국내 응급의료센터의 해독제 보유 현황

유제성,김의중,이한식,김승호,정성필,You, Je-Sung,Kim, Eui-Chung,Lee, Hahn-Shick,Kim, Seung-Ho,Chung, Sung-Pil 대한임상독성학회 2007 대한임상독성학회지 Vol.5 No.2

Purpose: Inadequate hospital stocking and unavailability of essential antidotes is a worldwide problem. The purpose of this study was to determine the adequacy of antidote stocks in Korean hospitals based on a modified version of US antidote stocking guidelines. Methods: Both written and telephone surveys to collect information on hospital demographics and antidote stocking were given to the emergency departments or hospital pharmacies of 117 hospitals with emergency medical centers. The twenty antidotes included in the survey were taken from year 2000 US antidote stocking guidelines, except for activated charcoal and black widow spider antivenin. Antidote stocks were compared by hospital size, geographic location, and type of emergency medical center. Results: Complete responses were received from all hospitals. A mean of $12.4{\pm}2.9$ antidotes were adequately stocked per hospital. All hospitals stocked atropine, $CaCl_2$ naloxone, and sodium bicarbonate. However, digoxin Fab fragment (16%), cyanide kits (15%), EDTA (10%), BAL (9%), and fomepizole (1%) were not uniformly stocked. Large and teaching hospitals were significantly more likely to stock greater numbers of antidotes. Conclusions: Korean hospitals as a group do not have adequate antidote stocks. Korean stocking guidelines and an antidote management system are recommended in order to correct these deficiencies.

