정상 혈청 크레아티닌을 가진 응급실 환자에서의 조영제 연관 신증

김종하,박신률,김종근 영남대학교 의과대학 2015 Yeungnam University Journal of Medicine Vol.32 No.2

Background: Contrast-induced nephropathy (CIN) can cause serious adverse effects. To reduce the occurrence of CIN related computed tomography (CT) in emergency patients, we assessed the respective roles of serum creatinine (SCr) alone and estimated glomerular filtration rate (eGFR) as an early predictor for CIN related CT. Methods: For patients with SCr <1.5 mg/dL who underwent CT in emergency department (ED) between September 2012 and October 2013, we assessed the prevalence of CIN and its adverse effects. The Modification of Diet in Renal Disease Study (MDRD) and Cockcroft-Gault (CG) formula was used for the calculation of eGFR. Practical calculation was performed by electronic medical record (EMR) system for MDRD and internet calculating service for CG. And we investigated the prevalence of CIN in eGFR <60 mL/min/1.73 m2 before CT. Results: A total of 1,555 patients were enrolled. The prevalence of CIN after CT was 4.6% and it showed correlation with renal deterioration, increased in-hospital mortality, and prolonged hospitalization. Despite baseline SCr <1.5 mg/dL, among enrolled patients, 11.3% as MDRD equation and 29.5% as CG formula were <60 mL/min/1.73 m2 and in this condition, the prevalence of CIN was significantly high (odds ratio was 2.87 [1.64-5.02] as MDRD equation and 2.03 [1.26-3.29] as CG formula). Conclusion: Just SCr <1.5mg/dL was not appropriate to recognize preexisting renal insufficiency, but eGFR using MDRD equation was useful in predicting the risk of CIN related CT in ED. Using EMR, calculation of eGFR can be easier and more convenient.

종합병원 응급실 진료공간의 특성과 색채 분석

김소희,박신률 한국문화공간건축학회 2018 한국문화공간건축학회논문집 Vol.- No.61

As aging have been accelerated, More emergency patients have visited emergency medical centers, on account of frequently occurring crimes, traffic accidents, industrial accidents, and diseases. Recently, Emergency room in the general hospital decided the policy of ‘Master Plan of Emergency Medical care’, according to which emergency service is reorganized into functional and emotional based service and more reasonable hospital study tried to investigate healing space for patients and medical staff. The color environment of emergency room as healing space is very important visual perception environment in psychological, emotional and functional aspects. The application of color to emergency room with finish material should be done in consideration with purpose of the healing space, emotional and functional factor and design element about patients. As result the survey, the use of color and material for patient is no difference with general space in spite of emergency room's speciality. Considering this study, in usage and analysis of color to emergency room, who are main users, should be developed and applied because there is visuality but not enough color arrangement element with finish material as design element. Color plan should be more diversified based on emergency room as wall, floor, ceiling, door, furniture, and signage.

응급실 노인환자의 섬망 유발에 대한 위험인자 조사

곽경훈,도병수,박신률,이삼범 대한응급의학회 2011 대한응급의학회지 Vol.22 No.5

Purpose: Delirium is a common and worrisome problem among elder hospitalized patients. Many studies have sought to evaluate the risk factors of delirium. Most of these studies have dealt with the intensive care unit, with virtually nothing known about the emergency room. Our study was designated to evaluate the risk factors in an emergency department. Methods: We retrospectively reviewed 414 cases of elder patients admitted to the general ward of internal medicine via the emergency room between January 2009 and December 2009. We divided these patients into a delirium group and non-delirium group. We statistically evaluated 31known risk factors of delirium in these two groups. Results: Using chi-square test, 14 of 31 known risk factors of delirium were proven as risk factors of delirium in an emergency room. Using logistic regression, three of the 14proven risk factors were revealed as prior factors. Conclusion: A variety of factors of delirium are risk factors of delirium in an emergency room. A few important known risk factors are failed to pass statistically evaluation. These results are influenced by cultural pecularities of South Korea. Also, the small sample size limited conclusive evaluation. Nonetheless, the importance of patients’ past medical history, laboratory results, and choice of medication when treating elder hospitalized patients to prevent delirium is likely important in reducing mortality and morbidity.

