부산,경남 지역에서 전원 의뢰된 중증외상 분석을 통한 119 구급대의 환자 분류와 이송병원 선정에 대한 고찰

임종언 ( Jong Eon Lim ),염석란 ( Seok Ran Yeom ),조석주 ( Suck Ju Cho ),한상균 ( Sang Kyun Han ),박성욱 ( Sung Wook Park ),이성화 ( Sung Hwa Lee ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

Purpose: The objective of this study was to determine the appropriateness of Emergency Medical Service`s (EMS`s) triage and transport of severely injured patients in Busan and Kyungnam, Korea. Methods: The medical records of the Emergency Medical Information Center were retrospectively reviewed from January 1, 2010 to December 31, 2010. We identified the number of patients that should have been transferred from a secondary to a tertiary hospital according to the EMS field triage protocol. Results: In a total of 472 cases requests to be transferred to a third hospital were made through the Emergency Medical Information Center. Of these, 207 patients(43.9%) should have been transferred to a tertiary hospital according to the EMS field triage protocol. Among them, thirty-three(15.9%) patients satisfied step 1, 15(7.0%) satisfied step 2, and 117(56.5%) satisfied step 3. Twenty-three(11.1%) patients satisfied both steps 1 and 3. Conclusion: We found the triage by the EMS in the transfer of severely injured patients to a tertiary hospital to be inappropriate and re-education of EMS personnel regarding the EMS field triage protocol is needed. Because many patients are transferred from a secondary to a third hospital, we suggest changing the EMS field triage protocol to expand the severe injury criteria. A need exists to authorize secondary hospitals to transfer severely injured patients directly because there are no trauma centers in Korea. (J Trauma Inj 2012;25:145-151)

다발성 외상환자에서 폐좌상과 심근좌상의 상관관계

류지호 ( Ji Ho Ryu ),염석란 ( Seok Ran Yeom ),정진우 ( Jin Woo Jeong ),민문기 ( Mun Ki Min ),박맹렬 ( Maeng Real Park ),김용인 ( Yong In Kim ),한상균 ( Sang Kyun Han ),박성욱 ( Sung Wook Park ) 대한외상학회 2011 大韓外傷學會誌 Vol.24 No.1

Purpose: This study was conducted to evaluate the correlations among pulmonary contusion severity, trauma score and cardiac troponin I (cTnI) level. Methods: We prospectively evaluated patients with multiple injuries who had been admitted to the emergency department (ED) from July 2007 to July 2008. We first measured the total creatinine kinase (CK), the MB fraction of CK (CK-MB), TnI, and myoglobin within 2 hours after the injury. We then checked the electrocardiogram, x-ray, and computed tomography (CT) results. Finally, we assessed the injuries as variables and then compared the results for patients with elevated TnI levels (group A) and patients whose TnI levels fell within the normal range (group B). Results: Eighty-six of the 92 patients admitted to the ED were enrolled. The pulmonary contusion score (PCS) was well correlated with PaO2/FiO2. TnI levels were correlated with PCS. When TnI levels were above 0.86 ng/ml, the mortality was estimated with 100% sensitivity and 86.1% specificity. Conclusion: Pulmonary contusion severity is correlated with TnI level. When the PCS is high and the cTnI level is elevated in multiple-injury patients, we recommend continuous cardiac monitoring and further evaluation. (J Korean Soc Traumatol 2011;24:31-36)

일개 응급센터에 내원한 외상성 혈관손상 환자의 임상적 특성

박용면 ( Yong Myeon Park ),염석란 ( Seok Ran Yeom ),정진우 ( Jin Woo Jeong ),한상균 ( Sang Kyun Han ),조석주 ( Suck Ju Cho ),류지호 ( Ji Ho Ryu ),김용인 ( Yong In Kim ),정성운 ( Sung Woon Chung ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.1

Purpose: The mortality and the amputation rates due to vascular trauma remain high despite advanced vascular surgical techniques and supportive management. The clinical features of patients with vascular trauma have not been well studied in the Korean population. The aim of this study was to analyze the clinical characteristics of patients with vascular trauma and to develop a database and guidelines for improving the outcomes of treatment. Methods: The medical records of 37 patients with traumatic vascular injuries who had visited in an emergency center between January 2002 and December 2006 were retrospectively reviewed and statistically analyzed. Results: The mean age was 37.8 years, and the male-to-female ratio was 5.2:1. The mechanism of vascular trauma was penetrating in 18 patients and blunt in 19 patients. Upper extremities were most frequently injured (39.4%). The treatment methods were primary repair in 21 patients, exploratory laparotomies in 7, radiological interventions in 3, resections and graft interpositions of the pseudoaneurysm in 3, observations in 3 and a bypass graft in 1. Four out of the 37 patients died, and three of these who died had injuried abdominal vessels. Twenty-five of the patients recovered completely, four expired, seven had neuropathy in the course of treate-ment, one had his limb amputated, and one experienced wound necrosis. Conclusion: Peripheral vessel injuries are commonly accompanied by nerve, muscle, or tendon injuries. Patients without associated fractures or compartment syndrome had good prognosis. Although the time intervals from hospital arrival to definite treatment were the shortest among patients with blunt abdominal vascular injuries, three expired. Therefore, we offer a `critical pathway` to improve the outcomes of patients with blunt abdominal vascular injury. (J Korean Soc Traumatol 2009;22:5-11)

