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Objective@#The purpose of this study was to determine the type of video laryngoscope training that is appropriate for emergency medical technicians (EMT) familiar with direct laryngoscopes, to prepare them for tracheal intubation while they are wearing personal protective equipment (PPE). @*Methods@#Thirty-eight healthy EMTs were recruited. The participants underwent two tests with four different laryngoscopes: Macintosh, McGrath, Pentax Airway Scope (PENTAX-AWS), and A-LRYNGO. The first test was conducted just after a lecture without any hands-on workshops. The second test was conducted after a hands-on workshop. In each test, we measured the time required for tracheal intubation, intubation success rate, etc., and asked all the participants to respond to a short questionnaire. @*Results@#The time to complete the insertion of the endotracheal tube with the Macintosh laryngoscope did not significantly change (P=0.098), but the rest of the outcomes significantly improved after the hands-on workshop (all P<0.05). Despite the unfamiliarity of the practitioners with video laryngoscopes and their wearing PPE, intubation-related performances were good with the two-channel type video laryngoscopes after the hands-on workshop (all P<0.05). @*Conclusion@#In preparation for an infectious disease pandemic such as the coronavirus disease 2019 (COVID-19), it would be reasonable to train EMTs who would be wearing PPE on the procedure for intubating a trachea with a channeltype video laryngoscope.
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Objective@#This study aimed to analyze the association between the culprit artery and the diagnostic accuracy of automatic electrocardiogram (ECG) interpretation in patients with ST-segment elevation myocardial infarction (STEMI). @*Methods@#This single-centered, retrospective cohort study included adult patients with STEMI who visited the emergency department between January 2017 and December 2020. The primary endpoint was the association between the culprit artery occlusion and the misinterpretation of ECG, evaluated by the chi-square test or Fisher exact test. @*Results@#The rate of misinterpretation of the automated ECG for patients with STEMI was 26.5% (31/117 patients). There was no significant correlation between the ST segment change in the four involved leads (anteroseptal, lateral, inferior, and aVR) and the misinterpretation of ECG (all P > 0.05). Single culprit artery occlusion significantly affected the misinterpretation of ECG compared with multiple culprit artery occlusion (single vs. multiple, 27/86 [31.3%] vs. 4/31 [12.9%], P = 0.045). There was no association between culprit artery and the misinterpretation of ECG (P = 0.132). @*Conclusion@#Single culprit artery occlusion might increase misinterpretation of ECG compared with multiple culprit artery occlusions in the automatic interpretation of STEMI.
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Objective@#We investigated the effects of a quick Sequential Organ Failure Assessment (qSOFA)–negative result (qSOFA score <2 points) at triage on the compliance with sepsis bundles among patients with sepsis who presented to the emergency department (ED). @*Methods@#Prospective sepsis registry data from 11 urban tertiary hospital EDs between October 2015 and April 2018 were retrospectively reviewed. Patients who met the Third International Consensus Definitions for Sepsis and Septic Shock criteria were included. Primary exposure was defined as a qSOFA score ≥2 points at ED triage. The primary outcome was defined as 3-hour bundle compliance, including lactate measurement, blood culture, broad-spectrum antibiotics administration, and 30 mL/kg crystalloid administration. Multivariate logistic regression analysis to predict 3-hour bundle compliance was performed. @*Results@#Among the 2,250 patients enrolled in the registry, 2,087 fulfilled the sepsis criteria. Only 31.4% (656/2,087) of the sepsis patients had qSOFA scores ≥2 points at triage. Patients with qSOFA scores <2 points had lower lactate levels, lower SOFA scores, and a lower 28-day mortality rate. Rates of compliance with lactate measurement (adjusted odds ratio [aOR], 0.47; 95% confidence interval [CI], 0.29–0.75), antibiotics administration (aOR, 0.64; 95% CI, 0.52–0.78), and 30 mL/kg crystalloid administration (aOR, 0.62; 95% CI, 0.49–0.77) within 3 hours from triage were significantly lower in patients with qSOFA scores <2 points. However, the rate of compliance with blood culture within 3 hours from triage (aOR, 1.66; 95% CI, 1.33–2.08) was higher in patients with qSOFA scores <2 points. @*Conclusion@#A qSOFA-negative result at ED triage is associated with low compliance with lactate measurement, broad-spectrum antibiotics administration, and 30 mL/kg crystalloid administration within 3 hours in sepsis patients.
