의식저하로 내원한 에틸렌 글리콜 중독 환자 1례

민진홍,이장영,민문기,정성필,김승환,유인술,Min Jin Hong,Lee Jang Young,Min Moon Gi,Chung Sung Pil,Kim Seung Whan,Yoo In Sool 대한임상독성학회 2004 대한임상독성학회지 Vol.2 No.2

Ethylene glycol poisoning can cause profound morbidity and is almost universally fatal if untreated. Central nervous system depression, pulmonary edema, and acute oligulic renal failure with crystalluria are among the most commonly encountered complication of ingestion. Ingestion of ethylene glycol may be an important contributor in patients with metabolic acidosis and subsequent renal failure. The diagnosis of ethylene glycol poisoning is based on nonspecific clinical symptoms and signs and indirect and direct laboratory measurement of ethylene glycol. As a result, diagnosis and treatment sometimes can be delayed. We describe 52-year-old man who visited to emergency department with mental change of unknown origin. The patient has high anion gap metabolic acidosis and renal failure due to ingestion of antifreeze that contained ethylene glycol. We used hemodialysis for elimination technique. The patient was discharged with minimal complication.

의도적으로 철쭉 섭취 후 발생된 성인 전신 중독 증상 1례

정상민,이승한,임정수,윤상열,유승,이진웅,김승환,유인술,유연호,Jeong, Sang-Min,Lee, Seung-Han,Lim, Jeong-Soo,Yoon, Sang-Yeol,Ryu, Seung,Lee, Jin-Woong,Kim, Seung-Whan,Yoo, In-Sool,You, Yeon-Ho 대한임상독성학회 2009 대한임상독성학회지 Vol.7 No.2

It is well known that Rhododendron sclippenbashii contains the toxic material grayanotoxin. So, Koreans do not eat it, but they do eat azalea although it contains grayanotoxin. That is why there have been no reports about Rhododendron sclippenbashii intoxication after ingesting it intentionally, not accidentally. In this case, the patient was admitted to the emergency room with several toxic symptoms after intentionally consuming 50 blossoms of Rhododendron sclippenbashii to get rid of thirst. Treatment with saline infusion and atropine was successful and the outcome was favorable enough in this case to produce a complete cure without any sequelae at discharge. But toxic symptoms were seen for 24 hours, although the symptoms usually fade in 9 hours. Therefore, we should carefully treat and observe, for over 24 hours, the patient who intentionally ingests about 50 blossoms of Rhododendron sclippenbashii.

2개 대학병원 응급센터에 내원한 급성 불화수소산 노출 환자에 대한 임상적 경험

한규홍,양중일,조성욱,조용철,유승,이진웅,김승환,유인술,유연호,박정수,Han, Kyu-Hong,Yang, Jung-Il,Jo, Seung-Yook,Cho, Yong-Chul,Ryu, Seung,Lee, Jin-Woong,Kim, Seung-Whan,Yoo, In-Sool,You, Yeon-Ho,Park, Jung-Soo 대한임상독성학회 2009 대한임상독성학회지 Vol.7 No.2

Purpose: We investigated the clinical characteristics and demographics of patients who suffered from hydrofluoric acid chemical injury and the mechanism of damage. Methods: We retrospectively reviewed the medical records of patients who were exposed to hydrofluoric acid from March 2004 to March 2009 and who were seen at the emergency centers in two university teaching hospitals. Results: Forty four patients out of 47 patients suffered from chemical burn, while the injuries of the remaining 3 could not be identified by the medical records. A total of 17 hydrofluoric acid chemical injury patients were enrolled during the study period, and their mean age was $29.6{\pm}7.0$. All the patients were accidentally injured by contact with the material and none of them inhaled or ingested the material. Only 6 patients wore appropriate protective equipments and 5 underwent the water irrigation for more than 10 minutes. The most common exposure area was the hand and forearm (70.5%). Less than 1% of all of the patients had their total body surface (TBS) exposed to hydrofluoric acid (mean=0.35%). The mean time interval from calcium gluconate administration to pain relief was $33.6{\pm}8.8$ hours. Conclusion: When exposed to hydrofluoric acid, it is important to wear protective equipment and undergo water irrigation for more than 10 minutes. Pain and skin damage were observed in all the patients. After treatment, we concluded that administration of calcium gluconate and pain killers was successful in relieving pain, and the prognosis was also positive for the admitted and followed up patients when less than 1% of the TBS was exposed.