흉부 X선에서 COVID-19 폐렴 검출을 위한 DL 알고리즘의 적용

장세범,정한솔,박신률 대한응급의학회 2021 대한응급의학회지 Vol.32 No.3

Objective: This study evaluated the deep learning (DL) algorithm performance to detect lesions that suggest pneumonia in chest X-rays (CXR) of suspected coronavirus disease 2019 (COVID-19) patients. Methods: This retrospective study included consecutive patients who visited a screening clinic in Daegu, and were suspected to be afflicted with the COVID-19 during the COVID-19 epidemic. CXR were analyzed using the commercial artificial intelligence product that provides free online DL algorithms to the public for COVID-19. Computerized tomography was used as the standard reference. Performance of the DL algorithm was evaluated by the sensitivity and specificity, and results were compared to the CXR records of emergency physicians (EP) in charge of the actual screening triage clinic during the COVID-19 epidemic. Results: Totally, 114 patients were evaluated, of which 38 patients were positive for COVID-19. In 85 CXRs examined (36 COVID-19 and 49 non-COVID-19) with findings of pneumonia in computerized tomography, the DL algorithm showed significantly higher sensitivity as compared to the EP (DL, 98.8% [93.6%-99.9%] vs. EP, 85.9% [76.6%-92.5%]; P<0.01). Moreover, the DL algorithm showed significantly higher sensitivity for detecting CXRs with COVID-19 pneumonia, as compared to the EP (DL, 100.0% [90.3%-100%] vs. EP, 91.7% [77.5%-98.3%]; P=0.08). Conclusion: We conclude that for examining the CXR of patients with suspected COVID-19, sensitivity of the DL algorithm is superior than the EP for detecting lesions suggesting pneumonia. Thus, the application of the DL algorithm is potentially useful in screening triage clinics to detect COVID-19 pneumonia

A Case of Unknown Cause of Subcutaneous Emphysema Presented by Generalized Edema

이삼범,김종하,박신률,도병수 대한응급의학회 2016 대한응급의학회지 Vol.27 No.3

Subcutaneous emphysema and pneumomediastinum are commonly derived from trauma or injury of respiratory or gastrointestinal tracts, but occasionally the origin of air was not determined at evaluation. We report on a case of severe subcutaneous emphysema detected using simple X-ray films in the emergency department, which extended to almost all of the bodies, with a review of the literature.

응급실에 내원한 H1N1 인플루엔자 감염 환자의 연도별 임상 특성: 일개 응급의료센터 관찰연구

남상서,도병수,박신률,이삼범 대한응급의학회 2014 대한응급의학회지 Vol.25 No.1

Purpose: Daegu, Korea was severely affected by pandemicand post-pandemic H1N1 infection during August 2009 toMarch 2012. The aim of this study was to analyze variousclinical characteristics of patients who visited the emergencydepartment with H1N1 infection during the first threeyears, and to compare the results for each year. We thenperformed an evaluation of the differences. Methods: The medical records of patients who visited ouremergency department and conformed to H1N1 virus infectionby conventional rRT-PCR during the pandemic wavefrom August 2009 to March 2010(wave 1) and post-pandemicwaves from August 2010 to March 2011(wave 2)and from August 2011 to March 2012(wave 3) werereviewed. A total of 986 patients (wave 1; 840, wave 2; 144,wave 3; 2) were included in this study. We analyzed theclinical characteristics, proportions of pneumonia, admissionrate, relationships with underlying medical conditions,and requirement for mechanical ventilation of the infectedpatients, and then performed a statistical evaluation of thedifferences between wave 1 and wave 2 that was severelyaffected. Results: During wave 1,840 patients, during wave 2, 144patients, and during wave 3, two patients were diagnosed asnovel influenza. Age 18-39 showed a significantly higherrate(78.7%) in the wave 1 patients group. Main clinical symptomswere cough and febrile sense in both waves. Patientswith underlying medical conditions in wave 2(97 cases,67.4%) showed a higher rate than those of wave 1(101cases, 12.0%). Chronic obstructive pulmonary disorder wasthe most closely related underlying disorder in wave2(18.8%). Patients requiring admission(37.5%) and ventilatorycare(6.9%) due to severe pneumonic symptoms showed asignificantly higher rate in wave 2. Only two young patientswere diagnosed as novel influenza. Both complained of mildfever and cough, which recovered spontaneously. Conclusion: Most cases of influenza A (H1N1) infectionwere uncomplicated, characterized by influenza-like symptomsand spontaneous recovery. The number of patientsshowed a marked decreased year by year, however, theseverity of clinical presentations increased in wave 2. Youngadults who did not have cross-reactive antibodies to novelinfluenza A (H1N1) from previous infection or immunizationwere dominant in wave 1. Older patients with underlyingmedical conditions were more likely to admitted and presentfatal progress in wave 1 and wave 2. Because influenzaviruses are unpredictable, continued national preparedness,flexible response, and careful monitoring are essential.

