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유인술 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2
Author performed a prospective study of patients who visited to emergency department of Chungnam national university hospital via emergency vehicles during the of six months from September, 1,1996 to February, 28,1997. This study assessed the adequate patient tranfer via EMS system and to suggest more advanced guideline for patient transfer. The results were as follows: 1. Among the total 713 patients who transported, 63.7% were male and 36.3% were female. The peak age was 4th and 5th decade 2. Among 713 patients, 620(87.0%)visited via 119 system,57(8.0) via police, 36(5.0%0 via private ambulance. 3. The mobilization distance of ambulance is most common in below 5Km and in below 10min(64.4%) for the required time moving out to scene, within 11-20min. from scene to hospital(49.4%) 4. 87(12.2%) patients were classified into immediate, 176(24.7%) into urgent, and 450(63.1%) into non-urgent. 5. In the prehospital core, airway maintenance was performed in 26.3%, respiratory care, 45.5%, circulation care, 38.1%, C-spine immobilization, 28.0%, spinal immobilization, 24.5%, and fracture immobilization, 35.8%, respectively. 6. The communication between rescuer and hospital was performed insufficiently (0.6).
유인술,김철,김준식,조준필 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2
Chest pain is one of the most frequent complaints for which patients seek medical attention, and the evaluation of chest pain is among the most challenging problems in emergency department. Because it has the dangers of missing the diagnosis and little objective evidence. The potential harm resulting from the improper assessment and management of the patient with this complaint is enormous. So, on the basis of cause producing the chest pain we can take advantage for rapid and accurate diagnosis. We reviewed the 616 patient's records from Jul. 1994 to Jun. 1995. The result was: Cardiac Disease 321 (52.11%) (Acute Myocardial Infarction 33.02%, Angina 30.02%, Arrhythmia 9.03%, Myocardial Disease 7.79%, etc.), Pulmonary Disease 112 (18.18%), Psychiatric Disease 65 (10.55%), Gastrointestinal Disease 46 (7.47%), Musculoskeletal System Disease 17 (2.76%), Total Mortality Rate was 25 (4.06%) for chest pain and 7.79% in cardiac disease. Finally most common cause of chest pain was ischemic heart disease, but in Korea most of patients who suffer from chest pain did not recognize relationship between the chest pain and cardiac disease. Thus we concluded that knowledge of chest pain can be used for reducing the unexpected death and the financial costs for the diagnosis and delayed treatment, and we must advise relationship between risks of cardiac diseases and chest pain via the mass media.
Verapamil 전투약이 Isoflurane-N2O 마취중 Sodium Nitroprusside 의 혈역학과 폐내가스 교환효과에 미치는 영향
유경연,하인호,지재술,권갑수 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.2
Controlled hypotension induced with sodium nitroprusside (SNP) has been most widely used to facilitate the surgical procedure and to reduce blood loss. However, major problem with its clinical use is cyanide toxicity, which is dose related. And resitance and tachyphylaxis, probably being mediated by sympathoadrenal response to lowered blood pressure, is known to increase dose requirements. Accordingly, several attempts have been made to attenuate sympathetic activity and therefore to reduce dose requirement of SNP. Verapamil, a representative calcium channel blocker, exerts inotropic and chronotropic effect, as well as vasodilation. And it is, also, known to impair pulmonary gas exchange. The purpose of these experiments was to evaluate hemodynamic and gas exchange effects of verapamil, and also its efficacy for reducing the amount of SNP during induced hypotension in patients anesthetized with isoflurane and N2O. Twenty five patients, scheduled to undergo general anesthesia with hypotension, were randomly assigned to two groups. Twelve patients were pretreated with verapamil (160mg, SOD: verapamil group) and the other thirteen were not (control group). The results were as follows: 1) Cardiac index remained unchanged in both groups and did not differ significantly between groups at all times. 2) Heart rate was significatly lower in verapamil group than in control group in the hypotensive period. (113± 3.3 vs 103± 2.7, p $lt; 0.05) 3) Hypotension induced by SNP resulted from a marked decrease in systemic vascular resistance in both groups. 4) MPAP, PCWP, CVP, SVR and PVR significantly decreased after SNP infusion in both groups, but they did not differ significantly between the groups at all times. 5) SNP dose requirements to attain the same MAP reduction did not differ significantly between groups. (5.5±0.8vs 4.1±0.8mcg/kg/min, NS) 6) Verapamil pretreatment produced no significant change in intrapulmonary shunt fraction at all times. 7) SNP caused a signficant decrease in arterial oxygen tension in both group, bhere were no significant difference between groups at all times. From the above results, it might be concluded 1) that verapamil, in clinical doses, does not blunt a reflex increase in sympathetic activity in response to SNP induced vasodilation, since it produced only a minor influence on SNP induced hemodynamics and the SNP dose requirements, and that verapamil does not inhibit hypoxic pulmonary vasoconstriction during isoflurane-N2O anesthesia. Thus, verapamil could not be a valuable adjunct of SNP in enhancing the hypotensive effect in spite of preserved arterial oxygenation.
유인술,박재황 大韓應急醫學會 1992 대한응급의학회지 Vol.3 No.1
We performed a review of 406 patients who visited to ER through the EMS system during the past two years period from July 1990 to June 1992(A) and a statistical analysis of 400 population`s answer about a question of the 129 emergency system.(B) The results were obtained as follows; A. 1) Among the total 406 patients, 267 were male(65.8%) and 139 were female(34.2%). The peak age was 4th decade. 2) The underlying medical disease was the major cause of the transport; 227cases(55.9%). The most predominant delivery time was within 10 to min; 263cases(52.4%). The major transport time was 8:00 PM to 4:00 AM; 193cases(47.5%). 3) Among the transported patients, admission rates were 22.2%(90cases), discharge against advice: 9.1%(37 cases), hopeless discharge; 4.4%(18cases), DOA; 3.2%(13 cases), DAA; 3.2%(13 cases), transfer; 3.2%(13 cases). B. 1) 82%(82 cases) of the total 100 pts, was transported by public and private vehicles. 2) The rates which knows the 129 EMS systm was 38.8%(135 cases) and the method of use; 18.0%(72 cases) 3) 26.7%(80 cases) of the total 300 cases have an experiment of education about the emergency first aid.
응급의학 영역에서의 법적인 문제 : A Countermeasure through the legal witness cases 법정 증언 사례를 통한 대책
유인술,박재황 대한응급의학회 1994 대한응급의학회지 Vol.5 No.1
이상의 사례에서 살펴본 바와 같이 우리나라는 법의 제도가 없기 때문에 사망과 관련된 많은 문제들을 응급의학과에서 해결해야 하는 상황을 맞고 있다. 즉, 응급의학을 전공하는 의사는 법의 역할도 함께 수행하여야 하는 상황인 것이다. 따라서 다른과를 전공하는 의사들 보다도 의료에 관계된 법규를 잘 알고 있어야 함은 물론, 사회의 제반 현상에도 많은 관심을 가져야 하겠다. 또한 죽음의 문제와 관련된 많은 법적인 처리 과정이나 보상등에 대한 관심과 함께 이러한 문제는 항시 의료기록이 정리된 후에 발생하기 때문에 사건 발생 당시 상황이나 현장 등에 대한 청취 및 기록 등을 철저히 하는 습관을 가져야 함은 물론 응급의학과 전공의 교육에 있어서도 이러한 점에 비중을 두어 자기 스스로에 대한 보호를 할 수 있도록 하는 능력을 배양시켜야 할 것으로 사료된다.