The effects of aroma massage and foot bath on psychophysiological response in stroke patients.

[Purpose] This research aimed to examine the effects of back massage and foot bath with blended essential oil on psychophysiological response in stroke patients. [Subjects and Methods] The subjects were 14 adult stroke patients randomly divided into the experimental group (7 patients) and the control group (7 patients). Physical and psychological stress, mood state and sleep satisfaction was measured using evaluation instruments and body temperature was measured with infrared thermography (T-1000). [Results] Measurements included physical and psychological stress, and mood state of the experiment group became significantly lower than that of the control group. The body temperature and sleeping satisfaction of the experimental group became significantly higher than that of the control group. [Conclusion] The present study suggested that aroma therapy and foot bath that can be used as alternative physical therapy that offers an overall beneficial effect on psychophysiological response such as reduced stress, mood state and increased body temperature, sleeping satisfaction of stroke patients.

A trend in epidemiology and outcomes of out-of-hospital cardiac arrest by urbanization level: a nationwide observational study from 2006 to 2010 in South Korea.

BACKGROUND: The goal of this study is to better understand the trend in epidemiological features and the outcomes of emergency medical service (EMS)-assessed out-of-hospital cardiac arrest (OHCA) according to the community urbanization level: metropolitan, urban, and rural. METHODS: This study was performed within a nationwide EMS system with a single-tiered basic-to-intermediate service level and approximately 900 destination hospitals for eligible OHCA cases in South Korea (with 48 million people). A nationwide OHCA database, which included information regarding demographics, Utstein criteria, EMS, and hospital factors and outcomes, was constructed using the EMS run sheets of eligible cases who were transported by 119 EMS ambulances and followed by a medical record review from 2006 to 2010. Cases with an unknown outcome were excluded. The community urbanization level was categorized according to population size, with metropolitan areas (more than 500,000 residents), urban areas (100,000-500,000 residents), and rural areas (<100,000 residents). The primary end point was the survival to discharge rate. Age- and sex-adjusted survival rates (ASRs) and standardized survival ratios (SSRs) with 95% confidence intervals (CIs) were calculated compared to a standard population. The adjusted odds ratios (AORs) and 95% CIs for survival were calculated and adjusted for potential risk factors using stratified multivariable logistic regression analysis. RESULTS: There were 97,291 EMS-assessed OHCAs with 73,826 (75.9%) EMS-treated cases analyzed, after excluding the patients with unknown outcome (N=4172). The standardized incidence rate increased from 37.5 in 2006 to 46.8 in 2010 per 100,000 person-years for EMS-assessed OHCAs, and the survival rate was 3.0% for EMS-assessed OHCAs (3.3% for cardiac etiology and 2.3% for non-cardiac etiology) and 3.6% for EMS-treated OHCAs. Significantly different trends were found by urbanization level for bystander CPR, EMS performance, and the level of the destination hospital. The ASRs for survival were significantly improved by year in the metropolitan areas (3.6% in 2006 to 5.3% in 2010) but remained low in the urban areas (1.4% in 2006 to 2.3% in 2010) and very low in the rural areas (0.5 in 2006 and 0.8 in 2010). The SSRs (95% CIs) in the metropolitan areas were 1.19 (1.06-1.34) in 2006 and 1.77 (1.64-1.92) in 2010, whereas the SSRs were observed to be less than 1.00 during the five-year period in both urban and rural areas. The AORs (95% CIs) for survival significantly increased to 1.42 (1.22-1.66) in the metropolitan areas and to 1.58 (1.18-2.11) in the urban areas while not increasing in the rural areas, compared to the level of each group of areas in 2006. CONCLUSIONS: In this nationwide cohort study from 2006 to 2010, the standardized incidence rate and survival to discharge rate of EMS-assessed OHCAs increased annually in metropolitan and urban communities but did not increase in rural communities. Further investigations should be undertaken to improve the performance and outcomes in rural communities.

Precise minute ventilation delivery using a bag-valve mask and audible feedback.

