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급성 Acetaminophen 중독시 복용량에 의한 N-Acetylcysteine의 사용은 적절한가?
김태근,김민정,이진희,정성필,이한식,박유석,Kim, Tae-Geun,Kim, Min-Joung,Lee, Jin-Hee,Chung, Sung-Pil,Lee, Hahn-Shick,Park, Yoo-Seok 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.2
Purpose: In many Korean hospitals, serum acetaminophen concentrations in cases of overdose cannot be measured initially because of inadequate laboratory facilities. Under these circumstances, physicians base the administration of the antidote, N-acetylcysteine, on ingestion amounts as determined by initial history taking. We therefore examined the correlated between ingested amounts and serum acetaminophen concentrations. Methods: Medical records were reviewed retrospectively for patients who presented to the ED with acetaminophen overdose between January 2002 and March 2006. Fifty-nine patients were recruited and sixteen patients were excluded. The forty-three remaining patients were placed into either the high-risk or low-risk group based on their ingested amount (140 mg/kg), and were separately categorized into the toxic or non-toxic group based on their serum acetaminophen concentrations, according to the Rurnack-Matthew nomogram. Results: Ten patients (83.3%) among twelve in the high-risk group were found to have non-toxic serum concentrations, and just one patient (3.2%) among thirty-one in the low-risk group fell into the toxic group based on their serum concentrations. The sensitivity and specificity of risk stratification of the ingested amount as a predictor of intoxication requiring antidote therapy were 66.7% and 75.0%, respectively. Conclusion: This study suggests that the therapeutic decision for acetaminophen overdose should not be based solely on ingested amount only, but requires assessment of acetaminophen concentration.
급성 약물중독 환자의 응급 기관내 삽관에서 임상적 특성
한얼 ( Eol Han ),정현수 ( Hyun Soo Chung ),박유석 ( Yoo Seok Park ),유제성 ( Je Sung You ),주영선 ( Youngseon Joo ),공태영 ( Taeyoung Kong ),박인철 ( Incheol Park ),정성필 ( Sung Phil Chung ) 대한임상독성학회 2015 대한임상독성학회지 Vol.13 No.1
Purpose: The aim of this study was to compare the clinical characteristics in emergency endotracheal intubation between patients with acute drug intoxication and medical disease. Methods: Data for airway registry collected in two emergency departments (ED) between April 2006 and March 2010 were reviewed retrospectively. The airway registry data included patient’s demographic information and variables such as Cormack-Lehane grade, 3-3-2 finger analysis, success rate, the number of attempts at intubation, complications of intubation, and clinical outcomes after intubation. Results: A total of 1480 patients were enrolled; 62 patients were classified as belonging to the intubation group after the drug intoxication group. No significant differences in Cormack-Lehane grade, 3-3-2 finger analysis, success rate, the number of attempts at intubation, and complications after intubation were observed between patients with acute drug intoxication and medical disease. However, significant difference was observed for indication of emergency endotracheal intubation. While emergency endotracheal intubations were usually performed in medical patients because of failure of airway patency, they were performed in intoxicated patients with the goal of preventing serious complications. Conclusion: Anatomical structures related to endotracheal intubation, the process and clinical outcome of intoxicated patients are not significantly different from those for medical patients.
경추 손상 환자에서 전산화 단층 촬영 시행을 위한 임상적 기준: NEXUS 기준과 Canadian cervical spine rule
최양환 ( Yang Hwan Choi ),조준호 ( Jun Ho Cho ),좌민홍 ( Min Hong Choa ),박유석 ( Yoo Seok Park ),정현수 ( Hyun Soo Chung ),정성필 ( Sung Pil Chung ) 대한외상학회 2008 大韓外傷學會誌 Vol.21 No.1
Purpose: National Emergency X-Radiography Utilization Study (NEXUS) criteria and the Canadian Cervical Spine rule (CCR) are commonly used in cervical trauma patients to determine whether a plain cervical X-ray should be performed. However, plain cervical X-rays are so inaccurate that cervical spine computed tomography (CT) is often considered as a screening test. We studied the usefulness of the NEXUS criteria and the CCR for determining the need for a CT evaluation in the emergency department (ED). Methods: This prospective observational study was conducted from January 2007 to March 2008. Plain X-ray and CT scans of the cervical spine were performed on blunt trauma patients with neck pain. The relevancy of CT was examined using the NEXUS criteria and the CCR. Sensitivity, specificity, positive predicted value, and negative predicted value analyses were performed to diagnose the cervical spine injury. Results: During the study period, 284 patients were enrolled in this study. The sensitivity, specificity, positive predicted value, and negative predicted value of the NEXUS criteria were 87.5%, 1.1%, 5.0%, and 60.0% respectively, while those of the CCR were 87.5%, 8.2%, 5.3%, and 91.6%. There were two missed fracture cases when the NEXUS criteria and the CCR were applied independently, however, no cases were missed when both were applied. Conclusion: This study suggests the NEXUS and the CCR in combination can be used as a guide to CT evaluation for cervical spine injury in the ED.
