소화관내 이물에 대한 고찰

윤한덕,류진호,박주경,허탁,조석주,김성근,민용일 大韓應急醫學會 1997 대한응급의학회지 Vol.8 No.1

We analyzed records at Chonnam university hospital from Sep. 1. 1993 to Aug. 31. 1996 to assess clinical significance of the foreign body in the gastrointestinal tract. There were 133 episodes consisting of 79 pediatric and 54 adult patients as possible to review. In the pediatric patients, the coin was the most common cause of foreign body ingestion, while adult patients were usually caused by bones and meat. We removed foreign bodies in the oral cavity and oropharynx in 12 cases using direct laryngopharyngoscpy and forcep. Endoscopy was performed successfully in 47 of 51 patients in which was attempted; there were two complications composed of an aspiration pneumonia and a mediastinitis due to esophageal perforation. There were spontaneous passage of foreign bodies in 48 cases. We observed complications in 6 cases in which 4 cases needed operations due to complications. Foreign bodies which pass into the stomach can be observed for development of complications, as 94% of foreign bodies which reach the stomach spontaneously pass. Only 4 patients required interventions, which was done without mortality.

경추손상이 의심되는 환자에서 경추전방 연부조직 폭 측정의 의의

박주경,김성근,윤한덕,허탁,조석주,민용일 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Prevertebral soft tissue swelling of cervical spine lateral radiogram is well known as an indirect evidence of occult cervical spine injury. But the clinical and statistical value of it has been of debate. We tried to analyse the value of cervical prevertebral soft tissue width as a screening test for cervical spine injury by comparison of two categorized study groups; the control group, traumatized patients without cervical spine injury and the injury and the injury group, traumatized patients with bony cervical injury. The injury group consisted of patients admitted between September 1993 and December 1994 with an ED diagnosis of bony cervical injury. The control group consisted of patients admitted between January 1994 and June 1994 who received cervical spine lateral radiograph because of suspicion of cervical spine injury or as a routine check. In both group, we sampled the patients who received cervical spine lateral rediograph within 24 hours after injury and excluded the patients less than 15 years old and more than 65 years old, In the control group, we confirmed the patients had no problem in cervical spine of follow-up. 101 control patients and 68 injury patients were identified. The injury group was further divided into two subgroups: those with injuries at C1-C3 to the upper injury subgroup and those with injuries at C4-C7 to the lower injury sub group. The prevertebral soft tissue widths of injury group were larger than of control group at C2(mean 6.1mm versus 4.5mm) and also at C6(mean 13.4mm versus 11.2mm). Especially upper injury subgroup had quite large value of C2 prevertebral soft tissue width(mean 14.1mm). Nevertheless, both in C2 and C6, there is no cutoff value with acceptable sensitivity and specificity as a screening test. But the 7mm at C2 and 14mm at C6 had high specificity(90%) and were thought to be a good radiologic indicators of further evaluation.

신손상 진단에 있어 현미경적 혈뇨의 의의

임정환,오봉렬,나국주,김현수,윤한덕,허 탁,조석주,민용일 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

The evaluation of patients with microscopic hematuria after blunt abdominal trauma has become controversial. We tested the hypothesis that renal contusion can be diagnosed clinically and that these patients do not require radiographic evaluation. To evaluate the association of microscopic hematuria without shock and with renal injury, we reviewed the medical records of 252 patients following blunt abdominal trauma. Microscopic hematuria without shock was noted in 58 of 252 patients. Of the 58 patients 52 had renal contusion, 4 had renal laceration, 1 had a renal rupture and 1 had renal pedicle injury. All of the patients with renal contusions experienced no complications from nonoperative management. But, avoiding a radiopraphic evaluation in patients with blunt renal trauma plus microscopic hematuria and no shock would miss a few cases of severe renal injury.

혈복이 의심되는 복부둔상 환자에서 응급 초음파 검사의 의의

윤한덕,박주경,류진호,허 탁,조석주,김성근,민용일 대한응급의학회 1997 대한응급의학회지 Vol.8 No.2

The reliability of emergency ultrasonographic(US) detection of hemoperitoneum and solid organ injury in blunt abdominal trauma was evaluated retrospectively. From October 1, 1995 to August 31, 1996, 90 patients were included in the study. Ultrasonographic findings showed a sensitivity, specificity, and accuracy of 97.6%, 97.9%, and respectively, in detecting intraabdominal fluid collection. We believe that US in an emergency center is a quick, safe screening method in the evaluation of blunt abdominal trauma. In our department, US has replaced diagnostic peritoneal lavage(DPL) and computed tomography(CT) as the screening study of first choice.

