고압산소치료가 정상압 산소치료에 비해 일산화탄소 중독의급성 신경-정신 상태 개선에 더 효과적인가?

고찬영,조현영,최한주 대한응급의학회 2018 대한응급의학회지 Vol.29 No.5

Objective: The evidence that hyperbaric oxygen (HBO) therapy is more effective for improving the acute neuropsychological status (ANS) of carbon monoxide poisoning than normobaric oxygen (NBO) therapy is not convincing. This is because the levels of carboxyhemoglobin (COHb) do not correlate with the clinical severity of carbon monoxide poisoning and there is no universally accepted severity scale of carbon monoxide poisoning. This paper suggests a new scale for the clinical and neurological severity of carbon monoxide poisoning, called the ANS, and assesses the effect of HBO therapy for each level of ANS compared to NBO therapy. Methods: A total of 217 patients who had been hospitalized because of carbon monoxide poisoning from January 2009 to July 2013 were studied. ANS was suggested as a new severity scale of carbon monoxide poisoning considered in the Glasgow Coma Scale, acute neuro-psychologic signs and symptoms, or cardiac ischemia on the initial medical contact. HBO therapy is indicated in those who have a loss of consciousness, seizure, coma, abnormal findings on a neurological examination, pregnancy, persistent cardiac ischemia, level of COHb >25%, or severe metabolic acidosis (pH <7.2). The end point is the day of discharge, and recovery is defined as a normal neuro-psychological status without any sequelae. Results: The levels of troponin T and creatinine increased significantly with increasing ANS score. In the moderate to severe group (ANS 2 and 3), the recovery rate was significantly higher when treated with HBO therapy than with NBO therapy (P=0.030). On the other hand, the development of delayed neuro-psychological sequelae (DNS) did not correlate with any level of ANS, type of oxygen therapy, or recovery on discharge. Conclusion: In the moderate to severe poisoned group, HBO therapy is more effective for improving the ANS from carbon monoxide poisoning than NBO therapy. On the other hand, the development of DNS of HBO therapy is no more preventable than with NBO therapy. Although the level of ANS is low, the patient needs to be provided with sufficient information and a follow-up visit is recommended for any abnormal symptoms because the ANS does not correlate with the development and degree of DNS.

