BACKGROUND: It is difficult to evaluate the effectiveness of ongoing cardiopulmonary resuscitation(CPR). Recent studies suggest that continuous end-tidal carbon dioxide(ETC02) monitoring may be useful non-invasive indicator of CPR. The purpose of this study is to determine whether ETC02 monitoring during CPR could be used as a prognostic indicator of resuscitation and survival. METHOD: A prospective, clinical study was performed from May 1997 to April 1998 at the department of emergency medicine, Ewha Womans University Mokdong hospital. All patients were immediately connected to mainstream capnometer sensor between the tube and the bag after endotracheal intubation using infrared capnometer. RESULT: The study included 70 patients (39 were men) with a mean age of 55+/-16 years. 37 patients with return of spontaneous circulation(ROSC) had higher maximal ETCO2 during CPR than 33 Patients without ROSC (26.9+/-19.4 vs 10.2+/- 9.0mmHg, p=0.0001). The ETCO2 was not significantly different in relation to age, gender, initial rhythm, and survival time after ROSC. But there was significant difference in immediate cause of arrest in ROSC group (P=0.0016). When maximal ETC02 was less than 10mmHg, we observed sensitivity of 83.8%, specificity of 54.5% in predicting ROSC. There were 6 patients with ROSC in spite of maximal ETCO2 was less than 10mmHg. CONCLUSION: Continuous ETCOB monitoring during CPR may be useful, noninvasive, and valuable predictor of successful resuscitation and survival from cardiac arrest. But ETCO2 should lot be used as a single indicator for the withdrawal of CPR.
Carbon Dioxide* ; Carbon* ; Cardiopulmonary Resuscitation* ; Emergency Medicine ; Female ; Heart Arrest ; Humans ; Intubation, Intratracheal ; Prospective Studies ; Resuscitation ; Sensitivity and Specificity

Purpose: This study aimed to investigate burnout and resilience among emergency physicians (EPs) at university teaching hospitals during the coronavirus disease (COVID-19) pandemic. Materials and Methods: In April to May 2021, a survey was administered to 331 and 309 emergency medicine specialists and residents, respectively, from 31 university teaching hospitals in Korea. Data on the respondents’ age, sex, designation, working area, experience with treating COVID-19 patients, and personal experience with COVID-19 were collected. Based on the participants’ characteristics, quality of life (compassion satisfaction, burnout, and secondary traumatic stress), resilience, emotional content, and self-image were analyzed. Results: A total of 247 responses were analyzed. Compared to specialists, compassion satisfaction and resilience in residents were not good, burnout was severe, and emotional content and self-image were less positive. Experiences with treating COVID-19 patients did not cause any difference in quality of life, resilience, emotional content, and self-image among participant subgroups. Personal COVID-19 experiences were associated with poor compassion satisfaction, resilience, less positive emotional content and self-image, and severe burnout. Compassion satisfaction, secondary traumatic stress, and resilience can definitively affect burnout. Conclusion The quality of life and resilience of EPs in university teaching hospitals in Korea during the COVID-19 pandemic have been low. Supportive measures to improve resilience can prevent burnout among emergency staff, particularly residents and EPs, with personal experiences related to COVID-19.

PURPOSE: The purpose of this study is examine the effects of clinical art therapy on self-esteem, anxiety, and pain of pediatric burn patients. METHODS: Hospitalized pediatric patients, age from 6 to 15, at H specialized burn hospital located in Seoul were chosen as subjects for this study. Total 11 people were participated. An experimental group received 8 sessions of a clinical art therapy program, twice a week with each 40 minutes long. As for measurement tools, a Rosenberg Self-Esteem Scale (RSES) and a State Anxiety Inventory for Children (SAIC) were used. And a Visual Analog Scale (VAS) was implemented before and after each session. Also, a Drawing a Person test was analyzed along with individual characteristics. RESULTS: 1) The self-esteem score after art-therapy was improved from 28.1+/-3.4 to 32.9+/-3.1 (P<0.001), 2) The Anxiety score after art-therapy was decrease from 34.6+/-3.7 to 26.8+/-2.8 (P<0.001), 3) Overall 8 sessions of each art-therapy, there were significant reduction in the pain scale score (least squares means: 2.5 (2.1~2.8), P<0.001). CONCLUSION: The study demonstrate positive effects of clinical art therapy on self-esteem, anxiety, and pain of pediatric burn patients.
Anxiety ; Art Therapy ; Burns ; Child ; Humans

