미치광이 풀 중독에 의해 발생한 조증

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.

Nicotine 패치에 의한 Nicotine 중독 증례

손유동,이재성,강구현,최정태,안무업,서정열,안희철,Sohn, You-Dong,Lee, Jae-Sung,Kang, Gu-Hyun,Choi, Jung-Tae,Ahn, Moo-Eob,Seo, Jeong-Youl,Ahn, Hee-Cheol 대한임상독성학회 2007 대한임상독성학회지 Vol.5 No.1

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.

외상 센터 및 외상팀의 필요성

임경수 ( Kyoung Soo Lim ),안무업 ( Moo Eob Ahn ),황성오 ( Sung Oh Hwang ),정윤규 ( Yoon Kyu Chung ),유수영 ( Soo Young Yoo ),강성준 ( Sung Joon Kang ),김헌주 ( Hun Joo Kim ) 대한외상학회 1990 大韓外傷學會誌 Vol.3 No.2

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.

병원전 심정지환자의 심폐소생술 결과

황성오 ( Sung Oh Hwang ),안무업 ( Moo Eob Ahn ),김영식 ( Young Sik Kim ),임경수 ( Kyung Soo Lim ),윤정한 ( Jung Han Yun ),최경훈 ( Kyung Hoon Choe ) 대한응급의학회 1992 대한응급의학회지 Vol.3 No.1

Background: In Korea, the victims with prehospital cardiac arrest have little chance to survive, because bystanders do not know how they resuscitate the victims and emergency medical system is incomplete. And there has been no report about resuscitation attempt and survival rate of the prehospital cardiac arrest in Korea. Study Objectives : This study was undertaken to determine the overall survival rate and the factors influencing to survival when cardiopulmonary resuscitation was attempted to the victims of prehospital cardiac arrest. Study Subjects . We studied prospectively 31 consecutive victims with prehospital cardiac arrest. Results . Cardiac arrest were caused by trauma(52 %), cardiac diseases(26%) and non-cardiac medical diseases(22%). Spontaneous circulation was restored (ROSC) in 12 victims(39 %). And patient with non-traumatic cardiac arrest were more likely to restore spontaneous circulation(73%) than were patients with traumatic cardiac arrest(0.7%, P<0.05). Patients having ventricular fibrillation on ECG monitoring were more likely to restore spontaneous circulation(64.3% ) than were other patients(13%, P<0.05). Mean circulatory arrest time was 19.1+-9.9 minutes and it was shorter in patients with ROSC(13.8+-5.3) than patients without ROSC(22.4+-10.7, P<0.05). Cutting point between two group was 19 minutes. Among 12 patients who restored spontaneous circulation, 6 patients had only transient ROSC, 5 patients died from brain death(two moribund discharge was included) and only 1 patient discharged alive without neurologic complication.Conclusion . Under the current setting of emergency medical system in Korea, our data revealed improved rate of ROSC in victims of prehospital cardiac arrest, when circulatory arrest time was short(<19 minutes) and ECG rhythm on hospital arrival was ventricular fibrillation from non-traumatic causes. And considering the feasibility to survive, cardiopulmonary resuscitation should be attempted to the victims with prehospital cardiac arrest.

개방성 분쇄 함몰 두개골절의 즉각 골편 복위술

조용준,김영옥,송준호,황장회,김성민,안명수,오세문,안무업,Cho, Yong Jun,Kim, Young Ock,Song, Joon Ho,Hwang, Jang Hoi,Kim, Sung Min,Ahn, Myung Soo,Oh, Sae Moon,Ahn, Moo Eob 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.5

Objective : The classic and accepted surgical method of compound comminuted depressed skull fractures (FCCD) involves total resection of all the contaminated bone and fragments at the fracture site. A second operation for cranioplasty is then performed at a later date. However, we have believed that primary repair of these bony defects can be achieved by the replacement of bone fragments at the time of the initial debridement, and this can be accomplished without danger to patient. The authors retrospectively reviewed the surgical results to assess the advantages and disadvantages, and also propose the selection criteria of replacement of fractured bone fragments as a primary procedure in FCCD. Materials and Methods : The authors analyzed the data extracted from medical records, and radiological findings in 22 of 71 patients with FCCD, who underwent immediate replacement of fractured bone fragments between April 1993 and October 1998. The mean follow-up period was 13.7 months. The selection criteria for the operation included the patients with mild to moderate severity, regardless of the degree of contamination or dural violation, which presented in hospital within 24 hours of injury. Results : The ages of the patients varied from 4 to 63 years, and there were 20 males and 2 females. Seventeen of 22 patients were fully conscious on admission and the others also had relatively good Glasgow coma scales. Sixteen fractures were located in the frontal area, 9 with involvement of the frontal sinuses, and 6 in the parietal and temporoparietal areas. Of the 22 patients, 8(36.3%) had dural lacerations with 3 of these requiring patching with pericranium, and 12(54.5%) had intracranial hematoma requiring wide craniotomy. The degree of wound contamination was also variable. Fifteen patients had relatively clean wounds, while seven(31.8%) had seriously contaminated wounds with soil, sand, hair, and wood. Only one patient(4.5%) developed infection, and the bone fragments were removed. All wounds healed primarily without pulsatile defect, the skull has remained solid, and no complications have occurred, except the infected case. Conclusion : It is proposed that bone fragments removal for FCCD, regardless of the degree of contamination or dural violation, is not necessary and that primary bone fragments replacement avoids a second operation for cranioplasty.