비상징기 중도 뇌성마비 청소년을 위한 실제 사물과 음성산출도구의 효과성 비교

고찬영,한경임 한국보완대체의사소통학회 2017 보완대체의사소통연구 Vol.5 No.1

Background and Objectives: The purpose of this study was to compare the effects of using real objects and voice output aids(VOCAs) for non-symbolic communicators with severe cerebral palsy. Method: Participants were two non-symbolic adolescents with severe cerebral palsy who had not used AAC aid. This study used alternating treatments design (ATD) between sessions. The intervention was composed with baseline, treatment Ⅰ, generalization Ⅰ, treatment Ⅱ, generalization Ⅱ and a maintenance phase. The intervention strategies were composed of the most-to-least prompt system in the treatment Ⅰ and the least-to-most prompt system in the treatment Ⅱ. Results: First, two adolescents revealed higher requesting in real objects than VOCAs at the beginning of intervention, but revealed higher requesting using VOCAs in generalization. Second, at the beginning of intervention, two adolescents barely produced spontaneous vocalization but revealed higher spontaneous vocalization using VOCAs than real objects in generalization. Conclusion: AAC intervention with VOCA impacted on an increase in requesting and spontaneous vocalization of adolescents with severe cerebral palsy. AAC intervention was needed for non-symbolic communicators to get the cause-and-effect concept and to develop into symbolic communicators. 배경 및 목적: 본 연구의 목적은 비상징기 의사소통 단계에 있는 중도 뇌성마비 청소년을 위한 실제 사물과 음성산출 도구(VOCA)의 효과를 비교하는 것이었다. 방법: 연구 참여자는 AAC 사용 경험이 전혀 없는 비상징기의 중도 뇌성마비 청소년으로 16세 이상이지만 특수학교 초등학교에 재학 중인 남학생 2명이었다. 연구 설계는 각 학생별로 회기 간 교대중재설계를 사용하였다. 중재는 기초선, 중재Ⅰ단계, 일반화Ⅰ, 중재Ⅱ 단계, 일반화Ⅱ와 유지단계로 구성되었다. 중재전략으로는 중재Ⅰ단계에서 최대-최소촉구 전략을 사용하였고, 중재Ⅱ 단계에서는 최소-최대촉구 전략을 사용하였다. 결과: 연구 결과 첫째, 비상징기 중도 뇌성마비 청소년 2명 모두 중재 초기에는 VOCA보다 실제 사물을 이용해서 요구하기 비율이 높게 나타났으나 중재 후기와 일반화 단계에서는 VOCA를 사용할 때 요구하기 비율이 높게 나타났다. 둘째, 비상징기 중도 뇌성마비 청소년 2명 모두 중재 초기에는 자발적 발성이 거의 없었지만 중재 Ⅱ단계 와 일반화 단계에서 두 학생은 모두 실제 사물보다 VOCA에서 자발적 발성의 비율이 더 높았다. 결론: 결론적으로 VOCA를 이용한 AAC 중재는 비상징기 중도 뇌성마비 청소년의 요구하기 기능과 자발적 발성 증진에 효과적이며 의사소통을 위한 기초 개념인 인과개념을 확립하고 상징기로의 전환을 위해 필요함을 알 수 있다.

일반인 심폐소생술 후 발생한 좌심실 파열 1례

고찬영 대한응급의학회 2018 대한응급의학회지 Vol.29 No.4

Chest compression is the most important component of cardiopulmonary resuscitation, but excessive chest compression can cause serious mechanical complications. Skeletal injuries are the most frequent complications of chest compression, but lacerations of the heart and great vessels are very rare. We report a case of a 62-year-old woman who developed an acute alteration in mental status, and underwent chest compression by a lay rescuer for 5 minutes. When she arrived at the emergency department, she regained consciousness, but constantly complained of chest pain and hypotension. Chest computed tomography revealed a left ventricular free wall rupture with extravasation and hemopericardium. She was managed with surgical repair and was discharged without complications after 21 days of admission.

응급센터를 통해 중환자실에 입원한 패혈증 환자의 예후 예측에 있어서 응급센터 내원 초기의 APACHE 2 Score와 MEDS Score의 유용성 비교

고찬영,김영식,신태용,하영록 대한중환자의학회 2008 Acute and Critical Care Vol.23 No.2

Background: To determine the prognostic value of the initial APACHE II score in the ED compared with the classic APACHE II score in the ICU and to check the usefulness of the MEDS score together for more rapid risk stratification of septic patients admitted to the ICU via the ED. Methods: We prospectively checked the initial APACHE II and MEDS scores of all the patients who had systemic inflammatory response syndrome in the ED and the classic APACHE II scores after admission to the ICU, as well 6 months later. We enrolled the only sepsis cases in the final diagnosis after reviewing the medical records. We evaluated the predictive abilities of the initial APACHE II and MEDS scores compared with the classic APACHE II score. Results: During 6 months, 58 patients diagnosed with sepsis were enrolled. Twenty-four (41.4%) patients died within 28 days of admission and 34 patients survived. The mortality group had a significantly higher mean classic APACHE II score (19 ± 6.7 vs. 15 ± 5.0, p < 0.01) and a higher mean MEDS score (16.67 ± 2.70 vs. 8.91 ± 3.11, p < 0.01) than the survivor group. The initial APACHE II score at the ED was not significantly different between the two groups. ROC analysis showed the discriminative power of the MEDS score in predicting mortality was much better than the APACHE II score (areas under the curves of the APACHE II score in the ED and ICU, and the MEDS scores were 0.668, 0.807, and 0.967, respectively; p < 0.01). Conclusions: The initial APACHE II score in the ED did not predict mortality better than the classic APACHE II score. However, the MEDS score predicted the poor prognosis of septic patients more rapidly and accurately in the ED than the APACHE II model.

