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.

한국인의 항파상풍 항체의 정성적 조사

손유동 ( You Dong Sohn ),임경수 ( Kyoung Soo Lim ),최욱진 ( Wook Jin Choi ),안지윤 ( Ji Yun Ahn ),김원 ( Won Kim ),최윤백 ( Youn Back Choi ),홍은석 ( Eun Seok Hong ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.1

Background: In Korea, vaccination against tetanus began in the mid-1950s. At present, there is a routine immunization schedule with diphtheria, pertussis, and tetanus (DPT) vaccines at 2,4,6 month after birth and booster at 15-18 month and 4-6 years. However, further prophylactic programs according to guidelines of Center for Disease Control do not exist due to the absence of tetanus toxoid. And we have usually used only passive immunization, tetanus immunoglobulin, as a prophylactic regimen for injured patients. In this study, we aimed to determine the tetanus antibody titers levels of Koreans and point out problems of prophylactic programs after a routine immunization schedule. Methods: This study was conducted with 112 healthy adults from August 29, 2003 to September 19, 2003. No volunteers had unstable vital signs, or had taken any medication for chronic illnesses. A questionnaire was used for the volunteers to assess their knowledge about tetanus vaccination schedule, and the whole blood was withdrawn from each volunteer to determine qualitative anti-tetanus antibody titers using TQS (Tetanus Quick Stick). TQS had been introduced as a rapid, easy method to determine the immune status. Results: Of the 112 studied subjects, only 13 (11.6%) were found to have protective levels of anti-tetanus antibody titers. There was no association between quantitative antibody titers and age, sex, educational status, economy, place of birth or residence, military service, and vaccination. Conclusion: Although tetanus is a preventive disease by the antibodies developed as a result of vaccination and its occurrence is not very common, it is associated with a rather high mortality rate. Recently, there has beena tetanus immunization shortage in Korea caused by an absence of tetanus toxoid. The effect of a tetanus shortage makes the tetanus antibody values go under the protective level for most adults. We recommend that tetanus prophylaxis in Korea should be performed following the guidelines of Center for Disease Control and Prevention.

Nicotine 패치에 의한 Nicotine 중독 증례

손유동,이재성,강구현,최정태,안무업,서정열,안희철,Sohn, You-Dong,Lee, Jae-Sung,Kang, Gu-Hyun,Choi, Jung-Tae,Ahn, Moo-Eob,Seo, Jeong-Youl,Ahn, Hee-Cheol 대한임상독성학회 2007 대한임상독성학회지 Vol.5 No.1

Nicotine poisoning arising from the use of nicotine patches is rare. However, because nicotine patches are classified as an OTC drug, the risk of misuse or abuse is increasing. Nicotine poisoning using nicotine patches shows an unusual clinical presentation compared to that from oral ingestion of multiple doses of nicotine. We present a case of misused nicotine patches that cause a nicotine poisoning. A thirty-nine year-old healthy man visited the ER with complaints of an intermittent cramping abdominal pain with nausea and vomiting. Upon physical examination, there were no specific findings except increased bowel sounds, and the patient's initial laboratory findings were also unremarkable except for an increased bilirubin level. CT revealed a mild degree of fatty liver. The patient's symptoms did not improve any further with conservative management. During his ED stay, we meticulously took his history again, and we discovered that he had used nicotine patches for three days, six days before admission, and had misused the nicotine patches as NSAID patches. The patient's diagnosis of nicotine poisoning was confirmed by a urine cotinine level ten times the normal value. After a 12-hour stay in the ED, his symptoms disappeared without any specific management.

