우연한 협죽도(Nerium indicum) 복용에 의한 디지털리스양(digitalis-like) 중독 증상

송예완,안정환,이정아,김기운,최상천,정윤석,Song, Ye-Wan,Ahn, Jung-Hwan,Lee, Chung-Ah,Kim, Gi-Woon,Choi, Sang-Cheon,Jung, Yoon-Seok 대한임상독성학회 2009 대한임상독성학회지 Vol.7 No.1

Although Nerium indicum poisoning is a globally rare occurrence, Nerium oleander poisoning is known to occur frequently in the Mediterranean regions. To our knowledge, this is the first reported case of accidental Nerium indicum poisoning in Korea. Its poisoning symptoms and signs are similar to that of digitalis poisoning, because of the presence of cardiac glycosides in Nerium indicum. A 16-year-old boy was admitted to the emergency department four hours prior to the accidental ingestion of Nerium indicum petals. The patient complained of nausea, vomiting, and dizziness. His initial vital signs were stable; laboratory blood test results were within normal levels, except for the blood digoxin level (1.5 ng/dL). An electrocardiogram (ECG) analysis showed normal sinus rhythm, progressive PR prolongation and second-degree Morbiz type I AV block. Conservative treatments including activated charcoal administration were conducted, because toxic symptoms and signs were not severe. The patient was admitted to the intensive care unit for close observation. His ECG was converted to normal rhythm after 1 day and the toxic symptoms and signs were completely resolved after 4 days.

독사 교상후 발생한 전신적 합병증 - 혈액학적 합병증과 신경학적 합병증을 중심으로 -

박은정,윤상규,안정환,최상천,김기운,민영기,이국종,정호성,정윤석,Park, Eun-Jung,Yoon, Sang-Kyu,Ahn, Jung-Hwan,Choi, Sang-Cheon,Kim, Gi-Woon,Min, Young-Gi,Lee, Kuk-Jong,Jung, Ho-Sung,Jung, Yoon-Seok 대한임상독성학회 2009 대한임상독성학회지 Vol.7 No.2

Purpose: This study explored and evaluated the systemic complications resulting from the bite of Korean venomous snake, focussing on hematologic and neurologic features. Methods: Medical records (demographic data, clinical measurements including laboratory results, severity score, and amount of antidote administration, and hospitalization course) of consecutive patients who presented with snakebites to two university teaching hospital during a 10-year period were retrospectively reviewed. Subgroup analysis was conducted for evaluations of anti-acetylcholine esterase administration in complicated victims. Results: The 170 patients displayed occurrence rates of hematologic and neurologic complications of 12.9% and 20.6%, respectively. Among 22 patients with hematologic complications, isolated thrombocytopenia was evident in eight patients (36.4%), prothrombin time (PT) / activated partial thromboplastin time (aPTT) prolongation in 11 patients (50.0%), and both in three patients (13.6%). The mean time to recovery was $4.5{\pm}1.8$ days for isolated thrombocytopenia, and $5.1{\pm}1.8$ days for PT and aPTT prolongation. Hematologic complications could occur suddenly 1?4 days after hospitalization. Among 35 patients with neurologic complications, dizziness was evident in 16 patients (45.7%), and diplopia / blurred vision in 19 patients (54.3%). The mean time to recovery was $3.4{\pm}0.6$ days in patients receiving anti-acetylcholine esterase and $6.9{\pm}1.8$ days in those not receiving anti-acetylcholine esterase (p=0.00). Conclusion: Occurrence rates of hematologic and neurologic complications following venomous snake bite differed as compared to other studies conducted in Korea. Onset of hematologic complications can occur rapidly days after admittance. Anti-acetylcholine esterase administration may be effective in treating neurologic complications.

고압산소 치료에 대한 일개 권역 응급센터의 최근 10년 경험 및 제언

윤정훈 ( Jung Hoon Yoon ),김기운 ( Gi Woon Kim ),정윤석 ( Yoon Seok Jung ),한철수 ( Cheol Soo Han ),민영기 ( Young Gi Min ),조준필 ( Joon Pil Cho ),최상천 ( Sang Cheon Choi ) 대한임상독성학회 2013 대한임상독성학회지 Vol.11 No.2

