흉골골절이 의심되는 외상환자에서 초음파의 진단적 효용성

염석란,김재광,이근,박철완,양혁준,현성열,임용수,진욱 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Purpose: This study compared the value of ultrasonography(US) in the diagnosis of sternal fractures with those of conventional radiography and bone scan. Material and Method: From March 2000 to March 2001, in Gil Medical Center, Gachon Medical College, 44 patients(22 women and 22 men, mean age 46 years, range 5∼81 years) complained of tenderness in the sternal area. The cases histories of these patients with clinically suspected sternal fracture due to blunt trauma were prospectively studied. At the time of admission, conventional radiography(sternal view) was done. At one day after admission, sternal ultrasonography was obtained, and after 4∼5 days, a bone scan was done. Sternal ultrasonographic findings, conventional radiographic findings, and bone-scan findings were compared. In addition, a 12-lead ECG was done. When it was necessary, cardiac enzyme was checked and echocardiography was performed. Result: In 21 of 44 patients(48%), a sternal fracture was found by sternal US. Only 9 of 21 patients (43%) were diagnosed as having a sternal fracture by using conventional radiography. 23 of 44 patients (52%) have negative findings on sternal US; they also had negative findings on conventional radiography. Except for 7 unchecked patients, 13 of 21 patients(62%) were diagnosed as having a sternal fracture by bone scan, and among the 23 patients who had negative findings on sternal US, the 19 patients checked with a bone scan also had negative findings. Conclusion: Sternal US can find sternal fractures that are difficult to find on conventional radiography. Compared with bone scan, sternal US takes a shorter time and sternal US is not difficult. Additionally, combined lesions with sternal fractures(peristernal hematoma, soft tissue swelling) and costar cartilage fractures are diagnosed more easily when using sternal US.

기관내 삽관이 어려웠던 폐동맥 sling을 동반한 기관협착 환아1예

염석란,신중호,신종환,이근,류일,현성열,진욱,김재광 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Pulmonary arterial sling, a rare developmental vascular anomaly forms a sling around the distal trachea and the proximal right main bronchus, where it sometimes makes tracheo-bronchial stenosis. Tracheo-bronchial stenosis from pulmonary arterial sling may produce non-specific symptoms of stridor, noisy breathing, dyspnea, recurrent upper respiratory tract infection, chronic cough, and dysphagia. The diagnosis of this anomaly begins with a high index of suspicion because of the lack of pathognomonic finding on usual evaluation. In this case, initial difficult intubation makes us evaluate further. Other cases reported the diagnosis is established by imaging studies, usually MRI and angiography. But, when our case was evaluated, we used cervico-thoracic enhanced computered tomography and tracheal fluoroscopy. Up to now, tracheobronchial stenosis from vascular anomaly is a rare and challenging disorder with a poor prognosis. However, early exact diagnosis would make us perform the accurate surgical treatment and reduce the mortality and morbidity.

교통사고로 내원한 접형척추(butterfly vertebra) 환자 1예 보고

염석란,이근,박철완,양혁준,현성열,류일,진욱 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

A butterfly vertebra is a rare, but very important congenital anomaly that must be differentially diagnosed with compression fracture of the vertebral body. It has characteristic findings on simple X-ray, CT, and MRI. These findings are an anterior wedging contour on the sagittal image, a widening of the transverse diameter on the coronal image, adaptations of nearby vertebral endplates on the sagittal image, communicated intervertebral disc spaces on the sagittal and the coronal images, a well-defied midline bony defect with a sclerotic margin in the vertebral body on the axial image, and a normal body signal intensity on MRI. Because of legal problems and further plans for treatment, close attention must be given to patients who complain of back pain and who have decreased anterior height of the vertebral body after trauma. In those patients, a butterfly vertebra must be differentially diagnosed with compression fracture of vertebral body. We report one such case here.

