파라콰트를 음독하고 내원한 환자의 예후와 연관된 인자와 혈액관류술의 효과

성애진,장재영 대한중환자의학회 2010 Acute and Critical Care Vol.25 No.1

Background: Paraquat has been widely used as a non-selective contact herbicide and it may induce damage to many organs. This study aimed to assess the factors that can predict the prognosis of paraquat poisoning and to determine the effect of hemoperfusion. Methods: We retrospectively reviewed 132 patients who were poisoned with paraquat from January 2005, to December 2008. The patients were divided into two groups: The first groups included the death and survived groups, and the second groups included the hemoperfusion and non-hemoperfusion groups. We investigated the mortality, the factors that can predictive the prognosis and the effect of hemoperfusion. Results: There were 79 males and 53 female (mean age: 56.1±15.1 years). The significant differences between the death and survival groups were the volume of paraquat ingested, the mental status, GCS (Glasgow coma scale), pH, base deficit, HCO3, serum Cr (creatinine), serum AST (aspartate transaminase), serum glucose, K (kalium), urine sodium dithionite test and hemoperfusion. The significant differences between the hemoperfusion and non-hemoperfusion groups were the mortality and the mean survival time. Multivariate regression analysis reveled four predictive factors and their`s Odd ratio: 1) urine sodium dithionate test = strong 14.256, 2) hemoperfusion 0.493, 3) Cr > 0.95 mg/kg 31.603 and 4) an amount of ingested paraquat > 45 ml 16.945. Conclusions: The predictive factors for mortality were the amount of paraquat ingested > 45 ml, a urine sodium dithionite test = strong and a serum Cr > 0.95 mg/dl. Hemoperfusion couldn`t be used a predictive factor for mortality, but it increased the mean survival time.

뇌 지방색전증에 의한 심정지 증례 1례

성애진,이수훈,신현탁,임대성 대한응급의학회 2022 대한응급의학회지 Vol.32 No.6

Fat embolism syndrome is a rare disease associated with long bone fractures and plastic surgery. In previous studies of cerebral fat embolism, no reports of cardiac arrest occurred by cerebral fat embolism. Therefore, we aimed to report the first case of cardiac arrest by cerebral fat embolism after scalp lipoma removal.

실신 환자에서 심각한 질환을 예측할 수 있는 초기 인자

성애진,류현욱,서강석,박정배,정제명,이원기,조용근,서준석,제동욱,김창호 대한응급의학회 2007 大韓應急醫學會誌 Vol.18 No.6

Purpose: To stratify the risk of syncope by analyzing related risk factors of patients with possibly serious etiology who visit the emergency room with syncope. Methods: We studied 201 patients who visited the emergency room of Kyungpook National University Hospital with syncope from January 2004 to December 2006. We defined serious etiology as arrhythmia, angina pectoris, myocardial infarction, septic shock, meningitis, cerebral infarction, subarachnoid hemorrhage, brain tumor, significant hemorrhage, and malfunction of cardiac pacemaker requiring immediate treatment and intervention. We analyzed the relationship between 81 risk factors and serious etiology to stratify the risk for patients with syncope. Results: The patient group consisted of 105 males and 96 females with an average age of 56.4±20.7 years. Fifty-four patients had serious etiology. Among the 81 risk factors, those identified through univariate and multivariate analysis as having high predictive sensitivity and specificity were shortness of breath (odds ratio [OR]: 18.34, 95% confidence interval [CI]: 5.59-60.16); abnormal electrocardiography (OR: 10.29, 95% CI: 1.43-74.33); hematocrit <28.3% (OR: 9.64, 95% CI: 3.47-26.73); age ≥47 years (OR: 6.24, 95% CI: 1.14-34.17); and admission via an out-patient department or by transfer from outside hospital (OR: 4.07, 95% CI: 1.15-14.36). Conclusion: Risk factors correlated with serious etiology for syncope are shortness of breath, abnormal electrocardiography, hematocrit <28.3%, age ≥47 years, and admission via an out-patient department or transfer from an outside hospital.

2009년 국내 응급실 중독환자 다기관조사: 두 번째 연차보고

성애진 ( Ae Jin Sung ),이경우 ( Kyung Woo Lee ),소병학 ( Byung Hak So ),이미진 ( Mi Jin Lee ),김현 ( Hyun Kim ),박경혜 ( Kyung Hye Park ),박정배 ( Jeong Bae Park ),염석란 ( Seok Ran Yeom ),오성범 ( Seong Beom Oh ),유지영 ( Ji You 대한임상독성학회 2012 대한임상독성학회지 Vol.10 No.1