Purpose: The aim of this study is to investigate current status, indications, and complications of hyperbaric oxygen therapy. Methods: A retrospective investigation of patients who underwent hyperbaric oxygen therapy at a university medical center from September 2004 to August 2013 was conducted based on patients’ medical records and results of an email survey for 99 emergency centers. Results: During the study period, a total of 233 patients underwent hyperbaric oxygen therapy. Indications for hyperbaric oxygen treatment of illness or injury were as follows: 1) 151 cases of acute carbon monoxide poisoning( 65.4%), 2) flap wound management, including 42 cases(18.2%), 3) skin care transplanted, including 23 cases(10.4%), 4) Burger’s disease, including 5 five cases(2.1%), respectively. Total application time* frequency was 1,088 and total time was 1,239 hours. Among 233 patients who underwent hyperbaric oxygen therapy, 32 patients(13.7%) had complications: 1) otalgia in 21 cases(9.0%), 2) mastoiditis?in six cases(2.6%), 3) hemotympanum in five cases(2.1%), respectively. There were only 8 emergency centers that currently had an operational hyperbaric oxygen chamber in 77 emergency centers(10.4%). Conclusion: Indications identified through this study showed difference from current indications worldwide. It seems necessary that physicians’ perception regarding application of hyperbaric oxygen therapy for more indications be changed and improved. A hyperbaric chamber capable of providing respiratory assistance and intensive care is also needed. A good network for sharing treatment experiences and a specialized team for administration of hyperbaric oxygen therapy is also required.

중증 외상환자에서 mesh를 이용한 일시적 수술창 봉합의 경험

김연우 ( Yeon Woo Kim ),정용식 ( Yong Sik Jung ),김욱환 ( Wook Hwan Kim ),민영기 ( Young Gi Min ),김기운 ( Ki Woon Kim ),이국종 ( Kug Jong Lee ) 대한외상학회 2005 大韓外傷學會誌 Vol.18 No.1

Background: Abdominal compartment syndrome has multiple etiologies that are not only related to trauma but also any problem condition in the absence of abdominal injury. To determine whether prevention of the abdominal compartment syndrome after celiotomy for trauma victims justifies the use of temporary abdominal coverage with monofilament knitted polypropylene mesh (Malex mesh) in severely injured patients. Method: Medical records at the Ajou University Medical Center were reviewed for a 32-month period from May 1st, 2002 to December 31st, 2004. Twenty-nine consecutive patients requiring celiotomy who were survived until at the end of celiotomy received temporary abdominal coverage and staged abdominal repairs with Malex mesh. One of them was dissecting aortic aneurysm patient and the others were all trauma victims. Malex mesh prosthesis coverage was used in cases of abdominal compartment syndrome due to excessive fascial tension, severe bowel edema and retroperitoneal hemorrhage or edema followed by staged abdominal repairs. Result: Eighteen of twenty-nine patients were survived. Demographic characteristics, injury severity number of abdominal-pelvic bone injuries, mortality rate, complications, number of operations for permanent closure, required time for permanent closure showed no difference between man and women or child and adult. Except one dissecting aortic aneurysm patient, trauma cases showed 3.24±0.98 injury sites. All cases that received temporary abdominal coverage and staged abdominal repairs did not show abdominal compartment syndrome. 10.08±5.85 days and 2.27±0.82 times of operation required making permanent abdominal closure after temporary abdominal coverage followed by staged abdominal repairs. Most of surviving patients have shown antibiotic-resistant organism and fungus infection. Patients who received permanent closure recovered from infectious problem completely. Conclusion: The use of Malex mesh for temporary abdominal coverage in severely injured patients undergoing celiotomy was effective treatment method.

Amisulpride 중독과 QT 간격 연장 1례

이정아,박현수,민영기,김기운,Lee Choung Ah,Park Hyeon Soo,Min Young Gi,Kim Gi Woon 대한임상독성학회 2005 대한임상독성학회지 Vol.3 No.2

Amisulpride is a newly developed atypical antipsychotic agent effective in treating the positive and negative symptom of schizophrenia. Over-dose of amisulpride can cause hypocalcemia and thus may lead to QT prolongation. We report a case of hypocalcemia and QT prolongation. The QT prolongation was normalized after calcium supplement.

Zipeprol(레스피렌$^{(R)}$)을 탐닉하던 노인의 급성 중독 사망례

이두환,최상천,안정환,조영신,김기운,민영기,정윤석,Lee, Doo-Hwan,Choi, Sang-Cheon,Ahn, Jung-Hwan,Cho, Young-Shin,Kim, Gi-Woon,Min, Young-Gi,Jung, Yoon-Seok 대한임상독성학회 2009 대한임상독성학회지 Vol.7 No.2

