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손목 관절과 발목 관절 손상 환자의 진단에 있어 응급 초음파의 유용성
이성실 ( Sung Sil Lee ),김동언 ( Dong Un Kim ),박득현 ( Deuk Hyun Park ),조현영 ( Hyun Young Cho ),안성준 ( Seung Jun Ahn ),고찬영 ( Chan Young Kho ),신태용 ( Tae Yong Shin ),김영식 ( Young Sik Kim ),하영록 ( Young Rock Ha ) 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.2
Purpose: Ultrasound is of proven accuracy in abdominal and thoracic trauma and may be useful for diagnosing extremity injury in situations where radiography is not available, such as disasters and military and space applications. However, the diagnosis of fractures is suggested by history and physical examination and is typically confirmed with radiography. As a alternative to radiography, we prospectively evaluated the utility of extremity ultrasound performed by trained residents of emergency medicine (EM) one patient with wrist and ankle extremity injuries. Methods: Initially, residents of EM performed physical examinations for fractures. The emergency ultrasound (EM US) was performed by trained residents, who used a portable ultrasound device with a 10- to 5-MHz linear transducer, on suspected patients before radiography examination. The results of emergency ultrasound and radiography and the final diagnosis were recorded, and correlations among them were determined by using Kappa`s test. Results: Thirty-nine patients were enrolled in our study. The average age was 36.6±19.3 years. There were radius Fx. (n=21), radius-ulna Fx. (n=1), ulna Fx. (n=1), and contusion (n=2) injuries among the wrist injury and lat.-med. malleolar Fx. (n=13), lat. malleolar Fx. (n=6), and med. malleolar Fx. (n=3) injuries among the ankle injury. Comparing EM US with radiography, we found the sensitivity, specificity, positive predictive value, and negative predictive value of EM US for Fx. diagnosis to be 100%, 66.7%, 97.3%, 100% and those of radiography to be 97.2%, 100%, 100%, and 75%, respectively. Kappa`s test for a correlation between the Fx. diagnosis of EM US and the final diagnosis of Fx was performed, and Kappa`s value was 0.787 (P = 0.004). Conclusion: EM US for Fx. can be performed quickly and accurately by EM residents with excellent accuracy in remote locations such as disaster areas and in military and aerospace applications. EM US was as useful as radiography in our study and had a high correlation to the final diagnosis of Fx. Therefore, ultrasound should performed on patients with extremity injury to determine whether extremity evaluation should be added to the FAST (focused abdominal sonography trauma) examination. (J Korean Soc Traumatol 2007;20:130-137)
응급센터에 내원한 외상환자에서 간과된 골절의 요인 분석
박득현 ( Deuk Hyun Park ),이성실 ( Sung Sil Lee ),김동언 ( Dong Un Kim ),조현영 ( Hyun Young Cho ),이영근 ( Young Geun Lee ),김준수 ( Jun Su Kim ),전진 ( Jin Jun ),김영식 ( Young Sik Kim ),하영록 ( Young Rock Ha ),신태용 ( Tae Yo 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.1
Purpose: A missed fracture is a very common occurrence in the Emergency Department (ED) and can have serious results because of delays in treatment, resulting in long-term disability. It is also one of the most common causes leading to medical legal issues. We analyzed the causes of missed fractures by using a bone scan which is known to be an effective tool for diagnosing bony lesions. Methods: We reviewed the medical records of trauma patients who underwent a bone scan after being discharged the ED from September 2006 to March 2008. Cases of missed fractures were identified by using electronic medical records to review each diagnosis. Definition of missed fracture was read after bone scan by radiologist. We decided that there was no fracture if we read `trauma-related lesion` or `cannot rule out fracture` on a bone scan read by a radiologist. Enrolled patients were analyzed by age, sex, time until bone scan and Injury Severity Score (ISS). Patients were divided into two groups, alert mentality and not-alert mentality, so there were split between a diagnosis group and a missed fracture group. ISS was also used in determining the severity of the patient`s injury upon discharge from the ED. Results: A total of 532 patients were enrolled in this study. Of those, 487 patients were in the diagnosis group, and 45 patients (8.4%) were discovered to have had a fracture. Of the 45 missed fracture patients, 34 patients (6.4%) had one-site fractures, 8 patients (1.5%) had two-site fractures, and 3 patients (0.6%) had threesite fractures. The most commonly missed fracture was multiple rib fractures (18 patients, 30.5%), followed by lumbosacral (LS) spine fractures (10 patients, 16.9%), thoracic spine fractures (8 patients, 13.6%), and clavicle fractures (6 patients, 10.2%). Mean age was 50.12±18.54 years in the diagnosis group and 57.38±16.88 years in the missed fracture group. For the diagnosis group, the mean ISS was 9.03±8.26, but in the missed fracture group it was17.53±9.69. Missed fractures were much more frequent in the not-alert mentality (p<0.01) and in the high ISS (ISS≥16) group (p<0.01). Conclusion: Missed fractures occur most frequent in patients of old age, not-alert mentality, and high ISS. Multiple rib and spine fractures were found to be the most frequent missed fractures, regardless of trauma severity. This study also shows a high possibility of clavicle and scapula fractures in patients with severe trauma. (J Korean Soc Traumatol 2009;22:37-43)
최욱진,하영록,오제혁,조영순,Won Woong Lee,손유동,조규종,Chan-Young Koh,도한호,정원준,Seung Mok Ryoo,Jae Hyun Kwon,Hyung Min Kim,Su-Jin Kim,Chan Yong Park,이진희,Jae Hoon Lee,Dong Hyun Lee,SIN-YOUL PARK,Bo Seung Kang 대한의학회 2020 Journal of Korean medical science Vol.35 No.7
Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.
