중환자에서 APACHE Ⅲ score와 사망율과의 관계

조준필,김준식,이영주 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

To evaluate the relationship between APACHE Ⅲ score and mortality in critically ill adult ICU patient, we studied the 548 patients who were admitted to the ICU from June 1, 1994 to January 31, 1995. We did not include patients with burn injuries, patients aged less than 15 years, or chest pain patients, in order to rule out myocardial infarction and unsatisfactory data files. There were 120 multiple trauma patients, 68 sepsis patients, 62 hemorrhagic shock patients, 20 multiple organ failure patients, and 120 patients with, among other conditions, durg intoxi-cation, diabetic ketoacidosis, renal failure, hepatic encephalopathy, and cerebral hemorrhage or infarction. The APACHE Ⅲ scores of survivors and non-survivors were analyzed with Chi-square test and compared. The number of nonsurvivors was 168 patients, and the overall mortality rate was 30.7%. there was a positive correlation between a high APACHE Ⅲ score and mortality ; all patients with more than 90 points expired. The average points of the survivors was 34.52 ±15.48 and of nonsurvivors was 77.74 ±31.37. The difference between each group is significant statistically. The average APACHE Ⅲ points was 47.8. The APACHE Ⅲ score is a good prognostic tool to predict the mortality rate in ICU adult patients, and can be used for selection of patients and for ICU admission/discharge. It can also be used to compare the efficacy of intensive care in different hospitals.

전방 또는 전측방 흉수 종양 수술에서 후측방도달법

조경석,박춘근,성재훈,허필우,박춘근,백민우,김달수,강준기 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.5

경련 발작에 대한 초·중·고교 응급처치교육 모듈 평가

조준필,박남수,안정환 韓國學校保健學會 2009 韓國學校保健學會誌 Vol.22 No.1

Purpose : The purpose of this study was to evaluate the effectiveness of first aid education module on convulsion and seizure for students in elementary, middle and high school. Methods : This study has implemented to 2 types of test groups and control group in each 3rd and 5th grade of elemenary school, 2nd grade of middle school and high school within target school. The data were collected through a self-reported questionnaire to before, after and one month after education from July, 11 to September 4, 2007. Results : The test group who received first aid education possessed greater knowledge about convulsion and seizure relative to the control group not received education. The overall students has satisfied and been understood well with this module. The educators agreed to the practical aspects of this module in school setting. Conclusion : The above results implicated the importance of a continuous and systematic first aid education program among students. For effective first aid education, there needs a development of targeted educational materials for each grade student and training programs for educators.

응급실에 내원한 소아의 수부손상에 대한 임상적 고찰

김재우,조준필 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Background: Child hand injuries have increased in industrial society. Considering the complications following even the best of treatments, injury prevention is very important. The objective of this study is to shed light on the prevalence, epidemiology, injury site, and etiology of child hand injuries. Method: The subjects was 245 children under the age of 15, who visited the emergency department at Ajou university hospital from January 1998 to December 1999. This study was performed retrospectively by reviewing the charts and analyzing the sex and age distributions, the monthyl and daily distributions, the causes of injury, the types of injury, and the sites of injury. Results: The male to female ratio was 1.35:1, and the largest age group was from 1 to 3 years old. The number of injuries was the highest on Sundays and in November. About 53% of the patients visited the emergency room between 8 pm and midnight. Doors were the most common causes and crushing was the most common type of child hand injuries. The most common injury site was the fingertip, followed by the DIP joint and the PIP joint. These hand injuries were treated by emergency physicians(52.2%), plastic surgeons(25.7%), and orthopedic surgeons(20.4%). Conclusion: Child hand injuries were most frequent in 1 to 3 year olds. A large number of these injuries occurred because of children getting their fingertips caught in door. If these are to be prevented injuries, are to be prevented. Education and advertisement on the use safety equipment on doors in order to protect children must be reinforced.

