In a prehospital setting, the narrow therapeutic window of epinephrine necessitates its cautious administration to avoid anaphylaxis. In this case, a 46-year-old man presented severe anaphylactic symptoms. Following the standard protocol, the emergency medical technician (EMT) administered intramuscular epinephrine; however, symptoms persisted. Under the oversight of the emergency medical services (EMS) medical director, an additional intravenous bolus of epinephrine was administered, unfortunately leading to atrial fibrillation. This case underscores the potential risks of intravenous epinephrine, which is not typically recommended for anaphylaxis without continuous monitoring. Since 2019, Korea has initiated a pilot program to expand the EMT scope of practice, which gives them the authority to administer epinephrine for anaphylaxis. The ultimate decision regarding epinephrine use for anaphylaxis, emphasizing patient safety, rests with the EMS medical director. Proper training for EMTs, coupled with the EMS medical director’s comprehensive knowledge and meticulous protocol adherence, can ensure patient safety and optimal outcomes.
Citations
Citations to this article as recorded by
Oral Cephalosporin-Induced Anaphylaxis Presenting With Severe Tachycardia: A Case of Microdosed Epinephrine Over Standard Protocols Anupama R S, Rohan Krishna NK, Sathya Lakshmi Mekkoth, N Sridhara, Shivaraj K Cureus.2025;[Epub] CrossRef
Atrial Fibrillation in a Young Healthy Adult: A Case Report From Anaphylaxis to Arrhythmia Louis A Enchill, Eugene K Yeboah, Sergei Klokov, Ogheneakpobor E Ubogun, Suchith B Suresh Cureus.2025;[Epub] CrossRef
Chanhong Min, Dong Eun Lee, Hyun Wook Ryoo, Haewon Jung, Jae Wan Cho, Yun Jeong Kim, Jae Yun Ahn, Jungbae Park, You Ho Mun, Tae Chang Jang, Sang-chan Jin
Clin Exp Emerg Med 2022;9(3):207-215. Published online August 31, 2022
Objective High-quality cardiopulmonary resuscitation with chest compression is important for good neurologic outcomes during out-of-hospital cardiac arrest (OHCA). Several types of mechanical chest compression devices have recently been implemented in Korean emergency medical services. This study aimed to identify the effect of prehospital mechanical chest compression device use on the outcomes of OHCA patients.
Methods We retrospectively analyzed data drawn from the regional cardiac arrest registry in Daegu, Korea. This registry prospectively collected data from January 2017 to December 2020. Patients aged 18 years or older who experienced cardiac arrest presumed to have a medical etiology were included. The exposure variable was the use of a prehospital mechanical device during transportation by emergency medical technicians. The outcomes measured were neurologic outcomes and survival to discharge. Logistic regression analysis was used.
Results Among 3,230 OHCA patients, 1,111 (34.4%) and 2,119 (65.6%) were managed with manual chest compression and with a mechanical chest compression device, respectively. The mechanical chest compression group showed poorer neurologic outcomes than the manual chest compression group (adjusted odds ratio, 0.12; 95% confidence interval, 0.04–0.33) and decreased survival to discharge (adjusted odds ratio, 0.39; 95% confidence interval, 0.19–0.82) after adjustment for confounding variables.
Conclusion Prehospital mechanical chest compression device use in OHCA was associated with poorer neurologic outcomes and survival to discharge compared to manual chest compression.
Citations
Citations to this article as recorded by
Adjusting on-scene CPR duration based on transport time interval in out-of-hospital cardiac arrest: a nationwide multicenter study Daseul Kim, Jae Yong Yu, Minha Kim, Gun Tak Lee, Sang Do Shin, Sung Yeon Hwang, Daun Jeong Scientific Reports.2025;[Epub] CrossRef
Mechanical versus manual cardiopulmonary resuscitation (CPR): an umbrella review of contemporary systematic reviews and more Ayman El-Menyar, Mashhood Naduvilekandy, Sandro Rizoli, Salvatore Di Somma, Basar Cander, Sagar Galwankar, Fatimah Lateef, Mohamed Alwi Abdul Rahman, Prabath Nanayakkara, Hassan Al-Thani Critical Care.2024;[Epub] CrossRef
Impact of the life-sustaining treatment decision act on organ donation in out-of-hospital cardiac arrests in South Korea: a multi-centre retrospective study Min Jae Kim, Dong Eun Lee, Jong Kun Kim, In Hwan Yeo, Haewon Jung, Jung Ho Kim, Tae Chang Jang, Sang-Hun Lee, Jinwook Park, Deokhyeon Kim, Hyun Wook Ryoo BMC Medical Ethics.2024;[Epub] CrossRef
Individualized decision making in on-scene resuscitation time for out-of-hospital cardiac arrest using reinforcement learning Dong Hyun Choi, Min Hyuk Lim, Ki Jeong Hong, Young Gyun Kim, Jeong Ho Park, Kyoung Jun Song, Sang Do Shin, Sungwan Kim npj Digital Medicine.2024;[Epub] CrossRef
Pediatric Chest Compression Improvement Via Augmented Reality Cardiopulmonary Resuscitation Feedback in Community General Emergency Departments: A Mixed-Methods Simulation-Based Pilot Study Keith Kleinman, Tai Hairston, Brittany Smith, Emma Billings, Sean Tackett, Eisha Chopra, Nicholas Risko, Daniel Swedien, Blake A. Schreurs, James L. Dean, Brandon Scott, Therese Canares, Justin M. Jeffers The Journal of Emergency Medicine.2023; 64(6): 696. CrossRef
Objective This study aimed to determine the factors that affect successful esophageal foreign body (FB) removal using a Foley catheter and to identify methods to increase the success rate.
