Acute and Critical Care

Case Report

Neurology
Abducens paralysis—a rare complication of spinal anesthesia at an emergency department: a case report: Mustafa Korkut, Cihan Bedel; Received December 4, 2021 Accepted January 28, 2022 Published online July 5, 2022; DOI: https://doi.org/10.4266/acc.2021.01697 [Epub ahead of print]

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The sixth cranial nerve (CN VI) is a rare site of complication associated with spinal anesthesia and can produce secondary symptoms of ocular muscle palsy. A 38-year-old man was admitted to the emergency department with complaint of diplopia and limited lateral gaze in the first week after endoscopic urological surgery under spinal anesthesia. Isolated unilateral CN VI palsy was considered after excluding differential diagnoses. Ocular palsy and diplopia regressed with conservative treatment during follow-up, and the patient was discharged. This article aims to show that CN VI palsy is a rare complication of spinal anesthesia, which can be observed in the emergency department.

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Cranial Nerve Six Palsy After Vaginal Delivery with Epidural Anesthesia: A Case Report
Jennifer Olivarez, Scott Gutovitz, Caylyne Arnold
The Journal of Emergency Medicine.2024; 66(3): e338. CrossRef

Original Articles

Nursing
The effect of time management education on critical care nurses’ prioritization: a randomized clinical trial: Fatemeh Vizeshfar, Mahnaz Rakhshan, Fatemeh Shirazi, Roya Dokoohaki; Acute Crit Care. 2022;37(2):202-208. Published online April 28, 2022; DOI: https://doi.org/10.4266/acc.2021.01123

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Abstract PDF

necessiBackground: Nurses are at the forefront of patient care, and time management skills can increase their ability to make decisions faster. This study aimed to assess the effect of a time management workshop on prioritization and time management skills among nurses of emergency and intensive care units.
Methods
This randomized clinical trial was performed with 215 nurses. The educational intervention about time management was held in the form of a workshop for the intervention group. The time management questionnaire was completed by both groups before, immediately after, and 3 months after the intervention.
Results
Most participants were female (n=191, 88%), with a mean age of 31.82 years (range, 22–63 years). Additionally, the participants’ work experience ranged from 1 to 30 years (mean±standard deviation, 8.00±7.15 years). After the intervention, the mean score of time management increased significantly in the intervention group, but no significant difference was observed in this regard in the control group. The results also revealed a significant difference between the intervention and control groups regarding the mean score of time management 3 months after the intervention (P<0.001).
Conclusions
Time management training helped nurses adjust the time required to perform and prioritize various tasks.

Citations

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Nursing core competencies for postresuscitation care in Iran: a qualitative study
Mahnaz Zali, Azad Rahmani, Kelly Powers, Hadi Hassankhani, Hossein Namdar-Areshtanab, Neda Gilani
BMJ Open.2024; 14(1): e074614. CrossRef
Critical care nurses’ experiences of caring challenges during post-resuscitation period: a qualitative content analysis
Mahnaz Zali, Azad Rahmani, Hadi Hassankhani, Hossein Namdar-Areshtanab, Neda Gilani, Arman Azadi, Mansour Ghafourifard
BMC Nursing.2024;[Epub] CrossRef
Impact of time management program on stress and coping strategies adopted by nursing students with regard to academic performance
Juby Mary Chacko, Achamma Varghese, Nirmala Rajesh
IP Journal of Paediatrics and Nursing Science.2023; 6(1): 48. CrossRef
Perceived clinical competence and predictive role of time management in nursing students
Maryam Behdarvand, Mehrnaz Ahmadi, Nasrin Khajeali
Nurse Education in Practice.2023; 72: 103789. CrossRef
Examining the impact of time management and resilience training on work-family conflict among Iranian female nurses: a randomized controlled trial
Sedigheh Peykar, Hakimeh Vahedparast, Tayebeh Gharibi, Razieh Bagherzadeh
BMC Nursing.2023;[Epub] CrossRef

