ABSTRACT
A thesis submitted to the committee of Graduate School, KongJu National University in partial fulfillment of the requirements for the degree of Master of Emergency Medical Service Conferred in August, 2021
Objective:
This study aimed to evaluate the general status of Carb...
ABSTRACT
A thesis submitted to the committee of Graduate School, KongJu National University in partial fulfillment of the requirements for the degree of Master of Emergency Medical Service Conferred in August, 2021
Objective:
This study aimed to evaluate the general status of Carbon monoxide(CO) poisoning patients transferred by 119 paramedics for 2 years and investigate the cares provided in prehospital and hospital settings, thereby identifying problems and suggesting solutions for improvement in the prehospital and hospital care.
Methods:
This study retrospectively investigated the prehospital care reports and hospital electronic medical records of 141 patients diagnosed with CO poisoning who were transferred to an emergency medical center in Daejeon city through 119 paramedics. The data were analyzed retrospectively using patients' reports that visited for two years from January 2017 to December 2018. Variables of the onset year, gender, age, transport distance, time from onset to hospital arrival, patient classification, intentionality of the patient, cause of CO poisoning, mental state, oxygen therapy dosage and initial assessment were extracted from the prehospital care report, while that of initial evaluation, primary CO-Hb level, secondary CO-Hb level on arterial blood gas analysis (ABGA), hyperbaric oxygen therapy, and hospitalization from the hospital electronic medical records of the patients.
The collected data were analyzed with frequency analysis, percentage, Chi-square test, Fisher's Exact test, t-test, and Wilcoxon test using IBM SPSS Statistics Ver. 25.0.
Result:
1) The portion of male patients was larger than that of female, accounting for 62.4% (88 patients) and 37.6%(53 patients) respectively. Smoke inhalation and unconsciousness were the most common chief problems the patient had, each accounting for 34.0%(34 patients) and 22.7%(32 patients) of the whole subjects. 56.0%(79 patients) of the subjects were with intentionality, 62.0%(49 patients) of whom had charcoal burning as cause of CO poisoning, while 54.9%(34 patients) of the patients with no intentionality had fire as the cause.
2) There were statistically significant differences in the rate of whether the pre-hospital oxygen therapy was performed between groups with different patient classification : prehospital oxygen therapy was not performed in 19.6% (21 patients) among patients classified as 'emergency', 32.0% (8 patients) among classified as 'semi-emergency' and 14.3% (1 patients) among patients classified as 'potent emergency'. For the causes of CO poisoning, 64.0% of patients with charcoal burning as the cause of CO poisoning (32 patients) were administered with 15L of oxygen per minute, while 54.2%(13 patients) among patients with coal briquette. Oxygen therapy was not performed in 40.0% (4 patients) of patients with charcoal fire, while 37.1% (13 patients) of patients with fire, showing a statistically significant difference. There were statistically significant differences in oxygen saturation level between normal subjects and subjects with abnormality in that 15.1% (11 patients) of normal subjects had primary CO-Hb level higher than 25% while 55.4% (36 patients) of subjects with abnormality(p=.000).
3) For the hyperbaric oxygen therapy according to primary CO-Hb in hospitals, the therapy was performed in 80.9% (38 patients) of patients with level higher than 25%, while 19.1% (9 patients) of patients with level between 5-24% and 9.7% (3 patients) with level lower than 5% showing a statistically significant difference(=41.944, p=0.000). The mean and standard deviation of primary CO-Hb were 29.51±13.31 for the patient group with therapy and 10.83±11.53 for the patient group without therapy, showing a statistically significant difference(t=7.390, p=0.000), and when comparing the mean value and standard deviation of the primary CO-Hb with those of secondary CO-Hb, the statistically significant differences were both found in the patient group with (Z=6.901, p=0.000) and without(Z=5.443, p=0.000) the therapy. For the post-therapeutic outcomes according to hyperbaric oxygen therapy, 85.7% (54 patients) of the patients with hyperbaric oxygen therapy showed improvements and 14.3% (9 patients) didn't, while 75.6% (59 patients) of the patients without therapy showed improvements and 24.4% (19 patients) didn't, but showing no statistically significant difference.
Conclusion:
In conclusion, it is necessary to measure the carbon monoxide level and oxygen saturation using CO oximetry, administer high concentration of oxygen at 15L per minute, and rapidly transfer the patient in the 119 setting. In addition, hyperbaric oxygen therapy should be considered as an management option for patients with CO poisoning in the hospital setting.
