'퇴원설명문'에 의한 72시간내 부적절한 응급센터 재방문의 감소

박하영,심민섭,송형곤,송근정,Park, Ha Young,Sim, Min Seob,Song, Hyoung Gon,Song, Keun Jeong 한국의료질향상학회 2006 한국의료질향상학회지 Vol.12 No.1

Background : Patients who were discharged from the emergency department(ED) may revisit. These patients are divided into two groups; one is expected scheduled condition, the other is unexpected condition. These patients of inappropriate revisits to the ED would be unsatisfied, difficult to make rapport and take legal action as a result of additional medical charges. The purpose of this study was to reduce inappropriate revisits to the ED with a new method which was developed by analyzing inappropriate revisits in 2002. Methods : This study was conducted in a tertiary hospital consisting of 1,278 beds. The most common cause of inappropriate revisits was the medical team's lack of explanation about a disease. Thus we decided that the effective method was to offer full explanations to patients to understand the clinical pathway of a disease. We made four types of stickers to explain most common 4 diseases in 2003. An emergency physician completed 'discharge explanation report' and explained it to patients in 2004. Results : In 2002 inappropriate revisited patients were 164, patients with four diseases were 79. During the same period of 2003, inappropriate revisited patients were 56 (-65.9%), four disease patients were 6 (-92.4%) and in 2004 inappropriate revisited patients were 52, four disease patients were 19. Causes of revisits were lack of explanation about a disease in 35 patients (44.3%) in 2003, and 5 patients (83.3%) in 2003, and 16 patients (84.2%). Conclusions : Application of 'explanation stickers' at discharge reduced inappropriate revisits from 34.5% in 2002 to 15.9% in 2003. Application of 'Discharge explanation report' by emergency physician reduced inappropriate revisits from 15.9% in 2003 to 13.5% in 2004. Reduction of inappropriate revisits elevated the quality of medical treatment, and decreased patients' dissatisfaction in ED.

연구논문 : 심폐소생술 불필요(DN(A)R) 동의 취득에 대한 전공의 의식조사

이태림 ( Tae Rim Lee ),신태건 ( Tae Gun Shin ),심민섭 ( Min Seob Sim ),조익준 ( Ik Joon Jo ),송형곤 ( Hyoung Gon Song ),송근정 ( Keun Jeong Song ),정연권 ( Yeon Kwon Jeong ),최병인 ( B. I Choe ) 한국의료윤리학회 2011 한국의료윤리학회지 Vol.14 No.3

This survey, which was conducted over the course of 3 months in 2009, was designed to investigate what the medical residents of one university hospital in Seoul think about DNAR orders. A total of 214 out of 468 residents (45.7%) answered the questionnaire. Participants were divided into two groups according to their experiences with taking DNAR order. There was no difference between the two groups on the definition of DNAR, its limitations, and when to issue DNAR orders. However, the two groups showed different opinions concerning who should be consulted in obtaining consent for DNAR and whether or not it was necessary to review DNAR orders. Residents who were experienced in giving DNAR orders felt more inclined to discuss the situation with the patient`s family members rather than the patient herself and thought that DNAR orders would not need to be reconsidered. These differences in opinion may result from the different experiences the two groups of residents had in actually ordering DNAR in the clinical setting. This study shows that more research and discussion is needed in order to establish the limitations and precise definition of DNAR orders.

In-Hospital Utstein Style 에 의한 3차 의료기관 응급의료센터에서의 심폐소생술 성적

송근정,이정훈,성일순,정연권,최성욱 대한응급의학회 2001 대한응급의학회지 Vol.12 No.1

Background: To assess and report the outcomes of resuscitation, we apply the 1997 published In- Hospital Utstein Style to an actual emergency department. This study was designed to develope the data base for comparing and striding the outcomes of resuscitation. Methods: This study was carried out in a tertiary hospital from July 1998 to June 1999. The subjects were adult patients over the age of 20 years who received resuscitation at the emergency department. After making out the protocol for the In-Hospital Utstein Style, we gathered data prospectively. Results: Among 51,347 patients, 36 patients received 42 resuscitations. Forty-two(42) cases(100%) had witnessed arrest. Advance life support(ALS) intervention at the time of cardiac arrest included intravenous catheterization, 41cases(97.6%); intravenous drug injection, 20 cases(47.6%); endotracheal intubation, 20 cases(47.6%); and artificial ventilation, 12 cases(28.6%). Immediate causes of cardiac arrest were respiratory depression, 11 cases(26.2%); hypotension, 11 cases(26.2 %)·, metabolic, 9 cases(21.4%); and myocardial ischemia/infarction,5 cases(11.9%). Initial EKG ryhthms were pulseless electrical activity,31 cases(73.8%); ventricular tachycardia/flbrillation, 6 cases(14.3%); and asystole, 5 cases(11.9%). the average interval from cardiac arrest to initial defibrillation was 1.8±2.2 minutes, and the average interval from cardiac arrest to epinephrine injection was 2.6 ± 3.1 minutes. The average duration of resuscitation was 22.6± 18.4 minutes. Return of spontaneous circulation occured in 26 cases/42 case(61.9%). Of the 2 survivng patients who were discharged, 1 patient is still alive after 6 months, and the other is still alive after 1 year. Conclusion: Although the In-Hospital Uetein Style has many complementary factors, its results we very Objective thus use of the In-Hospital Utstein Style is recommend혀 for determining the outcomes of resuscitation.

