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구급일지를 통한 병원 전 환잔 분류 및 처치의 적절성 평가 연구
민순식,김재광,이근,박철완,양혁준,류일,현성열,이훈규,정환모,김윤 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4
Background: Recently, patients' demands for emergency medicine are increasing, and most of prehospital medical care, including basic life support, cardiopulmonary resuscitation and triage, are provided by paramedics or emergency medical technicians. Evaluation of the adequacy of prehospital management and triage has become important for improving the quality and the effectiveness of the emergency medical system. Methods: The 202 patients who were transferred by ambulance with paramedics, nurses, or emergency medical technicians to the Emergency Department in Gil Medical Center from July 1, 1999, to September 31, 1999, were enrolled. This study was conducted prospectively by using the emergency physician,s log and newly devised protocols recorded by paramedics or nurses. Results: 1) Male to female ratio was 1: 0.8, and the peak age of the patients were the 4th(18.8%) and 6th decade(15.3%). 2) Of the 202 patients, 84 patients were transferred for trauma and 118 for medical problems. The mean transfer time was 6±1.73 minutes. 3) The validities of prehospital triage and decisions using the trauma severity measure and the disease severity measure, were 33.3% in trauma patients and 57.6% in medical patients.4) The results for the adequacy rate in prehospital management analyzed by using the rate of necessity of treatment. performance of treatment, and adequate treatment were as follows: oxygen supply.38.1/41.6/93.8 ; wound dressing. 19.3/71.8/92.9 ; immobilization of the cervical spine, 15.8/56.3/92.9 ; application of a spinal board. 12.9/42.3/72.7 ; application of a splint, 9.9/50.0/60.0 ; manual maintenance of an airway. 9.9/55.0/63.6 ; and CPR, 4.5/66.7/0. 5) Kind of ALS(Advanced Life Support) were not conducted(peripheral IV, EKG. intubation, medical administration. defibrillation, pacing). The rates of necessity of treatment were as follows: peripheral IV, 40.6%; ECG monitoring, 23.3% ; endotracheal intubation, 8.9% ; medical administration, 8.9% ; defibrillation. 3.5%; and pacing. 1.5% Conclusion: The adequacy of prehospital triage and decisions using trauma and disease severity measures was relatively low. To improve the adequacy of BLS(Basic Life Support) and to increase the performance of ALS(Advanced Life Support), we must create challenges to develop new protocols and to supplement new equipment.
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안석근,임용수,김재광,민순식,류일,양혁준,박철완,이근 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.3
Background : Puffer fish can be the source of lethal food poisoning in humans. Tetrodotoxin(TTX) poisonings are not infrequently seen in Korea, but there are few clinical reports. So we reviewed the patients of TTX poisoning and analyzed the clinical characteristics of patients. Methods : A retrospective study was performed of 40 patients who visited Chung Ang Gil Hospital from Jan. 1, 1995 to May. 31, 1998 with a diagnosis of TTX poisoning by a review of patients medical records and telephone inquiries. The diagnosis of TTX poisoning was made by causal links between consumption of puffer fish and the development of typical symptoms of tetrodotoxication. The clinical severity of the patients in this study was classified according to the classification of Fukuda. Results : Mean age of the patients was 40 years. The highest incidence was in the 4th decade in 21 patients(52.5%). The ratio of male to female was 3.44:1. Seasonal distribution excluding cases in 1998 was 12 patients in spring, 6 in summer, 5 in autumn and 12 in winter. The mean interval between consumption and symptom onset was 137 minutes. Common initial symptoms were circumoral numbness(32 patients) and paresthesia of extremities(24 patients). Various symptoms were developed after ingestion of puffer fish such as neuromuscular(39 patients), cardiovascular/pulmonary(23 patients) and gastrointestinal(16 patients) system. Mean recovery time from the onset of symptom was 22.00 hours. All were treated with symptomatic and supportive measures and recovered completely without sequelae. In 2 cases ventilatory supports were applied for 18.5 hours and 31.5 hours respectively.
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진욱,김재광,양혁준,박철완,이훈규,이근,민순식,류일,현성열 대한외상학회 2000 大韓外傷學會誌 Vol.13 No.2
Background: Traumatic rupture of the diaphragm after blunt trauma is rare, but traumatic rupture and injuries of the diaphragm are on the increase and commonly result from blunt truncal traumas or penetrating stab wounds. The diagnosis of blunt traumatic rupture of the diaphragm often is difficult in the absence of accompanying abdominal or thoracic injury and is often delayed because of serious concurrent injuries and a lack of specific clinical signs and symptoms. Delayed diagnosis of a diaphragmatic rupture with accompanying strangulation of a herniated viscera results in higher morbidity and mortality rates. The aim of this study is to help early diagnosis and treatment by evaluating patients with blunt or penetrating diaphragmatic injuries. Methods: A clinical analysis was made of 21 cases of blunt and penetrating diaphragmatic injuries which had been treated during the 8 years from January 1992 to December 1999 at the Department of General Surgery and Chest Surgery, Gachon Medical College Center. These records were studied in a retrospective manner. Results: The results are as follows: 1) The most common ages were in the 3rd and 4th decades (28.6% and 28.6%). There were 16 males and 5 females (M:F=3.2:1). 2) The traumatic ruptures of diaphragm were due to blunt trauma in 16 (76.2%) patients and penetrating trauma in 5 (23.8%) patients. 3) The most common symptoms were abdominal pain (76.2%), chest pain (66.7%), and dyspnea (47.6%). 4) Seventeen of the 21 patients were diagnosed before operation; five patients were diagnosed during operation. 5) Twelve of the 21 patients were operated on within 24 hours (57.2%). 6) The most common associated intraabdominal injured organ was the liver; the most common herniated organ was the stomach. 7) The operations were done using a laparotomy alone in 15 patients, a thoracotomy in 5 patients, and a thoracoabdominal incision in 1 patient. 8) Postoperative complications developed in 3 patients (14.3%). 9) There were no deaths. Conclusion: Diagnosis of diaphragmatic rupture and injury is a great challenge to the surgeon. To prevent delays in diagnosis and attendant complications, the surgeon and the emergency physician must maintain a high index of suspicion for the presence of diaphragmatic trauma in patients with blunt injuries, particularly in the presence of accompanying thoracoabdominal injury.
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