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글라이포세이트-계면활성제 제초제로 유발된 백서의 저혈압모델에서 지방에멀젼정맥주사(intravenous fat emulsion)의 효과에 대한 선행연구
조별님희,유인술,안홍준,김건동,김훈,유승 대한응급의학회 2013 대한응급의학회지 Vol.24 No.6
Purpose: Decontamination and supportive care are general types of treatment for glyphosate surfactant herbicide (GlySH) intoxication. However, no particular treatment for refractory shock has been established as a conventional therapy. Therefore, this study examined whether intravenous fat emulsion therapy (IFE) is effective on GlySHinduced shock. Methods: This preliminary study was conducted on 10 rats. After anesthesia and catheterization, shock was induced by GlySH infusion. After a stabilization period, animals were randomized to receive intravenous normal saline (Group 1)or 20% lipid emulsion (Group 2). Results: In the shock state, there was no significant difference between the two groups for systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). In the post-management state, there was no significant difference between the two groups for SBP and MAP. However, there was a significant difference for DBP (Group 1, median 72.5 (IQR 52.8-74.6) mmHg; Group 2, median 77.6 (IQR 74.8-98.3) mmHg, p=0.016), SBP variation (Group 1, median 5.5 (IQR 1.6-11.1) mmHg; Group 2,median 25.6 (IQR 15.5-42.9) mmHg, p=0.008); DBP variation (Group 1, median -1.02 (IQR -4.69-11.0) mmHg; Group 2, median 21.1 (IQR 14.0-43.2) mmHg, p=0.008); MAP variation (Group 1, median 1.15 (IQR -2.6-11.0) mmHg;Group 2, median 23.2 (IQR 14.2-42.8) mmHg, p=0.008). Conclusion: The IFE increased blood pressure when shock was induced using GlySH. However, further studies are required to determine what components induced the shock and permitted a response to the IFE.
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중심정맥도관삽입술 시 위치이상의 빈도를 감소시키는 방법: 실시간 초음파 유도하 재위치
안홍준,김건동,조별님희,정원준,유연호,유승,이진웅,김승환,유인술,조용철 대한중환자의학회 2013 Acute and Critical Care Vol.28 No.4
Background: The purpose of this retrospective and prospective study is to evaluate the efficiency of ultrasound (US) guidance as a method of decreasing the malposition rate of central venous catheterization (CVC) in the emergency department (ED). Methods: We retrospectively enrolled 379 patients who underwent landmark-guided CVC (Group A) and prospectively enrolled 411 patients who underwent US-guided CVC (Group B) in the ED of a tertiary hospital. Malposition of the CVC tip is identified when the tip is not located in the superior vena cava (SVC). In Group B, we performed US-guided intravascular guide-wire repositioning and then confirmed the location of the CVC tip with chest radiography when the guide-wire was visible in any three other vessels rather than in the approached vessel. In the case of a guide-wire inserted into the right subclavian vein (SCV), the left SCV and both internal jugular veins (IJV) were referred to as the three other vessels. The two subject groups were compared in terms of the malposition rate using Fisher’s exact test (significance = p < 0.05)Results: There were 38 malposition cases out of a total of 790 CVCs. The malposition rates of Groups A and B were 5.5% (21) and 4.1% (17), respectively, and no statistically significant difference in malposition rate between the two groups was found. In Group B,the malposition rate was decreased from 4.1% (17) to 1.2% (5) after the guide-wire was repositioned with US guidance, which led to a statistically significant difference in malposition rate (p < 0.01). Conclusions: The authors concluded that repositioning the guide-wire with US guidance increased correct placement of central venous catheters toward the SVC.
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저체온 치료를 시행받은 심정지 및 목맴 환자의 초기 뇌전산화단층촬영상 시신경초 지름과 신경학적 예후와의 연관성
김건동,안홍준,조별님희,정상민,이준완,유연호,유인술,정원준 대한중환자의학회 2013 Acute and Critical Care Vol.28 No.4
Background: Early prediction of neurologic outcome is important to patients treated with therapeutic hypothermia after hypoxic brain injury. Hypoxic brain injury patients may have poor neurologic prognosis due to increased intracranial pressure. Increased intracranial pressure can be detected by optic nerve sheath diameter (ONSD) measurement in computed tomography (CT) or ultrasound. In this study, we evaluate the relation between neurologic prognosis and optic nerve sheath diameter measured in brain CT of hypoxic brain injury patients. Methods: We analyzed the patient clinical data by retrospective chart review. We measured the ONSD in initial brain CT. We also measured and calculated the gray white matter ratio (GWR) in CT scan. We split the patients into two groups based on neurologic outcome,and clinical data, ONSD, and GWR were compared in the two groups. Results: Twenty-four patients were included in this study (age: 52.6 ± 18.3, 18 males). The mean ONSD of the poor neurologic outcome group was larger than that of the good neurologic outcome group (6.07 mm vs. 5.39 mm, p = 0.003). The GWR of the good neurologic outcome group was larger than that of the poor outcome group (1.09 vs. 1.28, p = 0.000). ONSD was a good predictor of neurologic outcome (area under curve: 0.848), and an ONSD cut off ≥ 5.575 mm had a sensitivity of 86.7% and a specificity of 77.8%. Conclusions: ONSD measured on the initial brain CT scan can predict the neurologic prognosis in cardiac arrest and hanging patients treated with therapeutic hypothermia.
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정현호,정시경,오주석,우선희,소병학,위정희,김지훈,임지용,최승필,박경남,조별님희,홍성엽 대한응급의학회 2017 Clinical and Experimental Emergency Medicine Vol.4 No.2
Objective: Outbreaks of transmissible respiratory infection are suspected to have significant effects on the health of pediatric and geriatric patients. The objective was to assess the impact of the Middle East respiratory syndrome (MERS) outbreak on the use of emergency resources. Methods: An ecologic analysis of emergency department (ED) records between September and December 2015, was performed. Data was obtained from the National Emergency Department Information System database for Korea. All demographic and diagnostic data from patients presenting with febrile symptoms as a main complaint were collected. The data were compared to the equivalent period in the three years preceding the MERS outbreak in Korea. Results: Following the MERS outbreak, there was an increase in overall ED visits by febrile patients and the proportion of visits by febrile patients, relative to total ED attendances. This effect was more prominent in the children under five years. The duration of the chief complaint before ED arrival and the length of ED stay were significantly increased among younger pediatric patients. Decreased body temperature on arrival was observed in younger pediatric patients. Conclusion: MERS outbreak appears to have had a significant effects on ED use by febrile patients. The use of emergency care services by pediatric patients makes them more vulnerable to an outbreak of a transmissable disease. An effective strategy to control emergency center visits by non-urgent febrile patients and provide proper medical services is urgently needed.
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