응급의료센터 과밀화 해소를 위한 환자 전원

이경룡,구홍두,박인철,김승환,장석준,심호식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

To reduce the degree of overcrowding in level Ⅲ emergency care centers, authors have conducted a prospective study of patient who were transferred to level Ⅰ or Ⅲemergency center based on the non-emergent patient guideline currently used at the severance Hospital, level Ⅲ emergency center, during the period of 65 days from Jan. 1st 1995 to Mar. 6th 1995. Followings are guideline for non-emergent patient described by the Korean government low: 1) systolic blood pressure greater than 80/100 of normal. 2) respiration rate between 10 to 24 per minute. 3) pulse rate between 60 to 100 per minute. 4) body temperature between 36 to 37.5℃ by rectal. 5) relatively alert mental status. 6) patient not requiring emergency operation at the time of examination. The results were as follows: 1. Among the total 5,301 patients, 464 patients ranged from age of 1 to 82 years old were transferred to level Ⅰor Ⅱ emergency center after simple treatment. 2. Among the 464 patients, 276 patients were treated in expected hospital with medical problems in 101 (36.6%) patients, and 175 (63.4%) patients had surgical problems. 3. Among the 276 patients, 122 (44.2%) patients were admitted, 145 (52.9%) patients were discharged from the emergency room after adequate treatment. 4. Among the transferred patients, simple laceration (33.0%) were most common, acute gastroenteritis (12.0%), and simple contusion (10.5%) were followed. These results suggest that about 10% of patients visiting level Ⅲ emergency care center, can be safely transferred to nearest level Ⅰor Ⅱ emergency centers on the bases of non-emergent patient guideline described by Emergency Medical Service law. These guideline, if put into proper use, can reduce the degree of overcrowding problems in level Ⅲ emergency care center through out the country.

Stroke에서 감압적 개두술, 정위적 조직 생검과 병리적 소견 고찰 : 중증 제뇌탈출을 동반한 초급성 뇌경색과 신경교종 내 출혈 감별 To differentiate the Herniated hyperacute Cerebral Infarction from the Glioma bleeding

이주용,조준,박호권,장상근,문창택,한혜승,이경룡 건국대학교 의과학연구소 2004 건국의과학학술지 Vol.14 No.-

The authors in this manuscript aimed to provide a practical importance of the differential diagnosis of intracranial brain tumor with emphasis on non-neoplastic abnormalities such as cytotoxic edema of the penumbra zone in strokes. The well known SOLs are cerebral ischemic, inflammatory and dysplastic lesions, which intraaxially imitate glioma and other neurogenic tumors. Brain tumor is the one of common intracranial space-occupying lesions (SOLs) on the diagnostic images. However, many non-neoplastic lesions may be indistinguishable from tumors. Especially, early mortality used to be caused by space-occupying hyperacute ischemic stroke, brain edema and herniations. For the retrospective analysis, the authors reviewed the patient charts, the emergency brain Computerized Tomography (CT), magnetic resonance imaging (MRI), clinical stroke history. From Jan. 2003 to Dec. 2003, we managed total 61 acute strokes in ICU. Even though we operated six decompressive craniotomies, nine stereotactic craniotomies including two procedures of brain biopsy and three extraventricular drainage procedures, three patients (4.91%) were finally expired out from the induced herniation and medullary failure by those aggressive strokes. 43 patients (70.5%) were recovered good from stroke attack. 15 patients (24.6%) were improved with residual neurologic deficits. In conclusion, aside from growing efforts of the radiologist to make the early diagnostic impression, the authors suggest that urgent neurosurgical explorations with the pathologic diagnostic decision should be requested to decrease the fatality.

Scorpion intoxication 1례

이경룡,윤천재,이한식 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Scorpion intoxication is not often encountered. Scorpion venom is complex and species-specific, those of the family Buthidae being most harmful to humans. The toxin consists of phospholipase, acetylinesterase, hyaluronidase, serotonin, and neurotoxins. A neurotoxins envenomation can produce severe systemic toxicity, especially in children. Symptoms include throat spasms, muscular fasciculations, abdominal clamps, seizures, increased or decreased blood pressure, oliguria, dysrhythmias, pulmonary edema, and respiratory collapse. We experienced a 60-year-old female patient who suffered abdominal clamp and both leg pain with multifocal PVC through to be caused by scorpion intoxication. She hypertension for several years, but no medications. During last six months she had suffered from facial palsy. So she had received herb medication with scorpion venom. After treatment for 3days she recovered well and discharged. We report this case with literature reviews.

