유기인계 및 카바메이트계 중독 환자의 심혈관계 양상

이상범,김정호,도병수,Lee, Sam-Beom,Kim, Jung-Ho,Do, Byung-Soo 대한임상독성학회 2004 대한임상독성학회지 Vol.2 No.1

Purpose: We would evaluate the cardiovascular manifestations of the patients with acute organophosphate and carbamate poisoning in the emergency department. Methods: This was retrospectively studied with the review of patient's charts, included total 38 patients were admitted during the past two years in the emergency department of Yeungnam university hospital with the diagnosis of organophosphate or carbamate poisoning. Results: Cardiovascular complications were variously developed in many patients. Electrocardiographic findings were as follows; 4 ($10.5\%$) cardiac arrhythmias included 1 cardiac arrest caused by ventricular fibrillation, 14 ($36.8\%$) sinus tachycardias, 3 ($7.9\%$) sinus bradycardias, and 17 ($44.7\%$) normal sinus rhythms. Conduction disturbances were 23 ($60.5\%$) like as prolonged QTc, 4 ($10.5\%$) ST-T changes, 2 (5.3%) first degree AV block, and 3 ($7.9\%$) right bundle branch block were shown. Other cardiovascular complications were 22 ($57.9\%$) hypertensives, 4 ($10.5\%$) hypotensives, 15 ($39.5\%$) tachycardias, 2 ($5.3\%$) bradycardias, 18 ($47.4\%$) hypoxemics, 12 ($31.6\%$) metabolic acidosis, and 9 ($23.7\%$) pulmonary edemas. Sixteen patients ($42.1\%$) needed ventilatory support because of respiratory paralysis. No patients died in hospital and 36 ($94.7\%$) patients were alive-discharged. Conclusion: Cardiovascular complications are variously in patients with acute organophosphate and carbamate poisoning. Especially, some findings included ventricular arrhythmias, QTc prolongation, hypoxemia, acidosis, and blood pressure changes are known as major precipitating factors to increase the mortality. So, intensive support and aggressive treatment are needed in patients shown various cardiovascular manifestations in the emergency department.

지역기상이 노인외상에 미치는 영향

김정호 ( Jung Ho Kim ),도병수 ( Byung Soo Do ),이삼범 ( Sam Beom Lee ),이성훈 ( Sung Hoon Lee ),시종원 ( Jong Won Si ),이재영 ( Jae Young Lee ),김오룡 ( Oh Lyong Kim ) 대한외상학회 2006 大韓外傷學會誌 Vol.19 No.2

Purpose: Many factors influence the occurrence and severity of geriatric trauma, and regional weather is regarded as one factor that influences geriatric trauma. In this study, to predict the type, severity, and incidence of geriatric trauma patient, we analyzed the influence of regional weather on geriatric trauma. Methods: The subjects of our investigation were trauma patients over sixty-five years of age who visited the Emergency Department (ED) of Yeungnam University Hospital during a one-year period. We retrospectively reviewed the medical charts of 436 geriatric trauma patients, and the data were analyzed by using SPSS 12.0 for Window. The weather was based on data from the Korea Meteorological Administration. Results: The average age was 72.8 years old, and the ratio of males to females was 1:1.1. The mean spell out ISS was 10.8, and no difference was found between males and females. Slips were the most common cause of trauma. The largest numbers of aged trauma patients, 46, visited the ED in May, and the smallest number of such patients, 24, visited the ED in December. In addition to, summer saw the largest number of aged trauma patients. The type of trauma, the Injury Severity Score, and the number of patients had no relationship with season. On sunny days, the ISS was larger in patients who had hypotension and who had tachycardia. On rainy day, the ISS was larger in male patients and cultivator accident patients. The number of patients was larger on partly cloudy days. Conclusion: In spring and summer and on partly cloudy days, we must be prepared to treat aged traumatized patients in the E.D. On rainy days, visual sensation, tactual sense, and acoustic sense must be closely examined. In addition,on rainy day, aged male traumatized patients or cultivator accident patients must to be closely observation. (J Korean Soc Traumatol 2006;19:97-104)

가토의 대동맥 내피세포 배양시 혈관내피 성장인자와 사이클로스포린의 효과

송기환(Ki Hwan Song),박영도(Young Do Park),도병수(Byung Soo Do),서보양(Bo Yang Suh),심민철(Min Chul Shim),권굉보(Koing Bo Kwun) 대한외과학회 1995 Annals of Surgical Treatment and Research Vol.48 No.4

