다발성 외상 후 횡문근융해증 환자에서의 손상초기 급성신부전의 예측인자

문중범,이강현,황성오,이진웅,한병근,최승옥,강성준 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Background: Acute renal failure(ARF) is a serious complication of rhabdomyolysis after multiple trauma, and may increase morbidity and mortality. The aim of this study was to elucidate predicting factors for the development of ARF induced by rhabdomyolysis at an early stage of multiple trauma. Methods: This prospective, observational study was conducted at the emergency department of a level I trauma center. Patients with acute multiple trauma, whose plasma levels of creatine phosphokinase(CPK) were higher than 1,000 IU, were included in this study. We excluded patients with any history of myocardial infarction, stroke, underlying renal disease, and/or infectious disease. We collected clinical and laboratory data including age, heart rate, mean arterial blood pressure, injury severity score, serum myoglobin, lactic dehydrogenase, creating phosphokinase, and base excess. Collected data were compared between patients who had ARF and patients who did not have ARF. Results: Eighty-eight patients were enrolled in this study. Eighteen patients(20.5%) developed ARF. The injury severity score(ISS)(p=0.001), the base excess(p<0.001), CPK(p=0.003), and myoglobin(p<0.001) were higher in patients with ARF than in patient without ARF. Logistic regression analysis revealed that early predictors for ARF were high ISS, high base excess, high CPK, and high myoglobin. Conclusion: We could identify early predicting factors for acute renal failure induced by rhabdomyolysis, these factors included ISS, serum CPK and myoglobin, and base excess in the arterial blood gas analysis performed at the emergency department.

해군 심해잠수사의 폐기능에 대한 일반적 고찰

문중범 ( Moon Joong Bum ),차수강 ( Cha Su Gang ),김재현 ( Kim Jae Hyun ) 국군의무사령부 2004 대한군진의학학술지 Vol.35 No.1

Therapeutic administration of risperidone attenuates renal oxidative stress following whole-body ischemia and reperfusion injury in a rat model of cardiac arrest

채희진,문중범,조준휘,옥택근,신명철,박윤수,안웅찬,한다솜,허성미,노재성,이태경 대한응급의학회 2023 대한응급의학회 학술대회초록집 Vol.2023 No.2

응급센터에 내원한 급성 복통 환자의 진단관련 변수들이 초진 정확도에 미치는 영향 분석

조광윤,문중범,김동원,안무업,이재성,천승환,손유동,최기훈,조준휘,이태헌,김남호,서정열 대한노인병학회 2009 Annals of geriatric medicine and research Vol.13 No.4

Background: Abdominal pain is a common complaint seen at emergency centers. Various diseases can cause abdominal pain making it difficult to make a correct diagnosis. In the elderly, however, the consequences of an incorrect or delayed diagnosis can be more critical. We investigated the accuracy of initial diagnoses in the emergency center and analyzed the associations among medical factors including age. Methods: We compared the ICD 10 codes of initial diagnoses to the codes of final diagnoses, defined the ‘degree of agreement’ using a 5 point scale, and classified patients into ‘high degree of agreement’ or ‘low degree of agreement’ groups. According to the severity of illness, we classified patients as ‘admission’ or ‘out patient follow up’. According to their illness, we classified them as ‘surgical’ or ‘medical’. According to age, we classified them as ‘elderly’ or ‘adult’. Finally, we analyzed the statistical significance of each association. Results: Overall, admitted patients and surgical diagnoses had higher degrees of agreement. ‘Elderly’ patients had no significant difference in ‘degree of agreement’ from ‘adult’ patients. Conclusion: Among patients presenting with acute abdominal pain to the emergency center, the degree of agreement between initial diagnosis and final diagnosis is dependent on the diagnostic characteristics of the disease, and not on the age of the patients. Further studies on the diagnostic accuracy of individual diseases are needed. Additional diagnosis associated variables, for example comorbidity and prognosis, needs to be studied regarding relationship to dia- gnostic accuracy. 연구배경: 복통은 응급센터를 방문하는 환자 중 많은 수 가 호소하는 흔한 증상이다. 복통은 다양한 질환들에 의해 유발될 수 있으며, 진단이 쉽지 않은 경우가 많으며, 초기 진단이 잘못되거나 지체되는 경우 환자의 예후에 나쁜 영향을 준다. 또한 의료자원의 소모와 의료비용의 증가를 초래하게 된다. 그러므로, 급성복통질환의 초기진단의 정확도를 파악하고, 이에 영향을 주는 변수들과의 연관성을 분석하는 것이 응급센터의 진료의 질을 향상시키는 데 도움이 될 것이다. 방법: 조사기간 중 응급센터를 방문하는 환자 중 15세 이상 환자를 대상으로 초기진단 및 추적 검사 후 최종진단을 비교하였다. 초기진단과 최종 진단의 ICD‐10 질병 분류코드를 서로 비교하여, 그 일치한 정도를 5점 분류법을 이용하여 진단일치도로 정의하였다. 이를 비교하여 고일치도군과 저일치도군으로 분류하였다. 응급센터 진료 결과에 따라 입원 치료 시 입원군으로, 통원 치료 시 외래군으 로 분류하였다. 응급센터 담당진료부서에 따라 외과계군과 내과계군으로 분류하였다. 15세 이상 65세 미만을 성인군으로, 65세 이상을 노인군으로 분류하였다. 95% 신뢰수준에서 각 진단관련 변수의 통계적 연관성을 조사하였다. 결과: 개별 질환 중 급성 충수염, 요로결석, 급성 담낭염 등의 외과계 질환이 입원율 및 진단 일치도가 높았으며, 기능성 위장관 이상, 급성 위염 등 내과계 질환의 입원율 및 진단 일치도가 대체로 낮았다. 연령군별로 진단 일치도 는 통계적으로 유의한 차이를 보이지 않았다. 입원 여부 및 질환계통에 따라 진단일치도는 유의한 차이를 보였다. 결론: 응급센터를 방문하는 급성복통 환자의 진단 정확도는 개별원인 질환의 진료 특성과 관련이 있으며, 환자 쪽 특성인 연령과는 유의한 연관성이 없다. 개별진단의 진단 정확도를 비교하는 추가적인 연구가 필요하며, 합병증, 예후 등 다른 진단관련 변수와의 연관성에 대한 연구도 필요하다.

