병원전 심정지환자의 심폐소생술 결과

황성오 ( Sung Oh Hwang ),안무업 ( Moo Eob Ahn ),김영식 ( Young Sik Kim ),임경수 ( Kyung Soo Lim ),윤정한 ( Jung Han Yun ),최경훈 ( Kyung Hoon Choe ) 대한응급의학회 1992 대한응급의학회지 Vol.3 No.1

Background: In Korea, the victims with prehospital cardiac arrest have little chance to survive, because bystanders do not know how they resuscitate the victims and emergency medical system is incomplete. And there has been no report about resuscitation attempt and survival rate of the prehospital cardiac arrest in Korea. Study Objectives : This study was undertaken to determine the overall survival rate and the factors influencing to survival when cardiopulmonary resuscitation was attempted to the victims of prehospital cardiac arrest. Study Subjects . We studied prospectively 31 consecutive victims with prehospital cardiac arrest. Results . Cardiac arrest were caused by trauma(52 %), cardiac diseases(26%) and non-cardiac medical diseases(22%). Spontaneous circulation was restored (ROSC) in 12 victims(39 %). And patient with non-traumatic cardiac arrest were more likely to restore spontaneous circulation(73%) than were patients with traumatic cardiac arrest(0.7%, P<0.05). Patients having ventricular fibrillation on ECG monitoring were more likely to restore spontaneous circulation(64.3% ) than were other patients(13%, P<0.05). Mean circulatory arrest time was 19.1+-9.9 minutes and it was shorter in patients with ROSC(13.8+-5.3) than patients without ROSC(22.4+-10.7, P<0.05). Cutting point between two group was 19 minutes. Among 12 patients who restored spontaneous circulation, 6 patients had only transient ROSC, 5 patients died from brain death(two moribund discharge was included) and only 1 patient discharged alive without neurologic complication.Conclusion . Under the current setting of emergency medical system in Korea, our data revealed improved rate of ROSC in victims of prehospital cardiac arrest, when circulatory arrest time was short(<19 minutes) and ECG rhythm on hospital arrival was ventricular fibrillation from non-traumatic causes. And considering the feasibility to survive, cardiopulmonary resuscitation should be attempted to the victims with prehospital cardiac arrest.

위암환자의 위배출시간에 관한 연구

황성오(Sung Oh Hwang),이상주(Sang Joo Lee),이상인(Sang In Lee),박인서(In Suh Park),최홍재(Heung Jai Choi),박창윤(Chang Yun Park) 대한내과학회 1990 대한내과학회지 Vol.39 No.2

N/A Gastric emptying in patients with stomach cancer can be influenced by several factors, such as location, size, depth of invasion, and gross morphology. In order to identify the change of gastric emptying in patients with stomach cancer, a gastric emptying scan using solid test meal (99mTc-DTPA labeled scrambled egg: was performed on 12 healthy subjcts and 44 patients with stomach cancer. The results were as follows: 1) The mean of gastric emptying times (GET, T1/2) in the control group was 35.8±12.1 (Mean±S.D) minutes, and the gastric emptying rate (GER) at 60 minutes after ingestion of test meal was 75.1%. 2) In the stomach cancer group, the mean of GET was delayed (56.7±37.4 minutes) compared with that of the control group, although insignificant statistically, and the GER at 60 minutes was reduced (57.8%) more than in the control group. 3) In patients with a tumor located distally, invaded beyond the muscle layer (T2-T4 group) or larger than 5 cm in diameter, the mean of GET was delayed, and the GER at 60 minutes was reduced more than in the control group(p<0.05). 4) In patients with tumor of Borrmann's type II, type III, and type IV, the mean of GET was delayed, and the GER at 60 minutes was reduced more than in the contro1 group (p<0.05). In conclusion, gastric emptying of solid meal in patients with stomach cancer was delayed in cases with a tumor located distally. invaded beyond the muscle layer, or involved extensively.

