응급 기관 내 삽관에 있어 노인과 성인간의 해부학 및 임상적 특성 비교

이누가,유제성,제상모,박유석,정성필,박인철 대한응급의학회 2010 大韓應急醫學會誌 Vol.21 No.6

Purpose: The aim of the study was to compare the clinical characteristics in emergency endotracheal intubation procedures between non-elderly and elderly patients. Methods: Data for airway registry, which were collected in two emergency departments (ED) between April 2006 and March 2010, were retrospectively reviewed. The airway registry data included patient’s demographic information and variables such as Cormack-Lehane grade, 3-3-2 finger analysis, success rate, the number of attempts at intubation,complications of intubation, and clinical outcomes after intubation. Results: A total of 1,457 patients were enrolled. The mean age of the patients was 62.2±15.7 and 62.1%(n=905)were male. A total of 726(49.8%) patients were classified as being in the elderly intubation group(≥65 years). Cormack-Lehane grade, 3-3-2 finger analysis, the relationship between the number of attempts and success rate, the relationship between Cormack-Lehane classification and success rate, complications, and clinical outcomes after intubation showed no significant difference between elderly and non-elderly groups. Conclusion: Anatomical structures related to endotracheal intubation, the process and clinical outcomes of elderly patients are not different than for non-elderly adult patients. However, considering the lower physiologic reservoir and higher comorbidities of elderly patients, a more vigorous approach to emergency airway management in the elderly is needed.

중증화상환자: 응급실에서 놓치지 말아야 할 평가와 처치

이누가 대한응급의학회 2023 대한응급의학회 학술대회초록집 Vol.2023 No.1

말초 혈액의 미성숙 과립구를 반영하는 델타뉴트로필을 이용한 급성 충수돌기염 환자의 천공에 대한 의의

이누가,정성필,김민정,김현종,이한식,이종욱 대한응급의학회 2012 大韓應急醫學會誌 Vol.23 No.3

Purpose: The delta neutrophil index corresponds to calculated immature granulocyte counts and severity of sepsis. This study was conducted in order to investigate the diagnostic value of the delta neutrophil index as a preoperative laboratory marker for appendiceal perforation in patients with acute appendicitis. Methods: This study was conducted as a retrospective analysis of patients confirmed pathologically as appendicitis at two hospitals from November 2009 to September 2010. Delta neutrophil index was automatically calculated as a subset of routine complete blood count testing. The diagnostic performance of the delta neutrophil index for perforated appendicitis was evaluated. Results: During the study period, 308 patients were enrolled. Among them, 32 patients (10.4%) were confirmed as perforated appendicitis. The delta neutrophil index was significantly higher in the perforated group, compared with the non-perforated group (4.8±7.1% vs 2.0±2.0%,p<0.05). Sensitivity and specificity of the delta neutrophil index for prediction of perforated appendicitis was 25.0%and 96.7%, respectively, at a cutoff level of 5% with an area under the curve of 0.78 on the ROC (receiver operating characteristics) curve. Conclusion: Results of this study suggested an association of the delta neutrophil index with perforated appendicitis. However, the sensitivity was not high enough for use as clinical guidance.

독성 알코올 중독 환자에 대한 고찰

이누가 ( Nu Ga Rhee ),정성필 ( Sung Phil Chung ),박인철 ( In Cheol Park ),이경룡 ( Kyeong Ryong Lee ),김현진 ( Hyun Jin Kim ),김건배 ( Gun Bea Kim ),조영순 ( Young Soon Cho ),권인호 ( In Ho Kwon ),김승환 ( Seung Whan Kim ) 대한임상독성학회 2012 대한임상독성학회지 Vol.10 No.1

Purpose: Toxic alcohols are responsible for accidental and suicide motivated poisonings, resulting in death or permanent sequelae for the afflicted patients. Major therapeutic modalities in these cases include treatment with alcohol dehydrogenase inhibitors and extracorporeal elimination. There have been a number of case reports of toxic alcohol intoxication in Korea. The purpose of this study was to review the clinical characteristics of patients suffering toxic alcohol intoxication. Methods: We retrospectively reviewed the medical records of patients who presented with toxic alcohol intoxication at 8 emergency departments (ED) from Jun 2005 to Nov 2011. Patients who ingested methanol, isopropyl alcohol, ethylene glycol, and other alcohols except ethanol, were included in this study. The clinical characteristics of these patients were analyzed to include anion and osmolar gap, and estimated concentration of alcohol in the body. Results: During the study period, 21 patients were identified who had ingested toxic alcohol (methanol; 12 patients, ethylene glycol; 9 patients). At ED arrival, the mean anion gap was 18.7±6.9 and the osmolar gap was elevated in 13 patients. Oral and IV ethanol were administrated to 11 patients in order to inhibit alcohol dehydrogenase. Extracorporeal elimination procedures such as hemodialysis were performed in 9 patients. There were no fatalities, but the one patient suffered permanent blindness. Conclusion: This study found that ethylene glycol and methanol were the substances ingested which produced toxic alcohol intoxication. The patients presented with high anion gap metabolic acidosis and were typically treated with oral ethanol and hemodialysis.

