일개 권역응급의료센터에 내과계 질환으로 내원한 노인 환자의 주증상 및 관련된 특성

정시경,임지용,홍성엽,최세민,최승필 대한노인병학회 2013 Annals of geriatric medicine and research Vol.17 No.3

Background: This research is to determine the chief complaints and related features of elderly patients who are presented to emergency department with medical problems. Methods: Medical records of patients, 65 years or above, who visited Uijeongbu Hospital Emergency Center between January 1, 2012 and June 30, 2012 were reviewed retrospectively. Age, gender, mode of transportation to the hospital, chief complaints, and diagnosis were among the subjects analyzed. Results: Elderly patients with medical problems, 3,468 visited the emergency department, constituting 12.66% from 27,396 patients in total during the research period. Patients aged 70 to 74 were 28.45%, composing the most among the age groups. Ambulance was the mode of transportation used by 43.06% of the patients and 42.96% of them stayed overnight, while 11.13% stayed in the intensive care units. The most frequent chief complaints were abdominal pain (16.81%), dyspnea (13.96%), and fever (11.16%). The most common diagnosis for patients with abdominal pain was gastritis (20.75%), chronic heart failure (26.03%) for dyspnea, and pneumonia (28.96%) for fever. The main diagnoses of in-patients according to the order of frequency were cerebral vascular accident (16.38%), pneumonia (12.48%), and chronic heart failure (6.04%). Conclusion: The number of elderly patients who stayed overnight and stayed in the intensive care units have increased comparing to younger patients. The top 10 most frequent chief complaints accounted for 78.92% by medical elderly patients. The results of this research could be used for the development of geriatric emergency medicine training programs and critical pathway for interns and residents. 연구배경: 내과계 질환으로 응급의료센터에 내원한 노인환자의 주증상과 관련 특성을 알아보고자 한다. 방법: 2012년 1월1일부터 2012년 6월30일까지 중소도시의 일개 병원 응급의료센터로 내원한 환자 중 65세 이상노인 환자의 의무기록을 후향적으로 분석하였다. 환자의 나이, 성별, 내원 수단, 내원 시간, 주증상, 퇴원 시 진단명 등을조사하였다. 결과: 연구 기간 내 총 27,396명의 환자가 응급의료센터를방문하였고, 본 연구 대상인 내과계 질환의 노인 환자는 3,468 명(12.66%)이었다. 가장 많은 연령대는 70‒74세로 노인 환자의 28.45%를 차지하였다. 노인 환자의 43.06%가 응급의료센터 내원 시 구급차를 이용하였고 입원율은 42.96%, 중환자실입원율은 11.13%였다. 응급의료센터로 내원하게 된 주증상은 복통(16.81%), 호흡곤란(13.96%), 발열(11.16%), 흉통(9.40%), 어지럼증(6.57%) 순이었다. 주증상이 복통인 경우위염(20.75%) 진단이 가장 많았으며, 호흡곤란은 만성심부전(26.03%), 발열은 폐렴(28.96%) 진단이 가장 많았다. 입원환자에서 주된 진단명은 뇌졸중(16.38%), 폐렴(12.48), 만성심부전(6.04%) 순이었다. 결론: 응급의료센터로 내원한 노인 환자의 입원율, 특히중환자실 입원율이 젊은 환자에 비해 높았다. 노인 환자가응급의료센터로 내원하게 하게 된 주증상은 복통, 호흡곤란, 발열 순이었고 가장 많았던 상위 10개 주증상이 전체 내원환자의 78.92%를 차지하였다. 이 연구의 결과는 응급센터의료진을 대상으로 한 노인응급의학 과정의 교육 프로그램개발 및 치료 표준화 구축 등의 기초 자료가 될 수 있겠다.