외상에 의한 병원전 및 응급실 사망 환자의 10년 전후의 비교

오성범 ( Sung Bum Oh ),이강현 ( Kang Hyun Lee ),차경철 ( Kyung Chul Cha ),지호진 ( Ho Jin Ji ),김호중 ( Ho Jung Kim ),김현 ( Hyun Kim ),황성오 ( Sung Oh Hwang ),배금석 ( Keum Suk Bae ),김헌주 ( Hun Joo Kim ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2

Background: Trauma-induced deaths can be prevented by implementation of trauma system during prehospital phases and in-hospital phases. To reduce the preventable death rate (PDR), it is essential to improve the treatment strategy during the prehospital phases and the in-hospital phases. This study was designed to compares the prehospital death and emergency department (ED) death in a city before and after implementation of trauma system. Method: We evaluated the prehospital and ED data of 106 trauma patients who had died in 1991 and 2001. Trauma deaths were reviewed and the preventability of those deaths was judged by three professional panels according to appropriateness of diagnosis and treatment in prehospital phases and in-hospital phases. Deaths were classified as preventable and nonpreventable. We compared the preventable death of 1991 with those of 2001. Result: Trauma patients were 993 in 1991 and 3,094 in 2001. Trauma-induced deaths were 60 in 1991 and 46 in 2001. The death rate decreased from 6% in 1991 to 1.5% in 2001 (p<0.001). Death rate by traffic accident decreased from 90% (54/60) in 1991 to 67% (31/46) in 2001 (p<0.001). The PDR decreased from 40% (24/60) in 1991 to 13% (6/46) in 2001 (p<0.001). The time elapsed from the scene of accident to ED arrival decreased from 111 minutes in 1991 to 53 minutes in 2001 (p<0.001). There was no significant difference in Injury Severity Score between 1991 and 2001 (p=0.283). Conclusion: The rate of preventable death decreased from 1991 to 2001. Implementation and improvement of the trauma system has positive effects on trauma-induced death rate, PDR and the time elapsed from the scene of accident to ED arrival.

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)

스키와 스노보드 사고에서 두부손상의 특징

강성찬 ( Sung Chan Kang ),이강현 ( Kang Hyun Lee ),최한주 ( Han Joo Choi ),박경혜 ( Kyung Hye Park ),김상철 ( Sang Chul Kim ),김현 ( Hyun Kim ),황성오 ( Sung Oh Hwang ) 대한외상학회 2008 大韓外傷學會誌 Vol.21 No.1

Purpose: Skiing and snowboarding are becoming increasingly popular. Accordingly, the incidences of injuries among skiers and snowboarders are also increasing. The purpose of this study was to investigate the injury patterns of and the contributing factors to head injuries of skiers and snowboarders and to evaluate the differences in characteristics between skiing and snowboarding head injuries. Methods: One-hundred patients who visited the emergency department of Wonju Christian Hospital between January 2005 and March 2007 due to head injuries from skiing and snowboarding were enrolled. The mechanisms and the histories of the injuries were investigated by surveying the patients, and the degrees of head injuries were estimated by using brain CT and the Glasgow Coma Scale. The degrees and the characteristics of brain injuries were also analyzed and compared between skiers and snowboarders. Results: Out of 100 patients, 39 were injured by skiing, and 61 were injured by snowboarding. The mean age of the skiers was 26.7±10.0, and that of the snowboarders was 26.7±6.2. The percentage of male skiers was 43.6%, and that of snowboarders was 63.9%. The most frequent initial chief complaints of head-injured skiers and snowboarders were headache and mental change. The most common mechanism of injuries was a slip down. The mean Abbreviated Injury Scale Score (AIS score) of the skier group was 4.5±2.1 and that of the snowboarder group was 5.9±5.0 (p=0.222). The percentage of helmet users was 7.1% among skiers and 20.8% among snowboarders (p=0.346). Head injuries were composed of cerebral concussion (92.0%) and intracranial hemorrhage (8.0%). Intracranial hemorrhage was most frequently caused by falling down (62.5%). Conclusion: The most common type of head injury to skiers and snowboarders was cerebral concussion, and severe damage was usually caused by jumping and falling down. No differences in the characteristics of the head injuries existed between skiing and snowboarding injuries.

