심폐소생술의 최신지견

송근정 대한가정의학회 2002 Korean Journal of Family Medicine Vol.23 No.7

현대적인 심폐소생술은 1950년대부터 발전하기 시작하여 지금도 많은 학문적인 발전이 이루어지고 있다. 병원 내 심폐소생술에 관한 용어의 정의는 '병원 내 심폐소생술 Utstein 정의'에 규정되어 있다. 심폐소생술 지침은 그동안 미국심장학회 지침과 유럽소생학회 지침으로 크게 양분되어 있었는데, 국제심폐소생술 위원회에 의한 공동 지침이 완성되었고, '심폐소생술과 응급심장 처치에 관한 지침 2000'이 2000년도에 발표되었다. 특징은 알고리듬의 단순화와 과학적인 결과를 바탕으로 한다는 것이다. 특히 변화된 부분은 성인 심정지 환자의 기본소생처치에서 심장 마사지와 인공호흡을 15 : 2의 비율로 통일하고, 환기량을 저용량으로 하고, 일반인에게 경동맥 촉지법과 하임리히법을 가르치지 않는다는 것이다. 기관 삽관의 튜브 크기가 통일되었으며, 심실빈맥/심실세동의 알고리듬에서 epinephrine대신에 vasopressin을 사용할 수 있고, 자동 제세동기의 사용을 권장하고, 급성 관상동맥 증후군에서 병원전 심전도의 중요성, 혈전용해제의 빠른 사용, 급성 허혈성 뇌졸중에서의 병원전 평가와 빠른 혈전용해제 사용이 추가되었다. 그러나 심폐소생술을 시행한 후의 생존율과 신경학적 예후는 결과가 좋지 않으며, 따라서 정확한 심폐소생술의 시행과 함께 심정지가 일어나지 않도록 적극적인 처치를 하여야 한다. (가정의학회지 2002;23:825-830)

In-Hospital Utstein Style 에 의한 3차 의료기관 응급의료센터에서의 심폐소생술 성적

송근정,이정훈,성일순,정연권,최성욱 대한응급의학회 2001 대한응급의학회지 Vol.12 No.1

Background: To assess and report the outcomes of resuscitation, we apply the 1997 published In- Hospital Utstein Style to an actual emergency department. This study was designed to develope the data base for comparing and striding the outcomes of resuscitation. Methods: This study was carried out in a tertiary hospital from July 1998 to June 1999. The subjects were adult patients over the age of 20 years who received resuscitation at the emergency department. After making out the protocol for the In-Hospital Utstein Style, we gathered data prospectively. Results: Among 51,347 patients, 36 patients received 42 resuscitations. Forty-two(42) cases(100%) had witnessed arrest. Advance life support(ALS) intervention at the time of cardiac arrest included intravenous catheterization, 41cases(97.6%); intravenous drug injection, 20 cases(47.6%); endotracheal intubation, 20 cases(47.6%); and artificial ventilation, 12 cases(28.6%). Immediate causes of cardiac arrest were respiratory depression, 11 cases(26.2%); hypotension, 11 cases(26.2 %)·, metabolic, 9 cases(21.4%); and myocardial ischemia/infarction,5 cases(11.9%). Initial EKG ryhthms were pulseless electrical activity,31 cases(73.8%); ventricular tachycardia/flbrillation, 6 cases(14.3%); and asystole, 5 cases(11.9%). the average interval from cardiac arrest to initial defibrillation was 1.8±2.2 minutes, and the average interval from cardiac arrest to epinephrine injection was 2.6 ± 3.1 minutes. The average duration of resuscitation was 22.6± 18.4 minutes. Return of spontaneous circulation occured in 26 cases/42 case(61.9%). Of the 2 survivng patients who were discharged, 1 patient is still alive after 6 months, and the other is still alive after 1 year. Conclusion: Although the In-Hospital Uetein Style has many complementary factors, its results we very Objective thus use of the In-Hospital Utstein Style is recommend혀 for determining the outcomes of resuscitation.

EMS 헬기로 이송한 외상환자의 분석

송근정 대한외상학회 1997 大韓外傷學會誌 Vol.10 No.2

This report is a anterospective clinical study of 32 trauma patients by EMS helicopter. The Samgsung Flight Team operated EMS helicopter. Tbe duration of study is from December 1996 to October 1997. We obtained the following results; 1) Of 32 total trauma patients, male to female ratio was 2.6: 1. The majority of patients 5th decades. 2) By the mechanism of trauma, motor vehicle accident 26 cases, fall down 2 cases, slip down 2 cases, electrical burn 1case, stab injury 1 case. 3) Mean total tranport time is 96.4 min and mean patient tranport time is 47. 1 min. 4) The most common crew type is 1 physician and 1 nurse(59.4% ). 5) The mean GCS is 11.8 and the mean ISS is 14.6. 6) Of 32 total trauma patients, 25 patients admitted, 4 patients transferred, 1 patient discharged from emergency department.