염소가스 노출 환자의 1년간 추적관찰

권혁술,손유동,안희철,안지윤,Kwon, Hyuk-Sool,Sohn, You-Dong,Ahn, Hee-Cheol,Ahn, Ji-Yun 대한임상독성학회 2008 대한임상독성학회지 Vol.6 No.2

Purpose: Chlorine gas is a common irritant that usually causes mild respiratory symptoms. One severe symptom, RADS (Reactive Airway Dysfunction Syndrome), is not well known to physicians. We analyzed the clinical features of chlorine gas exposure. Methods: We prospectively collected 25 cases of chlorine gas exposure near our emergency center on January 10th, 2007, and analyzed demographic data, event-to-ER interval, symptoms, and laboratory results based on medical records. Results: Only 2 patients out of 25 were admitted because of severe symptoms, the rest were discharged without complications. Sixty percent of them visited the ER within 12 h of exposure. The most common symptoms were chest discomfort (60%), headache (40%), nausea (40%), throat irritation (26%), and cough (32%). Two out of eight dyspnea cases showed abnormal pulmonary function, but only one case was diagnosed as RADS. Conclusion: Most symptoms after chlorine gas exposure can be treated conservatively. However, patients with chlorine exposure should be followed up long term for delayed complications.

위장관염으로 오인된 콜히친 중독 1례

안지윤,손유동,권혁술,안희철,Ahn, Ji-Yun,Sohn, You-Dong,Kwon, Hyuk-Sool,Ahn, Hee-Chol 대한임상독성학회 2008 대한임상독성학회지 Vol.6 No.2

A 47-year-old woman ingested about 12 mg of colchicine with suicidal intent. Colchicine, a highly poisonous alkaloid, is a commonly used treatment for gout, Bechet's disease, and familial Mediterranean fever. Despite the knowledge of its side effects, the risk of a significant overdose is under-appreciated. She suffered from acute multisystem toxicity, including gastrointestinal disorders, bone marrow suppression, alopecia, and probable pancreatitis, but she ultimately recovered with supportive therapy. We report a case of acute colchicine toxicity from a single overdose with a review of the literature.

네일 건(Nail Gun) 사고에 의한 경부 관통상 1례

한종순 ( Jong Soon Han ),손유동 ( You Dong Sohn ),안지윤 ( Ji Yoon Ahn ),안희철 ( Hee Cheol Ahn ),권혁술 ( Hyuk Sool Kwon ),서강열 ( Gang Yeol Seo ),조광윤 ( Kwang Yun Cho ),박승민 ( Seung Min Park ) 대한외상학회 2011 大韓外傷學會誌 Vol.24 No.1

Powered by compressed air, a nail gun is an essential alternative tool to a hammer on any construction site. This useful machine launches nails at high speed, automatically embedding them in a piece of wood in only a fraction of a second. In spite of its convenience, life-threatening and fatal nail gun injuries can occur when a nail gun is misused, such as in a suicide attempt, or when the operator has insufficient training because combustion nail guns are capable of firing projectiles at velocities higher than 150 m per second. Although injuries by nail guns are rarely reported, there have been reports of nail gun injuries to the head and the trachea in Korea. In the emergency room, the authors experienced a patient injured by an accidental shooting of a nail gun while working in construction. In that accident, a nail penetrated the patient`s cervical vertebra through the left cheek. This report is aimed at studying medical treatment for patients with penetrating injuries caused by nail guns. (J Korean Soc Traumatol 2011;24:48-51)

외상환자의 전산화 단층촬영소견에서 나타난 달무리 소견의 임상적 유용성

이승용 ( Seung Yong Lee ),손유동 ( You Dong Sohn ),안희철 ( Hee Cheol Ahn ),강구현 ( Gu Hyun Kang ),최정태 ( Jung Tae Choi ),안무업 ( Moo Eob Ahn ),서정열 ( Jeong Youl Seo ) 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.2