간 절제술에 있어서 동맥혈 KBR(Ketone Body Ratio)의 의의

김홍진(Hong Jin Kim),윤성수(Sung Su Yun),도병수(Byung Soo Do),서우석(Woo Seok Seo),송선교(Sun Kyo Song),심민철(Min Chul Shim),권굉보(Koing Bo Kwun),함희원(Hee Won Ham) 대한외과학회 1992 Annals of Surgical Treatment and Research Vol.43 No.6

흉부압박대 인공호흡 비율의 변화에 따른 소생술 방법의 정확도 비교: 마네킨을 이용한 연구

이성훈 ( Sung Hoon Lee ),이삼범 ( Sam Beom Lee ),도병수 ( Byung Soo Do ) 영남대학교 기초/임상의학연구소 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

Background:Newly revised cardiopulmonary resuscitation (CPR) guideline in 2005 recommends 30 chest compressions and 2 rescue breaths during CPR for all rescuers to use for all adult victims. We would compare the accuracy of the CPR methods by revised CPR guideline in 2005 and previous guideline in 2000. Materials and Methods:Fifty medical students during the introduction to clinical medicine (ICM) were investigated after 30 minutes lecture and brief education of CPR methods. Each students performed twice both CPR methods, the one by guideline 2005 (method A), 4 cycles of 30 compressions every 2 breaths, and the other by guideline 2000 (method B), 10 cycles of 15 compressions every 2 breaths. Resci® Anne mannekin and Laerdal® skillmeter were used and paper reports were printed after each tests. After then, we compared the technical accuracy of the results between method A (30:2) and method B (15:2). 1) Results:Total fifty students (37 males, 13 females) were tested, their mean age was 25.1, mean body weight was 63.5 kg. The technical accuracy on chest compression was not different between two methods and also the technical accuracy on ventilation was not different between two methods except total ventilation number (p>0.05). Conclusion:We could not find significant differences of technical accuracy between both CPR methods. So we don`t think new guideline 2005 is superior to previous guideline 2000 by technical efforts although it`s hemodynamic responses and other clinical benefits is excluded in this study.

응급의학은 어떤 의학분야이며 그 미래는?

도병수,이삼범 영남대학교 의과대학 2002 Yeungnam University Journal of Medicine Vol.19 No.2

Emergency medicine(EM) is the specialty of evaluating, stabilizing and initiating treatment for patients with life of limb-threatening illnesses or injuries. Techniques unique to the specialty of EM are the triage systems, quick stabilization methods, and emergency surgery procedures. The field of EM encompasses areas such as emergency department management, disaster planning and management, the management of emergency medical service(EMS) systems, research into such areas as brain and heart resuscitation, trauma and disaster management, survival medicine, and environmental emergencies(cold and heat injuries, poisioning, decompression sickness and barotrauma). Today, in addition to providing emergency care, the emergency specialists have moral and legal obligations to assess and report probable cases of child and spouse abuse, sexual assault, and alcohol and drug abuse. Future, the EM should provide surveillance, identification, intervention, and evaluation of injury and disease, therefore EM will remain as a key component of evolving community health care system.

응급의료와 그 적용 법률에 대한 개요

도병수,이삼범 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.3

Background : The medicolegal problems can be occurred in all medical field. Especially ED can be more exposed to the legal claims due to the very nature of ED business and characteristics of ED patient (or their family member). All emergency physicians, as a ED manager, should be concerned about the law associated with emergency care for handling the medicolegal problem. So they can deal with and prevent the legally risky situations that may be occurred in ED practice. Ultimately we can reduce the risk of a malpractice lawsuit and provide good emergency care services Suggestion :The authors would like to suggest several items that we have thought the ED physicians and managers always have to remember to manage the medicolegally risky situations 1. Every member of ED health care team must be trained in understanding the patients' wants and desires. 2. The emergency physicians and nurses must realize that they are the best risk management tools in the hospital. 3. ED physician should have the knowledge of the law associated with emergency health care. 4. Develop the system that can share the informations about the medicolegal events which were experienced by each ED health care providers of every health care institutes. 5. We should never forget the time honored sentences, "Good medicine is good law".

