• 한국컴퓨터정보학회논문지
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• 제24권10호
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• pp.167-174
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• 2019

본 연구는 기관 내 삽관 수행 시 성공률에 영향을 미치는 신체적 요인에 대해 알아보기 위한 비동등성 단일군 사후 유사 실험연구이다. 연구결과 기관 내 삽관을 성공적으로 수행한 시간과 신체적 요인은 상관관계가 있는 것으로 나타났다. 특히 기관 내 삽관 수행 시 수행자의 팔의 각도는 수행시간에 영향을 미쳤으며, 팔의 각도가 좁아질수록 수행시간이 짧아지는 결과를 보였다. 기관 내 삽관 수행 시 수행자의 팔의 각도를 줄일 수 있도록 노력한다면 성공적인 기관 내 삽관을 시행할 수 있을 것이다. 하지만 다양한 환경 및 직군에 대한 추가적인 후속 연구를 통해 임상적 활용의 가능성을 확인해야 할 것이다.

• 한국응급구조학회지
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• 제25권3호
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• pp.7-16
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• 2021

Purpose: The I-gel device is Korea's most frequently used airway management method during pre-hospital cardiopulmonary resuscitation (CPR). This study aimed to compare changes in ventilation volume according to the fixation method with a simulated manikin. Methods: We placed I-gel into an advanced life support simulator and compared tape and band fixation conditions. CPR was performed according to the 2020 Korean CPR guidelines, using a mechanical chest compression device and an adult bag. The positional shift of I-gel and the ventilation volume of the simulated manikin were measured after performing CPR for 20 minutes. Five trials were carried out in each setting. Statistical analysis was carried out with SPSS 27.0. P < .05 was considered significant. Results: Positional shift after 20 minutes of CPR was as follows: tape fixation, 7.2 ± 0.2 mm; band fixation, no change, indicating a significant difference between the two groups (p=.003). The mean ventilation volume was tape fixation, 482.63 ± 30.84 mL; band fixation, 544.96 ± 22.98 mL, showing a significant difference (p=.002). Conclusion: When using the I-gel during pre-hospital CPR, using a band-type fixing device with elasticity rather than fixing the tape provides stable and appropriate ventilation by maintaining the fixed position.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권3호
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• pp.173-179
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• 2015

Issues related to the control of seizures and bleeding, as well as behavioral management due to mental retardation, render dental treatment less accessible or impossible for patients with Sturge-Weber syndrome (SWS). A 41-year-old man with SWS visited a dental clinic for rehabilitation of missing dentition. A bilateral port-wine facial nevus and intraoral hemangiomatous swollen lesion of the left maxillary and mandibular gingivae, mucosa, and lips were noted. The patient exhibited extreme anxiety immediately after injection of a local anesthetic and required various dental treatments to be performed over multiple visits. Therefore, full-mouth rehabilitation over two visits with general anesthesia and two visits with target-controlled intravenous infusion of a sedative anesthesia were planned. Despite concerns regarding seizure control, bleeding control, and airway management, no specific complications occurred during the treatments, and the patient was satisfied with the results.

• 간호행정학회지
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• 제15권4호
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• pp.527-538
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• 2009

Purpose: The purpose of this study was to reclassify the advanced nursing practices of critical care nurse practitioners(CCNPs) in intensive care unit and measure the time and frequency of CCNP's activities. Method: Practices of ICU nurses are divided into RN's and CCNP's practices by a panel of ICU nursing experts. Each practice of CCNP is defined and CCNP's working time and service frequencies are monitored in general hospitals. Result: Practices of CCNP were classified into 4 domains and 32 practices. Fourteen practices by CCNPs were completed in 10 minutes and the other 12 practices consumed 10-30 minutes. A priority of practice in respiratory therapy was given to artificial airway management, management of tracheostomy patient, lower respiratory care, and the priority of CRRT was management of anticoagulation. Conclusions: Advanced nursing practices of CCNPs were recognized from those of RNs. A further research of CCNPs practices should be extended to other advanced practices and it is required to evaluate economic value of advanced nursing practice in the national health insurance system.