응급실에 내원한 안면 깊은 열상환자에서 무마취 피하봉합 후 피부본드 사용의 효과

고찬영,김호중,조영순,전덕호,김재우 대한응급의학회 2012 大韓應急醫學會誌 Vol.23 No.6

Purpose: To evaluate the effectiveness of non-analgesic subcutaneous suture with an adhesive agent. Methods: We sutured lacerated wounds with an adhesive agent using a non-analgesic method and measured pain and patient satisfaction. We classified three steps (I: entering the needle, II: pulling the fiber, III: tying) in the suture sequence and evaluated the pain (painfulness, tolerance,painlessness) for each step. Results: Of 276 patients admitted within the period, 111were enrolled in this study. The mean wound characteristics were 11±4 mm (depth) and 23±18 mm (length). Overall,83(75%) patients were sutured without additional analgesics. On a pain scale, all steps were measured at over 90% with respect to tolerance and painlessness. In step II, tolerance (63%) and painfulness (10%) was higher than in the other steps (p<0.05). The mean rate of satisfaction was 4.7 (group 1, 4.8; group 2, 4.6; group, 3; 4.6, group 4, 4.7 (p=0.673). Conclusion: Non-analgesic subcutaneous suture with adhesive agent was very effective for patients who were admitted to the emergency department with deep facial lacerations with a length of no more than 2 cm

결절성경화증 환자에게 동반된 혈관근지방종 파열과 자발성 기흉 1례

고찬영,김호중,조영순,김재우,전덕호 대한응급의학회 2012 大韓應急醫學會誌 Vol.23 No.5

Tuberous sclerosis is a genetic multi-system disorder characterized by wide spread hamartomas in several organs. We present the case of a 28-year-old female patient diagnosed with tuberous sclerosis combined with life threatening complication. She developed a peri-renal hemorrhage due to an angiomyolipoma rupture and spontaneous pneumothorax at a time. In order to diagnose and treat this problem, the emergency physician should understand the clinical presentation and complication associated with tuberous sclerosis.

심부정맥혈전증으로 오인된 데스모이드종양에 의한 외장골정맥 압박 1례

고찬영 대한소아응급의학회 2021 대한소아응급의학회지 Vol.8 No.2

Desmoid tumor, also known as desmoid-type fibromatosis, is a rare, intermediate, locally aggressive tumor with a high possibility of local infiltration and recurrence, potentially leading to life-threatening problems. We report a case of a 15-year-old girl who visited the emergency department with a 1-week history of the left leg swelling. A point-of-care ultrasound on the leg showed dilated left femoral and popliteal veins. Subsequently, a computed tomography venogram demonstrated a large pelvic mass compressing the left external iliac vein. She underwent tumor resection, and was uneventfully discharged on day 12.

