외상환자에서 내원 초기 고혈당증과 예후와의 상관 관계

장태창,설동환,서강석 대한응급의학회 2006 대한응급의학회지 Vol.17 No.1

Long-term benefits of chest compression-only cardiopulmonary resuscitation training using real-time visual feedback manikins: a randomized simulation study

장태창,류현욱,Sungbae Moon,안재윤,Dong-Eun Lee,이원기,Sang Gyu Kwak,김정호 대한응급의학회 2020 Clinical and Experimental Emergency Medicine Vol.7 No.3

Objective Cardiopulmonary resuscitation (CPR) education with a feedback device is known to result in better CPR skills compared to one without the feedback device. However, its long-term benefits have not been established. The purpose of this study was to evaluate the long-term CPR skill retention after training using real-time visual manikins in comparison to that of non-feedback manikins. Methods We recruited 120 general university students who were randomly divided into the real-time feedback group (RTFG) and the non-feedback group. Of them, 95 (RTFG, 48; non-feedback group, 47) attended basic life support and automated external defibrillation training for 1 hour. For comparison of retention of CPR skills, the two groups were evaluated based on 2-minute chest compression performed immediately after training and at 3, 6, and 9 months. The CPR parameters between the two groups were also compared using a generalized linear model. Results At immediately after training, the performance of RTFG was better in terms of average chest compression depth (51.9±1.1 vs. 45.5±1.1, p<0.001) and a higher percentage of adequate chest compression depth (51.0±4.1 vs. 26.9±4.2, p<0.001). This significant difference was maintained until 6 months after training, but there was no difference at 9 months after training. However, there was no significant difference in the chest compression rate and the correct hand position at any time point. Conclusion CPR training with a real-time visual feedback manikin improved skill acquisition in chest compression depth, but only until 6 months after the training. It could be a more effective educational method for basic life support training in laypersons.

독사교상으로 인한 급성심근경색증 1례

장태창,이경원,서영우 대한응급의학회 2011 대한응급의학회지 Vol.22 No.6

We experienced a rare case of acute myocardial infarction associated with a coagulopathy-complicating snake bite. A previously healthy 72-year-old Korean woman was bitten on the right thumb by a snake of unknown species. She was admitted to a local medical center for one day and exhibited painful progressive swelling along the entire right arm. She also complained of chest discomfort. She had an ST-elevation and T wave-inversion on an ECG. She was then transferred to our emergency department. We found a regional wall motion abnormality on echocardiography, and elevated cardiac enzymes in a laboratory test. We also observed coagulopathy and a thrombus in the left ventricle on follow-up echocardiography. An acute myocardial infarction was confirmed by percutaneous coronary angiography, which showed the total occlusion and stenosis of several coronary arteries.

복부외상으로 응급개복술을 시행한 환자에서 병원전단계 황금시간의 의의

장태창 ( Tae Chang Jang ),이경원 ( Kyung Won Lee ) 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.2

Purpose: The golden hour concept in trauma is pervasive despite little evidence to support it. This study addressed the association between prehospital time and in-hospital mortality in seriously injured abdominal trauma victims. Methods: A retrospective study was conducted over a three-year period from 2006 to 2008. We analyzed trauma victims with abdominal injuries who underwent an emergency laparotomy in a local emergency center located in a city with a population of 2,500,000. According to the ``golden hour`` concept, we separated the trauma victims into two groups (Gourp 1: prehospital time ≤ 1 hour, Group 2: prehospital time > 1hour) and investigated several factors, such as time, process, and outcome. Results: During the period from January 2006 to December 2008 139 trauma victims underwent an emergency laparotomy, and 89 of them were enrolled in this study. Between the two groups, emergency department (ED) access, transportation, and injury mechanism showed statistically meaningful differences, but no statistically meaningful differences were observed in various measures of the outcome, such as length of hospital stay, length of Intensive Care Unit stay, and mortality. In a univariate logistic regression study, age (odds ratio [OR]: 1.101; 95% confidence interval [CI]: 1.026 to 1.182), Revised Trauma Score (RTS) (OR: 0.444; 95% CI 0.278 to 0.710), hemoglobin (OR: 0.749; 95% CI: 0.585 to 0.960), and creatinine (OR: 24.584; 95% CI: 2.019 to 299.364) were significant prognostic factors, but prehospital time was not. In a multivariate logistic regression study, age and RTS were significant associated with mortality. Conclusion: In this study, we found no association between prehospital time and mortality among abdominal trauma patient who underwent an emergency laparotomy. We suggest that in our current out-of-hospital and emergency care system, until arrival at the hospital time may be less crucial for trauma victims than once thought. (J Korean Soc Traumatol 2010;23:180-187).

