독실라민 중독시 발생할 수 있는 발작의 특성과 위험인자

송범수 ( Beom Soo Song ),이기만 ( Ki Man Lee ),김선욱 ( Sun Wook Kim ),유제성 ( Je Sung You ),정태녕 ( Tae Nyung Chung ),박유석 ( Yoo Seok Park ),정성필 ( Sung Phil Jung ),구홍두 ( Hong Du Goo ),박인철 ( In Cheol Park ) 대한임상독성학회 2010 대한임상독성학회지 Vol.8 No.2

Purpose: Doxylamine is antihistamine drug that is used as a hypnotic. It is also used for suicidal attempts because it can be easily purchased at the pharmacy without a prescription. There were many articles about the complications after doxylamine intoxication such as a rhabdomyolysis, but only a few articles have reported on seizure. We reviewed the cases of doxylamine intoxication with seizure that were treated in the emergency department. Methods: We reviewed the medical records of the patients who were over 15 years old and who were intoxicated by doxylamine at 3 emergency medical centers from January 2006 to June 2010. We reviewed the patients’age, gender, the dose of doxylamine ingested, if gastrointestinal decontamination was done, the time from intoxication to hospital arrival, the seizure history, treatment of seizure, the electroencephalography (EEG) results, the brain computed tomography (CT) results and the blood test results. Results: There were 168 patients who were intoxicated by doxylamine during the study period. Twelve patients had a seizure episode. The differences between the patients who developed seizure and the patients who did not were the dose and the serum levels of sodium and creatinine. The only clinically meaningful difference was the amount of doxylamine. The amount of doxylamine ingested (>29 mg/kg) predicted the development of seizure with a sensitivity of 75% and a specificity of 92% on the ROC curve. One patient among the seizure patients expired in the emergency department. Conclusion: In case of doxylamine intoxicated patients, there is close relationship between seizure and ingested amount, so close observation needs to be done for the patients who ingest too much because doxylamine can cause death. Further prospective studies are needed for doxylamine intoxicated patients with a seizure episode.

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.

뇌졸중 위험인자를 가진 어지럼 환자에서의 확산강조 자기공명영상

강형구,윤유상,이진희,박인철,이경룡,정상원,구홍두,김승호 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Background: The management of vertiginous patients is a great challenge to emergency physicians. We evaluated the diagnostic value of a diffusion-weighted image(DWI) in differentiating central vertigo from the peripheral vertigo in patients who presented no neurological symptoms other than risk factors for stroke. Methods: From March 2000 to February 2001, we retrospectively analyzed the cases of 68 patients who visited the emergency department with symptoms of isolated vertigo and who had risk factors for stroke. DWIs, computed tomograms(CT), and medical records were reviewed, and the final diagnose, the DWIs and the CT readings, the risk factors for stroke, and the time it took waiting for a DWI or CT scan were analyzed. Results: Of the 68 patients, 21(30.8%) had central vertigo: 15 vertebrobasilar transient ischemic attacks(VB-TIA), 4 brain stem infarctions, 1 cerebellar infarction, and 1 cerebellopeduncular infarction. The DWI showed a 28.6% sensitivity, a 97.9% specificity, and an 85.7% positive predictive value in diagnosing central vertigo. It also had a 100% sensitivity in detecting infarctions. Conclusion: A DWI had a comparable sensitivity to MRI in detecting central vertigo and small, but potentially, lethal infarctions in our patient population. We recommend clinical application of DWI in the emergency department evaluation of isolated vertigo patients with risk factors for stroke.

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.

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.

응급진료시 여성환자의 소변검체 채취방법

박원녕,정상원,이종호,구홍두,심호식,김승호 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Background: Urinalysis is a useful laboratory test in the diagnosis of various diseases. In sampling for the urinalysis, there is much concern about contamination that can lead to misdiagnosis in the mid-stream urine sampling method. We conducted this study to determine, in terms of concordance of results and contamination in culture, whether there was any superiority in nod-stream sampling methods with or without disinfection measures compared to the catheterization method. Materials and Methods: We used three kinds of urine sampling methods sequentially, mid-stream non-clean catch, mid-stream clean catch, and catheterization, for ambulatory, non-pregnant, non-men-struating female patients who visited NHIC Ilsan Hospital emergency department during a one-week period in September 2001. Each sample was electrophotometrically analyzed for leukocyte esterase, nitrite, and blood by using a reagent strip and was cultured immediately or after overnight refrigeration. Results: Of the 41 patients, 9 had culture-proven urinary tract infections. The concordance rates(kappa) for nitrite, blood, and leukocyte esterase were 0.875, 0.403, and 0.406 between non-clean catch and catheterized samples and 0.875, 0.481, and 0.560 between clean catch and catheterized samples, respectively. The contamination rate of the non-clean catch, the clean catch, and the catheterized samples were statistically different: 51.2%, 29.3% and 0%, respectively. Conclusion: We found that cleaning with disinfectant was effective for reducing the contamination rate, even though the best urine sampling method for zero contamination was catheterization. We recommend considering cost, patients' comfort, an acceptable threshold for contamination, and the necessity for a culture before choosing a urine sampling method for women who visit the emergency department.

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.

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.

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.

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.