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대한응급의학회> 대한응급의학회지> Improving Communication Skill Competency in the Emergency Department through Role Play and Direct Observation

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Improving Communication Skill Competency in the Emergency Department through Role Play and Direct Observation

Hyun Soo Chung , Barry Issenberg , Je Sung You , Jun Ho Cho , Min Joung Kim , In Cheol Park , Hahn Shick Lee , Sung Phil Chung
  • : 대한응급의학회
  • : 대한응급의학회지 24권2호
  • : 연속간행물
  • : 2013년 04월
  • : 216-223(8pages)
대한응급의학회지

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Purpose: Good communication between patient and medical staff in an emergency department (ED) fosters patient satisfaction and improves healthcare outcomes. Assessment and implementation of training is key in providing better patient care. The purpose of this study is to evaluate the effect of providing communication skills training to ED physicians and nurses using problem identification, role playing and direct observation. Methods: The ED faculty in collaboration with an external communications expert group developed a communication skills training manual. The training group participated in simulated patient scenarios followed by video feedback and debriefing sessions. The participants were assessed on their communication skills while delivering care to live patients in real clinical situations before and after the training. The communication skills of the training group were compared with those of the control group. Results: A total of 28 residents and nurses from two departments were enrolled in this study. Pre- to post-training scores (scale 1-5) for the training group improved from 3.0 [2.8, 3.9] to 3.9 [3.1, 4.3] (p=0.025). However, the preand post-score difference between the training and control groups was not statistically significant. Conclusion: Role play training has been found to be effective in improving communication skills. However, future research is required to develop a more effective training method and determine how to facilitate training implementation in complex clinical healthcare settings, such as the PED.

UCI(KEPA)

I410-ECN-0102-2013-510-002264795

간행물정보

  • : 의약학분야  > 외과학
  • : KCI등재
  • :
  • : 격월
  • : 1226-4334
  • : 2384-048x
  • : 학술지
  • : 연속간행물
  • : 1990-2022
  • : 2748


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12020 대한민국 응급의학과 전문의 총조사

저자 : 김선구 , 조광현 , 김인병 , 이미진 , 윤유상 , 박경혜 , 박송이 , 김홍재 , 기동훈 , 서범석 , 주영민 , 지창근 , 최석재 , 여인환 , 강지훈 , 정우진 , 임대성 , 이의선 , 이형민 , 왕순주

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 5호 발행 연도 : 2022 페이지 : pp. 1-1 (1 pages)

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23차 병원 응급실을 빈번히 이용하는 소아 환자들의 특성

저자 : 채현석 ( Hyun-seok Chai ) , 박관진 ( Gwan Jin Park ) , 김영민 ( Young Min Kim ) , 김상철 ( Sang Chul Kim ) , 이지한 ( Ji Han Lee ) , 김김훈 ( Hoon Kim ) , 이석우 ( Seok-woo Lee )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 5호 발행 연도 : 2022 페이지 : pp. 421-428 (8 pages)

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Objective: Frequent emergency department (ED) visit is a global public health problem that can delay proper management and reduce the quality of medical services. While many researches were done on adult frequent ED users, studies lack on pediatric patients. This study was designed to identify the characteristics of the frequent pediatric ED users and risk factors related to pediatric frequent ED visits.
Methods: This was a retrospective observational study using ED-based data derived from pediatric patients at a tertiary university hospital. The main exposure variable was frequent pediatric ED visits, which were defined as more than 4 visits within a year (January 1-December 31, 2019). Characteristics and risk factors for frequent pediatric ED users were evaluated using forward stepwise regression analysis.
Results: During the study period, 10,050 pediatric ED visits (8,313 patients) were identified. Of which, 550 (5.5%) were frequent ED visits (114 patients, 1.4%). The independent risk factors for frequent pediatric ED visits were age <1 year (adjusted odds ratio [AOR], 2.79; 95% confidence interval [CI], 1.32-5.93), visiting during spring and winter (AOR, 5.72; 95% CI, 3.36-9.75) and visiting due to medical problem (AOR, 1.66; 95% CI, 1.02-3.08). Primary diagnosis of unspecified convulsions, acute lower respiratory infection, other specified medical care, and arrhythmia were associated with frequent pediatric ED visits.
Conclusion: Age <1 year, visiting ED during spring and winter, visiting ED due to medical problem can increase the risk of frequent ED visit by pediatric patients.

