중증 외상환자에서 염기 결핍수치의 유용성

문준동,김수진,문철규,최성혁,전정민,이성우,홍윤식 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Background: This study's objective was to determine the prognostic value of the base deficit measured in the emergency department(ED) and to determine whether base deficit can provide information not provided by advanced injury scoring system. Methods: This study was a retrospective analysis of data collected for two years. Thirty-two severe trauma patients who were admitted to the Emergency Department of Korea University Hospital were included in this study. The patients were divided into two groups: the normal base deficit group(-3 mmol/L to 3 mmol/L) and the elevated base deficit group(>3 mmol/L). The base-deficit value, age, sex, head injury, organ failure rate, and survival were considered, and the also Revised Trauma Score(RTS), Acute Physiology And Chronic Health Evaluation(APACHE II), and Injury Severity Score(ISS) were measured. Result: The elevated base-deficit group showed a lower survival rate and a higher organ failure rate compared to the normal base deficit group. Logistic Regression showed a strong association between base deficit and mortality rate. Among the previous injury scoring Systems(RTS, APACHE II, ISS), base deficit had the strongest correlation with RTS. By using base deficit value and the RTS together, we obtained a higher positive predictive value than that obtained by using base deficit or RTS alone. Conclusion: The admission value of the base deficit in the ED is a useful tool in predicting the outcome in severe trauma patients, and it can be an adjunct to previous injury scoring systems. As an advanced injury scoring System is developed in the future, the base deficit may have some significant role.

일차반응자의 기본 소생술 교육에 따른 질 측정 변수의 분석

문준동,최성혁 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.2

Purpose: As an emergency medical system provider, cardiopulmonary resuscitation (CPR) quality for first responder is an important determinant of cardiac arrest outcome. However, feedback on their CPR performance is often lacking. In this simulation study, we analyzed their CPR variables after CPR training based on high-quality CPR requirements highlighted by the 2010 American Heart Association updated guidelines. Furthermore, we aimed to compare the CPR quality between first responders and emergency medical technicians. Methods: Firefighters employed at Seoul metropolitan fire and disaster headquarters in 2011 and 2012 were included in the study. The data were collected from a PC Skill reporting System (Laerdal, Norway) 5 hours after CPR training. Outcomes included compression variables (depth, rate,hand position, full release, delivered per minute, duty cycle),ventilation variables (volume, flow rate) and hands-off time variables (hands-off fraction, time for airway and breathing,automated external defibrillator (AED)). Results: Sixty-one members to the emergency medical technician group and 66 members to the first responder group were recruited and were tested after CPR training. Results of the first responder group were as follows: for average compression variables, depth 57.6 mm, rate 108.3 numbers/min, correct hand position 90.0%, full release 100.0%,and duty cycle 40.8%. For average ventilation variables, volume 526.2 ml and flow rate 316.8 ml/sec. These values were same for both groups and showed no statistical significance. The number of compressions performed per minute was better in the emergency medical technician group (74.4 versus 70.6, p<0.002), as was total hands-off time (65.5 sec versus 73.2 sec, p<0.000) and hand-off fraction (32.0% versus 35.2%, p<0.000). Time for operating AED was found to be same for both groups but time for airway and breathing management was shorter in the emergency medical technician group (41.0 sec versus 48.0 sec, p<0.000)Conclusion: The first responder group showed that through short-term CPR training, overall measured quality of CPR was in compliance with international consensus guidelines. But total hands-off time was longer in the first responder group and the time spent for airway and breathing management rather than operating AED was significantly different between the two groups. Appropriate training programs for first responder's airway and breathing skills are required to minimize interruption time.

