폐 실질과의 누공을 형성한 대동맥궁 동맥류 1례

위준선,한승철,정승태,윤영윤,정경운,문정미,전병조,허탁,민용일 대한응급의학회 2003 대한응급의학회지 Vol.14 No.2

Massive hemoptysis represents a major medical emergency that is associated with high mortality. The causes of hemoptysis are various and include pulmonary and cardiovascular disorders and trauma. The causes of pulmonary disorder are tuberculosis, bronchiectasis, abscess, malignancy, bronchitis, and fungal infection. The causes of cardiovascular disorder are mitral stenosis, pulmonary embolism, and congestive heart failure. A fistula between an aortic aneurysm and the pulmonary parenchyma is one of the causes of hemoptysis, but it is a rare. However, if undiagnosed, it is a uniformly fatal cause of massive hemoptysis. This is a case of bleeding from a fistula between an aortic arch aneurysm and a lung parenchyma in a patient with an aortic arch aneurysm who presented with massive hemoptysis. He had suffered intermittent hemoptysis since he was diagnosed with an aortic arch aneurysm three years before. A high clinical suspicion must be maintained when a history of intermittent hemoptysis is obtained in patients with an aortic aneurysm or prior aortic graft surgery.

뇌경색과 뇌출혈이 함께 발생한 감염성 심내막염 1례

위준선,정승태,윤영윤,정경운,문정미,전병조,허탁,민용일 대한응급의학회 2003 대한응급의학회지 Vol.14 No.1

Risk factors for infective endocarditis include injection drug abusers and patients with structural heart defects undergoing dental procedures. Infective endocarditis is clinically important because it is hard to diagnose it in its early stage owing to its various clinical manifestations, and because its morbidity and mortality increase when neurologic complications occur. This is a case of infective endocarditis in the course of treatment of which complicating cerebral hemorrhage and infarction progressed rapidly and prompted death.

권역응급의료센터 운영경험 : 광주권역을 중심으로

위준선,윤영윤,전병조,윤한덕,허탁,민용일 대한응급의학회 2002 대한응급의학회지 Vol.13 No.1

Purpose: As Gwangju Wide Regional Emergency Medical Center was newly opened during February 2001, a comparative analysis was performed of patients who had visited the emergency department before and after the opening in order to measure the difference and to provide basic data for its management. Methods: The 9,995 patients, who had visited between February 1. 1999, and July 31, 1999, before the opening and the 12,457 patients who visited between February 1, 2001, and July 31, 2001, after its opening were compared according to sex, age, non-trauma or trauma, means and form of visit, attending department, length of stay in the emergency department, form of discharge, and time of death verification (dead-on-arrival(D.O.A) versus dead-after-arrival (D.A.A) ) Results: The total number of patients increased by 24%. The admission rate was 31.8% before the opening and 40.6% after the opening; the mean length of stay in the emergency department was 15.7 hours before the opening and 12.2 hours after the opening. The mean length of stay of admitted patients decreased from 26.6 hours before the opening to 18.3 hours after the opening. Conclusion: The decrease in the mean length of stay in the emergency department from 15.7 hours before the opening to 12.2 hours after the opening is viewed as a positive result, but is still not satisfactory. Accordingly, it is considered urgent that every clinical department take an active part in improving circulation of patients both in the Emergency Intensive Care Unit(EICU) on the second floor and in the emergency ward on the fifth floor, as well as in providing rapid medical care and decisions on treatment strategies in the emergency department on the first floor.

