ABSTRACT
BACKGROUND: The end-tidal carbon dioxide (ETCO2) is defined as a partial pressure of carbon dioxide at the end of an exhaled breath. And it has been found to correlate with cardiac output during cardiopulmonary resuscitation (CPR) in animal model. The purpose of this study is to determine that the assessment of ETCO2 could provide a highly sensitive predictor of return of spontaneous circulation (ROSC) during CPR. METHODS: Prospective, observational study was performed from Oct 1996 to Mar 1997 at the Severance hospital. All patients were endotracheally intubated and connected immediately to mainstream capnography sensor. We measured ETCO2 with Escort II model 20100 monitor(Medical Data Electronics, Inc, USA). It works on the principle of nondispersed infrared absorption with radiometric single beam optics. RESULTS: This study included 70 patients (52 were men) with a mean age of 54+/-15 years. ROSC was obtained in 43 patients. The initial ETCO2 averaged 15.5 +/-8.2 mmHg in survivors and 6.5+/-5.3 mmHg in nonsurvivors (p<0.01), and during the first 20 minutes of CPR, the maximal ETCO2 averaged 29.7+/-10.3 mmHg in survivors and 10.2+/-8.9 mmHg in nonsurvivors (p<0.01). ETCO2 was not significantly different in relation to initial rhythm, survival time after ROSC and possible cause of arrest. There is no cutoff value of ETCO2 satisfying greater than 90% of both sensitivity and specificity in predict ROSC. When maximal ETCO2 was less than 12 mmHg, we observed sensivity of 100% in predicting ROSC. CONCLUSION: Our results demonstrate that ETCO2 measurement represents a valuable, noninvasive, and clinical tool for monitoring patients during CPR.
Subject(s)
Humans , Absorption , Capnography , Carbon Dioxide , Carbon , Cardiac Output , Cardiopulmonary Resuscitation , Models, Animal , Observational Study , Partial Pressure , Prospective Studies , Sensitivity and Specificity , SurvivorsABSTRACT
BACKGROUND: Headache is a common complaint in patients presenting to the emergency department(ED). Many patients suffered sustained headache even after presenting to the ED. This study investigate whether the patients were received analgesics and timely adequate. METHOD: We analyzed 131 adolescent and adult patients with non-traumatic headache without any neurologic deficit in two emergency department during 6 months period retrospectively. RESULTS: The positive and negative predictive value according to primary impression were 47% and 74% respectively. The mean time to take brain computed tomography(CT) after ED presentation was 120 minutes. The patients with primary impression of intracranial hemorrhage(mainly SAH) were the most fast(mean time 88+/- 70 minutes). 28(21%) patients were received analgesics before taking brain CT(after ED presentation), and 70(53%) patients after CT, 27(54%) patients after cerebrospinal fluid examination. The mean time interval were 43, 126 and 149 minutes on each group being received the analgesics. CONCLUSION: According to this study many patients suffered sustained headache before being classified to certain type of disorder. It may due to the reasons that there were no definite guidelines treating headache, the pain itself, or the physician treats patients as physician's way.
Subject(s)
Adolescent , Adult , Humans , Analgesics , Brain , Cerebrospinal Fluid , Emergencies , Emergency Service, Hospital , Headache , Neurologic Manifestations , Retrospective StudiesABSTRACT
STUDY OBJECTIVES: To describe the clinical and laboratory findings of 17 patients who survived after paraquat poisoning DESIGN: Retrospective chart review Setting : Two University Hospital EDs METHODS: We reviewed the medical records of 17 patients, who survived after paraquat poisoning at Asan Medical Center and Ajou University Hospital from October 1994 to September 1995. RESULTS: There were 11 males and 6 females aged 5-60 years(mean, 30.6). On the amount of paraquat ingestion, the patients who swallowed the diluted chemical were 5, ingested but not swallowed the chemical were 3, swallowed one mouthful of the chemical were 7, swallowed two mouthful of the chemical was 1, and who swallowed four mouthful of the chemical was 1. The causes of poisoning were accidental ingestion in 6 patients and suicidal attempt in 11 patients. Mean initial WBC count was 11088(+/-4485)/microliter. Elevated serum creatinine levels were shown in 4 cases and mean peak serum level was 2.37(+/-.22)mg/dL. Elevated serum SGOT levels were shown in 8 cases, and mean peak serum level was 80.5(+/-7.5)IU/L. Elevated serum SGPT levels were shown in 8cases, and mean peak serum level was 151.1(+/-09.8)IU/L. 10 patients were poisoned in drunken state. There was no patient showing abnormal finding in the chest roentgenogram. CONCLUSION: Survivors of paraquat poisoning tend to be recovered from mild renal and hepatic dysfunction.