Ding-Kuo Chien

Solanum erianthum intoxication mimicking an acute cerebrovascular disease

We describe a case of Solanum erianthum poisoning that happened to a 75-year-old man. He ate the S erianthum that he gathered from the countryside, believing that it would be helpful in improving the numbness of his distal limbs. S erianthum is a solanaceous plant that contains a variable concentration of solanum alkaloids, causing gastrointestinal irritation, and tropane alkaloids that have anticholinergic properties producing typical and sometimes severe atropinelike symptoms. The diagnosis of S erianthum poisoning was made based on clinical symptoms and signs of anticholinergic syndrome associated with a history of vegetable meal from countryside and, moreover, on identification of the vegetable obtained from his family. Gastrointestinal decontamination and symptomatic treatment were useful in treatment of acute poisoning.

MASS GATHERING EMERGENCY MEDICINE: A REVIEW OF THE TAIWAN EXPERIENCE OF LONG-DISTANCE SWIMMING ACROSS SUN-MOON LAKE

Summary Once a year during the festival of Sun-Moon Lake in Nan-Tou County, Taiwan, a long-distance swimming mass gathering (LDSMG) event takes place. This event, in which participants swim an estimated 30 km, is very popular; the total number of spectators and participants at the 2002 festival was 15,189. This study, the first pertaining to the LDSMG, aimed to review the effect of the environmental factors at this particular mass gathering event, with mass being defined here as more than 1,000 people, upon the events patient presentation rate (PPR). This was done to provide improved medical services at this event in future years The study also aimed to collect patient data from the two medical stations (one upstream and one downstream) and analyze the differences between them. In 2002, the number of patients requiring first aid treatment was determined from data gathered on-site. A total of 63 presented at on-site medical stations (PPR, 4.15 per 1,000 attendees), where 14 patients presented to a downstream medical station and 49 to an upstream medical station. The mean age of the patients was 35.46 ± 15.14 years; ages ranged from 1 to 65 years. Forty-nine of the patients (78%) were male. Fifty-nine patients were treated with medication (3.88 per 1,000 attendees), and two were taken to hospital (0.13 per 1,000 attendees). Injuries sustained included trauma (71%), such as impact, fall, sprain, stabbed laceration and burn, hypothermia (5%), and foreign bodies (3%). The PPR at the LDSMG was related to factors including the presence or absence of seating, whether the event was outdoors or indoors, mobility of the crowd, whether the activity was contained within a boundary, attendance figures, and humidity level. The weather, particularly the relative humidity (81%), was also positively correlated with an increase in the number of presentations at the medical stations.

Factors Analysis of Cardiopulmonary Resuscitation Outcomes in the Elderly in Taiwan

SUMMARY Performing cardiopulmonary resuscitation (CPR) can save countless lives, but its use is rather controversial in elderly patients. Some researchers believe that there is an inverse ratio between the success of CPR and the age of the patient, while others believe that the uniqueness of each case and existing comorbidities are more important factors. CPR can result in severe injury for patients. Therefore, physicians often face a dilemma between rational and moral decisions when dealing with older patients suffering from cardiac arrest. The solution to this problem rests on the determination of whether CPR will benefit the patient. This analysis, supported by a literature review and a review of the outcomes of CPR, considered different factors in elderly patients, including age, sex, prehospital emergency medical service, preexisting disease, witnessed cardiac arrest, initial arrest electrocardiogram rhythm, CPR locations, and ethics. Quality of life and the cost of medical care for the elderly affect the benefit analysis of CPR. Indeed, a large amount of money is spent on elderly CPR patients who remain in critical condition before finally dying in the hospital. Factors contributing to decisions to resuscitate also include post-resuscitation quality of life, and the will of patients, families and doctors. In short, patient age is not a barrier to performing CPR. However, to achieve the best outcome of CPR, one must consider the disease diagnosis of elderly patients as a useful reference to help improve medical care for this group.

Dyspnea in pregnancy

Dyspnea in pregnancy is common. It can result from adaption to body changes in pregnancy and also from complications therein. Understanding the mechanisms of change in the respiratory system during pregnancy helps with the differential diagnosis of dyspnea in normal pregnancy as opposed to pathological dyspnea.

EXTRACORPOREAL MEMBRANE OXYGENATION-ASSISTED CARDIOPULMONARY RESUSCITATION FOR AN IN-HOSPITAL CARDIAC ARREST PATIENT

SUMMARY Extracorporeal membrane oxygenation (ECMO) is used as a resuscitative tool for cardiogenic shock or cardiac arrest patients in the emergency department. It provides a better outcome for an in-hospital cardiac arrest (IHCA) patient, even if the patient has received prolonged cardiopulmonary resuscitation. We present the case of a 44-year-old female IHCA patient who presented to the emergency department with sudden onset of chest pain and cold sweating. Cardiac arrest occurred approximately 20 minutes after she arrived at the emergency department. Spontaneous heart beating returned immediately after cardiopulmonary resuscitation, and the patient was then supported by quickly applying ECMO. Thereafter, primary percutaneous transluminal coronary angioplasty was performed by a cardiologist. The patient received ECMO support for a total of 12 days. There were no major complications noted during the hospital stay. In conclusion, the use of ECMO to support cardiopulmonary function during cardiopulmonary resuscitation can improve the chance of survival in cases of IHCA that have better central nervous function after being weaned from ECMO. Shorter cardiopulmonary resuscitation duration and less organ damage may predict a better outcome in these patients. [International Journal of Gerontology 2010; 4(2): 99–103]