한국인의 항파상풍 항체 역가

구홍두,최옥경,장석준,정구영,이정운,김승호 대한응급의학회 1993 대한응급의학회지 Vol.4 No.2

Inspite of immunization, TETANUS remains a disease with a high morbidity and mortality rate. Tetanus has been still occurred more frequently in developing countries where immunization programs are inadequate. In Korea, there is a routine immunuzation schedule with diphtheria, pertussis, and tetanus(DPT) vaccines at 2,4,6 month after birth at 18 month. But further prophylactic programs are not exist. Moreover, we have usually used only passive immunization, tetanus antitoxin, as a prophylactic regimen for injured patients instead of guidelines of Center for Disease Control. The purpose of this study was to assess the baseline tetanus immunity state and to suggest the proper immunization schedule and adequate prophylactic guideline for injured patients in Korea. One hundred thirty one trauma patients from emergency department of Severance hospital from September to November of 1993 were included. Antietanus antibody titers of the patients were analyzed by ELISA assay. The mean antitetanus antibody titer was 0.728 ±0.236IU/mL. The titers were diminished rapidly with age. In pediatric group(age under 15), the mean titer was 3.251 ±0.426 IU/mL and in geriatric group(age over 64), the mean titer was 0.007 ±0.002 IU/mL which was below the minimal protective antibody titer(0.01 IU/mL). While all of the pediatric patients have protective antibody titer, only 69.2% of young adults(15-39, n=65), 56.7% of adults(40-64, n=30), and 57.2% of geriatrics(>65, n=14) have protective antibody titer. Our results suggest that tetanus prophylaxis is unnecessary in the age under 14. In other age groups, however, our data strongly support the need of prophyulaxis.

Lamotrigine 단독 과량복용으로 발생한 횡문근융해증

김건배,구홍두,Kim, Gun-Bea,Gu, Hong-Du 대한임상독성학회 2008 대한임상독성학회지 Vol.6 No.2

Lamotrigine is a newer anti-epileptic drug for adjunctive treatment of refractory epilepsy, partial seizures, generalized tonic-clonic seizures, and bipolar disorder. Lamotrigine overdose causes serious central nervous and cardiovascular problems, but reports are uncommon. Few lamotrigine overdoses have been described because anti-epileptic drug use is limited and usually used with combination of other anti-epileptic drugs. In addition, most patients visit emergency departments with multi-drug overdoses, so few cases of lamotrigine poisoning alone exist. We had a female patient visit our emergency department a couple of hours after a lamotrigine overdose treated with intravenous hydration and urine alkalization by NaHCO3. She recovered successfully without any evidence of renal injury. However, she developed profound rhabdomyolysis, a previously unreported complication of this medication. We suggest that serial creatine kinase levels should be measured after lamotrigine poisoning.

응급의료센터 과밀화 해소를 위한 환자 전원

이경룡,구홍두,박인철,김승환,장석준,심호식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

To reduce the degree of overcrowding in level Ⅲ emergency care centers, authors have conducted a prospective study of patient who were transferred to level Ⅰ or Ⅲemergency center based on the non-emergent patient guideline currently used at the severance Hospital, level Ⅲ emergency center, during the period of 65 days from Jan. 1st 1995 to Mar. 6th 1995. Followings are guideline for non-emergent patient described by the Korean government low: 1) systolic blood pressure greater than 80/100 of normal. 2) respiration rate between 10 to 24 per minute. 3) pulse rate between 60 to 100 per minute. 4) body temperature between 36 to 37.5℃ by rectal. 5) relatively alert mental status. 6) patient not requiring emergency operation at the time of examination. The results were as follows: 1. Among the total 5,301 patients, 464 patients ranged from age of 1 to 82 years old were transferred to level Ⅰor Ⅱ emergency center after simple treatment. 2. Among the 464 patients, 276 patients were treated in expected hospital with medical problems in 101 (36.6%) patients, and 175 (63.4%) patients had surgical problems. 3. Among the 276 patients, 122 (44.2%) patients were admitted, 145 (52.9%) patients were discharged from the emergency room after adequate treatment. 4. Among the transferred patients, simple laceration (33.0%) were most common, acute gastroenteritis (12.0%), and simple contusion (10.5%) were followed. These results suggest that about 10% of patients visiting level Ⅲ emergency care center, can be safely transferred to nearest level Ⅰor Ⅱ emergency centers on the bases of non-emergent patient guideline described by Emergency Medical Service law. These guideline, if put into proper use, can reduce the degree of overcrowding problems in level Ⅲ emergency care center through out the country.

