응급실 퇴실배치와 한국형 응급환자 분류체계를 통한 응급여부, 내원수단의 관계

왕일재,조석주,염석란,배병관,조영모,이강호,김미정,황성연,박재성 대한응급의학회 2018 대한응급의학회지 Vol.29 No.2

Objective: The policy to judge the level of emergency (emergent vs non-emergent) based on Korean Triage and Acuity Scale (KTAS) has been introduced by government to control the flow of emergency patients. The purpose of this study is to identify the variables expected to affect the disposition and to compare the relative importance of the variables. And we also evaluate the validity of the policy to judge the level of emergency based on KTAS. Methods: We enrolled a total of 29,865 patients who visited a Wide Regional Emergency Center in Busan from Jan 2016 to Dec 2016. Data of those patients were extracted from National Emergency Department Information System (NEDIS) and analysed retrospectively. We determined disposition as the outcome variable. We evaluated the relationship between disposition and visit time, visit mode (firehouse ambulance, inter-facility transfer and self-transport), level of emergency based on KTAS, cause of morbidity. And we also evaluated general and conditional dominances of those variables to compare their relative importance each other. Results: The disposition of the patients was discharge to home (53.5%), general ward admission (30.3%), intensive care unit admission (11.6%), and inter-facility transfer (4.8%). In the univariate analysis, age, gender, visit time, visit mode, cause of morbidity, KTAS level had a significant effect on the disposition. All variables that had a significant effect on univariate analysis also had a significant effect on disposition in multivariate analysis. As a result of dominance analysis, visit mode was the most important variable in both general dominance and conditional dominance. However, if KTAS was devided into 5 levels, it was the most important variable. Conclusion: Level of emergency based on KTAS was significantly effective on patient disposition, however it was relatively less important compared to the visit mode. If the visit mode is reflected in the triage system, triage accuracy is expected to be improved. And it also can be a good option to construct triage system based on 5 level KTAS.

성문위기도기를 적용한 장시간의 심폐소생술 후 발생한 위식도접합부 파열에 의한 기복증

왕일재,염석란,박맹렬,이성화,박순창,김형빈 대한응급의학회 2017 大韓應急醫學會誌 Vol.28 No.3

Gastric rupture after cardiopulmonary resuscitation (CPR) is a rare complication. In most cases, it is associated with bystander-provided CPR, bag-mask ventilation, and difficult airway management. To the best of our knowledge, there has been only one previous case report in the literature regarding gastric rupture after CPR via supraglottic airway. We present a case of a gastroesophageal junction rupture secondary to CPR with supraglottic airway. Healthcare providers should consider that gastric rupture can be a complication from performing CPR.

혈관내 풍선 확장에 의한 대동맥 차단소생술이 적용된 돼지 복부 장기 조직의 기계적 거동 평가

왕일재,유지훈,허업,송승환,안효영,송찬희,이치승,유동만,Wang, Il Jae,You, Ji-Hun,Huh, Up,Song, Seunghwan,Ahn, Hyo Young,Song, Chan-Hee,Lee, Chi-Seung,Ryu, Dong-Man 한국재료학회 2020 한국재료학회지 Vol.30 No.4

Abdominal organs are the most vulnerable body parts under vehicle trauma, and there is high mortality from acute injuries in accidents. There are various ways to reduce this high mortality; one method is Resuscitative Endovascular Balloon Occlusion of the Aorta, which has recently become very popular as a minimally invasive alternative in the emergent management of patients with non-compressible hemorrhages below the diaphragm. However, high safety factor for patients is applied in actual clinical practice because there is no exact standard for the operating time. Therefore, in this study, the effects of the mechanical behavior of organ tissues for the duodenum, kidney, and liver on the operating time of Resuscitative Endovascular Balloon Occlusion of the Aorta is investigated in order to obtain data needed to establish standards of operating time. In characteristic analysis of organ tissues, uniaxial tensile test and compression test are conducted according to the operating time.

