BACKGROUNDS: Headache is one of the common symptoms complained by patients at the emergency department. Postural headache is the characteristic symptom that is aggravated at upright position and relieved at recumbent position. This postural headache is associated with low cerebrospinal fluid (CSF) pressure. Spontaneous intracranial hypotension(SIH) is an unusual syndrome of postural headache and low CSF pressure without a precipitating event. The diagnosis of SIH is confirmed by 60mmH2O or less CSF opening pressure on lumbar puncture. However, the cases of SIH with normal CSF opening pressure have been reported. so it is needed to complement the diagnostic criteria of SIH. METHODS: A retrospective descriptive study with reviewing medical records of 10 patients who had been admitted at Asan Medical Center from Apr. 1995 to Jul. 1999 was done. Analyses were done on 22 variables of age, sex, clinical symptoms, spinal analysis findings, radiologic findings and therapeutic modality. Fisher's exact test and Mann-Whitney test were applied for statistical analysis (p-value < 0.05). RESULTS: 1. The male to female ratio was 3 : 7, and the mean age was 37.30+/-5.96 years. 2. Postural headache was characteristic symptom & complained by all patients. 3. The mean CSF pressure was 22.8+/-30.8 mmH2O. 4. Brain MRI demonstrated the pachymeningeal enhancement in all patients. 5. Radioisotope cisternography demonstrated slow ascent of tracer to the cerebral convexity in 88.9% patients, early soft tissue uptake suggestive of CSF leakage & rapid urinary accumulation of tracer in 66.7% patients, respectively. 6. 90.0% of all patients were recovered with autologous epidural blood patches, and 10.0% were recovered with conservative management. CONCLUSION: The SIH is an unusual syndrome. but we can diagnose the SIH in the patient, complains of a postural headache, if any following two or more criteria are present. 1. 60mmH2O or less CSF opening pressure on lumbar puncture. 2. Brain MRI finding : the pachymeningeal enhancement. 3. Cisternography findings : slow ascent of tracer to the cerebral convexity, early soft tissue uptake suggestive of CSF leakage & rapid urinary accumulation of tracer.
Blood Patch, Epidural ; Brain ; Cerebrospinal Fluid ; Chungcheongnam-do ; Complement System Proteins ; Diagnosis ; Emergency Service, Hospital ; Female ; Headache ; Humans ; Intracranial Hypotension* ; Magnetic Resonance Imaging ; Male ; Medical Records ; Retrospective Studies ; Spinal Puncture

BACKGROUND: When using the data based on history, ECG and cardiac enzyme, two to eight percent of patients with acute chest pain are incorrectly perceived as being at low risk and therefore sent home mistakenly. It is known that changes of Doppler parameters appear first, before regional asynergy in 2D-echocardiography, electrocardiographic change and chest pain. however, the clinical application of Doppler information in the diagnosis of acute myocardial infarction remains uncertain, especially in elderly patients. METHODS: From March 1998 to March 1999, pulsed wave Doppler echocardiography was performed in patients with acute myocardial infarction within 6 hours, and Doppler parameters were evaluated. Each Doppler parameters were compared between elderly (age > or =65) and young(age < 65) groups. RESULT: E peak velocity & E/A ratio showed significant differences between two groups(p<0.05). especially, Stroke volume, isovolumic relaxtion time & myocardial performace index showed marked difference(p<0.01). CONCLUSION: Diastolic Doppler parameters of elderly group were significantly changed than younger group. however systolic Doppler parameters were relatively preserved. Among Doppler parameters, myocardial performance index is a conceptrally new, simple and reproducible Doppler index of combined systolic and diastolic myocardial performance, and it may be useful as screening test for patients with AMI in elderly patients.
Aged ; Chest Pain ; Diagnosis ; Echocardiography, Doppler ; Electrocardiography ; Humans ; Mass Screening ; Myocardial Infarction* ; Stroke Volume

PURPOSE: The use of mechanical compression devices may be considered as an alternative method to treat cardiac arrest. This study aimed to assess the influence of vertical location of cardiac arrest scene to survival rate. Furthermore, it set out to examine the effect of mechanical compression devices on the survival rate. METHODS: This is retrospective, observational study of cardiac arrest patients from Gangdong-gu, Seoul between September 2015 and February 2016. The data were collected by 119 rescue records and cardiac arrest summary list, and the resuscitation result variables were analyzed. We also conducted a survey on 119 paramedics regarding the subjective valuation and drawback of using mechanical compression devices. RESULTS: The odd ratio of return of spontaneous circulation (ROSC) in vertical location of cardiac arrest scene was 0.40 (95% confidence interval, 0.17 to 0.98; p=0.044). The odd ratio of survival to admission comparing manual compression with mechanical compression was 0.73 (95% confidence interval, 0.26 to 1.99; p=0.532). A total of 54 paramedics completed the survey, and 46 (85.2%) of them answered that there was a decrease in the quality of chest compression if the scene was other than the 1st floor. Fifty-three (93.1%) replied that mechanical compression devices can be a counter-measure. CONCLUSION: Vertical location of cardiac arrest scene independently effects ROSC of out of hospital cardiac arrest. However, there was no difference in the survival rate between manual and mechanical compressions.
Allied Health Personnel ; Cardiopulmonary Resuscitation* ; Heart Arrest* ; Humans ; Methods ; Observational Study* ; Out-of-Hospital Cardiac Arrest* ; Resuscitation ; Retrospective Studies* ; Seoul ; Survival Rate ; Thorax

