응급의학 전문의로 건강하게 일하기 위해서는 무엇이 필요한가?

장민석 ( Min Seok Jang ),이형민 ( Hyung Min Lee ),조광현 ( Kwang Hyun Cho ),김인병 ( In Byung Kim ),이미진 ( Mi Jin Lee ),윤유상 ( Yoo Sang Yoon ),박경혜 ( Kyung Hye Park ),박송이 ( Song Yi Park ),김홍재 ( Hong Jae Kim ),기동훈 ( 대한응급의학회 2022 대한응급의학회지 Vol.33 No.4

Objective: Unlike the temporary nature of an emergency resident's job, the position of an emergency physician is one of a lifelong commitment requiring stability and persistence. However, it is hard to pursue a healthy lifestyle because of the 24 hours a day, 7 days a week (24/7) working schedule. The emergency room environment demands high physical and mental stamina, and hence the health problems of emergency physicians have a significant impact on the patient’s outcome. Our study was designed to analyze the emergency physician’s health status and influencing factors based on the data from the 2020 Korean Emergency Physician Survey. Methods: Based on the results of the survey, the factors affecting health were classified into several categories, such as personal character, working conditions, lifestyle, and emotional status. Statistical methods have been used to determine whether these factors can affect self-rated health. Results: The self-rated health worsened for emergency physicians in their 40s rather than in their 30s. However, drinking, smoking, and eating patterns had no effect on self-rated health. Also, the actual number of shifts was observed to bear no relationship with health. Sleeping, wellness, and mood affected self-rated health. Physicians who felt they were unhealthy, expected an early retirement because of the burden of night shifts. Conclusion: Emergency physicians in Korea have a low self-rated health status. Mental stress, exercise, and sleep had an impact on the status. Physicians who served long-term night shifts saw a deleterious effect on their sleep and mood, and this damage was cumulative. The career longevity of an emergency physician thus requires a reasonable night shift schedule and age-modified adjustments.

응급의학과 전문의 총조사 자료를 이용한 응급의학과 의사의 남녀 차이

배경수 ( Kyung Su Bae ),박경혜 ( Kyung Hye Park ),강지훈 ( Ji Hun Kang ),기동훈 ( Donghune Key ),김인병 ( In Byung Kim ),김홍재 ( Hong-jae Kim ),박송이 ( Song Yi Park ),서범석 ( Beom Sok Seo ),여인환 ( In Hwan Yeo ),윤유상 ( Yoo S 대한응급의학회 2022 대한응급의학회지 Vol.33 No.4

Objective: In this study, we compared differences based on the gender of Korean emergency physicians to provide basic data for future emergency medicine development plans. Methods: We used data from the emergency physician survey (2020) conducted by the Korean Society of Emergency Medicine. A total of 1,303 emergency physicians responded to the survey. We adjusted demographic data relating to age, position, and work duration as an emergency physician, which could affect the differences based on gender. After propensity score matching, we compared working hours, work burden, income, motives for applying for emergency medicine, and future plans of the emergency physicians by sex. Results: The total working hours per month and night shifts per month were higher in men compared to the women. The women felt more pressure in the following areas: number of emergency patients, relationships with administrative agencies, insufficient emergency medical technician manpower, patients’ compliance, and relationships with other emergency physicians. Monthly income was higher in men. Women placed a higher value on ‘Acquiring a range of knowledge’ and ‘Degree of interest in working in the emergency room’ than men as motivation for applying for positions in emergency medicine. Regarding future plans, women placed less value on income and more on having enough free time and avoiding burnout. The retirement age was about 3 years lower for women than for men. Conclusion: This study revealed gender differences in working hours, income, motivation for applying for emergency medicine, work burden, and future plans. It is expected that these differences are caused by physical limitations and socio-cultural backgrounds. It is recommended that more detailed investigations be carried out through qualitative research. These results could help in gender considerations while hiring emergency physicians.

Yamaguchi index에 의한 파라쿼트 중독 환자의 예후 결정

김인병,최성욱,김성중,김경수,이영수 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Study objective: To evaluate the significance of Yamaguchi index as a predictor of outcome in patients with acute paraquat poisoning Design: Retrospective chart review Setting: Two university Hospital EDs Methods: We reviewed the medical records of 47 patients with acute paraquat poisoning(18 survived and 29 died). The Eq1 was defined as : Eq1=[K+] x [HCO₃] / 0.088[Cre] mEq L¹ The patient's data were plotted as calculated Eq1 values(y-axis) against interval of time from ingestion to admission (T) (x-axis). The study patients were divided into three groups. Group A consisted of patients with Eq1> 1500-399LogT; Group B consisted of patients with Eq1: 930-399LogT < Eq1 ≤ 1500-399LogT; Group C consisted of patients with Eq1 ≤ 930-399LogT. Results: There was a significant difference among three groups (A, B and C) as far as prognosis was concerned(P<0.01). In group A, all patients survived(survival rate 100%). In group B, six of 13 patients survived(survival rate 46%). In group C, none of patients survived Isurvival rate 0%). Conclusion: Yamaguchi index is a significant predictor of outcome in patients with acute paraquat poisoning

