Hoon Lim

Chest injury following cardiopulmonary resuscitation: A prospective computed tomography evaluation

INTRODUCTION Traumatic chest injuries may occur following cardiopulmonary resuscitation (CPR). The aim of this study was to address the frequency of injuries, especially rib and sternal fractures, and also to identify factors that contribute to post-CPR trauma. METHODS This study was a prospective cross-sectional study conducted in the emergency departments (ED) of eight academic tertiary care centers. To evaluate injuries secondary to CPR, we performed chest computed tomography (CT) in patients who were successfully resuscitated from cardiac arrest. Contributing factors that might be related to injuries were also investigated. RESULTS We enrolled 71 patients between 1 January 2011 and 30 June 2011. Rib and sternal fractures were diagnosed in 22 and 3 patients, respectively. Females were more susceptible to rib fracture (p=0.036). When non-physicians participated as chest compressors in the ED, more ribs were fractured (p=0.048). The duration of CPR and number of compressors were not contributing factors to trauma secondary to CPR. There was a wide variation in the frequency of rib fractures from hospital to hospital (0-83.3%). In high-risk hospitals (in which more than 50% of patients had rib fractures), the average age of the patients was higher, and non-physicians took part in ED CPR more often than they did at low-risk hospitals. CONCLUSION The incidence of rib fracture following CPR was different in various hospitals. The presence of non-physician chest compressors in the ED was one of the contributing factors to rib fracture. Further studies on the influence of resuscitators and relation between quality of chest compression and CPR-induced injuries are warranted to reduce complications following CPR.

Comparison of lactated Ringer’s solution and 0.9% saline in the treatment of rhabdomyolysis induced by doxylamine intoxication

Objective: To compare the effectiveness and side effects of lactated Ringer’s solution (LR) and 0.9% saline (NS) in the treatment of rhabdomyolysis induced by doxylamine intoxication. Methods: In this 15-month-long prospective randomised single-blind study, after excluding 8 patients among 97 doxylamine-intoxicated patients, 28 (31%) patients were found to have developed rhabdomyolysis and were randomly allocated to NS group (n = 15) or LR group (n = 13). Results: After 12 h of aggressive hydration (400 ml/h), urine/serum pH was found to be significantly higher in the LR group, and serum Na+/Cl− levels to be significantly higher in the NS group. There were no significant differences in serum K+ level and in the time taken for creatine kinase normalisation. The amount of sodium bicarbonate administered and the frequency administration of diuretics was significantly higher in the NS group. Unlike the NS group, the LR group needed little supplemental sodium bicarbonate and did not develop metabolic acidosis. Conclusion: LR is more useful than NS in the treatment of rhabdomyolysis induced by doxylamine intoxication.

Effects of script-based role play in cardiopulmonary resuscitation team training

Background The purpose of this study is to compare the cardiopulmonary resuscitation (CPR) team dynamics and performance between a conventional simulation training group and a script-based training group. Methods This was a prospective randomised controlled trial of educational intervention for CPR team training. Fourteen teams, each consisting of five members, were recruited. The conventional group (C) received training using a didactic lecture and simulation with debriefing, while the script group (S) received training using a resuscitation script. The team activity was evaluated with checklists both before and after 1 week of training. The videotaped simulated resuscitation events were compared in terms of team dynamics and performance aspects. Results Both groups showed significantly higher leadership scores after training (C: 58.2±9.2 vs 67.2±9.5, p=0.007; S: 57.9±8.1 vs 65.4±12.1, p=0.034). However, there were no significant improvements in performance scores in either group after training. There were no differences in the score improvement after training between the two groups in dynamics (C: 9.1±12.6 vs S: 7.4±13.7, p=0.715), performance (C: 5.5±11.4 vs S: 4.7±9.6, p=0.838) and total scores (C: 14.6±20.1 vs S: 12.2±19.5, p=0.726). Conclusion Script-based CPR team training resulted in comparable improvements in team dynamics scores compared with conventional simulation training. Resuscitation scripts may be used as an adjunct for CPR team training.

