Post contrast acute kidney injury prediction model in STEMI patients who underwent PCI

범진호 대한응급의학회 2022 대한응급의학회 학술대회초록집 Vol.2022 No.2

서방형 아세트아미노펜 중독 환자에 대한 고찰

범진호 ( Jin Ho Bum ),이누가 ( Nuga Rhee ),김민정 ( Min Joung Kim ),박정숙 ( Jung Suk Park ),김현종 ( Hyun Jong Kim ),정성필 ( Sung Pil Chung ),이한식 ( Hahn Shick Lee ) 대한임상독성학회 2011 대한임상독성학회지 Vol.9 No.2

Purpose: The Rumack-Matthew nomogram cannot be applied in managing overdose by extended release (ER) preparation acetaminophen (AAP). This study analyzed the clinical characteristics of ER preparation AAP overdose in order to develop a treatment recommendation. Methods: We retrospectively reviewed the medical records of patients presented to the emergency department as a result of AAP overdose from Jan 2008 to Dec 2010. Only those patients who ingested an ER preparation of AAP were included in the study. Their blood AAP concentrations were measured at 4 and 8 hours after ingestion. Clinical variables related to AAP intoxication were analyzed. Results: Of the total 108 AAP overdose patients identified during the 3-year period, 20 suffered specifically with ER preparation AAP overdose. The mean estimated ingestion amount was 167.5 mg/kg. Treatments including gastric lavage, activated charcoal, and N-acetyl cysteine (NAC) were performed on 10, 14, and 11 patients, respectively. Hepatotoxicity was diagnosed in only one patient who was then successfully treated with NAC. In another case, blood AAP concentration continued to increase until at least 11-hours after ingestion. Conclusion: This study suggested that blood AAP concentrations associated with ingestion of ER formulations of AAP, may increase in an extended manner. Therefore, multiple sampling and longer periods between samples assessing AAP blood concentration may be required for incidences of extended release overdose.

가상 현실 신경학적 검사 교육 도구(VRNET) 버전 2.0을 의과대학 학생 교육에 적용한 경험

양시용,범진호,한은아,조준호 한국의료시뮬레이션학회 2023 한국의료시뮬레이션학회지 Vol.7 No.2

Background: In 2018, we developed a Virtual Reality Neurologic Examination Teaching tool (VRNET) to educate medical students on the neurological symptoms of the eye and face that could not be easily simulated by standardized patients (SP). VRNET 2.0, an enhanced version, facilitates neurological examinations of the arms and legs, thereby eliminating the need for SP and relying solely on the program for education. This study introduces VRNET 2.0 and reports its application in medical student education. Methods: This retrospective study analyzed the responses to a questionnaire administered to 362 fourth-year medical students after the completion of a practice run from March 2018 to October 2021. The questionnaire included questions on satisfaction, difficulty, appropriateness of time allocation, expectation, and achievement of learning goals. Results: Compared to the training method using SP + VRNET in 2019, training using VRNET 2.0 in 2021 was found to be superior in terms of satisfaction (8.18 [SP+VRNET] vs 8.81 [VRNET 2.0], p=.011) and difficulty (7.95 [SP+VRNET] vs 7.25 [VRNET 2.0], p=.040). Conclusion: Neurologic examination training using VRNET 2.0 for medical students showed higher satisfaction and lower difficulty than the training program combining SP and VRNET. Further research is essential to assess the actual educational effectiveness of VRNET 2.0.

The experience of applying Virtual Reality Neurological Examination Teaching tool(VRNET) Version 2.0 for medical students

