• 의료법학
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• 제19권2호
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• pp.209-233
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• 2018

이 연구의 목적은 5년간(2012년~2016년) 응급실 도착 전 심정지 환자의 자발순환회복 여부를 파악하고, 이에 미치는 요인을 규명하기 위하여 시도하였다. 이 연구는 우리나라 전국을 대상으로 2012~2016년 '질병관리본부'에서 실시한 '급성심장정지조사 원시자료'를 주 자료로 사용하였다. 2012년부터 2016년 5년간의 국가 심장정지 조사 자료 중 심장정지 환자 136,212명을 분석 대상으로 하였다. 일반적 특성, 사회·인구학적 특성, 발생관련 특성에 따른 응급실 도착 전 자발순환 회복 여부를 파악하기 위해 교차분석을 하였고, 자발순환 회복 여부에 미치는 요인을 분석하고자 이분형 로지스틱 회귀분석을 실시하였다. 분석결과 응급실 도착 전 자발순환 회복 여부에 미치는 요인은 응급실 도착전 심폐소생술 지속 이송 여부, 응급실 도착 전 급성심장정지 목격 여부, 일반인 심폐소생술 시행 종류, 급성심장정지 발생 장소, 급성심장정지 발생 원인이었다(P<0.001, P<0.01). 그러므로, 심정지 환자의 자발순환 회복에 영향을 미치는 요인을 중심으로 체계적인 정부의 보건정책 시행과 대중적인 보건교육을 강화해야 할 것이다.

• The Korean Journal of Pain
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• 제2권1호
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• pp.49-56
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• 1989

Bell's palsy is not a serious disease and recovery is spontaneous in more half of the patients, but this recovery is long delayed in many instances and the cosmetic effect of an altered facial appearance is psychologically distressing. The etiology is unknown, but Kettle's ischemic hypothesis has been widely accepted. The aim of treatment is to reduce edema and improve circulation to the facial nerve. Stellate ganglion block (SGB) resulted in abolishing cerebral vascular spasm and in increasing cerebral blood flow. Thus, stellate ganglion block is effective in treatment of Bell's palsy. From 1978 to Oct. 1988, we have treated 222 patients (20 patients were recurred cases) with facial palsy by SGB and analysed the effect of SGB. We noticed that SGB was very effective in early repetitive treatment (90% recovery). This study is reported and the literature is reviewed.

• 한국응급구조학회지
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• 제18권1호
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• pp.55-66
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• 2014

Purpose : The purpose of the study is to investigate the knowledge, attitude, confidence, and experiences of community health practitioner(CHP) regarding cardiopulmonary resuscitation(CPR). Methods : The subjects were 333 CHP in G Province, C Province, and I Metropolitan City. A structured self-reported questionnaire was filled out by 209 participants from July 29, 2013 to September 30, 2013. Results : Confidence level toward CPR was intermediate, and knowledge and attitude level was very low. Seventeen participants performed CPR to cardiac arrest victim. Eleven patients among 25 patients had spontaneous recovery of circulation (ROSC). So the rate was very high. Conclusion : It is necessary to perform the efficient CPR in CHP. In order to improve the positive attitude and confidence in CHP, the renewal system must maintain every two years.

• Journal of Chest Surgery
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• 제31권9호
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• pp.827-836
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• 1998

