Chih-Hsien Chi

National Cheng Kung University, 臺南市, Taiwan, Taiwan

Are you Chih-Hsien Chi?

Claim your profile

Publications (32)109.82 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: Understanding trunk muscle activity during chest compression may improve cardiopulmonary resuscitation (CPR) training strategies of CPR or prevent low back pain. This study investigates the trunk muscle activity pattern of chest compression in health care providers to determine the pattern alternation during chest compression. Thirty-one experienced health care providers performed CPR for 5 minutes at a frequency of 100 compressions per minute. An electromyography (EMG) system was used to record muscle activity in the first minute, the third minute, and the fifth minute. Electrodes were placed bilaterally over the pectoralis major, latissimus dorsi, rectus abdominis, erector spinae, and gluteus maximus. We calculated the root mean square (RMS) value and maximal amplitude of the EMG activity, median frequency, and delivered force. The maximal amplitude of EMG of the pectoralis major, erector spinae, and rectus abdominis showed large muscle activity above 45% of maximal voluntary contraction under chest compression. There were no significant differences in the RMS value of one chest compression cycle (RMS100%) and median frequency for all muscles at the first, third, and fifth minutes. Only gluteus maximus showed significant imbalance. The EMG ratios (erector spinae/rectus abdominis; erector spinae/gluteus maximus) increased significantly over time. The delivered force, compression depth, and number of correct depth decreased significantly over time. We suggest that the muscle power training for the pectoralis major, erector spinae, and rectus abdominis could be helpful for health care providers. Keeping muscle activity balance of bilateral gluteus maximus and maintaining the same level of EMG ratios might be the keys to prevent low back pain while performing CPR.
    The American journal of emergency medicine 11/2013; · 1.54 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: RATIONALE: Deliberate self-poisoning (DSP), the most common form of deliberate self-harm, is closely associated with suicide. Identifying risk factors of DSP is necessary for implementing prevention strategies. OBJECTIVES: This study aimed to evaluate the relationship between benzodiazepine (BZD) treatment in psychiatric outpatients and DSP cases at emergency departments (EDs). METHODS: We performed a retrospective nested case-control study of psychiatric patients receiving BZD therapy to evaluate the relationship between BZD use and the diagnosis of DSP at EDs using data from the nationwide Taiwan National Health Insurance Research Database. RESULTS: Regression analysis yielded an odds ratio (OR) and 95 % confidence interval (95 % CI) indicating that the use of BZDs in psychiatric outpatients was significantly associated with DSP cases at EDs (OR = 4.46, 95 % CI = 3.59-5.53). Having a history of DSP, sleep disorders, anxiety disorders, schizophrenia, depression, or bipolar disorder was associated with a DSP diagnosis at EDs (OR = 13.27, 95 % CI = 8.28-21.29; OR = 5.04, 95 % CI = 4.25-5.98; OR = 3.95, 95 % CI = 3.32-4.70; OR = 7.80, 95 % CI = 5.28-11.52; OR = 15.20, 95 % CI = 12.22-18.91; and OR = 18.48, 95 % CI = 10.13-33.7, respectively). After adjusting for potential confounders, BZD use remained significantly associated with a subsequent DSP diagnosis (adjusted OR = 2.47, 95 % CI = 1.93-3.17). Patients taking higher average cumulative BZD doses were at greater risk of DSP. CONCLUSION: Vigilant evaluation of the psychiatric status of patients prescribed with BZD therapy is critical for the prevention of DSP events at EDs.
    Psychopharmacology 05/2013; · 4.06 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Purpose: Timely identification and transport are crucial for the pre-hospital management of stroke by emergency medical service (EMS) providers. In this preliminary study, our aim was to develop an educational program which can improve 1) stroke knowledge and 2) triage accuracy of identifying acute stroke within 3 hours of symptom onset by dedicated EMS providers in Tainan city. Methods: A total of 33 providers received a written test before, immediately after, and 3 months after completing the educational program, which was about stroke knowledge, diagnosis, and management. The test (total score, 39) contained three sections: two on stroke knowledge (consisting of true-false and choice questions) and one on clinical scenarios (situational descriptions and videos). Results: The mean total score improved significantly immediately after the program. An increase in mean score was also noted for all three sections. The increase in total score lasted 3 months. The linear regression model showed greater improvement on scores correlated with lower pretest total score only, not correlated with age, gender, work year and the learning or working experience. Conclusion: The educational program increased knowledge about stroke and improved the accuracy of triage by dedicated EMS providers. Further investigation is needed to determine the effectiveness of similar educational programs for non-dedicated EMS responders.