제 2부: 기본소생술

송근정,김재범,김진희,김찬웅,박선영,이창희,장용수,조규종,조영석,정성필,황성오,2015 심폐소생술 가이드라인 기본소생술 전문위원회 대한응급의학회 2016 대한응급의학회지 Vol.28 No.4

응급의학과 전공의 수련 현황과 개선을 위한 보고서 : 대한응급의학회 수련위원회

송근정,박정배,양혁준,이부수,이중의,임용수,최승필,허탁,황성오 대한응급의학회 2003 대한응급의학회지 Vol.14 No.3

Emergency Medicine is a medical specialty that provides comprehensive emergency care. The spectrum of emergency medicine includes humanity as well as medical care for emergency patients. Since the Korean Society of Emergency Medicine has been established and the training course for emergency residents has begun, quality improvement of the training course still remains to be one of the most important issues in emergency medicine. This report is to understand the current status of training of emergency residents and to improve the quality of training of emergency residents. The survey was performed with questionnaires regarding current status of training and opinions to improve quality of training. The questionnaires were sent to all emergency physicians and emergency residents registered to the Korean Society of Emergency Medicine via an electronic mail or a printed letter. The response rates were 49.6% for emergency physicians and 35.8% for emergency residents. On the basis of the result of this survey, we suggest five proposals for improving the quality of resident training course. These include complete adherence of each institution to training guidelines presented by the Korean Society of Emergency Medicine, development of the education program compatible to each institution, shortening of length of training duration from 4 years to 3 years, promotion of the training environment, and introduction of evaluation examination to the training course.

실물화재실험을 통한 화재현장 피해자의 일산화탄소와 저산소증에 의한 손상예측

안무업,유기철,송근정 대한응급의학회 1997 대한응급의학회지 Vol.8 No.4

Background: The fire victims are affected not only by burn and trauma but also carbon monoxide(CO) and hypoxia. It may be useful to triage mass casualties of fire field tht preestimate the victim's injury sevrrities by experiments of measuring the concentration of CO and oxygen according to time progression. Method: We prepared one house of apartment as like usual residental environment. The mesuring of concentrations of CO and oxygen was started from firing. Result: 3.8 Min. after firing: CO concentration(0.007%) was reached to the level that can give rise to spontaneous headache, 5 Min: The concentration of CO was increased. At this level(0.0012%), the victims of fire may be suffered severe headache inspite of mild movement. 5.5 Min: At this time, 0.02% of CO concentration that the victims can't escape by themselves was checked. 6 Min: 0.08% was measured, most patients may be unconscious and the symptoms will be more severe at this CO concentration because of hypoxia. 6.4Min: It was absolutly impossible to be survival at this time due to incresing of CO concentration(0.195%) and decreasing of O2 concentration(5%). Conclusion: It is within 5.5 Min. that the patient can escape by themselves, and impossible to be survival more than 6.5 Min. in fire field. Rescuers and EMTs must consider time factor as well as sysmtoms of patients.

울산 남부 초등학교 계단사고에서 발생한 압좌손상의 고찰

안무업,유기철,송근정 대한응급의학회 1997 대한응급의학회지 Vol.8 No.4

Background: Fatal events have shown us how very easily a mass of human beings may asphyxiate themselves. An accident of this type happened March 3, 1997 at Nambu primary school in Ulsan. We analyse this incident to supply basic data for crowed disaster planning. Method: We conducted a sruvey at the scene of the accident and two hospitals at which the patients were admitted. We interviewed victims, victim's family, and rescuers. We analysed several aspects: prehospital management, in hospital management, traumatic and crush asphyxia symptom, and management of patients with changes in mental status. Results: One child died and 10 children were injured. The mean ISS(injury severity score) and RTS(reviced trauma score) was 4.6 and 11.3 respectively. 8 cases of traumatic and crush asphyxia was occurred. And, the seven out of 10 patients suffered changes in mental status. Conclusion: It is importmant to understand at crowd disaster that the injured persons require basic airway care and breathing support as rapidly as possible, prior to any other managements and studies.

