구급일지를 통한 병원 전 환잔 분류 및 처치의 적절성 평가 연구

민순식,김재광,이근,박철완,양혁준,류일,현성열,이훈규,정환모,김윤 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: Recently, patients' demands for emergency medicine are increasing, and most of prehospital medical care, including basic life support, cardiopulmonary resuscitation and triage, are provided by paramedics or emergency medical technicians. Evaluation of the adequacy of prehospital management and triage has become important for improving the quality and the effectiveness of the emergency medical system. Methods: The 202 patients who were transferred by ambulance with paramedics, nurses, or emergency medical technicians to the Emergency Department in Gil Medical Center from July 1, 1999, to September 31, 1999, were enrolled. This study was conducted prospectively by using the emergency physician,s log and newly devised protocols recorded by paramedics or nurses. Results: 1) Male to female ratio was 1: 0.8, and the peak age of the patients were the 4th(18.8%) and 6th decade(15.3%). 2) Of the 202 patients, 84 patients were transferred for trauma and 118 for medical problems. The mean transfer time was 6±1.73 minutes. 3) The validities of prehospital triage and decisions using the trauma severity measure and the disease severity measure, were 33.3% in trauma patients and 57.6% in medical patients.4) The results for the adequacy rate in prehospital management analyzed by using the rate of necessity of treatment. performance of treatment, and adequate treatment were as follows: oxygen supply.38.1/41.6/93.8 ; wound dressing. 19.3/71.8/92.9 ; immobilization of the cervical spine, 15.8/56.3/92.9 ; application of a spinal board. 12.9/42.3/72.7 ; application of a splint, 9.9/50.0/60.0 ; manual maintenance of an airway. 9.9/55.0/63.6 ; and CPR, 4.5/66.7/0. 5) Kind of ALS(Advanced Life Support) were not conducted(peripheral IV, EKG. intubation, medical administration. defibrillation, pacing). The rates of necessity of treatment were as follows: peripheral IV, 40.6%; ECG monitoring, 23.3% ; endotracheal intubation, 8.9% ; medical administration, 8.9% ; defibrillation. 3.5%; and pacing. 1.5% Conclusion: The adequacy of prehospital triage and decisions using trauma and disease severity measures was relatively low. To improve the adequacy of BLS(Basic Life Support) and to increase the performance of ALS(Advanced Life Support), we must create challenges to develop new protocols and to supplement new equipment.

경증 두부 외상 후 발생한 저나트륨혈증 3례

이근,박철완,표창해,안석근,임용수,민순식 대한응급의학회 1998 대한응급의학회지 Vol.9 No.1

Many patients whose chief complaint is headache caused by accident such as traffic accident, falling, or assaults visit to emergency center. Majority of these patients has mild or moderate symptoms, and there is no need to treat surgically. However, the fact that head injury can cause SIADH(syndrome of inappropriate secretion of antidiuretic hormone)is likely to be overseen. Acute hyponatremia might have been associated with death or permanent brain damage. Hyponatremia is best handled by early recognition and correction of a downward trend in the serum sodium. Unfortunately, this is often difficult in the head-injured patient, where hyponatremia may occur fairly rapidly and is confused by symptoms of head injury. When moderate to severe hyponatremia occurs, it is important to determine its etiology and expeditiously initiate corrective action. There has not been any reported case of the occurrence of symptomatic SIADH after mild head injury in Korea yet. The authors report the experience of three cases of symptomatic SIADH after mild head injury with review of the literatures.

심근 좌상 환자에서 ^(99m)Tc-MIBI-Heart SPECT의 유용성

신중호,양혁준,이근,민순식,염석란,김재광,임용수,진욱,현성열 대한응급의학회 2002 대한응급의학회지 Vol.13 No.1

Purpose: This study analyzed the value of ^(99m)Tc-MIBI SPECT(Single Photon Emission Com-puted Tomography) in the deagnosis of myocardial contusion after blunt chest trauma. Methods: We evaluated 24 patients with cardiac contusions after blunt chest trauma who were diagnosed by clinical symptoms, chest x-ray, electrocardiogram(ECG), and Creatine phospho-kinase(CPK). ^(99m)Tc-MIBI SPECT was performed within 48 hours along with the above tests prospectively. Results: 1. Among the 24 patients, 14 patients were finally diagnosed as having a myocardial contusion by means of ECG, echocardiography, (^99m)Tc-MIBI SPECT, and cardiac enzyme. 2. The sensitivity, specificity and accuracy of ^(99m)Tc-MIBI SPECT were 46.7%, 66.7%, and 54.2%, respectively. The same results for initial ECG were 46.6%, 88.9%, and 62.5%. 3. For those who had positive findings in ^(99m)Tc-MIBI SPECT, average hospital stay was 14.5 days and abnormal electrocardiogram was found in 90.0%. However, for those who had negative findings, average hospital stay was 11.2 days and abnormal electrocardiogram was found in 35.7%. Conclusion: ^(99m)Tc-MIBI SPECT is not a definite modality in diagnosing myocardial contusion, but can be useful in diagnosing and determining the need for hospitalization after cardiac contusion.

