• The Korean Journal of Pain
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• v.1 no.1
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• pp.106-119
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• 1988

For the relief of pain in 3 cases of whiplash syndromes (case I, II and IV) and in one of reflex sympathetic dystrophy (case III), we have carried out six intentional. total spinal blocks (TSB) which attempted two times in case I, three in case II and one in carte III whoso various symptoms were chronically unresponsive to the usual conservative treatments, and a time of cervical epidural and right suprascapular nerve block in case W whose acute symptom lasted 4 drys following the cervical injury (see fables from 1 to 9). During the 753, we have observed clinically the sequential charges of respiration, lid and pupil reflexes, body motion and consciousness. And checked the blood pressure, pulse rate and arterial Pco2. The effectiveness of those blocks has been assessed by using the Visual Analog Scale which is designed to measure the patient$\acute{s}$ subjective intensity of pain and also we have found out the sequelae following those blocks. The methods of the blocks were as the following: 1. Under the N.P.O. for 8~10 hours, the preparations of immediate cardiopulmonary resuscitation and premedication with atropine 0.5mg at thirty minutes before the TSB, it was performed by injecting the mixture of 2% mepivacaine 10 or 15ml and normal saline 10 or 5ml through No. 23 G. spinal needle into the subarachnoid space of $C_7-T_1$ interspinous region with fully flexed neck on the lateral posture. Immediately after the injection of the local anesthetic in the lateral position, the patient$\acute{s}$ were hasten to change Trendelenburg$\acute{s}$ position in order to act the drugs cephalad and to make easy controlled respiration with oxygen. 2. The cervical epidural block was done by injecting the mixture of 0.5% bupivacaine 4ml, normal saline 4ml and triamcinolone 15mg through No. 18 G. Tuohy needle into the epidural space on the same region and posture as the above without premedication.7he suprascapular nerve block was done by injecting of 0.5% bupivacaine 3ml only into the right suprascapular fossa on the sitting posture. The results were as the following: 1. The cessation of respiration was seen within 5 minutes following the subarachnoidal injection of the above 20ml mixture in 2 to 3 minutes and then soon the consciousness began to disappear. The loss of Lid and pupil reflexes noted between 5 to 10 minutes and the size of the dilated pupils was equal between 5 to 20 minutes, but the pupil of the dependent side on tile lateral position was dilated 1 to 3 minutes earlier than that of the independent. The patients had r=ever responded to any stimulations during the TSB except their heart funtion. 2. The recovery of the TSB was as the following, firstly the ankle and lower limb of the independent side began to move slightly with in 34 to 75 minutes after the injection and then that of the dependent Secondly the neck and upper limb moved 6 to 15 minutes later than the lower limb. Thirdly the self respiration began to appear between 40 to 80 minutes from the block. The lid and pupil reacted to touch and light respectively between 40 to 80 minutes but the pupil of the independent side responded earlier than that of the depends. Lastly the consciousness recovered completely between 80 to 125 minutes from the block. 3. In the cardiopulmonary function during the TSB, the blood pressure were stable except the 210/130 tory at the and block of case I. There were bradycardias between 65 to 85 minutes in case I and II but no arrythmia on the EKG. The level of the arterial Pco2 was maintained to 43~45 torr during the TSB. 4. The effectiveness of the above blocks was no pain(0%) in case IV, and light (10~20%) in case I and II but no improvement in case III. 5. The right arm weakness has been complicated as to be Injected accidently the "COLD" local anesthetic at the End block of case I.

• Fire Science and Engineering
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• v.30 no.6
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• pp.137-141
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• 2016

Cross contamination between a patient and rescuer or CPR trainees can occur when performing mouth to mouth ventilation during cardiopulmonary resuscitation (CPR). On the other hand, there has been a lack of research on the filtration efficacy of face shields that are designed to protect people from cross-contamination. This study aims to secure the safety of rescuers from communicable diseases in pre-hospital emergency settings and CPR trainees by verifying the protective effects of face shields. The FA shield and CM Shield were used to verify the safety. The bacteria collected from filters used by CPR trainees were incubated. These incubated bacteria were smeared onto the new filters, and were then blown out through the filters using a Bag Valve Mask (BVM) and the pathogens at the front and the back of the filters were checked. While the FA shield was effective in preventing the transmission of pathogens, the CM shield did not prevent the transmission of pathogens. Therefore, some of face shields that received national certification are ineffective in preventing cross-contamination. Accordingly, it is necessary to verify the safety of other face shields used domestically.

• Journal of Internet of Things and Convergence
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• v.8 no.6
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• pp.115-122
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• 2022

Recently, the importance of CPR training for the layperson has been emphasized to improve the survival rate of out-of-hospital cardiac arrest patients. An accurate and realistic training strategy is required for the CPR training effect for laypersons. In this study, we develop an extended reality (XR) based CPR training system and evaluate its usability. The XR based CPR training system consisted of three applications. First, a 3D heart anatomy image registered to the manikin is transmitted to the smart glasses to guide the chest compression point. The second application provides visual and auditory information about the CPR process through smart glasses. At the same time, the smartwatch sends a vibration notification to guide the compression rate. The 'Add-on-kit' is a device that detects the depth and speed of chest compression via sensors installed on the manikin and sends immediate feedback to the smartphone. One hundred laypersons who participated in this study agreed that the XR based CPR training system has realism and effectiveness. XR based registration technology will contribute to improving the efficiency of CPR training by enhancing realism, immersion, and self-directed learning.

