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응급실에 내원한 안면부 열상환자에게서 흉터를 최소화하기 위한 방법으로 적용한W-성형술의 효용성: 단기 추적관찰 결과
인용남,박정수,김훈,이석우,강준호,이지한,민진홍 대한응급의학회 2015 대한응급의학회지 Vol.26 No.4
Purpose: Facial scars are a main complaint of patients who had undergone suture in the emergency department. Therefore, effective techniques for minimizing scar formation are required. W-plasty, a widely used method of scar correction, has been performed to change the scar direction or divide it into multiple segmented scars. This method can be applied in the initial stage of wound repair in the emergency department. The aim of this study was to investigate the effectiveness of direct application of W-plasty to the wound in simultaneously accomplishing the aforementioned objectives. Methods: This was a prospective study, from June 2012 to June 2014. Either simple debridement or W-plasty for facial laceration was performed in 31 patients. In patients in the simple debridement group, the excision was made along the laceration margin. In patients in the W-plasty group, the excision was made within the W-form predesigned margin of the laceration. The prognosis was evaluated using the Stony Brook scar evaluation scale (SBSES). Results: Among 31 patients, 15 underwent simple debridement and 16 underwent W-plasty. In procedure time, there was no significant difference between the two groups. No complications were observed in either group. The median SBSES score was 4 (IQR, 3-4) in the simple debridement group and 5 (IQR, 5-5) in the W-plasty group, indicating a significant difference between the two groups (p<0.001). Conclusion: We achieved good results of direct W-plasty application to wound lacerations in terms of minimal scar formation. Thus, for patients with facial lacerations, we suggest that application of W-plasty to the wound debridement is more effective than the classic simple debridement.
불화수소산 노출 환자에서 동맥 내 글루콘 산 칼슘 주입 치료 후 조직 손상의 정도와 임상지표 간의 비교 분석
이지한,인용남,강준호,한규홍,민진홍,박정수,김훈,이석우 대한응급의학회 2014 대한응급의학회지 Vol.25 No.3
Purpose: Hydrofluoric acid (HFA) causes injury via tissuepenetration by the free fluoride ion. Methods for treatmentof HFA burns include continuous intra-arterial infusion ofcalcium gluconate, which is especially useful for patientswith dermal burns of the digits caused by HFA. However,no comparative study of tissue injury grade with clinical factorsamong patients with HFA burns treated with continuousintra-arterial infusion of calcium gluconate has been conductedin Korea. Methods: We conducted a prospective study at the emergencydepartment of a university teaching hospital betweenJanuary 2011 and June 2013. The subjects enrolled in thisstudy consisted of 33 patients with HFA burns. After completionof treatment, we divided the patients into threegroups according to the type of skin lesions. Patients requiringa skin graft or surgical flap were included in the pooroutcome group, those who had to undergo incision anddrainage in the moderate outcome group, and those whodid not require further treatment in the good outcome group. Results: After completion of all treatments, 22 of the 33patients were included in the good outcome group andseven in the moderate outcome group; the remaining fourpatients were included in the poor outcome group, as theymet the above-mentioned criteria, experienced longer-lastingpain, and were more frequently treated with injection incomparison with the other patients. Conclusion: Patients with HFA burns with long-term painwho need frequent arterial injections despite undergoingintra-arterial calcium gluconate treatment are likely to havepoor outcome; therefore, they require more proactive interventions.
발열환자에서 프로파세타몰 사용시 발생하는 혈압저하의 예측인자 연구
곽치환,이지한,최홍락,인용남,민진홍,박정수,김훈,이석우 대한응급의학회 2016 대한응급의학회지 Vol.27 No.6
Purpose: This study aimed to identify predictive factors for decreased blood pressure in patients prescribed with propacetamol in the emergency room using clinical and laboratory indicators of sepsis. Methods: Among patients aged 18 years or older with a fever, who visited Chungbuk National University hospital’s emergency room between July and December of 2014, 246 patients underwent intravenous infusion of propacetamol to control body temperature. Of these, 112 patients fulfilled all study requirements. Patients whose systolic or diastolic blood pressure dropped below 90 mmHg or 60 mmHg, respectively, were included in the blood pressure decline group. Additional inclusion criteria were a decline in systolic blood pressure of more than 30-mmHg and thereby treated with fluids or inotropics after intravenous infusion of propacetamol. Remaining patients were included in the blood pressure maintenance group. The relationship of each factor between the two groups was then investigated. Results: Twenty-nine patients (25.9%) showed a significant decrease in blood pressure, and among many factors, highsensitivity C-reactive protein (hs-CRP) (cut off value, 11.86; sensitivity, 72.4%; specificity, 69.9%; area under curve [AUC], 0.698) and procalcitonin (cut off value, 0.67; sensitivity, 75.9%; specificity, 60.2%; AUC, 0.667) levels showed a statistically significant effect. Of the 29 patients with a decrease in blood pressure, 10 patients received fluids and inotropics; procalcitonin in particular showed a significant effect. Conclusion: When propacetamol is administered to patients at the emergency room, and if hs-CRP or procalcitonin levels are high, there is an increased risk of a decrease in blood pressure. In particular, if procalcitonin levels are high, aggressive treatment is required, such as administration of inotropics in addition to fluids.
적극적 자살예방 중재 전략 개발을 위한 자살 의도를 노출한 자살시도자의 위험요인 분석
김지민,이해주,주가원,김상철,전혁진,박관진,인용남,김훈,이석우 대한응급의학회 2019 대한응급의학회지 Vol.30 No.2
Objective: This study examined the clinical characteristics of suicide attempters who exposed their suicidal intension to suggest an active intervention strategy for suicide prevention based on the regional emergency medical service system. Methods: A prospective database of suicide attempters who visited the emergency department of Chungbuk National University Hospital between October 2013 and December 2017 was used. All of the adult patients who provided consent for the initial assessment for suicidal attempters were eligible, excluding cases with unknown exposure of suicidal intension. The primary and secondary endpoints were the risk factors affecting exposure to the suicidal intension and characteristics of the exposure group. The adjusted odds ratios (AORs) of exposure to suicidal attempts after adjusting for potential confounders was calculated. Results: Of a total 1,035 suicidal attempters enrolled, 332 (32.1%) were included in the exposure group. The exposure group was more likely to have an educational level above high school and no religion, and have suicidal characteristics at night time (18:00-08:00), under the influence of alcohol, suicidal plan before 1 week, and suicidal method involving asphyxia (P<0.05). The exposure group was more likely to have no guardian (AORs, 1.46; 95% confidence interval [CI], 1.00-2.12), use methods involving asphyxia (AORs, 2.07; 95% CI, 1.46-2.91), and attempt suicide at night (18:00 to 08:00) (AORs, 1.38; 95% CI, 1.05-1.83) compared to the no exposure group. Conclusion: Models need to be established, where regional mental health welfare center, local government, fire headquarter, and tele-communication companies can participate in the implementation of an active intervention strategy.