응급의료센터에 내원한 비외상성 흉통환자의 임상 양상

도병수,정준영,이삼범,박종선,신동구,김영조 영남대학교 의과대학 1999 Yeungnam University Journal of Medicine Vol.16 No.2

Background: Patients with acute non-traumatic chest pain are among the most challenging patients for care by emergency physicians, so the correct diagnosis and triage of patients with chest pain in the emergency department(ED) becomes important. To avoid discharging patients with acute myocardial infarction(AMI) without medical care, most emergency physicians attempt to admit almost all patients with acute chest pain and order many laboratory tests for the patients. But in practice, many patients with non-cardiac pain can be discharged with simple tests and treatment. These patients occupy expensive intensive care beds, substantially increasing financial cost and time of stay at ED for the diagnosis and treatment of myocardial ischemia and AMI. Despite vigorous efforts to identify patients with ischemic heart disease, approximately 2% to 5% of patients presented to the ED with AMI and chest pain are inadvertently discharged. If the cause for the chest pain is known, rapid and accurate diagnosis can be implemented, preventing wastes in time and money and inadvertent discharge. Methods and Results: The medical records of 488 patients from Jan. 1 to Dec. 31, 1997 were reviewed. There were 320(angina pectoris 140, AMI 128) cases of cardiac diseases, and 168(atypical chest pain 56, pneumothorax 47) cases of non-cardiac diseases. The number of associated symptoms were 1.1±0.9 in non-cardiac diseases, 1.4±1.1 in cardiac diseases and 1.7±1.1 in AMI(p<0.05). In laboratory finding the sensitivity of electrocardiography(EKG) was 96.1%, while the sensitivity of myoglobin test ranked 45.1%. Admission rate was 71.6% in for cardiac diseases and 50.6% for non-cardiac diseases(p<0.01). Mortality rate was 8.8% in all cases, 13.8% in cardiac diseases, 0.6% in non-cardiac diseases, and 28.1% especially in AMI. Conclusion: In conclusion, all emergency physicians should have thorough knowledge of the clinical characteristics of the diseases which cause non-traumatic chest pain, because a patient with any of these life-threatening diseases would require immediate treatment. Detailed history on the patient should be taken and physical examination performed. Then, the most simple diagnostic approach should be used to make an early diagnosis and to provide treatment.

대구광역시 지역 응급의료체계의 현황분석을 통한 보완 및 개선책 제시

도병수,이삼범 대한응급의학회 2000 대한응급의학회지 Vol.11 No.2

Background: The EMSS can be defined as the complete chain of human and physical resources that provides patient care in cases of sudden illness and injury. To provide effective emergency care through the EMSS in a region, the organized EMSS should be periodically evaluated and improved in both aspects of quality and munber on the detected portions of defect. The EMSS in Taegu has been systematically developed since the gas explosion disaster happened at Sangin Dong, on 28th April, 1995. After then, many institutes have been organized, and various plans for improving Taegu regional EMSS have been suggested. The training of EMTs for operating the systems and various equipments which are needed for performing prehospital care and transporting the patient to hospital also has been undertaken. Method: We reviewed the effectiveness and problems of each EMSS elements established and operated during the past five years in Taegu by looking over the documents related to EMSS in the institutes concerned and accomplishing written survey from prehospital care providers belonged to Fire-Fight department. Result: Although the regional EMSS in Taegu has been well developed since 1995 in all its aspects, such as manpower, equipment and control system, but some ineffectiveness in the operation of EMSS and deficits of resources, especially manpower, are found. Conclusion: The emergency physicians should have to analyze the problems of their regional EMSS that involved in personally, and reestablish the long term plans for improving the regional EMSS at this point.

응급센터 입원환자의 통증처치에 대한 응급의학적 고찰

도병수,김현정,정준영,도호석,이창현,이삼범 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Study objective: To recognize importance of pain management in ED and properly manage the ED patients complaining pain by analyzing the intervals between arrival time in ED and pain medicine starting time, the types and the administered routes of pain medicine. Design: Retrospective review of ED charts Setting: University teaching hospital Participants: The patients had admitted in ED of Yeungnam University Hospital with a chief complaint of acute abdominal pain or pain due to bone fracture between June 1, 1995 and December 31, 1995. Results: The study group consisted 256 patients, 161 of them female. ED administrations of analgesics were 103 cases, 17 of them administered more than two times. The average time interval between arrival time and medication time was 169.02±120.25 minutes. Each types of perceived analgesics were antispasmodics 55 cases(53.40%), NSAID 26 cases(25.24%) and opioid 19 cases(18.45%). Every analgesics were administered through intramuscular routes, except only 3 cases. Violences of patients or relatives due to delayed pain control were occured 32 cases, 5 cases of them self-discharged and looked for other hospitals. Conclusion: Emergency physicians including interns and residents delayed management so long and ordered inappropriate administration routes and types of analgesics. So we thought proper protocols about pain management in ED were established.