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Backgroud: Despite continous efforts to improve the prehospital trauma care system in Korea, the preventable death rate has been reported to be high. The purpose of this study was to evaluate the prehospital trauma care system in Seoul by analyzing 119 rescue databases. Methods: The 119 rescue data bases of 22,275 trauma patients, who were transported to the secondary and tertiary hospital in Seoul by Seoul 119 rescue services from January 1, 2000 to December 31, 2000, were analyzed. Results: The response time(mean 3.7 min.) showed no time, weekly, and regional variations. However, the transport time from field to hospital showed was high in the morning rush hour(7:00 to 10:00 am), and was gradually decreased and the lowest between 10:00 pm and 7:00 am. There was also a regional variation in the transport time, which was short in the central area and long in the peripheral area of Seoul. Prehospital cares were given to the 10,999 trauma patients(49.4%). Of the 464 unresponsive patients(2%), only 236 patients were identified in transported hospitals. The outcomes of these unresponsive patients were DOA(54%), survival(19%), death in ER(14%), transfer to other hospitals(8%), and death after admission(5%) in order. Conclusion: We suggest that this study may be helpful to the establishment and improvement of the prehospital trauma care system as well as the determination of the adequate numbers and locations of trauma center in Seoul.
Background. Endotracheal intubation is one of the most important and challenging tasks that an emergency physician has to perform. Complications associated with this procedure range from local trauma of the airway to death caused by unrecognized misplacement of the endotracheal tube. This study was designed to investigate complications of intubation including rapid sequence intubation in the emergency department. Method. One hundred four consecutive patients requiring endotracheal intubation in the emergency department of the Stanford Medical Center over a 8-month period were studied prospectively. Result. The indications for intubation were acute respiratory failure(60.5%), airway protection(30.8%), and cardiopulmonary arrest(8.7%). 97(93.3%) intubations were inserted orally, remaining 7(6.7%) were intubated via the nasotracheal route. Of 97 orotracheal intubations, rapid sequence intubation was used in 71(73.2%) cases. Grouped by level of training, junior residents attempted 69(66.3%) intubations, senior residents 21(20.2%), and staff 13(12.5%). Of the 104 intubations, 92(88.5%) were successful on the first or second attempt. 12 procedures(11.5%) required more than two attempts at intubation. A total of 36(34.6%) complications occurred. Esophageal intubations occurred in 13 cases, right main stem intubation in 13, pulmonary aspiration in 4, and others in 6. Fourteen patients(13.5%) died after intubation. Conclusion. The complication rate of endotracheal intubation in the emergency department is high. In order to decrease the complication, detailed knowledge, skill, and equipments about endotracheal intubation are required. The good condition of a patient before intubation appears to be important for survival.
Introduction This study was performed to investigate whether brain temperature measured with a noninvasive method is higher than other body temperatures during targeted temperature management (TTM) after cardiac arrest. Material & Method Fifteen male domestic pigs were assigned to the sham (n = 5), CPR-Only (n = 5) and CPR-TTM (n = 5) groups. In the CPR-Only and CPR-TTM groups, 10 min of induced ventricular fibrillation and cardiopulmonary resuscitation were provided before temperature management. In the sham and CPR-Only groups, the esophageal temperature was maintained at 37°C for 30 h, maintained at 33°C for 16 h and rewarmed at a rate of 0.25°C/h for 14 h in the CPR-TTM group. Esophageal temperature (TE), rectal temperature (TR), pulmonary artery temperature (TP) and noninvasive brain temperature (TB) were collected. The primary outcome was the difference between TB and other body temperatures. Result TB was significantly lower than other body temperatures during experiments in all three groups (P < 0.001), with mean temperature differences ranging from -1.35°C to -0.86°C. Temperature differences were significant among other body regions except TE - TP in the sham group (P = 0.174) and TR - TP in the CPR-Only group (P = 0.530). Conclusion In our swine experimental models, brain temperature measured with the noninvasive method was lower than rectal, esophageal and pulmonary artery temperatures, regardless of the experimental group.
Introduction The neurological outcome after cardiac arrest is still poor and the main mechanism of brain injury after cardiac arrest is ischemia-reperfusion injury. According to recent study, low serum kallistatin level was associated with poor neurological outcome of cardiac arrest survivors. Kallistatin is a protein that is encoded by the SERPINA4 gene and is known to contribute to antioxidant activity by inhibiting the activity of NADPH oxidase. Therefore, this study was conducted to investigate the antioxidant role of kallistatin in human neuronal cells and the purpose of this study is to identify that depletion of kallistatin makes excessive reactive oxygen species and worsens oxidative damage. Material & Method SERPINA4 small interfering RNA(siRNA) was transfected into human neuronal cells to produce kallistatin knockdown neuronal cells. After producing the SERPINA4 knockdown cells, the expression level of kallistatin was measured. To induce ischemia-reperfusion injury, SERPINA4 knockdown and control cells were exposed to 60 minutes of oxygen-glucose deprivation(OGD) followed by 23 hours of reoxygenation(Reoxy) and cell viability was measured. The levels of oxidative stress and apoptosis were compared by measuring the concentration of kallistatin, NADPH oxidase(Nox-1), hydrogen peroxide, and caspase-3 in kallistatin knockdown cells and control cells and each treated with OGD/Reoxy. Result SERPINA4 siRNA transfection suppressed kallistatin expression. OGD/Reoxy reduced cell viability in both SERPINA4 knockdown and control siRNA cells. It was confirmed that the expression of kallistatin was inhibited in the cell group transfected with SERPINA4 siRNA compared to the control siRNA group.(p < 0.001) Nox-1 expression and hydrogen peroxide level was increased in the cells that had undergone OGD/Reoxy processing on kallistatin knockdown group.(p < 0.001) When the control group and the kallistatin knockdown group were processed to OGD/Reoxy, it was confirmed that caspase-3 expression was elevated and apoptosis was promoted.(Control siRNA: p < 0.05, SERPINA4 siRNA: p < 0.01) Conclusion Inhibition of kallistatin expression did not inhibit the activity of NADPH oxidase, through the OGD/Reoxy process, NADPH oxidase expression was increased. As a result, more free radicals were generated, more hydrogen peroxide was produced, and more caspase-3 was produced, thereby promoting apoptosis.