비위관 삽입시 국소마취의 효과

김태경,정순미,김인병,김경환 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Purpose: This study was conducted to assess the effect of sprayed 10% xylocaine as a local anesthesia in reducing the pain associated with nasogastric tube(NGT) placement Method: This was a prospective, randomized, case-controlled trial conducted in the emergency department of a university teaching hopital. Study participants were alert patients requiring NGT placement for diagnostic or therapeutic purposes. Patients having NGT placement were randomized to receive either a 10% xylocaine solution or nothing sprayed in the nasopharynx and oropharynx, After 5 minutes, the distal 5 cm of the NGT were lubricated with a liberal amount of sterile, water-soluble, and non-anesthesient jelly before placement. After each procedure, the patient recorded assessment of subjective pain on a 100-mm visual analog scale(VAS). Result: A total of 71 patients were evaluated in the study with 32 in the case group and 39 in the control group. The mean VAS value of the case group was 38.8 mm(95% confidence interval[CI] 2.4 to 51.3); that of control group was 63.31 mm. The mean difference between groups was 24.40 mm(95% CI, 26.9 to 75.9). A statistically significant difference was achieved between the case and the control groups(p<0.01). Conclusion: Sprayed nasopharyngeal and oropharyngeal 10% xylocaine results in a statistically significant reduction in pain during NGT placement.

PC12를 이용한 신경세포 허혈모델에서 irp94 유전자의 발현

김승환,양영모,하영록,정성필,유인술,김인병 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Background: The ischemia responsive protein 94 kDa(irp94) gene belongs to the heat shock protein 110 family and was isolated in 1999 from rat brain by transiently induced forebrain ischemia. The PC12 cell is the pheochromocytoma cell line of rat, which is differentiated to a sympathetic neuron-like cell by the stimulation of a nerve growth factor. This study is to determine whether irp94 is expressed when an ischemia-like condition is induced by ATP depletion in cultured PC12 cells in vitro. Methods: PC12 cells were maintained as monolayer cultures in RPMI-1640 medium(Sigma) supplemented with 10% horse serum, 5% fetal bovine serum, 5 mg/ml transferrin, and 1 mg/ml insulin in a humidified 5% CO2 incubator at 37℃. The ATP depleting agent antimycin A was added at concentrations of 1, 2.5, and 5 μM to simulate ischemia, and 10 μg/ml of tunicamycin, which is expected to express heat shock protein maximally, was used as a positive control. The cells were harvested after a 60-minute incubation, and the total RNA was extracted. The reverse transcription polymerase chain reaction(RT-PCR) was performed to use 501 bp irp94 cDNA as a molecular probe, and the expression of irp94 mRNA was analyzed by northern blotting. Results: The irp94 mRNA expression was enhanced, compared to the negative control group, as the concentration of antimycin A was increased. Conclusion: This study suggests that irp94 mRNA expression is enhanced as the severity of ischemia is increased. Thus, it is possible to investigate the mechanism of ischemic neuronal injury indirectly by using this in-vitro model of neuronal ischemia.

급성 중독 환자에 대한 역학적 고찰 : 서울과 지방의 비교

김성중,김인병,최성욱,김경수,이영수,Choi, Jong Moo 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Study objective: To compare patients with acute poisoning between urban and rural areas Design: Retrospective chart review of 217 patients with acute poisoning Setting: Two University Hospital EDs Methods: patients were divided into two groups according to hospital. The group A was 109 patients who came to ED of Asan Medical Center and the group B was patients who came to ED of Ajou University Hospital from June 1994 to February 1995. We analysed the age and sex distributions, poisoning substances. causes of poisoning and the past history of psychiatric problems in patients of the two groups. Results: Total number of patients with acute poisoning were 109 in the group A and 108 in the group B. Female was more prevalent than male in the group A and male was more than female in the group B. There was a significant difference in sex distribution between two groups. The mean age of the group A was 27.7 years which was significantly different from the mean age of the group B, 33.7 years. The age incidences in both group were highest in 2nd decade. The accidental poisoning cases were 37% in the group A and 31% in the group B. The rates of committed suicide were 7% in the group A and 22% in the group B. The most common agent of poisoning was therapeutic drug in the group A and agricultural or industrial chemical in the group B. The overall mortality was 5% in the group A and 15% in the group B. Conclusion: There were significant differences in age and sex distributions. poisoning substances, causes of poisoning and the past history of psychiatric problems between two groups.

