응급실에서 기관내 삽관후 발생한 후두육아종 1례

조남수,김용배,조수형,송민엽,송성용 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Endotracheal intubation has been used widely for the maintenance of airway in the emergency patient and CPR in the acute airway obstruction patient and to treat respiratory insufficiency. Endotracheal intubation has many advantages but it may cause several complications which rate about 4% of endotracheal intubation patient. Among these complications, laryngeal granuloma is a relatively rare complication arising about 1 case per 10,000∼20,000 cases. Authors report a case of laryngeal granuloma which developed after endotracheal intubation required during emergency treatment. Case: A 55-year old female patient visited Chosun University Hospital Emergency Room complaining of dyspnea, cyanosis and sweating on Feb. 8th 1995. According to past history, she had a little obesity, dyspnea on exercise and mild hypertension. At arrival, blood pressure was 240/110mmHg, pulse rate 150 rates/min, respiratory rate 12/min, body temperature 36.5℃ and cyanosis with sweating on whole body was observed. And the mental state was semicoma. At 5 minutes after arrival, sudden respiratory arrest developed and immediate endotracheal intubation which emergency treatment was performed it was difficult to intubate endotracheally due to short neck and obesity. At 1 hour after arrival, general condition of the patient recovered well and extubation was done. The patient was transferred to internal medicine department and discharged after 12 days of medical treatment. At 2 months after discharge, the patient felt a progressive hoarseness and foreign body sensation of larynx. She was diagnosed as laryngeal granuloma at ENT department of Chosun University. She underwent the surgical operation and discharged in good health after 7 days of admission.

서남해안 지방에서 발생한 Vibrio vulnificus 감염의 임상적 고찰

조남수,김춘호,김성중,김용배,조수형,안태훈 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: V. vulnificus infection in found between May and October when the man who has hepatic disorder or immunity disorder eats raw shellfish and it causes the systemic symptoms such as sudden fever, chilling, shock and stupor and local skin lesions like bleb and necrosis. This disease has 46∼61% of fatality rate in spite of intensive treatment. This study conducts the examination of history, epidemic study, ingesting raw fish and bacteriologic investigation in the patients with similar clinical symptoms to the above and examines the diagnostic dorrelations. Method: It is conducted with 31 cases who admitted at emergency medical center of Chosun University Hospital from May of 1995 to September of 1998 and are suspected to have V.vulnificus infection. It analyze bacteriologic examination, the survey of residence, eating raw shellfish, hepatic disorder, alcohol drinking habits and skin lesion. Results: 1) The rate of male and female is 15.5:1 and in the age, 18 cases are in fifties, seven are in forties and six are over sixties. 2) Clinically, V.vulnificus is detected in 20 of 31 cases which is suspected to have V.vulnificus infection and it is not detected in 5 cases. Other bacteria are detected in 6 cases and they include staphylococcus aureus, pseudomonas species, β-hemolytic streptococcus and E-coil. 3) In local distribution, Kohung has 10 cases, Shinan and Mokpo have six, Haenam and Kangjin have five, Yongkwang and Muan have five, Naju and Yongam have five and Kwangju has one. 4) Eating fishes and raw shellfishes is found in 31 cases. In the kind of shellfishes, eating raw clam is 10 cases, raw thin-shelled surf calm is 8 cases, raw oyster is 5 cases and sliced raw fish is 4 cases and pickled sea foods are 4 cases. 5) The cases with hepatic disorder are 23 and 15 cases with heavy alcohol drinking Carrier are included. The cases with Diabetic Mellitus are four and those with pulmonary tuberculosis are two. Two cases have not basal diseases. 6) On the opinion of skin lesion, 20 cases show vesicular necrosis, 7 cases have dendriform erythema, 3 cases have papule and one case doesn't show clear skin lesion. Conclusion: When V.vulnificus infection is detected, it is fatal and those who have hepatic disorder or heavy alcohol drinking habit must avoid eating fishes and shellfishes raw in summer. It is important to have emergency treatment for the patient whose V.vulnificus infection is suspected. It is considered that the administration of initial antibiotics is effective by generalizing the clinical symptom, epidemic opinion and patient history even before the results of bacteriologic confirmed.

