기술집약적 국제화 기업에서의 해외학습, 혁신성과의 기업성과에 대한 영향 연구

김부수(Boo Soo Kim),송성근(Seong Geun Song),조형래(Hyung Rae Jo) 국제e-비즈니스학회 2020 e-비즈니스 연구 Vol.21 No.3

활력증후가 안정적인 복부둔상 환자에서 증가된 liver transaminase치가 가지는 간손상 진단의 임상적 의의

김주현,김영식,김상철,김호중,김선만,이부수 대한응급의학회 2003 대한응급의학회지 Vol.14 No.3

Purpose: A patient at the emergency department (ED) with blunt abdominal trauma may still have the possibility of liver injury, even though they are hemodynamically stable. Computed tomography (CT) scanning or ultrasonography (US) is available if they are hemodynamically stable. However ultrasonography (US) has technical differences between physicians depending on their skill and computed tomography (CT) is expensive and time consuming, while liver transaminase is widely available, relatively inexpensive. Therefore, we studied diagnostic value of liver transaminase as a screening test for liver injury in hemodynamically stable patients with blunt abdominal trauma. Methods: From March 2000 to February 2001, we treated 44 hemodynamically stable patients with suspected blunt abdominal trauma who were patients with elevated liver transaminase. An evaluation protocol including patient' s age, sex, injury mechanism, history, physical examination, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Injury Severity Scale (ISS), liver transaminase, abdominal US and abdominal CT was prospectively performed on all patients by residents and the staff of the emergency department. Based on the confirmed diagnosis of abdominal CT, patients were divided into two groups: groupⅠwith liver injury and group Ⅱ without liver injury. We analysed the two groups by using the t-test and the chi-square test, and calculated the sensitivity, the specificity and the predictive value of serum aspartate aminotransferase (AST) and serum alanine aminotransferase (ALT) by using multiple cutoff values. Results: There were 34 male patients (76.3%) and 10 female patients (23.70/o) and the average age of all patients was 37 years. Triage RTS and GCS were, respectively, 11.7±0.7 and 13.9±2.1 in group Ⅰ, and 11.4±1.2 and 13.2±3.5 in group Ⅱ, the differences between the two groups were statistically insignificant. The ISS was 26.8±9.4 in group Ⅰ and 21.1±8.0 in group Ⅱ, and the differences was statistically significant. AST and ALT were, respectively, 288.0±113.7 IU/L and 177.9±95.8 IU/L in group I and 148.1±84.8 IU/L and 95.1+59.8 IU/L in group Ⅱ. The maximum value of the highest sensitivity and minimal specificity of AST and ALT, calculated using the receiver operator curve, were AST > 256.3 IU/L and/or ALT > 122.0 IU/L, for which the sensitivity and the specificity were 61.1% and 84.6%, and the positive and the negative predictive values were 73.3% and 75.8%, respectively. Conclusion: We recommend that all patient with suspected blunt abdominal trauma be evaluated using serum liver transaminase as a screening test for liver injury even though they are hemodynamically stable. If AST > 256.3 IU/L and/or ALT 122.0 >IU/L, they should be evaluated with abdominal CT to confirm liver injury.

단기교육으로 시행가능한 심실기능평가법

김원,임경수,오병연,홍은석,김영식,김선만,이부수,현석천,김영득 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: The initial history, physical examination, and ECG assessment should focus on identification of potentially serious noncardiac or cardiac disorders, including coronary artery disease, congestive heart failure, and electrical instability at the emergency room. additionally, it is essential to define disease severity, stability and need for emergency therapy. echocardiography is a useful tool for this purpose. especially Doppler echocardiography may be more sensitive and time-saving diagnostic tool for the evaluation of patients presenting with cardiogenic symptoms. So we evaluate the feasibility of the echocardiographic measurement by emergency physicain after short-term course. Method and Results: Twenty volunteers(10 male, 38.8±9.3 years) were included in the study for measurement of myocardial performance index and established parameters of ventricular function using conventional echo-Doppler methods. Myocardial performance index: (ICT+IRT)/ET, was obtained by subtracting ejection time(ET) from the interval between cessation and onset of the mitral inflow velocity to give the sum of isovolumic contraction time(ICT) and isovolumic relaxation time(IRT). The most of mean values of echocardiogrphic parameters were not significantly different between those of cardiologist and those of emergency physicians(p<0.01). The duration for measuring myocardial performance index was shortest among echocardiographic parameters. the validity of echocardiographic parameters measured by emergency physicians was proved relatively good. Conclusion: It is proved to be feasible for emergency physician to perform echocardiographic evaluation of ventricular function after short-term course

