• 한국간호교육학회지
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• 제16권1호
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• pp.121-128
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• 2010

Purpose: Bystander CPR has demonstrated improved survival of out-of-hospital cardiac arrest. The purpose of this study was to evaluate the effects of CPR education in the rural community. Method: One hundred eighty-nine rural laypersons (105 in the experimental group and 84 in the control group) participated in this study. In the experimental group, questionnaires were completed after participating in a small group BLS (Basic Life Support) course. In the control group questionnaires were collected from two rural health service centers. Data were analysed using $X^2$test, independent t-test and paired t-test. Result: There were significant differences in barriers to performing CPR, attitude and intention toward CPR and necessity recognition between the two groups. Conclusion: The proportion of positive attitudes toward CPR and willingness to perform CPR was higher in the experimental group than the control group. CPR education increased anxiety of being sued because of a bad outcome. For future CPR education for laypersons, the reluctance of bystanders to perform CPR should be reconsidered and CPR education should be extended to the rural community.

• 한국화재소방학회논문지
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• 제34권2호
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• pp.103-109
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• 2020

이 연구는 기본심폐소생술 교과목을 이수한 응급구조과 학생을 대상으로 수행자 엉덩관절 각도에 따라 기본심폐소생술의 질이 향상되는지 알아보고자 하였다. 기본심폐소생술 중 엉덩관절 각도에 따른 기본심폐소생술 질(가슴압박 깊이, 완전한 이완, 압박속도 등)을 측정하기 위해 SimPad SkillReporter와 Resusci Anne® QCPR®을 이용하여 비교 분석하였고, 2015 AHA Guideline 따랐으며, 가슴압박과 인공호흡의 비율은 30:2로 5주기 시행하였다. 실험군과 대조군의 일반적인 자세에서는 엉덩관절 각도, 인공호흡정도, 가슴압박 깊이, 가슴압박 속도, 가슴압박 이완, 가슴압박 정확도, 가슴압박 중단시간(Hands off time), 가슴압박 적용시간 비율은 큰 차이를 보이지 않았다(p > 0.05). 엉덩관절 각도를 90도로 유지하는 기본심폐소생술은 유지하지 않았을 때와 큰 차이는 없었으나, 적정깊이와 100% 이완에서는 좋은 결과를 보여 주어 보다 더 나은 심폐소생술 질 향상을 기대할 수 있을 것이다.

• Journal of Korean Biological Nursing Science
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• 제6권2호
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• pp.57-68
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• 2004

The contrast medium is very commonly used in more than 90% of computed tomography(CT) scans. It is difficult to predict the occurrence of adverse reactions and the degree of adverse reactions are diverse from mild urticaria, itching, nausea, vomiting to even cardiopulmonary arrest. The purpose of this study was to evaluate the symptoms, occurrence rate and risk factors of the adverse reactions in patients after contrast injection during CT examinations. Two hundreds sixty-five patients showed symptoms of adverse reactions out of 71,117 adult patients who received intravenous contrast administration during CT scans from January 2003 to December 2003 at a general hospital. Data was collected by reviewing adverse reaction records and electronic medical record. The results of this study were as follows; 1. Adverse reactions occurred in 265 out of a total of 71,117 patients(0.37%). Clinical symptoms of adverse reactions were most commonly dermatologic problems such as urticaria(69.81%) and itching(63.02%), followed by dyspnea(14.34%), dizziness(11.70%), nausea(6.79%), and vomiting(7.17%). 2. Anaphylactoid reactions occurred in 47 out of a total of 265 patients, and their pattern of symptoms were most commonly related to cardiovascular system(90.91%), followed by respiratory system(82.22%), gastrointestinal system(51.72%), and dermatologic system(16.51%). Eleven patients were transferred to emergency room for further treatment and two patients needed cardiopulmonary resuscitation. 3. The adverse reactions were significantly more common in women than in men(0.46% vs.0.32%, p=.003) and in type D contrast medium than the others(p<.001). The occurrence rate of adverse reactions was not significantly different according to the age and infusion speed of the contrast medium.