노인 심정지의 초기 동맥혈가스분석에서 자발순환회복 예측 지표에 대한 연구

임현준,조준휘,문중범,박찬우,신명철,김가을,박윤수,양고은,옥택근 대한응급의학회 2021 대한응급의학회지 Vol.32 No.2

Objective: The number of elderly patients in Korea has been on the rise recently, and hence the number of out-of-hospital cardiac arrest (OHCA) elderly patients is also rising. The causes of cardiac arrest for the elderly vary, and, it is difficult to predict the recovery of spontaneous circulation (ROSC) in OHCA patients. Therefore, the purpose of this study was to ascertain the predictive value of arterial blood gas analysis (ABGA) results in achieving ROSC in the elderly. Methods: A retrospective analysis of emergency department patients with OHCA was performed at the Kangwon National University Hospital, Korea from 1 January 2016 to 31 December 2019. The initial ABGA results were compared between two patient groups, those who had achieved a return of spontaneous circulation and those who had not. Univariate and multivariable analyses were performed to elucidate the factors associated with ROSC. Results: Overall, 229 OHCA patients were included in the final analysis. The lactate level was independently related to ROSC. A receiver operating characteristics (ROC) curve was plotted to obtain the best cutoff value. The lactate level <9.85 mmol/L showed the largest area under the ROC curve (AUC) to predict ROSC (AUC, 0.666; 95% confidence interval, 0.588-0.743). Multiple regression analysis was performed using the cutoff value, which was a lactate level of 9.85 (odds ratio, 2.907; 95% confidence interval, 1.432-5.902; P=0.003). Conclusion: The ABGA results during the cardiopulmonary resuscitation of OHCA patients, showed that the lactate level was an independent factor associated with ROSC. The lactate cutoff value was 9.85 mmol/L.

일개 도 지역 자살 시도 환자에 대한 병원전 단계 분석

김기환,조준휘,문중범,박찬우,신명철,김가을,이준석,박윤수,옥택근 대한응급의학회 2018 대한응급의학회지 Vol.29 No.6

Objective: This study examined the characteristics of suicidal attempters, including pre-hospital patients and those who visited the emergency department. Methods: Suicidal attempters who had been reported to the 119 call center were selected between July 2015 and June 2016. Sex, age, place, methods of suicidal attempt, season, time, and suicide success rate were reviewed in the fire center records. Results: A total 961 suicide attempters were enrolled. Among them, 53.6% were males who had an approximately 2.6 times higher mortality than that of females (9.2%). The most preferred place to commit suicide was the home in both sexes (68.0% in male, 82.8% in female) and the most preferred methods was drug intoxication, particularly pesticide. The method with the highest mortality was hanging and the lowest was self-harm. The season of the highest mortality was spring. The success of suicide and the time variation were similar. Most of the un-transferred patients also selected fatal suicide attempts compared to transfer patients. Conclusion: Unlike previous studies, this study includes information on un-transferred patients. Overall, the probability of death was highest as more than 50 years men chose hanging as a method, which had an influence on the un-transferred patients group.

