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하영록,김훈,유승,정성필,김승환,유인술 대한응급의학회 2002 대한응급의학회지 Vol.13 No.4
Purpose: The purpose of this study is to determine for upper abdominal pain, the accuracy of emergency abdominal ultrasonography (EAU) performed by emergency physicians with limited training. Methods: Two PGY-3 emergency physicians, who had received 2 hours of hands-on training, including the normal anatomy of a biliary system, liver, kindney, spleen, and pancreas, and who had studied the pathologic findings for another month were the subjects of this study. They used a Sonosite 180? to perform EAU on patients with upper abdominal pain within 2 months after training. We determined the agreement between the radiologist’s abdominal ultrasonography(RAU) and EAU by using Kappa statistics. Results: A total of 59 patients were enrolled. The agreement between the EAU and the RAU findings was 0.97, 0.88, 0.79, 0.73, 0.62, and 0.57 for gall bladder (GB) distension, cholelithiasis, GB wall thickening, duct dilatation, choledocholithiasis, and pericholecystic fluid, respectively (p<0.05). Conclusion: The results of EAU, performed by emergency physician with limited training on patients suffering from upper abdominal pain had a significant agreement with the RAU. However, more educations and cautions are warranted for diagnosing pericholecystic fluid and choledocholithiasis.
하영록 대한의사협회 2012 대한의사협회지 Vol.55 No.11
Bedside ultrasonographic examination is known to be a quick, noninvasive, cost-effective,repeatable, and harmless diagnostic modality. It can be a powerful tool for clinicians, especially in time-dependent situations including trauma. Focused assessment with sonography in trauma (FAST) has been established as a protocol especially specifically for hemodynamically unstable patients with blunt abdominal trauma. The physiologic priority of airway, breathing,circulation, and disability (ABCD) of injured patients should be assessed using a multi-systemic,multi-focused, problem-based, and point-of-care ultrasound as an extension of physical examination. This ultrasound-enhanced trauma life support, so called FAST-ABCD, can provide a great deal of important information for helping the primary physician in critical decision-making by systemically combining the airway, lung, cardiovascular, abdominopelvic, orbital, and transcranial ultrasound. Additionally, it can provide information on airway patency, guidance of endotracheal intubation and cricothyroidotomy, lung contusion, limited hemodynamics, differential diagnosis of shock, intracranial hypertension, and even more extensively on a secondary survey from head to toe. The indications for the utility of ultrasound in trauma continue to evolve beyond FAST. FAST-ABCD could be incorporated into advanced trauma life support by obtaining more evidence through more studies worldwide.
Ketoprofen의 국소도포와 근주사용시 진통효과의 비교
하영록,김옥준,김승호 대한응급의학회 1997 대한응급의학회지 Vol.8 No.4
Background: Ketoprofen is one of frequently used analgesics to relive the localized pain. Ketoprofen can be administered in many route such as oral, percutaneous, intramuscular(IM) or intravascular. In order to reduce the systemic side effects and gastrointestinal irritation and to avoid pain from unnecessary injection of ketoprofen, a 3% ketoprofen gel was formulated. The object of this study is to compared the efficacy of analgesic effects between an intramuscular injection and topical ketoprofen in patient with contusion or sprain. Method: The efficacy of analgesic effect was evaluated following 100mg IM or 3% gel percutaneous administration by using verbal rating scale from 0 to 10. Wilcoxon rand sum test was used to compare the efficacy between two groups. Result: Sixty-seven adult patients were enrolled in a prospective study. Sex and site of injury was not statistically significant. There was no statistical difference between IM and percutaneous administration in efficacy of analgesia from 0 to 20 minute. But after 20 minutes, statistical difference was observed between two groups. Pain relief in percutaneous adminstration group is more effective than IM group. Conclusion: Percutaneous application of ketoprofen gel is an effective alternative to ketoprofen IM injection for relief of pain with simple contusion and sprain in adult without remarkable side effect.