Zipeprol dihydrochloride is a non-opioid mucolytic, antitussive agent and it is frequently prescribed for respiratory symptoms such as cough and sputum. The main pharmacologic mechanisms of zipeprol are inhibition of superior laryngeal nerve stimulation and direct antagonism for stimulation of the bronchial receptors, which might have an effect for the drug's mucolytic action. Many cases of drug abuse with zipeprol have occurred world-wide due to the hallucinogenic effect of the drug. In Korea, zipeprol was reported to be the most commonly abused drug among young people for the 1990s. Zipeprol associated death was first reported since 1991 and 69 cases of death related to zipeprol abuse were further reported during 8 years (between 1991 and 1998). In addition to the hallucinogenic effect, dyspnea, extrapyramidal symptoms, seizure, cerebral edema have been reported as the signs and symptoms of toxic zipeprol overdose. However, zipeprol abuse is not common for old age people and non drug abusers. We report here on a fatal case of acute zipeprol poisoning in an eighty five year old drug addicted woman.

Glufosinate ammonium 중독 후에 발생한 해마 손상에 의한 선행성 기억상실 1례

설승환,박현수,안정환,박희영,이필휴,김기운,Seol Seung-Hwan,Park Hyeon-Soo,Ahn Jung-Hwan,Park Hee-Young,Lee Phil-Hyu,Kim Gi-Woon 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.1

Glufosinate ammonium (GLA), a phosphinic acid derivate of glutamate, is a broad-spectrum contact herbicide. It structurally resembles glutamate, a typical excitatory amino acid in the central nervous system. In korea, the ingestion of GLA for suicidal attempt or accidental event has increased. The neurological complication of GLA intoxication are characterized by loss of consciousness, convulsion, or memory impairment. But, the exact mechanism of GLA toxicity is yet unknown. This report is about a patient with GLA intoxication who showed anterograde amnesia with selective bilateral hip-pocampal lesions supported GLA intoxication with literature reviews supported.

급성 일산화탄소 중독에 의한 심혈관계 독성의 임상 양상 및 경과

이인수 ( In Soo Lee ),정윤석 ( Yoon Seok Jung ),민영기 ( Young Gi Min ),김기운 ( Gi Woon Kim ),최상천 ( Sang Cheon Choi ) 대한임상독성학회 2012 대한임상독성학회지 Vol.10 No.2

Purpose: The aim of this study was to evaluate the cardiovascular manifestations and clinical course in patients with acute carbon monoxide poisoning. Methods: A retrospective study was conducted over a 36 month period on consecutive patients who visited an emergency medical center and were diagnosed with acute carbon monoxide poisoning. A standardized data extraction protocol was performed on the selected patients. Results: A total of 293 patients were selected during the study period. Cardiac manifestations were observed in 35.2% (n=103) of the patients: hypotension in 11 patients (3.8%), ECG abnormalities in 44 patients (15.0%) and cardiac enzyme abnormalities in 103 patients (35.2%). Echocardiography was performed on 56 patients with cardiac toxicity: 12 patients had abnormal results (5 patients with global hypokinesia and 7 patients with regional wall akinesia). Five patients died within 3 hours after ED admission, and the remaining patientswere discharged alive. At 3 months after discharge, none of these patients had died.The SOFA scores in the severe cardiac toxicity group and non-severe cardiac toxicity group at the time of arrival were 2.53±2.29 and 2.19±2.12, respectively (p=0.860). Conclusion: Cardiovascular manifestations occurafter acute CO poisoning at arateof 35.2%. Even those with severe cardiovascular toxicity recovered well within 10 days after admission. Therefore, the importance of cardiac toxicity after acute CO poisoning is not significant initself in the clinical course, and the short-term prognosis of cardiac toxicityis unlikely to be unfavorable in acute CO poisoning.

구급대원을 대상으로 한 환자평가 교육 전·후 수행도의 비교

이무상(Moo-Sang Lee),이슬기(Seul-Ki Lee),김기운(Gi-Woon Kim) 한국산학기술학회 2016 한국산학기술학회논문지 Vol.17 No.7

