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In our contry, prehospital cardiac arrest means death because layman can not perform cardiopulmonary resuscitation(CPR) and there is no emergency medical technician and transport system for treating victims with prehospital cardiac arrest. And many of physicians usually do not try to perform CPR because they used to treat victims with prehospital cardiac arrest as the dead, so-called death on arrival(DOA). Recently, we experienced a 52 year-old man who sustained from prehospital cardiac arrest induced presumably by variant angina initiated about 20 minutes before hospital arrival. On hospital arrival, he had a fine ventricular fibrillation, but spontaneous circulation was restored (ROSC) at 14 minutes after CPR strated. At 2 hours after ROSC, marked elevation of ST segment appeared and shortly, complete AV block developed. After sublingual and intravenous administration of nitroglycerin, ECG changes disappeared. Diffuse spasm of coronary artery with ST segment elevation was documented during coronary angiogram which showed no atherosclerotic change of coronary artery. He recovered good neurologic function(cerebral performance categories 1) and discharged on his foot.
Resuscitation medicine, which is a relatively young field of clinical medicine, has emerged as an endeavor to resuscitate victims suffering sudden death. Cardiopulmonary resuscitation (CPR) is utilized in order to treat a transient, reversible, sudden unexpected death. Currently, it is expected that millions of lay people worldwide learn CPR and millions of patients suffering sudden cardiac arrest receive CPR. Even though the history of CPR includes folklore related to various attempts that have been made to save lives, modern CPR based on clinical research and evidence has been introduced and developed over the last several decades. Researchers and organizations have contributed to the development of resuscitation skills by establishing CPR guidelines and disseminating this knowledge to lay people. Despite recent advances in CPR technique, sudden death remains a major health issue in developed countries and the survival rate resulting from out-of-hospital cardiac arrest remains low. This review provides insight into the progression of resuscitation medicine by evaluating the history of CPR.
황성오 ( Sung Oh Hwang ),김영식 ( Young Sik Kim ),안무업 ( Mu Eob Ahn ),임경수 ( Kyoung Soo Lim ),오중환 ( Joong Hwan Oh ),윤정한 ( Jung Han Yoon ),최경훈 ( Kyung Hoon Choe ),강성준 ( Sung Joon Kang ) 대한응급의학회 1992 大韓應急醫學會誌 Vol.3 No.2
To evaluate the physiologic extent. Of pulmonary contusion and effect of PEEP therapy for pulmonary contusion, we studied 16 patients received PEEP t,herapy with pulmonary cont.usion from nonpenet,rating chest trauma. Hemodynamic parameters including pulrnonary vascular resistance index and intrapulmonary shunt fraction were calculated from st.andard measurement, and arterial oxygen tension was measured. Pulmonary vascular resistance index and intrapulmonary shunt fraction were increased in patient group. Arterial oxygen tension was decreased wit.h increase of the intrapulmonary shunt fraction(R=0.75). Art.er minimal PEEP therapy(5-10 cmHO), pulmonary vascular resistance index was remained unchanged and intrapulmonary shunt fraction was decreased without significant changes of pulmonary hemodynamics. Increment of arterial tension was increased with decrease of intrapulrnonary shunt fraction(R=0.43). Decreased stroke volume index suggested of cardiac injury such as cardiac contusion in patient group. These results of our study suggested that increased intrapulmonary shunt fraction caused arterial hypoxia in pulmonary contusion and arterial oxygen tension was increased as a result of reduced intrapulmonary shunt by PEEP therapy.
