생리식염수 및 포도당수액 정액 투여가 에탄올 농도에 미치는 효과에 관한 연구

김원율,이상래,안지영,안성훈,류석용,김경환,김홍용 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3

Background: In emergency department, there are many drunken patients with various emergency medical situations. In these patients, evaluation and management of the medical problems are delayed from time to time because of the uncooperative nature of the patients and because of consciousness and sensory changes. A precise evaluation can only be obtained when the patients become sober. For this purpose, most clinicians start IV fluid loading. This study was carried out to evaluate the effect of IV fluid(normal saline and glucose solution) on the rate of ethanol clearance in such patients Methods: Ten volunteers(healthy males in their twenties and with a Michigan alcohol screening test below 4) were enrolled in this study. Alcohol intake was restricted to at least 48 hours before the test and food intake to at least 4 hours. For the test, A predetermined dose of ethanol(1 gm/kg) was given to the volunteers. Each volunteer was tested on three consecutive times with 3 or more days interval for alcohol wash out period . On the lst day, the volunteers received ethanol only per os. On the second day, they received ethanol and a liter of IV 10% dextrose solution. Each day, blood was drawn from the antecubital vein to measure the ethanol level at the time of ethanol ingestion and at 0.5, 1, 1.5, 2, 3, 4, 5 and 6 hours after ingestion. The repeated measure ANOVA test was used for the statistical analysis. Results: The difference in the blood ethanol level between the 3 test was F=1.7, p=0.184 and the difference corrected by the time factor was F=0.32, and p=0.985. Conclusion: There was no significant difference in the blood ethanol level between the tests. In conclusion, the IV normal saline or glucose solution does not accelerate ethanol clearance in suffering

응급센터에서의 박리성 대동맥류에 대한 임상적 고찰

우건화,김원율,김홍용 대한응급학회 1998 대한응급의학회지 Vol.9 No.2

Dissecting aortic aneurysm is an emergency condition which requires prompt diagnosis and management. From January 1992 to December 1996, 54 patients were admitted to our department. Patients were categorized according to the Stanford classification of aortic dissection and investigation of the clinical records utilized the retrospective method. Male constituted the majority, accounting for 38(70.4%) of the total number of patients, whereas females accounted for 16(29.6%). Mean age was 52.1±2.2 years old (range: 25∼82). Clinical findings included chest pain in 46 cases(85.2%), renal failure in 11(20.4%), aortic insufficiency in 10(18.5%) and stroke in 9(16.7%). Predisposing factors were hypertension in 48 cases(88.9%), Marfan's syndrome in 5(9.3%) and diabetes mellitus in 1(1.8%). 21 patients(type A:12, type B:9) underwent surgical treatment. There were three(2 in type A and 1 in type B) deaths in the surgical treatment group and nine(5 in type A and 4 in type B) deaths in the medical treatment group. These results reflect our current policy in the management of dissecting aortic aneurysm.

흉부외상 환자에서 응급 전산화 단층촬영의 효용성에 관한 분석

우건화,김원율,김경환,김홍용,이기재 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.1

Background. Trauma is the third leading cause of death, irrespective of age, and the leading cause of death in persons under 40 years of age. Computed tomography(CT) is an effective technique in the initial emergent evaluation of the abdomen and head following blunt trauma. Most chest injuries are not seen on conventional chest radiography, or may be underestimated. But routine use of CT in the initial emergent evaluation of chest trauma is controversial. CT, however, has been shown to be useful in the diagnosis of unsuspected chest injuries and in directing therapeutic interventions. This review discusses the efficacy of emergent CT in patients with blunt trauma on the chest. Methods. To evaluate the efficacy of CT of the thorax, a retrospective study comparing early thoracic CT scanning with initial chest roentgenogram(CXR) was carried out on 121 patients with blunt trauma on the chest. The interval between CXR and CT was less than 1 hour. Results. Among 121 patients, 42 patients had normal initial chest roentgenogram in whom 19 patients showed normal CT findings, Sensitivities of diagnosing pneumothorax and pleural effusion by CXR were low (49.3% and 45.1% respectively), whereas 65.7%(44/67) of patients had thoracostomy only by CXR. Conclusion. Although sometimes abused in patients with chest trauma, CT of the thorax is an effective method of detecting thoracic injuries and provides accurate information regarding their pattern and extent in the initial emergent diagnosis.