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3한국소아소생술테이프의 효용성 검증: 소아의 체중과 기관내관 크기 예측을 중심으로

저자 : 김보성 ( Boseong Kim ) , 장혜영 ( Hye Young Jang ) , 노노현 ( Hyun Noh ) , 박수연 ( Suyeon Park ) , 이영주 ( Youngjoo Lee ) , 조영신 ( Young Shin Cho ) , 박준범 ( Joonbum Park ) , 정혜진 ( Heajin Chung ) , 김상일 ( Sang-il Kim ) , 서범석 ( Beom Sok Seo ) , 손영화 ( Young Wha Sohn )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 5호 발행 연도 : 2022 페이지 : pp. 429-435 (7 pages)

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Objective: Various tools using the length-based method for weight estimation and decisions regarding equipment size have been used in pediatric resuscitation globally. The Korean Pediatric Resuscitation Tape (KPRT) is one such tool that has been developed recently. This study was performed to validate the use of KPRT in Korean children.
Methods: Data on the measured weights and the endotracheal tube (ETT) sizes used for children aged 12 years or less, who received general anesthesia, were collected by reviewing medical records from June 2018 to October 2020 at two hospitals in the urban areas of Korea. We compared the weight and ETT size estimated by the KPRT to the actually measured weight and ETT size used for the study population. We also calculated the weight and ETT size using an agebased formula and compared these values to the actual values of the patients. We then analyzed the agreement between these estimated values and the actual values of the children.
Results: A total of 1,237 children were included in this study. The intra-class correlation coefficient of agreement between the actual weight and estimated weight by the KPRT was 0.94 compared to 0.93 when estimated by the age-based formula. The weighted kappa coefficient of the agreement between the ETT size actually used, and the size estimated by the KPRT was 0.61 compared to 0.74 when estimated by the age-based formula. The estimated ETT sizes using the KPRT were smaller than the actual size used in children under three years old, whereas it was larger for children aged eight years or more.
Conclusion: Our study showed that the KPRT was a dependable tool for estimating the weight and ETT size of Korean children. Future studies would be needed to augment the reliability of the KPRT in pediatric resuscitation.

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4Factors in early hospital arrival following suspected acute stroke symptoms

저자 : Dong Hyeob Han , Jonghwan Shin , Jin Hee Jung , Kyoung Jun Song , Hui Jai Lee , Kyoung Min You

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 5호 발행 연도 : 2022 페이지 : pp. 436-447 (12 pages)

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Objective: We investigated the factors that affect the time from the onset of acute stroke symptoms to arrival at the emergency department (ED).
Methods: Between July 2019 and February 2020, patients with acute stroke symptoms who visited a public hospital were evaluated by retrospective analysis using a prospective survey. The data for this study was gathered from baseline interviews with patients enrolled in stroke surveys. The primary outcome was time to arrival at the ED, evaluated as a binary variable with a value of 4.5 hours.
Results: Overall, 205 patients were included in the final analysis. Among them, 47% (n=96) of patients with acute stroke symptoms arrived at the ED later than 4.5 hours from the time of onset of acute stroke symptoms. After multivariable logistic regression analyses, it was found that patients with higher National Institutes of Health Stroke Scale (NIHSS) scores, patients who did not live with their family members, and patients who were found by a passerby were associated with early ED arrival post onset of acute stroke symptoms. Among patients diagnosed with acute stroke, those with higher NIHSS scores or underlying malignant diseases were found to present earlier at the ED.
Conclusion: Approximately half of the patients (47%) with acute stroke symptoms presented to the ED within 4.5 hours. Higher NIHSS scores and the presence of underlying malignancy were identified as the key factors that were associated with an early presentation at the ED from the time of onset of acute stroke.

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5Effect of albumin on the outcomes in septic patients with hypoalbuminemia in the emergency department: a propensity score-matched retrospective cohort study

저자 : Ji Eun Hwang , Jae Hyuk Lee , Joonghee Kim , Inwon Park

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 5호 발행 연도 : 2022 페이지 : pp. 448-459 (12 pages)

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Objective: A low albumin concentration is known to be associated with poor prognosis in patients with sepsis, but the benefits of albumin administration in these patients are unclear. This study was performed to investigate the effect of albumin administration on the outcomes of patients suffering from sepsis or septic shock.
Methods: This was a retrospective, propensity score-matched cohort study of septic patients with an initial serum albumin level < 3.0 g/dL admitted to the emergency department (ED) of an urban tertiary university hospital. Patients who received 20% albumin within 24 hours of admission to the ED were compared with those who did not. We performed a 1:1 propensity score-matched analysis. The primary outcome was the 28-day mortality rate and the secondary outcomes were the Sequential Organ Failure Assessment (SOFA) score at 24, 48, and 72 hours, the need for mechanical ventilation and renal replacement therapy (RRT), and admission to the intensive care unit (ICU).
Results: A total of 1,284 patients were included in the study, and the overall mortality rate was 29.4%. After propensity score matching, 192 patients in the albumin group and 192 in the control group were included in the final analysis. There was no significant difference in the 28-day mortality rates. The SOFA scores at 24, 48, and 72 hours were higher in the albumin group than in the control group. The rates of RRT and admission to the ICU were also higher in the albumin group.
Conclusion: In patients with sepsis and hypoalbuminemia, albumin replacement was not associated with higher 28-day mortality, but was associated with the higher SOFA scores, higher rates of RRT application and admission to the ICU.

