우리 나라 재해 의료의 문제점 : 수원시 재해 대응 훈련의 평가를 통하여 본 ANALYSIS OF EMERGENCY RESPONSE EXERCISE IN THE MOCK DISASTER IN SUWON

곽동진,정윤석,진재우,조준필,김 철,김행재,배택환,김준식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Natural or man-made disasters are serious enough to paralyse the functions of the nation or regional distinct and affect the property and lives of numerous citizens. The first two hours after occurrence of the disaster are critical for determining death or permanent disabilities of the casualties. The current Disaster Medical Service(DMS) System in our country adopts mainly civil defense model which focuses the cause of the accident, compensation of the victims, or reconstruction. So in the initial phase of disaster, the appropriate rescue and emergency treatment is not provided effectively. In order to assess and reorganize the current status of DMS System in Korea, the Department of Emergency Medicine, Ajou University School of Medicine, planned and conducted an emergency response exercise in Suwon city on April 28, 1995. The exercise, which took place near the Kyunggido Culture and Art Center, coordinated the efforts of the Suwon Fire Department and other related agencies. As well as providing training on emergency response, the exercise was valuable for identifying areas of weakness which will be address in the future.

응급실을 내원한 요로결석 환자

김성중,김준식,조준필 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

A clinical study was made on 139 cases of urolithiasis among the total number of 14798 who visited in the emergency center during 7 months from June 1994 to December 1994.The 186 patients was suspected the urolithiasis, then the 150 patients was followed through out-patient department of Urology and performed Intravenous pyelogram. Among the 150 cases, the urolithiasis was confirmed in 139 cases. The results are summarized as follows: 1. The ration of the male to female is approximately 2.97:1. 2. The age of the patients ranged from 20 to 50 in approximately 80.6%. 3. Among 52 patient who were not revealed stone in KUB, 45 patients were shown micro-scopic hematuria. The 22 patients were revealed urolithiasis in IVP.The 6 patients found the urolithiasis spontaneously delivered.The 17 patients were diagnosed through out-patient department of urology. 4. The 7 patients, who not hematuria and no stones in KUB, were revealed urolithiasis in IVP performed at other hospital. 5. The major clinical symptoms and signs were flank pain(117 cases),abdominal pain and suprapublic discomfort(35 cases),fever(7 cases),low back pain(7 cases),nausea and vomiting(6 cases),painful urination(1 case),and urinary frequency(1 case). 6. The specific location of the stones showed 98 cases in ureter, 7 cases in kidney,bilaterality(3 cases),and multiple stones(8 cases). The ureteral stones located most frequently in the lower 1/3 of the ureter with 55 cases.

겸상적혈구 혈증에 의한 동통성 발작 1례

김효철,배택환,정윤석,김현수,조준필,김준식,곽연식 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

The sickle cell disease are a group of hemoglobin disorders characterized by red cells that undergo sickle shape transformation when they are deoxygenated. Sickle cell disease is transmit-ted as an autosomal recessive trait. This unusual property, due to the polymerization of sickle hemoglobin results in anemia and vasoocclusive complication. 1) The most clinically significant of these disease are sickle cell anemia, sickle cell hemoglobin C disease, and sickle cell beta thalassemia. Symptoms of pallor, fever, abdominal and joint pain, enlargement of the liver and spleen, swelling of hands and feet first appear near the latter part of the first year of life. Intravascular sickling affects all organs. For clinical and therapeutic purposes, exacerbations may be classified as vasoocclusive or pain, aplastic, hemolytic or sequestration crisis. we experienced a 22 year old female patient who suffered severe multiple joint pain and back pain thought to be caused by vasoocclussive phenomena.

진달래 꽃에 의한 Grayanotoxin 중독 3 례

김아진,김준식,신동운,백광제,한승백,이용주 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3

Traditionally, the Rhododendron species has been used in gastrointestinal disorder or hypertension. Grayanotoxin exists in honey, flowers, pollen, and the nectar of the Rhododenron species. We experienced 3 cases of Grayanotoxin intoxication. The symptoms of intoxication were nausea, vomiting, hypotension, bradycardia, diplopia, dizziness, and chest discomfort. Generally, the treatment for Grayanotoxin intoxication is fluid resuscitation and injection of atropine sulfate. The patients who were intoxicated with Grayanotoxin were discharged without complication after supportive care.