• 대한한방내과학회지
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• 제31권4호
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• pp.892-900
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• 2010

Objectives : To save the lives of patients with cardiac arrests, CPR must be performed rapidly and precisely. Regarding its critical necessity, there is a growing tendency to encourage whomever witnesses the cardiac arrest to perform basic CPR. However, the attitude toward basic CPR nor its current state of education in Korean Oriental Medical arena, which is one of the dual axes unique to Korean medical system, are not known. This is a kind of pilot study to research attitudes toward and the educative effect of basic CPR among oriental medical doctors in Korea. Methods : We carried out surveys and tests targeting nineteen apprentice doctors working in Dongguk University Ilsan Oriental Hospital, who were receiving training for 'AHA BLS course for healthcare providers', on the attitude toward and educative effect of basic CPR before and after the education. Results : The pre-educational survey showed that most of the participants felt the necessity to be trained in the BLS course, were not confident about performing CPR, and not well-acquainted with the whole process of performing CPR. After education, however, none of them responded with a lack of confidence to perform basic CPR, and the score of the confidence to perform basic CPR was significantly increased, too (from $2.05{\pm}0.71$ to $4.05{\pm}0.40$, n=19, p<0.001). Moreover, all of them answered they were satisfied with this BLS course, and it aroused their sense of responsibility as oriental medical doctors. All the participants passed the exam, and their average score for BLS scheme performance was $28.2{\pm}1.3$. Conclusions : It is necessary, in the future, to set up a management system for intensive, regular and continuous reeducation and expand the research on the perception and attitude targeting larger numbers and more multilevel groups of oriental medical doctors.

• 한국응급구조학회지
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• 제26권2호
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• pp.97-111
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• 2022

연구 목적: 병원 밖 심정지(OHCA)에서 자동제세동기(AED)의 사용은 환자의 생존율을 향상시킨다. 싱가포르는 절도를 막고자 공공 AED를 '브레이크 글래스' 기전의 잠금 박스로 보호하고 있는데 지역사회 대응자들은 AED를 회수하기 위해 유리를 깨면서 부상을 당하곤 했다. 최초로 시도한 본 연구는 성공적인 AED 회수에 영향을 미치는 요인들을 밝히고 만연한 부상을 문서화하고자 하였다. 연구 방법: 설문지를 작성, 배포하였다. 참가자는 지난 12개월 동안 OHCA에 대처한 자들이다. 비교 검정은 피셔-프리만-할턴 정확 검정 또는 피어슨 카이제곱 검정을 사용하여 5% 유의 수준에서 시행되었고, 로짓링크함수를 사용하여 다중로지스틱회귀분석을 시행하였다. 연구 결과: 88명의 참가자가 적격했다. 성공적인 AED의 회수는 직업, 연령, 성별 및 시간 영향을 받지 않았다. myResponder 앱의 활성화로 OHCA에 대응했던 참가자들은 성공적으로 AED를 회수할 가능성이 높았다. (AOR 11.111, 95% CI: 2.141-58.824) 결 론: 모바일 myResponder 앱을 활용할 경우 AED회수 성공률이 훨씬 높았다. AED의 성공적 회수는 시간 뿐만 아니라 이용자의 성별, 연령, 직업과 무관했다. 싱가포르에서 지역사회 대응자들은 부상 위험에도 불구하고 심정지에 대응할 적극적 자세가 되어 있다.

• Journal of Chest Surgery
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• 제13권3호
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• pp.212-218
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• 1980

A severe crushing injury of the chest produce a very striking syndrome referred to as traumatic asphyxia. This syndrome is characterized by bluish-red discoloration of the skin which is limited to the distribution of the valveless veins of the head and neck. And also if it is characterized by bilateral subconjunctival hemorrhages and neurological manifestations. But these clinical entities faded away progressively in a few weeks. Apporximately 90% of the patients who live for more than a few hours will recover from traumatic asphyxia when it occurs as a single entity. And so, death results from either severe associated injuries of from subsequent infection, rather than from pulmonary or cardiac insufficiency in traumatic asphyxia. We have experienced 4 cases of traumatic asphyxia with severe crushing thoracic injuries at department of the chest surgery, Captial Armed forces General Hospital during about 3 years from April 1977 to Aug. 1980. The 1st 22 year-old male was struct 2$\frac{1}{2}$ ton truck on the road and was transferred to this hospital immediately. He had taken tracheostomy due to severe dyspnea with contusion pneumonia and for removal of a large amount of bronchial secretion. The 2nd case was 23 year-old male who was got buried in a chasm. In this case, the heavy metal post tumbled over him back while at work. The 3rd case was 39 year-old male who leapt out of a window in 5th story while fire broke out in living room by oil stove heating. He had multiple rib fracture with right hemothor x and right colle's fracture and pelvic bone fracture. The last 22 year-old male was run over by a gun carriage. The wheel of this gun carriage passed over his thorax and right chin. He was brought to this hospital by helicopter. when he was first examined at emergency room, he was in semicomatose state and has pneurmomediastinum with multiple rib fracture and severe subcutaneous emphysema. As soon as he arrived, bilateral closed thoracostomy was performed and cardiopulmonary resuscitation was done. In hospital 8th weeks, chest series showed fibrothorax in right side even if chest wall stabilized. All 4 cases had multiple petechiae over their facees and chest and bilateral subconjunctival hemorrhages referred to as traumatic asphyxia. 3 cases except one case who received splenectomy, had been suffered from contusion pneumonia and had been treated with respiratory care. In these 3 cases, they had warning of impending injury before accident, and took a deep breath hold it and braces himself. And also, even if he had not impending fear in remaining one case, he had taken a deep breath and had got valsalva maneuver for pulling off the heavy metal post. Intrathoracic pressure rose suddenly and resulted to traumatic asphyxia in this situation. All these cases were recovered completely without sequelae except one fibrothorax, right.