    Acta neurologica Taiwanica 03/2013; 22(1):4-12.
  • [show abstract] [hide abstract]
    ABSTRACT: PURPOSES: Although electrolyte abnormalities have been generally considered the major cause of out-of-hospital cardiac arrest (OHCA) in patients with kidney disease (KD), this association has never been prospectively validated. METHODS: A prospective, observational study was conducted in a tertiary university hospital between January 2008 and December 2009. The study sample consisted of consecutively admitted patients with nontraumatic OHCA. Based on the estimated glomerular filtration rate (eGFR, unit: milliliters per minute per 1.73 m(2)), the enrollees were divided into 3 groups: group A (normal kidney function or mild KD; eGFR, 60.0), group B (moderate KD; eGFR between 15.0 and 59.9), and group C (severe KD; eGFR<15.0 or on dialysis). The laboratory findings of the groups were compared. Two-tailed P values less than .005 were considered significant. RESULTS: Two hundred thirty-four enrollees (137 were male) were divided into 3 groups: group A (n = 51; 21.8%), group B (n = 128; 54.7%), and group C (n = 55; 23.5%). Compared with the other 2 groups, group C presented significantly higher serum potassium and magnesium and lower pH and hemoglobin level (all P < .005). After stratifications of the significant variables, a post hoc analysis revealed that group C presented significantly higher incidences of hypermagnesemia (Mg >2.5 mmol/L) and severe hyperkalemia (K >6.5 mmol/L) (both P < .005) than the other 2 groups. The odds ratios of the incidence of severe hyperkalemia in group C was 3.37 (95% confidence intervals, 1.46-7.77) compared with group A (50.9% vs 23.5%, P < .005). CONCLUSIONS: Severe hyperkalemia is common in patients with OHCA who have severe KD and should be considered during resuscitation for these patients.
    The American journal of emergency medicine 11/2012; · 1.54 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: BACKGROUND: Because out-of-hospital cardiac arrests (OHCAs) due to a major trauma rarely present with shockable rhythms, the potential benefits of using automated external defibrillators (AEDs) at the scene of traumatic OHCAs have not been examined. METHODS: We conducted an observational, retrospective cohort study using an Utstein-style analysis in Tainan city, Taiwan. The enrollees were adult patients with traumatic OHCAs accessed by emergency medical technicians (EMTs) from January 1, 2004 to December 31, 2010. The exposure was the use or non-use of AEDs at the scene, as determined by the clinical judgment of the EMTs. The primary outcome evaluated was a sustained (≥2h) return of spontaneous circulation (ROSC), and the secondary outcomes were prehospital ROSC, overall ROSC, survival to hospital admission, survival at one month and favorable neurologic status at one month. RESULTS: A total of 424 patients (313 males) were enrolled, of whom 280 had AEDs applied, and 144 did not. Only 25 (5.9%) patients had received bystander cardiopulmonary resuscitation (CPR), and merely 21 (7.5%) patients in the AED group presented with shockable rhythms. Compared to the non-AED group, the primary and secondary outcomes of the AED group were not significantly different, except for a significantly lower prehospital ROSC rate (1.1% vs 4.9%, p<0.05). Multivariate analysis showed no significant interactions between the use of AEDs and other key variables. Use of the AED was not associated with sustained ROSC (OR 1.33; 95% CI 0.75-2.38, p=0.33). CONCLUSIONS: In a community with a low prevalence of shockable rhythms and administration of bystander CPR in patients with traumatic OHCA, we found no significant differences in the sustained ROSC between the AED and the non-AED groups. Considering scene safety and the possible interruption of CPR, we do not encourage the routine use of AEDs at the scene of traumatic OHCAs.
