Thai Journal of Emergency Medicine

Editorial

ฺBorwon Wittayachamnankul — 2025-01-25

Comparison between Quality of Chest Compression by Foot and Hand in Middle School Children: A Randomized, Crossover Manikin Study

Warathathai Phusinakkaragul — 2025-01-25

Introduction Cardiopulmonary resuscitation (CPR) by a bystander can increase the survival rate of patients experiencing out-of-hospital cardiac arrest (OHCA). However, performing high-quality CPR using the standard hand-only technique may not be possible in cases where the bystander is a child. In special situations, it has been found that using the foot for chest compressions is equally effective as using the hand in adults. However, the effectiveness of this method when the bystander is a child is under-researched. Thus, we aimed to investigate the efficacy of chest compressions performed using a foot compared to those performed using a hand in children under 15 years of age. The investigation focused on three key parameters: 1) compression rate, 2) compression depth, 3) percentage of full chest recoil over two minutes.
Method This crossover randomized controlled trial study was conducted between January and October 2023. We recruited 44 student participants aged 13-15 years. The participants used CPR Training Manikins with feedback data. Methods of chest compressions were assigned by simple random sampling, and after two minutes, the participants switched to the alternative method.
Results Compression rate by hand exceeded by foot (11.3±14.2 bpm, P<0.001), while the percentage of full chest recoil by hand surpassed that during foot compressions (26.2±23.9%, P<0.001). Conversely, compression depth by foot was greater than by hand (-14.7±7.4 mm, P<0.001).
Conclusion In school-aged children, chest compressions using a foot have an advantage in compression depth compared to hand compression. However, manual chest compressions maintain a faster compression rate and a higher percentage of chest recoil, aligning with established standards. The weight of the chest compressor does not significantly impact the overall efficiency of chest compressions.

Case report: Interfacility care of abdominal evisceration in penetrating abdominal injury

Tinna Sarapak — 2025-01-25

Evisceration of abdominal contents is one of the serious consequences of a penetrating abdominal injury which is an indication of patient transferal to an emergency exploratory laparotomy at a tertiary care hospital. Advanced Trauma Life Support is a systematic approach should be performed together with infectious control, damage control resuscitation and prevention of "the Diamond of Death". These are crucial components that could decrease morbidity and mortality rates in patients with abdominal evisceration. Therefore, this article aims to provide and discuss the options and recommendations for emergency and interfacility care of abdominal evisceration.

Pelvic Binding Device from Resistance Band and Bed Sheet

Piriya Treerattanapan — 2025-01-25

Background Pelvic injuries are common in blunt injury mechanisms. Unstable pelvis fracture results in an increased pelvic volume that can accommodate a large volume of blood and rapid death. The pelvis can be stabilized with a binder or sheet to limit this expansion and control hemorrhage.
Objective To compare a pelvic binding device from resistance band and bed sheet and compare its effectiveness with commercial pelvic binding device.
Method Experimental study for comparing pelvic binding device from resistance band and bedsheet. Between 1st May -30th September 2021, twenty- four emergency medicine residents of Phramongkutklao hospital were enroll. This study was done in two consecutive parts. Firstly, the volunteers pulled the 25 kg resistance exercise band until reach an appropriate tension 150 N that able to hold the fracture. The stretching length were recorded. Secondly, the resistance band was assembled to bed sheet for creating a pelvic binding device. Then the volunteers were asked to apply the device to simulated patient with appropriate length. The time of applying was recorded comparing with commercial pelvic binding device (T-test).
Results The length that volunteers pulled the resistance band to reach 150 N was 12.22 ± 0.04 cm. The time for applying the pelvic binding device made from resistance band was 68.21 seconds, comparing to commercial device at 68.01 seconds (P-value 0.290).
Conclusion The pelvic binding device made from resistance band and bed sheet is effective for holding the pelvic fracture. The time use for applying this device comparing to commercial device was not different.

Association of drug-warfarin interactions and supratherapeutic international normalized ratio of prothrombin time in the emergency department

Supa Niruntarai — 2025-01-25

Introduction Warfarin is a vitamin K antagonist anticoagulant that is widely used for prophylaxis and treatment of thromboembolism. Several factors can cause the international normalized ratio (INR) of the prothrombin time to exceed the target ranges of treatment, including drug-drug interactions, leading to abnormal bleeding and potential fatality.
Objectives The primary objective was to evaluate the association of drug-drug interactions between drugs on the warfarin interaction list and warfarin for the supra-therapeutic INR. Additionally, the study aimed to assess how frequently drugs from the warfarin interaction list were prescribed to patients in the emergency department (ED) and to evaluate the severity of bleeding resulting from these interactions.
Method This was a retrospective medical record review study of patients aged 15 years or older who were currently taking warfarin during the index ED visits from 1 January 2015, and 30 June 2017 and had at least one INR blood test.
Results From 530 ED visits included, at least one drug on the warfarin interaction drug list was prescribed in 378 ED visits (71.3%). Overall, 133 of 530 visits (25.1%) had supratherapeutic INR. From these 133 visits, 50 had abnormal bleeding, gastrointestinal and intracranial bleeding were found in 12% and 5%, respectively. Univariable logistic regression analysis revealed that taking warfarin with more than one drug in the highly probable group on the warfarin drug interaction list was associated with supratherapeutic INR (OR 2.6; 95% CI: 1.27-5.32; P-value = 0.01), as well as taking warfarin with paracetamol and another drug on the list (OR 2.25; 95% CI: 1.06-4.78; P-value = 0.03).
Conclusions Approximately three-fourths of patients received at least one drug on the warfarin interaction drug list. Warfarin-drug interactions were associated with supra-therapeutic INR and bleeding. Hospitals should seek prevention strategies for this issue in the future.

Cost of Emergency Medical Services: the case of Phitsanulok province

Chanon Phuengrueang — 2025-01-25

Introduction The compensation rates for emergency medical services (EMS) are determined by the Emergency Medical Committee (EMC), but these rates have remained unchanged since the year 2009 (B.E. 2552). Furthermore, they are inconsistent with the categorization of service areas and contemporary conditions, such as fluctuations in oil prices.
Objectives To analyze the pre-hospital costs of EMS from a service-providing perspective in Phitsanulok, categorized by levels of operation team response and geographical areas.
Introduction The compensation rates for emergency medical services (EMS) are determined by the Emergency Medical Committee (EMC), but these rates have remained unchanged since the year 2009 (B.E. 2552). Furthermore, they are inconsistent with the categorization of service areas and contemporary conditions, such as fluctuations in oil prices. Objectives To analyze the pre-hospital costs of EMS from a service-providing perspective in Phitsanulok, categorized by levels of operation team response and geographical areas.
Results It was found that apart from levels of operation and severity, the study results clearly indicated disparities in costs among flat, mountainous, and remote areas. it was revealed that the compensation rate was lower than the average cost of emergency medical services at all levels of patient severity. However, the cost of Advanced Life Support (ALS) operations was nearly equivalent to the compensation received (with costs exceeding compensation by an average of 12 Baht).
Conclusion The findings reveal that the service cost exceeds the compensation across all emergency levels, with variations in costs among different geographical areas. The National Institute for Emergency Medicine may contemplate augmenting compensation and prioritizing the geography variations. This study pertains exclusively to Phitsanulok Province. The subsequent study should broaden its scope to include other provinces with varying topographic situations.