국내 헬리콥터 응급의료체계의 미래 발전방향

염석란,김오현,이강현 대한의사협회 2020 대한의사협회지 Vol.63 No.4

This paper discusses the future development of air ambulance operations in Korea. Helicopter emergency medical services are a useful means of transporting critically ill patients to the right hospital, at the right time. It is an important element of the emergency medical system to treat acute diseases at the scene, or in transit. For more efficient operations of the emergency medical helicopters (air ambulances or the so-called ‘Doctor Helgi’ in Korea), various challenges are faced. These include, the expansion of air ambulance bases, proper placement of rendezvous points (landing point), increase of field transport requests, and the operation of night missions. First, it is necessary to reduce the disparity in the benefits of emergency medical care for critically ill patients through the expansion of helicopter bases. Second, through the advancement of joint operations of the pan-ministerial emergency medical helicopters, the time from dispatch to helicopter take-off should be minimized, and a quality improvement program for air transportation should be carried out. Third, it is necessary to increase the number of insufficient rendezvous points and ensure the safety of the helicopters during takeoff and landing, to activate field transportation. Finally, the safety of patients and medical staff should be secured through the systematic preparation of the air transport system for future night missions. To solve these tasks, an appropriate legal system for helicopter emergency medical service is required. Based on the improved system, it is expected that everyone will enjoy equal rights for health, regardless of the regions.

흉골골절이 의심되는 외상환자에서 초음파의 진단적 효용성

염석란,김재광,이근,박철완,양혁준,현성열,임용수,진욱 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Purpose: This study compared the value of ultrasonography(US) in the diagnosis of sternal fractures with those of conventional radiography and bone scan. Material and Method: From March 2000 to March 2001, in Gil Medical Center, Gachon Medical College, 44 patients(22 women and 22 men, mean age 46 years, range 5∼81 years) complained of tenderness in the sternal area. The cases histories of these patients with clinically suspected sternal fracture due to blunt trauma were prospectively studied. At the time of admission, conventional radiography(sternal view) was done. At one day after admission, sternal ultrasonography was obtained, and after 4∼5 days, a bone scan was done. Sternal ultrasonographic findings, conventional radiographic findings, and bone-scan findings were compared. In addition, a 12-lead ECG was done. When it was necessary, cardiac enzyme was checked and echocardiography was performed. Result: In 21 of 44 patients(48%), a sternal fracture was found by sternal US. Only 9 of 21 patients (43%) were diagnosed as having a sternal fracture by using conventional radiography. 23 of 44 patients (52%) have negative findings on sternal US; they also had negative findings on conventional radiography. Except for 7 unchecked patients, 13 of 21 patients(62%) were diagnosed as having a sternal fracture by bone scan, and among the 23 patients who had negative findings on sternal US, the 19 patients checked with a bone scan also had negative findings. Conclusion: Sternal US can find sternal fractures that are difficult to find on conventional radiography. Compared with bone scan, sternal US takes a shorter time and sternal US is not difficult. Additionally, combined lesions with sternal fractures(peristernal hematoma, soft tissue swelling) and costar cartilage fractures are diagnosed more easily when using sternal US.

기관내 삽관이 어려웠던 폐동맥 sling을 동반한 기관협착 환아1예

염석란,신중호,신종환,이근,류일,현성열,진욱,김재광 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Pulmonary arterial sling, a rare developmental vascular anomaly forms a sling around the distal trachea and the proximal right main bronchus, where it sometimes makes tracheo-bronchial stenosis. Tracheo-bronchial stenosis from pulmonary arterial sling may produce non-specific symptoms of stridor, noisy breathing, dyspnea, recurrent upper respiratory tract infection, chronic cough, and dysphagia. The diagnosis of this anomaly begins with a high index of suspicion because of the lack of pathognomonic finding on usual evaluation. In this case, initial difficult intubation makes us evaluate further. Other cases reported the diagnosis is established by imaging studies, usually MRI and angiography. But, when our case was evaluated, we used cervico-thoracic enhanced computered tomography and tracheal fluoroscopy. Up to now, tracheobronchial stenosis from vascular anomaly is a rare and challenging disorder with a poor prognosis. However, early exact diagnosis would make us perform the accurate surgical treatment and reduce the mortality and morbidity.

