Acute and Critical Care

Young Gi Min

5 Articles

A Case of Acute on Chronic Salicylate Poisoned Elderly Patient with Early Utilization of Continuous Venovenous Hemodiafiltration: A Case Report: Ji Sook Lee, Woo Chan Jeon, Young Gi Min, Won Hyun Ryu, Yoon Seok Jung, Sang Cheon Choi; Korean J Crit Care Med. 2011;26(3):177-180.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.177

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Abstract PDF: Salicylate poisonings are divided into acute and chronic syndromes. The most challenging aspect of the management of aspirin-poisoning may be recognition of subtle signs and symptoms of chronic, unintentional overdose. Chronic poisoning typically occurs in elderly as a result of unintentional overdosing on salicylates used to treat chronic conditions. Treatment is directed toward preventing intestinal absorption of the drugs and enhanced elimination. After the first-line treatments, aspirin overdose with its complications of hemodynamic, electrolyte and acid-base issues, is best managed by prompt hemodialysis. We report a case of a 87-year-old woman, who presented with acute on chronic salicylate poisoning. After early continuous venovenous hemodiafiltration, old woman made a good recovery from the salicylism but suffered paralytic ileus caused by aspirin enteroliths. Physician can decide a prompt hemodialysis for salicylate-poisoned patients, who worsen clinical courses despite of first-line therapies.

Clinical Characteristics of Acute Brain Swelling in Patients Successfully Resuscitated from Non-traumatic Out-of-hospital Cardiac Arrest: Wonhyun Ryu, Young Joo Lee, Eun Jung Park, Yoon Seok Jung, Young Gi Min; Korean J Crit Care Med. 2010;25(4):219-223.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.219

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BACKGROUND
The number of cardiac arrest patients who are resuscitated has increased with the development of emergency medical services. Brain swelling is often found in these patients, following return of spontaneous circulation. This study identifies risk factors for brain swelling, describes it's frequency, analyzes the effect of brain swelling on neurological outcome, and compares the results with other studies.
METHODS
A retrospective analysis had been conducted on cardiac arrest patients who visited the emergency room at a university hospital during a 24 month period since 2007. Thirty-seven successfully resuscitated patients were divided into 2 groups based on computed tomography findings; these groups consisted of 14 patients with brain swelling and 23 patients without brain swelling. Comparative studies were conducted on post-lab findings and several additional factors.
RESULTS
The 14 patients with brain swelling were significantly younger and showed a higher clinical performance category score than patients without brain swelling. Initial serum lactic acid levels showed good correlation with brain swelling.
CONCLUSIONS
An urgent CT should be conducted and aggressive treatment pursued when brain swelling is suspected, after consideration of various prognostic factors.

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Cerebral Edema After Cardiopulmonary Resuscitation: A Therapeutic Target Following Cardiac Arrest?
Erik G. Hayman, Akil P. Patel, W. Taylor Kimberly, Kevin N. Sheth, J. Marc Simard
Neurocritical Care.2018; 28(3): 276. CrossRef
Prognostic values of gray matter to white matter ratios on early brain computed tomography in adult comatose patients after out-of-hospital cardiac arrest of cardiac etiology
Byung Kook Lee, Kyung Woon Jeung, Kyoung Hwan Song, Yong Hun Jung, Wook Jin Choi, Soo Hyun Kim, Chun Sung Youn, In Soo Cho, Dong Hun Lee
Resuscitation.2015; 96: 46. CrossRef

The Usefulness of Lactate Clearance Adjusted to Time as a Predictive Index in Patients with Severe Sepsis and Septic Shock: Jung Hwan Ahn, Sang Cheon Choi, Young Gi Min, Yoon Seok Jung, Sung Hee Chung, Young Joo Lee; Korean J Crit Care Med. 2009;24(3):134-139.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.134

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Abstract PDF

BACKGROUND
The lactate concentration should be used to examine the severity of sepsis or any state of shock. This study was conducted to investigate the prognostic power of the lactate clearance, as adjusted for time, between the survivors and nonsurvivors of patients with severe sepsis or septic shock.
METHODS
The study was performed on 67 patients over 16 years old and who were admitted to the intensive care unit (ICU) with severe sepsis or septic shock. They were divided into the survivors (n = 37) and nonsurvivors (n = 30). The blood lactate concentrations were assayed at intervals ranging from 8 to 24 hours and the APACHE III scoring was done daily for 2 weeks or until discharge or death. The lactate clearance, as adjusted for time, was defined using the following formula: [(the maximal lactate concentration - the normal lactate concentration)/the time to normalize the lactate concentration] x 1,000.
RESULTS
There were no significant differences of age, gender and the length of the ICU stay between the survivors and non-survivors. There were significant difference of the time to measuring the maximal serum lactate concentration (3.2 +/- 12.3 hours vs. 28.8 +/- 64.6 hours, respectively; p = 0.037), the lactate clearance, as adjusted for time (132.27 +/- 112.88 mol/L . hour vs. 59.67 +/- 72.60 mol/L . hour, respectively; p = 0.002), the lactate clearance during 24 hours (46.0 +/- 26.3% vs. 22.6 +/- 45.6%, respectively; p = 0.018) and the APACHE III score (67.6 +/- 22.7 vs. 83.9 +/- 21.6, respectively; p = 0.005) between the survivors and non-survivors. The lactate clearance, as adjusted for time and the APACHE III score were the predictive factors for survival on the logistic regression analysis (odd ratio 0.987; p = 0.028 vs. odd ratio 1.046; p = 0.006).
CONCLUSIONS
Lactate clearance, as adjusted for time, could be used as a prognostic index, as well as the APACHE III score, for patients with severe sepsis or septic shock.

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Lactate Clearance and Outcome in Septic Shock Patients with Low Level of Initial Lactate
Yun Su Sim, Cho Rom Hahm, So Yeon Lim, Gee Young Suh, Kyeongman Jeon
The Korean Journal of Critical Care Medicine.2011; 26(2): 78. CrossRef

A Case of Valproic Acid Overdose Treated with Continuous Veno-Venous Hemodiafiltration: A Case Report: Sang Cheon Choi, Jung Hwan Ahn, Yoon Seok Jung, Young Gi Min; Korean J Crit Care Med. 2009;24(2):99-101.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.99

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Abstract PDF: Valproic acid intoxication is a fairly common clinical problem that can result in serious complications. Traditionally the treatment of valproic acid overdose has been limited to supportive measures, but high blood levels may require extracorporeal removal, and publications on this experience are scarce. This case demonstrated continuous veno-venous hemodiafiltration successfully used in patient with severe valproic acid overdose who was hemodynamically unstable.

Aortic Dissection Presenting as Lower Leg Ischemia: A Case Report: Young Shin Bae, Yeon Woo Kim, Young Gi Min, Young Ju Lee; Korean J Crit Care Med. 2004;19(2):134-138.

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Abstract PDF: We report a 47-year-old man who presented with acute right leg pain without any other symptoms on visit to ER. But he had the severe back pain when the leg pain developed. Contrast CT revealed no enhancement on right common iliac artery and aortic dissection from the lower level of right renal artery to the iliac artery bifurcation. Angiographic stent insertion was performed immediately, but the patient showed reperfusion syndrome and died after 3 days. Aortic dissection with the isolated peripheral vascular complications is rare. Aortic dissection should be included in the differential diagnosis of patients with acute lower leg ischemia like peripheral arterial occlusive disease.

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