• Journal of the Korea Academia-Industrial cooperation Society
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• v.13 no.12
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• pp.5950-5957
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• 2012

CPR with minimized hands-off time is one of integral factors for the improvement of the survival rate of patients. The purpose of this study was to examine the relationship of the installation of C-steps on the main stretcher to CPR accuracy and errors. The subjects in this study were 70 paramedics in 10 firehouses in the province of C(35 for control group, 35 for experimental group), and their CPR accuracy on the main stretchers was checked. As a result, it's found that the main stretchers equipped with the C-steps served to boost the accuracy of chest compression by creating suitable environments for that in terms of height and posture(t=65.104, p=.000), to improve the accuracy of artificial respiration by providing a proper amount of ventilation(t=5.207, p=.000), and to bolster the self-confidence of the paramedics about CPR(t=-10.612, p=.000). In conclusion, the mounting of C-steps on the main stretcher is expected to be of use for the improvement of the survival rate of cardiac-arrest patients by ensuring the precise performance of high-quality CPR.

• Proceedings of the KIEE Conference
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• 2008.07a
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• pp.1971-1972
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• 2008

Cardiopulmonary resuscitation(CPR) is an important clinical technique performing artificial ventilation and chest compression on a patient under emergent situation before arriving in hospital. Since the quality of CPR significantly affects the survival rate, it would be of great advantage to monitor respiration in real time during CPR. However, currently applied respiratory air flow transducers are difficult to apply with sensing elements in the middle of the flow axis. The present study developed a new turbulent air flow transducer conveniently applicable to CPR. Abrupt changes in diameter of the flow tube generated turbulence in air flow, thereby pressure difference was obtained to estimate the air flow rate, with no physical object on the flow plane. Expiration and inspiration were separated by the direction of the pressure difference, resulting in good symmetry. Pressure-flow relationship was tested on a quadratic model, which provided accurate enough estimation results. Therefore, the present turbulent air flow transducer seemed appropriate to monitor respiration during CPR.

• Journal of The Korean Society of Clinical Toxicology
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• v.13 no.1
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• pp.36-39
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• 2015

Copper sulfate is a copper compound used widely in the chemical and agriculture industries. Most intoxication occurs in developing countries of Southeast Asia particularly India, but rarely occurs in Western countries. The early symptoms of intoxication are nausea, vomiting, diarrhea, and abdominal cramps, and the most distinguishable clue is bluish vomiting. The clinical signs of copper sulfate intoxication can vary according to the amount ingested. A 75-year old man came to our emergency room because he had taken approximately 250 ml copper sulfate per oral. His Glasgow Coma Scale (GCS) score was 14 and vital signs were blood pressure 173/111 mmHg, pulse rate 24 bpm, respiration rate 24 bpm, and body temperature $36.1^{\circ}$ .... Arterial blood gas analysis (ABGa) showed mild hypoxemia and just improved after 2 L/min oxygen supply via nasal cannula. Other laboratory tests and chest CT scan showed no clinical significance. Three hours later, the patient's mental status showed sudden deterioration (GCS 11), and ABGa showed hypercarbia. He was arrested and his spontaneous circulation returned after 8 minutes CPR. However, 22 minutes later, he was arrested again and returned after 3 minutes CPR. The family did not want additional resuscitation, so that he died 5 hours after ED visit. In my knowledge, early deaths are the consequence of shock, while late mortality is related to renal and hepatic failure. However, as this case shows, consideration of early definite airway preservation is reasonable in a case of supposed copper sulfate intoxication, because the patients can show rapid deterioration even when serious clinical manifestation are not presented initially.

• Journal of the Korea Convergence Society
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• v.12 no.7
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• pp.105-111
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• 2021

The purpose of this study is to determine how the pre-test performed before training affects the results of CPR performance. In the case of the pre-test group(PTG), a pre-evaluation was performed for 1 minute before training, and the group that did not perform the pre-test(NPTG) performed only regular education. In both groups, skill test was performed for 1 minute after training. As a result of comparing the pre and post-test of PTG, there were statistically significant changes in chest compression depth, rate, and compression recoil. There was a statistically significant difference only in the chest compression rate in the chest compression performance results of the two groups after training. There was a statistically significant difference in the results of confidence after training in both groups. It is judged that the pre-test conducted before training has a good influence not only on the results of chest compression, but also on confidence improvement. Therefore, it is judged that it is necessary to develop additional programs such as pre-education test in order to increase the concentration of CPR education for the general population.