Infection
Incidence and risk factors associated with early death in patients with emergency department septic shock: Matthew S. Reaven, Nigel L. Rozario, Maggie S. J. McCarter, Alan C. Heffner; Acute Crit Care. 2022;37(2):193-201. Published online February 11, 2022; DOI: https://doi.org/10.4266/acc.2021.00857

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Abstract PDF

Background
Limited research has explored early mortality among patients presenting with septic shock. The objective of this study was to determine the incidence and factors associated with early death following emergency department (ED) presentation of septic shock.
Methods
A prospective registry of patients enrolled in an ED septic shock clinical pathway was used to identify patients. Patients were compared across demographic, comorbid, clinical, and treatment variables by death within 72 hours of ED presentation.
Results
Among the sample of 2,414 patients, overall hospital mortality was 20.6%. Among patients who died in the hospital, mean and median time from ED presentation to death were 4.96 days and 2.28 days, respectively. Death at 24, 48, and 72 hours occurred in 5.5%, 9.5%, and 11.5% of patients, respectively. Multivariate regression analysis demonstrated that the following factors were independently associated with early mortality: age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.03–1.05), malignancy (OR, 1.53; 95% CI, 1.11–2.11), pneumonia (OR, 1.39; 95% CI, 1.02–1.88), urinary tract infection (OR, 0.63; 95% CI, 0.44–0.89), first shock index (OR, 1.85; 95% CI, 1.27–2.70), early vasopressor use (OR, 2.16; 95% CI, 1.60–2.92), initial international normalized ratio (OR, 1.14; 95% CI, 1.07–1.27), initial albumin (OR, 0.55; 95% CI, 0.44–0.69), and first serum lactate (OR, 1.21; 95% CI, 1.16–1.26).
Conclusions
Adult septic shock patients experience a high rate of early mortality within 72 hours of ED arrival. Recognizable clinical factors may aid the identification of patients at risk of early death.

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Early Prediction of Mortality for Septic Patients Visiting Emergency Room Based on Explainable Machine Learning: A Real-World Multicenter Study
Sang Won Park, Na Young Yeo, Seonguk Kang, Taejun Ha, Tae-Hoon Kim, DooHee Lee, Dowon Kim, Seheon Choi, Minkyu Kim, DongHoon Lee, DoHyeon Kim, Woo Jin Kim, Seung-Joon Lee, Yeon-Jeong Heo, Da Hye Moon, Seon-Sook Han, Yoon Kim, Hyun-Soo Choi, Dong Kyu Oh, S
Journal of Korean Medical Science.2024;[Epub] CrossRef
Red cell distribution width and in‐hospital mortality in septic shock: A public database research
Qiong Ding, Yingjie Su, Changluo Li, Ning Ding
International Journal of Laboratory Hematology.2022; 44(5): 861. CrossRef

Review Articles

CPR/Resuscitation
Critical emergency medicine and the resuscitative care unit: Maria Mermiri, Georgios Mavrovounis, Dimitrios Chatzis, Ioannis Mpoutsikos, Aristea Tsaroucha, Maria Dova, Zacharoula Angelopoulou, Dimitrios Ragias, Athanasios Chalkias, Ioannis Pantazopoulos; Acute Crit Care. 2021;36(1):22-28. Published online January 28, 2021; DOI: https://doi.org/10.4266/acc.2020.00521

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Abstract PDF

Critical emergency medicine is the medical field concerned with management of critically ill patients in the emergency department (ED). Increased ED stay due to intensive care unit (ICU) overcrowding has a negative impact on patient care and outcome. It has been proposed that implementation of critical care services in the ED can negate this effect. Two main Critical Emergency Medicine models have been proposed, the “resource intensivist” and “ED-ICU” models. The resource intensivist model is based on constant presence of an intensivist in the traditional ED setting, while the ED-ICU model encompasses the notion of a separate ED-based unit, with monitoring and therapeutic capabilities similar to those of an ICU. Critical emergency medicine has the potential to improve patient care and outcome; however, establishment of evidence-based protocols and a multidisciplinary approach in patient management are of major importance.

