야생식물 중독의 임상 양상

옥택근,박찬우,조준휘,천승환,이승용,김성은,최기훈,배지훈,서정열,안희철,안무업,조병렬,김용훈,Ok, Taek-Gun,Park,, Chan-Woo,Cho, Jun-Hwi,Cheon, Seung-Whan,Lee, Seung-Young,Kim,, Sung-Eun,Choi, Ki-Hoon,Bae, Ji-Hoon,Seo, Jeong-Yeul,Ahn, Hee-Cheo 대한임상독성학회 2005 대한임상독성학회지 Vol.3 No.2

Purpose: With the recent boom in 'eating healthy', many adults are interested in dieting to prevent future diseases. However only well trained experts can distinguish between what are edible vegetables and herbs from their poisonous look-alikes. In cases where a patient unknowingly ingests a poisonous herb, is caught off guard by the poisonous side effects that occur because of their lack of knowledge of what they have ingested. This paper will focus on the need to educate the public about the risks involved with ingesting wild vegetables and herbs and study the emergency diagnosis and treatment of poisoned patients that enter the emergency room. Method: This study was done in the spring of 2004 (from March to May) in the Kangwon Young-Seo districts of Korea. 15 subjects used in this study, entered the emergency room showing signs of toxic symptoms. Data was collected by examining subject's records. Additional data was collected by collaborating with physicians in the hospital that diagnosed and treated the subjects. Identifying the poisonous vegetable or herb is the first step to proper diagnosis and treatment. Subjects admitted to the emergency room, underwent a battery of tests: laboratory examination, ECG, radiological exam and etc. Results: The demographics of the study encompassed subjects with the average age of $50{\pm}19$ years old. There were 10 men and 5 women. Common symptoms of this study included; gastrointestinal symptoms such as nausea, vomiting, epigastric pain and so on. In the case of Caltha palustris ingestion, additional symptoms were present; bradycardia and hypotension which lasted for a long time. While cases that ingested Scopolia parviflora had little effect on vital signs but manic episodes lasted for about three days. Veratrum patulum ingestion showed signs of bradycardia and hypotension but contrary to Caltha palustris recovery was shorten by treating with dopamine. However, dizziness, headache and paresthesia of the extremities continued for a long time. Finally Sium ninsi ingestion showed visual disturbance, paresthesia of the extremities, dizziness as their initial symptoms. Conclusion: The risks involved with ingesting wild plants without the proper knowledge can lead to serious side effects and steps need to be taken to educate the public. In addition, all emergency physicians need to have a working knowledge of the symptoms and signs associated with ingesting toxic wild plants and need to treat accordingly.

급성 약물 중독 환자에서 위세척의 치료 실태

옥택근,조준휘,박찬우,천승환,이승용,김성은,최기훈,배지훈,서정열,안희철,안무업,조병렬,김용훈,Ok Taek Geun,Cho Jun Hwi,Park Chan Woo,Cheon Seung Whan,Lee Seung Yong,Kim Sung Eun,Choi Ki-Hoon,Hae Ji Hoon,Seo Jeong Yeul,Ahn Hee Cheol,Ahn Moo Eo 대한임상독성학회 2005 대한임상독성학회지 Vol.3 No.1

The majority of acute toxic poisoning occur via oral route. The most important emergency treatment of acute poisoning are gastric lavage. Gastric lavage should be considered a patient has ingested a potentially life-threatening amount of a poison and the procedure can be undertaken within 60 mins of ingestion. But, gastric lavage does not consist properly in the cases of emergency situation or an inexperienced doctors treat. The purpose of this study was to determine whether gastric lavage is performed properly. Eighty patients were enrolled in the study in 12-month period from January to December 2002. A retrospective chart review was performed on patients identified as drug overdose who admitted to ER. To assess whether there was a subgroup of patients who may have been candidates for the initiation of gastric lavage in the ER, the patients divided in two groups by time interval from toxin ingestion to ER arrival. The group 1 that admit within 60 minutes after drug ingestion was 38 cases ($47.5\%$), and the group 2 patient who admitted after 60 minutes was 42 cases ($52.5\%$). The average age was $44\pm19$ years in group 1, and $48\pm24$ years in group 2. There were no differences in sexual distribution of two groups. The mean time interval was $49\pm20$ minutes in the group $1,258\pm190$ minutes in the group 2. Only thirty ($37.5\%$) of the patients had an overdose for which the treatment of gastric lavage was potentially feasible according to guideline. The correctly performed gastric lavage was 18 ($47.4\%$) in group 1, 12 ($28.6\%$) in group 2. We must enforce education about the gastric lavage, and do so that may treat according to guideline.

