응급센터 내 외래운영

정순미,김인병,김경환 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

Background: Authors investigated the out patient management trial running in our ED. This ED is a local emergency center with over 39,000 visits a year. The OPD(Out-Patient Department) in ED was designed to give feed-back on the medical examination and treatments done by house-staffs of emergency medicine and also to experience the satisfaction of treating OPD patients at a regular schedule, which emergency medicine is most deficient of. Methods: All patients visiting the OPD in ED for 5 months were included. Patient's characteristics, diagnoses, number of follow-up visits, complications and referred cases were retrospectively reviewed. A survey on satisfaction of the OPD patients were done. Faculties of emergency medicine were also surveyed. Results: 735 patients(4.7% of total 15,570 ED visits) have visited the OPD in ED during the 5 months, 38% of these patients were less than 10 years of age. The common diagnoses were lacerations, burns, dog bites, nail injuries etc. in order of frequency. The average number of follow-up visits were 2.8 times. Patients with nail injuries and distal finger tip fractures visited most frequently averaging 5.7 times. 7 complications were found. 7 patients were referred to specialists. 87% of OPD patients were satisfied with the treatment given. Remaining 13% expressed unsatisfied opinions such as complexity of administration in ED(6.5%), overcrowding(3.3%), long waiting time and changing of physicians. All three of the faculties were more than moderately satisfied with OPD in ED. Conclusion: OPD in ED satisfied the patients and the emergency physicians. This could be suggested as a way of managing patients at an OPD basis in a residency training hospital.

저체온증과 동반된 고혈압성 뇌출혈 1례

정순미,김태경,김인병,김경환 대한응급의학회 2002 대한응급의학회지 Vol.13 No.1

Hypothermia is not an uncommon condition that emergency physicians meet in their emergency department services. Most cases involve mild hypothermia and are rewarmed will without any complication or sequelae. Hypothermia is well known to be correlated with drug intoxication, such as with alcohol. Since alcohol adds to the suppressive effect on central nervous system due to hyporthermia, most intoxicated patients are so deeply drunk that they look comatous. We report the case of a 41- year old male drunk and semi-comatous and who had been left in his car for more than 12 hours on a freezing cold night. He arrived at our emergency department with a body temperature of 27.3℃. The patient was warmed with active rewarming, and during procedure, the patient appeared markedly hypertensive, instead of showing rewarming shock. After initial stabilization the patient was taken for a cerebral CT scan and was found to have a large amount of intracranial hemorrhage. He was treated conservatively in the intensive care unit and was discharged as a hopeless case.

과호흡증후군 환자에서 이온화칼슘,마그네슘과 산-염기상태의 변화에 대한 고찰

윤천재,정순미,장문준,이한식 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.3

Background. Tetanic spasm is often noted in hyperventilating patients coming in to emergency departments. Classical explanation for this phenomenon was decreased ionized calcium levels due to respiratory alkalosis precipitated by the hyperventilation. Clinically these symptoms were observed in hypocalcemia and were thought as such without doubt, But6 clinical investigation on the levels of ionized calcium levels have not been clarified. Recent investigations on hyperventilating volunteers have suggested other pathophysiology for tetanic spasm in hyperventilating patients which is the decrement of ionized magnesium level rather than ionized calcium. We wanted to see if these results applied to our hyperventilating patients and see if ionized magnesium level was a factor producing tetanic symptoms. Method and Material, 35 patients with diagnosis of hyperventilation syndrome by emergency physician were studied retrospectively. Hyperventilating patients arriving at Severance hospital Emergency Center from Jan. 1996 to Feb. 1998 were included. Patients with cardiovascular, pulmonary diseases, history of renal or liver disease were excluded. Ion-selective method was used to detect ionized calcium, magnesium levels and arterial blood gas features. Average levels were compared to reference ranges and Wilkoxon-rank, sum test was used to compare hyperventilating patients with tetanic spasm and those with other symptoms such as dyspnea, chest pain and palpitations. Results. 1) Sodium, potassium and chloride levels were 138mmol/L, 3.6mm/l, 106mm/l each which were within a normal range. 2) Degrees of hyperventilation were similar with average of PH 7.54(7.4-7.71), pCO₂ 23.6mmHg, showing respiratory alkalosis. 3) Ionized calcium and ionized magnesium each showed 0.61mg/dl, 0.16mg/dl lower values than the lowest reference ranges which were 4.5-5.6mg/dL for ionized calcium and 1.19-1.63 for ionized magnesium. 4) No statistical difference points were observed between the tetanic spasm group and group without spasm. Female preponderance were noted in tetanic spasm group. Conclusion. We conclude that other than decrement of ionized calcium, decrement of ionized magnesium could be a factor for inducing tetanic spasm in respiratory alkalosis caused by hyperventilation.

