강체요소를 이용한 인발 공정의 상계요소 해석 ( An Analysis for Drawing of Strip by UBET with Rigid Elements )

최일국,최영,허관도 대한기계학회 2001 대한기계학회 춘추학술대회 Vol.1 No.3

충남에서 발생한 중증응급환자의 응급의료기관 일차 방문, 전원 및 재전원 현황

최일국,최한주,이혜정 대한응급의학회 2018 대한응급의학회지 Vol.29 No.5

Objective: Regionalization is one of the principal subjects for the advancement of rural emergency medical service systems in South Korea. This study shows the characteristics of interhospital transfer and status of the incidence of three major emergency disorders (acute myocardial infarction [AMI], acute stroke, and severe trauma) in one local province. Methods: A retrospective study was conducted for patients with three major emergency disorders who visited emergency medical facilities in one local province from January 2013 to December 2015, on the basis of the National Emergency Department Information System (NEDIS) data. Results: The incidence of three major emergency disorders had increased annually. Patients with each of these disorders tended to choose distinguishing methods of visiting emergency medical facilities. AMI patients tended to visited emergency medical facilities using private cars or on foot, while severe trauma patients usually visited by 119 ambulance, and acute stroke patients used 119 ambulance and private car in similar amounts. Overall, 65% of AMI patients were treated in intraregional medical facilities, but about 70% of acute stoke and severe trauma patients were transferred outside of the region. Conclusion: Because each of these disorders has an individual characteristic, it is difficult to expect a solution for the problems associated with emergency disorders just by assuring the availability of medical resources. Based on regionalization, a policy to provide the optimal treatment for those emergency disorders should be developed by planning public medical service systems based on the individual characteristics of emergency disorders, the standardized transfer plans of emergency patients and the assurance for mobilization and sharing of confined medical resources.

급성 심근경색으로 오인된 외상성 경막하출혈 후 발생한 Tako-tsubo syndrome 1례

최일국,강경호,이영진,김익범,고혁상,오성범 대한응급의학회 2008 대한응급의학회지 Vol.19 No.6

Electrocardiographic changes frequently occur after severe physical or emotional stress. Such changes can mimic acute ST-segment elevation myocardial infarction with elevated serum cardiac-specific markers (CK-MB, Troponin I), segmental wall motion abnormalities, and myocardial dysfunction. Several reports, however, have found that coronary angiography revealed no significant stenosis. We present a 70-yearold female with a traumatic subdural hematoma testing positive for cardiac enzymes, and ECG changes suggestive of acute ST-segment elevation myocardial infarction. Such a case, however, fits the diagnostic parameters of Tako-tsubo cardiomyopathy, or Tako-tsubo syndrome; even though its etiology, pathophysiology, diagnosis, and treatment remain uncertain. Tako-tsubo syndrome is characterized by a distinctive form of systolic dysfunction that predominantly affects the distal LV chamber, but a favorable outcome with appropriate medical therapy is expected. Because of its unusual nature and favorable prognosis, it is clear that Tako-tsubo syndrome is an important affliction that should be recognized by any emergency department.

가역적인 신경학적 이상을 동반한 낙뢰손상 환자: 증례보고

최일국,최한주 대한응급의학회 2015 대한응급의학회지 Vol.26 No.4

Lightning injury can cause systemic deterioration, including neurologic deficits. We present a case of lightning injury with reversible neurologic deficits in a 49-year-old man. Clinical manifestations of neurologic deficits due to lightning injury vary from lightheadedness to paralysis. In order to achieve a favorable outcome, immediate respiratory support and careful neurologic examinations are key elements during initial resuscitation. If secondary injuries due to any type of trauma following lightning were suspected, emergency physicians should make a decision regarding use of advanced diagnostic and therapeutic modalities.