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Inhaled anaesthetic gas for severe bronchospasm at the emergency department
Osman Adi, Farah Nuradhwa Apoo, Chan Pei Fong, Azma Haryaty Ahmad, Nurul Liana Roslan, Faheem Ahmed Khan, Shahridan Fathil
The American Journal of Emergency Medicine.2024; 75: 179. CrossRef
Patients’ Expectations in Emergency Department at King Abdulaziz University Hospital: A Cross-Sectional Survey-Based Study
Ahmad H Bakhribah, Ghaida A. Eissa, Dania W Alsulami, Marah A Alotaibi, Htoun M Abdulmannan, Imad M Khojah
Cureus.2024;[Epub] CrossRef
The impact of emergency department length of stay on the outcomes of trauma patients requiring hospitalization: a retrospective observational study
Ahmed Faidh Ramzee, Ayman El-Menyar, Mohammad Asim, Ahad Kanbar, Khalid Ahmed, Bahaa Daoud, Saji Mathradikkal, Ahmad Kloub, Hassan Al-Thani, Sandro Rizoli
World Journal of Emergency Medicine.2023; 14(2): 96. CrossRef
Value of Intensive Nursing Detail Management in Intensive Care Unit Nursing
Yansong Li, Lehong Zhou, Qin Wei, Zhaoqi Dong
Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1. CrossRef
Effect of Early Low-Calorie Enteral Nutrition Support in Critically Ill Patients: A Systematic Review and Meta-analysis
Qidong Jiang, Tao Xu, Dinesh Rokaya
BioMed Research International.2022; 2022: 1. CrossRef
Is the Critical Care Resuscitation Unit Sustainable: A 5-Year Experience of a Beneficial and Novel Model
Elizabeth Powell, Iana Sahadzic, Daniel Najafali, Emilie Berman, Katie Andersen, Leenah Z. Afridi, Zoe Gasparotti, Erin Niles, Jeffrey Rea, Thomas Scalea, Daniel J. Haase, Quincy K. Tran, Edward A. Bittner
Critical Care Research and Practice.2022; 2022: 1. CrossRef

Rapid response system
Rapid response systems in Korea: Bo Young Lee, Sang-Bum Hong; Acute Crit Care. 2019;34(2):108-116. Published online May 31, 2019; DOI: https://doi.org/10.4266/acc.2019.00535

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Abstract PDF

The inpatient treatment process is becoming more and more complicated with advanced treatments, aging of the patient population, and multiple comorbidities. During the process, patients often experience unexpected deterioration, about half of which might be preventable. Early identification of patient deterioration and the proper response are priorities in most healthcare facilities. A rapid response system (RRS) is a safety net to identify antecedents of these adverse events and to respond in a timely manner. The RRS has become an essential part of the medical system worldwide, supported by all major quality improvement organizations. An RRS consists of a trigger system and response team and needs constant assessment and process improvement. Although the effectiveness and cost-benefit of RRS remain controversial, according to previous studies, it may be beneficial by decreasing in-hospital cardiac arrest and mortality. Since the first implementation of RRS in Korea in 2008, it has been developed in over 15 medical centers and continues to expand. Recent accreditation standards and an RRS pilot program by the Korean government will promote the proliferation of RRSs in Korea.