응급의료정보센터의 인지도와 응급의료 전화상담에 대한 조사

문준동,김낙훈,왕성배,최성혁,이성우,홍윤식 대한응급의학회 2005 대한응급의학회지 Vol.16 No.5

두부외상환자에서의 예후인자

최성혁,문준동,김수진,문철규,이성우,홍윤식 대한응급의학회 2001 대한응급의학회지 Vol.12 No.2

Background: Predicting outcome after head trauma is of great interest for clinicians, especially in the early stage. It may provide a basis for therapeutic strategies and may be helpful to select different approaches. But, reliable outcome prediction from head trauma is still unresolved. The purpose of this study is to determine which clinical parameters can be used effectively after an event of head trauma. Methods: In our study we studied head trauma patients who came to the Emergency department of Korea University Medical School Anam Hospital from the 1st of June 1998 to 31th of January 2000, looked into medical records, and studied the records in a retrospective manner. The head trauma patients were divied into two group, a) favourable outcome-related and b) unfavourable outcome-related. The two groups were then subdivided according to their sex, age, the mechanism of their injury, the time they came in, alcohol drinking, loss of consciousness, vomiting, pupil change, previous medical illness, associated injuries and were seperately compared and analyzed. And the factors affecting Glasgow Outcome Scale(GOS) were analyzed in the parameters of Injury Severity Score(ISS), Revised Trauma Score(RTS), Glasgow Coma Scale(GCS), motor score of GCS(mGCS), Marshall Computed Tomographic Classification(MCTC). Statistically, t-test and Mann-Whistney rank sum test using Jandel-sigma were used in the study and then were assessed in Chi-square analysis methods. The statistical significance was determined at a level of p less than 0.05. Results: The total of the head trauma patients, added up to 129 people, 99:males and 30:females. Among this sum, 99 patients showed a favourable outcome and 30 patients showed an unfavourable outcome at discharge. The causes of injury included: automobile accident in 42 cases; fallss in 26; assaults in 6; and accidental-slipping injury etc in 55 cases. 12 patients had bilateral unreactive pupils on admission, 2 had unilateral reactive pupils, and 113 had bilateral reactive pupils. Compared to the favourable outcome-related head trauma group, the unfavourable outcome-relared head trauma group had more history of loss of consciousness, unreactive pupils and tended to have previous medical illness. There were no difference in alcohol related, vomiting and associated injuries between two groups(favourable outcome-related head trauma group: unfavourable outcome-related head trauma group). Substantial difference were observed in GCS, mGCS, ISS, RTS, MCTC between two groups. Patients with unfavourable outcome had a significantly higher ISS, lower RTS, lower mGCS. After MCTC, patients with mass lesion had unfavourable outcome than patients with diffuse injury. Conclusion: Age, history of loss of consciousness, previous medical illness and unreactive pupil change are predictives of outcomes of head trauma patients with respect to Glasgow outcome scale. The lower GCS, lower RTS, lower mGCS, higher ISS, mass lesion based on CT scan provide poorer prognostic outcome in patients with head trauma. Use of prognostic factors thorough complete history taking and physical examination would provide useful prognostic information and facilitate improved therapeutic decision-malting in head-injuried patients.

