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新손상정도계수에 의한 외상 환자의 분석과 적정진료의 평가
설동환,서강석,박정배,정제명,서준석,이정호,최승필 대한응급의학회 2002 대한응급의학회지 Vol.13 No.2
Purpose: The Injury Severity Score (ISS) has limited predictive power and is difficult to calculate. We used the New Injury Severity Score (NISS) and compared it to the ISS. The purpose of this study was to give a prognosis and predict the mortality for trauma patients by using the ISS and the NISS and to compare Trauma and Injury Severity Score(TRISS) method using NISS with the TRISS method using ISS. Methods: A retrospective study of 100 trauma victims who visited the emergency room of Kyungpook National University Hospital from September 2000 to May 2001 was made using the ISS, the NISS, and the TRISS methods. Results: A comparison between survivors and nonsurvivors showed differences in the revised trauma score (RTS), ISS, NISS, and TRISS Ps-1 by using RTS and the ISS and TRISS Ps-2 by using RTS and NISS (p<0.01). We found that the NISS was more predictive of survival than the ISS. A receiver operating curve analysis and Hosmer Lemeshow statistics showed that both the NISS and the ISS provided a good fit throughout its entire range of prediction. Conclusion: By comparing the ISS with the NISS, we concluded that the NISS better separated survivors from nonsurvivors. The NISS predicted survival better and was easier to calculate than the ISS. The results of the TRISS method using NISS were satisfactory, and we expect to use this method in quality assessment with further study and modification.
대형 화재에 의한 연기 흡입 손상 환자에 대한 임상적 고찰
설동환 ( Dong Hoan Seol ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.1
Background: Many of fire victims of large fires die from smoke inhalation injury. For this reason, it is important to diagnose and manage smoke inhalation injuries. The purposes of this study were to find effectiveness in use of chest x-ray and bronchoscopic examination in diagnosis and management of smoke inhalation injury. Method: We analyzed the case histories of victims of a large fire who visited the emergency department of Kyungpook National University Hospital from the day admission, February, 18, 2003 to the time of each patient`s discharge. Results: The results of this study showed that severity of chest x-rays at the day 2 of insult correlated with PaO2/FiO2 ratio, Pulmonary function tests. bronchoscopic exam and wash out, oxygen therapy, medications, etc. were effective in improving patient`s clinical course. Conclusions: Follow up chest x-ray can be helpful in classifying severity, diagnosing and managing smoke inhalation injured patients. In addition to other supportive care, bronchoscopic tracheal wash out technique could be useful in managing these patients.
의식변화를 주 증상으로 내원한 응급실 노인환자의 임상적 고찰
이정호,서준석,설동환,최마이클승필,서강석,박정배,정제명 대한응급의학회 2004 대한응급의학회지 Vol.15 No.1
P u r p o s e: The number of geriatric patients admitted to the emergency department (ED) is growing as the elderly population grows. The altered mental status of the elderly is more difficult to evaluate and manage than others. The purpose of this study was to determine the etiologies of altered mental status in elderly patients visiting the ED. M e t h o d s: A retrospective study was made of 119 patients who visited the ED of Kyungpook National University Hospital for altered mental status from January 2001 to June 2002. R e s u l t s: The results of this study showed that extracranial causes (67.8%) were more than intracranial causes (31.9%): metabolic (35.3%), cerebrovascular (29.4%), extracranial infection (16.0%), cardiovascular (8.4%), drugs/toxins (8.4%), and intracranial infection (2.5%). The group with underlying disease or with brain imaging done showed more intracranial causes than extracranial causes. The results showed that the age, the initial Glasgow coma scale (GCS) score, a new positive finding on a brain image, and the causes of the mental change had significant influence on improvement of the mental status and on the survival rate (p < 0.05). C o n c l u s i o n: Initial evaluation of the underlying disease, the GCS score, an early study of brain imaging, and a search for possible metabolic causes, as well as others should be done simultaneously to deliver high quality care to elderly patient. Knowledge of the most frequent causes of altered mental status in elderly patients may assist the emergency physician in the approaching these potentially ill patients and managing their care.
김종근,최마이클승필,서강석,설동환,박정배,정제명 대한응급의학회 2002 대한응급의학회지 Vol.13 No.1
Purpose: The purpose of this research is to estimate the overall survival rate and to understand the factors influencing hospital discharge when cardiopulmonary resuscitaion is attempted on out-of hospital cardiac arrest victims. Methods: From March 2000 to February 2001, we studied prospectively 71 consecutive victims with out-of-hospital cardiac arrest. We used the same record based on the "Utstein Style". Results: Fifty-three of the 71 patients were transported by 119 ambulance; the remainder were transported by non-119 ambulance. An initial rhythm of pulseless electrical activity(PEA) was present in 66.2% of the patients, ventricular fibrillation (VF)/ventricular tachycardia in 22.5%, and asystole in 11.3%. Fifty-five of the 71 (77.5%) were cardiac arrest cases witnessed by a layman. The number of cardiac etiologies was 24 (33.8%), non-cardiac etiologies 36 (50.7%), and unknown causes 11 (15.5%). There were no statistical differences in return of spontaneous circulation (ROSC) and survival rate related to the causes of cardiac arrest, initial EKG rhythm, and method of transportation. Of the 71 patients, 29 patients,(40.2%) experienced ROSC; seven patients survived. Conclusion: With the increase in cardiovascular disease and traffic accidents, the number of out-of hospital cardiac arrests has risen accordingly. However, the survival rate has not changes much compared to the past. Major factors contributing to the unchanged survival rate are lack of bystander CPR, defibrillation in the prehospital stage, inappropriate CPR by EMT, early pronouncement of death, and unskilled CPR by the physician, and improvement in these areas are necessary in order to bring about a change.