손상정도계수(ISS)를 이용한 응급실 내원 교통사고환자의 분석

박규남 ( Kyu Nam Park ),김용철 ( Yong Chul Kim ),이원재 ( Won Jae Lee ),황주일 ( Ju Il Hwang ),김세경 ( Se Kyeng Kim ),김인철 ( In Chul Kim ) 대한응급의학회 1992 대한응급의학회지 Vol.3 No.1

Injury severity measures are getting increasing importance for the quality assurance and injury research. Injury severit,y score(ISS) analysis is a method for the scalar measure of anatomic injury widely used and an important contribution to trauma research. A retrospective study of 349 cases of the traffic accident victims who were visited to emergency room of Kangnam St. Marys Hospital from March 1991 to August 1991 by ISS 85 was made. In this study, we have found out following results. 1. The female/male ratio was 69: 31, predominant in male and the mean age was 32.4 years. 2. The mean ISS of all traffic accident victims was 8.8+-10.6. 3. The mean ISS by age group showed the highest score above 7th decade in both male(14.0+-21. 0) and female(7.8+-10.7). 4. By the analysis of the accident type, the incidences of pedestrian TA, passenger TA and driver TA were 51.9%, 24.0% and 23.5% respectively. Mortalities of each accident type were 6.6% (pedestrian TA), 3.5% (passenger TA) and 2.4% (driver TA). Mean ISS revealed the most high in pedestrian TA(10.3+-12.5), followed by driver TA(8.2+-7. 7) and passenger TA(7.8+-8.0). 5. By the analysis of the arrival time, which was within one hour after traffic accident, the peak arrival time was from 20 hours to 22 hours(18%) and the score of the highest mean ISS was 19.8+-23.0 in 22 24 hours. 6. By the analysis of the day and arrival within one hour after traffic accident, the peak arrival day was Tuesday (19%) and the hightest mean ISS was 12.1+-10.6 on Friday. 7. The most common cause of death was head trauma(59% ). 8. As the injury severity score increased, the mortality rate incresed.

가토의 골수내 식염수 주입이 말초혈액 제변수에 미치는 영향

황주일,김세경,이원재,이기중,김병기,박규남,김인철 大韓應急醫學會 1992 대한응급의학회지 Vol.3 No.1

Study Objective: To examine the effects of intraosseous saline infusion on hematologic parameters. Design and Setting: Eight New Zealand White rabbits were anesthized intramuscular ketamine injection, An initial blood sample was withdrawn from an earlobe artery under introduction of anesthesia. An 18-gauge intraosseous(10) needle was inserted into proximal tibia of rabbits, and 10 mL/kg of normal saline was infused over two minutes after the intraosseus needle insertion. Measurements: Complete blood counts were performed on the blood sampled. The light microscopic examination of the peripheral blood smear was perfomed by clinical pathologic staff. Results: No statistically significant differences were found in hematologic paramenters from samples drawn before and after intraosseous infusion. Conclusion: We advocate less caution in the interpretation of hematologic studies performed on blood samples obtained soon after an intraosseous infusion.

심한 저칼륨혈증을 동반한 갑상선 중독성 주기성 마비 2례

유승진,최승필,최경호,오동렬,황주일,나병호,김세경 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Thyrotoxic periodic paralysis occurs primarily in Orientals with an overwhelming male preponderance and a higher association of specific HLA antigens. Clinical manifestations include onset after high carbohydrate ingestion or heavy exertion with progressive symmetric weakness leading to flaccid paralysis of the extremities and other muscle groups, lasting several hours. Other precipitating facters include trauma, infection, administration of epinephrine, thyroid hormone, or corticosteroid. If hypokalemia is present, potassium administration may help abort the attack. Although propranolol can be efficacious in preventing further episodes, the only definitive treatment is euthyroid state. The pathophysiology is still controversal, but reflects altered potassium and calcium dynamics as well as certain morphologic characteristics within the muscle unit itself. We discribed two patients with thyrotoxic periodic paralysis who had a no familial history of paralysis and had a decreased level of serum potassium during attack.

