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

No abstract available.
Adenocarcinoma* ; Diagnosis* ; Lung Neoplasms ; Lung* ; Neoplasm Metastasis*

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

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

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

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 "Out-of-hospital Utstein Style" is an internationally recommended guideline for reporting outcome data for out-of-hospital resuscitation events. This study was designed to evaluate the current status of out-of-hospital cardiopulmonary resuscitation (CPR) in a tertiary emergency department and to provide basic data for a unified report on guidelines for resuscitation in Korea. METHODS: A clinical analysis of the out-of-hospital cardiac arrest (OHCA) patients, CPR performed in a tertiary emergency department, from July 1995 to December 2002 was conducted. The evaluation was made using Utstein reporting guidelines. RESULTS: Four hundred forty-nine patients were included in this study. The cardiac arrests were caused by non-cardiac medical diseases (41.9%), cardiac diseases (39.6%), unknown (10.0%), and trauma (8.5%). The initial electrocardiogram (ECG) showed asystole in 58.6% of the cases, other rhythms in 29.4%, and ventricular fibrillation/ventricular tachycardia (VF/VT) in 12.0%. Spontaneous circulation was restored (ROSC) in 41.2% of the cases. Twenty-four (5.3%) patients with witnessed and cardiogenic cardiac arrests had VF/VT on initial ECG, and of them, 5 (20.8%) patients were discharged alive. The mean circulatory arrest time was 19.7+/-13.6 minutes, and it was shorter in patients with ROSC (16.9+/-11.6) than in patients without ROSC (22.1+/-14.7, p= 0.003). CONCLUSION: The overall survival rate of OHCA patients was 6.7%, which was poorer than those of western countries. The overall duration from collapse to advanced cardiac life support (ACLS) was 19.7 minutes, which was too long. Major factors contributing to the low survival rate were most likely the lack of bystander CPR, delay in activating the emergency medical system (EMS), and inappropriate CPR by the EMT. We should make every effort to improve these areas.
Advanced Cardiac Life Support ; Cardiopulmonary Resuscitation* ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Heart Arrest ; Heart Diseases ; Humans ; Korea ; Out-of-Hospital Cardiac Arrest* ; Resuscitation ; Survival Rate ; Tachycardia

PURPOSE: The ultimate goals of wound management are to avoid infection and to achieve a functional and cosmetically cceptable scar. The authors intended to determine the infection rate, as well as the patients, and the wounds, characteristics, associated with wound infection and with suboptimal appearance after traumatic wound management. METHODS: This prospective study was performed from Dec. 2002 to Aug. 2003 at Ewha Womans University Mokdong Hospital. Structured data sheets were completed at the times of the patient's Emergency Department visit and the Out Patient Department (OPD) follow-ups. Infection was determined at the time of follow-up, and a cosmetic score was determined at the time of suture removal. A multivariate analysis was used to determine the adjusted odds ratio (OR) of infection. RESULT: Of the 401 patients enrolled, infection was developed in 43 patients (10.7%). The characteristics associated with wound infection on multivariate analysis were age (adjusted OR per years, 1.024; 95% CI=1.010 to 1.037) and bite wounds (adjusted OR 8.645; 95% CI=2.753 to 27.150). A wound location on the head was associated with a lower risk of infection (adjusted OR 0.294; 95% CI=0.150 to 0.563). Suboptimal wound appearance increased with infection (p<0.0001). CONCLUSION: Both the patients and the wound's characteristics have influence on the likelihood of infection in cases of traumatic wounds. We found that increasing age, and bite wounds were associated with high risk of infection. Wound on the head were associated with lower risk of infection. Education were provided to patients. Efforts are needed.
Cicatrix ; Education ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Head ; Humans ; Multivariate Analysis ; Odds Ratio ; Prospective Studies ; Risk Factors* ; Sutures ; Wound Infection ; Wounds and Injuries*

PURPOSE: We have evaluated type of medical errors and severity of results in the emergency department (ED). We also analyze the contributory factors of medical errors for the patient's safety and the quality improvement. METHODS: This study the was prospectively performed from May to August 2005. Medical errors that occurred in the ED were reported anonymously by emergency physicians. The type of medical errors and contributory factors were reported. The severity levels of errors were categorized into 5 levels: level 1- life threatening consequences; level 2- potentially life or limbs threatening consequences; level 3- serious failure or delay of diagnosis or treatment; level 4- inappropriate or unnecessary delay or treatment; level 5- no harm. RESULTS: The total number of patients admitted in the ED during the study period was 16,513, and 177 errors (1.5 errors/day) reported in 160 patients (9.7/1,000 patients). The most frequently occurring medical error was order omission (18.0%), but interpretation errors (11.3%) resulted in the most serious consequences (3.6+/-1.2). More than half of medical errors were no harm (51.4%). Educational and environmental (61 errors) factors were the most frequent causes of medical errors. CONCLUSION: Medical errors frequently occur in the ED. Reducing ED errors will require the improvement of ED environments, better communication, and reinforcement of education by supervising faculty members.
Anonyms and Pseudonyms ; Diagnosis ; Education ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Extremities ; Humans ; Medical Errors* ; Prospective Studies ; Quality Improvement

BACKGROUND: Arginine vasopressin (AVP) is widely used as a vasopressor agent. Some recent studies have suggested that AVP may exert an immunomodulatory effect. However, the mechanism about the anti-inflammatory effect of AVP is not well known. We investigated the effect of AVP on the ihibitor of kappa B (IkappaBalpha)/nuclear factor-kappa B (NF-kappaB) pathway in RAW 264.7 cells. METHODS: Cultured RAW 264.7 cells were pretreated with AVP and stimulated with lipopolysaccharide (LPS). To evaluate the effect of AVP on inflammatory cytokines, the concentration of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were assessed by an enzyme-linked immunosorbent assay technique. The expression of IkappaBalpha and nuclear translocation of NF-kappaB p65 were measured by Western blotting, and IkappaB kinase (IKK) activity was analyzed by an in vitro immune complex kinase assay. To confirm the AVP effect on IkappaBalpha/NF-kappaB cascade and via V2 receptor, we added tolvaptan (V2 receptor antagonist) after AVP pretreatment. RESULTS: The increase of IL-6 and TNF-alpha in LPS-stimulated RAW 264.7 cells was suppressed by a treatment with AVP. Pretreatment of AVP inhibited increasing of IKK activity and IkappaBalpha degradation induced by LPS in RAW 264.7 cells. Furthermore, LPS induced and NF-kappaB transcription was inhibited by AVP pretreatment. The observed changes in IKK activity, IkappaBalpha degradation and NF-kappaB transcription by AVP was abolished by tolvaptan treatment. CONCLUSIONS: Our results suggest that AVP showed anti-inflammatory effect on LPS-induced IkappaBalpha/NF-kappaB cascade in mouse macrophages via V2 receptors.
Animals ; Antigen-Antibody Complex ; Arginine Vasopressin ; Blotting, Western ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; I-kappa B Kinase ; Interleukin-6 ; Macrophages ; Mice ; NF-kappa B ; Phosphotransferases ; Receptors, Vasopressin ; Tumor Necrosis Factor-alpha