Purpose: The purpose of this study was to examine the occurrence of toxic exposure cases in Korean emergency centers using a toxic exposure surveillance system-based report form and to provide guidelines for the prevention and treatment of toxic exposures. Methods: We retrospectively reviewed the medical records of toxic exposure patients who had visited emergency centers from January 2009 to December 2009. Epidemiology data points for the toxic exposure cases included age, gender, type of exposure, number and kind of substances involved, reason and route of poison exposure, manage-ment of the patients in the emergency departments, and the clinical outcome. Results: A total of 3,501 patients from 12 emergency departments were enrolled in the study. 50.0% of the total exposure patients were male and 63.0% of the total cases were fatal. Acute intoxication occurred in 91.3% of the total patients and suicidal intent was the most common (43.3%) reason for exposure. The most common route of exposure was ingestion (75.9%). Of the total cases, pesticides were involved in 26.3%, sedatives/hypnotics/antipsychotics were involved in 22.0%, and bites and envenomations were involved in 15.7%. Conclusion: We provided a database of patients who were admitted to emergency departments after poisoning incidents. We recommend that toxicology professionals develop a classification scheme for toxicants which is adequate for Korean domestic circumstances and initiate a toxic surveillance system for all types of exposures. With support of a psychiatric surveillance system for suicidal patients and establishment of social mediation for pesticide poisoning, major reductions in poison exposures can be achieved.

일개 3차병원 응급의료센터의 10년 전후 만족도 비교 분석

제동욱,김창호,성애진,서준석,류현욱,박정배,정제명,서강석 대한응급의학회 2007 大韓應急醫學會誌 Vol.18 No.6

Purpose: To compare differences in overall satisfaction with emergency department (ED) services with the results obtained 10 years previously, in order to study effects of several component factors on patients’willingness to revisit and to give recommendations. Methods: This study was performed with questionnaires from 318 patients and proxies who were admitted to the emergency ward through the emergency medical center from February 19th, 2007 to March 18th, 2007. Evaluation of data was by frequency analysis, chi‐square test, t‐test, multiple regression analysis, and path analysis. Results: During a one month study period, 244 patients and proxies (77% of those eligible) completed on-site questionnaires. Sociodemographic factors had no statistically significant influence on satisfaction with ED services. In multiple regression analysis to evaluate the correlation of various factors with satisfaction, the regression coefficients were 0.435(p<0.001) for reliability, 0.248(p<0.001) for accessibility, 0.179(p<0.001) for kindness, and 0.133 (p=0.004) for environmental respectively. In path analysis, the direct effect of overall satisfaction on patient willingness for re-visit was 0.582. The direct effect of overall satisfaction reliability on willingness to give recommendations were 0.594, and 0.250 respectively. Conclusion: In slight contrast to the study performed 10 years previously, the factors with the most correlation to overall satisfaction with ED services in this study were environment, kindness of hospital personnel, accessibility, and reliability of medical personnel. We confirmed that overall satisfaction is the most important factor influencing willingness for re‐visit and willingness to recommend services, but found that the component factors vary as the point of survey or hospital conditions changes.

응급실 내원 환자를 통한 직업손상 발생유형 빈도분석

김재윤,채창호,성애진,신상도 대한직업환경의학회 2011 대한직업환경의학회 학술대회 논문집 Vol.2011 No.11

Critical Pathway Implementation for Minor Motor Vehicle Trauma Patients

홍종근,황성연,이영환,성애진,이준호,조광원,신지미 대한응급의학회 2011 大韓應急醫學會誌 Vol.22 No.5

Purpose: The high rate of road traffic crashes and rising medical costs are critical health care problems in Korea as well as in the United States. To reduce the medical cost of minor traffic accidents, we hypothesized that implementation of a 7-day critical pathway (CP) for minor car accident patients (MCP) would decrease medical costs and hospitalization time without lowering patient satisfaction level. Methods: A pretest-posttest experimental design was used to verify the effects of CP on MCP, from June 1 to December 31, 2010. A 7-day admission schedule with daily predefined order communication system (OCS) order set was implementated for MCP. On the day of discharge,MCP completed a satisfaction survey, and the total medical cost and cost per day were calculated. Satisfaction with physician and nursing care were also surveyed using the Brief Encounter Psycho-Social Instrument-Korea tool. Results: Overall rating did not differ in patients processed normally and using the CP, but length of admission was reduced in CP patients. Total medical costs were not different in either group but cost per day was higher in the CP group. Satisfaction with physicians, but not nurses, satisfaction was improved after CP implementation. Conclusion: A critical pathway for MCP reduces length of admission without decreasing patient satisfaction. Total medical costs are not changed after CP implementation but cost per day is significantly increased. Improved job satisfaction in physician but not for nurses was observed after CP implementation. It seems that CP is a effective tool for MCP.