병원내 재난 : 한국의 현실과 재난대비 계획 제안 Status of Korea and proposal of countermeasures

김준식,김행재,김철,유인술,조준필 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

입원치료를 요하는 소아의 급성복증

배택환,김준식,유인술,조준필,이철주,민영기 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

The acute abdomen defined as an acute abdominal condition which needs immediate decision for treatment is one of the most common cause for emergency care. One thound six hundreds nine patients were visited to pediatric emergency center due to acute abdomen. To aid in early diagnosis and proper treatment, a clinical review was made on 278 cases of acute abdomen under 15 yrs old which admitted to Pediatrics and General surgery via emergency center from June of 1994 to May of 1995. The results as follows: It was 17.3% of total visiting to pediatric emergency center due to gastrointestinal sysmptoms. The sex ratio(Male: Female) was 2.35:1. Acute gastroenteristis was the most common acute abdominal condition(54%) and followed by acute appendicitis(17.9%), and intussusception(13.9%). The most common chief commplaint was vomiting(58%) and followed by abdominal pain(39.4%), diarrhea(35.8%), and fever(42.1%). One hundred fifty-five patients were visited to pediatric emergency center via local clinic and thirty patients via OPDs. The operations were done in 75 patients. Among them, immediate operation were done in 60 patients and delayed operations were done in 15 patients, but there is no difference in complication.

낙상으로 인한 좌심실 파열 후 생존한 환자 1례

배택환,김행재,정윤석,김준식,조준필,이철주 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Blunt or nonpenetrating chest injuries are common after motor vehicle accidents or falls. Blunt injury to the heart ranges from contusion to rupture. Cardiac rupture, however, is un-common and associated with a very high mortality rate ; left ventricular rupture due to falling is even more rare. We experienced a case of left ventricular rupture of the heart caused by a fall, which the patient survived. A 63-year-old man fell off a ladder and presented with hypotension from left hemothorax and pericardial tamponade. The hemothorax was relieved via an emergency closed thoracostomy but dyspnea and hypotension continued. And so, echocardio-graphy was done and pericardial tamponade was detected. Emergency left thoracotomy was done to repair the rupture site. We believe that patients with cardiac rupture who reach the hospital alive can often be saved by prompt diagnosis and immediate surgical treatment.

응급의료센터로 내원한 급성심근경색증 환자

정윤석,김준식,유인술,조준필 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Early reperfusion can prevent myocardial necrosis, and clinical trials with reperfusion therapy demonstrating a significant reduction in acute myocardial infarction(AMT) mortality have dramatically changed the treatment paradigm for AMI. All patients with symptoms and ECG findings suggestive of AMI should be considered for treatment with thrombolytic agents. However, only a minority of AMI patients actually receive a thrombolytic therapy. Many patients are often excluded from treatment because they do not meet the criteria for age, duration of the chest pain, and a qualifying ECG. And late arrival at the hospital is a frequently cited reason for not giving a thrombolytic agent. To confirm the reason for not receiving an early reperfusion therapy, we obtained the data for the clinical characteristics, the time intervals between the symptom onset and the start of a thrombolytic agent infusion, the method of reperfusion therapy, the reason for not giving a thrombolytic agent and overall outcomes by retrograde chart review. During the 12-month study period between July 1994 and June 1995, 113 patients were finally diagnosed to AMI, who presented to Emergency Center of Ajou University Hospital in total 30,819 patients. The results were followings: 1. The average age was 59±12 years old, the ratio of male to female was 3.2:1. The direct visited patients to our hospital were 31 and the transfered were 82. 2. The chief complaints were chest pain(86.7%), dyspnea, dyspnea, and mental change. The common preceding diseases were angina pectoris(10 cases), old myocardial infarction(9 cases), congestive heart failure(2 cases) and typical chest pain but not diagnosed(23 cases). The risk factors were smoking(81 cases), hypertension (46 cases) and DM (22 cases). 3. 75 patients had arrived within 12 hours from symptom onset and 38 patients after 12 hours. 45cases (54.7%) were performed the reperfusion therapy ; 31 patients were taken the thrombolytic therapy by tissue-type Plasminogen Activator. 4. The most common reason for not receiving a reperfusion therapy was the time delay and the main was the patient/bystander factor. 5. 75.2%(85 cases) of the patients discharged with or without complications, 7.1% (8 cases) died, 10.6% (12 cases) discharged moribundly, and 7.1% (8 cases) discharged against advise. In conclusion, the time delay was the first reason for not receiving a reperfusion therapy in AMI patients. And the education for the AMI symptom and BLS (Basic Life Support) to the people, good EMS(Emergency Medical Service) system, early definite diagnosis and aggresive therapy may decline the mortality rate.