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6패혈증 환자에서 혈장내 무세포 혈색소(plasma cell-free hemoglobin)와 사망률의 관계

저자 : 변궁도 ( Gungdo Byun ) , 황지은 ( Ji Eun Hwang ) , 이재혁 ( Jae Hyuk Lee ) , 김중희 ( Joonghee Kim ) , 박인원 ( Inwon Park )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 5호 발행 연도 : 2022 페이지 : pp. 460-470 (11 pages)

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Objective: This study sought to investigate the association between plasma cell-free hemoglobin (pHb) and mortality in sepsis or septic shock.
Methods: We performed a retrospective analysis of the prospective collected data of patients with sepsis or septic shock. Patients were divided into 4 groups according to their pHb concentrations using a restricted cubic spline: group I (pHb ≤20 mg/dL), group II (20 < pHb ≤40 mg/dL), group III (40 < pHb ≤60 mg/dL), and group IV (pHb >60 mg/dL). The primary outcome was the 28-day mortality, and a multivariate Cox proportional hazard regression method was used for analysis.
Results: A total of 372 patients were included in the analysis and the overall 28-day mortality rate was 16.7%. The median pHb concentration of the patients was 24.8 mg/dL (reference range, 0-5). The mortality rate did not increase in proportion to the pHb concentrations and was the lowest in group II (20.3%, 11.0%, 16.3%, and 26.7% in groups I, II, III, and IV, respectively). In the Cox proportional hazard regression analysis, group I was independently associated with 28-day mortality compared with group II (hazard ratio, 2.19; 95% confidence interval, 1.18-4.07). Group IV had a higher mortality rate compared to group II, but it was not statistically significant (hazard ratio, 2.17; 95% confidence interval, 0.85-5.56).
Conclusion: A low concentration of pHb (pHb ≤20 mg/dL) was associated with 28-day mortality in patients with sepsis or septic shock.

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7Is the immediate blood pressure control using parenteral antihypertensive drug needed for patients with severe high blood pressure with epistaxis in the emergency department?

저자 : Kyunghoon Shin , Kyunghoon Park , Heekyung Lee , Changsun Kim , Laurie Seiwon Kim , Ji Won Yoo

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 5호 발행 연도 : 2022 페이지 : pp. 471-479 (9 pages)

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Objective: This study aimed to assess whether the conventional treatments administered in the emergency department (ED) for hypertensive urgencies (observed or peroral [PO]-controlled) in severe high blood pressure (BP) patients with epistaxis increase the incidence of epistaxis recurrence and the mortality rate as compared to immediate BP control using intravenous (IV) antihypertensive medication
Methods: A retrospective study over 7 years was conducted at the ED of a tertiary university hospital. Among adult patients with spontaneous epistaxis, subjects with severe high BP (systolic BP ≥180 mmHg or diastolic BP ≥120 mmHg) were included in the study. Participants were divided into three groups determined by the methods used to control BP: non-controlled, PO-controlled, and IV-controlled groups. The incidence of epistaxis recurrence and mortality rate within 6 months were compared.
Results: Among the 380 patients enrolled, 238 were discharged from the ED without any pharmacological antihypertensive treatment (non-controlled group), 83 received PO antihypertensive medication (PO-controlled group), and 59 received IV antihypertensive medication (IV-controlled group). Of these, 29 (12.2%), nine (10.8%), and seven (11.9%) patients from the non-controlled, PO-controlled, and IV-controlled groups, respectively, experienced epistaxis recurrence within 24 hours, which was statistically not different among the three groups (P=0.948). The 6-month mortality rates were determined to be 0.8%, 2.4%, and 3.4% in the non-controlled, PO-controlled, and IV-controlled groups, respectively. The difference was also not significant among the groups (P=0.294).
Conclusion: The conventional treatments of hypertensive urgencies (observed or PO-controlled) in patients with severe high BP with epistaxis in the ED did not increase the incidence of epistaxis recurrence and short-term mortality rate when compared to immediate BP control using IV antihypertensive medication.

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8응급의료센터에서 진단된 급성 단순 방광염 환자의 항생제 내성률 및 적절한 항생제에 대한 고찰

저자 : 정수용 ( Soo Young Chung ) , 김영식 ( Youngsik Kim ) , 정루비 ( Rubi Jeong ) , 이규현 ( Kyoohyun Lee ) , 유우성 ( Woosung Yu ) , 윤영탁 ( Youngtak Yoon ) , 최승주 ( Seungju Choi )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 5호 발행 연도 : 2022 페이지 : pp. 480-486 (7 pages)

