응급센터에서의 기관내 삽관

서길준 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Background. Endotracheal intubation is one of the most important and challenging tasks that an emergency physician has to perform. Complications associated with this procedure range from local trauma of the airway to death caused by unrecognized misplacement of the endotracheal tube. This study was designed to investigate complications of intubation including rapid sequence intubation in the emergency department. Method. One hundred four consecutive patients requiring endotracheal intubation in the emergency department of the Stanford Medical Center over a 8-month period were studied prospectively. Result. The indications for intubation were acute respiratory failure(60.5%), airway protection(30.8%), and cardiopulmonary arrest(8.7%). 97(93.3%) intubations were inserted orally, remaining 7(6.7%) were intubated via the nasotracheal route. Of 97 orotracheal intubations, rapid sequence intubation was used in 71(73.2%) cases. Grouped by level of training, junior residents attempted 69(66.3%) intubations, senior residents 21(20.2%), and staff 13(12.5%). Of the 104 intubations, 92(88.5%) were successful on the first or second attempt. 12 procedures(11.5%) required more than two attempts at intubation. A total of 36(34.6%) complications occurred. Esophageal intubations occurred in 13 cases, right main stem intubation in 13, pulmonary aspiration in 4, and others in 6. Fourteen patients(13.5%) died after intubation. Conclusion. The complication rate of endotracheal intubation in the emergency department is high. In order to decrease the complication, detailed knowledge, skill, and equipments about endotracheal intubation are required. The good condition of a patient before intubation appears to be important for survival.

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.

백서 Paraquat 두여에 의한 간과 폐 조직의 산화성 손상에서 Vitamin C와 Deferoxamine의 항산화 효과에 관한 연구

정연권,서길준,정중식,정성은,최국진,윤여규 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: The toxicity of paraquat has been known to be caused by oxygen free radicals which leads to the lipid peroxidation and multiple organ failure. Although vitamin C has been known to be a potent antioxidant, recently there are numerous data which have shown that a low dose of vitamin C may act as a prooxidant due to the stimulation of the Fenton reaction with metal ions, which produces hydroxyl radicals. It has been reported that a deferoxamine in paraquat intoxication could reduce the production of the hydroxyl radicals by the inhibition of the Fenton reaction through the reduction of iron ion in tissue. The aim of this study was to evaluate the effect of the high and low dose of vitamin C and deferoxamine on lipid peroxidation and plasma TNF-α in paraquat intoxication. Methods: Female Sprague -Dawley rats were divided into seven groups: control group which was not given paraquat(20 mg/kg), P group which was given paraquat only, PVH group given paraquat and high dose of vitamin C(100 mg/kg), PVL group given paraquat and low dose of vitamin C(10 mg/kg), PVHD given paraquat, high dose of vitamine C and deferoxamine(100 mg/kg), PVLD given paraquat, low dose of vitamin C and deferoxamine, and PD given paraquat and deferoxamine. Animals were killed at 6 and 24 hours after treatment. Malondialdehyde(MDA), superoxide dismutase(SOD) and glutathione(GSH) contents, catalase activity, plasma TNF-α, and histologic changes in the lung and liver tissue were measured. Results: The lung histology in the PVH and PD or PVHD groups showed the significant decreases in the alveolar edema and interstitial thickness compared to the P group. The liver histololgy in the PVH and PVHD groups demonstrated marked differences in the central venous and sinusoidal dilatation compared to that of the P group. While the MDA levels of the lung and liver in the PVH and PD groups showed the significant reduction compared to that of the P group at 6 hours after treatment, all groups showed the significant changes compared to the P group at 24 hours. There was no significant change of the SOD levels of the lung and liver at 6 hours among all groups. At 24 hours, the SOD levels of the lung in PVH, PVL, and PVHD groups showed the significant increases compared to the P group. The increase of the SOD level in groups combined with deferoxamine, however, revealed a little reduction. The SOD level of the liver in PVH group only significantly increased compared to the P group at 24 hours. There was no significant change of the GSH level of the lung and liver among all groups at 6 hours. At 24 hours, the GSH level of the lung and liver were significantly increased in both PVH and PD group and PVH group, respectively, compared to the P group. Although the catalase activity of the lung was not significantly increased, that of liver was signiflcantly increased in both PVHD and PD groups compared to the P group at 6 hours. The catalase activities of the lung and liver were significantly increased in PVH, PD, and PVHD at 24 hours. The concentrations of the plasma TNF-α were slightly decreased at 6 hours and slightly increased at 24 hours compared to that of the P group, but they were not significant. Conclusion: This study showed that although the low dose of vitamin C had no effect, the high dose of vitamin C revealed a decrease of the MDA level and an increase of SOD, GSH, and catalase activity in the lung and liver tissues, and the effect of the high dose of vitamin C increased with time. The administration of the deferoxamine with or without high dose of vitamin C, however, significantly showed the inhibition of the lipid peroxidation and antioxidant effect and low dose vitamin C decreased the effect of deferoxamine. The effects of the vitamin C and deferoxamine on plasma TNP-α were not clearly shown.

