외상성 뇌손상 환자에 있어서 S100β의 혈중 농도와 뇌손상의 정도 및 예후의 관계

김오현,이강현,윤갑준,박경혜,장용수,김현,황성오,Kim, Oh Hyun,Lee, Kang Hyun,Yoon, Kap Jun,Park, Kyung Hye,Jang, Yong Su,Kim, Hyun,Hwang, Sung Oh 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.2

Purpose: $S100{\beta}$, a marker of traumatic brain injury (TBI), has been increasingly focused upon during recent years. $S100{\beta}$, is easily measured not only in cerebrospinal fluid (CSF) but also in serum. After TBI, serum S 10019, has been found to be increased at an early stage. The purpose of this study was to evaluate the clinical correlations between serum $S100{\beta}$, and neurologic outcome, and severity in traumatic brain injury. Methods: From August 2006 to October 2006, we made a protocol and studied prospectively 42 patients who visited the emergency room with TBI. Venous blood samples for $S100{\beta}$, protein were taken within six hours after TBI and vital signs, as well as the Glasgow Coma Scale (GCS), were recorded. The final diagnosis and the severity were evaluated using the Abbreviated Injury Score (AIS), and the prognosis of the patients was evaluated using the Glasgow Outcome Score (GOS). Results: Thirty-eight patients showed a favorable prognosis (discharge, recovery, transfer), and four showed an unfavorable prognosis. Serum $S100{\beta}$, was higher in patients with an unfavorable prognosis than in patients with a favorable prognosis, and a significant difference existed between the two groups ($0.74{\pm}1.50\;{\mu}g/L$ vs $7.62{\pm}6.53\;{\mu}g/L$ P=0.002). A negative correlation existed between serum $S100{\beta}$, and the Revised Traumatic Score (R2=-0.34, P=0.03), and a positive correlation existed between serum $S100{\beta}$, and the Injury Severity Score (R2=0.33, P=0.03). Furthermore, the correlation between serum $S100{\beta}$, and the initial GCS and the GCS 24 hours after admission to the ER were negative (R2=-0.62, P<0.001; R2=-0.47, P=0.005). Regarding the GOS, the mean serum concentration of $S100{\beta}$, was $7.62\;{\ss}{\partial}/L$ (SD=${\pm}6.53$) in the expired patients, $1.15\;{\mu}g/L$ in the mildly disable patient, and $0.727\;{\mu}g/L$ (SD=${\pm}0.73$) in the recovered patients. These differences are statistically significant (p<0.001). Conclusion: In traumatic brain injury, a higher level of serum concentration of $S100{\beta}$, has a poor prognosis for neurologic outcome.

쇼크 환자에서 비침습적인 심박출량 측정

김오현,김현,이강현,황성오,최한주 대한응급의학회 2010 大韓應急醫學會誌 Vol.21 No.5

Purpose: Invasive determination of cardiac output (CO) is possible via a pulmonary artery catheter but catheter implantation has risks. Clinicians can assess CO safely using a non-invasive cardiac output device such as a commercially available doppler system (ultrasonic cardiac output monitor, USCOM, USCOM Ltd, Australia) or using impedance cardiography (ICG). The purpose of this study was to investigate the consistency of hemodynamic measurements between ICG and USCOM in shock patients. Methods: From June 2007 to October 2007, we prospectively evaluated 21 patients with shock, who visited our emergency center. We measured CO and systemic vascular resistance (SVR) using ICG and USCOM on arrival, and at 30, 60, 90, and 120 minutes. Results: The mean difference in CO between ICG and USCOM was 1.08±2.13 L/min. The percent limits of agreement (LOA) were -60.0 to 84.7% between ICG and USCOM. The correlation coefficient for CO between ICG and USCOM was 0.76 (p<0.01). CO values measured by ICG and USCOM were 4.3±1.7 vs 5.9±3.9 initially, 4.8±2.2 vs 6.0±3.9 at 30 min, 4.3±1.6 vs 5.1±2.9 at 60 min,4.2±1.6 vs 4.9±2.7 at 90 min, and 4.1±1.6 vs 5.0±2.9 at 120 min, respectively. Statistical significance was observed within each modalities (p=0.03) but we did not find statistical significances between the two modalities. SVR (dynes*sec/cm5) values were measured by ICG and USCOM on arrival, and at 30, 60, 90, and 120 minutes. No statistical significance was seen within and between study groups. Conclusion: ICG and USCOM do not show clinically acceptable agreement.

