가토의 골수내 식염수 주입이 말초혈액 제변수에 미치는 영향

황주일,김세경,이원재,이기중,김병기,박규남,김인철 大韓應急醫學會 1992 대한응급의학회지 Vol.3 No.1

Study Objective: To examine the effects of intraosseous saline infusion on hematologic parameters. Design and Setting: Eight New Zealand White rabbits were anesthized intramuscular ketamine injection, An initial blood sample was withdrawn from an earlobe artery under introduction of anesthesia. An 18-gauge intraosseous(10) needle was inserted into proximal tibia of rabbits, and 10 mL/kg of normal saline was infused over two minutes after the intraosseus needle insertion. Measurements: Complete blood counts were performed on the blood sampled. The light microscopic examination of the peripheral blood smear was perfomed by clinical pathologic staff. Results: No statistically significant differences were found in hematologic paramenters from samples drawn before and after intraosseous infusion. Conclusion: We advocate less caution in the interpretation of hematologic studies performed on blood samples obtained soon after an intraosseous infusion.

장시간 불가피한 공복(fasting)후 인체의 내분비 변화 : 삼풍백화점 붕괴 사고후 구조된 3인의 증례 THREE CASES IN COLLAPSE OF SAMPOONG DEPARTMENT STORE

박규남,황주일,박조현,오동렬,이원재,오승택,김세경,김인철 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

The interactions between nutrition and the endocrine system are more intimate and complex that previously thought. Nutrition modulates secretion and activity of many hormones, as part of the stress adaptation process. Fasting, in particular, produces a number of important changes in the endocrine system, with teleological purpose of helping the body tolerate the lack of food ingestion. These changes are therefore beneficial and protective, although at times they may not appear to be that way. The endocrine changes of fasting mediate the metabolic response. We must emphasize that these changes are completely reversible when appropriate nutrition is established. These changes are as followes: 1) decreased insulin and increased glucagon levels, 2) decreased thyroid effect, 3) decreased sympathetic activity, 4) hypothalamic hypogonadism, 5) decreased growth, 6) altered glucocorticoid secretion and metabolism, 7) impaired mineralocorticoid response, 8) decreased ADH secretion and effect. We experienced three cases of involuntary prolonged fasting after collapse of Sampoong department store. They were released from collapsed field after 11(case Ⅰ), 13(case Ⅱ), 17days(case Ⅲ) respectively. In each case, the endocrine changes of plasma levels were as followes: decrease of cortisol in case Ⅰ, increase of GH in case Ⅱ, decrease of free T3, T3, cortisol and increase of reverse T3, insulin in case Ⅲ. Each one did not show the same endocrine changes of plasma levels. But we think these changes of fasting are beneficial in metabolic response of human.

혈중 콜레스테롤과 음독자실시도

최승필,권태욱,황주일,김세경 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Objective: Several studies suggest that a low cholesterol concentration is associated with a greater than normal risk of mortality from suicide. The authors sought to determine whether a low cholesterol level is associated with a history of serious suicide attempts among drug ingested ED patients. Method: serum cholesterol levels of attempted suicide of 89 patients, aged 20-72 years, were obtained from the ED admission biochemical profiles. Results: The seriousness of suicide attempt was associated with low serum cholesterol concentration in all age subgroups. Conclusions: Low cholesterol concentration should be futher investigated as a potential biological marker of suicide risk.

12. 외상성 비장손상에 관한 임상적 고찰

이원재,박규남,황주일,박조현,김세경,김인철 대한외과학회 1992 대한외과학회 학술대회 초록집 Vol.1992 No.5

외상성 비장손상에 관한 임상적 고찰

이원재,임근우,황주일,박규남,김세경 대한응급의학회 1994 대한응급의학회지 Vol.5 No.2

The spleen is most commonly injured organ following abdominal trauma and is involved frequently in penetrating wounds to the left lower chest, flank, and upper abdomen. Management of the injured spleen has changed radically the over past years. Once regarded as a mysterious organ of unestablished benefit, the spleen is now recognized efforts important immunologic factory as well as a reticuloendothelial filter. Recognition of these immunologic consequences has stimulated efforts to conserve splenic mass, irrespective of age. With the appreciation of the spleen's segmental anatomy, advances in operative technique, and the development of topical hemostatic agents, splenorrhaphy has proved to be both feasible and safe. We reviewed retrospectively two hundred and twenty one cases of blunt splenic trauma that were managed College during last decade of Jan. 1980 to Dec. 1989. The following results were obtained ; 1) Male to Female ratio was 165 : 56 and most frequently injured age group was third decade(20-29) and childhood(0-9). 2) The most common cause of injury was motor vehicle accidents(57.4%), followed by violent trauma(27%), falling down(14%), stab wound(1%), and others(1%). 3) Expired cases after operation were fifteen and overall motality rate was 6%. 4) Associated injured cases were eighty six(39%), and most frequently associated injury was rib fracture(19.5%), followed by liver(12.2%), kidney(8.1%), and intestine(7.2%). 5) Surgical management was performed in 214 cases, the most commonly performed procedure was splenectomy(77.8%), next was splenorrhaphy(9%), partial splenectomy(5.5%), and bleeding control and drainage(4.5%). 6) Postoperative complications developed in twenty-five cases(11.3%), and pulmonary complication is most common, next was intraabdominal abscess, bowel obstruction, and rebleeding. 7) Overall splenic salvage rate is 22%.