Objective: Bystander cardiopulmonary resuscitation is important for the survival of cardiac arrest patients. The rapid recognition of cardiac arrest by dispatchers leads to quicker initiation of bystander cardiopulmonary resuscitation. This study examines the use of video phone by dispatchers in recognizing cardiac arrest. Methods: Between June to October 2018, 227 participants were recruited (114 lay people and 113 dispatchers) for this study. Lay people participants answered prepared questionnaires after watching 6 scenario video clips of a collapsed virtual patient with unresponsiveness. Dispatchers were divided into two groups: audio call group and video call group. The audio call group judged for occurrence of a cardiac arrest in the 6 scenarios, referring only to questionnaires of the lay people. The video call group judged the same scenarios referring to questionnaires and scenario video clips. The score of correct answers of each scenario was subsequently analyzed. Results: Significant difference was obtained for the total score among the audio call group and the video call group (3.67 ±1.3 vs. 4.66±1.11, respectively; P<0.001). In 2 scenarios concerning cardiac arrest with gasping, the correct answer rate was higher in the video call group (63.9% vs. 85.2%, P<0.001; 59.5% vs. 74.8%, P=0.014). In 2 other scenarios showing non-cardiac arrest with normal breathing, the correct answer rate was also higher in the video call group (52.7% vs. 71.4, P=0.010; 38.2% vs. 63.6%, P<0.001). Conclusion This study determined that compared to the audio call group, dispatchers of the video call group were more accurate in recognizing cardiac arrest. This indicates that video phones are more helpful in determining gasping and in discerning cardiac arrest with syncope or seizure.

Objective: The incidence of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest has increased rapidly over the past 10 years. On the other hand, automated external defibrillators (AEDs) are still only used in a minority of cases. This study investigated the feasibility of mobile video call guidance to facilitate AED use for laypeople. Methods: Ninety laypersons were randomized into three groups: mobile video call guided, voice call guided, and nonguided. The participants were exposed to a simulated cardiac arrest requiring AED use and guided by video call, voice call, or not. The simulation experiments were saved as a video clip, and other researchers blinded to simulation assessed the performance according to a prespecified checklist after the simulations. The performance score and analyzed time intervals from AED arrival to defibrillation in the three groups were compared. Results: The basic characteristics were similar in the three groups. Performance scores in the checklist for using AEDs were higher in the mobile video call guided group, particularly in a category of ‘power on AED’ and ‘correctly attaches pads’ than non-guided groups. The performance scores in the category of ‘safely delivers a shock and resume compression’ were also higher in the mobile video call group. On the other hand, the time interval to defibrillation was significantly longer in the mobile video call group. Conclusion This study showed that mobile video call guidance might be an alternative method for laypeople to facilitate AED use, but further well-designed research will be needed.

Objective: The coronavirus disease 2019 (COVID-19) pandemic saw rising cases of out-of-hospital cardiac arrests. In addition, there was an increase in the number of cardiac arrest terminations. This study analyzes the 3-year status (2018 to 2020) of out-of-hospital cardiac arrest resuscitation terminations. Methods: This study is a retrospective observational study based on the diary of 119 first aid activities in the Seoul area. Factors analyzed included patient demographics, history, location of occurrence, witness status, cause of cardiac arrest, electrocardiogram rhythm, reasons for cardiac arrest termination, and hospital transfer. Data obtained from the periods January 1, 2018, to December 31, 2019 (defined as the pre_COVID-19 period) and from January 1, 2020, to December 31, 2020 (defined as the COVID-19 period) were compared and analyzed. Results: There was an increase in the number of terminated resuscitation cases during the study period. Most cases were elderly men with chronic disease who underwent asystole arrest at home. The reasons for the termination of resuscitation were obvious evidence of death, refusal of cardiopulmonary resuscitation (CPR) by the guardian, medical guidance, and cessation of prior life-sustaining treatment. During the COVID-19 pandemic, clear evidence of death and refusal of CPR by caregivers were statistically and significantly increased. Conclusion The results of this study indicate a rise in the number of cases subjected to termination of resuscitation during the COVID-19 period. It is, therefore, necessary to find a way to improve this situation.