• 한국응급구조학회지
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• 제10권2호
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• pp.53-62
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• 2006

Purpose: There has been an increase in the number of prehospital cardiac arrests due to the increasing number of cardiovascular diseases and the increase in the average age of the population. We performed this study to identify the proper resuscitation technique and AED to be used to increase the survival rate in prehospital cardiac arrests. Methods: This studied 159 victims with prehospital cardiac arrests(VF or VT rhythm) by EMT's Reports from January to August, 2005. Results: 108 of 159 victims(67.9%) were shocked by AED. Eighty of 159 victims(50.9%) were recorded with AED shock in prehospital cardiac arrests. A number of shocks is averaged 2.19; 46.2% of one-shock and 86.1% of 1-3 shock. EMS first-tier response interval from time of dispatch to scene arrival was 5.88 minutes, from scene arrival to scene start was 7.36 minutes, from scene start to hospital admission was 9.91 minutes and from scene arrival to AED shock was 6.84 minutes. EMT provided advanced care to prehospital cardiac arrests: 97.5% in CPR, 10.1% in advanced airway management, 67.9% in AED shock. Conclusion: With the increase in cardiovascular disease and old age, the number of prehospital cardiac arrests has risen gradually. However, there were lack of CPR by bystander, defibrillation and advanced cardiac life support(ACLS) in prehospital stage. To improve the adequacy of basic life support and to increase the performance of ACLS, especially AED, we must create challenges to develop new protocols in prehospital care.

• 대한치과마취과학회지
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• 제13권4호
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• pp.195-201
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• 2013

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease caused by the degeneration of upper and lower motor neurons. The disorder causes muscle weakness and atrophy in airway muscles including pharyngeal, laryngeal and other respiratory muscles. The response to muscle realxant is also altered in patients with ALS. Because of the inherent muscle weakness and associated respiratory insufficiency, particular attentions are needed in anesthetic management of ALS patients. We used proper doses of inhalation anesthetics and opioids under EEG-entropy (electroencephalography-entropy)-monitoring without the use of muscle realxants in the anesthetic management of a patient with ALS. The patient early recovered and was discharged on the same day without any respiratory complications.

• 대한후두음성언어의학회지
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• 제20권2호
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• pp.118-125
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• 2009

Bilateral vocal fold immobility (BVFI) is a challenging condition which may result from diverse etiologies including vocal fold paralysis, synkinesis, cricoarytenoid joint fixation, and interarytenoid scar. Most patients present with dyspnea and stridor, but sometimes with a breathy dysphonia. Careful history taking, laryngoscopic evaluation under general anesthesia or awaken status, laryngeal EMG, and imaging studies with CT and/or MRI are helpful for providing a precise diagnosis and planning appropriate managements. In children, congenital neurological disorder is one of the most common etiologies, and spontaneous recovery has been reported in more than 50% of cases. Therefore, observation for more than 6 months while securing the upper airway with tracheostomy if needed is a generally accepted rule before deciding any destructive procedure to be undertaken. In children with advanced posterior glottic stenosis, laryngotracheal reconstruction with rib cartilage graft should be considered. In contrast to children, BVFI most commonly occurs as sequalae of surgical complication in adults. Diverse static or dynamic procedures can be applied; posterior cordotomy, vocal fold lateralization, endoscopic or open arytenoidectomy, arytenoid abduction, and reinnervation, electrical laryngeal pacing, which need to be carefully selected according to each patient's needs and pathophysiology of BVFI.

• Journal of Dental Anesthesia and Pain Medicine
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• 제24권1호
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• pp.1-17
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• 2024

The video laryngoscope is a novel instrument for intubation that enables indirect visualization of the upper airway. It is recognized for its ability to enhance Cormack-Lehane grades in the management of difficult airways. Notably, video laryngoscopy is associated with equal or higher rates of intubation success within a shorter time frame than direct laryngoscopy. Video laryngoscopy facilitates faster and easier visualization of the glottis and reduces the need for Magill forceps, thereby shortening the intubation time. Despite the advanced glottic visualization afforded by video laryngoscopy, nasotracheal tube insertion and advancement occasionally fail. This is particularly evident during nasotracheal intubation, where oropharyngeal blood or secretions may obstruct the visual field on the monitor, thereby complicating video laryngoscopy. Moreover, the use of Magill forceps is markedly challenging or nearly unfeasible in this context, especially in pediatric cases. Furthermore, the substantial blade size of video laryngoscopes may restrict their applicability in individuals with limited oral apertures. This study aimed to review the literature on video laryngoscopy, discuss its clinical role in nasotracheal intubation, and address the challenges that anesthesiologists may encounter during the intubation process.

