Yong In Kim

A 10-s rest improves chest compression quality during hands-only cardiopulmonary resuscitation: A prospective, randomized crossover study using a manikin model

OBJECTIVES This study was designed to assess changes in cardiopulmonary resuscitation (CPR) quality and rescuer fatigue when rescuers are provided with a break during continuous chest compression CPR (CCC-CPR). METHODS The present prospective, randomized crossover study involved 63 emergency medical technician trainees. The subjects performed three different CCC-CPR methods on a manikin model. The first method was general CCC-CPR without a break (CCC), the second included a 10-s break after 200 chest compressions (10/200), and the third included a 10-s break after 100 chest compressions (10/100). All methods were performed for 10 min. We counted the total number of compressions and those with appropriate depth every 1 min during the 10 min and measured mean compression depth from the start of chest compressions to 10 min. RESULTS The 10/100 method showed the deepest compression depth, followed by the 10/200 and CCC methods. The mean compression depth showed a significant difference after 5 min had elapsed. The percentage of adequate compressions per min was calculated as the proportion of compressions with appropriate depth among total chest compressions. The percentage of adequate compressions declined over time for all methods. The 10/100 method showed the highest percentage of adequate compressions, followed by the 10/200 and CCC methods. CONCLUSION When rescuers were provided a rest at a particular time during CCC-CPR, chest compression quality increased compared with CCC without rest. Therefore, we propose that a rescuer should be provided a rest during CCC-CPR, and specifically, we recommend a 10-s rest after 100 chest compressions.

Acupuncture as analgesia for non-emergent acute non-specific neck pain, ankle sprain and primary headache in an emergency department setting: a protocol for a parallel group, randomised, controlled pilot trial.

Introduction This study aims to assess the feasibility of acupuncture as an add-on intervention for patients with non-emergent acute musculoskeletal pain and primary headache in an emergency department (ED) setting. Methods and analysis A total of 40 patients who present to the ED and are diagnosed to have acute non-specific neck pain, ankle sprain or primary headache will be recruited by ED physicians. An intravenous or intramuscular injection of analgesics will be provided as the initial standard pain control intervention for all patients. Patients who still have moderate to severe pain after the 30 min of initial standard ED management will be considered eligible. These patients will be allocated in equal proportions to acupuncture plus standard ED management or to standard ED management alone based on computer-generated random numbers concealed in opaque, sealed, sequentially numbered envelopes. A 30 min session of acupuncture treatment with manual and/or electrical stimulation will be provided by qualified Korean medicine doctors. All patients will receive additional ED management at the ED physicians discretion and based on each patients response to the allocated intervention. The primary outcome will be pain reduction measured at discharge from the ED by an unblinded assessor. Adverse events in both groups will be documented. Other outcomes will include the patient-reported overall improvement, disability due to neck pain (only for neck-pain patients), the treatment response rate, the use of other healthcare resources and the patients’ perceived effectiveness of the acupuncture treatment. A follow-up telephone interview will be conducted by a blinded assessor 72±12 h after ED discharge. Ethics and dissemination Written informed consent will be obtained from all participants. The study has been approved by the Institutional Review Boards (IRBs). The results of this study will guide a full-scale randomised trial of acupuncture in an ED context. Trial registration number ClinicalTrials.gov: NCT02013908.

Characteristics and triage of a maritime disaster: an accidental passenger ship collision in Korea

The aim of this study was to analyze the characteristics of and responses to a maritime disaster, by reviewing the events surrounding the accidental collision of a high-speed passenger ship in South Korea. Of the 215 boarded passengers on a high-speed passenger ship sailing from Fukuoka to Busan, we retrospectively examined information of 114 victims of the ships collision with a whale on 12 April 2007. We referenced reports from the on-site disaster medical assistance team members; recorded notifications to the Busan 1339 Emergency Medical Information Centre, from the scene of the accident and data from the ships insurer. The 114 victims were transported to 20 different hospitals. Many patients were transported to nearby local hospitals from the scene of the accident; other patients were transported to more distant hospitals. Eighty-five patients were transported to hospitals through mobile emergency support units, whereas the other patients were transported directly by fire officers from the 119 Fire Officer Centre. One patient died in the transport. In conclusion, our national emergency medical service and disaster response system each suffer from many problems – especially a lack of cooperation among related departments and insufficient communication therein. The onboard planning and practice of a disaster plan is required, and a reliable information system between the scene of a maritime disaster and our emergency medical service system should be developed.

