성인 급성후두개염 환자에서 경부 측면방사선검사를 이용한 기도개방성의 예측

손재돈,김선욱,김민정,박인철,박유석,정태녕 대한응급의학회 2010 大韓應急醫學會誌 Vol.21 No.1

Purpose: We wanted to predict the high risk group that requires urgent airway intervention by using the parameters of the soft-tissue lateral neck radiographs of adult acute epiglottitis patients. Methods: This retrospective study was conducted in two teaching hospitals. The patients who were diagnosed with acute epiglottitis from June, 2007 to May, 2009 were enrolled and their medical records and x-ray films were reviewed. The width of the epiglottis at the widest point (EW), the width of the arytenoid at the widest point (AW),the prevertebral soft tissue distance at the third cervical spine (PSTD), the shortest distance from the epiglottis to the hypopharyngeal wall (EHD) and the shortest distance from the epiglottic root to the arytenoids’tip (EAD) were investigated and we performed regression analyses of these parameters of the patients in the high risk group that required urgent airway intervention. Results: A total of 42 patients were enrolled. Dyspnea and hoarseness were more frequent in the high risk group that required urgent airway intervention (p=0.008, 0.040,respectively). The EW was significantly longer (p=0.001) in the high risk group. The EHD and EAD were significantly shorter (p=0.012, <0.001, respectively) in the high risk group. Only the EAD showed significant correlation with the percent of airway patency on linear regression analysis (p=0.003) and the EAD was the only significant predictor for the high risk group on multivariate logistic regression analysis (p=0.043). The receiver operating characteristics curve of the EW/EAD for the high risk group was obtained and it showed the best predictive power (AUC: 0.977, p<0.001). Conclusion: The EAD noted on soft-tissue lateral neck radiography is an important predictor of high risk patients who require urgent airway intervention. The cut-off value of the EW/EAD for the predicting the high risk group is 2.44(sensitivity 100%, specificity 85.7%).

선박에서 배출되는 초미세먼지(PM<SUB>2.5</SUB>)측정 표준절차서 개발

이형돈(Hyungdon Lee),박승민(Seungmin Park),김보미(Bomi Kim),이진우(Jinwoo Lee),손재경(Jaekyung Shon) 대한환경공학회 2020 대한환경공학회 학술발표논문집 Vol.2020 No.11

급성관상동맥증후군 환자에서 증상 인지도가 병원 전 단계 지연에 미치는 영향

이지환,손재돈,김선욱,정태녕,박인철,박유석 대한응급의학회 2010 대한응급의학회지 Vol.21 No.1

Purpose: This study was performed to determine the association of symptom recognition with pre-hospital delay in patients with acute coronary syndrome (ACS), and to determine the factors influencing symptom recognition. Methods: A prospective study from June 1, 2009 to July 31, 2009 was performed. The pre-hospital delay was calculated by subtraction of the hospital-arrival time from the symptom-onset time. The pre-hospital delay of the patients that recognized the symptoms as cardiovascular in origin was compared to the patients that did not recognize the symptoms as cardiac in origin. In addition, the socioeconomic indexes and risk factors were evaluated. Results: Eighty three subjects were enrolled from a total of 205 patients suspected of having an ACS during the study period. No statistical differences were identified in the comparison of the pre-hospital delay by socioeconomic and risk factors of ischemic heart disease. The median pre-hospital delay of the patients that recognized the symptoms as cardiac was 2.9 hours compared to 11.9 hours among the patients that did not recognize the symptoms as cardiac;this difference was statistically significant (p=0.003). There were statistically significant differences in symptom recognition between the patients that had a history of cardiovascular disease and those that did not (p=0.037), and between the patients that took aspirin and those that did not (p=0.014). In addition, the severity of symptoms differed between the patients that recognized their symptoms and those that did not; this difference was statistically significant (p=0.019). Only the severity of symptoms was statistically significant by the logistic regression analysis (p=0.018). Conclusion: The pre-hospital delay was shorter, if patients that recognized the symptoms as cardiac in origin. A history of cardiovascular disease, taking aspirin and severity of symptoms were factors influencing the recognition of symptoms.