대형 화재로 인한 사상자의 손상 유형과 합병증 : 동인천 라이브호프 화재를 중심으로

신중호,김재광,염석란,신종환,민순식,임용수,양혁준,이근,황성연 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Background: High risks of fire alway exist for buildings in urban areas, especially those in downtown. Crowds, as well as more complex and larger structures, may cause more victims in the event of fire; therefore, emergency medical service plans must be established for such disastrous events. Methods: On the evening of October 30,1999, a fire broke out in downtown, Dong-Incheon Live-Hof restaurant; 56 people were killed and 76 were injured. Most of them were teenagers. We retrospectively reviewed the medical records of the victims, Results: 1) Among the 56 dead, 54 died from smoke inhalation, one from extensive burns, and one from sepsis during treatment. 2) Among the 76 injured, 70 patients suffered from smoke inhalation, 53 from burns, and 9 from several types of trauma (sprains, contusions, lacerations, abrasions, fractures, etc.). 3) Later complications were laryngeal edema, pulmonary edema, scar contracture, and hypoxic brain damage, and so forth. 4) Post traumatic stress syndrome was unexpectedly more prevalent in mildly to moderately injured survivors and witnesses than in seriously injured survivors. Conclusion: Many complications exist after a fire. Some may be resolved in time, but others may result in permanent sequelae. Early rescue, early triage, and early management during transport by emergency medical service (EMS) personnel can result in fewer complications and a lower mortality rate. Therefore, we propose the establishment of plans to be followed during various major disasters.

복어 중독의 임상적 고찰

안석근,임용수,김재광,민순식,류일,양혁준,박철완,이근 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.3

Background : Puffer fish can be the source of lethal food poisoning in humans. Tetrodotoxin(TTX) poisonings are not infrequently seen in Korea, but there are few clinical reports. So we reviewed the patients of TTX poisoning and analyzed the clinical characteristics of patients. Methods : A retrospective study was performed of 40 patients who visited Chung Ang Gil Hospital from Jan. 1, 1995 to May. 31, 1998 with a diagnosis of TTX poisoning by a review of patients medical records and telephone inquiries. The diagnosis of TTX poisoning was made by causal links between consumption of puffer fish and the development of typical symptoms of tetrodotoxication. The clinical severity of the patients in this study was classified according to the classification of Fukuda. Results : Mean age of the patients was 40 years. The highest incidence was in the 4th decade in 21 patients(52.5%). The ratio of male to female was 3.44:1. Seasonal distribution excluding cases in 1998 was 12 patients in spring, 6 in summer, 5 in autumn and 12 in winter. The mean interval between consumption and symptom onset was 137 minutes. Common initial symptoms were circumoral numbness(32 patients) and paresthesia of extremities(24 patients). Various symptoms were developed after ingestion of puffer fish such as neuromuscular(39 patients), cardiovascular/pulmonary(23 patients) and gastrointestinal(16 patients) system. Mean recovery time from the onset of symptom was 22.00 hours. All were treated with symptomatic and supportive measures and recovered completely without sequelae. In 2 cases ventilatory supports were applied for 18.5 hours and 31.5 hours respectively.

응급실내에서의 외상성 심장파열의 조기진단

김정철,김창현,김재광,양혁준,이훈규,민순식,이근,현성열,박희권 대한외상학회 2000 大韓外傷學會誌 Vol.13 No.2

Background: Survival from traumatic cardiac rupture is rare. Though the diagnostic methods and operative skills have been markedly improved recently, The mortality rate still remains high. However, victims with traumatic cardiac rupture who reach the hospital alive can be saved by early diagnosis and immediate surgical management. Method: Between February 1997 and July 1999, seven consecutive patients with penetrating or blunt injury to the heart visited our emergency center and were operated on at the Department of Thoracic and Cardiovascular Surgery in Gil Hospital of Gachon Medical School. The authors reviewed their medical and operation records retrospectively. Results: 1. The male-to-female ratio was 2.5:1. The causes of penetrating injury was stab injury by knife in 3 cases and by grinder in one case. The causes of blunt injury were encompassed passenger traffic accident in 1 case and pedestrian traffic accident in 2 cases. 2. The major common sites of cardiac injury were the rt ventricle in 3 patients with penetrating trauma and the 1t ventricle 2 patients with blunt trauma. 3. The frequently associated injuries in blunt cardiac rupture were rib fracture (4 cases) and hemothorax (5 cases). 4. Echocardiography was performed in 6 cases, and pericardial effusion was detected in all case. 5. The average time interval from arrival to operation was 100 minutes for penetrating injuries and 90 minutes for blunt injuries. 6. The mortality rate for patients with a penetrating cardiac rupture was 25% (1/4) and that for patients with a blunt cardiac rupture was 77% (2/3). Conclusion: In the emergency room, the place where emergency patients are treated called the ER, emergency room, bedside 2-D echocadiography was useful in detecting anatomical abnormalities in suspected cardiac rupture patients with unstable conditions. Echocardiography must be immediately available in the resuscitation area and must be performed and interpreted by the emergency physician or surgeons in the emergency room.

