급성 약물중독 환자의 응급 기관내 삽관에서 임상적 특성

한얼 ( Eol Han ),정현수 ( Hyun Soo Chung ),박유석 ( Yoo Seok Park ),유제성 ( Je Sung You ),주영선 ( Youngseon Joo ),공태영 ( Taeyoung Kong ),박인철 ( Incheol Park ),정성필 ( Sung Phil Chung ) 대한임상독성학회 2015 대한임상독성학회지 Vol.13 No.1

Purpose: The aim of this study was to compare the clinical characteristics in emergency endotracheal intubation between patients with acute drug intoxication and medical disease. Methods: Data for airway registry collected in two emergency departments (ED) between April 2006 and March 2010 were reviewed retrospectively. The airway registry data included patient’s demographic information and variables such as Cormack-Lehane grade, 3-3-2 finger analysis, success rate, the number of attempts at intubation, complications of intubation, and clinical outcomes after intubation. Results: A total of 1480 patients were enrolled; 62 patients were classified as belonging to the intubation group after the drug intoxication group. No significant differences in Cormack-Lehane grade, 3-3-2 finger analysis, success rate, the number of attempts at intubation, and complications after intubation were observed between patients with acute drug intoxication and medical disease. However, significant difference was observed for indication of emergency endotracheal intubation. While emergency endotracheal intubations were usually performed in medical patients because of failure of airway patency, they were performed in intoxicated patients with the goal of preventing serious complications. Conclusion: Anatomical structures related to endotracheal intubation, the process and clinical outcome of intoxicated patients are not significantly different from those for medical patients.

중증외상환자의 전산화단층촬영 및 중 재술에 의한방사선 유효선량 및 생애 귀속위험도

이원효 ( Won Hyo Lee ),공태영 ( Tae Young Kong ),김승환 ( Seung Hwan Kim ),유제성 ( Je Sung You ),박유석 ( Yoo Seok Park ),이재길 ( Jae Gil Lee ),정성필 ( Sung Phil Chung ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3

Purpose: This study was performed to calculate and analyze the effective radiation doses from computed tomography (CT) and radiologic intervention in patients in the emergency department (ED) with trauma critical pathway (CP) activation and further to estimate the lifetime attributable risks (LARs) for the incidence of and mortality from cancers induced by the radiation dose. Methods: Through a retrospective electrical chart review of 104 injured patients who trauma critical pathway were activated from November 2012 to March 2013, we calculated effective radiologic doses by taking the product of the dose-linear product of the scan and the conversion coefficient. After a determination of the image results, we divided the patients into two groups, negative or positive, and calculated the effective dose for each group. With these results, we estimated the LARs for the incidence of and the mortality from cancers by using the table in the Biologic Effects of Ionizing Radiation (BEIR)-VII report. Results: A total of 76 patients were enrolled. The mean age was 49.0±8.5 years. The mean injury severity score (ISS) was 12.7±8.4. The cumulative effective dose (CED) for individual patients varied from 2.8 mSv to 238.8 mSv, and the mean was 47.6±39.9 mSv. The CED in patients with an ISS≥16(63.2±26.6 mSv) was higher than that of patients whose ISS<16(33.5±23.1 mSv) (p<0.001). The CED in patients who were treated with surgery or intervention(69.0±45.2 mSv) was higher than that of patients who were treated conservatively(33.6 ±22.4 mSv) (p<0.001). The LARs for cancer incidence and mortality were 328.5±308.6 and 189.0±159.3 per 100, 000 people, respectively. Conclusion: The CED and the LAR for trauma CP-activated patients in the ED were significant, so efforts should be made to decrease the effective dose received by severely injured patients.

독실라민 중독시 발생할 수 있는 발작의 특성과 위험인자

송범수 ( Beom Soo Song ),이기만 ( Ki Man Lee ),김선욱 ( Sun Wook Kim ),유제성 ( Je Sung You ),정태녕 ( Tae Nyung Chung ),박유석 ( Yoo Seok Park ),정성필 ( Sung Phil Jung ),구홍두 ( Hong Du Goo ),박인철 ( In Cheol Park ) 대한임상독성학회 2010 대한임상독성학회지 Vol.8 No.2

Purpose: Doxylamine is antihistamine drug that is used as a hypnotic. It is also used for suicidal attempts because it can be easily purchased at the pharmacy without a prescription. There were many articles about the complications after doxylamine intoxication such as a rhabdomyolysis, but only a few articles have reported on seizure. We reviewed the cases of doxylamine intoxication with seizure that were treated in the emergency department. Methods: We reviewed the medical records of the patients who were over 15 years old and who were intoxicated by doxylamine at 3 emergency medical centers from January 2006 to June 2010. We reviewed the patients’age, gender, the dose of doxylamine ingested, if gastrointestinal decontamination was done, the time from intoxication to hospital arrival, the seizure history, treatment of seizure, the electroencephalography (EEG) results, the brain computed tomography (CT) results and the blood test results. Results: There were 168 patients who were intoxicated by doxylamine during the study period. Twelve patients had a seizure episode. The differences between the patients who developed seizure and the patients who did not were the dose and the serum levels of sodium and creatinine. The only clinically meaningful difference was the amount of doxylamine. The amount of doxylamine ingested (>29 mg/kg) predicted the development of seizure with a sensitivity of 75% and a specificity of 92% on the ROC curve. One patient among the seizure patients expired in the emergency department. Conclusion: In case of doxylamine intoxicated patients, there is close relationship between seizure and ingested amount, so close observation needs to be done for the patients who ingest too much because doxylamine can cause death. Further prospective studies are needed for doxylamine intoxicated patients with a seizure episode.

외상 환자 관리에서 Critical Pathway의 적용

심홍진 ( Hong Jin Shim ),장지영 ( Ji Yong Jang ),이재길 ( Jae Gil Lee ),김승환 ( Seong Hwan Kim ),김민정 ( Min Joung Kim ),박유석 ( You Seok Park ),박인철 ( In Chel Park ),김승호 ( Seung Ho Kim ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

Purpose: For trauma patients, an early-transport and an organized process which are not delayed in hospital stage are necessary. Our hospital developed a procedure, the trauma Critical Pathway (CP), through which a traumatic patient has the priority over other patients, which makes the diagnostic and the therapeutic processes faster than they are for other patients. Methods: The records of patients to whom Trauma CP were applied from January 1, 2011 through April 15. 2012. were reviewed. We checked several time intervals from ER visiting to decision of admission-department, to performing first CT, to applying angio-embolization, to starting emergency operation and to discharging from ER. In addition, outcomes such as duration of ICU stay, hospital stay and mortality were checked and analyzed. Results: The trauma CP was applied to a total of 143 patients, of whom, 48 patients were excluded due to pre-hospital death, ER death, transferring to other hospital and not severe injury. Thus 95 patients(male 64, 67.3%) were enrolled in this study. Fifty-nine patients(62.1%) were injured by the traffic accident. The mortality rate was 10.5% and the mean Revised Trauma Score (RTS) of the patients was 6.4±2.0. After visiting ER, decision making for admission was completed, on average, in 3 hours 10 seconds. The mean time intervals for the first CT, angio-embolization, surgery and discharge were 1 hour 20 minutes, 5 hours 16 minutes, 7 hours 26 minutes and 6 hours 13 minutes, respectively. Conclusion: The trauma CP did not show the improvement of time interval outcome, as well as mortality rate. However, this test did show that the trauma CP might be able to reduce delays in procedures for managing trauma patients at the university-based hospitals. To find out the benefit of CP protocol, a large scaled data is required. (J Trauma Inj 2012;25:159-165)