응급실로 내원한 급성 호중구 감소성 소장 결장염(Typhlitis) 1례

김향숙,정윤석,조준필 대한응급의학회 1999 대한응급의학회지 Vol.10 No.4

Typhlitis or neutropenic enterocolitis is a life-threatening, necrotizing process of the cecum whose incidence is increasing. Typhlitis presents as fever, abdominal pain, and diarrhea in neutropenic patients. As the incidence of typhlitis increases, emergency physicians must be aware of this rapidly progressive and potentially fatal disease. The definitive management of typhlitis is controversial. The most prudent course for the emergency physician is to initiate aggressive medical management early in the ED. We describe a 25-year-old man with severe neutropenia presented to the emergency department with fever, abdominal pain, diarrhea that began 2days earlier. Abdominal computerized tomography(CT) demonstrated diffuse concentric thickening of the cecal wall, intramural edema, inflammatory bowel changes but no free air and abscess formation. He was recovered by early diagnosis and aggressive medical therapy. We report a case of typhlitis with literature reviews.

신생아 이송에서의 저체온증

김향숙,정윤석,조준필,박문성,배기수 대한응급의학회 1999 대한응급의학회지 Vol.10 No.4

Back Ground : Hypothermia is a condition that can lead to serious complications and even to death in newborn. Although the temperature control is essential in neonatal care, it is often neglected during urgent transfer from local private hospitals. The purpose of this study is to evaluate the incidence and clinical outcomes of transfer induced neonatal hypothermia. Subjects and Method : In this retrospective study, subject is limited to transferred outborn babies with age less than 27 hours from June 1996 to May 1999. A total of 3,086 patients were admitted in NICU during the study period and inborn and outborn babies were 1,743(56%) and 1,343(44%) respectively. Among the 1,343 outborn babies, 212 babies were transferred from the private hospital within 24 hours of birth and were eligible for the study. Rectal temperature on arrival, transfer time, birth weight, gestational age, initial arterial gas study, and clinical outcome were compared. Statistical analysis has been done with chi-sqaure test and multiple logistic regression analysis. Results : There were 84 cases(39.6%) hypothermia(<36℃) among the 212 babies and the rate of hypothermia in transfered babies have not decreased over the study period. There were significantly more hypothermia in lower gestational age (less than 28 weeks) and lower birth weight (less than 2,000gm) caused hypothermia significantly more than normal gestational age or normal range of birth weight. And time interval (less than 12 hour) from birth to arrival at emergency department was also significant factor in hypothermia. The mortality rate was three fold higher in hypothermia than normothermic or hyperthermic babies. Conclusion: This study shows that hypothermia during neonate transportation is a major cause of neonatal mortality and morbidity in prehopital care. Body temperature control during transport of neonates under 24 hours of age should be emphasized for the better outcome of treatment.

흉부 둔상 후 전종격동 출혈에 의한 종격동 압전 1예

윤상규,박종석,조준필 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Sternal fractures are most common in drivers of motor vehicles whose anterior chest hits the steering wheel during sudden deceleration. Sternal fractures may result in mediastinal hematoma secondary to bone marrow oozing. The hematoma usually resolves itself without complications, so an anterior mediastinal hematoma causing tamponade is rarely reported. We describe a case of blunt chest trauma resulting in a sternal fracture with a resultant anterior mediastinal hematoma and mediastinal tamponade.

응급실을 내원한 요로결석 환자

김성중,김준식,조준필 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

A clinical study was made on 139 cases of urolithiasis among the total number of 14798 who visited in the emergency center during 7 months from June 1994 to December 1994.The 186 patients was suspected the urolithiasis, then the 150 patients was followed through out-patient department of Urology and performed Intravenous pyelogram. Among the 150 cases, the urolithiasis was confirmed in 139 cases. The results are summarized as follows: 1. The ration of the male to female is approximately 2.97:1. 2. The age of the patients ranged from 20 to 50 in approximately 80.6%. 3. Among 52 patient who were not revealed stone in KUB, 45 patients were shown micro-scopic hematuria. The 22 patients were revealed urolithiasis in IVP.The 6 patients found the urolithiasis spontaneously delivered.The 17 patients were diagnosed through out-patient department of urology. 4. The 7 patients, who not hematuria and no stones in KUB, were revealed urolithiasis in IVP performed at other hospital. 5. The major clinical symptoms and signs were flank pain(117 cases),abdominal pain and suprapublic discomfort(35 cases),fever(7 cases),low back pain(7 cases),nausea and vomiting(6 cases),painful urination(1 case),and urinary frequency(1 case). 6. The specific location of the stones showed 98 cases in ureter, 7 cases in kidney,bilaterality(3 cases),and multiple stones(8 cases). The ureteral stones located most frequently in the lower 1/3 of the ureter with 55 cases.