Background: Patient safety has a direct impact on the patient’s health and life, so all members of the hospital should consider it first. Patient safety accidents are often occured by organizational problems rather than individual medical personnel. Therefore, effective interprofessional collaboration(IPC) among experts is essential, so interprofessional education(IPE) is considered important. Methods: : A prospective study method of one-group pretest-posttest design was used that provides IPE using active learning-oriented teaching methods for health workers in various occupations of various hospitals, and evaluates self-efficacy, communication confidence, and attitude toward IPE. Results: : 17 trainees from 8 hospitals were evaluated. First, the average of the awareness of patient safety culture was 3.62 points. Next, the score of each indicators increased in the pre-post evaluation. The average of communication confidence was from 3.73 to 3.95 points, self-efficacy was from 3.99 to 4.11 points, and attitude toward IPE was from 4.44 to 4.52 points, but not significant. Conclusions This study would have a great significance in that it was conducted on health workers in various occupations of various hospitals. As a result of a pre and post education survey conducted with trainees, the score was improved in communication confidence, self-efficacy, and attitude toward IPE. It seems to be due to the use of active learning teaching methods, and the active participation of trainees.

BACKGROUND: It is important to evaluate the patient presenting with non-traumatic chest pain in emergency department, and it is also difficult to classify appropriately. The purpose of this study is to predict probability of acute myocardial infarction(AMI) and assess the group for low probability of AMI that is target for observation-unit of chest pain in emergency department. METHODS: A prospective, clinical study was performed from March 1998 to August 1998 at the department of emergency medicine, Ewha Womans University Mokdong hospital. We classified high-probability group and low-probability group of AMI according to Goldman's algorithm and then compared with the final diagnosis. RESULTS: The study included 218 patients. 84 patients(39%) was the high-probability group and 134 patients(61%) was the low-probability group of AMI. As compared with final diagnosis, AMI was 47 patients(56%) among the high-probability group and 1 patient(0.7%) among the low-probability group. We observed sensitivity of 98%, specificity of 78% in predicting AMI. CONCLUSION: The classification according to Goldman's algorithm may be useful predictor of AMI and improve triage for emergency department patient with chest pain. It is also helpful for management of observation-unit of chest pain in emergency department.
Chest Pain* ; Classification ; Diagnosis ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Female ; Humans ; Prospective Studies ; Sensitivity and Specificity ; Thorax* ; Triage

Failure of automatic control of ventilation (Ondine's curse syndrome) is a rare syndrome that sometimes occurs following localized brainstem dysfunction. In this report, we present a case of a 52-year-old male who was admitted to the hospital with sudden-onset nausea. On examination, no lateralization signs were presented. After one hour, his consciousness was altered and he became apneic. After endotracheal intubation and mechanical ventilation, his mentality improved and he was able to ventilate spontaneously. Cranial magnetic resonance imaging demonstrated acute infarction in both cerebellar inferior aspects involving the right side of the medulla. Eleven hours later, the patient's consciousness altered again. Computed tomography demonstrated newly developed hydrocephalus and emergent craniotomy, and extraventricular drainage were performed. The patient improved in both consciousness and respiratory status but complained of mild ataxia and left arm weakness. We recommend cautious examination and early diagnosis and therapeutic decisions in cases of patients with atypical presentation of stroke.
Arm ; Ataxia ; Brain Infarction ; Brain Stem ; Brain Stem Infarctions ; Consciousness ; Craniotomy ; Drainage ; Early Diagnosis ; Humans ; Hydrocephalus ; Infarction* ; Intubation, Intratracheal ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nausea ; Respiration, Artificial ; Sleep Apnea, Central ; Stroke ; Ventilation

