Change in peak expiratory flow rate after the head-tilt/chin-lift maneuver among young, healthy, and conscious volunteers

조시온,이재백,진영호,정태오,윤재철,박보영 대한응급의학회 2019 Clinical and Experimental Emergency Medicine Vol.6 No.1

Objective The head-tilt/chin-lift (HT/CL) is a simple, routinely used maneuver to open the upper airway. Changes in the peak expiratory flow rate (PEFR) before and after the HT/CL maneuver have not been evaluated among conscious volunteers who are regarded as a control cohort. 'Methods Sixty healthy 20-year-old volunteers (30 males and 30 females) were enrolled. The supine position was defined as the position at which the ear-eye line was at a 10° angle to the horizontal. The HT/CL position was defined as the position at which the ear-eye line was at a 25° angle to the horizontal. PEFR was measured using a hand-held device with the subject in the supine position (pre-PEFR) and HT/CL position (post-PEFR), respectively. One set was defined as these two measurements. Five sets of measurements were performed on each subject (300 sets). The set with the maximal and minimal difference between pre-PEFR and post-PEFR were excluded from the analysis. We used a paired t-test to compare the mean pre-PEFR and post-PEFR values for the entire group and subgroups divided by sex, height, body weight, body mass index and response status. Results Overall, 360 measurements (180 sets) were analyzed. The mean pre-PEFR and post-PEFR were 316.1±87.6 and 346.5±94.7 L/min, respectively. Further, significant differences were observed for sex, height, body weight, and body mass index. In 10 subjects, post-PEFR was lower than pre-PEFR. Conclusion PEFR increased by 9.6% after the HT/CL maneuver in young conscious subjects, but some subjects showed decreased PEFR after the HT/CL maneuver.

The Effect of Shoulder Muscle Succinylcholine Injection on Foreleg Raising Power (Sion’s Local Paralysis): A second experiment

조시온 대한응급의학회 2023 대한응급의학회 학술대회초록집 Vol.2023 No.2

티백의 손상에 따른 미세플라스틱의 유출경향

김시온 ( Kim Sion ),조은하 ( Jo Eunha ),최수훈 ( Choi Soohoon ) 한국물환경학회 2020 한국물환경학회·대한상하수도학회 공동 춘계학술발표회 Vol.2020 No.-

In the current research, various conditions were evaluated to understand the release of fibrous microplastics and organic leachate from teabags. Six commercial teabags composed of 4 different plastic materials were tested under different temperatures, fiber damages, and water contact times. The main object of the research was to verify the amount of microplastics or organic leachate that may occur in tea consumed in our every day lives. The main focus was to verify the fibrous microplastic release and organic leachate of teabags under different damages. Damages of 1 ~ 10 cm were conducted on the teabags and submerged in glass vials under different temperatures. The teabags were cut with steal scissors of different degrees and the tea leaves were removed. Empty teabags were washed with deionized (DI) water for three trials before the experiments were conducted. Three empty teabags were submerged in every glass vial and submerged under constant temperatures in a water bath. the water bath contained a shaker where the samples were shaked during each trial. After being submerged in the water bath, the water from the teabags were filtered through a cellulous acetate membrane filter with pore sizes of 1 μm. Each filter was rinsed thoroughly and filtered with DI water before filtrations of the teabag samples. Filtered fibrous microplastics were counted with an optical microscope. Residual microplastics in the filtered water were analyzed with a TOC anayzer, dynamic light scattering analyzer, and SEM imaging. Results showed a logametric increase for both fibrous microplastic release and organic leachate with the increase of the damage inflicted on the teabags. Samples under higher temperatures also showed a higher release of the fibrous microplastics and leached TOC matter. The time for which the damaged teabags were submerged under water also showed a strong correlation with plastic release and TOC leaching. The hydraulic size of the filtered microplastics were in the size range of 1 nm to 2.4 μm. SEM resulted also showed similar sizes of microplastics with EDX results indicating the fibers as polymeric matters. The type of teabags and its assembly method also indicated a degree of influence in the release and leachate of the teabags. The current research has showed the amount of potential mircroplastic consumption via tea consumption.

티백의 손상 정도에 따른 미세플라스틱의 유출특성

조은하(Eun Ha Jo),김시온(Sion Kim),최수훈(Soohoon Choi) 대한환경공학회 2020 대한환경공학회 학술발표논문집 Vol.2020 No.11

Comparison of the National Early Warning Score+Lactate score with the pre-endoscopic Rockall, Glasgow-Blatchford, and AIMS65 scores in patients with upper gastrointestinal bleeding

김대진,조시온,이재백,진영호,정태오,윤재철,박보영 대한응급의학회 2018 Clinical and Experimental Emergency Medicine Vol.5 No.4

