Serial Measurements of C-reactive Protein and Albumin Levels in Prediction of Prolonged Mechanical Ventilation in Pesticide-Intoxicated Patients

배병관,박성욱,이성화,한상균,염석란,조석주 대한응급의학회 2012 大韓應急醫學會誌 Vol.23 No.5

Purpose: This study attempted ot determine whether serial measurements of serum C-reactive protein (CRP) and albumin levels can be used for prediction of prolonged mechanical ventilation (PMV) in patients with pesticide intoxication. Methods: We conducted a retrospective analysis of 36pesticide-intoxicated patients who were admitted to the intensive care unit (ICU) and received mechanical ventilation for >72 hours between January 2010 and December 2011. Patients were divided into two groups: patients on mechanical ventilation for ≥15 days (PMV group; n=9) and patients on mechanical ventilation for <15 days (non-PMV group; n=27). Clinical and laboratory parameters were measured at presentation to the emergency department (ED). CRP and albumin levels were measured at presentation and thereafter for nine days. Results: A higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, a longer time to reach peak CRP level (CRP duration), and a larger decrease in albumin levels (ΔAlbumin) were observed in the PMV group,compared with the non-PMV group. Of these parameters,duration of continuous increasing CRP levels for >4 days [odds ratio (OR), 2.06; 95% confidence interval (CI), 1.10-3.86] and ΔAlbumin >2.0 g/dL (OR, 7.81; 95% CI, 1.04-58.67) showed an independent association with PMV. Conclusion: Serial measurements of serum CRP and albumin levels can be used for identification of patients at risk for PMV. Increase in serum CRP level for more than four consecutive days and decrease in albumin level greater than 2.0 g/dL could discriminate PMV patients from non-PMV patients.

10年後의 保險會社

배병관 성균관대학교 무역연구소 1997 세계보험 시장과 한국의 보험회사 Vol.1 No.-

Is it reasonable emergency department doctor must activate the whole trauma team if they meet the patients who fell above 20 feet?

태원웅,배병관,왕일재,한상균,박성욱,김형빈,조영모,박순창,이성화 대한응급의학회 2020 大韓應急醫學會誌 Vol.31 No.1

Objective: Many trauma centers use their own criteria for major trauma patients, and these criteria are organized according to physiological causes and their related mechanisms. Mechanism related criteria have high sensitivity but low specificity. We confirmed 20 feet as a single factor for trauma team activation criteria. Methods: This study was retrospectively conducted in the Pusan National University Hospital trauma center, which is a level 1 trauma center in Busan. Patients were grouped as group 1, a fall from less than 20 feet; and group 2, a fall from more than 20 feet. We compare the two groups of prognostic factors using logistic regression analysis. Results: The relationship between the height of the fall and the patient’s prognosis showed a positive relationship on the logistic regression analysis. Yet the cut-off value of a 20 foot height showed poor predictive power for the patient’s prognosis. Conclusion: In conclusion, as trauma team activation criteria, a 20 foot height seems to be a reasonable aspect of patients’ clinical prognosis between above 20 feet and below 20 feet. Yet it seems to be controversial as a cut-off value. Thus, more studies will be needed to identify a specific height for trauma team activation.

Carbon monoxide poisoning-induced type 1 Brugada electrocardiographic pattern

조영모,염석란,조석주,배병관,이대섭,현태규,안진희,왕일재 대한응급의학회 2021 大韓應急醫學會誌 Vol.32 No.5

Carbon monoxide (CO) can cause a variety of electrocardiogram (ECG) changes. The Brugada ECG patterns are very rare in CO poisoning cases. We detected a patient with a CO-induced type 1 Brugada ECG pattern with chest pain. The panel genetic test and echocardiogram revealed normal findings. The Brugada phenocopy gradually improved over 3 days. We reviewed the literature and suggested possible mechanisms.

구급대원 현장응급처치 숙련도에 대한 구급대원과 지도의사의 인식 비교

임대성,김성춘,박송이,류지호,배병관,김선휴,최병호,양태원,김정은,강지훈,김민희,김이민,조영학,정봉규,박재기,차준재 대한응급의학회 2020 대한응급의학회지 Vol.31 No.4

