노인외상환자의 예후 인자

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

Background: It has been documented that certain prognostic factors may affect the outcomes of the old aged victims by trauma. Considering that trauma is the sixth most common cause of death in people over the age of 65 years and there is a rapid growth of elderly population, it is paramount to understand the prognostic factors when dealing with geriatric trauma patients. Hypothesis and Goals: It can be hypothesized that the prognostic factors should be determined independently between populations being consisted of different races, countries, socio-economic states, cultures, or so on. Thus, the study was designed to evaluate the factors affecting the outcomes of elderly Korean trauma patients. Methods: One hundred forty six patients aged over 65 years were retrospectively reviewed, who visited the Emergency Center of Korea University from January, 1997 to June, 1998. Of 146 patients, 7 were excluded due to discharge against advice or transfer to the other hospitals. Parameters analyzed were age, sex, mechanism of injuries, body region injured, Injury Severity Score (ISS), previous medical illness, hospital morbidity, duration of hospital stay, and cost. Each patient was classified into improved or not-improved group depending on the outcomes, and young-old or old-old group depending on the age. The factors affecting the hospital stay in improved patients were analyzed in the parameters of previous medical illness, hospital morbidity, multiple injuries, ISS, and age. All statistical tests were conducted with two-tailed levels of 0.05. Results: Of 139 patients, the mean age was 74±7.1 years, mean ISS 9.3±7.26, mean hospital stay 27±27.1 days. Most commonly injured body region was the extremities due to fall from a level surface. Rate of previous illness showed 0.94 medical diseases per person and were aggravated after trauma in 39 patients (60.9%). Hospital morbidity rate was 0.46 incidents per person. There were no differences in age and duration of hospital stay between the improved and the not-improved group. Substantial differences were noted in affected body region, incidence of previous illness, and hospital morbidity between the groups (p=NS). Not-improved group had higher ISS(p<0.05). ISS, previous illness and hospital morbidity affected the duration of hospital stay in the improved group. Hospital stay was 40±25.1 days in patients with ISS over 6 while 6±8.6 days in those with ISS 5(p<0.05). Hospital stay in the improved was 26±26.9 days while 31±24.8 days in the improved old-old group (p=NS). Hospital stay in the young-old minor trauma (ISS5) patients with previous illness and hospital morbidity was 26±10.1 days while 4±7.3 days in those without previous illness and hospital morbidity (p<0.05). Conclusion: Previous medical illness and hospital morbidity, not age, are predictive of outcomes of geriatric trauma patients with respect to hospital stay. As most of the hospital morbidity was a trauma-induced aggravation of previous medical illness and hospital morbidity contributing poor outcomes can be potentially avoidable, routine aggressive care for the geriatric trauma patients with previous medical illnesses is needed.

응급센터에서의 집중치료

문철규,최성혁,이성우,전정민,홍윤식 대한응급의학회 1997 대한응급의학회지 Vol.8 No.2

Study Object: To date, the study of critical illness in the emergency department has been limited. The purpose of this study was to determine the length of stay and procedures performed on critical care patients in ED, and to be help to estabilish Emergency physicians` education program. Method: We reviewed patient`s medical record, who visited ED, Korea Univ. Hospital from Jan. 1996 to Jun. 1996 and admited to ICU. We analyzed data to age, sex, clinical diagnosis, length of stay, and critical procedures in ED. Results: The 12,721 patients visited ED during the study period, the 441 of 12,721(3.50%) patients admited to ICU. 56 patients were excluded whose medical re cords were incomplete. The study populations consisted of 164 women and 220 men. The mean age were 52 year old(median, 58 year old). The mean length of stays were 606.1(1445.9minutes(median, 180 minutes). One hundred sixty one of these patients(41.8%) recieved one or more critical procedures. The medical critical patients were 252 cases, and surgical critical patients were 133 cases. The mean length of stay of medical critical patients was 738.8(1748.9 minutes(median, 177.5 minutes)in medical department, 44.0% of them recieved critical procedures in ED. The surgical critical patients averaged 354.9(410.7 minutes(median, 190 minutes) and 37.6% recieved critical procedures. Conclusion: Critical ill patients stay in the ED with a substantial amount of time, before admition to the ICU. Critical ill patients who have hemodynamiccal unstable conditions, compromized cardiopulmonary functions, and neurologic deficities, were managed in ED frequntly. Typical critical care procedures are commonly performed by emergency physicians. Therefore, it is important for emergency physician to prepare to critical ill patients.

외상 환자 치료의 적정성 비교

최성혁,문철규,전정민,이성우,홍윤식 대한응급의학회 1997 대한응급의학회지 Vol.8 No.2

As the productive activities have vastly increased following industrialization and urbanization in the modern society, the resulting high mobility of people and goods have caused a sharp increase in the accidents in the work places as well as traffic accidents. In particular, deaths caused by injuries are generally concentrated in the economically active young peoples, producing incalculable losses to the society and nation as a whole. Advanced nations with superior medical care systems have succeeded in reducing incidents of such deaths by operating trauma centers. Especially noteworthy is the case of the United States where such specialized trauma centers have greatly contributed to reducing deaths from injuries in the non-urban areas with less access to medical facilities. At present Korea has no medical centers specializing in injuries. In large cities, the injuries are being treated tertiary medical facilities while in the provinces they are referred to small and medium-sized hospitals that constitute secondary medical facilities. Currently in Korea the trauma patients are treated at general hospitals that consist of 726 secondary medical facilities and 40 tertiary medical centers nationwide. The secondary medical facilities which tend to take most responsibility for the treatment of trauma are generally deficient in medical staff and facilities(including operating and intensive care facilities). Despite such deficiency and limitations, no regulations treatment or transportation of trauma patients. This article reports the outcome of a comparative analysis of the results of trauma treatments among different types of medical facilities based on objective data in the hope that such study would facilitate a comparison with the treatment systems of advanced countries and thereby contribute to a precise formulation of problems that must be addressed in this area.