경기북부 일개병원에 내원한 말라리아 환자의 임상적 고찰

정시경,오영민,최세민,최경호,이운정,김세경 대한응급의학회 2002 대한응급의학회지 Vol.13 No.2

Purpose: In this study, we analyzed clinical manifestations of and ways to manage malaria. Methods: The medical records of the patients confirmed as malaria by using peripheral blood smear at Ui jungbu St. Mary's hospital from April 1997 to November 2001 were reviewed retrospectively. Results: Of the 179 patients, there were 111 males and 59 females, and their mean ages were 32.3 ±14.5, 34.9 ±18.1 years, respectively. Malaria occurred throughout the year and peaked during the sixth to ninth months (84.1%). All cases were vivax malaria. All 170 patients had fever, but tertian fever was seen in only 81 (48%) patients, Laboratory abnormalities were hemoglobin below 12 g/dL in 70 (41.2%) patients, WBC below 4000/mm³in 49 (28.9%), platelet count below 120,000/mm³in 142(83.5%). Of the 92 patients who underwent ultrasonography of the abdomen, splenomegaly was seen in 81(89%) patients. The time from onset of symptoms to admission ranged from 2 to 30 days with a mean 8.1±5.5 days. All patients responded promptly to drug therapy. One patient developed recurrent malaria 120 days after the first attack. Another patient experienced multifocal splenic infarction. Conclusion: All patients with malaria had fever and chills. The most common laboratory findings were thrombocytopenia and anemia. All patients responded promptly to drug therapy. As cases of malaria in Korea are increasing, early diagnosis and treatment, as well as prevention, are important.

응급의료센터와 중환자실에서 소아 중환자의 예후인자 예측을 위한 PELOD Score와 PIM 2 Score의 유용성

정시경,이운정,문윤주,우선희,경연영,최세민,정원중,박규남 대한중환자의학회 2010 Acute and Critical Care Vol.25 No.3

Background: This study was conducted to compare two models of the pediatric logistic organ dysfunction (PELOD) score and the pediatric index of mortality (PIM) 2 score in the emergency department (ED) and intensive care unit (ICU). Methods: 90 pediatric patients who were admitted to the ICU in ED from January 2003 to December 2008 were enrolled in this study. PELOD score and PIM 2 score calculations were performed in the ED and ICU. We classified these patients into either the survivor or non-survivor groups and analyzed the clinical variables between two groups. We used Hosmer-Lemeshow goodness-of-fit tests to evaluate calibration, receiver operating characteristic (ROC) curves and standardized mortality ratio (SMR). Results: Among the 90 pediatric patients, 56 (62.2%) were male, and 9 (10.0%) patients died. Expected mortalities were PIM 2 = 10.35, PELOD = 8.33 in ED and PIM 2 = 8.84, PELOD = 8.26 in ICU. PIM 2 showed fit calibration (x2 = 6.228, p = 0.622) in the ED. In the ICU, both PELOD and PIM 2 showed calibration (x2 =4.625, p = 0.185) and (x2 = 7.616, p = 0.472), respectively. PIM 2 in ED showed the best discrimination, with area under the curve (AUC) = 0.949 (95% CI, 0.881−0.984). Conclusions: PIM 2 score in ED was fit. Also, PELOD and PIM 2 score in ICU was fit. But PELOD in ED was unfit.

폐부종과 심정지가 발생한 페노바비탈 중독환자

오동렬,이운정,박규남,김세경,김영민,이환,유은영,최경호,정시경 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Phenobarbital is a long-acting barbiturate causing generalized depression of neuronal activity in the brain. Its effect is primarily achieved through enhanced GABA-mediated synaptic inhibition. Its use as an antiepileptic agent was first described in 1912. Before the introduction of phenytoin, phenobarbital is used as sedative-hypnotics. It is used for the treatment of epilepsy and status epilepticus. All barbiturates, including phenobarbital, have a high potential for abuse. They were frequently used for suicide attempts in the past, but they have in large part been replaced by benzodiazepines. The onset of symptoms depends on the drug and the route of administration. Mild to moderate barbiturate intoxication resembles ethanol inebriation with slurred speech, ataxia, and lethargy. Severe acute barbiturate intoxication is life threatening. Early deaths are generally cardiovascular-related. Hypotension, shock, pulmonary edema, and cardiac arrest that occurs with large doses are caused by depression of central sympathetic tone and as well as by direct depression of cardiac contractility. The potentially fatal oral dose of phenobarbital is 6-10g. We describe an 23-year-old woman with pulmonary edema, and cardiac arrest ingestion of 18grams of phenobarbital. She was completely recovered by successful cardiopulmonary resuscitation and homoperfusion. We report a case with literature review.

