Background; Automated external defibrillator(AED) represent a major breakdown to permit more widespread application of the principle of early defibrillation. Many mcent efforts to improve emergency medical services(EMS) and increase survival rates are simply efforts to get defibrillation to patients as rapidly as possible. AED is major innovation for the prehospital care of ventricular fibrillation cardiac arrest patients. The purpose of this study is to evaluate the course of initial training to three different groups(nurses, firefighters, and EMT trainee) to use AED, Method: We studies the efficacy of education of AED to 33 nurses, 15 EMT trainee, and 16 firefighters. Training lasted 75 mins and included 45 mins an overview of defibrillation, protocols for using the AED, and operation of the AED(Laerdal Heartstart 3000), 15 mins demonstraion. A check list was used to grade the performance of cardiopulmonary resuscitation, operation of the AED, and the time required to deliver the first three defibrillations. Result: There were no statistically significant differences in performance and time required to deliver an electrical countershock among the groups(p=0.4). To the second test, 92% of all group completed all steps successfully. The step most often failed was the preparing of the AED for defibrillation. Conclusion: In nurses, EMT trainee, and firefighters, it is both feasible and effective to train AED use irrespective of the degree of the trainee.
Background: Septic shock is characterized by an abnormal vascular tone that has been related to various factors. Myocardial depression can also occur in septic shock. Various experimental studies have indicated that the myocardial depression could be present early in the course of septic shock. This study aimed to assess hemodynamic characteristics according to outcome of septic shock in emergency department. Methods: The study population comprised 20 patients admitted to our emergency department for septic shock. All patients with septic shock(prolonged hypotension, signs of tissue hypoperfusion, signs of sepsis, suspected source of infection, or documented bacteremia) had conventional serial hemodynamic evaluations in emergency department to identify early hemodynamic variables that predicted outcome. All patients were monitored with a pulmonary artery catheter and an arterial catheter. Hemodynamic measurements and oxygen profile were obtained. Results: There were 9(53%) survivors and 8(47%) nonsurvivors. There were no significant differences in systolic pressure, pulse rate, mean pulmonary artery pressure, pulmonary capillary wedge pressure, systemic vascular resistance index, and pulmonary vascular resistance index between survivors and nonsurvivors at initial hemodynamic value. However, significant differences were found in cardiac index(4.3 +- 0.5 vs. 2.74 +- 0.7 L/min/m, stroke volume index(44 +- 10 vs. 23 + 5 ml/beat/m2),left ventricular stroke work index(39 +- 11 vs. 15 +- 6 gm m/m, and right ventricular stroke work index(8.1 +- 3.0 vs. 5.2 +- 2.9 gm m/m between survivors and nonsurvivors at initial hemodynamic value. Conclusion: Survivors had better myocardial function than nonsurvivors during the early phase of septic shock. This results suggest that myocardial depression during septic shock develops in the early course of septic shock, which is associated with outcome.
Background: Organophosphate insecticides poisoning is one of the most commom toxicologic emergencies in Korea. There have been few reports of organophosphate intoxication via parenteral route, although many reports on organophosphate intoxication by oral ingestion were present in the literature. This study aimed to validate the clinica@l characteristics of organophosphage intoxication according to the route of administration to the body. Methods: Data were collected retrospectively by the review of the medical records from 49 patients with organophosphate intoxication. Severity of intoxication was classified by the Namba' s Classification. Collected data were analysed and compared on the clinical features and laboratory findings between the patient intoxicated by inhalation or contact(parenteral group, n=23) and the other oral ingestion(enteral group, n=26). Results: Severity class by clinical features was higher in enteral group than parenteral group. Severity class by serum cholinestetrase level was not positively correlated with severity class by clinical manifestations. Cholinesterase level tended to overestimate the severity of intoxication in parenteral group. Ventilator therapy and admission to intensive care unit were more frequently needed in enteral group than parenteral group in case that the severity class by clinical features was equal. Conclusion: In patients with organophosphate intoxication by parenteral route, serum cholinesterase level of the patient had disparity with clinical severity of intoxication. Considering this disparity, clinical severity should be considered as a more important indicator for treatment of organophosphate intoxication including atropinization, rather than serum cholinesterase level in patients intoxicated by parenteral route.