Outcomes of asphyxial cardiac arrest patients who were treated with therapeutic hypothermia: A multicentre retrospective cohort study

INTRODUCTION While therapeutic hypothermia (TH) is in clinical use, its efficacy in certain patient groups is unclear. This study was designed to describe the characteristics and outcomes of patients with out-of-hospital cardiac-arrest (OHCA) caused by asphyxia, who were treated with TH. PATIENTS AND METHODS A multicentre, retrospective, registry-based study was performed using data from the period 2007-2012. Comatose patients who were treated with TH after asphyxial cardiac arrest were included, while those who with cardiac arrest attributed to hanging, drowning or gas intoxication were excluded. RESULTS Of a total of 932 OHCA patients in the registry, 111 were enrolled in this study. The mean age was 65.8±16.3 years with individuals who were ≥65 years of age accounted for 61.3% of the cohort. Foreign-body airway obstruction was the most common cause (70.3%) of the cardiac arrest. Eighty patients (72.1%) presented with an initial non-shockable rhythm. In all institutions target TH temperatures were 32-34°C, but TH maintenance times varied. A total of 52 patients (46.8%) survived, of whom six patients (5.4%) showed a good neurologic outcome (cerebral performance category scale 1-2). The pupil light reflex, corneal reflex and time to return of spontaneous circulation (p=0.012, 0.015 and 0.032, respectively) were associated with survival. Witnessed arrest, age, previous lung disease, bystander basic life support and time factors were not associated with survival. CONCLUSION About half of patients who underwent TH after asphyxial cardiac arrest survived, but a very small number showed a good neurologic outcome. The TH maintenance times were not uniform in these patients. Additional research regarding both the appropriate TH guidelines for patients with asphyxial cardiac arrest and improvement of their neurologic outcome is needed.

Outcome and current status of therapeutic hypothermia after out-of-hospital cardiac arrest in Korea using data from the Korea Hypothermia Network registry

Objective Therapeutic hypothermia (TH) has become the standard strategy for reducing brain damage in the postresuscitation period. The aim of this study was to investigate current TH performance and outcomes in out-of-hospital cardiac arrest (OHCA) survivors using data from the Korean Hypothermia Network (KORHN) registry. Methods We used the KORHN registry, a web-based multicenter registry that includes 24 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TH between 2007 and 2012 were included. The primary outcomes were neurological outcome at hospital discharge and in-hospital mortality. The secondary outcomes were TH performance and adverse events during TH. Results A total of 930 patients were included, of whom 556 (59.8%) survived to discharge and 249 (26.8%) were discharged with good neurologic outcomes. The median time from return of spontaneous circulation (ROSC) to the start of TH was 101 minutes (interquartile range [IQR], 46 to 200 minutes). The induction, maintenance, and rewarming durations were 150 minutes (IQR, 80 to 267 minutes), 1,440 minutes (IQR, 1,290 to 1,440 minutes), and 708 minutes (IQR, 420 to 900 minutes), respectively. The time from the ROSC to coronary angiography was 1,045 hours (IQR, 121 to 12,051 hours). Hyperglycemia (46.3%) was the most frequent adverse event. Conclusion More than one-quarter of the OHCA survivors (26.8%) were discharged with good neurologic outcomes. TH performance was appropriately managed in terms of the factors related to its timing, including cooling start time and rewarming duration.

Neurologic outcome of comatose survivors after hanging: a retrospective multicenter study