구조자의 위치에 따른 적절한 후두마스크기도기 삽입방법은 무엇일까? : 검지손가락법과 엄지손가락법의 비교

천경하,문준동 한국응급구조학회 2017 한국응급구조학회지 Vol.21 No.3

2인구조자 심폐소생술 시 환기방법에 따른 가슴압박 중단시간의 비교 : 일개 대학병원 간호사를 대상으로

현광록,문준동 한국응급구조학회 2015 한국응급구조학회지 Vol.19 No.2

음주 외상 환자

이성우,문준동,최성혁,문철규,홍윤식 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: We studied the incidence of trauma caused by alcohol related accidents, and the effects that alcohol has on the occurrence, the extent, and the outcome to the patient. Methods: In our study we studied trauma patients excluding pediatric patients(15 years old and under) who came to the Emergency department of Korea University Medical School Anam Hospital from the 1st of January 1996 to 30th of June 1996, looked into their medical records, and studied the records in a retrospective manner. The trauma patients were devided into two groups, a) alcohol-related and b) alcohol-non-related. The two groups were then subdivided according to their sex, age, the time they came in, the anatomical part of the trauma, the mechanism of their injury, the extent of the injury, the length of their hospital stay, the length of their ED stay and were seperately compared and analyzed. Statistically, ANOVA and logistic regression analysis using SAS were used in the study and then was assessed in Chi-square analysis methods. Results: The total of the trauma patients, added up to 832 people, 577:male and 255:female. Among this sum, 163 trauma patients were alcohol related(male:127 & female:36). 115 people were in the age group of 21-40. Compared to the non-alcohol related trauma group, the alcohol-related group had more facial & scalp injuries and tended to come in the hours between 0-6 AM. The cause of the injuries were mostly by fist-fighting and suicide, compared to mostly accidental-slipping injuries in the non alcohol-related group. There were no difference in the degree of the injury(ISS) and the length of hospital stay between the two groups, whereas the length of the stay at the ED was longer to the alcohol-related trauma patients. Conclusion: Alcohol related trauma patients were mostly in their 20s and 30s, came to the hospital at a late time and the reason for their visit were mostly because of fist fighting. In the Emergency department, because prompt and correct diagnosis is quite difficult to make in this group, their ED stay tended to be longer. We can conclude that measuring the blood alcohol level of these patients, continuing the psychological therapy and educating people is needed.

중증외상환자에서 병원전 외상 처치가 현장체류시간에 미치는 영향

양진철,문준동 한국응급구조학회 2020 한국응급구조학회지 Vol.24 No.1

119 구급대원의 법의학 지식에 대한 연구

이희영,문준동,Lee, Hee-Young,Moon, Jun-Dong 한국응급구조학회 2019 한국응급구조학회지 Vol.23 No.2

Purpose: It is crucial that 119 emergency medical technician (EMT) have adequate knowledge regarding forensic science. This study aimed to assess the forensic knowledge of EMTs in the Republic of Korea. Methods: This study was conducted on EMTs of five fire stations in D metropolitan city between August 6 and August 13, 2018. A questionnaire consisting of items on crime-related incident recognition (i.e., mechanical asphyxiation, trauma, sex crimes, and child abuse), forensic evidence management (i.e., evidence collection, preservation, and recording) was administered to the participants. Finally, 119 questionnaires were analyzed. Results: The ratio of correct answers for crime-related incidents recognition was 55.82%, which was lower than that for forensic evidence management(84.5%). In particular, the scores for the type of neck compression(16.5%) and wound assessment(44.0%) were low. The percentage of correct answers for forensic evidence management was 78.4% for evidence collection, 84.4% for evidence preservation, and 90.6% for evidence recording. Previous forensic education experience was not a significant variable. Conclusion: Specific and practical forensic science education on perception of crime-related incident, including asphyxia and wound identification, and forensic evidence collection is needed.

급성 뇌졸중 의심 환자의 병원 전 지연 원인 분석

이남진,문준동 사단법인 한국응급구조학회 2020 한국응급구조학회지 Vol.24 No.2

Purpose: Stroke is a time-sensitive disease that could have reduced complications and mortality with timely diagnosis and treatment. This study aimed to analyze the causes of delay in detecting the clinical signs and symptoms of stroke. Methods: This retrospective observational study analyzed the emergency medical services reports of suspected stroke patients with positive predictive values on the Cincinnati Prehospital Stroke Scale. The study was conducted in Daejeon, Republic of Korea from January 1, 2016 through December 31, 2017. Results: Prolonged prehospital time was associated with high blood pressure, history of cerebrovascular disease, and incidences during daily activities, and sleep. High blood pressure and complications from a previous stroke strongly associated with the prolonged stroke-detection phase (p<.05). Total prehospital time was shortened when patients had evident stroke symptoms, such as decreased level of consciousness, dysarthria, and hemiplegia (p<.05). There was no significant difference in gender or age as a factor that delayed the total prehospital time of the suspected stroke patients. Conclusion: Many patients did not recognize the early clinical symptoms and signs of a stroke. Furthermore, risk factors, such as high blood pressure and history of stroke, prolonged the total prehospital time. Therefore, we need targeted interventions that educate about warning symptoms of stroke, along with emphasis on the importance of emergency calls to substantially reduce the prehospital delays.