic-clonic seizure, which was treated with lorazepam and phenytoin. We conducted endotracheal intubation, after which he was admitted to the intensive care unit (ICU). There were recurrent events of hypoglycemia below BSL<50 mg/dl after admission. We repeatedly infused 50 ml 50% glucose 10 times and administered 1 mg of glucagon two times. The plasma insulin level was 0.2 uU/ml on initial blood sampling and 0.2 uU/ml after 5 hours. After 13 hours, his BSL stabilized but his mental status had not recovered. Diffuse brain injury was observed upon magnetic resonance imaging (MRI) and severe diffuse cerebral dysfunction was found on electroencephalography (EEG). Despite 35 days of ICU care, he died from ventilator associated pneumonia.

The Predictors of Survival and Functional Outcome in Patients with Pontine Hemorrhage

  • Jung, Dae-Sung;Jeon, Byung-Chan;Park, Yong-Sook;Oh, Hyung-Suk;Chun, Tae-Sang;Kim, Nam-Kyu
    • Journal of Korean Neurosurgical Society
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    • v.41 no.2
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    • pp.82-87
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    • 2007
  • Objective : Pontine hemorrhages usually result in a much higher morbidity and mortality than any other intracranial vascular lesion. The purpose of this study was to evaluate survival and the contributing factors for patients with pontine hemorrhage. Methods : Of the 41 patients who were admitted to our hospital with their first acute pontine hemorrhage from 1997 to 2005, 35 patients were included in this study. Medical records were reviewed to confirm the accuracy of diagnosis and collect demographic, clinical and radiological data. The patients were divided into two groups, survivors and deceased patients; then the survivors were divided again into a group of patient with good results and those with poor results. The location of the hematoma, maximum anteroposterior [AP] diameter, maximum transverse diameter, hematoma volume, ventricular extension, extension into the midbrain, hydrocephalus and initial Glasgow coma scale [GCS] were evaluated. Results : The two year survival rate was 58.5%. The survival of patients with pontine hemorrhage was affected by initial GCS score and transverse hematoma dimeter. Functional outcome of patients who survived was affected by initial GCS, maximum transverse diameter, maximum AP diameter and hematoma volume. Conclusion : The rate of survival after pontine hemorrhage is associated with the transverse diameter of the hematoma and more importantly the initial GCS. Long-term outcome of survivors is influenced by the initial GCS, transverse diameter, AP diameter and volume. Through the multivariate analysis, initial GCS is the only significant factor on survival. Strictly speaking, initial GCS is not modifiable. However, surgical reduction may be considered to amend theses decisive factors. Additional study for indication, timing and method of surgical management is needed.

Study on the Effect of Sopungbosim-tang on Hypertension, Thrombosis and Brain damage (소풍보심탕이 고혈압, 혈전 및 뇌진탕에 미치는 영향)

  • Bae Kyung IL;Kim Dang Hee;Lee Yang Gu;Kim Yoon Sik;Seol In Chan
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.16 no.2
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    • pp.245-256
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    • 2002
  • This studt was investigated to prove the effect of SPBST on the hypertension, the thrombosis and the brain damage. The results were as follows; 1. SPBST affected the htpertension as adepressant, but insignificant. 2. SPBST decreased significantly dopamine, aldosterone but ineffective on the epinephrine, norepinephrine and renin activity. 3. SPBST increased the NO product but insignificant. 4. SPBST had a death suppression effect by 50% in pulmonary thrombosis inducement experiment and activated slightly on the fibrinolytic activity. 5. SPBST suppressed significantly platelet diminution and prolonged insignificantly PT and APTT. 6. On the measure of the blood flow rate induced by the thrombus, in vivo SPBST accelerated the blood flow rate, in vitro insignificant. 7. SPBST had no toxicity on the PC12 cell and B103 cell induced by amyloid β protein (-35) and a protective effect, in proportion to the density. 8. SPBST decreased significantly coma duration time in a Infatal dose of KCN and showed 50% of survival rate in a fatal dose. 9. SPBST decreased significantly ischemic area and edema incited by the MCA blood flow block. These results indicate that SPBST can be used in hypertension, the thrombosis, the brain damage, the ischemic cerebral infarction and the acute stage of the brain damage. Further study will be needed about the functional mechanism and etc.