    Resuscitation 10/2012; · 4.10 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: PURPOSES: Outcome prediction for out-of-hospital cardiac arrest (OHCA) is of medical, ethical, and socioeconomic importance. We hypothesized that blood ammonia may reflect tissue hypoxia in OHCA patients and conducted this study to evaluate the prognostic value of ammonia for the return of spontaneous circulation (ROSC). METHODS: This prospective, observational study was conducted in a tertiary university hospital between January 2008 and December 2008. The subjects consisted of OHCA patients who were sent to the emergency department (ED). The primary outcome was ROSC. The prognostic values were calculated for ammonia levels and the partial pressure of ammonia (pNH(3)), and the results were depicted as a receiver operating characteristics curve with an area under the curve. RESULTS: Among 119 patients enrolled in this study, 28 patients (23.5%) achieved ROSC. Ammonia levels and pNH(3) in the non-ROSC group were significantly higher than those in the ROSC group (167.0 μmol/L vs 80.0 μmol/L, P < .05; 2.61 × 10(-5) vs 1.67 × 10(-5) mm Hg, P < .05, respectively). The predictive capacity of area under the curve for ammonia and pNH(3) for non-ROSC was 0.85 (95% confidence interval, 0.75-0.95) and 0.73 (95% confidence interval, 0.61-0.84), respectively. The multivariate analysis confirmed that ammonia and pNH(3) are independent predictors of non-ROSC. The prognostic value of ammonia was better than that of pNH(3). The cutoff level for ammonia of 84 μmol/L was 94.5% sensitive and 75.0% specific for predicting non-ROSC with a diagnostic accuracy of 89.9%. CONCLUSIONS: Hyperammonemia on ED arrival is independently predictive of non-ROSC for OHCA patients. The findings may offer useful information for clinical management.
    The American journal of emergency medicine 07/2012; · 1.54 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Bacteremia is a severe bacterial infection with significant mortality and morbidity. Clinical parameters that reliably predict the presence of community-onset bacteremia are less elucidated. During 96 randomly selected days between August 2006 and July 2007, a prospective study was conducted to analyze the risk factors of community-onset bacteremia among febrile adults who visited the emergency department (ED) of a medical center. Patients hospitalized in the 30 days prior to the study, patients experiencing consciousness alteration, and nursing facility residents were excluded. The mean age of the 396 febrile adults enrolled in the study was 53.8 years (range, 18-95 years), and 60 (15.2%) patients had true bacteremia, with the predominance of monomicrobial Gram-negative pathogens (42 patients). In a multivariate analysis, several factors were independently associated with community-onset bacteremia, including an age of >65 years (odds ratio [OR], 2.81; 95% confidence interval [CI], 1.25-6.33), the presence of rigor (OR, 13.7; 95% CI, 4.47-42.0) or chills (OR, 6.04; 95% CI, 1.10-32.9), a body temperature >39.9 °C (OR, 2.68; 95% CI, 1.03-6.94), blood urea nitrogen >20 mg/dL (OR, 5.56; 95% CI, 2.03-15.7), a blood urea nitrogen/creatinine ratio >16 (OR, 2.29; 95% CI, 1.03-5.11), and thrombocytopenia (OR, 6.09; 95% CI, 1.84-20.0). After scoring each risk factor, a logistic regression model for the prediction of bacteremia was developed, and the area under the receiver operating characteristic curve was 0.91. Some easily determined clinical parameters were independently associated with community-onset bacteremia among febrile adults, and the most significant predictor was the presence of rigor. Although the proposed predictive model needs further validation, it may be of use for the early identification of bacteremic episodes in ED practice.