한국 핸드볼 경기의 내용분석과 미래방향 : Content Analysis and Future Directions

박천조,백상서,채병준,안길영 한국스포츠리서치 2003 한국 스포츠 리서치 Vol.20 No.1

This study is to investigate the researches with handball game by research domain and methodological aspects during its 10years (1990-2000). As results of analyzing methodological structure, characteristics of subjects by research domain and the number of articles statistical techinics by years. 1. the researches of handball games need longitudinal study with academic arena in accordance with the globalization trends. 2. The number of case and representative is to provide academic suport therefore it is nesessary to provide effect size for handball games for identify susficious questions sample sizes for students and professors in the field of measurement & evaluation 3. It is proud to acculately need to test methodological research domains in order for performing handball related researches journal to be acknowledged by scholars in other parts of the world. the focus must be on equality rather than on quantity.

패혈증 백서 모델에서 비타민-C의 효과

이중의,신상도,표창해,서길준,정성은,윤여규 대한응급의학회 1999 대한응급의학회지 Vol.10 No.4

Background : Multi-organ failure from sepsis is very lethal disease entity, which is suspected to be caused by activated inflammatory cells. Inflammatory cells activated by endotoxins generate oxidants and cytokines such as TNF-α and IL-6, which in turn stimulate macrophages and neutrophils. Augmented inflammation makes an organ-injury deteriorate into an organ-failure, which may progress to multi-organ failure. This study is designed to evaluate the therapeutic effects of vitamin-C, a scavenger of oxidants, in sepsis. Methods : Male Sprague-Dawley rats were divided into 3 groups : a control group, a group injected intrapetoneally with LPS(lipopolysaccharide), and a group injected intraperitoneally with LPS and vitamin-C. Each eight rats were sacrified 24 hours and 48 hours after injection, and samples of the blood, the liver and the lung were obtained. Biochemical assays of TNF-α level in the blood and malondialdehyde(MDA)level, catalase activity and nitric oxide synthase(NOS)activity in the liver and the lung tissues were performed. Results : Serum TNF-α level, tissue lipid peroxidation and tissue i-NOS activity were dramatically increased, and tissue catalase activity was exhausted rapidly in sepsis. High dose vitamin-C administration decreased serum TNF-α level, tissue lipid peroxidation and tissue i-NOS induction, and protected against catalase exhaustion. Conclusion : high dose vitamin-C therapy was proved to have definite antioxidant effect in septic condition.

사망 진단서(시체 검안서) 작성의 문제점

김규석,임용수,이중의,서길준,윤여규,어은경,염석란,정연권,이윤성 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates Methods: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. Results: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital,101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). Conclusion: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.

