우리 나라 재해 의료의 문제점 : 수원시 재해 대응 훈련의 평가를 통하여 본 ANALYSIS OF EMERGENCY RESPONSE EXERCISE IN THE MOCK DISASTER IN SUWON

곽동진,정윤석,진재우,조준필,김 철,김행재,배택환,김준식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Natural or man-made disasters are serious enough to paralyse the functions of the nation or regional distinct and affect the property and lives of numerous citizens. The first two hours after occurrence of the disaster are critical for determining death or permanent disabilities of the casualties. The current Disaster Medical Service(DMS) System in our country adopts mainly civil defense model which focuses the cause of the accident, compensation of the victims, or reconstruction. So in the initial phase of disaster, the appropriate rescue and emergency treatment is not provided effectively. In order to assess and reorganize the current status of DMS System in Korea, the Department of Emergency Medicine, Ajou University School of Medicine, planned and conducted an emergency response exercise in Suwon city on April 28, 1995. The exercise, which took place near the Kyunggido Culture and Art Center, coordinated the efforts of the Suwon Fire Department and other related agencies. As well as providing training on emergency response, the exercise was valuable for identifying areas of weakness which will be address in the future.

진달래 꽃에 의한 Grayanotoxin 중독 3 례

김아진,김준식,신동운,백광제,한승백,이용주 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3

Traditionally, the Rhododendron species has been used in gastrointestinal disorder or hypertension. Grayanotoxin exists in honey, flowers, pollen, and the nectar of the Rhododenron species. We experienced 3 cases of Grayanotoxin intoxication. The symptoms of intoxication were nausea, vomiting, hypotension, bradycardia, diplopia, dizziness, and chest discomfort. Generally, the treatment for Grayanotoxin intoxication is fluid resuscitation and injection of atropine sulfate. The patients who were intoxicated with Grayanotoxin were discharged without complication after supportive care.

겸상적혈구 혈증에 의한 동통성 발작 1례

김효철,배택환,정윤석,김현수,조준필,김준식,곽연식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

The sickle cell disease are a group of hemoglobin disorders characterized by red cells that undergo sickle shape transformation when they are deoxygenated. Sickle cell disease is transmit-ted as an autosomal recessive trait. This unusual property, due to the polymerization of sickle hemoglobin results in anemia and vasoocclusive complication. 1) The most clinically significant of these disease are sickle cell anemia, sickle cell hemoglobin C disease, and sickle cell beta thalassemia. Symptoms of pallor, fever, abdominal and joint pain, enlargement of the liver and spleen, swelling of hands and feet first appear near the latter part of the first year of life. Intravascular sickling affects all organs. For clinical and therapeutic purposes, exacerbations may be classified as vasoocclusive or pain, aplastic, hemolytic or sequestration crisis. we experienced a 22 year old female patient who suffered severe multiple joint pain and back pain thought to be caused by vasoocclussive phenomena.

응급실을 내원한 요로결석 환자

김성중,김준식,조준필 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

A clinical study was made on 139 cases of urolithiasis among the total number of 14798 who visited in the emergency center during 7 months from June 1994 to December 1994.The 186 patients was suspected the urolithiasis, then the 150 patients was followed through out-patient department of Urology and performed Intravenous pyelogram. Among the 150 cases, the urolithiasis was confirmed in 139 cases. The results are summarized as follows: 1. The ration of the male to female is approximately 2.97:1. 2. The age of the patients ranged from 20 to 50 in approximately 80.6%. 3. Among 52 patient who were not revealed stone in KUB, 45 patients were shown micro-scopic hematuria. The 22 patients were revealed urolithiasis in IVP.The 6 patients found the urolithiasis spontaneously delivered.The 17 patients were diagnosed through out-patient department of urology. 4. The 7 patients, who not hematuria and no stones in KUB, were revealed urolithiasis in IVP performed at other hospital. 5. The major clinical symptoms and signs were flank pain(117 cases),abdominal pain and suprapublic discomfort(35 cases),fever(7 cases),low back pain(7 cases),nausea and vomiting(6 cases),painful urination(1 case),and urinary frequency(1 case). 6. The specific location of the stones showed 98 cases in ureter, 7 cases in kidney,bilaterality(3 cases),and multiple stones(8 cases). The ureteral stones located most frequently in the lower 1/3 of the ureter with 55 cases.

