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이승한,최옥경,정구영 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1
The Emergency Medical Technitian(EMT) is the main personnel of Emergency Medical Service Systems, requiring a whole set of special rescue skills and the knowledges for emergent patients in prehospital area. The most important aspects of the EMT system is the medical direction, which is education, protocol, and quality assurance especially in implementing phase. The EMT system just has been started in Korea with legislative effort of Emergency Medical Act since 1994. There has been no data about the frequencies of prehospital emergency care and it`s medical evaluation. Therefore, we investigated the volume of the prehospital emergency care performed by 119 rescue personnel, and assessed the accuracy of cardiopulmonary resuscitation(CPR) skills. We also analyzed which personal factors influence the accuracy of CPR skills by using the multiple regression test in SAS program. One hundred sixty four(64.5%) of the 259 rescuer graduated highschool, and 66.4% had less than 4 years career as a rescuer. Sixty one percentage has less than four times of CPR training. The interval from the last CPR training was less than 6 months in 59.1%, and less then 1 year in 71.4%. While over 75% of 119 rescuers had the experiences of primary emergency cares, about 50% had of CPR and of vital sign check. The accuracy of chest compression were 48.3%, 50.2%, and 52.2% in the rate, depth, and the site, but the accuracy of ventilation, and the ratio of inspiration and expiration. The accuracy of CPR was influenced only by times of CPR training(p=0.0083), not by the education level, the professional career, nor interval after the last training. From the above results, we could have conclusion that EMT training program should be focused to the initial patient assessment, and CPR training should be shared more time in ventilation than in chest compression. Also we could reach to a conclusion that it is important to increase the times of CPR training for improving the accuracy of CPR and that the proper interval of the training might be less than 3 months in early phase.
김성환,황성오,이강현,조준휘,강구현,문중범,이승환,윤정한,최경훈,김영식 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3
Background: The aim of this study was to determine whether the conventional subcostal approach is suitable for emergency pericardiocentesis in patients with cardiac tamponade or impending cardiac tamponade. Methods: This study was a prospective, observational study conducted at the emergency department of a tertiary hospital, Patients who had symptomatic pericardial effusion and who needed emergency pericardiocentesis in the emergency department were included in this study. We measured the epicardium-to-pericardium distance at the subcostal, parasternal, and apical area with two-dimensional echocardiography to determine the appropriate puncture site for pericardiocentesis. An epicardium-to-pericardium distance of more than 1.0 cm was considered as the primary safety factor in determining the Puncture site for pericardiocentesis. The skin-to-pericardium distance was considered as secondary safety factor. Results: Ninety-five consecutive patients(55 males and 40 females; total mean age: 53 year old) with cardiac tamponade or impending cardiac tamponade were enrolled in this study. The puncture site for pericardiocentesis, as determined by echocardiography, was the subcostal area in 43 patients(45%), the apical area in 40 patients(42%), the left parasternal area In 11 patients(12%), and the right parastemal area in one patient(1%). Pericardiocentesis failed in 2 patients(2%) with the subcostal approach and in one patient(1%) with the apical approach. The average epicardium-to-pericardium distance was 31 ±21 mm in patients with the subcostal approach and 21±8 mm in patients with other approaches. There were no differences in the amount of pericardial fluid and in the intraperical pressure among patient groups according to puncture site. There were two procedure related complications: a puncture of the right ventricle with the subcostal approach and a ventricular tachycardia with the apical approach.
Chemical Reactivity of Ti<sup>+</sup> within Water, Dimethyl Ether, and Methanol Clusters
Koo, Young-Mi,An, Hyung-Joon,Yoo, Seoung-Kyo,Jung, Kwang-Woo Korean Chemical Society 2003 Bulletin of the Korean Chemical Society Vol.24 No.2
The intracluster ion-molecule reactions of $Ti^+(H_2O)_n,\;Ti^+(CH_3OCH_3)_n,\;and\;Ti^+(CH_3OD)_n$ complexes produced by the mixing of the laser-vaporized plasma and the pulsed supersonic beam were studied using a reflectron time-of-flight mass spectrometer. The reactions of $Ti^+$ with water clusters were dominated by the dehydrogenation reaction, which produces $TiO^+(H_2O)_n$ clusters. The mass spectra resulting from the reactions of $Ti^+\;with\;CH_3OCH_3$ clusters exhibit a major sequence of $Ti^+(OCH_3)_m(CH_3OCH_3)_n$ cluster ions, which is attributed to the insertion of $Ti^+$ ion into C-O bond of $CH_3OCH_3$ followed by $CH_3$ elimination. The prevalence of $Ti^+(OCH_3)_m(CH_3OD)_n$ ions in the reaction of $Ti^+\;with\;CH_3OD$ clusters suggests that D elimination via O-D bond insertion is the preferred decomposition pathway. In addition, the results indicate that consecutive insertion reactions by the $Ti^+$ ion occur for up to three precursor molecules. Thus, examination of $Ti^+$ insertion into three different molecules establishes the reactivity order: O-H > C-O > C-H. The experiments additionally show that the chemical reactivity of heterocluster ions is greatly influenced by cluster size and argon stagnation pressure. The reaction energetics and formation mechanisms of the observed heterocluster ions are also discussed.
김성훈,김지연,김현영,신채희,김동완,김기환,박현용,박무인,박선자,구자영 고신대학교 의학부 2002 高神大學校 醫學部 論文集 Vol.17 No.1
Primary small cell carcinoma of the stomach is a very rare cell type in gastric cancer and an extremely aggressive tumor with grave prognosis. Because of the highly malignant potency, chemotherapy for the primary therapy of small cell carcinoma is accepted generally. We report a 44-year-old man with primary advanced gastric small cell carcinoma who respond to cisplatin and etoposide combination chemotherapy.