A plan for strengthening pediatric emergency care: establishment of pediatric certified emergency center

Pediatric patients (younger than 19 years) account for approximately 25% of all emergency patients. Pediatric patients have large proportions of toddlers (aged 1–5 years), low severity, illness (rather than injury), and after-hours visits. Considering these features, the authors, affiliated with the policy research team in the Korean Society of Pediatric Emergency Medicine, suggest the establishment of the pediatric certified emergency center (PCEC) to stratify Korean pediatric emergency medical system according to the Korean Acuity and Triage Scale (KTAS). The PCEC is a facility dedicated to the emergency care for a large population of KTAS 3–4 patients (i.e., mildly ill). In addition, the PCEC may perform early stabilization and transfer to the pediatric emergency centers for pediatric patients having KTAS 1–2 illnesses and injuries. To facilitate the application of emergency centers for the PCEC, the designation criteria should be flexible in terms of manpower, facility, and equipment. Financial support from the government is essential for sustainable PCEC.

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.

Part 3. Advanced cardiac life support: 2015 Korean Guidelines for Cardiopulmonary Resuscitation

No abstract available.

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.

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.

Use of Backboard and Deflation Improve Quality of Chest Compression When Cardiopulmonary Resuscitation Is Performed on a Typical Air Inflated Mattress Configuration

No study has examined the effectiveness of backboards and air deflation for achieving adequate chest compression (CC) depth on air mattresses with the typical configurations seen in intensive care units. To determine this efficacy, we measured mattress compression depth (MCD, mm) on these surfaces using dual accelerometers. Eight cardiopulmonary resuscitation providers performed CCs on manikins lying on 4 different surfaces using a visual feedback system. The surfaces were as follows: A, a bed frame; B, a deflated air mattress placed on top of a foam mattress laid on a bed frame; C, a typical air mattress configuration with an inflated air mattress placed on a foam mattress laid on a bed frame; and D, C with a backboard. Deflation of the air mattress decreased MCD significantly (B; 14.74 +/- 1.36 vs C; 30.16 +/- 3.96, P < 0.001). The use of a backboard also decreased MCD (C; 30.16 +/- 3.96 vs D; 25.46 +/- 2.89, P = 0.002). However, deflation of the air mattress decreased MCD more than use of a backboard (B; 14.74 +/- 1.36 vs D; 25.46 +/- 2.89, P = 0.002). The use of a both a backboard and a deflated air mattress in this configuration reduces MCD and thus helps achieve accurate CC depth during cardiopulmonary resuscitation.

A Qualitative Study for development of an Informed Consent Form using an iPad in an Emergency Department

PURPOSE: This study identifies best practices for informed consent for emergent computed tomography (CT) scans and development of a new document used to explain the informed consent using an iPad in an emergency department (ED). METHODS: Literature review, semi-structured interviews, and observations of informed consent were used for development of a new process for informed consent. Participants were ED physicians, residents, and senior nurses. Interviews were conducted for identification of agreed best practice and to derive new structural documents for classification of the information into relevant sections. RESULTS: Interviews identified a variety of perceived current deficits in informed consent, including difficult contents and missing explanation of the possible adverse events, such as radiation hazards. Participants provided examples of poor informed consent that were thought to have led to patient dissatisfaction; these included delay for patients who do not agree to undergo CT scan due to brief or inaccurate explanation. The interviewers' responses were used to reach a unifying 'best practice' for the content of informed consent. Their opinions were also used in implementation of a new tool for informed consent using the iPad. CONCLUSION: A new informed consent was developed using an iPad in order to provide a more efficient and organized template, which includes visual information necessary to facilitate understanding. Additional video clips were also developed in order to provide adjuvant materials for detailed explanations.