High-dose Vitamin C therapy in Methemoglobinemia

이경우,강태신,박신률 대한응급의학회 2014 大韓應急醫學會誌 Vol.25 No.2

Methylene blue is the first choice antidote for managementof methemoglobinemia, however, some patients are refractoryto methylene blue and in most cases, methylene bluecannot be available instantly in Korean emergency departmentsbecause of import suspension. A 69-year-old womanvisited our emergency department for tachypnea andcyanosis after ingesting 30 tablets of dapsone. Becausemethylene blue was not available, we intravenously administrated10 g of vitamin C for symptomatic methemoglobinemia. Repeated i.v. administrations of 10 g of vitamin C inpatient without preexisting renal insufficiency successfullytreated dapsone-induced methemoglobinemia withoutcausing renal complications. Thus, we recommend that ifmethylene blue is unavailable or methemoglobinemia isrefractory to methylene blue, repeated administrations of 10g of vitamin C may be considered for the treatment ofmethemoglobinemia in patients without renal insufficiency.

Ultrasonographic findings in Fitz-Hugh-Curtis syndrome: a thickened or three-layer hepatic capsule

문유호,김정호,정원준,박신률 영남대학교 의과대학 2018 Yeungnam University Journal of Medicine Vol.35 No.1

Fitz-Hugh-Curtis syndrome (FHCS) is characterized by inflammation of the perihepatic capsules associated with the pelvic inflammatory disease (PID). FHCS is not a serious disease, but if not treated properly, it can result in increased medical costs, prolonged treatment, and dissatisfaction with treatment. However, early recognition of FHCS in the emergency department can be difficult because its symptoms or physical findings may mimic many other diseases. Although contrast-enhanced computed tomography (CECT) is the useful imaging modality for recognition of FHCS, it is available only when a high suspicion is established. We performed point-of-care ultrasonography in an 18-year-old woman who had a sharp right upper quadrant (RUQ) abdominal pain without PID symptoms and found a thickened or three-layer hepatic capsule. These findings coincided with areas showing increased hepatic capsular enhancement in the arterial phase of CECT. These results show that if the thickened or three-layer hepatic capsule without evidence of a common cause of RUQ pain is observed on ultrasonography in women of childbearing age with RUQ abdominal pain, the physician can consider the possibility of FHCS.

응급실에서 섬망 위험이 높은 환자를 조기 인지하기 위한 평점표의 활용

김종하,도병수,이삼범,김정호,박신률 대한응급의학회 2019 대한응급의학회지 Vol.30 No.1

Objective: This study was conducted to evaluate scorecards for early recognition of high-risk patients of delirium in the emergency department (ED). Methods: Data from 399 consecutive patients aged 65 years or older between January 1, 2015 and December 31, 2015 were retrospectively analyzed. Delirium was identified by reviewing medical records and was confirmed by a psychiatrist. The study population was divided into a training and validation group. Predisposing factors were evaluated and validated by multivariate logistic regression analysis and a calibration plot, after which a scorecard was constructed using these factors and applying points to double odds to each regression coefficient. Results: Dementia, transfer from a long-term care facility, acute acid-base imbalance, moderate pain, and stroke were independent predisposing factors for delirium in ED, with assigned scores in the scorecard of 3, 2, 2, 2, and 2, respectively. The total score of the scorecard for delirious patients was significantly higher than that for non-delirious patients in both the training and validation groups. The coefficient of determination (R2) of the calibration plot was 0.74 and 0.68 in the training and validation group, respectively. In the receiver operation characteristic curve, the cut-off point of the scorecard for delirium was 2.5 and the sensitivity, specificity, and accuracy were 75.0%, 87.8%, and 86.7% in training group, while they were 76.9%, 85.1%, and 84.2% in the validation group, respectively. Conclusion: The scorecard was a useful screening tool for early recognition of patients with a high-risk of developing delirium in the ED.

Splenic artery aneurysm with the double-rupture phenomenon

김정호,정한솔,김종하,박신률,이삼범,도병수 대한응급의학회 2017 Clinical and Experimental Emergency Medicine Vol.4 No.2

Splenic artery aneurysm is the third most common type of intra-abdominal aneurysm, with a prevalence rate of 0.01% to 10.4% in the general population. Splenic artery aneurysm is usually asymptomatic and is typically detected by chance and does not require surgical management; however, if rupture occurs, although rare, the patient’s situation can become critical. We report our experience with a man who presented with left flank and left shoulder pain. His symptoms were caused by multiple hematomas confined to the spleen, but 2 days after admission, he developed delayed hemoperitoneum and required surgical management. We believe that his condition was due to delayed intraperitoneal bleeding called the double-rupture phenomenon; emergency physicians must consider this phenomenon when taking care of splenic artery aneurysm patients.