• KSII Transactions on Internet and Information Systems (TIIS)
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• 제17권4호
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• pp.1080-1099
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• 2023

Digital healthcare combined with telemedicine services in the form of convergence with digital technology and AI is developing rapidly. Digital healthcare research is being conducted on many conditions including shock. However, the causes of shock are diverse, and the treatment is very complicated, requiring a high level of medical knowledge. In this paper, we propose a shock detection method based on the correlation between shock and data extracted from hemodynamic monitoring equipment. From the various parameters expressed by this equipment, four parameters closely related to patient shock were used as the input data for a machine learning model in order to detect the shock. Using the four parameters as input data, that is, feature values, a random forest-based ensemble machine learning model was constructed. The value of the mean arterial pressure was used as the correct answer value, the so called label value, to detect the patient's shock state. The performance was then compared with the decision tree and logistic regression model using a confusion matrix. The average accuracy of the random forest model was 92.80%, which shows superior performance compared to other models. We look forward to our work playing a role in helping medical staff by making recommendations for the diagnosis and treatment of complex and difficult cases of shock.

• KSII Transactions on Internet and Information Systems (TIIS)
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• 제16권7호
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• pp.2209-2224
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• 2022

The Internet of Things (IoT) is being used in a wide variety of fields due to the recent 4th industrial revolution. In particular, research is being conducted that combines IoT with the medical field such as telemedicine. Among them, the field of shock detection is a big issue in the medical field because the causes of shock are diverse, treatments are very complex, and require a high level of medical knowledge and experience. The transmission of infectious diseases is common when treating critically ill patients, especially patients with shock. Thus, to effectively care for shock patients, we propose an architecture that continuously monitors the patient's condition, and automatically recommends a drug injection treatment according to the patient's shock condition. The patient's hemodynamic information is continuously monitored, and the patient's shock generation information is recorded periodically. With the recorded patient information, the patient's condition is determined and automatically injected with necessary medication. The medical team can find out whether the patient's condition has improved by checking the recorded information through web applications. The study can help relieve the shortage of medical personnel and help prevent transmission of infectious disease in medical staff. We look forward to playing a role in helping medical staff by making recommendations for the diagnosis and treatment of complex and difficult shocks.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제21권1호
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• pp.65-68
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• 1999

Multiple facial trauma patient should be carefully treated because of severe bleeding on extraoral and intraoral wound, possibilty of airway obstruction and hypovolemic shock. Hypovolemic shock may be divided to hemorrhagic shock and non-hemorrhagic shock. Also hemorrhagic shock is divided to mild, moderate and severe shock according to the degree of blood volume depletion. Mild shock occurs in blood loss of less than 20% of blood volume and moderate shock does in blood loss of 20-40% of blood volume. And Severe shock occurs in blood loss of more than 40% of blood volume. The goal of emergency care of trauma patient is that respiration and perfusion should be recovered to satisfactory level and that normal vital sign is maintained. We reported the case of multiple facial trauma patient with severe bleeding and hopovolemic shock and metabolic acidosis who was treated with adequate supply of fluid transfusion, intubation, tracheostomy and emergency operation.

• Journal of Trauma and Injury
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• 제22권2호
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• pp.148-153
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• 2009

