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Tsung-Chien Lu

Publications and source records attributed to Tsung-Chien Lu.

9 recordsLinked to original sources
PubMed2006

A web-based Utstein style registry system of in-hospital cardiopulmonary resuscitation in Taiwan.

PURPOSE OF THE STUDY: The Web-Based Registry System on In-hospital Resuscitation (WRSIR) is the first prospective, web-based, multi-site, and Utstein-based reporting system in Taiwan. This study was conducted to evaluate the feasibility of the system in one of the participating hospitals and identify prognostic factors associated with survival. MATERIAL AND METHODS: The WRSIR is an on-line registry system coded with the active server page (ASP) programming method. Information was gathered and entered on-line by trained staff using spreadsheets that could be automatically created according to the updated Utstein in-hospital template. Through the implementation of the system, in a tertiary teaching hospital we evaluated all adults with in-hospital cardiac arrest receiving cardiopulmonary resuscitation between 1 October 2004 and 30 September 2005. The main outcome measures were return of spontaneous circulation (ROSC), survival to hospital discharge, and cerebral performance category score at the time of discharge. Logistic regression analysis was performed to determine independent predictors of survival. RESULTS: A total of 330 cases experienced in-hospital resuscitation. ROSC occurred in 233 cases (71%) and 61 patients (18%) survived to hospital discharge. Thirty-five patients (58%) had a good neurological outcome with the cerebral performance category (CPC) score of 1 or 2 among survivors. The major predictor of ROSC was initial rhythm of VT/VF (adjusted OR 0.36, 95% CI 0.16-0.78). CONCLUSION: This study examined the feasibility of a web-based registry system on in-hospital resuscitation using the Utstein style in an oriental country. It provides a comprehensive and standardised method for on-line registry of data collection, allowing individual hospitals to track each case for quality improvement. A further nationwide registry will enforce the possibility of data analysis and future perspective research of in-hospital resuscitation.

Aged↗
PubMed2006

The demand for prehospital advanced life support and the appropriateness of dispatch in Taipei.

INTRODUCTION: Implementing prehospital advanced life support (ALS) services requires more medical and societal resources in training and equipment. The actual demand for ALS services in our communities was not clear. To ensure good use of expensive resources, it is important to evaluate the demand and appropriateness of ALS services before full-scale implementation takes place. OBJECTIVE: To evaluate the rate and characteristics of demand for ALS, and the appropriateness of ALS dispatch of the emergency medical service (EMS) system in metropolitan Taipei City. METHODS: A retrospective, cross-sectional analysis of the EMS records of Taipei City Fire Department from April 1999 to December 2000 was conducted. Stratified random sampling of all EMS records in the second week of January, April, July and October of 2000 were obtained, along with the corresponding ALS dispatch records. Retrospective ALS demand criteria, including the chief complaints, mechanisms of injury/illness, initial vital signs and types of care rendered, were developed to estimate the rate of ALS demand. ALS demand is expressed as the percentage of cases fulfilling ALS criteria over the total number of EMS cases. Appropriate ALS dispatches were those ALS dispatches determined as fulfilling the ALS demand criteria. RESULTS: Among the sampled 5433 EMS cases, 490 (9.02%) were determined as a demand for ALS care. ALS demands varied from region to region, and were higher during winter months and afternoon rush hours. There were 175 actual ALS dispatches, accounting for 3.22% of the sampled EMS services. The triage performance was suboptimal: the appropriateness of ALS dispatch was 37.14%; the overtriage rate was 72.86%. CONCLUSION: Around nine percent of EMS calls demand ALS services. The current triage performance for proper ALS dispatch was suboptimal. A correct ALS dispatch protocol and more dispatcher training programmes should be established in the communities to ensure best use of valuable ALS resources.

Advanced Cardiac Life Support↗
PubMed2006

Neuroleptic malignant syndrome after the use of venlafaxine in a patient with generalized anxiety disorder.

Neuroleptic malignant syndrome (NMS) is a potentially lethal adverse reaction to neuroleptics, which is characterized by hyperthermia, extrapyramidal symptoms, altered consciousness and autonomic dysfunction. Although NMS is most commonly induced by the high-potency neuroleptics, its development has also been associated with the use of non-neuroleptic agents that block central dopamine pathways. A 68-year-old man with generalized anxiety disorder and depressive symptoms presented at the emergency department (ED) with high fever, tremor, muscle rigidity, rhabdomyolysis and altered mental status. NMS was considered to have been caused by the recent addition and subsequent dose increase in his treatment regimen of venlafaxine, a serotonin norepinephrine reuptake inhibitor. He was successfully treated with bromocriptine, lorazepam, and fluid hydration in the ED and intensive care unit.

Aged↗
PubMed2006

Tension pneumoperitoneum following upper gastrointestinal endoscopy.

