1339 서울응급의료정보센터의 이용 현황에 관한 분석

송형곤,곽영호,서길준 대한응급의학회 2002 대한응급의학회지 Vol.13 No.1

Purpose: For proper operation of the Seoul Emergency Medical Service Information Center, We analyzed the contents of the phone-calls made to the center. Methods: We retrospectively analyzed phone calls made to the center from Jul. 1 to Sep. 30, 2001. Results: The total number of phone calls made to the center during the above-mentioned period was 42,143, and the average number of calls was 458.1±32.3 per day. Most calls came between 09:00 and 12:00 (85 calls, 18.6%), and hours with the fewest calls were from 03:00 to 06:00 (18 calls, 3.9%). The average length of the calls was 2 minutes 38 seconds. Most callers(25,454 calls, 60.4%) asked questions about a disease or first aid which were considered as non-urgent, and 9,586 (22.7%) asked for simple advice about a hospital or a clinic and also considered as non-urgent. There were 885 (2.1%) calls that were considered as emergent situations and there were 1,686 cases (6.7%) connected to the Rescue system 1-1-9 for the rapid evacuation. Conclusion: The results show that the Seoul Emergency Medical Information Center does not perform the proper functions that it should in emergent situations.

서울대학교 병원 A강당(특강) : 기본생명유지술

송형곤 대한임상병리사협회 2008 임상생리검사학회 발표자료집 Vol.2008 No.-

아급성기 대량 재해 지역에서의 의료 지원 : '99 대만 지진 의료 지원을 중심으로

송형곤,강보승,송근정,정연권 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3

Background: There was a powerful earthquaken(Richter Scale 7.6) In Tiawan, on Sep.21, 1999. We supported the organized medic긴 services in that area during 5 days. Methods: We made the protocol and analyzed the results prospectively. Results: We took care of a total of 708 patients from sep. 23 to sep. 27. Traumatized patients related to the earthquake were 245(34.6%), and most of them had minor injuries. Two hundred thirty-nine(239, 33.8%) patients visited us for medical disease related to living in a group. There were 29(4.1%) patients who complained of neuropsychiatric problems due to the post-earthquaken stress. Because the condition of the patients was so bad, 18(2.5%) were transferred to receive more medical services. Conclusion: In disaster area, organized medical services have two different roles, especially in the subacute stage. One is responsibility for real emergency medical care, and the other is medical care of non-emergency patients.

응급의료 헬리콥터를 이용한 환자이송에 대한 고찰

송형곤,김병철,송근정,정연권,신백효 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Background: The first EMS helicopter was introduced to Korea in 1996 and from Dec. 1. 1997, it was used for transporting emergent patients. Authors, here upon, report the transporting experiences. Methods: From Dec. 1, 1996 to Dec. 31, 1997, Samsung Medical Center's EMS helicopter was used for air evacuation of critically ill patients. The patients data prospectively analyzed. Result: A total of 65 patients were transported. Male to female ratio was 1.95:1. The mean transport time was 64.1 min(10 - 160 min). Majority of the evacuated patients was surgical patients (General Surgery : 16, Orthopedic surgery : 10, Neurosurgery : 6, Internal medicine : 13, Pediatrics : 3, and others : 3). Twenty-one of the 65 patients transported were admitted to ICU and 31 did not require ICU care. During the air evacuation, one physician and one nurse trained for air evacuation attended the patients. No medical problems or deaths developed during the air evacuation period. Conclusion: The first EMS helicopter was introduced to Korea in 1996. From Dec. 1, 1996 to Dec. 31, 1997, Samsung Medical Center's EMS helicopter was used for air evacuation of critically ill patients. The patients data reported.

이마앞겉질을 제거한 흰쥐 중격옆핵내 이마겉질-중격옆핵로 신경연접의 미세구조

송형곤(Hyoung-Gon Song),안의태(E-Tay Ahn),고정식(Jeong-Sik Ko),박경호(Kyung-Ho Park) 대한해부학회 2003 Anatomy & Cell Biology Vol.36 No.5