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Association between the timing of ICU admission and mortality in patients with hospital-onset sepsis: a nationwide prospective cohort study
Yoon Hae Ahn, Jinwoo Lee, Dong Kyu Oh, Su Yeon Lee, Mi Hyeon Park, Haein Lee, Chae-Man Lim, Sang-Min Lee, Hong Yeul Lee, Chae-Man Lim, Sang-Bum Hong, Dong Kyu Oh, Gee Young Suh, Kyeongman Jeon, Ryoung-Eun Ko, Young-Jae Cho, Yeon Joo Lee, Sung Yoon Lim, Su
Journal of Intensive Care.2023;[Epub] CrossRef
Findings from a decade of experience following implementation of a Rapid Response System into an Asian hospital
Augustine Tee, Bryan Peide Choo, Roshni Sadashiv Gokhale, Xiqin Wang, Mashithah Mansor, Hong Choon Oh, Daryl Jones
Resuscitation Plus.2023; 16: 100461. CrossRef
Development of a comprehensive model for the role of the rapid response team nurse
Youn-Hui Won, Jiyeon Kang
Intensive and Critical Care Nursing.2022; 68: 103136. CrossRef
Characteristics and outcomes of patients screened by rapid response team who transferred to the intensive care unit
Song-I. Lee, Jeong Suk Koh, Yoon Joo Kim, Da Hyun Kang, Jeong Eun Lee
BMC Emergency Medicine.2022;[Epub] CrossRef
Mortality of patients with hospital-onset sepsis in hospitals with all-day and non-all-day rapid response teams: a prospective nationwide multicenter cohort study
Dong-gon Hyun, Su Yeon Lee, Jee Hwan Ahn, Jin Won Huh, Sang-Bum Hong, Younsuck Koh, Chae-Man Lim, Dong Kyu Oh, Gee Young Suh, Kyeongman Jeon, Ryoung-Eun Ko, Young-Jae Cho, Yeon Joo Lee, Sung Yoon Lim, Sunghoon Park, Jeongwon Heo, Jae-myeong Lee, Kyung Cha
Critical Care.2022;[Epub] CrossRef
Korean nurses’ perception and performance on communication with physicians in clinical deterioration
Bo-Gyeong Jin, Kyoungrim Kang, Hyun-Jin Cho
Medicine.2022; 101(38): e30570. CrossRef
Clinical Nurses’ Intention to Use Defibrillators in South Korea: A Path Analysis
Dongchoon Uhm, Gye-Hyun Jung
Healthcare.2022; 11(1): 61. CrossRef
Rapid Response System Should Be Enhanced at Non-general Ward Locations: a Retrospective Multicenter Cohort Study in Korea
Byung Ju Kang, Sang-Bum Hong, Kyeongman Jeon, Sang-Min Lee, Dong Hyun Lee, Jae Young Moon, Yeon Joo Lee, Jung Soo Kim, Jisoo Park, Jong-Joon Ahn
Journal of Korean Medical Science.2021;[Epub] CrossRef
Impact of hospitalization duration before medical emergency team activation: A retrospective cohort study
Jinmi Lee, Yujung Shin, Eunjoo Choi, Sunhui Choi, Jeongsuk Son, Youn Kyung Jung, Sang-Bum Hong, Tai-Heng Chen
PLOS ONE.2021; 16(2): e0247066. CrossRef
A multicentre validation study of the deep learning-based early warning score for predicting in-hospital cardiac arrest in patients admitted to general wards
Yeon Joo Lee, Kyung-Jae Cho, Oyeon Kwon, Hyunho Park, Yeha Lee, Joon-Myoung Kwon, Jinsik Park, Jung Soo Kim, Man-Jong Lee, Ah Jin Kim, Ryoung-Eun Ko, Kyeongman Jeon, You Hwan Jo
Resuscitation.2021; 163: 78. CrossRef