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Objective@#This study aimed to evaluate the efficacy of a bougie and glidescope video laryngoscope (GVL) for ground intubation by novice prehospital caregivers. We hypothesized that the intubation outcome using a bougie or GVL was superior to that using the Macintosh laryngoscope (MCL) with a stylet (MCLS) in ground intubation. @*Methods@#A randomized crossover manikin study was conducted. Studied groups were categorized into 4 according to the intubation devices used; MCLS, Macintosh laryngoscope with bougie (MCLB), glidescope video laryngoscope with a stylet (GVLS), and glidescope video laryngoscope with bougie (GVLB). The primary outcome was the total endotracheal intubation time and the secondary outcome was the success rate for endotracheal intubation. @*Results@#The use of a bougie did not cause a significant difference in the intubation time (MCLS vs. MCLB, P=0.213; GVLS vs. GVLB, P=0.633) and the success rate of endotracheal intubation (MCLS vs. MCLB, P>0.990; GVLS vs. GVLB, P=0.077) was compared with the use of a stylet in MCL and GVL. The use of GVL showed a longer endotracheal intubation time compared with MCLS (MCLS vs. GVLS, P<0.001; MCLS vs. GVLB, P<0.001). GVLB showed a decreased success rate of endotracheal intubation compared with the use of MCL (MCLS vs. GVLB, P=0.004; MCLB vs. GVLB, P<0.001). @*Conclusion@#The use of the GVL and a bougie could not affect the performance of endotracheal intubation on the ground. The use of MCL and a stylet for ground intubation could increase the intubation success rate and shorten intubation time compared with the use of a bougie or the use of GVL.
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Objective@#Overcrowded emergency departments (ED) are a worldwide problem, which could cause treatment delays and increased mortality of patients. This study aimed at evaluating the effect of admission decisions by emergency physicians without consultation of an internal medicine doctor on the emergency department length of stay (ED LOS) and survival rate of patients diagnosed with medical disease. @*Methods@#The study was a retrospective observational study comparing the ED LOS of patients admitted to the internal medicine (IM) department before and after the policy change regarding admission decisions, implemented in July 2017. During and after the policy change, emergency physicians took decisions on the arrangements and treatment for patients by processing their admission and providing follow-up care without further specialist consultations. The ED LOS and rate of admission to the IM department were compared between the study period (October 2017 to October 2018) and the control period (June 2016 to June 2017). @*Results@#The median ED LOS of patients admitted to the IM department decreased from 164.0 minutes (interquartile range [IQR], 118.0-234.0) in the control period to 114.0 minutes (IQR, 104.0-208.0) in the study period. After propensity score matching, the median ED LOS of patients admitted to the IM department decreased from 187.0 minutes (IQR, 136.0-253.0) in the control period to 144.0 minutes (IQR, 104.0-208.0) in the study period. @*Conclusion@#The admission decisions made by emergency physicians reduced the ED and hospital LOS of patients visiting the ED and diagnosed with medical disease.
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Objective@#This study aimed to evaluate the efficacy of a bougie and glidescope video laryngoscope (GVL) for ground intubation by novice prehospital caregivers. We hypothesized that the intubation outcome using a bougie or GVL was superior to that using the Macintosh laryngoscope (MCL) with a stylet (MCLS) in ground intubation. @*Methods@#A randomized crossover manikin study was conducted. Studied groups were categorized into 4 according to the intubation devices used; MCLS, Macintosh laryngoscope with bougie (MCLB), glidescope video laryngoscope with a stylet (GVLS), and glidescope video laryngoscope with bougie (GVLB). The primary outcome was the total endotracheal intubation time and the secondary outcome was the success rate for endotracheal intubation. @*Results@#The use of a bougie did not cause a significant difference in the intubation time (MCLS vs. MCLB, P=0.213; GVLS vs. GVLB, P=0.633) and the success rate of endotracheal intubation (MCLS vs. MCLB, P>0.990; GVLS vs. GVLB, P=0.077) was compared with the use of a stylet in MCL and GVL. The use of GVL showed a longer endotracheal intubation time compared with MCLS (MCLS vs. GVLS, P<0.001; MCLS vs. GVLB, P<0.001). GVLB showed a decreased success rate of endotracheal intubation compared with the use of MCL (MCLS vs. GVLB, P=0.004; MCLB vs. GVLB, P<0.001). @*Conclusion@#The use of the GVL and a bougie could not affect the performance of endotracheal intubation on the ground. The use of MCL and a stylet for ground intubation could increase the intubation success rate and shorten intubation time compared with the use of a bougie or the use of GVL.
