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최기훈,안희철,안무업,정재봉,김성은,배지훈,서정열,조준휘,박찬우,옥택근,Choi Gi Hoon,Ahn Hee Cheol,Ahn Moo Eob,Chung Jae Bong,Kim Sung Eun,Bae Ji Hoon,Seo Jeong Yeol,Cho Jun Hwi,Park Chan Woo,Ok Taek Gun 대한임상독성학회 2004 대한임상독성학회지 Vol.2 No.1
In emergency department, the clinicians occasionally meet some patients with toxicity caused by ingestion of unknown wild edible greens or herbal agents. Due to there was few quantitative or qualitative studies about the mechanism or clinical features of these materials, it' s hard to approach to the patients and start the initial management in emergency department. Authors experienced the case of poisoning by Scopolia Japonica ingestion. We report this case with review of Scopolia Japonica.
박상헌 ( Sang Heon Par ),안무업 ( Moo Eob Ahn ),서정열 ( Jeong Yeol Seo ),한재현 ( Jae Hyun Han ),홍은석 ( Eun Seong Hong ),이강현 ( Kang Hyun Lee ),김훈 ( Hoon Kim ),박창배 ( Chang Bae Park ) 대한응급의학회 2014 大韓應急醫學會誌 Vol.25 No.4
Purpose: This study was conducted in the base hospital of Tangalle, Sri Lanka, in order to improve a new emergency operating system. Methods: Emergency staff and patients were surveyed based on the five point Likert scale. Doctors and nurses were asked to rate their level of satisfaction regarding theirrelationship with patients. Patients were asked to rate their level of satisfaction with doctors, facilities, and the environment in the hospital. Results: Doctors were overall satisfied with their job, scoring an average of 3.7. They were displeased with limitation of autonomous decision making on medical treatment, which they gave a score of 2.80. Nurses were generally satisfied with emergency services, with a score of 4.53. Nurses feel discomfort in non-specialized training (3.02). They also sense a lack of opportunities in their hospital (3.12). Patients’ findings indicate that most patients were satisfied (4.2) and were displeased with wait time (3.429) and the attention that was given to each patient (3.92). When asked if they would recommend their physician to others and were willing to come back to their physician, outcomes were generally positive, receiving scores of 4.1, respectively. Conclusion: Findings showed that in order to create a wellstructured system in the emergency centers around the Tangalle area, it is crucial to meet the needs of both patients and the emergency staff. Patients must have a sense of rapid treatment as well as privacy. Training should be provided to the staff so that they are better informed in quality care and up to date on recent studies.
김정혁 ( Jeong Hyeok Kim ),안무업 ( Moo Eob Ahn ),김동원 ( Dong Won Kim ),이태헌 ( Tae Hun Lee ),한재현 ( Jae Hyun Han ),홍은석 ( Eun Seong Hong ),이강현 ( Kang Hyun Lee ),김훈 ( Hoon Kim ) 대한응급의학회 2015 大韓應急醫學會誌 Vol.26 No.1
Purpose: After creating a new emergency medical service in Tangalle, Sri Lanka, this analysis intends to determine the changes of satisfaction related to the facility and medical care givers. With this information, an assessment regarding the role of PCU (preliminary care unit) and the contribution of PCU is made possible. Furthermore, the baseline data can be used for further development of emergency medical service. Methods: PCU survey was conducted before and after the establishment on site at Tangalle, Sri Lanka. Patients were surveyed based on a five point Likert scale. Patients were asked to rate their level of satisfaction with doctors, facili-ties, and the environment in the hospital. Results: After the establishment of PCU the number of patients increased by 270% (from 11,496 patients in Year 2011 to 31,120 patients in Year 2014). The number of patients returning home also increased from 2412 to 14,315. Prior to the establishment of PCU, the choice of visiting emergency centers was based on the following order: Kindness of doctors, quality of medical treatment, kindness of nurses. After the establishment of PCU, the choice of visiting emergency cen-ters was changed: From ranking 7th to 2nd, cleanliness of hospi-tal facilities. From ranking 19th to 9th, amenities. Satisfaction rat-ings regarding the patients` perspective of doctors have not changed. However, the satisfaction ratings of the following have changed statistically: From ranking 9th to 2nd, admission process was simple. From ranking 8th to 3rd, PCU had proper medical devices and equipment. From 6th to 5th, received the results of tests quickly. On the other hand, the satisfaction rat-ing for waiting time was pushed back from 7th to 10th. Conclusion: After establishment of the PCU, positive indi-cations were: increase in the number of patients, increase in the capacity to receive patients, and increase in satisfac-tion with the facility. The level of satisfaction regarding the medical staff was unchanged. The level of satisfaction regarding waiting time was decreased.
In our contry, prehospital cardiac arrest means death because layman can not perform cardiopulmonary resuscitation(CPR) and there is no emergency medical technician and transport system for treating victims with prehospital cardiac arrest. And many of physicians usually do not try to perform CPR because they used to treat victims with prehospital cardiac arrest as the dead, so-called death on arrival(DOA). Recently, we experienced a 52 year-old man who sustained from prehospital cardiac arrest induced presumably by variant angina initiated about 20 minutes before hospital arrival. On hospital arrival, he had a fine ventricular fibrillation, but spontaneous circulation was restored (ROSC) at 14 minutes after CPR strated. At 2 hours after ROSC, marked elevation of ST segment appeared and shortly, complete AV block developed. After sublingual and intravenous administration of nitroglycerin, ECG changes disappeared. Diffuse spasm of coronary artery with ST segment elevation was documented during coronary angiogram which showed no atherosclerotic change of coronary artery. He recovered good neurologic function(cerebral performance categories 1) and discharged on his foot.