Purpose: Necrotizing fasciitis is a rare, life-threatening, and rapidly progressive soft tissue infection associated with extensive necrosis. Despite recent advances in its management, outcomes have not improved and the mortality rate from this disease is still high. The objective of this study was to identify the predictive factors of mortality for patients diagnosed with necrotizing fasciitis in the ED. Methods: A total of 38 necrotizing fasciitis cases diagnosed by an emergency department from January 2001 to April 2012 were retrospectively reviewed. Results: Mean serum lactate levels were significantly higher in non-survivors than survivors (8.03±4.48 vs. 3.26± 2.46, p=0.001). Serum glucose levels, arterial pCO2, and HCO3 values were significantly lower in non-survivors than survivors (114.75±78.01 vs. 203.92±122, p=0.027;25.02 ±6.82 vs. 32.74±7.06, p=0.005; 13.76±6.08 vs. 20.63± 5.12, p=0.002, respectively). Microorganisms isolated included coagulase-negative Staphylococci from seven patients (18.4%), Acinetobacter baumannii from six patients (15.8%), Enterococcus faecium from five patients (13.2%), Staphylococcus aureus from five patients (13.2%), Betahemolytic Streptococcus from three patients (7.9%), Enterococcus faecalis from three patients (7.9%), Escherichia coli from two patients (5.3%), Pseudomonas aeruginosa from two patients (5.3%), Enterobacter cloaca from two patients (5.3%), Klebsiella oxytoca from two patients (5.3%), and Klebsiella pneumonia from two patients (5.3%). More Acinetobacter baumannii were cultured from the non-survival group than the survival group (p=0.022), while there was no statistical difference from surgical treatment between the survivor and non-survivor group (p=0.460). Interestingly, serum lactate levels above 4.0 mmol/L were a predictor of mortality in the ED (OR, 20.000; confidence interval, 1.796-222.777). Conclusion: Initial serum lactate levels above 4 mmol/ Larea predictor of mortality in patients diagnosed with necrotizing fasciitis in the ED.
오성범 ( Sung Bum Oh ),이강현 ( Kang Hyun Lee ),차경철 ( Kyung Chul Cha ),지호진 ( Ho Jin Ji ),김호중 ( Ho Jung Kim ),김현 ( Hyun Kim ),황성오 ( Sung Oh Hwang ),배금석 ( Keum Suk Bae ),김헌주 ( Hun Joo Kim ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2
Background: Trauma-induced deaths can be prevented by implementation of trauma system during prehospital phases and in-hospital phases. To reduce the preventable death rate (PDR), it is essential to improve the treatment strategy during the prehospital phases and the in-hospital phases. This study was designed to compares the prehospital death and emergency department (ED) death in a city before and after implementation of trauma system. Method: We evaluated the prehospital and ED data of 106 trauma patients who had died in 1991 and 2001. Trauma deaths were reviewed and the preventability of those deaths was judged by three professional panels according to appropriateness of diagnosis and treatment in prehospital phases and in-hospital phases. Deaths were classified as preventable and nonpreventable. We compared the preventable death of 1991 with those of 2001. Result: Trauma patients were 993 in 1991 and 3,094 in 2001. Trauma-induced deaths were 60 in 1991 and 46 in 2001. The death rate decreased from 6% in 1991 to 1.5% in 2001 (p<0.001). Death rate by traffic accident decreased from 90% (54/60) in 1991 to 67% (31/46) in 2001 (p<0.001). The PDR decreased from 40% (24/60) in 1991 to 13% (6/46) in 2001 (p<0.001). The time elapsed from the scene of accident to ED arrival decreased from 111 minutes in 1991 to 53 minutes in 2001 (p<0.001). There was no significant difference in Injury Severity Score between 1991 and 2001 (p=0.283). Conclusion: The rate of preventable death decreased from 1991 to 2001. Implementation and improvement of the trauma system has positive effects on trauma-induced death rate, PDR and the time elapsed from the scene of accident to ED arrival.
Unsatisfied results of return of spontaneous circulation (ROSC) estimates were caused by the fact that the predictability of the predictors was insufficient. This unmet estimate of the predictors may be affected by transitional events due to behaviors which occur during cardiopulmonary resuscitation (CPR). We thus hypothesized that the discrepancy of ROSC estimates found in statistical characteristics due to transitional CPR events, may affect the performance of the predictors, and that the performance of the classifier dichotomizing between ROSC and No-ROSC might be different during CPR. In a canine model (n=18) of prolonged ventricular fibrillation (VF), standard CPR was provided with administration of two doses of epinephrine 0 min or 3 min later of the onset of CPR. For the analysis of the likelihood of a successful defibrillation during CPR, Support Vector Classification was adopted to evaluate statistical peculiarity combining time and frequency based predictors: median frequency, frequency band-limited power spectrum, mean segment amplitude, and zero crossing rates. The worst predictable period showed below about 1 min after the onset of CPR, and the best predictable period could be observed from about 1.5 min later of the administering epinephrine through 2.0-2.2 min. As hypothesized, the discrepancy of statistical characteristics of the predictors was reflected in the differences of the classification performance during CPR. These results represent a major improvement in defibrillation prediction can be achieved by a specific timing of the analysis, as a change in CPR transition.