의정부시 집중호우로 발생한 입원환자 분석

정시경,유은영,오동렬,이환,최경호,김영민,이운정,김세경 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.1

Background : Flood is the most common natural disaster in our country. Lots of victims occurred during the period of flood in the northem territory of Kyoungkido on August 5, 1998. We tried to describe the characteristics of the flood-related injury and illness, management and medical requirements. Methods : We interviewed the patients admitted to 8 hospitals in Ujungbu and reviewed medical records from Aug 5 to Aug 14, 1998. Results : There were total 102 patients, male were 52% and women were 48%. Most of Patients were between 30's and 60's. Most of them were minor, and less than 3% of them needed critical care. The diagnosis were laceration(39.2%), contusion (22.5%), fracture(13.7%), infectious disease(7.8%), ligament rupture(7.8%), aggrevation of chronic illness(5.9%), dermatitis(2.0%) and traumatic hyphema(1.0%), The laceration occured in the foot(37.9%), lower leg(27.0%), thigh(16.2%), hand(10.8%) and head(8.1%). The location of ligament injury were achilless tendon(62.5%), hand(25%) and knee(12.5%). The 67.5% of flood-related laceration patients progressed to cellulitis, especially in sutured wound and a typical tetanic patient was developed. Of hospitalized patients, 2 patients showed evidence of post-traumatic stress disorder(PTSD). Conclusion : During flood, civils have better to be educated about prevention of injury, such as wearing of shoes and clothes. Although laceration was minor, lacerated wounds should be thoroughly irrigated, debrided the margin and considered delayed closure, tetanus immunization. Reportedly, there is an increased prevalance of PTSD and depression after disasters. Therefore mental health care will be required in the future.

흰쥐에서 심정지후 Pentoxifylline이 뇌의 허혈-재관류 손상에 미치는 효과

정시경,김영민,오동렬,최경호,박승현,이운정,박규남,유은영,이원재,김세경 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: Two major events occurring in the cerebral hemodynamics after successful resuscitation from cardiac arrest are reactive hyperemia and postischemic hypoperfusion. In this study, we examined the effect of Pentoxifylline(PTX) on the rat brain following cardiac arrest. Methods: Fourteen rats were anesthetized and artificially ventilated. Cardiac arrest was produced by chest compression and clamping of tracheal tube for 3 minutes in ketamine anesthetized rats. Circulation was restored by standard cardiopulmonary resuscitation methods. In 7 rats, PTX 10mg/kg was infused at 10min after cardiac arrest(PTX group). In the other 7 rats, same amount of normal saline was infused(control group). Results: In both groups, hemodynamic variables, neurologic deficit(ND) score and histopathologic findings of hippocampal CA1 neurons were observed. Hemodynamic variables and ND score were not significantly different between two groups. Delayed ischemic neurons of hippocampal CA1 were decreased in PTX group(2.2±2.4%) compared with control group(9.1±1.2%). Conclusions: We conclude that PTX prevented development of delayed ischemic neurons in hippocampal CA1 after cardiac arrest. PTX may be useful in emergency situations following cardiac arrest.

응급의료센터에 내원한 급성 신우신염 환자에서 초기 C-reactive Protein과 신장 전산화단층촬영의 유용성

김미경,정시경,최세민,최승필,박규남,이운정,우선희 대한응급의학회 2009 대한응급의학회지 Vol.20 No.5

Purpose: This study was conducted to determine the predictive value of the C-reactive protein (CRP) and kidney computed tomography (CT) in the emergency department (ED) for predicting the severity of acute pyelonephritis. Methods: One hundred thirty-nine patients who were diagnosed with acute pyelonephritis between January 2007 and June 2008 were enrolled in this study. The patient underwent a kidney CT in the ED and the CT findings were classified as normal, a focal wedge-shaped lesion, a multi-focal wedge-shaped lesion, a mass-effect lesion, and abscess formation. The symptoms, vital signs, past history, initial laboratory findings, serum CRP in the ED, and the length of the hospital stay based on the kidney CT grade in the ED were compared. Results: Among the 139 patients, 138 were females and the mean age was 48.5±17.7 years. We classified the CT grades as follows: grade 1, normal (n=20); grade 2, focal wedge-shaped lesion (n=25); grade 3, multi-focal wedgeshaped lesion (n=45); grade 4, mass-effect lesion (n=42); and grade 5, abscess formation (n=7). Statistically significant differences in leukocyte count, neutrophil ratio, ESR, CRP, and length of hospital stay existed between the CT grades. Patients were classified into two groups based on the CT grade (the mild group [grades 1 and 2], and the severe group [grades 3~5]). The leukocyte count, neutrophil ratio, ESR, CRP, maximal body temperature, duration of fever, duration of pyuria >3 days, and length of hospital stay were greater in the severe group. Based on the results of multivariate logistic regression analysis, the CRP level was shown to be an independent predictor that affected the severe group. The area under the ROC curve for CRP was 0.775 (95% CI, 0.695~0.854). Conclusion: The CRP level in the ED was an independent predictor that affected the severe group. Thus, the initial CRP level with the kidney CT grade may be used as a prognostic indicator of acute pyelonephritis in the ED.