일개 권역응급의료센터로 내원한 중독환자의 임상적 특징

염석란 부산대학교 병원 암연구소 2006 부산대병원학술지 Vol.- No.20

Purpose: The purpose of this study is to determine the best management method of acute intoxicated patients by the analysis of acute intoxications in a authorized regional emergency center. Methods: We reviewed retrospectively the medical records of 185 patients with acute intoxication in the Pusan Authorized Regional Emergency Medical Center, Pusan National University Hospital during one year from June 2004 to May 2005. Result: Total number of patients was 185 which is 1.0% of total ED patient. The male to female ratio was 1:1. The distribution of age showed the highest incidences in 4th(22.7%) and 3rd(16.2%), 5th (16.2%) decades. From all cases of intoxication, 69.7% was done on purpose. Acute intoxications were occurred in house mostly as 41.7%. The percentage of patents who transferred to emergency medical center of PNUH was 56.2%. The common intoxicated materials were insecticides(40%) and medicines(28.2%). The most patients(88.65%) intoxicated by a single toxic material. The patients(29.1%) visited to emergency department within 2 hours after ingestion of toxic material had clinically advantages to be performed gastric lavage. The gastric decontamination was performed in 45.6% of all patients. Among them the gastric lavage were performed in 68 cases. The outcomes of the intoxicated patients were discharge at ED(28.1%), transfer to other hospital(24.3%), discharge against medical advice(24.3%), admission(12.0%), death at ED(9.1%), other(2.2%). Conclusion: Acute intoxication is one of important part of emergency medicine. We must develop the systemic medical service of intoxication and the education programs for preventing acute intoxication and strict legal control of drugs are important and necessary.

Effect of use and type of helmet on occurrence of traumatic brain injuries in motorcycle riders in Korea: a retrospective cohort study

Seo Sowon,Yeom Seok Ran,Park Sung-Wook,Wang Il Jae,Cho Suck Ju,Yang Wook Tae,Cho Youngmo 대한외상학회 2023 大韓外傷學會誌 Vol.36 No.2

Purpose: The purpose of this study was to investigate (1) the association among helmet wearing, incidence rate of traumatic brain injury (TBI), and in-hospital mortality; TBI was diagnosed when the head Abbreviated Injury Scale (AIS) was ≥1, and as severe TBI when head AIS was ≥3; and (2) the association between helmet type and incidence rate of TBI, severe TBI, and in-hospital mortality of motorcycle accidents based on the newly revised Emergency Department-based Injury In-depth Surveillance (EDIIS) data. Methods: Data collected from EDIIS between January 1, 2020 and December 31, 2020 were analyzed. The final study population comprised 1,910 patients, who were divided into two groups: helmet wearing group and unhelmeted group. In addition, the correlation between helmet type and motorcycle accident was determined in 596 patients who knew the exact type of helmet they wore. A total of 710 patients who wore helmet but did not know the type were excluded from this analysis. Multivariate logistic regression was performed in both the groups to investigate the factors affecting the primary (occurrence of TBIs) and secondary outcomes (severe TBI and in-hospital mortality). Results: The prevalence of Injury Severity Scores, TBIs, and severe TBIs as well as in-hospitalmortality were the highest in the unhelmeted group. Additionally, the results from the group that wore and knew the type of helmet worn indicated that wearing a full-face helmet decreased the incidence of TBIs in comparison to a half-face helmet. Conclusions: The wearing of a helmet in motorcycle accidents is very important as it plays a role in reducing the occurrence of TBIs and severe TBIs and in-hospital mortality. The use of a full-face helmet lowered the incidence of TBIs.

쏠종개(Plotosus lineatus) 가시에 의한 자창 및 국소 중독 1례

정진우,염석란,조석주,김은경 대한응급의학회 2002 대한응급의학회지 Vol.13 No.3

Although encounters with poisonous marine organisms occur predominantly in warm temperatures and tropical seas, dangerous marine animals are found as far north as 50˚latitude. There are some 1000 catfish species inhabiting both fresh and salt waters; many of these fishes are capable of inflicting serious stings. The oriental catfish (Plotosus lineatus) possesses one of the most potent known marine toxins, and it is potentially lethal. We report a case of moderate envenomation by an oriental catfish, A 42-year-old male was stung by an oriental catfish. A puncture wound was noted on his left swollen thumb. He complained of severe pain in the hand and foream, especially in the punctured finger. Initial management included hot-water immersion, tetanus prophylaxis, antibiotics, analgesics and digital nerve block. He was discharged after observation in the emergency department.

급성 펜플루라민 중독 2례

정진우,염석란,조석주 대한응급의학회 2003 대한응급의학회지 Vol.14 No.1

Fenfluramine is an amphetamine-derived substance first developed in the late 1960s for appetite control. Because of its known side effects at therapeutic doses, it is now controlled by the government and has been withdrawn from the market, but the underground market is still big. When overdosed, it can produce a wide range of neurologic and car diovascular symptoms, and even death, when a large amount is ingested. We report two cases of acute fenfluramine overdose: a fatal case with generalized seizure and pulseless electrical activity, and a case of relatively mild intoxication.