Methods In this retrospective, cross-sectional study, we included pediatric patients who presented with esophageal FB impaction that was removed using a Foley catheter in the emergency departments of tertiary care and academic hospitals. We analyzed the effect of the patients’ age, sex, and symptoms; FB type, size, and location; Foley catheter size; complications during FB removal; duration between FB ingestion and removal; operator’s years of training; sedation; success rate of FB removal; endoscopy; and patient’s posture during FB removal on the success of Foley catheter-based FB removal.
Results Of the 43 patients we enrolled, Foley catheter-based FB removal was successful in 81.4% (35/43) but failed in 18.6% (8/43) of patients; no FB-removal-related complications were reported. There was no significant association between the success rate of Foley catheter-based FB removal and any study variable. A higher number of years in training tended to increase the success rate of Foley catheter-based FB removal, although statistical significance was not achieved.
Conclusion Children’s esophageal FB removal is a practical challenge in the emergency rooms, and using a Foley catheter is associated with a high success rate of the removal and low occurrence of complications. In this study, no single variable was found correlated with the success rate of Foley catheter-based esophageal FB removal in pediatric patients, which may indicate multiple variables interacting with one another to affect the success rate.
Citations
Citations to this article as recorded by
Predictive validity of resource-adjusted Korean Triage and Acuity Scale in pediatric gastrointestinal tract foreign body patients Jin Hee Lee, Jin Hee Jung, Hyun Noh, Mi Jin Kim Scientific Reports.2024;[Epub] CrossRef
Objective The incidences of prehospital advanced airway management by emergency medical technicians in South Korea are increasing; however, whether this procedure improves the survival outcomes of patients experiencing out-of-hospital cardiac arrest remains unclear. The present study aimed to investigate the association between prehospital advanced airway management and neurologic outcomes according to a transport time interval (TTI) using the Korean Cardiac Arrest Research Consortium database.
Methods We retrospectively analyzed the favorable database entries that were prospectively collected between October 2015 and December 2016. Patients aged 18 years or older who experienced cardiac arrest that was presumed to be of a medical etiology and that occurred prior to the arrival of emergency medical service personnel were included. The exposure variable was the type of prehospital airway management provided by emergency medical technicians. The primary endpoint was a favorable neurologic outcome.
Results Of 1,871 patients who experienced out-of-hospital cardiac arrest, 785 (42.0%), 121 (6.5%), and 965 (51.6%) were managed with bag-valve-mask ventilation, endotracheal intubation (ETI), and supraglottic airway (SGA) devices, respectively. SGAs and ETI provided no advantage in terms of favorable neurologic outcome in patients with TTIs ≥12 minutes (odds ratio [OR], 1.37; confidence interval [CI], 0.65–2.87 for SGAs; OR, 1.31; CI, 0.30–5.81 for ETI) or in patients with TTI <12 minutes (OR, 0.57; CI, 0.31–1.07 for SGAs; OR, 0.63; CI, 0.12–3.26 for ETI).
Conclusion Neither the prehospital use of SGA nor administration of ETI was associated with superior neurologic outcomes compared with bag-valve-mask ventilation.
Citations
Citations to this article as recorded by
Early Advanced Airway Management and Clinical Outcomes in Out-of-Hospital Cardiac Arrest: A Nationwide Observational Study Jung Ho Lee, Dahae Lee, Eujene Jung, Hyun Ho Ryu, Jeong Ho Park, Young Sun Ro, Kyoung Jun Song Journal of Clinical Medicine.2025; 14(21): 7652. CrossRef
Prehospital airway management for out‐of‐hospital cardiac arrest: A nationwide multicenter study from the KoCARC registry Hansol Chang, Daun Jeong, Jong Eun Park, Taerim Kim, Gun Tak Lee, Hee Yoon, Sung Yeon Hwang, Won Chul Cha, Tae Gun Shin, Min Seob Sim, Ik Joon Jo, Seung‐Hwa Lee, Sang Do Shin, Jin‐Ho Choi Academic Emergency Medicine.2022; 29(5): 581. CrossRef
Effect of citywide enhancement of the chain of survival on good neurologic outcomes after out-of-hospital cardiac arrest from 2008 to 2017 Dong Eun Lee, Hyun Wook Ryoo, Sungbae Moon, Jeong Ho Park, Sang Do Shin, Corstiaan den Uil PLOS ONE.2020; 15(11): e0241804. CrossRef
First
Prev
