응급진료시 여성환자의 소변검체 채취방법

박원녕,정상원,이종호,구홍두,심호식,김승호 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Background: Urinalysis is a useful laboratory test in the diagnosis of various diseases. In sampling for the urinalysis, there is much concern about contamination that can lead to misdiagnosis in the mid-stream urine sampling method. We conducted this study to determine, in terms of concordance of results and contamination in culture, whether there was any superiority in nod-stream sampling methods with or without disinfection measures compared to the catheterization method. Materials and Methods: We used three kinds of urine sampling methods sequentially, mid-stream non-clean catch, mid-stream clean catch, and catheterization, for ambulatory, non-pregnant, non-men-struating female patients who visited NHIC Ilsan Hospital emergency department during a one-week period in September 2001. Each sample was electrophotometrically analyzed for leukocyte esterase, nitrite, and blood by using a reagent strip and was cultured immediately or after overnight refrigeration. Results: Of the 41 patients, 9 had culture-proven urinary tract infections. The concordance rates(kappa) for nitrite, blood, and leukocyte esterase were 0.875, 0.403, and 0.406 between non-clean catch and catheterized samples and 0.875, 0.481, and 0.560 between clean catch and catheterized samples, respectively. The contamination rate of the non-clean catch, the clean catch, and the catheterized samples were statistically different: 51.2%, 29.3% and 0%, respectively. Conclusion: We found that cleaning with disinfectant was effective for reducing the contamination rate, even though the best urine sampling method for zero contamination was catheterization. We recommend considering cost, patients' comfort, an acceptable threshold for contamination, and the necessity for a culture before choosing a urine sampling method for women who visit the emergency department.

가상화된 현장에서의 스마트 시공관리와 시뮬레이션을 통한 안전관리

박원녕(Peter Park) 대한토목학회 2022 대한토목학회 학술대회 Vol.2022 No.10

질식성 심정지 모델에서 Epinephrine과 Vasopressin의 비교

정순미,박원녕,정성필,황태식,장문준,이한식 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.1

Background : Vasopressin has recently been recognized to have greater effect on improving blood flow to myocardium and brain during cardiac resuscitation than epinephrine and also improves rates of ROSC(return of spontaneous circulation) and survival in pre-hospital and in-hospital prolonged refractory cardiac arrest patients who did not respond to the standard epinephrine treatment. This study was designed to investigate the effects of vasopressin on ROSC rates and survival rates in rat asphyxia arrest model. Method & Material : Thirty male sprague-Dawley rats were used. Anesthesia was induced with halothane and nitrous oxide and ventilatory care was maintained. EtCO₂ was adjusted to 30-40㎜Hg and halothane was maintained. Right internal carotid artery and right femoral vein were cannulated and EKG electrodes were attached. After 10 minutes of asphyxia, group 1 was treated with 1ml of saline, group 2 with 1ml (0.001㎎/100g) of epinephrine and groups 3 with 1ml (0.16u/100g) of vasopressin for resuscitation. Statistical significance was an analyzed by SPSS with ANOVA and chi-square tests. Results : No significant difference were seen in baseline measurements. There ROSC and three 60 minutes survivals were found in group 1, whereas nine ROSC and eight 60 minutes survivals were obtained in groups 1 and all of the subjects in group 3 showed ROSC and 60 minutes survival, but no statistical differences were seen between groups 2 and 3. Conclusion : Vasopressin seems to have similar effect on improving ROSC and survival rates compared to epinephrine in rat asphyxia models.

고칼륨혈증에서 심전도의 진단적 의의

윤수영,박원녕,정성필,김승호,이한식 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3

Background: Hyperkalemia is a common and potentially life-threatening metabolic disorder. The electrocardiogram(ECG) is known to be a relatively sensitive diagnostic tool for hyperkalemia. However many exceptions, in which patients showed normal ECG findings even though hyperkalemic, have been reported. The purpose of this study was to determine the extent of correlation between the ECG findings and hyperkalemia and to determine when the ECG has value for diagnosing hyperkalemia. Methods: Patients who had been diagnosed as having hyperkalemia at two university hospitals during three years were enrolled in this study. We reviewed the medical records of the patients and evaluated the following 6 ECG abnormalities: tall T waves, narrow T waves, QRS widening, atrioventricular block, loss of P waves, and sine waves. We defined tall T waves and narrow T waves as 20 percentiles of heights and widths of the T waves from the 100 patients with normokalemia. Results: During the study period, there were 100 hyperkalemic patients, and we analyzed 69 available electrocardiograms. Abnormal ECG findings were revealed in 67%of 69 patients. The higher the serum potassium level, the more abnormal ECG findings. The common ECG abnormalities were tall T waves and loss of P waves. The patients with normal ECGs even though hyperkalemic had relatively low potassium levels. And whether chronic renal disease was not correlated to the ECG abnormality. Conclusion: The electrocardiogram is a good diagnostic tool for hyperkalemia if it is used with accurate diagnostic criteria. Thus, hyperkalemia should be considered when the ECG shows tall T waves or loss of P waves.