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Objective@#Overcrowded emergency departments (ED) are a worldwide problem, which could cause treatment delays and increased mortality of patients. This study aimed at evaluating the effect of admission decisions by emergency physicians without consultation of an internal medicine doctor on the emergency department length of stay (ED LOS) and survival rate of patients diagnosed with medical disease. @*Methods@#The study was a retrospective observational study comparing the ED LOS of patients admitted to the internal medicine (IM) department before and after the policy change regarding admission decisions, implemented in July 2017. During and after the policy change, emergency physicians took decisions on the arrangements and treatment for patients by processing their admission and providing follow-up care without further specialist consultations. The ED LOS and rate of admission to the IM department were compared between the study period (October 2017 to October 2018) and the control period (June 2016 to June 2017). @*Results@#The median ED LOS of patients admitted to the IM department decreased from 164.0 minutes (interquartile range [IQR], 118.0-234.0) in the control period to 114.0 minutes (IQR, 104.0-208.0) in the study period. After propensity score matching, the median ED LOS of patients admitted to the IM department decreased from 187.0 minutes (IQR, 136.0-253.0) in the control period to 144.0 minutes (IQR, 104.0-208.0) in the study period. @*Conclusion@#The admission decisions made by emergency physicians reduced the ED and hospital LOS of patients visiting the ED and diagnosed with medical disease.
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Objective@#Prior studies have explored the relationship between initial body temperature (BT) and mortality in patients with sepsis in the emergency department (ED). However, there has been no study on whether or not changes in BT are associated with prognosis in these patients. We hypothesize that BT measured upon ED arrival and septic shock registry enroll time are related to the prognosis of patients with septic shock. @*Methods@#We conducted a prospective, observational, registry-based study. Each patient was assigned to 1 of 4 groups according to BT upon ED arrival and registry enrollment. Odds ratios for 28-day mortality according to the patient group were estimated using multivariable logistic regression. We also conducted logistic regression sensitivity analysis, except for patients whose time interval between arrival and enrollment was less than 1 hour. @*Results@#A total of 2,138 patients with septic shock were included. The 28-day mortalities were 13.7%, 11.2%, 13.0%, and 25.8% in groups 1, 2, 3, and 4, respectively (P<0.001). After adjusting for age, sex, mean atrial pressure, respiratory rate, Sequential Organ Failure Assessment score, lactate concentration, comorbidity, and suspicious infection focus, the risk of mortality was significantly low in patients from group 1 (adjusted odds ratio [aOR], 0.433; 95% confidence interval [CI], 0.310-0.604) and group 2 (aOR, 0.540; 95% CI, 0.336-0.868) compared with group 4. In the sensitivity analysis, group based on BT measured upon ED arrival and registry enrollment also remained an independent predictor of mortality. @*Conclusion@#Afebrile status upon ED arrival and registry enrollment were strongly associated with higher 28-day mortality in patients with septic shock.