한 · 미 통상 관계의 성격과 전망 - 한 · 미FTA를 중심으로 -

정하용 한국외교협회 2018 외교 Vol.127 No.0

2018년 타결된 한 · 미FTA 재협상은 1980년대 이후 지속되어 온 미국의 일방주의적 통상 정책이 여전히 한 · 미 통상 관계를 규정하고 있다는 점을 잘 보여준 협상이다. 한 · 미FTA 재협상은 경제적 동인보다는 미국의 국내정치적 요구에 기인한 정치적 고려를 강하게 반영한 것으로 한 · 미FTA는 미국의 국내정치적 상황에 따라서 조정되거나 극단적으로는 폐기의 위협에 놓일 수도 있음을 시사하고 있다. 이러한 불확실성에도 불구하고 여전히 한 · 미FTA는 양국 간 갈등이 아닌 협력을 강화시킬 수 있는 기제로 발전될 수 있는 가능성을 내포하고 있고, 이는 통상의 상호 보완 구조를 통하여 강화될 수 있다. 한 · 미FTA로 대표되는 한 · 미통상관계가 양국 간의 협력을 강화시켜 줄 수 있는 제도로 작동하기 위해서는 한국의 입장에서는 통상 마찰에 대비한 기회 비용을 최소화하기 위한 교역 구조의 변화 노력이 반드시 이루어져야 한다. 통상 관계에서 발생하는 단절의 기회비용이 비대칭적으로 높은 구조에서는 한 · 미FTA는 경제 논리와는 무관한 정치적 관계에 의해 언제든지 재규정될 수 있는 취약한 협정이 될 수 있기 때문이다.

119 구급대원들의 활동실태와 업무만족도

권선숙,유인술 대한응급의학회 1998 대한응급의학회지 Vol.9 No.2

Background: It goes without saying for the importance of pre-hospital care in EMS system. At present 119 rescuers take charge of the majority for the pre-hospital care in Korea. But the present activity and job satisfaction of 119 rescuers is not studied. Method: The authors analyzed the questionnaire from the 98 rescuers had taken the lessons on emergency medical technician training program at the Central Fire Fighting School, Cheonan city. We used a Likert's five stage barometer for the analysis of job satisfaction. Result: On regional distribution of rescuers 29.6% was in metropolitan city and 70.4% was from each province. On sexual distribution male was 93%, average age was about 30 years old. The academic background was commonly below the high school graduation. Sixty-one of 98 rescuers(62.2%) was married. The monthly mean income is 1.07 million Won. There was a statistical difference of the monthly mean income between the age, sex, and the period of work(p<0.05). The average duration of job was 27 months. In most cases, the patients or relatives decided the evacuation hospital(89.8%). 67.0% of rescuers answered the necessity of emergency communication system during transport. The serious problems during transport were the lack of manpower, the knowledge of emergency care, the deficit of emergency equipment and telecommunication system. The priority of decision for evacuation hospital is the presence of special medical team, the severity of patient, the presence of modern hospital. The emergency equipment of ambulance was satisfactory in general. Almost all the rescuers(99.0%) want continuous education and 92.7% of them want at the emergency center or general hospital twice a year. The degree of job satisfaction was the job of special knowledge and skills, the professional work and self-assurance in order. Conclusion: 119 rescuers were gratified generally at the job satisfaction. But it was poor at work condition. The authors think that a government office and the korean society of Emergency Medicine must hard work for the improvement of work condition and the administration of continuous education.

대전시 응급의료체계 구축을 위한 의료자원의 실태조사

유인술 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2

Emergency Medical Services(EMS) system is definded as the systemized orgarnization is composed of all elements for the emergency medical care profer of good quality inside the established region. So EMS is the extension of emergency medical care into the community. The 15 elements of EMS system as follows:(1)manpower, (2)training, (3)communications, (4)transportation, (5)facilities, (6)critical care units, (7)public safety agents, (8)consumer participation, (9)access to care, (10)transfer of care, (11)standarization of patients records, (12)public information and education, (13)independent review and evaluation, (14)disaster linkage, and (15)mutual aid agreements. An EMS system may be developed to address the emergency medical needs of a small community, a metropolis, a large geographical region, of a nation. The majority of systems are focused on the local of regional level. Most organizer of EMS do not have the luxury of developing completely new systems, so they have to work with pre-existing components, such as hospitals and ambulance, that are already providing services. Therefor, the construction of EMS system in Taejeon city is accomplished with a similar method. Taejeon city is accomplished with a similar method. Taejon city is central area of Korea geographically. In the size of a city the greatest city next to Seoul, but it has the most small population among the 6 large city of Korea. On the present condition of emergency medical resources in Taejeon city the problem points are a deficit of prehospital care persons and training, the regional disproportion of general hospital and the disproportion of emergency hospital grade. Therefor, the pertinet harmony of this resources is required.

응급의료체계를 통하여 내원한 응급실 환자에 대한 분석

유인술,박재황 圓光大學校 醫科學硏究所 1993 圓光醫科學 Vol.9 No.1-2

At July, ist, 1991, the EMS system was established in Korea. We performed (A) a review of 406 patients who visited to ER of WonKwang University Hospital through the EMS system for two years from July, 1990 to June, 1992 and (B) a statistical analysis of 400 population’s replies to a questionnaire about the 129 Emergency Medical Service system. The results were obtained as follows ; A. 1) Among the total 406 patients, male were 267(65.8%) and female were 139(34.2%). The peak age was 4th decade. 2) The underlying medical disease was the major cause of the transport ; 227 cases(55.9%). The most prevalent delivery time was between 10 and 20 min. ; 263 cases(52.4%). The major transport time was between 8 : 00 PM and 4 : 00 AM ; ’93 cases(47.5%). 3) Among the transported patients, admission cases were 90(22.2%), discharge against advice ; 37(9.1%), hopeless discharge ; 18(4.4%), DOA ; 13(3.2%), DAA ; 13(32%), transfer ; 13(32%) B. 1) 82 cases(82.0%) of the total 100 patients were transported by public and private vehicles. 2) 135 persons(38.8%) of 400 population knew the 129 EMS system, and 72(19.0%) knew to use this system. 3) 80 persons(26.7%) of the total 300 non-medical populations had an experience of education about the emergency first aid.