해상 원격 진료를 이용한 증례 분석

김윤진(Yun Jin Kim),조석주(Seok Ju Cho),김영주(Young Joo Kim),배석주(Seok Joo Bae),이상엽(Sangyeoup Lee),민홍기(Hong Gi Min),홍정익(Jeong Ik Hong),염석란(Suk Ran Yeom) 한국항공우주의학협회 2005 항공우주의학회지 Vol.15 No.1

부산광역시 경로당의 안전시설 현황 조사

배정이(Jeong Yee Bae)(裵井珥),정상태(Sang Tae Jeong)(鄭尙泰),노맹석(Maeng Seok Noh)(盧孟錫),손혜숙(Hae Sook Sohn)(孫惠淑),홍주희(Ju Hee Hong)(洪周希),염석란(Seok Ran Yeom)(廉釋蘭),김태구(Tae Gu Kim)(金泰九),마창수(Chang Su Ma)(馬昌守),김윤정(Yoon Jung 위기관리 이론과 실천 2011 Crisisonomy Vol.7 No.1

본 연구는 노인의 손상사망의 주요원인이 되고 있는 낙상사고 예방을 위한 기초자료조사로서, 부산시에 소재하고 있는 경로당 1,949개소 중 지역배분을 고려한 1/5 계통추출 방법으로 389개소를 선정하여 각 구군별로 안전실태를 조사하였다. 본 연구 결과는 95% 신뢰수준 하에서 오차한계 ±4.0% 로 본 연구 결과는 국가통계(승인번호 : 통계협력과09007)로 승인받은 바 있다. 경로당 안전실태 조사 항목은 총 28개 문항으로 실외 5문항, 실내계단 4문항, 현관 2문항, 거실/방 3문항, 욕실/화장실 4문항, 소화/대피시설 10문항으로 방문조사를 통하여 실시하였다. 분석 결과, 경로당의 실외 및 실내계단의 안전시설면에서는 전체적으로 경로당의 출입구에 야간조명과 센서 혹은 스위치 설치는 양호한 편이나 계단의 난간이나 미끄럼 방지장치는 매우 미흡하였고, 응급사태발생시를 대비한 긴급전화번호의 부착이나 변기 옆 손잡이 및 비상벨의 설치율도 극히 저조하였다. 특히 본 연구를 통하여 경로당의 소화 및 대피 시설은 상대적으로 매우 열악하다는 사실을 확인할 수 있었는데, 구급함과 연기감지기, 화재경보기, 가스누설 경보기, 구조대의 구비 및 자동화 소화설비는 거의 갖추어있지 않아 화재발생시 인명 피해가 우려된다. 결론적으로 부산광역시의 경로당 내에서의 노인의 낙상 및 화재 등 안전사고 예방을 위해서는 기본적인 안전시설의 보완이 시급하다고 할 수 있다. 따라서 노인을 대상으로 한 안전의식 증진 교육, 낙상예방 체조 등 운동 프로그램의 개발 및 보급 등으로 노인 손상예방과 안전증진을 위한 정책과 시설 개선 등 노력이 필요하다. Accidents involving elderly are an important cause of death and disability. They also have enormous financial implications The objective of this study was to investigate the safety facilities of senior citizen centers (Kyongrodang) in Busan. Methods: This descriptive study conducted visit-surveys with organized questionnaires and sampled 389 Kyongrodang in Busan. Data collected was analyzed descriptive statistics SPSS/WIN 17.0. Results: Findings revealed that gas leak sensor, fire alarm, smoke detector, sprinkler were not properly installed in almost senior citizen centers. The installations of first-aid kit and fire extinguisher are needed for elderly safety promotion, Conclusion: In senior citizens' centers, fall prevention safety education should be activated as a injury prevention program. This study gave a very useful and important data to prepare accident prevention program and to prepare accident prevention strategies.

