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봄나물 섭취 후 이상 행동을 주요 증상으로 내원한 환자 1례
옥택근,김윤성,박찬우,문중범,최기훈,서정열,안희철,안무업,조준휘,Ohk Taek-Geun,Kim Yoon-Seong,Park Chan-Woo,Moon Joong-Bum,Choi Ki-Hoon,Seo Jeong-Yeul,Ahn Hee-Cheol,Ahn Moo-Wob,Cho Jun-Hwi 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.1
With well-being boom recently, the common people, but not experts, are increasingly taking in them directly by picking wild herbs. However, only experts can distinguish between edible vegetables and poisonous herbs from the wild herbs. Especially, it is not even easy for experts to distinguish them only by looking into buds in spring without flowers or fruit. So, sometimes many patients are being carried into the emergency room by the toxic symptom after taking by misunderstanding the poisonous herbs as edible vegetables. For herb intoxication as well as drug intoxication, what kinds of vegetables patients took in, and when and how much they took in them are important information for curing. Of course, in the case of intoxicating in the wild herbs, the patients can have a lot of symptoms and sings-hemodynamic alteration and abnormal neurologic sign as well as gastrointestinal symptoms-according to the kinds of herbs which they took in. Therefore, it is difficult to find the kinds of herbs which they took in through the specific symptoms. Recently we experienced a case with showing typical anticholinergic symptoms after ingestion of Scopolia japonica. As a result, the publicity activities about the wild plants needs because if the person without their previous knowledge take in the poisonous herbs, serious side effects can be produced..
'만병초' (Rhododendron brachycarpum)에 의한 전신 중독 2례
옥택근,김윤성,박찬우,문중범,이봉기,조병렬,김용훈,김성은,최기훈,서정열,안희철,안무업,조준휘,Ohk, Taek-Geun,Kim, Yoon-Seong,Park, Chan-Woo,Moon, Joong-Bum,Lee, Bong-Ki,Cho, Byung-Yeul,Kim, Yong-Hoon,Kim, Seong-Eun,Choi, Ki-Hoon,Seo, Jeong-Ye 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.2
Historically, the common folk have made use of various wild herbs for both food and medicinal purposes. However, the misuse of these wild herbs can lead to adverse consequences, including severe poisoning in some cases. In cases of poisoning from wild herbs, patients can exhibit a variety of symptoms depending on the herbs involved, which in addition to gastrointestinal symptoms may include hemodynamic alteration and abnormal neurologic signs. In the present case, two patients were admitted to the emergency room with symptoms of toxicity after consuming Rhododendron brachycarpum liquor. Rhododendron brachycarpum and other wild herbs contain the toxic material grayanotoxin. Because of its serious toxic symptoms, great caution must be exercised in using rhododendrons for food and medicinal purposes.
객관 구조화 절차 기술 평가에서 채점자로서의 표준화환자의 신뢰도
손희정(Son, Hee-Jeong),문중범(Moon, Joong-Bum),이향아(Lee, Hyang-Ah),노혜린(Roh, Hye-Rin) 한국산학기술학회 2011 한국산학기술학회논문지 Vol.12 No.1
본 연구는 절차기술의 객관구조화 진료시험(Objective Structured Clinical Examination)에서 표준화환자가 평 가자의 역할을 수행할 수 있는지 알아보기 위해 신뢰도를 평가하는데 그 목적이 있다. 시험의 주제는 남성 도뇨관 삽관과 창상드레싱 2가지로 정하고, 2년 이상의 객관구조화 진료시험 채점 경력이 있는 표준화환자와 교수 각 4명을 2명씩 짝을 지워 한 주제 당 표준화환자 그룹과 교수 그룹이 동시에 채점하게 하였다. 표준화환자들에게는 술기의 정의, 방법, 주의점, 후유증에 대한 교육이 이루어졌으며 동영상이 포함된 강의, 교수의 시연 후 표준화환자가 직접 실습해보고 교수로부터 되먹임을 받는 순서로 총 8시간( 주제당 4시간)의 교육이 시행되었다. 8명의 평가자 모두 객 관구조화 진료시험 전날 모여 기존의 동영상자료를 이용한 가상 채점으로 1시간동안 채점 표준화를 이루었다. 채점 표는 체크리스트 14문항과 총괄평가 1문항으로 이루어졌다. 한 학생당, 주제당 5분간의 시험 후 2분간의 평가가 이 루어졌다. 표준화환자와 교수간의 분석은 GENOVA program을 이용하였다. 연구 결과 주제 전체에서 G상수는 0.839, 평가자의 신뢰도는 0.946으로 매우 높았다. 표준화환자그룹과 교수그룹 사이의 평가자간 일치도는 체크리스트에서 0.949, 총괄평가에서 0.908이었다. 