Optimal chest compression rate in cardiopulmonary resuscitation: a prospective, randomized crossover study using a manikin model.

Objectives When performing cardiopulmonary resuscitation (CPR), the 2010 American Heart Association guidelines recommend a chest compression rate of at least 100 min−1, whereas the 2010 European Resuscitation Council guidelines recommend a rate of between 100 and 120 min−1. The aim of this study was to examine the rate of chest compression that fulfilled various quality indicators, thereby determining the optimal rate of compression. Methods Thirty-two trainee emergency medical technicians and six paramedics were enrolled in this study. All participants had been trained in basic life support. Each participant performed 2 min of continuous compressions on a skill reporter manikin, while listening to a metronome sound at rates of 100, 120, 140, and 160 beats/min, in a random order. Mean compression depth, incomplete chest recoil, and the proportion of correctly performed chest compressions during the 2 min were measured and recorded. Results The rate of incomplete chest recoil was lower at compression rates of 100 and 120 min−1 compared with that at 160 min−1 (P=0.001). The numbers of compressions that fulfilled the criteria for high-quality CPR at a rate of 120 min−1 were significantly higher than those at 100 min−1 (P=0.016). Conclusion The number of high-quality CPR compressions was the highest at a compression rate of 120 min−1, and increased incomplete recoil occurred with increasing compression rate. However, further studies are needed to confirm the results.

Factors affecting the urologist’s decision to administer ureteral stone therapy: a retrospective cohort study

Objective We aimed to evaluate the factors influencing treatment option selection among urologists for patients with ureteral stones, according to the stone diameter and location. Methods We retrospectively reviewed the records of 360 consecutive patients who, between January 2009 and June 2014, presented to the emergency department with renal colic and were eventually diagnosed with urinary stones via computed tomography. The maximal horizontal and longitudinal diameter and location of the stones were investigated. We compared parameters between patients who received urological intervention (group 1) and those who received medical treatment (group 2). Results Among the 360 patients, 179 (49.7%) had stones in the upper ureter and 181 (50.3%) had stones in the lower ureter. Urologic intervention was frequently performed in cases of upper ureteral stones (P<0.001). In groups 1 and 2, the stone horizontal diameters were 5.5 mm (4.8 to 6.8 mm) and 4.0 mm (3.0 to 4.6 mm), stone longitudinal diameters were 7.5 mm (6.0 to 9.5 mm) and 4.4 mm (3.0 to 5.5 mm), and ureter diameters were 6.4 mm (5.0 to 8.0 mm) and 4.7 mm (4.0 to 5.3 mm), respectively (P<0.001). The cut-off values for the horizontal and longitudinal stone diameters in the upper ureter were 4.45 and 6.25 mm, respectively (sensitivity 81.3%, specificity 91.4%); those of the lower ureter were 4.75 and 5.25 mm, respectively (sensitivity 79.4%, specificity 79.4%). Conclusion The probability of a urologic intervention was higher for patients with upper ureteral stones and those with stone diameters exceeding 5 mm horizontally and 6 mm longitudinally.

