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We aimed to investigate the demographic characteristics, common chief complaints, and diagnosis of geriatric cancer-related emergency department (ED) visits and trends of ED outcomes. This retrospective observational study included all ED visits in South Korea between 2016 and 2020. The study population was older people ≥ 65 years living with cancer who visited ED with cancer-related problems. The demographics, common diagnoses, and ED outcomes were investigated. A multivariate logistic regression analysis was conducted to investigate factors associated with mortality. Geriatric cancer-related ED (GCED) visits were 746,416 cases over 5 years. The proportion of older adults among cancer-related ED visits increased from 50.1% in 2016 to 55.3% in 2020. The proportion of the “oldest old” (≥ 85 years) increased from 9.6 to 12.1%. For GCED, the ward admission rate after ED treatment was 60.2% and in-hospital mortality rate was 11.8%. Both of these increased with age group (“young old” (65–74), “middle old” (75–84), and “oldest old” (≥ 85 years) groups admission rates: 56.1%, 62.8%, and 68.0%; and mortality rates: 10.0%, 12.7%, and 15.7%, respectively). The most common diagnosis was pneumonia (4.9%). Old age and ambulance use were also associated with mortality. Older adults account for more than half of cancer-related ED visits, and their number is increasing every year. GCED visits are associated with high hospitalization and mortality, especially among the oldest old. It is important to prepare for a rise in GCED visits is necessary.

The aim of this study was to investigate whether 33% duty cycle increases end-tidal carbon dioxide (ETCO2) level, a surrogate measurement for cardiac output during cardiopulmonary resuscitation (CPR), compared with 50% duty cycle. Six pigs were randomly assigned to the DC33 or DC50 group. After 3 min of induced ventricular fibrillation (VF), CPR was performed for 5 min with 33% duty cycle (DC33 group) or with 50% duty cycle (DC50 group) (phase I). Defibrillation was delivered until return of spontaneous circulation (ROSC) thereafter. After 30 min of stabilization, the animals were re-assigned to the opposite groups. VF was induced again, and CPR was performed (phase II). The primary outcome was ETCO2 during CPR, and the secondary outcomes were coronary perfusion pressure (CPP), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and right atrial pressure (RAP). Mean ETCO2 was higher in the DC33 group compared with the DC50 group (22.5 mmHg vs 21.5 mmHg, P = 0.018). In a linear mixed model, 33% duty cycle increased ETCO2 by 1.0 mmHg compared with 50% duty cycle (P < 0.001). ETCO2 increased over time in the DC33 group [0.6 mmHg/min] while ETCO2 decreased in the DC50 group [-0.6 mmHg/min] (P < 0.001). Duty cycle of 33% increased SAP (6.0 mmHg, P < 0.001), DAP (8.9 mmHg, P < 0.001) RAP (2.6 mmHg, P < 0.001) and CPP (4.7 mmHg, P < 0.001) compared with the duty cycle of 50%. Duty cycle of 33% increased ETCO2, a surrogate measurement for cardiac output during CPR, compared with duty cycle of 50%. Moreover, ETCO2 increased over time during CPR with 33% duty cycle while ETCO2 decreased with 50% duty cycle.

Background: Information on cardiac contractility is very important in resuscitation of critically ill patients. However, the measurement of ejection fractions by echocardiography is very difficult to perform for non-cardiologists. We developed a video clip to train emergency medicine residents to measure visual ejection fraction and compared the improvement in their interpretation ability with that following the conventional training method. Objectives: Improvement of interpreting ability of vEF in short period. Methods: A total of 27 multicentre emergency medicine residents were recruited and divided into conventional training group (N = 13) and video clip training group (N = 14). Self-training was done for 1 week. Pre-test and post-test comprising 20 questions were used for evaluation, and scores and interpretation time were recorded. Results: The score of the video clip training group showed a statistically significant improvement in contrast to the conventional training group (the score of pre- and post-test, +-5% scoring method: correct answer; video clip training group, 5.4/20 to 10.4/20 (p < 0.001) versus conventional training group, 5.8/20 to 6.7/20 (p = 0.204)). Furthermore, there was a statistically significant reduction in the interpretation time (interpretation time of video clip training group, 417.7-358.8 s (p = 0.005) versus conventional training group, 416.8-411.5 s (p = 0. 497)). Conclusion: In the video clip training group, interpretation accuracy improved, and the interpretation time was shorter than that of the conventional training group. Based on these results, we conclude that improvement in the visual ejection fraction interpretation ability by emergency medicine residents can be expected.

