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의식이 명료한 다발성 외상환자에게 전신 전산화단층촬영이 반드시 필요한가?
문유호 ( You Ho Mun ),김윤정 ( Yun Jeong Kim ),신수정 ( Soo Jeong Shin,),박동찬 ( Dong Chan Park ),박신율 ( Sin Ryul Park ),류현욱 ( Hyun Wook Ryu ),서강석 ( Kang Suk Seo ),박정배 ( Jung Bae Park ),정제명 ( Jae Myung Chung ),배지 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.2
Purpose: Whole-body CT is a very attractive diagnostic tool to clinicians, especially, in trauma. It is generally accepted that trauma patients who are not alert require whole-body CT. However, in alert trauma patients, the usefulness is questionable. Methods: This study was a retrospective review of the medical records of 146 patients with blunt multiple trauma who underwent whole body CT scanning for a trauma workup from March 1, 2008 to February 28, 2009. We classified the patients into two groups by patients` mental status (alert group: 110 patients, not-alert group: 36 patients). In the alert group, we compared the patients` evidence of injury (present illness, physical examination, neurological examination) with the CT findings. Results: One hundred forty six(146) patients underwent whole-body CT. The mean age was 44.6±18.9 years. One hundred four (104, 71.2%) were men, and the injury severity score was 14.0±10.38. In the not-alert group, the ratios of abnormal CT findings were relatively high: head 23/36(63.9%), neck 3/6(50.0%), chest 16/36(44.4%) and abdomen 9/36(25%). In the alert group, patients with no evidence of injury were rare (head 1, chest 6 and abdomen 2). Nine(9) patients did not need any intervention or surgery. Conclusion: Whole-body CT has various disadvantages, such as radiation, contrast induced nephropathy and high medical costs. In multiple trauma patients, if they are alert and have no evidence of injury, they rarely have abnormal CT findings, and mostly do not need invasive treatment. Therefore, we should be cautious in performing whole-body CT in alert multiple trauma patients. (J Korean Soc Traumatol 2010;23:89-95)
유기인계 농약 중독환자에서 기계환기 필요성에 대한 예측인자 분석
박동찬 ( Dong Chan Park ),박정배 ( Jung Bae Park ),김윤정 ( Yun Jeong Kim ),신수정 ( Soo Jeong Shin ),문유호 ( You Ho Mun ),박신률 ( Sin Ryul Park ),류현욱 ( Hyun Wook Ryoo ),서강석 ( Kang Suk Seo ),정제명 ( Jae Myung Chung ) 대한임상독성학회 2010 대한임상독성학회지 Vol.8 No.2
Purpose: The purpose of this study is to investigate the factors that predict using mechanical ventilation for patients with organophosphate intoxication. Methods: We retrospectively reviewed the medical records of 111 patients with acute organophosphate intoxication and who were treated in our emergency center from January 2000 to December 2008. We compared the toxicologic characteristics, the laboratory findings and the APACHE II scores between the Mechanical Ventilation group (MV group) and the non-Mechanical Ventilation group (the non MV group). Results: Sixty three patients were in the MV group and 48 patients were in the non MV group. In the MV group, the patients had an older age (p<0.001), a larger amount of ingestion (p<0.001), a lower initial serum cholinesterase level (p=0.003), a higher APACHE II score (p<0.001) and they ingested a more toxic agent (p=0.001). There were no significant differences in gender, the type of visit and the arrival time between the MV group and the non MV group. Conclusion: We suggest that the patient’s age, the amount of organophosphate ingestion, the toxicity of the agent, the initial serum cholinesterase level and the APACHE II score are important factors to determine if mechanical ventilation will be applied for patients with organophosphate intoxication.