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.

외상성 기흉에 동반된 후복막기종 : 증례보고 Case Report

홍윤식,이성우,최성혁,전정민,문철규,문준동 대한외상학회 1998 大韓外傷學會誌 Vol.11 No.1

We describe a 23-year-old patient from blunt injury after motor vehicle accident. The cardiorespiratory and mental status were sufficient. He had pneumoretroperitoneum, left pneumothorax, complex zygoma fracture and left clavicle frature. Close drainage of left hemithorax and the diagnostic workups were done for evaluation of retroperitoneal free air. As free retroperitoneal gas has its source in a ruptured retroperitoneal viscus in common case, close attention was paid to possible abdominal symptoms. Abdominal computed tomography failed to demonstrate any pathology except free air in retroperitoneum. Surgical exploration of intraperitoneun and retroperitoneum wasn't revealed any injury. The patient was discharged after fixation of zygomatic fracture. The underlying pathophysiology of free retroperitoneal air in the absence of viscus and diaphragm lesions are discussed and the literatures are reviewed.

가정내 폭력 : 응급실 내원 환자를 중심으로

이성우,전정민,최성혁,문철규,홍윤식 대한응급학회 1998 대한응급의학회지 Vol.9 No.2

Background: Domestic violence once considered an infrequently occurring event existing only in deviant relationships, it has been more recently recognized as a widely distributed phenomenon resulting from multiple cultural social, psycological factors. According to declining world economics, family violence rises with a simultaneous curtailment of agencies available to assist battered persons and there is increasing pressure on emergency departments to serve those who might otherwise have sought help from public agency. In Korea, we don't have any clinical data about domestic violence, and authors analysed clinical pictures of domestic violence victims who came to the emergency department of Korea University medical center. Method: We reviewed the victims of the domestic violence retrospectively, who visited in ED, Korea Univ. Hospital from Jan. 1996 to the Dec. 1996. We Analysed data to Age, Sex, Injury severity score, location of injury, mechanism, perpetrator. Results: During the study period, total 134 domestic violence victims were identified. The young, females were predominantly victimized. And married women were more commonly violated.(about 70%). ISS was relatively mild (2.491), face and head were mainly injuried by punching and objects throwing. The Prevalence of domestic violence victims almost presented at Emergency department between 6:OO/P.M.and 8:00A.M.. Conclusion: Emergency physicians suspect domestic violence victims who injurd at face and head by punching or hitted wound. In these patients, we need more detail history and physical exam. And in case of repeated domestic violence, refer to neuropychatry dept and social workers with perpetratrs, and need mere concerte social programs for domestic violence.

MIMO 무선 LAN 프리앰블 구조 및 동기 알고리듬

이규인(Kyuin, Lee),문철규(Chulkyu Mun),조용수(Yongsoo Cho),위정욱(Jungwook Wee),최광호(Kwangho Choi) 한국통신학회 2003 한국통신학회 학술대회논문집 Vol.2003 No.7

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.

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.

병원 내 재난

홍윤식,이성우,최성혁,전정민,문철규 대한외상학회 1997 大韓外傷學會誌 Vol.10 No.2

Disaster is defined as an occurrence "when the destructive effects of natural or manmade forces overwhelm ability of a given area or community to meet the demand for health care". To be increased large hospital, events that affect the safety of the hospital environment are increased. Hospital disaster planning should encompass events that affect the safety of the hospital environment. Although most of the emphasis has been placed on general disaster planning, there is little written about disaster occurring within a hospital. Well organized medical team in disaster plan ins very important. We discuss implication of internal disaster and the design of a personal plan to be established to minimize functional disturbance. We analyze the patient's medical record who visit ED. Korea Univ. Hospital from Jan. 1996 to Jun. 1996 and admitted to ICU and estimate number of needed medical person at hospital disaster. We classified in-patients to 4 class 1 patients have unstable vital sign and non-ambulation, class 2 have stable vital sign, non-ambulation, class 3 have stable vital sign, ambulate with wheel-chair, class 4 have stable, ambulation without any help. We analyzed time duration to check blood pressure, respiration rate, pulse rate, estimate mental state. And then, we presumed number of needed triage team. We presumed maximum motality and morbidity, if hospital building is totally collapsed. Estimated number of medical person are sufficiently reflected to hospital disaster planning. And every hospital should have a comprehensive internal disaster plan because it is likely that at some time an internal emergency may occur. The emergency physician play a key role in hospital disaster plan. He carry out triage, stabilization, initial treatment and transport at collecting point Because emergency physicians interface with EMS, the community, and the hospital, they must embrace their role as leaders in hospital disaster planning.