응급실 증후군 감시체계의 운영 현황과 활성화 방안

조준필,민영기,최상천,Cho, Joon-Pil,Min, Young-Gi,Choi, Sang-Cheon 대한예방의학회 2008 예방의학회지 Vol.41 No.4

Due to heightened concerns regarding possible bioterrorist attacks, the Korea Center for Disease Control and Prevention introduced syndromic surveillance systems, which have been run by emergency departments in hospitals throughout Korea since 2002. These systems are designed to identify illness clusters before diagnoses are confirmed and reported to public health agencies, to mobilize a rapid response, and thereby to reduce morbidity and mortality. The Korea Center for Disease Control and Prevention performed drop-in syndromic surveillance successfully during the World Cup Football Games in 2002, the Universiad games in 2004, and the Asian Pacific Economic Cooperation meeting in 2005. In addition, sustainable syndromic surveillance system involving the collaborative efforts of 125 sentinel hospitals has been in operation nationwide since 2002. Because active data collection can bias decisions a physician makes, there is a need to generate an automatic and passive data collection system. Therefore, the Korea Center for Disease Control and Prevention plans to establish computerized automatic data collection systems in the near future. These systems will be used not only fur the early detection of bioterrorism but also for more effective public health responses to disease.

신장 동종이식 수여자에서 나타나는 야간성 다뇨에 관한 연구

조준필(Joon Pil Cho),박기일(Kiil Park) 대한외과학회 1987 Annals of Surgical Treatment and Research Vol.33 No.3

외상성 후복막강 혈종의 임상적 중요성 및 치료

안태완 ( Tae Wan Ahn ),조준필 ( Joon Pil Cho ),지훈상 ( Hoon Sang Chi ),김병로 ( Byung Ro Kim ) 대한외상학회 1991 大韓外傷學會誌 Vol.4 No.1

The management of retroperitoneal hematomas remains to be confusing to many surgeons because it often does not correlated well with the underlying mechanism of injuries and the treatment may differ considerably. So we reviewed 70 patients who had been admitted due to traumatic retroperitoneal hematomas at Young Dong Severance Hospital, Yonsei University College of Medicine from January 1986 to December 1990. 70 patients had retroperitoneal hematoma among 260 who had sustained abdominal trauma (blunt injury: 180, penetrating injury: 80). The most common cause was pedestrianauto accident who accounted 33 patients. According to Selivanov, the retroperitoneal hematoma is classified as Zone I (central), II (flank) and III (pelvic). In our series, the Zone I retroperitoneal hematoma consisted 18.6%, Zone II 31.4% and Zone III 58.6% ; the pelvic bone fracture was the most frequently implicated with retroperitoneal hematoma. Exploratory laparomy was performed in 27 patients and 43 patients were treated conservatively. 24 patients had hypovolemic shock at the emergency room and 5 of them expired (mortality rate: 20.8%). 12 patients required 6-15 units of blood and 3 of them died (mortality rate: 25%). 5 patients rquired more than 16 units of blood and 2 died (mortality rate: 40%). 14 patients recieved ventilatory care for more than 24 hours and 5 died. The overall mortality rate was 8.6% (6 out of 70).

탈구 정복시 etomidate 의 단독 투여에 의한 진정 효과

정윤석(Yoon Seok Jung),조준필(Joon Pil Cho),김기운(Gi Woon Kim),이종서(Christopher C. Lee),박인철(In Cheol Park) 대한응급의학회 2001 대한응급의학회지 Vol.12 No.1

Background : Etomidate as a sedative hypnotic agent is not a respiratory depressant, has an excellent pharmacodynamics, thereby making it an excellent agent for induction in rapid sequence intubation. The objectives of this study were to investigate the success rate, the safety, and the adverse effects using etomidate as the single agent for conscious sedation during a reduction of various dislocations. Methods : Any patient with a dislocation, which needed a reduction, from July 1, 1999 to May 21, 2000.was enrolled in this prospective study. Thus far, we have enrolled 20 patients. After an accurate diagnosis, we recorded the pre- and the post-administration transcutaneous oxygen saturation, heart rate, success rate, the sedation time, and we looked for any adverse effects. We used 0.3 mg/kg(20 mg) of etominate for conscious sedation and if needed more; the rescue dose was 0.15 mg/kg(10 mg). Results : The time of sedation ranged from 4 to 10 minutes with the average time being 7.15 minutes. There was no difference in the pre- and the post-administration heart rate. The oxygen saturation on pulse oximetry, for all patients range from 99~100% with average 99.5%, and while sedation the oxygen saturation dropped to average of 98.2%. Conclusions : We conclude that etomidate, as a single agent for conscious sedation, is effective and safe for reduction of the commonly dislocated joints seen in emergency department.

복부둔상세에서 진단적 복강세척술과 복부 전산화단층촬영의 진단적 의의

김명수 ( Myung Soo Kim ),조준필 ( Joon Pil Cho ),지훈상 ( Hoon Sang Chi ) 대한외상학회 1990 大韓外傷學會誌 Vol.3 No.2