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Objective: This study analyzed the urine cultures of emergency department patients diagnosed with acute uncomplicated cystitis and determined the antimicrobial resistance and appropriate treatment for our region.
Methods: Results of urine analysis and urine culture of acute uncomplicated cystitis patients diagnosed in our emergency department between January 2019 and December 2020 were examined and analyzed.
Results: In our study, 256 out of 340 urine culture samples (75.3%) were positive for cystitis. The most common microorganism was reported to be Escherichia coli (93.0%). The resistance rates of E. coli to the following antimicrobial agents were as follows: amikacin (0.0%), ampicillin (63.5%), amoxicillin/clavulanate (15.6%), aztreonam (7.1%), ceftazidime (3.4%), cefotaxime (16.4%), cefoxitin (5.5%), cefazolin (19.9%), ciprofloxacin (29.4%), cefepime (1.7%), ertapenem (0.0%), gentamicin (18.1%), piperacillin/tazobactam (2.1%), trimethoprim/sulfamethoxazole (36.1%), and tigecycline (0.4%). The prevalence of extended-spectrum beta-lactamase producing E. coli strains was 17.8%.
Conclusion: To determine the proper empirical antimicrobial treatment for acute uncomplicated cystitis, it is essential to examine the antimicrobial resistance. For our region, fosfomycin, nitrofurantoin, and 2nd and 3rd generation cephalosporin should be considered the first-line empirical treatment for acute uncomplicated cystitis.

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9응급 현장 초음파에서 측정된 승모판륜 수축 이동과 삼첨판륜 수축 이동의 유용성: 응급실에서 임상적으로 적용하기 위한 비대면 선행 실험연구

저자 : 조재열 ( Jae Youl Cho ) , 황정성 ( Jung Sung Hwang ) , 홍정석 ( Jung Seok Hong )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 5호 발행 연도 : 2022 페이지 : pp. 487-496 (10 pages)

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Objective: As a part of point-of-care ultrasound (POCUS), the rapid assessment of cardiac systolic function using tricuspid annular plane systolic excursion (TAPSE) and mitral annular plane systolic excursion (MAPSE) are thought to be valuable tools during a cardiac emergency. This article is an untact pilot experiment before the clinical application of these procedures in an emergency room.
Methods: Totally, 206 video samples from YouTube concerning echocardiograms of a normal heart, ischemic heart disease, congestive heart failure, cardiomyopathy, pulmonary hypertension, and pulmonary embolism were extracted and analyzed with free programs opened in internet services.
Results: The values of MAPSE, TAPSE, and TAPSE+MAPSE ranged between 13.3±2.3 mm, 23±2.8 mm, and 36± 4.5 mm, respectively, in the normal echocardiogram versus 7.8±2.5 mm, 16.5±5.0 mm, and 24.2±6.4 mm, respectively, in an abnormal echocardiogram (P<0.05). Positive correlations were obtained between MAPSE and TAPSE, MAPSE and TAPSE+MAPSE, and TAPSE and TAPSE+MAPSE (R2=0.346, R2=0.687, and R2=0.871, respectively). MAPSE ≤ 7.7 mm, TAPSE ≤18.5 mm, and TAPSE+MAPSE ≤27.7 mm show 100% sensitivity, and the specificities for an abnormal echocardiogram at these values are 51.8%, 63.3%, and 71.7%, respectively. At TAPSE ≤18.5 mm and TAPSE/ (TAPSE+MAPSE) ≤0.61, the sensitivity of pulmonary hypertension containing a pulmonary embolism is 81.2%, and the specificity is 81%. It is presumed that the lower these values, the higher the emergency.
Conclusion: In a cardiac emergency, differentiating left or right systolic heart failure is probably useful by checking not only MAPSE or TAPSE using POCUS, but also determining the ratios MAPSE/(MAPSE+TAPSE) or TAPSE/(MAPSE+TAPSE). However, further retrospective or prospective studies in an emergency room are required for a specific disease diagnosis.

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10COVID-19 유행이 119 구급대의 중증 환자 이송 시간에 미친 영향

저자 : 박종은 ( Jong Eun Park ) , 최성혁 ( Sung-hyuk Choi ) , 윤영훈 ( Young-hoon Yoon ) , 김정윤 ( Jung-youn Kim ) , 조영덕 ( Young-duck Cho ) , 이지영 ( Ji Young Lee ) , 박성준 ( Sung Joon Park )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 5호 발행 연도 : 2022 페이지 : pp. 497-505 (9 pages)

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Objective: As the coronavirus disease 2019 (COVID-19) pandemic continues, it is believed that COVID-19 may have affected the transportation time of 119 emergency medical services (EMS). However, there are only a few studies to support this claim. The current study was undertaken to investigate the altered pre-hospital transportation time according to the severity of the patient after the COVID-19 period.
Methods: This is a retrospective observational study conducted on patients aged 15 or older who visited three emergency medical centers from January 1, 2019, to December 31, 2020, using the 119 EMS. The primary outcome was total pre-hospital transportation time; secondary outcomes include activation time, response time, on-scene, and transportation time.
Results: Before COVID-19, the total pre-hospital transportation times for patients admitted to the intensive care unit and patients with out-of-cardiac arrest were 26.78±9.91 minutes and 27.92±8.38 minutes, respectively. Post-COVID-19, the time increased to 35.31±16.30 minutes and 32.46±14.69 minutes, respectively (P<0.001). Furthermore, the total prehospital transportation time before and after COVID-19 differed in the critical patient group with Korean Triage and Acuity Scale 1 and 2 (26.58±10.12 minutes vs. 33.93±15.78 minutes). In addition, an increase in the total pre-hospital transportation time was observed after COVID-19 in the emergency and non-emergency patient groups. An increased time interval was also determined for the activation time, response time, on-scene arrival, and transportation time for all patient groups after the COVID-19 pandemic (P<0.001).
Conclusion: COVID-19 has resulted in delays throughout the pre-hospital transportation time, greatly impacting critical patients.