PURPOSE The aim of this study is to identify the neurologic outcome of hanging patients and prognostic factors. MATERIALS AND METHODS We retrospectively investigated comatose hanging patients who arrived at the emergency departments (EDs) of twelve academic tertiary care centers during a period of seven years (2006-2012). Patients were analyzed separately according to whether out-of-hospital cardiac arrest (OHCA) occurred or not. The neurologic outcome was evaluated using the Cerebral Performance Category (CPC) at the time of hospital discharge. RESULTS A total of 1118 patients were admitted to the ED after hanging attempts. There were 159 comatose patients who did not experience OHCA. Twelve (7.5%) of 159 patients were discharged from the hospital with a poor neurologic outcome (CPC 3-5). These 12 patients received only conservative management without therapeutic hypothermia. On multivariate logistic regression analysis, mental state upon ED arrival and arterial pH were predicting factors for poor prognosis. One hundred twenty-one patients suffered OHCA and experienced restored spontaneous circulation after cardiopulmonary resuscitation. Among them, only five (4.1%) patients recovered consciousness to the level of CPC 1-2. The initial arterial pH and HCO3(-) were prognostic factors in hanging patients with OHCA. CONCLUSIONS Even though cardiac arrest did not occur after hanging injuries, 7.5% of patients could not recover consciousness. Therapeutic hypothermia should be considered for such patients. If OHCA occurred after the hanging injury, the proportion of patients with good neurologic outcome was very low at 4.1%.

The Poisoning Information Database Covers a Large Proportion of Real Poisoning Cases in Korea

The poisoning information database (PIDB) provides clinical toxicological information on commonly encountered toxic substances in Korea. The aim of this study was to estimate the coverage rate of the PIDB by comparing the database with the distribution of toxic substances that real poisoning patients presented to 20 emergency departments. Development of the PIDB started in 2007, and the number of toxic substances increased annually from 50 to 470 substances in 2014. We retrospectively reviewed the medical records of patients with toxic exposure who visited 20 emergency departments in Korea from January to December 2013. Identified toxic substances were classified as prescription drug, agricultural chemical, household product, animal or plant, herbal drug, or other. We calculated the coverage rate of the PIDB for both the number of poisoning cases and the kinds of toxic substances. A total of 10,887 cases of intoxication among 8,145 patients was collected. The 470 substances registered in the PIDB covered 89.3% of 8,891 identified cases related to poisoning, while the same substances only covered 45.3% of the 671 kinds of identified toxic substances. According to category, 211 prescription drugs, 58 agricultural chemicals, 28 household products, and 32 animals or plants were not covered by the PIDB. This study suggested that the PIDB covered a large proportion of real poisoning cases in Korea. However, the database should be continuously extended to provide information for even rare toxic substances.

Active bleeding in abdominal wall developing after liposuction

Figure 1 Large amount of haematoma with fat infiltration and muscle swelling at the left abdominal wall, with active bleeding and mild infiltration of the adjacent mesentery. Liposuction is now one of the most commonly performed cosmetic procedures. We observed active bleeding in the abdominal wall of a 51-year-old man who was admitted …

One-step fabrication of hierarchically structured silicon surfaces and modification of their morphologies using sacrificial layers

Fabrication of one-dimensional nanostructures is a key issue for optical devices, fluidic devices, and solar cells because of their unique functionalities such as antireflection and superhydrophobicity. Here, we report a novel one-step process to fabricate patternable hierarchical structures consisting of microstructures and one-dimensional nanostructures using a sacrificial layer. The layer plays a role as not only a micromask for producing microstructures but also as a nanomask for nanostructures according to the etching time. Using thismethod, we fabricated patterned hierarchical structures, with the ability to control the shape and density of the nanostructure. The various architectures provided unique functionalities. For example, our sacrificial-layer etching method allowed nanostructures denser than what would be attainable with conventional processes to form. The dense nanostructure resulted in a very low reflectance of the silicon surface (less than 1%). The nanostructured surface and hierarchically structured surface also exhibited excellent antiwetting properties, with a high contact angle (>165°) and low sliding angle (<1°). We believe that our fabrication approach will provide new insight into functional surfaces, such as those used for antiwetting and antireflection surface applications.

A case of sexual activity-induced external iliac artery rupture of a young healthy woman

Figure 1 Extravasation and massive haematoma of external iliac artery on axial (A) and coronal (B) view. External iliac artery rupture is a very rare occurrence when not iatrogenic in origin. We report an external iliac artery rupture in a 29-year-old married women who was admitted with sudden right …