한국의 예방 가능 외상 사망률과 외상 처치 체계의 변화

김현,정구영,김선표,김선휴,노현,장혜영,윤한덕,허윤정,류현호,정태오,황용,주정민,주명돈,한상균,조광원,최기훈,박준민,정현민,이수복,경연영,유지영,전우찬,안지윤,이장영,지호진,이태헌,김오현,차용성,차경철,이강현,황성오 대한응급의학회 2012 대한응급의학회지 Vol.23 No.2

Purpose: This study was performed in order to determine the changes over time in preventable and potentially preventable traumatic death rates, and to assess the factors that affected the deaths of trauma patients which occurred in Korean pre-hospital and hospital settings. Methods: All trauma deaths occurring either in the emergency department (ED) or after admission at twenty Korean hospitals between August 2009 and July 2010 were retrospectively analyzed. The deaths were initially reviewed by a team of multidisciplinary specialists and classified into nonpreventable,potentially preventable, and preventable deaths. Only preventable and potentially preventable deaths were the subject of our analysis. Structured data extraction included patient demographics, vital signs, injury severity, probability of survival, preventability of mortality,reported errors in the evaluation and management of the patient, and classification of error types (system, judgment,knowledge). Results: During the study period, 446 trauma victims died in the ED or within 7 days after admission. The mean age was 52 years, 74.1% were men and the mean time from injury to death was 35.6 hours. The most common cause of death was head injury (44.7%) followed by hemorrhage (30.8%) and multi-organ failure (8.0%). The rates of preventable/potentially preventable deaths were 35.2% overall and 29.8% when limited to patients surviving to admission. Of all death classifications, 31.2% were potentially preventable and 4.0% were preventable. Errors leading to preventable death occurred in the emergency department (51.2%), pre-hospital setting (30.3%) and during inter-hospital transfer (60.8%). Most errors were related to clinical management (48.4%) and structural problems in the emergency medical system (36.5%). Conclusion: The preventable death rates for Korean trauma victims were higher than those found in other developed countries, possibly due to poorly established emergency medical systems for trauma victims in pre-hospital and hospital settings. A system wide approach based on the emergency medical system and well-developed in-hospital trauma teams should be adopted in order to improve the quality of care of trauma victims in Korea.

외상성 뇌손상 환자에 있어서 S100β의 혈중 농도와 뇌손상의 정도 및 예후의 관계

김오현 ( Oh Hyun Kim ),이강현 ( Kang Hyun Lee ),윤갑준 ( Kap Jun Yoon ),박경혜 ( Kyung Hye Park ),장용수 ( Yong Su Jang ),김현 ( Hyun Kim ),황성오 ( Sung Oh Hwang ) 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.2

