응급의학은 어떤 의학분야이며 그 미래는?

도병수,이삼범 영남대학교 의과대학 2002 Yeungnam University Journal of Medicine Vol.19 No.2

Emergency medicine(EM) is the specialty of evaluating, stabilizing and initiating treatment for patients with life of limb-threatening illnesses or injuries. Techniques unique to the specialty of EM are the triage systems, quick stabilization methods, and emergency surgery procedures. The field of EM encompasses areas such as emergency department management, disaster planning and management, the management of emergency medical service(EMS) systems, research into such areas as brain and heart resuscitation, trauma and disaster management, survival medicine, and environmental emergencies(cold and heat injuries, poisioning, decompression sickness and barotrauma). Today, in addition to providing emergency care, the emergency specialists have moral and legal obligations to assess and report probable cases of child and spouse abuse, sexual assault, and alcohol and drug abuse. Future, the EM should provide surveillance, identification, intervention, and evaluation of injury and disease, therefore EM will remain as a key component of evolving community health care system.

뇌실외 배액술 시행과 관련된 뇌실염 : 원인균주와 경험적 치료약제의 적절성

도병훈,김신우,오종택,손종원,하상우,이응갑,장현하,이종명,김능수 대한감염학회 2005 감염과 화학요법 Vol.37 No.2

목적 : 본 연구는 뇌실외 배액술을 시행한 신경외과 환자들에서 뇌실염 발생 빈도, 원인균주와 감수성 추이 및 경험적 치료로 사용되는 항생제인 ceftazidime과 vancomycin의 적절성 여부에 대하여 조사하였다. 재료 및 방법 : 2000년 12월부터 2003년 10월까지 EVD를 시행한 경북대학교병원 신경외과 입원환자 340명 중 뇌실염이 발생한 39명을 대상으로 후향적으로 조사하였다. 결과 : 340명 중 39예 (11.5%)에서 뇌실염이 발생하였고 이들 가운데 4명이 뇌실염과 연관하여 사망하였다(10.3%). EVD 시행일로부터 뇌실염 발생까지는 평균 8.4일이었다. 원인균은 33예(87.1%)에서 확인되었으며 Aci-netobacter (19예, 45%), methicillin-resistant coagulase negative Staphylococcus (9예, 22%), methicillin-resistant Staphylococcus aureus (9예, 22%) 등의 순이었다. 가장 많이 동정된 Acinetobacter 19예 중에서 8예(42.1%)가 ceftriaxone에 내성을 보였으며 현재 경험적으로 널리 사용되는 ceftazidime에 대해서는 11예중 3예(27%)가 내성을 보였다. 결론 : 최근 EVD 시행과 관련된 뇌실염 뇌실염 최근 그람음성 non-fermenter 특히 Acinetobacter에 의한 경우가 증가하고 있으며, 이들 그람음성 non-fermenter는 현재까지 경험적으로 사용되는 ceftazidime에 점차 내성을 보이고 있다. 경험적 치료제에 대한 성공률을 높이기 위해서는 각 병원별 내실염의 원인균주의 감수성에 대한 검사가 필요하겠다. Purpose : To investigate the etiologic microorganisms of external ventricular drain (EVD)-related ventriculitis and the appropriateness of using ceftazidime and vancomycin as an empiric therapy in neurosurgical patients with EVD-related ventriculitis. Materials and Methods : Retrospective analysis of 39 patients with EVD-related ventriculitis among 340 neurosurgical patients to whom EVD had been placed during December 2000 and October 2003 at Kyungpook National University Hospital. Results : Thirty-nine EVD-related infections (39/340, 11.5%) occurred and the attributable mortality rate was 10.3% (4/39). The average duration from the ventricular catheter placement to the development of ventriculitis was 8.4 days. All patients with EVD infection had fever and 89.7% (35/39) of the patients showed nuchal rigidity. The positive culture rate in CSF was 87.1% (34/39) and the frequency of individual organism is as follows : Acinetobacter 45% (19 cases), methicillin-resistant coagulase negative Staphylococcus 22% (9 cases), methicillin-resistant Staphylococcus aureus 22% (9 cases), Enterococcus 5% (2 cases), Streptococcus pneumoniae 3% (1 case), non-fermenting gram-negative bacilli 3% (1 case). The polymicrobial infection rate was 15.4% (6/39). Among 19 cases of Acinetobacter infection, 42.1% (8/19) of the strains showed resistance to ceftriaxone and 15.7% (3/11) to ceftazidime. However, all cases were sensitive to meropenem. Conclusion : These findings show that the major etiologic organisms causing EVD-related ventriculitis have recently changed to Gram-negative non-fermenters, especially Acinetobacter. Because Gram-negative non-fermenting rods resistant to ceftazidime are increasing, an immediate change from ceftazidime plus vancomycin, the widely accepted empiric antibiotic therapy, to meropenem plus vancomycin should be considered when clinical symptoms and signs show no improvement or even deterioration.

