서울아산병원의 약물알레르기 경보시스템 초기적용 경험

손유동,이재호,오범진,김원,임경수 대한의료정보학회 2006 Healthcare Informatics Research Vol.12 No.2

Objective: This study was designed to describe how to develop the 'ASAN-Drug Allergy Alert System' and evaluate the usefulness of this system. Methods: The drug allergy alert system was developed by a task force that was consisted of emergency physicians, pharmacists, and programmers for ten months. Since this system had been implemented, we compared frequencies with a previous paper based system. Results: This system was implemented with three stages: an input stage, a censorship stage, and an alertness stage. The input of data was done by physicians and nurses as a multidisciplinary team. The censorship of data was charged of an allergist who confirmed whether a suspicious drug had caused life threatening symptoms or not. If the causative drug was confirmed by an allergist, an alert sign changed 'Code Yellow' to 'Code Red' automatically. After that censorship, an alert sign was noticed to clinicians as a yellow or red colored pop-up window. After an alert system, frequencies per month of report were increased from 44.6 to 594. Also, the report ratio of life threatening symptoms was increased from 5.4% to 12.5%(p<0.001). Conclusion: We assumed that the Asan-Drug Allergy Alert System could reduce medication errors effectively. (Journal of Korean Society of Medical Informatics 12-2,133-140, 2006)

Pulled elbow 진단을 위한 초음파 영상진단의 유용성

손유동,이유성,안희철,안지윤,박승민,이영환,이원웅 대한응급의학회 2013 대한응급의학회 학술대회초록집 Vol.2013 No.2

Background: 소아환자의 주관절 통증 중 대표적인 pulled elbow는 아직까지 명확한 진단법이 없이 환아의 임상양상, 처치후 반응을 보고 임상적으로 판단을 한다. 그래서, 영상검사의 무용성에 대해서도 이야기되고 있다. 이에 저자들은 pulled elbow의 진단에 초음파의 유용성을 알아보고자 이번 연구를 시행하게 되었다. Methods: 2013년 4월1일부터 7월 31일사이 본원 응급센터를 내원한 pulled elbow가 의심되는 환아 141명 중 초음파로 확진된 37명에 대해 retrospective study를 진행하였다. 연구군의 일반적인 특성을 위해, 나이, 성별, 이환 부위를 조사하였고, pulled elbow의 초음파 소견은 다음과 같이 시행하였다. 우선 환아의 팔을 완전히 펴게 한 다음, 초음파 탐촉자를 radiocapitellar joint에 평행하게 위치시켜(Fig. 1), supinator muscle 모양의 변화 유무, annular ligament의 관찰 유무, synovial fringe의 크기 변화 유무를 기록하였다(Fig. 2). 이때, 대조군은 이환된 팔의 반대쪽으로 선택하여 앞서 기술된 변수를 같이 기록하였다. 이후 일반적인 특성을 기술하기 위해 연속형 변수는‘평균±표준편차(95% 신뢰구간)’으로 표기하였으며, 이분형 변수는‘증례수(%)’로 표기 후 chi-squared test를 실시하였다. 연구군과 대조군으로 이루어진 짝으로 된 이분형 변수들의 통계적인 차이를 비교하기 위해, McNemar test를 시행하였고, 연구군에서 통계적인 의미를 가진 이분형 변수를 찾기 위해 Cochran’s Q test도 실시하였다. 그리고, 여기에서 나온 변수의 sensitivity, specificity 등도 계산하였다. Results: 연구군의 증례는 모두 37례였으며, 나이는 28.6±12.3개월(24.3~32.6개월)이었다. 성별에서 남아는 18명(48.6%)을 차지하였으나, 여아와의 통계적 차이는 보이지 않았다(p=1.0000). 이환된 팔은 왼쪽이 25례(67.6%)을 차지하였으며, 이는 오른쪽과 통계적인 차이를 보였다(p=0.0485). McNemar test의 결과는 다음과 같았다. Pulled elbow로 진단된, 즉 이환된 쪽에서 supinator muscle 모양의 변화가 있는 경우가 34례(92.9%)를 차지하여, 정상쪽에서의 supinator muscle 모양의 변화가 있는 경우인 6례(16.2%)와 통계적인 차이를 보였다(p<0.0001). 이환된 쪽에서 annular ligament가 확인이 된 경우는 13례(35.1%)를 차지한 반면, 정상쪽에서는 37례(100%)로 통계적인 차이를 보였다(p<0.0001). 마지막으로 이환된 쪽의 synovial fringe의 크기변화가 있는 경우는 23례(62.2%)를 차지하였고, 정상쪽에서는 8례(21.6%)로 통계적인 차이를 보였다(p=0.0041). 이후 실시한 Cochran’s Q test의 결과는 다음과 같았다. Pulled elbow로 진단된 37례에서 세 변수간의 차이는 통계학적으로 유의했으며(p=0.005), 다중비교에 따르면, supinator muscle 모양의 변화만이 다른 두 변수와 통계적인 차이가 나타났다(p<0.05). 초음파를 이용해서 supinator muscle 모양의 변화로 pulled elbow를 진단할 경우 sensitivity는 91.89% (78.09~98.30%), specificity는 83.78% (67.99~93.81%), positive predictive value는 85.00% (70.16~94.29%), negative predictive value는 91.18%(76.32~98.14%)로 나타났다. Conclusion: 초음파를 이용한 pulled elbow의 진단은 이전에 몇 차례 시도가 있었으나, 현재 통용되지 않고 있다. 하지만, 이번 연구를 통해 저자들은 supinator muscle 모양의 변화만으로 쉽게 pulled elbow의 진단을 내릴 수 있음을 확인하였다.

