수도권지역 일개 전문 응급의료센터로 내원한 외상환자의 연령군별 특성

조규종 ( Gyu Chong Cho ),문이상 ( Lee Sang Mun ),강희동 ( Hui Dong Kang ),손유동 ( You Dong Sohn ),오범진 ( Bum Jin Oh ),김원 ( Won Kim ),임경수 ( Kyoung Soo Lim ) 대한외상학회 2005 大韓外傷學會誌 Vol.18 No.2

Background: Although trauma has been the major cause of death in korea, there are few reports describing the epidemiologic characteristics of trauma victims according to age-group. Thus, this study aimed to describe the epidemiologic characteristics of trauma victims visiting an urban emergency medical center in Korea. Method: This study was conducted with all trauma victims who visited the emergency departments of Asan Medical Center from April 11, 2005 to May 10, 2005. After the subjects were divided into three groups such as child (≤ 14 years old), adult(15-64 years old) and elderly(≥ 65 years old), the prehospital courses, injury mechanisms, injury severities and clinical results were compared. Result: Among total 5,927 patients who visited the emergency medical center, 896(15.1%) patients were trauma victims. Although child under the age of 15 comprised 28.7% of the total trauma victims, less severe injuries(injury severity score < 9) accounted for 97.7% of the cases. The hospitalization rate for injury among child was 21.5%. however, although elderly aged 65 comprised only 5.9% of the total trauma victims, more severe injuries(injury severity score ≥ 9) accounted for 30.2% of the cases. The hospitalization rate for injury among elderly was 56.4%. Conclusion: Patterns of injury and clinical results by age-group were considerably different. less severe and non-hospitalized injuries were more common in child than other age-groups. while severe and hospitalized injuries were common in elderly.

중독감시체계를 이용한 중독정보 수집 및 분석: 후향적 기초조사

오범진,김원,조규종,강희동,손유동,이재호,임경수,Oh Bum-Jin,Kim Won,Cho Gyu-Chong,Kang Hui-Dong,Shon Yoo-Dong,Lee Jae-Ho,Lim Kyoung-Soo 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.1

Purpose: Toxic Exposure Surveillance System (TESS) is widely used for poisoning data collection and making a counterplan. But, there were few reports about poisoning data collection using TESS in Korea. The aim was to collect poisoning data using TESS report form and investigate the recognition of emergency physician about the necessity of TESS as preliminary survey. Methods: Retrospectively, we gathered data from hospital records about the patient who admitted hospital emergency room due to poisoning. Date were gathered by paper and/or web client system report form in patients recruited by ICD-10 codes Results: From Jun 2004 to May 2005,3,203 patients were enrolled in 30 hospitals and their mean age was $44.9{\pm}20.3years$ old(male: female = 1,565: 1,638). The most frequent site of exposure was their own residence (73.2%, 2,345/3,203) and most of reported patients were older than 20 years(89.7%, 2,871/3,203). Frequent substances involved in poisoning were medication(41.9%) and pesticide(33.3%). Intentional poisoning was 60.7%(1,954). In fatality, overall frequency was 5.1%(162/3,203) and the most frequent route of exposure was ingestion(96.3%, 156/162) and the most frequent substance was pesticide(85.2%, 138/ 162). Antidotes were administered in 202 patients(2-PAM, atropine, antivenin, N-acetylcystein, vitamin K, flumazenil, ethanol, methylene blue, naloxone, calcium compound). 19 of 20 emergency physicians agreed with necessity of TESS. Conclusion: Data collection using TESS report form showed preliminary poisoning events in Korea. Frequent poisoning substance were medication and pesticide. The fatality was mainly related with pesticide ingestion. Many doctors in emergency room recognized the necessity of TESS.

손목자해로 응급실에 내원한 환자수와 기후인자와의 관련성

한재현,서승완,조규종,김정미,서홍택,정유진,성수정,황재연,이원준,Han, Jae Hyun,Suh, Seung Wan,Cho, Gyu Chong,Kim, Jung Mi,Seo, Hong Taek,Jung, Yu Jin,Seong, Su Jeong,Hwang, Jae Yeon,Lee, Won Joon 한국정신신체의학회 2020 정신신체의학 Vol.28 No.2