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1병원간 전원에 대한 부산지역 응급실 의사들의 입장

저자 : 조석주 ( Suck Ju Cho ) , 황성연 ( Seong Youn Hwang ) , 이준호 ( Jun Ho Lee ) , 김형회 ( Hyung Hoi Kim ) , 이성화 ( Sung Hwa Lee ) , 박맹렬 ( Maeng Real Park ) , 박순창 ( Soon Chang Park )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 131-141 (11 pages)

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Purpose: In most areas of the world, transfers between emergency centers are performed through direct communication between physicians of transferring and receiving hospitals. The emergency medical information center “1339” (or 1339, for short), which had mediated inter-hospital transfers for about 10 years, was recently discontinued. This study aimed to survey the stance of physicians at transferring and receiving hospitals on the importance of 1339 functions. Methods: In May 2012, before the discontinuation of 1339 as a mediator, a questionnaire was distributed to emergency- related physicians at several hospitals on the level of emergency care in Busan. Results: There were 202 answers. Physicians of high level emergency centers had a higher tendency to transfer patients without pre-contact for transfer (p=0.019). The physicians at each level of care thought that direct communication between physicians was more accurate (69.9%), but mediation through 1339 was more convenient (53.6%). Mediation through 1339 was the most frequent resource used for pre-contact of inter-hospital transfers (58.1%). Conclusion: Physicians at each level of care tended to find pre-contact between physicians more accurate for inter-hospital transfers; however, they also thought mediation through 1339 was more convenient and it was the most frequently used resource for pre-contact of inter-hospital transfers.

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2병원 밖 심정지 환자에서 뇌출혈 유무에 따른 특징 및 예후 차이 분석: 후향적 분석

저자 : 장연식 ( Yeon Sik Jang ) , 임용수 ( Yong Su Lim ) , 조진성 ( Jin Seong Cho ) , 김진주 ( Jin Joo Kim ) , 현성열 ( Sung Youl Hyun ) , 양혁준 ( Hyuk Jun Yang ) , 이근 ( Gun Lee )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 142-148 (7 pages)

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Purpose: Spontaneous intracranial hemorrhage (ICH) is not an uncommon cause of cardiac arrest. The purpose of this study was to identify the prognosis of patients with ICH for Out-of-Hospital Cardiac arrest (OHCA). Methods: From January 2008 to December 2010, a total of 214 patients were checked brain computed tomography (CT) in OHCA. The majority of patients were male (136, 63.8%), and the median age was 55.0 (±16.7). We included all patients who were checked through brain CT for nontraumatic OHCA. Data were collected from electronic medical records and pre-hospital records. Demographic, clinical and laboratory data were compared between the ICH and non-ICH group. Results: The detection of ICH by clinical manifestations and laboratory data was difficult. Out of 214 patients, 21 (9.8%) patients were positive for ICH and 193(90.2%) patients had a normal brain CT. In demographic and clinical data, the neurological outcome (CPC score, p=0.009) and 30-day survival rate (p<0.001) were statistically different between the two groups. Using the Cox proportional hazards model, the ICH group had a 3.54 hazard ratio compared with non-ICH group. In addition, pH (p=0.033), lactate (p=0.023) in ABGA, potassium (p=0.008), glucose (p=0.026), and S-100 (p=0.047) showed significant results. Conclusion: The prognosis of ICH patients in OHCA is poor; further studies are needed to improve the prognosis of ICH patients after ROSC in OHCA.

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3A Comparison of Compression Rates on the Quality of Cardiopulmonary Resuscitation

저자 : Young Hoon Hong , Chong Kun Hong , Kyoung Yul Lee , Han Ho Jeong , Jung Hyun Kim , Yong Hwan Kim , Jun Ho Lee , Kwang Won Cho , Seong Youn Hwang

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 149-156 (8 pages)

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Purpose: In cardiopulmonary resuscitation (CPR) there are different opinions on the compression rate that should be applied. The aim of this study was to compare the total number of adequate compressions delivered during a fiveminute period among four groups of lay persons (≥139 min-1, 129-138, 114-128, and <114). Methods: This study represents a secondary data analysis from our previous research about the influence of age on fatigue during CPR. Participants were asked to perform chest compressions (without rescue breaths) at a rate of >100 times/minute and a depth of >5 cm for five minutes. A total of 86 participants were then divided into four groups based on their mean compression rate. Age, sex, and body mass index were analyzed as factors affecting the compression rates. Results: The group delivering a compression rate above 139 compressions min-1 performed better than those delivering below 114 compressions min-1 (p=0.03). There was no significant difference in the mean compression depth (p=0.13), percentage of incomplete chest recoil (p=0.277), or the percentage of incorrect hand positioning (p=0.091). All participants (except five) performed chest compressions at a rate above 100 compressions min-1. Conclusion: Our results suggest that a chest compression rate above 139 compressions min-1 does not deteriorate the quality of compressions compared to a lower chest compression rate (below 114 min-1) during a five-minute period. Most untrained lay people performed chest compressions well, within a range of 100~150 min-1.