발작성 상실성 빈맥 환자의 응급실 내 치료 결과 및 재발 인자에 관한 분석

전병조,문정미,위준선,정경운,김현창,정승태,허탁,민용일 대한응급의학회 2002 대한응급의학회지 Vol.13 No.4

Purpose: The purpose of this research was to evaluate the factors predicting recurrence and the characteristics of patients who recurred after the treatment of spontaneous paroxysmal supraventricular tachycardia (PSVT) with adenosine. Methods: From January 1999 to December 2001, 62 patients with PSVT were enrolled in this study. The conversion group included patients who had had a therapeutic response, which was defined as the occurrence of a change in the sinus rhythm after adenosine administration. The recurred group consisted of all patients who had not had a therapeutic response. Clinical features, the results of treatment, ECG findings, and the hemodynamic statuses were analyzed. Results: The treatments were vagal maneuver (5 pts, 7.5%), adenosine 6 ㎎ (37 pts, 55.2%), adenosine 12 ㎎ (14 pts, 20.9%), verapamil 5 ㎎ (9 pts, 13.4%), and cardioversion (2 pts, 3.0%). Twenty-five of the 62 patients failed to have a therapeutic response, yielding a recurrence rate of 40.3%. Atrioventricular reentrant tachycardia (AVRT) was more prevalent in the recurred group. The most common symptom at presentation was chest pain. The recurred group had increased heart rate, and increased blood pressure. When patients were monitered after adenosine, unifocal premature ventricular complex was the most common rhythm encountered in the conversion group, but atrial fibrillation, and multifocal premature ventricular complex was the most common rhythm encountered. Conclusion: Age, heart rate, difference in systolic blood pressure from presentation to discharge, previous history of heart disease, and rhythms encountered after adenosine administration ere factors predicting recurrence.

응급실에 내원한 환자에서 어지럼증의 원인과 임상양상의 분석

문원식,정경운,위준선,문정미,전병조,김용권,소정일,류진호,허탁,민용일 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Background: Recently, The number of patients who have been complaining of the vertigo or dizziness has been increasing due to rapid growth of elderly population and senile disease. The differentiation of dizzy patients is not familiar to most emergency physicians. This study was designed to differentiate true vertigo and to investigate the clinical difference among central vertigo, peripheral vertigo, and other causes of dizziness. Methods: The authors analyzed the cases of 237 dizzy patients who visited the emergency department of Chonnam University Hospital during the recent 2 years. For the base of dizziness, associated past illnesses, severity, nystagmus type, and the causes of central and peripheral vertigo. Results: Female patients were 142(59.9%) and male patients were 95(40.1%). The most common age group was the 6th decade. The origin of dizziness was classified as peripheral cause(25.3%), central cause(32.9%), and others(41.8%). As to nature of the dizziness, the rotatory sense was dominant in peripheral vertigo and the floating sense and blurred vision in central vertigo. Peripheral vertigo was triggered by position change of head and body, and central vertigo by the eye movement. Audiograms I showed that most patients with central vertigo had normal hearing, but 46.7% of thoswith peripheral vertigo had an abnormal hearing disturbance. Nystagmus was more prevalent in peripheral vertigo Conclusion: History taking and physical examination played an important role in the diagnosis of dizzy patients. An important part of the diagnosis of a dizzy patient could be to evaluate the peripheral origin, the central origin and others causes. Because central vertigo may be associated with a significant neurological pathology, spectral radiological studies, including MRI and CT, are mandatory to rule out a devastating brain lesion.

3차 병원의 병동에서 시행된 심폐소생술의 분석

류진호,정경운,위준선,문정미,전병조,문원식,김용권,소정일,허탁,민용일 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Background: Although cardiopulmonary resuscitation(CPR) is a very effective therapy in cardiac arrest, it is hard to prove the true effectiveness of CPR. Several studies about out-of-hospital and emergency department CPR exist, but only a few reports about in-hospital CPR are available. This study was designed to investigate in-hospital cardiac arrest, to analyze the result of CPR, and to evaluate the problems associated with in-hospital CPR. Methods: A clinical analysis of 71 cases of in-hospital CPR announcement from January 2000 to August 2000 was performed. The initial rhythm on cardiac arrest, return of spontaneous circulation(ROSC), and the survivals were analyzed in the case of the 46 true cardiac arrest patients. Results: During 8 months, there were 71 cases of in-hospital CPR announcement. Among them, there were 46 cases of true cardiac arrest and 25 cases of non-cardiac arrest. Of the 46 true cardiac-arrest cases, 27(58.7%) experienced ROSC, 15(32.6) survived for over 24 hours, and 7(15.2%) survived to be discharged. The initial rhythms on cardiac arrest were 30 cases(65.2%) of asystole, 14(30.4%) of PEA(pulseless electrical activity), and 2(4.3%) of ventricular fibrillation, with ROSC being 17 cases(56.7%), 9(64.3%) and 1(50.0%) cases and discharged survivors being 4 cases(13.3%), 3(21.4%) and 0(0.0%) cases, respectively. Conclusion: Extraordinarily high proportions of asystole and PEA were seen in the initial rhythm of cardiac arrest, and those were associated with high survival rates. Although further study is needed to evaluate the course leading to this high proportion of asystole and PEA, this result suggests that if the EMS system in the hospital is activated promptly and systematically, a better outcome will be achieved in case of cardiac arrest with asystole and PEA.