과도한 주간 졸림과 탈력발작을 주소로 내원한 환자에서 발견된 갑상선 중독증

정재경,김의중,Chung, Jae-Kyung,Kim, Eui-Joong 대한수면의학회 2011 수면·정신생리 Vol.18 No.1

기면병은 과도한 주간 졸림, 탈력발작, 수면 분절화, 입면환각의 특징을 가진 수면 질환이다. 기면병의 증상은 내과적, 신경과적 질환으로부터 생길 수도 있다. 17세의 고등학생 남자 환자가 3개월 전부터 발생한 참을 수 없는 과도한 주간 졸림으로 본원 수면클리닉을 통해 입원하였다. 내원 이후 측정된 체질량지수는 30.4 kg/$m^2$였고 맥박은 분당 70~90회, 혈압은 150/100~120/70 mmHg로 관찰되었다. 갑상선기능 검사에서 T3 391.2 ng/dL(60~181), free T4 4.38 ng/dL(0.89~1.76), TSH(thyroid stimulating hormone) <0.01 ${\mu}IU$/mL(0.35~5.5)로 갑상선 중독증이 시사되었다. 수면다원검사가 실시되었고, 수면 자세의 변환은 시간당 81 회로 매우 많은 편이었다. 입면 잠복기는 33.5분, 수면 효율은 47.9%, 입면에서 렘수면 입면시간은 153.6분으로 지연되었고 렘수면은 27.1%로 증가하였다. 주기성 사지 운동지수는 13.4/h로 나타났다. 수면잠복기반복검사에서 평균 입면잠복시간은 24초, SOREMP(sleep onset REM period)은 3회에서 관찰되었다. actogram상 수면-각성의 경계가 불분명하였고, HLA typing에서 DQB1 $^*0602$는 음성이었다. 환자의 갑상선중독증은 대해 3개월간 methimazole 30 mg, propranolol 40 mg이 투약되며 갑상선 기능이 호전되었다. 탈력발작은 venlafaxine 75 mg으로 조절되었고, 야간 수면 유지와 주기적 사지운동증을 치료 하기 위해 clonaze-pam 0.5 mg이 사용되었고 주관적인 야간 수면의 질은 향상되었다. 과도한 주간 졸림에 대해서는 3개월간 modafinil 200~400 mg이 투여되었고 부분적이긴 하지만 다소의 호전을 보이고 있다. 본 증례는 기면병으로 최종 진단된 환자에 있어 병력과 검사상 발견된 갑상선 중독증, 그리고 수면 효율 감소 등이 과도한 주간 졸림을 평가하는데 혼란 변수로 작용한 경우라 하겠다. 다만, 주간 과다 졸림이 modafinil에 부분적인 효과를 보이는 것, HLA DQB1 $^*0602$ 음성의 결과를 보인 환자에게 나타났던 탈력발작에 대해서도 더 설명이 필요할 것으로 보인다. 향후 CSF hypocretin level을 추가로 측정하고 수면 문제의 추이를 관찰하면서 추가적인 PSG와 MSLT가 필요할 것으로 사료된다. Narcolepsy is a sleep disorder, which is characterized by excessive daytime sleepiness (EDS) that is typically associated with cataplexy, sleep fragmentation and other REM sleep-related phenomenon such as sleep paralysis and hypnagogic hallucination. Narcoleptic symptoms can be developed from various medical or neurological disorders. A 17-year-old male patient admitted for the evaluation of EDS which started three-month ago. He slept more than 18 hours a day with cataplexy and hypnagogic hallucination. He was obese with body mass index (BMI) of 30.4 kg/$m^2$. After admission he was newly diagnosed to the thyrotoxicosis. T3 391.2 ng/dL (60-181), free T4 4.38 ng/dL (0.89-1.76), TSH <0.01 ${\mu}IU$/mL (0.35-5.5) were measured. His pulse rate ranged 70-90 beats per minute and blood pressure ranged 150/100-120/70 mmHg. Polysomnography revealed many fragmentations in sleep with many positional changes (81 times/h). Sleep onset latency was 33.5 min, sleep efficiency was 47.9%, and REM latency from sleep onset was delayed to 153.6 min. REM sleep percent was increased to 27.1%. Periodic limb movement index was 13.4/h. In the multiple sleep latency test (MSLT), average sleep latency was 0.4 min and there were noted 3 SOREMPs (Sleep Onset REM sleep period) on 5 trials. We couldn't discriminate the obvious sleep-wake pattern in the actigraph and his HLA DQB1 $^*0602$ type was negative. His thyroid function improved following treatment with methimazole and propranolol. Vital sign maintained within normal range. Cataplexy was controlled with venlafaxine 75 mg. Subjective night sleep continuity and PLMS were improved with clonazepam 0.5 mg, but the EDS were partially improved with modafinil 200-400 mg. Thyrotoxicosis might give confounding role when we were evaluating the EDS, though sleep fragmentation was one of the major symptoms of narcolepsy, but enormous amount of it made us think of the influence of thyroid hormone. The loss of sleep-wake cycle, limited improvement of EDS to the stimulant treatmen, and the cataplexy not supported by HLA DQB1 $^*0602$ should be answered further. We still should rule out idiopathic hypersomnia and measuring CSF hypocretin level would be helpful.

Metformin 과다 복용에 의한 대사성 젖산 산증 1례

박정숙,정성필,이한식,김의중,Park, Jung-Suk,Chung, Sung-Pil,Lee, Han-Shick,Kim, Eui-Chung 대한임상독성학회 2007 대한임상독성학회지 Vol.5 No.2

Metformin is antihyperglycemic, not hypoglycemic. It causes neither insulin release from the pancreas nor hypo glycemia, even when taken in large doses. But, there are several reports of metformin-associated lactic acidosis (MALT). We present a case report of severe lactic acidosis most probably resulting from high doses of metformin in a patient with no known contraindications for metformin. A 43-year-old female was admitted to the emergency department due to a metformin overdose. She had diabetes for 6 years, well-controlled with metformin and novolet. One hour before admission, she impulsively took 50g metformin (100 mg or 100 tablets). Physical examination for symptoms revealed only irritability, and laboratory evaluation revealed only mild leukocytosis. After one hour the patient was drowsy, and arterial blood gas analysis showed severe lactic acidemia Seven hours after ED arrival, she commenced hemofiltration treatment and was admitted to the intensive care unit. Continuous venovenous hemodiafiltration was initiated. Forty-eight hours later, full clinical recovery was observed, with return to a normal serum lactate level. The patient was discharged from the intensive care unit on the third day. A progressive recovery was observed and she was discharged from the general word on the thirteenth day.

