BACKGROUND: Current guidelines of advanced trauma life support recommend open thoracotomy when pericardiocentesis reveals bloody pericardial effusion in patients with blunt chest trauma. However, open thoracotomy may not be always required for treating patients alive until arriving emergency department, because rapid accumulation of the blood into pericardial space results in immediate death at scene. We report our experiences of treating traumatic pericardial effusion, and discuss the therapeutic modality in patients with traumatic pericardial effusion. METHODS: The study consisted of 37 patients(20 males and 17 females with the mean age 42) sustaining traumatic pericardial effusion. The patients were divided according to treatment modality into 3 groups(group I : patients receiving conservative management, group II : patients treated with pericardiocentesis, group III : patients required emergency thoracotomy). We compared clinical presentations, hemodynamic profiles and echocardiographic findings among three groups. RESULTS: Cardiac tamponade was present in 14 of 37 patients. Pericardiocentesis was performed in 13 patients, and open thoracotomy in 4 patients. Pericardiocentesis was curative in 9 patients. Thoracotomy was performed in only 3(24%) of 13 patients required pericardiocentesis. 3(75%) of 4 patients having moderate or severe pericardial effusion from penetrating injury were required open thoracotomy. CONCLUSION: In selected patients who have traumatic pericardial effusion by blunt chest injury, pericardiocentesis may be curative, and thoracotomy may not be inquired as long as bleeding via indwelling pericardial catheter is not sustained after pericardiocentesis.
Advanced Trauma Life Support Care ; Cardiac Tamponade ; Catheters ; Echocardiography ; Emergencies ; Emergency Service, Hospital ; Female ; Hemodynamics ; Hemorrhage ; Humans ; Male ; Pericardial Effusion* ; Pericardiocentesis ; Thoracic Injuries ; Thoracotomy ; Thorax

OBJECTIVE: The outcome of traumatic cardiac arrests remains poor. Nevertheless, the prehospital treatments for traumatic arrests are insufficient in Korea. This study was conducted to compare the prehospital treatments in traumatic and non-traumatic out-of-hospital cardiac arrests (OHCA). METHODS: This was a retrospective, single-center study based on the prospectively collected database of an academic tertiary medical center. The study period was from 2009 to 2017. The following items were compared: age, sex, rates of bystander cardiopulmonary resuscitation (CPR), prehospital intubation, prehospital defibrillation, prehospital epinephrine administration, CPR duration, rates of return of spontaneous circulation, and the survival discharge. RESULTS: Among 786 arrest patients, there were 226 (28.7%) traumatic cardiac arrests and 560 (71.2%) non-traumatic cardiac arrests. The rate of bystander CPR was lower (3.1% vs. 17.5%, P<0.001) in traumatic OHCAs. The prehospital intubation, defibrillation, and epinephrine administration were lower in traumatic OHCAs. CONCLUSION: The prehospital treatments, including bystander CPR, prehospital intubation, and epinephrine administration, were performed less actively in traumatic OHCAs. On the other hand, these results were limited to a single hospital.
Advanced Trauma Life Support Care ; Cardiopulmonary Resuscitation ; Epinephrine ; First Aid ; Hand ; Heart Arrest ; Humans ; Intubation ; Korea ; Out-of-Hospital Cardiac Arrest ; Prospective Studies ; Retrospective Studies

BACKGROUND: To describe the fast experience of case-leased advanced cardiac life support(ACLC) course in Korea. METHODS: We have given case-based ACLC course to 13 nurses(6 emergency nurses, 4 coronary care unit muses, 3 professors) and 17 physicians(4 emergency physicians, 12 emergency residents, 1 intem). We performed the case-based ACLS course according to 1992 American Heart Association guidelines and recommendations for advanced cardiac life support by american ACLS instructors(1 pulmonologist, 4 critical care nurses). We performed final theoretical written test and 2 times written survey (immediate and 100th day after the course) about the course. RESULTS: On final written test, all practitioners answered at leasts 70% of the questions correctly. There was no significant difference between nurses and physicians(86.2+/-3.6 of physicians and 82.5+/-6.8 of nurses, p=0.06). 90%of participants considered that case-based advanced cardiac life support was acceptable. 100th day after the course, 93%of participants answered that ACLS course have been helpful on his/her job and also want retraining of ACLS course. 70%of participants considered that ideal ACLS training committee in Korea is the Korean Society of Emergency Medicine. CONCLUSION: Case-based ACLS course is a useful educational method far physicians and nurses in Korea. In the future, we should organize Korean resuscitation committee and then make guidelines for ACLS, and then continuously educate physicians and nurses.
Adult* ; Advanced Cardiac Life Support ; Alprostadil ; American Heart Association ; Coronary Care Units ; Critical Care ; Emergencies ; Emergency Medicine ; Humans ; Korea* ; Resuscitation

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

Injuries are a major of cause of death and disability in the young. The advanced trauma management in the acute trauma cases is an important clinical practice to decrease the mortality. The Advanced Trauma Life Support (ATLS) course teaches a systematic, concise approach to the early care of the trauma patient in America. The ATLS course is vital to administering care for the injured patient in emergency department trauma rooms. The program has been adopted worldwide in over 60 countries, especially outside North America. The purpose of ATLS course is to orient physicians to the initial immediate assessment and resuscitation of the injured patient. The content and skills presented by the materials are designed to assist physicians in providing the first hour of emergency care for trauma patient. It is time to set up the guideline of advanced trauma management and adopt a standard training program which aligns more precisely with practice and needs of Korean doctors.
Advanced Trauma Life Support Care ; Americas ; Cause of Death ; Emergencies ; Emergency Medical Services ; Humans ; North America ; Resuscitation