Doxylamine succinate과용에 대한 고찰

오진호,윤천재,구홍두,이한식 대한응급의학회 1998 대한응급의학회지 Vol.9 No.2

Background: The number of patients of doxylamine overdose has increased, but there were little clinical reports. The purpose of this study is review the patients of doxylamine overdose for aid clinical decision making of patients disposition. Methods: We reviewed medical records of patients who ingested doxylamine succinate retrospectively from Jan. 1, 1996 to Dec. 31. 1996. Data that was recorded were followed: age, sex, psychiatric history, amounts of ingestion, time interval from ingestion to arrival to hospital, initial vital signs and symptoms, EKG, chest PA, Lab. findings, treatment, patients disposition, length of hospital stay, complication. Results: 1) Total number of patients was ninety and average dosage of ingestion was 1062mg. 2) Tachycardia was the most frequent anticholinergic symptom(46%). 3) Routine lab. Findings was not abnormal except one patient who was diagnosed as Rhabdomyolysis. 4) Gut decontamination was performed in patients who had arrived at hospital in 2-3hours, and who had ingested large dose of drug. 5) Five patients were admitted to Psychiatric dept. and one patient was admitted to emergency dept. for treatment of rhabdomyolysis. 6) The mean duration of hospital stay was 6.5 hours. Conclusion: The patients who ingested overdose of doxylamine was managed safely in emergency department, but we should warn against the posibility of rhabdomyolysis.

쇼크환자에서 혈청Lactate값과 예후의 관계

윤천재,김욱진,구홍두,김승호 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.4

Shock is often the final pathway through which a variety of pathologic processes lead to cardiovascular failure and death. The purpose of this study is to determine the value of serum lactate as a predictor of outcome in shock patient. We investigated the correlation between serum lactate levels and mortality in 42 patients whose systolic BP were below 90mmHg on initial presentation. Serial arterial blood lactate level were measured on admission and every 4 hours for one day. 29 patients were survived. Initial BP was not different between survivors and nonsurvivors. Lactate levels were significantly higher in the nonsurviviors than survivors(p<0.05). But, there were no difference in lactate clearance between survivors and nonsurvivors(p>0.05). 24 hours survival rate was 42.9% in patients whose lactate levels were above 100mg/dl initially and statistically significant in comparison with patients whose lactate levels were below 100mg/dl(p<0.01). The latters' survival rate was 85.7%. Our data suggest that initial lactate level could be correlated with the prognosis of shock patient.

어지러움증 환자에 대한 뇌전산화 단층촬영 시행의 지표

정성필,김욱진,구홍두,김승호 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.4

A retrospective analysis by chart review of consecutive 140 patients with vertigo who visited emergency department of Severance hospital from Jan 1994. All patients underwent cranial computed tomography to rule out intracranial lesion at the time of initial visit. The purpose of this study is to determine which clinical parameters can be used to select patients with vertigo requiring cranial computed tomography (CT) scan. The results were as follows ; 1. Twenty-two patients (15.7%) had positive CT scans. 2. There are no significant correlation between CT result and history of hypertension, previous cerebrovascular accident, nausea, vomiting, headache, tinnitus, nystagmus, Nylen-Barany test. 3. A statistical correlation existed between CT outcome and clinical variables on neurologic examination - moto and sensory deficit, diplopia, tandem gait, Romberg test, finger to nose test. 4. Patients with neurologic abnormality had an increased risk of a CT abnormality (51.2%). Our data suggest that the patient with vertigo who had neurologic abnormality should perform brain CT scan to rule out intracranial lesion, but a prospective study is required to confirm our results.