OBJECTIVES: The efficacy of a modified bag-valve mask (BVM) with a ventilation rate alarm system was compared with conventional BVM to maximize adequate minute ventilation volume delivery in a manikin model. METHODS: After a 30-minute instructional session on how to use the 2 types of BVM, volunteers were randomly assigned to ventilate a manikin in a 2-minute arrest simulation using 2 different types of BVM. The manikin cardiopulmonary resuscitation was performed with a mechanical chest compression device, to which we added a rate alarm, which makes a ticking sound to indicate each second and buzzes every sixth second, to ensure a regular ventilation rate (10 breaths per minute). Fifty-two volunteers attempted to squeeze the classic BVM at a rate of 8 to 10 times per minute during 2-minute trial (volume marked BVM [VBVM]). After a 1-hour break, artificial ventilation was performed at a rate of 9 times per minute with the guidance of the rate alarm (rate and volume adjusted BVM [RVBVM]). RESULTS: There were no correlations between the data and the participants' physical characteristics or levels of training. In this study, the accuracy of minute ventilation between the 2 groups showed a significant difference (P < .001). The minute ventilation rate was constant in the RVBVM group, whereas in the VBVM group, the minute ventilation rate was irregular. CONCLUSION: In a manikin arrest model, the use of RVBVM results in a more constant and regular minute tidal ventilation rate than the use of VBVM and is, therefore, expected to produce more favorable outcomes in practical resuscitative situations.

Lumbosacral plexopathy due to common iliac artery aneurysm misdiagnosed as intervertebral disc herniation.

We report a case of lumbosacral plexopathy caused by an isolated aneurysm in the common iliac artery. The patient presented with low back and buttock pain radiating to the right leg and numbness in the L5 and S1 dermatomes. A computed tomography scan showed an aneurysm of the right common iliac artery. This case serves to increase awareness of the possibility of lumbosacral plexopathy in patients with symptoms of a prolapsed intervertebral disc.

How can a single rescuer adequately deliver tidal volume with a manual resuscitator? An improved device for delivering regular tidal volume.

OBJECTIVES: A bag-valve mask (BVM) device is used as one of the first-line pieces of equipment in emergency situations. However, cardiopulmonary support providers do not recognise the exact tidal volume during procedures, and squeezing methods of BVM may not deliver the same tidal volume each time. To supply a regular and sustained tidal volume, adequate finger points were marked on the surface of a BVM. METHODS: In this study, a total of 83 volunteers participated and practised conventional BVM and volume-marked bag-valve mask (VBVM) procedures. The VBVM is simply a conventional BVM with an imaginary axis grid, drawn to guide the placement of the fingers. The VBVM method provides a constant volume of approximately 500-600 ml; the bag is squeezed until the thumb and the middle finger touch slightly. The results were then statistically analysed. RESULTS: The tidal volume delivered by the studied VBVM method is more accurate than the conventional BVM method (421.87±95.19 ml vs 534.21±24.22 ml, p<0.001). There was no statistical correlation except age between the results and the participants' training level or physical characteristics in the study. CONCLUSIONS: As the conventional BVM method cannot deliver a regular and sustained tidal volume, the authors invented the VBVM method. This method delivered a volume of 500-600 ml with more stability each time, which can improve the outcome of emergency patients.

Airway scope vs Macintosh laryngoscope during chest compressions on a fresh cadaver model.

PURPOSES: This study compared the Airway scope (AWS) to the Macintosh laryngoscope (ML) during chest compressions on a fresh cadaver. METHODS: This was a prospective crossover study. The participants who had experiences with AWS were excluded. The participants intubated with randomly assigned AWS or ML on a fresh cadaver during chest compressions. Primary outcome were as follows: time to intubation, ease of intubation (rated by using the visual analog scale [VAS]), and intubation success rate. RESULTS: Twenty-five were enrolled. Median time of intubation was similar between the AWS and ML (AWS, 18.5 seconds vs ML, 18.3 seconds; P = .112). The median VAS of AWS and ML were 3.0 and 2.0, respectively (P = .023). There was no failure of intubation. However, participants replied that the AWS was more difficult to use than the ML. CONCLUSION: Considering the lack of experience with the AWS, AWS could be an alternative intubation device during chest compressions after practices with AWS.

Effect of vehicle speed on the quality of closed-chest compression during ambulance transport.