Objective We compared the predictive value of the National Early Warning Score+Lactate (NEWS+L) score with those of other parameters such as the pre-endoscopic Rockall score (PERS), Glasgow-Blatchford score (GBS), and albumin, international normalized ratio, altered mental status, systolic blood pressure, age older than 65 years score (AIMS65) among patients with upper gastrointestinal bleeding (UGIB). Methods We conducted a retrospective study of patients with UGIB during 2 consecutive years. The primary outcome was the composite of in-hospital death, intensive care unit admission, and the need for ≥5 packs of red blood cell transfusion within 24 hours. Results Among 530 included patients, the composite outcome occurred in 59 patients (19 in-hospital deaths, 13 intensive care unit admissions, and 40 transfusions of ≥5 packs of red blood cells within 24 hours). The area under the receiver operating characteristic curve of the NEWS+L score for the composite outcome was 0.76 (95% confidence interval, 0.70 to 0.82), which demonstrated a significant difference compared to PERS (0.66, 0.59–0.73, P=0.004), but not to GBS (0.70, 0.64–0.77, P=0.141) and AIMS65 (0.76, 0.70–0.83, P=0.999). The sensitivities of NEWS+L scores of 3 (n=34, 6.4%), 4 (n=92, 17.4%), and 5 (n=171, 32.3%) were 100%, 98.3%, and 96.6%, respectively, while the sensitivity of an AIMS65 score of 0 (n=159, 30.0%) was 91.5%. Conclusion The NEWS+L score showed better discriminative performance than the PERS and comparable discriminative performance to the GBS and AIMS65. The NEWS+L score may be used to identify low-risk patients among patients with UGIB.

급성 신우신염을 가진 여성 환자에서 균혈증을 예측하기 위한 초기 혈장 프로칼시토닌, 젖산 및 C-반응성 단백질의 진단 성능 비교

김병진,조시온,이재백,진영호,정태오,윤재철,박보영 대한응급의학회 2019 대한응급의학회지 Vol.30 No.1

Objective: The purpose of the present study was to compare the diagnostic performance of initial procalcitonin, lactate, and high-sensitive C-reactive protein (hsCRP) for predicting bacteremia in female patients with acute pyelonephritis (APN). Methods: We conducted a retrospective study of female APN patients who visited the emergency department (ED) at the studied hospital between January 2015 and December 2016. The main outcome was bacteremia, which was reported via the first blood culture at ED. The patient demographics, co-morbidities, physiologies, and laboratory variables including initial procalcitonin, lactate, and hsCRP levels, were collected and analyzed to identify associations with the presence of bacteremia. The area under the receiver operating curve (AUROC) and sensitivity (SE)/specificity (SP) were calculated for each variable. Results: During the study period, 282 patients were enrolled. A total of 105 (37.2%) patients had bacteremia. Escherichia coli was the most frequent pathogen. The AUROC was 0.70 (0.63-0.76), 0.70 (0.63-0.76), and 0.56 (0.49- 0.63) for the procalcitonin, lactate, and hsCRP, respectively. At a cut-off value of 0.163 ng/mL, the procalcitonin level predicted bacteremia, with a SE /SP of 95.2%/22.6%, respectively. At a cut-off value of 0.7 mmol/L, the lactate level predicted bacteremia with a SE/SP of 96.2%/20.9%, respectively. The combination of a procalcitonin level >0.447 ng/mL or a lactate level >0.7 mmo/L was chosen, as they showed 100% SE and a 100% negative predictive value. Conclusion: The initial serum procalcitonin and lactate levels showed similar and fair discriminative performance for predicting bacteremia in female APN patients, while the hsCRP level showed poor performance. The combination of procalcitonin and lactate (procalcitonin level≤0.447 ng/mL and lactate≤0.7 mmol/L) can be used to identify patients at low risk of bacteremia.

Mortality difference between early-identified sepsis and late-identified sepsis

지운,조시온,이재백,진영호,정태오,윤재철,박보영 대한응급의학회 2020 Clinical and Experimental Emergency Medicine Vol.7 No.3

Objective The aim of the study was to compare the mortality rates of patients with early-identified (EI) sepsis and late-identified (LI) sepsis. Methods We performed a retrospective chart review of patients admitted to the emergency department and diagnosed with sepsis. EI sepsis was defined as patients with a Sequential Organ Failure Assessment (SOFA) score ≥2, based on 3 parameters of the SOFA score (Glasgow coma scale, mean arterial pressure, and partial pressure of oxygen/fraction of inspired oxygen ratio), measured within an hour of emergency department admission. The remaining patients were defined as LI sepsis. The primary outcome was in-hospital mortality. Results Of the total 204 patients with sepsis, 113 (55.4%) had EI sepsis. Overall mortality rate was 15.7%, and EI sepsis group had significantly higher mortality than LI sepsis (23.0% vs. 6.6%, P=0.003). The patients with EI sepsis, compared to those with LI sepsis, had higher SOFA score (median: 4 vs. 2, P<0.001); Acute Physiology and Chronic Health Evaluation (APACHE) II score (median: 14 vs. 10, P<0.001); were more likely to progress to septic shock within 6 hours after admission (17.7% vs. 1.1%, P<0.001); were more likely to be admitted to the intensive care unit (2.2% vs. 1.1%, P=0.001). Conclusion Mortality was significantly higher in the EI sepsis group than in the LI sepsis group.

