No abstract available.
Fatigue* ; Thorax*

Scrub typhus (Tsutsugamushi disease)is an acute febrile systemic illness caused by Rickettsia tsutsugamushi that is transmitted to humans by the bite of larval-stage trombiculid mites (chiggers). The authors analyzed chest radiographic findings of scrub typhus in 160 patients in Ulsan area. One hundred and eight (67.5%) of160 patients showed abnormal findings which included lung lesions in 108 patients (67.5%), cardiomegaly in 37 patients (23.1%), lymphadenopathy in 25 patients (15.6%) and pleural effusion in 11 patients (6.9%). Among the lung lesions, interstitial patterns were seen in 107 patients (66.9%), mostly fine or medium reticulonodular, and air-space patterns in 14 patients(8.8%) and combined interstitial and air-space patterns in 13 patients (8.1%). Sixty-four patients(40%) had combined chest radiographic findings. The typical chest radiographic findings of scrub typhus would be helpful in evaluation of the causes of acute febrile illness that occur during late fall in the endemic area.
Cardiomegaly ; Humans ; Lung ; Lymphatic Diseases ; Orientia tsutsugamushi ; Pleural Effusion ; Radiography, Thoracic* ; Scrub Typhus* ; Thorax* ; Trombiculidae ; Ulsan*

BACKGROUND: The inclusion of cardiopulmonary resuscitation (CPR) in formal education has been a useful approach to providing basic life support (BLS) services. However, because not all students have been able to learn directly from certified instructors, we studied the educational efficacy of the use of peer-assisted learning (PAL) to train high-school students to perform BLS services. METHODS: This study consisted of 187 high-school students: 68 participants served as a control group and received a 1-hour BLS training from a school nurse, and 119 were included in a PAL group and received a 1-hour CPR training from a PAL leader. Participants' BLS training was preceded by the completion of questionnaires regarding their background. Three months after the training, the participants were asked to respond to questionnaires about their willingness to perform CPR on bystander CPR and their retention of knowledge of BLS. RESULTS: We found no statistically significant difference between the control and PAL groups in their willingness to perform CPR on bystanders (control: 55.2％, PAL: 64.7％,P=0.202). The PAL group was not significantly different from the control group (control: 60.78±39.77, PAL: 61.76±17.80, P=0.848) in retention of knowledge about BLS services. CONCLUSION: In educating high school students about BLS, there was no significant difference between PAL and traditional education in increasing the willingness to provide CPR to bystanders or the ability to retain knowledge about BLS.

OBJECTIVE: This study was conducted to determine why rescuers could maintain adequate chest compression depth for longer periods during conventional cardiopulmonary resuscitation (CPR).METHODS: Various CPR parameters, including average compression depth (ACD), average compression rate, average ventilation time (AVT), and rescuers’ heart rates were recorded in real-time when 20 health care providers performed 10 minutes of conventional CPR during a simulation experiment.RESULTS: The ACD was maintained above 50 mm and was not significantly different during 19 consecutive CPR cycles. The average compression rate increased from 114.9±10.0/min (2nd cycle) to 120.1±13.8/min (18th cycle) (P=0.007), and the AVT increased from 8.7±1.5 seconds (3rd cycle) to 10.1±2.6 seconds (18th cycle) (P=0.002). The rescuers’ heart rates also increased gradually for 10 min; however, they increased rapidly and were highest during the ventilation phase. Their heart rates then decreased and were lowest during the early chest compression phases of each CPR cycle. Decreases in heart rates were significant in all CPR cycles (average decrease: 14.5±4.5 beats/min, P<0.001).CONCLUSION: The ACD was maintained adequately during 10 minutes of conventional CPR. However, the AVT increased significantly during the 10-minute period. The rescuers’ heart rates increased and decreased throughout all CPR cycles. These results showed that the ventilation phase might play a role as a resting period and be a reason for the maintenance of adequate chest compression depth for prolonged periods during conventional CPR.
Cardiopulmonary Resuscitation ; Fatigue ; Health Personnel ; Heart Rate ; Heart ; Humans ; Male ; Thorax ; Ventilation

