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안재윤 ( Jae Yun Ahn ),서강석 ( Kang Suk Seo ),박정배 ( Jung Bae Park ),정제명 ( Jae Myung Chung ),류현욱 ( Hyun Wook Ryoo ),강성원 ( Sung Won Kang ),최규일 ( Kyu Il Choi ),김윤정 ( Yun Jeong Kim ) 대한응급의학회 2009 大韓應急醫學會誌 Vol.20 No.5
Purpose: The following study was performed to compare basic life support (BLS) skills and knowledge over a 6 months interval in preclinical medical students. Methods: Upon initial instruction, 112 first-year medical students at a teaching hospital were given instructions in BLS, their knowledge performance was evaluated by written test and skills test via checklist designed by instructors and PC SkillReporting System(R) (Laerdal, Norway). Their performance was re-evaluated 6 months after initial BLS training in an identical fashion. Evaluation was performed on 103 out of 112 students who had taken initial BLS training. Results: The results of written test showed that the students evaluated right after taking initial BLS training have better knowledge of BLS compared to students evaluated 6 months after taking initial BLS training (p<0.001). Results of skills test evaluated by checklist showed decrease in adequate performance of students evaluated 6 months after BLS education in 12 out of 18 items compared to students who have just received initial BLS training. The decreases were statistically significant in 6 items. Total scores after 6 months were also lower compared with initial scores (p<.0.001). The results of the skills test using PC Skill Reporting System(R) demonstrated that the percentage of adequate ventilation volume, compression rate, hands-off time, and hand position were each 18.4%, 46.6%, 47.6%, 84.2% initially and 5.8%, 32.0%, 32.0%, 76.1% at 6 months after initial training. Students performed significantly worse 6 months post training in 4 out of 7 items (p<0.05). Conclusion: Knowledge and skills of preclinical medical students decreased significantly after a 6 month period compared to knowledge and skills after initial training. Therefore, retraining of BLS is required within 6 months, but more study is required to determine appropriate intervals and methods of retraining.
김창호 ( Chang Ho Kim ),박정배 ( Jung Bae Park ),류현욱 ( Hyun Wook Ryoo ),서강석 ( Kang Suk Seo ),서준석 ( Jun Seok Seo ),정제명 ( Jae Myung Chung ),제동욱 ( Dong Wook Je ),성애진 ( Ae Jin Sung ) 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.2
Purpose: This research was conducted to study whether the specific location of pelvic-bone fractures could increase the risk for injury to the urinary bladder, urethra, or lower gastrointestinal tract. Methods: We retrospectively reviewed the data of 234 patients with pelvic-bone fractures who visited the emergency department of Kyungpook National University Hospital from January 2004 to December 2006. The location of the pelvic-bone fracture was divided into 8 parts. The association of fracture location with injury to the urinary bladder, urethra, or lower gastrointestinal tract was analyzed with Fisher`s-exact test and multiple logistic regression. Results: Nineteen(19) patients had urinary bladder injury, 8 had urethral injury, and 9 had lower gastrointestinal tract injury. The following fracture locations were found to be significant; urinary bladder: sacroiliac (SI) joint (p<0.001), symphysis pubis (p=0.011), and sacrum (p=0.005); urethra: SI joint (p=0.020); lower gastrointestinal tract: symphysis pubis (p=0.028). After the multiple logistic regression analysis, the primary and the independent predictors for each of the injuries were as follows; urinary bladder: sacroiliac joint (p=0.000, odds ratio [OR]=10.469); lower gastrointestinal tract: symphysis pubis (p=0.037, OR=7.009). Conclusion: Consideration of further workup for injuries to the lower gastrointestinal and urinary tract is needed for some locations of pelvic-bone fractures because certain pelvic-bone fracture locations, especially the sacroiliac joint and the symphysis pubis, are associated with increased risk for injury to the lower gastrointestinal and urinary tracts. (J Korean Soc Traumatol 2007;20:90-95)
박동찬 ( Dong Chan Park ),박정배 ( Jung Bae Park ),김윤정 ( Yun Jeong Kim ),신수정 ( Soo Jeong Shin ),문유호 ( You Ho Mun ),박신률 ( Sin Ryul Park ),류현욱 ( Hyun Wook Ryoo ),서강석 ( Kang Suk Seo ),정제명 ( Jae Myung Chung ) 대한임상독성학회 2010 대한임상독성학회지 Vol.8 No.2
Purpose: The purpose of this study is to investigate the factors that predict using mechanical ventilation for patients with organophosphate intoxication. Methods: We retrospectively reviewed the medical records of 111 patients with acute organophosphate intoxication and who were treated in our emergency center from January 2000 to December 2008. We compared the toxicologic characteristics, the laboratory findings and the APACHE II scores between the Mechanical Ventilation group (MV group) and the non-Mechanical Ventilation group (the non MV group). Results: Sixty three patients were in the MV group and 48 patients were in the non MV group. In the MV group, the patients had an older age (p<0.001), a larger amount of ingestion (p<0.001), a lower initial serum cholinesterase level (p=0.003), a higher APACHE II score (p<0.001) and they ingested a more toxic agent (p=0.001). There were no significant differences in gender, the type of visit and the arrival time between the MV group and the non MV group. Conclusion: We suggest that the patient’s age, the amount of organophosphate ingestion, the toxicity of the agent, the initial serum cholinesterase level and the APACHE II score are important factors to determine if mechanical ventilation will be applied for patients with organophosphate intoxication.