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4패혈증 환자의 급성 신손상 발생 예측에 있어 혈장 Neutrophil Gelatinase-Associated Lipocalin 측정의 유용성

저자 : 이제엽 ( Je Yeob Lee ) , 김진용 ( Jin Young Kim ) , 박상오 ( Sang O Park ) , 이경룡 ( Kyeong Ryong Lee ) , 백광제 ( Kwang Je Baek ) , 홍대영 ( Dae Young Hong )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 157-163 (7 pages)

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Purpose: Serum creatinine is a late marker of acute kidney injury (AKI). We assessed the diagnostic value of plasma neutrophil gelatinase-associated lipocalin (NGAL) for predicting acute kidney injury in emergency department patients with sepsis. Methods: This was a prospective observational study of adult sepsis patients. Plasma NGAL levels were measured upon admission to the hospital, and clinical data and serum creatinine were collected daily during the hospital stay. The primary outcome measure was the occurrence of AKI based on criteria from the Acute Kidney Injury Network (AKIN). Results: A total of 178 patients were included, with 13 patients (7.3%) that developed AKI during their hospital stay; 9 and 4 were classified as AKIN stage 1 and 2, respectively. Six patients out of the 13 with AKI died. Mean plasma NGAL levels were 277 ng/mL in patients without AKI and 852 ng/mL in patients with AKI. The area under the receiver operating characteristic curve was 0.883 (95% confidence interval 0.803 to 0.964), the sensitivity was 91.7%, and the specificity was 80.5% for the prediction of AKI (using a cut-off value of 353.5 ng/mL). Conclusion: Plasma NGAL is a useful early marker that predicts the development of AKI in adult sepsis patients.

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5일산화탄소 중독에서 지연성 합병증 예측에 대한 자기공명영상의 효과

저자 : 최익준 ( Ik Joon Choi ) , 오용해 ( Yong Hae Oh ) , 김갑득 ( Gab Teug Kim )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 164-173 (10 pages)

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Purpose: Delayed neuropsychiatric sequelae (DNS) encompass a broad spectrum of neurological deficits, cognitive impairments, and affective disorders which commonly occur after a recovery from acute carbon monoxide (CO) poisoning. The early identification of patients with a high risk of DNS might improve their quality of care. Thus, we studied the role of magnetic resonance imaging (MRI) for the prediction of DNS. Methods: This retrospective study included 41 patients with CO poisoning from January 2009 to June 2012. Magnetic resonance imaging (MRI) was performed within seven days after CO poisoning. Positive MRI findings were defined as focal or diffuse signals in fluid-attenuated inversion recovery (FLAIR), diffusion weighted imaging (DWI), and T2 weighted imaging (T2WI). DNS was considered present when patients had clinical symptoms and signs of DNS within 3 months after CO poisoning. Clinical and biohumoral data were collected; univariate and multivariate statistical analyses were performed to identify the predictive role of MRI for DNS. Results: DNS occurred at a rate of 58.5%, with abnormal MRI findings associated with the development of DNS in the multivariate analysis. The sensitivity of MRI to DNS was 82.6%. In contrast, a normal MRI was seen in eighteen patients (43.9%). MRI revealed abnormalities in the deep white matter (41.5%), globus pallidus (34.1%), cerebral cortex (12.2%), medial temporal lobe (MTL)/hippocampus (7.3%), and cerebellum (4.9%). Among the MRI abnormalities revealed, lesions in the deep white matter were significantly associated with DNS development. Abnormal findings of the globus pallidus, cerebral cortex, MTL/hippocampus, and cerebellum were not associated with DNS development. Conclusion: This study demonstrates the utility of early MRI for the prediction of DNS. Future studies will be required to ascertain the prevention of DNS with hyperbaric treatment in CO poisoning.