연구목적 자살행동의 계절성은 잘 알려져 있는 현상이지만, 자해행동의 계절성은 알려진 바가 적다. 본 연구는 자해행동 중 하나인 손목자해행동이 계절성을 나타내는지를 확인하고, 기후인자와의 관련성을 파악하고자 했다. 방 법 자해행동의 계절성을 확인하기 위하여 2014. 12~2019. 5까지 일 병원 응급실에 손목자해행동으로 내원한 226명의 대상자의 월별 평균 내원 숫자가 월별로 차이를 나타내는지를 보았다. 손목자해행동과 기후인자와의 관련성을 확인하기 위하여 월 단위 시간변수와 기상청 데이터를 통해 획득한 월별 기후변수(기온, 일조량, 1개월 전 대기압)를 설명변수로 하고, 월 별로 손목자해행동으로 응급실에 내원한 횟수를 결과변수로 하여 일반화 가법모형을 이용한 다중 포아송 회귀분석을 실시하였다. 결 과 손목자해행동으로 응급실에 내원한 대상자의 월 평균 숫자는 남자에서 유의한 월별 차이가 있었고, 9월에 가장 많았다(남자 : p=0.048, 여자 : p=0.21, 전체 : p=0.28). 다중 회귀분석 결과 손목자해로 응급실에 내원한 월 평균 환자의 숫자는 남자에서는 1달전 대기압과 기온의 교호작용과 관련이 있었고(p=0.010), 여자에서는 일조량과 양의 상관관계[p=0.044, β=4.70×10-3, 95% CI=(1.19×10-4, 9.27×10-3)]를 보였다. 결 론 손목자해행동은 남성에서 두드러진 계절성을 보이며, 이는 기후변수의 변화와 관련성이 있다. Objectives : Although the seasonality of suicide is a well-known phenomenon, little is reported about the seasonality of non-suicidal self-injury. The purpose of this study was to identify the seasonality of wristcutting behavior and to examine its relationship with meteorological factors. Methods : To identify the presence of seasonality, we investigated whether there was a difference in the average number of visits per month to an emergency room (ER) of an urban hospital for 226 patients with wrist-cutting behavior enrolled between December 2014 and May 2019. To ascertain significant meteorological factors, we used the multiple Poisson regression using generalized additive model with time, monthly temperature, monthly sunshine hour, and atmospheric pressure in the prior month as explanatory variables. Results : In males, the average number of monthly visits to the ER for wrist cutting behavior differed by month and was the highest in September (male : p=0.048, female : p=0.21, total : p=0.28). As a result of multiple regression analysis, the average number of patients admitted to the ER for wrist cutting behavior was related to the interaction between atmospheric pressure in the prior month and temperature in males (p=0.010), and showed a positive correlation with sunlight in females [p=0.044, β=4.70×10-3, 95% CI=(1.19×10-4, 9.27×10-3)]. Conclusions : Wrist cutting behavior shows seasonality in male, which is associated with changes in meteorological variables.

중국산 바르는 관절약을 복용 후 발생한 살리실레이트 중독 2례

이수열,유지영,조규종,유지영,Lee, Soo-Youl,Ryu, Ji-Yeong,Cho, Gyu-Chong,You, Ji-Young 대한임상독성학회 2007 대한임상독성학회지 Vol.5 No.2

Because of the ready availability of aspirin, salicylate poisoning remains a common problem in many countries. Another potential source of salicylate poisoning is medicated oil containing methyl salicylate (oil of wintergreen). Methyl salicylate poses a much greater safety threat than aspirin tablets because of its liquid, concentrated form and high lipid solubility. Because of this danger, the toxic potential of medicated oil containing methyl salicylate should be fully appreciated both by physicians and by the general public. We encountered two cases of salicylate poisoning resulting from accidental ingestion of Chinese medicated oil. We report these cases along with a review of the literature.

국내 농약 제품표지 내용 및 유독성 표시의 적절성

오범진,노형근,김원,조규종,손유동,강희동,임경수,Oh Bum Jin,Roh Hyung-Keun,Kim Won,Cho Gyu Chong,Shon Yoo Dong,Kang Hui Dong,Lim Kyoung Soo 대한임상독성학회 2005 대한임상독성학회지 Vol.3 No.2

