OBJECTIVE: We aimed to describe electrocardiographic (ECG) findings in spontaneous pneumothorax patients before and after closed thoracostomy. METHODS: This is a retrospective study which included patients with spontaneous pneumothorax who presented to an emergency department of a tertiary urban hospital from February 2005 to March 2015. The primary outcome was a difference in ECG findings between before and after closed thoracostomy. We specifically investigated the following ECG elements: PR, QRS, QTc, axis, ST segments, and R waves in each lead. The secondary outcomes were change in ST segment in any lead and change in axis after closed thoracostomy. RESULTS: There were two ECG elements which showed statistically significant difference after thoracostomy. With right pneumothorax volume of greater than 80%, QTc and the R waves in aVF and V5 significantly changed after thoracostomy. With left pneumothorax volume between 31% and 80%, the ST segment in V2 and the R wave in V1 significantly changed after thoracostomy. However, majority of ECG elements did not show statistically significant alteration after thoracostomy. CONCLUSION: We found only minor changes in ECG after closed thoracostomy in spontaneous pneumothorax patients.
Electrocardiography* ; Emergency Service, Hospital ; Hospitals, Urban ; Humans ; Pneumothorax* ; Retrospective Studies ; Thoracostomy*

Objective: Overcrowded emergency departments (ED) are a worldwide problem, which could cause treatment delays and increased mortality of patients. This study aimed at evaluating the effect of admission decisions by emergency physicians without consultation of an internal medicine doctor on the emergency department length of stay (ED LOS) and survival rate of patients diagnosed with medical disease. Methods: The study was a retrospective observational study comparing the ED LOS of patients admitted to the internal medicine (IM) department before and after the policy change regarding admission decisions, implemented in July 2017. During and after the policy change, emergency physicians took decisions on the arrangements and treatment for patients by processing their admission and providing follow-up care without further specialist consultations. The ED LOS and rate of admission to the IM department were compared between the study period (October 2017 to October 2018) and the control period (June 2016 to June 2017). Results: The median ED LOS of patients admitted to the IM department decreased from 164.0 minutes (interquartile range [IQR], 118.0-234.0) in the control period to 114.0 minutes (IQR, 104.0-208.0) in the study period. After propensity score matching, the median ED LOS of patients admitted to the IM department decreased from 187.0 minutes (IQR, 136.0-253.0) in the control period to 144.0 minutes (IQR, 104.0-208.0) in the study period. Conclusion The admission decisions made by emergency physicians reduced the ED and hospital LOS of patients visiting the ED and diagnosed with medical disease.

Objective: This study aimed to evaluate the efficacy of a bougie and glidescope video laryngoscope (GVL) for ground intubation by novice prehospital caregivers. We hypothesized that the intubation outcome using a bougie or GVL was superior to that using the Macintosh laryngoscope (MCL) with a stylet (MCLS) in ground intubation. Methods: A randomized crossover manikin study was conducted. Studied groups were categorized into 4 according to the intubation devices used; MCLS, Macintosh laryngoscope with bougie (MCLB), glidescope video laryngoscope with a stylet (GVLS), and glidescope video laryngoscope with bougie (GVLB). The primary outcome was the total endotracheal intubation time and the secondary outcome was the success rate for endotracheal intubation. Results: The use of a bougie did not cause a significant difference in the intubation time (MCLS vs. MCLB, P=0.213; GVLS vs. GVLB, P=0.633) and the success rate of endotracheal intubation (MCLS vs. MCLB, P>0.990; GVLS vs. GVLB, P=0.077) was compared with the use of a stylet in MCL and GVL. The use of GVL showed a longer endotracheal intubation time compared with MCLS (MCLS vs. GVLS, P<0.001; MCLS vs. GVLB, P<0.001). GVLB showed a decreased success rate of endotracheal intubation compared with the use of MCL (MCLS vs. GVLB, P=0.004; MCLB vs. GVLB, P<0.001). Conclusion The use of the GVL and a bougie could not affect the performance of endotracheal intubation on the ground. The use of MCL and a stylet for ground intubation could increase the intubation success rate and shorten intubation time compared with the use of a bougie or the use of GVL.

