Objective: This randomized crossover simulation study aimed to compare the effectiveness of chest compressions, performed during 10 minutes of cardiopulmonary resuscitation, in three different compression postures: standing posture (SP), single-leg kneeling posture (SLKP) and both legs kneeling posture (BLKP) on a manikin lying on a bed. Methods: Enrolled participants were doctors, nurses and emergency medical technicians who worked in the emergency department and performed chest compressions (CCs) without ventilation for 5 sessions (10 minutes) in the three compression postures from June to August 2019. The chest compression parameters (CCPs) such as compression depth, compression rate (CR), the accuracy of compression depth (ACD) and accuracy of relaxation (AR) were collected by the Resusci Anne PC skill report system. The statistical differences of CCPs between three postures were analyzed. Results: A total of 32 participants were enrolled in this study. There were no significant differences between SP, SLKP and BLKP on compression depth (52.6 vs. 53.2 vs. 50.9 mm, P>0.05), CR (110.2 vs. 111.8 vs. 111.6 compressions/min, P>0.05), ACD (43.7% vs. 47.0% vs. 46.3%, P>0.05), and AR (99.4% vs. 99.0% vs. 99.3%, P>0.05). There were no significant differences in CCPs according to chest compression time in the three postures. However, there was a significant difference between the SP and BLKP (16.0 vs. 14.0, P=0.023) on the Borg scale of subjective fatigability. Conclusion In our study, when rescuers performed chest compression on a hospital bed, the parameters of CCs for the three compression postures were similar.

Objective: This randomized crossover simulation study aimed to compare the effectiveness of chest compressions, performed during 10 minutes of cardiopulmonary resuscitation, in three different compression postures: standing posture (SP), single-leg kneeling posture (SLKP) and both legs kneeling posture (BLKP) on a manikin lying on a bed. Methods: Enrolled participants were doctors, nurses and emergency medical technicians who worked in the emergency department and performed chest compressions (CCs) without ventilation for 5 sessions (10 minutes) in the three compression postures from June to August 2019. The chest compression parameters (CCPs) such as compression depth, compression rate (CR), the accuracy of compression depth (ACD) and accuracy of relaxation (AR) were collected by the Resusci Anne PC skill report system. The statistical differences of CCPs between three postures were analyzed. Results: A total of 32 participants were enrolled in this study. There were no significant differences between SP, SLKP and BLKP on compression depth (52.6 vs. 53.2 vs. 50.9 mm, P>0.05), CR (110.2 vs. 111.8 vs. 111.6 compressions/min, P>0.05), ACD (43.7% vs. 47.0% vs. 46.3%, P>0.05), and AR (99.4% vs. 99.0% vs. 99.3%, P>0.05). There were no significant differences in CCPs according to chest compression time in the three postures. However, there was a significant difference between the SP and BLKP (16.0 vs. 14.0, P=0.023) on the Borg scale of subjective fatigability. Conclusion In our study, when rescuers performed chest compression on a hospital bed, the parameters of CCs for the three compression postures were similar.

BACKGROUND: The purpose of this retrospective and prospective study is to evaluate the efficiency of ultrasound (US) guidance as a method of decreasing the malposition rate of central venous catheterization (CVC) in the emergency department (ED). METHODS: We retrospectively enrolled 379 patients who underwent landmark-guided CVC (Group A) and prospectively enrolled 411 patients who underwent US-guided CVC (Group B) in the ED of a tertiary hospital. Malposition of the CVC tip is identified when the tip is not located in the superior vena cava (SVC). In Group B, we performed US-guided intravascular guide-wire repositioning and then confirmed the location of the CVC tip with chest radiography when the guide-wire was visible in any three other vessels rather than in the approached vessel. In the case of a guide-wire inserted into the right subclavian vein (SCV), the left SCV and both internal jugular veins (IJV) were referred to as the three other vessels. The two subject groups were compared in terms of the malposition rate using Fisher's exact test (significance = p < 0.05). RESULTS: There were 38 malposition cases out of a total of 790 CVCs. The malposition rates of Groups A and B were 5.5% (21) and 4.1% (17), respectively, and no statistically significant difference in malposition rate between the two groups was found. In Group B, the malposition rate was decreased from 4.1% (17) to 1.2% (5) after the guide-wire was repositioned with US guidance, which led to a statistically significant difference in malposition rate (p < 0.01). CONCLUSIONS: The authors concluded that repositioning the guide-wire with US guidance increased correct placement of central venous catheters toward the SVC.
Catheterization, Central Venous* ; Central Venous Catheters* ; Emergencies ; Humans ; Jugular Veins ; Prospective Studies ; Radiography ; Retrospective Studies ; Subclavian Vein ; Tertiary Care Centers ; Thorax ; Ultrasonography ; Vena Cava, Superior

We reported a case of acute intoxication by tramadol and zolpidem, resulting in QT prolongation in a patient. A 38-year-old male patient presented to the emergency department (ED) because of poisoning from 3 g of tramadol and 50 mg of zolpidem 4 hours before. During supportive treatment, he developed QT prolongation without clinical manifestations. He was discharged 5 days after admission without any sequelae. We measured the blood and urine concentrations of tramadol and zolpidem at various time points, which revealed a blood tramadol concentration-dependent change in QT intervals and an increased blood tramadol concentration at 8 hours after the ED visit. Tramadol and zolpidem were metabolized by the same enzyme, cytochrome P450 3A4. Therefore, competitive inhibition may increase drug toxicity. In addition, the blood concentration of tramadol may increase and result in QT prolongation even after appropriate initial treatment.