고양종합터미널 화재 사고를 통한 재난의료대응체계 고찰

채한교,김건배,박원녕,박준석,서준석,김인병,차명일 대한응급의학회 2015 대한응급의학회지 Vol.26 No.2

Purpose: The purpose of this study was to report medical care activities of Disaster Medical Assistance Team (DMAT) and medical facilities that responded to the Goyang Bus Terminal fire on May 26, 2014, and to draw improvement of the current disaster medical response system. Methods: We retrospectively reviewed emergency medical service (EMS) run sheet and medical records of patients who visited the emergency department the day of the fire. We also interviewed the officials involved in disaster response. Results: A total of 73 patients participated in this study. Among them, 9 were classified as Emergency, 60 as Non- Emergency, and 4 as Death on arrival (DOA). Fifty one patients visited the nearest hospital, and 17 patients were transported by EMS. DMAT arrived at the scene in 58 minutes, however there was little medical activity. Conclusion: Initial Triage and distribution of patients was rather inadequate and DMAT arrived late. For the future, we recommend constant training of the paramedics and leaders of 119, and to mend DMAT requesting and response system.

심폐소생술 지침을 따르고 계십니까?

권인호,이신호,박원녕,김은기,구홍두 대한응급의학회 2008 대한응급의학회지 Vol.19 No.6

Purpose: In 2000, the American Heart Association and International Liaison Committee on Resuscitation published guidelines for CPR (Cardiopulmonary Resuscitation), and these guidelines were revised in 2005. Many physicians perform CPR differently than suggested by these guidelines. We investigated guideline conformation rates for CPR by non-emergency physicians. Methods: From January 1st, 2005, to December 31st, 2005, and from January 1st, 2007, to September 30th, 2007, 103 in-hospital CPR cases were enrolled. We separated the 103 cases into two groups: 2005 patients and 2007 patients. Fifty-two cases in the 2005 group and 51 cases in the 2007 group were enrolled. The defibrillation method, defibrillation energy, epinephrine use, and atropine use were analyzed. Results: Nineteen cases (82.6%) in the 2005 group and three cases (21.4%) in the 2007 group were performed using the appropriate defibrillation method (p=0.0002). Seventeen cases (73.9%) in the 2005 group and four cases (28.6%) in the 2007 group received the appropriate defibrillation energy (p=0.0069). Seven cases (14.0%) in the 2005 group and 16 cases (32.0%) in the 2007 group used the appropriate epinephrine dose (p=0.0325). Fourteen cases (28.0%) in the 2005 patient group and 14 cases (29.2%) in the 2007 patient group used the appropriate atropine dose (p=0.8983). Conclusion: Although CPR guidelines were renewed in 2005, many physicians do not follow these guidelines. We suggest that adequate information, education, feedback, and further study are needed for guideline conformation.

Meralgia Paresthetica를 아십니까?

김건배,권인호,박원녕,구홍두 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.2

Meralgia paresthetica (MP), first described in 1878, is a sensory mononeuropathy of the lateral femoral cutaneous nerve (LFCN) characterized by pain, tingling, numbness,and paresthesias localized to the anterolateral thigh. There are many etiologies for MP, including those that are spontaneous (idiopathic, metabolic or mechanical) and iatrogenic (surgery, trauma). A 46-year-old female came to our emergency department (ED) with a right hip pain that developed after two days of an altered mental status from high amounts of multiple drugs (benzodiazepine, SSRI, and antipsychotics) to commit suicide. Her past medical and surgical histories were unremarkable. In addition, her vital signs were stable and her electrocardiography was unremarkable. On the other hand, laboratory tests showed an elevated creatinine kinase 14787 IU/L (normal range, 26~140 IU/L) and urine myoglobin >1000 ng/mL (normal range, 0~10 ng/mL). She was admitted to our ED for the management of rhabdomyolysis. The patient didn't slip down and slept on her right side for a long period. An initial pelvis and femur x-ray ruled out a fracture and a straight leg raise test was negative. We took a lumbar spine x-ray to rule out a herniated intervertebral disk because she complained of pain in the second and third lumbar distribution of her right thigh. These x-rays were unremarkable. We presumed she had a hip and thigh contusion and gave her painkillers, but her symptoms did not improved. After a day, the patient complained of numbness (5/10)rather than pain. We then suspected peripheral neuropathy. Her electromyography and nerve conduction velocity confirmed right LFCN neuropathy, MP. MP is often clinically diagnosed and treated conservatively. It is a neurologic disorder due to the entrapment of the LFCN. This case shows no that a long period lacking in movement can cause MP. In future cases, the possibility of peripheral neuropathy should be considered, especially in mentally altered patients after drug intoxication.