패러글라이딩 사고에 대한 분석

김승환,김인병,정순미,정성필,장석준 대한외상학회 1999 大韓外傷學會誌 Vol.12 No.1

$quot;Background: Paragliding injuries are increasing recently due to the growing popularity of this sport. This topic has been discussed in numerous journals in the European countries with large mountains, such as Austria, Germany and Switzerland, Those studies gave information regarding the flight phase during which an injury ocurred, the type and site of injury, and suspected reasons for the accidents. This study was done to compare our data to those of other nations and give preventive advices to reduce injuries occurring during paragliding. Method: Nineteen paragliders documented as having injuries during paragliding at Chung-Ju, Korea from 1990 to 1997 were included in the study. Their accident reports including medical records, were analyzed retrospectively. Result: Eighteen of the injured were male with one female and their mean age was 25.6 years old. Five injuries were suffered during take-off, of which technical error was the cause in most cases. Also, 5 injuries occurred during flight due to a sudden change of thermal and wind condi- tions. The majority of injuries were suffered during the landing period, affecting 9 paragliders. They were mostly due to forced landings, unexpected obstacles, and sudden change of wind conditions. Thirty-three percent suffered spine trauma and 29% were involved in injuries of the lower extremities. Upper limb injuries occurred in 19%, and 19% also suffered cerebral concussion or contusion. Conclusion: We have found that spine and ankle injuries were commonly occur during paragliding, especially the landing phase. Proper knowledge of the procedures, adequate training and appropriate foot wear could help in reducing injuries while paragliding.$quot;

질식성 심정지 모델에서 Epinephrine과 Vasopressin의 비교

정순미,박원녕,정성필,황태식,장문준,이한식 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.1

Background : Vasopressin has recently been recognized to have greater effect on improving blood flow to myocardium and brain during cardiac resuscitation than epinephrine and also improves rates of ROSC(return of spontaneous circulation) and survival in pre-hospital and in-hospital prolonged refractory cardiac arrest patients who did not respond to the standard epinephrine treatment. This study was designed to investigate the effects of vasopressin on ROSC rates and survival rates in rat asphyxia arrest model. Method & Material : Thirty male sprague-Dawley rats were used. Anesthesia was induced with halothane and nitrous oxide and ventilatory care was maintained. EtCO₂ was adjusted to 30-40㎜Hg and halothane was maintained. Right internal carotid artery and right femoral vein were cannulated and EKG electrodes were attached. After 10 minutes of asphyxia, group 1 was treated with 1ml of saline, group 2 with 1ml (0.001㎎/100g) of epinephrine and groups 3 with 1ml (0.16u/100g) of vasopressin for resuscitation. Statistical significance was an analyzed by SPSS with ANOVA and chi-square tests. Results : No significant difference were seen in baseline measurements. There ROSC and three 60 minutes survivals were found in group 1, whereas nine ROSC and eight 60 minutes survivals were obtained in groups 1 and all of the subjects in group 3 showed ROSC and 60 minutes survival, but no statistical differences were seen between groups 2 and 3. Conclusion : Vasopressin seems to have similar effect on improving ROSC and survival rates compared to epinephrine in rat asphyxia models.