INTRODUCTION: Transport of patients with ongoing cardiopulmonary resuscitation (CPR) occurs frequently. It may not be possible to obtain rapid hospital access while maintaining CPR quality, because the ambulance's high speed can cause increased vibration and vehicle movement. We aimed to assess how the speed of ambulance affects chest compressions. MATERIALS AND METHODS: Five cycles of CPR were performed to the Resusci Anne manikin with the PC skill reporting system by experienced emergency medical technicians in ambulance traveling at one of four different speeds: stationary, 30, 60, or 90km/h. Performance and acceleration data of chest compressions at different speeds were compared using repeated measures analysis of variance (ANOVA). RESULTS: Fractions of chest compressions with adequate depth, duty cycles, average rates of chest compressions, and no flow fractions showed significant differences among different speeds (p=0.026, <0.001, <0.001, 0.005, respectively), while average depth of chest compressions did not. Accelerations of 2Hz component and ratios of 3-12Hz to 0-2Hz components showed significant differences among different speeds (p=0.001 for all). None of the outcome variables showed a significant difference between the two types of ambulance. CONCLUSIONS: The speed of ambulance affects some aspects in the quality of chest compression during transport. Chest compressions with excessive depth, the average rate of chest compressions, and no-flow fraction increase as the speed of ambulance increase. Increase in the speed of ambulance also causes relative increase of high frequency acceleration in the chest compression, which represents unnecessary movement and force applied.

Role of sonography in the emergency room to diagnose sternal fractures.

BACKGROUND: The diagnosis of a sternal fracture is often difficult when the fracture site shows only minimal displacement on conventional radiography. Recently, sonography (US) has been used widely in the emergency room (ER). We investigated the diagnostic performance of US in the ER for the diagnosis of sternal fractures. METHOD: Thirty-six consecutive patients examined for pain and tenderness in the sternum after blunt chest trauma were enrolled in the study. Antero-posterior and lateral radiographs and sonograms of the sternum were obtained within 24 hours after admission. The 2 imaging modalities were interpreted in a blinded manner and their diagnostic sensitivity and specificity were calculated. The final diagnosis was based on results from the clinical examination, radiographs, and sonograms. RESULT: Twenty-four of the 36 patients were diagnosed with sternal fractures. The sensitivity and specificity of the plain radiographs were 70.8% (95% CI = 56.0-85.6%) and 75.0% (95% CI = 60.9-89.1%), respectively. In contrast, sonography had a 100% sensitivity and specificity (95% CI = 90.3-100%). CONCLUSION: US has a higher sensitivity and specificity in diagnosing sternal fractures than conventional radiographs. US should be considered in patients with symptoms suggesting sternal fractures whose radiographs remain indeterminate.

Use of diffusion-weighted MRI in the emergency department for unconscious trauma patients with negative brain CT.

Diffusion-weighted MRI, a type of MR technique that can distinguish between cerebral fat embolism and diffuse axonal injury, is presented in this report. Emergency physicians should consider using diffusion-weighted imaging in unconscious trauma patients when their brain CT scans are unremarkable.

Relationship between healing time and mean perfusion units of laser Doppler imaging (LDI) in pediatric burns.

BACKGROUND: Laser Doppler imaging (LDI) is a noninvasive technique used to assess burn depth. However, there have been no studies regarding the use of LDI in predicting burn healing time. OBJECTIVES: The aims of this study are to evaluate the relationship between healing time and the amount of perfusion seen on LDI and to determine a cut-off value for LDI that predicts if a burn will heal within 14 days. STUDY DESIGN: Consecutive patients younger than 15 years old with partial-thickness burns were recruited from May to November 2006 for this prospective observational study. The mean number of perfusion units (PU) as determined by LDI (Periscan PIM 3 system) was obtained within 2-3 days following injury. Healing time was estimated clinically by two physicians and marked by the observation of reepithelization. The mean PU was compared between the early (healed with 14 days) and late healing groups (healed later than 14 days). The usefulness of the mean PU in predicting healing time within 14 days was estimated by receiver operating characteristic curve analysis. RESULTS: A total of 103 patients with 181 partial-thickness burn wounds were enrolled in this study. The mean PU from LDI was higher in the early healing group compared to the late healing group (380.2+/-157.8 vs. 185.8+/-115.8, p<0.001). When using 250 PUs as a cut-off value to predict early healing, the sensitivity and specificity were 80.6% and 76.9%, respectively. The area under the ROC curve was 0.844 (p<0.001, 95% CI=0.780-0.908). CONCLUSIONS: This study suggests the mean PU as determined by LDI can be used as a valuable tool in predicting the healing time of burn wounds.