휴대전화를 통한 Alerting Call이 중증 응급환자 진료에 미치는 영향

김건배,이신호,박원녕,최선행,구홍두 대한응급의학회 2008 大韓應急醫學會誌 Vol.19 No.5

Purpose: The overcrowding of the ECC (Emergency Care Center) is a significant problem for most general hospitals. This overcrowding can be a potential cause of undesirable outcomes in critically ill patients. The purpose of this study was to evaluate the effect of an alerting call, with a cellular phone, before the presentation of critically ill patients in overcrowded emergency care centers. Methods: One hundred and two patients with cardiac arrest, altered mental status, dyspnea, and chest pain were brought to the emergency care center by 119 EMS (Emergency Medical Transport System) from July 2007 to August 2007 and March 2008 to April 2008 and were enrolled in this study. The EMS made 39 alerting calls with a cellular phone before arrival to the ECC. Each alerting call was answered by the senior resident emergency physician over a 24 hour period. We prospectively reviewed the data and compared the cases with an alerting call to those without such a call. Results: Thirty-nine (38%) patients arrived at the ECC with an alerting call and 63 (62%) without one. The general characteristics between the two groups were not different. The mean duration for the initiation of care for the patients with a cardiac arrest, with an alerting call, was faster than for those who arrived without an alerting call; the difference in the start of compressions was significant (p=0.006). For patients with altered mental status, all variables studied showed a significant statistical difference (p<0.001) between the two study groups. For acute dyspnea and chest pain, the first set of vital signs (p=0.004) and the ABG (p=0.001) were significantly different between the two groups. The mean time to the initiation of care was faster for the patients with an alerting call than for those without an alerting call. Conclusion: The initiation of care in critically ill patients was significantly faster with a cellular phone alerting call before the patient’s arrival to the ECC. Therefore, an alerting call from the 119 EMS to the ECC appears to improve the time to initiating emergency care of critically ill patients in the ECC.

건설현장 업무생산성 향상을 위한 Cost-BIM 적용

노준오(Noh Jun Oh),박원녕(Park Won Nyoung) 한국BIM학회 2018 KIBIM Magazine Vol.8 No.4

Morphine 과량복용 후 중독증상을 보인 환자의 지연된 Naloxone 치료 1례

김건배 ( Gun Bea Kim ),박원녕 ( Won Nyung Park ),구홍두 ( Hong Du Gu ) 대한임상독성학회 2012 대한임상독성학회지 Vol.10 No.1

Opioids are the one of the most commonly used drugs to control cancer pain all over the world. But, we should not overlook the potential risk of opioid intoxication because they have well-known detrimental side effects. The opioid intoxication can be diagnosed thorough various clinical manifestations. The altered mental status, respiratory depression, and miosis is very representative clinical features although these symptoms don’t always appear together. Unfortunately the opioid-toxidrome can be varied. A 42 years old man came to our emergency room after taking about 900 mg morphine sulfate per oral. He was nearly alert and his respiration was normal. Even though his symptoms didn’t deteriorated clinically, serial arterial blood gas analysis showed increase in PaCO2. So we decided to use intravenous naloxone. Soon, he was fully awaked and his pupils size was increased. After a continuous infusion of intravenous naloxone for 2 hours, PaCO2 decreased to normal range and his pupil size also returned to normal after 12 hours. Though the levels of serum amylase and lipase increased slightly, his pancreas was normal according to the abdominal computed tomography. He had nausea, vomit, and whole body itching after naloxone continuous infusion, but conservatively treated. We stopped the continuos infusion after 1 day because his laboratory results and physical examinations showed normal. As this case shows, it is very important to prescribe naloxone initially. If you suspect opioid intoxication, we recommend the initial use of naloxone even though a patient has atypical clinical features. In addition, we suggest intranasal administration of naloxone as safe and effective alternative and it’s necessary to consider nalmefene that has a longer duration for opioid intoxication.