충남지역 중증응급질환 환자들의 응급의료이용에 대한 코로나-19 팬데믹의 영향

최일국,노을희,최한주 대한응급의학회 2023 대한응급의학회지 Vol.34 No.6

Objective: This study analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic on emergency care utilization in Chungnam Province by examining the status of emergency care utilization during this period. Methods: This study retrospectively analyzed 154,946 patients who visited emergency medical institutions in Chungnam Province for a major emergency between January 2015 and December 2021, using the National Emergency Department Information System data. Results: The incidence of the The three major emergency diseases are acute myocardial infarction (AMI), acute stroke, severe trauma decreased. Primary visits to the regional and local emergency medical centers increased, except for local emergency medical institutions. The utilization rate of the 119 ambulance service in 2020 decreased significantly for AMI compared to the previous year and was the lowest among the three major emergency diseases. Air transportation by helicopter decreased during the COVID-19 pandemic. The rate of emergency room arrivals within the golden hour decreased during the COVID-19 pandemic. The transfer and retransfer rates also decreased for all three major emergency diseases. Despite the decreased number of patients during the pandemic, the ratio of primary visits to the local emergency medical centers for the three major emergency diseases increased, and the lengths of stay in the emergency room increased. Conclusion: The COVID-19 pandemic significantly impacted the occurrence, transportation, and therapeutic response to the three major emergency diseases in Chungnam Province. The vulnerability of patients with AMI in the pre-pandemic era was further exacerbated during the pandemic.

스포츠 유틸리티 차량 관련 교통사고 탑승자 손상의 특성과 대응방안 - 한국형 자동차사고 심층분석 조사자료 기반 -

최일국,최한주 위기관리 이론과 실천 2015 Crisisonomy Vol.11 No.8

스포츠 유틸리티 차량(sport-utility vehicle, SUV)은 최근 수년간 차급별 국내 판매 및 생산의 비중이 늘고 있다. 스포츠 유틸리티 차량이 다른 차량들에 비해 비교적 높은 차체 중심을 가지고 있어 우리나라에서도 탑승자의 안전성 향상에 대한 연구가 계속되어 왔다. 저자들은 한국형 자동차사고 심층분석 조사자료(Korean In-Depth Accident Study Database, KIDAS Database)를 기반으로 스포츠 유틸리티 차량 관련 교통사고의 탑승자 손상의 특성을 분석하였다. 스포츠 유틸리티 차량 사고의 손상중증도는 국도와 기타 도로에서 다른 도로들에 비해 손상중증도가 높게 발생하고, 전복사고의 경우 다른 충돌 방향들에 비해 손상중증도가 유의하게 높았다. 안전벨트를 착용하였을 때 최대약식상해등급이 미착용한 탑승자보다 유의하게 낮았다. The incidence of traffic accidents related to SUV (Sport-utility vehicle) has increased gradually in Korea. We analyzed the characteristics of SUV-related occupant injuries based on the KIDAS (Korean In-Depth Accident Study) Database. The severity score of SUV-related occupant injury was significantly influenced by road types; higher on national highways and other roads (including downtown streets) but lower on expressways and local roads). It is statistically significant that the roll-over accidents was more dangerous than other types of injury-mechanism and fastening seat belts could reduce the occupant’s severity of injury (MAIS).

충남 지역 중증응급질환 환자들의 응급의료 이용에 대한 코로나19 팬데믹의 영향

최일국,최한주,노을희 대한응급의학회 2022 대한응급의학회 학술대회초록집 Vol.2022 No.2

심전도정보전달체계 구축이 ST 분절 상승 심근경색 환자의 재관류 치료 시간 단축에 미치는 효과

최일국,최한주,오성범,강태수 대한응급의학회 2011 대한응급의학회지 Vol.22 No.6

Purpose: Prompt reperfusion therapy by means of primary percutaneous coronary intervention is an effective method for treating patients with ST-segment elevation myocardial infarction (STEMI). According to the ACC/AHA guidelines for these patients, the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon time) should be 90 minutes or less. The aim of this study was to evaluate the effect of establishing an ECG transmission system and communication procedure in the emergency department (ED) to minimize door-to-balloon time for STEMI patients. Methods: We established both the out-of hospital and inhospital aspects of the ECG transmission system. Before patient arrival at our ED, we would attempt to receive initial ECGs from the referring hospitals via fax. In ideal cases,ECG findings were immediately reported to interventional cardiologists by the referring primary ED physician. Door-toballoon time segments were analyzed in a retrospective manner. We compared the effectiveness in minimizing reperfusion time between the use of inter-hospital 12-lead ECG transmission before patient arrival, and direct communication between emergency physicians and attending interventional cardiologists. Results: Of the total 142 STEMI patients who received percutaneous coronary intervention (PCI) during the study period,112 (78.9%) received PCI within 90 min. The mean door-toballoon time of the 27 patients admitted with a pre-arrival 12-lead ECG transmission was significantly less than the others. Conclusion: Establishing both out-of hospital and in hospital strategies to reduce door-to-balloon time in patients with STEMI, by using pre-arrival ECG transmission and direct communication between emergency physicians and interventional cardiologists, is an effective approach to minimize time to reperfusion.

