Comparison Analysis of Performance among the types of Intraosseous Needle in Animal Bone Models

PURPOSE: To compare each type of intraosseous needles for the performance. METHODS: Eighteen doctors participated. We chose chicken legs for the pediatric tibia model, and the metatarsal bone of swine for the adult humerus model, based on CT and bonedensitometry testing. We decided chicken legs for a pediatric tibia, metatarsal bones of swine for an adult humerus. Each doctor performed intraosseous insertion into the chicken leg 3 times per needle and 1 time per needle for the swine foot. In our study, we compared the following: intravenous needle (IV), spinal needle (SN), bone marrow aspiration needle (BN), Jamshidi needle (JN), and EZ-IO TM (EZ-IO). RESULTS: The success rate of EZ-IO, JN, BN, IV, and SN was 79.6%, 63%, 57.4%, 42.6%, 16.7%, respectively in the pediatric model. The bending or broken rate of IV and SN was 42.6% and 59.3%. The success rate of EZ-IO, JN, BN, SN, and IV was 83.3%, 44.4%, 33.3%, 22.2%, and 22.2%, respectively in the adult model and the success rate of the IO device, such as EZ-IO and JN was higher than in others. The time to insert was 18.9~32.0 seconds to all devices but SN, BN, IV had wide standard deviations. CONCLUSION: We suggest that using commercial intraosseous devices are more effective than using IV, SN, and BN to achieve vascular access in severely ill patients. Further study of real patient models is needed to clarify the usefulness of the devices demonstrating successful results in this study.

Influence of the Werther Effect: An Increase of Intentional Carbon Monoxide Poisoning

PURPOSE: Suicide attempts are known to be influenced by mass media reports. The purpose of this study was to evaluate the effects of mass media reporting celebrity suicides on an increase of intentional carbon monoxide (CO) poisoning and suicide attempts. METHODS: We retrospectively reviewed the medical records of the consecutive patients who presented with suicide attempts to the Emergency Department of Ajou University Hospital during a 24 month period. We obtained the demographic data, any past history of suicide attempt and the methods of suicide attempts from the medical records of the suicide attempters. Time series analysis was conducted for evaluating the influence of mass media reporting of celebrity suicide on the suicide rates. RESULTS: We finally enrolled 770 patients during the study period. The total number of suicide attempts by CO poisoning was 18 and the average number of suicide attempts by CO was 0.33+/-0.73 per week. All of the suicide attempts by CO poisoning occurred after a celebrity committed suicide using CO from burning charcoal. CONCLUSION: This study showed that celebrity suicide by CO poisoning resulted in the Werther effect, which made the rate of intended CO poisoning increase, and the study provided further evidence for the need to actively restrain mass media reporting of suicide to decrease the Werther effect.

Knotting of Pulmonary Artery Catheter in Cardiac Transplantation: A case report / 대한마취과학회지

A pulmonary artery catheter (PAC) is a useful monitoring device for measuring pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac output, but its insertion brings about many complications including pulmonary artery rupture, infarction, thrombosis and infection. This case concerns the knotting of a PAC in a 27 year-old female patient who had undergone cardiac transplantation due to dilated cardiomyopathy. The PAC was inserted via the right subclavian vein to the pulmonary artery and withdrawn to the superior vena cava before heart was removed. After the weaning of the cardiopulmonary bypass (CPB), we tried to reinsert the PAC, which was neither advanced nor withdrawn. Postoperative chest x-ray revealed that the PAC appeared to be knotted in the subclavian vein. Two days later, we loosened the knot of the PAC and removed it via femoral and bracheal cineangiography techniques guided by fluoroscopy without any complications. In this case, we thought the knotting of the PAC occurred at insertion due to severe tricuspid regurgitation, and its size was reduced at withdrawal before the CPB and wedging to the subclavian vein. Knotting of PAC is very rare and unpredictable, but once it or other complications of the PAC is suspected, we recommend that the manipulation of the PAC should be stopped and x-ray should be checked.