We reviewed retrospectively medical records and films of 83 patients who underwent abdominal computed tomogram and/or diagnostic peritoneal lavage following abdominal blunt trauma between January 1986 and december 1990. Thirty eight among 83 patients were operated because of positive findings of abdominal computed tomogram and/or diagnostic peritoneal lavage. Only one patient of thirty eight revealed no definite intraaabdominal organ injuries except non significant retroperitoneal hematoma due to pelvic bone fracture. The interval time from initial evaluation at emergency room to laparotomy was average 8.4 hours. Positive findings of diagnostic peritoneal lavage provided fastest discision of laparotomy, of which time interval was average 6.4 hours. Diagnostic peritoneal lavage showed that sensitivity was 95.8%, specificity 85.7%, and accuracy 93.5%. Abdominal computed tomogram showed that sensitivity was 75.0%, specificity 100%, and accuracy 73.9%. False negative findings were more frequent in patients who was taken abdominal computed tomogram than diagnostic peritoneal lavage. We conclude that in order to facilitate the early and precise recognition of intraab-dominal organ injuries following blunt abdominal trauma, diagnostic peritoneal lav-age is more superior method to abdominal computed tomogram. Nevertheles abdo-minal computed tomogram is non invasive procedures and provides intraabdominal or retroperitoneal organ specific findings. So abdominal computed tomogram helps us to manage hemodynamically stable patients conservatively dependent upon degree of solid organ injuries or retroperitoneal hematoma under close observation.

외과계 중환자실 환자에서의 다발성장기부전증

조영업(Young Up Cho),조준필(Joon Pil Cho),신증수(Cheung Soo Shin),지훈상(Hoon Sang Chi) 대한외과학회 1994 Annals of Surgical Treatment and Research Vol.46 No.5

지역사회 재가 노인의 낙상에 영향을 미치는 요인

백경원,송현종,정윤석,문혜원,조준필,Paek, Kyung-Won,Song, Hyun-Jong,Jung, Yoon-Seok,Moon, Hae-Won,Cho, Joon-Pil 대한예방의학회 2001 예방의학회지 Vol.34 No.1

Objectives : To analyze factors associated with elderly falls in a community dwelling, a comparatively important, but somewhat neglected, health mailer. Methods : Data came from personal interview surveys using a questionnaire of 552 people aged 65 or older living in a community. Socioeconomic, and health related characteristics were investigated as independent variables and experiences of falling in the previous year as the dependent variable. Results : 118(21.4%) of the elderly subjects experienced a fall in the previous year. 24 subjects experienced more than two falls, accounting for 20.3% of the elderly fall victims studied. Factors affecting the falls were families living together, level of daily activity, heart disease, and aconuresis;, therefore an elderly person who lives alone, lives independently, has heart disease, or suffers urinary incontinence had a demonstrated increased chance of failing. Conclusion : Groups at risk for luting included elderly persons living alone, living independently, suffering heart disease, or experiencing urinary incontinence. When an elderly fall prevention program is developed and implemented, these results should be considered.

베르테르 효과의 영향; 의도적 일산화탄소 중독의 증가

허인영,최상천,이정아,안정환,민영기,정윤석,조준필,김진숙,Heo, In-Young,Choi, Sang-Cheon,Lee, Chung-Ah,Ahn, Jung-Hwan,Min, Young-Gi,Jung, Yoon-Seok,Cho, Joon-Pil,Kim, Jin-Sook 대한임상독성학회 2009 대한임상독성학회지 Vol.7 No.2

Purpose: Suicide attempts are known to be influenced by mass media reports. The purpose of this study was to evaluate the effects of mass media reporting celebrity suicides on an increase of intentional carbon monoxide (CO) poisoning and suicide attempts. Methods: We retrospectively reviewed the medical records of the consecutive patients who presented with suicide attempts to the Emergency Department of Ajou University Hospital during a 24 month period. We obtained the demographic data, any past history of suicide attempt and the methods of suicide attempts from the medical records of the suicide attempters. Time series analysis was conducted for evaluating the influence of mass media reporting of celebrity suicide on the suicide rates. Results: We finally enrolled 770 patients during the study period. The total number of suicide attempts by CO poisoning was 18 and the average number of suicide attempts by CO was $0.33{\pm}0.73$ per week. All of the suicide attempts by CO poisoning occurred after a celebrity committed suicide using CO from burning charcoal. Conclusion: This study showed that celebrity suicide by CO poisoning resulted in the Werther effect, which made the rate of intended CO poisoning increase, and the study provided further evidence for the need to actively restrain mass media reporting of suicide to decrease the Werther effect.

둔상으로 인한 간손상의 비수술적 치료

정구영(Koo Young Jung),정준(Joon Chung),조준필(Joon Pil Cho),지훈상(Hoon Sang Chi),민진식(Jin Sik Min) 대한외과학회 1994 Annals of Surgical Treatment and Research Vol.46 No.2

교통사고로 인한 중증손상 환자에 대한 분석

정지윤 ( Ji Yoon Jung ),백경원 ( Kyung Won Paek ),이국종 ( Kug Jong Lee ),조준필 ( Joon Pil Cho ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2

Background: To provide information about serious traffic accident injuries in Suwon, Korea, during the year of 2000, we conducted an epidemiologic study of injured patients. Methods: The data were obtained by reviewing medical records of patients requiring hospital admission due to traffic injury. A retrospective study, the selection of patients was made according to ICD-10 code. Results: A total of 1389 patients were surveyed. With respect to the causes of injury, traffic accidents accounted for the highest percentage (40.2%). More men than women were injured in all age groups. The highest frequency of traffic injuries was noted in patients ranging in age from 20 to 39 years. The occurrences of accidents were distributed evenly throughout the year, with little seasonal correlation. As for the time of day, the accidents occurred more often in the afternoon and evening. Most of patients were admitted to general ward. The mean ISS of all traffic accident patients was 9.41±7.81. Factors associated with injury severity were sex, age, road user, time of day, and results of ED treatment. Conclusion: This is the first study of serious traffic accident injuries in Suwon for the year 2000. As such, our findings constitute the seminal information for future research, including collection of further data, analyses, and extensions to other cities.