동물마취제 졸레틸 장기 남용에 의한 중독 1례

왕일재,김용인,염석란 대한응급의학회 2013 대한응급의학회지 Vol.24 No.1

Zoletil is a non-narcotic, nonbarbiturate, injectable veterinary anesthetic agent, which is routinely used as a veterinary anesthetic. Zoletil is an equal weight (1:1 ratio) combination of tiletamine hydrochloride and zolazepam hydrochloride. Tiletamine is a dissociative anesthetic agent with pharmacological similarity to ketamine, and zolazepam is a nonphenothiazine,diazepinone minor tranquillizer similar to diazepam. Zoletil is the term used in Europe and Telazol is used in the USA. Adverse effects of zoletil in animals include salivation, vomiting, tachycardia, seizures, central nervous system stimulation, apnea, and prolonged recovery time. A 30-year old male who was poisoned with zoletil visited our emergency center and presented with several symptoms. We report on a case of Zoletil poisoning.

속목정맥을 이용한 중심정맥 삽관시 머리 회전과 다리 거상의 영향

왕일재,박성욱,염석란,한상균,이성화,조석주 대한응급의학회 2012 大韓應急醫學會誌 Vol.23 No.1

Purpose: The aim of this study was to evaluate the effect of head rotation and leg elevation as it impacts the depth from the skin surface to the internal jugular vein (IJV), the diameter of the IJV, and the relative anatomical location of the IJV to the carotid artery (CA). Methods: A total of 20 volunteers were enrolled in this study. In a supine position with/without 30˚head rotation to the left, and with/without 30˚leg elevation, the depth from skin surface to IJV, the IJV diameters, and the anatomical relationship between IJV and CA were measured using 2-dimensional ultrasound from the right side of the neck. The relative position of the IJV to the CA was depicted as an angle ranging from -180˚to +180˚. The measurements observed in each position were compared. Results: As the head was rotated to the left, the depth of the IJV from the skin surface decreased and the anteroposterior IJV diameter increased significantly (all p<0.001). The relative position of the IJV to the CA tended to move in an anterior and medial direction during head rotation. Leg elevation had a significant impact on the transverse diameter of the IJV, but only when the head was rotated (p=0.027). With leg elevation, there was no consistent locational change of the IJV relative to the carotid artery, and there were no significant changes observed for IJV depth relative to the surface of the skin or IJV anteroposterior diameter. Conclusion: Our results indicated that head rotation increases the risk of carotid artery puncture by increasing the overlap of the carotid artery and the IJV. To decrease the risk of carotid artery puncture, a neutral head position should be maintained during IJV catheterization, with a central approach.

고위험외상 선별도구로서 변형소아점수와 새롭게 고안된 확장된 변형소아외상점수의 유용성: 두 단계에 의한 외상팀 활성화 지지

강문철,왕일재,조석주,염석란,한상균,박성욱,이성화,박순창,이대섭,조현민 대한응급의학회 2017 대한응급의학회지 Vol.28 No.6

Purpose: A secondary triage tool for pediatric trauma patients, “modified pediatric trauma score (mPTS)” was introduced to predict high risk trauma. Methods: Pediatric trauma patients (≤15 years) presenting to the Pusan National University Hospital trauma center emergency department were analyzed retrospectively. The patients were classified into high risk and low risk groups. The high risk group was assigned an Injury Severity Score ≥12, death, intensive care unit admission, or urgent intervention (intubation, closed thoracostomy, emergency angiography and embolization, emergency surgery). The airway, blood pressure, fractures, level of consciousness, and external wounds were evaluated and the mPTS was calculated. Results: One hundred seventy-seven patients were enrolled in this study. The mPTS had a sensitivity, specificity, positive predictive value, and negative predictive value of 88%, 54%, 60%, and 85%, respectively. Overtriage and undertriage was 39% and 14%, respectively. The mPTS missed 6 high risk patients and all 6 patients were abdominal injury patients. The mPTS was modified to include an abdominal physical examination and/or focused assessment with sonography for trauma. The newly developed scoring system was called the extended mPTS (E-mPTS). The E-mPTS had a sensitivity of 98% and negative predictive value of 98%. The safe level of overtriage (38%) was maintained. Conclusion: mPTS was applied to the patients and the undertriage rate was too high. The extended mPTS improved undertriage to 2% while maintaining the overtriage rate at a safe level. The E-mPTS is expected to have a resource saving effect when used as a pediatric trauma team activation standard.

