• 제목/요약/키워드: severe ill patient

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Enteral Nutrition in Critically Ill Patient With Septic Shock Requiring Vasopressor: Case Report

  • Hee Young Kim;Min Young Noh;Jisun Lee
    • Clinical Nutrition Research
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    • 제13권1호
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    • pp.1-7
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    • 2024
  • Nutritional support in critically ill patients is an essential aspect of treatment. In particular, the benefits of enteral nutrition (EN) are well recognized, and various guidelines recommend early EN within 48 hours in critically ill patients. However, there is still controversy regarding EN in critically ill patients with septic shock requiring vasopressors. Therefore, this case report aims to provide basic data for the safe and effective nutritional support in septic shock patients who require vasopressors. A 62-year-old male patient was admitted to the intensive care unit with a deep neck infection and mediastinitis that progressed to a septic condition. Mechanical ventilation was initiated after intubation due to progression of respiratory acidosis and deterioration of mental status, and severe hypotension required the initiation of norepinephrine. Due to hemodynamic instability, the patient was kept nil per os. Subsequently, trophic feeding was initiated at the time of norepinephrine dose tapering and was gradually increased to achieve 75% of the energy requirement through EN by the 7th day of enteral feeding initiation. Although there were signs of feeding intolerance during the increasing phase of EN, adjusting the rate of EN resolved the issue. This case report demonstrates the gradual progression and adherence to EN in septic shock patient requiring vasopressors, and the progression observed was relatively consistent with existing studies and guidelines. In the future, further case reports and continuous research will be deemed necessary for safe and effective nutritional support in critically ill patients with septic shock requiring vasopressors.

건강보험청구자료로 본 요양병원의 기능 유형 (A Taxonomy of Geriatric Hospitals Using National Health Insurance Claim Data)

  • 임민경;김선제;선정연
    • 한국병원경영학회지
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    • 제28권2호
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    • pp.9-20
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    • 2023
  • Purpose: This study classified the actual functions of geriatric hospitals and examined the differences in their characteristics, in order to provide a basis for discussions on defining the functions of geriatric hospitals and how to pay for care. Methodology: This study used various administrative data such as health insurance data and long-term care insurance data. Cluster analysis was used to categorize geriatric hospitals. To examine the validity of the cluster analysis results, we conducted a discriminant analysis to calculate the accuracy of the classification. To examine cluster characteristics, we examined structure, process, and outcome indicators for each cluster. Findings: The cluster analysis identified five clusters. They were geriatric hospitals with relatively short stays for cancer patients(cluster 1; cancer patient-centered), geriatric hospitals with relatively large numbers of patients using rehabilitation services(cluster 2; rehabilitation patient-centered), geriatric hospitals with a high proportion of relatively severe elderly patients(cluster 3; severe elderly patient-centered), geriatric hospitals with a high proportion of mildly ill elderly patients with various conditions(cluster 4; mildly ill elderly patient-centered), and geriatric hospitals with a significantly higher proportion of dementia patients(cluster 5; dementia patient-centered). The largest number of geriatric hospitals were categorized in clusters 4 and 5, and the structure and process indicators for these clusters were generally lower than for the other clusters. Practical Implications: We have confirmed the existence of geriatric hospitals where the medical function, which is the original purpose of a geriatric hospital, has been weakened. It has been observed that the quality level of these geriatric hospitals is likely to be lower compared to hospitals that prioritize enhanced medical functions. Therefore, it is suggested to consider the conversion of these geriatric hospitals into long-term care facilities, and careful consideration should be given to the review of care-giver payment coverage.

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원인불명의 극심한 식욕부진(食慾不振)을 호소한 고령 환자 치험례 (Case of an Old-Age Patient with Ill-defined Severe Anorexia)

  • 정기용;하유군;백종우;최유경;김동우;박종형;전찬용
    • 동의생리병리학회지
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    • 제22권1호
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    • pp.256-261
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    • 2008
  • Anorexia is a common symptom in the elderly patients. Causes of anorexia in the elderly are very diverse and multifactorial. Causes include physiological changes associated with aging, mental disorders such as depression, anorexia tardive, dementia, medical diseases such as cancer(lung and gastrointestinal cancer), benign gastrointestinal disorders, cardiac disorders, pulmonary disease, thyroid disorders, infection. Medications such as digoxin, theophylline have also been implicated in the problem. No cause is found in about one quarter of patients. Management is directing at treating causes and providing nutritional support. In Oriental medicine, the appetite has close relation to Biwi. The main cause of anorexia is the insufficiency of Biwi. The physiology of Biwi is that Bi sends clarity(food essence) upward and Wi sends digested food downward. Specially if the physiologic function of Wi is disordered by various factors, Wi cannot send digested food downward. As a result, the anorexia can present by the disorder of Wi function. We experienced a case of an 74 years old female patient with ill-defined severe anorexia differentiated as Wijoongheohan. The patient was managed with fluid therapy and Jeonghyangsiche-tang. The anorexia and other symptoms improved continuously during hospitalization.