응급진료센터에 내원한 지역획득 폐렴 환자에서 델타뉴트로필을 이용한 패혈성 쇼 크 발생 예측의 유용성

주영선,이누가,김현종,유제성,정현수,정성필,이한식,이종욱 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.2

Purpose: The delta neutrophil index (DNI) corresponds to the calculated immature granulocyte counts and the severity of sepsis. The aim of this study was to investigate the diagnostic value of DNI as a predictable laboratory marker for septic shock in patients with severe community-acquired pneumonia in emergency department. Methods: The present study was a retrospective analysis of patients with pathologically confirmed communityacquired pneumonia from December 2011 to February 2012 at a hospital. The DNI was automatically calculated as a subset of routine complete blood count test. The diagnostic performance of DNI for septic shock in patients with community-acquired pneumonia was evaluated. Results: During the study period, 105 patients were enrolled. Among them, 27 patients (25.7%) were confirmed as having septic shock according to predetermined criteria. The initial value of DNI was significantly higher in septic shock group than in non-shock group (8.7% vs 2.3%,p=0.008). The peak value of DNI was also significantly higher in septic shock group (18.6% vs 4%, p<0.001). The sensitivity and specificity of the initial and peak DNI values for predicting septic shock in patients with communityacquired pneumonia were 48.2%, 96.2%, 74.1%, and 87.2%, respectively, at initial and peak cutoff levels of 11.2% and 8.7% with an area under the curve (AUC) of 0.72 and 0.81 on the Receiver Operating Characteristic (ROC) curve. The AUC to predict septic shock was 0.74 for the CURB-65 scale. The AUC was significantly increased when peak DNI was added to CURB-65 scale (p=0.007). Conclusion: This study suggested that the DNI is associated with septic shock in patients with community-acquired pneumonia. Clinically, the peak value of DNI added to CURB-65scale could improve predictable performance of septic shock in patients with community-acquired pneumonia.

심한 척추기형을 동반한 기도협착의 수술적 교정 1례

조현민,이누가,이두연 대한흉부외과학회 2002 Journal of Chest Surgery (J Chest Surg) Vol.35 No.11

Surgical Therapy of Airway Compression with Severe Kyphoscoliosis

응급센터로 내원한 급성 췌장염 환자에서 경증 임상경과를 예측하기 위해 CTSI와 비교한 Harmless Acute Pancreatitis Score

강성우,이누가,김현종,유제성,이한식,정성필 대한응급의학회 2012 大韓應急醫學會誌 Vol.23 No.6

Purpose: Several scoring systems and biochemical markers have been proposed for the early prediction of acute pancreatitis. The Harmless Acute Pancreatitis Score (HAPS) is a novel scoring system to recognize acute pancreatitis patients with a non-severe clinical course. This study was conducted to evaluate the usefulness of HAPS to predict good prognosis of acute pancreatitis in the emergency department (ED). Methods: We retrospectively reviewed the electronic medical records of patients who presented to the ED with acute pancreatitis from January 2010 to December 2011. The parameters constituting HAPS, including physical signs of peritonitis (rebound abdominal tenderness), hematocrit and serum creatinine levels were abstracted. Severe clinical course was defined as having one of the following: mortality while in hospital, necrosis as assessed by contrast CT, need for artificial ventilation or dialysis. The diagnostic performance of HAPS for predicting harmless course was evaluated by sensitivity, specificity, and predictive values. Results: During the study period, 144 patients with a final diagnosis of acute pancreatitis were included. Among these 144 patients, 79 were predicted to have a non-severe course by HAPS, of whom 4 patients progressed to severe pancreatitis. The sensitivity, specificity, positive and negative predictive values were 61.5%, 81.8%, 94.9% and 27.7%, respectively. Conclusion: This study suggests that HAPS is simple and can be assessed within a few hours in the ED. HAPS also showed a high positive predictive value that predicts a nonsevere course of acute pancreatitis. Therefore, HAPS may be used as a scoring system to identify non-severe acute pancreatitis in the ED.