Objective: This study aimed to investigate the perception of emergency medical service (EMS) providers and medical directors toward the field skill proficiency of EMS providers. We further examined differences in perception according to the certification and hospital career of individuals. Methods: This survey was conducted enrolling all active EMS providers in Busan, Ulsan, and Gyeongnam, as well as emergency physicians who participated in direct medical direction. Pre-developed questionnaires were sent as text messages to individual EMS providers and emergency physicians using an internet-based survey tool (Google Forms). Questionnaires were composed of 25 items in 7 categories: “airway management”, “ventilatory support”, “circulatory support”, “field assessment and management of trauma patients”, “field assessment and management of patients with chest pain”, “field assessment and management of patients with neurologic symptoms”, and “other items”. The response was based on a five-point Likert scale, where 0 score indicated no experience at all. Results: The questionnaire was distributed to 1,781 EMS providers and 52 medical directors; of these, 1,314 (73.7%) EMS providers and 34 (65.3%) medical directors completed the survey. EMS providers rated themselves as above average (3 points) for most of the questions. However, the majority responded that they had no experience or low proficiency in endotracheal intubation and prehospital delivery (median 2; interquartile range [IQR], 0-3). Conversely, medical directors assessed the EMS provider’s proficiency as above average in use of I-gel, recognition of hypoglycemia, field management of trauma patients, use of oropharyngeal and nasopharyngeal airway, use of laryngeal mask airway, and optimal oxygen supply (median, 4; IQR, 3-4), but responded with low scores for most other questions. Based on the EMS provider certification, nurses scored themselves more proficient than level-1 emergency medical technicians (EMTs) for intravenous access (P<0.001), whereas level-1 EMTs recognized themselves more proficient than nurses for endotracheal intubation (P<0.001), use of Magill forceps (P=0.004), and pediatric cardiopulmonary resuscitation (P<0.001). Conclusion: This study recognized the discrepancies in the perception of EMS provider’s field skill proficiency, as perceived by EMS providers and medical directors, and between level-1 EMTs and nurses. We propose that regional EMS authorities need to make persistent efforts to narrow these perception gaps through effective educational programs for EMS providers and medical directors.

골반골절 환자의 골절위치와 출혈량간의 상관관계 분석을 통한 대량수혈 필요에 대한 간단한 예측도구 개발: 골반골 출혈 지수

이상식 ( Sang Sik Lee ),배병관 ( Byung Kwan Bae ),한상균 ( Sang Kyoon Han ),박성욱 ( Sung Wook Park ),류지호 ( Ji Ho Ryu ),정진우 ( Jin Woo Jeong ),염석란 ( Seok Ran Yeom ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

Purpose: Hypovolemic shock is the leading cause of death in multiple trauma patients with pelvic bone fracures. The purpose of this study was to develop a simple prediction method for injury severity and amount of hemorrhage via an analysis of the correlation between the site of pelvic bone fracture and the amount of transfusion and to verify the usefulness of the such a simple scoring system. Methods: We analyzed retrospectively the medical records and radiologic examination of 102 patients who had been diagnosed as having a pelvic bone fracture and who had visited the Emergency Department between January 2007 and December 2011. Fracture sites in the pelvis were confirmed and re-classified anatomically as pubis, ilium or sacrum. A multiple linear regression analysis was performed on the amount of transfusion, and a simplified scoring system was developed. The predictive value of the amount of transfusion for the scoring system as verified by using the receiver operating characteristics (ROC). The area under the curve of the ROC was compared with the injury severity score (ISS). Results: From among the 102 patients, 97 patients (M:F=68:29, mean age=46.7±16.6 years) were enrolled for analysis. The average ISS of the patients was 16.2±7.9, and the average amount of packed RBC transfusion for 24 hr was 3.9±4.6 units. The regression equation resulting from the multiple linear regression analysis was ``packed RBC units=1.40×(sacrum fracture)+1.72×(pubis fracture)+1.67×(ilium fracture)+0.36`` and was found to be suitable (p=0.005). We simplified the regression equation to ``Pelvic Bleeding Score=sacrum+pubis +ilium``. Each fractured site was scored as 0(no fracture) point, 1(right or left) point, or 2(both) points. Sacrum had only 0 or 1 point. The score ranged from 0 to 5. The area under the curve (AUC) of the ROC was 0.718 (95% CI: 0.588-0.848, p=0.009). For an upper Pelvis Bleeding Score of 3 points, the sensitivity of the prediction for a massive transfusion was 71.4%, and the specificity was 69.9%. Conclusion: We developed a simplified scoring system for the anatomical fracture sites in the pelvis to predict the requirement for a transfusion (Pelvis Bleeding Score (PBS)). The PBS, compared with the ISS, is considered a useful predictor of the need for a transfusion during initial management. (J Trauma Inj 2012;25:139-144)

