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측벽 급성심근경색 진단을 위한 새로운 전흉부 유도: V5E, V6E
오성범,황규욱 대한응급의학회 2018 대한응급의학회지 Vol.29 No.1
Purpose: The 12-lead electrocardiogram has limitation for detection of lateral wall myocardial infarction (MI). Therefore, this study was conducted to compare the location of leads V5 and V6 with the left ventricle (LV) lateral wall using multidetector computed tomography (MDCT) and propose new additional leads for detection of lateral wall MI. Methods: From 120 study subjects who underwent chest MDCT, we measured the angle (θ) between the midsagittal plane and long axis of LV on the coronal imaging of MDCT. Using this, another angle (90-θ) between the long axis of LV and leads V5 and V6 was calculated. After the location of the leads V5 and V6 was identified using axial and coronal images of MDCT, the positional relationship between leads V5 and V6 and the lateral wall was compared based on the thoracic spine. Results: The θand 90-θwas 52.2 ±10.3 and 37.8 ±10.3 , respectively. Leads V5 and V6 faced the LV lateral wall very obliquely. The score of leads V5 and V6 position based on the thoracic spine was 6.9±1.8 points as the level of lower part of 9th vertebral body. Meanwhile, the lateral wall of LV was 4.7±2.2 points as the lower part of the 8th vertebral body. Thus, leads V5 and V6 were located lower by the height of one thoracic vertebral body than the lateral wall of LV on coronal images (p<0.001). Conclusion: Leads V5 and V6 are inappropriate for detection of the lateral wall MI. To diagnose that more efficiently, we propose the new additional leads, elevated V5 and elevated V6, located two or three intercostal spaces upward from leads V5 and V6.
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강창신,최한주,김상일,김용오,김정윤,김정호,노 현,류현호,위정희,황규욱,홍기정,안재윤,윤준성,고은실,이민희,고성근,이태영,노을희,박준범 대한응급의학회 2024 대한응급의학회지 Vol.35 No.1
While the Korean Triage and Acuity Scale (KTAS) was introduced in 2016 as a tool to identify patients at risk of catastrophic events, including death in the ED, the triage system for the pre-hospital stage still lacks evidence. The pre-hospital stage is characterized by time-sensitive and complex scenarios, where rapid and accurate decision-making is paramount to optimize patient outcomes. Despite the vital role of pre-hospital care providers, the invalidated and subjective current triage system consisting of 4-stages is still used at the pre-hospital stage, and hence, it needs to be modified to be more objective, standardized, and reliable. To improve the Korean emergency medical system, the pre-hospital KTAS (Pre-KTAS) was developed in 2020, and then two pilot projects were conducted in 2022 and 2023. This paper not only reveals the results of the first and second pilot projects for Pre-KTAS but also highlights the potential benefits of using this newly developed triage tool in the pre-hospital setting. Furthermore, this paper suggests ways to improve the emergency medical system (EMS) in Korea by improving patient safety, resource allocation, and overall emergency response efficiency.
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