The traditional approach to treatment of posttraumatic hypotension generally follows the principle of aggressive fluid resuscitation espoused by the American College of Surgeons in its Advanced Trauma Life Support course. A number of reports published in the last decade however, have questioned the safety and clinical appropriateness of this traditional approach, with recent data demonstrating support for delayed or limited resuscitation. This review discusses the controversies and presents recommendations for the ideal resuscitation strategy for the Filipino trauma patient with hypotension. (Author)

Among the deaths from trauma, 50% were dead at the scene, 30% in several hours, and 20% in a few weeks by multiple organ failure. The 30% occurring in several hours may be saved with rapid assessment and management of injuries. Trauma deaths could be reduced through an organized trauma system and standardized and systemic approach by physicians involved in the initial assessment and management of trauma. This is likely to present emergent and general traumatic care to increase the ability of treating trauma patients on the base of Advanced Trauma Life Support (ATLS) by the American College of Surgeons (ACS). Thus, both legal and systemic reform with an establishment of trauma centers or use of the ATLS program in intra-hospital trauma team is necessary to maximize operation of the medical team. Introduction of and emphasis on the skill oriented ATLS program in the medical school curriculum is also needed to prepare for real situations rather than knowledge-orientated education.
Advanced Trauma Life Support Care* ; Curriculum ; Education ; Humans ; Multiple Organ Failure ; Resuscitation ; Schools, Medical ; Trauma Centers ; Triage

The infiltration of dilute epinephrine solution has been used for many years to provide hemostasis. However, epinephrine has adverse cardiovascular effects, such as arrhythmia, pulmonary edema, and even cardiac arrest. We have experienced epinephrine-induced cardiovascular crisis, with severe hypertension, tachycardia, and cardiac arrest after subcutaneous infiltration of a 2% lidocaine and 1 : 200,000 epinephrine solution in a patient with an asymptomatic subarachnoid hemorrhage. We provided successfully advanced cardiac life support in the operating room and cardioverted the patient back into a sinus rhythm with no untoward effects. The patient recovered without any apparent sequelae after intensive care.
Advanced Cardiac Life Support ; Arrhythmias, Cardiac ; Epinephrine ; Heart Arrest ; Hemostasis ; Humans ; Hypertension ; Critical Care ; Lidocaine ; Operating Rooms ; Pulmonary Edema ; Subarachnoid Hemorrhage ; Tachycardia

PURPOSE: The purpose of this study was to analyze attitude toward dignified dying of Korean students majoring in human service area. METHODS: The Q-methodology which provides a method of analyzing the subjectivity of each item was used. The 34 selected Q-statements from each of 38 subjects were classified into a shape of normal distribution using a 9 point scale. The collected data was analyzed using a QUANL PC program. RESULTS: Four types of attitude toward dignified dying from the subjects were identified. Type I is an expression type for happy emotion, Type II is a dislike type for life prolongation, Type III is a pursuit type for relationship improvement, and Type IV is a perception type for family presence. CONCLUSION: The results of the study indicate that integrating multi-disciplinary curriculum development related to dignified dying and death education for students majoring in human service area are needed.
Curriculum ; Humans ; Life Support Care

PURPOSE: The usefulness of focused abdominal sonography for trauma (FAST) is now included in the frame work of the advanced trauma life support for examination of thoraco- abdominal trauma. Ultrasonographic screening is controversial in patients with hollow viscus injury. The purpose of this study is to determine the characteristics of emergency trauma sonographic findings in patients with hollow viscus injury. METHODS: All patients with isolated viscus injury after blunt abdominal trauma were retrospectively enrolled in this study during the 5-year period from December 1997 to November 2002. The patients were screened by using ultrasonography and an underwent explolaparotomy. The patients were diagnosed with a hollow viscus injury based on the surgical findings. Patients with viscus injury combined with parenchymal organ injury after abdominal trauma were excluded. Ultrasonographic examinations were performed by the experienced emergency physicians during the trauma resuscitation. RESULTS: Sixty patients were included in this study. The most common injury site was jejunum (23.3%). The common findings of emergency trauma sonography were free fluid collection (56.7%), none of fluid collection (38.3%), free air and fluid collection (3.3%), and free air (1.7%). The presence of mesenteric injury was significantly associated with fluid collection (x2=0009). CONCLUSION: The most common sonographic findings in hollow viscus injury patients after blunt abdominal trauma are free intraperitoneal fluid (anechoic or mixed echo pattern), normal, and free air (reverberation) in that order. Massive intraperitoneal fluid is more often detected in patients who have a viscus injury combined with a ruptured mesenteric vessel.
Abdominal Injuries ; Advanced Trauma Life Support Care ; Emergencies ; Humans ; Intestines ; Jejunum ; Mass Screening ; Resuscitation ; Retrospective Studies ; Ultrasonography ; Wounds, Nonpenetrating