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: To manage a critically ill patient effectively, an emergency physician must make an accurate assessment of the patient's hemodynamic status. Although the hemodynamic status can be accurately measured through the use of a pulmonary artery catheter, this device has significant limitations in the emergency department. Instead, the most commonly used method of measuring cardiac output (CO) in the emergency department is transthoracic echocardiography (TTE). However, TTE has been reported to underestimate the CO. Impedance cardiography (ICG) is an established and accurate technique for noninvasive determination of hemodynamic parameters. Thus, this study aimed to assess the agreement between CO measurements made by using TTE and ICG. METHODS: In 20 healthy volunteers, the hemodynamic parameters (stroke volume and CO) obtained by TTE were compared with the parameters derived from simultaneous measurements by ICG. RESULTS: The mean stroke volumes and COs were 63.9+/-11.6 ml and 4.1+/-0.7 L/min, respectively, by TTE, and 77.2+/-10.2 ml and 5.0+/-0.6 L/min by ICG. The correlation coefficients for stroke volume and CO between TTE and ICG were 0.77 and 0.64. The mean difference in stroke volume between TTE and ICG was -13.3+/-6.4 ml (-19.5+/-10.5 %), and the mean difference in CO was -0.88+/-0.48 L/min (-20.1+/-11.6 %). CONCLUSION: In healthy volunteers, the comparison between TTE and ICG showed a good correlation for stroke volume and CO. However, the mean differences in stroke volume and CO between TTE and ICG were -19.5+/-10.5 % and -20.1+/-11.6 %, respectively.
Cardiac Output* ; Cardiography, Impedance ; Catheters ; Critical Illness ; Echocardiography* ; Emergencies ; Emergency Service, Hospital ; Healthy Volunteers ; Hemodynamics ; Humans ; Male* ; Pulmonary Artery ; Stroke Volume ; Volunteers*

PURPOSE: Plasma fibrin D-dimer (D-dimer) has been suggested as a potential screening marker of acute aortic syndrome (AAS) in the emergency department (ED). However, the appropriate thresholds of D-dimer for AAS have not yet been defined. Moreover, studies reporting determinants of D-dimer concentrations in AAS are scarce. METHODS: Data were collected retrospectively on patientsfor whom a D-dimer assay and enhanced computed tomography (CT) had been performed for differential diagnosis in the ED. The D-dimer assay used during the study was the quantitative latex agglutination assay. The study was conducted in a university ED with an annual census of 67,500 between March 2004 and February 2006. A receiver operating characteristics curve was used to find the optimal cutoff of the D-dimer to predict AAS in the ED. A multivariable linear regression analysis was used to identify factors associated with increased D-dimer concentrations in AAS. RESULTS: The enrolled patients (n=105) were divided into 2 groups according to enhanced CT findings: an AAS group (n=65) and a non-AAS group (n=40). The mean D-dimer level was higher in the AAS group (10.7+/-12.8 ug/mL) than in the non-AAS group (0.6+/-0.3 ug/mL)(p<0.001). The Ddimer test showed a 92.3% sensitivity, an 85.0% specificity, a 90.9% positive predictive value, an 87.2% negative predictive value, and a 90.5% accuracy for detection of AAS at a discriminate level of 1.0 ug/mL. Stratified age, smoking, extent of AAS, complications associated with AAS, and the time interval from symptoms to D-dimer testing were independently associated with D-dimer concentrations in AAS. CONCLUSION: At a discriminate level of 1.0 ug/mL, the Ddimer assay is a sensitive and specific test for the detection of AAS in the ED. D-dimer concentrations in AAS were significantly associated with stratified age, smoking, extent of AAS, complications associated with AAS, and the time interval from symptom onset to testing.
Agglutination ; Aorta ; Censuses ; Diagnosis, Differential ; Emergencies* ; Emergency Service, Hospital* ; Fibrin* ; Humans ; Latex ; Linear Models ; Mass Screening ; Plasma* ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Smoke ; Smoking ; Universities

PURPOSE: Effective chest compressions may improve the return of spontaneous circulation and positive neurologic outcomes in cardiac arrest victims. Out of concern for rescuer fatigue, guidelines for cardiopulmonary resuscitation (CPR) recommend that the individual applying chest compressions should be switched every 2 minutes, but there is little evidence to support this recommendation. In this study, we investigated whether or not changing the individual who is applying chest compressions every 2 minutes during cardiopulmonary resuscitation is appropriate or not. METHODS: We recruited health personnel working at one university hospital on a volunteer basis. On a randomly assigned day, we compared the effectiveness of the use of multiple rescuers following the 2 minute guideline, versus single rescuer (rescuer-limited) in performance of CPR. The resulting data was collected by use of CPR recording technology, and chest compression quality variables including compression rate, compression depth, proportion of adequate compression depth, and proportion of incomplete recoil were recorded. RESULTS: There were statistically significant improvements in the rescuer-limited trial outcome including average compression depth (p=0.013), proportion of adequate compression depth (p=0.027), and difference in reported fatigue (0.007). CONCLUSION: In this study, we found that a rescuer-limited method is more effective than the multiple rescuer method in terms of subjective fatigue and chest compression quality metrics.
Cardiopulmonary Resuscitation ; Fatigue ; Health Personnel ; Heart Arrest ; Humans ; Thorax