PURPOSE: The 2010 guidelines for cardiopulmonary resuscitation recommend a ventilation rate of 8 to 10/min for patients with an advanced airway; however, hyperventilation occurs in most cases. This study was conducted as an attempt to determine the effects of feedback under audio tone guidance on performance of positive-pressure ventilation using a bag-valve device and to apply this technique in clinical practice in order to reduce hyperventilation. METHODS: A total of 36 seniors at our medical school participated in the study. After receiving instruction in performance of positive-pressure ventilation using a bag-valve device, they performed ventilation using a cardiac arrest model with an advanced airway (Test 1). After they took Test 1 without any feedback, they were randomly assigned to the feedback group (Group A) and the control group (Group B) and took Test 2. In Group A, a high-pitched sound was delivered every 7 s for guidance of ventilation. RESULTS: In Group A, ventilation rate approximated feedback rate, whereas, in Group B, it showed a significant decrease, from 8.3+/-2.0 to 7.7+/-2.0/min (p<0.01). The mean ventilation volume did not differ between pre- and post-feedback. The mean inspiration time showed a decrease in both groups. However, no significant difference in mean inspiration time was observed between the two groups. CONCLUSION: Audio tone guidance can control the ventilation rate accurately without any significant change in ventilation volume and inspiration time.
Cardiopulmonary Resuscitation ; Heart Arrest ; Humans ; Hyperventilation ; Positive-Pressure Respiration ; Schools, Medical ; Ventilation

PURPOSE: This study compared the effects of counting chest compressions verbally and silently on the performance of cardiopulmonary resuscitation (CPR). METHODS: Forty-six medical students were enrolled in this study. After the participants performed a two-min CPR (Test 1), during which they counted each compression silently, they were divided randomly into Groups A and B. After a 30-min rest, the participants took Test 2. In Test 2, Group A performed two-min CPR, during which the participants counted the number of chest compressions verbally (Test 2A), and in Group B, CPR was performed using the same methods as detailed for Test 1 (i.e., with silent enumeration; Test 2B). Each student counted the number of chest compressions aloud from one to 30 in Test 2A. RESULTS: No significant differences were observed for either test (Tests 1 and 2) between Groups A and B. Although the mean compression rate (MCR) was increased significantly from 107.2+/-15.4 to 116.3+/-15.9/min between Tests 1 and 2B in Group B (p<0.01), a similar result was also obtained in Group A. In the individual interviews conducted with the Group A participants, all members reported having difficulty breathing while counting the number of chest compressions verbally when compared with silent enumeration. CONCLUSION: Tallying the numbers of chest compressions verbally did not significantly alter the performance of CPR.
Cardiopulmonary Resuscitation* ; Humans ; Manikins* ; Pilot Projects* ; Prospective Studies* ; Respiration ; Students, Medical ; Thorax* ; Voice

PURPOSE: One-handed chest compression (OHCC) technique is performed by one hand. Therefore chest compression (CC) depth might decrease rapidly. This study will evaluate the patterns of CC depth decaying in performing OHCC and assess the effects of alternating the hand which performs CC on the patterns of CC depth decaying. METHODS: This study was designed as a prospective randomized manikin simulation trial. Students of medical college participated. First, 10 students performed OHCC (chest compression:ventilation=30:2) in a pediatric manikin lying on a hard floor for 5 minutes (baseline study). After the baseline study, 32 students were recruited and randomized to group A and B. Group A performed OHCC with hand shift every other cycle (test 1). Group B performed OHCC with hand shift when they feel fatigue (test 2). The compression data were collected using the CPRmeter. The mean compression depths (MCD) were calculated at one minute intervals using the Q-CPR review software. The heart rates were monitored and the fatigue scales were collected every 1 minute. RESULTS: The MCD values were decreased significantly after 1 minute in the baseline study (p<0.05). However they were not changed in test 1 and decreased significantly after 4 minutes in test 2 (p<0.05). The heart rate and the fatigue scales were increased significantly with time in all tests (p<0.05). CONCLUSION: When OHCC was performed without shifting the hand which performed CC, the MCD decreased significantly after 1 minute. However, we could delay the time of decreasing MCD by shifting the hand which performed CC.
Cardiopulmonary Resuscitation ; Deception ; Fatigue* ; Hand* ; Heart Arrest ; Heart Massage ; Heart Rate ; Humans ; Manikins* ; Pilot Projects* ; Prospective Studies* ; Thorax* ; Weights and Measures