서포트 벡터 머신을 이용한 심폐소생술 변이의 변화에 따른 제세동 성공률 분석

장승진,황성오,이현숙,윤영로,Jang, Seung-Jin,Hwang, Sung-Oh,Lee, Hyun-Sook,Yoon, Young-Ro 대한의용생체공학회 2007 의공학회지 Vol.28 No.4

Unsatisfied results of return of spontaneous circulation (ROSC) estimates were caused by the fact that the predictability of the predictors was insufficient. This unmet estimate of the predictors may be affected by transitional events due to behaviors which occur during cardiopulmonary resuscitation (CPR). We thus hypothesized that the discrepancy of ROSC estimates found in statistical characteristics due to transitional CPR events, may affect the performance of the predictors, and that the performance of the classifier dichotomizing between ROSC and No-ROSC might be different during CPR. In a canine model (n=18) of prolonged ventricular fibrillation (VF), standard CPR was provided with administration of two doses of epinephrine 0 min or 3 min later of the onset of CPR. For the analysis of the likelihood of a successful defibrillation during CPR, Support Vector Classification was adopted to evaluate statistical peculiarity combining time and frequency based predictors: median frequency, frequency band-limited power spectrum, mean segment amplitude, and zero crossing rates. The worst predictable period showed below about 1 min after the onset of CPR, and the best predictable period could be observed from about 1.5 min later of the administering epinephrine through 2.0-2.2 min. As hypothesized, the discrepancy of statistical characteristics of the predictors was reflected in the differences of the classification performance during CPR. These results represent a major improvement in defibrillation prediction can be achieved by a specific timing of the analysis, as a change in CPR transition.

RFID와 HL7을 이용한 응급 의료 정보 시스템 설계 및 구현에 관한 연구

홍규석,황성오,이현숙,윤영로,Hong, Kyu-Seog,Hwang, Sung-Oh,Lee, Hyun-Sook,Yoon, Young-Ro 대한의용생체공학회 2007 의공학회지 Vol.28 No.5

In this paper, we designed the RFID(Radio Frequency Identification) Emergency Medical Information System(REMIS). This REMIS offers the emergency patient's medical information using RFID and HL7(Health Level 7) to an emergency medical technician. In emergency situation as like coma, if the communication, from the patient's current location to the hospital, is possible, REMIS offer the medical information of the patient through REMIS server to an emergency medical technician. In the state of communication blocked, REMIS can offer the patient identification and the emergency information through RFID tag, which the patient wear, to an emergency medical technician. When this system was designed, the protection of the patient's medical information and their privacy was considered, and the HL7 was used to be compatible with another medical systems. Therefore, in this paper, REMIS was designed that it is always possible to offer the emergency patient's information to an emergency medical technician regardless of any communication status and to improve the emergency rescue process, effectively.

스키와 스노보드 사고에서 척추손상의 특징

차용성 ( Yong Sung Cha ),이강현 ( Kang Hyun Lee ),김선휴 ( Sun Hyu Kim ),장용수 ( Yong Su Jang ),김현 ( Hyun Kim ),신태용 ( Tae Yong Shin ),황성오 ( Sung Oh Hwang ) 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.1