Keywords : CO poisoning, Emergency Medical Service(EMS), Hospital Care
ABSTRACT
A thesis submitted to the committee of Graduate School, KongJu National University in partial fulfillment of the requirements for the degree of Master of Emergency Medical Service Conferred in August, 2021
Objective:
This study aimed to evaluate the general status of Carbon monoxide(CO) poisoning patients transferred by 119 paramedics for 2 years and investigate the cares provided in prehospital and hospital settings, thereby identifying problems and suggesting solutions for improvement in the prehospital and hospital care.
Methods:
This study retrospectively investigated the prehospital care reports and hospital electronic medical records of 141 patients diagnosed with CO poisoning who were transferred to an emergency medical center in Daejeon city through 119 paramedics. The data were analyzed retrospectively using patients' reports that visited for two years from January 2017 to December 2018. Variables of the onset year, gender, age, transport distance, time from onset to hospital arrival, patient classification, intentionality of the patient, cause of CO poisoning, mental state, oxygen therapy dosage and initial assessment were extracted from the prehospital care report, while that of initial evaluation, primary CO-Hb level, secondary CO-Hb level on arterial blood gas analysis (ABGA), hyperbaric oxygen therapy, and hospitalization from the hospital electronic medical records of the patients.
The collected data were analyzed with frequency analysis, percentage, Chi-square test, Fisher's Exact test, t-test, and Wilcoxon test using IBM SPSS Statistics Ver. 25.0.
Result:
1) The portion of male patients was larger than that of female, accounting for 62.4% (88 patients) and 37.6%(53 patients) respectively. Smoke inhalation and unconsciousness were the most common chief problems the patient had, each accounting for 34.0%(34 patients) and 22.7%(32 patients) of the whole subjects. 56.0%(79 patients) of the subjects were with intentionality, 62.0%(49 patients) of whom had charcoal burning as cause of CO poisoning, while 54.9%(34 patients) of the patients with no intentionality had fire as the cause.
2) There were statistically significant differences in the rate of whether the pre-hospital oxygen therapy was performed between groups with different patient classification : prehospital oxygen therapy was not performed in 19.6% (21 patients) among patients classified as 'emergency', 32.0% (8 patients) among classified as 'semi-emergency' and 14.3% (1 patients) among patients classified as 'potent emergency'. For the causes of CO poisoning, 64.0% of patients with charcoal burning as the cause of CO poisoning (32 patients) were administered with 15L of oxygen per minute, while 54.2%(13 patients) among patients with coal briquette. Oxygen therapy was not performed in 40.0% (4 patients) of patients with charcoal fire, while 37.1% (13 patients) of patients with fire, showing a statistically significant difference. There were statistically significant differences in oxygen saturation level between normal subjects and subjects with abnormality in that 15.1% (11 patients) of normal subjects had primary CO-Hb level higher than 25% while 55.4% (36 patients) of subjects with abnormality(p=.000).
3) For the hyperbaric oxygen therapy according to primary CO-Hb in hospitals, the therapy was performed in 80.9% (38 patients) of patients with level higher than 25%, while 19.1% (9 patients) of patients with level between 5-24% and 9.7% (3 patients) with level lower than 5% showing a statistically significant difference(=41.944, p=0.000). The mean and standard deviation of primary CO-Hb were 29.51±13.31 for the patient group with therapy and 10.83±11.53 for the patient group without therapy, showing a statistically significant difference(t=7.390, p=0.000), and when comparing the mean value and standard deviation of the primary CO-Hb with those of secondary CO-Hb, the statistically significant differences were both found in the patient group with (Z=6.901, p=0.000) and without(Z=5.443, p=0.000) the therapy. For the post-therapeutic outcomes according to hyperbaric oxygen therapy, 85.7% (54 patients) of the patients with hyperbaric oxygen therapy showed improvements and 14.3% (9 patients) didn't, while 75.6% (59 patients) of the patients without therapy showed improvements and 24.4% (19 patients) didn't, but showing no statistically significant difference.
Conclusion:
In conclusion, it is necessary to measure the carbon monoxide level and oxygen saturation using CO oximetry, administer high concentration of oxygen at 15L per minute, and rapidly transfer the patient in the 119 setting. In addition, hyperbaric oxygen therapy should be considered as an management option for patients with CO poisoning in the hospital setting.
Keywords : CO poisoning, Emergency Medical Service(EMS), Hospital Care
주제어
#일산화탄소 중독, 응급구조사, 병원전 처치, 병원내 처치
※ AI-Helper는 부적절한 답변을 할 수 있습니다.