Six Sigma 활동을 통한 중증외상환자의 응급실 체류시간 개선 활동

김현수 ( Hyun Soo Kim ),김옥준 ( Ok Jun Kim ),최성욱 ( Sung Wook Choi ),김의중 ( Eui Chung Kim ),박영태 ( Young Tae Park ),고대이 ( Tae I Ko ),조윤경 ( Yun Kyung Cho ) 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.2

Purpose: This study was conducted to shorten the time spent at each stage of treatment and to reduce the total amount of time patients spend in the emergency department (ED) by applying Six Sigma in the treatment of major trauma patients. Methods: This is a comparative study encompassing 60 patients presenting to the ED of Bundang CHA Hospital from January 2008 to December 2008 and from July 2009 to March 2010. The stages of treatment for major trauma patients were divided into six categories (T1: total emergency department staying time, T2: duration of visit-radiologic evaluation time, T3: duration of visit-consult to department of admission, T4: duration of consultation-issue of hospital admissions time, T5: duration of visit-issue of hospital admissions time, T6: duration of issue of hospital admission-emergency department discharge time) and the total time patients spent in the ED was compared and analyzed for periods; before and after the application of Six Sigma. Results: After the application of Six Sigma, the numerical values in four of the six categories were significantly reduced; T2, T3, T4, and T5. However, the average of the total time patients spent in the ED did not show any remarkable change because the T6 increased highly. The level of Six Sigma increased 0.17σ. Conclusion: The application of Six Sigma for major trauma patients in the ED resulted in a significant improvement in the error rate for the total time patients spent in the ED. The Six Sigma activity has shown great potential. Therefore, the project is expected to bring better results in every stage of treatment if the levels of the hospital facilities are improved. (J Korean Soc Traumatol 2010;23:119-127)

응급의료전달체계의 각 요인이 중증외상환자의 예후에 미치는 영향 분석

임득호 ( Du Ko Lim ),정태녕 ( Tae Nyoung Chung ),이창재 ( Chang Jae Lee ),진수근 ( Su Guun Jin ),김의중 ( Eui Chung Kim ),최성욱 ( Sung Wook Choi ),김옥준 ( Ok Jun Kim ) 대한외상학회 2011 大韓外傷學會誌 Vol.24 No.2

Purpose: A few studies have assessed the factors affecting the prognoses for major trauma patients and those improving the circumstances when dealing with the trauma system. In that light, we analyzed factors, such as pre-hospital factors, the time to admission, the length of stay in the emergency department (ED) and emergency operation, influencing the outcomes for trauma patients. Methods: The patients who visited our emergency department from April 1, 2009, to February 29, 2011, due to major trauma were enrolled in the study. The inclusion criterion was a revised trauma score (RTS) < 7 or injury severity score (ISS) ≥ 16. We used reviews of medical records, to analyze each step of emergency medical care with respect to patients` sex, age, visit time and visit date. Continuous variables were described as a median with an interquartile range, and we compared the variables between the survival and the mortality groups by using the Mann-Whitney U test. Fisher`s exact test was used for nominal variables. Using the variables that showed statistical significance in univariate comparisons, we performed a logistic regression analysis, and we tested the model`s adequacy by the using the Hosmer-Lemeshow method. Results: A total of 261 patients with major trauma satisfied either the RTS score criterion or the ISS score criterion. Excluding 12 patients with missing data, 249 patients were included in this study. The overall mortality rate was 16.9%. Time to ED arrival, time to admission, time of ED stay, RTS, ISS, and visit date being a holiday showed statistically significant differences between the survival and the mortality groups in the univariate analysis. RTS, ISS, length of ED stay, and visit date being a holiday showed statistical significance in the multivariate analysis. Conclusion: The mortality rate did not show a significant relationship with the time to ED arrival, use of 119, on time to admission. Rather, it elicited a quite significant correlation with the trauma scoring system (RTS and ISS), the time of ED stay, and the visit date being a holiday.