Characteristics and Prognosis of Hospitalized Patients at High Risk of Deterioration Identified by the Rapid Response System: a Multicenter Cohort Study
Sang Hyuk Kim, Ji Young Hong, Youlim Kim
Journal of Korean Medical Science.2021;[Epub] CrossRef
Predicting severe outcomes using national early warning score (NEWS) in patients identified by a rapid response system: a retrospective cohort study
Sang Hyuk Kim, Hye Suk Choi, Eun Suk Jin, Hayoung Choi, Hyun Lee, Sang-Hwa Lee, Chang Youl Lee, Myung Goo Lee, Youlim Kim
Scientific Reports.2021;[Epub] CrossRef
A physician-led medical emergency team increases the rate of medical interventions: A multicenter study in Korea
Su Yeon Lee, Jee Hwan Ahn, Byung Ju Kang, Kyeongman Jeon, Sang-Min Lee, Dong Hyun Lee, Yeon Joo Lee, Jung Soo Kim, Jisoo Park, Jae Young Moon, Sang-Bum Hong, Amit Bahl
PLOS ONE.2021; 16(10): e0258221. CrossRef
Incorporating a real-time automatic alerting system based on electronic medical records could improve rapid response systems: a retrospective cohort study
Seung-Hun You, Sun-Young Jung, Hyun Joo Lee, Sulhee Kim, Eunjin Yang
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2021;[Epub] CrossRef
Effects of a Rapid Response Team on the Clinical Outcomes of Cardiopulmonary Resuscitation of Patients Hospitalized in General Wards
Mi-Jung Yoon, Jin-Hee Park
Journal of Korean Academy of Fundamentals of Nursing.2021; 28(4): 491. CrossRef
Early Warning Score and Cancer Patients at End-of-Life
Jae-woo Lee, Ye-Seul Kim, Yonghwan Kim, Hyo-Sun Yoo, Hee-Taik Kang
Korean Journal of Clinical Geriatrics.2021; 22(2): 67. CrossRef
Effectiveness of a daytime rapid response system in hospitalized surgical ward patients
Eunjin Yang, Hannah Lee, Sang-Min Lee, Sulhee Kim, Ho Geol Ryu, Hyun Joo Lee, Jinwoo Lee, Seung-Young Oh
Acute and Critical Care.2020; 35(2): 77. CrossRef
Current State and Strategy for Establishing a Digitally Innovative Hospital: Memorial Review Article for Opening of Yongin Severance Hospital
Soo-Jeong Kim, Ji Woong Roh, Sungwon Kim, Jin Young Park, Donghoon Choi
Yonsei Medical Journal.2020; 61(8): 647. CrossRef
Bleeding management after implementation of the Hemorrhage Code (Code H) at the Hospital Israelita Albert Einstein, São Paulo, Brazil
Michele Jaures, Neila Maria Marques Negrini Pigatti, Roseny dos Reis Rodrigues, Fernanda Paulino Fernandes, João Carlos de Campos Guerra
Einstein (São Paulo).2020;[Epub] CrossRef
Management of post-cardiac arrest syndrome
Youngjoon Kang
Acute and Critical Care.2019; 34(3): 173. CrossRef
Effect of a rapid response system on code rates and in-hospital mortality in medical wards
Hong Yeul Lee, Jinwoo Lee, Sang-Min Lee, Sulhee Kim, Eunjin Yang, Hyun Joo Lee, Hannah Lee, Ho Geol Ryu, Seung-Young Oh, Eun Jin Ha, Sang-Bae Ko, Jaeyoung Cho
Acute and Critical Care.2019; 34(4): 246. CrossRef
Evidence revealed the effects of rapid response system
Jae Hwa Cho
Acute and Critical Care.2019; 34(4): 282. CrossRef