응급의료 헬리콥터를 이용한 환자이송에 대한 고찰

송형곤,김병철,송근정,정연권,신백효 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Background: The first EMS helicopter was introduced to Korea in 1996 and from Dec. 1. 1997, it was used for transporting emergent patients. Authors, here upon, report the transporting experiences. Methods: From Dec. 1, 1996 to Dec. 31, 1997, Samsung Medical Center's EMS helicopter was used for air evacuation of critically ill patients. The patients data prospectively analyzed. Result: A total of 65 patients were transported. Male to female ratio was 1.95:1. The mean transport time was 64.1 min(10 - 160 min). Majority of the evacuated patients was surgical patients (General Surgery : 16, Orthopedic surgery : 10, Neurosurgery : 6, Internal medicine : 13, Pediatrics : 3, and others : 3). Twenty-one of the 65 patients transported were admitted to ICU and 31 did not require ICU care. During the air evacuation, one physician and one nurse trained for air evacuation attended the patients. No medical problems or deaths developed during the air evacuation period. Conclusion: The first EMS helicopter was introduced to Korea in 1996. From Dec. 1, 1996 to Dec. 31, 1997, Samsung Medical Center's EMS helicopter was used for air evacuation of critically ill patients. The patients data reported.

응급실로 내원한 소아학대 환자

최정태,안무업,송준호,안희철,황장회,조용준,유기철,신동훈,최영미,송근정 대한응급의학회 2000 대한응급의학회지 Vol.11 No.1

Background. To develop the guidelines and the education models for primary agents caring for victims of child abuse, and investigate victims of child abuse visited the department of emergency medicine, College of Medicine, Hallym University, Choon-chun Sacred Heart Hospital. Methods. Survey assessed the age, sex, visiting time, offender, tools of maltreatment, types of maltreatment, and types of injury of 47 victims under 18 years old visited the emergency center, between the Jul. 1996 and the Aug. 1998. The injury severiy of victims of child abuse was compared with control group of 197 general violence victims visited the same emergency center at the same duration. Results. The age distribution was 12.8%(n=6) of the 0-1 year old, 17%(n=8) of the 1-3 years old, 8.5%(n=4) of the 4-6 years old, 12.8%(n=6) of the 7-12 years old, and 48.9%(n=23) of over the 13 years old, The sex distribution was 49%(n=23) of male and 51%(n=24) of female, The most common visiting time was 59.6%(n=28) of the 22-02 o'clock. The types of abuse were 46.6%(n=22) of the physical abuse, 27.7%(n=13) of the neglect, 17%(n=8) of the psychic abuse, and 8.5%(n=4) of the sexual abuse. The offender was 38%(n=18) of the parents, 26%(n=12) of the relatives, 4.3%(n=3) of the grandmothers, and 6.4%(n=3) of the nurses. The severity of injury was applied to the ISS(injury severity score). The severity of injury according to ISS was mean ISS=3.82±2.2 in the case of child abuse and mean ISS=1.86±1.6 in the case of general violence(P=0.000). Conclusion. Most victims of child abuse still never come to the overt attention of physicians, social workers, or other professionals. Therefore the establishment of CAN(Child abuse and neglect) protocol and the organization of CAN team in the hospital consisted by department of emergency medicine, pediatrics, and psychiatrics is essential. Furthermore, the co-operation system with child welfare facilites and polices in community is needed.

울산 남부 초등학교 계단사고에서 발생한 압좌손상의 고찰

안무업,유기철,송근정 대한응급의학회 1997 대한응급의학회지 Vol.8 No.4

Background: Fatal events have shown us how very easily a mass of human beings may asphyxiate themselves. An accident of this type happened March 3, 1997 at Nambu primary school in Ulsan. We analyse this incident to supply basic data for crowed disaster planning. Method: We conducted a sruvey at the scene of the accident and two hospitals at which the patients were admitted. We interviewed victims, victim's family, and rescuers. We analysed several aspects: prehospital management, in hospital management, traumatic and crush asphyxia symptom, and management of patients with changes in mental status. Results: One child died and 10 children were injured. The mean ISS(injury severity score) and RTS(reviced trauma score) was 4.6 and 11.3 respectively. 8 cases of traumatic and crush asphyxia was occurred. And, the seven out of 10 patients suffered changes in mental status. Conclusion: It is importmant to understand at crowd disaster that the injured persons require basic airway care and breathing support as rapidly as possible, prior to any other managements and studies.