Glyphosate 근주 후 발생한 봉와직염 1례

김윤성,옥택근,신명철,최현영,문중범,김성은,서정열,안무업,조병렬,김용훈,이봉기,김명,조준휘,Kim, Yoon-Sung,Ohk, Taek-Gun,Shin, Myeung-Cheol,Choi, Hyun-Young,Moon, Joong-Bum,Kim, Sung-Eun,Seo, Jeong-Yeul,Ahn, Moo-Eob,Cho, Byung-Ryul,Kim, Yang 대한임상독성학회 2007 대한임상독성학회지 Vol.5 No.1

Glyphosate is the active ingredient in widely used herbicides. It acts through inhibition of the shikimate metabolic pathway in plants. This pathway does not exist in mammals, however, so glyphosate is presumably less toxic to humans. Nevertheless, fatal cases of glyphosate poisoning in humans have still occurred. Cases of glyphosate poisoning reported in the previous literature were almost always caused by intentional ingestion. Therefore, intramuscular injection of glyphosate with suicidal intent has not been reported. We report a case of 43-year-old man with poisoning due to intramuscular injection of glyphosate herbicide. He was admitted to the emergency department with a chilling sensation, local hotness, swelling, and tenderness at the site of glyphosate injection. He was treated with intravenous antibiotics and analgesics for 10 days and was discharged without any other complication.

사륜오토바이 사고 환자와 이륜오토바이 사고 환자에 대한 비교

김남호 ( Nam Ho Kim ),김명덕 ( Myung Deok Kim ),이태헌 ( Tae Hun Lee ),안무업 ( Moo Eob Ahn ),서정열 ( Jung Yeol Seo ),이재성 ( Jae Sung Lee ),김동원 ( Dong Won Kim ),이정열 ( Jung Ryul Lee ),박상헌 ( Sang Heon Park ),김유민 ( Yu 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.2

Purpose: All-terrain vehicle (ATV)-related injuries have increased since the introduction of ATVs to Korea. The purpose of this study is to compare patients with ATV-related injuries (PATV) to patients with motorcycle (MC)-related injuries (PMC). Methods: We retrospectively analyzed the clinical records of PATV and PMC who visited an emergency center in 2008. The cases of PMC were 164, and those of PATV were 52. Results: While PMC are seen evenly in the first half year and the second half year, PATV are seen mainly the first half year (from March to June: 73%). For PMC the most frequent injury mechanism was collision with another vehicle, while for PATV, it was side overturn/roll over. The injury severity score (ISS), the revised trauma score (RTS), the trauma score and the injury severity score (TRISS) were 5.6±5.6, 7.7±0.7, 5.0±2.1 for PMC and 7.1±7.5, 7.7±1.1, 5.5±1.5 for PATV, respectively. The most common injury sites were the lower extremities for PMC and the face for PATV. The rates of admission, surgery and the length of hospital stay were similar between PMC and PATV. Conclusion: This study shows that the risk of ATV accidents is similar to that of MC accidents. We recommend that the same safety standards and regulations that are applied to MCs should be used for ATVs. Safe and enjoyable paths have to be sought for drivers of ATVs. (J Korean Soc Traumatol 2010;23:128-133)

강원 영서 북부 지역의 약물 중독 실태

옥택근,조준휘,박찬우,김성은,최기훈,배지훈,서정열,정재봉,안희철,안무업,유기철,Ok, Taek-Gun,Cho, Jun-Hwi,Park, Chan-Woo,Kim, Sung-Eun,Choi, Ki-Hoon,Bae, Ji-Hoon,Seo, Jeong-Yeul,Chung, Jae-Bong,Ahn, Hee-Cheol,Ahn, Moo-Eob,You, Ki-Cheol 대한임상독성학회 2004 대한임상독성학회지 Vol.2 No.2