• 한국융합학회논문지
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• 제10권4호
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• pp.99-106
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• 2019

본 연구는 시뮬레이션을 기반으로 한 전문심장소생술 교육이 병원 전 단계에 구급대원이 환자에게 시행하는 전문심장소생술 직무수행에 미치는 영향을 분석하고 효과적인 전문심장소생술을 시행하기 위한 기초자료를 제공하는데 그 목적이 있다. 비동등성 대조군 전후 설계를 기초하였으며 연구대상은 K소방학교의 신규 임용된 구급대원 16명이 참여하였다. 평가 도구로 사용된 시뮬레이션 교육 프로그램과 평가지는 ACLS 시뮬레이션 전문가 6인(응급의학 전문의 2명, 전공교수 2명, 전문강사 2명)에게 사전 검토 및 의견을 받아 본 연구에 적합한 도구로 개발하였다. 교육은 이론 30분, 실습 150분으로 구성하여 4인 1조 1개팀으로 구성하였다. 강사가 5분간 시연을 한 후 개인별 실습 후 디브리핑(debriefing)을 통한 교정을 거친 후 개별, 팀별 교육을 실시하였다. 평가척도는 5점 리커트(Likert) 척도로 수행능력 평가 점수를 부여하였다. 자료분석은 Windows용 SPSS 22.0 프로그램을 사용하였으며, 대상자의 일반적 특성은 빈도분석을 하였으며, 실험군과 대조군의 동질성 검증은 t검정을 하였고 두 그룹의 집단의 차이 분석은 대응표본 t 검정(paired t-test)으로 분석하였다. 동질성 검사에 실험군과 대조군의 동질성을 확인 할 수 있었다. 전문심장소생술(ACLS) 수행기술 6가지에 대한 평가에서 시뮬레이션 교육을 받은 실험군이 교육을 받지않은 전통적 교육 방식의 대조군보다 모든 면에서 수행능력이 우수하였음을 증명하였다. 수행기술은 1. 심전도 2. 전문기기 3. 수액처치 4. 리더십과 팀워크 5. 의료지도 6. 이송중 평가 이상 6가지 이다. 일반적인 강의와 실습을 한 구급대원보다 시뮬레이션 교육을 받은 구급대원이 직무수행 능력이 향상된 것이 검증되었다 따라서 종합술기 과정에 있는 학생이나 임상에 종사하는 응급구조사에게 시뮬레이션 훈련과 교육이 확대 적용된다면 더 능숙하게 직무를 수행해 나갈 수 있을 것이며, 심정지 환자에게 제공되는 구급서비스가 향상될 것으로 기대한다.

• Journal of Chest Surgery
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• 제11권3호
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• pp.326-332
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• 1978

There appears some conduction defects frequently after total correction of Tetralogy of Fallot. Common defect is right bundle branch block due to surgical intervention. We experienced complete A-V block which occured 3 months later after total correction of Tetralogy of Fallot in a 8 year old boy. The patient was completely free of any A-V block after the operation for 3 months, and sudden onset of A-V block with coupled premature ventricular contractions resulted him in shock state during the attack of severe bronchopneumonia for 4 days prior to the second visit. Emergency implantation of Cordis demand type temporary pacemaker was necessary to control the complete heart block with bradyarrhythmia and frequent ventricular fibrillation. Permanent cardiac pacemaker was implanted two weeks later as indicated with Cordis Stanicor lambda demand pacemaker, and the patient was discharged uneventfully on the 8th post implantation day with the heart rate of 72/min. Another 3 months after the implantation, the patient was transported to this hospital as dead on arrival after an accidental fall from a 2 meter height, and all possible cardiopulmonary resuscitation was performed for 60 minutes at the emergency room in vain. Autopsy was done to find out the cause of sudden death and the etiology of complete heart block. Microscopic focal infarctions with scar formation were noted along the course of conduction system in the interventricular septum, which might be the main cause of complete heart block during the attack of severe bronchopneumonia complicated with acute bacterial endocarditis. The tip of the pacemaker wire was slipped from the granulation scar at the apex of the right ventricular cavity, and this might be the direct cause of pacing failure and death.