일개 권역응급의료센터로 내원한 중독환자의 임상적 특징

염석란 부산대학교 병원 암연구소 2006 부산대병원학술지 Vol.- No.20

Purpose: The purpose of this study is to determine the best management method of acute intoxicated patients by the analysis of acute intoxications in a authorized regional emergency center. Methods: We reviewed retrospectively the medical records of 185 patients with acute intoxication in the Pusan Authorized Regional Emergency Medical Center, Pusan National University Hospital during one year from June 2004 to May 2005. Result: Total number of patients was 185 which is 1.0% of total ED patient. The male to female ratio was 1:1. The distribution of age showed the highest incidences in 4th(22.7%) and 3rd(16.2%), 5th (16.2%) decades. From all cases of intoxication, 69.7% was done on purpose. Acute intoxications were occurred in house mostly as 41.7%. The percentage of patents who transferred to emergency medical center of PNUH was 56.2%. The common intoxicated materials were insecticides(40%) and medicines(28.2%). The most patients(88.65%) intoxicated by a single toxic material. The patients(29.1%) visited to emergency department within 2 hours after ingestion of toxic material had clinically advantages to be performed gastric lavage. The gastric decontamination was performed in 45.6% of all patients. Among them the gastric lavage were performed in 68 cases. The outcomes of the intoxicated patients were discharge at ED(28.1%), transfer to other hospital(24.3%), discharge against medical advice(24.3%), admission(12.0%), death at ED(9.1%), other(2.2%). Conclusion: Acute intoxication is one of important part of emergency medicine. We must develop the systemic medical service of intoxication and the education programs for preventing acute intoxication and strict legal control of drugs are important and necessary.

자발 호흡 환자에서 일회 심박출량의 변화에 대한 호흡종기 이산화탄소의 유용성

염석란,이재훈 대한응급의학회 2019 대한응급의학회지 Vol.30 No.2

Objective: Stroke volume (SV) measurements have been used to guide fluid management. Noninvasive, indirect, and convenient measurements of the SV for fluid therapy are required for most patients during spontaneous breathing (SB). On the other hand, the preferred method for an indirect prediction of the SV is unclear. This study examined the best of the indirect and predictable parameters responding to a SV variation during SB. Methods: Hemodynamic parameters, such as collapsibility of the inferior vena cava (cIVC), peak velocity variation in the common carotid artery (pvvCCA), collapsibility of the internal jugular vein (cIJV), and end-tidal carbon dioxide (ETCO2) were measured 180 times (6 different positions each in 30 normal subjects). The variables changed with the SV at the upper body elevation of 60 and 30 , in the supine position, at the lower body elevation of 30 and 60 , and lumbar elevation. Results: The SV showed the highest value at 30 of lower body elevation. Following fixed position changes, the ETCO2 during SB was the factor most correlated with the SV when compared to cIVC, cIJV, and pvvCCA (βcoefficient, 2.432 vs. -0.41, -0.033, and -0.654; P=0.004). The adjusted ETCO2 showed a significant change with the SV, even though the change in ETCO2 was not large. Conclusion: ETCO2 was less influenced by the SB than cIVC, pvvCCA, and cIJV because the ETCO2 change was in accordance but the variations of the other blood vessels did not coincide with a SV change. Therefore, ETCO2 monitoring for predicting the SV would be more important than the variations in the vessels during SB.

교통사고로 내원한 접형척추(butterfly vertebra) 환자 1예 보고

염석란,이근,박철완,양혁준,현성열,류일,진욱 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

A butterfly vertebra is a rare, but very important congenital anomaly that must be differentially diagnosed with compression fracture of the vertebral body. It has characteristic findings on simple X-ray, CT, and MRI. These findings are an anterior wedging contour on the sagittal image, a widening of the transverse diameter on the coronal image, adaptations of nearby vertebral endplates on the sagittal image, communicated intervertebral disc spaces on the sagittal and the coronal images, a well-defied midline bony defect with a sclerotic margin in the vertebral body on the axial image, and a normal body signal intensity on MRI. Because of legal problems and further plans for treatment, close attention must be given to patients who complain of back pain and who have decreased anterior height of the vertebral body after trauma. In those patients, a butterfly vertebra must be differentially diagnosed with compression fracture of vertebral body. We report one such case here.