전문 인명구조술팀에 의해 시행된 병원내 심폐소생술 결과의 In Hospital Utstein Style에 따른 분석

김호중,김영식,김선만,김상철,김주현,이부수 대한응급의학회 2002 대한응급의학회지 Vol.13 No.4

Purpose: This study assessed the results of the cardiopulmonary-cerebral resuscitation (CPCR) performed by advanced cardiovascular life support (ACLS) teams on cardiac-arrest patients in pundang - jeseang general hospital by using the in hospital Utstein style. Methods: From march 1999 to February 2001, we collected data based on a formatted protocol by using the in hospital utstein style. The subjects were adult patients over the age of 20 years who had not experienced trauma and who had been resusciated in the hospital (the emergency department (ED), the ward, and intensive care unit, etc.) by an ACLS team. We studied three groups: group Ⅰ (ED), group Ⅱ (general ward), and group Ⅲ (ICU). Results: among 100,552 patients who were admitted, we resuscitated 152 patients (23 in group Ⅰ, 83 group Ⅱ, 46 group Ⅲ). The number of male patient was higher than the number of female (78%/22%, 57%/43% & 53%/47%). For group Ⅰ, Ⅱ, and Ⅲ, respectively patients between 50 and 70 years of age were predominant, and in all groups, the most witness of the cardiac arrest was the nurse. Performed CPCR methods were complex (87%, 80% & 100%), compression only (4%, 0%, 0%), defibrillation only (9%, 17% & 0%) and ventilation only (0%, 3% & 0%). Initial EKG rhythms were VT/VF (9pts 39%, 44pts 53% & 22pts 48%), PEA (9pts 39%, 23pts 28% & 19pts41%) and asystol (5pts 22%, 16pts 19% & 5pts 11%). The average intervals (minutes) from arrest to CPCR were 0.4±0.4, 3.1±2.2, 1.0±0.6, from arrest to initial defibrillation were 2.7±1.3, 4.0±3.2, 3.0±1.1, from arrest to intubation were 0.5±0.4, 3.8±1.3 & 1.1±1.0 and from arrest to initial epinephrine were 1.4±0.7, 3.0±4.4, 1.5±1.1 The durations of resuscitation minutes were 23.1±22.1, 29.6±13.8, 19.4±14.6 The rates of return of spontaneous circulation were 70% (16/23), 55% (46/83), 77% (34/46). The number of discharged patinets were 3 (13%), 8 (9.6%), 9 (45%). The number of patients alive after 1year were 2 (8.7%), 2 (3.4%), 7 (15.2%). Conclusion: The rate of return of spontaneous circulation (ROSC) and the number of patinets after 1 year were higher when the resuscitation was performed quickly, and the ACLS team played a great role in this result. Thus, the resuscitation education and training of nurses are very important and should be pursued continuously.

심정지환자에서 epinephrine투여시 혈중 catecholamine의 변화

임경수,황성오,이부수,이강현,이진웅,임종천,김영식,김선만,김 현 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Background : Cardiac arrest is a potent stimulus for the release of endogenous catecholamine and high plasma catecholamine concentration has been reported during cardiopulmonary resuscitation(CPR). Few data were present about the clinical effect of high plasma catecholamine and endogenous catecholamine response to exogenous epinephrine administration during CPR. Purpose : This study was designed to evaluate endogenous catecholamine response to cardiac arrest and exogenously administered epinephrine during CPR. Method : In 21 cardiac arrest victims, blood sample for epinephrine and norepinephrine was drawn before and 1 minute after each epinephrine administration during CPR. 1mg of epinephrine was administered immediately after intravenous access and 3 minute interval during CPR. Plasma catecholamines were quantitated by high-performance liquid chromatography. Result : Baseline plasma epinephrine concentraqtion was higher in patients with cardiac arrest than normal controls (985±1627 vs 194±173 pg/ml, p<0.05). Baseline plasma norepinephrine concentration was also elevated in patients with cardiac arrest than normal controls, although statistically insignificnat(1965±4915 vs 360±250 pg/ml). Plasma epinephrine concentration in cardiac arrest patients was significantly elevated after exogenous administration of epinephrine, but its response was blunted after the third does of epinephrine. Plasma norepinephrine concentration in cardiac arrest patients was also elevated, but its response was observed only after the first epinephrine administration. Plasma epinephrine concentration was persistently higher in patients with return of spontaneous circulation (ROSC) than patients without ROSC. there was no significant difference of plasma norepinephrine concentration whether spontaneous circulation was restored or not. Endogenous epinephrine response to exogenous epinephrine was not observed in patients having prolonged arrest time over 20 minutes. Conclusion : Results of this study suggests that significant amount of catecholamine is released by exogenous epinephrine administration in spite of high plasma catecholamine concentration, and degree of endogenous catecholamine response influences resuscitation outcome.

