Taehun Lee

The 2025 Korean Guidelines for Cardiopulmonary Resuscitation include a first aid section developed through a systematic review and evidence appraisal. The revision aimed to strengthen prehospital first aid response capacity while reflecting the Korean healthcare system, field feasibility, and relevant legal and institutional contexts. The guidelines provide evidence-based recommendations for seven priority emergencies: adult chest pain suggestive of myocardial infarction, suspected acute ischemic stroke, asthma-related dyspnea, anaphylaxis, seizures, shock, and syncope. Core principles emphasize early recognition, prompt activation of emergency medical services, minimizing delays to definitive care, and safe condition-specific interventions. Key recommendations include assisting with patient-prescribed medications when appropriate (e.g., nitroglycerin, inhaled bronchodilators, and epinephrine autoinjectors), using structured stroke screening tools, preventing aspiration through proper positioning and withholding oral intake in patients at risk of dysphagia, administering oxygen only for hypoxemia, and initiating cardiopulmonary resuscitation in patients who are unconscious and not breathing normally. Seizure management focuses on safety and emergency medical services activation criteria, while care for shock and syncope emphasizes patient positioning and post-event assessment. These recommendations provide practical, evidence-based guidance for improving patient safety and outcomes in prehospital settings.

Background: Foreign body airway obstruction is a sudden emergency that can occur unexpectedly in healthy people, leading to severe consequences if immediate first aid is not provided. Unlike the Heimlich maneuver for adults, the first aid for infant choking is less widely known and more complex, making it difficult to explain verbally. This study aimed to assess the efficiency of using an animated graphics interchange format (GIF) to teach first aid for infant choking due to foreign bodies. Methods: Eighty adults who had not received recent training in choking first aid within the last two years were randomly assigned to either the auditory (n = 40) or audiovisual (n = 40) groups. The participants were asked to perform first aid on an infant manikin under the guidance of a researcher using a smartphone in a separate room. The auditory group received verbal instructions only, while the audiovisual group received animated GIFs on their smartphones along with verbal instructions simultaneously. The entire process was recorded with two cameras, and two emergency physicians reviewed the videos to assess the adequacy of the first aid administered. Results: The “infant position”, “supporting arm posture”, and “head tilt” were more adequate in the audiovisual group. The Instruction Performance scores were higher in the audiovisual group. There was no significant difference in the time required to administer first aid between the two groups. Conclusions: Audiovisual guidance using animated GIFs has been shown to effectively enhance the adequacy of first-aid performance for infant airway obstruction caused by foreign bodies.

Wearing level D personal protective equipment (PPE) after the first outbreak of coronavirus disease 2019 (COVID-19) has become mandatory in Korea. However, PPE use worsened paramedics’ on-scene dispatch. A delayed response to patients experiencing cardiac arrests, could cost them their lives. This study was therefore conducted to determine not only whether PPE wearing affects the dispatch time but also the time difference between wearing PPE inside the ambulance while en route to the scene and wearing PPE outside the ambulance before departure to ascertain the optimal location for paramedics to wear PPE. The response times of paramedics for reaching the cardiac arrest patients before (pre-PPE group) and after (post-PPE group) PPE wearing became mandatory were compared. Forty-five paramedics participated in a PPE-wearing simulation. The total amount of time spent by them wearing PPE was measured outside the ambulance, in the passenger seat, and in the patient care compartment. The median response time for the post-PPE group was 1–1.5 min longer than that for the pre-PPE group for dispatches within 10 km. The average time for PPE suit-up was the shortest outside the ambulance (140.53 s). It was 178.47 s in the passenger seat, whereas it was 151.22 s in the patient care compartment. The response time increased after wearing PPE. PPE suit-up time was shortest outside the ambulance. Considering the wearing time, prognosis, safety of the paramedics, the location at which PPE are worn should be appropriately determined.

Background: The delta neutrophil index (DNI), a prognostic and diagnostic marker for sepsis, is based on the leukocyte count. Platelet activation, similar to leukocyte activation, plays a crucial role in host defense against pathogens and may serve as a predictor of sepsis outcome. However, the combined evaluation of mean platelet component (MPC) and DNI has rarely been used to assess sepsis. Methods: To assess the prognostic and diagnostic validity of the simultaneous evaluation of DNI and MPC in cases of human febrile sepsis, we conducted measurements of cellular indices, including DNI and MPC, as well as molecular biomarkers, including procalcitonin (PCT) and C-reactive protein (CRP). This study was carried out in patients admitted to the emergency department with suspected sepsis. Results: Using a cutoff value of 2.65%, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the DNI in sepsis were found to be 69%, 73.9%, 77.9%, and 64.1%, respectively. Furthermore, significant differences in DNI and MPC levels were observed between the sepsis and non-sepsis groups (6.7 ± 7.8% versus 2.1 ± 2.2% (p = 0.000) and 26.0 ± 1.9 g/dL versus 26.8 ± 1.4 g/dL (p = 0.002), respectively). Notably, there was a negative correlation between DNI and MPC, with the strength of the correlation varying based on the cause of sepsis. By setting the cutoff value of the DNI to 6.2%, its sensitivity, specificity, and NPV improved to 100%, 80.3%, and 100%, respectively, although the PPV remained at 10.6%. Conclusions: In our study, the DNI demonstrates superior effectiveness compared with other molecular biomarkers, such as CRP and procalcitonin, in distinguishing septic febrile patients from non-septic febrile patients. Additionally, a negative correlation exists between MPC and DNI, making MPC a valuable marker for differentiating the etiology of sepsis. These findings hold significant clinical implications, as DNI/MPC evaluation is a cost-effective and readily applicable approach in various impending sepsis scenarios. Notably, this study represents the first examination of the prognostic and diagnostic validity of employing the simultaneous evaluation of DNI and MPC in human cases of febrile sepsis.