응급실 내원환자에서 혈청 AST 상승의 의미

김현창,고영호,문정미,위준선,정경운,전병조,허탁,민용일 대한응급의학회 2003 대한응급의학회지 Vol.14 No.1

응급실 내원환자에서 혈청 AST 상승의 의의

김현창,고영호,문정미,위준선,정경운,전병조,허탁,민용일 대한응급의학회 2003 대한응급의학회지 Vol.14 No.1

Purpose: Serum aspartate aminotransferase (AST) is an enzyme widly used in the diagnosis of acute liver disease. It is also highly sensitive in cases of myocardial infarction and muscular injury. This study is designed to ascertain the utility of AST for diagnosis in emergency room. Methods: From July 2001 to September 2002, 98 patients with AST greater than ten times (400 U/L) the normal range were identified by the biochemistry laboratory in the Emergency Medical Center of Chonnam National University Hospital. The patients' clinical records were studied to determine the diagnosis, the clinical course, the physical finding on arrival, the past history, other serological and imaging studies, etc. Results: The most common cause of elevated AST level was hepatic in origin (74 cases, 75.5%). Other causes were soft tissue injury (13 cases, 13.3%) and myocardial infarction (11 cases, 11.2%). In group with hepatic causes forraised AST, 21 (28.3%) patients had pancreaticobiliary desease, 20 (27.0%) patients were in conditions producing hepatic ischemia, 18 (24.3%) patients had hepatocellular desease, 6 (8.1%) patients had traumatic liver injury, and 4 (5.4%) patients had malignancy. The hepatic ischemia was caused by sepsis (6 cases, 30.0%), heart failure (6 cases,30.0%), hypoxia (5 cases, 25.0%), and prolonged hypotension (3 cases, 15.0%). Conclusion: The main cause of a notably increased serum AST level is known to be hepatocellular disease, but this study for emergency patients revealed that other causes, such as hepatic ischemia, traumatic liver injury, and muscular disease, were also remarkable. When the level of serum AST is abnormally high, the clinician must consider not only hepatocellular disease but also prolonged hypotension, circulatory collapse, hypoxia, traumatic liver injury, etc.

원인 불명의 아나필락시스 쇼크에서 진단된 포층병 1례

정경운,고영호,김현창,위준선,문정미,전병조,허탁,민용일 대한응급의학회 2003 대한응급의학회지 Vol.14 No.2

Hydatid disease is a parasitic infection caused by the Echinococcal species. Humans are intermediate hosts and become infected directly by contact with canines or indirectly by contact with food, water, and contaminated objects. This disease involves multiple organs, including liver, lung, heart, muscle, bone, kidney, and brain. Rupture of a hydatid cyst, which is the most common complication of this disease, can cause serious sequelae, including allergic reaction, secondary infection, biliary obstruction, and metastasis. The hydatid disease occurs principally in areas of cattle and sheep ranching. In Korea, this disease is rare, and only a few cases have been reported. We report a case of hydatid disease with anaphylactic shock and suggest that hydatid cyst complications must be kept in mind when dealing with patients who have a history associated with an endemic region.

경피적 척추 성형술 후 골 시멘트에 의해 발생한 치명적인 폐 색전증 1례

정경운,고영호,김현창,위준선,문정미,전병조,허탁,민용일 대한응급의학회 2003 대한응급의학회지 Vol.14 No.1

Percutaneous vertebroplasty is a safe and effective procedure for the treatment of benign and malignant lesions of the spine, but has been associated with some known complications. Most complications are related to the percutaneous approach, but more severe complications related to the unwanted migration of acrylic cement can occur. We report an unusual case of a fatal pulmonary embolism caused by acrylic cement. Known factors related to cement leakage are incorrect needle position, the consistency of the cement, and the vascularity of the lesion. Emergency physicians should consider acute pulmonary embolism as a diagnosis when evaluating a patient who is suffering from dysnea or chest pain after an orthopedic procedure performed with cement.