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Objective@#To evaluate the prognostic factors associated with the sustained return of spontaneous circulation (ROSC) and survival to hospital discharge in traumatic out-of-hospital cardiac arrest (TOHCA) patients without prehospital ROSC. @*Methods@#We analyzed Korean nationwide data from the Out-of-Hospital Cardiac Arrest Surveillance, and included adult TOHCA patients without prehospital ROSC from January 2012 to December 2016. The primary outcome was sustained ROSC (>20 minutes). The secondary outcome was survival to discharge. Multivariate analysis was performed to investigate factors associated with the outcomes of TOHCA patients. @*Results@#Among 142,905 cases of OHCA, 8,326 TOHCA patients were investigated. In multivariate analysis, male sex (odds ratio [OR], 1.326; 95% confidence interval [CI], 1.103–1.594; P=0.003), and an initial shockable rhythm (OR, 1.956; 95% CI, 1.113–3.439; P=0.020) were significantly associated with sustained ROSC. Compared with traffic crash, collision (OR, 1.448; 95% CI, 1.086–1.930; P=0.012) was associated with sustained ROSC. Fall (OR, 0.723; 95% CI, 0.589–0.888; P=0.002) was inversely associated with sustained ROSC. Male sex (OR, 1.457; 95% CI, 1.026–2.069; P=0.035) and an initial shockable rhythm (OR, 4.724; 95% CI, 2.451–9.106; P<0.001) were significantly associated with survival to discharge. Metropolitan city (OR, 0.728; 95% CI, 0.541–0.980; P=0.037) was inversely associated with survival to discharge. Compared with traffic crash, collision (OR, 1.745; 95% CI, 1.125–2.708; P=0.013) was associated with survival to discharge. @*Conclusion@#Male sex, an initial shockable rhythm, and collision could be favorable factors for sustained ROSC, whereas fall could be an unfavorable factor. Male sex, non-metropolitan city, an initial shockable rhythm, and collision could be favorable factors in survival to discharge.
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OBJECTIVE: We evaluated the clinical characteristics and prognoses of patients with septic shock who transferred to the emergency department (ED) in a tertiary referral center. METHODS: This study was performed using a prospective, multi-center registry of septic shock, with the participation of 11 tertiary referral centers in the Korean Shock Society between October 2015 and February 2017. We classified the patients as a transferred group who transferred from other hospitals after meeting the inclusion criteria upon ED arrival and a non-transferred group who presented directly to the ED. Primary outcome was hospital mortality. We conducted multiple logistic regression analysis to assess variables related to in-hospital mortality. RESULTS: A total of 2,098 patients were included, and we assigned 717 patients to the transferred group and 1,381 patients to the non-transferred group. The initial Sequential Organ Failure Assessment score was higher in the transferred group than the non-transferred group (6; interquartile range [IQR], 4–9 vs. 6; IQR, 4–8; P < 0.001). Mechanical ventilator (29% vs. 21%, P < 0.001) and renal replacement therapy (12% vs. 9%, P=0.034) within 24 hours after ED arrival were more frequently applied in the transferred group than the non-transferred group. Overall hospital mortality was 22% and there was no significant difference between transferred and non-transferred groups (23% vs. 22%, P=0.820). Multivariable analysis showed an odds ratio for in-hospital mortality of 1.00 (95% confidence interval, 0.78–1.28; P=0.999) for the transferred group compared with the non-transferred group. CONCLUSION: The transferred group showed higher severity and needed more organ support procedures than the nontransferred group. However, inter-hospital transfer did not affect in-hospital mortality.
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Humans , Emergencies , Emergency Service, Hospital , Hospital Mortality , Logistic Models , Mortality , Observational Study , Odds Ratio , Prognosis , Prospective Studies , Renal Replacement Therapy , Retrospective Studies , Sepsis , Shock , Shock, Septic , Tertiary Care Centers , Ventilators, MechanicalABSTRACT
OBJECTIVE: This study aimed to identify the effects of serum potassium and lactate on neurologic outcomes in out-of-hospital post-cardiac arrest adult patients. METHODS: This study was a single center, retrospective observational study. We recruited out-of-hospital post-cardiac arrest adult patients admitted to an intensive care unit from 2011 to 2017. Primary outcome was good neurologic outcome at discharge. To evaluate the prognostic impact of serum potassium and lactate, univariate and multivariate logistic regression analyses were performed. RESULTS: A total of 57 patients were included in this study. The number of patients with good neurologic outcome was 19 (33.3%). In the univariate analysis, good neurologic outcome patients showed a higher smoking rate, shorter pre-hospital transportation time, higher rate of percutaneous coronary intervention, and lower severity score (all p < 0.05). The good neurologic outcome patients also presented higher pH, lower partial pressure of carbon dioxide, and lower potassium regarding laboratory findings on the first hospital day (all p < 0.05). In the multivariate analysis, the independent factors favoring good neurologic outcome were pre-hospital transportation time (adjusted odds ratio [aOR], 0.82; 95% confidence interval [CI], 0.69–0.97; P=0.019) and lower partial pressure of carbon dioxide on the first hospital day (aOR, 0.95; 95% CI, 0.91–0.99; P=0.034). CONCLUSION: Serum potassium and lactate were not significantly associated with good neurologic outcome in out-of-hospital post-cardiac arrest adult patients. The prognostic factors for good neurologic outcome were pre-hospital transportation time and initial partial pressure of carbon dioxide.