항파상풍 톡소이드 주사후 항파상풍 항체 역가

이한식,하영록,구홍두,장석준,심호식,김승환,이정운 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Objective : Tetanus decreased in prevalence since the systemic vaccination began in 1940s. Despite of the improvement in treatment like critical care with ventilatior or antibiotics, the mortality rate resides around 45%. Currently the tetanus prevention protocol recommends immunization in infancy and boosters every tenth years. Thereafter the immunization with toxoid only or toxoid plus immunoglobulin injections is recommended according to the type of injury. In most of ED in Korea, only tetanus immunoglobulin is given without any basis. Previously we proved the effect that passive immunization with the immunoglubulin 250 IU last long for only a month. At this time we measured the effect of the active immunization with toxoid and its effect was compared to the effect of the tetanus immunoglobulin to find out the logical tetanus prevention after an injury. Method: 20 healthy adult volunteers were injected with tetanus toxoid and their anti-tetanus antibody titers measured before the injection, 1 week and 4 weeks after the inection. No volunteers have taken any medication for chronic illness(e.g. hepatits, tuberculosis) or had an tetanus immunization or booster in the last 6 months. Antibody titers were measured by IMMUNOZYM??-TETANUS and t-test was performed on the results, Results: 1. Total 20 volunteers(12 males and 8 females) were participated. 2. Subjects` ages were 21 to 44 years old and there were no relevance to the antibody titer. 3. The antibody titers of before the anti-tetanus toxoid injection and 1 week, 4 weeks after the injection revealed significant difference and the antibody titers of the first and the forth week after the injection also showed a significant difference. Conclusion: Currently in Korea, the tetenus immunoglobulin 250 IU given alone as tetanus prevention was injected, but it did not elevate the anti-tetanus antibody titer for 4 weeks where as tetanus toxoid injected intramuscularly did significantly. Therefore, tetanus toxoid should be given on the dirty injuries with additional tetanus immunoglobulin injection to accomplish the correct method of tetanus, tetanus toxoid prevention.

응급의료센터로의 외상환자 전원에 대한 고찰

김옥준,김승환,구홍두,최옥경,김승호 대한응급의학회 1993 대한응급의학회지 Vol.4 No.1

We performed a prospective study of 303 transferred patients(21.8%) to our emergency center from their initially visited hospitals for 6 months from July 1992 to December 1992. The results were as followed; 1) One thousand three hundred eighty eight trauma patients were visited to the emergency center for 6 months. Among the transferred 303 patients, 99 cases were due to traffic accident, 72 cases were falling down injury, and 62 cases were blunt trauma injury. 2) In terms of injury severity score, patients who were directly admitted to our emergency center had a score of 2.51±5.39, while those who were transferred had score 4.53±6.24. The scores were statistically significant. The combined patient population had a injury severity score of 2.95±5.64. There was no statistical difference between the severely injured patient group (ISS>=16) and the less severely injured patient group(ISS<16). 3) Among the patients who were transferred to our emergency center, those who were discharged from initially visited hospitals within 1 hour had ISS of 3.56±5.70, while those were discharged over 24 hours had ISS of 5.27±4.37. But there was no statistical difference between two groups. 4) Of the 303 patients who were transferred to our emergency center, 265 were from Seoul and Kyung-Gi Do and 38 were from various other regions. Among the transferred patients who were brought to emergency center after at least 24 hours of their accidents, 30 patients were elective transfer(patients` need)while 25 were not-elective transfer(further evaluation or proper treatment). Within this group, 3 were severely injured patients, of them two expired. 5) Severely injured patients(ISS>=16) occupied only 15 cases(4%)among 303 patients who were transferred to the emergency center. Among them 10 patients expried at the emergency center. The causes of death were irreversible shock in 4 cases, intracranial problem in 4 cases and hypoxia due to airway obstuction in 2 cases. In the cases of transferred patients there were no interhospital communi-cation before transfer. From the above information, we conclude that the tansferred patients to our emergency center had a higher ISS than of those who directly visited to the center. For effective treatment and higher survival rate, interhospital communication, presence of medical personel during transfer, performing of basic life support prior to transfer and strict limitations for transfer except critically-ill patients are important.