2년간 응급실에 내원한 비외상성 병원전 심정지 환자에 대한 임상적 분석 : 광주ㆍ전남 지역을 중심으로

윤한덕,박주경,민용일 대한응급의학회 1997 대한응급의학회지 Vol.8 No.3

Background : Care for prehospital cardiac arrest is one of the major concerns of emergency medical services. But, in Korea, prehospital emergency medical service systems are not yet well established. We tried to offer one of the fundamental data for development of these systems. Methods : After application of exclusion criteria, 183 patients who transferred to emergency center of our hospital after cardiac arrest in consecutive 24 months from Jan, 1,1994 to Dec, 31,1995 were included in this study. Retrospective review of the hospital charts of these patients was done. For statistical analysis, we divided patients to some categories, t-test or chi-square analysis was used. Results : 24 patients of the 183 patients were secondary visitors(cardiac arrest was occurred during transfer from other hospitals), 159 patients were primary visitors. In the primary visitor group, only one third was ambulance visitors, and there is no statistical differences between arrest time of ambulance visitors and non-ambulance visitors(35±27 vs 37±24 min, p=NS). No organized bystander CPR was done. After arrival, 131 patients received CPR and 87 patients(66.4%) were not responded, 31 patients(23.1%) experienced transient ROSC, 13 patients(10.0%) survived until discharge, and only 2 patients(1.5%) were returned to their lives. Conclusion : We failed to find significant statistical survival differences between ambulance visitors and non-ambulance visitors, between presumed cardiac etiology group and non-cardiac etiology group. Survival rate was high in witnessed arrest group than unwitnessed arrest group(14.5% vs 2.1%, p=0.015).

유기인계농약 음독환자에서 내원시 혈장 Cholinesterase 활성도의 의의

전병조,문정미,윤한덕,허탁,민용일 대한응급의학회 2002 대한응급의학회지 Vol.13 No.1

Purpose: Plasma cholinesterase is a sensitive measure determining the severity of organophosphate intoxication. The author evaluated the usefulness of the plasma cholinesterase level as a prognostic indicator of the severity of organophosphate intoxication. Methods: From June 1999 to May 2001, 55 patients presented with organophoshate insecticide intoxication to the Emergency Medical Center of the Chonnam National University Hospital, and these were enrolled in this study. The plasma cholinesterase activities of these 55 patients were determined at the time of presentation. The relationships between the plasma cholinesterase level and the clinical variables of organophosphate toxicity, quantity of ingested poison, elapsed time to gastric lavage, and the APACHE score at the time of hospitalization were analyzed. Results: The plasma cholinesterase activity significantly decreased in association with the degree of toxicity of the poison (p<0.001), elapsed time to gastric lavage (p<0.001), and the quantity of organophoshate ingested (p=0.013). In the 55 patients, lower plasma values of cholinesterase were observed in patients with longer durations of mechanical ventilation (r= 0.717, p<0.001) and in patients who developed pneumonia during treatment (r=-0.538, p<0.001). Also, decreased cholinesterase activity correlated with a higher APACHE score(r=-0.672, (p<0.001). Conclusion: These results suggest that immediate determination of the plasma cholinesterase level at the time of hospitalization may be useful as a prognostic indicator in patients with organophosphate intoxication.

초오 중독 환자에서 심혈관계의 변화에 대한 고찰

문정미,이병국,전병조,윤한덕,허탁,민용일 대한응급의학회 2002 대한응급의학회지 Vol.13 No.1

Purpose: The roots of Aconitum plants (e.g.,A carmichaelii, A napellus) have been believed to possess anti-inflammatory, analgesic, and cardiotonic effects and have been used in traditional Chinese medicine mainly for the treatment of musculoskeletal disorders. Because of low safety margin, it is not uncommon to visit emergency departments to have variable amounts of highly toxic diterpene alkaloids (e.g., aconitine) contained in their systems. Typical manifestations of aconitine posioning are neurological, cardiovascular, and gastrointestinal problems. The known cardiovascular manifestations are several types of arrhythmia and hypotension. The author experienced a cases of transient ventricular ischemic change in an EKG and elevation in cardiac enzymes. This study aimed to evaluate cardiac ischemia associated with aconitine poisonining. Methods: The author analyzed 13 patients with aconitine poisoning, who visited the Emergency Department of Chonnam National University Hospital from 1995 to 2001. Variables included in data analysis were age, sex, clinical features, cardiac enzyme levels, and EKG changes. Results: Aconitine had been taken for a variety of medical problems, including arthralgia, neuralgia, and some gastrointestinal complaints. All patients suffered from neurological (tingling of the mouth and skin, followed by numbness and weakness in the extremities), cardiovascular (palpitation, dizzness), and gastrointestinal (nausea, vomiting) manifestations. Most patients had a variety of cardiac rhythm disturbances. Two patients exhibited transient cardiac ischemia, including cardiac enzyme elevation and ischemic changes on their an EKGs. Conclusion: Two patients (15.4%) among 13 patients showed transient cardiac ischemia, including cardiac enzyme elevation and ischemic changes on their EKGs. It is important to observe the possibility of myocardial toxicity of aconitum and to evaluate the mechanism of cardiac toxicity through clinical and experimental study.