따라서 적절한 교육이 선행되어진다면 표준화환자도 절차기술의 객관화진료시험에 신뢰할 만한 평가자로 이용되어질 수 있을 것이다. The purpose of this study is to investigate whether standardized patient(SP) can be used as a reliable examiner in Objective Structured Clinical Examination(OSCE). 4 SPs and 4 faculties who have more than 2 years experience of OSCE scoring were selected. For 1 assignment 2 members of faculty and 2 SPs were designated as raters. SPs were educated for assessing 2 technical skills, male Foley catheter insertion and wound dressing, for 8 hours (4 hours / day, each topic). The definition, method, cautions and complications for each of procedural skills were covered in the education. Theoretical lectures, video learning, faculty demonstration and practical training on mannequins were employed. The 8 raters were standardized for an hour with simulated OSCE scoring using previous videos on the day before the OSCE. Each assessment was composed of 14 checklists and 1 global rate. The allotted time for each assignment was 5minutes and for evaluation time 2 minutes per student. The evaluation from the faculty and SPs were compared and analyzed with the GENOVA program. The overall generalizability coefficient (G coefficient) was 0.839 from two cases of OASTS. The reliability of the raters was high, 0.946. The inter-rater agreement between faculty group and SP group was 0.949 for checklist and 0.908 for global rating. Therefore SPs can play a role of raters in OSCE for procedural skills, if they are given the appropriate training.
지호진,김현,김선휴,오성범,문중범,이강현,황성오,Ji Ho Jin,Kim Hyun,Kim Sun Hyu,Oh Sung Bum,Moon Joong Bum,Lee Kang Hyun,Hwang Sung Oh 대한임상독성학회 2005 대한임상독성학회지 Vol.3 No.1
Blister beetles produce cantharidin, which is toxic to people and animals. Cantharidin has been believed to be an aphrodisiac and an abortifacient based on its tendency to cause marked irritation to the genitourinary system leading to priapism in men and pelvic congestion in women for many years. Cantharidin was used by oriental traditional medicine for more than 2000 years. Typical signs related to cantharidin ingestion are gastrointestinal tract and urinary tract irritation, endotoxemia, shock and myocardial dysfunction. Cantharidin is a severe irritant to epithelial linings (gastrointestinal tract, urinary tract, and skin) and develop systemic inflammatory response syndrome. We report a case of corrosive esophagogastritis and acute renal failure by ingestion of cantharidin.
김윤성,옥택근,신명철,최현영,문중범,김성은,서정열,안무업,조병렬,김용훈,이봉기,김명,조준휘,Kim, Yoon-Sung,Ohk, Taek-Gun,Shin, Myeung-Cheol,Choi, Hyun-Young,Moon, Joong-Bum,Kim, Sung-Eun,Seo, Jeong-Yeul,Ahn, Moo-Eob,Cho, Byung-Ryul,Kim, Yang 대한임상독성학회 2007 대한임상독성학회지 Vol.5 No.1
Glyphosate is the active ingredient in widely used herbicides. It acts through inhibition of the shikimate metabolic pathway in plants. This pathway does not exist in mammals, however, so glyphosate is presumably less toxic to humans. Nevertheless, fatal cases of glyphosate poisoning in humans have still occurred. Cases of glyphosate poisoning reported in the previous literature were almost always caused by intentional ingestion. Therefore, intramuscular injection of glyphosate with suicidal intent has not been reported. We report a case of 43-year-old man with poisoning due to intramuscular injection of glyphosate herbicide. He was admitted to the emergency department with a chilling sensation, local hotness, swelling, and tenderness at the site of glyphosate injection. He was treated with intravenous antibiotics and analgesics for 10 days and was discharged without any other complication.