Acetaminophen 중독 환자에서 N-Acetylcysteine 투여경로에 따른 치료효과 및 부작용 비교

채효주 ( Hyo Ju Chae ),이누가 ( Nu Ga Rhee ),김현종 ( Hyun Jong Kim ),유제성 ( Je Sung You ),정성필 ( Sung Phil Chung ),이한식 ( Hahn Shick Lee ) 대한임상독성학회 2012 대한임상독성학회지 Vol.10 No.2

Purpose: Serious acetaminophen (AAP) poisoning causes hepatotoxicity. N-acetylcysteine (NAC) is the most effective therapy for AAP poisoning and can be administered orally and intravenously (IV). Several studies have compared the efficacy of these two routes of administration and the results have been controversial. The purpose of this study was to compare the efficacy of oral and IV NAC for the prevention of hepatic toxicity in Korean patients whose serum AAP levels were higher than normal. Methods: A retrospective before/after study was performed, in which the patients presented to the emergency department with an AAP overdose from February 1995 to March 2012. A 3-day oral NAC regimen was used in the beginning, and a 20-hr intravenous regimen was then used from 2007. This study assessed the complications of an AAP overdose, such as hepatotoxicity, hepatic failure and renal failure as well as the side effects of the treatment regimen. Results: A total of 41patients was enrolled in this study. The median ALT and AST were 63 (IU/L) and 57 (IU/L) for the oral NAC treated patients, and 14 (IU/L) and 20 (IU/L) for the IV NAC treated patients (p=0.004 and p=0.001, respectively). The incidence of complications was similar in the treatment groups (p=0.399). Among the patients, 7 patients developed hepatotoxicity and were treated successfully with oral or IV NAC. Conclusion: This study suggests that IV NAC and oral NAC can prevent and successfully treat hepatic toxicity in patients whose serum AAP levels are higher than normal.

요관결석의 위치와 크기에 따른 임상양상 고찰

이준영,김민정,김현종,이누가,정성필,이한식 대한응급의학회 2011 대한응급의학회지 Vol.22 No.6

Purpose: This study was designed to correlate the size and position of ureteral stones to their clinical manifestation. Methods: This study was a retrospective review of medical records of 201 patients who visited the emergency department complaining of renal colic and diagnosed with ureteral stone(s) by use of computed tomography from July to December 2011. The size and position of a stone and the corresponding ipsilateral hydronephrosis, as well as the number and type of administered analgesics, were evaluated. Results: Ureteral stones were located at the ureteropelvic junction in 2.0% of cases, at the proximal ureter between the ureteropelvic junction and the iliac vessels in 41.8% of cases, at the ureter crossing external iliac vessels in 1.0%of cases, at the distal ureter between the iliac vessels and the ureterovesical junction in 12.9% of cases, and at the ureterovesical junction in 42.3% of cases. Where the ureter crossed external iliac vessels, the mean size of stones was significantly larger in the upper ureter, as 5.3±2.3 mm,than in the lower ureter, as 4.2±1.8 mm. Pain duration and stone size were significant factors associated with hydronephrosis by logistic regression analysis. Ketorolac was selected as the first-line analgesics in 169 patients (94.9%). The factor affecting the response to analgesic treatment was stone size. Patients needing analgesic administration three times or more, had smaller stones. Conclusion: Most of the ureteral stones observed were located in the proximal ureter and at the ureterovesical junction. Hydronephrosis occurred more often in patients who had longer periods of pain and larger stones. Patients with smaller stones needed more frequent administration of pain killers.

서방형 아세트아미노펜 중독 환자에 대한 고찰

범진호 ( Jin Ho Bum ),이누가 ( Nuga Rhee ),김민정 ( Min Joung Kim ),박정숙 ( Jung Suk Park ),김현종 ( Hyun Jong Kim ),정성필 ( Sung Pil Chung ),이한식 ( Hahn Shick Lee ) 대한임상독성학회 2011 대한임상독성학회지 Vol.9 No.2

Purpose: The Rumack-Matthew nomogram cannot be applied in managing overdose by extended release (ER) preparation acetaminophen (AAP). This study analyzed the clinical characteristics of ER preparation AAP overdose in order to develop a treatment recommendation. Methods: We retrospectively reviewed the medical records of patients presented to the emergency department as a result of AAP overdose from Jan 2008 to Dec 2010. Only those patients who ingested an ER preparation of AAP were included in the study. Their blood AAP concentrations were measured at 4 and 8 hours after ingestion. Clinical variables related to AAP intoxication were analyzed. Results: Of the total 108 AAP overdose patients identified during the 3-year period, 20 suffered specifically with ER preparation AAP overdose. The mean estimated ingestion amount was 167.5 mg/kg. Treatments including gastric lavage, activated charcoal, and N-acetyl cysteine (NAC) were performed on 10, 14, and 11 patients, respectively. Hepatotoxicity was diagnosed in only one patient who was then successfully treated with NAC. In another case, blood AAP concentration continued to increase until at least 11-hours after ingestion. Conclusion: This study suggested that blood AAP concentrations associated with ingestion of ER formulations of AAP, may increase in an extended manner. Therefore, multiple sampling and longer periods between samples assessing AAP blood concentration may be required for incidences of extended release overdose.