Original Articles

Rapid response system
Epidemiology and Clinical Characteristics of Rapid Response Team Activations: Sei Won Kim, Hwa Young Lee, Mi Ra Han, Yong Suk Lee, Eun Hyoung Kang, Eun Ju Jang, Keum Sook Jeun, Seok Chan Kim; Korean J Crit Care Med. 2017;32(2):124-132. Published online May 31, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00199

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Abstract PDF

Background
To ensure patient safety and improvements in the quality of hospital care, rapid response teams (RRTs) have been implemented in many countries, including Korea. The goal of an RRT is early identification and response to clinical deterioration in patients. However, there are differences in RRT systems among hospitals and limited data are available.
Methods
In Seoul St. Mary’s Hospital, the St. Mary’s Advanced Life Support Team was implemented in June 2013. We retrospectively reviewed the RRT activation records of 287 cases from June 2013 to December 2016.
Results
The median response time and median modified early warning score were 8.6 minutes (interquartile range, 5.6 to 11.6 minutes) and 5.0 points (interquartile range, 4.0 to 7.0 points), respectively. Residents (35.8%) and nurses (59.1%) were the main activators of the RRT. Interestingly, postoperative patients account for a large percentage of the RRT activation cases (69.3%). The survival rate was 83.6% and survival was mainly associated with malignancy, Acute Physiology and Chronic Health Evaluation-II score, and the time from admission to RRT activation. RRT activation with screening showed a better outcome compared to activation via a phone call in terms of the intensive care unit admission rate and length of hospital stay after RRT activation.
Conclusions
Malignancy was the most important factor related to survival. In addition, RRT activation with patient screening showed a better outcome compared to activation via a phone call. Further studies are needed to determine the effective screening criteria and improve the quality of the RRT system.

Citations

Citations to this article as recorded by

Development of a comprehensive model for the role of the rapid response team nurse
Youn-Hui Won, Jiyeon Kang
Intensive and Critical Care Nursing.2022; 68: 103136. CrossRef
Failure mode and effect analysis (FMEA) to identify and mitigate failures in a hospital rapid response system (RRS)
Ehsan Ullah, Mirza Mansoor Baig, Hamid GholamHosseini, Jun Lu
Heliyon.2022; 8(2): e08944. CrossRef
Neurological Emergencies in Patients Hospitalized With Nonneurological Illness
Sang-Beom Jeon, Han-Bin Lee, Yong Seo Koo, Hyunjo Lee, Jung Hwa Lee, Bobin Park, Soh Hyun Choi, Suyeon Jeong, Jun Young Chang, Sang-Bum Hong, Chae-Man Lim, Sang-Ahm Lee
Journal of Patient Safety.2021; 17(8): e1332. CrossRef
Rapid response systems in Korea
Bo Young Lee, Sang-Bum Hong
Acute and Critical Care.2019; 34(2): 108. CrossRef

How to Decrease the Malposition Rate of Central Venous Catheterization: Real-Time Ultrasound-Guided Reposition: Hongjoon Ahn, Gundong Kim, Byulnimhee Cho, Wonjoon Jeong, Yeonho You, Seung Ryu, Jinwoong Lee, Seungwhan Kim, Insool Yoo, Yongchul Cho; Korean J Crit Care Med. 2013;28(4):280-286.; DOI: https://doi.org/10.4266/kjccm.2013.28.4.280

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Abstract PDF

BACKGROUND
The purpose of this retrospective and prospective study is to evaluate the efficiency of ultrasound (US) guidance as a method of decreasing the malposition rate of central venous catheterization (CVC) in the emergency department (ED).
METHODS
We retrospectively enrolled 379 patients who underwent landmark-guided CVC (Group A) and prospectively enrolled 411 patients who underwent US-guided CVC (Group B) in the ED of a tertiary hospital. Malposition of the CVC tip is identified when the tip is not located in the superior vena cava (SVC). In Group B, we performed US-guided intravascular guide-wire repositioning and then confirmed the location of the CVC tip with chest radiography when the guide-wire was visible in any three other vessels rather than in the approached vessel. In the case of a guide-wire inserted into the right subclavian vein (SCV), the left SCV and both internal jugular veins (IJV) were referred to as the three other vessels. The two subject groups were compared in terms of the malposition rate using Fisher's exact test (significance = p < 0.05).
RESULTS
There were 38 malposition cases out of a total of 790 CVCs. The malposition rates of Groups A and B were 5.5% (21) and 4.1% (17), respectively, and no statistically significant difference in malposition rate between the two groups was found. In Group B, the malposition rate was decreased from 4.1% (17) to 1.2% (5) after the guide-wire was repositioned with US guidance, which led to a statistically significant difference in malposition rate (p < 0.01).
CONCLUSIONS
The authors concluded that repositioning the guide-wire with US guidance increased correct placement of central venous catheters toward the SVC.