• Journal of Hospice and Palliative Care
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• v.17 no.2
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• pp.66-74
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• 2014

Purpose: This study is aimed to investigate perceptions of caregivers and medical staff toward do not resuscitate (DNR) and advance directives (AD). Methods: Participants were 141 caregivers and 272 medical staff members from five general hospitals. A questionnaire used for the study consisted of 20 items: 14 about DNR perceptions, three about AD, one each for age, gender and employment. Results: Both medical staff and caregivers strongly recognized the need for DNR and AD, and the level of recognition was higher with medical staff than caregivers (DNR ${\chi}^2=44.56$, P=0.001; AD ${\chi}^2=16.23$, P=0.001). The main reason for the recognition was to alleviate sufferings of patients in the terminal phase. In most cases, DNR and AD were filled out when patients with terminal conditions were admitted, and patients made the decisions by consulting with their guardians. Medical staff better recognized the need and for growing demand for guidelines for the DNR and AD decision making process than caregivers (${\chi}^2=7.41$, P=0.0025). Conclusion: This study showed that patients highly rely on their caregivers when making decisions for DNR and AD. Thus, it is important that patients and caregivers are provided with objective information about the decisions. Since participants' strong support for DNR and AD was mainly aimed at alleviating patients' suffering, further study is needed in the association with hospice care. Medical staff also needs to understand the different views held by caregivers and fully consider the disparity when informing patients/caregivers to make the DNR and AD decisions.

• Quality Improvement in Health Care
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• v.7 no.2
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• pp.138-155
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• 2000

Background: Factors related to waiting and staying time for patient care in emergency care center (ECC) were examined during 1 month from Apr. 1 to Apr. 30, 1997 at an ECC of Yeungnam university hospital in Taegu metropolitan city, to obtain the baseline data on the strategy of effective management of emergency patients. Method: The study subjects consisted of the 1,742 patients who visited at ECC and the data were obtained from the medical records of ECC and direct surveys. Results: The mean interval between ECC admission time and initial care time by each ECC duty residents was 83.1 minutes for male patients and 84.9 minutes for female patients, and mean ECC staying time (time interval between admission and final disposition from ECC) was 718.0 minutes in men and 670.5 minutes in women. As the results, the mean staying time in ECC was higher in older age, and especially the both of initial care time and staying time were highest in patients of medical aid, and shortest in patients of worker's accident compensation insurance. The on admission or not, previously endotracheal-intubation state of patient. The ECC staying ti initial care time was much more delayed in patients of not having previous medical records and the ECC staying time was higher in referred patients from out-patient department, in transferred patients from the other hospitals and patients having previous records, and in patients partly used the order-communicating system. The factors associated with the initial care time were the numbers of ECC patients and the existence of any true emergent patients, being cardiopulmonary resuscitation (CPR) statusme was much more longer in patients of drug intoxication, in CPR patients, in medical department patients, in transfused patients and in patients related to 3 or more departments. And according to the numbers of duty internships, the ECC staying time for four internships was more longer than for five internships and after admission ordering was done, also-more longer in status being of no available beds. As above mentioned results, the factors for the ECC staying time were thought to be statistically significant (P<0.01) according to the patient's age and the laboratory orders and the X-ray films checked. And also the factor for the ECC staying time were thought to be statistically significant (P<0.01) according to the status being of no available beds, the laboratory orders and/or the special laboratory orders, the X-ray films checked, final disposing department, transferred to other hospital or not, home medication or not, admission or not, the grades of beds, the year grades of residents, the causes of ECC visit, the being CPR status on admission or not, the surgical operation or not, being known personells in our hospital. Conclution: Authors concluded that the relieving method of long-staying time in ECC was being establishing the legally proved apparatus which could differentiate the true emergency or non-emergency patients, and that the methods of shortening ECC staying time were doing definitely necessary laboratory orders and managing beds more flexibly to admit for ECC patients and finally this methods were thought to be a method of unloading for ECC personnels and improving the quality of care in emergency patients.

• Clinical and Experimental Pediatrics
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• v.48 no.10
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• pp.1090-1095
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• 2005

Purpose : In the case of serious respiratory distress syndrome(RDS) or relapse of clinical appearances after single treatment, we obtained more effective results with multiple-dose surfactant replacement therapy. We carried out this investigation for comparing and observing clinical progress between single-dose(group S) and multiple-dose(group M) pulmonary surfactant treatment group of neonatal RDS. Methods : We investigated 48 neonates who were diagnosed as RDS and treated with pulmonary surfactant(PS) replacement therapy in NICU of Kyunghee University hospital from January 2002 to March 2004, then we compared and verified clinical progress of 32 neonates in group S with that of 16 neonates in group M. Results : There were no significant statistical differences in average birth weights, average gestational periods, initial pH values of birth, whether operation of resuscitation at that time of birth was made or not, whether prenatal steroid prescription for mother, RDS classification standardized by Bomsel, and ventilation index(VI) before instillation of PS of two groups. However, there was significant statistical difference in a/A $PO_2$(P<0.05). We could observe changes of VI and a/A $PO_2$ within 72 hours have been continuously improved at group S rather than group M. In spite of relapses, group M changed for the better after second dose. There were also no significant differences between the two groups in duration of ventilator therapy, mortality within 28 days after birth, intraventricular hemorrhage by complication, retinopathy of premature, necrotizing enterocolitis, chronic lung diseases, sepsis, and DIC. Conclusion : In these relapse cases, as there were no significant differences in the mortality rate and the occurence of complication between group S and group M, the requirement of multiple-dose PS replacement therapy which brought improvement of prognosis was emphasized.