돼지의 실혈성 쇽모델에서 혈장증량제의 중심정맥내 주입과 골수내 주입에 대한 혈역학적 지수에 대한 효과

이원재,박규남,황주일,임근우,김세경 대한응급의학회 1994 대한응급의학회지 Vol.5 No.1

Venous access remains often as a clinical problem for pediatric patients in hemorrhagic shock state. This study compares resuscitation with PENTASPAN(10% pentastarch) by central venous and intraosseous route in hemorrhagic shock model. The swines were bled to a mean arterial pressure of 30 mmHg. This state of shock was sustained for 30 minutes. Resuscitation was performed with Pentaspan infused at 50 mL/min by a manual pressure. The hemodynamic response to Pentaspan resuscitation was comparable in both group. There was no significant difference in mean arterial pressure, heart rate, cardiac output, pulmonary capillary wedge pressure, pulmonary artery pressure, arterial oxygen saturation, and mixed venous oxygen saturation. For fixed rate infusion, intraosseous resuscitation with Pentaspan is as effective as that infused by central venous route in improving hemorrhagic shock state.

손상정도계수(ISS)를 이용한 응급실 내원 교통사고환자의 분석

김세경,박규남,김용철,이원재,황주일,김인철 대한응급의학회 1992 대한응급의학회지 Vol.3 No.2

Injury severity measures are getting increasing importance for the quality assurance and injury research. Injury severity score(ISS) analysis is a method for the scalar measure of anatomic injury widely used and an important contribution to trauma research. A retrospectively study of 349 cases of the traffic accident victims who were visited to emergency room of Kangnam St. Mary's Hospital from March 1991 to August 1991 by ISS-85 was made. In the study, we have found out following results. 1. The female/male ratio was 69 : 31, predominant in male and the mean age was 32.4 years. 2. The mean ISS of all traffic accident victims was 8.8±10.6. 3. The mean ISS by age group showed the highest score above 7th decade in both male(14.0±21.0) and female(7.8±10.7). 4. By the analysis of accident type, the incidences of pedestrian TA, passenger TA and driver TA were 51.9%, 24.0 and 23.5% respectively. Mortalities of each accident type were 6.6%(pedestrian TA), 3.5%(passenger TA) and 2.4%(driver TA). Mean ISS revealed the most high in pedestrian TA(10.3±12.5), followed by driver TA(8.2±7.7) and passenger TA(7.8±8.0). 5. By the analysis of the arrival time, which was with in one hour traffic accident, the peak arrival time from 20 hours to 22 hours(18%) and the score of the highest ISS was 19.8±23.0 in 22-24 hours. 6. By the analysis of the day arrival within one hours after traffic accident, the peak arrival day was Tuesday (19%) and the highest mean ISS was 12.1±10.6 on Friday. 7. The most common cause of death was head trauma (59%) 8. As the injury severity score increased, the mortality rate increased.

대규모의 종교집회에서 요구되는 응급의료의 수준

권태욱,황두영,양관모,이환,황주일,김세경 대한응급의학회 1997 대한응급의학회지 Vol.8 No.2

STUDY OBJECTIVE To determine the level of medical care required for mass gatherings and describe the types of medical problems encountered in a religious mass gathered ceremony. DESIGN: Standard charts and a four-tiered triage system(minor, moderate, urgent, and emergent) were developed before the event. The triage system was applied to each chart retrospectively by a single emergency physician. SETTING: Medical staff(10 physicians, 13 nurses, 1 pharmacist, and 54 first-aid attendants) were based in 8 advanced life support(ALS) clinics. INTERVENTIONS: First-aid attendants referred patients to the clinics, where nurses conducted initial assessments and referred patients to physicians at the venue. Three ambulances were stationed at the venues. RESULT: 22 trauma patients were developed and 183 medical complaints were encountered. Only 7 urgent medical problems were encountered.

심한 저칼륨혈증을 동반한 갑상선 중독성 주기성 마비 2례

유승진,최승필,최경호,오동렬,황주일,나병호,김세경 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Thyrotoxic periodic paralysis occurs primarily in Orientals with an overwhelming male preponderance and a higher association of specific HLA antigens. Clinical manifestations include onset after high carbohydrate ingestion or heavy exertion with progressive symmetric weakness leading to flaccid paralysis of the extremities and other muscle groups, lasting several hours. Other precipitating facters include trauma, infection, administration of epinephrine, thyroid hormone, or corticosteroid. If hypokalemia is present, potassium administration may help abort the attack. Although propranolol can be efficacious in preventing further episodes, the only definitive treatment is euthyroid state. The pathophysiology is still controversal, but reflects altered potassium and calcium dynamics as well as certain morphologic characteristics within the muscle unit itself. We discribed two patients with thyrotoxic periodic paralysis who had a no familial history of paralysis and had a decreased level of serum potassium during attack.

소아에서 외상성 질식 증후군에 대한 임상적 고찰

박승현,최승필,나병호,황주일,나석주,전해명,김세경 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Traumatic asphyxia has often been described as a rare clinical syndrome characterized by cervicofacial cyanosis and edema, multiple petechiae, and subconjunctival hemorrhage after a severe crush injury of the thorax or upper part of the abdomen. The pathogenesis of traumatic asphyxia is that after compression of the chest or upper abdomen, intrathoracic pressure increased suddenly. Blood is forced out of the right atrium through the valveless innominate and jugular veins into the head and neck. This sudden increased thoracic pressure in small venules and capillaries causes rapid dilation and minute hemorrhages producing the petechiae often seen. Treatment is supportive and should be focused on the associated injuries. The prognosis for traumatic asphyxia is very good despite the alarming initial physical appearance. If the patient survives the initial insult, the prognosis is excellent. Neurologic sequale may be permernant. We experienced five case of the traumatic asphyxia, and its clinical and pathophysiologic features are discussed. Increased awareness of this syndrome by emergency physicians will result in better reporting ad understanding of its clinical implications.