소방구급대원의 응급처치 적절성 평가와 재교육 필요성

류석용,김원율,김경환,이상래,이경호,김홍용,이승한 대한응급의학회 2000 대한응급의학회지 Vol.11 No.2

Background: The prehospital emergency medical system(EMS) for 119 rescue has progressed considerably, but leaves much to be desired. To improve prehospital EMS, we need to evaluate prehospital patient care, and reeducation. Methods: The records of 1,882 patients, who visited Sanggye Paik Hospital Emergency Department via 119 rescue from April 1 to July 30, 1999, were analyzed according to the quality of patient care as documented by the 119 rescue protocol and database. Patients are grouped into 5 classes based on the quality of the care received. Class 1A received adequate care, class 1B received inadequate care, class 1C did not receive the necessary care, and class 2A received unnecessary care, class 2B did not receive unnecessary care. The results of such analyses are presented to the fireman at monthly meetings, thus reeducating them. Results: The overall results were 1027 cases in Class 1A(55%), 83 in 1B(4%), 149 in 1C(8%), 21 in 2A(1%), and 602 in 2B(32%). Well performed care(1A+2B) occured in 1629 cases(87%) and badly performed care(1B+1C+2A) occured in 253cases(13%). Well perfomed care gradually increased from April to July (April 83%, May 85%, June 87%, and July 89%). Conclusion: Meticulous appraisal of the quality of prehospital patient care and reeducation through the regular meetings of EMS physicians and firemen in each community is needed for developing a model protocol for indirect retrospective medical control of the prehospital EMS.

응급센터로 내원한 Doxylamine 과용환자들에 대한 임상적 고찰

이경호,김경환,김원율,안성훈,이상래,안지영,류석용,김홍용 인제대학교 1999 仁濟醫學 Vol.20 No.1

독시라민은 급성 약물 중독으로 응급센터를 내원하는 환자들에서 가장 많은 비율을 차지하는 약물로서 비교적 안전한 약물로 알려져 있으나 최근 여러 보고에 의하면 횡문근융해증이나 심정지와 길은 치명적인 합병증을 유발시키기도 하는 약물로 보고되고 있다. 따라서 저자들은 독시라민 약물 중독 환자들에 대한 임상적 고찰을 시행하여 약물 중독 증상의 종류와 발현 빈도 등을 알아보고 그에 따른 치료 지침을 세우는데 도움이 되고자 연구를 시행하였다. Background: Doxylamine is common sleeping aid that are frequently involved in suicide attempts in adolescents. However, despite the frequency of doxylamine overdose, satisfactory evaluation of clinical symptomatology and consequence of the cases has not been published. Method: 71 cases of mono-intoxication with doxylamine were evaluated retrospectively with respect to age, gender, amounts of ingestion, symptoms, signs, ECG and laboratory findings from January 1, 1997 to December 31, 1997. Result: Male to female ratio was 1:2.7 and the age of 70% of the patients ranged between 20 and 39 years. The average dosage of ingestion was 44 times of single therapeutic dose(25mg). The frequent anticholinergic symptoms were tachycardia(21.1%), vomiting(19.7%), agitation(18.3%), mydriasis(16.9%) and catatonic stupor(9.9%). No anticholinergic symptoms were observed in 46.5% patients. Two patients were admitted to psychiatric department and six patients were admitted to medical department. Conclusion: Although doxylamine overdose did not lead to serious complications in most of the cases presented here, we have to be aware that serious complication, rhabdomyolysis and subsequent acute renal failure, hypotension, cardiac arrest and seizure, may happen.