조준호,범진호,양시용 대한응급의학회 2022 대한응급의학회 학술대회초록집 Vol.2022 No.2

노인 발열 환자에 있어 전산화단층촬영 진행과 응급실 재내원과의 상관 관계

노민형,조준호,범진호,한은아 대한응급의학회 2021 대한응급의학회지 Vol.32 No.4

Objective: The number of elderly people visiting emergency rooms is rapidly increasing. Fever is one of the common complaints of patients who come to the emergency room, and it is often difficult to determine its cause in elderly patients only through basic examinations and tests. This study sought to verify the relationship between computed tomography and emergency department revisits of febrile elderly patients. Methods: This study is a retrospective medical record analysis study. Patients who came to our emergency room between September 2016 and September 2019, aged 65 years or more, and with body temperature higher than 37.8 C at the time of presentation or during their stay in the emergency room were enrolled. Patient age, sex, vital signs at triage, laboratory tests, whether computed tomography (CT) was conducted or not were analyzed. The primary outcome was set as revisits to the emergency department within 72 hours after discharge, due to any reason. Results: Three thousand two hundred and forty patients were enrolled and of these 289 patients revisited the emergency department (ED). In the revisit (-) group, CT was performed on 44.09% of patients and 54.67% of patients in the revisit (+) group thus showing a statically significant difference. Conclusion: This study showed that in elderly patients with fever presenting to the ED, patients who underwent a CT had 1.558 higher odds of revisit to the ED compared to patients who did not undergo a CT. From this result, it should be considered that the decision to discharge the febrile elderly patients based on the results of CT examination may not be appropriate.

응급실에 내원한 담관염을 동반한 총담관 폐쇄 환자에서 신속처리과정 도입이 예후에 미치는 영향

이상용,장성일,정성필,이혜선,전소영,유제성,공태영,범진호,고동률 대한응급의학회 2022 대한응급의학회지 Vol.33 No.3

Objective: Biliary decompression through bile drainage is a key treatment for common bile duct obstruction with cholangitis. However, the effectiveness of early interventions has not been studied sufficiently in Korea. This study investigated the effectiveness of fast-track biliary decompression. Methods: A group of patients diagnosed with common bile duct obstruction with cholangitis between January 1, 2014, and December 31, 2019, was reviewed retrospectively. We divided them into two groups: before and after the implementation of fast-track biliary decompression. The following items were analyzed in the two groups: time to intervention, number of hospital days, length of stay in the emergency department, and intensive care unit (ICU) admission. Results: Between January 1, 2014, and December 31, 2019, 418 patients were admitted for common bile duct obstruction, and a total of 369 patients were included in this study. Of these, 168 patients visited the hospital prior to implementation of the treatment, and 201 patients visited after implementation. The time to intervention was 6.1 (4.2-11.0) hours in the fast-track group, which was about 9 hours shorter than the other group (P<0.001). There was no statistical difference in the number of hospital days, emergency department length of stay, and ICU admissions (P=0.535, P=0.034, P=0.322). Conclusion: The time to intervention was shortened significantly in the fast-track group. However, we did not observe a significant improvement in patient prognosis. It may be possible that the procedure time may need to be shortened for a better prognosis. This should be investigated in future studies.

응급실에 내원한 상부위장관 정맥류 출혈 환자에서 표준진료지침의 적용이 환자의 예후 및 응급실 체류시간에 미치는 영향

이재환,유제성,박고은,박주영,정성필,공태영,범진호,고동률 대한응급의학회 2021 대한응급의학회지 Vol.32 No.5

Objective: Endoscopic hemostasis is a key treatment for variceal upper gastrointestinal bleeding. However, the effects of early endoscopy in variceal upper gastrointestinal bleeding have not been sufficiently studied. This study investigated the effects of the use of the critical pathway (CP) for upper gastrointestinal bleeding. Methods: The study was designed as a ‘before and after’ study. A group of patients diagnosed with variceal upper gastrointestinal bleeding from January 1, 2011, to December 31, 2014, and CP activated patients from January 1, 2015, to December 31, 2018, were reviewed retrospectively. The study endpoints included an analysis of the following in the two groups: time from emergency department (ED) arrival to endoscopy, number of blood transfusions, hospitalization period, intensive care unit (ICU) admission, 30-day mortality. Results: From January 1, 2011, to December 31, 2018, 207 patients were admitted with variceal upper gastrointestinal bleeding, and 137 patients with a Blatchford score of 7 or higher were included in the study. Of these, 88 patients visited before the implementation of CP and 49 patients visited thereafter. The time from ED arrival to endoscopy was 218.1± 201.7 minutes in the CP activated group, which was about 200 minutes shorter (P=0.046) than the non-CP group. There was no statistical difference in 30-day mortality, transfusion, emergency room hospitalization time, number of ICU admissions, and hospitalization days (P=0.348, P=0.394, P=0.651, P=0.164, and P=0.069). Conclusion: After CP, the time to endoscopy was significantly shortened, but it did not reduce mortality.