Acute Myocardial Infarction with Elevated ST-segment Only in Lead aVR

옥택근,강구현,조정래,장용수,안희철,조규종,안정환,조준휘 대한응급의학회 2014 大韓應急醫學會誌 Vol.25 No.2

Lead aVR ST segment elevation in patients with clinicallysuspected acute coronary syndrome strongly suggests thepossibility of occlusion of the left main coronary artery(LMCA), and stenosis or occlusion in this area can causesevere life-threatening left ventricular dysfunction or malignantarrhythmias. Thus, it could be a sign suggestive of apoor prognosis for patients. In this study, we report on thecase of a 67-year-old male who presented to the emergencydepartment with total occlusion of LMCA with STsegmentelevation in only lead aVR, and without ST-segmentelevation in other leads.

강원 영서 북부 지역의 약물 중독 실태

옥택근,조준휘,박찬우,김성은,최기훈,배지훈,서정열,정재봉,안희철,안무업,유기철,Ok, Taek-Gun,Cho, Jun-Hwi,Park, Chan-Woo,Kim, Sung-Eun,Choi, Ki-Hoon,Bae, Ji-Hoon,Seo, Jeong-Yeul,Chung, Jae-Bong,Ahn, Hee-Cheol,Ahn, Moo-Eob,You, Ki-Cheol 대한임상독성학회 2004 대한임상독성학회지 Vol.2 No.2

Acute poisoning is one of the diseases which need the most fastest emergency measures at the very beginning. However, at present, The Korea doesn't manage the toxication all over the country, and in particular, there is no guide to medical cure paying due regard to the traits of each area. This paper focused on the issue that the necessary data in preparing the facilities for the treatment of the poisoned patients and materials for medical treatment including antidote would have to be collected, after finding the special features of the symptoms by searching the present conditions of the poisoning in small towns next to farm villages in the North area of Youngseo, Kangwon province. This study was based on the questionnaires from 111 patients who were carried into the emergency room by the poisoning in two university hospitals of the North area of Youngseo, Kangwon, for one year, 2002. Upon investigation, the patients(111) visiting emergency room by the acute poisoning during the research period was found to be 0.37 percent of all patients(30,085) visiting emergency room. Among them, the most high percentage was given in their twenties and thirties at the rate of $39.6\%$, and the ratio($40.5\%$) of the poisoned patients after their fifties was much higher than a research($10\%$) of other areas. Many poisoned patients came to their rescue in an emergency room generally in spring and in winter, from 7 a.m. to 3 p.m. Agricultural chemical of the toxic materials had a majority at a ratio of $57.7\%$, and paraquat of the agricultural chemicals was found to have a lot of toxicity by $31.7\%$. As the trace of the toxication, the oral poisoning was common by $89.2\%$, and $55.9\%$ in the case of operating gastric lavage and nasogastric irrigation, but only $14.4\%$ for prescribing antidote. The mortality of the acute poisoned patients was $17.2\%$, and the toxication by paraquat held a majority. As a result, the acute poisoning of the North area in Youngseo, Kangwon had both of the characteristics of the rural and the city, and the patients over their fifties by the population aging had more attack of the disease than other regions. Also, with the high ratio of the toxication by the agricultural chemicals, especially, the lethal agricultural chemical was used frequently. Therefore, these dangerous situations need to find the ways to cope with.

봄나물 섭취 후 이상 행동을 주요 증상으로 내원한 환자 1례

옥택근,김윤성,박찬우,문중범,최기훈,서정열,안희철,안무업,조준휘,Ohk Taek-Geun,Kim Yoon-Seong,Park Chan-Woo,Moon Joong-Bum,Choi Ki-Hoon,Seo Jeong-Yeul,Ahn Hee-Cheol,Ahn Moo-Wob,Cho Jun-Hwi 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.1

With well-being boom recently, the common people, but not experts, are increasingly taking in them directly by picking wild herbs. However, only experts can distinguish between edible vegetables and poisonous herbs from the wild herbs. Especially, it is not even easy for experts to distinguish them only by looking into buds in spring without flowers or fruit. So, sometimes many patients are being carried into the emergency room by the toxic symptom after taking by misunderstanding the poisonous herbs as edible vegetables. For herb intoxication as well as drug intoxication, what kinds of vegetables patients took in, and when and how much they took in them are important information for curing. Of course, in the case of intoxicating in the wild herbs, the patients can have a lot of symptoms and sings-hemodynamic alteration and abnormal neurologic sign as well as gastrointestinal symptoms-according to the kinds of herbs which they took in. Therefore, it is difficult to find the kinds of herbs which they took in through the specific symptoms. Recently we experienced a case with showing typical anticholinergic symptoms after ingestion of Scopolia japonica. As a result, the publicity activities about the wild plants needs because if the person without their previous knowledge take in the poisonous herbs, serious side effects can be produced..

