PURPOSE: The 2005 guidelines for cardiopulmonary resuscitation (CPR) caution that effective compression is essential (Class I) and chest compression (CC) by rescuers should be switched every 2 minutes to avoid rescuer's fatigue. It is controversial how long effective CC by a single individual can be provided. There are few reports about CPR quality, especially when rescuers perform CC for more than 10 minutes. The mean CPR period was about 30 minutes in Korea. We investigated the quality of CC and rescuer's fatigue after about 30 minutes. METHODS: From April 2009 to July 2009, health care providers (HCPs) were recruited into this study. The study simulated 2 person, in-hospital CPR. On the test day, which had been randomly assigned, each participant performed 7 CCs for about 30 minutes. The period of each CC was 2 minutes, and the period of each circulation check was 5 seconds. Participants' heart rates (HR) and visual analogue scale (VAS) scores for fatigue were obtained before and after each CC. Data for each 2 minutes CC was obtained with the use of Resusci Anne(R) with the Laerdal(R) PC skill reporting system. We used one-way repeated measures ANOVA for comparison of quality and fatigue of each CC and multiple linear regression for finding the predictors for correct CC. SPSS 17.0 was used for analysis. RESULTS: Among a total of 30 HCPs, data from 27 were analyzed. All participants were certified as a BLS provider and some were certified as BLS instructors. The rate of effective compression was 83.8+/-24.3%. Despite 2 min CC tasks were repeated alternatively for about 30 minutes, there were no differences in the number of correct CCs, depth and velocity of compression, and the number of incorrect CCs. CONCLUSION: During in-hospital CPR, HCPs may provide effective chest compressions on shifts with minimal effect of fatigue, even if they provide CC for 30 minutes.
Cardiopulmonary Resuscitation ; Fatigue ; Health Personnel ; Heart Rate ; Humans ; Korea ; Linear Models ; Manikins ; Thorax

PURPOSE: It is difficult to predict volume responsiveness in hemodynamically unstable patients with spontaneous breathing activity. Our objective was to test whether the respiratory variations in pulse oximetry plethysmography (POP) waveform amplitude could predict fluid responsiveness to fluid resuscitation (FR) in spontaneously breathing adult shock patients. METHODS: We investigated 21 patients presenting with shock in the Emergency Room. We assessed hemodynamic status and calculated the respiratory variations in POP waveform amplitude before and after FR. Heart rate, blood pressures (MAP, SBP), maximal POP (POPmax), minimal POP (POPmin) and deltaPOP, defined as deltaPOP = (POPmax - POPmin) / ([POPmax + POPmin] / 2) were recorded. We measured hemodynamic parameters by doppler ultrasound, USCOM(R). RESULTS: Comparisons of hemodynamic parameters between before and after FR showed no significant difference in heart rate, but POP showed significant differences in changes in SBP, MAP, cardiac index, stroke volume index and respiratory variations. In response group(> or =15% in delta CI), the change in cardiac index, stroke volume index, and the respiratory variation in the POP were not significantly different. CONCLUSION: In spontaneously breathing patients with shock, we suggest that delta POP is not a reliable parameter in the prediction of fluid responsiveness.
Adult ; Emergencies ; Heart Rate ; Hemodynamics ; Humans ; Oximetry ; Plethysmography ; Respiration ; Resuscitation ; Shock ; Stroke Volume

A 35-year-old woman suffered from elementary visual symptom that was confirmed as nonconvulsive simple partial status epilepticus arising from the right occipital lobe. 99mTc-ECD SPECT and 18F-FDG PET were done during the ictal and interictal phase, respectively, which were documented by EEG. Subtraction images of SPECT and PET were overlayed on the MRI by SISCOM to compare the area of metabolic change with that of perfusion change. There was no definite mismatch between the hypermetabolic area and the hyperperfusion area during nonconvulsive status epilepticus.
Adult ; Electroencephalography ; Female ; Fluorodeoxyglucose F18* ; Humans ; Magnetic Resonance Imaging ; Occipital Lobe* ; Perfusion ; Status Epilepticus* ; Tomography, Emission-Computed, Single-Photon*

Idiopathic hypereosinophilic syndrome (IHES) is a rare disease characterized by peripheral blood eosinophilia and eosinophilic infiltration of multiple organs, including the nervous system. The neurologic manifestations in hypereosinophilic syndrome are variable, but eosinophilic meningitis as a manifestation has not been well documented in IHES. We report a case of eosinophilic meningitis associated with IHES, which showed a good response to steroid treatment.
Eosinophilia ; Eosinophils* ; Hypereosinophilic Syndrome* ; Meningitis* ; Nervous System ; Neurologic Manifestations ; Rare Diseases