위험질병 근병증 (Critical Illness Myopathy)

  • 이동국
    • Annals of Clinical Neurophysiology
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    • 제4권2호
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    • pp.91-97
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    • 2002
  • The field of critical care medicine has flourished, but an unfortunate result of improved patient survival in the intensive care unit is the occurrence of certain acquired neuromuscular disorders. During the last two decades, various neuromuscular disorders were recognized as common causes of weakness occurring in critically ill patients. The two most common disorders are an acute quadriplegic myopathy predominantly associated with the use of intravenous corticosteroids and neuromuscular junction blocking agents and severe systemic illness termed critical illness myopathy(CIM), and an axonal sensorimotor polyneuropathy termed critical illness polyneuropathy. I will review briefly about general components of the CIM.

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Laminar Cortical Necrosis (Polioencephalomalacia) caused by Postoperative Fluid Overload in a Dog with Pyometra

  • Jeong, Yoon-Soo;Kim, Ill-Hwa;Kang, Hyun-Gu
    • 한국임상수의학회지
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    • 제34권2호
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    • pp.98-102
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    • 2017
  • A 7-year-old, intact, female Siberian husky presented with vomiting and diarrhea after a fight with a dog with which it lived. The bitch was diagnosed with pyometra and severe dehydration. The patient received IV fluid therapy for 2 day pre- and post-operatively. Four days post-surgery, the patient had a decreased level of consciousness and suffered a tonic-clonic generalized seizure. On magnetic resonance imaging and histopathological findings, a diagnosis of laminar cortical necrosis caused by fluid overload was made. This case provides important information on the potential for fluid overload in a dehydrated patient giving rise to critical condition and death.

안면신경초종 수술 후유증 환자에 대한 침 및 침전기 자극술의 효과 (Case Study : Effects of Acupuncture and Electro-acupuncture on a Patient with Sequelae Caused by Removal of Facial Schwannoma)

  • 이상영;왕공덕;설재욱;강휘중
    • 동의생리병리학회지
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    • 제27권3호
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    • pp.327-330
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    • 2013
  • The purpose of this study is to report a clinical progress of treatment of sequelae caused by removal of facial schwannoma through Korean medicine. A patient was diagnosed with facial schwannoma by MRI on 4th June 2012 in local university hospital, he had right facial palsy, auditory hypersensitivity, dizziness after removal of facial schwannoma. Between 25th July 2012 and 26th January 2013, he was treated with acupuncture, cupping, electro-acupuncture every week and observed by House-Brackmann facial nerve grading system(H-B scale) and MoReSS every month. He had 29 times treatments. At the first of treatment, his state was Grade IV (H-B scale), 4/8(facial nerve grading), 10 points during action 7 points during rest(MoReSS) and he had severe facial palsy, ill-acrimation, auditory hypersensitivity. At the middle of treatment, October 2012, symptoms improved. State was Grade III (H-B scale), 5/8(facial nerve grading), 7 points during action 3 points during rest(MoReSS). Severe facial palsy improved ; Forehead creasing and union motor function recovered, he was able to close his eyes so ill-acrimation improved. At the end of treatment, January 2012, state was Grade II (H-B scale), 7.5/8(facial nerve grading), 3 points during action 1 point during rest(MoReSS). He had only occasional tinnitus and auditory hypersensitivity. Acupuncture and electro-acupuncture are estimated to be good for facial palsy after removal of facial schwannoma. More cases are required to develop treatment of facial palsy.