성격형성, 순간기억, 인지력, 감정깊이 조절기능들과 관련이 있는 이마앞겉질에서 보상, 욕구, 중독, 기대감 등과 관련이 있는 중격옆핵으로 들어오는 신경연결을 확인하고 연접형태의 미세구조를 밝히고자 이 연구를 시행하였다. 체중 250~300 g 정도의 흰쥐를 실험동물로 하였으며, 이들을 정상군, 대조군, 실험군으로 구분하여 실험하였다. 실험군 동물은 sodium pentobarbital로 마취하여 뇌정위고정대에 고정시킨 후 한쪽 이마뼈에 구멍을 만들고 이마앞겉질을 흡인하여 제거하였으며, 2일 후 희생시켜서 1% paraformaldehyde와 1% glutaraldehyde 고정액으로 관류고정시켰다. 뇌에서 중격옆핵을 punching하여 관류고정액에서 다시 고정한 후, 2% osmium tetroxide액에서 이차고정을 시행하였다. Araldite에 포매하였고 미세절편은 4% uranyl acetate와 2.7% lead citrate로 이중 염색하였으며, JEOL 100CX-II 전자현미경으로 관찰하였다. 관찰결과, 대조군 중격옆핵의 미세구조는 정상군과 차이를 보이지 않았다. 실험군의 중격옆핵에서는 신경그물의 구조에 상당한 변화를 보였는데, 가장 뚜렷한 변화를 보인 것은 퇴행된 축삭종말들로서 축삭가지돌기연접(axodendritic synapse)과 축삭가시연접(axospinous synapse)을 이룬 것들 가운데 일부였다. 퇴행중인 축삭종말들 외에도 아교세포의 세포질돌기들이 확장하여 퇴행구조들을 분리시키면서 용해시켰고, 퇴행종말과 연접했던 가지돌기나 가지돌기가시 안에는 많은 티끌 같은 물질들이 흩어져 있었다. 특히 퇴행종말과 연접했던 가지돌기가시들이 가지돌기 속으로 퇴축되면서 가지돌기들이 팽대현상을 보였다. 이와 같은 변화는 이마앞겉질에서 중격옆핵으로 들어온 축삭종말들이 퇴행하면서 일어나는 병리적 진행과정으로 신경학적 실험에서 흔히 관찰되는 것이었다. 따라서 대뇌 이마앞겉질에서 중격옆핵으로 정보를 보내는 신경섬유의 종말은 가시돌기세포 (spiny cell)의 가지돌기 (dendrite)와 가지돌기가시(dendritic spine)에 연접하는 것이 밝혀졌다. Prefrontal cortex is called psycological cortex, since it deals with making up of individual personality, regulation of personal depth of feeling, working memory, planning, maintaining attention, etc. Whereas, nucleus accumbens (septi) is called the center of reward and motivation or the center of pleasure, since it deals with feeding, drinking, sex, exploration, appetitive learning, drug addiction, etc. Present study was aimed at the proving the prefronto-accumbens input ultrastructurally. Sprague Dawley rats anesthetized with sodium pentobarbital and were removed their prefrontal cortex with suction instrument. Two days following the operation, heads of rats were fixed by perfusion of with 1% glutaraldehyde-1% paraformaldehyde solution via left ventricle. Peristaltic pump was used during perfusion. Two hours later, brains were removed and refixed for 24 hours in the refrigerator, and small tissues of the nucleus accumbens were punched out with punching needle. Tissue blocks were fixed in 2% osmic acid for 2 hours and were embedded in araldite mixture. Ultrathin sections stained with uranyl acetate-lead citrate solution were observed with JEOL 100 CX II electron microscope. In the nucleus accumbens, some axodendritic terminals and axospinous terminals were found degenerated, and volume of activated glial cytoplasm was increased. The degenerated terminals were seen isolated from intact structures by activated glial processes and removed by glial cytoplasm. The result confirms that axon terminals coming from prefrontal cortex input to the spiny neurons of nucleus accumbens septi, on their dendrites and/or dendritic spines.

정상 분만 후 발생한 대동맥 박리증

심민섭,송형곤,정연권,송근정 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Hypertension is a risk factor for developing fatal aortic dissection. Aortic dissection occurs 2~3 times as often in men than in women between ages of 50~70 years old. Among other risk factors, aortic dissection occurs especially in women below the age of 40 years old in pregnancy-related cases. In pregnancy-related cases, aortic dissection occurs n the third trimester and in puerperium, as well as in multiparous women. The writers experienced an aortic dissection related pregnancy. The patient was 32 years old, diagnosis of dissection occurred in the postpartum period. Although, aortic dissection is a rare complication of pregnancy, the knowledge of this may assist the emergency physician save the lives of patients.