Citations

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Safety and Feasibility of Ultrasound-guided Peripherally Inserted Central Catheterization for Chemo-Delivery
Tak-Joong Song, Shin-Seok Yang, Woo-Sung Yoon
Journal of Surgical Ultrasound.2019; 6(1): 14. CrossRef
Single Center Experience of Ultrasonography-guided Bedside Procedures for Surgical Patients
Dooreh Kim, Dae Hyun Cho, Yun Tae Jung, Jae Gil Lee
Journal of Surgical Ultrasound.2018; 5(2): 61. CrossRef
Direction of the J-Tip of the Guidewire to Decrease the Malposition Rate of an Internal Jugular Vein Catheter
Byeong jun Ahn, Sung Uk Cho, Won Joon Jeong, Yeon Ho You, Seung Ryu, Jin Woong Lee, In Sool Yoo, Yong chul Cho
The Korean Journal of Critical Care Medicine.2015; 30(4): 280. CrossRef

Analysis of Prognostic Factors Early in Emergency Department (ED) and Late in Intensive Care Unit (ICU) of the Critically Ill Patients Admitted in the ICU via ED: Ru Bi Jeong, Jung Hwan An, Hyun Min Jun, Sung Min Jeong, Tae Yong Shin, Young Sik Kim, Young Rock Ha; Korean J Crit Care Med. 2012;27(4):237-248.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.237

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Abstract PDF: BACKGROUND
Many critically ill patients in the ED are hospitalized to the ICU, but most prognosis predicting systems have been developed based on the physiochemical variables of the critically ill in the ICU. The objective of this study is to identify prognostic predictors early in the ED when compared with well-known predictors in the ICU and estimate their predictive abilities.
METHODS
An observational prospective study was performed in an urban ED. Information of all the critically ill patients admitted to the ICU via the ED including vital signs, laboratory results, and physiochemical scoring systems were checked during 6 months and divided into the early stage for the ED and the late stage in the ICU. Poor outcome was defined as 28-days mortality. After checking for significant predictors among them through univariate analysis, we identified the most discriminating predictors in each stage using logistic regression and a decision tree analysis.
RESULTS
A total of 246 patients were enrolled. In univariate analysis, the significant predictors including central venous pressure, fraction of inspired oxygen (FiO2), pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2), albumin, mortality in emergency department sepsis, acute physiology and chronic health evaluation II, simplified acute physiology score II, and sequential organ failure assessment scores were identified in the early stage, while PaO2/FiO2, base excess, unmeasured anion, albumin, anion gap, albumin-corrected anion gap, APACHEII, SAPSII, SOFA, and rapid emergency medicine score were identified in the late stage. Through a decision tree analysis, PaO2/FiO2 and SAPSII were revealed as the most discriminating predictors in the ED and ICU, respectively.
CONCLUSIONS
The prognosis discriminating predictor in critical patients was different between the ED and ICU. Emergency physicians should pay more attention to the critical patients having low PaO2/FiO2.

Outcome after Admission to Intensive Care Unit Following Out-of-Hospital Cardiac Arrest: Comparison between Cardiac Etiology and Non-Cardiac Etiology: Hwan Seok Kang, Hun Jae Lee, Jae Hwa Cho, Jin Hui Paik, Ji Hye Kim, Jun Sig Kim, Seung Baik Han; Korean J Crit Care Med. 2010;25(4):212-218.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.212