응급센터 입원환자의 통증처치에 대한 응급의학적 고찰

도병수,김현정,정준영,도호석,이창현,이삼범 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Study objective: To recognize importance of pain management in ED and properly manage the ED patients complaining pain by analyzing the intervals between arrival time in ED and pain medicine starting time, the types and the administered routes of pain medicine. Design: Retrospective review of ED charts Setting: University teaching hospital Participants: The patients had admitted in ED of Yeungnam University Hospital with a chief complaint of acute abdominal pain or pain due to bone fracture between June 1, 1995 and December 31, 1995. Results: The study group consisted 256 patients, 161 of them female. ED administrations of analgesics were 103 cases, 17 of them administered more than two times. The average time interval between arrival time and medication time was 169.02±120.25 minutes. Each types of perceived analgesics were antispasmodics 55 cases(53.40%), NSAID 26 cases(25.24%) and opioid 19 cases(18.45%). Every analgesics were administered through intramuscular routes, except only 3 cases. Violences of patients or relatives due to delayed pain control were occured 32 cases, 5 cases of them self-discharged and looked for other hospitals. Conclusion: Emergency physicians including interns and residents delayed management so long and ordered inappropriate administration routes and types of analgesics. So we thought proper protocols about pain management in ED were established.

견관절의 유착성 관절낭염 환자에 대한 자가신장운동의 효과

서병도,신형수 대한물리치료학회 2010 대한물리치료학회지 Vol.22 No.1

Purpose: The purpose of this study was to compare the effectiveness of (a) a self stretching exercise (SSE) maintained below the level of pain with (b) physical therapy (PT) performed without pain limitation in patients with adhesive capsulitis. Methods: Forty-three subjects with frozen shoulder were recruited. Subjects were randomly assigned to one of two groups ? an experimental group (SSE group, n1=18) and a control group (PT group, n2=25). The duration of each intervention was five weeks. We assessed night pains, range of motion (ROM), and shoulder function. Results: Overall, subjects in both groups improved over five weeks (p<0.05). The change in the PT group was greater (p<0.05). Conclusion: SSE carried out under the pain threshold may be used to treat patients with adhesive capsulitis SSE can be prescribed with PT as part of a home program or of group management.

응급실에서 시행한 상용심전도의 효용성에 대한 고찰

도호석,이창현,이삼범,도병수 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Study objectives : To determine whether routine performance of an ECG could have been safely avoided in a subset of ED(emergency department) patients admitted to a university hospital. Design : Retrospective consecutive case series. Setting : University teaching hospital. Type of participants : All patients admitted through Yeungnam university hospital during a three month period. Methods and interventions : Acceptable indications for an admission ECG were prospectively developed. Charts of all patients were reviewed to determine whether any of these were present, whether an admission ECG performed, and whether an admission ECG resulted in a change in patients management or outcome. Measurements and main result : There were 984 admissions through ED during the study period. Of these 608 patients had an ECG performed at ED. Of the 608 patients 140(23.0%) had at least one acceptable indication and 468(77.0%) had no for an ECG. Among the 140 who had an indication for an ECG at ED, 56(40.0%) patients ECG were interpreted abnormal (95% confidence interval[CI], 32%∼48%). Among the 468 who had no indications, only 3(0.64%) patients ECG were interpreted abnormal (95% CI, 0%∼1.36%) and the ECG result in a change in management, but no change in outcome (95% CI, 0%∼0.64%). Conclusion : The routine or admission ECG could have been avoided in no acceptable ED indication. We should have to try continuously for making acceptable criteria of ECG in ED of Korea, and then we have to prevent needless ECG and cardiac work up that increasing the cost and evacuation time from ED.