Takayasu′s 동맥염에 의한 쇄골하 동맥류(1예)

조남수,조수형,박광철 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Takayasu's arteritis is a non-specific inflammatory process that involves the aorta and its main branches, the etiology of which remains unknown. This arteritis occurs predominantly in young Asian women, although there have been many documented cases in males and non-Asians. Criteria for the diagnosis of Takayasu's arteritis were developed by The Subcommittee on Classification of Vasculitis of the American College of Rheumatology in 1990, of which a modified version is shown in Table 1. The presence of three or more of the six criteria shown demonstrated a diagnostic sensitivity of 90.5% and a specificity of 97.8%. Takayasu's arteritis is known as 'pulseless disease,' and this non-specific inflammatory arteriopathy typically produces segmental arterial narrowing and occlusion with resultant end-organ ischemic consequences, including upper extremity digital necrosis, stroke, visceral ischemia and renal failure. Previously reported sites of aneurysm formation include the thoracic and abdominal aorta, as well as the innominate, the carotid and the superior mesenteric arteries, but rarely the subclavian artery. A 26-year-old man presented with a progressively enlarging and tender pulsatile mass at the base of the left neck, intermittent Claudication of the upper limbs in association with a decreased brachial artery pulse and a bruit over the subclavian artery. Computed tomography and aortography demonstrated a 4 cm × 5 cm aneurysm of the left subclavian artery. There was no evidence of occlusive disease. An aneurysmectomy with 8 mm hemashield graft interposis was performed. Pathology revealed a chronic, active inflammatory process. Aneurysm formation is an unusual complication of Takayasu's arteritis. Emergency department physicians must carefully observed patiens with symptomatic upper extremity pain and paresthesia and must consider whether those symptoms might be due to the formation of a subclavian artery aneurysm due to Takayasu's arthritis

급성 약물 중독에 대한 임상적 고찰

조수형,조남수,김용배 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

A clinical observation was made on 194 cases of drug intoxication to Chosun University hospital via emergency room during one year from January 1994 to December 1994. The observed results were summarized as follows; 1. The ratio of drug intoxicated patients to total patients of emergency room was 1.3%(194 patients of the total 14,836 patients) 2. Female was slightly more than male (54% : 46%) and the age group of the third decade was of the largest proportion. 3. In monthly distribution, September had the largest propotion(14.4%). The largest proportion of the time interval on arrival to emergency room and of presumed time of poisoning was night(8 p.m. ∼12 p.m.). 4. Suicidal attempt was the most common motive of drug intoxication(82.5%). 5. The most common drug of intoxication was S.H.T.(sedatives, hypnotics, tranquilizer)(24.7%). 6. The abnormal signs on arrival to emergency room were tachycardia, tachypnea, hypertension in order of frequency. 7. The observed abnormal laboratory findings on arrival to emergency room were leukocytosis(97 cases), glucosuria(21 cases), proteinuria(10 cases) in order of frequency. 8. The outcome of the patients were recovery(42.8%), against discharge(35%), hopeless discharge(16%), death(6,2%).

사회복지시설 위탁운영에 관한 연구

조원탁,김형수 동신대학교 2004 論文集 Vol.14 No.-

This article shows the characteristics of the juridical person of social welfare to solve the problems concerning entrusting management of social welfare organization in Korea. And this paper explains the basis of law about entrusting management of social welfare organization. Finally this shows the recent amendments of social welfare law and development. In Korea, since the modern social welfare organiztion has been introduced, many institution were developed. Even though the volume became remakably bigger, the quality and equity of management was not formless, a little bit confused until now. In conclusion, when the goverment entrust the social welfare organization to the private sector, it is important for the goverment to execute a appropriate and transparant procedures to manage and achive the non-profital goal of social welfare organization.