답손(Dapsone)중독환자의 예후와 특성 분석

장석준,정성필,김승환,구홍두,심호식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

We reviewed 26 dapsone intoxication patients who had visited Severance Hospital Emergency Care Center from January 1991 to January 1995 : 13 of them ingested intentionally, but the other ingested accidentally. Among the admitted patients the highest and lowtheest initial value of methemoglobin level is 59.6% & 10.1%. The frequency of symptoms at presentation was following 16 patients complained cyanosis of lip area, 10 patients complained dyspnea, 4 patients complained mental change, 4 patients complained vomiting, 2 patients complained nausea. The inital level of methemoglobin was less than 50% except in one patient. In the view points of total doses of methylene blue used, less than 100mg was used in 9 patients(34.6%) but in one case, amount of 6400mg was loaded. There were 5 patients(19.2%) in September & 4 patients (15.4%) in January. In respect of result, there were 13 discharged cases (50%) for symptom improvement, and 5 mortality cases(19.2%). The transferred cases from Gangwondo account 19 patients(73.1%). All of them is not directly emergency care center visiting patients but transferred patients from remotely located hospitals. Dapsone intoxication results in severe tissue hypoxic symptoms from malfunction of normal hemoglobin thus only with appropriate available doses of methylene blue & activated charcoal, good outcomes will be expected. If aggressive therapy such as hemodialysis is introduced in treatment of severe dapsone intoxication, the outcomes may be slightly improved better than in other supportive care cases.

삼일엽 원충(Plasmodium vivax)감염에 의한 부정맥 및 심막 삼출액 발생 1예

유제성,이진희,정성필,구홍두,박인철 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

말라리아에 감염되었을 경우, 고열 외에 뇌형 말라리아, 급성신부전, 급성 폐부종, 저혈당, 세균성 감염 등의 합병증을 유발하는 것으로 알려져 있다. 드물지만, 외국에서는 열대열 원충에 의해 부정맥이나 심막 삼출액 등과 같은 심장 질환이 발생한 보고도 있다. 하지만 본 예와 같이 삼일열 원충에 의해서도 서맥, 2도, 3도 방실결절 차단의 부정맥과 심막 삼출액 발생할 수도 있다. 말라리아가 빈발하는 지역에서 이런 증상의 환자를 발견하는 경우, 반드시 말라리아 감염을 의심하고, 적절한 진단 및 치료가 이루어지도록 해야 할 것이다. 저자들은 삼일열 원충에 의해 부정맥 및 심막 삼출액이 발생한 환자 1예를 경험하였기에 보고하였다. Plasmodium vivax is a typically seen infectious disease in Korea. The incidence of Plasmodium vivax malaria has been increasing in recent year despite of worldwide attempts at control. Fever, anemia, thrombocytopenia, and splenomegaly are the most common manifestations seen in Korean patient with P. vivax. Cardiac involvement is thought to be a very rare complication of malaria infection. Cardiac complication seems to be limited to acute infection with Plasmodium falcifarum. However we have experienced cardiac complication such as pericardial effusion, and complete AV block by Plasmodium vivax. Physicians should consider cardiac involvement in patient who present hypotension, fever and arrhythmia in malaria endemic area.