응급실로 내원한 소아학대 환자

최정태,안무업,송준호,안희철,황장회,조용준,유기철,신동훈,최영미,송근정 대한응급의학회 2000 대한응급의학회지 Vol.11 No.1

Background. To develop the guidelines and the education models for primary agents caring for victims of child abuse, and investigate victims of child abuse visited the department of emergency medicine, College of Medicine, Hallym University, Choon-chun Sacred Heart Hospital. Methods. Survey assessed the age, sex, visiting time, offender, tools of maltreatment, types of maltreatment, and types of injury of 47 victims under 18 years old visited the emergency center, between the Jul. 1996 and the Aug. 1998. The injury severiy of victims of child abuse was compared with control group of 197 general violence victims visited the same emergency center at the same duration. Results. The age distribution was 12.8%(n=6) of the 0-1 year old, 17%(n=8) of the 1-3 years old, 8.5%(n=4) of the 4-6 years old, 12.8%(n=6) of the 7-12 years old, and 48.9%(n=23) of over the 13 years old, The sex distribution was 49%(n=23) of male and 51%(n=24) of female, The most common visiting time was 59.6%(n=28) of the 22-02 o'clock. The types of abuse were 46.6%(n=22) of the physical abuse, 27.7%(n=13) of the neglect, 17%(n=8) of the psychic abuse, and 8.5%(n=4) of the sexual abuse. The offender was 38%(n=18) of the parents, 26%(n=12) of the relatives, 4.3%(n=3) of the grandmothers, and 6.4%(n=3) of the nurses. The severity of injury was applied to the ISS(injury severity score). The severity of injury according to ISS was mean ISS=3.82±2.2 in the case of child abuse and mean ISS=1.86±1.6 in the case of general violence(P=0.000). Conclusion. Most victims of child abuse still never come to the overt attention of physicians, social workers, or other professionals. Therefore the establishment of CAN(Child abuse and neglect) protocol and the organization of CAN team in the hospital consisted by department of emergency medicine, pediatrics, and psychiatrics is essential. Furthermore, the co-operation system with child welfare facilites and polices in community is needed.

법적인 문제를 일으키는 응급환자

송근정,장문준,이한식 대한응급의학회 1993 대한응급의학회지 Vol.4 No.2

Recently, number of legal problems beside of malpractice is increasing in hospital, especially in ED, with a social economic development. A retrospective study of consecutive 72 patients who visited YDSH ED profiled legal problems due to stab wound, D.O.A. patient caused by violent crime, patient had been arrested by lawfal agent, rape, gun-shot wound, hopeless person and organ donor were included in this study. The purpose of this article is due to prevent and prepare for the such legal problem by understanding legal aspect of problems listed above. The results were as follows : 1. There was 59 patients of stab wound with male/female ratio of 2.7 to 1, admission/discharge was 23 to 36 patients. 2. Five D.O.A. patients were caused by violent crime, 3 patients by blunt trauma and 2 patients by stab injury. 3. Three patients were related with arrest. 4. Two patients were related with rape. 5. There was I patient in hopeless, gun-shot wound and donor respectively.

우리나라 응급의학과에서의 Rapid Sequence Intubation

송근정,김병철,안무업 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.3

Background : Assessing and securing airway is the beginning of the treatment for emergency patients. Rapid Sequence Intubation is a technique that uses sedatives and neuromuscular blockers to perform endotracheal intubation. This is a basic technique that all emergency physicians must master. Therefore, we investigated the recent circumstance of Rapid Sequence Intubation in patients at the emergency department. Methods : Ten-item surveys were mailed to the board certified emergency physicians in the emergency department of 45 hospitals. Among the 45 surveys, 37 surveys were returned. The rate of reply was 82.2%. Results : Throughout the hospital, 35/37 of the endotracheal intubation was performed in the emergency department. Anesthesiologists were not called for endotracheal intubation in 34/37 emergency department, and anesthesiologists were not called for the use of neuromuscular blockers in 36/37 emergency departments. 35 emergency departments used sedatives. The sedatives used were as follows : midazolam(48.6%), diazepam(25.7%), thiopental sodium(22.9%), and ketamine(2.9%). 30 emergency departments used neuromuscular blockers. The neuromuscular blockers used were as follows : succinylcholine(46.7%), vecuronium(43.3%), and pancuronium(10.0%). The rate of Rapid Sequence Intubation was 33.8%. Various monitoring devices were used during Rapid Sequence Intubation ; cardiac monitors 90.5%, pulse oximeters 80.4%, noninvasive blood pressure monitors 64.9%, and ETCO₂12.8%. Only 6 of 37 hospitals had the assessment program for endotracheal intubations and 60% was the assessment rate in these hospitals ; however, there was no proctocol for the quality assurance assessment. Conclusion : Emergency endotracheal intubation was performed independently by the physician of the emergency department. The Rapid Sequence Intubation was effective and had low adverse effect. We recommended that Rapid Sequence Intubation should be used more aggressively in patients. Also, applying these assessment proctocol in patients, we could improve the quality of assurance assessment.