Purpose: The bicycle is a clean and future-oriented means of transportation and bicycle usage is growing. The bicycle has been in the spotlight lately with Europe and North America as the center. The purpose of this study was to establish proper prevention strategies for bicycle injuries. Methods: In this retrospective study, we analysed 148 bicycle-related injury patients who visited our hospital between Feb 1, 2008 and Jan 31, 2009. Information such as age, gender, injury severity score, injury time, injury place, and other characteristics were collected. Data were analysed using SPSS 12.0K. Results: Among the enrollees, 80.4% were male. Patients over 65 years of age accounted for only 18.2% of the group, but average injury severity score (ISS) of this group was the highest. Injuries occurred frequently between 16:00 and 22:00 in the evening, while the severity was higher between 00:00 and 08:00 in the morning. Most of the injuries developed on the roads, which included local roads, national highways, and alleyways. Injuries on the roads were more severe than those that occurred in other places. Conclusion: There have been suggestions for using bicycles safely. Legislation on bicycle helmet use already exists. Also, protective apparatus such as knee pads, wrist guards, and protection vests are recommended for use. Construction of more bike trails will be necessary. Above all, bicycle riders` safety consciousness is the most important part.
Purpose: The Glasgow Coma Scale (GCS), though it is widely used for triage, has been criticized as being unnecessarily complex. Recently, a 3-point Simplified Motor Score (SMS, defined as obeys commands=2; localizes pain=1; withdrawals to pain or worse=0) was developed from the motor component of the GCS and was found to have a similar test performance for triage after traumatic brain injury when compared with the GCS as the criterion standard. The purpose of this study was to validate the SMS. Methods: We analyzed the patients who visited Kyungpook National University Hospital emergency center after traumatic brain injury from 2006 January to 2006 June. The test performance of the GCS, its motor component, and SMS relative to three clinically relevant traumatic brain injury outcomes (abnormal brain CT scans, Abbreviated Injury Scale (AIS)≥4, and mortality) were evaluated with areas under the receiver operating characteristic curves (AUCs). Results: Of 504 patients included in the analysis, 25.6% had an abnormal brain CT scans, 13.1% had AIS≥4, and 5.0% died. The AUCs for the GCS, its motor component, and SMS with respect to the abnormal CT scans were 0.776, 0.715, and 0.716, and respectively, those for AIS≥4 and mortality, were 0.969, 0.973, and 0.968, and 0.931, 0.909, and 0.909, respectively. Conclusion: The 3-point SMS demonstrated similar test performance when compared with the 15-point GCS score and its motor component for triage after traumatic brain injury in our populations. (J Korean Soc Traumatol 2008;21:71-77)
Purpose: This study was conducted to evaluate the length of the catheter used in a needle thoracostomy for emergency decompression of a tension pneumothorax by measuring the chest wall thickness (CWT) in patients with chest trauma. Methods: A retrospective review of 201 patients with chest trauma who had been transported the emergency department in a tertiary university hospital in a metropolitan area between 1 January and 31 February 2007 was performed. The average CWT at the second intercostal space (ICS) in the midclavicular line (MCL) was measured by using a chest computed tomography scan. Results: As the left and the right mean CWTs were 3.4±1.0 cm and 3.4±1.0 cm, respectively, there was no significant statistical difference between them. The mean CWT of female patients was significantly higher than that of male patients (p=0.001). The mean CWT of patients under the age of 65 years was significantly thicker than that of the patients over the age of 65 years (p<0.001). Of the studied patients, 12 (6.0%) a CWT >5 cm. Conclusion: A 5 cm-length catheter in a needle thoracostomy may be insufficient for emergency decompression of a tension pneumothorax, so a catheter longer than 5 cm in length is needed. (J Korean Soc Traumatol 2009;22:1-4)
Purpose: Disaster is defined as hazards that impact on human lives, causing adverse physical, social, economic or even political effects that exceed abilitiesto rapidly and effectively respond. The purpose of this study, conducted in 2003 and in 2005, was to improve regional disaster plans through a disaster-recognition survey conducted among medical personnel and rescuers in Daegu, Korea. Methods: This study was carried out using a questionnaire to gauge disaster awareness among medical personnel and 119 rescuers in the Daegu area. We compared responses obtained from medical personnel with those obtained from 119 rescuers. One way ANOVA was used for comparisons. Statistical significance attributed to a pvalue less than 0.05. Results: Many medical personnel and 119 rescuers showed a poor understanding of the disaster response system with regard to activities and triage systems at disaster sites, communication between facilities emergency response exercises in mock disasters, and laws and regulations related to regional governments and facilities. This lack of understanding was especially evident among medical personnel. Conclusion: This study revealed that medical personnel and rescuers in Daegu had little understanding of and ability to cope with actual disaster conditions. In view of the close cooperation required in disaster situations between regional medical facilities, rescue workers and government agencies, disaster training and education are imperative. If these groups can work together well, any disaster can be dealt with rapidly and effectively.