With development of economic and social state, the traffic accident and industrial injury is increasing progressively. Especially, the most patients injured by traffic accident or falling-down have multiple injuries. We studied the injured patients who visited emergency center of Wonju Christian Hospital from January 1991 to June 1991 prospectively. Over a 6-month period, 2,669 patients admitted and multiple injured patients occupy 39.2%(1,045/2,669). The severe injured patients who were defined as Injury Severity Score(ISS) was above 16 point occupy 14.2%(378/2,669) and mortality of injured patients was 3.2%(86/2,669). Among expired patients, the D.O.A was 35(40.7%) and the patients expired at E.R was 29(33.7%). And the more multiple injured, the more stay time at emergency center was spent. So we need well-organized trauma team and trauma triage system in recent time. But there are many problems in organizing trauma system, and the most serious problem is financial one in builting trauma center and managing of trauma team. We conclude that trauma triage system and trauma center should be organized in a short time and governmental support in economics must be considered.
Nicotine poisoning arising from the use of nicotine patches is rare. However, because nicotine patches are classified as an OTC drug, the risk of misuse or abuse is increasing. Nicotine poisoning using nicotine patches shows an unusual clinical presentation compared to that from oral ingestion of multiple doses of nicotine. We present a case of misused nicotine patches that cause a nicotine poisoning. A thirty-nine year-old healthy man visited the ER with complaints of an intermittent cramping abdominal pain with nausea and vomiting. Upon physical examination, there were no specific findings except increased bowel sounds, and the patient's initial laboratory findings were also unremarkable except for an increased bilirubin level. CT revealed a mild degree of fatty liver. The patient's symptoms did not improve any further with conservative management. During his ED stay, we meticulously took his history again, and we discovered that he had used nicotine patches for three days, six days before admission, and had misused the nicotine patches as NSAID patches. The patient's diagnosis of nicotine poisoning was confirmed by a urine cotinine level ten times the normal value. After a 12-hour stay in the ED, his symptoms disappeared without any specific management.
송근정(Keun Jeong Song),안무업(Moo Eob Ahn),안희철(Hee Cheol Ahn),최정태(Jung Tae Choi),최영미(Young Mee Choi),유기철(Ki Cheol You),조용준(Yong Jun Cho),황장회(Jang Hoi Hwang),송준호(Joon Ho Song),신동훈(Dong Hoon Shin) 대한응급의학회 2000 大韓應急醫學會誌 Vol.11 No.1
Background: It is important for the medical providers who work in the emergency department to have the adequate knowledge about the nature and ways to deal with the patients who suffer from domestic violence because in our country the management of them is prmarliy performed at the emergency centers. The purpose of this study is to provide basic data about the domestic violence and to help in developing the education and management model for the medical providers. Methods: The authors retrospectively reviewed the medical records of 198 patients who visited the emergency center of Chunchon Sacred Heart Hospital from July 1997 to August 1998. Results: The violence against the spouses was highest(108 cases:54.4%) and most of the victims were female(92%) in those cases. The violence against children younger than age 3 was 30%. The majority of the victims were amved around noon (54.5%) and among them, the aged and children were more concentrated. The degree of injury was severer than that of the victims of general violence. Conclusion: In this study the violence against the spouses was the highest in incidence and against the aged was the lowest. The violence rate against children younger than age 3 was lower than that of other comparable studies. The indolence of sexual violence was significantly lower than that of other countries The degree of injury was generally severer than that of general violence patients. But these result should be carefully criticized and accepted because up to now the system for the detection and management for them is not well established.
이창원 ( Chang Won Lee ),안지윤 ( Ji Yun Ahn ),조규종 ( Gyu Chong Cho ),이원웅 ( Won Woong Lee ),손유동 ( Yoo Dong Son ),안희철 ( Hee Chol Ahn ),안무업 ( Moo Eob Ahn ),서정열 ( Jeong Youl Seo ) 대한응급의학회 2010 大韓應急醫學會誌 Vol.21 No.4
Purpose: Barriers to cardiopulmonary resuscitation (CPR) education are magnified by relative cost and course availability. E-learning has emerged as a viable solution for continuous, on-demand training and organizational learning. We assessed the hypothesis that E-learning is a viable strategy for CPR training of the general public and sought to evaluate its effects on CPR quality compared to traditional classroom-based methods. Methods: The E-learning program was specifically designed to teach basic life support skills, and consisted of 50 minutes internet lectures and simulation videos. The training session was freely available to twenty two officers in rural South Korea. The trainees were able to practice with a mannequin and an automated external defibrillator (AED) trainer at their place of employment over the course of 3 days. The control group was trained at a hospital by certified instructors using the same equipment during a 2 hour period. At the end of the course, the participant`s skills were evaluated using a checklist and a skill performance test. Results: Forty two subjects were enrolled finally with 19 and 23 belonging to the E-learning and the control groups, respectively. One E-learning trainee was excluded because he was absent from the skills test. The mean time to learn CPR and AED techniques was 29.0±24.5 minutes in the e-learning group. The mean age of the E-learning group was significantly older than that of the control group (32.4=4.0 vs. 26.0±1.5, p<0.001). However, we did not find any significant differences in their weight, height or CPR educational status. Before the education sessions, the willingness to perform CPR and their confidence in performing CPR were not significantly different among the two groups. Regarding skill performance, there were no significant differences between the groups except the volume of ventilation. The control group showed a higher volume of ventilation than the e-learning group (1,031.7±521.6 vs. 548.8±303.3, p=0.004). Conclusion: E-learning accompanied with appropriate practice can be a helpful tool for public CPR training. The demand for E-learning will increase, and this study shows that e-learning programs can be successful, yielding similar results as traditional, classroom-based training.