폐부종과 심정지가 발생한 페노바비탈 중독환자

오동렬,이운정,박규남,김세경,김영민,이환,유은영,최경호,정시경 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Phenobarbital is a long-acting barbiturate causing generalized depression of neuronal activity in the brain. Its effect is primarily achieved through enhanced GABA-mediated synaptic inhibition. Its use as an antiepileptic agent was first described in 1912. Before the introduction of phenytoin, phenobarbital is used as sedative-hypnotics. It is used for the treatment of epilepsy and status epilepticus. All barbiturates, including phenobarbital, have a high potential for abuse. They were frequently used for suicide attempts in the past, but they have in large part been replaced by benzodiazepines. The onset of symptoms depends on the drug and the route of administration. Mild to moderate barbiturate intoxication resembles ethanol inebriation with slurred speech, ataxia, and lethargy. Severe acute barbiturate intoxication is life threatening. Early deaths are generally cardiovascular-related. Hypotension, shock, pulmonary edema, and cardiac arrest that occurs with large doses are caused by depression of central sympathetic tone and as well as by direct depression of cardiac contractility. The potentially fatal oral dose of phenobarbital is 6-10g. We describe an 23-year-old woman with pulmonary edema, and cardiac arrest ingestion of 18grams of phenobarbital. She was completely recovered by successful cardiopulmonary resuscitation and homoperfusion. We report a case with literature review.

반복적인 경련을 동반한 아이소니아지드(Isoniazid) 중독환자의 치험 1례

이환,오동렬,정시경,김영민,이운정,김세경,이원재,최경호 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Isoniazid(Isonicotinic acid hydrazide) is an antimicrobial drug used since 1952 as a first line agent for the prophylaxis and treatment of tuberculosis. Isoniazid is well known for problems in population having a high prevalence of isoniazid use for prophylaxis or treatment of tuberculosis. But intentional or accidental isoniazid overdose is uncommon. The ingestion of toxic amounts of isoniazid causes recurrent seizures, profound metabolic acidosis, coma and even death. In adults, toxicity can occur with the acute ingestion of as little as 1.5g of isoniazid. Doses larger than 30mg per kg often produce seizures. When ingested in amounts of 80-150mg per kg or more, isoniazid can be rapid fatal. 40-year-old woman having previous pulmonary tuberculosis ingested 7gram of isoniazid(140mg/kg) to attempt suicide approximately 30 minutes prior to visit to our emergency medical center. She had recurrent generalized tonicclonic seizures and metabolic acidosis. We report one patient treated with pyridoxine, which was equivalent to the amount of isoniazid ingested and administered as a intravenous dose and oral dose

흰쥐에서 심정지후 Pentoxifylline이 뇌의 허혈-재관류 손상에 미치는 효과

정시경,김영민,오동렬,최경호,박승현,이운정,박규남,유은영,이원재,김세경 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: Two major events occurring in the cerebral hemodynamics after successful resuscitation from cardiac arrest are reactive hyperemia and postischemic hypoperfusion. In this study, we examined the effect of Pentoxifylline(PTX) on the rat brain following cardiac arrest. Methods: Fourteen rats were anesthetized and artificially ventilated. Cardiac arrest was produced by chest compression and clamping of tracheal tube for 3 minutes in ketamine anesthetized rats. Circulation was restored by standard cardiopulmonary resuscitation methods. In 7 rats, PTX 10mg/kg was infused at 10min after cardiac arrest(PTX group). In the other 7 rats, same amount of normal saline was infused(control group). Results: In both groups, hemodynamic variables, neurologic deficit(ND) score and histopathologic findings of hippocampal CA1 neurons were observed. Hemodynamic variables and ND score were not significantly different between two groups. Delayed ischemic neurons of hippocampal CA1 were decreased in PTX group(2.2±2.4%) compared with control group(9.1±1.2%). Conclusions: We conclude that PTX prevented development of delayed ischemic neurons in hippocampal CA1 after cardiac arrest. PTX may be useful in emergency situations following cardiac arrest.