배경: 고려대학교 흉부외과학교실에서는 심폐소생술에서 인공심 사용이 기존의 표준 심폐소생술에 비해 나은 결과를 보인다는 점에 착안하여 한국형 이동식 심폐소생기를 개발하고자 하였다. 1997년 1월부터 8월까지 한국형 이동식 심폐소생기 개발의 전단계로 심폐정지 모델 결정 및 표준 폐쇄식/ 개흉식 심폐소생술의 비교와 관찰지표 설정을 위한 준비실험을 실시하였다. 대상 및 방법: 실험은 한국산 잡견 9마리(28-35kg)를 대상으로 폐쇄식 심폐소생술군 4마리와 개흉식 심폐소생술군 5마리로 나누어, 4분 간의 심정지 및 15분간의 일차 심폐소생술(basic life support; BLS)과 30분간의 이차 심폐소생술(advanced life support; ALS)을 실시하였다. 심장압박은 폐쇄식군의 경우 흉부에 압박을 가하였고 개흉식군에서는 직접 심장을 맛사지하였다. 소생술기간에 양군 모두 동일한 조건의 폐환기 상태를 유지하였으며, 자발성 순환회복은 이차심폐소생술 기간 초기부터 재세동과 에피네프린 및 탄산수소 나트륨을 투여하여 유도하였다. 결과: 심폐소생술 기간안에 평균 체동맥압은 BLS 동안 폐쇄식군이 33$\pm$11 mmHg인데 비해 개흉식군은 45$\pm$15 mmHg로 높게 유지되었으며, ALS 동안에도 폐쇄식군 44$\pm$15 mmHg에 비해 개흉식군이 83$\pm$36 mmHg로 높게 유지 되었으나 통계상의 유의성은 없었다. 한편 평균 폐동맥압은 BLS 동안 폐쇄식군에서 32$\pm$10 mmHg로 평균 체동 맥압과 비슷한 정도로 증가하였으나 개흉식군은 22$\pm$4 mmHg로 평균 체동맥압의 약 50%정도까지만 증가하였고, ALS 동안에도 폐쇄식군은 32$\pm$15 mmHg로 개흉식군의 24$\pm$10 mmHg보다 높게 유지되었으나 통계처리상 유의성 은 없었다. 자발성 순환회복(restoration of spontaneous circulation; ROSC) 및 심폐소생 성공 여부에서 폐 쇄식군은 4마리 모두 사망하였으나 개흉식군은 5마리중 4마리가 생존하였고 생존기간은 384$\pm$705시간이였다 (p<.05). 결론: 본 연구 결과 개흉식 심폐소생술은 폐쇄식 소생술에 비해 비록 통계학상의 차이는 없었으나 소생술 기간 동안 비교해서 안정된 혈역학 상태를 유지하여서 자발성 순환회복 및 장단기 생존율을 향상시킬 수 있었다고 판단된다.

• International Journal of Internet, Broadcasting and Communication
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• 제13권1호
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• pp.229-237
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• 2021

This study aimed to help build a quality control program to improve cardiac arrest treatment via analysis of medical records in a local tertiary general hospital to evaluate factors that influence clinical outcomes of in-hospital cardiac arrest. At first, the medical records of in-hospital cardiac arrest were analyzed, and targeted surveys about functional and structural factors associated with cardiopulmonary resuscitation (CPR) were conducted amongst the workforce in charge of cardiac arrest treatment. From January 2012 through June 2013, a total of 486 adult cases of in-hospital cardiac arrests, except for those occurring in the emergency room, were enrolled in this study. Among the patients, those of recovery of spontaneous circulation were 57.8%; 13.8% of patients were discharged alive; 8.9% of patients were discharged without significant neurologic sequela. Despite CPR is usually successful when administered as quickly as possible, in this analysis showed that prompt reaction after initial recognition was significantly lower in nurses compared with doctors. Analysis of survey results showed that confidence in performing CPR was significantly associated with the experience of CPR in doctors, while in nurses educational experience showed a correlation. In order to improve quality of in-hospital CPR system maintaining and increasing confidence of CPR performance is the most important factor. Therefore it can be helpful to develop and apply a phased, customized education program using training simulators as well as personalizing them to increase the personnel's confidence in CPR performance.

• 한국응급구조학회지
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• 제25권1호
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• pp.205-221
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• 2021

Purpose: This paper is to determine whether automatic defibrillators (AEDs) deployed across communities make a contribution to prevent death in patients with acute cardiac arrest out-of-hospital. Methods: A total of 30,179 cases of cardiac arrest investigation data from the Korea Centers for Disease Control and Prevention was matched to those on emergency medical statistics drawn from annual report for the 2018 Central Emergency Medical Center, and statistics from the National Statistical Office in 2018. Results: Multiple logistic regression analyses revealed that availability of emergency medical resources across associated with different survival rates at emergency room after taking variability of the patient's personal characteristics and episodic situational characteristics held constant. The survival rate was 1.71 times higher for patients living in communities with more than 105 AEDs avaiable per 100,000 inhabitants than for those living in communities with less than 55 AEDs. Conclusion: The survival-related factors of patients with acute cardiac arrest that occurred out-of-hospital were found to be associated with patients' and episodic situational characteristics. The hospital stage were found to be associated with patients characteristics and episodic situational characteristics, The variability of AED available in a community has an impact on survival rate after emergency room treatment.