좌측 편마비를 주소로 내원한 난소 과자극 증후군 1례

손유동,임경수,김우주,안지윤,오범진,김원 대한응급의학회 2005 大韓應急醫學會誌 Vol.16 No.4

Nicotine 패치에 의한 Nicotine 중독 증례

손유동,이재성,강구현,최정태,안무업,서정열,안희철,Sohn, You-Dong,Lee, Jae-Sung,Kang, Gu-Hyun,Choi, Jung-Tae,Ahn, Moo-Eob,Seo, Jeong-Youl,Ahn, Hee-Cheol 대한임상독성학회 2007 대한임상독성학회지 Vol.5 No.1

Nicotine poisoning arising from the use of nicotine patches is rare. However, because nicotine patches are classified as an OTC drug, the risk of misuse or abuse is increasing. Nicotine poisoning using nicotine patches shows an unusual clinical presentation compared to that from oral ingestion of multiple doses of nicotine. We present a case of misused nicotine patches that cause a nicotine poisoning. A thirty-nine year-old healthy man visited the ER with complaints of an intermittent cramping abdominal pain with nausea and vomiting. Upon physical examination, there were no specific findings except increased bowel sounds, and the patient's initial laboratory findings were also unremarkable except for an increased bilirubin level. CT revealed a mild degree of fatty liver. The patient's symptoms did not improve any further with conservative management. During his ED stay, we meticulously took his history again, and we discovered that he had used nicotine patches for three days, six days before admission, and had misused the nicotine patches as NSAID patches. The patient's diagnosis of nicotine poisoning was confirmed by a urine cotinine level ten times the normal value. After a 12-hour stay in the ED, his symptoms disappeared without any specific management.

외상 환자에서의 cardiac troponin 1 상승군에서의 기초 조사

손유동 ( You Dong Sohn ),임경수 ( Kyoung Soo Lim ),안지윤 ( Ji Yun Ahn ),박정근 ( Jung Kuen Park ),조규종 ( Gyu Chong Cho ),오범진 ( Bum Jin Oh ),김원 ( Won Kim ) 대한외상학회 2005 大韓外傷學會誌 Vol.18 No.2

Background: Cardiac troponin I (cTnI) is a sensitive cardiac marker of myocardial injury. In normal coronary angiogram, positive cTnI values may be detected in various events such as sepsis, stroke, trauma and so on. To investigate characteristics of cTnI positive group in trauma patients, we designed this study between cTnI positive group and cTnI negative group. Method: Trauma patients who visited emergency room within 24 hours after accidents were included. Patients who had renal failure, acute coronary syndrome, sepsis, spontaneous SAH were excluded. Retrospective study of 97 trauma patients was done. We investgated ISS (injury severity score), positive cTnI, EKG abnormality, shock class, ICU admission rate and mortality. Result: In comparing with non chest trauma group, chest trauma group, whose chest AIS (Abbreviated Injury Score) is more than 3 point, had significant values in ISS, positive cTnI, EKG abnormality, shock class and ICU admission rate. Also, in non chest trauma group, we found several patients whose cTnI level was positive. When non chest trauma group was divided into two subgroups, the mortality and shock class of positive cTnI group were higher than that of negative cTnI group. When all trauma patients were divided into two groups, a positive cTnI group had higher values in ISS, shock class, ICU admission rate and mortality than that in a negative cTnI group. Conclusion: We found that cTnI were positive in patients of cardiac contusion but also in various trauma cases. In non chest trauma patients, we assumed that hypotension caused cTnI elevating. The cTnI could play a role in predicting prognosis in trauma patients.

