Comparison of Manual Versus Mechanical Chest Compression During Simulative out of Hospital Cardiac Arrest

PURPOSE: The quality of cardiopulmonary resuscitation (CPR) has been identified as an important factor for improving survival rate. This prospective study was conducted for comparison of manual chest compression and mechanical chest compression during simulative out of hospital cardiac arrest. And evaluation of quality of manual compression was performed on-scene and during ambulance transportation. METHODS: A total of 24 emergency medical technicians (EMTs) participated in our study. During a period of one month, they were educated by E-learning on the importance of decreasing hands off time during CPR and anything else about CPR. We instituted the scenario of out of hospital cardiac arrest. They performed CPR twice in each same situation: they performed manual chest compression the first time. And, the second time, they used the mechanical chest compression device (X-CPR(TM)). We evaluated the performance by camcorder monitoring and Q-CPR(TM) for measurement of manual compression depth and flow time. RESULTS: A total of 48 cases were performed in this study. Twenty four cases were included in the manual CPR group (H-Group) and 24 cases were included in the mechanical group (M-group). CPR of the H group vs. the M group was performed for a mean 19.71+/-2.97 min, 21.95+/-4.16 min on scene, and in a moving ambulance. The average compression rate was 122+/-14.80 min-1 vs 104.38+/-6.40 min-1 (p<0.001), and the compression depth was 44.25+/-8.50 mm vs 42.37+/-4.28 mm (p=0.34), respectively. No statistical difference was observed in the flow time ratio between manual and mechanical chest compression (67.04+/-11.12 vs 64.13+/-6.61, p=0.28). However, the quality of compression of the H-group, the ratio of insufficient compression, and the ratio of insufficient release during transport were higher than those on-scene (p=0.02, p=0.01). CONCLUSION: In comparison of chest compression rates between the two groups, the M-group showed a higher rate of chest compression. However, no significant difference in chest compression depth and flow time ratio was observed between the H- and M-groups. When performing manual chest compression during transport, EMTs should be careful of adequate chest compression and release.

Digitalis-like Toxic Symptoms Occurring after Accidental Nerium indicum Poisoning

Although Nerium indicum poisoning is a globally rare occurrence, Nerium oleander poisoning is known to occur frequently in the Mediterranean regions. To our knowledge, this is the first reported case of accidental Nerium indicum poisoning in Korea. Its poisoning symptoms and signs are similar to that of digitalis poisoning, because of the presence of cardiac glycosides in Nerium indicum. A 16-year-old boy was admitted to the emergency department four hours prior to the accidental ingestion of Nerium indicum petals. The patient complained of nausea, vomiting, and dizziness. His initial vital signs were stable; laboratory blood test results were within normal levels, except for the blood digoxin level (1.5 ng/dL). An electrocardiogram (ECG) analysis showed normal sinus rhythm, progressive PR prolongation and second-degree Morbiz type I AV block. Conservative treatments including activated charcoal administration were conducted, because toxic symptoms and signs were not severe. The patient was admitted to the intensive care unit for close observation. His ECG was converted to normal rhythm after 1 day and the toxic symptoms and signs were completely resolved after 4 days.

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.