안면부 골절과 전산화 단층 촬영으로 진단된 두부 손상의 연관성

송진우 ( Jin Woo Song ),조익준 ( Ik Joon Jo ),한상국 ( Sang Kook Han ),정연권 ( Yeon Kwon Jeong ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.1

Purpose: In this study, we retrospectively investigated the medical records of patients with facial fractures and suspected cranial injuries in order to determine if there was any relationship between various facial fracture patterns and cranial injuries. Methods: Medical records were reviewed to identify patients diagnosed with facial fractures who underwent cranial computed tomography (CT) scans. Records were reviewed for gender, age, injury mechanism, facial fracture pattern, and presence or absence of cranial injuries. Facial fracture patterns were classified as isolated fractures (tripod, zygomatic arch, maxilla, orbit, and mandible), combined fractures, or total fractures. Cranial injuries included skull fractures, traumatic subarachnoid hemorrhages, subdural hemorrhages, epidural hemorrhages, and contusional hemorrhages. All cranial injuries were established by using cranial CT scans, and these kinds of cranial injuries were defined radiologically-proven cranial injuries (RPCIs). We evaluated the relationship between each pattern of facial fractures and the incidence of RPCIs. Results: Of 132 eligible patients with facial fractures who underwent cranial CT scans, a total of 27 (20.5%) patients had RPCIs associated with facial fractures. Falls and slips were the most common causes of the fractures (31.8%), followed by assaults and motor vehicle accidents (MVAs). One hundred one (76.5%) patients had isolated facial fractures, and 31 (23.5%) patients had combined facial fractures. Fractures were found most commonly in the orbital and maxillary bones. Patients with isolated maxillary fractures had a lower incidence of RPCIs than those with total mandibular fractures. RPCIs frequently accompanied combined facial fractures. Conclusion: Combined facial fractures had a significant positive correlation with RPCIs. This means that facial fractures caused by stronger or multidirectional external force are likely to be accompanied by cranial injuries. (J Korean Soc Traumatol 2009;22:18-23)

연구논문 : 심폐소생술 불필요(DN(A)R) 동의 취득에 대한 전공의 의식조사

이태림 ( Tae Rim Lee ),신태건 ( Tae Gun Shin ),심민섭 ( Min Seob Sim ),조익준 ( Ik Joon Jo ),송형곤 ( Hyoung Gon Song ),송근정 ( Keun Jeong Song ),정연권 ( Yeon Kwon Jeong ),최병인 ( B. I Choe ) 한국의료윤리학회 2011 한국의료윤리학회지 Vol.14 No.3

This survey, which was conducted over the course of 3 months in 2009, was designed to investigate what the medical residents of one university hospital in Seoul think about DNAR orders. A total of 214 out of 468 residents (45.7%) answered the questionnaire. Participants were divided into two groups according to their experiences with taking DNAR order. There was no difference between the two groups on the definition of DNAR, its limitations, and when to issue DNAR orders. However, the two groups showed different opinions concerning who should be consulted in obtaining consent for DNAR and whether or not it was necessary to review DNAR orders. Residents who were experienced in giving DNAR orders felt more inclined to discuss the situation with the patient`s family members rather than the patient herself and thought that DNAR orders would not need to be reconsidered. These differences in opinion may result from the different experiences the two groups of residents had in actually ordering DNAR in the clinical setting. This study shows that more research and discussion is needed in order to establish the limitations and precise definition of DNAR orders.

중증 외상 환자의 입원 결정 지연에 영향을 미치는 요인과 공동진료시스템

강문주 ( Mun Ju Kang ),신태건 ( Tae Gun Shin ),심민섭 ( Min Seob Sim ),조익준 ( Ik Joon Jo ),송형곤 ( Hyoung Gon Song ) 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.2