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Abstract PDF

BACKGROUND
To evaluate the post-resuscitation intensive care unit outcome of patients who initially survived out-of-hospital cardiac arrest (OHCA).
METHODS
We retrospectively analyzed patients who were admitted to the ICU after OHCA in a tertiary hospital between January, 2005 and December, 2009. We compared the patients' clinical data, the factors associated with admission and the prognosis of patients in cardiac and non-cardiac groups.
RESULTS
Sixty-four patients were included in this study. Thirty-four patients were in the cardiac group and thirty patients were in the non-cardiac group. The mean age was 57.3 +/- 15.1 years of age in the cardiac group and 61.9 +/- 15.7 years of age in the non-cardiac group (p = 0.235). The collapse-to-start of the CPR interval was 5.9 +/- 3.8 min in the cardiac group and 6.0 +/- 3.2 min in the non-cardiac group (p = 0.851). The complaint of chest pain occurred in 12 patients (35.3%) in the cardiac group and 1 patient (3.3%) in the non-cardiac group (p = 0.011). The time duration for making a decision for admission was 285.2 +/- 202.2 min in the cardiac group and 327.7 +/- 264.1 min in the non-cardiac group (p = 0.471). The regional wall motion abnormality and ejection fraction decrease were significant in the cardiac group (p = 0.002, 0.030). Grade 5 CPC was present in 8 patients (23.5%) in the cardiac group and 14 patients (46.7%) in the non-cardiac group.
CONCLUSIONS
The key symptom that could initially differentiate the two groups was chest pain. The time duration for making an admission decision was long in both groups. The CPC score of the cardiac group was lower than that for the non-cardiac group.

Citations

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Management of post-cardiac arrest syndrome
Youngjoon Kang
Acute and Critical Care.2019; 34(3): 173. CrossRef

The Effect of Emergency Department Treatment Time on Outcomes in Acute Stroke Patients: Dong Wook Lee, Eui Chung Kim, Ok Jun Kim, Sung Wook Choi, Young Tae Park, Yun Kyung Cho; Korean J Crit Care Med. 2010;25(2):76-82.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.76

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Abstract PDF: BACKGROUND
Stroke is a disease that leads to a long period of disability and death. Accordingly, the initial treatment is so influential on the prognosis of a patient that shortening the time to initial treatment after hospital admission has a very important role in the entire treatment regimen. This study aimed to demonstrate the effect of the Emergency Department treatment time at Bundang CHA Hospital for acute stroke patients to improve the treatment regimen through six sigma activities.
METHODS
The outcomes for 246 patients with suspected acute strokes who were admitted to the Emergency Department of Bundang CHA Hospital, the flow of the emergency department process divided into 11 phases, and the duration of each phase were determined. Patients were classified as before and after six sigma activities and compared.
RESULTS
The five phases statistically demonstrated the effect of meaningful improvement in the duration of visit-receiving CT prescriptions, visit-receiving lab prescriptions, consult request-arriving to the emergency department, visit-CT angiography results, and visit-the issue of hospital admissions. In the next 2 phases, the sigma level also improved by 0.71sigma and 0.06sigma. However, the total emergency department stay time was not statistically meaningful. The time required time was increased and the sigma level was decreased by 0.19sigma.
CONCLUSIONS
The result of six sigma activities showed the effect of the treatment system improvement with a partial decrease in the duration of each phase, but the total emergency department stay time was not improved owing to environmental factors. For better results, continuous improvement of the treatment system and expansion of hospital facilities will be required.

Case Report

Hemothorax in an Uncontrolled Anticoagulated Patient: Fight or Flight?: A Case Report: Soon Ho Chon, Sung Ho Shinn, Chul Burm Lee; Korean J Crit Care Med. 2009;24(1):37-38.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.37

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Abstract PDF: Hemothorax in a patient on anticoagulant therapy for atrial fibrillation after blunt trauma is not an uncommon event. However, massive hemothorax in such a patient with an extremely uncontrolled and high international normalized ratio (INR) may pose a serious dilemma. We report a case of a patient under anticoagulant therapy for atrial fibrillation who underwent an emergent thoracotomy for massive hemothorax with an INR of 9.57.

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