The aim of this study was to investigate whether the 1-year survival rate of out-of-hospital cardiac arrest (OHCA) patients with malignancy was different from that of those without malignancy. All adult OHCA patients were retrospectively analyzed in a single institution for 6years. The primary outcome was 1-year survival, and secondary outcomes were sustained return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge and discharge with a good neurological outcome (CPC 1 or 2). Kaplan-Meier survival analysis and Cox proportional hazard regression analysis were performed to test the effect of malignancy. Among 341 OHCA patients, 59 patients had malignancy (17.3%). Sustained ROSC, survival to admission, survival to discharge and discharge with a good CPC were not different between the two groups. The 1-year survival rate was lower in patients with malignancy (1.7% vs 11.4%; P=0.026). Kaplan-Meier survival analysis revealed that patients with malignancy had a significantly lower 1-year survival rate when including all patients (n=341; P=0.028), patients with survival to admission (n=172, P=0.002), patients with discharge CPC 1 or 2 (n=18, P=0.010) and patients with discharge CPC 3 or 4 (n=57, P=0.008). Malignancy was an independent risk factor for 1-year mortality in the Cox proportional hazard regression analysis performed in patients with survival to admission and survival to discharge. Although survival to admission, survival to discharge and discharge with a good CPC rate were not different, the 1-year survival rate was significantly lower in OHCA patients with malignancy than in those without malignancy.

The most common manifestations of aortic dissection (AD) are severe chest pain and back pain. However, we experienced a rare case of type I aortic dissection with bilateral common carotid artery involvement, which presented with only a sudden thunderclap bifrontal headache.

Spontaneous spinal epidural hematoma (SEH) is a rare disease. Furthermore, Brown-Séquard syndrome due to spontaneous SEH has been rarely reported. Early detection of spontaneous SEH is not easy because early symptoms are often atypical and neurologic findings are often absent in the early stage. Early diagnosis and urgent surgical management are needed to prevent permanent neurologic deficits. We report a case of a 30-year-old patient who presented with Brown-Séquard syndrome due to spontaneous SEH. The patient has recovered successfully without any complications through surgical decompression within 12 hours of onset.

We conducted this study to investigate whether ESI combined with qSOFA score (ESI+qSOFA) predicts hospital outcome better than ESI alone in the emergency department (ED). This was a retrospective study for patients aged over 15years who visited an ED of a tertiary referral hospital from January 1st, 2015 to December 31st, 2015. We calculated and compared predictive performances of ESI alone and ESI+qSOFA for prespecified outcomes. The primary outcome was hospital mortality, and the secondary outcome was composite outcome of in-hospital mortality and ICU admission. We calculated in-hospital mortality rates by positive qSOFA in each subgroup divided according to ESI levels (1, 2, 3, 4+5). 43,748 patients were enrolled. The area under receiver-operating characteristics curves were higher in ESI+qSOFA than in ESI alone for both mortality and composite outcome (0.786 vs. 0.777, P<.001 for mortality; 0.778 vs. 0.774, P<.001 for composite outcome). In each subgroup divided by ESI levels, patients with positive qSOFA had significantly higher in-hospital mortality rate compared to those with negative qSOFA (20.4% vs. 14.7%, P=.117 in ESI level 1 subgroup; 11.3% vs. 2.7%, P=.001 in ESI level 2 subgroup; 2.3% vs. 0.4%, P<.001 in ESI level 3 subgroup; 0.0% vs. 0.0% in ESI level 4 or 5 subgroup). The prognostic performance of ESI+qSOFA for in-hospital mortality was significantly higher than that of ESI alone. Within each subgroup, patients with positive qSOFA had higher in-hospital mortality compared to those with negative qSOFA.