Tension pneumoperitoneum is a potentially lethal complication of numerous iatrogenic procedures, including upper gastrointestinal (UGI) endoscopy. We report a 69-year-old man with UGI bleeding who developed tension pneumoperitoneum and cardiac arrest after UGI endoscopy. He was successfully resuscitated with needle decompression. Emergency surgery revealed a perforated gastric ulcer, and subtotal gastrectomy with Billroth II anastomosis was performed. Recovery was smooth and he was discharged from the hospital 18 days later. Tension pneumoperitoneum should be suspected in all patients who develop circulatory collapse with acutely distended abdomen after UGI endoscopy. Early identification relies on a high index of suspicion. Prompt treatment with needle decompression should not be delayed for confirmatory radiography once the clinical diagnosis is made.

Aged↗
PubMed2005

Machine and operator performance analysis of automated external defibrillator utilization.

BACKGROUND AND PURPOSE: The availability of an automated external defibrillator (AED) can improve the outcome of patients with out-of-hospital cardiac arrest (OHCA). On June 1, 2000, Taipei City became the first city in Taiwan to equip emergency medical services personnel with AEDs. This study was conducted to assess the performance of the AED machine in detecting ventricular fibrillation (VF) and ventricular tachycardia (VT) in the population, and to assess operator performance in its use. METHODS: AED use in OHCA patients was assessed over a 1-year period. Electrocardiography and voice records retrieved from AED data cards were analyzed. A shockable rhythm was defined as either VF or VT. AED machine performance was assessed based on the correct identification of these rhythms. Operator performance was evaluated according to American Heart Association guidelines. RESULTS: A total of 978 AED rhythm analyses were obtained for 653 OHCA patients. The sensitivity and specificity for detecting shockable rhythms by the AED machine were 90.0% (95% confidence interval [CI], 85.3% to 93.3%) and 100% (95% CI, 99.5% to 100%), respectively. Sensitivity for coarse VF, fine VF, rapid VT, and slow VT was 97.5%, 74.2%, 63.6% and 60.0%, respectively. An AED was deployed in 18 non-OHCA patients and in 119 patients after they had been moved into the ambulance. Non-compliance with standard procedures occurred during AED use in 162 patients, including interference of movement by cardiopulmonary resuscitation (CPR) in progress in 69, untimely machine turn-off in 49, leads fell off or disconnected in 33, failure of shock delivery after charge in 28, and interference of movement other than CPR in 22. CONCLUSIONS: This study found that the AED machine has high specificity and high sensitivity in detecting VF and VT, especially coarse VF. Efforts are needed to improve the timing of AED deployment and emergency medical technician compliance with standard procedures.

Adolescent↗
PubMed2004

Emergency medical services utilization during an outbreak of severe acute respiratory syndrome (SARS) and the incidence of SARS-associated coronavirus infection among emergency medical technicians.

OBJECTIVES: This was a study to evaluate the utilization of emergency medical services (EMS) systems during the outbreak of severe acute respiratory syndrome (SARS), and to assess the incidence of infection among emergency medical technicians (EMTs). METHODS: This was a prospective, observational study conducted in the EMS system of Taipei, Taiwan. Probable/suspect cases of SARS were defined by World Health Organization criteria. SARS-related transports were categorized into 1) requests from hospitals for probable/suspect cases of SARS, 2) quarantined individuals, and 3) febrile persons. City ambulances were organized into teams A, B, and C for transports of different perceived risks. Data on the EMS volume, the transport category, the final SARS status of patients, and the EMT responsible for the transports were collected. The EMS projected volume was computed by previous years' data and compared with that collected. The SARS incidence among EMTs was assessed by investigating probable SARS (P-SARS) and by surveying the seroprevalence of SARS-associated coronavirus (SARS-CoV) antibody. RESULTS: From March 18 to June 19, 2003, there were 7,961 EMS transports, similar to the volume projected from previous years (7,506) (95% CI = 6,688 to 8,324). Of these, 1,760 (22.1%) were SARS-related. When SARS-related transports were excluded, there was a 12.2% decrease (95% CI = 11.4% to 12.9%) in EMS activities. Requests from hospitals, quarantined individuals, and febrile citizens accounted for 23%, 18%, and 59% of SARS-related transports. Among the 397 P-SARS cases in the city of 2.65 million people (incidence 0.01%, 95% CI = 0.01% to 0.02%), 138 (35%) required EMS transports. Two EMTs working in team C, the team with the lowest risk, developed P-SARS. One of them died soon thereafter. The incidence of P-SARS was 0.6% (95% CI = 0.2% to 2.2%), or 0.1% (95% CI = 0.03% to 0.4%) per transport. SARS-CoV serology was available in 74.1% of EMTs who were alive. In addition to the surviving P-SARS EMT, one EMT from team A, the team with the highest risk, was seropositive. Combining P-SARS and the seropositive case, three EMTs were infected (incidence 1.3%, 95% CI = 0.4% to 3.6%). No patient transported by the infected EMTs developed SARS. The hospitals serving EMS by the infected EMTs had been involved in a clustered outbreak prior to the EMTs' infections. CONCLUSIONS: During the outbreak of SARS, the overall EMS volume did not change significantly, but the non-SARS EMS activities decreased. Compared with the general population, EMS providers are at higher risk of contracting the SARS virus regardless of different perceived levels of risk. Standard protections and procedures for infection control should be strictly followed during transport and within the hospital environment.

Coronavirus Infections↗