대장내시경검사 후 발생한 의인혈액복강

김균무,장태창 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.3

Colonoscopy is a routinely performed diagnostic and therapeutic procedure for colorectal diseases. Abdominal pain after colonoscopy is a relatively common complication;however, hemoperitoneum is a very rare complication. We report a case of a 51-year-old male patient who suffered from a left upper quadrant pain after diagnostic colonoscopy at a healthcare promotion center. He had a routine screening test, including computed tomography (CT), and the follow-up CT showed an iatrogenic hemoperitoneum without a definite spleen injury. That is complication is rare, but potentially life-threatening. We recommend a high suspicion for this complication for its early diagnosis and proper treatment.

시멘트 경화제 중독으로 인한 급성 신손상 1례

서영우,장태창,김균무,고승현 대한임상독성학회 2018 대한임상독성학회지 Vol.16 No.2

Chronic silica nephropathy has been associated with tubulointerstitial disease, immune-mediated multisystem disease, chronic kidney disease, and end-stage renal disease. On the other hand, acute intentional exposure is extremely rare. The authors’ experienced a 44-year-old man who took rapid cement hardener (sodium silicate) in a suicide attempt whilst in a drunken state. He visited the emergency department approximately 1 hour after ingestion. Information on the material was obtained after 3 L gastric lavage. The patient complained of a sore throat, epigastric pain, and swollen to blood tinged vomitus. Proton pump inhibitors, hemostats, steroid, and fluids were administered. Nine hours after ingestion, he was administered 200 mL hematochezia. Immediately after, a gastroenterologist performed an endoscopic procedure that revealed diffuse hyperemic mucosa with a color change and variable sized ulceration in the esophagus, whole stomach, and duodenal 2nd portion. Approximately 35 hours later, persistent oligouria and progressive worsening of the renal function parameters (BUN/Cr from 12.2/1.2 to 67.5/6.6 mg/dL) occurred requiring hemodialysis. The patient underwent 8 sessions of hemodialysis for 1 month and the BUN/Cr level increased to 143.2/11.2 mg/dL and decreased to 7.6/1.5 mg/dL. He was discharged safely from the hospital. Follow up endoscopy revealed a severe esophageal stricture and he underwent endoscopic bougie dilatation. Acute cement hardener (sodium silicate) intoxication can cause renal failure and strong caustic mucosal injury. Therefore, it is important to consider early hemodialysis and treatment to prevent gastrointestinal injury and remote esophageal stricture.

응급실 전담 의사의 내과 입원 결정권과 응급 병동이 응급실 체류 시간에 미치는 영향

박준성,장태창,이숙희,고승현,이경우,김균무,서영우 대한응급의학회 2022 대한응급의학회지 Vol.33 No.3

Objective: The emergency department (ED) length of stay (LOS) is related to ED overcrowding and emergency practice. This study aimed to investigate the effects of enabling an ED doctor to have the authority to make hospitalization decisions and utilization of the emergency ward on ED LOS. Methods: This retrospective observational study included patients who were admitted through a local emergency medical center. We compared the ED LOS between the periods' March to July 2018 and March to July 2019. In the latter period, ED doctors were authorized to take decisions on patient hospitalizations from the internal medicine department, and the emergency ward was operated under these new conditions. Results: A total of 6,291 patients were included in the study, with 2,934 in 2018 and 3,357 in 2019. In the comparison of ED LOS for internal medicine inpatients by year, there was a significant reduction in the total ED LOS (1,129.0 [491.0- 1,618.0] minutes vs. 539.0 [344.0-1,016.25] minutes, P<0.001), LOS before the admission decision (345.0 [198.0-634.0] minutes vs. 280.0 [176.0-442.3] minutes, P<0.001), and LOS after the admission decision (415.0 [147.0-1,089.0] minutes vs. 179.5 [80.0-422.0] minutes, P<0.001). In a subgroup analysis of internal medicine inpatients in 2019, the admission sheets of an ED doctor showed a significant decrease in LOS before the admission decision (268.0 [170.5-424.5] minutes vs. 404.0 [252.0-570.5] minutes, P<0.001). Also, the utilization of the emergency ward showed a significant decrease in LOS after the admission decision (147.0 [75.0-283.0] minutes vs. 187.0 [81.0-460.0] minutes, P<0.001). Conclusion: The delegation of hospitalization decisions to the ED doctor and the subsequent utilization of the emergency ward shorten the ED LOS of internal medicine inpatients.