강산 및 강알칼리 음독에서 냉각 용액을 사용한 희석 요법과 중화 요법의 가능성

이중의,송형곤,김동훈,권운용,곽영호,서길준,윤여규 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Background: There is no effective treatment modality for caustic agent ingestion. Dilution and neutralization are prohibited because of the risk of secondary thermal injury. This experiment is designed to evaluate the amount of dilution and neutralization heat and to gauge the applicability of dilution and neutralization therapy using cold solutions to suppress the peak temperature. Methods: This is an in-vitro chemical experiment. HCl, CH3COOH, NaOH, and NH4OH are selected as representatives of strong and weak acids and strong and weak alkali, respectively. 20℃, 11.6M, 5.8M, and 2.9M solutions of each acid and alkali are made and mixed using a magnetic stirrer at a room air temperature of 28℃. The peak temperature, the duration above 40℃, and the heat amount are measured or calculated. Results: When a 11.6M HCl or NaOH solution is diluted with same amount of water, 32 or 18cal. per mL of HCl or NaOH is produced, respectively. HCl produces a significant peak temperature, but NaOH does not. The lower the concentration, the lower the amount of heat production. 11.6M CH3COOH and NH4OH solutions don't produce dilution heat.11.6M and 5.8M solutions of all acids and alkali produce destructive neutralization heat. However, 2.9M solutions produce neutralization heat which might be controllable. When a 11.6M HCl or NaOH solution is neutralized with a -10℃ 2.9 M NaOH or HCl solution, respectively, the peak temperature produced is below 40℃ and seems to add little thermal damage to viable tissue. Conclusion: Dilution and neutralization with a cold solution in cases of strong acid or alkali ingestion is a promising method to avoid thermal injury.

발열이 있는 호중구 감소증 환자에서의 위험도 예측인자

정중식,권운용,김규석,임용수,이중의,서길준,윤여규 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3

Background: Most febrile neutropenic patients are treated in an aggressive manner. However, identification of low-risk patients may enable clinicians to administer risk-based treatment. The object of this study is to certify the factors associated with increased risk at the time of visiting the emergency department. Methods: This is a retrospective study. We reviewed the medical records of 101 febrile neutropenic patients who had visited the emergency department of Seoul National University Hospital from January 1998 to August 1999. We assumed 22 risk prediction factors that could be assessed at admission to the emergency department and 5 factors that could be assessed during treatment course. To find independent risk-prediction factors, we analyzed these factors respectively by using multiple regression analysis. Results: Tachycardia(aOR=136.5), altered mentality(aOR=28.8), decreased renal function(aOR=20.1), and significant comorbidity(aOR=17,2) are the independent factors associated with higher mortality. Altered mentality(aOR=31.6) and decreased renal function(CCr < 75㎖/min, aOR=5.4) are those associated with a higher incidence of septic shock. Independent factors associated with persistent(more than 3 days) fever are the early(within 10 days) onset of fever after last chemotherapy(aOR=8.8) and the existence of new pulmonary infiltrates on a simple chest X-ray(aOR=4.3). Conclusion: The stability of vital signs, the change of mentality, the renal function, the existence of significant comorbidity, the existence of new pulmonary infiltrates, and the rate of neutropenia are clinically useful risk-prediction factors in febrile neutropenia at the time of visiting the emergency department.

파라콰트 중독에서의 항산화치료

권운용,조유환,송형곤,김명천,이중의,서길준,윤여규 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Background: Paraquat causes severe tissue toxicity when ingested, but has no effective treatment modality. We have shown that high dose vitamin C has effective antioxidant activities against the paraquat intoxication in a previous animal experiment. This study was designed to evaluate the effect of antioxidant therapy with high dose vitamin C and vitamin E in human cases of paraquat intoxication. Methods: From August 1999 to August 2001, 19 paraquat intoxication patients who visited the emergency department of the Seoul National University Hospital and the Kyounghee University Hospital were enrolled to this study. They were devided into two groups, a control group(9 patients) and a study group(10 patients). The control group received only conservative managements including gastro-intestinal decontaminati-on. The study group received conservative managements plus the antioxidant therapy which was composed of vitamin C 24 gm/day intravenously and 20 gm/day orally, and vitamin E 1.6 gm/day orally. Results: In the study group, 5 of 10 patients(50%) survived, but all patients of the control group died(p=0.003). There were no significant differences in age, sex, and usage of gastric lavage and activated charcoal between the two groups. Difference in ingested amount of paraquat between the two groups could not be analyzed due to the inexact and subjective measuring methods based on patients' histories. Conclusion: Antioxidant therapy with high dose vitamin C and vitamin E is effective in vival rate in paraquat intoxicated patients.

The Effects of Oxidant and Antioxidant Activity on Rat Peritonitis Induced by Ceeal Ligation and Puncture

Suh, Gil Joon,Youn Yeo Kyu,Kim, Soo Tae Seoul National University 1994 The seoul journal of medicine Vol.35 No.1