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6응급실 소아 손상 환자의 중증도 예측을 위한 PRISM III의 유용성

저자 : 이상훈 ( Sang Hun Lee ) , 박경혜 ( Kyung Hye Park ) , 박득현 ( Deuk Hyun Park ) , 조준호 ( Jun Ho Cho ) , 박하영 ( Ha Young Park ) , 권인호 ( In Ho Kwon ) , 여운형 ( Woon Hyung Yeo ) , 이준엽 ( Jun Yeob Lee ) , 김양원 ( Yang Weon Kim )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 174-180 (7 pages)

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Purpose: The primary prevention and proper initial treatment of childhood injuries is important, as it encompasses a bigger social and economic burden than cancer and ischemic heart disease. The Pediatric Risk of Mortality III (PRISM III) scoring system, used to evaluate the severity or mortality of pediatric patients in critical condition, was investigated for children with injuries in an emergency department (ED). Methods: A retrospective analysis included data on 293 injured children (age<16) who visited the ED in two hospitals from March 2010 to February 2012. Physiologic and laboratory data were collected to calculate the PRISM III score and the Injury Severity Score (ISS). The correlation was analyzed between PRISM III scores, the Revised Trauma Scale (RTS), and ISS. The PRISM III score and ISS were assessed for their ability to predict mortality by comparing their receiver operating characteristic (ROC) curves. Results: The median PRISM III score was 5.0 (Interquartile Range, 5.0-9.0) and correlated with RTS and ISS (the Spearman`s rho were -0.19 (p=0.001) and 0.20 (p=0.001), respectively. Five children did not survive after ED admission. The area under the ROC (AUC) was 1.00 for PRISM III (95% confidence interval [CI], 0.99-1.00), and the cutoff value was placed over 20 to predict mortality. The AUC of ISS and RTS was 0.99 (95% CI, 0.98-1.00) and 0.99 (95% CI, 0.98-1.00), respectively. Conclusion: The PRISM III score excellently predicts the mortality of injured children in the ED, and can be used to sort minor pediatric trauma patients in the ED. However, the PRISM III score had no great difference or advantage compared with RTS. The development of other tools for effective prognosis is needed to efficiently predict mortality and severity in the ED.

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7응급진료센터에 내원한 지역획득 폐렴 환자에서 델타뉴트로필을 이용한 패혈성 쇼크 발생 예측의 유용성

저자 : 주영선 ( Young Seon Joo ) , 이누가 ( Nu Ga Rhee ) , 김현종 ( Hyun Jong Kim ) , 유제성 ( Je Sung You ) , 정현수 ( Hyun Soo Chung ) , 정성필 ( Sung Phil Chung ) , 이한식 ( Hahn Shick Lee ) , 이종욱 ( Jong Wook Lee )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 181-187 (7 pages)

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Purpose: The delta neutrophil index (DNI) corresponds to the calculated immature granulocyte counts and the severity of sepsis. The aim of this study was to investigate the diagnostic value of DNI as a predictable laboratory marker for septic shock in patients with severe community-acquired pneumonia in emergency department. Methods: The present study was a retrospective analysis of patients with pathologically confirmed communityacquired pneumonia from December 2011 to February 2012 at a hospital. The DNI was automatically calculated as a subset of routine complete blood count test. The diagnostic performance of DNI for septic shock in patients with community-acquired pneumonia was evaluated. Results: During the study period, 105 patients were enrolled. Among them, 27 patients (25.7%) were confirmed as having septic shock according to predetermined criteria. The initial value of DNI was significantly higher in septic shock group than in non-shock group (8.7% vs 2.3%, p=0.008). The peak value of DNI was also significantly higher in septic shock group (18.6% vs 4%, p<0.001). The sensitivity and specificity of the initial and peak DNI values for predicting septic shock in patients with communityacquired pneumonia were 48.2%, 96.2%, 74.1%, and 87.2%, respectively, at initial and peak cutoff levels of 11.2% and 8.7% with an area under the curve (AUC) of 0.72 and 0.81 on the Receiver Operating Characteristic (ROC) curve. The AUC to predict septic shock was 0.74 for the CURB-65 scale. The AUC was significantly increased when peak DNI was added to CURB-65 scale (p=0.007). Conclusion: This study suggested that the DNI is associated with septic shock in patients with community-acquired pneumonia. Clinically, the peak value of DNI added to CURB-65 scale could improve predictable performance of septic shock in patients with community-acquired pneumonia.

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8Indoxacarb 살충제 중독 환자의 임상양상

저자 : 정상민 ( Sang Min Jung ) , 이경우 ( Kyung Woo Lee ) , 강태신 ( Tae Shin Kang )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 188-198 (11 pages)

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Purpose: Indoxacarb insecticide poisoning causes methemoglobinemia, which is occasionally life-threatening. However, there is limited data on indoxacarb effects after human ingestion. The purpose of this study was to examine the clinical features, complications, management, and medical outcome of patients with indoxacarb insecticide poisoning. Methods: We retrospectively reviewed the medical records of 10 patients with indoxacarb insecticide poisoning who had visited our emergency centers from January 2008 to December 2011. We collected data on the general characteristics of the patients, their clinical symptoms and signs, laboratory data, management of their condition, and clinical results. Results: Among the 10 patients, 8 were diagnosed with methemoglobinemia. The clinical manifestations of indoxacarb insecticide poisoning were hypotension (3 patients), altered mentality (5 patients), cyanosis (5 patients), dyspnea (2 patients), seizure (3 patients), and cardiac arrest (2 patients). Four patients had a poisoning severity score of 3 and 2 patients had a poisoning severity score of 2. Four patients were treated with methylene blue for methemoglobinemia and one patient was treated with a high dose (150 mg/kg) of ascorbic acid. The serum methemoglobin saturation of five patients who were treated with methylene blue or a high dose of ascorbic acid was nearly normalized. Four patients experienced rhabdomyolysis, pneumonia, hemolytic anemia, acute pancreatitis, and heart failure as a complication of indoxacarb insecticide poisoning. Conclusion: We observed a variety of clinical features, complications, management, medical outcome, and clinical course of patients with indoxacarb insecticide poisoning. We could also ascertain the efficacy of methylene blue and high dose ascorbic acid for indoxacarb-induced metheglo-binemia.