Purpose: S100β, a marker of traumatic brain injury (TBI), has been increasingly focused upon during recent years. S100β, is easily measured not only in cerebrospinal fluid (CSF) but also in serum. After TBI, serum S100β, has been found to be increased at an early stage. The purpose of this study was to evaluate the clinical correlations between serum S100β, and neurologic outcome, and severity in traumatic brain injury. Methods: From August 2006 to October 2006, we made a protocol and studied prospectively 42 patients who visited the emergency room with TBI. Venous blood samples for S100β, protein were taken within six hours after TBI and vital signs, as well as the Glasgow Coma Scale (GCS), were recorded. The final diagnosis and the severity were evaluated using the Abbreviated Injury Score (AIS), and the prognosis of the patients was evaluated using the Glasgow Outcome Score (GOS). Results: Thirty-eight patients showed a favorable prognosis (discharge, recovery, transfer), and four showed an unfavorable prognosis. Serum S100β, was higher in patients with an unfavorable prognosis than in patients with a favorable prognosis, and a significant difference existed between the two groups (0.74±1.50 μg/L vs 7.62±6.53 μg/L P=0.002). A negative correlation existed between serum S100β, and the Revised Traumatic Score (R2=-0.34, P=0.03), and a positive correlation existed between serum S100β, and the Injury Severity Score (R2=0.33, P=0.03). Furthermore, the correlations between serum S100β, and the initial GCS and the GCS 24 hours after admission to the ER were negative (R2=-0.62, P<0.001; R2=-0.47, P=0.005). Regarding the GOS, the mean serum concentration of S100β, was 7.62 ß∂/L (SD=±6.53) in the expired patients, 1.15 μg/L in the mildly disable patient, and 0.727 μg/L (SD=±0.73) in the recovered patients. These differences are statistically significant (p<0.001). Conclusion: In traumatic brain injury, a higher level of serum concentration of S100β, has a poor prognosis for neurologic outcome. (J Korean Soc Traumatol 2007;20:138-143)

Trends of Lipase and General Features in Organophosphates Induced Acute Pancreatitis

조남협,김현,정우진,김용원,김태훈,김오현,차경철,이강현,황성오,차용성 대한응급의학회 2014 대한응급의학회지 Vol.25 No.3

Purpose: There have been few case reports and studieson acute pancreatitis associated with organophosphate(OP) poisoning. We investigated prevalence, general characteristics,trends of lipase levels, and findings of computedtomography (CT) in acute pancreatitis associated with OPpoisoning. Methods: A retrospective review was conducted of 84 consecutivecases of organophosphate insecticide poisoningthat were diagnosed and treated at the EmergencyDepartment of the Wonju Severance Christian Hospitalfrom January 2008 to April 2012. Results: Acute pancreatitis was seen in 14 patients(16.7%). In pancreatitis patients, diagnosis was made at EDpresentation in eight patients (57.1%) and after hospital day(HD) #2 in six patients (42.9%). In the subgroup of patientswith an elevated lipase level, after OP poisoning time ofpeak lipase level and time to normalization were 3.6 (IQR2.2-5.6) h and 50.6 (IQR 26.7-86.1) h, respectively. CTswere all grade A according to Balthazar classification. Significant differences were observed between the pancreatitisvs. non-pancreatitis groups in terms of ingestedamounts [300 (IQR 125-450) mL vs. 100 (IQR 30-200) mL,p=0.007], pH [7.26 (IQR 7.11-7.36) vs. 7.35 (IQR 7.27-7.40), p=0.048], and serum lactate [5.85 (IQR 3.53-9.53)mmol/L vs. 3.39 (IQR 2.31-5.99) mmol/L, p=0.037], respectively. No statistical differences in terms of respiratory failurerequiring ventilator care, shock, pneumonia, and AKI wereobserved between the pancreatitis vs. non-pancreatitisgroups. No statistical differences in terms of total admissionlength, ICU admission length, and mortality were observedbetween the pancreatitis vs. non-pancreatitis groups. Conclusion: The prevalence of acute pancreatitis in OPpoisoning was 16.7%. After OP poisoning time of peaklipase level and time to normalization were 3.6 (IQR 2.2-5.6)h and 50.6 (IQR 26.7-86.1) h, respectively. In the acute pancreatitisgroup, ingested amounts, serum lactate were higherand serum pH was less than in the non-pancreatitis group.

