증례보고 : 맥섬석에 의한 식도내 이물 3례

정태녕,윤유상,박인철,조광현,김승호 대한응급의학회 2003 대한응급의학회지 Vol.14 No.5

애완용 햄스터에 의한 교상 후 발생한 아나필락시스 1례

정태녕,윤유상,박준석,박인철,조광현,김승호 대한응급의학회 2004 대한응급의학회지 Vol.15 No.1

응급진료 단계에서 패혈증이 의심되는 환자의 예후 예측 도구로서 Mortality inEmergency Department Sepsis (MEDS) 점수 체계의 적용

정태녕,오제혁,조광현,이진희,김승호 대한응급의학회 2007 대한응급의학회지 Vol.18 No.2

Purpose: Recent guidelines for sepsis treatment emphasizes the need for early recognition of disease, leading to the development of the MEDS scoring system. However, there has been no prospective validation or comparison against other scoring systems. Therefore, we prospectively validated the MEDS scoring system and compared it with Multiple Organ Dysfunction Score (MODS) and Sepsisrelated Organ Failure Assessment (SOFA) scoring systems. Methods: MEDS, MODS, and SOFA scores of 288 patients who were suspected to have systemic infection were calculated at the times of their emergency department visits, and clinical data of the patients were reviewed after six months. Results: MEDS, MODS, and SOFA scoring systems were all valid in the prediction of mortality according to logistic regression analysis. The results of probit analysis revealed significant and direct relationships between the scores and the mortality rate and demonstrated the parallelism of the mortality prediction of the three scoring systems. The cut-off values for the MEDS scoring system successfully divided subjects into five groups according to their risk for death. And the MEDS score well predicted the admission to ward or intensive care unit in survived patients. Conclusion: MEDS, MODS, and SOFA scor all were good predictors of outcome for patients with suspected sepsis and showed the same degree of predictive power. The MEDS scoring system, however, featured ease of calculation and definite clinical cut-off values which were useful in guiding decisions about treatment options. It also was well correlated with the prognosis of survived patients. We believe it to be the most useful and appropriate clinical prediction tool in cases of suspected sepsis in the emergency department.

목격자의 행태가 병원전 심정지 환자의 병원 도착까지의 시간에 미치는 영향 분석

정태녕,박인철,윤유상,김승호 대한응급의학회 2005 大韓應急醫學會誌 Vol.16 No.1

Tube thoracostomy training with a medical simulator is associated with faster, more successful performance of the procedure

정태녕,김선욱,유제성,정현수 대한응급의학회 2016 Clinical and Experimental Emergency Medicine Vol.3 No.1

Objective Tube thoracostomy (TT) is a commonly performed intensive care procedure. Simulator training may be a good alternative method for TT training, compared with conventional methods such as apprenticeship and animal skills laboratory. However, there is insufficient evidence supporting use of a simulator. The aim of this study is to determine whether training with medical simulator is associated with faster TT process, compared to conventional training without simulator. Methods This is a simulation study. Eligible participants were emergency medicine residents with very few (≤3 times) TT experience. Participants were randomized to two groups: the conventional training group, and the simulator training group. While the simulator training group used the simulator to train TT, the conventional training group watched the instructor performing TT on a cadaver. After training, all participants performed a TT on a cadaver. The performance quality was measured as correct placement and time delay. Subjects were graded if they had difficulty on process. Results Estimated median procedure time was 228 seconds in the conventional training group and 75 seconds in the simulator training group, with statistical significance (P=0.040). The difficulty grading did not show any significant difference among groups (overall performance scale, 2 vs. 3; P=0.094). Conclusion Tube thoracostomy training with a medical simulator, when compared to no simulator training, is associated with a significantly faster procedure, when performed on a human cadaver.

응급의료센터로 내원한 패혈쇼크 환자에서 각 중증도 점수체계의 예후 도구로서의 유용성 평가

이형주,정태녕,이재영,배진건,김의중,최성욱,김옥준,조윤경 대한응급의학회 2012 대한응급의학회지 Vol.23 No.6

Purpose: The aim of the study was to validate abbreviated mortality in emergency department sepsis (MEDS) scoring system by comparing it with original MEDS score and to assess the prognostic value of other prognostic factor for sepsis patients including multiple organ dysfunction score (MODS), sepsis-related organ failure assessment (SOFA)score, and serum procalcitonin level. Methods: Adult patients visiting emergency department (ED) with evidence of septic shock were enrolled to the study. MEDS score, MODS, and SOFA score were calculated based on initial clinical data. Receiver-operating characteristics (ROC) analyses were used to assess the prognostic factors for predicting mortality. Kaplan-Meier survival analyses (KMSA) were used to determine whether the prognostic factors had correlation with survival time. Results: Only MODS showed significant predicting power for mortality (p=0.003, area under curve=0.625). Estimated median survival of all the patients calculated by KMSA was 11.0(standard error 1.7) days, and predefined criteria of all prognostic factors showed significant differences in survival time. Conclusion: MEDS, abbreviated MEDS, MODS, and SOFA scoring systems were useful factors for predicting survival time of septic shock patients visiting ED.