파라콰트 중독 환자의 생존율에 영향을 미치는 초기 검사 지표

정경운,김현창,전병조,윤한덕,허탁,민용일 대한응급의학회 2002 대한응급의학회지 Vol.13 No.1

Purpose: Paraquat (1, 1-dimethyl-4, 4'-bipyridylium chloride) is widely a used non-selective herbicide. In spite of efforts to improve the outcome in patients poisoned with paraquat, the mortality rates still remains high. The purpose of this study is to identify initial stat laboratory parameters which can affect the survival rate of these patients. Methods: A retrospective analysis by chart review was done on 67 patients who had ingested paraquat and who had presented to the Emergency Medical Center of Chonnam University Hospital from June 1997 to July 2001. Results: The results were as follows: 1) Survivors were significantly younger than the nonsurvivors (38 years vs 44 years, p= 0.03). The volume of paraquat ingested by survivors was significantly smaller than that ingested by the deceased (1 mouthful vs 3 mouthfuls, p<0.001). 2) The WBC count and the levels of serum AST, BUN and serum creatinine in the deceased were significantly higher than those in the survivors. The levels of serum potassium and bicarbonate, arterial pH, and base excess in survivors were significantly higher than those in the deceased. 3) A multivariate analysis revealed that serum creatinine, serum potassium, and arterial base excess were associated with the fatality rate. Conclusion: Initial stat laboratory parameters including arterial blood gas analysis, renal function test, and serum electrolytes could be used to predict the outcome of patients poisoned with paraquat. However, the development of readily applicable and reliable indices predicting outcome is desired for the future.

Jimson weed(흰꽃독말풀) 섭취 후 발생한 항콜린성 중독 2례

김성근,박주경,김용권,윤한덕,소정일,류진호,허탁,민용일 대한응급의학회 1998 대한응급의학회지 Vol.9 No.2

Jimson weed, also known as Datura stramonium, is a member of the Solanaceae family. Jimson weed was us American Indians for medicinal and religious purposes. All parts of the Jimson weed plant are poisons, containing the alkaloids atropine, hyoscyamine and scopolamine. So, it is caused by these components to make anticholinergic toxicity within 6h after ingestion. Initial manifestations include dry mucous membrane, blurred vision, thirst, difficulty swallowing and speaking, and photophobia, and may be followed by hyperthermia, confusion, agitation, combative behavior, hallucination, urinary retention, seizure and coma.. We experienced two patients who developed combative behavior and agitation with pupil dilation caused by Jimson weed. They discharged with improvement after supportive therapy for 2days.

권역응급의료센터 운영경험 : 광주권역을 중심으로

위준선,윤영윤,전병조,윤한덕,허탁,민용일 대한응급의학회 2002 대한응급의학회지 Vol.13 No.1

Purpose: As Gwangju Wide Regional Emergency Medical Center was newly opened during February 2001, a comparative analysis was performed of patients who had visited the emergency department before and after the opening in order to measure the difference and to provide basic data for its management. Methods: The 9,995 patients, who had visited between February 1. 1999, and July 31, 1999, before the opening and the 12,457 patients who visited between February 1, 2001, and July 31, 2001, after its opening were compared according to sex, age, non-trauma or trauma, means and form of visit, attending department, length of stay in the emergency department, form of discharge, and time of death verification (dead-on-arrival(D.O.A) versus dead-after-arrival (D.A.A) ) Results: The total number of patients increased by 24%. The admission rate was 31.8% before the opening and 40.6% after the opening; the mean length of stay in the emergency department was 15.7 hours before the opening and 12.2 hours after the opening. The mean length of stay of admitted patients decreased from 26.6 hours before the opening to 18.3 hours after the opening. Conclusion: The decrease in the mean length of stay in the emergency department from 15.7 hours before the opening to 12.2 hours after the opening is viewed as a positive result, but is still not satisfactory. Accordingly, it is considered urgent that every clinical department take an active part in improving circulation of patients both in the Emergency Intensive Care Unit(EICU) on the second floor and in the emergency ward on the fifth floor, as well as in providing rapid medical care and decisions on treatment strategies in the emergency department on the first floor.