오르필(Orfil) 과다복용에 의한 중독환자 1예

김인병,조광현,손대곤,이한식 대한응급의학회 1994 대한응급의학회지 Vol.5 No.2

Orfil intoxication is not often encountered. But using the new knowledge about its pharmacodynamics and pharmacokinetics we could improve on its fatalities which are usually associated its central nervous system depression mediated by γ-aminobutyric acid, idiopathic hepatotoxicity and hemorrhagic pancreatitis thought to be mediated by immune mechanism. We report a case of valproate intoxication patient with serum valproic acid level of 2020 ㎍/mL who died from complications of progressive liver and pancreas failure known to be associated with valpoic acid.

응급의료 측면에서의 의료사고 유형

김인병,정상원,장석준,이한식 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.4

This study reviewed 48 malpractice claims of emergency patients filed in two tertiary level hospitals and at Association of malpractice patients' family. Problems related to treatment and misdiagnosis each accounted for 18 (38%) and 19 (39%) of all claims. Especially issues concerning emergency medical service system including of inadequate transport, delay in triage and transport accounted for 9 cases (19%) of all claims. But in patients' aspect, the malpractices more problems associated with treatment (77%) than misdiagnosis (13%). The claims were analyzed according to hospital levels, primary, secondary (27 problems) and tertiary hospital (21 problems). Comparison of the causes of malpractice claims against primary, secondary and tertiary hospitals resulted in more misdiagnosis claims against primary, secondary hospitals than tertiary hospitals. The symptoms associated with the claims were in order of abdominal pain (29.7%), dyspnea (13.5%), chest pain (10.8%), fracture and wound (10.8%). 83.3% of medico-legal accidents of emergency patients result in deaths (40 cases) where as 22% in non-emergency patients result in deaths. This alerts us to the seriousness of medical accidents of emergncy patient.

응급의학과 전문의의 근무형태와 만족도 : Working Patterns and Level of Satisfaction

김인병,김경환,정순미,조준필 대한응급의학회 2002 대한응급의학회지 Vol.13 No.3

Purpose: This research was to investigate and analyze the working conditions and level of satisfaction, to suggest ideal working conditions for emergency medicine specialists, and to propose a future direction for the advancement of emergency medicine. Methods: Among the 185 doctors who were EM board-certified from 1996 to 2000 in Korea, this survey was sent to 129 emergency medicine specialists; to those 57 answered the questionnaire. The questionnaire was made up of 17 items in the form of short answeres and descriptions. The analysis was done using the SPSS WIN program. Results: From the survey, the level of dissatisfaction was found to be higher than the level of satisfaction and the most prominent cause was the working conditions, including night duty. The most ideal working pattern sought after was an 8-hour workshift and this result did not vary with the specialists the position in the hospital. At present, night duty is not performed by most specialists, but rather extended weekend duty is. The number of specialists employed at most emergency medical centers is under 3 (81.7%). As the ideal number of specialists (more than 4 in 89.5%)is not being reached, 24-hour stationing of a specialist at an emergency medical center is not being achieved. Conclusion: This survey was done in order to establish the proper working conditions and a base for improving emergency medicine itself by investigating and studying the present working conditions of emergency medicine specialists, their complaints, and their proposals for advancing of emergency medicine.

응급환자에서의 초음파진단의 이용

김인병,송근정,이한식 대한응급의학회 1994 대한응급의학회지 Vol.5 No.1

The Ultrasonography is benefit in the imaging diagnosis of disease and trauma, because it is simple, movable, rapid, non-invasive and economical tool. The Ultrasonography is especially useful in the diagnosis of some emergency cases. We trained the Ultrasonography for emergency patients by emergency physician for 1 year prior to this prospective study. We analysis the time efficiency, indication of disease, and diagnostic accuracy of ultrasonography in E.D. The 87 cases were received emergency ultrasonography at Emergency Center of Yong Dong Severance Hospital during 6 months from Aug. 1, 1993 to Jan. 31, 1994. Among the 87 cases, 30 cases were performed ultrasonography by radiologist and comparative studies were made. There were differences of time distribution for taking ultrasonography between E.D. and adiologist. While emergency ultrasonography was performed on 45 cases(51%), none of the cases received radiollogy ultrasonography within 1 hr. and 15 cases(30%) received radiology ultrasonography after 5 hrs. of arrival. Therefore we conclude that emergency ultrasonography is time efficient. In distribution of primary problems, medical problems counted 51 cases(54%), traumatic cases were 24 cases (27%) and obstetric and gynecology cases were 12 cases(14%). In comparison between the final diagnosis and diagnosis obtained from emergency sonography, sensitivity 95%, specificity 75% and accuracy 93% was obtained. The 30 cases (34%) out of 87 cases received both emergency and radiology ultrasonography and obtained a result of sensitivity 89%, specificity 100% and accuracy 90%. Diagnostic ultrasonography is very appropriate for use in emergency medicine and should be put in the hands of those who will use it to its fullest potential benefit.