• Journal of Hospice and Palliative Care
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• 제16권4호
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• pp.216-222
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• 2013

목적: 본 연구는 노인환자 심폐소생술금지 결정에 대한 간호사의 윤리적 태도와 정서상태를 파악하여 생의 말기에 있는 노인환자가 인간으로서의 존엄성을 유지하도록 돕고, 심폐소생술금지 상황에 효과적으로 대처할 수 있는 간호사의 윤리적 태도와 정서상태의 지지체계를 구축하기 위한 기초자료를 제시하고자 한다. 방법: 본 연구는 2011년 8월 1일부터 9월 15일까지 M시에 소재하고 있는 3개의 노인요양병원과 3개의 종합병원에 근무하고 있는 간호사 153명을 대상으로 실시하였으며 수집된 자료는 SPSS WIN Program을 사용하여 실수와 백분율, 평균과 표준편차, Pearson's Correlation Coefficients로 분석하였다. 결과: 심폐소생술금지 결정에 대한 간호사의 윤리적 태도 평균은 2.68/4점이었으며, 가장 높은 점수를 받은 항목은 '심폐소생술금지 환자의 치료범위는 심폐소생술은 시행하지 않지만 다른 치료는 전과 마찬가지로 최선을 다하여 행하는 것이 옳다($3.23{\pm}0.57$)'이며 가장 낮은 점수를 받은 항목은 '심폐소생술금지가 선언된 후 의사들이 환자에게 관심이 줄어드는 것은 당연하다($2.12{\pm}0.63$)'였다. 심폐소생술금지 결정에 대한 간호사의 정서상태 평균은 2.36/4점이었으며, 가장 높은 점수를 받은 항목은 '이해하고 공감한다($2.91{\pm}0.52$)'이며 가장 낮은 점수를 받은 항목은 '불쾌하게 느낀다($2.03{\pm}0.60$)'였다. 심폐소생술금지 결정에 대한 간호사의 윤리적 태도와 정서상태에 대한 상관관계를 분석한 결과 두 변수간의 유의한 상관관계는 나타나지 않았다(r=-0.12, P=0.13). 결론: 노인환자의 심폐소생술금지 결정에 대해 간호사의 윤리적 태도는 비교적 높고 정서상태는 약간 긍정적인 것으로 나타났다. 이와 같은 요인들은 대상자 특성, 지역사회 및 환경, 문화적 특성 등에 많은 영향을 받을 수 있으므로 앞으로 각각의 변수별로 세분화된 후속연구 및 반복연구를 제언한다.

• Tuberculosis and Respiratory Diseases
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• 제72권6호
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• pp.481-485
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• 2012

Background: Tracheostomy is a common procedure for patients requiring prolonged mechanical ventilation. However, the timing of tracheostomy is quite variable. This study was performed to find out the factors determining the timing of tracheostomy in medical intensive care unit (ICU). Methods: Patients who were underwent tracheostomy between January 2008 and December 2009 in the medical ICU of Seoul National University Hospital were included in this retrospective study. Results: Among the 59 patients, 36 (61.0%) were male. Median Acute Physiology And Chronic Health Evaluation (APACHE) II scores and Sequential Organ Failure Assessment scores on the admission day were 28 and 7, respectively. The decision of tracheostomy was made on 13 days, and tracheostomy was performed on 15 days after endotracheal intubation. Of the 59 patients, 21 patients received tracheostomy before 2 weeks (group I) and 38 were underwent after 2 weeks (group II). In univariate analysis, days until the decision to perform tracheostomy (8 vs. 14.5, p<0.001), days before tracheostomy (10 vs. 18, p<0.001), time delay for tracheostomy (2.1 vs. 3.0, p<0.001), cardiopulmonary resuscitation (19.0% vs. 2.6%, p=0.049), existence of neurologic problem (38.1% vs. 7.9%, p=0.042), APACHE II scores (24 vs. 30, p=0.002), and $PaO_2/FiO_2$ <300 mm Hg (61.9% vs. 91.1%, p=0.011) were different between the two groups. In multivariate analysis, APACHE II scores${\geq}20$ (odds ratio [OR], 12.44; 95% confidence interval [CI], 1.14~136.19; p=0.039) and time delay for tracheostomy (OR, 1.97; 95% CI, 1.11~3.55; p=0.020) were significantly associated with tracheostomy after 2 weeks. Conclusion: APACHE II scores${\geq}20$ and time delay for tracheostomy were associated with tracheostomy after 2 weeks.