외상성 횡격막 손상의 임상적 분석

진욱,김재광,양혁준,박철완,이훈규,이근,민순식,류일,현성열 대한외상학회 2000 大韓外傷學會誌 Vol.13 No.2

Background: Traumatic rupture of the diaphragm after blunt trauma is rare, but traumatic rupture and injuries of the diaphragm are on the increase and commonly result from blunt truncal traumas or penetrating stab wounds. The diagnosis of blunt traumatic rupture of the diaphragm often is difficult in the absence of accompanying abdominal or thoracic injury and is often delayed because of serious concurrent injuries and a lack of specific clinical signs and symptoms. Delayed diagnosis of a diaphragmatic rupture with accompanying strangulation of a herniated viscera results in higher morbidity and mortality rates. The aim of this study is to help early diagnosis and treatment by evaluating patients with blunt or penetrating diaphragmatic injuries. Methods: A clinical analysis was made of 21 cases of blunt and penetrating diaphragmatic injuries which had been treated during the 8 years from January 1992 to December 1999 at the Department of General Surgery and Chest Surgery, Gachon Medical College Center. These records were studied in a retrospective manner. Results: The results are as follows: 1) The most common ages were in the 3rd and 4th decades (28.6% and 28.6%). There were 16 males and 5 females (M:F=3.2:1). 2) The traumatic ruptures of diaphragm were due to blunt trauma in 16 (76.2%) patients and penetrating trauma in 5 (23.8%) patients. 3) The most common symptoms were abdominal pain (76.2%), chest pain (66.7%), and dyspnea (47.6%). 4) Seventeen of the 21 patients were diagnosed before operation; five patients were diagnosed during operation. 5) Twelve of the 21 patients were operated on within 24 hours (57.2%). 6) The most common associated intraabdominal injured organ was the liver; the most common herniated organ was the stomach. 7) The operations were done using a laparotomy alone in 15 patients, a thoracotomy in 5 patients, and a thoracoabdominal incision in 1 patient. 8) Postoperative complications developed in 3 patients (14.3%). 9) There were no deaths. Conclusion: Diagnosis of diaphragmatic rupture and injury is a great challenge to the surgeon. To prevent delays in diagnosis and attendant complications, the surgeon and the emergency physician must maintain a high index of suspicion for the presence of diaphragmatic trauma in patients with blunt injuries, particularly in the presence of accompanying thoracoabdominal injury.

방광 파열의 진단에 있어서 복부 전산화 단층 촬영과 지연성 신-뇨관-방광단순촬영의 의의

강영준,진욱,임용수,김재광,류일,현성열,양혁준,이근,민순식 대한응급의학회 2005 大韓應急醫學會誌 Vol.16 No.1

급성 대동맥박리증의 수술성적 및 수술전 처치에 대한 임상적 고찰

현성열,박국양,이재웅,이창하,전양빈,박철현,염석란,신종환,민순식,김재광,임용수,양혁준,진욱,류일 대한흉부외과학회 2002 Journal of Chest Surgery (J Chest Surg) Vol.35 No.12

배경: 대동맥박리증은 사망률이 매우 높은 질환으로 조기 진단 및 치료가 되지 않으면 예후가 매우 불량한 질환이다. 최근 컴퓨터단층화촬영과 심초음파 기술의 발달로 진단률이 높아지고 조기수술이 가능하게 되었으며 술전 응급실에서 적극적인 약물투여로 사망률이 낮아지고 있는 상태이다. 따라서 이 연구는 후향적으로 응급실에서의 처치 및 수술 결과를 분석하였다. 대상 및 방법: 1991~2001년까지 외과적 교정술을 시행받은 급성 대동맥박리증 환자 42명을 대상으로 하였다. 남자가 18례, 여자가 24례였으며 연령은 평균 51.1세였다. 또한 응급실을 경유한 경우가 34례, 외래를 통한 입원이 8례였다. 결과: 수술은 상행대동맥치환술이 26례였으며 이중 대동맥판막 치환술을 병행한 경우가 7례였다. 하행대동맥치환술은 7례였으며 Bentall술식은 9례에서 시행하였다. 응급실 내원시 혈압강하제와 β-수용체차단제를 20례에서 투여하였으며 이중 6례(30%)에서 사망하였다. 이런 약물을 투여하지 않은 22례환자중 10례(45.5%)에서 사망하였다. 전체 사망은 16례(38%)였다. 결론: 대동맥박리증은 응급실이나 외래에서 조기진단이 필요하며 가능한한 비침습적 검사방법을 택하고 환자상태에 따라 적극적인 술전 약물처치가 이루어져야 할 것으로 생각된다. Clinical Analysis of Surgical Results and Preoperative Management of Acute Aortic Dissection