두부 외상 환자의 고혈당과 예후와의 상관관계

현석천,이종안,박준석,박상문,김갑득,장인성,김승열,송화식 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Severe head injury is associated with a stress response that includes hyperglycemia, which has been shown to worse outcome during cerebral ischemia. To better define the relationship between head injury and hyperglycemia, admission glucose level were analyzed in 150 head injured patients from January 1995 to December 1995. Our retrospective study demonstrated a higher glucose level in patients with low Glasgow Coma Scale(GCS) score, especially at 3-5 GCS score, compared to those with high GCS scores. Also a higher glucose level was noted in patients with vegetative state and dead than in those with good recovery and moderate disability. Hyperglycemia(serum glucose level≥200mg%) was associated with decreased level of consciousness and a poor outcome. We conclude that admission hyperglycemia is a significant indicator of severity of injury(p<0.001), but not significant predictor outcome from head injury. After controlling for the influence of the GCS score, glucose levels do not have an independent effect on outcome.

복부외상 환자에 관한 임상적 고찰

현석천,박준석,김갑득,송화식 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

This report is a retrospective clinical study of 60 patients with abdominal trauma admitted and treated at the department of emergency medicine of DanKuk University hospital during the period from January 1995 to December 1995. we obtained following results. 1) The sex distribution was 45 males(75%) and 15(25%) females with significant predominence in male(3:1), and the age distribution revealed high incidence in second to fourth decades(50%). 2) The cases of the abdominal trauma were traffic accident(80%) in most common, violence, fall down in order frequency. All were blunt trauma. 3) The clinical manifestations and physical examination were abdominal pain(92%), abdominal tenderness, rigidity, decreased bowel sound, rebound tenderness in order frequency. 4) The shock status on admission(below 80 mmHg in systolic) were 10 cases with high mortality(30%). 5) The hematocrit changes in serial check after admission were 36 cases(60%). 6) The diagnostic methods were abdominal paracentesis, simple X-ray, abdominal sonography, abdominal CT, and DPL(Diagnostic Peritoneal Lavage). The abdominal paracentesis showed positive 36 cases(63%) among 48 cases. Abdominal paracentesis was one of the valuable diagnostic method in abdominal trauma. The Abdominal CT was the best diagnostic method in solitary organ injury, but the diagnostic rate was very low(25%) in small bowel injury. 7) The injured intraabdominal organs were small bowel(41%), liver(30%), spleen(20%), and kidney(17%). 8) The commonly associated extraabdominal injury were chest trauma(30%), upper and lower extremity injuries(20%), head trauma(15%). 9) The overall mortality rate was 5%, in abdominal trauma with multiple injury.

복부 외상 환자에서 혈뇨의 임상적 의의

김승열,현석천,김갑득,송화식 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.4

To evaluate the relationship between urine RBC and clinical significance, in traumatic victims, we investigated 492 patients with RBC positive urinalysis sustained from trauma who visited our emergency department from september 1995, to October 1996. The result: The most common cause of traumatic urine RBC positive is crash accident(89.6%). The most common symptom and sign were abdominal pain and related symptoms(peritoneal irritation signs, nausea, & vomiting), with the frequency of 48.7%. Concerning with diagnostic tools of 170 cases, 154 cases were diagnosed by CT, and 7 cases were diagnosed by both CT and diagnostic peritoneal lavage, all this 7 cases were intestine perforations, and CT findings of 5/ 7 cases were normal(Reading has been done by emergency physicians). Conclusion: Our investigation showed that hematuria was meaningful as the diagnosis clue of intraabdominal organ injuries rather than renal injuries in the traumatic victims. So, hematuria may be a considerable sign when surgeon decides to do exploratory laparotomy of not, especially hemodynamically unstable patients who CT or other diagnostic tools were contraindicated due to the clinical status. Futhermore, in the case of patients with altered mentality, infants, and chidren unable to take physical examination and medical history, hematuria can be a very useful finding to detect intraabdominal organ injuries.

