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병원 기반 임상 수련이 119 구급대원의 활력징후 측정율에 미치는 효과
조유환,신상도,서길준,김재산 대한응급의학회 2007 대한응급의학회지 Vol.18 No.4
Purpose: To evaluate the effect of hospital-based emergency medical technician (EMT) training on pre-hospital evaluation. Methods: Three level 1 EMTs were trained at a regional emergency center for three months in an education program designed to improve pre-hospital evaluation. In order to assess the effectiveness of the training, we compared the rates at which EMTs measured vital signs during the three months before training (pre-training group) and the three months immediately after training (post-training group). We assigned one point to each of the following vital sign parameters when it was measured by an EMT: systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR), respiratory rate (RR), and body temperature (BT). The composite scores (range 0-5) were calculated and compared. Results: Of a total of 1,364 cases, 674 cases (49.4%) involved the pre-training group and 668 (52.2%) involved male patients. There were no significant differences in prehospital parameters (sex, proportion of injury, mental status, vital signs) or in pre-hospital management between the preand post-training group. The measurement rates of SBP, DBP, PR, and BT were not improved in the post-training group compared to the pre-training group, but the RR measurement rate was much greater in the post-training group than in the pre-training group (30.0% versus 7.7%, p<0.001). As a result, the composite score was also higher to a statistically significant degree in the post-training group (1.42±1.62 versus 1.18±1.39, p=0.003). Conclusion: Hospital-based training for EMT improved the rate at which vital signs were measured, mostly particularly the respiratory rate.
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강알칼리 중독에서 약산을 이용한 중화요법의 유용성에 대한 실험적 연구 : In-vivo Study
조유환,조익준,신중호,이중의,서길준,윤여규 대한응급의학회 2003 대한응급의학회지 Vol.14 No.1
Purpose: This study was designed to prove the efficacy of neutralization with weak acid against strong alkali ingestion and to evaluate exothermic reaction of neutralization therapy. Methods: 30 New Zealand White rabbits were anesthetized with intravenous injection of ketamine and xylazine. After gastric lavage was done, a oro-gastric catheter and a electric thermometer probe were inserted into stomach. And then the rabbits were divided into six groups. The first group was given 3M NaOH 16.5 mL only. The second and third groups were given 3M NaOH 16.5 mL and then 1M CH₃COOH 52.14 mL one and three minutes later, respectively. The fourth and fifth groups were given tap water instead of CH₃COOH, and the sixth group was given CH₃COOH only. We monitored intra-gastric temperature continuously, compared arterial pHs before alkali infusion and 15 minutes later, measured gastric pH 15 minutes later, and examined pathologic findings of stomach after sacrificing. Results: There was no significant thermal effect in all groups, and gastric pH of neutralization groups was much lower than alkali alone or dilution groups. Changes of arterial pH after 15 minutes were greater in alkali alone and dilution groups than neutralization groups. In gross and microscopic findings of stomach, only mucosal injuries were observed in neutralization groups, especially in one minute group. But all stomach layers were destroyed in alkali alone and dilution groups. Conclusion: Neutralization therapy never makes additional thermal injury, and has protective effects against local tissue destruction and systemic alkalemia. Dilution therapy shows little or no effects.
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신상도,조유환,천성빈,정성구,곽영호,이중의,서길준 대한응급의학회 2004 대한응급의학회지 Vol.15 No.1
P u r p o s e: This study was designed to evaluate the effect of emergency department (ED) overcrowding on the outcome of patient care. Methods: A retrospective review of medical records was obtained from Order Communicating System in the adult ED at a tertiary care teaching hospital from September 1, 2001 to November 30, 2001. For the overcrowding index, the length of stay in the ED and the time from registration to order were calculated. The outcome was defined as the result of care done in the ED or during hospitalization. The overcrowding effect on the outcome was tested by using a multivariate logistic regression analysis. Compared with the survival group, the odds ratio (OR) and 95% confidence interval (95% CI) of the death group was calculated with adjustments for gender, age, arrival time in the ED, arrival day of the week, clinical department, operation, hospitalization in the intensive care unit, and injury or disease. R e s u l t s: The number of total cases was 5,852. Of these, 3,046 was males and 2,806 females. Of these, the number of mortality cases in the ED was 106. A total of 2,025 patients were hospitalized. Of all the hospitalization cases, 161 died on the ward in spite of management. The length of stay in the ED, and adjusted OR were significantly increased in the total death cases and in the death cases on the ward compared to those of the survival cases. For time, from registration to order above 10 minute, compared to those below 10 minute, the adjusted OR for death in the ED was significantly increased. C o n c l u s i o n: The overcrowding indices, such as the length of stay or the time from registration to order, were related with the outcome, that is, total death and death in the ED or on the ward.