응급의료센터의 단기입원치료실 활용경험

최승필,박승현,정시경,박규남,김영민,김세경,이운정,이환 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Overcrowding of emergency department is a serious and growing problem at St. Mary's Hospital. This has motivated the development of short-stay unit(SSU) as an alternative ward to routine hospital admission and ED discharge. In our hospital a SSU begun to admit patients in January 6, 1997. The SSU received 247 patients from the ED during the eight month interval(January 6, 1997 to August 31, 1997). To examine the utilization of the SSU in ED, we retrospectively analyzed 247 patients admitted in SSU from the ED, and compared the average hours per patient with acute gastroenteritis spent in the ED during the 2-month intervals before(July-August 1996) and after(July-August 1997) the establishment of the SSU. The following results were obtained; 1. The total patients consist of EM 92(37.2%), GS 48(19.4%), IM 24(9.7%), PS 21(8.5%), OS 20(8.1%), OBGY 14(5.7%) and others 28(11.3%) 2. The results of EM patients admitted in SSU from ED 1) Sex ratio of male to female was 1:1.1 and the mean age was 37.3±16years 2) In diagnosis, acute gastroenteritis was 29 cases(31.5%), multiple contusion 14 cases(15.2%), drug intoxication 12 cases(13%), limb laceration 6 cases(6.5%), tendon rupture of hand 6 cases(6.5%), and others 19 cases(20.6). 3) Mean length of stay in ED was 9.18 hours. 4) Among 92 patients to the SSU, 79 patients(85.9%) were discharged, 11 patients(11.9%) formally admitted to hospital and 2 patients(2.2%) transferred to otherhospital. The mean hospital stay time of the patients admitted to SSU was 2.6 days. 3. There was a significant reduction in the average stay time spent in the ED by treat-and-releasing patients with acute gastroenteritis after the establishment of the SSU(from 14.65±9.6 to 7.52±5.4 hr/patient, p<0.001). Conclusively, the establishment of the SSU can shorten the average stay time that treat-and-releasing patients spend in the ED, and reduce the number of admitted patients waiting in the ED.

응급센터에서 기관내 삽관을 시행하지 않은 호흡곤란 환자의 동맥혈 이산화탄소분압과 호기말 이산화탄소분압의 연관성분석

김형국,박승현,오동렬,박규남,이원재,황두영,최승필,이운정,정시경,김세경 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Background: The end-tidal carbon dioxide tension(ETCO₂) is defined as a partial pressure of carbon dioxide at the end of an exhaled breath. The purpose of this study is to determine the correlation between ETCO₂and arterial carbon dioxide tension(PaO₂) in nonintubated patients with respiratory distress in emergency department(ED). Methods: A prospective non-blind study was performed in ED of our university hospitals. Participants included all nonintubated adult patients with respiratory distress requiring arterial blood gas analysis. ETCO₂was measured with a capnography monitor during tidal volume breathing. ETCO₂were recoreded at the time of arterial blood gas sampling. The correlation between ETCO₂and PaCO₂was analyzed in all patients and in subgroups by simple linear regression. Results: Sixty patients were enrolled. In all patients, ETCO₂was 5.72mmHg lower than PaCO₂and correlated well with PaCO₂(r²=0.716). ETCO₂correlated best with PaCO₂in patients who were either acidotic or non-smoking. Conclusion: ETCO₂correlate well with PaCO₂in nonintubated patients with respiratory distress in ED. ETCO₂may be sufficient to reflect PaCO₂in selected patients and obviate the need for repeat arterial blood gas determination.

아세트아미노펜 중독 환자에서 NAC 치료중 반감기의 임상적 이용

이승호,이미진,이운정,이원재,김세경 대한응급의학회 2003 대한응급의학회지 Vol.14 No.1

Purpose: A plasma acetaminophen halflife of more than 4 hours has been correlated with hepatotoxicity in acetaminophen overdosing not treated with an antidote. However, the acetaminophen halflife has not been studied in patients receiving the antidote N-acetylcysteine (NAC). Methods: Ninety-eight (98) patients with acetaminophen overdoses, all of whom were treated with N-acetylcysteine were studied. A minimum of 2 plasma acetaminophen values > 2.0 ㎍/ml were available for calculating the acetaminophen halflife, assuming first-order kinetics. Results: Overall, the median acetaminophen halflife was 6.2h ours (range, 1. 15~103.9 hours). Sixty-two (62) patients with no hepatotoxicity (AST<100 U/L), 13 patients with little hepatotoxicity (100 U/L<AST<1,000 U/L), 17 patients with severe hepatotoxicity (AST>1,000 U/L) without acute hepatic failure, and 6 patients with hepatotoxicity (AST>1,000 U/L) with hepatic failure had acetaminophen halflives of 3.7 hours (range, 1.15-23.2 hours), 5.9 hours (range, 1.96-26.2 hours), 6.3 hours (range, 2.19-15.38 hours), and 32.8 hours (range, 5.48-103.9 hours), respectively (p<0.05). A receiver operating characteristic curve analysis showed that an acetaminophen halflife of 5.19 hours provided better discrimination (sensitivity=69.6%, specificity=84.0%, accuracy=80.6%). Conclusion: The acetaminophen halflife correlates well with the degree of liver damage in patients treated with N-acetylcysteine. Longer halflives reflect a greater toxic effect on the liver.

