BACKGROUND: Provision of early adequate chest compression remains a standard of care for optimal outcome in cardiopulmonary arrest. Inadequate chest compression during CPR may result in the insufficient blood flow to preserve critical organ function. Therefore, authors performed this study to characterize fatigue-induced deterioration in the adequacy of closed-chest compression performed over period 5 minutes and to determine whether CPR providers recognize the effects of fatigue on compression adequacy. METHOD: Prospectively we carried out the study with an electronic CPR teaching mannequin(ResusciAnnie with Skillmeter; Laerdal) placed on a patient stretcher. The mannequin was equipped with a real-time remote display that records the numbers of total and correct compressions. Compression are judged as correct by the mannequin if both depth and placement are appropriate in keeping with standard advanced cardiac life support guidelines. Our study subjects were 27 nurses and doctors, each with certification of BLS and experience of CPR in ED. Each subject performed a 5 minute session of chest compressions. Also subjects were asked to verbally indicate the point during their 5 minute compression period at which they felt too fatigued to provide effective compressions. For statistical analysis, one-way repeated-measures ANOVA and regression test was used. RESULT: The number of total compressions attempted per minute did not decrease significantly(P=.565). But we found 81.0% of compressions performed during the first 1 minute to be correct. The percentages for minutes 2 through 5 were decreased significantly as follows: 73.0%, 68.0%, 65.0%, 57.0%(P=.0003). Regression analysis revealed a decrement in compression adequacy of 13.0% per minutes after the first 1 minute of compression. The time of indicated fatigue was 220+/-29 seconds(mean+/-SD) CONCLUSION: Although compression rate was maintained over time, chest compression quality declined significantly over the study period. Because CPR providers could not recognize their ability to provide proper compression, cardiac arrest team leaders should carefully monitor compression adequacy and change the CPR providers each 3 minutes during CPR to assure maximally effective care for patients receiving CPR.
Advanced Cardiac Life Support ; Cardiopulmonary Resuscitation* ; Certification ; Fatigue ; Heart Arrest ; Humans ; Manikins ; Prospective Studies ; Standard of Care ; Thorax

No abstract available.

No abstract available.
Animals ; Evoked Potentials* ; Evoked Potentials, Motor* ; Rats* ; Spinal Cord Injuries* ; Spinal Cord*

Two kinds of copper-pure and 70% dilute alloy suspension were introduced into the vitreous of albino rabbits, and electron microscopical observation was carried out on the retinal tissue after several periods from 1 day up to 60 days. Major changes are as follows: 1. Early response of rabbit retina with pure copper foreign body exhibited severe and diffuse destruction with much deposition of particles mainly in nerve fiber layer. The influence of 70% copper alloy to the retinal tissues tended to demonstrate mild, localized and delayed in occurrence. 2. In the nerve fiber layer where the tissue disintegration took place Muller cell demonstrated the features of mitosis and proliferation. Including this rare incidence, it is possible to conclude that Muller cell proliferation occur in any part of the retina if the condition allows. 3. Cytoid bodies mainly consisting with glycogen aggregates within the Miiller cell processes in nerve fiber layer was one of prominent pictures in early stage. 4. Muller cells took an important role in reparative process replacing the destructive portion of the retinal cells with the extension of the same cells beyond the external limiting membrane toward the choroid. 5. At the late stage, the Muller cells contained abundant filaments replacing the reduced number of smooth surfaced endoplasmic reticulum and other organells. That implicats the enhancement of supportive mechanism at the occasion of the disintegration of retinal tissue prolonged. 6. A relatively early sign was active phagocytosis of retinal pigment epithelial cells engulfing the reminiscent fragment of ouer pigment of visual cells.
Alloys ; Cell Proliferation ; Choroid ; Copper ; Endoplasmic Reticulum ; Ependymoglial Cells ; Epithelial Cells ; Foreign Bodies ; Glycogen ; Incidence ; Membranes ; Mitosis ; Nerve Fibers ; Phagocytosis ; Rabbits ; Retina* ; Retinaldehyde