외상 환자에 대한 바늘감압술에서 흉벽 두께와 바늘 길이의 관계

김지완 ( Jee Wan Kim ),정진우 ( Jin Woo Jeong ),조석주 ( Suck Ju Cho ),염석란 ( Seok Ran Yeom ),한상균 ( Sang Kyoon Han ),박성욱 ( Sung Wook Park ) 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.2

Purpose: A tension pneumothorax is a fatal condition that requires immediate intervention. Although a definitive treatment for a tension pneumothorax is a tube thoracostomy, needle decompression can provide temporary relief, that is lifesaving. The traditional procedure for needle decompression involves inserting a needle or catheter at the second intercostal space, the midclavicular line. Recent evidence suggests that the commonly used catheters do not have sufficiently penetrate the chest wall. There are also claims that a lateral approach to needle decompression is easier and safer than the traditional anterior approach. The purpose of this study is to evaluate the optimal approach for needle decompression for the Korean population by measuring chest wall thicknesses at the points used for both the anterior and the lateral approaches. Methods: The chest wall thickness (CWT) of trauma victims who visited the Emergency Center of Pusan National University Hospital was measured by computed tomography (CT) images. The CWT was measured at the points used for the anterior and the lateral methods and was compared with the length of commonly used catheters, which is 45 mm. Results: The mean CWT at the second intercostal space, the midclavicular line, was shorter than the CWT at the 5th intercostal space, the anterior axillary line. However, the percentage of patients whose CWT was greater than 45 mm was larger when measured anteriorly (8.2%) that when measure laterally (5.7%). Female patients and those older than 60 were more likely to have an anterior CWT greater than 45 mm (28.2% for females and 15.5% for those older than 60). Conclusion: The percentage of trauma victims in Korea whose CWT is greater than 45 mm is lower than the values previously reported by other countries. However, females and older patients tend to have thicker chest walls, so the lateral approach would be suggested when performing needle decompression for such patients with suspected tension pneumothoraces. (J Korean Soc Traumatol 2010;23:63-67)

어떤 다발성 외상환자가 중환자실에 오래 있게 되는가?: Injury severity score와 손상부위 수의 비교

조무진 ( Mu Jin Jo ),이성화 ( Seong Hwa Lee ),조석주 ( Seok Ju Cho ),염석란 ( Seok Ran Yeom ),한상균 ( Sang Kyoon Han ),박성욱 ( Sung Wook Park ),이대섭 ( Dae Seop Lee ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.2

Purpose: Injury severity score (ISS), a widely used scoring system, is used to define the severity of trauma in multiple-trauma patients. Nevertheless, ISS cut-off value for predicting the outcome of multiple-trauma patients has not been confirmed. Thus, this study was performed to determine the more useful method for predicting the outcome for multiple-trauma patients: the ISS or the number of anatomical Abbreviated injury scale (AIS) injury regions. Methods: for 195 consecutive patients who a regional emergency medical center, we analyzed the ISS and the number of anatomical AIS injury region. The patients were divided into four groups based on the ISS and the number of anatomical AIS regions. We compared intensive-care-unit (ICU) admission days and hospitalization days and ICU stay ratio (ICU admission days/hospitalization days) between the four groups. Results: In the groups with an ISS more than 17, the results were not significantly different statistically the group with 2 anatomical AIS injury regions and more than 3 anatomical AIS injury regions. Also, in the group with an ISS of 17 or less, the results were the same as those for patients with an ISS more than 17 (p>0.05). Among the patients with 2 anatomical AIS injury regions, patients with an ISS more than 17 patients had more ICU admission days and a higher ICU stay ratio than patients with an ISS 17 or less. Also, Among the patients with 3 anatomical AIS injury regions, the results were the same as those for patients with 2 anatomical AIS injury regions. Conclusion: Patients with high ISS, regardless of the number of anatomical AIS injury regions had significantly longer ICU stays and higher ICU admission ratio. Thus, the ISS may be a better method than the number of anatomical AIS injury regions for predicting the outcomes for multiple-trauma patients.

다발성 중증 외상 환자들의 치료에 대한 응급 외상팀 운영의 효과

이성화 ( Seong Hwa Lee ),조석주 ( Suck Joo Cho ),염석란 ( Seok Ran Yeom ),류지호 ( Ji Ho Ryu ),정진우 ( Jin Woo Jung ),한상균 ( Sang Kyun Han ),김용인 ( Yong In Kim ),박맹렬 ( Maeng Real Park ),김영대 ( Young Dae Kim ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.2