PURPOSE: Acute appendicitis is one of the more challenging disease entities to diagnose. Early and correct diagnosis is necessary to decrease morbidity and mortality. The diagnosis of acute appendicitis does not depend on a single modality because it is often difficult and the symptoms of appendicitis can change with time. The Alvarado score is a sensitive and specific tool for diagnosis of appendicitis. But the effectiveness of a single Alvarado score for diagnosis of acute appendicitis can be less meaningful due to diagnostic difficulties. The purpose of this study was to evaluate the usefulness of repeatedly checked Alvarado scores in acute abdomen patients as a diagnostic tool for acute appendicitis. METHODS: A total of 196 patents who visited our ER with acute abdominal pain between March 2008 and February 2009 were enrolled. Emergency physicians checked the initial Alvarado score and re-checked that score after 3 hours of observation. We prospectively compared the results between (a) the initial and the 3 hours Alvarado scores and (b) the final pathology. RESULTS: We measured diagnostic for the initial Alvarado score and the 3 hours Alvarado score groups. The sensitivities of the two groups for detecting appendcitis were 85.1% and 92.0%, respectively; specificities were 81.6% and 89.0%; positive predictive values were 78.7% and 87.0%; negative predictive values were 87.3% and 93.3%; accuracy scores were 83.2% and 90.3%. All diagnostic values of the 3 hours Alvarado score group were superior to those of the initial Alvarado score group. CONCLUSION: Repeatedly checked Alvarado scores provides a superior diagnostic accuracy to the initial Alvarado score alone. Thus, we can say that repeatedly checked 3 hours Alvarado scores are more useful for diagnosing acute appendicitis than an initial, one-time checking of the Alvarado score. This new scoring system will be particularly useful to physicians who are working in health care facilities where computerized tomography or ultra-sonography is not available.
Abdomen, Acute ; Abdominal Pain ; Appendicitis ; Delivery of Health Care ; Diagnosis, Differential ; Emergencies ; Humans ; Mass Screening ; Prospective Studies ; Severity of Illness Index

A 45-year-old man presented at the emergency department with severe whole abdominal pain. He was struck on the abdomen by a soccer ball in the soccer game 12 hours ago. Initial vital signs were unstable, but stabilized soon after fluid resuscitation. CT scans were performed to diagnose injury to the intraabdominal organs. CT scans showed hemoperitoneum and rupture of hepatocellular carcinoma (HCC). Transarterial chemoembolization and catheter drainage were performed. He was discharged on the 22th day. Rupture of HCC is mostly occurred in the advanced stage of HCC, but very rarely happened after abdominal trauma. Treatment of choice for traumatic rupture of HCC was not established yet. In our case, the patient was cured by transarterial chemoembolization without laparotomy. Considering that the treatment for traumatic liver injury is supportive care or laparotomy, emergency physician should remember that traumatic rupture of HCC also can cause hemoperitoneum after abdominal trauma.
Abdomen ; Abdominal Pain ; Athletic Injuries ; Carcinoma, Hepatocellular ; Catheters ; Drainage ; Emergencies ; Hemoperitoneum ; Humans ; Laparotomy ; Liver ; Middle Aged ; Resuscitation ; Rupture ; Soccer ; Vital Signs

A 56-year-old man was transferred to the emergency department complaining of right lower quadrant pain of 3 days duration. The Maximal tender area was the slightly upper part of the abdomen up to McBurney's point. We ordered CT to evaluate for several disease such as appendicitis, diverticulitis and primary epiploic appendagitis, and the patient was diagnosed with omental infarct based on the CT finding. After five days of supportive care, the symptoms were resolved. Omental infarct is a rare cause of acute abdominal pain, which is often misdiagnosed as acute appendicitis when it presents with right lower quadrant pain. Although surgical resection is required in severe cases, most cases are successfully managed with supportive treatment. The emergency physician should consider omental infarct as a differential diagnosis in patients with right lower quadrant pain.
Abdomen ; Abdominal Pain ; Appendicitis ; Diagnosis, Differential ; Diverticulitis ; Emergencies ; Emergency Service, Hospital ; Humans ; Infarction ; Middle Aged ; Omentum