응급의학과의 인식 및 발전 방향에 대한 연구조사 : 광주광역시 및 전라남도 지역을 중심으로

조수형,조남수,김성중 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3

Background: The present study was performed in order to identify the possible future location of the Department of Emergency Medicine and future demand for and supply of manpower through a survey of the heads of Kwangju City and Chollanam-do hospitals. The survey covered the degrees of recognition and understanding, the necessity, the future prospects, and the direction of development of the Department of Emergency Medicine. Methods: A total of 33 large-scale general hospitals were selected in county districts having more than 200 sickbeds as of November 1999. Among them, the heads of 29 hospitals responded to the survey. The survey had a total of 31 questions, including 6 questions on the status of the emergency room. Six(6) questions concerned the degree of recognition of the Department of Emergency Medicine. Six(6) questions concerned the degree of understanding of the Department of Emergency Medicine. Six(6) questions concerned the necessity for the Department of Emergency Medicine, and 7 questions concerned the future prospects and direction of development. The results of the survey were analyzed. Results: 1) As to the question of the degree of recognition, the Department of Emergency Medicine was known to all. That is, 50% of the respondents were well aware of the department, and 50% a little, Nineteen(19) respondents(65%) answered that it was convenient to have the Department of Emergency Medicine in a university hospital, among which 16 respondents(55%) answered that it was because of the rapid treatment of emergency patients. 2) As to the question of the degree of understanding, particularly, the areas of medical examination and treatment by the Department of Emergency Medicine, 15 respondents answered that it was for the treatment of patients who needed to receive emergency treatment, while 12 respondents answered that it was for the diagnosis and treatment of all patients who visited the emergency room. Only 7 respondents(24%) answered positively as to the possibility of the Department of Emergency Medicine using thrombolysis medicine. 3) All except for one respondent had a positive view on the necessity for the Department of Emergency Medicine, and all except for 3 respondents wanted to have specialized doctors in emergency medicine work at the corresponding hospital. As to the type of schedule, 10 hospitals(34%) wanted to have only night shifts, and 11 hospitals(38%) wanted to have both day and night shifts. Most hospitals needed two or more workers in the field. 4) As to the question of the direction of development, many respondents were of the opinion that the hiring of specialized doctors in emergency medicine would not be of greatly help to the finances of the hospital due to increased labor costs. It seems that improvement of the medical system to improve hospital financing is a required prerequisite for the development of the Department of Emergency Medicine. Also, 21 respondents(83%) were of the opinion that it would take a considerable amount of time to activate the Department of Emergency Medicine with respect to the future prospects of the department. Conclusion: It was shown in the present survey that the heads of hospitals in Kwangju City and Chollanam-do recognized the Department of Emergency Medicine in a positive way, but it was necessary to establish both a delivery system for emergency medicine and collaboration with and support by other medical areas for its future development. It was estimated that in the future, more than 55 doctors specializing in emergency medicine would be needed as medical manpower for the general hospitals in the districts.

초등학교 학생들을 위한 과학탐구능력 측정 도구 개발

조선형,정수길 淸州敎育大學校 科學敎育硏究所 1996 科學과 數學敎育論文集 Vol.17 No.-

The purpose of this study was to develop the science education items for 5th grade classes in Korean elementary school. The inquiry learning is recently showing more high achievement in learning method than traditional either extension of science inquiry skills or coefficiently score and experimental skills. Past quarter of a century, in spite of the inquiry learning declines its teaching method, but it should be encourage the teaching method of science and technology in society(STS) in and out of Korea on thesedays. There are no useful evaluation items of inquiry learning in elementary school, and so need good them according to teach the inquiry learning for achieved the goal of science teaching. The Author studied the development of instrument of measuring science inquiry skills of elementary school students. The 10 science inquiry skill properties were selected from SAPA program, with what are observing, classifying, measuring, predicting, inferring and operating instruments, controlling variabling and concluding or generalization on corporational inquiry skills in material things, motion and energy, life and earth science. The evaluation items are 25 with which divided into 10 skills that developed 2 dr 3 items for 40 minutes. Each point of validity and objectivity are 0.92 what same in the first treatment to 130 students and 177 students in second. In second(II) treatment, the standard deviation 3.712, the coefficient 0.568, average index of discrimination 0.347, index of response 63.9%, average index of difficulty 52.19, and measuring standard error 0.297. At last, the developing evaluation items are almostly very well by the indexes, but a few items(1,6 and some others) are need to change or to make clear once again.