본 연구는 119구급대원을 대상으로 환자평가 수행도에 대한 교육 전·후를 비교함으로써, 구급대원을 대상으로 한 적절한 교육방법 및 기초자료를 제시하기 위해 진행하였다. 전국 4개 시·도 119구급대원 26명을 대상으로 하였으며, 연구는 2015년 12월 14일부터 17일까지 시행하였다. 구급대원이 직접 모의환자를 대상으로 환자평가 및 보고를 시행하도록 하였고, 환자평가를 진행하는 동안 각각의 증상(두통, 가슴통증, 호흡곤란)에 대한 체크리스트(checklist)를 사용하여 교육 전·후를 평 가하였다. 연구 결과는 중앙값(사분위값)으로 기술 분석하였고, 교육 전 환자평가 수행도는 100점 만점에 66점(54.00-80.25) 이었으나 교육 후 88.5점(80.00-93.00)으로 유의한 상승을 보였다(p<0.001). 환자평가 수행도 중 가슴통증 증례 5개의 항목, 두통 증례 7개의 항목, 호흡곤란의 증례 9개의 항목에서 교육 후에 유의한 증가를 보였고, 환자와의 관계형성에서는 구급대 원을 다시 만나고 싶은 정도의 평가점수가 유의한 상승을 보였다(p<0.01). 또한 환자상태 보고 적절성의 모든 평가항목은 교육 후 수행도가 유의하게 상승하였다(p<0.01). 본 연구의 결과는 시뮬레이션 실습에 의한 교육이 119구급대원들의 환자 평가 수행도 개선에 필요하다는 것을 보여준다. 따라서 119구급대원에 대한 실질적이고 체계적인 환자평가 교육은 필요하며, 지속적이고 많은 교육의 기회가 주어져야 할 것이다. The current study was conducted to make pre-post comparisons of education done for 119 emergency medical technicians (EMT) on the patient assessment performance. The data are expected to offer applicable training methods and educational resources for emergency medical services. Twenty six EMT from four cities and provinces participated in the study, which was carried out from 14 to 17 December, 2015. The technicians performed a patient assessment and marked reports on simulated patients. In the course of the assessment, a pre-post evaluation of education was done using a checklist regarding the respective symptoms, such as headache, chest pain, and dyspnea. The median value (quartile value) was used as the descriptive analysis. While patient assessment scores marked 66 points (54.00-80.25) out of 100 (p<0.01) before education, there was a significant increase in the after-education scores, which reached 88.5 points (80.00-93.00). The patient assessment performances revealed a significant increase (p<.0.01) in 5 chest pain, 7 headache, and 9 dyspnea items after education. Similarly, there was an increase in wanting to meet the EMT again scale in regards to categories involved in developing positive relations with patients. Moreover, the adequacy in the patient condition reports all marked a significant increase (p<0.01) in assessment categories. The present study shows that education based on simulation practices are necessary for improvements in patient assessment performance of 119 EMT. Therefore, practical and systematic patient assessment educations may serve as a prerequisite. Further opportunities should be provided for the EMT consistently.

일개 권역응급의료센터에서의 중증 외상환자의 전원 현황과 문제점

이원철 ( Won Chul Lee ),조충현 ( Choong Hyun Jo ),정경원 ( Kyoung Won Jung ),민영기 ( Young Gi Min ),최상천 ( Sang Cheon Choi ),김기운 ( Gi Woon Kim ),안정환 ( Jung Hwan Ahn ),정용식 ( Yong Sik Jung ),황선애 ( Sun Ae Hwang ),김지 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.1

Purpose: Trauma is one of the leading causes of death, especially among young people. Life-threatening conditions are very common in multiple-traumatized patients due to concurrent multi-organ injuries. Treating such severely injured patients is time critical. However, in Korea, the transfer of severely injured patients is not uncommon due to the lack of a mature trauma care system. In developed countries, the preventable trauma death rate is very low, but the rate is still very high in Korea. This study`s objective was to demonstrate the current serious state in which severely injured patients have to be transferred from a Regional Emergency Medical Center even though it actually serves as a trauma center. Methods: Ajou University Medical Center is a tertiary hospital that serves as a trauma center in Gyeonggido. The medical records at Ajou University Medical Center for a 1-year period from January 1, 2008, to December 31, 2008, were retrospectively reviewed. A severely injured patient was defined as a patient who showed more than 15 point on the ISS (injury severity score) scale. We investigated the clinical characteristics of such patients and the causes of transfer. Results: Out of 81,718 patients who visited the Regional Emergency Medical Center, 19,731 (24.1%) were injured patients. Among them, 108 severely-injured patients were transferred from one Regional Emergency Medical Center to other hospitals. The male-to-female ratio was about 3.5:1, and the mean ISS was 23.08. The most common mechanism of injury was traffic accidents (41.7%). A major cause of transfer was the shortage of intensive care units (44.4%); another was for emergent operation (27.8%). Most of the hospitals that received the severely-injured patients were secondary hospitals (86.1%). Conclusion: Although the Regional Emergency Medical Center played a role as a trauma center, actually, severely-injured patients had to be transferred to other hospitals for several reasons. Most reasons were related with the deficiencies in the trauma care system. If a mature trauma care system is well-organized, the numbers of transfer of severely injured patients will be reduced significantly. (J Korean Soc Traumatol 2010;23:6-15)