화학물질 누출에 의한 대량재해 : Methyl Isocyanate 누출을 중심으로

양혁준,최중명,유동준 한국응급구조학회 1999 한국응급구조학회지 Vol.3 No.1

Background: We are in the edge of some human made disasters such as hazardous materials and air pollution, for example, the world news reported that the city of Bhopal, India had serious victims related with a leaking out of the chemical materials, Methyl Isocyanate and many people in India were killed by. These situations many people who live in this world are world are worrying about are not others, but just ours and people consider about that kind of the disasters are the possible situation to happen to all the people. Therefore, we performed this basic study to recognize the risk of Methyl Isocyanate leak accident and to prepare local disaster plan with EMS system. Method : Trace 8.0, a simulation software made by the U.S. company Safer System was used as a tool to estimate the diffusion distance, area and its victims at the concentrations of 0.02ppm, 0.2ppm 5ppm respectively for an assumed B-city of 2 hundred thousands population count in which was presumed 500kg Methyl Isocyanate gas to leak out. Results : 1. During 1 hour, maximum diffusion distances of 0.02ppm 0.2ppm and 5ppm were 5.41km, 1.61km and 0.29km respectively on the plume impact. 2. Maximum population counts influenced by Methyl Isocyanate gas at the concentrations of 0.02ppm 0.2ppm and 5ppm were 40838, 4346 and 222 on the plume impact, while those were 138238, 17261 and 1588 on the vulnerability impact, respectively. 3. Therefore, 17261 persons must put on respiratory device and 138283 persons must be evacuated to safety place within 1 hour. Conclusions : Only small amount leak of Methyl Isocyanate may cause tremendous chemical disaster in urban area so its disaster plan must be prepared with an accident simulation program and Material Safety Data Sheets(MSDS). Especially, nearby emergency center of an industrial complex must have a strong position about preparation of chemical disaster plan and perform a disaster dill of hazardous material accident annually.

외상후 응급의학과에서 사망한 환자에 대한 임상적 고찰

양혁준,박철완,이근 대한응급의학회 1993 대한응급의학회지 Vol.4 No.2

This study reviewed 103 deaths resulting from trauma in a 30 months in a 30 months period at the Emergency Department of Chung Ang Gil Hospital to evaluate problems in prehospital and hospital resuscitative care. The results were summarized as follows : 1. Among 103 patients who died of trauma, 71 patients were male(68.9%) and 32 patients were female(31.1%). The mortality rate was 0.095% of all 107,741 patients who admitted to the Emergency Department.(Death On Arrival was 0.53%(573 cases) and Death After Arrival was 0.24%(256 cases)during the same period.) 2. The patients who arrived at the Emergency Department from 30 to 60 minutes after onset of urgent situation was 43.7%, but within 1 minutes only 10.7%. The cases transferred by ambulances was only 19.4%, most of rest were moved by public or private vehicles. 3. The cause of trauma was Traffic Accident in 75%, among them 42.7% were pedestrian injury. 4. The time interval between arrival at Emergency Department and onset of cardiac arrest was commonly within 10 minutes in 40.8% of patients. In 43.7% of patients, death was pronounced within 30 minutes after onset of cardiac arrest. 5. The trauma resuscitation were performed as primary surveys and then secondary procedures. The primary surveys were completed in about 3 minutes after the patients arrival : access of airway (89.3%), oxygen administration(86.4%), IV access(92.2%), and EKG monitoring(81.6%). The secondary procedures were initiated within 10 minutes : endotracheal intubation(81.6%), CVP monitoring(46.6%), paracentesis & DPL(44.7%) and thoracentesis & chest tube insertion(21.4%). 6. The main causes of death were brain injury(36.4%) and irreversible shock(32.0%). On physical examination, the most frequent injuried site was head and neck as 35.4%. 7. The mean ISS of all deaths was 45.24 ±13.59, the mean GCS was 6.44 ±3.36 and the mean RTS was 3.20 ±2.38. By the TRISS method, the mean Ps of deaths was 0.2441. Unexpected death, who were died inspite of Ps?0.5, were 23 cases.