In response to modern events, every nation endeavors to develop plans to meet the challenges of disasters, but it is not possible to be prepared for every event and the ability to respond adequately is often limited. In the Republic of Korea, national disaster response efforts are defined by the Korea Basic Law for Disaster and Safety Management of 2004 and the establishment of the National Emergency Management Agency (NEMA) provides a framework for a holistic disaster prevention and recovery plan. However, the tragedy involving the sinking of the Sewol ferry in 2014 revealed a number of flaws in the current Korean disaster response system. In response to the shortcomings demonstrated in the Sewol incident, both NEMA and the Korean Coast Guard dissolved and the Korean disaster response system is being revised under the creation of the new Ministry of Public Safety and Security. However, the current national disaster management system still has many significant underlying and systematic problems that must be addressed. First, there is confusion concerning the responsible governmental organizations that will handle the various aspects of a comprehensive disaster management plan. Second, the relationships between the laws and government organizations involving planning, managing and reporting are in a vertical relationship, while the entities responsible for the actual response efforts exist in a horizontal relationship. This organizational limitation results in a slowdown of communication and confusion between the responsible parties. Thirdly, and consequently, there is a significant lack of unity and organization between the many organization responsible for disaster response. Finally, an efficient, accurate database of resources available to meet disasters remains to be developed. These and other limitations reveal that there is a significant amount of work that remains in order for Korea to have the same level of disaster response system of other developed nations.
Developed Countries ; Disaster Planning* ; Disasters* ; Emergencies ; Humans ; Jurisprudence ; Korea* ; Military Personnel ; Republic of Korea ; Safety Management

Violence against medical personnel has been increasing recently, and violence in the doctor's office has become a serious threat to the safety of patients and medical personnel. However, medical personnel are not receiving adequate protection from violence, and the Assault Prevention Act against Medical Personnel has not been passed. Therefore, medical personnel must currently take measures to protect themselves from violence. The main perspective on countermeasures for violence against medical personnel is not that violence itself but that violence can disturb a physician's practice. In case of a violent incident in a doctor's office, medical personnel must take aggressive legal action. In addition medical personnel, the government, law enforcement officials, and citizens should make an effort to build a cooperative system for eliminating violence from the medical field.
Humans ; Law Enforcement ; Medical Staff* ; Violence*

BACKGROUND: We conducted this study to verify whether a mechanical ventilator is adequate for cardiopulmonary resuscitation (CPR). METHODS: A self-inflating bag resuscitator and a mechanical ventilator were used to test two experimental models: Model 1 (CPR manikin without chest compression) and Model 2 (CPR manikin with chest compression). Model 2 was divided into three subgroups according to ventilator pressure limits (P(limit)). The self-inflating bag resuscitator was set with a ventilation rate of 10 breaths/min with the volume-marked bag-valve procedure. The mode of the mechanical ventilator was set as follows: volume-controlled mandatory ventilation of tidal volume (Vt) 600 mL, an inspiration time of 1.2 seconds, a constant flow pattern, a ventilation rate of 10 breaths/minute, a positive end expiratory pressure of 3 cmH2O and a maximum trigger limit. Peak airway pressure (P(peak)) and Vt were measured by a flow analyzer. Ventilation adequacy was determined at a Vt range of 400-600 mL with a P(peak) of < or = 50 cmH2O. RESULTS: In Model 1, Vt and P(peak) were in the appropriate range in the ventilation equipments. In Model 2, for the self-inflating bag resuscitator, the adequate Vt and P(peak) levels were 17%, and the P(peak) adequacy was 20% and the Vt was 65%. For the mechanical ventilator, the adequate Vt and P(peak) levels were 85%; the P(peak) adequacy was 85%; and the Vt adequacy was 100% at 60 cmH2O of P(limit). CONCLUSIONS: In a manikin model, a mechanical ventilator was superior to self-inflating bag resuscitator for maintaining adequate ventilation during chest compression.
Cardiopulmonary Resuscitation* ; Manikins* ; Models, Theoretical ; Positive-Pressure Respiration ; Thorax ; Tidal Volume ; Ventilation* ; Ventilators, Mechanical*