광주·전남 지역 병원간 응급 의료 전달 체계에 대한 연구 : 조선대학교 병원 응급의료센터를 중심으로

조남수,조수영 조선대학교 2001 The Medical Journal of Chosun University Vol.26 No.1

Background: To provide basic data to help construct regional EMSS. Methods: Using a questionnaire, the authors investigated prospectively the data of 766 patients transferred directly to Emergency Medical Center of Chosun University Hospital from other hospitals from April 1 to May 31, 2000. Results: 1) Transfer records; Transfer records of 407(53.1%) patients were faithful, 159(20.7%) patients were unfaithful. 47(6.2%) patients made a phone call to the emergency room or the Department of Emergency Medicine, 9(1.2%) patients to other departments, and 144(18.8%) patients were others. 2) The distribution of the region; A regional distribution of 766 patients transferred to Chosun University Hospital. The transfer took less than 1 hour in 134 patients, it took 1~2 hours in 150 patients, 2~3 hours in 222 patients and 3 hours or more in 260 patients. 3) The mode of transfer; Of the 766 patients, 8(1.1%) patients were transferred by foot, 78(10.2%) patients by a 119 rescue ambulance, 428(55.9%) patients by a hospital ambulance, 31(4.0%) patients by an emergency rescue party, 149(19.5%) patients used private cars, 67(8.8%) patients used public transportation and 5(0.6%) patients were transferred by others means. 4) The reason of transfer; 138(18%) transferred patients from primary hospital or secondary hospital wanted the transfer. 306(39.9%) patients were transferred due to inducement, 162(21.1%) patients due to the absence of specialized departmental doctors, 64(8.4%) patients due to emergency surgery, 46(6%) patients due to bed deficit and 50(6.5%) patients due to other reasons. 5) Diagnosis and treatment in ER; Among all transferred patients, 6 patients were in pericardiocentesis, 103 patients in CT(brain), 61 patients in MRI(brain), 65 patients CT(other part), 10 patients in MRI(other part), 15 patients in closed thoracostomy, 148 patients in central vein catheterization, 5 patients in 4-vessel angiogram and 152 patients in endotracheal intubation. 6) The result of treatment; 458(59.8%) patients were admitted, 148(19.3%) patients to ICU, 15(2%) patients were admitted to a delivery room, 14(1.8%) patients were transferred to an other hospital, 30(3.9%) patients were in a mortuary, 101(13.2%) patients were discharged and 221 patients were admitted for an emergency operation. Conclusion: For effective and well organized EMSS the following are required. Communication prior to the patients transfer. Reinforcement of ambulance equipment and training of emergency staff for long distance transfer of a serious case. A detailed record of early state and treatment of transferred patients. The standardizational the transfer records which contains first aid treatment including fluid treatments, address and early vital signs of patients. Investigation and study for newlydeveloped transfer records.

응급실 내원 환자 14,836례의 통계적 고찰

조수형,조남수,임경준 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Cases of 14,836 patients who visited the emergency room at the Chosun University Hospital from January 1 to December 31, 1994 were analyzed statistically according to sex, age, department, admission, discharge and used transportations. The results were as follows: 1) Considering sexual distribution, male patients were 52.3% and female patients were 47.7%. 2) According to age categories, 4th decade of life was most frequent. 3) According to the department distribution, internal medicine accounted for 22.7%, orthopedic surgery 15.4%, neurosurgery 12.4% and pediatrics 11.7%. 4) The rate of patients admitted via emergency room was 38.0% of total number of patients visited emergency room. The department distribution was as follows: internal medicine 24.1%, neurosurgery 13.7%, orthopedic surgery 12.1%, general surgery 10.5%. 5) 62.0% of patients visited emergency room were discharged. The department distribution was as follows: internal medicine 21.9%, orthopedic surgery 17.5%, pediatrics 13.3%. 6) The number of DOA patients was 212(14.3%) and it showed highest rate in December. 7) A car and taxi were the most frequently used transportation(70%) but the used rate of hospital, 119 and 129 ambulance tended to increase. 8) Emergency room was visited most frequently from 20 to 24 hours. 9) Consumed time from arrival to emergency care of the relevant department was within one hour(67%).

鐵 陽極 溶出反應에 의한 燐成分 除去

강민수,김형석,박승조 동아대학교 환경문제연구소 1995 硏究報告 Vol.18 No.1

This study was on the removal of phosphorus compounds in domestic and synthetic wastewater using iron-anode electrolytic reactor. The experiments were performed at different current, reaction time and flow rate. The results are as follows ; 1. For the synthetic wastewater with the flow rate of 1.5 ℓ/min and 0.75 ℓ /min, the removal efficiencies were 97% and 98%, respectively. The order conditions of this continuous experiments are current density 2.54 A/dm² and reaction time 20 minutes. 2. The optimal conditions of the batch experiment for synthetic wastewater were current density 0.95 A/dm² and reaction time 3.0 minutes with no addition of electrolyte. With electrolyte, the optimal conditions were current density 2.54 A/dm² and reaction time 1.0 minutes. For the both experiments, the removal efficiencies were far over 97%.