응급의료전용 헬기 탑승자 교육프로그램 개발 및 효과

이정일,이강현,차경철,차용성,김오현,김현,황성오 대한응급의학회 2013 대한응급의학회지 Vol.24 No.4

Purpose: The Ministry of Health and Welfare of korea started operating the Helicopter Emergency Medical Service (HEMS) System in 2011 to improve emergency medical services given by physicians aboard helicopters. The purpose of this study was to evaluate the HEMS education program for its effectiveness and satisfaction from trainees. Methods: A survey of trainees was conducted at the very end of training and education. Trainees for a HEMS crew surveyed included doctors (8), nurses (4), emergency medical technicians (12), pilots (10), flight dispatchers (4) and an administrator (1). The study period was from August 8,2011 to August 12, 2011. The amount of HEMS education was 16 hours, including 8 hours of theoretical education, 5hours of simulation and 3 hours of table-top simulation. Results: In an analysis of programs according to trainee satisfaction, the theoretical training program received an average of 4.2±0.7 points and; the practical and simulation training program received; 4.4±0.8 points. The simulated practical training program thus received a higher score than theoretical education, but the difference was insignificant (p=0.834). Conclusion: For the HEMS training programs, the practical and simulation training satisfaction score were higher than the theoretical program. A focus on simulation programs for HEMS could therefore serve as a goal of the HEMS education program.

“강하고 빠르게 압박하세요”의 청각신호 기능이 있는 자동제세동기를 이용한 가슴압박 독려가 일반인 심폐소생술의 질에 미치는 영향

윤정민,황성오,차용성,김오현,김태훈,정우진,김용원,고진,김현,이강현,차경철 대한응급의학회 2014 대한응급의학회지 Vol.25 No.4

Purpose: We conducted this study in order to evaluate thequestion of whether a simple voice prompt, “push hard andfast”, could improve the quality of chest compression performedby lay people. Methods: Non-medical college students with no experienceof cardiopulmonary resuscitation (CPR) education participatedin this study. They were randomly divided into two groupsmetronomeprompt automated external defibrillator (AED)(M) group and metronome with intermittent “push hard andfast” voice prompt AED (V) group and performed two cyclesof chest compression-only CPR. “Push hard and fast” voicewas prompted every 10 seconds. The rate of metronomewas fixed to 100/min in two groups. We measured compressiondepth, compression rate, and total compression frequencyusing ResusciAnne SkillReporterTM (Laerdal, Korea). Results: A total of 208 volunteers were enrolled. There were120 (57.7%) females, and mean age was 21±2 years old. The compression depth was deeper in the V group (40.0±12 mm) than in the M group (35.9±13 mm) (p=0.02). Themean rate of chest compression was faster in the V group(98±20 cpm) than in the M group (88±31 cpm) (p=0.07)(*cpm: compressions per minute). Total frequency of chestcompression during 2-cycle CPR was also higher in the Vgroup (392±80) than in the M group (341±117) (p<0.001). Conclusion: A simple voice prompt, “push hard and fast”,can improve the quality of chest compression performed byuntrained lay people.

Adverse Cardiovascular Events after a Venomous Snakebite in Korea

차용성,김오현,이준우,김형일,차경철,김현,이강현,황성오 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.2

Purpose: Although cardiac involvement is an infrequently recognized manifestation of venomous snakebites, little is known of the adverse cardiovascular events (ACVEs) arising as a result of snakebite in Korea. Accordingly, we studied the prevalence of ACVEs associated with venomous snakebites in Korea and compared the clinical features of patients with and without ACVEs. Materials and Methods: A retrospective review was conducted on 65 consecutive venomous snakebite cases diagnosed and treated at the emergency department of Wonju Severance Christian Hospital between May 2011 and October 2014. ACVEs were defined as the occurrence of at least one of the following: 1) myocardial injury, 2) shock, 3) ventricular dysrhythmia, or 4) cardiac arrest. Results: Nine (13.8%) of the 65 patients had ACVEs; myocardial injury (9 patients, 13.8%) included high sensitivity troponin I (hs-TnI) elevation (7 patients, 10.8%) or electrocardiogram (ECG) determined ischemic change (2 patients, 3.1%), and shock (2 patient, 3.1%). Neither ventricular dysrhythmia nor cardiac arrest was observed. The median of elevated hs-TnI levels observed in the presentstudy were 0.063 ng/mL (maximum: 3.000 ng/mL) and there was no mortality in the ACVEs group. Underlying cardiac diseases were more common in the ACVEs group than in the non-ACVEs group (p=0.017). Regarding complications during hospitalization, 3 patients (5.4%) in the non-ACVEs group and 3 patients (33.3%) in the ACVEs group developed bleeding (p=0.031). Conclusion: Significant proportion of the patients with venomous snakebite is associated with occurrence of ACVEs. Patients with ACVEs had more underlying cardiac disease and bleeding complication.