응급의학과 전문의들의 수면의 질 분석

김한별,박경혜,김인병,양혁준,이기중,임태호,한승백,강구현,강영준,김주영,김 철,박유석,박주옥,박준범,박준석,박현경,손재돈,오세현,오영민,이동욱,이형민,정시영,정진우,조광현,조영순,조한진,최대해,2015 응급의학과 전문의 총조사 위원회 대한응급의학회 2016 대한응급의학회지 Vol.27 No.5

Purpose: Emergency physicians cannot help doing night shift, and consequentially their circadian rhythms are broken and sleep quality decrease. We investigate sleep quality and the factors related with it, and make a suggestion for improvement of sleep quality. Methods: A nationwide survey was conducted with a representative sample of 406 emergency medicine specialist doing medical practice in emergency department in 2015. Results: The mean time of all duties was 14, and night duties were 7 per four weeks. Over half respondents thought they have some sleep problem in recent two weeks and are worried about sleep. The most common symptoms they have after night shift were fatigue and tiredness, and the next one is impaired memory, concentration, and judgement. Average Epworth Sleepiness Scale (ESS) was 7.54 (min 0, max 24), and 19 respondents had serious sleepiness during day time and may need medical advice. There was no difference of sleep quality according to sex, and whether having uninterrupted nap during night shift. However, the respondents having regular schedule pattern had better sleep quality and less day time sleepiness. Higher ESS was correlated with less satisfaction on shift schedule, intenser duty work, physically and mentally unhealthiness. Conclusion: Over half respondents answered they have sleep-related problems, and complaint various symptoms after night shift. Emergency physicians having regular shift schedule had better sleep quality and less symptoms after night shift. This requires additional analysis for the practically possible pattern of shift schedule.

응급의학과 수련 만족도에 대한 분석과 향후 교육 수련 발전 방향에 대한 제안

박송이,박경혜,김인병,양혁준,이기중,임태호,한승백,강구현,강영준,김주영,김 철,박유석,박주옥,박준범,박준석,박현경,손재돈,오세현,오영민,이동욱,이형민,정시영,정진우,조광현,조영순,조한진,최대해 대한응급의학회 2016 대한응급의학회지 Vol.27 No.5

Purpose: At 1990, the first emergency medicine residency training was started in Korea. However, there was no date and discussion about the satisfaction of emergency medicine residency training and improvement point. The aim of this study is to investigate the satisfaction of emergency medicine residency training and suggest for improvement on the future emergency medicine residency training. Methods: A nationwide survey was conducted with a representative sample of 432 emergency medicine specialist involved in emergency care in 2015. Results: The average score of satisfaction for emergency medicine residency training was 3.29±1.09. The most satisfied part was about procedure skills as 3.70±0.99, and the most needed part for future residency training was about communication skill as 4.27±0.77. Satisfaction gap among each training hospitals was significant. Emergency physicians in training hospital considered that patient management and administration, communication skills, prehospital emergency medical service system, educational methods, and research are important in this order. On the other hand. Emergency physicians in non-training hospital considered that medical knowledge, procedure skills, professionalism, and resource utilization are more important. However there was no difference in recommendation between clinical practitioners and non-clinical practitioner. Conclusion: Korean emergency physicians are satisfied with residency training in procedure skills, patient management and administration, and professionalism and highly recommended them. Communication skill is most highly recommended, but show low satisfaction. Developing the advanced competency assessment for specialist board can lead to residency curriculum change. Furthermore, the Korean Society of Emergency Medicine needs to provide standardized and systematic residency curriculum in order to minimize the disparity between the training hospitals.

응급의학과 전문의가 느끼는 응급실 폭력에 대한 불안과 이에 대한 요인

유도환,이동욱,이형민,조광현,양혁준,김인병,이기중,한승백,오세현,김 철,박준석,강영준,박현경,박유석,강구현,조한진,조영순,박준범,정진우,박경혜,최대해,정시영,박주옥,손재돈,김주영 대한응급의학회 2016 대한응급의학회지 Vol.27 No.5