병원내 재난 : 한국의 현실과 재난대비 계획 제안 Status of Korea and proposal of countermeasures

김준식,김행재,김철,유인술,조준필 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

흉통을 주소로 내원한 환자의 임상적 고찰

유인술,김철,김준식,조준필 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Chest pain is one of the most frequent complaints for which patients seek medical attention, and the evaluation of chest pain is among the most challenging problems in emergency department. Because it has the dangers of missing the diagnosis and little objective evidence. The potential harm resulting from the improper assessment and management of the patient with this complaint is enormous. So, on the basis of cause producing the chest pain we can take advantage for rapid and accurate diagnosis. We reviewed the 616 patient's records from Jul. 1994 to Jun. 1995. The result was: Cardiac Disease 321 (52.11%) (Acute Myocardial Infarction 33.02%, Angina 30.02%, Arrhythmia 9.03%, Myocardial Disease 7.79%, etc.), Pulmonary Disease 112 (18.18%), Psychiatric Disease 65 (10.55%), Gastrointestinal Disease 46 (7.47%), Musculoskeletal System Disease 17 (2.76%), Total Mortality Rate was 25 (4.06%) for chest pain and 7.79% in cardiac disease. Finally most common cause of chest pain was ischemic heart disease, but in Korea most of patients who suffer from chest pain did not recognize relationship between the chest pain and cardiac disease. Thus we concluded that knowledge of chest pain can be used for reducing the unexpected death and the financial costs for the diagnosis and delayed treatment, and we must advise relationship between risks of cardiac diseases and chest pain via the mass media.

허혈 조건부여가 심근기능의 회복에 미치는 영향 : 적출 심장모델을 이용한 실험연구 Isolated heart experimental study

백광제,김준식,한승백,전영진,이인성 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: Brief episode of coronary artery occlusion(i.e.,ischemic preconditioning) makes the heart more resistant to injury from a subsequent ischemic insult. Although a great deal of effort has been made in studying ischemic preconditioning, the underlying mechanism of ischemic preconditioning and its effect on hypothermic insult has not been elucidated. This study was performed to see whether ischemic preconditioning protects against the depression of cardiac contractility induced by hypothermic cardioplegic arrest/reperfusion. And recently, adenosine was known to have some correlation with the mechanism of preconditioning. If so, does this effect remain after the blockade of adenosine receptor by 8-phenyl theophyline? Method: Twenty-four Sprague-Dawley rat weighed 250-350g were used and divided into three groups. Rat hearts were removed rapidly, and each isolated heart paced with a rate of 180/min was perfused by modified Krebs-Hensleit buffer(KHB) solution on a Langendorff apparatus for an hour. After obtaining baseline data including left ventricular pressure(LVP), dp/dt, and coronary flow, cardiac arrest was induced by perfusion of 0℃ crystalloid cardioplegic(St Thomas) solution. After that, all hearts were stored in the same St Thomas solution at same temperature for 2 hours. In group Ⅰ(control group), the heart was reperfused by KHB solution. In group Ⅱ(preconditioning group), the heart was subjected to two 2-minute episode of global ischemia followed by 5 minute reperfusion with KHB solution(preconditioning) before cardiac arrest. In group Ⅲ(phenyl theophylline group), the heart was subjected to preconditioning procedure and 8-phenyl theophylline at 10μM in concentration was added to KHB solution at time of reperfusion. Observing parameter was obtained in each group at 10, 20, 40 and 60 minutes after starting reperfusion and compared statistically by use of one way ANOVA test(STASTICA, release 4.5). p-value less than 0.05 was considered significant. Results: Although depressed LVP, dp/dt, and coronary flow were seen in all groups during the reperfusion period, the preconditioned group showed more effective recovery of LVP than that of the control group, especially at 10, 20 and 40 minutes(p<.05). We failed to demonstrate the difference between the phenyl theophylline group and the control group(p=NS). Conclusion: These results suggest that ischemic preconditioning has protective effect on recovery state of hypothemic cardioplegic arrest/reperfusion. Its protective effect was limited during early reperfusion stage and was blocked by adenosine blocker.