Impact of Middle East respiratory syndrome outbreak on the use of emergency medical resources in febrile patients

정현호,정시경,오주석,우선희,소병학,위정희,김지훈,임지용,최승필,박경남,조별님희,홍성엽 대한응급의학회 2017 Clinical and Experimental Emergency Medicine Vol.4 No.2

Objective: Outbreaks of transmissible respiratory infection are suspected to have significant effects on the health of pediatric and geriatric patients. The objective was to assess the impact of the Middle East respiratory syndrome (MERS) outbreak on the use of emergency resources. Methods: An ecologic analysis of emergency department (ED) records between September and December 2015, was performed. Data was obtained from the National Emergency Department Information System database for Korea. All demographic and diagnostic data from patients presenting with febrile symptoms as a main complaint were collected. The data were compared to the equivalent period in the three years preceding the MERS outbreak in Korea. Results: Following the MERS outbreak, there was an increase in overall ED visits by febrile patients and the proportion of visits by febrile patients, relative to total ED attendances. This effect was more prominent in the children under five years. The duration of the chief complaint before ED arrival and the length of ED stay were significantly increased among younger pediatric patients. Decreased body temperature on arrival was observed in younger pediatric patients. Conclusion: MERS outbreak appears to have had a significant effects on ED use by febrile patients. The use of emergency care services by pediatric patients makes them more vulnerable to an outbreak of a transmissable disease. An effective strategy to control emergency center visits by non-urgent febrile patients and provide proper medical services is urgently needed.

횡격막을 통한 심낭내 탈장에 의한 심장 눌림증

우선희,정시경,이운정,이동호,이원재,김세경 대한응급의학회 2004 대한응급의학회지 Vol.15 No.4

Herniation of intra-abdominal contents into the pericardial cavity is rare. We observed a delayed intrapericardial diaphragmatic hernia presenting as a tamponade secondary to a previous pericardioperitoneal window for drainage of a pericardial effusion. The diagnosis of an intrapericardial hernia should be considered in patients presenting with gastrointestinal and/or cardiorespiratory symptoms following surgical procedures involving the diaphragm.

시뮬레이션을 이용한 응급실 위기관리 팀 훈련 프로그램의 개발 및 시범적용

백희진,정시경,박상현,박규남,박지은,김영민 대한응급의학회 2008 대한응급의학회지 Vol.19 No.6

Purpose: Emergency departments (EDs) are complex and dynamic working environments in which crises can easily develop. ED members must be trained to recognize and prevent impending crises or resolve active ones. Patient simulation (PS) is emerging as an effective tool in team training. We investigate the participants’ responses to a simulation-based ED Crisis Management Team Training (CMTT) program we developed and applied. Methods: We developed a pilot 2-hour simulation-based ED-CMTT program and applied to ED members who worked in three different types of EDs. The program was consisted of a lecture for principles of crisis resource management (CRM) and team dynamics, orientation to simulator and simulation environment, PS session with videoassisted debriefing and survey. After finishing the program, participants completed a survey and were solicited comments. Results: Fifty-two trainee participated in more than one of total seven pilot programs. The responses for the program are as follow: enjoyable and satisfied, 4.00±0.74; helpful for their teamwork, 3.98±0.73; understanding of CRM principles, 4.00±0.63; attainment of learning objectives, 3.80± 0.83; quality of faculty, 3.90±0.63; time allocation, 3.40± 0.70. The responses for PS session are as follow: realism of scenario, 3.98±0.63; realism of simulator, 3.10±1.05; realism of simulation environment, 3.44±0.98; quality of audio-visual system, 3.81±0.74. Overall comments were positive and commonest request was to have more experiences in variable scenarios. However, some problems like time shortage and lack of realism were also pointed. Conclusion: The participants’ reaction show that the simulation- based ED-CMTT program was well accepted by ED members. Creating more variable crisis scenarios and realistic simulation setting will be necessary for improving the program.