소아에서 외상성 질식 증후군에 대한 임상적 고찰

박승현,최승필,나병호,황주일,나석주,전해명,김세경 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Traumatic asphyxia has often been described as a rare clinical syndrome characterized by cervicofacial cyanosis and edema, multiple petechiae, and subconjunctival hemorrhage after a severe crush injury of the thorax or upper part of the abdomen. The pathogenesis of traumatic asphyxia is that after compression of the chest or upper abdomen, intrathoracic pressure increased suddenly. Blood is forced out of the right atrium through the valveless innominate and jugular veins into the head and neck. This sudden increased thoracic pressure in small venules and capillaries causes rapid dilation and minute hemorrhages producing the petechiae often seen. Treatment is supportive and should be focused on the associated injuries. The prognosis for traumatic asphyxia is very good despite the alarming initial physical appearance. If the patient survives the initial insult, the prognosis is excellent. Neurologic sequale may be permernant. We experienced five case of the traumatic asphyxia, and its clinical and pathophysiologic features are discussed. Increased awareness of this syndrome by emergency physicians will result in better reporting ad understanding of its clinical implications.

돼지의 실혈성 쇽모델에서 혈장증량제의 중심정맥내 주입과 골수내 주입에 대한 혈역학적 지수에 대한 효과

이원재,박규남,황주일,임근우,김세경 대한응급의학회 1994 대한응급의학회지 Vol.5 No.1

Venous access remains often as a clinical problem for pediatric patients in hemorrhagic shock state. This study compares resuscitation with PENTASPAN(10% pentastarch) by central venous and intraosseous route in hemorrhagic shock model. The swines were bled to a mean arterial pressure of 30 mmHg. This state of shock was sustained for 30 minutes. Resuscitation was performed with Pentaspan infused at 50 mL/min by a manual pressure. The hemodynamic response to Pentaspan resuscitation was comparable in both group. There was no significant difference in mean arterial pressure, heart rate, cardiac output, pulmonary capillary wedge pressure, pulmonary artery pressure, arterial oxygen saturation, and mixed venous oxygen saturation. For fixed rate infusion, intraosseous resuscitation with Pentaspan is as effective as that infused by central venous route in improving hemorrhagic shock state.

손상정도계수(ISS)를 이용한 응급실 내원 교통사고환자의 분석

김세경,박규남,김용철,이원재,황주일,김인철 대한응급의학회 1992 대한응급의학회지 Vol.3 No.2

Injury severity measures are getting increasing importance for the quality assurance and injury research. Injury severity score(ISS) analysis is a method for the scalar measure of anatomic injury widely used and an important contribution to trauma research. A retrospectively study of 349 cases of the traffic accident victims who were visited to emergency room of Kangnam St. Mary's Hospital from March 1991 to August 1991 by ISS-85 was made. In the study, we have found out following results. 1. The female/male ratio was 69 : 31, predominant in male and the mean age was 32.4 years. 2. The mean ISS of all traffic accident victims was 8.8±10.6. 3. The mean ISS by age group showed the highest score above 7th decade in both male(14.0±21.0) and female(7.8±10.7). 4. By the analysis of accident type, the incidences of pedestrian TA, passenger TA and driver TA were 51.9%, 24.0 and 23.5% respectively. Mortalities of each accident type were 6.6%(pedestrian TA), 3.5%(passenger TA) and 2.4%(driver TA). Mean ISS revealed the most high in pedestrian TA(10.3±12.5), followed by driver TA(8.2±7.7) and passenger TA(7.8±8.0). 5. By the analysis of the arrival time, which was with in one hour traffic accident, the peak arrival time from 20 hours to 22 hours(18%) and the score of the highest ISS was 19.8±23.0 in 22-24 hours. 6. By the analysis of the day arrival within one hours after traffic accident, the peak arrival day was Tuesday (19%) and the highest mean ISS was 12.1±10.6 on Friday. 7. The most common cause of death was head trauma (59%) 8. As the injury severity score increased, the mortality rate increased.