낙상으로 인한 좌심실 파열 후 생존한 환자 1례

배택환,김행재,정윤석,김준식,조준필,이철주 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Blunt or nonpenetrating chest injuries are common after motor vehicle accidents or falls. Blunt injury to the heart ranges from contusion to rupture. Cardiac rupture, however, is un-common and associated with a very high mortality rate ; left ventricular rupture due to falling is even more rare. We experienced a case of left ventricular rupture of the heart caused by a fall, which the patient survived. A 63-year-old man fell off a ladder and presented with hypotension from left hemothorax and pericardial tamponade. The hemothorax was relieved via an emergency closed thoracostomy but dyspnea and hypotension continued. And so, echocardio-graphy was done and pericardial tamponade was detected. Emergency left thoracotomy was done to repair the rupture site. We believe that patients with cardiac rupture who reach the hospital alive can often be saved by prompt diagnosis and immediate surgical treatment.

응급의료센터로 내원한 급성심근경색증 환자

정윤석,김준식,유인술,조준필 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Early reperfusion can prevent myocardial necrosis, and clinical trials with reperfusion therapy demonstrating a significant reduction in acute myocardial infarction(AMT) mortality have dramatically changed the treatment paradigm for AMI. All patients with symptoms and ECG findings suggestive of AMI should be considered for treatment with thrombolytic agents. However, only a minority of AMI patients actually receive a thrombolytic therapy. Many patients are often excluded from treatment because they do not meet the criteria for age, duration of the chest pain, and a qualifying ECG. And late arrival at the hospital is a frequently cited reason for not giving a thrombolytic agent. To confirm the reason for not receiving an early reperfusion therapy, we obtained the data for the clinical characteristics, the time intervals between the symptom onset and the start of a thrombolytic agent infusion, the method of reperfusion therapy, the reason for not giving a thrombolytic agent and overall outcomes by retrograde chart review. During the 12-month study period between July 1994 and June 1995, 113 patients were finally diagnosed to AMI, who presented to Emergency Center of Ajou University Hospital in total 30,819 patients. The results were followings: 1. The average age was 59±12 years old, the ratio of male to female was 3.2:1. The direct visited patients to our hospital were 31 and the transfered were 82. 2. The chief complaints were chest pain(86.7%), dyspnea, dyspnea, and mental change. The common preceding diseases were angina pectoris(10 cases), old myocardial infarction(9 cases), congestive heart failure(2 cases) and typical chest pain but not diagnosed(23 cases). The risk factors were smoking(81 cases), hypertension (46 cases) and DM (22 cases). 3. 75 patients had arrived within 12 hours from symptom onset and 38 patients after 12 hours. 45cases (54.7%) were performed the reperfusion therapy ; 31 patients were taken the thrombolytic therapy by tissue-type Plasminogen Activator. 4. The most common reason for not receiving a reperfusion therapy was the time delay and the main was the patient/bystander factor. 5. 75.2%(85 cases) of the patients discharged with or without complications, 7.1% (8 cases) died, 10.6% (12 cases) discharged moribundly, and 7.1% (8 cases) discharged against advise. In conclusion, the time delay was the first reason for not receiving a reperfusion therapy in AMI patients. And the education for the AMI symptom and BLS (Basic Life Support) to the people, good EMS(Emergency Medical Service) system, early definite diagnosis and aggresive therapy may decline the mortality rate.

입원치료를 요하는 소아의 급성복증

배택환,김준식,유인술,조준필,이철주,민영기 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

The acute abdomen defined as an acute abdominal condition which needs immediate decision for treatment is one of the most common cause for emergency care. One thound six hundreds nine patients were visited to pediatric emergency center due to acute abdomen. To aid in early diagnosis and proper treatment, a clinical review was made on 278 cases of acute abdomen under 15 yrs old which admitted to Pediatrics and General surgery via emergency center from June of 1994 to May of 1995. The results as follows: It was 17.3% of total visiting to pediatric emergency center due to gastrointestinal sysmptoms. The sex ratio(Male: Female) was 2.35:1. Acute gastroenteristis was the most common acute abdominal condition(54%) and followed by acute appendicitis(17.9%), and intussusception(13.9%). The most common chief commplaint was vomiting(58%) and followed by abdominal pain(39.4%), diarrhea(35.8%), and fever(42.1%). One hundred fifty-five patients were visited to pediatric emergency center via local clinic and thirty patients via OPDs. The operations were done in 75 patients. Among them, immediate operation were done in 60 patients and delayed operations were done in 15 patients, but there is no difference in complication.