동시에 내원한 대량환자의 응급의학과내 처치에 대한 고찰

도병수 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

A multicasuality incident usually refers to an isolated, geographically focused event which produces a limited number of casualities that tare managed within a community. Our emergency department(ED) was experienced two cases of multicasuality events in Taegu, Korea. And we could gain experience with in-ED-community multicasuality events management. We tried to analyse emergency department disaster management in the review of two community muticasuality events including fall downing accident and food poisoning. The result of ED management survey shows the importance of the hospital's disaster plan to presuppose a large influx of patients, notification of the hospital, mobilization of additional personnel resources including triage and trauma team and preparation of ED space and beds.

경계면 요소를 이용한 기초거동에 관한 수치해석

심도식,박병수 도립 강원전문대학 1998 道立 江原專門大學 論文集 Vol.1 No.1

This research is an numerical study of investigating effects of base roughness of strip footing in sandy foundation on load-settlement characteristics, ultimate bearing capacity, and failure mechanism. For model foundation, Jumunjin Standard Sand was used and prepared in the specially built model container to simulate loading conditions of the strip footing in field. Parametric experiments under plane strain conditions were performed by changing properties of interface between foundation and footing such as placing vinyl, aluminum, sand paper, and sand itself beneath the model footing. Relative densities of sandy foundation was also changed during tests. Ultimate values obtained from tests were compared with estimated values by using limit equilibrium methods. The load-settlement behavior of footing obtained from tests was also compared with results from using a numerical technique of Finite Element Method with hyperbolic constitutive relation.

KSDeN^TM process의 영양염류 제거 특성

김도군,천상욱,김병군,서인석,박철휘,김성준,류수현 대한상하수도학회 2002 상하수도학회지 Vol.16 No.4

Intermittent aeration processes have been much of interest as an excellent alternative for nutrients removal for upgrading secondary wastewater treatment plants, with minimum modification. Also, operational flexibility of those proposes a good opportunity for newly planed plants. Here, a pilot study was conducted to evaluate the performance of a continuous flow intermittent aeration process (KSDeN^TM process). The influent was collected at the effluent channel of the grit chamber of a large sewage treatment plant. The influent characteristics with standard deviation were 243.2±170.9mg/L for TCOD_cr, 47.5 13.9mg/L for T-N, 8.4±8.3mg/L for T-P and 5.2±1.8 for C/N ratio. Effluent of 1^st sedimentation tank was 208.2±87.6mg/L for TCOD_cr, 35.0±10.3mg/L for T-N, 4.8±1.9mg/L for T-P and 6.1±2.3 for C/N ratio. The average removal efficiencies of TCOD_cr, T-N and T-P were 93.6, 77.0 and 86.4% and effluent TCOD_cr, T-N and T-P concentrations were 12.5, 9.2 and 0.7mg/L respectively, satisfying regulatory limits. Alkalinity deficiency was not observed during the oxic periods, which is one of the special features of an intermittent aeration process. The results showed higher COD, T-N and T-P removal efficiencies and stability with varying influent conditions, compared to other conventional fixed phase nutrients removal processes.

내심형 영구자석 동기전동기의 특성을 고려한 고속운전

윤병도,이병송,김수열 중앙대학교 기술과학연구소 1994 기술과학연구소 논문집 Vol.24 No.-

This paper describes current controlled PWM technique of IPM synchronous motors for a wide variety of speed control applications. The IPM synchronous motors have a saliency, in which the q-axis inductance is larger than the d-axis inductance. As a consequence, there exists a reluctance torque component. Thus when this component is added to the torque component produced by the stator currents and the air-gap flux, IPM motor drives are readily applicable where full torque is required up to full or base speed. They are however limited in their ability to operate in the power limited regime where the available torque is reduced as the speed is increased above its base value. This paper reviews the operation of the IPMSM drives when they are constrained to be within the permissible envelope of maximum inverter voltage and current to produce the rated power and to provide this with the highest attainable rotor speed. The wide variety of speed control strategy is analyzed and performance is investigated by the computer simulation using actual parameters of a drive system. Simulation results are given and discussed.

경추 후종인대 골화증의 수술적 치료

김영수,진동규,조용은,진병호,윤영설,박정필,윤도흠 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.9