• Journal of Chest Surgery
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• v.52 no.2
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• pp.70-77
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• 2019

Background: Extracorporeal life support (ECLS) is used as a bridge to revascularization in high-risk patients with ischemic heart disease. We reviewed our experiences of coronary artery bypass grafting (CABG) after ECLS in patients with cardiac arrest or refractory cardiogenic shock. Methods: We retrospectively reviewed 4,616 patients who underwent CABG at our institution between May 2006 and February 2017. We identified patients who underwent CABG following ECLS for cardiogenic shock or cardiac arrest. Twenty-three patients (0.5% of all CABG cases) were enrolled in the analysis. Their median age was 65 years (Q1-Q3, 58-77 years). Nine patients (39.1%) were diagnosed with ST-elevation myocardial infarction. Mechanical complications after acute myocardial infarction, including acute mitral regurgitation, left ventricular rupture, and ventricular septal defect, occurred in 9 patients (39.1%). Results: The median time from cardiopulmonary resuscitation to ECLS initiation was 25 minutes (Q1-Q3, 18.5-28.5 minutes). Conventional CABG was performed in 10 patients (43.5%) who underwent concomitant intracardiac procedures. Postoperative ECLS was required in 16 patients (69.5%). The rate of successful ECLS weaning was 91.3% (n=21). There were 6 early mortalities (26.1%). Conclusion: CABG after ECLS was very rare in real-world circumstances. Although the early mortality rate was high, the risk of mortality may be acceptable under such devastating circumstances.

• Journal of Trauma and Injury
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• v.33 no.4
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• pp.207-218
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• 2020

The following recommendations are presented herein: All trauma patients admitted to the resuscitation room should be constantly (or periodically) monitored for parameters such as blood pressure, heart rate, respiratory rate, oxygen saturation, body temperature, electrocardiography, Glasgow Coma Scale, and pupil reflex (1C). Chest AP and pelvic AP should be performed as the standard initial trauma series for severe trauma patients (1B). In patients with severe hemodynamically unstable trauma, it is recommended to perform extended focused assessment with sonography for trauma (eFAST) as an initial examination (1B). In hemodynamically stable trauma patients, eFAST can be considered as the initial examination (2B). For the diagnosis of suspected head trauma patients, brain computed tomography (CT) should be performed as an initial examination (1B). Cervical spine CT should be performed as an initial imaging test for patients with suspected cervical spine injury (1C). It is not necessary to perform chest CT as an initial examination in all patients with suspected chest injury, but in cases of suspected vascular injury in patients with thoracic or high-energy damage due to the mechanism of injury, chest CT can be considered for patients in a hemodynamically stable condition (2B). CT of the abdomen is recommended for patients suspected of abdominal trauma with stable vital signs (1B). CT of the abdomen should be considered for suspected pelvic trauma patients with stable vital signs (2B). Whole-body CT can be considered in patients with suspicion of severe trauma with stable vital signs (2B). Magnetic resonance imaging can be considered in hemodynamically stable trauma patients with suspected spinal cord injuries (2B).

• The Korean Journal of Emergency Medical Services
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• v.27 no.3
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• pp.7-16
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• 2023

Purpose: The objective of this study was to compare the outcome of out-of-hospital cardiac arrest (OHCA) between National Health Insurance(NHI) and Medical Aid(MA), before (2019) and during 2020 COVID-19 in Seoul. Methods: This is a retrospective cohort study that used nationwide OHCA registry collected in 2019 and 2020. The participants were patients with medical etiology who lived in Seoul and were transferred by 119 ambulance in Seoul. It was classified into NHI and MA according to health insurance status. Main outcomes included survival rate and good neurological recovery. Results: A total of 2,888 patients (2,543 NHI and 345 MA) in 2019 and 2,949 patients (2,638 NHI and 311 MA) in 2020 were included. In 2020, the bystander cardiopulmonary resuscitation (CPR), was significantly lower in MA (25.7%) than in NHI (38.1%). Survival rate in the MA decreased from 11.6% in 2019 to 10.6% in 2020, while increased from 10.1% to 13.3% in NHI. The odds ratio of good neurological recovery were 0.47 (95%CI, 0.25-0.86) for the MA group compared with NHI during 2020 COVID-19. Conclusion: There were disparities in bystander CPR and good neurological recovery by health insurance status during COVID-19 pandemic. Public health interventions should strive to reduce disparity of MA group in OHCA.