Purpose: The anxiety of ED staffs due to violence causes their panic, frustration and humiliation against their patients and lowers the quality of medical practice of ED. With the 2015 Korean Emergency Physician Survey (KEPS), it figures out the factors influencing the anxiety level against violence and assists how to prepare future countermeasure. Methods: From August 2015 to October 2015, a survey was conducted for emergency physician as target respondents. The group with presenting their anxieties due to violence in ER was defined as 1 and 2 points by Likert scale of 5 (anxiety group) and compared with the groups of 3-5 points (no anxiety group). The survey results related to demographic data, workload and violence were performed by statistical analysis using SPSS version 18.0. It was regarded as significant in the case of less than p-value 0.05. And it was compared with the KEPS 2010 and 2015 above and figured out its changed aspects. Results: The anxiety group were 172 (43.5%) from 395 of respondents and there was not significant difference between these 2 groups from demographic data. Regarding with the factors of security guard, workload and violence intensity they experienced, there was significant difference (p-value<0.05). In comparison of the results of 2010 and 2015, there was not significant difference among each factor. Conclusion: The severity of violence in ER was perceived but the preparation for countermeasures was not enough. The appropriate countermeasures will be needed such as adjustment for workload, preparation for working regulations about security guard and repeated training.

2015 응급의학과 전문의 총조사 최종보고서

이형민,조광현,양혁준,김인병,이기중,한승백,오세현,김 철,박준석,강영준,박현경,박유석,강구현,조한진,조영순,박준범,정진우,박경혜,최대해,정시영,박주옥,이동욱,손재돈,김주영 대한응급의학회 2016 대한응급의학회지 Vol.27 No.5

The Korean Society of Emergency Medicine (KSEM) in celebration of its 20 years took upon itself to survey its members on how they are faring in their workplaces, in 2010. The survey was called 2010 Korean Emergency Physician Survey (KEPS). 2010 KEPS was the first survey of its kind conducted by KSEM. The results were striking in that it revealed overburdened Emergency Physicians (EP) working in less than ideal conditions and dissatisfied as a whole. But these results only went as far as reflecting the state of emergency medicine (EM) in Korea in the eyes of KSEM members, and not enough effort was put into finding the causes or in improving the state of EM. In turn, KSEM members were dismayed with the use of survey results. The purpose of 2015 KEPS was to find out the changes in current state of EP, which were little or no changes. The results will be analyzed and prioritized to resolve any policy and well-being issues by providing meaningful and effective resolution plans. If given the choice to reselect the EM specialty dropped. Clearly the results won’t improve unless EP ourselves take the initiative. The 2015 survey team devoted themselves in seeing the bigger picture for the future of EM. They agreed in order to secure a continuous advancement in EM it is imperative to improve the satisfaction and respect of the EP before anything else. The results of the survey must serve to improve working conditions and longevity of EP.

2015 대한응급의학회 응급의학과 전문의 총조사: 2010-2015년까지 주요한 변화들

이형민,조광현,양혁준,김인병,이기중,한승백,오세현,김 철,박준석,강영준,박현경,박유석,강구현,조한진,조영순,박준범,정진우,박경혜,최대해,정시영,박주옥,이동욱,손재돈,김주영 대한응급의학회 2016 대한응급의학회지 Vol.27 No.5

Purpose: The second Korean Emergency Physician Survey (KEPS) was done in 2015. 2010 KEPS, first comprehensive study on emergency physicians (EP) in Korea, revealed EP felt over-burdened and unsatisfied. The purpose of 2015 KEPS was to find out what changed since the last survey, and what we need for the future. Methods: 2015 KEPS Committee way established. 2010 survey questions were reviewed by the committee. The survey was on 1,418 members of Korean Society of Emergency Medicine (KESM), using a questionnaire on the web and e-mail from June to October of 2015. Results: 437 (31%) EP working in 182 hospitals participated in the survey. The biggest change was the increase in the number of EP. There were 1,120 (79%) clinically active EP working in all types of emergency facilitis. Even though working hours have decreased from 232.7 to 210.4 hours per month, night shifts increased from 7.4 to 7.6 per month. Average salary has increased but satisfaction is still dismal. The answers to choosing the specialty again, and the satisfaction with Emergency Medical Services system, and the prospect in 10 years have decreased. Expectation during Residency training increased. Conclusion: Increase in the number of EP, brought about improvements in the welfare and working conditions. But the satisfaction is still low. In order to build a better future for EM. There must be some form of improvement in satisfaction of EP in following years.