Background The Delta Neutrophil Index (DNI), a prodiagnostic marker for sepsis, utilizes leukocyte count. Platelet activation, similar to leukocytes, plays a crucial role in host defence against pathogens and may serve as a predictor of sepsis outcome. However, the combined evaluation of Mean Platelet Component (MPC) and DNI in assessing sepsis has been rarely used. Methods To assess the prodiagnostic validity of simultaneous utilization of DNI and MPC in cases of human febrile sepsis, we conducted measurements of cellular indices, including DNI and MPC, as well as molecular biomarkers such as procalcitonin (PCT) and C-reactive protein (CRP). This study was carried out on patients admitted to the emergency department with suspected sepsis. Results Using a cutoff value of 2.65%, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DNI in sepsis were found to be 69%, 73.9%, 77.9%, and 64.1%, respectively. Furthermore, significant differences in DNI and MPC levels were observed between the sepsis and non-sepsis groups (6.7±7.8% versus 2.1±2.2%, P=0.000 and 26.0±1.9 g/dl versus 26.8±1.4 g/dl, P=0.002), respectively. Notably, there was a negative correlation between DNI and MPC, with the strength of the correlation varying based on the cause of sepsis. By setting the cutoff value for DNI at 6.2%, the sensitivity, specificity, and NPV improved to 100%, 80.3%, and 100%, respectively, although the PPV remained at 10.6%. Importantly, the DNI≥6.2 group exhibited a higher incidence of death (10.9%, 5/46) and multiorgan failure (19.6%, 9/46) compared to the DNI<6.2 group (0.0%, 0/46 and 0.0%, 0/167, respectively) (P=0.000 and P=0.000, respectively). Conclusions In our study, DNI demonstrates superior effectiveness compared to other molecular biomarkers such as CRP and procalcitonin in distinguishing febrile septic patients from febrile nonseptic patients and predicting prognosis. Additionally, there exists a negative correlation between MPC and DNI, making MPC a valuable marker for differentiating the etiology of sepsis. These findings hold significant clinical implications as DNI/MPC is a cost-effective and readily applicable approach in various impending sepsis scenarios. Notably, this study represents the first examination of the prodiagnostic validity of simultaneously employing DNI and MPC in human cases of febrile sepsis.

(1) Background: The government of South Korea has established a nationwide web- and mobile-based emergency teleconsultation network by designating urban and rural hospitals. The purpose of this study is to analyze the characteristics and effectiveness of the tele-emergency system in South Korea. (2) Methods: Tele-emergency consultation cases from May 2015 to December 2018 were analyzed in the present study. The definition of a tele-emergency in the present study is an emergency consultation between doctors in rural and urban hospitals via a web- and mobile-based remote emergency consultation system (RECS). Consultations through an RECS are grouped into three categories: medical procedure or treatment guidance, image interpretation, and transportation requests. The present study analyzed the characteristics of the tele-emergency system and the reduction in unnecessary transportation (RUT). (3) Results: A total of 2604 cases were analyzed in the present study from 2985 tele-emergency consultation cases. A total of 381 cases were excluded for missing data. Consultations for image interpretation were the most common in trauma cases (71.3%), while transfer requests were the most common in non-trauma cases (50.3%). Trauma patients were more frequently admitted to rural hospitals or discharged and followed up with at rural hospitals (20.3% vs. 40.5%) after consultations. In terms of disease severity, non-severe cases were statistically higher in trauma cases (80.6% vs. 59.4%; p < 0.001). The RUT was statistically highly associated with trauma cases (60.8% vs. 42.8%; p < 0.001). In an analysis that categorized cases by region, a statistically higher proportion of transportation was used in island regions (69.9% vs. 49.5%; p < 0.003). More RUT was associated with non-island regions (30.1% vs. 50.5%; p = 0.001). (4) Conclusions: The tele-emergency system had a great role in reducing unnecessary patient transportation in non-severe trauma cases and non-island rural area emergency cases. Further research is needed for a cost/benefit analysis and clinical outcomes.

Sepsis is an emergent infectious disease and a leading cause of death despite immediate intervention. While Delta neutrophil index (DNI) and myeloperoxidase (MPO) are known as a prodiagnostic marker of sepsis, the preclinical evidence of the best marker of sepsis is unclear. For this, using a well-designed cecal ligation and puncture (CLP)-induced sepsis mouse model, we comparatively measured the level and cost-effectiveness of sepsis biomarkers such as DNI, myeloperoxidase (MPO), procalcitonin (PCT), and tumor necrosis factor-alpha (TNF-α). First, we found that the optimal time point for early detection is at 6 h, 24 h post-CLP. Strikingly, the peak level and fold change of DNI was revealed at 24 h, further showing the best fold change as compared with other biomarker levels. Given the fold change at 6, 24 h, PCT was next to DNI. Third, a cost-effectiveness survey showed that DNI was the best, with PCT next. Further, DNI level was moderate positively associated with PCT (ρ = 0.697, p = 0.012) and TNF-α (ρ = 0.599, p = 0.040). Collectively, these data indicate that DNI in CLP-induced sepsis mice is as effective as the existent inflammatory biomarkers such as MPO, PCT and TNF-α to predict the prognosis of sepsis. This might have clinically important implications that DNI is cost effective, thus quickly and rationally applying to diverse types of imminent sepsis regardless of species. This might be the first report on the validity of DNI in preclinical CLP-induced murine sepsis.

Ahn ME, et al. J Korean Med Assoc. 2019 May;62(5):258-264. https://doi.org/10.5124/jkma.2019.62.5.258