약물중독에 의한 내원 전 심정지 환자의 특성과 심폐소생술 결과
김윤권,김현,원호경,이권일,오성범,문중범,이강현,황성오,Kim Yun Kwon,Kim Hyun,Won Ho Kyong,Lee Kwon Il,Oh Sung Bum,Moon Joong Bum,Lee Kang Hyun,Hwang Sung Oh 대한임상독성학회 2005 대한임상독성학회지 Vol.3 No.2
Purpose: This study was to investigate the resuscitation outcomes and the clinical characteristics of non-traumatic drug-induced out-of-hospital cardiac arrest by analyzing data from a single institution's registry. Method: We conducted a retrospective study of 795 patients who came to the emergency department with non-traumatic drug-induced out-of-hospital cardiac arrest during the period $1991{\~}2004$. Only patients over 18 years of age were included. Clinical characteristics. variables associated with cardiac arrest, and data during resuscitation were obtained from our cardiac arrest database. Patients were divided into two groups: drug-induced cardiac arrest (drug group, n=33), and non drug-induced cardiac arrest (non-drug group, n=762). Results: Spontaneous circulation was restored in 23 ($72{\%}$) patients in the drug group and in 314 ($45{\%}$) patients in the non-drug group ($x^2=0.020$). The patients who discharged alive number were 46 ($6{\%}$) in the non-drug group and 0 ($0{\%}$) in the drug group ($x^2=0.005$). The witnessed arrest, the epinephrine doses, and total defibrillation energy were not different between two groups. Conclusion: The return of spontaneous circulation rate was higher in the drug group than the non-drug group. However the drug group was lower survival discharge rate than in the non-drug group.
슈퍼와파린(superwarfarin) 살서제 중독으로 인한 장기간 혈액응고장애 1례
박찬우 ( Chan Woo Park ),조준휘 ( Jun Hwi Cho ),배준호 ( Joon Ho Bae ),문중범 ( Joong Bum Moon ),천성빈 ( Sung Bin Chon ),안기옥 ( Ki Ohk Ahn ),이희영 ( Hui Young Lee ) 대한임상독성학회 2011 대한임상독성학회지 Vol.9 No.2
Superwarfarin, such as brodifacoum, is a highly lethal vitamin K antagonist used as a rodenticide. Brodifacoum has a particularly long half-life in the body, which ranges to several months, and therefore requires prolonged treatment with antidotal vitamin K. We experienced a case whereby an 18-year-old male was presented to the hospital with a severe bleeding disorder. It was discovered that he had ingested brodifacoum rodenticide with intent to commit suicide. Despite continual treatment with vitamin K, the bleeding disorder persisted for several months before he recovered. We report this case with literature review.
외상환자의 초기 사망 예측 지표로서의 내원 초기의 염기 결핍, 젖산 및 강이온 차이의 유용성 비교
박경혜 ( Kyung Hye Park ),이강현 ( Kang Hyun Lee ),김선휴 ( Seon Hyu Kim ),오성범 ( Sung Bum Oh ),문중범 ( Joong Bum Moon ),김현 ( Hyun Kim ),황성오 ( Sung Oh Hwang ),김헌주 ( Heon Ju Kim ) 대한외상학회 2005 大韓外傷學會誌 Vol.18 No.2
Purpose: Currently, there is a variety of systems available for predicting prognosis of trauma patients such as trauma score, Injury severity score (ISS) and acid-base variables. But it is not clear that the initial acid-base variables are predictors of prognosis in trauma patients at the emergency department. The objective of this study is to compare the base deficit, lactate and strong ion gap as an early predictor of mortality in trauma patients. Methods: Retrospective record review of 136 trauma patients needed to admit to intensive care unit via emergency department (June 2004 to February 2005). Data included age, injury mechanism, ISS, Revised trauma score (RTS), Multiple organ dysfunction score (MODS), Acute physiology and chronic health evaluation III (APACHE III), Glasgow coma scale (GCS), laboratory profiles, calculated anion gap and strong ion gap. Patients were divided into survivors and non-survivors, shock group and non-shock group with comparison by t-test; significance was assumed for p<0.05. Correlation between acid-base variables and mean arterial blood pressure (MABP) was evaluated. Results: There was a significant difference between the RTS (p=0.00), APACHE III (p=0.00), MODS (p=0.00), GCS (p=0.00) of survivors and non-survivors. There was no significant difference between the ISS (p=0.082), lactate (p=0.541), base excess (p=0.468) and SIG (p=0.894) of survivors and non-survivors. There was a significant difference between the RTS (p=0.023), APACHE III (p=0.002), lactate (p=0.000), base excess (p=0.000) and SIG (p=0.000) of shock and non-shock group. There was no significant difference between the ISS (p=0.270), MODS (p=0.442) and GCS (p=0.432) of shock and non-shock group. The base excess was most correlated to MABP (r2=0.150). Conclusion: Initial base deficit, serum lactate and SIG are not predictors of mortality in moderate to severe trauma patients. Initial base deficit, serum lactate and SIG are correlated with the mean arterial blood pressure in trauma patients in emergency department.