Objective: Overcrowded emergency departments (ED) are a worldwide problem, which could cause treatment delays and increased mortality of patients. This study aimed at evaluating the effect of admission decisions by emergency physicians without consultation of an internal medicine doctor on the emergency department length of stay (ED LOS) and survival rate of patients diagnosed with medical disease. Methods: The study was a retrospective observational study comparing the ED LOS of patients admitted to the internal medicine (IM) department before and after the policy change regarding admission decisions, implemented in July 2017. During and after the policy change, emergency physicians took decisions on the arrangements and treatment for patients by processing their admission and providing follow-up care without further specialist consultations. The ED LOS and rate of admission to the IM department were compared between the study period (October 2017 to October 2018) and the control period (June 2016 to June 2017). Results: The median ED LOS of patients admitted to the IM department decreased from 164.0 minutes (interquartile range [IQR], 118.0-234.0) in the control period to 114.0 minutes (IQR, 104.0-208.0) in the study period. After propensity score matching, the median ED LOS of patients admitted to the IM department decreased from 187.0 minutes (IQR, 136.0-253.0) in the control period to 144.0 minutes (IQR, 104.0-208.0) in the study period. Conclusion The admission decisions made by emergency physicians reduced the ED and hospital LOS of patients visiting the ED and diagnosed with medical disease.

Objective: This study aimed to evaluate the efficacy of a bougie and glidescope video laryngoscope (GVL) for ground intubation by novice prehospital caregivers. We hypothesized that the intubation outcome using a bougie or GVL was superior to that using the Macintosh laryngoscope (MCL) with a stylet (MCLS) in ground intubation. Methods: A randomized crossover manikin study was conducted. Studied groups were categorized into 4 according to the intubation devices used; MCLS, Macintosh laryngoscope with bougie (MCLB), glidescope video laryngoscope with a stylet (GVLS), and glidescope video laryngoscope with bougie (GVLB). The primary outcome was the total endotracheal intubation time and the secondary outcome was the success rate for endotracheal intubation. Results: The use of a bougie did not cause a significant difference in the intubation time (MCLS vs. MCLB, P=0.213; GVLS vs. GVLB, P=0.633) and the success rate of endotracheal intubation (MCLS vs. MCLB, P>0.990; GVLS vs. GVLB, P=0.077) was compared with the use of a stylet in MCL and GVL. The use of GVL showed a longer endotracheal intubation time compared with MCLS (MCLS vs. GVLS, P<0.001; MCLS vs. GVLB, P<0.001). GVLB showed a decreased success rate of endotracheal intubation compared with the use of MCL (MCLS vs. GVLB, P=0.004; MCLB vs. GVLB, P<0.001). Conclusion The use of the GVL and a bougie could not affect the performance of endotracheal intubation on the ground. The use of MCL and a stylet for ground intubation could increase the intubation success rate and shorten intubation time compared with the use of a bougie or the use of GVL.

Objective: With the increased incidence and prevalence rates of ST-segment elevation myocardial infarction (STEMI), emergency physicians (EPs) are expected to diagnose STEMI accurately and quickly based on electrocardiograms (ECGs) with minimal clinical information. However, a misdiagnosed ECG by EPs could be diagnosed as STEMI by a cardiologist. We evaluated the diagnostic performance of EPs in interpreting ECGs of STEMI in terms of the agreement of this diagnosis with that of a cardiologist. Methods: This study was performed using 122 de-identified ECGs of STEMI patients who had their diagnosis confirmed through emergent coronary arteriography and percutaneous coronary intervention. Three EPs and a cardiologist participated in the survey. For each ECG, physicians were asked, “Based on the ECG provided, is there ST elevation, ST depression, or no ST-segment change?” The overall agreement for ST change diagnosis between the EPs and a cardiologist was analyzed using Cohen’s kappa coefficient (κ). Fleiss’s kappa was used to determine the level of agreement of the three EPs. Results: There was a substantial level (k>0.6) of inter-rater agreement of the ECG interpretation (IRAE) between the EPs and the cardiologist and between the three EPs. However, in subgroups according to the culprit artery for the overall STEMI ECG, the level of IRAE between the EPs and a cardiologist and between the three EPs was substantially lower (k<0.6) when relating to the anteroseptal wall due to occlusion of the left anterior descending artery. Conclusion In evaluating STEMI ECGs, the accuracy of the EPs suggests a substantial level of IRAE relating to the lateral and inferior wall and a relatively low level of IRAE with respect to the anteroseptal wall.

Objective: This study aimed to analyze the association between the culprit artery and the diagnostic accuracy of automatic electrocardiogram (ECG) interpretation in patients with ST-segment elevation myocardial infarction (STEMI). Methods: This single-centered, retrospective cohort study included adult patients with STEMI who visited the emergency department between January 2017 and December 2020. The primary endpoint was the association between the culprit artery occlusion and the misinterpretation of ECG, evaluated by the chi-square test or Fisher exact test. Results: The rate of misinterpretation of the automated ECG for patients with STEMI was 26.5% (31/117 patients). There was no significant correlation between the ST segment change in the four involved leads (anteroseptal, lateral, inferior, and aVR) and the misinterpretation of ECG (all P > 0.05). Single culprit artery occlusion significantly affected the misinterpretation of ECG compared with multiple culprit artery occlusion (single vs. multiple, 27/86 [31.3%] vs. 4/31 [12.9%], P = 0.045). There was no association between culprit artery and the misinterpretation of ECG (P = 0.132). Conclusion Single culprit artery occlusion might increase misinterpretation of ECG compared with multiple culprit artery occlusions in the automatic interpretation of STEMI.