To investigate whether the relationship between heart rate and neurological outcome is independent of therapeutic hypothermia (TH) and whether heart rate is related to hemodynamic instability post-cardiac arrest. Retrospective review of an out-of-hospital cardiac arrest registry was performed. The primary exposure was heart rate quartiles at 24 h post-cardiac arrest. The primary outcome was a poor neurological outcome, which was defined as having a cerebral performance category (CPC) of 3–5 at 28 days. Secondary outcomes were mean blood pressure and serum lactate at 24 h and Sequential Organ Failure Assessment (SOFA) scores at admission. In total, 155 patients were enrolled. The proportion of patients with a poor CPC was significantly greater in higher heart rate quartiles; similar results were observed in patients who did and did not undergo TH. Serum lactate levels at 24 h were significantly higher in the 3rd and 4th quartile groups than in the 1st quartile group. Additionally, SOFA scores were significantly higher in the 4th quartile group than in the 1st and 3rd quartile groups. Relative tachycardia is associated with poor neurological outcomes in post-cardiac arrest patients, independent of TH, and with higher serum lactate levels and admission SOFA scores.

The aim of this study was to investigate whether 33% duty cycle increases end-tidal carbon dioxide (ETCO.sub.2) level, a surrogate measurement for cardiac output during cardiopulmonary resuscitation (CPR), compared with 50% duty cycle. Six pigs were randomly assigned to the DC33 or DC50 group. After 3 min of induced ventricular fibrillation (VF), CPR was performed for 5 min with 33% duty cycle (DC33 group) or with 50% duty cycle (DC50 group) (phase I). Defibrillation was delivered until return of spontaneous circulation (ROSC) thereafter. After 30 min of stabilization, the animals were re-assigned to the opposite groups. VF was induced again, and CPR was performed (phase II). The primary outcome was ETCO.sub.2 during CPR, and the secondary outcomes were coronary perfusion pressure (CPP), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and right atrial pressure (RAP). Mean ETCO.sub.2 was higher in the DC33 group compared with the DC50 group (22.5 mmHg vs 21.5 mmHg, P = 0.018). In a linear mixed model, 33% duty cycle increased ETCO.sub.2 by 1.0 mmHg compared with 50% duty cycle (P < 0.001). ETCO.sub.2 increased over time in the DC33 group [0.6 mmHg/min] while ETCO.sub.2 decreased in the DC50 group [-0.6 mmHg/min] (P < 0.001). Duty cycle of 33% increased SAP (6.0 mmHg, P < 0.001), DAP (8.9 mmHg, P < 0.001) RAP (2.6 mmHg, P < 0.001) and CPP (4.7 mmHg, P < 0.001) compared with the duty cycle of 50%. Duty cycle of 33% increased ETCO.sub.2, a surrogate measurement for cardiac output during CPR, compared with duty cycle of 50%. Moreover, ETCO.sub.2 increased over time during CPR with 33% duty cycle while ETCO.sub.2 decreased with 50% duty cycle.

The aim of this study was to investigate whether 33% duty cycle increases end-tidal carbon dioxide (ETCO.sub.2) level, a surrogate measurement for cardiac output during cardiopulmonary resuscitation (CPR), compared with 50% duty cycle. Six pigs were randomly assigned to the DC33 or DC50 group. After 3 min of induced ventricular fibrillation (VF), CPR was performed for 5 min with 33% duty cycle (DC33 group) or with 50% duty cycle (DC50 group) (phase I). Defibrillation was delivered until return of spontaneous circulation (ROSC) thereafter. After 30 min of stabilization, the animals were re-assigned to the opposite groups. VF was induced again, and CPR was performed (phase II). The primary outcome was ETCO.sub.2 during CPR, and the secondary outcomes were coronary perfusion pressure (CPP), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and right atrial pressure (RAP). Mean ETCO.sub.2 was higher in the DC33 group compared with the DC50 group (22.5 mmHg vs 21.5 mmHg, P = 0.018). In a linear mixed model, 33% duty cycle increased ETCO.sub.2 by 1.0 mmHg compared with 50% duty cycle (P < 0.001). ETCO.sub.2 increased over time in the DC33 group [0.6 mmHg/min] while ETCO.sub.2 decreased in the DC50 group [-0.6 mmHg/min] (P < 0.001). Duty cycle of 33% increased SAP (6.0 mmHg, P < 0.001), DAP (8.9 mmHg, P < 0.001) RAP (2.6 mmHg, P < 0.001) and CPP (4.7 mmHg, P < 0.001) compared with the duty cycle of 50%. Duty cycle of 33% increased ETCO.sub.2, a surrogate measurement for cardiac output during CPR, compared with duty cycle of 50%. Moreover, ETCO.sub.2 increased over time during CPR with 33% duty cycle while ETCO.sub.2 decreased with 50% duty cycle.