경증 두부 외상을 가진 환자의 경추 손상을 예측할 수 있는 관련 인자

박철우 ( Chul Woo Park ),성애진 ( Ae Jin Sung ),이준호 ( Jun Ho Lee ),황성연 ( Seong Youn Hwang ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.2

Purpose: This study aimed to determine new criteria for detecting independent factors with high sensitivity in cases of cervical spine injury. We compared the sensitivity, the specificity, and the false negative predictive value (NPV) of plain radiographs with those of computed tomography for cervical spine injury in patients with minor head injury. Methods: We retrospectively reviewed the cases of 357 patients who underwent both cervical plain radiographs and computer tomography from January 2006, to September 2008. Patients were divided into two groups: the cervical spine injury group and the no cervical spine injury group. New criteria were organized based on variables that had significant differences in the logistic regression test. Results: Among the 357 patients, 78 patients had cervical spine injuries. The average age was 43.9±15.2 yrs old, and the male-to-female ratio was 1.90. The most common mechanism of injury was motor vehicle accidents. There was a significant difference in loss of consciousness, Glasgow Coma Scale (GCS)=14, neurologic deficit, posterior neck tenderness, and abnormality of the cervical plain radiographs between the two groups on the logistic regression test. New criteria included the above five variables. If a patient has at least variable, the area under the ROC curve of the new criteria was 0.850, and the sensitivity and the false NPV were 87.2% and 5.2%, respectively. Conclusion: New criteria included loss of consciousness, GCS=14, neurologic deficit, posterior neck tenderness, and abnormality of the cervical plain radiographs. If the patient had at least 1 variable, he or she could have a of cervical spine injury with a sensitivity of 87.2% and a false NPV of 5.2%. (J Korean Soc Traumatol 2009;22:154-60)

내원 경로에 따른 급성 수면제 및 진정제 중독의 임상 양상 비교 분석

윤선일,이경우,김균무,성애진,장태창 대한응급의학회 2013 대한응급의학회지 Vol.24 No.6

Purpose: The prevalence of intoxication and toxidromes,such as altered mental status, from Sedatives/hypnotics is high. Many patients have been transferred to a higher-level emergency center. This study was designed to analyze the clinical features of these patients and to compare patients transferred from a regional hospital with patients who directly visited a higher-level emergency center. Methods: A retrospective study was conducted on 298sedative/hypnotic intoxication patients examined from January 2008 to December 2012. After excluding patients intoxicated from other category medications and missing data on medical records, 158 acute intoxication patients were enrolled in the study and divided into transferred and direct-visit groups. Gastric lavage patients (n=108) were also subdivided into two groups by irrigation site. Clinical features, treatments, and complications were investigated. Results: There were no significant differences between the two groups in initial clinical manifestations, laboratory data,and toxicological information, except for charcoal treatment and complications from pneumonia. The use of charcoal was significantly lower in the group transferred from a regional medical center. The transferred group showed a higher incidence of pneumonia than the direct-visit group (10/54(18.5%) vs. 5/104(4.8%), respectively, p=0.007). In the subgroup analysis of gastric lavage patients, there was also a higher incidence of pneumonia in the regional hospital lavage group compared to the higher-level emergency center lavage group (8/32(25.0%) vs. 5/76(6.6%), respectively,p=0.011). From a comparative analysis of pneumonic complications and mental status, pneumonia patients showed a higher incidence of painful responses and unresponsive mentality (6(40.0%) and 4(26.7%), respectively, p<0.001). Conclusion: In acute sedative/hypnotic intoxication patients, transferred patients, including regional hospital gastric lavage patients, showed a higher incidence of pneumonia. Pneumonic complication patients showed a higher incidence of a decreased mentality. Therefore, for patients transferred or treated for an altered mental status, precautions for complications from pneumonia must be considered.

말초 정맥혈과 동맥혈에서 측정된 가스 분석 지표간의 상관성 및 일치성

정영보,김진주,김재혁,임용수,조진성,현성열,성애진,양혁준 대한응급의학회 2011 대한응급의학회지 Vol.22 No.1

Purpose: To determine the correlation and agreement between perpheral venous and arterial values in emergency department patients Methods: The study was conducted at an urban teaching hospital emergency department with an annual volume of 80,000 patient visits. Prospective comparison of paired peripheral venous and arterial values were evaluated from October, 2009 to February, 2010. Peripheral venous and arterial samples were taken as simultaneously as possible when patients who were deemed by the attending doctor to require an peripheral arterial sample presented in the emergency department. Collected information included age, sex,vital signs, emergency department initial diagnosis, lactate,pH, base excess, bicarbonate, pO2, and pCO2. Statistical methods were Shapiro-Wilk test, Spearman rho test, linear regression analysis, and Bland-Altman plots. Results: Among the 546 patients, 50 were excluded and 496 were included. The majority (59.5%) of patients were male. Correlation constant (rho) of pH and lactate were 0.907 and 0.901, respectively. Mean difference and CI (confidence interval) of pH were -0.04 and -1.34~1.56,respectively. Mean difference and CI of lactate were 0.11mmol/L and -0.15~0.07 mmol/L, respectively. Conclusion: Moderate correlation and agreement between perpheral venous and arterial pH, lactate, base excess, and CO2 was evident. Especially, peripheral venous pH, lactate correlated very well and had reasonable agreement with peripheral arterial values to serve as substitutes.