Objective: Automated external defibrillators (AEDs) have been installed for use on out-of-hospital cardiac arrest (OHCA) patients in Korea. However, there are very few cases in which the AED was used before the 119 paramedics arrived in cardiac arrest patients. This study investigated whether the locations of the AED in Korea were appropriate. Methods: This study analyzed the locations of OHCA patients, AED installations, and the number of OHCA patients within a 100-m grid around the AEDs in public and residential areas by province. The information on acute cardiac arrest patients was obtained from the original data of the Korea Disease Control and Prevention Agency. The installation of AEDs is registered with the National Emergency Medical Center. Results: The number of OHCA patients in public and residential areas was 28,434 and 95,713, respectively, and the number of installed AEDs in these locations was 15,387 and 11,420, respectively. The number of OHCA patients per AED was 1.8 in public areas and 8.4 in residential areas, and there were significant differences by province (P<0.001). The percentage of OHCA patients within the 100-m grid around the AEDs was 21.9% and 23.1% in public and residential areas, respectively (P<0.001). Conclusion There were significant differences in the AED placement locations in public and residential areas by province. In addition, the percentage of OHCA patients within a 100-m grid around AED was only 22.9%, indicating that the number of AEDs was insufficient. Efforts to enhance the AED placements and monitoring are needed to resolve the regional deviations.

PURPOSE: Recently, the bispectral index monitor has been promoted as an objective measure of sedation depth during pediatric procedural sedation in the emergency department (ED). However, rectal administration of thiopental sodium for pediatric procedural sedation has not been validated. METHODS: Patients aged one to seven years and undergoing primary closure procedures for simple facial and hand laceration in the ED were enrolled. Procedural sedation was performed by rectal administration of thiopental sodium. The bispectral index score and the Ramsay Sedation Scale were recorded every 10 minutes during sedation. The investigator and treating physician were blinded to bispectral index scores, which were later correlated with the Ramsay Sedation Scales values. Receiver operator characteristic (ROC) curves were conducted to determine the ability of the bispectral index score to discriminate various thresholds of sedation depth. RESULTS: One hundred thirty paired measurements were obtained from 12 patients. The Spearman's correlation coefficient for paired measurements, was -0.906 (95% confidence interval: [-9.8] ~ [-8.1], p<0.001). ROC curve analysis demonstrated a high discriminatory power for bi-spectral index scores in predicting the level of sedation, with areas under the curve at least 0.95 for all Ramsay Sedation Scale thresholds. CONCLUSION: Bispectral index monitoring can serve as a useful, objective measure of sedation depth in pediatric procedural sedation with rectal administration of thiopental sodium in the ED.
Administration, Rectal ; Consciousness Monitors* ; Emergencies* ; Emergency Service, Hospital* ; Hand ; Humans ; Lacerations ; Research Personnel ; ROC Curve ; Thiopental* ; Weights and Measures

PURPOSE: Effectiveness of the performance of bystander cardiopulmonary resuscitation (CPR) has a decisive impact on the outcomes for out-of-hospital cardiac arrest patients who receive it. After initial CPR education, CPR performance for those trained declines over time. Public education in CPR is commonly recommended to be repeated every 2 years. In this study, we evaluated the willingness of those who have been CPR trained to perform CPR as impacted by their training experience. METHODS: The staff of a small firm received 2 hours of primary CPR education. Two years later, their CPR training was repeated in an identical manner. Participants answered a questionnaire regarding their willingness to perform bystander CPR. Those who answered that they wouldn't perform bystander CPR were asked to select their reason. We also inquired about what they viewed as the most difficult phase of CPR performance, and collected their opinions about the overall necessity and appropriate time period for re-education. RESULTS: Those who answered 'definitely yes' to 'willingness to perform to CPR' increased from 36.6% before primary CPR education to 74.2% afterward. But 2 years later and before re-education, only 30.1% answered 'definitely yes' to 'willingness to perform CPR'. Meanwhile, 41.2% and 29.4% answered that 'fear of legal liability' and 'fear of poor knowledge/performance' were the reasons why they would not perform bystander CPR. Ventilation was the most difficult stage in CPR identified by 34% of the participants, and 18.4% answered that chest compression was the most difficult stage in CPR. 93.6% answered that they should receive CPR re-education. CONCLUSION: The willingness to perform bystander CPR declined significantly after 2 years. Therefore routine public re-education for bystander CPR is necessary.
Cardiopulmonary Resuscitation ; Humans ; Out-of-Hospital Cardiac Arrest ; Surveys and Questionnaires ; Thorax ; Ventilation

Early defibrillation with an automated external defibrillator (AED) is crucial to survival success in sudden cardiac arrest. Dissemination of public-access AEDs have increased the frequency of early defibrillations and contributed to improved outcomes after out-of-hospital cardiac arrests (OHCAs). However, public-access AEDs are not yet widely-disseminated in Korea. We report the first survival case of an OHCA patient who received shocks from a public-access AED in Korea.
Death, Sudden, Cardiac ; Defibrillators ; Heart Arrest ; Humans ; Korea ; Out-of-Hospital Cardiac Arrest ; Shock