응급의료센터로 내원한 급성심근경색증 환자

정윤석,김준식,유인술,조준필 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Early reperfusion can prevent myocardial necrosis, and clinical trials with reperfusion therapy demonstrating a significant reduction in acute myocardial infarction(AMT) mortality have dramatically changed the treatment paradigm for AMI. All patients with symptoms and ECG findings suggestive of AMI should be considered for treatment with thrombolytic agents. However, only a minority of AMI patients actually receive a thrombolytic therapy. Many patients are often excluded from treatment because they do not meet the criteria for age, duration of the chest pain, and a qualifying ECG. And late arrival at the hospital is a frequently cited reason for not giving a thrombolytic agent. To confirm the reason for not receiving an early reperfusion therapy, we obtained the data for the clinical characteristics, the time intervals between the symptom onset and the start of a thrombolytic agent infusion, the method of reperfusion therapy, the reason for not giving a thrombolytic agent and overall outcomes by retrograde chart review. During the 12-month study period between July 1994 and June 1995, 113 patients were finally diagnosed to AMI, who presented to Emergency Center of Ajou University Hospital in total 30,819 patients. The results were followings: 1. The average age was 59±12 years old, the ratio of male to female was 3.2:1. The direct visited patients to our hospital were 31 and the transfered were 82. 2. The chief complaints were chest pain(86.7%), dyspnea, dyspnea, and mental change. The common preceding diseases were angina pectoris(10 cases), old myocardial infarction(9 cases), congestive heart failure(2 cases) and typical chest pain but not diagnosed(23 cases). The risk factors were smoking(81 cases), hypertension (46 cases) and DM (22 cases). 3. 75 patients had arrived within 12 hours from symptom onset and 38 patients after 12 hours. 45cases (54.7%) were performed the reperfusion therapy ; 31 patients were taken the thrombolytic therapy by tissue-type Plasminogen Activator. 4. The most common reason for not receiving a reperfusion therapy was the time delay and the main was the patient/bystander factor. 5. 75.2%(85 cases) of the patients discharged with or without complications, 7.1% (8 cases) died, 10.6% (12 cases) discharged moribundly, and 7.1% (8 cases) discharged against advise. In conclusion, the time delay was the first reason for not receiving a reperfusion therapy in AMI patients. And the education for the AMI symptom and BLS (Basic Life Support) to the people, good EMS(Emergency Medical Service) system, early definite diagnosis and aggresive therapy may decline the mortality rate.

입원치료를 요하는 소아의 급성복증

배택환,김준식,유인술,조준필,이철주,민영기 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

The acute abdomen defined as an acute abdominal condition which needs immediate decision for treatment is one of the most common cause for emergency care. One thound six hundreds nine patients were visited to pediatric emergency center due to acute abdomen. To aid in early diagnosis and proper treatment, a clinical review was made on 278 cases of acute abdomen under 15 yrs old which admitted to Pediatrics and General surgery via emergency center from June of 1994 to May of 1995. The results as follows: It was 17.3% of total visiting to pediatric emergency center due to gastrointestinal sysmptoms. The sex ratio(Male: Female) was 2.35:1. Acute gastroenteristis was the most common acute abdominal condition(54%) and followed by acute appendicitis(17.9%), and intussusception(13.9%). The most common chief commplaint was vomiting(58%) and followed by abdominal pain(39.4%), diarrhea(35.8%), and fever(42.1%). One hundred fifty-five patients were visited to pediatric emergency center via local clinic and thirty patients via OPDs. The operations were done in 75 patients. Among them, immediate operation were done in 60 patients and delayed operations were done in 15 patients, but there is no difference in complication.