아지드화 나트륨(sodium azide) 음독 후 사망한 1례

남연우,김정언,조준호,정성필,이한식,김의중,Nam, Yeoun-Woo,Kim, Jung-Eon,Cho, Jun-Ho,Chung, Sung-Pil,Lee, Hahn-Shick,Kim, Eui-Chung 대한임상독성학회 2008 대한임상독성학회지 Vol.6 No.1

Sodium azide (NaN3) is a white to colorless, crystalline powder that is highly water soluble, tasteless, and odorless. It is used mainly as a preservative in aqueous laboratory reagents and biologic fluids and also as an automobile airbag gas generant. Although it has caused deaths for decades, the toxic properties and effects of sodium azide in humans remains unknown. A 31-year-old comatose female was transported to the emergency department with an empty bottle labeled sodium azide. She developed cardiac arrest 15 minutes after arrival and expired in spite of 30 minutes of resuscitative effort. Subsequently, resuscitation team members incidentally suffered from sodium azide's exposure and developed eye discomfort, skin rashes parasthesias, pruritus, sore throat, and headache.

소아기 주의력결핍 과잉행동장애 양상이 성인기 알코올 사용장애에 미치는 영향

은태경(Tae-Kyung Eun),김한오(Hano Kim),박선희(Sunhee Park),임재영(Jae-Young Lim),정재경(Jae-Kyung Chung),김의중(Eui-Joong Kim),이규영(Kyu Young Lee),방수영(Soo-Young Bhang),이진경(Jin-Kyung Lee),주은정(Eun-Jeong Joo) 한국중독정신의학회 2017 중독정신의학 Vol.21 No.1

Objectives : To find a possible association between childhood Attention Deficit Hyperactivity Disorder (ADHD) features and adulthood alcohol use disorder, we investigated the scores of the Wender-Utah Rating Scale (WURS) in Korean male patients with alcohol use disorder. Methods : Seventy-one adult male patients with alcohol use disorder and 71 normal adult male controls were included in the study. The ADHD features of childhood were determined using the WURS. The total score and three Factor Sum Scores (Impulsivity score, Inattention score, Mood instability score) were analyzed. In addition, we investigated the scores of the Adult ADHD Self-Report Scale-V1.1 (ASRS) and clinical characteristics in association with childhood ADHD features. Results : Childhood ADHD and adulthood ADHD features were found 28.2% and 14.1% in the patient group, respectively. The WURS scores were significant-ly higher in the patient group, as compared to the control group. Familial loading of alcohol use disorder and depression, ASRS, education, occupational status, and previous suicidal attempts were associated with one or more Factor Sum Scores. Higher inattention score was associated with previous suicidal attempts in the patients group (p=0.038, OR=1.16). Conclusion : The study results indicated that childhood ADHD features are the risk factors of adulthood alcohol use disorder in the Korean male population. Especially, childhood inattention could be a significant risk factor for suicidal behavior in patients with alcohol use disorder.

허혈성 대장염 없이 전신성 홍반성 루푸스에서 발현한 직장 궤양

손기창 ( Ki Chang Sohn ),허원각 ( Won Gak Heo ),주민수 ( Min Su Chu ),김의중 ( Eui Joong Kim ),정종혁 ( Jong Hyeok Chung ),최석채 ( Suck Chei Choi ),윤기중 ( Ki Jung Yun ),서검석 ( Geom Seog Seo ) 대한소화기학회 2019 대한소화기학회지 Vol.73 No.5