강산 및 강알칼리 음독에서 냉각 용액을 사용한 희석 요법과 중화 요법의 가능성

이중의,송형곤,김동훈,권운용,곽영호,서길준,윤여규 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Background: There is no effective treatment modality for caustic agent ingestion. Dilution and neutralization are prohibited because of the risk of secondary thermal injury. This experiment is designed to evaluate the amount of dilution and neutralization heat and to gauge the applicability of dilution and neutralization therapy using cold solutions to suppress the peak temperature. Methods: This is an in-vitro chemical experiment. HCl, CH3COOH, NaOH, and NH4OH are selected as representatives of strong and weak acids and strong and weak alkali, respectively. 20℃, 11.6M, 5.8M, and 2.9M solutions of each acid and alkali are made and mixed using a magnetic stirrer at a room air temperature of 28℃. The peak temperature, the duration above 40℃, and the heat amount are measured or calculated. Results: When a 11.6M HCl or NaOH solution is diluted with same amount of water, 32 or 18cal. per mL of HCl or NaOH is produced, respectively. HCl produces a significant peak temperature, but NaOH does not. The lower the concentration, the lower the amount of heat production. 11.6M CH3COOH and NH4OH solutions don't produce dilution heat.11.6M and 5.8M solutions of all acids and alkali produce destructive neutralization heat. However, 2.9M solutions produce neutralization heat which might be controllable. When a 11.6M HCl or NaOH solution is neutralized with a -10℃ 2.9 M NaOH or HCl solution, respectively, the peak temperature produced is below 40℃ and seems to add little thermal damage to viable tissue. Conclusion: Dilution and neutralization with a cold solution in cases of strong acid or alkali ingestion is a promising method to avoid thermal injury.

급성 심근경색증과 유사한 임상 양상을 보이는 급성 스트레스성 심근병증 환자들의후향적 연구

조인철,송형곤,조익준 대한응급의학회 2007 大韓應急醫學會誌 Vol.18 No.2

Purpose: “Stress-induced cardiomyopathy”or “Takotsubo cardiomyopathy”, which mimics acute myocardial infarction (AMI), has recently been reported, particularly in Japan. However, little is known about the characteristics of this syndrome. We retrospectively evaluated twenty-three cases of this novel syndrome. Methods: We analyzed twenty-three patients(7 men and 16 women) who fulfilled the following inclusion criteria: 1) age >18 years old; 2) no previous cardiac disease, especially coronary artery disease; 3) acute onset of symptoms; 4) ST segment elevation or depression and/or T-wave inversion on ECG; 5) cardiac enzyme elevation; 6) regional wall motion abnormality in the echocardiogram or left ventriculogram; 7) no significant stenosis in the coronary angiogram. Results: The most common stressful conditions that preceded the chest pain were: emotional stress (n=8, 34.8%), medical illness (n=7, 30.4%), accident (n=3, 13.1%), and recovery from surgery (n=3, 13.1%). The average initial creatinine kinase MB fraction and cardiac troponin I level were 32.2±51.7 ng/ml and 4.11±19.7 ng/ml, respectively. ECG changes [ST-segment elevation or depression (n=10, 43.5%) and T-wave inversion (n=19, 82.6%)] were usually found, whereas in contrast a Q wave was rarely found (n=3, 13.4%). The average left ventricular ejection fraction (LVEF) was decreased to 43.2±12.2% and regional wall motion abnormality [apex only (n=11, 47.8%), global (n=7, 30.4%)] was found on the initial echocardiograms. Upon follow- up echocardiograms, the average LVEF was improved to 60.6±5.8% and regional wall motion abnormality was normalized in all patients. Conclusion: Stress-induced cardiomyopathy, mimicking AMI, is triggered by psychologically and physically stressful events. This condition is characterized by a distinctive form of systolic dysfunction and favorable outcomes with medical therapy.

응급실에서의 적절한 객담채취가 결과에 미치는 영향

최태민,조익준,송형곤 대한응급의학회 2007 大韓應急醫學會誌 Vol.18 No.4

Purpose: In clinical situations requiring the use or the sputum Gram stain test, the adequacy of specimens is often compromised by improper sample generation by patients. We designed a study to evaluate the effect of good written instruction for sputum expectoration on the outcome of sample adequacy. Methods: Data were collected from adult patients over age 15 at a tertiary teaching hospital emergency department who had the sputum Gram stain test from October 1 to October 31, 2006. Patients were given carefully written instruction cards for sputum expectoration, together with a bottle of mineral water to gargle before expectoration. Patients’ data were compared to a group of patients who visited the same ED during the same month in 2005. Results: The total numbers of sputum tests were 164 in 2006 and 151 in 2005. The number and percentage of adequate specimens increased from 62(44%) in the 2005 patient group to 114(69.5%) in the 2006 patient group (p=0.000). Conclusion: By the simple use of properly written instructions for expectoration and of mineral water for oral gargling before sputum expectoration, the adequacy of sputum specimens for testing can be significantly improved.

중심 정맥 삽관술과 연관된 부정맥 발생의 위험 인자

김민정,심민섭,송형곤,정연권,최필조,조준휘 대한응급의학회 2005 大韓應急醫學會誌 Vol.16 No.6