중증외상환자의 전산화단층촬영 및 중 재술에 의한방사선 유효선량 및 생애 귀속위험도
이원효 ( Won Hyo Lee ),공태영 ( Tae Young Kong ),김승환 ( Seung Hwan Kim ),유제성 ( Je Sung You ),박유석 ( Yoo Seok Park ),이재길 ( Jae Gil Lee ),정성필 ( Sung Phil Chung ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3
Purpose: This study was performed to calculate and analyze the effective radiation doses from computed tomography (CT) and radiologic intervention in patients in the emergency department (ED) with trauma critical pathway (CP) activation and further to estimate the lifetime attributable risks (LARs) for the incidence of and mortality from cancers induced by the radiation dose. Methods: Through a retrospective electrical chart review of 104 injured patients who trauma critical pathway were activated from November 2012 to March 2013, we calculated effective radiologic doses by taking the product of the dose-linear product of the scan and the conversion coefficient. After a determination of the image results, we divided the patients into two groups, negative or positive, and calculated the effective dose for each group. With these results, we estimated the LARs for the incidence of and the mortality from cancers by using the table in the Biologic Effects of Ionizing Radiation (BEIR)-VII report. Results: A total of 76 patients were enrolled. The mean age was 49.0±8.5 years. The mean injury severity score (ISS) was 12.7±8.4. The cumulative effective dose (CED) for individual patients varied from 2.8 mSv to 238.8 mSv, and the mean was 47.6±39.9 mSv. The CED in patients with an ISS≥16(63.2±26.6 mSv) was higher than that of patients whose ISS<16(33.5±23.1 mSv) (p<0.001). The CED in patients who were treated with surgery or intervention(69.0±45.2 mSv) was higher than that of patients who were treated conservatively(33.6 ±22.4 mSv) (p<0.001). The LARs for cancer incidence and mortality were 328.5±308.6 and 189.0±159.3 per 100, 000 people, respectively. Conclusion: The CED and the LAR for trauma CP-activated patients in the ED were significant, so efforts should be made to decrease the effective dose received by severely injured patients.
독실라민 중독시 발생할 수 있는 발작의 특성과 위험인자
송범수 ( Beom Soo Song ),이기만 ( Ki Man Lee ),김선욱 ( Sun Wook Kim ),유제성 ( Je Sung You ),정태녕 ( Tae Nyung Chung ),박유석 ( Yoo Seok Park ),정성필 ( Sung Phil Jung ),구홍두 ( Hong Du Goo ),박인철 ( In Cheol Park ) 대한임상독성학회 2010 대한임상독성학회지 Vol.8 No.2
Purpose: Doxylamine is antihistamine drug that is used as a hypnotic. It is also used for suicidal attempts because it can be easily purchased at the pharmacy without a prescription. There were many articles about the complications after doxylamine intoxication such as a rhabdomyolysis, but only a few articles have reported on seizure. We reviewed the cases of doxylamine intoxication with seizure that were treated in the emergency department. Methods: We reviewed the medical records of the patients who were over 15 years old and who were intoxicated by doxylamine at 3 emergency medical centers from January 2006 to June 2010. We reviewed the patients’age, gender, the dose of doxylamine ingested, if gastrointestinal decontamination was done, the time from intoxication to hospital arrival, the seizure history, treatment of seizure, the electroencephalography (EEG) results, the brain computed tomography (CT) results and the blood test results. Results: There were 168 patients who were intoxicated by doxylamine during the study period. Twelve patients had a seizure episode. The differences between the patients who developed seizure and the patients who did not were the dose and the serum levels of sodium and creatinine. The only clinically meaningful difference was the amount of doxylamine. The amount of doxylamine ingested (>29 mg/kg) predicted the development of seizure with a sensitivity of 75% and a specificity of 92% on the ROC curve. One patient among the seizure patients expired in the emergency department. Conclusion: In case of doxylamine intoxicated patients, there is close relationship between seizure and ingested amount, so close observation needs to be done for the patients who ingest too much because doxylamine can cause death. Further prospective studies are needed for doxylamine intoxicated patients with a seizure episode.
중증도 분류도구로서 변형 Emergency Severity Index의 평가자간 신뢰도
박유석,조진경,윤천재,박인철,이경룡,김승호 대한응급의학회 2002 대한응급의학회지 Vol.13 No.3
Purpose: Triage in the emergency departmen (ED) is the preliminary clinical sorting process before full disclosure of patients' problems so that patients with the highest acuity are treated first in the setting of resource constraints. To overcome the inter-rater variability of existing triage tools, the Emergency Severity Index(ESI) was developed and was shown to be both valid and reliable in practice. Because of the disparity in practice patterns and some inappropriate criteria in the original ESI, the authors have modified the ESI and determined its inter-rater reliability. Methods: We applied the modified ESI to a convenient sample of adults who visited an urban academic ED between July 24, 2001, and August 5, 2001. After completion of a short, 4-hour training course on the modified ESI, an intern and emergency medicine resident pair triaged the patients independently. The inter-rater reliability was measured using a weighted kappa analysis and was categorized as excellent( 0.8),good (0.60-0.79),or fair( 0.59). Results: Five hundred forty-two patients were enrolled. The overall weighted kappa between the intern and the resident was 0.82 (95% Cl : 0.78-0.86). Among the 542 patients, 469/542 (87%), pairs agreed exactly, 67(12%) pairs disagreed by 1 level, and 6 (1%) pairs by 2 levels. Conclusion: In this study, the modified ESI demonstrated excellent inter-rater reliability when used by residents and interns for our ED patients.