Purpose: To determine the appropriate level of electrocardiography (EKG) education that should be incorporated into the curriculum of emergency medical technician (EMT) students. Methods: Consensus by EMT professors and emergency medicine specialists was obtained using two rounds of the Delphi survey. The questionnaire consisted of 70 items: 12 related to basic knowledge, 8 related to general interpretation of the EKG, 26 related to interpretation of arrhythmia, 20 related to interpretation of structural anomalies, infarction and systemic disease, and 4 related to interpretation of EKG findings used for advanced cardiac life support. We considered consensus to have been achieved if greater than 7 of 9 scores (66.7%) were concordant. Results: Fifty nine and 24 subjects were included in the first and second rounds of the Dephi survey, respectively. Response rates in the first and second rounds were, respectively, 59% and 40.7%. Of the 70 items, the panel came to a consensus for 40 of them. Conclusion: These findings should be used to provide guidance when building curricula for EMT students.
Purpose: Skiing and snowboarding are becoming increasingly popular. Accordingly, the incidences of injuries among skiers and snowboarders are also increasing. The purpose of this study was to investigate the injury patterns of and the contributing factors to head injuries of skiers and snowboarders and to evaluate the differences in characteristics between skiing and snowboarding head injuries. Methods: One-hundred patients who visited the emergency department of Wonju Christian Hospital between January 2005 and March 2007 due to head injuries from skiing and snowboarding were enrolled. The mechanisms and the histories of the injuries were investigated by surveying the patients, and the degrees of head injuries were estimated by using brain CT and the Glasgow Coma Scale. The degrees and the characteristics of brain injuries were also analyzed and compared between skiers and snowboarders. Results: Out of 100 patients, 39 were injured by skiing, and 61 were injured by snowboarding. The mean age of the skiers was 26.7±10.0, and that of the snowboarders was 26.7±6.2. The percentage of male skiers was 43.6%, and that of snowboarders was 63.9%. The most frequent initial chief complaints of head-injured skiers and snowboarders were headache and mental change. The most common mechanism of injuries was a slip down. The mean Abbreviated Injury Scale Score (AIS score) of the skier group was 4.5±2.1 and that of the snowboarder group was 5.9±5.0 (p=0.222). The percentage of helmet users was 7.1% among skiers and 20.8% among snowboarders (p=0.346). Head injuries were composed of cerebral concussion (92.0%) and intracranial hemorrhage (8.0%). Intracranial hemorrhage was most frequently caused by falling down (62.5%). Conclusion: The most common type of head injury to skiers and snowboarders was cerebral concussion, and severe damage was usually caused by jumping and falling down. No differences in the characteristics of the head injuries existed between skiing and snowboarding injuries.
Purpose: S100β, a marker of traumatic brain injury (TBI), has been increasingly focused upon during recent years. S100β, is easily measured not only in cerebrospinal fluid (CSF) but also in serum. After TBI, serum S100β, has been found to be increased at an early stage. The purpose of this study was to evaluate the clinical correlations between serum S100β, and neurologic outcome, and severity in traumatic brain injury. Methods: From August 2006 to October 2006, we made a protocol and studied prospectively 42 patients who visited the emergency room with TBI. Venous blood samples for S100β, protein were taken within six hours after TBI and vital signs, as well as the Glasgow Coma Scale (GCS), were recorded. The final diagnosis and the severity were evaluated using the Abbreviated Injury Score (AIS), and the prognosis of the patients was evaluated using the Glasgow Outcome Score (GOS). Results: Thirty-eight patients showed a favorable prognosis (discharge, recovery, transfer), and four showed an unfavorable prognosis. Serum S100β, was higher in patients with an unfavorable prognosis than in patients with a favorable prognosis, and a significant difference existed between the two groups (0.74±1.50 μg/L vs 7.62±6.53 μg/L P=0.002). A negative correlation existed between serum S100β, and the Revised Traumatic Score (R2=-0.34, P=0.03), and a positive correlation existed between serum S100β, and the Injury Severity Score (R2=0.33, P=0.03). Furthermore, the correlations between serum S100β, and the initial GCS and the GCS 24 hours after admission to the ER were negative (R2=-0.62, P<0.001; R2=-0.47, P=0.005). Regarding the GOS, the mean serum concentration of S100β, was 7.62 ß∂/L (SD=±6.53) in the expired patients, 1.15 μg/L in the mildly disable patient, and 0.727 μg/L (SD=±0.73) in the recovered patients. These differences are statistically significant (p<0.001). Conclusion: In traumatic brain injury, a higher level of serum concentration of S100β, has a poor prognosis for neurologic outcome. (J Korean Soc Traumatol 2007;20:138-143)