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9Cardiopulmonary Resuscitation Training for a Layperson Through Conventional Instructor-led Training and a Self-learning Program Using the CPR Anytime Kit

저자 : Soo Hoon Lee , Kyu Seok Kim , Jae Hyuk Lee , Tae Yun Kim , Chang Woo Kang , Chan Jong Park , Joong Hee Kim , You Hwan Jo , Joong Eui Rhee , Dong Hoon Kim

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 199-208 (10 pages)

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Purpose: We aimed to investigate whether a trained layperson could perform high quality Cardiopulmonary Resuscitation (CPR) after conventional training and a selflearning program using the “CPR Anytime” kit. Methods: Traditional CPR training for a lay rescuer was conducted two weeks before a CPR contest for high school students. “CPR Anytime” training kits were distributed to the students for their practical training at home or in school. The students were tested in pairs for two-person CPR with rescuer breaths and an automated external defibrillator. The quantitative and qualitative data regarding the quality of CPR, including chest compression and rescuer breaths, were collected using a standardized checklist and a skill reporter. Results: A total of 161 teams with 322 students, including 116 males and 206 females, participated in the CPR contest in pairs. The mean depth and rate for the chest compression were 49.0±8.2 mm and 110.2±10.2 /min, respectively. The mean tidal volume for the rescue breaths was 604.8±208.7 ml. The percentage of participants satisfying the correct chest compression rate of 100/min and depth of 50 mm was 87.3% and 52.2%, respectively. Only 25.2% of the participants satisfied an optimal tidal volume (between 500 ml and 600 ml). Shallow compression (57.5%) and under-ventilation (44.4%) were the major causes of incorrect compression and ventilation, respectively. Conclusion: The quality of CPR with rescuer breaths in the trained lay rescuer was not adequate, especially for mouthto- mouth rescue breathing. Therefore, the development of teaching methods to improve rescue breathing or omit mouth-to-mouth ventilation in training should be considered.

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10일차반응자의 기본 소생술 교육에 따른 질 측정 변수의 분석

저자 : 문준동 ( Jun Dong Moon ) , 최성혁 ( Sung Hyuk Choi )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 209-215 (7 pages)

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Purpose: As an emergency medical system provider, cardiopulmonary resuscitation (CPR) quality for first responder is an important determinant of cardiac arrest outcome. However, feedback on their CPR performance is often lacking. In this simulation study, we analyzed their CPR variables after CPR training based on high-quality CPR requirements highlighted by the 2010 American Heart Association updated guidelines. Furthermore, we aimed to compare the CPR quality between first responders and emergency medical technicians. Methods: Firefighters employed at Seoul metropolitan fire and disaster headquarters in 2011 and 2012 were included in the study. The data were collected from a PC Skill reporting System? (Laerdal, Norway) 5 hours after CPR training. Outcomes included compression variables (depth, rate, hand position, full release, delivered per minute, duty cycle), ventilation variables (volume, flow rate) and hands-off time variables (hands-off fraction, time for airway and breathing, automated external defibrillator (AED)). Results: Sixty-one members to the emergency medical technician group and 66 members to the first responder group were recruited and were tested after CPR training. Results of the first responder group were as follows: for average compression variables, depth 57.6 mm, rate 108.3 numbers/ min, correct hand position 90.0%, full release 100.0%, and duty cycle 40.8%. For average ventilation variables, volume 526.2 ml and flow rate 316.8 ml/sec. These values were same for both groups and showed no statistical significance. The number of compressions performed per minute was better in the emergency medical technician group (74.4 versus 70.6, p<0.002), as was total hands-off time (65.5 sec versus 73.2 sec, p<0.000) and hand-off fraction (32.0% versus 35.2%, p<0.000). Time for operating AED was found to be same for both groups but time for airway and breathing management was shorter in the emergency medical technician group (41.0 sec versus 48.0 sec, p<0.000) Conclusion: The first responder group showed that through short-term CPR training, overall measured quality of CPR was in compliance with international consensus guidelines. But total hands-off time was longer in the first responder group and the time spent for airway and breathing management rather than operating AED was significantly different between the two groups. Appropriate training programs for first responder`s airway and breathing skills are required to minimize interruption time.

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