Purpose: The morbidity of pesticides are largely related with accidental ingestion in human. The four principal ideals of clarity, completeness, conformity and consistency of label are important to make a correct usage and prevent unnecessary health risk. The aim of this study is to evaluate the appropriateness of pesticides labelling practice in Korea. Methods: The photographic label images of pesticide products were gathered through visiting thirteen manufacturers that produce pesticide products in Korea. We scored labelling practice by guidelines of Food and Agriculture Organization of the United Nations in 1995. Results: From August 2005 to November 2005, we gathered 1,296 label images of pesticide and $58.3{\%}$ (755/1,296) of images were scored by check lists for reviewing label content. The average score of four check list categories was $71.9{\pm}2.2$. Each categorical score were $91.7{\pm}0.9$ for the information appearing on the label, $31.3{\pm}0.0$ for safety precaution, $77.7{\pm}2.0$ for instructions for use, $87.0{\pm}8.7$ for general configurations. In safety precaution, the sentence of keeping locked up the product and two mandatory safety pictograms were missed in all label images. In general configurations category, there was score difference in product package types between bottle and bag container ($85.1{\pm}9.0$ vs. $90.3{\pm}7.2$, p < 0.01). Conclusion: Although there was no comparable previous data, the score of safety precaution was lowest than other categories because the two mandatory safety pictograms and locked up warning sentence were missed. In general configurations, the colour contrast was more inappropriate in the labels on bottle than bag container.

의도성 여부를 중심으로 한 일산화탄소 중독환자의 임상적 특성

조민기 ( Min Ki Cho ),김양원 ( Yang Weon Kim ),이경룡 ( Kyeong Ryong Lee ),이경우 ( Kyung Woo Lee ),이장영 ( Jang Young Lee ),조규종 ( Gyu Chong Cho ),조준호 ( Junho Cho ),김현종 ( Hyun Jong Kim ),김승환 ( Seong Hwan Kim ),정성필 대한임상독성학회 2012 대한임상독성학회지 Vol.10 No.2

Purpose: The purpose of this study was to identify the changes in the characteristics of patients with carbon monoxide (CO) poisoning, as well as the distinctive differences in intentionally exposed patients. Methods: The medical records of CO poisoning patients, who visited nine emergency departments between January 2010 and December 2011, were reviewed retrospectively. The clinical information including age, gender, hospitalization, type of discharge, cause and location of exposure, site of onset, concentration of initial blood carboxyhemoglobin (COHb), methods of treatment and presence of neurological complications was examined. The subjects were divided into an intentional and non-intentional group and the differences between them was compared. Results: A total 209 subjects were recruited. The median age was 38 years (29~49.5 years). They frequently complained of nausea and vomiting, and the most common exposures occurred in winter, normally in the home. The cause of exposure was usually fire, followed by incomplete combustion of fuels. The median initial blood COHb was 13.15%. The proportion of intentionally exposed patients was 21%. They were significantly younger, more frequently discharged against medical advice, and showed a higher initial blood COHb level (22.85%) than the non-intentional group. Conclusion: This study suggests that those with intentional CO poisoning are normally discharged against medical advice even when they have a higher initial COHb level. An adequate explanation of the delayed neurologic sequelae and short term follow-up observation is recommended for those patients with intentional exposure.

고둥 섭취 후 발생한 일가족 테트라민 중독 1례

이창원,곽정근,박경춘,유지영,유지영,조규종,Lee, Chang-Won,Kwak, Jung-Keun,Park, Kyung-Choon,Ryu, Ji-Yeong,You, Ji-Young,Cho, Gyu-Chong 대한임상독성학회 2007 대한임상독성학회지 Vol.5 No.1

Certain parts of shellfish contain poisonous substances and cause intoxication. Tetramine toxin is found in the salivary gland of Neptunea. Three family members were admitted to the hospital with chief complaints of dizziness and blurred vision, gait disturbance, and spasms of the lower extremities after ingesting Neptunea. Physical examination revealed sluggish pupil light reflexes, but laboratory studies were normal. Symptoms were completely resolved within 24 hours after injection of atropine. We report a case of three patients with dizziness and blurred vision, gait disturbance, and spasms of the lower extremities due to Neptunea tetramine toxin.

응급실에서 정맥주사 시행 시 9.6% 리도카인 표면국소마취제의 진통효과

박덕 ( Duk Park ),유지영 ( Ji Yeong Ryu ),조규종 ( Gyu Chong Cho ),유지영 ( Ji Young You ) 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.2

Purpose: A eutectic mixture of local anesthetics (EMLA(R)) cream has been used as a topical anesthetic to reduce the pain of procedures penetrating the skin. It is generally applied for 40 to 60 minutes before the painful procedure. Because of the long application period, EMLA(R) is not useful in the emergency department (ED). The purpose of this study was to determine whether a 20-minute application of 9.6% lidocaine would be useful in reducing the pain of routine peripheral intravenous cannulation in the ED. Methods: We examined 27 male and 19 female patients ages over 18 years of age who required intravenous cannula insertion. Intravenous insertion was performed on 46 patients: 24 patients in the placebo group (mean age: 40.0 years) and 22 in the 9.6% lidocaine group (mean age: 37.6 years). The 9.6% lidocaine or placebo gel was applied and covered with an occlusive dressing for 20 minutes. Pain was scored by the patients using a 0-to 10-cm visual analogue scale. Results: The patients in the 9.6% lidocaine group (mean pain score: 3.4) experienced less pain than those in the placebo group (mean: 5.3), and the difference was statistically significant (p=0.029). Conclusion: We concluded that a 20-minute application of 9.6% lidocaine is safe and effective for reducing pain associated with venipuncture. (J Korean Soc Traumatol 2007;20:115-118)