원주시 재해대책 훈련의 평가

이진웅,임경수,김선만,안무업,황성오,이부수,김영식,이강현,강성준 대한응급의학회 1994 대한응급의학회지 Vol.5 No.2

To initiate an EMS(Emergency Medical System)-based disater plan at Wonju city (population : 170,000), a mock disaster was developed and carried out. The scenario involved a mock train derailment near Wonju Station resulting in 40 casualties (status : 5 dead, 4 urgent, 10 moderate, and 21 non-urgent). The duties of the disaster relief team were determined by the specific situation at that time. The mock disaster was carried out at the Wonju Station plaza on April 29th, 1994 from 2 to 4 PM. The mock disaster was evaluated by timing each level of response and after completion of the simulation, a meeting was held for discussion. The following results were obtained. 1. The reaponse time for reaching the site was ; disaster relief team 6 minutes, emergency relief team 10 minutes, medical support team 20 minutes, and military support team 25 minutes. 2. The time interval from triage (citical, emergency treatment needed patients) to emergency treatment was 80 minutes and was due to the small number of emergency and medical support personnel. 3. The time interval from triage to transportation : (1) Twenty minutes from start of exercise to 110 minutes for the last patient. (2) Urgent patients : First was evacuated after 20 minutes and the last after 80 minutes (average : 42.5 minutes). The critical patient transported after 80 minutes was trapped inside a structure, and therefore time consuming. (3) Moderate patients : First was after 30 minutes and last was 85 minutes (average : 56 minutes). (4) Non-urgent : First was after 35 minutes and last was 110 minutes (average : 90 minutes). All were transported by bus, two were evacuated by ambulance after misjudgement by the emergency personnel. (5) The dead were transported by truck after all living patients were transported. 4. Points discussed at evaluation meeting : (1) The current Winju city's disaster relief personnel lack systematic training. (2) The fire department does not have a specialized relief team, and are lacking in emergency aid techniques and equipment. (3) The police department lacks plans for guiding emergency vehicles and controlling the disaster site. (4) The military hospital had in sufficient and outdated medical equipment, and cooperation with the medical team was poor. (5) There was a definite need of more emergency relief personnel and more training was needed in triage. (6) Cooperation between our medical personnel and the military medical personnel was insufficient. (7) The recognition of critical patient tags by the relief personnel was inadequate. (8) Communication between the relief teams was problematic due to the absence of a wireless communication system. Conclusion : For an effective simulated disaster relief exercise at Wonju city, all relief teams need adequate and sufficient equipment with a systematized training program consisting of a joint exercise at least twice a year. Sufficient emergency relief personnel with adequate equipment should decrease the time consumed at triage and emergency treatment.

Paraquat 중독환자의 초기검사로서 sodium dithionite를 이용한 소변내 paraquat검출의 임상적 의의

윤갑준,임경수,이진웅,김영식,이부수,박덕우,김선만,이강현,황성오,안무업 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Background : Mortality from paraquat intoxication depends upon plasma paraquat concentration. To know the severity of paraquat intoxication is important for directing therapeutic modality and predicting prognosis. Sodium dithionite test for urinary paraquat provides an easy and simple method to determine the severity of paraquat intoxication in emergency department. purpose : To determine whether the result urinary paraquat test by sodium dithionite can predict outcome in patients with paraquat intoxication in emergency department. Subjects : 48 patients(male 31, female 17, mean age 37 years) who had exposure to paraquat and presented within 24 hours after exposure. Result : Thirty five patients were positive in paraquat urine test and thirteen patients were negative. Clinical manifestations were more severe in positive patients than in negatives. Complication was much more in positives than in negatives. 28 of 35 patients(80%) in positives and 2 of 13 patients(15%) in negatives died. Conclusion : Positive test for urinary paraquat is associated with high mortality and morbidity from paraquat intoxication, and qualitative test for urinary paraquat by sodium dithionite is an useful method to determine the severity of paraquat intoxication in emergency department.