급성 일산화탄소중독에서의 심근손상 발생과 심전도 변화의 특성

최일국,최한주 대한응급의학회 2015 大韓應急醫學會誌 Vol.26 No.4

Purpose: Electrocardiographic findings such as Tp-Te interval, Tp-Te dispersion, and Tp-Te/QT ratio could be used to predict dysrhythmic events regarding any kind of toxic materials. We investigated the prevalence of cardiac toxicity related to acute carbon monoxide (CO) poisoning and the characteristics of electrocardiographic changes corresponding to the severity of intoxication. Methods: This retrospective observational study was conducted with 113 patients of acute CO poisoning from May, 2013 to July, 2014. Myocardial injury (MI) was determined based on an elevation of serum troponin T within the first 24 hours of the ED visit. The study population was classified according to Acute Neuropsychiatric Status (ANS) scoring: a mild intoxication group (ANS scores 0 and 1) and a severe intoxication group (ANS scores 2 and 3). Results: Prevalence of MI was higher in the severe intoxication group of acute CO poisoning (p<0.001). QTc was significantly prolonged in the MI group (p=0.007). However, no differences in other electrocardiographic parameters were observed between MI group and non-MI group. Conclusion: Myocardial injury was combined more frequently with a severe intoxication group of acute CO poisoning compared to a mild intoxication group. A specific feature of eletrocardiogram in myocardial injury with acute CO poisoning was a QTc prolongation.

낮은 변형범위구역과 연관된 교통사고 탑승자 손상의 특성 및중증 손상자 사례 분석을 통한 예방 대책 - 한국형 자동차사고 심층분석 조사자료 기반 -

최일국,최한주,이강현,박종찬,최지훈 위기관리 이론과 실천 2016 Crisisonomy Vol.12 No.1

경미한 교통사고에서는 탑승자 손상에 대한 현장 평가 및 분류에서 중증 외상 환자의 발생을 간과할 가능성이 있다. 본 연구는 한국형 교통사고 심층분석 조사자료 데이터베이스를 이용하여 낮은 변형범위구역과 연관된 교통사고의 탑승자 손상의 일반적 특성 및 중증 손상자들의 특성을 분석하였다. 낮은 변형범위구역과 연관된 교통사고에서도 사망을 포함한 중증 손상자가 적지 않게 발생하고 있다. 중증 손상자 발생의 위험성은 사고 기전이 전복사고, 정면충돌, 그리고 좌측 측면충돌 경우 증가하며, 안전장치 미사용과 유의한 연관성이 있다. 중증 손상자의 손상 부위는 머리 및 목 손상이 가장 많고, 흉부 손상 및 복부 손상이 그 다음 빈도이다. 경미한 교통사고 탑승자 손상에 대한 올바른 접근은 적확한 사고 현장 평가와 사고의 분류 단계에서 사고 기전 및 차체의 손상 특성에 대한 이해, 환자의 손상 정도 등을 종합적으로 평가하는 것이다. 중증 손상 발생에 대한 예방 대책은 안전장치 장착 및 착용에 관한 법규를 제정 및 강화하고, 준수된 안전 행동에 대하여 사회적 제도를 통한 혜택을 고려하는 것이다. Occupant injuries related to the low deformation extent of car accidents were not regarded as severely injured patients in trauma care. Although the deformation extent (Zone 1) is not meaningful according to the CDC’s guidelines for Field Triage of Injured Patients, many severe occupant injuries including motor vehicle deaths actually occurred related to low deformation extent. We analyzed the characteristics and injury severity of patients with low deformation extent (Zone 1 and Zone 2) based on the Korean In-Depth Accident Study Database. Rollover crashes, frontal crashes and left side-impact crashes were related to the mortality of the occupant injuries with low deformation extent. It is obvious that wearing seatbelts and deploying airbags can protect the occupants, particularly drivers. Prevention strategies should include the reinforcement of a law which requires installation and use of safety devices such as airbags.