Comparison of Epidemiological Characteristics and Outcomes for the In-hospital Cardiac Arrest between Poisoned Patients in Korea: A Population Study Based on Korean Health Insurance Review and Assessment Service

PURPOSE: Poisoning is an important cause of death in Korea. We aimed to investigate the epidemiological characteristics and outcomes for in-hospital cardiac arrest (IHCA) in poisoned patients in Korea. METHODS: This is a population-based study, analyzing 576 IHCA patients who were poisoned and registered in the Korean Health Insurance Review and Assessment Service in 2013. The cardiopulmonary resuscitation outcomes, including survival discharge and 30-day survival rate, were analyzed. The main diagnoses were categorized in accordance with the Korean Standard Classification of Diseases version 6. RESULTS: The overall survival discharge and 30-day survival rate were 31.6% and 15.3%, respectively. The most common etiologies of poisoning were pesticides (54.3%), drugs and medications (21.9%), carbon monoxide (8.9%), and unspecified substances (5.4%); the 30-day survival rate for each etiology was 16.6%, 15.2%, 9.8%, and 19.4%, respectively. A geographical analysis showed a high 30-day survival rate in Gwangju (32.0%), Daejeon (25.0%) and Ulsan (25.0%). CONCLUSION: Pesticides poisoning is the most common cause for IHCA patients. The survival rate after IHCA by poisoning was similar in pesticides poisoning than in other toxic etiologies. Therefore, it is crucial to reduce pesticide poisoning and to establish a poisoning information inquiry system.

Antipyretic Efficacy of Intravenous Propacetamol in the Management of Fever for Children Less than 15 Years of Age in an Emergency Center

PURPOSE: Fever is one of the most common symptoms in children visiting the emergency department. When oral antipyretics use is limited, IV antipyretics may be necessary for control of fever. In this study, we examined the current status of use and antipyretic effect of propacetamol, a precursor of acetaminophen, in fever management for children of age younger than 15 in an emergency center. METHODS: We reviewed medical records of 101 patients who were prescribed IV propacetamol from September 1st to December 31st in 2013. Among these patients, 59 children received propacetamol via intravenous injection for control of fever. We investigated variable data including age, sex, weight, chief complaint, reason for use of intravenous propacetamol, history of liver disease, and body temperature before the injection. In addition, to examine the antipyretic efficacy of IV propacetamol, we thoroughly investigated administration dose, number of injections, use of other antipyretics, other antipyretic therapy (ex. like tepid massage or ice bag), fever clearance time, etc. RESULTS: Intravenous propacetamol at a dose of 26.16 mg/kg was used in 59 patients and fever was controlled under 38degrees C within 2 hours in 39 patients (66.1%). Fever was relieved under 38degrees C within 4 hours or general condition was improved in 49 patients (83.0%). CONCLUSION: In this study, we examined the antipyretic efficacy of intravenous propacetamol in management of fever for children younger than 15 years of age in an emergency center. Optimized uses of intravenous propacetamol according to age and weight were effective for pediatric patients with fever who cannot swallow oral medications.

Comparison of Epidemiological Characteristics and Outcomes for the in-hospital Cardiac Arrest between Nursing Care Hospitals Versus Non-nursing Care Hospitals of Korea: A Population Study Based on Korean Health Insurance Review and Assessment Service

PURPOSE: The aim of this study was to investigate the epidemiological characteristics and outcomes for in-hospital cardiac arrest (IHCA) patients who were 65 years and older between nursing care hospitals versus non-nursing care hospitals in Korea. METHODS: This is a population study enumerating 24,203 IHCA patients registered in Korean Health Insurance Review and Assessment Service in 2013. The Cardiopulmonary resuscitation (CPR) outcomes including survival discharge and 30 day survival rate were analyzed. The main diagnoses of IHCA patients were categorized according to the Korean Standard classification of Disease version 6 (KCD-6). All data of patients who were CPR recipients in nursing care hospitals were compared with those of CPR recipients in non-nursing care hospitals. RESULTS: The overall survival discharge and 30 day survival rate were 29.5% and 28.1%, respectively. However, the survival discharge rate of IHCA patients was significantly low in nursing care hospitals compared to non-nursing care hospitals (20.0% vs. 30.0%, p<0.001). The 30 day survival rate was similarly low in nursing care hospitals (20.1% vs. 28.4%, p<0.001). The most common diagnosis of IHCA patients was respiratory disease in nursing care hospitals and cardiovascular disease in non-nursing care hospitals. The most common respiratory disease leading to IHCA in nursing care hospitals was acute respiratory infections. CONCLUSION: The survival rate after IHCA was lower in nursing care hospitals, and the major diagnosis leading to CPR was acute respiratory infections rather than chronic underlying diseases. Therefore, it is crucial to set higher standards in performing CPR and controlling infections in nursing care hospitals nationwide.

Comparison of Instructional Methods for Teaching Cardiopulmonary Resuscitation to School Children: CPR Anytime(R) and Little Anne(R)

PURPOSE: We compared the effectiveness of CPR Anytime(R) and Little Anne(R) for instructing schoolchildren in CPR. METHODS: We gave CPR instructions to 774 school children (24 classes) from the fifth to the eighth grade in 12 schools. We randomly selected two classes of the same grade from each school. Each class was given two hours of CPR instruction using either the Korean version of CPR Anytime(R) or Little Anne(R). The number of CPR Anytime(R) per student was 1:1 and Little Anne(R) was 1:6. The lesson consisted of didactic lecture, skill practice, and skill test. We compared the skill performance of students according to the instruction method. RESULTS: Three hundred ninety-seven (51%) students were taught using CPR Anytime(R) and 377 (49%) with Little Anne (R). There was no difference in the compression depth, hand position, adequacy of chest recoil, volume of ventilation, self-confidence, and willingness to do CPR between the two instructional methods. The average compression depth was less than 40~50 mm. Elementary school students showed more confidence and willingness to do CPR than middle school students. CONCLUSION: There was no difference in CPR skill performance after instruction using either Anytime CPR(R) or Little Anne(R).