Purpose: Few studies have been done for spinal injuries after skiing and snowboarding accidents. Assuming that the riding patterns of skiing and snowboarding were different, we analyzed the differences between the mechanisms, diagnoses and levels of spinal injuries caused by them. The purpose of this study was to gain a better understanding of spinal hazards associated with skiing and snowboarding in order to educate skiers and snowboarders. Methods: We conducted a prospective study of 96 patients who had sustained spinal injuries as a result of skiing and snowboarding accidents from January 2003 to March 2006. We used a questionnaire, radiological studies, history taking, and physical examinations. We analyzed the mechanism of injury, the level of spinal injury, the severity of spinal injury, and the Abbreviated Injury Scale scores (AIS score). We used the t-test and the chi-square test. Results: The skiing and the snowboarding injury group included in 96 patients. The skiing injury group included 30 patients (31.2%), and the snowboarding injury group included the remaining 66 patients (69.8%). The primary mechanism of injury in skiing was collisions and in snowboarding was slip downs (p=0.508). The primary level of spinal injury in skiing and snowboarding was at the L-spine level (p=0.547). The most common athlete ability of the injured person was at the intermediate level (p=0.954). The injured were most commonly at the beginner or the intermediate level (p=0.302). The primary diagnosis of spinal injury in skiing and snowboarding was back spain (p=0.686). The AIS scores did not differed between the two groups (p=0.986). Conclusion: The most common spinal injury after skiing and snowboarding accidents was back sprain. There was no difference in the severity of spinal injury between skiing and snowboarding accidents. (J Korean Soc Traumatol 2007;20:33-39)

대량 폐동맥 혈전색전증으로 인한 심정지 환자의 심폐소생술 - 혈전용해제사용 경험 2 예 -

조준휘(Jun Hwi Cho),황성오(Sung Oh Hwang),이강현(Kang Hyun Lee),이진웅(Jin Woong Lee),이서영(Seo Young Lee),박해상(Hae Sang Park),김성환(Seong Whan Kim) 대한응급의학회 2002 대한응급의학회지 Vol.13 No.1

The massive pulmonary thromboembolism is serious illness that can lead to death within an hour after its occurrence. The incidence of cardiac arrest caused by massive pulmonary thromboembolism has been known as about 7%. Invasive therapeutic modalities to treat massive pulmonary thromboembolism during cardiac arrest including thoracotomy or cardiopulmonary bypass have been shown little effect. Administration of a thrombolytic agent is an alternative choice of treating massive pulmonary thromboembolism during cardiac arrest. This report describes our experience of cases with massive pulmonary thromboembolism that were treated with administration of a thrombolytic agent during CPR.

유기인계 중독에 의한 심근손상 환자에서의 경흉부 심장 초음파검사를 사용한 심장기능평가

이윤석 ( Yoonsuk Lee ),김오현 ( Oh Hyun Kim ),김형일 ( Hyung Il Kim ),차경철 ( Kyoung Chul Cha ),김현 ( Hyun Kim ),이강현 ( Kang Hyun Lee ),황성오 ( Sung Oh Hwang ),차용성 ( Yong Sung Cha ) 대한임상독성학회 2015 대한임상독성학회지 Vol.13 No.2

Purpose: Cardiac complications may occur in cases of organophosphate (OP) poisoning. However, a few studies regarding patterns of cardiac toxicity as determined by transthoracic echocardiography (TTE) after exposure to OP have been reported. In the current study, the authors examined cardiac functions using TTE in patients with myocardial injury caused by exposure to OP. Methods: A retrospective review was conducted on 16 consecutive cases of OP poisoning with myocardial injury(defined as elevated troponin I within 48 hours of arrival at the regional emergency center in South Korea and diagnosed and treated at the center from January 2012 to November 2014. Results: TTE was performed in 11 (69%) of the 16 patients with an elevated troponin I (TnI) level within 48 hours. Of these 11 patients, 5 patients (45.5%) exhibited reduced ejection fraction (EF), and 3 exhibited regional wall motion abnormality (RWMA). Two patients (18.2%) had both reduced systolic function and RWMA. Two of the 5 patients with reduced EF returned to normal systolic function, however two patients did not regain normal systolic function after admission. One patient expired due to multiple organ failure, and 4 patients were transferred with a moribund status. Twelve of 15 patients who survived to discharge (at 4 to 35 months) were followed. Five of these patients died during follow-up and 7 survived without further complications. Conclusion: OP can cause reversible cardiac dysfunction including reduced systolic function and RWMA. Serum TnI may be useful for initial assessment of cardiac function during the workup of patients suffering from OP poisoning. After the initial assessment of cardiac enzyme, further evaluation with TTE in patients with abnormal cardiac enzyme will be necessary to understand the cardiac toxicity.