    Diagnostic microbiology and infectious disease 03/2012; 73(2):168-73. · 2.45 Impact Factor
  • Ming-Yuan Hong, Chih-Hsien Chi
    New England Journal of Medicine 07/2011; 365(4):358. · 51.66 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: We performed an assessment of an independent rapid flu clinic service (RFCS) unit, which was set up outside the emergency department (ED) during the 2009 H1N1 pandemic season. The unit was able to relieve the crowding of regular ambulatory and emergency services. Between August and December 2009, a total of 6,152 patients with influenza-like illness were enrolled in this observational retrospective study. Patients with positive influenza tests were interviewed to evaluate the efficiency of RFCS. The mean length of stay (LOS) for the RFCS was 50 minutes, which was shorter than the LOS for ambulatory services (1 hour) and regular ED services (3.5 hours). Overall, 88% of patients were satisfied with the RFCS. Of 6,152 patients receiving flu tests, 1,235 (20%) had a positive result. Fever (odds ratio [OR], 4.28, 95% confidence interval [CI]: 3.11-5.89), fever combined with cough and sore throat (OR, 2.52; 95% CI: 2.18-2.92), fever combined with sore throat (OR, 2.42; 95% CI: 2.13-2.75), history of contacting confirmed flu patients within 7 days (OR, 2.40; 95% CI: 2.07-2.78), fever combined with cough (OR, 2.19; 95% CI: 1.92-2.47), sore throat (OR, 2.03, 95% CI: 1.79-2.30); and cough (OR, 1.91, 95% CI: 1.69-2.17) were significantly associated with positive influenza tests. Setting up the RFSC was beneficial to health care facilities during a pandemic flu season.
    American journal of infection control 07/2011; 40(2):165-9. · 3.01 Impact Factor
  • Chih-Hsien Chi, Jui-Yi Tsou, Fong-Chin Su
    [show abstract] [hide abstract]
    ABSTRACT: Although increasing consecutive compressions during cardiopulmonary resuscitation (CPR) is beneficial to patients, it possibly affects the workload and, ultimately, the quality of CPR. This study examines the effects of compression-to-ventilation ratio on external chest compression performance of rescuers. Subjects were 17 health care providers. Each participant performed CPR with 3 compression-to-ventilation ratios: 15:2, 30:2, and 50:5. The duration of CPR was 5 minutes in each group, with a rest period of 50 minutes in between. The manikin was equipped with a 6-axis force load cell to measure the force applied. An 8-camera digital motion analysis system was used to collect the 3-dimensional trajectory information. Data were compared using the crossover design. Ratings of perceived exertion and body area discomfort were measured. The mean compression forces (in Newtons) delivered at 1 minute 20 seconds to 1 minute 40 seconds and at 4 minutes 20 seconds to 4 minutes 40 seconds were 494.65 ± 53.58 and 478.64 ± 50.29, respectively (P = .047), for compression-to-ventilation ratios of 15:2; 473.57 ± 49.69 and 435.59 ± 56.79, respectively (P < .001), for ratios of 30:2; and 468.44 ± 38.05 and 442.18 ± 43.40, respectively (P = .012), for ratio of 50:5. Diminished compression force in the ratio 50:5 was observed at 1 minute 20 seconds, and in the 30:2 ratio, it was observed at 4 minutes 20 seconds. The mean joint angles in each group did not differ significantly between 1 minute 20 seconds and 4 minutes 20 seconds. The Ratings of Perceived Exertion Scale was 3.38 ± 1.64 in 15:2, 4.06 ± 1.43 in 30:2, and 4.35 ± 1.54 in 50:5 (P = .045). Waist discomfort was noted in 50:5 after 4 minutes 20 seconds of external chest compression. Rescuer fatigue must be considered when raising the consecutive compression during CPR. Switching the compressor every 2 minutes should be followed where possible.
    The American journal of emergency medicine 11/2010; 28(9):1016-23. · 1.54 Impact Factor
  • Source
    European Journal of Intensive Care Medicine 10/2010; 36(10):1788; author reply 1789-90. · 5.17 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Scabies is highly contagious and requires prompt diagnosis and implementation of infection control measures to prevent transmission and outbreaks. This study investigated the clinical and administrative correlates associated with missed diagnosis of scabies in an emergency department (ED). This was a retrospective study of patients with incidental scabies infestations who were admitted to a university hospital via the ED during a 4-year period. A total of 135 inpatients were identified as having scabies; among them, 111 patients (82%) had visited the ED. Scabies were diagnosed during the ED stay in 39 of 111 patients (35%), while the diagnosis was missed in the ED in 72 patients (65%). Although no geographic clusters suggestive of nosocomial scabies transmission were registered, 160 medical workers and one hospitalized patient received prophylactic treatment due to direct skin-to-skin contact with inpatient scabies cases during the study period. Overcrowding (odds ratio [OR] = 8.4; 95% confidence interval [CI] = 1.9 to 38.0) and time constraints (OR = 8.2; 95% CI = 1.9 to 34.7) in the ED were associated with a missed diagnosis of scabies during ED stay. Patients with lower illness severity scores were at higher risk for failure to diagnose and to treat scabies prior to hospital admission (OR = 5.7; 95% CI = 1.6 to 20.9). Missed diagnoses of scabies during ED stay may result in nosocomial spread and increase the unnecessary use of prophylactic treatments. ED overcrowding, time constraints, and less severe illness compromise ED recognition of scabies. Health care workers should be especially alert for signs of scabies infestations under these conditions.