3차 의료기관에 내원한 병원전 심정지 환자에게 시행된 119 응급처치에 대한 평가

전용규,윤재철,조시온,정태오,진영호,이재백,김진회,이현경 대한응급의학회 2011 대한응급의학회지 Vol.22 No.5

Purpose: The large disparity in outcomes of out-of-hospital cardiac arrest (OHCA) between communities makes it important determine pre-hospital factors associated with outcome of OHCA. The study evaluated pre-hospital care performed by 119 rescuers in OHCA and investigated pre-hospital factors that influenced return of spontaneous circulation (ROSC) and automated external defibrillator (AED) use. Methods: We retrospectively analyzed 119 OHCA patients with presumed cardiac origin admitted to our emergency department transported by 119 rescuers from May 2007 to April 2010. Patients were divided according to achievement of ROSC and AED use prior to comparative analysis. Results: Twenty six patients (21.8%) experienced ROSC and only five patients (4.2%) survived to discharge. In the study area, scene-to-hospital arrival time was significantly shorter in the ROSC group (15.0±5.8 minutes) than the non-ROSC group (19.4±9.1 minutes) (p=0.02) and electrocardiography (ECG) application was associated with non-AED use. Conclusion: Cooperation of emergency medical services and hospitals in the community to reduce hospital arrival time is needed to improve ROSC in OHCA patients. AED use on scene prior to ECG application will be encouraged and higher level training and continuous education of 119 rescuers for AED use will be needed to enhance AED application.

의식이 명료한 상태로 내원한 글루포시네이트 중독환자에서 신경학적 합병증예측인자로서 암모니아 농도 차이의 유용성

오태환,이재백,진영호,정태오,조시온,김소은,이정문,윤재철 대한응급의학회 2016 대한응급의학회지 Vol.27 No.5

Purpose: The serum ammonia level was postulated as a surrogate marker for severe neurotoxicity in glufosinate ammonium (GLA) poisoning. The aim of this study is to evaluate whether the level of serum ammonia can predict delayed neurologic complications in patients with GLA poisoning presented with alert mentality. Methods: Thirty-six GLA-poisoned patients presented to our emergency department with alert mentality initially were analyzed retrospectively. The baseline characteristics, laboratory findings, ammonia level (initial and second ammonia level, frequency of hyperammonemia, and difference of ammonia level), and clinical outcomes were compared between non-neurologic (n=16) and neurologic complication groups (n=20). Results: Neurologic complications occurred in 20 patients (55.6%) with 14.3 hours (median) of latent period. The initial ammonia level and frequency of initial hyperammonemia did not show any difference between the two groups. However, the difference of ammonia level between the 2nd and 1st samples was an independent predictor of delayed neurologic complication (adjusted odds ratio; 1.184 (95% confidence interval (CI); 1.01-1.387, p=0.037)). The area under the curve and cut-off point of the difference of ammonia level for the prediction of delayed neurologic complication was 0.936 (95% CI; 0.756-0.992) and 15.4 umol/L respectively. Conclusion: The difference of ammonia level rather than the initial ammonia level could be used to predict delayed neurologic complication in GLA-poisoned patients presented with alert mentality.

중증 뇌손상이 없는 둔상 환자에서 초기 중증도 예측인자로서 D-dimer의 역할

손석우,이재백,진영호,정태오,조시온,이정문,윤재철,김소은 대한응급의학회 2018 大韓應急醫學會誌 Vol.29 No.5

Objective: The purpose of this study was to evaluate whether or not the d-dimer level indicating hyperfibrinolysis could be a predictor of early poor outcome (massive transfusion, death within 24 hours) associated with trauma-induced coagulopathy in blunt trauma without significant brain injury. Methods: This study was a retrospective observational study using 516 blunt trauma patients without significant brain injury. The poor outcome group, including patients receiving massive transfusion and those who died within 24 hours, consisted of 33 patients (6.4%). The variables were compared between the poor outcome group and good outcome group, and logistic regression analysis was performed using statistically significant variables. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the poor outcome prediction ability of the initial d-dimer level. Results: The poor outcome group showed more serious anatomical, physiological, and laboratory data than the good outcome group. In the ROC curve analysis for evaluation of the poor outcome prediction of the d-dimer level, the area under the curve value was 0.87 (95% confidence interval [CI], 0.84-0.90) while the cut-off value was 27.35 mg/L. In the logistic regression analysis, the high d-dimer level was shown to be an independent predictor of poor outcome (adjusted odds ratio, 14.87; 95% CI, 2.96-74.67). Conclusion: The high d-dimer level (>27.35 mg/L) can be used as a predictor for the poor outcome of patients with blunt trauma without significant brain injury.