시체검안서 작성을 위한 사망 원인 조사 방법에 관한 연구

옥택근,조준휘,박찬우,김윤성,문중범,최기훈,서정열,안희철,안무업,이봉기,조병렬,김용훈 대한응급의학회 2006 대한응급의학회지 Vol.17 No.3

춘천시 응급의료서비스 취약지역 분석 및 권역 평가

옥택근,조준휘,천인국,김민수,이태헌,김창환,배선학 한국지역지리학회 2022 한국지역지리학회지 Vol.28 No.2

The objectives of this study were to identify areas vulnerable to emergency medical services and to evaluate whether detailed areas of emergency centers could reflect reality. To this end, patient transfer history data and network-based spatial analysis using road networks were analyzed together. As a result of analyzing the scope of services to find out vulnerable areas of emergency medical care, most of the vulnerable areas of emergency medical care that took more than 20 minutes from the emergency dispatch center to the reporting point were distributed outside the basin. In the case of the emergency response center zone, both patient transport history data and spatial location-location model showed a high rate of discrepancy between the emergency center zone and the center where the actual dispatch was made. The network-based spatial analysis method using a road network was evaluated to be as likely to be used as the analysis result of patient transfer history data. 이 연구는 119 응급의료서비스 취약지역을 찾아내고 119안전센터의 세부 권역이 현실을 반영하고 있는지 탐색하기 위한 것이다. 이를 위해 119환자이송 이력 자료 분석과 도로망을 이용한 네트워크 기반의 공간분석을 병행하여 수행하였다. 응급의료 취약지역을 알아보기 위해 서비스 범위를 분석한 결과 119안전센터에서 신고지점까지 20분 이상 소요되는 응급의료취약 지역은 대부분 춘천분지 외곽지역으로 나타났다. 119안전센터의 권역과 실제 출동이 이루어지는 센터 간 일치도 평가에서는 119환자이송 이력 자료와 입지-배분 모형 결과가 유사하게 나타났다. 특히, 대룡 권역과 효자 권역에서 권역 간 조정이필요하였다. 또한, 도로망을 이용한 네트워크 기반의 공간분석 방법은 119환자이송 이력 자료 분석 결과와 비교하였을 때 그활용 가능성을 확인할 수 있었다.

강원도 특별구급대 교육에 대한 구급대원의 요구도와 만족도 조사

옥택근,이태헌,조준휘,안무업,양고은 대한응급의학회 2022 대한응급의학회지 Vol.32 No.6

Objective: To expand the scope of the work performed by emergency medical service (EMS) providers, a 3-day education training course was implemented at the national level to organize and operate a special EMS unit consisting of level-1 EMS providers and nurses. We conducted an evaluation of the curriculum for EMS providers that completed the education course. Methods: From June 2019 to July 2020, a survey was conducted to evaluate the curriculum of 270 EMS providers that completed the training course in Gangwon province. We analyzed differences between educational needs, satisfaction with educational contents, and job performance confidence with respect to age, sex, certification, and career. Results: We analyzed the contents of 143 questionnaires received from the EMS providers. Satisfaction with the “instructor” was highest at 4.52 points, and satisfaction with the “education” provided was lowest at 3.89 points. Those aged over 40 had the highest satisfaction scores for “education”, and a significant inverse relationship was found between age and satisfaction (P=0.020). In the overall curriculum, educational need was highest among those with a career duration of ≥ 3 years and those in their 30s. Regarding educational contents, the need for advanced cardiovascular resuscitation was greatest and the need for emergency delivery was lowest, but this difference was not significant. Conclusion: When designing a curriculum for EMS providers in the future, segregation into similar groups is required to reflect their educational needs.

구급대원 교육 어떻게 하고 있나요?

옥택근 대한응급의학회 2022 대한응급의학회 학술대회초록집 Vol.2022 No.2

'만병초' (Rhododendron brachycarpum)에 의한 전신 중독 2례

옥택근,김윤성,박찬우,문중범,이봉기,조병렬,김용훈,김성은,최기훈,서정열,안희철,안무업,조준휘,Ohk, Taek-Geun,Kim, Yoon-Seong,Park, Chan-Woo,Moon, Joong-Bum,Lee, Bong-Ki,Cho, Byung-Yeul,Kim, Yong-Hoon,Kim, Seong-Eun,Choi, Ki-Hoon,Seo, Jeong-Ye 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.2

Historically, the common folk have made use of various wild herbs for both food and medicinal purposes. However, the misuse of these wild herbs can lead to adverse consequences, including severe poisoning in some cases. In cases of poisoning from wild herbs, patients can exhibit a variety of symptoms depending on the herbs involved, which in addition to gastrointestinal symptoms may include hemodynamic alteration and abnormal neurologic signs. In the present case, two patients were admitted to the emergency room with symptoms of toxicity after consuming Rhododendron brachycarpum liquor. Rhododendron brachycarpum and other wild herbs contain the toxic material grayanotoxin. Because of its serious toxic symptoms, great caution must be exercised in using rhododendrons for food and medicinal purposes.