입원치료를 요하는 소아의 급성복증

배택환,김준식,유인술,조준필,이철주,민영기 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

The acute abdomen defined as an acute abdominal condition which needs immediate decision for treatment is one of the most common cause for emergency care. One thound six hundreds nine patients were visited to pediatric emergency center due to acute abdomen. To aid in early diagnosis and proper treatment, a clinical review was made on 278 cases of acute abdomen under 15 yrs old which admitted to Pediatrics and General surgery via emergency center from June of 1994 to May of 1995. The results as follows: It was 17.3% of total visiting to pediatric emergency center due to gastrointestinal sysmptoms. The sex ratio(Male: Female) was 2.35:1. Acute gastroenteristis was the most common acute abdominal condition(54%) and followed by acute appendicitis(17.9%), and intussusception(13.9%). The most common chief commplaint was vomiting(58%) and followed by abdominal pain(39.4%), diarrhea(35.8%), and fever(42.1%). One hundred fifty-five patients were visited to pediatric emergency center via local clinic and thirty patients via OPDs. The operations were done in 75 patients. Among them, immediate operation were done in 60 patients and delayed operations were done in 15 patients, but there is no difference in complication.

낙상으로 인한 좌심실 파열 후 생존한 환자 1례

배택환,김행재,정윤석,김준식,조준필,이철주 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Blunt or nonpenetrating chest injuries are common after motor vehicle accidents or falls. Blunt injury to the heart ranges from contusion to rupture. Cardiac rupture, however, is un-common and associated with a very high mortality rate ; left ventricular rupture due to falling is even more rare. We experienced a case of left ventricular rupture of the heart caused by a fall, which the patient survived. A 63-year-old man fell off a ladder and presented with hypotension from left hemothorax and pericardial tamponade. The hemothorax was relieved via an emergency closed thoracostomy but dyspnea and hypotension continued. And so, echocardio-graphy was done and pericardial tamponade was detected. Emergency left thoracotomy was done to repair the rupture site. We believe that patients with cardiac rupture who reach the hospital alive can often be saved by prompt diagnosis and immediate surgical treatment.

급성음낭증환자의 감별진단

정도영,배택환,김 원,조준필 대한응급의학회 1997 대한응급의학회지 Vol.8 No.3

Acute scrotum is any pathologic condition of the scrotum or intrascrotal contents that requires emergency medical or surgical management. Management of each disease entity is different, but the differential diagnosis is very difficult. So many testes were lost due to delay of the adequate diagnosis or unnecessary explorations had been taken under the misdiagnosis. A study was done to evaluate the differential diagnostic value of clinical symptoms and signs, physical examinations, laboratory data and radiologic studies including scrotal Doppler ultrasonography on acute scrotum patients. During the two years, thirty patients were visited to emergency medical center of Ajou university. There were 5 patients with testicular torsion, 16 acute epididymitis, 5 orchitis, 3 edema of scrotum, 1 infected hydrocele, the mean age of total patients was 17 years old. Symptoms and signs, laboratory data showed no specific ability to differentiate each disease entities, but radiographic evaluations were useful to differentiate testicular torsion from non-torsion acute scrotum. We could suggest that scrotal Doppler ultrasonography is useful for early differential diagnosis of the acute scrotum, especially in emergency department

겸상적혈구 혈증에 의한 동통성 발작 1례

김효철,배택환,정윤석,김현수,조준필,김준식,곽연식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

The sickle cell disease are a group of hemoglobin disorders characterized by red cells that undergo sickle shape transformation when they are deoxygenated. Sickle cell disease is transmit-ted as an autosomal recessive trait. This unusual property, due to the polymerization of sickle hemoglobin results in anemia and vasoocclusive complication. 1) The most clinically significant of these disease are sickle cell anemia, sickle cell hemoglobin C disease, and sickle cell beta thalassemia. Symptoms of pallor, fever, abdominal and joint pain, enlargement of the liver and spleen, swelling of hands and feet first appear near the latter part of the first year of life. Intravascular sickling affects all organs. For clinical and therapeutic purposes, exacerbations may be classified as vasoocclusive or pain, aplastic, hemolytic or sequestration crisis. we experienced a 22 year old female patient who suffered severe multiple joint pain and back pain thought to be caused by vasoocclussive phenomena.

동전을 삼킨 소아환자의 임상적 고찰을 통한 처치 계획

김향숙,배택환,조준필,정윤석 대한외상학회 1999 大韓外傷學會誌 Vol.12 No.2

Coins are the most common esophageal foreign body in children. We performed this study to determine a therapeutic plan for coin ingestion in children. We retrospectively reviewed the charts and radiographs of 87 coin-ingestion patients treatead at university hospital from June 1994 to February 1998. In addition, information was collected from telephone interview. The patients age of the patients was 52.8 ±29.4 months. Fifty-two patients (63.2%) were male. There were 63 (70.1%) children with an esophageal (61 cases) or a pharyngeal (2 cases) coin. The remaining 24 (29.1%) children passed the coin from the esophagus to the stomach. Of the 87 ingested coins, 45 were 100 Won, 20 were 10 Won, 11 were 50 Won, 10 were 500 Won, and 1 was unknown. Endoscopy was performed in 57 cases with 1 esophageal perforation. The Foley catheter method of coin extraction was attempted in that 1 case and was successful without complication. Twenty -one of the coins passed spontaneously without complication. The average time of spontaneous passage were 5.5 ±5.5 days (maximum of 22 days). These results suggest that all children who swallow coins should have roentgenograms taken to determine the location. Coins that lodge in the esophagus may cause several serious complications. Esophageal, except lower esophageal coins, coins should be removed promptly. If the coin passes to the stomach it will generally pass through the remainder of gastrointestinal tract without complication. Therefore, all children who have coins in their stomaches should be observed until the coins passed through the anus.