중증 외상 환자의 재원기간에 관련된 응급의료전달 체계 내 요인 분석

진수근,정태녕,임득호,이창재,김의중,최성욱,김옥준 대한응급의학회 2011 대한응급의학회지 Vol.22 No.6

Purpose: Severe trauma is indicative of poor patient prognosis and higher mortality rates. Moreover, severe trauma may be related with higher hospital costs. Our recent study showed that severe trauma costs significantly more per patient than general trauma. Length of hospital stay was shown to be an independent factor contributing to higher cost in the study. We assessed factors affecting length of hospital stay in severe trauma patients. Methods: Data from the severe trauma registry was collected prospectively and retrospectively reviewed. Time of emergency department (ED) registration, mechanism of injury, initial vital signs, revised trauma score (RTS), injury severity scale (ISS), specialty consultation time, time to admission decision, ED length of stay, and overall hospital length of stay (LOS) were evaluated. All factors listed above were put into a univariate, Cox proportional hazard analysis. LOS and other factors resulting in p-values under 0.20were included in the multivariate analysis. Results: A total of 249 patients were enrolled to the study. There were significant univariate analysis results for RTS and ISS (p=0.001, 0.006, respectively). The only significant multivariate analysis result was for RTS (p=0.025, hazard ratio=1.167). Conclusion: Higher RTS score is an independent factor leading to earlier discharge from the hospital in severe trauma patients.

응급 전산화단층촬영에서 조영제 사용에 따른 신독성

조영순,정태녕,손대곤,김승호 대한응급의학회 2003 대한응급의학회지 Vol.14 No.2

Purpose: In the last 30 years, there has been a markedly increased use of iodinated contrast agents in diagnostic and interventional radiological procedures. Due to the possible side effect of nephrotoxicity of these radiocontrast agents, we investigated the incidence of nephrotoxicity and attempted to identify the patient groups at higher risk for contrast nephrotoxicity among the patients who underwent emergency computerized tomography. Methods: We reviewed the medical records of 1,572 patients who had undergone contrast computerized tomography at the Emergency Center, Yonsei Medical Center, from January to May 2002. We defined contrast nephrotoxicity as any increase in the creatinine value of more than 0.5mg/dL (44㎛ol/L) or 25% compared to the baseline value. Results: We found 21 patients (1.3%) who met the criterion for contrast nephrotoxicity: 13 patients with normal renal function, and 8 patients with a higher than normal creatinine value before contrast-enhanced computerized tomography. The incidence of contrast nephrotoxicity in the patient group with normal renal function was 0.8% (13/1551), compared to 38.1% (8/21) in the pre-existing renal insufficiency group. There were no statistical differences on the amounts of dye used and the frequencies of risk factors for contrast nephrotoxicity between the patients in pre-existing renal insufficiency group who developed nephrotoxicity and who did not. The renal function of all patients returned to the baseline value without dialysis or renal replacement therapy. Conclusion: Pre-existing renal insufficiency is the most important risk factor for contrast nephrotoxicity. We need to take precautions and to have a proper protocol for the prevention of contrast nephrotoxicity in emergency care.

중증 외상 환자 이송 시 의료지도 요청 및 병원 사전 통보에 영향을 미치는 요인에대한 고찰

박상현,정태녕,이창재,김영갑,이주택,이찬희,김의중,최성욱,김옥준,배진건 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.5

Purpose: This study examined the factors affecting the precaution and request of medical direction for prehospital emergency treatment of major trauma patients by 119 rescue services. Methods: Medical records and prehospital run reports of major trauma patients with an Injury Severity Score (ISS)above 15 were reviewed. In total, 123 patients who were transferred by 119 rescue services to the Emergency Department of one hospital from December 1, 2010 to February 28, 2013 were enrolled. A total of 123 patients with major trauma satisfied the ISS criterion. Excluding 26patients with missing data, 97 patients were included in this study. Out of these 97 patients, 72 patients were male and the mean age was 46±16.1 years. The statistical methods used in the analysis were the Receiver-Operating Characteristic curve and Fisher’s exact test. Results: Between the hospital precaution group and nonprecaution group, the only significant difference was in the RTS score (p=0.007). In total, 52 patients (39 male patients;mean age 49.52±16.14 years) with major trauma were transferred during the medical direction period. Between groups that requested medical direction and groups that did not, the only significant difference was the time interval from the call to hospital arrival (p=0.032). Conclusion: Within the variables we examined, transport of major trauma patients, in addition to low incidence of precaution and request for medical direction by 119 rescue services, only a few were considered.

비외상성 복통을 주소로 응급의료센터에 내원한 젊은 여성 환자의 급성 복증 감별에 있어서 이학적 및 검사실 인자들에 대한 다변량 분석

이창재,정태녕,임득호,진수근,김옥준,최성욱,김의중,조윤경 대한응급의학회 2011 大韓應急醫學會誌 Vol.22 No.6

Purpose: One of the most challenging groups of patients to diagnose that visit an emergency department (ED) is the female with acute abdominal pain. The causes of acute abdominal pain range from minor, self-limiting conditions to life-threatening disorders. Differential diagnosis for these patients is extensive and frequently requires multiple examinations and tests. This study analyzed the effectiveness of surgical abdomen detection using various physical examination and clinical laboratory methods, for young women reporting non-traumatic abdominal pain. Methods: This study reviewed computed tomography (CT)reports for 232 women, aged 21~35 years old, who visited our ED for nontraumatic abdominal pain from July 2009 to June 2010. Bivariate analyses relating physical and laboratory methods used to detect surgical abdomen were conducted. A multivariate logistic regression model was then derived,with all variables in the final model significant at p<0.05. Results: The number of patients who required surgical intervention was 88, while the number who did not require surgery was 144. Significant predictive methods for identifying surgical abdomen were maximal tenderness site (p=0.019), rebound tenderness (p=0.037), white blood cell count (p=0.012) and urine blood (p=0.037). The bootstrap result was identical in 1000 samples with a 95% confidence interval. Conclusion: Maximal tenderness site, rebound tenderness,and results indicating leukocytosis and hematuria were found to be independently valid factors for detection of surgical abdomen in young women evaluated in our ED due for nontraumatic abdominal pain.