Subject(s)
Adult , Humans , Carbon Dioxide , Cardiopulmonary Resuscitation , Heart Arrest , Hydrogen-Ion Concentration , Intensive Care Units , Lactic Acid , Logistic Models , Multivariate Analysis , Observational Study , Odds Ratio , Partial Pressure , Percutaneous Coronary Intervention , Potassium , Prognosis , Retrospective Studies , Smoke , Smoking , TransportationABSTRACT
PURPOSE: This study aimed to evaluate the thermal protective function of firefighter clothes and gloves through real scale fire simulations. METHODS: Firstly, the fire simulation by real scale flame was performed for firefighter clothes. A manikin equipped with firefighter clothes was directly exposed to flames which energy average is 84 Kw/m2. for 22 seconds. Heat flux gauges attached on the body measured surface temperature elevation. Secondly, we also performed the other fire simulation by hot plate exposure to firefighter gloves. Firefighter gloves with heat flux gauges exposed hot plate which temperature is 300℃ in both dry and moist conditions. Primary outcome was surface temperature change of manikin body (first simulation) and hand (second simulation) over times. RESULTS: In the first flame simulation, the surface temperature of face and shoulders elevated more rapidly comparing with the other body surface area when initial period of flame shutter open. After 18sec of shutter open, the surface temperature of upper trunk elevated rapildy. After shutter closure, high surface temperature kept continuously on right side of face and left shoulder. In the second hot plate simulation, fingers and palms showed higher surface temperature than the other areas of hands in the both dry and wet conditions. CONCLUSION: This study suggests that the real scale flame enables firefighter clothes to lose their heat protective function suddenly after 18 seconds. Additionally, the protective function of firefighter gloves were relatively weaker in the palmar side of fingers than the other parts of hand. There should be additional study for evaluate thermal protection performance of firefighter clothes. And, further effort for reinforce palmar side of fingers of firefighter gloves should be done.
Subject(s)
Humans , Body Surface Area , Clothing , Fingers , Firefighters , Fires , Hand , Hot Temperature , Manikins , Patient Simulation , ShoulderABSTRACT
OBJECTIVE: This study aimed to evaluate the efficacy of i-gel blind intubation (IGI) as a rescue device for definitive airway management in ground intubation for pre-hospital trauma patients. METHODS: A prospective randomized crossover study was conducted with 18 paramedics to examine intubation performance of two blind intubation techniques through a supraglottic airway devices (IGI and laryngeal mask airway Fastrach), compared with use of a Macintosh laryngoscope (MCL). Each intubation was conducted at two levels of patient positions (ground- and stretcher-level). Primary outcomes were the intubation time and the success rate for intubation. RESULTS: The intubation time (sec) of each intubation technique was not significantly different between the two positions. In both patient positions, the intubation time of IGI was shortest among the three intubation techniques (17.9±5.2 at the ground-level and 16.9±3.8 at the stretcher-level). In the analysis of cumulative success rate and intubation time, IGI was the fastest to reach 100% success among the three intubation techniques regardless of patient position (all P < 0.017). The success of intubation was only affected by the intubation technique, and IGI achieved more success than MCL (odds ratio, 3.6; 95% confidence interval, 1.1 to 11.6; P=0.03). CONCLUSION: The patient position did not affect intubation performance. Additionally, the intubation time with blind intubation through supraglottic airway devices, especially with IGI, was significantly shorter than that with MCL.
