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우재혁 ( Jae Hyug Woo ), 임용수 ( Yong Su Lim ), 김재광 ( Jae Kwang Kim ), 김진주 ( Jin Joo Kim ), 현성열 ( Sung Youl Hyun ), 양혁준 ( Hyuk Jun Yang ), 이근 ( Gun Lee ), 이미진 ( Mi Jin Lee ) 대한응급의학회 2009 大韓應急醫學會誌 Vol.20 No.6
Purpose: This study evaluated the efficacy and positive influences of a critical event monitoring system (CEMS), which is an automatic alerting system for patients with critical laboratory results. Methods: We compared various patient data variables with hyperkalemia during the 1 year before and after CEMS, which was initiated in July 2007 (Before group: July 2006~June 2007, After group: July 2007~June 2008). Results: A total of 2,417 patients had severe hyperkalemia (K+≥6.5 mmol/L) during the period. Of the 2,417, 1680 were excluded, Leaving 389 patients to be enrolled in the `before group` and 348 in the `after group`. Baseline characteristics were similar between the two groups. Although the load of work for the medical staff increased during the period when CEMS was begun, the time interval from critical laboratory results to appropriate treatment decreased (72.68±94.03 vs. 70.07±92.28 minutes) as did the length of hospital stays (20.27±27.01 vs. 17.03±26.89 days). These decreases were not statistically significant. Decreases in time interval and hospital stay were more prominent for patients treated in the ICU and by emergency physicians during the day time. Mortality within 48 hours (19.5 vs. 19.5%) did not change after beginning CEMS. Mortality in the ICU (2.04 vs. 1.94%, p=0.046) decreased after beginning CEMS. Conclusion: Information technology strategies such as using CEMS may be an effective tool for improving the quality of medical care. But we must also consider other factors such as work load of the medical staff which also influence the quality of medical care.
Purpose: Trauma is one of the most common causes of death for children, and identifying severely injured children quickly in an overcrowded emergency room (ER) is difficult. Therefore, severe injury must be prevented, and the severity of injuries in children must be determined easily from their general characteristics and pre-hospital factors. Methods: Injured children younger than 15 years of age who visited the ER from June 2011 to May 2013 were enrolled. According to the revised trauma score (RTS) of the patients, the study population was divided in two groups, a severe group (RTS<7) and a mild group (RTS≥7). The general characteristics and the pre-hospital factors were compared between the two groups. Results: Six hundred seventy-three children were enrolled, their mean age was 8.03 (±4.45) years, and 476 (70.73%) patients were male. Of these patients, 22 patients (3.27%) were in the severe group, and 651 patients (96.73%) were in the mild group. Fewer males were in the severe group than in the mild group (50.00% vs. 71.43%, p=0.030), and children in the severe group were younger than children in the mild group (3.50 vs. 8.00 years, p=0.049). In the severe group, toddlers (54.55%, p=0.036) were the most common age group. Severe injuries occurred more often in spring (32.81%) and summer (54.56%) than in autumn (9.09%) and winter (4.55%) (p=0.026). The most common places of injury in the severe group were roads (50.00%, p=0.009), and the most common mechanisms of injury in the severe group were traffic accidents (50.00%), followed by falls (31.82%) (p=0.011). Most severely injured children were transferred by ambulance (72.73%, p=0.000). Conclusion: The results of this study may be helpful for identifying severely injured children quickly in the field and the ER. To prevent severe pediatric injuries, precautions and policies based on these results should be established. [ J Trauma Inj 2014;27:43-49 ]
우재혁 ( Jae Hyug Woo ), 이근 ( Gun Lee ), 조진성 ( Jin Seong Cho ), 양혁준 ( Hyuk Jun Yang ), 임용수 ( Yong Su Lim ), 김진주 ( Jin Joo Kim ), 박원빈 ( Won Bin Park ), 장지용 ( Jee Yong Jang ), 장재호 ( Jae Ho Jang ), 현성열 ( Sung Youl H) 대한응급의학회 2015 大韓應急醫學會誌 Vol.26 No.5
Purpose: This study describes the disaster medical responses to the disaster scene of long-distance on a highway; 106-vehicle chain collision on Yeong-Jong Grand Bridge on February 11, 2015 and we discuss the disaster communication by social media. Methods: Records of disaster medical responses from records of relevant organizations and messages of social media were collected. Medical records and the results of triage were reviewed retrospectively. Casualties were categorized into four groups according to results of triage; Red- Yellow-Green-Black. Kappa statistics were used to measure agreement between results of triage and casualties' outcome. Results: Disaster Medical Assistant Team (DMAT) arrived on the scene one hour after accidents occurred. DMAT settled in a temporary base camp in the middle part of the scene and did not build an emergency air shelter. DMATs from four hospitals were separated into four mobile units of DMAT and they joined the rescue team. Disaster communication by social media was useful. Seventy six casualties were transported and two died; 28.9% of casualties were transported to the nearest regional emergency medical center; 20.0% of red casualties were transported to a higher level of care again. Kappa statistics were 0.122 (95% CI, -0.049~0.291; p=0.094). Conclusion: In the disaster scene of long-distance on a highway, adequate location of triage and treatment area may be the front or rear of the scene and separation of DMATs can be helpful. Disaster communication by social media was helpful. Education and policies will be required for more effective triage and dispersion of casualties.