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전원측 리액터 불평형을 고려한 전압형 컨버터의 전류 보상 제어기 구현
전지용,조유환,이근홍 한국산학기술학회 2004 한국산학기술학회논문지 Vol.5 No.5
본 연구에서는 인버터를 구동하는 용도의 직류전원장치에 대한 제어 알고리즘 개발을 목표로 하고 있으며, 구동과 희생기능을 갖는 전압형 PWM 컨버터에서 운전시 전원의 불평형을 보상하는 제어방법을 제안하고자 한다. 이를 위해 전력회생기능을 갖는 정류기에 대하여 기존 다이오드 및 SCR을 이용한 정류방식과의 비교를 통해 본 제어방식의 우수성을 시뮬레이션과 실험을 통해 입증하고자 한다. 전력변환기가 항상 평형상태를 유지하기 위해 전류제어 루프에 의하여 불평형 상태를 보상하는 방법을 사용하였으며, 통상적으로 전력변환기의 구성시 각상의 리액턴스가 같지 않은 누설변압기 등의 사용을 가능하게 하므로 제안된 전력변환기의 리액턴스가 불평형상태가 되어도 운전시 항상 평형상태로 유지되어 시스템을 안정적으로 구동 시킬 수 있는 제어기법의 설계를 통해 어떤 환경에서도 장치의 안정된 구동특성을 확인하고자 하였다. In this paper, the control algorithm of DC source device for inverter starting is proposed and the control method for compensating unbalance system source on operating time in the voltage type PWM converter with driving and regenerative faculty is suggested. The maintaining method of balancing condition for converter of AC source is used the compensating unbalanced status by current control loop. In order to solve the problem which the unbalanced system control is used to leakage transformer not equaled reactance by each phase in rectifier system. The proposed H/Wand control algorithm of rectifier system is contributed to minimize of device and rising efficiency.
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병원전 심정지 환자에서 바소프레신과 에피네프린의 병용 투여군과 에피네프린 단독 투여군 간의 심폐소생술 결과 비교: 전향적 관찰연구
이선우,조유환,이진희,김태윤,김규석,이중의 대한응급의학회 2009 대한응급의학회지 Vol.20 No.1
Purpose: A recent study demonstrated that the effects of vasopressin were superior to epinephrine in patients with asystole. According to the Korean national registry of out-ofhospital cardiac arrest (OHCA), more than 2/3 of paients had asystole. This study was performed to evaluate whether the combined administration of vasopressin and epinephrine in the emergency department (ED) for patients with OHCA would increase survival and survival discharge. Methods: From October 2007 to June 2008, we changed the cardiopulmonary resuscitation (CPR) protocol in adult, non-traumatic OHCA in that 40 U of vasopressin was to be administered as soon as possible followed by epinephrine (VSP group). Data about cardiac arrest were collected using the Utstein templates. Data from January to September 2007, when vasopressin had not been used, were also collected for comparative analysis (EPN group). These two groups were compared in terms of rate of survival and survival discharge. Results: There were 59 and 62 patients in the EPN group and the VSP group, respectively. There were no significant differences in the baseline characteristics including age, cardiac rhythm of asystole, witnessed arrest, and bystander CPR. Survival was similar between the EPN group and VSP group (46% vs 57%, p=0.240) as was survival discharge (20% vs 15%, p=0.398, respectively). Conclusion: The combination therapy of vasopressin and epinephrine during CPR for OHCA does not show any survival advantage over epinephrine alone.
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권운용,조유환,송형곤,김명천,이중의,서길준,윤여규 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4
Background: Paraquat causes severe tissue toxicity when ingested, but has no effective treatment modality. We have shown that high dose vitamin C has effective antioxidant activities against the paraquat intoxication in a previous animal experiment. This study was designed to evaluate the effect of antioxidant therapy with high dose vitamin C and vitamin E in human cases of paraquat intoxication. Methods: From August 1999 to August 2001, 19 paraquat intoxication patients who visited the emergency department of the Seoul National University Hospital and the Kyounghee University Hospital were enrolled to this study. They were devided into two groups, a control group(9 patients) and a study group(10 patients). The control group received only conservative managements including gastro-intestinal decontaminati-on. The study group received conservative managements plus the antioxidant therapy which was composed of vitamin C 24 gm/day intravenously and 20 gm/day orally, and vitamin E 1.6 gm/day orally. Results: In the study group, 5 of 10 patients(50%) survived, but all patients of the control group died(p=0.003). There were no significant differences in age, sex, and usage of gastric lavage and activated charcoal between the two groups. Difference in ingested amount of paraquat between the two groups could not be analyzed due to the inexact and subjective measuring methods based on patients' histories. Conclusion: Antioxidant therapy with high dose vitamin C and vitamin E is effective in vival rate in paraquat intoxicated patients.
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