• 한국응급구조학회지
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• 제24권3호
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• pp.155-160
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• 2020

Torsades de pointes refers to polymorphic ventricular tachycardia (PMVT), which is caused by the suppression of potassium channels owing to genetic and electrolytic abnormalities, resulting in the extension of the QT interval. Symptoms range from spontaneous circulation recovery to fainting and sudden death. Defibrillation, magnesium correction, and the use of lidocaine as an antiarrhythmic agent are recommended as treatments for persistent torsades de pointes. Currently, only amiodarone is available in the ambulance; however, torsades de pointes does not respond efficiently to amiodarone because it suppresses potassium channels and increases the refractory period of the myocardium. Lidocaine, in contrast, reduces the relative refractory period of the myocardium caused by suppressing sodium channels; thus, it inhibits the occurrence of and treats arrhythmia. In cases where PMVT did not respond to defibrillation, the administration of lidocaine showed no difference in survival and discharge rates compared to amiodarone. Thus, ambulances must be equipped with provisions to administer lidocaine.

• Journal of Chest Surgery
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• 제54권5호
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• pp.396-399
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• 2021

A 58-year-old man, incapable of maintaining oxygen saturation with mechanical ventilation, was admitted to our hospital for veno-venous extracorporeal membrane oxygenation (ECMO) treatment. He was diagnosed with acute respiratory distress syndrome (ARDS) due to influenza A pneumonia. His condition stabilized with antibiotics and steroid administration, but weaning from ECMO failed due to post-infectious pulmonary sequelae. On day 84 after admission, he underwent bilateral lung transplantation. In the postoperative phase, he did not regain consciousness even after discontinuation of sedatives for 3 days. However, spontaneous pupillary reflex and eye movements were preserved, while communication and upper and lower limb movements were affected. The nerve conduction study was diagnostic of Guillain-Barré syndrome. He was managed with intravenous immunoglobulins and plasmapheresis. Mild recovery of the facial muscles was seen, but he died 24 days post-surgery due to progressive ARDS and sepsis.

• 중환자간호학회지
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• 제16권3호
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• pp.99-108
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• 2023

Purpose : This retrospective study aims to provide basic data for intervention to improve clinical outcomes and identify the characteristics of the rebound hyperthermia (RHG) and non-rebound hyperthermia (NRHG) groups by checking body temperature in patients with post-cardiac arrest syndrome. Method : The study involved 118 patients who completed target temperature management (TTM) in an acute-care unit. Data were analyzed for frequency, percentages, mean, standard deviation, median, and quartiles, and compared using the chi-squared test and Mann-Whitney U-test. Results : Rebound hyperthermia (RH) was observed in 74 (62.7%) patients, predominantly male (69.5%), with an average age of 64.54 ± 15.98, and a body mass index of 23.22 ± 4.75kg/m² (overweight). Hypertension (50%) was the most common co-morbidity, followed by diabetes and heart disease (33.1%). Neuron-specific enolase levels were higher in the NRHG 24, 48, and 72 hours after recovery of spontaneous circulation (p = .037, p < .001, p = .008). The APHCHE IV was also higher in the NRHG (p < .001). RH occurred 25.49 (7.28-52.96) hours after TTM completion, lasting for 2 (1-3) hours. Temperature reduction strategies included notifying doctors, administering antipyretics, and nursing intervention, with the latter being the most common at 94.6%. Half of the subjects in the RHG and 77.3% in the NRHG fell into cerebral performance categories 3, 4, and 5 (p = .003). Conclusion : RH is more likely a body mechanism related to CPR and TTM than a result of pathogenic infection. Therefore, we require an active intervention for hyperthermia, and a patient-specific nursing intervention protocol.