최규일 ( Kyu Ill Choi ),서강석 ( Kang Suk Seo ),류현욱 ( Hyun Wook Ryoo ),박정배 ( Jung Bae Park ),정제명 ( Jae Myung Chung ),안재윤 ( Jae Yoon Ahn ),강성원 ( Seong Won Kang ),이재혁 ( Jae Hyuck Yi ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.2
Purpose: Early diagnosis and management of therapeutic interventions are very important in chest trauma. Conventional chest X-rays (CXR) and computed tomography (CT) are the diagnostic tools that can be quickly implemented for chest trauma patients in the emergency department. In this study, the usefulness of the CT as a diagnostic measurement was examined by analyzing the ability to detect thoracic injuries in trauma patients who had visited the emergency department and undergone CXR and CT. Methods: This study involved 84 patients who had visited the emergency department due to chest trauma and who had undergone both CXR and CT during their diagnostic process. The patients` characteristics and early vital signs were examined through a retrospective analysis of their medical records, and the CXR and the CT saved in the Picture Archiving Communication System (PACS) were examined by a radiologist and an emergency physician to verify whether or not a lesion was present. Results: Pneumothoraxes, hemothoraxes, pneumomediastina, pulmonary lacerations, rib fractures, vertebral fractures, chest wall contusions, and subcutaneous emphysema were prevalently found in a statistically meaningful way (p<0.05) on the CT. Even though their statistical significance couldn`t be verified, other disorders, including aortic injury, were more prevalently found by CT than by CXR. Conclusion: CT implemented for chest trauma patients visiting the emergency department allowed disorders that couldn`t be found on CXR to be verified, which helped us to could accurately evaluate patients. (J Korean Soc Traumatol 2009;22:142-7)
문유호 ( You Ho Mun ),김윤정 ( Yun Jeong Kim ),신수정 ( Soo Jeong Shin ),박동찬 ( Dong Chan Park ),박신율 ( Sin Ryul Park ),류현욱 ( Hyun Wook Ryu ),서강석 ( Kang Suk Seo ),박정배 ( Jung Bae Park ),정제명 ( Jae Myung Chung ),배지 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.2
Purpose: Whole-body CT is a very attractive diagnostic tool to clinicians, especially, in trauma. It is generally accepted that trauma patients who are not alert require whole-body CT. However, in alert trauma patients, the usefulness is questionable. Methods: This study was a retrospective review of the medical records of 146 patients with blunt multiple trauma who underwent whole body CT scanning for a trauma workup from March 1, 2008 to February 28, 2009. We classified the patients into two groups by patients` mental status (alert group: 110 patients, not-alert group: 36 patients). In the alert group, we compared the patients` evidence of injury (present illness, physical examination, neurological examination) with the CT findings. Results: One hundred forty six(146) patients underwent whole-body CT. The mean age was 44.6±18.9 years. One hundred four (104, 71.2%) were men, and the injury severity score was 14.0±10.38. In the not-alert group, the ratios of abnormal CT findings were relatively high: head 23/36(63.9%), neck 3/6(50.0%), chest 16/36(44.4%) and abdomen 9/36(25%). In the alert group, patients with no evidence of injury were rare (head 1, chest 6 and abdomen 2). Nine(9) patients did not need any intervention or surgery. Conclusion: Whole-body CT has various disadvantages, such as radiation, contrast induced nephropathy and high medical costs. In multiple trauma patients, if they are alert and have no evidence of injury, they rarely have abnormal CT findings, and mostly do not need invasive treatment. Therefore, we should be cautious in performing whole-body CT in alert multiple trauma patients. (J Korean Soc Traumatol 2010;23:89-95)
이유철(Yoo Chul Lee),여상희(Sang Hee Yeo),이원기(Won Kee Lee),강덕식(Duk Sik Kang),강이철(Echeol Kang),곽연식(Yun Sik Kwak),김보완(Bo Wan Kim),이종명(Jong Myung Lee),장봉현(Bong Hyun Chang),정제명(Jae Myung Chung),조희중(Hee Jung Cho 한국의학교육학회 2003 Korean journal of medical education Vol.15 No.1
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Purpose: Kyungpook National University School of Medicine initiated a pilot project to admit small number of qualified students who received BS degree or above in the field of sciences in 1996. This study was conducted to evaluate effectiveness of the pilot project. Methods: Students academic grades, outcome of their opinion surveys on adaptability to the school life, difficulties and problems from the classes of 1996 to 2001 were analyzed. Results: A total of 57 students were admitted to this program over the past 7-year period, 54.8% of them from natural science major and 36.8% from engineering. Students admitted with BS degree were performing above average in the class by % rank. There was no significant difference in academic performance between the natural science and the engineering major. Of 20 graduated, only one took career in basic medical science (physiology). The students thought undergraduate education was helpful in maturing personal characters than in knowledge or skill attainment. Conclusion: The achievement of medical students admitted after baccalaureate level was comparable to that of students with two years of premedical education.