Rectal involvement by systemic lupus erythematosus (SLE) is quite rare. Approximately 14 cases have been reported worldwide, but only one with ischemic colitis has been reported in Korea. A 17-year-old female patient was hospitalized with abdominal pain and hematochezia. Sigmoidoscopy revealed only a simple rectal ulcer without ischemic colitis. cytomegalovirus and bacterial infections were excluded. A sigmoidoscopic rectal biopsy indicated a rectal invasion by SLE, but the patient showed an acute worsening conditions that did not respond to treatment. This paper reports a case of rectal ulcer that developed in SLE without ischemic colitis with a review of the relevant literature. (Korean J Gastroenterol 2019;73:299-302)

중증 손상 기전의 안정된 환자에서 중증도 예측 인자들에 대한 다변량 분석

이재영 ( Jae Young Lee ),이창재 ( Chang Jae Lee ),이형주 ( Hyoung Ju Lee ),정태녕 ( Tae Nyoung Chung ),김의중 ( Eui Chung Kim ),최성욱 ( Sung Wook Choi ),김옥준 ( Ok Jun Kim ),조윤경 ( Yun Kyung Cho ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.2

Purpose: For determining the prognosis of critically injured patients, transporting patients to medical facilities capable of providing proper assessment and management, running rapid assessment and making rapid decisions, and providing aggressive resuscitation is vital. Considering the high mortality and morbidity rates in critically injured patients, various studies have been conducted in efforts to reduce those rates. However, studies related to diagnostic factors for predicting severity in critically injured patients are still lacking. Furthermore, patients showing stable vital signs and alert mental status, who are injured via a severe trauma mechanism, may be at a risk of not receiving rapid assessment and management. Thus, this study investigates diagnostic factors, including physical examination and laboratory results, that may help predict severity in trauma patients injured via a severe trauma mechanism, but showing stable vital signs. Methods: From March 2010 to December 2011, all trauma patients who fit into a diagnostic category that activated a major trauma team in CHA Bundang Medical Center were analyzed retrospectively. The retrospective analysis was based on prospective medical records completed at the time of arrival in the emergency department and on sequential laboratory test results. PASW statistics 18(SPSS Inc., Chicago, IL, USA) was used for the statistical analysis. Patients with relatively stable vital signs and alert mental status were selected based on a revised trauma score of more than 7 points. The final diagnosis of major trauma was made based on an injury severity score of greater than 16 points. Diagnostic variables include systolic blood pressure and res-piratory rate, glasgow coma scale, initial result from focused abdominal sonography for trauma, and laboratory results from blood tests and urine analyses. To confirm the true significance of the measured values, we applied the Kolmogorov-Smirnov one sample test and the Shapiro-Wilk test. When significance was confirmed, the Student``s t-test was used for comparison; when significance was not confirmed, the Mann-Whitney u-test was used. The results of focused abdominal sonography for trauma (FAST) and factors of urine analysis were analyzed using the Chi-square test or Fisher`s exact test. Variables with statistical significance were selected as prognostics factors, and they were analyzed using a multivariate logistics regression model. Results: A total of 269 patients activated the major trauma team. Excluding 91 patients who scored a revised trauma score of less than 7 points, 178 patients were subdivided by injury severity score to determine the final major trauma patients. Twenty-one(21) patients from 106 major trauma patients and 9 patients from 72 minor trauma patients were also excluded due to missing medical records or untested blood and urine analysis. The investigated variables with p-values less than 0.05 include the glasgow coma scale, respiratory rate, white blood cell count (WBC), serum AST and ALT, serum creatinine, blood in spot urine, and protein in spot urine. These variables could, thus, be prognostic factors in major trauma patients. A multivariate logistics regression analysis on those 8 variables showed the respiratory rate (p=0.034), WBC (p=0.005) and blood in spot urine (p=0.041) to be independent prognostic factors for predicting the clinical course of major trauma patients. Conclusion: In trauma patients injured via a severe trauma mechanism, but showing stable vital signs and alert mental status, the respiratory rate, WBC count and blood in the urine can be used as predictable factors for severity. Using those laboratory results, rapid assessment of major trauma patients may shorten the time to diagnosis and the time for management. (J Korean Soc Traumatol 2012;25:49-56)