외상성 흉부 대동맥 손상 환자에서 시행한 혈관내 치료의 임상적 고찰

박영민,왕일재,염석란,조영모,박성욱,조석주,박시홍,허업,송승환,김선희,권훈,이대섭 대한응급의학회 2022 대한응급의학회지 Vol.32 No.6

Objective: Blunt thoracic aortic injury (BTAI) is a rare but fatal injury. BTAI has been treated surgically, but thoracic endovascular aortic repair (TEVAR) is used as a treatment option and has shown good results. The purpose of this study was to analyze the outcomes of patients with BTAI treated using TEVAR. Methods: BTAI patients who had received TEVAR for five years were analyzed. We investigated injury severity score, aortic injury site, computed tomography findings and mortality. Results: We identified 17 patients, and all were diagnosed using computed tomography. Twelve patients received TEVAR as an emergency, and the remaining five patients received TEVAR delayed. The most common injury site was isthmus (82%), and the median injury severity score was 33. There were 15 cases with a BTAI grade of 3 and two cases with a BTAI grade of 4. The mortality rate was 11.8% (n=2). Conclusion: TEVAR is more meaningful because it is easier and faster and has fewer complications than thoracotomy in patients with traumatic aortic injury.

Attempted Suicide by Nitrogen Gas Asphyxiation: A Case Report

박성욱,왕일재,염석란,한상균,김형빈,조영모,배병관 대한임상독성학회 2017 대한임상독성학회지 Vol.15 No.1

Nitrogen is an inert gas that is harmless to humans under normal conditions. While it is not inherently toxic, nitrogen gas becomes dangerous when it displaces oxygen, resulting in suffocation. Herein, we report a case of a 34-yearold man who attempted suicide by nitrogen asphyxiation who presenting with decreased mental function and agitation. Lactic acidosis and hyperammonemia were observed on presentation at the emergency department, but these improved after a few hours. After 2 days, the patient regained full consciousness, and was discharged without any complications. Survival after asphyxiation due to nitrogen gas is very rare, and these patients are more likely to have poorer outcomes. There is a potential for the increasing use of nitrogen gas as a method of committing suicide because of the ease of access to this gas.

Using the pre-hospital shock index multiplied by the AVPU scale as a predictor of massive transfusion and coagulopathy in patients with trauma

최영훈,왕일재 대한응급의학회 2023 대한응급의학회 학술대회초록집 Vol.2023 No.2

Is the shock index a useful tool in trauma patients with alcohol ingestion?

박시홍,왕일재,조영모,양욱태,염석란,이대섭,민문기,천모세,허업,송찬희,김예은 대한응급의학회 2023 대한응급의학회지 Vol.34 No.5

Objective: Alcohol consumption is a frequent risk factor for trauma. The shock index is widely used to predict the prognosis of trauma, and alcohol can influence the shock index in several ways. This study investigated the usefulness of the shock index in trauma patients who had ingested alcohol. Methods: This was a retrospective, observational, single-center study. We performed a logistic regression analysis to assess the association between alcohol consumption and massive transfusions. A receiver operating characteristic (ROC) curve was constructed to determine the predictive value of the shock index for patients who had ingested alcohol. Results: A total of 5,128 patients were included in the study. The alcohol-positive group had lower systolic blood pressure and higher heart rate; consequently, the shock index in this group was higher. There was no significant difference between the proportion of the alcohol-positive and alcohol-negative groups who underwent massive transfusions and suffered hospital mortality compared to the overall proportion of patients who underwent massive transfusion based on the shock index. In the logistic regression analysis, the alcohol-negative group showed higher odds ratios for massive transfusions compared to the alcohol-positive group. The area under the ROC curve for predicting massive transfusion was 0.831 for the alcohol-positive group and 0.825 for the alcohol-negative group. However, when a cutoff value of 1 was used, the false positive rate was significantly higher in the alcohol-positive group. Conclusion: The shock index is a useful tool for predicting outcomes in patients with trauma. However, in patients who have ingested alcohol, the shock index should be interpreted with caution.