OBJECTIVE: Central venous catheter (CVC) misplacement can result in incorrect readings of the central venous pressure, vascular erosion, and intravascular thrombosis. Several studies have examined the correlation between the guidewire J-tip direction and misplacement rate. This study examined whether the guidewire J-tip direction (cephalad vs. caudad) affects the misplacement rate in right subclavian venous catheterization. METHODS: This prospective randomized controlled study was conducted between February 2016 and February 2017. The subjects were divided into two groups (cephalad group vs. caudad group) and the misplacement rate was compared according to guidewire J-tip direction in each group. RESULTS: Of 100 patients, the cephalad and caudad groups contained 50 patients each. The age, sex, and operator experience were similar in the two groups. In the cephalad group, misplacement of CVC insertion into the ipsilateral internal jugular vein occurred in two cases. In the caudad group, misplacement of CVC insertion into the contralateral subclavian vein occurred in one case, with loop formation in the brachiocephalic trunk in one case. Guidewire J-tip direction showed no significant correlation with CVC misplacement. CONCLUSION: The guidewire J-tip direction does not influence the rate of misplacement.
Brachiocephalic Trunk ; Catheterization* ; Catheters* ; Central Venous Catheters ; Central Venous Pressure ; Humans ; Jugular Veins ; Prospective Studies ; Reading ; Subclavian Vein ; Thrombosis

Objective: The diagnostic accuracy of novice residents in evaluating the scrotal pathology by point-of-care (POC) ultrasonography(US) was compared with that by the conventional US to determine the level of experience required toachieve competency. Methods: Three novice residents underwent a one-day training course on identifying scrotal pathologies using POC US.They performed POC US on patients with an acute scrotum to identify five pathological findings. The diagnosis was confirmedby conventional scrotal US. The sensitivity and specificity of POC US by novice residents were calculated, and thechanges in sensitivity and specificity over time were observed. Results: Sixty-two patients were included; the overall sensitivity and specificity were 76.7% (95% confidence interval [CI],61.3%-88.2%) and 78.9% (95% CI, 54.4%-93.9%), respectively. Decreased blood flow in the testicle showed very goodspecificity (100%; 95% CI, 93.8%-100.0%). The sensitivity and accuracy were variable at first 18 scans of each resident,but increased after 18 scans and were maintained over time. Conclusion Although the diagnostic accuracy of novice residents in evaluating the scrotal pathology using POC US wasvariable at first, the accuracy improved over time, especially after 18 scans of each resident. Nevertheless, larger, longtermresearch is needed to confirm the results of this study.

OBJECTIVE: Radio-contrast abdomino-pelvic computed tomography (APCT) is considered the gold standard diagnostic tool for an acute abdomen in the emergency department. On the other hand, APCT has a risk of contrast-induced nephropathy. Emergency physicians evaluate the creatinine (Cr) level prior to taking a APCT for the above reason but it takes time to evaluation the serum Cr level. This study hypothesized that Cr measured by a point-of-care test (POCT) can shorten the time to making clinically important decisions for patients with an acute abdomen. METHODS: This prospective randomized study was conducted between March 2017 and October 2017. The subjects were divided into two groups (Cr measured by laboratory vs. Cr measured by POCT). To analyze the clinical acceptability for creatinine, agreement was demonstrated graphically by Bland-Altman plots. This study compared the time to make a clinically important decision by physicians and the length of stay at the emergency department in both groups. RESULTS: A total of 76 patients were eligible for the study, 38 patients were assigned to each group. There was no statistically significant difference in the time to the first medical examination (P=0.222) and emergency department stay time (P=0.802). On the other hand, the time to recognition of the Cr level (P < 0.001), time to performing APCT (P < 0.001), time to decision making (P < 0.001), and time to initiation of treatment (P < 0.001) were shortened significantly in the point-of-care creatinine group. CONCLUSION: In this study, the POCT for creatinine can allow rapid decision making by shortening the time to performing the radio-contrast APCT than the laboratory for patients with an acute abdomen.
Abdomen, Acute* ; Creatinine* ; Decision Making* ; Emergencies ; Emergency Service, Hospital ; Hand ; Humans ; Length of Stay ; Point-of-Care Systems* ; Prospective Studies

OBJECTIVE: Malposition of central venous catheterization (CVC) may cause vascular related complications and catheter dysfunctions. The aim of this study was to reduce the malposition rate of CVC by repositioning the malposition after confirming the location of the guide-wire with ultrasound (US) guidance. METHODS: This research assessed the before study (group A) from January to December 2016 and after study (group B) from January to December 2017 in the emergency department. CVCs were performed using the anatomical landmark technique (group A) and US guided technique (group B). In group B, if the guided-wire was misplaced, it was drawn back and repositioned under US guidance. The final location of the catheter tip was confirmed by chest X-ray. The rate of malposition before and after repositioning of the two groups was compared. RESULTS: The subjects were group A (694 cases) and group B (619 cases) with a total of 1,313 patients. The rate of malposition before repositioning of the two groups were 16 cases (2.3%) and 13 cases (2.1%), respectively, and no statistically significant difference was observed (P>0.05). In group B, there were 10 cases (1.6%) of guidewire malposition that was identified and three cases (0.5%) of catheter malposition could not be identified under US examination. The malpositioned guidewires were all corrected by repositioning under ultrasound guidance. The rate of malposition after repositioning of the two groups were 2.3% (n=16) and 0.5% (n=3), respectively, and a statistically significant difference was observed (P=0.009). CONCLUSION: With US guidance, confirming the location and repositioning CVC guidewire can reduce the malposition rate in CVCs.
Catheterization, Central Venous* ; Catheters ; Central Venous Catheters* ; Emergency Service, Hospital ; Humans ; Methods* ; Moving and Lifting Patients ; Thorax ; Ultrasonography*