• 한국화재소방학회논문지
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• 제25권5호
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• pp.21-31
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• 2011

병원 밖에서 발생한 비외상성 심정지 환자에 대한 119 구급대원의 처치 현황과 개선방안을 연구하기 위해 대전충남에 근무하는 119 구급대원 322명에게 설문을 실시하였다. 119 구급대원들은 병원전 비외상성 심정지 환자에 대해 CPR은 96.9%(309명), AED는 53%(169명)에서 거의 매번 또는 매번 실시한다고 하였다. 1급 응급구조사와 간호사의 경우 IV는 94.7%(143명)에서 가끔 실시하거나 실시한 적이 없다고 하였고 약물처치의 경우도 90.7%(136명)에서 실시한 적이 없다고 응답하였다. AED, 기도확보 및 IV 를 실시하지 못했던 이유에 대해서는 구급인원이 부족하고, 시간이 부족하며, 흔들리는 구급차 때문이라는 의견이 많았다. 임상실습이나 병원실습의 경험이 있는 119 구급대원이 IV나 약물처치를 더 자주 실시하는 것으로 나타났다. 결론적으로, 심정지 환자의 소생률을 향상시키기 위해서는 구급차에 탑승하는 구급인원을 보강하고, 일반인들도 할 수 있는 기본심폐소생술 처치에서 더 나아가 전문심장소생술을 실시할 수 있도록 1급 응급구조사에게 에피네프린의 사용을 허가하며, 임상실기 교육을 강화하고 구급대원을 법적으로 보호할 수 있는 방안이 마련되어야 할 것이다.

• 한국응급구조학회지
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• 제5권1호
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• pp.199-212
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• 2001

This research, aiming at analyzing the Emergency Medical Technicians' duties prior to establishing a baseline for question development in the national exams to qualify for the EMTs, investigated the importance and frequency per unit specified in the description with the EMTs to be subjects working on the task spot by means of questionnaires. The EMT duties were classified into 9 items like 1) the notification and response, 2) the scene size-up, 3) the patient assessment, 4) the emergency care, 5) the patient transport, 6) the duties at hospital clinics, 7) the operational management, 8) the receiving and responding to a call, 9) the self-development, and put the functional tasks into 52 items, describing the task elements into 177 items, and then questioned 112 EMTs working on the spot from July 21 through August 30, 2000, which showed the following results. 1) The distribution of subjects' career showed the highest rate with 33.9% for those who careered "less than a year", only 13.4% for those with more than 4 years and the highest rate with 43.8% for those who aged at 20-25. And 70.5% of all those who were questioned was the junior college graduates, 58.9% for those working at fire station and 29.5% working at hospital clinics. 2) Looking at the distribution of frequency and importance for each task element, questioning 'the patients main symptoms', 'accidental type', 'place of the patients identification' showed the highest rate in both frequency and importance in the field of "notification and response". 3) In the "scene size-up", identifying the patients showed the highest rate of frequency and importance, compared to other field of tasks, among which "identifying the patients' state" showed the highest rate of frequency (2.66) and importance (2.81). 4) In the "patient assessment", "identifying the patients" showed the high rate of frequency and importance in most elements of task, especially the importance showed the highest rate with 2.83 for the task of airway management and the cervical immobilization during "the primary assessment", and the frequency showed the highest rate for questioning the past case of the task of grasping the patients' history. 5) In the "emergency care", "the management of the heart attacked patients" and "the advanced cardiac life support" showed a high rate in the importance, whereas the frequency showed a very low rate. The high rate of frequency during the emergent task was the management of "musculoskeletal system injury patients" and of "the gastro-intestinal and urinary genital system injury patient support." In care of the patients with heart attack, the management of the airway showed the highest rate with 2.95, whereas the management of alcoholic abused patients and of dying patients, showed comparatively lower rate of assessment in the importance. The frequency of tasks showed the highest rate with 2.69 in the control of bleeding and the lowest with 0.47 in the management of abnormal delivery of child. 6) As to the patient transport, "the emergency transport" showed the highest rate with 2.74 and the unemergent transport with 2.55 in the importance, and the task importance at hospital showed the highest rate with 2.89 in managing the cardio-pulmonary resuscitation and with 2.60 in identifying the patient state. 7) Of all the tasks related with "operational task", the high importance was to "educate for the management of the first responder", but the frequency of tasks mostly showed a low rate and "receiving and responding to a call" showed relatively a high rate of importance and frequency. And related with "the self-development", "the health care management" and "the stress control" on working spot showed a high rate, but the frequency mostly showed a low rate.