응급진료센터에서의 전산화단층촬영 : ANALYSIS ON APPLICATION OF HEALTH INSURANCE 의료보험 적용에 대한 분석

윤천재,정순미,장문준,김승호 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.4

A CT scan has been covered by an insurance since January 1, 1996. As a complication, it resulted in auditting many cases. The insurance lists some guidelines(approval and disapproval). In our experiences, the guidelines were not net the exact usefulness of CT and may disturb the doctor's decision for patient disposition. This study was focused on verifying the irrationality of the current guidelines. We retrospectively reviewed the charts of consecutive 189 patients who underwent CT scans during this period. The results were as follows: 1) The total cases were 228. 2) Fifty three of 228 cases were auditted. 3) Thirty four of 52 cases were brain CT scans which were taken for sudden headache (including post-traumatic headache and vertigo). Ten of 52 cases were chest CT and 4 of 10 were taken to search blebs and bullae resulting in pneumothorax. These can be included not only in the approval guidelines but also in the disapproval guidelines. This result indicates that approval and disapproval guidelines are inappropiate in many ways. Newer criteria should be considered to solve this confusion.

응급의학과 전문의의 근무형태와 만족도 : Working Patterns and Level of Satisfaction

김인병,김경환,정순미,조준필 대한응급의학회 2002 대한응급의학회지 Vol.13 No.3

Purpose: This research was to investigate and analyze the working conditions and level of satisfaction, to suggest ideal working conditions for emergency medicine specialists, and to propose a future direction for the advancement of emergency medicine. Methods: Among the 185 doctors who were EM board-certified from 1996 to 2000 in Korea, this survey was sent to 129 emergency medicine specialists; to those 57 answered the questionnaire. The questionnaire was made up of 17 items in the form of short answeres and descriptions. The analysis was done using the SPSS WIN program. Results: From the survey, the level of dissatisfaction was found to be higher than the level of satisfaction and the most prominent cause was the working conditions, including night duty. The most ideal working pattern sought after was an 8-hour workshift and this result did not vary with the specialists the position in the hospital. At present, night duty is not performed by most specialists, but rather extended weekend duty is. The number of specialists employed at most emergency medical centers is under 3 (81.7%). As the ideal number of specialists (more than 4 in 89.5%)is not being reached, 24-hour stationing of a specialist at an emergency medical center is not being achieved. Conclusion: This survey was done in order to establish the proper working conditions and a base for improving emergency medicine itself by investigating and studying the present working conditions of emergency medicine specialists, their complaints, and their proposals for advancing of emergency medicine.

Utstein Style에 의한 병원내 심정지 환자의 분석

이한식,정성필,김욱진,정순미,강형구,김승호 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.1

Background : The in-hospital “Utstein style” is international recommended guidelines for reporting outcome data from in-hospital resuscitation events. This study was designed to evaluated the current status of in-hospital cardiopulmonary resuscitation(CPR), and to provide basic data for the unified reporting guideline of resuscitation in Korea. Methods : The patients who had received CPR in a university hospital were searched during one year period from March 1997. The variables according to the Utstein style were evaluated with review of the medical records. Results : During the period, 428 patients had received CPR. Excluding the patients of out-of-hospital arrest and less than 8 years, 242 were enrolled. Their initial ECG rhythms were 55 of asystole, 148 of pulseless electrical activity, and 39 of ventricular fibrillation, The spontaneous circulation was returned in 118(49%), and 48(20%) were maintained more than 24 hours. Twenty-two patients(9%) were discharged with spontaneous respiration. Among the survivors, 17 had the Cerebral Performance Category of 1. Conclusion : We recommend the Utstein style to report the outcome of in-hospital CPR.