응급 안와 전산화 단층촬영을 시행한 안와골절 환자

진재우,김철,김행재,배택환,정윤석 대한외상학회 1998 大韓外傷學會誌 Vol.11 No.1

In the emergency department, orbital wall fracture which is associated with fracture of basal skull or other facial bones is frequently seen. And orbital wall fractures which may produce cosmetic problems and functional orbital damages are increasing in frequency with the rise in number of traffic accidents, assaults and sport activities. Recently, we reviewed medical records of 54 cases which were taken orbital CT scan in emergency department. These cases were analyzed in age and sex distribution, injury causes, physical findings, anatomical locations, other skull and facial fractures, difficulties of diagnosis, and complications. The diagnosis is based on clinical symptoms and signs and radiologic procedures, but it may be difficult to detect fractures with plain X-rays of orbit because of the superimposition of the shadow by other bony structures. It is important to recognize the associated signs and symptoms in order that the diagnosis should not be missed. And emergency physician should show much attention to its anatomical structure, difficulties of diagnosis with plain orbital films and later cosmetic and functional complications.

응급실로 내원한 안외상 환자의 임상적 고찰

김행재,곽동진,김철,배택환,민영기,진재우,이철주 대한응급의학회 1998 대한응급의학회지 Vol.9 No.1

The authors analysed statically 420 Cases of the ocular trauma among 35,460 patients who visited to the emergency department, from Jul. 1995 to Jun. 1996. Ocular trauma is one of the commonest causes of eye diseases and blindness, but its patterns and incidences are variable according to the environment. A large number of patients can be readily treated in the emergency department. Prevention is, of course, the best management, but when an ocular injury occurs, proper emergency treatment can often prevent permanent damage.

소아에서의 독극물 : 임상적 고찰과 중증도 분류 Clinical Analysis and Severity Grading

김원,김행재,김철,진재우,배택환,곽동진 대한응급의학회 1998 대한응급의학회지 Vol.9 No.1

Background: To find out characteristics and classification of toxic agents by clinical analysis of pediatric poisoning and to determine the clinical availability of grading by using MSPC score. Methods: Subjects were patients under 15 years exposed to toxic agents, who visited Ajou university hospital emergency center from June, 1994 to October, 1997. The study was performed retrospectively. Results: The subjects were 126 cases and male to female sex ratio was 1.2:1. Mean age was 29±30 months old. The most common route of exposure was ingestion, following contact, inhalation and bite. The most common reason was mistake by the patient, following mistake by caregiver, suicide attempt and accident. The MSPC score distribution of symptomatic patient was as follows; 1 point: 26 cases(63.4%), 2 point: 12 cases(29.2%), 3 point: 1 case(2.4%), 4 point: 2 cases(4.8%). The classification of exposed poison was as follows; therapeutic drugs: 29 cases(23.0%), non-therapeutic drugs: 97 cases(73.0%). The most common exposed poison was household products: 23 patients(18.3%) were admitted to hospital. Conclusion: There was statistically significant difference in the classification of poison, MSPC score, treatment modality at hospital, first followup period after discharge between admitted group and non-admitted group. There was statistically significant difference in the reason of exposure, route of exposure, MSPC score, admission period according to patient's age. severity grading according to MSPC score is regarded as an available method to determine the modality of management.

우리 나라 재해 의료의 문제점 : 수원시 재해 대응 훈련의 평가를 통하여 본 ANALYSIS OF EMERGENCY RESPONSE EXERCISE IN THE MOCK DISASTER IN SUWON

곽동진,정윤석,진재우,조준필,김 철,김행재,배택환,김준식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Natural or man-made disasters are serious enough to paralyse the functions of the nation or regional distinct and affect the property and lives of numerous citizens. The first two hours after occurrence of the disaster are critical for determining death or permanent disabilities of the casualties. The current Disaster Medical Service(DMS) System in our country adopts mainly civil defense model which focuses the cause of the accident, compensation of the victims, or reconstruction. So in the initial phase of disaster, the appropriate rescue and emergency treatment is not provided effectively. In order to assess and reorganize the current status of DMS System in Korea, the Department of Emergency Medicine, Ajou University School of Medicine, planned and conducted an emergency response exercise in Suwon city on April 28, 1995. The exercise, which took place near the Kyunggido Culture and Art Center, coordinated the efforts of the Suwon Fire Department and other related agencies. As well as providing training on emergency response, the exercise was valuable for identifying areas of weakness which will be address in the future.