Purpose: Prolonged stay in the emergency department (ED), which is closely related with the time interval from the ED visit to a decision to admit, might be associated with poor outcomes for trauma patients and with overcrowding of the ED. Therefore, we examined the factors affecting the delay in the decision to admit severe trauma patients. Also, a multidisciplinary department system was preliminarily evaluated to see if it could reduce the time from triage to the admission decision. Methods: A retrospective observational study was conducted at a tertiary care university hospital without a specialized trauma team or specialized trauma surgeons from January 2009 to March 2010. Severe trauma patients with an International Classification of Disease Based Injury Severity Score (ICISS) below 0.9 were included. A multivariable logistic regression analysis was used to find independent variables associated with a delay in the decision for admission which was defined as the time interval between ED arrival and admission decision exceeded 4 hours. We also simulated the time from triage to the decision for admission by a multidisciplinary department system. Results: A total of 89 patients were enrolled. The average time from triage to the admission decision was 5.2 ±7.1 hours and the average length of the ED stay was 9.0±11.5 hours. The rate of decision delay for admission was 31.5%. A multivariable regression analysis revealed that multiple trauma (odds ratio [OR]: 30.6, 95%; confidence interval [CI]: 3.18-294.71), emergency operation (OR: 0.55, 95%; CI: 0.01-0.96), and treatment in the Department of Neurosurgery (OR: 0.07, 95%; CI: 0.01-0.78) were significantly associated with the decision delay. In a simulation based on a multidisciplinary department system, the virtual time from triage to admission decision was 2.1±1.5 hours. Conclusion: In the ED, patients with severe trauma, multiple trauma was a significant factor causing a delay in the admission decision. On the other hand, emergency operation and treatment in Department of Neurosurgery were negatively associated with the delay. The simulated time from triage to the decision for admission by a multidisciplinary department system was 3 hours shorter than the real one. (J Korean Soc Traumatol 2010;23:113-118)

서울지역 대기오염과 급성관상동맥증후군 환자의 흉통 발생의 관계에 대한 연구

조익준,신중호,정성구,서길준,이중의,정연권,이창현,윤여규 대한응급의학회 2002 대한응급의학회지 Vol.13 No.3

Purpose: There have been some studies on the hazardous effects of air pollution for patients with cardiovascular diseases. This study was designed to evaluate the possible relationship between air pollution and development of chest pain in acute coronary syndrome patients. Methods: The medical records of 109 acute coronary syndrome patients, who visited two university hospital emergency rooms in the Seoul area between January 1999 and July 2001, were reviewed. Hourly concentrations of particulate mass< 10 μm and of four gaseous air pollutants were measured at 19 different points in the Seoul area. The data were analyzed using a case-crossover approach. Results: The analysis of the data showed no definite relationship between chest pain development and either the concentrations of particulate mass<10 μm(PM_10) or of four gaseous air pollutants; namely, carbon monoxide (CO), nitrogen dioxide(NO₂), ozone (O₃), and sulfur dioxide (SO₂). However, increases in the concentrations of particulate matter, gaseous NO₂and gaseous O₃showed a positive correlation, but without statistical significance. Conclusion: This study shows no relationship between the concentrations of PM10 and other air pollutants with the development of chest pain in acute coronary syndrome patients. However, for particulate mass<2.5μm, which is currently not measured in the Seoul area, the possibility of a relationship between development of chest pain in acute coronary syndrome patients and particulate air pollutants still exists.

119구급대를 통한 서울지역 외상환자 진료체계에 대한 통계분석

서길준,이승한,조익준,권운용,송형곤,이중의,윤여규 대한응급의학회 2001 대한응급의학회지 Vol.12 No.2

Backgroud: Despite continous efforts to improve the prehospital trauma care system in Korea, the preventable death rate has been reported to be high. The purpose of this study was to evaluate the prehospital trauma care system in Seoul by analyzing 119 rescue databases. Methods: The 119 rescue data bases of 22,275 trauma patients, who were transported to the secondary and tertiary hospital in Seoul by Seoul 119 rescue services from January 1, 2000 to December 31, 2000, were analyzed. Results: The response time(mean 3.7 min.) showed no time, weekly, and regional variations. However, the transport time from field to hospital showed was high in the morning rush hour(7:00 to 10:00 am), and was gradually decreased and the lowest between 10:00 pm and 7:00 am. There was also a regional variation in the transport time, which was short in the central area and long in the peripheral area of Seoul. Prehospital cares were given to the 10,999 trauma patients(49.4%). Of the 464 unresponsive patients(2%), only 236 patients were identified in transported hospitals. The outcomes of these unresponsive patients were DOA(54%), survival(19%), death in ER(14%), transfer to other hospitals(8%), and death after admission(5%) in order. Conclusion: We suggest that this study may be helpful to the establishment and improvement of the prehospital trauma care system as well as the determination of the adequate numbers and locations of trauma center in Seoul.

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.