Purpose: The osmolar gap increases in proportion to the ethanol level. Some previous studies have shown that the correlation between the osmolar gap and the ethanol level is weak in trauma patient by using an indirect comparison with other patients. We conducted a direct comparison of the correlation of the osmolar gap to the ethanol level between trauma patients and non-trauma patients. We also analyzed the accuracy of the estimated ethanol level between the two groups. Methods: The research candidates were adult patients who had visited the emergency department of our hospital from December 2003 to November 2008. By using a retrospective chart review, we classified them into three subgroups: non-trauma without shock, trauma without shock, and trauma with shock. In each group, we compared the correlation between the osmolar gap and the measured ethanol level, and we analyzed the accuracy of the estimated ethanol level by using Lin's concordance correlation coefficient. Results: Four hundred forty-seven patients were enrolled in this study. For correlation of the osmolar gap and the measured ethanol level, Pearson's correlation coefficient was 0.916 in all patients, 0.939 in non-trauma without shock patients, 0.917 in trauma without shock patients, and 0.844 in trauma with shock patients. In the analysis of the accuracy of the estimated ethanol level by using Lin's concordance correlation coefficient, the accuracy in trauma with shock patients was lower than that in non-trauma without shock patients. Conclusion: We found that the correlation between the osmolar gap and the measured ethanol level in the patient group with trauma was lower than it was in the patient group without trauma. Moreover trauma patients with shock had a lower accuracy of the estimated ethanol level than non-trauma patients.

• 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.

• 한국임상수의학회지
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• 제34권3호
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• pp.197-199
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• 2017

A 14-year-old castrated male ShihTzu diagnosed with chronic kidney disease (CKD) 6 months prior was referred to our clinic. The patient had been experiencing symptoms such as vomiting, poor appetite and hind limbs weakness. Hematology tests showed that he had a non-regenerative anemia. With aggressive treatment, the patient's state had gotten worse. He showed ragged breath, vomiting blood and loss of consciousness temporarily. Hematocrit maintained low level. Gastric hemorrhage was strongly suspected by hematemesis. Whole blood transfusion was performed and heparin was used as an anticoagulant. Prior to transfusion, the blood cross matching between donor and patient was performed and the result was compatible. After the transfusion was stabilized, 1 mg of protamine sulfate for each 100 units of heparin was prepared and given intravenously over 3 minutes to reverse the effects of heparin. Immediately after protamine injection, the patient conducted severe anaphylactic shock. Protamine sulfate is used to reverse the anticoagulant action of heparin in dogs and humans. The adverse reaction of protamine sulfate range from mild reaction to fetal cardiac arrest. When using protamine sulfate as heparin neutralization, it can lead to the death of a patient cause of anaphylactic shock. For this reason, the protamine sulfate should be injected slowly with antihistamine and the clinician should carefully monitor patients.

• The Korean Journal of Pain
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• 제28권4호
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• pp.280-283
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• 2015

Caudal epidural injection is a common intervention in patients with low back pain and sciatica. Even though the complications of fluoroscopically directed epidural injections are less frequent than in blind epidural injections, complications due to contrast media can occur. We report a case of anaphylactic shock immediately after injection of an intravenous nonionic contrast medium (iohexol) during the caudal epidural injection for low back pain and sciatica in a patient without a previous allergic history to ionic contrast media (ioxitalamate). Five minutes after the dye was injected, the patient began to experience dizziness, and the systolic blood pressure dropped to 60 mmHg. Subsequently, the patient exhibited a mild drowsy mental state. About 30 minutes after the subcutaneous injection of 0.2 mg epinephrine, the systolic blood pressure increased to 90 mmHg. The patient recovered without any sequela. Life-threatening complications after injection of intravenous contrast medium require immediate treatment.

• 대한약침학회지
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• 제4권3호
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• pp.109-117
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• 2001

