출혈성 쇼크와 패혈성 쇼크에서 쇼크인덱스의 의의

이베안 ( Be Ahn Lee ),정상헌 ( Sang Hun Jung ),한갑수 ( Gap Su Han ),이성우 ( Sung Woo Lee ),홍윤식 ( Yun Sik Hong ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.1

Background: Shock Index (SI) is a ratio calculated to weigh Heart rate and Systolic Blood Pressure (SBP) differently. As we know increased the SI over 0.9 is a early predictor of circulatory failure induced by hypovolemia. This study was designed to evaluate the SI as a value of prognostic factor in Hemmorrhagic Shock and Septic Shock patients. Methods: From March 2001 to February 2002, patients presenting to the Emergency department with post traumatic hemorrhagic shock and septic shock patients. Exclusion criteria were age less than 15 years, cardiopulmonary arrest and death on arrival. We compared with admission days, ICU periods, survival rate, Revised trauma score, Base excess, and total amounts of transfusion for evaluation of reliability. Two groups were identified by the SI: group1 had an SI of more than 0.9, and group2 had an SI of less than 0.9. Results: There were 29 hemmorrhagic shock patients, and 30 septic shock patiens. In hemorrhagic shock, group 1 had significantly higher value of compared items (p<0.05). In septic shock, the value were not significantly different between group1 and group 2 (p> 0.05). Conclusion: The SI may be useful to evaluate acute hemodynamic status induced by hypovolemia. But the SI cannot be useful to evaluate hemodynamic status induced by multiorgan dysfunction. The SI cannot be a predictor of prognosis in septic shock.

중증 외상에서 Glasgow Coma Scale(GCS) 운동반응의 의의

신중호 ( Jung Ho Shin ),이성우 ( Sung Woo Lee ),정인철 ( In Chul Jung ),김수진 ( Su Jin Kim ),이베안 ( Be An Lee ),문성우 ( Sung Woo Moon ),정상헌 ( Sang Hun Jung ),김낙훈 ( Nak Hoon Kim ),최성혁 ( Sung Hyuk Choi ),홍윤식 ( Yun Si 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2

Background: Severely injured patients need an optimal triage system that can differentiate those patients who require the resources of the trauma center from those who do not. American national guidelines recommend that patients with Glasgow Coma Scale (GCS) scores less than 14 or triaged-Revised Trauma Score (t-RTS) less than 11 should be triaged to trauma centers. Although, in many studies, the GCS score has been shown to be the strongest single prognostic predictor in trauma patients, the presence of unmeasurable components of the GCS limits its usefulness. Also, it is difficult for emergency medical technicians to estimate the GCS in a prehospital setting because of its complexity and the shortage of time. This study was designed to evaluate the efficacy of the motor component of the GCS in severely injured patients. We hypothesized that the motor component of the GCS (GCSM) would be equally sensitive as the total GCS in triage of severely injuried patients. Methods: We reviewed a total of 114 patient who visited the Emergency Center of Korea University Ansan Hospital between December 2001 and September 2002. Of those 114 patients, 36 were excluded because of inadequate medical records or visiting after cardiac arrest. The parameters that we used as tools for analysi, were age, sex, GCS score, RTS, Injury Severity Score (ISS), actual survival rate (As), and probable survival rate (Ps). We defined severely injured patients (t-RTS ≤11) requiring care in a trauma center or intensive care unit. Based on American College of Surgeons Committee on Trauma (ACSCOT) guidelines, we defined GCS ≤13 as positive triage by GCS, ISS ≥16 as positive triage by ISS, and GCSM ≤5 as positive triage by the motor component of GCS. The sensitivity and the specificity were calculated, and a statistical analysis by t-test was conducted with two-tail α levels of 0.05. Results: Of the 78 patients, the mean age was 44.7±2.2,and the mean ISS was 21.7±1.0. The GCSM was found to have a sensitivity of 85.7% and a specificity of 98.0% for t-RTS≤11. The GCS had a sensitivity of 89.3% and a specificity of 90.0% (p = not significant). Conclusion: Our results indicate that the motor component of GCS is a sensitive predictor of patients` poor prognosis and that the GCSM is equivalent to the GCS for prehospital triage. In view of the simplicity of the GCSM, its substitution for the GCS in triage systems might lead to a higher use rate among prehospital healthcare providers.