Objective: The purpose of this study was to determine the type of video laryngoscope training that is appropriate for emergency medical technicians (EMT) familiar with direct laryngoscopes, to prepare them for tracheal intubation while they are wearing personal protective equipment (PPE). Methods: Thirty-eight healthy EMTs were recruited. The participants underwent two tests with four different laryngoscopes: Macintosh, McGrath, Pentax Airway Scope (PENTAX-AWS), and A-LRYNGO. The first test was conducted just after a lecture without any hands-on workshops. The second test was conducted after a hands-on workshop. In each test, we measured the time required for tracheal intubation, intubation success rate, etc., and asked all the participants to respond to a short questionnaire. Results: The time to complete the insertion of the endotracheal tube with the Macintosh laryngoscope did not significantly change (P=0.098), but the rest of the outcomes significantly improved after the hands-on workshop (all P<0.05). Despite the unfamiliarity of the practitioners with video laryngoscopes and their wearing PPE, intubation-related performances were good with the two-channel type video laryngoscopes after the hands-on workshop (all P<0.05). Conclusion In preparation for an infectious disease pandemic such as the coronavirus disease 2019 (COVID-19), it would be reasonable to train EMTs who would be wearing PPE on the procedure for intubating a trachea with a channeltype video laryngoscope.

Objective: The purpose of this study was to identify prognostic factors related to outcomes of out-of-hospital cardiac arrest caused by pesticide poisoning. Methods: This retrospective observational study used countrywide population-based data from the Out-of-Hospital Cardiac Arrest Surveillance of the Korean Centers for Disease Control and Prevention from January 2008 to December 2018. Adult out-of-hospital cardiac arrest (OHCA) patients (over the age of 18) poisoned by a pesticide who experienced cardiac arrest and a subsequent return of spontaneous circulation (ROSC) were included in the study. The primary outcome variables were prognostic factors related to survival at hospital discharge, and the secondary outcome variable was good neurological outcome (Cerebral Performance Categories 1 or 2) at hospital discharge. Results: Three hundred and three patients were enrolled in the study, and 48 (15.8%) survived until hospital discharge (the hospital discharge group), and 255 (84.2%) died in hospital (the in-hospital death group). Fifteen (4.9%) of the 303 study subjects had a good neurological outcome, and 288 (95.1%) had a poor neurological outcome. Multivariate logistic regression showed that sustained pre-hospital ROSC was significantly associated with survival to discharge (adjusted odds ratio [AOR]=3.186; 95% confidence interval [CI], 1.436-7.068; P=0.004) and good neurological outcome (AOR=8.945; 95% CI, 2.974-26.907; P≤0.001). Conclusion Sustained pre-hospital ROSC is associated with a favorable outcome in cases of OHCA induced by pesticide poisoning.

Objective: This study examined the characteristics of patients visiting the emergency department (ED) with fever after the chronification of the coronavirus disease 2019 (COVID-19) pandemic. Methods: This retrospective observational study analyzed the medical records of patients who visited the ED with fever from May 1 to October 31, 2021, and the corresponding period in 2019. This study was conducted at a single center in Seoul, Korea. Results: There was no statistical difference in the comorbidities of the patients of the two groups: the AC (after the COVID-19 pandemic) group and the BC (before the COVID-19 pandemic) group. As for the level of consciousness at the time of ED arrival, there was a significantly larger decrease in consciousness (verbal response or less) in the AC group than in the BC group (P=0.002). In the case of the National Early Warning Score (NEWS), the proportion was higher in the AC group in the moderate-risk and high-risk groups (P=0.003). The median time from symptom onset to ED arrival was 15.7 hours in the BC group and 13.8 hours in the AC group, and there was no significant difference (P=0.137). When leaving the ED, the AC group had a higher admission rate to the ward and intensive care unit than the BC group. There was no statistical difference in the in-hospital mortality between the two groups (2.9% and 2.4%, respectively; P=0.62). Conclusion Patients who visited the emergency room with fever after one year of the COVID-19 pandemic showed a similar time from symptom onset to ED arrival compared to patients who visited before the COVID-19 pandemic. In addition, there was no difference in in-hospital mortality among these patients compared to those with fever before the COVID-19 pandemic.