심폐소생술 후 생존 퇴원한 환자들의 중장기 예후 평가와 신경학적, 정신적, 사회적 결손의 종류

정우진,김현,차용성,김오현,김태훈,김용원,차경철,이강현,황성오 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.4

Purpose: Anoxic neurologic deficits are an important cause of morbidity and mortality in post-cardiac arrest patients. Cardiopulmonary resuscitation (CPR), a series of life-saving actions, improve the chance of survival following cardiac arrest; however, there are few reports on neuropsychiatric function in patients successfully resuscitated after cardiac arrest. We conducted this study to evaluate the long-term neurologic, psychiatric, and social deficits in post-cardiac arrest patients. Methods: We reviewed medical records from eight university hospitals from January 2009 to December 2009. Patients,older than 14 years old, successfully resuscitated after cardiac arrest and with a cerebral performance category scale (CPC) 1 or 2 were enrolled. Among 56 included patients,the mean age was 57 years old and 37 patients were male. Forty-two cases were presumed to have cardiac etiology and 14 were considered to have a non-cardiac etiology. The initially recorded rhythms, in 50% of patients, were ventricular fibrillation and pulse-less ventricular tachycardia. The mean length of a hospital stay was 30 days. Results: At hospital discharge, 51 patients (91.1%) with successful resuscitation showed CPC 1 and 5 patients (8.9%) showed CPC 2. Twenty-four (42.9%) patients suffered from a variety of neuro-psychosocial deficits, such as memory disturbances, attention deficits, post-traumatic stress disorder, and difficulty initiating exercise. Conclusion: Despite successful resuscitation, a considerable number of patients complained of various neuro-psychiatric deficits. The most common neuro-psychosocial deficits were disturbances in short-term memory.

Usefulness of delta neutrophil index for early prediction of overt disseminated intravascular coagulopathy in patients with venomous snakebite

차용성,이강현,이석정,권호철,이종욱,김형일,김오현,차경철,김현,황성오 대한응급의학회 2018 Clinical and Experimental Emergency Medicine Vol.5 No.2

Objective Clinically, consumptive coagulopathy, such as disseminated intravascular coagulopathy (DIC), is the most important among the common venomous snakebite complications owing to the serious hemorrhage risk associated with this condition. We evaluated the predictive value of the delta neutrophil index (DNI)—a new indicator for immature granulocytes—for DIC diagnosis. Methods This retrospective observational study consecutively assessed adult patients with venomous snakebites for over 51 months. Patients were categorized into the no DIC and DIC groups. DNI values were measured within 24 hours after snakebite. Results Thirty patients (26.3%) developed DIC. The DIC group had significantly higher median initial DNI than the no DIC group (0% vs. 0.2%, P<0.001). When the DIC group was divided into early and late groups (within and over 24 hours after snakebite, respectively), the DNI of the former was significantly higher than that of the latter and no DIC group. The late DIC group had significantly higher DNI than the no DIC group. Furthermore, DNI positively correlated with the DIC score (r=0.548, P<0.001). The initial DNI (odds ratio, 4.449; 95% confidence interval, 1.738 to 11.388; P=0.002) was an early DIC predictor. The area under the curve based on the initial DNI’s receiver operating characteristic curve was 0.724. Conclusion DNI values were significantly higher in the DIC group. Additionally, DNI was an early predictor of DIC development in patients with venomous snakebites in the emergency department.