응급실로 내원한 소와외상 환자의 연령에 따른 상대 위험도 비교에 관한 연구

김경환,김홍용,김원율,류석용 대한외상학회 1999 大韓外傷學會誌 Vol.12 No.1

Pediatric trauma is increasing in number with the development of contemporary society. The pediatric population is not homogeneous but is composed of several distinct subgroups. Therefore it is very important to understand the differences in diagnoses among the childhood age subgroups presented to the Emergency Department(ED). The purpose of this study was to determine the most common diagnoses of pediatric patients in the ED and to compare the diagnoses among four age subgroups. Thus, we studied 6,058 pediatric trauma patients retrospectively who visited Sanggye Paik hospital Emergency Department in the year 1997. The most common diagnosis of pediatric trauma patients in ED was compared among four age subgroups: 0 to 1(infancy), 2 to 6(preschool), 7 to 12(elementary school), and 13 to 15 year old(middle school). We stratified the traumatic body areas by core content for Emergency medicine guided by American college of Emergency Physicians and also stratified patients by the presumed diagnosis made by the emer- gency department. The face was the most common injured body site, followed by the upper extremity, head, and the lower extremity. Laccration was the most common diagnosis, followed by contusion, fracture, and foreign body. The relative risk in facial soft tissue injury was preschool(2.8), infancy 8#c elementary school(2.2), and middle school(1.0), in descending order. The relative risk in laceration was in preschool(1.5), elementary school(1.3), infant(1.1), middle school(1.0) in descending order. Our study found significant differences in diagnoses and relative risks among four age subgroups presented to the ED. Although the data presented here may not be representative of all hospital EDs, I believe this study provides valuable insight into the age- related diagnostic differences among pediatric trauma patients seen in the ED. In conclusion, the differences in diagnoses between the oldest age subgroup and the youngest age subgroup are expected to be exacerbated in future years. The information from this study can be used to plan services, such as follow-up, referral, social services, and staffing to best address the needs of pediatric trauma patients in the ED. The information can also be used to improve the training of emergency physicians. We found that the improvement of protective sur- roundings for children, the intensification of safety education, and the security of safe playthings and playground were needed against pediatric trauma. The most important of all, however, is parents interest in the safety of their children.

수술로 확인된 출혈성 황체에 대한 임상적 고찰

류석용,김홍용,김원율,김경환 인제대학교 2001 仁濟醫學 Vol.22 No.1

Backgrounds: Ovarian hemorrhage from the corpus luteum due to menstruation or pregnancy can be a life-threatening surgical condition and occurs at all stages of a woman's reproductive life. The condition is often confused with other surgical emergencies, such as appendicitis and ectopic pregnancy. Materials and Methods: From the records of the Department of Emergency Medicine, Inje University, Sanggye Paik Hospital, 50 consecutive cases of a hemorrhagic corpus luteum, which had been diagnosed from July 1995 to July 1999, were reviewed and analyzed. Results: The ages of the patients ranged from 15 to 44 years with a mean of 32.6 years. Twenty-six cases (52.0%) involved the right ovary, and twenty-four cases (48.0%) involved the left ovary. Rupture of the corpus luteum occurred most frequently between the 20th and the 30th days of the menstrual cycle. Lower abdominal pain was the most common clinical symptom (35 cases, 70.0%). Blood transfusions were required in 15 patients with an intraperitoneal blood loss of more than 500ml. Ultrasound was done in all patients, and 31 patients (62.0%) had fluid collections within cut-de-sacs. Culdocentesis was done in 35 patients, and was positive for hemoperitoneum in 32 patients (91.4%). Ultrasound or culdocentesis was positive for hemoperitoneum in 47 cases (94.0%) . Conclusions: There are no typical symptoms and signs that will make a definitive diagnosis possible as they are mimicked by other surgical emergencies such as acute appendicitis and ectopic pregnancy. The diagnosis of a hemorrhagic corpus luteum should be considered in the differential diagnosis of an "acute abdomen" in a woman of childbearing age. We suggest that a precise history, ultrasound, and culdocentesis are essential for the diagnosis of a hemorrhagic corpus luteum.