응급실 퇴실배치와 한국형 응급환자 분류체계를 통한 응급여부, 내원수단의 관계

왕일재,조석주,염석란,배병관,조영모,이강호,김미정,황성연,박재성 대한응급의학회 2018 대한응급의학회지 Vol.29 No.2

Objective: The policy to judge the level of emergency (emergent vs non-emergent) based on Korean Triage and Acuity Scale (KTAS) has been introduced by government to control the flow of emergency patients. The purpose of this study is to identify the variables expected to affect the disposition and to compare the relative importance of the variables. And we also evaluate the validity of the policy to judge the level of emergency based on KTAS. Methods: We enrolled a total of 29,865 patients who visited a Wide Regional Emergency Center in Busan from Jan 2016 to Dec 2016. Data of those patients were extracted from National Emergency Department Information System (NEDIS) and analysed retrospectively. We determined disposition as the outcome variable. We evaluated the relationship between disposition and visit time, visit mode (firehouse ambulance, inter-facility transfer and self-transport), level of emergency based on KTAS, cause of morbidity. And we also evaluated general and conditional dominances of those variables to compare their relative importance each other. Results: The disposition of the patients was discharge to home (53.5%), general ward admission (30.3%), intensive care unit admission (11.6%), and inter-facility transfer (4.8%). In the univariate analysis, age, gender, visit time, visit mode, cause of morbidity, KTAS level had a significant effect on the disposition. All variables that had a significant effect on univariate analysis also had a significant effect on disposition in multivariate analysis. As a result of dominance analysis, visit mode was the most important variable in both general dominance and conditional dominance. However, if KTAS was devided into 5 levels, it was the most important variable. Conclusion: Level of emergency based on KTAS was significantly effective on patient disposition, however it was relatively less important compared to the visit mode. If the visit mode is reflected in the triage system, triage accuracy is expected to be improved. And it also can be a good option to construct triage system based on 5 level KTAS.

Cardiac Arrest in a Patient with a Severely Distended Colon

박순창,조영모,김형빈,배병관,박성욱 대한응급의학회 2017 大韓應急醫學會誌 Vol.28 No.3

Toxic megacolon is a devastating complication of colitis, which is commonly caused by inflammatory bowel disease. Frequently reported complications of toxic megacolon are bleeding, sepsis, colon perforation, and shock. Herein, we report a rare case of cardiac arrest that was likely caused by toxic megacolon in a 49-year-old male, who experienced 3 months of intermittent dyspnea and abdominal distension that abruptly worsened before presentation. Our case suggests that severe colon dilation complicated by toxic megacolon, especially accompanied by cardiopulmonary symptoms and signs, has the potential to progress to an abdominal compartment syndrome, which is a rare but life-threatening complication.

Hemorrhagic shock caused by closed internal degloving injury: a case report

김형빈,박순창,이성화,배병관,조영모,장재훈,박성욱 대한응급의학회 2019 大韓應急醫學會誌 Vol.30 No.5

A closed internal degloving injury is a soft tissue injury, in which the subcutaneous tissue is ripped from the underlying fascia. In rare cases, a closed internal degloving injury can lead to hemorrhagic shock. A 79-year-old woman was brought to the emergency department following an auto-pedestrian accident, in which she was hit by a car. She was in a stupor and was hypotensive. The initial evaluation was unremarkable. During management, the patient required the transfusion of a large volume of blood, and vasoactive agent. Abdominal computed tomography revealed a large hematoma in her lower back and gluteal area and she was diagnosed with a closed internal degloving injury. Missed or delayed diagnosis of this type of injury may result in a significant increase in transfusion requirements and irreversible hemorrhagic shock.

STONE 점수는 요로 결석 의심 환자에서 전산화단층촬영 검사를 제한하는데 사용될 수 있을까? - 단일 기관 후향적 연구

박성욱,이동근,김형빈,조영모,배병관,왕일재,염석란 대한응급의학회 2018 대한응급의학회지 Vol.29 No.2

Objective: The STONE score was developed to gauge the ureter stone probability. On the other hand, it is unclear if the STONE score is also applicable to Koreans. This study evaluated whether the STONE score can identify patients with suspected nephrolithiasis for whom a computed tomography (CT) scan can be obtained in the emergency department, targeting Koreans. Methods: Patients presenting to the emergency medicine (ED) with flank pain and a suspicion of a ureter stone between January 2016 and December 2016 were reviewed retrospectively. After calculating the STONE score, the enrolled patients were classified into the low, moderate, high score group. In each group, the prevalence of a ureter stone and other clinical diseases on a CT scan were investigated. Results: Among the 156 patients included in the analysis, 124 (79.5%) had a ureter stone and an alternative diagnosis was made in 12 (7.7%). The prevalence of a ureter stone and alternative diseases in the high score group was 87.7% (71/81) and 4.9% (4/81), respectively. The proportion of patients with nephrolithiasis increased significantly (P<0.001), but the proportion of patients with other clinical diseases did not decrease significantly across the score groups (P=0.196). The area under the receiver operating characteristic curve was 0.711 (95% confidence interval, 0.633-0.780; P=0.001) with a cut off score higher than 8 (sensitivity 82.3%, specificity 50.0%) for the STONE score. Conclusion: In this setting, the STONE score had a low specificity and could not accurately assess a ureter stone. More studies aimed at Koreans are warranted before a CT scan can be limited using the STONE score.