Acute poisoning is one of the diseases which need the most fastest emergency measures at the very beginning. However, at present, The Korea doesn't manage the toxication all over the country, and in particular, there is no guide to medical cure paying due regard to the traits of each area. This paper focused on the issue that the necessary data in preparing the facilities for the treatment of the poisoned patients and materials for medical treatment including antidote would have to be collected, after finding the special features of the symptoms by searching the present conditions of the poisoning in small towns next to farm villages in the North area of Youngseo, Kangwon province. This study was based on the questionnaires from 111 patients who were carried into the emergency room by the poisoning in two university hospitals of the North area of Youngseo, Kangwon, for one year, 2002. Upon investigation, the patients(111) visiting emergency room by the acute poisoning during the research period was found to be 0.37 percent of all patients(30,085) visiting emergency room. Among them, the most high percentage was given in their twenties and thirties at the rate of $39.6\%$, and the ratio($40.5\%$) of the poisoned patients after their fifties was much higher than a research($10\%$) of other areas. Many poisoned patients came to their rescue in an emergency room generally in spring and in winter, from 7 a.m. to 3 p.m. Agricultural chemical of the toxic materials had a majority at a ratio of $57.7\%$, and paraquat of the agricultural chemicals was found to have a lot of toxicity by $31.7\%$. As the trace of the toxication, the oral poisoning was common by $89.2\%$, and $55.9\%$ in the case of operating gastric lavage and nasogastric irrigation, but only $14.4\%$ for prescribing antidote. The mortality of the acute poisoned patients was $17.2\%$, and the toxication by paraquat held a majority. As a result, the acute poisoning of the North area in Youngseo, Kangwon had both of the characteristics of the rural and the city, and the patients over their fifties by the population aging had more attack of the disease than other regions. Also, with the high ratio of the toxication by the agricultural chemicals, especially, the lethal agricultural chemical was used frequently. Therefore, these dangerous situations need to find the ways to cope with.

지역병원에서 다발성 손상환자 후송시의 문제점

임경수 ( Kyoung Soo Lim ),김영식 ( Young Sik Kim ),안무업 ( Moo Eob Ahn ),황성오 ( Sung Oh Hwang ),조남천 ( Nam Cheon Cho ),강성준 ( Sung Joon Kang ) 대한응급의학회 1992 대한응급의학회지 Vol.3 No.1

A prospective review of 53 multiple injured patients(ISS16) initially treated at local com- munity hospitals and subsequently transported more than 50km to a referral emergency center was completed. All injury mechanisms were blunt, and among them traffic accidents occupied the 54.7%. Revised Trauma Score ranged from 0 to 12 (mean, 10.4) and Injury Severity Score ranged from 16 to 50(mean, 24.3). No prior notification of patient transfer to the referring facility was received in 52(98.1%) cases, and absent or very incomplete records were evident in 44 (83.0% ) cases. The quality of care during initial stabilization and transport was evaluated by ATLS guide- lines for airway management, cervical immobilization, breathing support, treatment of shock, fracture immobilization, neurologic evaluation, secondary assessment. Life-threatening deficiencies were identified in 10(18.9%) patients and serious deficiencies in 32(60.4% ). Most frequent departures from these standards involved failure to place a nasogastric tube before transport(58.5% ), inadequate breathing support(30.2 @4 ), inadequate cervical irnmobilization (24.5% ) and inadequate shock treatment(17.0%). This study dernonstrates the need for education of emergency physicians about priorities in trauma management and ATLS courses. Furthermore guidelines for transport and interhospital communication must be established in rural area.

피부 찰과상을 통한 파라쿼트 중독에 의한 사망 1례

김성은,조준휘,천승환,이승용,최기훈,배지훈,서정열,안희철,안무업,옥택근,박찬우,Kim, Sung-Eun,Cho, Jun-Hwi,Cheon, Seung-Whan,Lee, Seung-Young,Choi, Ki-Hoon,Bae, Ji-Hoon,Seo, Jeong-Yeul,Ahn, Hee-Cheol,Ahn, Moo-Eob,Ok, Taek-Gun,Park, Chan 대한임상독성학회 2005 대한임상독성학회지 Vol.3 No.2

Paraquat, is a widely used for its great effect as a herbicide. But the mortality rate by paraquat intoxication is known to be very high. It is thought to act by changing form to superoxide and peroxide free radical. Almost paraquat intoxication is through ingestion. A few intoxication of paraquat is through skin absorption. But there was no known death case through skin absorption. We experienced a case of a expired patient by paraquat intoxication through skin abrasion and scratching wound. A 75-year-old man was visited emergency room after motorcycle accident during transporting paraquat. He has multiple abrasion and scratching wound on extremities, and pelvic bone fracture. There was no evidence of ingestion of paraquat. But serum/urine gramoxone level was all positive. In spite of wound irrigation and hemoperfusion, his condition was been gone form bed to worse. 2 days after, multiple organ failure and the respiratory arrest were developed and he was expired. Paraquat intoxication through skin wound is extremely dangerous and death by that could possibly happen