응급 의료 센터내 사망 환자의 분석

유인술,김준식,진재우,이철주,민영기,조준필 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

We need the constitute of Emergency medical system that connect prehospital care of inhospital care effectively for optimal treatment of emergency patient. The analysis of actual condition of our emergency medical system, through study of mortality case in emergency medical center will be a aid to the constitute. The authors performed a review on the records of 60 cases who died in Ajou university Emergency medical center during management, since June 1994 to september 1995. Among the 60 patient, 72% were male and 28% were female. In nontrauma patient, 6th decade was many, in trauma patients, 3rd and 5th decade was many. Among the 60 patient, 33% were traumatic cases, 66% were nontraumatic cases. Among the traumatic patients, more than half of the cases were due to motor vehicle accidents. The most frequent time interval from onset of emergent situation to arreving at emergency center was more than 2 hours. The most common transfer method was by 119 ambulance. In most cases, prehospital treatments were not taken. In most cases, initial mental status was comatose, and systolic blood pressure was less than 60 mmHg. Most cardiovascular resuscitation was done in 30 min. to an hour. In cases as traffic accident of ischemic heart disease, where rapid transportation of the patient is critical for the patient's survival, however, in most cases it took more than two hours to bring such patients to hospital, and first aid treatment before arrival to hospital was rare. No prehospital treatment was done to nearly all patient. In many cases the patient was already in under coma or shock state. The inhospital care at emergency center was made relatively quickly and adequately. The mean duration of cardiopulmonary resustation was 30min to one hour. From this study, we could notice the poor quality of prehospital care in the region ,near Ajou university hospital, and we came to know that the improvement of quality of prehospital care was the most important factor to reduce the motality of emergency department patient. that is, in the treatment of emergency patients, weak points has been revealed in the pre-hospital treatment, the improvement of which is important factor for the survival of emergency patients.

시판 청량음료 시음 후의 마뇨산 배설에 관한 실험적 연구

장성훈,김청식,김준식 건국대학교 의과학연구소 1999 건국의과학학술지 Vol.9 No.-

In this study, we measured the urinary excretion of the hippuric acid after ingestion of several kinds of common soft drinks. The urinary hippuric acid has been known as a sensitive and specific biomarker of toluene exposure in workplace. But it has not been known exactly that drinking some kinds of soft drinks can increase urinary hippuric acid significantly even in usual dosage. These phenomena surely can invoke problems in interpretation of urinary hippuric acid at the regular health check up of the workers exposed to toluene. We recruited 140 healthy volunteers(medical school students) and surveyed their diet history, medication, smoking and drinking habit before experiment. The persons who had eaten some kinds of food or drinks which were including benzoic acid were excluded and the rest 122 were divided into 2 groups. The Experimental group(n=88) drank the soft drinks which contained benzoic acid, and the control group(n=34) drank the soft drinks which contained not. We checked the excretion of urinary hippuric acid in 1.5hr and 3hr after ingestion of the drinks in each group. The measurement of urinary hippuric acid was performed by using high performance liquid chromatography(HPLC). The results were as follows: 1. The mean age(year) was 23.3±1.4 in experimental group, and 23.5±2.4 in control group; the number of female was 13(14.8%) and 4(11.8%) in each group. 2. The geometric mean of urinary hippuric acid before drinking soft drinks was 0.24, and 0.21g/l in experimental and control group(p=0.426). In 1.5 hour after ingestion of the drinks, the geometric mean increased 1.14g/l in experimental group, and 0.17g/l in control group, which was significantly different after adjusting the urinary hippuric acid before drinking(p<0.01). By addition some other covariates(sex, smoking in amount) in the model, the result was not changed(p<0.01). In 3.0 hour after ingestion, the geometric mean was 0.32 and 0.16g/l in each group, even the difference was much smaller than that of 1.5 hour after drinking, which was statistically different after adjusting the urinary hippuric acid of before drinking(p<0.01), sex and smoking additionally(p<0.01). 3. The mean increasement of urinary hippuric acid after 1.5 hour(Diff 1) after ingestion was 0.83 in experimental group, which was significantly different from that of control group(-0.06, p<0.01). Diff 2(the increasement after 3.0 hour) was also different from each other(p<0.01). 4. We used 7 different kinds of soft drinks in experimental group. The increasement after drinking them was different from 0.57 to 1.05g/l after 1.5 hour, from -0.08 to 0.08g/l after 3.0 hour, but statistically not significant in each other(p=0.146, p=0.849 in sequence). We concluded that the soft drinks which contain benzoic acid could increase the urinary hippuric acid excretion significantly, even over 1.0g/l without toluene exposure. It seems to be needed that check the diet and drink(at least 3.0 hour before collect the urine) history is essential in interpretation of urinary hippuric acid concentration.