Subject(s)
Humans , Airway Management , Allied Health Personnel , Cross-Over Studies , Emergency Medical Technicians , Intubation , Laryngeal Masks , Laryngoscopes , Prospective Studies , Simulation TrainingABSTRACT
OBJECTIVE: To evaluate the clinical characteristics, therapeutic interventions, and outcomes of patients with septic shock admitted to the emergency department (ED). METHODS: This study was a preliminary, descriptive analysis of a prospective, multi-center, observational registry of the EDs of 10 hospitals participating in the Korean Shock Society. Patients aged 19 years or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion were included. RESULTS: A total of 468 patients were enrolled (median age, 71.3 years; male, 55.1%; refractory hypotension, 82.9%; hyperlactatemia without hypotension, 17.1%). Respiratory infection was the most common source of infection (31.0%). The median Sepsis-related Organ Failure Assessment score was 7.5. The sepsis bundle compliance was 91.2% for lactate measurement, 70.3% for blood culture, 68.4% for antibiotic administration, 80.3% for fluid resuscitation, 97.8% for vasopressor application, 68.0% for central venous pressure measurement, 22.0% for central venous oxygen saturation measurement, and 59.2% for repeated lactate measurement. Among patients who underwent interventions for source control (n=117, 25.1%), 43 (36.8%) received interventions within 12 hours of ED arrival. The in-hospital, 28-day, and 90-day mortality rates were 22.9%, 21.8%, and 27.1%, respectively. The median ED and hospital lengths of stay were 6.8 hours and 12 days, respectively. CONCLUSION: This preliminary report revealed a mortality of over 20% in patients with septic shock, which suggests that there are areas for improvement in terms of the quality of initial resuscitation and outcomes of septic shock patients in the ED.
Subject(s)
Humans , Male , Central Venous Pressure , Compliance , Emergency Service, Hospital , Hyperlactatemia , Hypotension , Lactic Acid , Mortality , Oxygen , Patient Care Bundles , Prospective Studies , Resuscitation , Sepsis , Shock , Shock, SepticABSTRACT
PURPOSE: Fire suits are very important protective equipment for firefighters. In fire scene, radiant heat and warmed water invade into conventional protective clothing gap. The safety of firefighters has long been a hot topic in Korea. Nevertheless, there are still lack of researches and investigations for safety of firefighters. We revealed the characteristics of the burn site and the hospitalization of injured firefighters according to the wearing of the conventional and special protective clothing. METHODS: This study analyzed the data obtained from the online survey (ko.surveymonkey.com) from September 19, 2016 to October 21, 2016 for nationwide firefighters who are cooperating with the National Security Agency. 4,891 firefighters responded to the questionnaire and 424 burn victims were reported. The analysis was conducted with 322 except 102 incomplete responders. The obtained data was analyzed with Chi-square test (P<0.05). RESULTS: The most common site of burn injury during firefighting was hand 166 (51.6%) followed by face 79 (24.5%), neck 55 (17.1%) and wrist 49 (15.2%). The number of people wearing conventional protective clothing was 81 (25.2%) and the number of people wearing special protective clothing was 20 (6.2%). The number of people wearing protective gloves was 247 (76.7%). In terms of protective clothing in injured firefighters, special protective clothing showed lower hospitalization rate comparing with conventional protective clothing (24.7% vs. 5.0%, P<0.05). CONCLUSION: The most common site of burn injury in Firefighters is hand. The special protective clothing showed lower hospitalization rate comparing with conventional protective clothing.
Subject(s)
Humans , Burns , Firefighters , Fires , Gloves, Protective , Hand , Hospitalization , Hot Temperature , Human Body , Korea , Neck , Protective Clothing , Security Measures , Water , WristABSTRACT
PURPOSE: This study analyzed the prognostic factors affecting admission in acute alcohol-intoxicated traumatic brain injury (TBI) patients visiting the emergency room. METHODS: A multicenter, retrospective observational study was conducted on 821 acute alcohol-intoxicated adult trauma patients, who visited 10 university hospital emergency centers from April to November 2016. The primary outcome was hospital admission. The secondary outcome was in-hospital mortality. RESULTS: One hundred sixty-eight patients diagnosed with acute alcohol-intoxicated TBI were analyzed. The increase in blood alcohol concentration was associated significantly with a mild decrease in admission (adjusted odds ratio, 0.993; 95% confidence interval, 0.989 to 0.998; p=0.01). Moderate to severe TBI patients showed a significant increase in admission compared to mild TBI patients (adjusted odds ratio, 12.449; 95% confidence interval, 3.316 to 46.743; p < 0.001). CONCLUSION: This study showed that the admission was inversely correlated with the blood alcohol concentration and is correlated directly with the increase in the severity in TBI. Therefore, emergency physicians may be required to identify the severity of TBI rapidly and accurately in acute alcohol-intoxicated trauma patients visiting the emergency room.