To estimate the quality of the emergency medical services system of Wonju City, we studied the diurnal variations of 179 non-traumatic cardiac arrest victims who received cardiopulmonary resuscitation at the emergency center of Wonju Christian Hospital. Diurnal variations of non-traumatic cardiac arrest patients were as follows : The occurrence of cardiac arrest at day-time was higher than night-time; 18 cases (11%) from midnight to AM 4, 25 cases (14%) from AM 4 to AM 8, 42 cases (24%) from AM 8 to AM 12, 46 cases (25%) from AM 12 to PM 4, 35 cases (19%) from PM 4 to PM 8, 13 cases (7%) from PM 8 to midnight. Witness cardiac arrest was increased more during the day than night; 40% from midnight to AM 4, 48%from AM 4 to AM 8, 57% from AM 8 to AM 12, 52%from AM 12 to PM 4, 60% fmm PM 4 to PM 8, 38% from PM 8 to midnight. The transportation time at night-time cardiac arrest was more longer than day-time cardiac arrest; 3012mins from midnight to AM 4, 26+-9mins from AM 4 to AM 8, 27+-12mins AM 8 to AM 12, 25+-11mins from AM 12 to PM 4, 25+-9mins from PM 4 to PM 8, 3515mins from PM 8 to midnight. The rate of restoration of spontaneous circulation(ROSC) in day-time cardiac arrest was higher than the night-time cardiac arrest; 30% from midnight to AM 4, 36% from AM 4 to AM 8, 32%AM 8 to AM 12, 44% from AM 12 to PM 4, 41% from PM 4 to PM 8, 15% from PM 8 to midnight. The survival rate of cardiac arrest has been correlated with collapse time, early bystander CPR, earh advanced care. To improve outcome for prehospital cardiac arrest, we concluded that early bystander CPR, and early advanced life support should be performed at the scene and during the transportation especially at night.
To estimate the quality of the emergency medical services system of Wonju City, we studied the diurnal variations of 179 non-traumatic cardiac arrest victims who received cardiopulmonary resuscitation at the emergency center of Wonju Christian Hospital. Diurnal variations of non-traumatic cardiac arrest patients were as follows : The occurrence of cardiac arrest at day-time was higher than night-time; 18 cases (11%) from midnight to AM 4, 25 cases (14%) from AM 4 to AM 8, 42 cases (24%) from AM 8 to AM 12, 46 cases (25%) from AM 12 to PM 4, 35 cases (19%) from PM 4 to PM 8, 13 cases (7%) from PM 8 to midnight. Witness cardiac arrest was increased more during the day than night; 40% from midnight to AM 4, 48%from AM 4 to AM 8, 57% from AM 8 to AM 12, 52%from AM 12 to PM 4, 60% fmm PM 4 to PM 8, 38% from PM 8 to midnight. The transportation time at night-time cardiac arrest was more longer than day-time cardiac arrest; 3012mins from midnight to AM 4, 26+-9mins from AM 4 to AM 8, 27+-12mins AM 8 to AM 12, 25+-11mins from AM 12 to PM 4, 25+-9mins from PM 4 to PM 8, 3515mins from PM 8 to midnight. The rate of restoration of spontaneous circulation(ROSC) in day-time cardiac arrest was higher than the night-time cardiac arrest; 30% from midnight to AM 4, 36% from AM 4 to AM 8, 32%AM 8 to AM 12, 44% from AM 12 to PM 4, 41% from PM 4 to PM 8, 15% from PM 8 to midnight. The survival rate of cardiac arrest has been correlated with collapse time, early bystander CPR, earh advanced care. To improve outcome for prehospital cardiac arrest, we concluded that early bystander CPR, and early advanced life support should be performed at the scene and during the transportation especially at night.
Background and purpose: The purpose of this study is to compare two clinical predictive rules, the pre-arrest- morbidity(PAM) index and the prognosis-after-resuscitation(PAR) score, which predict failure to survive following in- hospital cardiopulmonary resuscitation(CPR). Method: The study population consisted of 162 consecutive adult patients who underwent CPR at Wonju Christian Hospital over a year period. The PAM index and PAR score were calculated from the most recent data available for each variable prior to cardiac arrest. Each predictive tool was compared between the group of discharge alive and the group of in-hospital mortality. Performance of the predictive scores was also compared by receiver-operating characteristic(ROC) curves where appropriate. Results: PAM index of study population was 4.39+-2.69 and PAR score was 2.99+-3.36. PAM index in the group of discharge alive was 1.87+-2.79, and PAM index in the group of in-hospital mortality was 4.51+-2.62. PAR score in the group of discharge alive was 0.75+-1.75, and PAR score in the group of in-hospital mortality was 3.1+-3.4. The PAM index identified 15 patients with a score>8, while the PAR score identified 39 patients with a score>4, none of whom survived. The sensitivity of the PAR score for the prediction of failure to survive was 25%, while that of the PAM index was 10%, neither index incorrectly identified a patient as a non-survivor who eventually survived. Both of predictive methods were not significantly different in the ROC curve. Conclusion: Although further confirmation is necessary, PAM index and PAR score may provide useful prognostic information to physicians and patients involved with decisions about do-not-resuscitate orders.
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