병원 도착 전 사망 환자의 사인기재에 관한 고찰

강용선,이경룡,박인철,조광현,김승호,이한식 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Background: To the emergency physician, issuing a death certificate is becoming a burden as the DOAs(Deaths on Arrival) have increased in recent years. We analyzed the agreement on the causes of death issued by emergency physicians and attempted to find out whether emergency physicians complied with the guidelines for issuing death certificates. Material & Method: A survey questionnaire containing twelve pre-selected DOA cases which were supplemented with relevant past medical history and physical examination was used. The cases, with varying causes of death, were chosen from the medical records of DOA patients who presented to the emergency department at Severance Hospital, Yonsei University College of Medicine, from January 1997 to December 2000. The questionnaires were sent to 60 emergency physicians(22 specialists and 38 residents) at 22 university-affiliated teaching hospitals and 2 general hospitals across the nation. They were asked to identify the most probable direct cause of death for each of the 12 cases. The same questionnaire was sent to medical examiners at the National Institute of Scientific Investigation and to a Korean emergency physician at Albert Einstein College of Medicine in New York, USA. We also included an open question about the optimal age for the use of 'senility' as a cause of death. Results: All 60 emergency physicians responded to the survey. The average number of causes of death per case was 9.7(7∼ 14). The range of concordance of causes of death was 23.3% to 66.6%. Out of a total of 720 causes of death given by the emergency physicians,35(4.9%) failed to adhere to the death certification guidelines, Also, 210 causes of death were not listed in the Korean classification of standard causes of death. Interestingly, the medical examiner answered 'unknown etiology' and the emergency physician in the USA answered 'cardiopulmonary arrest' or 'respiratory arrest' in most cases. Regarding 'senility' as a cause of death, 22 physicians(36.7%) thought the optimal age was over 80 years. Conclusion: A significant lack of agreement exists in determining the cause of death for the DOA patients arriving at emergency departments, Therefore, an all-out effort is essential to find ways to improve and resolve this situation. As the death certificate is a legal document and a basis for vital statistics, emergency physician should seek a rational consensus to improve and resolve these inconsistencies.

구급차를 이용한 응급 환자의 중증도 분류

박인철,이경룡,이한식 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Authors performed a prospective study of patients who visited to ED of Severance Hospital via ambulance during the period of six months from April, 1, 1995 to September, 30, 1995. Our study assessed the adequate patient transfer via EMS system and to suggest more advanced guideline for patient transfer. The results were as follows: 1) Among the total 16,794 patients, 2,250 visited via ambulance ranged from age of 1 to 89 years old with an average 43yrs. 2) Among 2,250 patients, 1,122(50%) visited via 119 system, 546(24%) via 129 EMS system, and 582(26%) via other hospital ambulances 3) 270(12%) patients were classified into urgent, 894(405) into emergent, and 1,086(48.4%) into non-emergent. 4) For the patients via 119 system, 102(9.1%) patients were classified urgent and 630(56.1%) non-emergent, via 129 EMS system, 78(14.3%) urgent and 228(41.8%) non-emergent, and via other hospital ambulances, 90(15.5%) urgent and 228(39.2%) non-emergent. These results show that patients who visited level Ⅲ emergency care center via ambulances were classified into non-emergent about 50%. We conclude that if more effective classifying system which used by EMT for emergency patients is applyed, non-emergent patients can be transferred to more low grade emergency center, and the overcrowding of level Ⅲ emergency center can be improved.

뇌졸중 위험인자를 가진 어지럼 환자에서의 확산강조 자기공명영상

강형구,윤유상,이진희,박인철,이경룡,정상원,구홍두,김승호 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Background: The management of vertiginous patients is a great challenge to emergency physicians. We evaluated the diagnostic value of a diffusion-weighted image(DWI) in differentiating central vertigo from the peripheral vertigo in patients who presented no neurological symptoms other than risk factors for stroke. Methods: From March 2000 to February 2001, we retrospectively analyzed the cases of 68 patients who visited the emergency department with symptoms of isolated vertigo and who had risk factors for stroke. DWIs, computed tomograms(CT), and medical records were reviewed, and the final diagnose, the DWIs and the CT readings, the risk factors for stroke, and the time it took waiting for a DWI or CT scan were analyzed. Results: Of the 68 patients, 21(30.8%) had central vertigo: 15 vertebrobasilar transient ischemic attacks(VB-TIA), 4 brain stem infarctions, 1 cerebellar infarction, and 1 cerebellopeduncular infarction. The DWI showed a 28.6% sensitivity, a 97.9% specificity, and an 85.7% positive predictive value in diagnosing central vertigo. It also had a 100% sensitivity in detecting infarctions. Conclusion: A DWI had a comparable sensitivity to MRI in detecting central vertigo and small, but potentially, lethal infarctions in our patient population. We recommend clinical application of DWI in the emergency department evaluation of isolated vertigo patients with risk factors for stroke.