코로나-19 유행 전 후 중증응급질환자의 임상적 특성 비교 분석

김동훈,장태창 한국콘텐츠학회 2023 한국콘텐츠학회논문지 Vol.23 No.9

Severe emergency patients are vulnerable to infectious diseases and can have high severity and high mortality rates. Efficient response will be possible if the clinical characteristics of severe emergency patients are identified during the COVID-19 period. The study was conducted with severe emergency patients who visited the emergency room from February 1, 2018 to January 31, 2022. The total number of inpatients and severe emergency patients before and after COVID-19 decreased from 64,897, 10,524 to 52,127, 9,630. After the pandemic, Korean Triage and Acuity Scale(KTAS) result showed a high rate in level 1-3[level 1: 1,248(11.9%)vs1,245(12.9%), level 2: 2,314(22.0%)vs2,674(27.8%), level 3: 5,421(51.5%)vs5,189(53.9%)], and as a result of leaving the emergency room the intensive care unit admission rate and death rate rose[752(7.1%)vs792(8.2%), 865(8.2%)vs846(8.8%)]. During the COVID-19 pandemic, severe emergency patients showed high severity at the beginning of their visit and relatively poor treatment progress.

병원외 심정지 후 자발순환회복 환자의 관상동맥조영술 결과

서영우,장태창,이경원 대한응급의학회 2011 대한응급의학회지 Vol.22 No.5

Purpose: Coronary artery disease is the most common cause of out-of-hospital cardiac arrest (OHCA). Primary percutaneous coronary intervention (PCI) is currently the most effective reperfusion strategy in acute myocardial infarction. The decision to perform PCI in an unconscious resuscitated OHCA patient is challenging because of uncertainty of the clinical course, status of the coronary artery and prognosis. The study evaluated clinical characteristics,angiographic findings and results of OHCA patients who were successfully resuscitated and underwent PCI. Methods: A retrospective study was performed from January, 2008 to December, 2010. Thirty four OHCA patients who successfully resuscitated and followed by PCI were enrolled. They were divided into significant and nonsignificant coronary artery group. Significant coronary artery group (n=23) was subdivided into survival and mortality subgroup. Results: Twenty three of the 34 patients had significant coronary disease on coronary angiography. There was no significant difference between the two groups in clinical and electrocardiography (ECG) findings based on age, sex,presence of chest pain, initial ECG, and ECG after return of spontaneous circulation (ROSC). The significant coronary artery group displayed higher creatine kinase-MB and troponin-I levels, and more common presence of ventricular fibrillation (VF) prior to PCI. The survival subgroup showed a lower number of significant stenotic coronary arteries, better neurologic finding prior to PCI and lower levels of cardiac biomarkers such as creatine kinase-MB and troponin-I. Conclusion: PCI after ROSC in OHCA patients with presumed ischemic cardiac etiology may be reasonable, even in the absence of a definite clinical and ECG finding. The presence of VF or serial cardiac biomarkers is helpful in deciding whether to perform PCI.

응급실을 통한 입원 환자의 진균 감염에 대한 국내역학조사(2011~2013)

서영우,박준수,장태창 대한의진균학회 2016 대한의진균학회지 Vol.21 No.4

Background: Fungal infections are frequent encountered conditions presented in various clinical forms. The prevalence of fungal infection is gradually growing because of the increase in aged population and immune-compromised host which is susceptible factor of fungal infection. Broad array of studies of fungal infection have been published in Korea. However, epidemiologic study of fungal infection in admitted patients via emergency department has not been conducted. Objective: The purpose of this study is to generate background data for emergency department visits in relation to fungal infection for developing a subsequent management and control system. Methods: The data was collected from National Emergency Department Information System (NEDIS) in Korea from 2011 to 2013. Data analysis was done to evaluate the age distribution of admission, regional variance and sex of the patients with fungal infection. Results: The patients were divided into five groups according to their primary diagnosis which were skin fungal infection, subcutaneous mycoses, opportunistic mycoses, systemic mycoses and other mycoses. The annual admission ratio of general fungal infections increased from 2.15 persons per 100,000 in 2011 to 2.46 persons per 100,000 in 2013. The highest admission ratio was seen in opportunistic mycoses group followed by cutaneous fungal infections, other mycoses, subcutaneous mycoses and systemic mycoses groups. Conclusion: This study provides a basic set of data pertaining to fungal infections in emergency departments. Therefore, more systemically approached researches are required to implement sounder management and control systems of fungal infections presented in emergency departments.