조현우 ( Hyun-woo Cho ), 우재혁 ( Jae-hyug Woo ), 임용수 ( Yong-su Lim ), 장재호 ( Jae-ho Jang ), 조진성 ( Jin-seong Cho ), 최재연 ( Jea-yeon Choi ), 양혁준 ( Hyuk-jun Yang ), 현성열 ( Sung-youl Hyun ) 대한응급의학회 2018 大韓應急醫學會誌 Vol.29 No.5
Objective: This paper reports the status of the advanced cardiac life support (ACLS) according to the guidelines by residents belonging to other departments other than the department of emergency medicine. The differences in status between the junior group and senior group was also investigated according to grades of residents. Methods: The ACLS performance for in-hospital cardiac arrest cases of one academic hospital, except for the cases occurring in intensive care unit between November 2015 and October 2017, were analyzed retrospectively. Data included the characteristics of residents, patients' outcomes, ACLS performance, and conventional treatment having discordance with the ACLS guidelines. Leaders during cardiopulmonary resuscitation (CPR) were divided into a junior group and senior group. Results: A total of 152 cases were enrolled in this study. Of these, 131 cases (86.2%) showed at least one treatment with inconsistency from the guidelines and the incidence of discordant treatment was similar in the two groups (55 [85.9%] vs. 76 [88.4%], P=0.657). Implicit use of sodium bicarbonate was more frequent in the senior residents group (odds ratio [OR], 3.04; 95% confidence interval [CI], 1.36-6.81). On the other hand, no use of a defibrillator was less frequent in the senior residents group (OR, 0.14; 95% CI, 0.03-0.81). Conclusion: In both groups, the rate of discordance with the ACLS guidelines during CPR were high. The rate of implicit use of sodium bicarbonate and no use of defibrillator were significantly different in the two groups. A customized education strategy for ACLS is needed for each group.
최규성 ( Kyu-sung Choi ), 우재혁 ( Jae-hyug Woo ), 임용수 ( Yong-su Lim ), 김진주 ( Jin-joo Kim ), 장재호 ( Jae-ho Jang ), 최우성 ( Woo-sung Choi ), 민경진 ( Kyung-jin Min ), 조성진 ( Seong-jin Cho ), 강승걸 ( Seung-gul Kang ), 나경세 ( Ky) 대한응급의학회 2017 大韓應急醫學會誌 Vol.28 No.5
Purpose: This study was conducted to compare the characteristics of first suicide attempt patients with self-poisoning with those of self-injured patients. Methods: In this retrospective data analysis, data were collected from emergency department patients who made a first suicide attempt between October 2013 and January 2017. Data included demographic, socioeconomic, physical and mental health status, method of suicide attempt, and authenticity of suicide intent. Patients were classified into a self-poisoning and self-injury group. Results: Among 2,252 patients, 788 patients were making their first suicide attempt. Of these patients, 443 were self-poisoning patients. Males were less common among the self-poisoning group. Cohabitants (303 [89.4%] vs. 193 [81.4%]; p=0.010), married state (214 [57.4%] vs. 108 [41.2%]; p<0.001), and asking for help after suicide attempt (136 [86.1%] vs. 103 [73.6%]; p=0.009) was more common in the self-poisoning group than the self-injury group. However, planned suicide attempt was more frequent in the self-injury group (26 [16.0%] vs. 9 [4.7%]; p=0.001). Moreover, authenticity of suicide intent was higher in the self-injury group (12 [11.3%] vs. 42 [40.4%]; p<0.001). Conclusion: In the self-poisoning group, there was a higher rate of females, married people, existing cohabitants, and tendency to ask for help after suicide attempt. There were also more impulsive suicide attempts in this group. The results presented herein will help prevent self-poisoning suicide attempts among high risk patients.
Digoxin is commonly used in treatment of various heart conditions, such as atrial fibrillation, atrial flutter, and sometimes heart failure. The therapeutic range of digoxin is narrow. Therefore, Digoxin toxicity is common. However, severe digoxin intoxication is uncommon. Many cases involving application of Digoxin immune Fab for digoxin intoxication in other countries have been reported. However, no cases have been reported in Korea. We reported on one case, a 34-year-old male with acute and severe digoxin intoxication who was treated with digibind.. His chief complaint was gastrointestinal symptoms, including nausea and vomiting. Electrocardiography (ECG) showed third degree atrioventricular (AV) block. After an infusion of digibind., third degree AV block rhythm waschanged to first degree AV block. Nowadays, we can obtain a digoxin antidote from the national poisoning information center. Therefore, we should actively consider application of Digoxin immune Fab in patients with severe digoxin intoxication.