응급실에 내원한 불안정성 발작성 심실상성 빈맥환자에서 정맥내 Adenosine 투여효과

이원재,박규남,채장성,강동헌,임응훈,김세경,황주일,승기배,박승현,오동렬,이기중,최규보 대한응급의학회 1994 대한응급의학회지 Vol.5 No.2

Study purpose : To evaluate the efficacy of adenosione in the treatment of emergency department patients with unstable paroxysmal supraventricular tachycardia. Design : A ten-months prospective outcome study. Population : Patients with 16 or more old with unstable PSVT(systolic blood pressure of less than 90mmHg, chest pain, pulmonary edema, and/or altered mental status) by surface ECG criteria. Measurements : Patient's preadenosine and postadenosine heart rates, symptoms, and blood pressure, complications and recurrence of PSVT. Results : Fourteen patients mets inclusion criteria. After IV adenosine, One patient was found to have atrial flutter. PSVT were diagnosed in remaining thirteen patients. There were five male and eight female patients with a mean age 35.2(range, 16-52). Six patients presents with hypotension(mean systolic blood pressure, 78.6mmHg), four with chest pain, and three with both chest pain and hypotension. There were no patients with altered mental status or pulmonary edema. Eleven patients(85%) converted to sinus rhythm with adenosine therapy (initial 6mg adenosine : eight patients, additional 12mg : three patients). The remaining two patients required electrical cardioversion. Two patients converted to sinus rhythm by electrical cardioversion. In all cases, chest pain and hypotension resolved within minutes of conversion to sinus rythm. There were no clinically significant adverse effects or recurence of PSVT during emergency department observation period. Conclusion : In the unstable patient with PSVT, adenosine appears to be a safe and effective alternative to current advanced cardiac life support-recommended immediate electrical cardioversion.

능동적 가압-감압 심폐소생술

채장성,강동헌,이광수,권순애,김세경,임근우,박승현,오동렬,이기중,승기배,황주일,박규남,이원재,채규보 대한응급의학회 1994 대한응급의학회지 Vol.5 No.2

Background : Recent studies have demonstrated improved cardiopulmonary circulation during cardiac arrest with the use of a hand-held suction device(AMBU Cardio Pump) to perform active compression-decompression cardiopulmonary resuscitation in animal. The purpose of this study was to compare active compression-decompression with standard CPR during cardiac arrests in emergency department patients. Design : Patients in cardiac arrest in whom standard advanced cardiac life support failed were randomised to receive 2 minutes of either standard or active compression-decompression (ACD) CPR using hand-held suction device, followed by 2 minutes of the alternate technique. The ACD device was applied midsternum and used to perform CPR according to the guidelines of the American Heart Association : 80 compressions per minute, compression depth of 3.8 to 5cm, 50% duty cycle, and constant-volume ventilation. End-tidal carbon dioxide(ETCO2) concentration and hemodynamic variables were measured. In one case, Transcranial doppler sonography was used to assess cerebral blood flow velocity. Results : Twelve patients were enrolled. The mean ±SD ETCO2 was 8.33±2.72mmHg with standard CPR and 12.42±8.3mmHg with ACD-CPR(P<.001). Systolic arterial pressure with standard CPR was 74.75±11.31mmHg and with ACD-CPR, 88.58±16.91mmHg(P<.005). Diastolic arterial pressure with standard CPR was 2.66±6.14mmHg and with ACD-CPR, 1.16±8.11mmHg(P=NS). Base exess with standard CPR was -11.50±5.37 and with ACD-CPR, -11.42±5.37(P=NS). In one case, mean cerebral blood flow velocity with standard CPR was 25.2cm/sec, with ACD CPR, 30.5cm/sec. Conclusion : ACD-CPR is a simple manual technique that improved cardiopulmonary circulation in 12 patients during cardiac arrests.