중환자에서 APACHE Ⅲ score와 사망율과의 관계

조준필,김준식,이영주 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

To evaluate the relationship between APACHE Ⅲ score and mortality in critically ill adult ICU patient, we studied the 548 patients who were admitted to the ICU from June 1, 1994 to January 31, 1995. We did not include patients with burn injuries, patients aged less than 15 years, or chest pain patients, in order to rule out myocardial infarction and unsatisfactory data files. There were 120 multiple trauma patients, 68 sepsis patients, 62 hemorrhagic shock patients, 20 multiple organ failure patients, and 120 patients with, among other conditions, durg intoxi-cation, diabetic ketoacidosis, renal failure, hepatic encephalopathy, and cerebral hemorrhage or infarction. The APACHE Ⅲ scores of survivors and non-survivors were analyzed with Chi-square test and compared. The number of nonsurvivors was 168 patients, and the overall mortality rate was 30.7%. there was a positive correlation between a high APACHE Ⅲ score and mortality ; all patients with more than 90 points expired. The average points of the survivors was 34.52 ±15.48 and of nonsurvivors was 77.74 ±31.37. The difference between each group is significant statistically. The average APACHE Ⅲ points was 47.8. The APACHE Ⅲ score is a good prognostic tool to predict the mortality rate in ICU adult patients, and can be used for selection of patients and for ICU admission/discharge. It can also be used to compare the efficacy of intensive care in different hospitals.

병원내 재난 : 한국의 현실과 재난대비 계획 제안 Status of Korea and proposal of countermeasures

김준식,김행재,김철,유인술,조준필 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

응급 의료 센터내 사망 환자의 분석

유인술,김준식,진재우,이철주,민영기,조준필 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

We need the constitute of Emergency medical system that connect prehospital care of inhospital care effectively for optimal treatment of emergency patient. The analysis of actual condition of our emergency medical system, through study of mortality case in emergency medical center will be a aid to the constitute. The authors performed a review on the records of 60 cases who died in Ajou university Emergency medical center during management, since June 1994 to september 1995. Among the 60 patient, 72% were male and 28% were female. In nontrauma patient, 6th decade was many, in trauma patients, 3rd and 5th decade was many. Among the 60 patient, 33% were traumatic cases, 66% were nontraumatic cases. Among the traumatic patients, more than half of the cases were due to motor vehicle accidents. The most frequent time interval from onset of emergent situation to arreving at emergency center was more than 2 hours. The most common transfer method was by 119 ambulance. In most cases, prehospital treatments were not taken. In most cases, initial mental status was comatose, and systolic blood pressure was less than 60 mmHg. Most cardiovascular resuscitation was done in 30 min. to an hour. In cases as traffic accident of ischemic heart disease, where rapid transportation of the patient is critical for the patient's survival, however, in most cases it took more than two hours to bring such patients to hospital, and first aid treatment before arrival to hospital was rare. No prehospital treatment was done to nearly all patient. In many cases the patient was already in under coma or shock state. The inhospital care at emergency center was made relatively quickly and adequately. The mean duration of cardiopulmonary resustation was 30min to one hour. From this study, we could notice the poor quality of prehospital care in the region ,near Ajou university hospital, and we came to know that the improvement of quality of prehospital care was the most important factor to reduce the motality of emergency department patient. that is, in the treatment of emergency patients, weak points has been revealed in the pre-hospital treatment, the improvement of which is important factor for the survival of emergency patients.

입원치료를 요하는 소아의 급성복증

배택환,김준식,유인술,조준필,이철주,민영기 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

The acute abdomen defined as an acute abdominal condition which needs immediate decision for treatment is one of the most common cause for emergency care. One thound six hundreds nine patients were visited to pediatric emergency center due to acute abdomen. To aid in early diagnosis and proper treatment, a clinical review was made on 278 cases of acute abdomen under 15 yrs old which admitted to Pediatrics and General surgery via emergency center from June of 1994 to May of 1995. The results as follows: It was 17.3% of total visiting to pediatric emergency center due to gastrointestinal sysmptoms. The sex ratio(Male: Female) was 2.35:1. Acute gastroenteristis was the most common acute abdominal condition(54%) and followed by acute appendicitis(17.9%), and intussusception(13.9%). The most common chief commplaint was vomiting(58%) and followed by abdominal pain(39.4%), diarrhea(35.8%), and fever(42.1%). One hundred fifty-five patients were visited to pediatric emergency center via local clinic and thirty patients via OPDs. The operations were done in 75 patients. Among them, immediate operation were done in 60 patients and delayed operations were done in 15 patients, but there is no difference in complication.