PURPOSE: Renal infarction is one of the uncommon causes of acute abdominal pain, and it is often difficult to make a clinical diagnosis. This study was designed to investigate clinical predictors of the acute renal infarction and to suggest useful diagnostic tools to use in the emergency department(ED). METHODS: We reviewed medical records of the patients with a final diagnosis of acute renal infarction, which was confirmed by contrast-enhanced computed tomography (CT) scan or angiography of the abdomen between Jan. 1998 and Dec. 2000. RESULTS: Among 24 patients with acute nontraumatic renal infarction, 17 patients (71.0%) had a thromboembolic disease. A number of patients presented with nonspecific abdominal pain. 23 patients (95.8%) had elevated serum LDH after 24 hours of presention. On initial urinalysis, 75.0% of patients (18/24) showed hematuria. CONCLUSION: This study suggests that the patients with pain in the flank or the abdomen or the low back area should be performed a contrast-enhanced CT scan as soon as possible to rule out the possibility of acute renal infaction, especially when the patient has the high-risk triad of thromboembolism, elevated serum LDH, and hematuria.
Abdomen ; Abdominal Pain ; Angiography ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Hematuria ; Humans ; Infarction* ; Medical Records ; Thromboembolism ; Tomography, X-Ray Computed ; Urinalysis

The year 2019 was the 30th anniversary of the Korean Society of Emergency Medicine (KSEM) and the 18th International Congress of Emergency Medicine (ICEM) was held in Seoul, Korea. During the last 30 years, Korean emergency medicine has developed and grown enormously, not only in quantity but also in quality. Thus, it is an appropriate occasion to review the history of the KSEM, the three elements of its development, and the challenges to be met. The three major factors contributing to the development of emergency medicine in Korea are the training of emergency medical personnel, the enactment of the emergency medical law, and the creation of an emergency medical fund. The interaction of these three factors has had a synergistic effect on the development of Korean emergency medicine. The challenges to be resolved include the fragmented emergency medical system divided between the fire department and emergency medical centers, the failure of the patient transport system according to the classification of roles for each type of emergency medical center, insufficient quality control in prehospital treatment, and the lack of clarity for the scope of work of emergency medical technicians in the prehospital phase.

BACKGROUND: Psoriasis is a common, chronic skin disease characterized by recurrent erythematous skin plaque. Psoriatic lesion of patients exibits hyperproliferation of epidermis, a variable inflammatory cell infiltrate, and abnormalities of the papillary dermal blood vessels. Expansion of the dermal microvasculature and increased expression of VEGF in keratinocytes are prominent features of psoriasis. The normal appearing skin of psoriatic patients may respond to an injury with the appearance of a psoriatic lesion. It has been demonstrated that trauma or pressure on the skin develop psoriasis from normal appearing skin of psoriatic patients and temporary obligation of the vessels prevented the `Koebner phenomenon'. These clinical observations indicate the importance of the vascular compartment in the initiation of the psoriatic lesion. OBJECTIVE: We investigated the relationship between expression of VEGF and pressure in the development of Koebner phenomenon. METHOD: Metal sinker (10g) was added to the cultured HaCaT cells for 24 hours and the expression of VEGF was checked by immunohistochemistry. RESULTS: HaCaT cells pressured by metal sinker showed increased expression of VEGF compared to control cells. CONCLUSION: These results suggest that pressure probably induces the Koebner phenomenon through VEGF-induced angiogenesis.
Blood Vessels ; Epidermis ; Humans ; Immunohistochemistry ; Keratinocytes ; Microvessels ; Psoriasis* ; Skin ; Skin Diseases ; Vascular Endothelial Growth Factor A*