Development of a Mobile Application, "Wild Flowers of Bukhansan National Park (version 1.0)", for Identification of Plants in Bukhansan National Park

Kim, Sang-Tae,Lee, Seung-Yeon,Kim, Seung-Chul,Byun, Hye-Won,Lee, Sang-Tae,Kim, Mu-Yeal,Hong, Seok-Pyo,Chung, Young-Jae,Park, Ki-Ryong,Lee, Chung-Hee,Lee, Joong-Ku,Heo, Kyeong-In,Lee, Ji-Ye,Lee, Eun-Je National Science Museum of Korea 2011 Journal of Korean nature Vol.4 No.3

We developed the educational purpose mobile application, named "Wild Flowers of Bukhansan National Park (version 1.0)", aiming for easy identification of wild flowers for students and visitors in the park. When visitors find a flower or part of plant in the park, visitors can search for its name utilizing the pictures and characters provided in their own smartphone mobile devices or tablet PCs. The application provides pictures of wild flowers in the park and character-based searching system based on 12 diagnostic features (e.g., growth form, leaf arrangement, flower symmetry, petal color, petal number, sepal number, etc). We adopted the complete floristic survey of Chung and Lee (1962) and added species that we confirmed their distribution in the park during the development of this application. In summary, number of vascular plants in this park was estimated to be 428 taxa including 100 families, 280 genera, 327 species, 1 subspecies, 50 varieties, and 5 formas. We provided a total of 588 pictures representing 358 taxa and each taxon includes multiple pictures in many cases. Included identification quizzes can be an efficient educational tool as well as fun activity for students and visitors who are learning plant species in Korea. Our next step will include GPS function in the application for indicating visitor's location and for providing previously reported sites of the species that we interested in the map of the park. The future application which includes GPS function will be a valuable tool for the monitoring of rare plants, plant researches related to the climate changes, etc. We currently provide Korean iPhone version only, and English version and both of android versions will be serviced soon.

Electrical and optical properties of poly(3,4-ethylenedioxythiophene) oxidized with poly(4-styrenesulfonate) and AuCl3-doped reduced graphene oxide/single-walled carbon nanotube films for ultraviolet light-emitting diodes.

Lee, Byeong Ryong,Lee, Jae Hoon,Kim, Kyeong Heon,Kim, Hee-Dong,Kim, Tae Geun American Scientific Publishers 2014 Journal of nanoscience and nanotechnology Vol.14 No.12

<P>We report the effects of poly(3,4-ethylenedioxythiophene) oxidized with poly(4-styrenesulfonate) (</P>

Automatic Machine Fault Diagnosis System using Discrete Wavelet Transform and Machine Learning

Lee, Kyeong-Min,Vununu, Caleb,Moon, Kwang-Seok,Lee, Suk-Hwan,Kwon, Ki-Ryong Korea Multimedia Society 2017 멀티미디어학회논문지 Vol.20 No.8

Sounds based machine fault diagnosis recovers all the studies that aim to detect automatically faults or damages on machines using the sounds emitted by these machines. Conventional methods that use mathematical models have been found inaccurate because of the complexity of the industry machinery systems and the obvious existence of nonlinear factors such as noises. Therefore, any fault diagnosis issue can be treated as a pattern recognition problem. We present here an automatic fault diagnosis system of hand drills using discrete wavelet transform (DWT) and pattern recognition techniques such as principal component analysis (PCA) and artificial neural networks (ANN). The diagnosis system consists of three steps. Because of the presence of many noisy patterns in our signals, we first conduct a filtering analysis based on DWT. Second, the wavelet coefficients of the filtered signals are extracted as our features for the pattern recognition part. Third, PCA is performed over the wavelet coefficients in order to reduce the dimensionality of the feature vectors. Finally, the very first principal components are used as the inputs of an ANN based classifier to detect the wear on the drills. The results show that the proposed DWT-PCA-ANN method can be used for the sounds based automated diagnosis system.

Automatic Machine Fault Diagnosis System using Discrete Wavelet Transform and Machine Learning

Kyeong-Min Lee,Caleb Vununu,Kwang-Seok Moon,Suk-Hwan Lee,Ki-Ryong Kwon 한국멀티미디어학회 2017 멀티미디어학회논문지 Vol.20 No.8