손상정도계수와 외상치를 이용한 외상환자의 분석

송근정,장문준,김성중,조광현,김인병,최성욱,이한식 대한응급의학회 1993 대한응급의학회지 Vol.4 No.2

Trauma is one of the most common causes of death. Recently, injury severity score(ISS) is widely used to evaluate and classify the patients with multiple injury. Trauma score(TS) was developed as a means of providing rapid accurate assessment of the injured patient. Authors conducted a review of trauma patients who visited the emergency department of YongDong Severance Hospital from September 1992 to August 1993. ISS and TS were collected from comprehensive initial evaluation. The results were as follows : 1) The subjects were 10.2%(2,666 patients) of total 26,202 emergency patients. 2) Male to female ratio was 2.1 : 1. The age distribution was highest under 10 year(24.9%). The mean ISS was 3.5, and the mean ISS increased with ago. 3. Analysis of injury mechanism showed high incidence of traffic accident(35.3%), blunt trauma 25.7%, fall 24.2%, stabbing 10.7%, and others 4.3% in order. 4. The 8.0% of patients were admitted after initial management and their mean Iss was 12.6 mean TS was 15.5. 5. Among admitted traffic accident patients, the mean ISS of passenger T.A., pedestrian T.A. and driver T.A. were 19.0 ±9.9, 14.4 ±10.6, and 11.3 ±7.7 respectively. 6. Among 42 mortality cases, 25 patients were D.O.A. and 17 were expired. The mean ISS of D.O.A. Patients was 30.0; the mean Iss and mean Iss and mean TS of expired patients were 28.3 and 11.8 respectively. 7. The most common cause of death was head trauma(66.7%). 8. By comparing the ISS and TS of admitted and expired patients, mortality occurred above 16 point of ISS. The mortality increased with increasing ISS, but it was influenced by the trauma site and the severity of the particular injury site. Mortality also occurred below 15 point of TS, the mortality increased inversely with TS, and the mortality with TS, and the mortality was high below 13 point (above 40%).

법적인 문제를 일으키는 응급환자

송근정,장문준,이한식 대한응급의학회 1993 대한응급의학회지 Vol.4 No.2

Recently, number of legal problems beside of malpractice is increasing in hospital, especially in ED, with a social economic development. A retrospective study of consecutive 72 patients who visited YDSH ED profiled legal problems due to stab wound, D.O.A. patient caused by violent crime, patient had been arrested by lawfal agent, rape, gun-shot wound, hopeless person and organ donor were included in this study. The purpose of this article is due to prevent and prepare for the such legal problem by understanding legal aspect of problems listed above. The results were as follows : 1. There was 59 patients of stab wound with male/female ratio of 2.7 to 1, admission/discharge was 23 to 36 patients. 2. Five D.O.A. patients were caused by violent crime, 3 patients by blunt trauma and 2 patients by stab injury. 3. Three patients were related with arrest. 4. Two patients were related with rape. 5. There was I patient in hopeless, gun-shot wound and donor respectively.

실물화재실험을 통한 화재현장 피해자의 일산화탄소와 저산소증에 의한 손상예측

안무업,유기철,송근정 대한응급의학회 1997 대한응급의학회지 Vol.8 No.4

Background: The fire victims are affected not only by burn and trauma but also carbon monoxide(CO) and hypoxia. It may be useful to triage mass casualties of fire field tht preestimate the victim's injury sevrrities by experiments of measuring the concentration of CO and oxygen according to time progression. Method: We prepared one house of apartment as like usual residental environment. The mesuring of concentrations of CO and oxygen was started from firing. Result: 3.8 Min. after firing: CO concentration(0.007%) was reached to the level that can give rise to spontaneous headache, 5 Min: The concentration of CO was increased. At this level(0.0012%), the victims of fire may be suffered severe headache inspite of mild movement. 5.5 Min: At this time, 0.02% of CO concentration that the victims can't escape by themselves was checked. 6 Min: 0.08% was measured, most patients may be unconscious and the symptoms will be more severe at this CO concentration because of hypoxia. 6.4Min: It was absolutly impossible to be survival at this time due to incresing of CO concentration(0.195%) and decreasing of O2 concentration(5%). Conclusion: It is within 5.5 Min. that the patient can escape by themselves, and impossible to be survival more than 6.5 Min. in fire field. Rescuers and EMTs must consider time factor as well as sysmtoms of patients.

응급실의 약물중독 환자

송근정,조광현,이한식 大韓應急醫學會 1992 대한응급의학회지 Vol.3 No.1

Any short of medical drug, insecticide or foods sometimes makes harmful situation whether it is beneficial or not. Nowadays, the treatment for drug intoxication started mostly in emergency department. The initial treatment must start as soon as possible. The prognosis is depend upon a kind of drug, exposure time and time of initial treatment. Authors conducted a review of acute poisoned patients seen from April 1983 to July 1992, who visited emergency department of Yong Dong Severance Hospital. The results were as follows, 1. The patients of Drug intoxication account for 0.68% of total emergency department patients. 2. Male to female ratio was 1:1.9 and the age distribution revealed a high incidence in second decade(35.7%) 3. From all the cases of drug intoxication and 67.2% was done on purpose. 4. The drug used were sedatives, CO intoxication, pharmaceuticals, pesticide, in order. 5. Admission rate was 23.8% and mean hospital day 6.0 days. 6. ICU admission rate was 30.0% and mean staying time was 4.7 days.