Purpose: The management of hemorrhagic shock is critical for trauma patients. To assess hemorrhagic shock, the clinician commonly uses a change in positional blood pressure, the shock index, an estimate of the diameter of inferior vena cava based on sonography, and an evaluation of hypoperfusion complex shown on a CT scan. To add the finding for the hypoperfusion complex, the ``halo sign`` was introduced recently. To our knowledge, this ``halo sign`` has not been evaluated for its clinical usefulness, so we designed this study to evaluate its usefulness and to find the useful CT signs for hypoperfusion complex. Methods: The study was done from January 2007 to May 2007. All medical records and CT images of 124 patients with trauma were reviewed, of which 103 patients were included. Exclusion criteria was as follows: 1) age < 15 year old and 2) head trauma score of AIS ≥ 5. Results: The value of kappa, to assess the inter-observer agreement, was 0.51 (p < 0.001). The variables of the halo-sign-positive group were statistically different from those of the halo-sign-negative group. The rate of transfusion for the halo-sign-positive group was about 10 times higher than that of the halo-sign-negative group and the rate of mortality was about 6 times higher. Conclusion: In the setting of trauma, early abdominal CT can show diffuse abnormalities due to hypoperfusion complex. Recognition of these signs is important in order to prevent an unwanted outcome in hemorrhagic shock. We conclude that the halo sign is a useful one for hypoperfusion complex and that it is useful for assessing the degree of hemorrhagic shock. (J Korean Soc Traumatol 2007;20:144-148)

불화수소산에 의한 화학화상 2례

장성원 ( Sung Won Jang ),손유동 ( You Dong Sohn ),주명돈 ( Myung Don Ju ),최우익 ( Woo Ik Choi ) 대한외상학회 2006 大韓外傷學會誌 Vol.19 No.2

Hydrofluoric acid is a colorless gas or fuming liquid with a strong, irritating odor. Hydrofluoric acid burns are uncommon; however, if severe burn occur, they caused death from systemic effects, such as fatal cardiac arrthmia. We experienced two cases of hydrofluoric acid chemical burns on digits. These patients had typical clinical features of hydrofluoric acid chemical burns, such as pulsating pain at the burn site, as well as ischemic and necrotic skin changes. The hydrofluoric acid chemical burn was confirmed by a history of exposure. Subsequently, we made a calcium gluconate gel by mixing 20% calcium gluconate, an antagonist against hydrofluoric acid, with lubricant, and we injected 10% calcium gluconate subcutaneously when they complained of pain rated at higher than 5 on the pain scale. Simultaneously, we monitored the patients` electrocardiographs and checked their serum total calcium, ionized calcium, and magnesium levels serially. Clinical presentations and the emergency management of hydrofluoric acid chemical burns were reviewed along with the current literature. These patients were discharged without any significant complications. (J Korean Soc Traumatol 2006;19:173-177)

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.

응급실에서 이동식 단순 X-선 검사와 피폭선량과의 상관관계: 코호트 연구

김유정 ( Yu Jung Kim ),안희철 ( Hee Cheol Ahn ),손유동 ( You Dong Sohn ),안지윤 ( Ji Yoon Ahn ),박승민 ( Seung Min Park ),이원웅 ( Won Woong Lee ),이영환 ( Young Hwan Lee ) 대한임상독성학회 2013 대한임상독성학회지 Vol.11 No.2

Purpose: This study was conducted in order to determine the relationship between the number of portable X-rays and the radiation exposure dose for emergency medical service providers working in the emergency department (ED). Methods: A prospective study was conducted from February 15, 2013 to May 15, 2013 in the ED in an urban hospital. Six residents, seven emergency medical technicians (EMT), and 24 nurses were enrolled. They wore a personal radiation dosimeter on their upper chest while working in the ED, and they stayed away from the portable X-ray unit at a distance of at least 1.8 m when the X-ray beam was generated. Results: The total number of portable x-rays was 2089. The average total radiation exposure dose of emergency medical service providers was 0.504±0.037 mSv, and it was highest in the EMT group, 0.85(0.58-1.08) mSv. The average of the total number of portable X-rays was highest in the doctor group, 728.5(657.25-809). The relationship between the number of portable X-rays and the radiation exposure dose was not statistically significant(-0.186, p=0.269). Conclusion: Under the condition of staying away from the portable X-ray unit at a distance of least 1.8 m, the relationship between the number of portable X-rays and the radiation exposure dose was not statistically significant.