• The Korean Journal of Emergency Medical Services
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• v.28 no.2
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• pp.99-108
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• 2024

Purpose: This study aimed to compare the effectiveness of one-hand compression method (one-hand) and two-thumb compression methods (two-thumb) using a 3-year-old pediatric mannequin. Methods: Participants in the experiment were randomly assigned to 21 people with one hand and 21 people with two thumbs, who had completed a basic life support training course. The mannequin used a few junior QCPR manikis (Laerdal, Norway), based on an age of 3. The study followed the guidelines for two-rescuer pediatric CPR, performing chest compressions and ventilations in a 15:2 ratio for 5 cycles, 10 minutes. The chest compression number, depth, speed rate, and recoil rate were measured after 1, 3, and 5 cycles, respectively. Data were analyzed using SPSS 23.0. Results: Comparing the efficiency of chest compressions performed during 1, 3, and 5 cycles, the depth of chest compressions was 40.84±3.10 mm for the two thumbs and 51.48±4.79 mm for the one-hand, which was significantly different (p<.001). According to pediatric CPR guidelines, the frequency corresponding to the compression depth range of 40.00-50.00 mm was statistically higher at 57.1% (12 people) of two thumb than at 23.8% (5 people) of one hand (p<.001). Conclusion: While the current guidelines recommend one- or two-thumb encircling hand compressions for larger children, the use of one- or two-handed wrapped thumb compressions should be considered for smaller children, depending on the rescuer's judgment, when distinguishing between a child and an infant is difficult.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.75-82
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• 2010

Purpose: In Korea, trauma is the $3^{rd}$ most common cause of death. The trauma treatment system is divided into pre-hospital and hospital stages. Deaths occurring in the pre-hospital stage are 50% of the total death, and 20% of those are deaths that are preventable. Therefore, the purpose of our study is to calculate the preventable death rates caused by trauma in our current pre-hospital system, to analyze the appropriateness of the treatment of traumatized patients and to draw a conclusions about the problems we have. Methods: The study was done on traumatized patients who expired at the emergency department from January 1, 2005, to December 31, 2009, at the Korea University Medical Centers in Anam, Guro and Ansan. The data on the patients were reviewed retrospectively based on characteristics, conditions on admission and trauma severity. The patient's RTS (revised trauma score) and ISS (injury severity score) was calculated. Preventable death rate was calculated by TRISS (the trauma score-injury severity score). Results: A total of 168 patients were enrolled. All patients were intubated and underwent CPR. Of the total, 72% patients were male, and traffic accidents were the most common form of trauma (52.4%), falls being second (28.6%). Head injury, solitary or multiple, was the most common cause of death (55.4%). Thirty-eight (38, 22.6%) deaths were preventable. The 22.6% preventable death rate consisted of 15.5% potentially preventable and 7.1% definitely preventable deaths. Based on a logistic regression analysis, the relationship between the time intervals until transfusion and imaging and death was statistically significant in the hospital stage. In the pre-hospital stage, transit time from the site of the injury to the hospital showed a significant relationship with the mortality rate. Conclusion: One hundred sixty-eight (168) patients died of trauma at the 3 hospitals of Korea University Medical Center. The TRISS method was used to calculate the preventable death rate, with a result of 22.6%. The only factor that was significant related to the preventable death rate in the pre-hospital stage was the time from injury to hospital arrival, and the time intervals until transfusion and imaging were the two factors that showed significance in the hospital stage. Shortening the time of treatment in the field and transferring the patient to the hospital as quickly as possible is the most important life-saving step in the pre-hospital stage. In the hospital stage, the primary survey, resuscitation and diagnosis should proceed simultaneously.

• Journal of Hospice and Palliative Care
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• v.22 no.4
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• pp.198-206
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• 2019

Purpose: The Act on Hospice and Palliative Care and Decisions on Life-sustaining Treatment for Patients at the End of Life was enacted in 2016 and has taken effect since 2018 February. The content of this act was based on Physician Orders for Life-Sustaining Treatment (POLST) in the United States and we modified it for terminal cancer patients registering hospice. The object of this study is to investigate preference and implementation rate for modified Korean POLST (MMK-POLST) items in hospice ward. Methods: From February 1, 2017 to April 30, 2019, medical records regarding MMK-POLST were retrospectively analyzed for all patients hospitalized in the hospice ward of Gyeongsang National University Hospital. Results: Of the eligible 387 total cohorts, 295 patients filled out MK-POLST. MK-POLST has been completed in 133 cases (44.1%) by the patient themselves, 84 cases (28.5%) by the spouse, and 75 cases (25.4%) by their children, respectively. While only 13 (4.4%) out of 295 MK-POLST completed patients refused the parenteral nutrition and 5 patients (1.7%) for palliative sedation, the absolute majority of 288 (97.6%) patients did not want cardiopulmonary resuscitation (CPR) and ventilators and 226 people (76.9%) for pressor medications. Kappa values for the matched strength of MK-POLST implementation were poor for all items except CPR, ventilators and palliative sedation. Conclusion: Hospice patients refused to conduct cardiopulmonary resuscitation, ventilators and pressor agents. In contrast, antibiotics, parenteral nutrition and palliative sedation were favored in the majority of patients.