응급의료센터로 내원한 급성심근경색증 환자

정윤석,김준식,유인술,조준필 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Early reperfusion can prevent myocardial necrosis, and clinical trials with reperfusion therapy demonstrating a significant reduction in acute myocardial infarction(AMT) mortality have dramatically changed the treatment paradigm for AMI. All patients with symptoms and ECG findings suggestive of AMI should be considered for treatment with thrombolytic agents. However, only a minority of AMI patients actually receive a thrombolytic therapy. Many patients are often excluded from treatment because they do not meet the criteria for age, duration of the chest pain, and a qualifying ECG. And late arrival at the hospital is a frequently cited reason for not giving a thrombolytic agent. To confirm the reason for not receiving an early reperfusion therapy, we obtained the data for the clinical characteristics, the time intervals between the symptom onset and the start of a thrombolytic agent infusion, the method of reperfusion therapy, the reason for not giving a thrombolytic agent and overall outcomes by retrograde chart review. During the 12-month study period between July 1994 and June 1995, 113 patients were finally diagnosed to AMI, who presented to Emergency Center of Ajou University Hospital in total 30,819 patients. The results were followings: 1. The average age was 59±12 years old, the ratio of male to female was 3.2:1. The direct visited patients to our hospital were 31 and the transfered were 82. 2. The chief complaints were chest pain(86.7%), dyspnea, dyspnea, and mental change. The common preceding diseases were angina pectoris(10 cases), old myocardial infarction(9 cases), congestive heart failure(2 cases) and typical chest pain but not diagnosed(23 cases). The risk factors were smoking(81 cases), hypertension (46 cases) and DM (22 cases). 3. 75 patients had arrived within 12 hours from symptom onset and 38 patients after 12 hours. 45cases (54.7%) were performed the reperfusion therapy ; 31 patients were taken the thrombolytic therapy by tissue-type Plasminogen Activator. 4. The most common reason for not receiving a reperfusion therapy was the time delay and the main was the patient/bystander factor. 5. 75.2%(85 cases) of the patients discharged with or without complications, 7.1% (8 cases) died, 10.6% (12 cases) discharged moribundly, and 7.1% (8 cases) discharged against advise. In conclusion, the time delay was the first reason for not receiving a reperfusion therapy in AMI patients. And the education for the AMI symptom and BLS (Basic Life Support) to the people, good EMS(Emergency Medical Service) system, early definite diagnosis and aggresive therapy may decline the mortality rate.

응급실을 내원한 요로결석 환자

김성중,김준식,조준필 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

A clinical study was made on 139 cases of urolithiasis among the total number of 14798 who visited in the emergency center during 7 months from June 1994 to December 1994.The 186 patients was suspected the urolithiasis, then the 150 patients was followed through out-patient department of Urology and performed Intravenous pyelogram. Among the 150 cases, the urolithiasis was confirmed in 139 cases. The results are summarized as follows: 1. The ration of the male to female is approximately 2.97:1. 2. The age of the patients ranged from 20 to 50 in approximately 80.6%. 3. Among 52 patient who were not revealed stone in KUB, 45 patients were shown micro-scopic hematuria. The 22 patients were revealed urolithiasis in IVP.The 6 patients found the urolithiasis spontaneously delivered.The 17 patients were diagnosed through out-patient department of urology. 4. The 7 patients, who not hematuria and no stones in KUB, were revealed urolithiasis in IVP performed at other hospital. 5. The major clinical symptoms and signs were flank pain(117 cases),abdominal pain and suprapublic discomfort(35 cases),fever(7 cases),low back pain(7 cases),nausea and vomiting(6 cases),painful urination(1 case),and urinary frequency(1 case). 6. The specific location of the stones showed 98 cases in ureter, 7 cases in kidney,bilaterality(3 cases),and multiple stones(8 cases). The ureteral stones located most frequently in the lower 1/3 of the ureter with 55 cases.