Transduced PEP-1-AMPK inhibits the LPS-induced expression of COX-2 and iNOS in Raw264.7 cells

( Min Jea Shin ),( Yeom Pyo Lee ),( Dae Won Kim ),( Jae Jin An ),( Sang Ho Jang ),( Sung Min Cho ),( Seung Hoon Sheen ),( Hae Ran Lee ),( Hae Yong Kweon ),( Seok Woo Kang ),( Kwang Gill Lee ),( Jin Se 생화학분자생물학회 2010 BMB Reports Vol.43 No.1

Roles of Public Health Disaster Response Team within the National Disaster Response System in South Korea

Yea Eun Kim,Seok Ran Yeom,Yu Jeong Jeon 위기관리 이론과 실천 2019 Crisisonomy Vol.15 No.10

각종 재난 및 다수사상자 사고 발생 시 현장의료대응을 위하여 2016년부터 각 보건소에서는 「재난응 급의료비상대응매뉴얼」에 근거하여 보건소 신속대응반을 조직·운영하고 있다. 본 연구는 국가재난 대응체계 내 보건소 신속대응반의 운영 및 활동근거를 파악하고, 실제 활동사례 및 재난의료실무자 면담을 통해 이들의 역할을 분석하고 고찰하고자 시도되었다. 보건소 신속대응반은 국가재난안전관 리체계 내 긴급구조통제단의 응급의료반으로서, 2018년 8월 기준 전국 249개(468팀, 총 2,557명)이 다. 의료인 및 행정지원 인력으로 구성되며, 재난 현장에서의 역할은 초기 환자 분류, 의료자원조달 및 분배, 환자 이송, 현장응급의료지원, 언론 대응 및 의사소통 등이다. 보건소 신속대응반이 보다 체계적으로 국가안전관리체계 내에서 활동하기 위해서는 재난에 있어 공공보건의 역할에 대한 재정 립과 보건소 신속대응반 활동에 대한 법·제도적 뒷받침, 역량 강화를 위한 개인적, 조직적 차원에서 의 노력이 요구되며 이들을 대상으로 한 실증적 연구가 추후에 수행되어야 함을 제언한다. In South Korea, Public Health Disaster Response Team (PHDRT) has been organized by every Community Health Center since 2016. When a disaster or accident with heavy casualties is expected to occur, PHDRT is dispatched. This study shed light on the role of PHDRT within the Korean National Disaster Response System by analyzing the related law and regulations, their activities, and interviews with disaster medical professionals. PHDRT is the part of the national disaster management system in Korea, organized under the Framework Act on the Management of Disasters and Safety. As of 2018, there was a total of 468 teams and 2,557 members, mostly consisting of physicians, nurses and administrators. The roles of PHDRT in disaster medical response include early triage, medical resource planning, patient transportation, support of on-site emergency care, and media relations and communications. To facilitate the activities of PHDRT, their roles need to be well defined and supported by legal and institutional frameworks, along with individual and organizational efforts to strengthen capacity.

Factors and Their Correlation with Injury Severity of Elderly Pedestrian Traffic Accidents

( Tae Gyu Hyun ),( Seok-ran Yeom ),( Sung-wook Park ),( Deasup Lee ),( Hyung Bin Kim ),( Il Jae Wang ),( Byung Gwan Bae ),( Min Keun Song ),( Youngmo Cho ) 대한외상학회 2019 大韓外傷學會誌 Vol.32 No.3

Purpose: No previous study has assessed elderly pedestrian traffic accidents based on a nationwide database. This study aimed to help primary physicians who examine patients in emergency departments to determine and make prompt and accurate treatment decisions. Methods: This study used data from the Emergency Department-based Injury Indepth Surveillance from 2013 to 2017, managed by the Korea Centers for Disease Control and Prevention. Pedestrians aged ≥65 years were included, and using multivariate logistic regression multiple factors were analyzed to determine their relationship with injury severity. Results: Of 227,695 subjects, 6,498 were included, of whom 2,065 (31.8%) were severely injured. There were more female than male patients in all severity groups. Most accidents occurred in the afternoon and on general roads. In the multivariate analysis, the odds ratio (OR) of injury severity for male pedestrians was 1.165 (95% confidence interval: 1.034-1.313, p=0.012). Older age of patients and the use of ambulances were associated with greater injury severity. The accident time affected the degree of injury severity; i.e., compared to dawn, injury severity increased in the morning (OR: 1.246, p=0.047) and decreased at night (OR: 0.678, p<0.001). A significant difference was noted in the correlation between the type of vehicle causing the accident and the accident severity; i.e., motorcycle accidents had lower severity than bicycle accidents (OR: 0.582, p=0.047). Conclusions: Injury severity was correlated with sex, age, transportation to the ED, TA onset time, and type of vehicle. The study results suggest that injury severity may be positively reflected in initial assessments and overall integrated treatments by physicians and in the related policies.