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응급실로 내원한 요석 의심 환자에서 비조영증강 나선식 전산화단층촬영술과 경정맥 요로조영술의 정확도 비교
최혁중,김승우,이신득,김태수,박세훈,임태호,김선일,고병희 대한응급의학회 2004 大韓應急醫學會誌 Vol.15 No.6
accuracy of noncontrast helical computerized tomography (NHCT) with that of intravenous pyelography (IVP) in the evaluation of urolithiasis in the emergency room (ER). M e t h o d s: Between November 2003 and February 2004, a total of 47 consecutive patients presenting to the emergency department with acute flank pain were evaluated with NHCT followed by IVP. The mean of the time interval between NHCT and IVP was less than 5 minutes. All 47 sets of evaluations were later assessed randomly by an independent consulting radiologist for the presence, size, and location of a stone, ureteral dilatation, and secondary signs of ureteral obstruction. R e s u l t s: Forty-three of the 47 patients were diagnosed with urolithiasis. In 39 of the 43 patients diagnosed with ureteral calculi, the NHCT made the diagnosis. IVP made the diagnosis in 26 of the 43 patients. NHCT had a 90.7% sensitivity, 100% specificity, and 68% accuracy. Compared with IVP, using the McNemar test, NHCT was significantly better able to predict the presence of urolithiasis (p< 0 . 0 0 1 ) . C o n c l u s i o n s: Unnenhanced helical CT is superior to IVP in the demonstration of ureteral calculi in patients with suspected acute urolithiasis in the ER.
최혁중,이신득,임태호 대한응급의학회 2004 大韓應急醫學會誌 Vol.15 No.6
Pheochromocytomas are rare tumors that originate in chromaffin tissue and produce distant variant effects, such as EKG abnormality, myocarditis, cardiomyopathy, and acute coronary syndrome, by secretion of catecholamines. Such variant effects of pheochromocytoma tend to lead the emergency physician to a wrong diagnosis. We describe the case of a 29-year-old female with pheochromocytoma who was diagnosed at the ER as having myocarditis with acute renal failure. The diagnosis of pheochromocytoma was made later. To avoid misdiagnosis, we should include pheochromocytoma in the differential diagnosis. We should also use additional imaging tests, such as bed-side abdominal ultrasonography or abdominal CT, at the ER on relatively young patients presenting with hypertensive crisis, acute renal failure, and features, such as ischemic EKG changes, which are suggestive of acute coronary syndrome or m y o c a r d i t i s .
심상은,최혁중,강형구,임태호,강보승 대한응급의학회 2010 대한응급의학회지 Vol.21 No.4
Purpose: We use many electronic devices for treating patients in our emergency department. Several studies have reported an association between electromagnetic field exposure and risk of cancer and other diseases. Our purpose was to measure the intensity of power-frequency magnetic fields in the emergency department and evaluate the conditions exceeded regulation guidelines for power-frequency magnetic fields. Methods: Extremely low frequency magnetic fields were measured at 78 ordinary working spots in our tertiary hospital’s emergency department (ED) and evaluated according to national regulatory guidelines and SWEDAC. Each spot was measured four times. During measurement, every electrical device in the emergency department was turned on. Results: The average intensity of the magnetic fields in our emergency department was 0.99±1.27 mG. The maximum intensity was 8.3 mG, which was found in the pediatric section. Conclusion: The power-frequency magnetic field intensities of the various sections of our ED did not exceed national regulatory guidelines. However, pediatric and the minor emergency section showed magnetic fields intensities far above 2 mG. We found these high values outside the pediatric and waiting sections, where the electrical cabinet panel was located. We conclude that the electrical cabinet panel should be shielded and that similar studies are needed for other emergency departments.
경구기관삽관 시 기관삽관 기구에 따른 경추 움직임 비교: 마네킨 예비 연구
이상현,최혁중,강형구,강보승,임태호 대한중환자의학회 2010 Acute and Critical Care Vol.25 No.4
Background: In patients with limited cervical spine movement, equipment for orotracheal intubation should achieve sufficient laryngeal exposure with the least cervical spine movement. This study was designed to compare movement of the cervical spine during the orotracheal intubation with various intubating equipment. Methods: Twelve emergency physicians & residents with a total experience of >50 cases of endotracheal intubation in two emergency centers were assigned to perform orotracheal intubation with four different airway devices,including the Macintosh laryngoscope (ML), DCI video laryngoscope (DCI), Airway Scope (AWS) and Levitan Scope (LS), using the same manikin (AmbuⓇ airway management trainer) in random sequences. Movement of the C-spine was examined by measuring the angle formed by two lines which are parallel to the anterior surface of the C2 and C7 vertebrae bodies. The angle was measured when Cormack-Lehane grade II glottis exposure was achieved during intubation. Results: Mean cervical spine movements were 37.6 ± 9.2o, 32.2 ± 14.2o, 32.2 ± 6.45o and 17.4 ± 10.0o with the ML, DCI (p = 0.347), AWS (p = 0.094), and LS (p < 0.001), respectively, compared to that of ML. Cervical spine movement by LS was 54% less than that by ML. LS produced less cervical spine movement in comparison to DCI (p = 0.013) and AWS (p = 0.001). Conclusions: The Levitan Scope produced less movement of the cervical spine when compared to the Macintosh laryngoscope, DCI video-laryngoscope and Airway Scope during orotracheal intubation in a single airway training manikin model.
한국 소아에서 브로스로우(Broselow) 띠를 이용한 기관내관 크기 추정에 대한 연구
연제호,최혁중,강보승,김동원,임태호 대한응급의학회 2007 大韓應急醫學會誌 Vol.18 No.4
Purpose: Broselow Tape was designed to estimate endotracheal tube size on the basis of the body length of emergency pediatric patients. It was validated from the United States. We assess the accuracy of the Broselow Tape method for the prediction of endotracheal tube (ETT) size in Korean children. Methods: We reviewed pediatric anesthetic charts at a tertiary care hospital for one year, and in addition we collected data on gender, age, height, weight and fifth fingernail width for children visiting two tertiary emergency departments over four months. The inclusion criteria were that patients were American System of Anesthesiology (ASA) grade I or II, and that they were within the measuring range of Broselow Tape. The comparison of two data pairs was by cluster analysis and included stratification based on propensity scores, adjusting, and grouping. Results: Five hundred ninety-seven children and 537 pediatric anesthetic charts were included in this study. The mean ETT size as predicted by the Browslow tape method and as actually intubated were 5.12 mm and 5.11 mm (p=0.3851), respectively. The mean ETT size predicted by the 5th fingernail-width method and the age-based method were 5.48 mm (p<0.0001) and 4.95 mm (p < 0.001). Conclusion: There was no difference between the ETT size predicted by Browslow tape method and actual tube size. We conclude that Broselow Tape can be used to predict ETT size for Korean children.