Purpose: We performed this study to determine how the emergency trauma team affects the treatment of patients with multiple severe trauma and to discuss the effect and the direction of the emergency trauma team`s management. Methods: We performed a retrospective analysis of 518 patients who visited our emergency department with severe trauma from August 2006 to July 2008. We divided the severe trauma patients into 2 groups: patients before and after trauma team management (Group 1 and Group 2). Then, we compared demographic characteristics, mechanisms of injury, and treatment outcomes (lengths of stay in the ED, admission ratio, and in-hospital mortality) between the 2 groups. In the same way, patients with multiple severe trauma were divided into 2 groups, that are patients before and after trauma team management (Group 3 and Group 4) and analyzed. Results: There was no significant difference, except mean age, between groups 1 and 2. In group 4 patients, compared to group 3 patients, the lengths of stay in the ED were lower (p value<0.001), and the admission ratio were higher (p value=0.017), but there was no significant difference in the in-hospital mortality between the groups 3 and 4. Conclusion: When patients with multiple severe trauma visit the ED, the emergency trauma team`s management can decrease the lengths of stay in the ED and increase the admission ratio, but does not produce a decrease in the in-hospital mortality rate. Further investigations of emergency trauma team management are needed to improve treatment outcomes for patients with multiple severe trauma. (J Korean Soc Traumatol 2009;22:172-78)

조영제 부작용환자의 적절한 병원내 관찰시간에 대한 고찰

황순민 ( Sun Min Hwang ),이성화 ( Sung Hwa Lee ),염석란 ( Seok Ran Yeom ),류지호 ( Ji Ho Ryu ),정진우 ( Jin Woo Jeong ),김용인 ( Yong In Kim ),한상균 ( Sang Kyoon Han ) 대한임상독성학회 2010 대한임상독성학회지 Vol.8 No.1

Purpose: The purpose of this study was to determine the optimal length of time to observe patients with contrast media anaphylaxis in the Emergency Department. Methods: This study included the patients of all age groups who presented with anaphylaxis due to contrast media to the ED of Pusan National University Hospital from January 2006 to August 2009. The medical records were retrospectively reviewed. We analyzed the 100 patients who met the inclusion criteria. Their median age was 55 (46-62), and 38 out of the 100 patients (38%) were male. Results: The most common symptom of patients was urticaria. Corticosteroid and H1 antihistamine were given to most of the patients in the ED. All were discharged after observation in the ED and none were admitted to the ward. The average time from injection of the contrast media to the onset of symptom was 31 minutes (24-39) and the average time to symptom recovery was 127 minutes (89-188). The mean observation time in the ED was 93 minutes (59-153). Biphasic reactions were reported in only one case (1/100, 1%). Conclusion: These results suggest that patients who present with an anaphylactic reaction after radiologic studies that use intravenous contrast media can be safely discharged early from the ED because the symptom recovery time is not long and a biphasic reaction is rare.

경운기 사고에 의해 발생한 복부 및 회음부 장기 손상

여광희 ( Kwang Hee Yeo ),박찬용 ( Chan Yong Park ),김호현 ( Ho Hyun Kim ),박순창 ( Soon Chang Park ),염석란 ( Seok Ran Yeom ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.2

Purpose: Cultivator accidents are frequent and often lead to abdomino-perineal organ injury and, if severe, to death. This study presents the clinical characteristics, outcomes, and factors associated with mortality in patients who sustained an abdomino-perineal organ injury in cultivator accidents. Methods: We retrospectively analyzed the records of 53 patients who visited the emergency department of a tertiary hospital with abdomino-perineal organ injuries caused in cultivator accidents from April 2005 to March 2010. Results: All 53 patients had visited other medical institutions before visiting our hospital. Their mean age was 64.0± 11.1 (range, 20-80) years and 32 (60.4%) patients were 65 or older. The male-to-female ratio was 46:7. The chief complaint was abdominal pain (38 cases, 71.7%). The 53 patients included 41 cultivator operators (77.4%), 11 passengers (20.8%), and 1 passerby (1.9%). The causes of the injuries included a direct impact of the handlebar in 20 cases (37.7%), a rollover in 21 cases (39.6%), a fall in 10 cases (18.9%), and a wheel in two cases (3.8%). Several of the 53 patients had injuries to multiple abdomino-perineal organs, and the injured organs included the liver (23 cases, 26.4%), spleen (16 cases, 18.4%), pancreas (7 cases, 8.0%), small bowel (7 cases, 8.0%), mesentery (6 cases, 6.9%), adrenal gland (5 cases, 5.8%), and other organs. According to the abbreviated injury scale (AIS) dictionary, a thoracic injury was the most frequent co-injury (33 of 53 cases, 62.3%). Abdomino-perineal surgery was performed in 31 cases (58.8%) and angio-embolization was performed for six liver and two kidney injuries. Thirteen patients died (24.5%); all were males. The Injury Severity Scale (ISS) was lower in the survivors (17.8±8.5 vs. 27.0±16.0; p=0.010). Conclusion: With the aging of agricultural workers, safety education programs should be implemented. Furthermore, the patient transfer system in agricultural areas must be improved. [ J Trauma Inj 2015; 28: 60-66 ]