투신 사고와 자살 사이의 상당인과관계 인정과 손해배상의 범위에 대한 소고 - 대법원 2007.1.11. 선고 2005다44015 판결을 중심으로 - (Recognition of Reasonable Causation in Cases of Mentally Ill Patients Committing Suicide and the Adequate Level of Damages)

  • 이정선
    • 의료법학
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    • 제9권1호
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    • pp.165-196
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    • 2008
  • Recently the Supreme Court held that "in cases in which a patient suffering from a mental disorder attempts to commit suicide, fails, and then succeeds in a subsequent attempt, the following circumstances must be present in order to acknowledge reasonable causation between the negligence of the hospital with regards to taking care of the patient and the death of the patient; there must have existed negligence on the part of the hospital with regards to their failure to stop the 1stsuicide attempt, injurious aftereffects must have been caused to the patient by the1stsuicide attempt, and said aftereffects must have been the main cause for the 2nd successful suicide attemtp." This, in effect, lessens the requirements of past holdings of the Supreme Court which held that "to acknowledge reasonable causation between the negligence of the hospital and the patient that commits suicide, the patient must have experienced such severe physical and mental suffering from the previous attempt so that they could not help but choose to commit suicide". The fact that the Supreme Court did not clearly state such changes in their view on this matter should be corrected. Also, the fact that the court only held the hospital liable for damages of less than 50 million won, only calculating damages up to the point when the deceased passed, is inadequate compared to other cases and should be corrected.

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중환자에서 발생한 저혈량성 쇼크 동반 복직근초 혈종 1예 (A Case of Rectus Sheath Hematoma Complicated with Hypovolemic Shock in a Critically-Ill Patient)

  • 신홍준;김윤희;지수영;반희정;권용수;오인재;김규식;임성철;김영철;김수옥
    • Tuberculosis and Respiratory Diseases
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    • 제69권6호
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    • pp.480-482
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    • 2010
  • Rectus sheath hematoma (RSH) is a rare condition caused by hemorrhage into the rectus sheath. It is usually associated with severe cough, abdominal surgery, coagulopathy, and anticoagulation treatment. RSH can be difficult to diagnose and can be misdiagnosed as acute appendicitis, as diverticulitis, or as an ovarian mass. Although RSH usually presents as a benign condition, it can be life threatening, especially in the critically-ill patient. Here, we report a case of fatal RSH due to hypovolemic shock in a critically-ill 73-year-old woman, who had received heparin treatment due to acute myocardial infarction in the intensive care unit and who had been successfully treated by conservative management.

심한 하악 치조제 흡수를 가진 환자에서 임플란트를 이용한 가철성 국소의치로 수복한 증례 (Implant-assisted removable partial denture for severely atrophied mandible)

  • 최바다;김연주;이재훈
    • 대한치과보철학회지
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    • 제57권2호
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    • pp.171-175
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    • 2019
  • 치조제가 심하게 흡수된 하악의 정확한 해부학적 구조를 채득하는 것은 매우 어렵다. 이 경우 보다 정확한 인상을 채득하기 위하여 수정모형 제작법을 통한 기능 인상 채득이 추천된다. 이를 위해서는 양측에 2개의 임플란트 크라운을 이용하여 적절한 고정원을 얻을 필요가 있다. 이를 통해 임플란트 피개의치에서는 불가능하였던 수정모형 제작법을 시행할 수 있다. 본 증례에서는 하악의 치조제가 심하게 흡수된 80세 여환을 하악 양측 견치 부위의 임플란트 크라운을 지대치로 한 가철성 국소의치를 이용하여 수복하였다. 가철성 국소의치의 금속구조물을 이용하여 개인 트레이를 제작하고 수정모형 제작을 위한 이차 인상을 채득하였다. 환자는 앞선 2회의 피개의치 실패 후 제작된 최종 보철물에 만족하였다. 치료 초기에 행해진 피개의치 치료에서는 부정확한 인상법에 따른 부적절한 보철물로 인해 술자와 환자 모두 만족하지 못했지만, 2개의 임플란트를 적절한 고정원으로 이용함으로써 성공적인 수복이 가능하였다.

ESTIMATING THE NUMBER OF ICU PATIENTS OF COVID-19 BY USING A SIMPLE MATHEMATICAL MODEL

  • Hyojung Lee;Giphil Cho
    • East Asian mathematical journal
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    • 제40권1호
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    • pp.119-125
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    • 2024
  • Predicting the number of ICU patients holds significant importance, serving as a critical aspect in efficiently allocating resources, ensuring high-quality care for critically ill individuals, and implementing effective public health strategies to mitigate the impact of diseases. This research focuses on estimating ICU patient numbers through the development of a simple mathematical model. Utilizing data on confirmed COVID-19 cases and deaths, this model becomes a valuable tool for predicting and managing ICU resource requirements during the ongoing pandemic. By incorporating historical data on infected individuals and fatalities from previous weeks, we establish a straightforward equation. We found the substantial impact of the delay in infected individuals, particularly those occurring more than five weeks earlier, on the accuracy of ICU predictions. Proactively preparing for potential surges in severe cases becomes feasible by forecasting the demand for intensive care beds, ultimately improving patient outcomes and preventing excessive strain on medical facilities.