실습선 가야호의 멀미도 조사와 MSI 계산의 비교 분석에 관한 연구
한승재,하영록,김인철,Han, Seung-Jae,Ha, Young-Rok,Kim, In-Chul 해양환경안전학회 2014 해양환경안전학회지 Vol.20 No.4
본 연구에서는 선박의 우수한 운항 성능과 쾌적한 승선감의 확보를 위해, 부경대학교 실습선인 가야호를 대상으로 해상상태, 선수각 조건, 선속, 그리고 선내 위치별로 수행된 뱃멀미 발현에 관한 5차에 걸친 설문조사 결과와 선체운동해석법(Strip Method)에 기초한 수치계산을 통해서 얻은 계산결과를 비교, 분석하였다. 이를 통해 많은 수의 학생이 승선하는 실습선의 거주구역 배치에 대한 타당성 검증과 함께 항해 중 멀미도를 낮출 수 있는 침로와 선속의 결정에 도움이 될 것이다. 본 연구에 의하면 해상상태가 거칠수록 전체 멀미비율이 높게 나타났으며, 선내 위치별로는 선체의 중량중심에서 멀리 떨어져 있는 선교와 거주구역에서 수직가속도의 가중치가 높았고 멀미비율도 높게 나타났다. 그리고 선수파에 비해 횡요시 수직가속도의 가중치가 높게 나타났다. 멀미도 조사와 MSI 계산의 비교에서는 운동 수직가속도가 증가하면, 상대적으로 멀미도도 증가하고, 수직가속도가 증가하는 구역과 멀미도 발생구역이 일치하였다. In this paper, for better boarding performance and pleasant boarding sensitivity of the ship, comparison and analysis was performed of motion sickness questionnaire with MSI(Motion Sickness Incidence) calculation based on ship motion theory(Strip Method) due to sea condition, incident angle in main sail way, economic speed, and calculation position of the training ship Kaya of Pukyong National University. On theses works, the rougher sea conditions became, the higher total motion sickness rate was occurred. The weights of vertical acceleration and the rates of MSI were higher at the bridge and the accommodation, which were located farther from the center of gravity of the ship. And effects of the vertical acceleration of the ship were increased in rolling then in head sea. In comparison between motion sickness questionnaire with MSI calculation, when the vertical acceleration increased, the motion sickness rate increased. The location to increase vertical acceleration and the location to cause motion sickness were agreed.
실습선 가야호의 선속 변화에 따른 뱃멀미 지수에 관한 연구
한승재,하영록,이승철,이창우,김인철,Han, Seung-Jae,Ha, Young-Rok,Lee, Seung-Chul,Lee, Chang-Woo,Kim, In-Chul 해양환경안전학회 2014 해양환경안전학회지 Vol.20 No.2
본 연구에서는 실습선 가야호를 대상으로 하여 파랑 중 운동성능을 평가하였다. 그리고 쾌적한 승선감을 확보하기 위하여 실제 해상에서 운항중인 선박의 선내 위치별 수직가속도 성분을 선체운동 계산 기법을 통해서 구하고, 수직가속도 스펙트럼을 이용하여 가야호의 선속변화에 따른 가속도 계산 결과를 뱃멀미 지수(MSI; Motion Sickness Incidence)의 가이드라인과 비교 검토하여 멀미의 정도를 표시하였다. MSI 계산 결과는 선속이 5 knots, 10 knots, 12 knots로 커지는 순서대로 수직가속도의 가중치가 높게 나타나며, 입사각은 $180^{\circ}$와 $150^{\circ}$에 비해 선수사파인 $120^{\circ}$의 경우에 수직가속도의 가중치가 높게 나타났다. In this paper, the motion performance in waves for the training ship Kaya of Pukyong National University is obtained by using a computer program based on Strip method. To guarantee the pleasant seafaring in ocean, the vertical acceleration of ship motion is calculated according to the location of the ship. The results of calculation by changes of ship speed are compared with the guideline of MSI(Motion Sickness Incidence). The degree of motion sickness is shown and discussed through the comparison between calculated vertical acceleration spectrum and MSI guideline. The computational results of MSI were as follow; when ship speed increased in the order of 5 knots, 10 knots, 12 knots and encounter angle became the bow quartering sea of $120^{\circ}$ compared to $180^{\circ}$ and $150^{\circ}$, the vertical acceleration values grew higher.