자살시도자들에서 충동성과 자살시도의 의학적 치명도와의 관계

박지원,서경훈,손경훈,한재현,전영주,정유진,이원준,성수정,한창환,조규종,황재연,Park, Ji Won,Suh, Kyung Hoon,Son, Kyung Hoon,Han, Jae Hyun,Jeon, Yeong Ju,Jung, Yu Jin,Lee, Won Joon,Seong, Su Jeong,Han, Chang Hwan,Cho, Gyu Chong,Hwang, J 대한생물정신의학회 2018 생물정신의학 Vol.25 No.4

Objectives Although impulsivity has long been thought as an important factor influencing suicidal behaviors, it is unknown whether impulsivity increases the risk of dying from suicidal behaviors and what specific component among constructs of impulsivity contributes to the risk of dying among suicide attempters. Methods To elucidate the association between impulsivity and medical lethality of suicide attempt among suicide attempters, we consecutively recruited 46 suicide attempters who visited an emergency room of a general hospital located in a metropolitan area, Seoul, Republic of Korea, due to suicide attempts and consented to participate in this study. Then we assessed medical lethality with the Beck Lethality Scale (LS) and impulsivity with the Korean version of the Barratt Impulsiveness Scale-11-Revised (BIS). Demographic variables were obtained from medical records and structured social work reports for suicide attempters. Results Although total scores of the BIS did not correlate with LS scores, only the scores of self-control, that is one of the Barrett's six theoretical constructs of impulsivity in which the higher score indicates less self-control and more impulsivity, had a significant positive correlation with scores of LS (p = 0.003). The association remained significant after adjusting for variables known to affect suicide lethality such as job status, recent alcohol consumption, diagnosis of depressive disorders, and having a plan for suicide (${\beta}=0.429$, p = 0.009). Conclusions Not impulsivity in general, but poor self-control, in particular, predicts lethal suicidal behaviors among suicide attempters. The degree of self-control should be evaluated when assessing patients with elevated suicide risk, and proper measures should be installed to prevent possible future lethal suicide attempts.

외상 환자에서의 cardiac troponin 1 상승군에서의 기초 조사

손유동 ( You Dong Sohn ),임경수 ( Kyoung Soo Lim ),안지윤 ( Ji Yun Ahn ),박정근 ( Jung Kuen Park ),조규종 ( Gyu Chong Cho ),오범진 ( Bum Jin Oh ),김원 ( Won Kim ) 대한외상학회 2005 大韓外傷學會誌 Vol.18 No.2

Background: Cardiac troponin I (cTnI) is a sensitive cardiac marker of myocardial injury. In normal coronary angiogram, positive cTnI values may be detected in various events such as sepsis, stroke, trauma and so on. To investigate characteristics of cTnI positive group in trauma patients, we designed this study between cTnI positive group and cTnI negative group. Method: Trauma patients who visited emergency room within 24 hours after accidents were included. Patients who had renal failure, acute coronary syndrome, sepsis, spontaneous SAH were excluded. Retrospective study of 97 trauma patients was done. We investgated ISS (injury severity score), positive cTnI, EKG abnormality, shock class, ICU admission rate and mortality. Result: In comparing with non chest trauma group, chest trauma group, whose chest AIS (Abbreviated Injury Score) is more than 3 point, had significant values in ISS, positive cTnI, EKG abnormality, shock class and ICU admission rate. Also, in non chest trauma group, we found several patients whose cTnI level was positive. When non chest trauma group was divided into two subgroups, the mortality and shock class of positive cTnI group were higher than that of negative cTnI group. When all trauma patients were divided into two groups, a positive cTnI group had higher values in ISS, shock class, ICU admission rate and mortality than that in a negative cTnI group. Conclusion: We found that cTnI were positive in patients of cardiac contusion but also in various trauma cases. In non chest trauma patients, we assumed that hypotension caused cTnI elevating. The cTnI could play a role in predicting prognosis in trauma patients.