흰쥐에서 출혈량에 따른 비장세포 증식력과 말초임파구 아형의 변화

이한식,정성필,김욱진,조영순,장석준 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3

Background: Hemorrhage itself has been shown to produce abnormalities in immunity, particularly depression of the lymphocyte function. In order to better examine the amount of hemorrhage required to suppress the lymphocyte function, we determined the effect of graded fixed-volume hemorrhage on splenocyte proliferation and the lymphocyte subpopulation. Methods: Male Sprague-Dawley rats(weight,350∼400 g) were anesthetized, subjected to hemorrhages of 7.5 ㎖/㎏, 15 ㎖/㎏, and 22.5 ㎖/㎏ by percutaneous cardiac puncture with ㎖/㎏ needles, After 1, 2, 4, and 7 days, animals were killed to obtain the blood and spleen. The splenocyte proliferative capacity was measured by using the tritiated thymidine incorporation technique, and the peripheral lymphocyte subpopulation was determined using flow cytometry with the following monoclonal antibodies: T cell(CD3+), T helper cell(CD4+),7 cytotoxic cell(CD8+), and B cell(CD45RA+). Results: Hemorrhage of 7.5 ㎖/㎏ did not induce depression of splenocyte proliferation. However, for hemorrhage greater than 15 ㎖/㎏, the splenocyte proliferative capacity was significantly depressed at 2 days after hemorrhage and recovered at 4 days. Hemorrhage induced no changes in the relative percentage of lymphocyte subpopulations and in the number of each cell in peripheral blood. Conclusion: This study suggests that cellular immunity is depressed at 48 hrs after a hemorrhage greater than 15 ㎖/㎏ without any change in the peripheral lymphocyte subpopulation.

Scorpion intoxication 1례

이경룡,윤천재,이한식 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Scorpion intoxication is not often encountered. Scorpion venom is complex and species-specific, those of the family Buthidae being most harmful to humans. The toxin consists of phospholipase, acetylinesterase, hyaluronidase, serotonin, and neurotoxins. A neurotoxins envenomation can produce severe systemic toxicity, especially in children. Symptoms include throat spasms, muscular fasciculations, abdominal clamps, seizures, increased or decreased blood pressure, oliguria, dysrhythmias, pulmonary edema, and respiratory collapse. We experienced a 60-year-old female patient who suffered abdominal clamp and both leg pain with multifocal PVC through to be caused by scorpion intoxication. She hypertension for several years, but no medications. During last six months she had suffered from facial palsy. So she had received herb medication with scorpion venom. After treatment for 3days she recovered well and discharged. We report this case with literature reviews.

외상 환자의 세포 면역학적 변화

지훈상,이한식,민진식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Thirty trauma patients admitted to our emergency center had lymphocyte phenotypic subsets characterized throughout hospital course. The immunosuppressive disease and CNS injury patients were exclude. There was no mortality in our studied cases. T-lymphocyte(CD-3), T helper(CD-4), T suppressor(CD-8) and B-lymphocyte(CD-19) were quantified by monoclonal antibodies and flowcytometric analysis. Results were analyzed on the day of admission 1st day, 2nd day, 4th day and 8th day among three groups: Injury severity score(ISS) below 15(n=10), 15-25(n=10), over 25(n=10). The patients were compared to 20 healthy controls. The immunologic depression was maximal on 2nd day and nearly recovered on 8th day. ISS over 25 group was most significantly depressed in all subset of T- lymphocyte, but ISS 15-25 group was slightly depressed less than ISS below 15 group. The B-lymphocyte was changed in similar pattern like as all subset of each ISS group, but the initial B-lymphocyte slightly increased comparing controls. Therefore the immunologic depression is affected by severity of trauma, and the severe and mild depression of immune system is included. The patterns of immune depression of T-lymphocyte and its subset were double peak in mild and severe trauma patients. The B-lymphocyte is stimulated in severe trauma patients during the initial stage of injury.

구급차를 이용한 응급 환자의 중증도 분류

박인철,이경룡,이한식 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Authors performed a prospective study of patients who visited to ED of Severance Hospital via ambulance during the period of six months from April, 1, 1995 to September, 30, 1995. Our study assessed the adequate patient transfer via EMS system and to suggest more advanced guideline for patient transfer. The results were as follows: 1) Among the total 16,794 patients, 2,250 visited via ambulance ranged from age of 1 to 89 years old with an average 43yrs. 2) Among 2,250 patients, 1,122(50%) visited via 119 system, 546(24%) via 129 EMS system, and 582(26%) via other hospital ambulances 3) 270(12%) patients were classified into urgent, 894(405) into emergent, and 1,086(48.4%) into non-emergent. 4) For the patients via 119 system, 102(9.1%) patients were classified urgent and 630(56.1%) non-emergent, via 129 EMS system, 78(14.3%) urgent and 228(41.8%) non-emergent, and via other hospital ambulances, 90(15.5%) urgent and 228(39.2%) non-emergent. These results show that patients who visited level Ⅲ emergency care center via ambulances were classified into non-emergent about 50%. We conclude that if more effective classifying system which used by EMT for emergency patients is applyed, non-emergent patients can be transferred to more low grade emergency center, and the overcrowding of level Ⅲ emergency center can be improved.