일과성 전뇌 허혈/재관류 손상에서 재조합 클로토 단백질 투여에 의한 신경의 무균염증 손상에 대한 보호 효과

유제성,서상원,( Sojung Lee ),정용은,범진호,우지선,( Dae Ki Hong ) 대한응급의학회 2023 대한응급의학회 학술대회초록집 Vol.2023 No.2

상급종합병원 및 종합병원 응급실로 전원된 패혈성 쇼크 환자의 특성과 예후: 다기관 후향적 관찰연구

김민균,신태건,조익준,김원영,유승목,정성필,범진호,최성혁,김규석,조유환,강구현,서길준,신종환,임태호,한갑수,황승연,대한쇼크연구회 대한응급의학회 2018 대한응급의학회지 Vol.29 No.5

Objective: We evaluated the clinical characteristics and prognoses of patients with septic shock who transferred to the emergency department (ED) in a tertiary referral center. Methods: This study was performed using a prospective, multi-center registry of septic shock, with the participation of 11 tertiary referral centers in the Korean Shock Society between October 2015 and February 2017. We classified the patients as a transferred group who transferred from other hospitals after meeting the inclusion criteria upon ED arrival and a non-transferred group who presented directly to the ED. Primary outcome was hospital mortality. We conducted multiple logistic regression analysis to assess variables related to in-hospital mortality. Results: A total of 2,098 patients were included, and we assigned 717 patients to the transferred group and 1,381 patients to the non-transferred group. The initial Sequential Organ Failure Assessment score was higher in the transferred group than the non-transferred group (6; interquartile range [IQR], 4-9 vs. 6; IQR, 4-8; P<0.001). Mechanical ventilator (29% vs. 21%, P<0.001) and renal replacement therapy (12% vs. 9%, P=0.034) within 24 hours after ED arrival were more frequently applied in the transferred group than the non-transferred group. Overall hospital mortality was 22% and there was no significant difference between transferred and non-transferred groups (23% vs. 22%, P=0.820). Multivariable analysis showed an odds ratio for in-hospital mortality of 1.00 (95% confidence interval, 0.78-1.28; P=0.999)for the transferred group compared with the non-transferred group. Conclusion: The transferred group showed higher severity and needed more organ support procedures than the nontransferred group. However, inter-hospital transfer did not affect in-hospital mortality.

Korean Shock Society septic shock registry: a preliminary repor

신태건,황승연,강구현,김원영,류승목,김규석,조유환,정성필,주영선,범진호,최성혁,윤영훈,권운용,임태호,한갑수,최한성,서길준 대한응급의학회 2017 Clinical and Experimental Emergency Medicine Vol.4 No.3

Objective To evaluate the clinical characteristics, therapeutic interventions, and outcomes of patients with septic shock admitted to the emergency department (ED). Methods This study was a preliminary, descriptive analysis of a prospective, multi-center, observational registry of the EDs of 10 hospitals participating in the Korean Shock Society. Patients aged 19 years or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion were included. Results A total of 468 patients were enrolled (median age, 71.3 years; male, 55.1%; refractory hypotension, 82.9%; hyperlactatemia without hypotension, 17.1%). Respiratory infection was the most common source of infection (31.0%). The median Sepsis-related Organ Failure Assessment score was 7.5. The sepsis bundle compliance was 91.2% for lactate measurement, 70.3% for blood culture, 68.4% for antibiotic administration, 80.3% for fluid resuscitation, 97.8% for vasopressor application, 68.0% for central venous pressure measurement, 22.0% for central venous oxygen saturation measurement, and 59.2% for repeated lactate measurement. Among patients who underwent interventions for source control (n=117, 25.1%), 43 (36.8%) received interventions within 12 hours of ED arrival. The in-hospital, 28-day, and 90-day mortality rates were 22.9%, 21.8%, and 27.1%, respectively. The median ED and hospital lengths of stay were 6.8 hours and 12 days, respectively. Conclusion This preliminary report revealed a mortality of over 20% in patients with septic shock, which suggests that there are areas for improvement in terms of the quality of initial resuscitation and outcomes of septic shock patients in the ED.