Subject(s)
Adult , Humans , Alcohol Drinking , Blood Alcohol Content , Brain Injuries , Emergencies , Emergency Service, Hospital , Hospital Mortality , Observational Study , Odds Ratio , Patient Admission , Prognosis , Retrospective StudiesABSTRACT
OBJECTIVE: This study aimed to compare intubation performance between blind intubation through supraglottic airway devices and direct laryngoscopy by novices under manikin simulation. We hypothesized that the intubation time by novices using supraglottic airway devices was superior to that with the Macintosh laryngoscope (MCL). METHODS: A prospective, randomized crossover study was conducted with 95 participants, to evaluate i-gel, air-Q, LMA Fastrach, and MCL devices. Primary outcomes were the intubation time and the success rate for intubation. RESULTS: The i-gel showed the shortest insertion and tube passing time among the four devices; the i-gel and air-Q also showed the shortest total intubation time (all P<0.0083; i-gel vs. air-Q, P=0.03). The i-gel and MCL showed the highest cumulative success rate (all P<0.0083; i-gel vs. MCL, P=0.12). CONCLUSION: Blind intubation through the i-gel showed almost equal intubation performance compared to direct laryngoscopy.
Subject(s)
Airway Management , Cross-Over Studies , Intubation , Laryngeal Masks , Laryngoscopes , Laryngoscopy , Manikins , Prospective StudiesABSTRACT
Sinus tachycardia is an accelerated rhythm in which the rate of impulses arising from the sinoatrial node is elevated. Uncontrolled sinus tachycardia may result in a poor prognosis, particularly in patients with cardiovascular disease, because of a hemodynamic disturbance arising from the tachycardia itself. When sinus tachycardia is specifically triggered by anemia, shock, or fever, it is referred to as physiological sinus tachycardia. Physiological sinus tachycardia should resolve with correction of the underlying cause. Inappropriate sinus tachycardia (IST) is unexplained by physiological demand. Palpitation is the most frequent symptom in IST patients. Even though treatment of IST has insufficient efficacy and a relatively high recurrence rate, several treatment strategies such as use of a β-blocker, ivabradine, and radiofrequency catheter ablation can be used for IST patients.
Subject(s)
Humans , Anemia , Arrhythmia, Sinus , Cardiovascular Diseases , Catheter Ablation , Fever , Hemodynamics , Prognosis , Recurrence , Shock , Sinoatrial Node , Tachycardia , Tachycardia, SinusABSTRACT
PURPOSE: The goal of this study was to characterize the difficulty index of the items in the skills test components of the class I and II Korean emergency medical technician licensing examination (KEMTLE), which requires examinees to select items randomly. METHODS: The results of 1,309 class I KEMTLE examinations and 1,801 class II KEMTLE examinations in 2013 were subjected to analysis. Items from the basic and advanced skills test sections of the KEMTLE were compared to determine whether some were significantly more difficult than others. RESULTS: In the class I KEMTLE, all 4 of the items on the basic skills test showed significant variation in difficulty index (P<0.01), as well as 4 of the 5 items on the advanced skills test (P<0.05). In the class II KEMTLE, 4 of the 5 items on the basic skills test showed significantly different difficulty index (P<0.01), as well as all 3 of the advanced skills test items (P<0.01). CONCLUSION: In the skills test components of the class I and II KEMTLE, the procedure in which examinees randomly select questions should be revised to require examinees to respond to a set of fixed items in order to improve the reliability of the national licensing examination.
Subject(s)
Humans , Emergencies , Emergency Medical Technicians , LicensureABSTRACT
No abstract available.