한국인의 항파상풍 항체의 정성적 조사

손유동 ( You Dong Sohn ),임경수 ( Kyoung Soo Lim ),최욱진 ( Wook Jin Choi ),안지윤 ( Ji Yun Ahn ),김원 ( Won Kim ),최윤백 ( Youn Back Choi ),홍은석 ( Eun Seok Hong ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.1

Background: In Korea, vaccination against tetanus began in the mid-1950s. At present, there is a routine immunization schedule with diphtheria, pertussis, and tetanus (DPT) vaccines at 2,4,6 month after birth and booster at 15-18 month and 4-6 years. However, further prophylactic programs according to guidelines of Center for Disease Control do not exist due to the absence of tetanus toxoid. And we have usually used only passive immunization, tetanus immunoglobulin, as a prophylactic regimen for injured patients. In this study, we aimed to determine the tetanus antibody titers levels of Koreans and point out problems of prophylactic programs after a routine immunization schedule. Methods: This study was conducted with 112 healthy adults from August 29, 2003 to September 19, 2003. No volunteers had unstable vital signs, or had taken any medication for chronic illnesses. A questionnaire was used for the volunteers to assess their knowledge about tetanus vaccination schedule, and the whole blood was withdrawn from each volunteer to determine qualitative anti-tetanus antibody titers using TQS (Tetanus Quick Stick). TQS had been introduced as a rapid, easy method to determine the immune status. Results: Of the 112 studied subjects, only 13 (11.6%) were found to have protective levels of anti-tetanus antibody titers. There was no association between quantitative antibody titers and age, sex, educational status, economy, place of birth or residence, military service, and vaccination. Conclusion: Although tetanus is a preventive disease by the antibodies developed as a result of vaccination and its occurrence is not very common, it is associated with a rather high mortality rate. Recently, there has beena tetanus immunization shortage in Korea caused by an absence of tetanus toxoid. The effect of a tetanus shortage makes the tetanus antibody values go under the protective level for most adults. We recommend that tetanus prophylaxis in Korea should be performed following the guidelines of Center for Disease Control and Prevention.

위장관염으로 오인된 콜히친 중독 1례

안지윤,손유동,권혁술,안희철,Ahn, Ji-Yun,Sohn, You-Dong,Kwon, Hyuk-Sool,Ahn, Hee-Chol 대한임상독성학회 2008 대한임상독성학회지 Vol.6 No.2

A 47-year-old woman ingested about 12 mg of colchicine with suicidal intent. Colchicine, a highly poisonous alkaloid, is a commonly used treatment for gout, Bechet's disease, and familial Mediterranean fever. Despite the knowledge of its side effects, the risk of a significant overdose is under-appreciated. She suffered from acute multisystem toxicity, including gastrointestinal disorders, bone marrow suppression, alopecia, and probable pancreatitis, but she ultimately recovered with supportive therapy. We report a case of acute colchicine toxicity from a single overdose with a review of the literature.

응급의료기금 지원 사업 평가를 위한 델파이 연구

이선영,손유동,신상도,송경준,홍기정,노영선,김태한,박정호,박관진,고서영,이승철,정유진,문성배 대한응급의학회 2019 대한응급의학회지 Vol.30 No.4

Objective: This study aimed to achieve expert consensus for the evaluation of Emergency medical system operation fund (EMSOF) support projects using the Delphi method in Korea. Methods: The Delphi study was performed in June 2018. Experts who are members of the policy committee of the Korean Society of Emergency Medicine (KSEM) participated in the study. Respondents were asked to express their level of agreement of appropriateness for the following 6 categories for 21 projects: project contents, amount of support, indicators, performance, overall evaluation, and need to maintain. With a possible score of 9 points, the project categories were classified into 3 groups, inappropriate, moderate and appropriate, based on the median score of the respondents’ ratings in each question. Results: Sixteen of the 18 policy committee members participated in the survey. Their average professional work years were 8.2 years. All 21 projects were evaluated as appropriate for content. Amount of support and indicators were evaluated as moderate. Only 5 out of the 21 projects were evaluated as having appropriate indicators. No projects were evaluated as ineffective. Comprehensive evaluation of the projects was evaluated as moderate, and no project was evaluated as inappropriate in fund support. Conclusion: Overall, the contents of the EMSOF assistance project were rated high; however, there was a disagreement on the amount of support and evaluation indicators for each project. The results of this study are expected to be used as basic data to improve the use of EMSOF.

디메틸포름아미드 노출 후 발생한 독성 간염1례

주명돈,손유동,최우익 대한응급의학회 2006 大韓應急醫學會誌 Vol.17 No.5

폐 선암의 첫 증상으로 발생한 악성 심장막 삼출액으로 인한 심장눌림증 1례

진상찬,손유동,최우익 대한응급의학회 2006 大韓應急醫學會誌 Vol.17 No.4