    Academic Emergency Medicine 09/2010; 17(9):958-64. · 1.76 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Enterobacter cloacae is an important nosocomial pathogen. However, few studies specifically dealing with the clinical characteristics and outcome of extended-spectrum beta-lactamase (ESBL)-producing E. cloacae infections have been published. During an 8-year period in a medical center, of 610 E. cloacae bacteremic isolates, 138 (22.6%) with ESBL genes were designated the ESBL group, and 120 (19.6%) cefotaxime-nonsusceptible isolates without the ESBL phenotype and genes were designated the control group. Of the former group of isolates, 133 (96.3%) carried the bla(SHV-12) gene, 3 (2.1%) had bla(CTX-M3), and 2 (1.4%) had both the bla(SHV-12) and bla(CTX-M3) genes. After patients under the age of 18 years were excluded, there were 206 adults with E. cloacae bacteremia, and these consisted of 121 patients in the ESBL group and 85 in the control group. More episodes of hospital-onset and polymicrobial bacteremia, increased severity of illness, more cases of bacteremia onset in intensive care units (ICUs), and longer stays in the hospital and ICU after bacteremia onset were noted in the ESBL group. However, the crude and sepsis-related mortality rates in two groups were similar. Of the ESBL group, the in-hospital sepsis-related mortality rate of patients definitively treated by a carbapenem was lower than that of those treated by noncarbapenem beta-lactams (5/53, or 9.4%, versus 13/44, or 29.5%; P = 0.01) though the difference was not significant in the hierarchical multivariate analysis (P = 0.46). Among 62 patients with follow-up blood cultures within 14 days of bacteremia onset, breakthrough bacteremia was more common in those treated by a noncarbapenem beta-lactam agent than in those treated by a carbapenem (18/31, or 58.0%, versus 3/31, or 9.6%; P < 0.001). Thus, carbapenem therapy for ESBL-producing E. cloacae that cause bacteremia may provide therapeutic benefits.
    Antimicrobial Agents and Chemotherapy 09/2010; 54(9):3551-6. · 4.57 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Organotin compounds (OTCs) have been widely used as stabilizers in the production of plastic, agricultural pesticides, antifoulant plaints and wood preservation. The toxicity of triphenyltin (TPT) compounds was known for their embryotoxic, neurotoxic, genotoxic and immunotoxic effects in mammals. The carcinogenicity of TPT was not well understood and few studies had discussed the effects of OTCs on gap junctional intercellular communication (GJIC) of cells. In the present study, the effects of triphenyltin chloride (TPTC) on GJIC in WB-F344 rat liver epithelial cells were evaluated, using the scrape-loading dye transfer technique. TPTC inhibited GJIC after a 30-min exposure in a concentration- and time-dependent manner. Pre-incubation of cells with the protein kinase C (PKC) inhibitor did not modify the response, but the specific MEK 1 inhibitor PD98059 and PI3K inhibitor LY294002 decreased substantially the inhibition of GJIC by TPTC. After WB-F344 cells were exposed to TPTC, phosphorylation of Cx43 increased as seen in Western blot analysis. These results show that TPTC inhibits GJIC in WB-F344 rat liver epithelial cells by altering the Cx43 protein expression through both MAPK and PI3-kinase pathways.
    Journal of Occupational Medicine and Toxicology 01/2010; 5:17.