충수염의 임상적 고찰과 초음파의 유용성

박정배,양혁준,김형수,황성연,박철완,이근 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Appendicitis is the most common acute abdomen in Emergency Medical Center & outpatient department. But sometimes, it is difficult for us to diagnose because of clinically variable symptoms. We reviewed the ultrasonographic findings and analyse 521 cases of appendectomy patients about its distribution of sex and age, seasonal prevalence, clinical symptom and signs, laboratory findings, duration from onset of symptom to arrival at hospital, duration from arrival at hospital to operation, vital signs, operative results, and associated diseases, which were treated at the department of General Surgery & Emergency Medical Center in Chung Ang Gil Hospital from July, 1994 to June, 1995. The results were as follows : 1. The most common age group was second decade. And male to female ratio was 1.43:1. Seasonal variation was not significant. 2. Of 521 cases, 141 cases(27.1%) visited the hospital within 24 hours from the onset of symptom, and 259 cases(49.7%) visited between 24 to 48 hours. 3. In duration from arrival to operation, the cases within 6 hours were 263 (50.5%), the cases between 6 and 12 hours were 131(25..1%). 4. In systolic blood pressure, cases below 90mmHg were 19(3.6%), cases above 160mmHg were 23(4.4%). Below 60mmHg diastolic pressure were 55 cases(10.6%), cases above 110mmHg were 9(1.7%). In pulse rate, above 90 rate/min were 171(32.8%). 5. On admission leukocytosis was found in 413 cases(79.3%) and 342 cases of them were pathologic appendicitis. 6. Ultrasoundgraphy was performed in the 87 cases, but 23 cases were suggested appendicitis. Among 23 cases, 22(95.7%) revealed pathologic appendicitis at ooperation and labortatory examination. Of the 64 cases which were normal on ultrasonography, only 2 cases(3.1%) were proved to be appendicitis. 7. The results of 496 operations without ultrasonography were appendicitis in 390 cases(78.6%), mesenteric lymphadenopathy 36(7.3%), pelvic inflammatory disease 28(5.6%), fecalith 15(3.0%), terminal ileitis 8(1.6%), diverticulitis 7(1.4%), urinary tract stones 5(1.0%), cecal cancer 2 cases, right ovarian tumor 2 cases, tubo-ovarian abscess 2 cases, grater omentum internal hernia 1 case. Our results showed that the sensitivity of ultrasonohraphy was 95.8% and the specificity 98.4% in the diagnosis of appendicitis, It suggests that the ultrasonography is very helpful in the diagnosis & differential diagnosis of acute appeendiditis.

65세 이상 노인 급성 심근경색증 환자의 사망에 영향을 미치는 인자들

정봉기,양금열,손준혁,주시내,남홍우,전용덕,이홍순 대한노인병학회 2001 대한노인병학회지 Vol.5 No.2

TRISS Method와 ASCOT Method를 이용한 외상환자의 생존율 분석

김형수,배성만,양혁준,박철완,이근,고영관 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Despite traumatic injuries cause serious problems in our society, there are few adequate and objective scoring system that assess the severtiy of trauma patients. The Major Trauma Outcome Study(MTOS)in United States deisgned the TRISS(Trauma Score & Injury Severity Score)method by means of Revised Trauma Score(RTS),Injury Severity Score(ISS0,and age,while Champion et al deviced ASCOT(A Severtriy Characterizaiton Of Trauma)method to overcome the limitation of TRISS. This study attempted to make a comparison between TRISS and ASCOT by using date for 422 injured patients which were collected form September,1993 to February,1994. Ascot and TRISS were compared in their sensutivity,Specificity,disparity and Z-statistics. 1)Sex ratio of male to female was 2.8:1 and the commonest age of trauma patients was thirties (23.8%). 2)The average probability of survival(Ps)for 442 patient by TRISS method was 0.9228 and that of ASCOT method 0.9356. 3)Disparity of Ps between survival and non-survival using TRISS and ASCOT was relatively low for both indexes as 0.3507 and 0.3296, respectively. 4)The sensitivity rates(number of patients predicted to die who actually died/total who actually died)for the non-survival of both TRISS and ASCOT method were low (35.0%),but the specificity rates(number of patients predicted to live who actually lived/total who actually lived)for the survival of TRISS and ASCOT were 99.1%and 99.6%respectively. 5)Z-statistics(difference between predicted and actual number of death)of both TRISS(1.3224)and ASCOT(1.2234)resulted in positive value which meant that actual number of death exeeded predicted number of death. 6)The ASCOT that have presumed to be more accurate method for patients with head trauma and with multiple injuries to one portion of body,had its intricacy and difficult points in practical application. And the difference between the result of ASCOT and TRISS was not so significant. 7)It is thought that a new, more comprehensive index would like to be developed and thoroughly tested on a variety of data sets in order for it to be used in trauma system quality assurance evaluation.

응급의학과로 내원한 환자중 내원시 예상치 못했던 사망에 대한 고찰

김승렬,김상은,양혁준,정호성,박철완,이 근 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Patients die in the emergency department frequently ; however, there has been little about the incidence and cause of Emergency Department death in the emergency medicine literature. This study was conducted retrospectively to gain insight into the patients who die suddenly and unexpectedly in the Emergency Department(ED). A total of 360 patients were pronounced dead in the ED from 1991 through 1994 in Chung Ang Gil Hospital. Of the 360 patients, 309 (86%) were brought to the ED with cardiopulmonary resuscitation in progress or as do not resuscitation(DNR) patients, leaving 51(14%) patients who met the unexpected death criteria. Of the unexpected deaths, 32(62.7%) patients presented to the ED with either abnormal vital sign (24 of 32) or some alteration in consciousness (18 of 32), or both of them (10 of 56). Medical and surgical causes of death represented 47.1% (24 patients) and 15.6% (8 patients) of the unexpected deaths respectively. Trauma represented 19 (37.3%) of the unexpected deaths, with 14 of these being the result of motor vehicle collision. The yearly incidence of unexpected ED death is presented in numbers of deaths per 10,000 ED visits. In 1991, the incidence was 3.4, and in 1992, 1993 and 1994 those were 2.7, 2.2 and 2.1 respectively.