Objective : There has been no known report on the pain shock after administering Korean bee-venom therapy. Three accounts of pain shock were observed at the Sangji university affiliated Oriental medicine clinic from July 2001 through September 2001. This thesis will inform clinical progression and cautions on administering Korean bee-venom therapy. Methods: We were able to witness different patterns of pain shock during the treatment of degenerative knee joint, progressive oral paralysis, and A.L.S. In order to reduce heat toxicity of the bee venom, needling points were first massaged with the ice for 10 minutes before injecting $0.1{\sim}0.2cc$ of the bee venom. Points of injection were ST36, LI11, LI4 and others. Pain shock occurred after injecting on inner xi-an, outer xi-an and LI4. The phenomena associated with pain shock was recorded in chronological order and local changes were examined. Results: Through examining 3 patients with the pain shock, we managed to observe clinical progression, duration, and time linked changes on specific regions. We also managed to determine sensitive needling points for the pain shock. Conclution: Following results were obtained from 3 patients with the pain shock caused by Korean bee-venom therapy from July 2001 to September 2001. 1. Either positive or negative responses were shown after the pain shock. For case 1, extreme pain was accompanied with muscular convulsion and tremble, ocular hyperemia, delirium, stiffening of extremities, and hyper ventilation which all suggest positive responses. For case 2 and 3, extreme pain was accompanied with facial sweating, asthenia of extremities, pallor face, dizziness, weak voice, and sleepiness which are the signs of negative responses. 2. The time required to recover to stable state took nearly an hour (including sleeping time) and there was no side effect. 3. Precautions required to prevent the pain shock includes full concentration from the practitioner, accurate point location, precise amount of injection, physiological condition and psychological stability of the patient 4. Coping with the pain shock should be similar with a needle shock, and since extreme pain is accompanied, sufficient psychological rest must be provided. 5. Pain shock occurs because the patient cannot tolerate stimulation on the needling point. Thus, symptoms were similar to the needle shock in addition to excruciating pain. Further investigation and research must be done to have better understanding of an immune response and the pain shock associated with Korean bee-venom therapy.

• 대한치과마취과학회지
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• 제14권4호
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• pp.243-250
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• 2014

Generalized anaphylaxis is a most dramatic and acutely life-threatening allergic reaction and may cause death within a few minutes. Differential diagnosis of anaphylaxis is made by clinical signs, such as, mental change, respiratory distress, hypotension, hypoglycemia, urticaria and angioedema. Especially, insulin reaction, myocardial infarction and vasovagal syncope are considered as differential diagnosis. In cases of fatal anaphylaxis, respiratory and cardiovascular disturbances predominate and are evident early in the reaction. This is a case report of the intensive care of anaphylactic shock after intravenous injection of the penicillin in a old medically compromised patient with the maxillary osteonecrosis. The anaphylactic shock symptoms, such as, unconsciousness, respiratory disorder, no pulsation on carotid artery and cardiopulmonary arrest are occurred in intravenous injection of augmentin 1.2 g after the skin test. In spite of immediate emergency cares, such as intravenous injection of epinephrine, endotracheal intubation, cardiopulmonary resuscitation, and continuous intensive care, the patient is expired in 58 hours after anaphylactic shock attack.

• Journal of Trauma and Injury
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• 제33권3호
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• pp.170-174
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• 2020

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is considered an emerging adjunct therapy for profound hemorrhagic shock, as it can maintain temporary stability until definitive repair of the injury. However, there is limited information about the use of this procedure in children. Herein, we report a case of REBOA in a pediatric patient with blunt trauma, wherein the preoperative deployment of REBOA played a pivotal role in damage control resuscitation. A 7-year-old male patient experienced cardiac arrest after a motor vehicle accident. After 30 minutes of cardiopulmonary resuscitation, spontaneous circulation was achieved. The patient was diagnosed with massive hemoperitoneum. REBOA was then performed under ongoing resuscitative measures. An intra-aortic balloon catheter was deployed above the supraceliac aorta, which helped achieved permissive hypotension while the patient was undergoing surgery. After successful bleeding control with small bowel resection for mesenteric avulsion, thorough radiologic evaluations revealed hypoxic brain injury. The patient died from deterioration of disseminated intravascular coagulation. Although the patient did not survive, a postoperative computed tomography scan revealed neither remaining intraperitoneal injury nor peripheral ischemia correlated with the insertion of a 7-Fr sheath. Hence, REBOA can be a successful bridge therapy, and this result may facilitate the further usage of REBOA to save pediatric patients with non-compressible torso hemorrhage.