중증 뇌 손상 환자의 예후 인자에 관한 분석

송화식,현석천,김갑득 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

The author had analyzed respectively a series of 58 patients with severe head injury observed for 6 months from January 1995 to June 1995 to evaluate the significance of the factors of the factors affecting outcome. Severe head injury was defined as a Glasgow coma scale(GCS) score of 8 or less after acute non-surgical resuscitation, or deterioration to that level with 48 hours of impact. Our analysis was performed according to the patients age, initial GCS, pupil change, motor response, CT findings, systolic BP & arterial 02 level. The results were summerized as follows. 1. The most common cause of severe head injury was traffic accidents. 2. The 33(62%) out of 58 patients were found between third decade and sixth decade. 3. The initial GCS had does relationship with pupil change and motor response(P<0.001). Also hypoxia and hypotension affected the initial GCS but then was not significant statistical difference to out-come(P>0.1). The pupil change and the motor response were very strongly associated with the initial GCS (P<0.001). Also early hypotension (systolic pressure<90mmHg) and early hypoxia (Pa02<60mmHg) had a close correlation with initial GCS, but there was not significant statistical difference to out-come(P>0.1). 4. The factors affecting prognostic difference were initial GCS, pupillary abnormality, abnormal motor response, hypotension and hypoxia.

복부손상을 동반한 늑골골절

박상문,현석천,박준석,강명희,김갑득,송화식 대한응급의학회 1997 대한응급의학회지 Vol.8 No.2

Many authors have been reported that the abdominal trauma, especially injury of the liver and spleen, is frequently found with lower rib fractures, below the ninth rib fractures and the incidence was about 20 to 30%. In cases of rib fractures, intra-abdominal organs may be injured in the higher rib fractures than the ninth because the diaphragm is elevated at the level of fifth intercostal space in expiration period and the intra-abdominal lesions are often delayed evaluated due to the pain of the fractures and masked by the other injuries of the head and the extremities. So above reasons, we were often questioned what the level of rib fracture we must evaluate the intra-abdominal injury was? So we investigated 452 patients with rib fractures who visited our emergency medical center from 1995, January to 1996, December and divided into two groups accoring to the prescence of intra-abdominal organ injuries by each the level of rib fractures. The number of patients with intra-abdominal organ injuries were 75(16.6%) and the most frequently damaged organ was the liver(25 cases, 33.3%). We calculated the statistical values of each level of rib fractures by the Chi-Square method and got a result that the level of rib fracture we must evaluate the intra-abdominal injuries was the sixth rib fracture. Therefore, if we will meet the patients with rib fracture below the sixth, we must have attentions to the intra-abdominal injuries and evaluate the abdomen closely with various diagnostic methods.

Caowu(草鳥) 섭취후 발생한 심실 빈맥 1례

김승렬,박상문,현석천,김갑득,송화식,이 현 대한응급의학회 1997 대한응급의학회지 Vol.8 No.3

Aconitum species have been used in western and eastern medicine for centuries. In present, chinese medicine uses the drug to treat weak constitution, poor metabolism, dysuria, cardiac weakness, gout rheumatism in the limbs, neuralgia. Poisoning may occur from intentional or accidental ingestion, and the concentration of the toxic alkaloids - aonitine, mesaconitine, and hypoconitine - varies depending on species, place of origin, time of harvest, and processing procedure. In addition to cardiac arrhythmias, and hypotension, the alkaloids cause GI upset & neurological symptoms, especially numbness of the mouth and parethesia in the extrimities. The alkaloid causes a prolonged sodium current in cardiac muscle with slowed repolarization. The aconitine acts as a agonist of Na-channel receptor. Vaughan-Williams' classification I antiarrhythmic agents which belong to might be the first choice for the therapy of aconitine induced arrhythmias. The modification of the sodium system by aconitine seems to be responsible for the prolongation of the action potential and the appearance of extrasystoles and fibrillation. We experienced a 67-year-old male patient who suffered chest discomfort and palpitation with ventricular tachycardia through to e caused by aconitine. After treatment for 3days he recovered well and discharged. We report this case with literature review.

독사교상의 임상적 고찰

장인성,이종안,김승열,현석천,박상문,박준석,김갑득,송화식 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.4