1개 대학병원에 내원한 자살시도 사망자와 생존자의 비교 분석

황병선,조준휘,문중범,옥택근,신명철,김가을,이준열,박윤수,이강욱,이희영,양고은,박찬우 대한응급의학회 2020 대한응급의학회지 Vol.31 No.1

Objective: This study analyzed the characteristics of people who attempted suicide that resulted in deaths as compared to that of the suicide survivors. Methods: This study included 799 suicide attempts that occurred from March 1, 2015, to March 31, 2019 at the emergency department of the university hospital in a city of around 300,000 people. Suicide attempts were classified into the survivor and death groups, and the characteristics of each group were compared. The suicide deaths due to re-attempts were also analyzed. Results: There were more males than females in the death groups. There was a high proportion of people aged 50 or older in the death groups. Hanging, carbon monoxide poisoning, and jumping from great heights were the most commonly used methods of suicide in the death groups. In the selected death group, psychiatric symptom, physical illness, and economic problem among the suicidal causes and depressive disorder among the psychiatric diagnoses were factors that increase the risk of suicide death. Sixty-three point four percent of the survival groups and 52.5% of the selected deaths had not received psychiatric care. On the analysis of suicide deaths due to re-attempts, the average number of suicide attempts was 2.45±0.9. The time from the first suicide attempt to the last suicide attempt was 13.8±10.4 months. Conclusion: If it is necessary to make a treatment decision for a suicide attempt in a limited time, such as the case of treating a suicide attempter who visits an emergency department, it is necessary to consider the characteristic factors of the death attempts of suicidal people.

일개 도 지역 의도적 음독에 대한 병원전 단계 분석

안웅찬,조준휘,문중범,박찬우,신명철,김가을,이준열,박윤수,황병선,양고은,이희영,김민수,천인국,옥택근 대한응급의학회 2020 대한응급의학회지 Vol.31 No.1

Objective: This study examined the characteristics of the patients taking poison intentionally at the pre-hospital stage to prevent it at the community level. Methods: We retrospectively reviewed the data that had been reported to fire stations from January 2017 to December 2018. This data included sex, age, occupation, the season of the year, time, place, methods, alcohol ingestion, transferred to the hospital or not, and we examined how taking poison had an effect on the suicide success rate. Results: The subjects were a total of 1,356 patients who had been reported to fire stations due to intentionally taking poison. Forty-five point five percent of them were male, and 54.5% were female. The most common method of intentional taking poison was sedatives (58.3%), followed by pesticides (24.6%), antidepressants (19.0%), and other methods (12.6%). The home place was preferred more than any other places. The suicide success rate was 2.1% in males and 1.4% in females. For the age groups, those patients 40-64 years old tried taking poison much more than the other age groups. In the aspect of the season of the year, summer was the highest season for taking poison, at 30.3%. The daytime was more preferred than the night time. Conclusion: In this study, we analyzed the characteristics of the pre-hospital intentional poisoning cases according to gender, age, occupation, season of the year, time, and between the transferred and the untransferred groups. Efforts should be made in cooperation with the community to prevent suicide attempts by intentionally taking poison.

Aucubin exerts neuroprotection against forebrain ischemia and reperfusion injury in gerbils through antioxidative and neurotrophic effects

조준휘,옥택근,문중범,신명철,박윤수,안용찬,한다솜,채희진,허성미,이태경,박준하 대한응급의학회 2023 대한응급의학회 학술대회초록집 Vol.2023 No.2

지리정보시스템(geographic information system)을 이용한 응급환자 발생장소와 이송병원에 대한 분석정보의 시각화

한다솜,조준휘,문중범,옥택근,신명철,박윤수,김창환,배선학 대한응급의학회 2023 대한응급의학회지 Vol.34 No.6

Objective: Easy-to-understand information on emergency patient transportation and emergency medical resources is required to operate emergency medical resources appropriately. This study evaluated emergency patient transport routes using a geographic information system (GIS) and converted them into visual information to understand the current status of emergency medical resource use in the region. Methods: The basic data used in this study were collected from the 119 safety centers in Gangwon-do, South Korea, under the fire-fighting headquarters in Gangwon-do from January 2017 to December 2020. The data were analyzed using the geographic information system and converted to visual information. Results: The number of patients with cardiovascular disease, cerebrovascular disease, and traffic accidents was 12,944. Of these, 9,393 patients (72.6%) were transported from Chuncheon city, and 3,551 patients (27.4%) were transported out of Chuncheon city. The number of patients with cardiovascular diseases during the study period was 1,219 (9.4%); 782 patients (64.2%) were transported to the K-EMC (emergency medical center), and 437 patients (35.8%) were transported to the H-EMC. For cerebrovascular disease, 913 patients (7.1%) were transported to the EMC of Chuncheon city, with 585 (64.1%) K-EMC and 328 (35.9%) H-EMC patients. The number of traffic accident patients was 1,266 (9.8%). Five hundred and forty (42.7%) and 726 (57.3%) patients were transported to the K-EMC and H-EMC, respectively. Conclusion: The adequacy of facilities, equipment, and human resources required to treat cardiac and cerebrovascular diseases in K-EMC and severe trauma in H-EMC needs to be reviewed.