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김용오,박현수 대한중환자의학회 2014 Acute and Critical Care Vol.29 No.3
Background: Peripheral venous catheterization (PVC) is a less invasive and time consuming technique than central venous catheterization (CVC); however, for patients in circulatory collapse or receiving cardiopulmonary resuscitation (CPR), PVC cannot be achieved easily. CVC can provide not only a more effective administration route for medication, but also important hemodynamic information. Owing to the possibility of CPR interruptions and complications, CVC is recommended only after the failure of PVC. This observational study is aimed to evaluate the risks and benefits of CVC during CPR. Methods: This retrospective observational study was performed in the emergency department (ED) of a university hospital. Adult patients without a pulse on arrival were consecutively enrolled if subclavian CVC was performed at the beginning of CPR. Patients who already had an established intravenous route or had severe chest injuries on arrival were excluded. Closed-circuit television was used to evaluate the frequency of compression interruption. The incidence of iatrogenic pneumothorax, an acute mechanical complication associated with subclavian CVC, was investigated using chest X-ray after CPR. Results: During a 6-month period, 35 patients underwent CPR and 31 of these received subclavian CVC. Among the patients, one patient experienced iatrogenic pneumothorax (3.8%), and 13 CPR interruptions occurred in 10 subjects during subclavian CVC. Conclusions: During CPR in 31 patients, one iatrogenic pneumothorax was caused by subclavian CVC, and CPR interruptions were observed in approximately 30% of cases.
전신성 홍반성 루푸스 환자의 종격동 자연출혈 증례 1례
김용오,최한주 대한응급의학회 2022 대한응급의학회지 Vol.33 No.5
Spontaneous mediastinal hematoma is a rare disease associated with systemic lupus erythematosus (SLE). Endovascular treatment for spontaneous mediastinal bleeding with SLE is also rare but effective method preventing major surgery. The timely diagnosis is the key element to prevent the catastrophic course of complications corresponding to SLE.
두부외상환자에서 초기 뇌전산화단층촬영 소견에 의한 기존 뇌동맥류파열의 예측
김용오,김갑득,최한주 대한응급의학회 2014 大韓應急醫學會誌 Vol.25 No.5
Purpose: Rupture of pre-existing cerebral aneurysms hasoccasionally been reported as a cause of traumatic subarachnoidhemorrhage (TSAH) and intraparenchymal hemorrhage(IPH). SAH due to rupture of pre-existing cerebralaneurysm is an important differential diagnosis in TSAH. The aim of our study was to determine whether a rupture ina pre-existing cerebral aneurysm could be predicted basedon the pattern of hemorrhage on the initial computedtomography (CT) scan in patients with traumatic brain injury(TBI). Methods: A total of 336 patients who had undergone computedtomography angiography (CTA) for detection of ruptureof pre-existing cerebral aneurysm in TBI between theyears 2004 and 2013 were retrospectively studied. In orderto investigate CT findings of ruptured cerebral aneurysm,patients who had a lesion of SAH, IPH, or IVH were comparedwith the control group (who had intracranial lesions ofcontusion, epidural hematoma, subdural hematoma, orhemorrhagic contusion). Results: Fifty eight (17.3%) patients with TSAH harboredcerebral aneurysms, and 45 (13.4%) patients had rupturedcerebral aneurysms. The ruptured aneurysms showed significantassociation with CT findings of a diffuse hemorrhagein the basal cisterns (29.2%, p=0.003, OR=23.130),unilateral sylvian fissure (13.8%, p=0.039, OR=8.842),anterior interhemispheric fissure (20.0%, p=0.028,OR=14.000), and associated IPH (22.6%, p=0.011,OR=16.333). However, the ruptured aneurysms did notshow association with CT findings of hemorrhage on convexities,perimesencephalic cisterns, bilateral sylvian fissure,and IVH (p>0.1). Conclusion: Patterns of distribution of SAH and associatedIPH on initial CT can be predicted of rupture pre-existingcerebral aneurysm in patients with TBI.