Won Joon Jeong

Comparison of overlapping (OP) and adjacent thumb positions (AP) for cardiac compressions using the encircling method in infants

Objectives The aim of this manikin study was to compare the efficiency between overlapping (OP) and adjacent thumb positions (AP) for cardiac compressions using the encircling method in infants. Methods The study conducted from December 2010 to August 2011 involved 48 volunteers who were students in the emergency medical technician course. The authors let volunteers practice OP and AP as a crossover design. The authors monitored the simulated mean arterial pressure (MAP) generated during a 5-min chest compression. The fatigue level of the volunteers after the chest compression was evaluated with the Likert scale. Results There were no significant differences in MAP between the dominant hand and the non-dominant hand as the lower thumb of OP. Significant differences were observed in simulated systolic blood pressure, MAP and simulated pulse pressure between OP and AP at 1, 2, 3, 4 and 5 min. There were no significant differences among the changes in heart rate, respiratory rate and end-tidal CO2 during a 5-min chest compression by OP and AP. The Likert scale scores (1 no fatigue to 5= extreme fatigue) during the 5-min chest compressions were higher in AP than in OP at 2, 3 and 5 min. Conclusion Higher intrathoracic pressures were achieved by OP in this study. However, further studies are needed to validate these effects of overlapping thumbs technique in infant cardiopulmonary resuscitation, not manikin.

Is it possible to reduce intra-hospital transport time for computed tomography evaluation in critically ill cases using the Easy Tube Arrange Device?

Objective Patients are often transported within the hospital, especially in cases of critical illness for which computed tomography (CT) is performed. Since increased transport time increases the risks of complications, reducing transport time is important for patient safety. This study aimed to evaluate the ability of our newly invented device, the Easy Tube Arrange Device (ETAD), to reduce transport time for CT evaluation in cases of critical illness. Methods This prospective randomized control study included 60 volunteers. Each participant arranged five or six intravenous fluid lines, monitoring lines (noninvasive blood pressure, electrocardiography, central venous pressure, arterial catheter), and therapeutic equipment (O2 supply device, Foley catheter) on a Resusci Anne mannequin. We measured transport time for the CT evaluation by using conventional and ETAD method. Results The median transport time for CT evaluation was 488.50 seconds (95% confidence interval [CI], 462.75 to 514.75) and, 503.50 seconds (95% CI, 489.50 to 526.75) with 5 and 6 fluid lines using the conventional method and 364.50 seconds (95% CI, 335.00 to 388.75), and 363.50 seconds (95% CI, 331.75 to 377.75) with ETAD (all P<0.001). The time differences were 131.50 (95% CI, 89.25 to 174.50) and 148.00 (95% CI, 116.00 to 177.75) (all P<0.001). Conclusion The transport time for CT evaluation was reduced using the ETAD, which would be expected to reduce the complications that may occur during transport in cases of critical illness.

Analyzing the role of practice-assisting manpower and its impact in emergency medical care settings

Purpose: To investigate and analyse the role of practice-assisting manpower in the emergency care centers of teaching hospitals for more efficient allocation of the workload in hospitals to provide better medical care. Methods: We enrolled a total of eight practice-assisting manpower in four emergency care centers of teaching hospitals located in Daejeon Metropolitan City and Chungcheong Province areas. The current demographics and conditions of practice-assisting manpower and their work schedules were surveyed and collected. Board-certified emergency physicians from each hospital observed tasks performed by practice-assisting manpower for 60 minutes during both day and night shifts, and data collected were analysed by time-motion study method. Results: The practice-assisting manpower participants were of certified first-ranked Emergency Medical Technician (EMT). The mean working hours per week were 42.5 ± 3.3 h. The total number of performed tasks during the study period was 275 items (day shift: 141, night shift: 134) in total observation time. Tasks performed were divided into three categories: procedure-assisting (87 items), treatment-assisting (169 items), and personal activities (19 items). The time consumed for procedure-assisting tasks, treatment-assisting tasks, and personal activities were recorded as 8 h 35 min 47 s, 4 h 27 min 41 s, and 2 h 56 min 32 s, relatively. Conclusion: Though some items in both procedure-assisting and treatment-assisting tasks were classified as beyond the scope of work of EMT, it is observed that the role of practice-assisting manpower in emergency care is critical and significant for efficient patient care in the emergency care settings. This further suggests reconsidering the functions of practice-assisting manpower and reallocates duties among the workforce of emergency medical service providers for the present and future.

Usefulness of new method of central venous catheter securement using a continuous suture

Introduction To reduce the time required for suture closure for central venous catheterization, a new procedure was developed using a continuous suture technique. The present study was conducted to investigate the usefulness of this method. Method The study was conducted with 90 volunteers among the doctors in the university hospital. Preliminary training (using video) on the two fixation methods was given to the participants prior to the experiment. After applying the central vein of the pig skin, a suture up to the butterfly seal was prepared, and the participant was allowed to fix the suture using the classic method and the new method. The time required for suturing was measured in seconds, and the tension was determined using a tension measuring device after suturing. Result When using the new “one‐time method,” the time required was shortened by about 20.50 s on average compared with the conventional method (P < 0.001). The median and quartile of the tension of the thread for the one‐time method was 1.10 kg (1.00– 1.20 kg) and of the conventional method was 1.10 kg (1.00– 1.20 kg), which showed no statistically significant difference between the two groups (P = 0.476). Conclusion We found that the new one‐time method provided faster and more convenient central catheterization and catheter securement than the conventional methods.