신경회로망을 이용한 용접잔류응력 예측에 관한 연구

차용훈,김일수,김하식,이연신,김덕중,성백섭,서준열 韓國工作機械學會 2000 한국생산제조학회지 Vol.9 No.6

In order to achieve effective prediction of residual stresses, the series experiment were carried out and the residual stress-es were measured using the backpropagation algorithm from the neural network and the sectional method. Using the experimental results, the optiomal control algorithms using a neural network should be developed in order to reduce the effect of the external disturbances on residual stresses during GMA welding processes. The results obtained from the comparison between the measured and calculated results, showed that the neural network based on backpropagation algorithm can be used in order to control weld quality. This system can not only help to under-stand the interaction between the process parameters and residual stress, but also, improve the quantity control for welded structures. The development of the system is goal in this study.

흉통을 주소로 내원한 환자의 임상적 고찰

유인술,김철,김준식,조준필 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Chest pain is one of the most frequent complaints for which patients seek medical attention, and the evaluation of chest pain is among the most challenging problems in emergency department. Because it has the dangers of missing the diagnosis and little objective evidence. The potential harm resulting from the improper assessment and management of the patient with this complaint is enormous. So, on the basis of cause producing the chest pain we can take advantage for rapid and accurate diagnosis. We reviewed the 616 patient's records from Jul. 1994 to Jun. 1995. The result was: Cardiac Disease 321 (52.11%) (Acute Myocardial Infarction 33.02%, Angina 30.02%, Arrhythmia 9.03%, Myocardial Disease 7.79%, etc.), Pulmonary Disease 112 (18.18%), Psychiatric Disease 65 (10.55%), Gastrointestinal Disease 46 (7.47%), Musculoskeletal System Disease 17 (2.76%), Total Mortality Rate was 25 (4.06%) for chest pain and 7.79% in cardiac disease. Finally most common cause of chest pain was ischemic heart disease, but in Korea most of patients who suffer from chest pain did not recognize relationship between the chest pain and cardiac disease. Thus we concluded that knowledge of chest pain can be used for reducing the unexpected death and the financial costs for the diagnosis and delayed treatment, and we must advise relationship between risks of cardiac diseases and chest pain via the mass media.

겸상적혈구 혈증에 의한 동통성 발작 1례

김효철,배택환,정윤석,김현수,조준필,김준식,곽연식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

The sickle cell disease are a group of hemoglobin disorders characterized by red cells that undergo sickle shape transformation when they are deoxygenated. Sickle cell disease is transmit-ted as an autosomal recessive trait. This unusual property, due to the polymerization of sickle hemoglobin results in anemia and vasoocclusive complication. 1) The most clinically significant of these disease are sickle cell anemia, sickle cell hemoglobin C disease, and sickle cell beta thalassemia. Symptoms of pallor, fever, abdominal and joint pain, enlargement of the liver and spleen, swelling of hands and feet first appear near the latter part of the first year of life. Intravascular sickling affects all organs. For clinical and therapeutic purposes, exacerbations may be classified as vasoocclusive or pain, aplastic, hemolytic or sequestration crisis. we experienced a 22 year old female patient who suffered severe multiple joint pain and back pain thought to be caused by vasoocclussive phenomena.

CHARACTERISTICS AND SPECIFICITY OF THE INHIBITION OF RAT LIVER GLUCOSE - 6 - PHOSPHATASE BY Nα - TOSYL - L- LYSINE - CHLOROMETHYL KETONE

Joon Sig Choi,Hong Sug Choi,Jong Sang Park 생화학분자생물학회 1996 생화학분자생물학회 춘계학술발표논문집 Vol.- No.-