교통사고로 내원한 접형척추(butterfly vertebra) 환자 1예 보고

염석란,이근,박철완,양혁준,현성열,류일,진욱 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

A butterfly vertebra is a rare, but very important congenital anomaly that must be differentially diagnosed with compression fracture of the vertebral body. It has characteristic findings on simple X-ray, CT, and MRI. These findings are an anterior wedging contour on the sagittal image, a widening of the transverse diameter on the coronal image, adaptations of nearby vertebral endplates on the sagittal image, communicated intervertebral disc spaces on the sagittal and the coronal images, a well-defied midline bony defect with a sclerotic margin in the vertebral body on the axial image, and a normal body signal intensity on MRI. Because of legal problems and further plans for treatment, close attention must be given to patients who complain of back pain and who have decreased anterior height of the vertebral body after trauma. In those patients, a butterfly vertebra must be differentially diagnosed with compression fracture of vertebral body. We report one such case here.

흉골골절이 의심되는 외상환자에서 초음파의 진단적 효용성

염석란,김재광,이근,박철완,양혁준,현성열,임용수,진욱 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Purpose: This study compared the value of ultrasonography(US) in the diagnosis of sternal fractures with those of conventional radiography and bone scan. Material and Method: From March 2000 to March 2001, in Gil Medical Center, Gachon Medical College, 44 patients(22 women and 22 men, mean age 46 years, range 5∼81 years) complained of tenderness in the sternal area. The cases histories of these patients with clinically suspected sternal fracture due to blunt trauma were prospectively studied. At the time of admission, conventional radiography(sternal view) was done. At one day after admission, sternal ultrasonography was obtained, and after 4∼5 days, a bone scan was done. Sternal ultrasonographic findings, conventional radiographic findings, and bone-scan findings were compared. In addition, a 12-lead ECG was done. When it was necessary, cardiac enzyme was checked and echocardiography was performed. Result: In 21 of 44 patients(48%), a sternal fracture was found by sternal US. Only 9 of 21 patients (43%) were diagnosed as having a sternal fracture by using conventional radiography. 23 of 44 patients (52%) have negative findings on sternal US; they also had negative findings on conventional radiography. Except for 7 unchecked patients, 13 of 21 patients(62%) were diagnosed as having a sternal fracture by bone scan, and among the 23 patients who had negative findings on sternal US, the 19 patients checked with a bone scan also had negative findings. Conclusion: Sternal US can find sternal fractures that are difficult to find on conventional radiography. Compared with bone scan, sternal US takes a shorter time and sternal US is not difficult. Additionally, combined lesions with sternal fractures(peristernal hematoma, soft tissue swelling) and costar cartilage fractures are diagnosed more easily when using sternal US.

대형 화재로 인한 사상자의 손상 유형과 합병증 : 동인천 라이브호프 화재를 중심으로

신중호,김재광,염석란,신종환,민순식,임용수,양혁준,이근,황성연 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Background: High risks of fire alway exist for buildings in urban areas, especially those in downtown. Crowds, as well as more complex and larger structures, may cause more victims in the event of fire; therefore, emergency medical service plans must be established for such disastrous events. Methods: On the evening of October 30,1999, a fire broke out in downtown, Dong-Incheon Live-Hof restaurant; 56 people were killed and 76 were injured. Most of them were teenagers. We retrospectively reviewed the medical records of the victims, Results: 1) Among the 56 dead, 54 died from smoke inhalation, one from extensive burns, and one from sepsis during treatment. 2) Among the 76 injured, 70 patients suffered from smoke inhalation, 53 from burns, and 9 from several types of trauma (sprains, contusions, lacerations, abrasions, fractures, etc.). 3) Later complications were laryngeal edema, pulmonary edema, scar contracture, and hypoxic brain damage, and so forth. 4) Post traumatic stress syndrome was unexpectedly more prevalent in mildly to moderately injured survivors and witnesses than in seriously injured survivors. Conclusion: Many complications exist after a fire. Some may be resolved in time, but others may result in permanent sequelae. Early rescue, early triage, and early management during transport by emergency medical service (EMS) personnel can result in fewer complications and a lower mortality rate. Therefore, we propose the establishment of plans to be followed during various major disasters.

Methazolamide 복용 후 발생한 Stevens-Johnson Syndromex

정종호,이은정,김태형,전원선,우광진,양미연,강병일,은준영,추은주,전민혁 순천향의학연구소 2010 Journal of Soonchunhyang Medical Science Vol.16 No.1

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