전내장역위증에서의 충수염 천공 : a case report 치험1예

안성훈,이경호,김경환,윤영철,김원율,김홍용 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.3

Appendicitis is one of the most common disease in emergency department(ED), but produces perplexing diagnostic problems. A complete understanding of the anatomy, pathophysiology, and presenting signs and symptoms of appendicitis, combined with thorough history and physical examination, will be the most important factors in allowing emergency physician to make the correct diagnosis of appendicitis. Situs inversus totalis is a rare congenital anomaly occurring in every 10,000 to 50,000 people. It's etiology is obscure but apparently dose not influence normal health or life expectancy. We present a case of perforated appendicitis with situs inversus totalis in a 24-year-old woman whose chief complaint was pain on the left lower quadrant of the abdomen. Chest and abdominal X-ray showed situs inversus totalis, but these typical findings of situs inversus totalis were missed before performing abdominal ultrasonography in ED. We must carefully consider whether congenital anomaly is or not by physical examination and X-ray finding. For patients whose diagnosis is less clear, additional diagnostic tool, for instance ultrasonography is recommended in ED.

의식이 명료한 두부외상환자에서 뇌전산화단층촬영의 결정요인들 중 임상증상의 의의

김경환,윤영철,이경호,김원율,김홍용 대한응급의학회 1997 대한응급의학회지 Vol.8 No.4

Study objectives: To identify the value of symptoms in head trauma patients with mental status requiring a head CT scan. Method: A retrospective study was performed at an emergency center over & months period. Patients(age ? 7) were enrolled if they presented with a Glasgow Coma Scale score of 15 and underwent head CT after head trauma. The symptoms and signs were recorded in the entry forms prior to head CT. The symptoms found in the patients with normal CT were compared with those in abnormal CT showing intracranial injuries. Results: Among the 168 patients, traumatic intracranial abnormality was identified in 34(20.2%) by CT. Skull fracture was identified in 8(4.8%) in normal CT, 17(10.1%) in abnormal CT group by simple X-ray and CT. In the normal CT group without skull fracture, 65(52.0%) had headache, 61(48.8%) had loss of consciousness(LOC), 43(34.4%) had vomiting, 24(19.2%) had nausea, 7(5.6%) had dizziness. In the abnormal CT group without skull fracture, 14(77.8%) had headache, 9(50.0%) had LOC, 9(50.0%) had vomiting, 2(11.1%) had nausea, 2(11.1%) had dizziness. The patients with headache were significantly more common in the abnormal CT group. Conclusion : A head required in alert head trauma patients with any symptoms and signs of intracranial injuries, especially with headache.

다발성 외상환자에서 개흉술이 필요했던 환자에 대한 임상적 고찰

김경환,오상준,김홍용,우건화,김원율 대한외상학회 1999 大韓外傷學會誌 Vol.12 No.1

Background: Recently, multiple trauma patients have been increasing markedly due to the vast increase of traffic accidents, industrial disasters, and incidental accidents as well as the fre- quent use of murderous weapons. Because thoracic injuries could involve the heart, lung, and great vessel and would influence lives, prompt diagnosis and adequate treatment are essential. Most of the thoracic injuries can be managed with a conservative method and simple surgical procedure such as closed thoracostomy, but in certain cases open thoracotomy is necessary. Materials and Methods: We analyzed the surgical result of 64 cases of open thoracotomy after multiple organ injury mainly according to the patients chart review. Results: The most common type of thoracic lesion was hemothorax with or without pneu- mothorax and diaphragm rupture was second. 38.9% of thoracic injuries was accompanied by abdominal injuries and 32.5% by bone fractures. The modes of operation were ligations of torn vessels for bleeding control(32.4%), repair of diaphragm(24.6%), and repair of lung lacera- tion(18.2%) in order of frequency. Additional procedures were splenectomy(14 cases), repair of liver laceration(6 cases) and hepatic lobectomy(3 cases). The postoperative complication rate was 26.6% and operative mortality rate was 6.1%. The causes of death were acute renal failure(2 cases), respiratory failure(1 case), and sepsis(1 case).