호중구 세포에 대한 고장액의 영향에 대한 연구

정인철 ( In Chul Jung ),이베안 ( Be Ahn Lee ),김낙훈 ( Nak Hoon Kim ),박종수 ( Jong Soo Park ),최성혁 ( Sung Hyuk Choi ),홍윤식 ( Yun Sik Hong ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2

Background: To investigate the effects of hypertonic saline on the generation of oxygenderived free radicals in neutrophils, this study was designed. Methods: Human PMNs were isolated from healthy volunteers` peripheral blood by the modified Boyum method. Human PMNs were incubated in 140 mM, 180 mM, 200 mM NaCl with or without fMLP, and then the production of H2O2 was measured with a flow cytometer at 5, 30, 60, 120, and 180 minutes. Isolated PMNs were incubated in 180 mM NaCl before fMLP, after fMLP and also at the same time. H2O2 production was measured by flow cytometry. Results: Hypertonic saline resulted in the suppression of fMLP-mediated H2O2 production in human PMNs. There was no statistical difference in H2O2 production according to the NaCl concentration between 180 mM and 200 mM. fMLP-mediated H2O2 production in human PMNs did not decreased at hypertonic saline infusion after fMLP. Administration of hypertonic saline decrease fMLP-mediated H2O2 production in human PMNs and concentration of 180 mM Na+is effective as well as 200 mM Na+. However, the effects of hypertonic saline is minimal when hypertonic saline was administration after PMNs were stimulated. Conclusions: It is considered that early resuscitation is required in clinically.

상지의 운동제한을 보이는 소아에서 방사선 검사의 필요성

이성우,문성우,윤영훈,이베안,정상헌,전정민,홍윤식 대한응급의학회 2002 대한응급의학회지 Vol.13 No.3

Purpose: The study was designed to identify the necessity of radiographs and to decrease overutilization of radiographs in uncommunicable children who do not move their arms. This study provides clinical guidelines on radiographic evaluation and treatment of children with limited motion in the upper extremity. Methods: The cases of one hundred thirteen pediatric patients under 36 months of age, who had visited the Emergency Center of Korea University Ansan Hospital from January 2000 to December 2001, were retrospectively reviewed. Pediatric patients with upper extremity injuries due to multiple trauma, laceration or motor vehicle accident were excluded. Parameters analyzed were age, sex, mechanism of injury, physical findings, radiographic finding, and injuried upper extremity region. We described focal tenderness and regional edema as physical finding. Each patient without regional edema was classified into an improved or a not-improved group depending on the outcomes after manual reduction. All statistical tests were conducted with two-tailed levels of 0.05. Results: Of the 113 patients, the mean age was 18.6±0.89 months. The most common injury mechanisms were unknown and traction. Minimal edema in the elbow joint was seen in 5 cases, and supracondylar fractures due to short falls were seen in 4 (80%) of those cases (p<0.05). The improved group was finally confined to radial head subluxation in 88 patients. Although all the not-improved-group patients had received radiographs, no abnormal findings were seen in the elbow. However, clavicle fracture due to fall above or from a level surface were seen in 4 cases (20%) of the not-improved group (p<0.05). No difference of injury mechanism existed between the improved and the not-improved groups. Conclusion: Recommand Radiographic evaluations in Children not-used arm with regional edema before manual reduction. But without regional edema, manual reduction of elbow is first. If children without regional edema do not improve after manual reduction of elbow and they are injuried due to fall, children should be assessed for fractures of clavicle.

양측 상지 혈압차의 의의

김수진,정인철,이베안,우건화,이성우,홍윤식 대한응급의학회 2003 대한응급의학회지 Vol.14 No.3

Purpose: Inter-arm blood pressure differences of more than 10 mHg are measured not only in patents who have vascular diseases, such as aortic dissections, and aortic aneurysms, but also in heathy patents. We investigated the degree of and the factors for normal inter-arm blood pressure variations in our country. Methods: We prospectively studied the cases of 351 patients who visited the Emergency Department of Korea Universfty Hospital between May 1 and July-31, 2001. we collected clinical and demographic data, including age, sex, right/left handedness, and bilateral blood pressure. After we divided the cases into a Normal blood pressure group and a High blood pressure group, we compared the inter-arm blood pressure difference and influencing factors between the two group. Results: The variation in the inter-arm blood pressure was unrelated to age, sex, right/left handedness, and right/left arm in both groups. In the Normal blood pressure group (n=180), the systolic inter-arm blood pressure difference was 3.9±0.4 mmHg, and the diastolic inter-arm blood pressure difference was 3.6±0.4 mmHg. In the High blood pressure group (n=171), the systolic inter-arm blood pressure difference was 5.2±0.5 mmHg, and the diastolic inter-arm blood pressure difference was 4.8±0.5 mmHg. Conclusion: The variation in the inter-arm blood pressure was unrelated to age, sex, right/left handedness, and right/left arm. But inter-arm blood pressure difference was significant among subjects without exclusion criteria and was measured as about 5 mmHg in two groups.

풍진바이러스 감염에 의한 뇌염

김수진,우건화,김낙훈,이베안,최성혁,홍윤식 대한응급의학회 2003 대한응급의학회지 Vol.14 No.1

We experienced 5 cases of acute rubella encephalitis, a serious complication of rubella. The patients presented with convulsions and a deteriorated mental state, both of which occurred with a vanishing maculopapular rash and a lowgrade fever. The cerebrospinal fluid analysis showed pleocytosis and increased protein and normal glucose levels. We diagnosed the rubella encephalitis by detection of IgM in the serum. Rubella encephalitis is known to be a serious complication of rubella, and with poor prognosis. The mortality rate may reached as high 20%. Our cases recovered without any sequelae.