Objective: When bike riding under the influence of alcohol, incidence of injury increases, although reports of highly severe injuries is rare. Therefore, this study aimed to determine how drinking alcohol affects bicycle injuries. Methods: This study included patients who visited the emergency departments at 23 hospitals. Participants were enrolled in the emergency department-based injury in-depth surveillance program of the Korea Centers for Disease Control and Prevention, were over 15-years-old, and were injured while riding a bike either with or without alcohol intake. Patients with important data missing or insufficient data such as Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS) were excluded from the analysis. Results: A total of 28,094 patients were analyzed. The alcohol-intake group numbered 1,946 (6.9%) while the non-alcohol- intake group numbered 26,148 (93.1%). The incidence of severe injury (EMR-ISS≥25) in the alcohol-intake group was 451 (23.2%), whereas that in the non-alcohol-intake group was 2,881 (11.0%), which was statistically different between the two groups (P<0.001). According to multivariate logistic regression, the odds ratio of severe injuries in the alcohol-intake group was 2.04 (95% confidence interval, 1.80-2.30) compared to the non-alcohol-intake group after adjusting for age, alcohol use, type of road, sex, injury time, and transportation. Conclusion: Alcohol is associated with an increase in the incidence of severe injuries. Therefore, as part of preventive measures, it will be necessary to tighten regulations on post-drinking bike riding and improve awareness through public relations.
안현철 ( Hyun Chul An ), 임용수 ( Yong Su Lim ), 조진성 ( Jin Seong Cho ), 김진주 ( Jin Joo Kim ), 양혁준 ( Hyuk Jun Yang ), 박원빈 ( Won Bin Park ), 우재혁 ( Jae Hyug Woo ), 현성열 ( Sung Youl Hyun ) 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.5
Purpose: Studies have demonstrated that B-type natriuretic peptide (BNP) has a predictive value for sudden cardiac arrest in heart failure patients. The aim of this study was to investigate the usefulness of serum BNP levels for theprediction of death in post-cardiac arrest patients treated withtherapeutic hypothermia (TH). Methods: Out-of-hospital cardiac arrest (OHCA) survivors treated with TH between April 2007 and August 2010 were evaluated and divided into two groups based on death within 3 months. Initial serum BNP levels were checked and BNP levels compared between both groups. Results: A total of 162 patients were enrolled in the study. Among 162 patients, 109 patients were male (mean age of 50 years). The BNP levels of the non-survival group (n=77) were higher than those of the survival group (n=85); however, there was no statistical difference (19.45 pg/ml vs. 30.75 pg/ml, p=0.174). The BNP cutoff value of 106 pg/ml for death within 3 months had a sensitivity of 35.1% and a specificity of 78.8%. In the logistic regression analysis, BNP levels higher than 106 pg/ml were significantly associated with death within 3 months (odds ratio [OR], 2.625; 95% confidence interval [CI], 1.066-6.463) and other independent factors were BLS to ROSC (OR, 1.105; CI, 0.082- 1.038), non-VF/VT (OR, 3.698; CI, 1.632-8.380), and APACHE II score (OR, 1.117; CI, 1.035-1.204). Conclusion: Initial Serum BNP levels are related with death within 3 months for patients that received TH after OHCA. However, additional randomized and controlled studies are needed.
박신웅 ( Shin Woong Park ), 현성열 ( Sung Youl Hyun ), 김진주 ( Jin Joo Kim ), 임용수 ( Yong Su Lim ), 조진성 ( Jin Sung Cho ), 양혁준 ( Hyuk Jun Yang ), 박원빈 ( Won Bin Park ), 우재혁 ( Jae Hyug Woo ), 장재호 ( Jae Ho Jang ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3
Purpose: Trauma is one of the major cause of death in Korea. This study focused on the survival rate and the neurologic outcome for patients with traumatic cardiac arrest (CA) at one emergency center. Methods: We retrospectively reviewed the medical records of patients with traumatic CA who were seen at a regional emergency medical center from January 2010 to December 2011. From among major trauma patients at that medical center, adults older than 18 years of age who had CA were included in this study. CA included outof- hospital CA with arrival at the Emergency Department (ED) within three hours and in-hospital CA. We checked the survival rate and the neurologic outcome. Results: A total of 61 patients were analyzed: 32 patients had return of spontaneous circulation (ROSC), 6 patients survived to discharge (survival rate: 9.84%), and 4 were still alive 90 days after discharge. The Cerebral performance category (CPC) scores at 6 months after discharge showed 1 good and 5 poor in neurologic outcomes. Factors such as initial rhythm of CA, part with major injury, Revised Trauma Score (RTS) and pH, were significant for ROSC, survival, and neurologic outcome in patients with traumatic CA. Conclusion: In this study, patients who had traumatic CA showed a 9.84% survival rate and a 1.64% good neurologic outcome. The results are poorer than those for CA caused by disease. Multi-center, prospective studies are needed.