The effect of hydraulic bed movement on the quality of chest compressions: A pilot study

Objectives The hydraulic height control systems of hospital beds provide convenience and shock absorption. However, movements in a hydraulic bed may reduce the effectiveness of chest compressions. This study investigated the effects of hydraulic bed movement on chest compressions. Materials and methods Twenty‐eight participants were recruited for this study. All participants performed chest compressions for 2 min on a manikin and three surfaces: the floor (Day 1), a firm plywood bed (Day 2), and a hydraulic bed (Day 3). We considered 28 participants of Day 1 as control and each 28 participants of Day 2 and Day 3 as study subjects. The compression rates, depths, and good compression ratios (> 5‐cm compressions/all compressions) were compared between the three surfaces. Results When we compared the three surfaces, we did not detect a significant difference in the speed of chest compressions (p = 0.582). However, significantly lower values were observed on the hydraulic bed in terms of compression depth (p = 0.001) and the good compression ratio (p = 0.003) compared to floor compressions. When we compared the plywood and hydraulic beds, we did not detect significant differences in compression depth (p = 0.351) and the good compression ratio (p = 0.391). Conclusions These results indicate that the movements in our hydraulic bed were associated with a non‐statistically significant trend towards lower‐quality chest compressions.

Improvement of a cecal bascule by supportive care

A cecal bascule is a rare cause of intestinal obstruction, and the diagnosis is often challenging because the symptoms and signs are similar to those of small bowel obstruction. We, herein, present the case of an 82-year-old female who presented to our emergency department with lower abdominal pain. Computed tomography showed anterior medial folding of the cecum over the ascending colon with cecal dilatation, without bowel ischemia or perforation. A good outcome was obtained immediately after supportive care. To the best of our knowledge, this is the first report of a cecal bascule that was improved by supportive care.

Usefulness of ultrasonography for the evaluation of catheter misplacement and complications after central venous catheterization

Objective To assess whether ultrasonographic examination compared to chest radiography (CXR) is effective for evaluating complications after central venous catheterization. Methods We performed a prospective observational study. Immediately after central venous catheter insertion, we asked the radiologic department to perform a portable CXR scan. A junior and senior medical resident each performed ultrasonographic evaluation of the position of the catheter tip and complications such as pneumothorax and pleural effusion (hemothorax). We estimated the time required for ultrasound (US) and CXR. Results Compared to CXR, US could equivalently identify the catheter tip in the internal jugular or subclavian veins (P=1.000). Compared with CXR, US examinations conducted by junior residents could equivalently evaluate pneumothorax (P=1.000), while US examinations conducted by senior residents could also equivalently evaluate pneumothorax (P=0.557) and pleural effusion (P=0.337). The required time for US was shorter than that for CXR (P<0.001). Conclusion Compared to CXR, US could equivalently and more quickly identify complications such as pneumothorax or pleural effusion.

Comparison between an instructor-led course and training using a voice advisory manikin in initial cardiopulmonary resuscitation skill acquisition

Objective We compared training using a voice advisory manikin (VAM) with an instructor-led (IL) course in terms of acquisition of initial cardiopulmonary resuscitation (CPR) skills, as defined by the 2010 resuscitation guidelines. Methods This study was a randomized, controlled, blinded, parallel-group trial. We recruited 82 first-year emergency medical technician students and distributed them randomly into two groups: the IL group (n=41) and the VAM group (n=37). In the IL-group, participants were trained in “single-rescuer, adult CPR” according to the American Heart Association’s Basic Life Support course for healthcare providers. In the VAM group, all subjects received a 20-minute lesson about CPR. After the lesson, each student trained individually with the VAM for 1 hour, receiving real-time feedback. After the training, all subjects were evaluated as they performed basic CPR (30 compressions, 2 ventilations) for 4 minutes. Results The proportion of participants with a mean compression depth ≥50 mm was 34.1% in the IL group and 27.0% in the VAM group, and the proportion with a mean compression depth ≥40 mm had increased significantly in both groups compared with ≥50 mm (IL group, 82.9%; VAM group, 86.5%). However, no significant differences were detected between the groups in this regard. The proportion of ventilations of the appropriate volume was relatively low in both groups (IL group, 26.4%; VAM group, 12.5%; P=0.396). Conclusion Both methods, the IL training using a practice-while-watching video and the VAM training, facilitated initial CPR skill acquisition, especially in terms of correct chest compression.