응급센터로 내원한 박리성 대동맥류 환자의 조기진단을 위한 임상적 고찰

박재황,유인술 대한응급의학회 1994 대한응급의학회지 Vol.5 No.2

Dissecting aneurysm of the aorta is one of the most lethal of all intrathoracic diseases. but it is in difficulty for prediction of prognosis and has many sudden death cases. A chief complaint is the chest pain. Therefore, it has a necessity of differential diagnosis with other diseases on acute development of chest pain. So, the authors are to find the usefulness for screening test of dissecting aneurysm through the comparison of mediastinal width by the measurement of mediastinal widening on chest X-ray films between 200 adults of normal person and aneurysmal patients. The study materials are 34 adult patients of thoracic aorta aneurysm visit through the WonKwang university hospital emergency department during Jan. 1985 to Oct. 1994. The definition of mediastinal width is most widened distance at aortic knob and MT (MediastinoThoracic) ratio is a ratio of mediastinal width to chest width. In this study guidelines for abnormal mediastinal widening include a mediastinal width greater than 8.8cm in the erect posteroanterior film., greater than 10.3cm in the supine anterioposterior chest film at the aortic knob or a MT ratio greater than 0.32 in the erect P-A, greater than 0.37 in the supine A-P film on 95% confidence interval. The result indicate that chest X-ray has the valuable usefulness for screening test of dissecting anerysm.

응급센터 행려환자의 실태와 처리에 관한 연구

유인술,이석우 대한응급의학회 2002 대한응급의학회지 Vol.13 No.2

Purpose: Homeless patients receive little or no social and medical concern because of their low economic status and the absence of responsible family, and no epidemiological reports have been performed on homeless patients so far. To establish medical politics for public welfare, We analyzed the homeless patients visiting our emergency department(ED). Methods: A prospective descriptive study was accomplished for 215 homeless patients admitted at Chungnam national University Hospital's emergency department from July 1998 to June 2000. We investigated them in terms of age, sex, length of stay, diagnosis, level of consciousness, payment, sobriety, and admission. Results: A total 215 patients were enrolled (males:190, 88%). The fifth decade, 74 patients, was the largest age group (34.4%), followed by the sixth decades, 58 patients (27.0%). The largest groups for length of stay and final diagnosis were 101 for stays from 7 to 24 hours (47.0%) and 80 for alcoholism (37.2%). Fifth and sixth alcoholism patients were 55 of 80 (68.8%). Drunken patients were 132 of the total (61.4%). Alcoholism seemed to be the main cause of unconsciousness on ED admission as 67 of the 80 alcoholism patients were unconscious. No medical payment could be taken from the emergency medical fund. The local public welfare department accepted responsibility for payment from the local budget. Conclusion: Most homeless patients were in their fifth and sixth decades and had Problems with alcohol and medical payment. That is why they could not get the appropriate medical service. Further social and medical concerns are warranted for their health, and more investigations should be performed from a medical point of view, not a social-welfare one.

심정지 환자의 심폐소생술에서 대량의 에피네프린 사용효과

유인술,박재황 圓光大學校 醫科學硏究所 1994 圓光醫科學 Vol.10 No.1-2

To compare the return of spontaneous circulation(RSC) rates in cardiac arrest treated with standard doses of epinephrine(SDE) or high dose epinephrine(HDE), the author analyzed prospectively 56 adult victims of nontraumatic cardiac arrest visited the Wonkwang University Hospital emergency department from July, 1991 to December, 1993. At the discretion of the treating physician, patients received epinephrine in bolus doses ranging from 1 to 15㎎. HDE was defined as a dose of at least 0.15 ㎎/㎏ : smaller doses were defined as SDE. the patients were grouped as +RSC if they developed a sustained spontaneous palpable pulse or blood pressure and as -RSC if they did not develop a pulse or blood pressure. Patients were also grouped by their presenting rhythm. Potentially perfusing rhythm was electromechanical dissociation or ventricular tachycardia. Nonperfusing rhythm was asystole or ventricular fibrillation. Rates were analyzed using the Chi-square test and the two tailed unpaired t-test(p = 0.185). The effects were greatest in patients with nonperfusing rhythms(p = 0.119). One patient survived to hospital discharge. This study shows that high-dose epinephrine improves initial resuscitation rates in cardiac arrest. Its greatest effect is in patients with a nonperfusing rhythm.