  • Chih-Hsien Chi, Jui-Yi Tsou, Fong-Chin Su
    [show abstract] [hide abstract]
    ABSTRACT: Over-the-head cardiopulmonary resuscitation (CPR) is a method of chest compression, which may be easier to perform than standard CPR in a confined space. The purpose of this study was to evaluate the effects of over-the-head CPR on the kinematics and the force of delivered compressions. The subjects were 21 health care providers who were experienced in CPR. Each participant performed over-the-head CPR (O) and standard CPR (S). The compression-to-ventilation ratio was 30:2. The CPR duration was 2 minutes in each position, with a rest period of 15 minutes between each instance. The order in which positions were adopted was randomized. A manikin was equipped with a 6-axial force load cell to collect 3-dimensional compression forces at a sampling rate of 1000 Hz. An 8-camera digital motion analysis system was used to collect 3-dimensional trajectory information. Data were compared by crossover design analysis of variance (P < .05 represents statistical significance). No significant differences in range of motion of the head, shoulder, lower trunk, hip, and knee were obtained using the 2 methods. The compression forces in O and S were 386.64 +/- 47.32 and 397.35 +/- 41.89 N, respectively (P > .05). No significant differences between the compression frequencies, depths, and percentages correct were obtained using the 2 methods. There were no differences between the kinematics, compression forces, depths, and frequencies obtained using the O and S CPR methods as practiced by experienced providers.
    The American journal of emergency medicine 11/2009; 27(9):1112-6. · 1.54 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Back pain is often seen in professional rescuers after carrying out resuscitation. Back loading is known to be affected by the working surface height, but the relationship between the surface height and back loading during cardiopulmonary resuscitation (CPR) is poorly understood. The purpose of this study was to examine how back loading changes in response to CPR posture and surface height. Twenty-two experienced professional rescuers performed CPR using three surface heights; the floor (F), a table at a height of 63cm (HT) and one at a height of 37cm (LT). The mean and maximal low back moment and compression force at HT were significantly smaller than those at LT and F. The results suggest that the HT task of chest compression produces the lowest low back moment and compression force. Thus, HT positioning may decrease the probability of low back pain and is suggested to be optimal height for inexperienced resuscitators, those with back injury, or those requiring a long operating duration.
    Resuscitation 08/2009; 80(10):1181-6. · 4.10 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Necrotizing fasciitis (NF), a rare but severe infection, usually occurs in individuals with underlying chronic illness, but its clinical presentation among cirrhotic patients is infrequently discussed. Forty-two cirrhotic patients with 47 episodes of NF between 1995 and 2006 were analyzed. Their mean age was 55.6 years, with male preponderance (34 patients, 81%). Lower extremities were mainly involved (70%). Of 42 episodes with identified pathogens, 41 (97%) were monomicrobial infections and were caused mainly by Gram-negative rods (GNBs) (32, 76%), including Vibrio (15, 36%), Klebsiella (9, 21%), and Aeromonas spp. (6, 14%). As compared with NF caused by Gram-positive cocci (GPCs), NF caused by GNBs tended to have concurrent bacteremia (81% versus 50%, P=0.09) and initially presented with septic shock (75% versus 30%, P=0.02). However, the in-hospital mortality rate was similar for NF caused by GNBs and GPCs (34% versus 30%, P=1.00). In multivariate analyses, higher sepsis-related organ failure assessment scores (>8) and Child-Pugh class C at initial presentation were independently associated with poor prognoses.
    Diagnostic Microbiology and Infectious Disease 10/2008; 62(2):219-25. · 2.26 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Hypercalcemia is an uncommon cause of abdominal pain and may be overlooked in the Emergency Department. In this case report, we describe the case of a 48-year-old woman with a prior history of urolithiasis who presented to the Emergency Department with diffuse abdominal pain. She had taken Trichlormethiazide 1 mg daily for her urolithiasis. She was diagnosed with thiazide-related hypercalcemia; hyperparathyroidism and thyroid papillary carcinoma were unveiled during her hospitalization. A thorough history and complete physical examination, paired with appropriate but judicious diagnostic testing, are essential to detecting these unusual causes of abdominal pain.