흰쥐 출생후 발생단계에 따른 전뇌 기저부의 내측중격핵과 대각 Broca대에서 콜린성 신경세포에 대한 면역조직화학적 연구

고찬영,정영화홍영호 한국통합생물학회 1995 동물학회지 Vol.38 No.2

출생 후 0일, 7일, 14일, 21일 그리고 성체의 흰쥐 전뇌 기저부의 내측중격핵과 수직 및 수평대각 Broca대에서 choline acetyltransferase(ChAT)에 면역반응을 보이는 신경조직과 세포의 분화를 면역조직화학적 및 전자현미경적 방법을 이용하여 조사하였다. 출생 후 초기와 성체에서 신경세포의 세포질과 수상돌기에서 고루 ChAT 면역반응이 확인되었다. 뇌 기저부의 ChAT 면역반응 신경세포들은 발생에 따른 뇌 크기의 증대와 뇌 조직의 분화에 따라 점차 수적 증가를 보였다. 이 ChAT 면역반응 신경세포들은 세포의 모양과 세포제의 장 · 단축의 비에 따라 6가지 형 즉 1) 월형 2) 난형, 3) 세장형, 4) 방추형. 5) 삼각형, 6) 다각형으로 분류되었다 전뇌 기저 핵에서 원형과 난형 신경세포들의 출현율은 출생 후 0일에서 높았으나 성체로 되면서 감소된 반면, 세장형. 방추형. 삼각형 그리고 다각형 신경세포들의 출현율은 출생 후 0일에서는 낮았으나 성체로 되면서 증가하였다. 모든 핵들에서 ChAT 면역반응 신경세포체의 부피는 출생 후 0일에 996-1,252 Um3로 제일 작았으며, 내측중격핵과 수직대각 Broca대 그리고 수평대각 Broca대에서는 출생 후 21일에 각각 5,061, 5.701, 5,820 um3로 최대치를 보였다. 그후 성체로 되면서 모든 핵에서1,897-2,704 roms로 다시 감소하였다. 전자현미경적 관찰에서 출생 후 21일된 흰쥐 수평대각 Broca대에서 ChAT 면역반응은 핵의 핵질 일부와 핵막 그리고 미토콘드리아와 조면소포체에서 관찰되었다. 이 결과들로 미루어 출생 후 초기 발생단계에서 흰쥐 전뇌 기저부의 내측중격핵과 수직 및 수평대각 Broca대에서 ChAT 면역반응 신경세포들은 축삭과 수상돌기의 형성에 따라 세포의 형과 그 출현율 및 세포제의 크기에서 현저한 변화가 이루어지는 것으로 생각된다.

중대뇌동맥 뇌경색으로 오인된 자발성 척수 경막외혈종 1례

고찬영 대한응급의학회 2014 大韓應急醫學會誌 Vol.25 No.2

Spontaneous spinal epidural hematoma (SSEH) is anuncommon cause of spinal cord compression. Early diagnosisand appropriate management are important, however,diagnosis is often difficult due to variable neurologic deficit. We report on the case of a 69-year-old female patient in righthemiparesis. She was treated with thrombolysis therapy foracute cerebral infarction before being transferred to our hospital. Findings on a cervical spine magnetic resonance imageshowed spinal epidural hematoma and cord compression. She was prepared to undergo decompressive surgery, however,neurologic deficits began to show improvement. Shewas managed conservatively and was discharged withoutdeficits approximately nine days after onset.

일반인에 의한 완전자동형과 반자동형 자동제세동기의 사용능력 비교: 시뮬레이션 연구

고찬영,김주현 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.4

Purpose: This study compared the performance between the fully-automated external defibrillator (F-AED) and the semi-automated external defibrillator (S-AED) when used by laypersons. Methods: Thirty-three laypersons participated in a mannequin simulation study as part of Cardio-Pulmonary Resuscitation (CPR) training courses. After 30 minutes of didactic education for the Automated External Defibrillator (AED), they watched a video on how to use the fully-automated external defibrillator (F-AED) and a semi-automated external defibrillator (S-AED) instead of a hands-on education. Laypersons performed the S-AED first, then the FAED. Performances and shock delivery time intervals were recorded and evaluated. Results: The performances in shock delivery were better with the F-AED, although the overall performance was statistically insignificant. In terms of shock delivery interval, the F-AED was shorter than the S-AED (54.48±2.84 sec vs. 64.76±3.57 sec, respectively, p<0.01). In the post survey,F-AED had a higher preference (F-AED vs. S-AED 23(70%) vs. 5(15%), respectively, p<0.001). Conclusion: The F-AED had a better performance and shorter shock delivery time interval than the S-AED. The FAED should thus be considered for use, outside of the hospital,on cardiac arrest patients for early defibrillation.