To evaluate the efficacy of antivenin in the evenous snakebite patients, wd analyzed the 100 cases with evenous snakebite who was from the Chunan and rural arreas around the city. The data was obtained from the three major hospitals in the Chunan from 1995 .1 .1. to 1996. 6. 30. The injury of the evenous snakebite was commonly occurred in male, hot weather(June & August), and daytime. The majority of the snakebites were encountered in the exposed body surface areas, such as fingers, hands, feet and ankle. We treated the patients with antivenin in 60 cases, local incision & suction in 30 cases, and combination of antivenin and incision in 10 cases. The initial dosage of the antivenin was based on the severity of evenomation. We did not use the antivenin in 3 cases of grade 0. Forty-seven cases in grade Ⅰ were treated with an intravenous infusion of 1-3 vials (mean : 0.85vials) of antivenin(Biken) given within 12 hours after the bite, thirty-seven cases in grade Ⅱ with 1-5vials(mean:1.1vials), and thirteen cases in grade Ⅲ with 5-15vials(mean:9.2vials). Local necrosis around the site of snakebite and anemia(Hb<10) were occurred in 9 patients with use of antivenin and in 4 patients without use of antivenin in grade Ⅱ, and in 2 patients with use of antivenin in grade Ⅲ. Three patients in grade Ⅲ had early major complications including acute renal failure, pulmonary edema, and sepsis. Two out of three patients with major complications were not treated with antivenin. One case in grade Ⅱ without use of antivenin lost her fetus in 26th week. The deaths due to evenous snakebite was zero. We conclude that the patients with evenomation should be treated with and intravenous infusion of antivenin in 1st 6-8hour after snakebite to lessen the complication and mortality.

도플러지수를 이용한 급성 심근경색증의 진단에 있어 노인 환자의 특징

김원,조규종,오세현,이영수,이은주,홍진숙,김영득,현석천,임경수 대한노인병학회 2000 Annals of geriatric medicine and research Vol.4 No.4

단기교육으로 시행가능한 심실기능평가법

김원,임경수,오병연,홍은석,김영식,김선만,이부수,현석천,김영득 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: The initial history, physical examination, and ECG assessment should focus on identification of potentially serious noncardiac or cardiac disorders, including coronary artery disease, congestive heart failure, and electrical instability at the emergency room. additionally, it is essential to define disease severity, stability and need for emergency therapy. echocardiography is a useful tool for this purpose. especially Doppler echocardiography may be more sensitive and time-saving diagnostic tool for the evaluation of patients presenting with cardiogenic symptoms. So we evaluate the feasibility of the echocardiographic measurement by emergency physicain after short-term course. Method and Results: Twenty volunteers(10 male, 38.8±9.3 years) were included in the study for measurement of myocardial performance index and established parameters of ventricular function using conventional echo-Doppler methods. Myocardial performance index: (ICT+IRT)/ET, was obtained by subtracting ejection time(ET) from the interval between cessation and onset of the mitral inflow velocity to give the sum of isovolumic contraction time(ICT) and isovolumic relaxation time(IRT). The most of mean values of echocardiogrphic parameters were not significantly different between those of cardiologist and those of emergency physicians(p<0.01). The duration for measuring myocardial performance index was shortest among echocardiographic parameters. the validity of echocardiographic parameters measured by emergency physicians was proved relatively good. Conclusion: It is proved to be feasible for emergency physician to perform echocardiographic evaluation of ventricular function after short-term course

외상으로 인한 지연성 두개강내 혈종의 임상분석

김갑득,박준석,류명곤,강명희,이종안,김승렬,장인성,박상문,현석천,송화식 대한응급의학회 1998 대한응급의학회지 Vol.9 No.1

Experinece in the management of 74 patients with delayed traumatic intracranial hemorrhage(DTICH) of 474 head injury from January 1996 to December 1996 is presented with emphasis on the incidence, occurring time, risk factors and outcome. The incidence of DTICH was 15.6% of all hospitalized head-injury patients. After an injury, every patient had an immediate computerized tomography(CT) scan to diagnose intracranial pathology and then CT follow-up was carried out according to intial CT finding and neurological deficit. The lesion was almost occurred in patients with initial abnormal CT finding(85.1%). 82.4% of DTICH were noted within 72 hours after injury. The delayed epidural hematoma and intracerebral hemorrhage were almost noted in first 72 hours(>90%), but the delyed subdural hemorrhage was found after a time interval varying from 6 hours to 10 days. So we strongly recommend CT follow-up in 4-8hour, 24-72 hour, and then 7th day after head injury, especially in patients with initial abnormal CT findings. The risk factor of the delayed lesion was not hypotension, hypoxia, and consciousness level, but age of patients and the initial CT finding. The development of DTICH was not heralded by neurological deterioration. The prognosis of DTICH was not worse than non-DTICH. The patient with delayed subdural hemorrhage was better than the patient with non-delayed lesion(including hemorrhage and normal CT finding).