    Journal of Emergency Medicine 03/2008; 34(2):151-3. · 1.33 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Poisoning is a significant public health problem worldwide and is one of the most common reasons for visiting emergency departments (EDs), but factors that help to predict overall poisoning-related fatality have rarely been elucidated. Using 1512 subjects from a hospital-based study, we sought to describe the demographic and clinical characteristics of poisoning patients and to identify predictors for poisoning-related fatality. Between January 2001 and December 2002 we prospectively recruited poisoning patients through the EDs of two medical centers in southwest Taiwan. Interviews were conducted with patients within 24 hours after admission to collect relevant information. We made comparisons between survival and fatality cases, and used logistic regressions to identify predictors of fatality. A total of 1512 poisoning cases were recorded at the EDs during the study period, corresponding to an average of 4.2 poisonings per 1000 ED visits. These cases involved 828 women and 684 men with a mean age of 38.8 years, although most patients were between 19 and 50 years old (66.8%), and 29.4% were 19 to 30 years. Drugs were the dominant poisoning agents involved (49.9%), followed by pesticides (14.5%). Of the 1512 patients, 63 fatalities (4.2%) occurred. Paraquat exposure was associated with an extremely high fatality rate (72.1%). The significant predictors for fatality included age over 61 years, insufficient respiration, shock status, abnormal heart rate, abnormal body temperature, suicidal intent and paraquat exposure. In addition to well-recognized risk factors for fatality in clinical settings, such as old age and abnormal vital signs, we found that suicidal intent and ingestion of paraquat were significant predictors of poisoning-related fatality. Identification of these predictors may help risk stratification and the development of preventive interventions.
    BMC Public Health 02/2008; 8:7. · 2.08 Impact Factor
  • Chih-Hsien Chi, Jui-Yi Tsou, Fong-Chin Su
    [show abstract] [hide abstract]
    ABSTRACT: Depending on the clinical setting, rescuers may provide CPR from a kneeling (if the patient is on the ground) or standing (if the patient is in a bed) position. The rescuer position may affect workload, and hence rate of fatigue and quality of CPR. This study evaluates how three common rescuer positions affect the kinematics of CPR and the force of delivered compressions. Subjects were 18 health care providers experienced in CPR. Each participant performed CPR from three different positions: kneeling beside the Resusci Anne manikin placed on the floor (F); standing beside the manikin placed on a Table 63 cm in height (H), and standing beside the manikin placed on a Table 37 cm in height (L). The compression to ventilation ratio was 15:2. CPR duration was 5 min for each position, with a rest period of 50 min in-between. The order of position was randomised. The manikin was equipped with a six-axial force load cell to collect 3D compression forces at a sampling rate of 1000 Hz. An eight-camera Motion Analysis Digital System was adopted to collect 3D trajectory information. Data were compared using crossover-design analysis of variance (p<0.05 was regarded as statistically significant). Ratings of Perceived Exertion (RPE) were measured by modified Borg scale. Significant differences were observed in the head, shoulder, lower trunk, hip and knee angles between the three methods. Lower trunk flexion angle (degrees) for H, L, and F were -14.52+/-1.13, -28.83+/-1.75, and 14.39+/-1.14, respectively. Hip flexion angle for H, L, and F were -16.21+/-3.30, -42.59+/-4.75, and -47.39+/-4.36, respectively. However, compression force (N) in H, L, and F were 455.8+/-17.6, 455.7+/-14.0, 461.5+/-13.5, respectively (p>0.05). Compression depths (mm) were: 43.5+/-3.4, 42.0+/-5.4, 44+/-5.2, respectively (p>0.05). Compression frequencies (times/min) were: 117.9+/-12.4, 116.6+/-13.4, 108.8+/-11.7, respectively (p>0.05). No differences were found between the three positions for RPE. In this study, while the kinematics of CPR differed significantly with varying rescuer position, these differences did not affect the compression force, depth and frequency as performed by experienced providers.
    Resuscitation 02/2008; 76(1):69-75. · 4.10 Impact Factor

Publication Stats

120 Citations
23 Downloads
2k Views
109.82 Total Impact Points

Institutions

  • 1999–2013
    • National Cheng Kung University
      • • Department of Emergency Medicine
      • • Institute of Biomedical Engineering (IBE)
      臺南市, Taiwan, Taiwan
  • 2002–2012
    • National Cheng Kung University Hospital
      • Department of Pediatrics
      臺南市, Taiwan, Taiwan
  • 2010
    • National Health Research Institutes
      • National Institute of Infectious Diseases and Vaccinology
      Miao-li-chieh, Taiwan, Taiwan