부산시민의 안전의식 및 행태 조사연구

배정이(裵井이),정상태(鄭尙泰),손혜숙(孫惠淑),염석란(廉釋蘭),박현주(朴賢周),조성일(曺成一) 위기관리 이론과 실천 2012 Crisisonomy Vol.8 No.1

본 연구는 부산시민의 안전의식 및 행태를 조사하고, 안전사고 예방을 위한 기초자료조사로서, 부산광역시 총 17,088가구를 연구대상가구로 계통표본 추출하여 조사 하였으며, 연구방법은 대상가구를 직접 방문, 면접방식으로 조사표를 작성하거나 조사표를 배부 후 대상자가 직접 작성하고 회수하였다. 신뢰도는 95%신뢰수준 하에서 구군별 오차 한계 ±3.0% point로 한 자료를 토대로 안전의식 및 행태를 조사하였다. 분석 결과, 노인인구의 안전의식은 교통안전과 가정 내 안전에서 다른 연령층보다 낮은 인식도와 낮은 실천율을 나타내 안전에 취약계층임을 드러냈다. 특히, 교통안전에서 노인이 운전을 하거나 보행을 할 때 안전 수칙에 대한 교육 및 홍보는 시급하다고 할 수 있다. 따라서 부산시민 전체를 대상으로 한 안전의식 증진 교육과 안전사고를 예방하는 참여 교육 등의 프로그램의 개발 및 보급과 함께 노인인구에 대한 손상예방과 안전증진을 위한 정책 제정 노력이 필요하다.

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.

Successful Hemostasis by the use of Recombinant Factor VIIa in Uncontrolled Active Hemorrhage of Multiple Trauma Patients

주용민,염석란,류지호,정진우,김용인,민문기,박성욱,조석주 대한응급의학회 2011 大韓應急醫學會誌 Vol.22 No.1

Purpose: Uncontrolled bleeding is a leading cause of death in multiple-injury patients. It is very difficult to control hemorrhage due to microvascular injury in soft tissue by surgery or vascular intervention. Thus, hemostatic agents such as recombinant activated coagulation factor VII (rFVIIa) have become popular with regard to reducing transfusion volumes and correcting the hemorrhage-associated coagulopathy. Methods: From March 2007 to January 2010 we used rFVIIa in 15 multiple-injury patients. Transfused packed red blood cell (pRBC) volume was compared before and 6 h after administration of rFVIIa. Complete blood count, prothrombin time and activated partial thromboplastin time were also checked. Results: Mortality rate correlated strongly with initial severity of coagulopathy. Transfused pRBC volumes per hour were reduced significantly after rFVIIa (p=0.01), and coagulopathy was also significantly corrected. Thromboembolic events such as acute myocardial infarction and cerebrovascular attack, a fatal complication of rFVIIa, did not occur. Conclusion: The administration of rFVIIa can correct hemorrhage associated coagulopathy and reduce pRBCs transfusion volume. A quick decision regarding the administration of rFVIIa is needed for a more favorable outcome in multiple-injury patients with hemorrhagic shock.

Carbon monoxide poisoning-induced type 1 Brugada electrocardiographic pattern

조영모,염석란,조석주,배병관,이대섭,현태규,안진희,왕일재 대한응급의학회 2021 大韓應急醫學會誌 Vol.32 No.5

Carbon monoxide (CO) can cause a variety of electrocardiogram (ECG) changes. The Brugada ECG patterns are very rare in CO poisoning cases. We detected a patient with a CO-induced type 1 Brugada ECG pattern with chest pain. The panel genetic test and echocardiogram revealed normal findings. The Brugada phenocopy gradually improved over 3 days. We reviewed the literature and suggested possible mechanisms.