응급환자에 대한 맥박산소측정기의 임상적 평가

안철민,이한식,조광현,황태식,김성규 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Pulse oximetry is a noninvasive method of measuring blood oxygen saturation even before changes to the cardiopulmonary functions become apparent clinically. Therefore it has been widely excepted in many disciplines as a standard patient monitoring equipment. But its accuracy has been argued at low oxygen saturation levels. To determine the accuracy of the pulse oximetry in the emergency department where the patients presenting with respiratory difficulty are expected to have low oxygen saturation levels. Prospective, cross-sectional, paired measurements of oxygen saturation by two different pulse oxineters(SpO2) against oxygen saturation of arterial blood gas analysis(SaO2) was performed from May 1994 to September 1995 at two different university hospitals. Two pulse oxineters each with its digital probe were applied to the patient for the measurement of SpO2 simultaneously and arterial blood gas was drawn for analysis(ABGA) at the same time to measure SaO2. 98 patients who met the criteria mostly consisted of cardiopulmonary patients. There were no significant differences between mean SpO2(88.1±11.4, 88.2±10.0) of the two pulse oximeters and mean SaO2(88.7±11.4) from the arterial blood gas analysis(p=NS). Strong correlations were found(r=.80). But the regression declined as SaO2 decreased especially SaO2 < 90%. The pulse oximetry is potentially useful in patients with clinical signs of acute hypoxemia and patients receiving interventions that may produce acute hypoxemia, because of their ability to continuously monitor the oxygen saturation. But pulse oximetry along cannot identify the degree of hypoxemia or severity of distress. Therefore patients complaining of respiratory difficulty in an emergengy department, history and physical examination must be performed with pulse oximeter as a guide while backing it up with ABGA.

응급실의 약물중독 환자

송근정,조광현,이한식 大韓應急醫學會 1992 대한응급의학회지 Vol.3 No.1

Any short of medical drug, insecticide or foods sometimes makes harmful situation whether it is beneficial or not. Nowadays, the treatment for drug intoxication started mostly in emergency department. The initial treatment must start as soon as possible. The prognosis is depend upon a kind of drug, exposure time and time of initial treatment. Authors conducted a review of acute poisoned patients seen from April 1983 to July 1992, who visited emergency department of Yong Dong Severance Hospital. The results were as follows, 1. The patients of Drug intoxication account for 0.68% of total emergency department patients. 2. Male to female ratio was 1:1.9 and the age distribution revealed a high incidence in second decade(35.7%) 3. From all the cases of drug intoxication and 67.2% was done on purpose. 4. The drug used were sedatives, CO intoxication, pharmaceuticals, pesticide, in order. 5. Admission rate was 23.8% and mean hospital day 6.0 days. 6. ICU admission rate was 30.0% and mean staying time was 4.7 days.

법적인 문제를 일으키는 응급환자

송근정,장문준,이한식 대한응급의학회 1993 대한응급의학회지 Vol.4 No.2

Recently, number of legal problems beside of malpractice is increasing in hospital, especially in ED, with a social economic development. A retrospective study of consecutive 72 patients who visited YDSH ED profiled legal problems due to stab wound, D.O.A. patient caused by violent crime, patient had been arrested by lawfal agent, rape, gun-shot wound, hopeless person and organ donor were included in this study. The purpose of this article is due to prevent and prepare for the such legal problem by understanding legal aspect of problems listed above. The results were as follows : 1. There was 59 patients of stab wound with male/female ratio of 2.7 to 1, admission/discharge was 23 to 36 patients. 2. Five D.O.A. patients were caused by violent crime, 3 patients by blunt trauma and 2 patients by stab injury. 3. Three patients were related with arrest. 4. Two patients were related with rape. 5. There was I patient in hopeless, gun-shot wound and donor respectively.