급성신부전증에 합병된 에틸렌 글라이콜 중독의 성공적인 치험1례

이운정,박규남,양관모,유은영,이환,권태욱,나병호,이원재,황두영,김세경 대한응급의학회 1997 대한응급의학회지 Vol.8 No.4

Ethylene glycol is a sweet-tasting liquid with industrial use a solvent or as a starting reagent in chemical processes. Physicians are familiar with ethylene glycol because it is the major component of many antifreeze solutions and is taken in suicide attempts or, more often inadvertency. its metabolites may cause severe intoxication. Unfortunately, its administration and enhancement of elimination. The most commonly used elimination technique is hemodialysis We describe an 21-year-old man with acute renal failure dye to ingestion of antifreeze that contained ethylene glycol. He was transferred to our patient with severe ethylene glycol intoxication illustrates that aggressive and early treatment can prevent mortality and morbidity

경기북부 일개병원에 내원한 말라리아 환자의 임상적 고찰

정시경,오영민,최세민,최경호,이운정,김세경 대한응급의학회 2002 대한응급의학회지 Vol.13 No.2

Purpose: In this study, we analyzed clinical manifestations of and ways to manage malaria. Methods: The medical records of the patients confirmed as malaria by using peripheral blood smear at Ui jungbu St. Mary's hospital from April 1997 to November 2001 were reviewed retrospectively. Results: Of the 179 patients, there were 111 males and 59 females, and their mean ages were 32.3 ±14.5, 34.9 ±18.1 years, respectively. Malaria occurred throughout the year and peaked during the sixth to ninth months (84.1%). All cases were vivax malaria. All 170 patients had fever, but tertian fever was seen in only 81 (48%) patients, Laboratory abnormalities were hemoglobin below 12 g/dL in 70 (41.2%) patients, WBC below 4000/mm³in 49 (28.9%), platelet count below 120,000/mm³in 142(83.5%). Of the 92 patients who underwent ultrasonography of the abdomen, splenomegaly was seen in 81(89%) patients. The time from onset of symptoms to admission ranged from 2 to 30 days with a mean 8.1±5.5 days. All patients responded promptly to drug therapy. One patient developed recurrent malaria 120 days after the first attack. Another patient experienced multifocal splenic infarction. Conclusion: All patients with malaria had fever and chills. The most common laboratory findings were thrombocytopenia and anemia. All patients responded promptly to drug therapy. As cases of malaria in Korea are increasing, early diagnosis and treatment, as well as prevention, are important.

의정부시 집중호우로 발생한 입원환자 분석

정시경,유은영,오동렬,이환,최경호,김영민,이운정,김세경 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.1

Background : Flood is the most common natural disaster in our country. Lots of victims occurred during the period of flood in the northem territory of Kyoungkido on August 5, 1998. We tried to describe the characteristics of the flood-related injury and illness, management and medical requirements. Methods : We interviewed the patients admitted to 8 hospitals in Ujungbu and reviewed medical records from Aug 5 to Aug 14, 1998. Results : There were total 102 patients, male were 52% and women were 48%. Most of Patients were between 30's and 60's. Most of them were minor, and less than 3% of them needed critical care. The diagnosis were laceration(39.2%), contusion (22.5%), fracture(13.7%), infectious disease(7.8%), ligament rupture(7.8%), aggrevation of chronic illness(5.9%), dermatitis(2.0%) and traumatic hyphema(1.0%), The laceration occured in the foot(37.9%), lower leg(27.0%), thigh(16.2%), hand(10.8%) and head(8.1%). The location of ligament injury were achilless tendon(62.5%), hand(25%) and knee(12.5%). The 67.5% of flood-related laceration patients progressed to cellulitis, especially in sutured wound and a typical tetanic patient was developed. Of hospitalized patients, 2 patients showed evidence of post-traumatic stress disorder(PTSD). Conclusion : During flood, civils have better to be educated about prevention of injury, such as wearing of shoes and clothes. Although laceration was minor, lacerated wounds should be thoroughly irrigated, debrided the margin and considered delayed closure, tetanus immunization. Reportedly, there is an increased prevalance of PTSD and depression after disasters. Therefore mental health care will be required in the future.