BACKGROUND: Recent advances have been made in the treatment of acute stroke, but the effectiveness of the new therapies is highly time-dependent. The purpose of this study is to investigate the factors that influence the time from symptom onset to hospital arrival and the total arrival delay time for patients with acute stroke. METHODS: A prospective registry of patients presenting to the ED with signs or symptoms of acute stroke was established at Ewha Womans University Mokdong and Dongdaeumn hospitals from March to December 1999. We analyzed the prehospital delay time(reaction interval and total arrival delay) and factors associated with delayed arrival at the hospital. RESULTS: The study included 256 patients(49% were women) with a mean age of 62+/-13 years. 50.9% of the patients arrived within 3 hours, and 94.9% patients arrived within 24 hours after onset of symptoms of acute stroke. The total arrival delay time was 180 minutes(median time), and the reaction interval was 60 minutes(median time). Transportation by 119 or 129 ambulances was linked to shorter delay(47 minutes). Age, mental status, and degree of disability were statistically significant factors associated with delayed arrival at the hospital. CONCLUSION: Age, mental status, and degree of disability were significant factors associated with delayed arrival at the hospital. For effective treatment of acute stroke patients, increased public awareness to use an ambulance with direct transport to the acute-care hospital required.
Ambulances ; Female ; Humans ; Prospective Studies ; Stroke* ; Transportation

PURPOSE: To determine the helmet use rate, factors affecting helmet use in Korea, and the effects of helmet use on injuries. METHODS: This is a prospective study with patients who visited two emergency centers in Seoul during 7 months due to accidents that they had while riding a motorcycle. We examined the patients' general characteristics, whether to wear a helmet, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) on admission, and whether to be hospitalized. In addition, factors such as the patients' position, accident season, day of the week, hour and whether to drink were analyzed to see if they affect helmet use and injuries. RESULTS: A total of 178 patients participated in this study, and 57.3% wore a helmet. Around 20% of patients had head injuries. Head injuries were more frequent in those who did not wear a helmet. According to the result of analyzing factors affecting helmet use, the helmet non-use rate was high in patients whose age was 30 or less and drinkers. For the two groups, the odds ratios for helmet non-use were 2.3 (95% CI 1.2~4.5) and 4.2 (95% CI 1.2~ 15.2), respectively. CONCLUSION: This study shows that helmet use can prevent head injuries in motorcycle patients. Thus, in order to prevent head injuries, helmet use should be increased and, for this, education and regulation on helmet use should be reinforced, particularly for those aged 30 or younger and drinkers.
Craniocerebral Trauma ; Education ; Emergencies ; Glasgow Coma Scale ; Head Protective Devices* ; Humans ; Injury Severity Score ; Korea* ; Motorcycles* ; Odds Ratio ; Prospective Studies ; Seasons ; Seoul

Metformin which is an oral hypoglycemic agents, acts by enhancing insulin sensitivity, decreasing hepatic glucose production and increasing peripheral utilization of glucose. Deliberate self poisoning with oral hypoglycemic agents is rare. The lactic acidosis associated with metformin toxicity is well described in the medical literature. Metformin overdose even in otherwise healthy patients may produce a profound and life threatening lactic acidosis. We report a case of massive metformin ingestion(75g) in a patient presenting with lactic acidosis and hypotension. She died 24h after presenting to our emergency department despite bicarbonate treatment and hemofiltration therapy.
Acidosis ; Acidosis, Lactic ; Emergencies ; Glucose ; Hemofiltration ; Humans ; Hypoglycemic Agents ; Hypotension ; Insulin Resistance ; Metformin

Background: Interprofessional collaborative practice (IPCP) is emphasized in medical care for patient safety. As patient care is provided by teams, interprofessional competence is required to ensure the quality and safety of care and should be taught as early as possible.In this study, we introduced a 2-week interprofessional education (IPE) curriculum and attempted to describe and evaluate its effectiveness among medical students. Methods: We developed a 2-week IPE course and gave it to third- or fourth-year medical students (n = 166) from 2018 to 2019. The curriculum was composed of interactive lectures, discussions, small-group discussions, and simulation and was given to diverse medical students. Students were asked to report their satisfaction with the IPE program, write a reflection paper, and complete readiness for interprofessional learning scale (RIPLS) questionnaires before, immediately after, and 4 months after the curriculum. We also obtained 360° evaluations of the students by other health professionals 1 year after the training. Results: The IPE program changed students' attitudes about interprofessional learning, from less favorable to more favorable. The 360° evaluation by nurses revealed that students became more favored as teammates (overall satisfaction with them as teammates increased from 3.1/5 to 3.4/5) compared to medical interns before IPE training, and complaints from nurses about medical interns were significantly less frequent 1 year after the training. Conclusion The IPE program was effective in preparing medical students for team based collaborative practice even though it was short and exposed once in the curriculum. Further extension to other medical schools is recommended