응급실 난동환자에 대한 연구

김성중,장석준,이한식 大韓應急醫學會 1992 대한응급의학회지 Vol.3 No.1

Authors have reviewed emergency room violentee for 6 months and obtained following results; 1) Of violentees in the emergency room, male was 4 times much as female and a high incidence in third and fourth decade. 2) Traumatic patients were more violent than non-traumatic patients. Among traumatic: patients, assault was highest. The departmental distribution was Orthopedic Surgery, Internal Medicine and Plastic Surgery in order. 56 patients (21.2%) was drunken status. 3) The emergency room violence occured mostly in the night shift. 4) Patient caused more violence than a guardient. It happened mostly in front of the nursing station and in the emergency care unit. 5) The most of violence happened within 30 minutes in arrival. 6) The leading cause of violence was the delay of laboratory study and treatment. 7) The violence was mostly verbal abuse to the ED nurse. 8) Sixteen cases were reported to the police and they react in average 23 minutes. It is important to know the nature of the violent in emergency room. It helps in dealing with them and makes us realize about the education and training to the emergency personnels. It is necessary to solve the problems faced in the emergency deparment not only administrative and financial aids but also further study and endeaver of the emergency personnel.

과호흡증후군 환자에서 이온화칼슘,마그네슘과 산-염기상태의 변화에 대한 고찰

윤천재,정순미,장문준,이한식 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.3

Background. Tetanic spasm is often noted in hyperventilating patients coming in to emergency departments. Classical explanation for this phenomenon was decreased ionized calcium levels due to respiratory alkalosis precipitated by the hyperventilation. Clinically these symptoms were observed in hypocalcemia and were thought as such without doubt, But6 clinical investigation on the levels of ionized calcium levels have not been clarified. Recent investigations on hyperventilating volunteers have suggested other pathophysiology for tetanic spasm in hyperventilating patients which is the decrement of ionized magnesium level rather than ionized calcium. We wanted to see if these results applied to our hyperventilating patients and see if ionized magnesium level was a factor producing tetanic symptoms. Method and Material, 35 patients with diagnosis of hyperventilation syndrome by emergency physician were studied retrospectively. Hyperventilating patients arriving at Severance hospital Emergency Center from Jan. 1996 to Feb. 1998 were included. Patients with cardiovascular, pulmonary diseases, history of renal or liver disease were excluded. Ion-selective method was used to detect ionized calcium, magnesium levels and arterial blood gas features. Average levels were compared to reference ranges and Wilkoxon-rank, sum test was used to compare hyperventilating patients with tetanic spasm and those with other symptoms such as dyspnea, chest pain and palpitations. Results. 1) Sodium, potassium and chloride levels were 138mmol/L, 3.6mm/l, 106mm/l each which were within a normal range. 2) Degrees of hyperventilation were similar with average of PH 7.54(7.4-7.71), pCO₂ 23.6mmHg, showing respiratory alkalosis. 3) Ionized calcium and ionized magnesium each showed 0.61mg/dl, 0.16mg/dl lower values than the lowest reference ranges which were 4.5-5.6mg/dL for ionized calcium and 1.19-1.63 for ionized magnesium. 4) No statistical difference points were observed between the tetanic spasm group and group without spasm. Female preponderance were noted in tetanic spasm group. Conclusion. We conclude that other than decrement of ionized calcium, decrement of ionized magnesium could be a factor for inducing tetanic spasm in respiratory alkalosis caused by hyperventilation.

혈청 neuron specific enolase를 이용한 심정지후 신경학적 예후의 예측

강용선,정성필,박기일,김승환,김태승,이한식 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: The purpose of this study was to determine that the assessment of serum neuron specific enolase(NSE) could provide a reliable early predictor of neurologic outcome after cardiac arrest. Methods: Prospective, observational study was performed from April 1996 to March 1998 at a university teaching hospital ED. Serum NSE concentrations were analysed twice at 24 and 48 hours after return of spontaneous circulation(ROSC). Neurologic outcome was categorized using cerebral performance category(CPC). Results: Twenty-nine patients(16 were men) were enrolled during the study period. The mean age was 50.8 years. Nine(31%) of them showed good outcome defined as CPC 1-3, and 20(69%) patients showed bad outcome defined as CPC 4-5. In the good outcome group, the serum NSE was revealed 33.8±9.3 ng/ml at 24 hours, 34.0±4.73 ng/ml at 48 hours. While in the bad outcome group, it was 99.5±11.7 ng/ml and 114.6±15.8 ng/ml. The NSE at 48hr after ROSC was more prescise than that of 24hr. When the cutoff value of 50 ng/ml at 48hr, the sensitivity was 82%, and specificity was 93%. Conclusion: This study suggest that the serum NSE may represent a valuable, noninvasive, and useful clinical tool for prediction of neurologic outcome after cardiac arrest.