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대한응급의학회지 update

Journal of the Korean Society of Emergency Medicine

  • : 대한응급의학회
  • : 의약학분야  >  외과학
  • : KCI등재
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  • : 연속간행물
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  • : 1226-4334
  • : 2384-048x
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수록정보
수록범위 : 1권1호(1990)~31권2호(2020) |수록논문 수 : 2,548
대한응급의학회지
31권2호(2020년 04월) 수록논문
최근 권호 논문
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KCI등재

1병원 밖 심정지 환자에서 조기 관상동맥조영술 시행과 생존 퇴원율 향상

저자 : 천수민 ( Su-min Chun ) , 이상훈 ( Sang-hun Lee ) , 전재천 ( Jae-cheon Jeon ) , 최우익 ( Woo-ik Choi ) , 진상찬 ( Sang-chan Jin )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 31권 2호 발행 연도 : 2020 페이지 : pp. 127-134 (8 pages)

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Objective: Coronary angiography (CAG) is an important procedure in post-resuscitated patients with out of hospital cardiac arrest (OHCA). On the other hand, the timing of CAG is still controversial. This study investigated the relationship between electrocardiogram, cardiac enzyme, echocardiographic findings, and early coronary angiography (ECAG).
Methods: The medical records of OHCA patients from January 2014 to December 2018 were reviewed retrospectively. The total patients who underwent CAG for OHCA caused by cardiac origin were 48. They were divided into two groups according to survival discharge. The ECAG was defined as the time from reporting 119 to the CAG within two hours. The following items in the two groups were also analyzed: the prehospital factors, such as witnessed arrest, bystander cardiopulmonary resuscitation, shockable rhythm, and arrest to return of spontaneous circulation time; and the hospital factors, such as the timing of CAG, ST-segment elevation or depression in the electrocardiogram, troponin-I elevation, and transthoracic echocardiography findings.
Results: Twenty-seven patients out of 48 patients with OHCA (56.3%) underwent ECAG. In the survival group (n=35), ECAG incidence was significantly higher than the death group (n=24 [68.6%] vs. n=3 [23.1%], P=0.008) and the adjusted odds ratio of ECAG for predicting survival discharge was 10.69 (95% confidence interval, 1.7-68.8).
Conclusion: In this retrospective study, the patients applied with ECAG showed a better prognosis in the survival discharge rate than the patients with delayed CAG.

KCI등재

2병원전 외상성 심정지 환자의 심폐소생술 결과: 강원도를 중심으로

저자 : 임창우 ( Chang Woo Im ) , 이태헌 ( Taehun Lee ) , 옥택근 ( Taek Geun Ohk ) , 김오현 ( Oh Hyun Kim ) , 정상구 ( Sang Ku Jung ) , 김윤성 ( Yunsung Kim ) , 마범석 ( Bum Sug Ma ) , 안무업 ( Moo Eob Ahn ) , 서정열 ( Jeong Yeol Seo ) , 김동원 ( Dong Won Kim )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 31권 2호 발행 연도 : 2020 페이지 : pp. 135-145 (11 pages)

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Objective: This aim examined the outcomes of resuscitation and the clinical characteristics of patients with pre-hospital traumatic cardiac arrests (TCA).
Methods: The charts of patients with pre-hospital TCA who visited the various emergency department (ED) in Gangwondo from January 2013 to December 2017 were reviewed retrospectively.
Results: TCA patients comprised 0.3% of patients transferred by 119. A total of 367 patients were enrolled in the study. Traffic accidents were the leading cause of the arrest. The initial field and ED rhythm were mostly asystole (field, 79.6%; ED, 82.3%). It took 11.24±9.95 minutes from the call to the field. From the field to ED, it took 22.87±15.37 minutes. The total CPR time before ED arrival was 21.62±15.29 minutes. The causes of TCA were brain injury (35.7%), hypovolemic shock (29.2%), and severe lung injury (16.3%). Seventy TCA patients experienced at least one return of spontaneous circulation (ROSC). Twenty-six patients (7.14%) were admitted to the ward, and their average injury severity score was 38.96. Eight patients expired before 12 hours after transient ROSC. Four more patients expired before 24 hours. Four patients were discharged alive among patients who lived for more than 24 hours.
Conclusion: In this study, 1.5% of patients were discharged alive. The possibility of ROSC was higher as the time to ED, and the cardiopulmonary resuscitation time of 119 was shorter. Pulseless electrical activity rather than asystole tends to promote ROSC. The survival rate increased when ROSC occurred before arriving at the ED.

KCI등재

3패혈증 쇼크에서 바소프레신 투여 시기가 예후에 미치는 영향

저자 : 김성은 ( Sungeun Kim ) , 이강호 ( Kang Ho Lee ) , 민문기 ( Mun Ki Min ) , 류지호 ( Ji Ho Ryu ) , 이대섭 ( Dae Sup Lee ) , 이민지 ( Min Jee Lee ) , 왕일재 ( Il Jae Wang )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 31권 2호 발행 연도 : 2020 페이지 : pp. 146-151 (6 pages)

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Objective: This study analyzed the relationship between the timing of vasopressin treatment and the prognosis of patients with septic shock.
Methods: Patients who were admitted to a university hospital for one year using vasopressin were studied retrospectively. All records were collected through the medical records; several factors were studied to determine the prognosis of the patient. The 24-hour, 48-hour mortality, and hospital mortality were examined. The difference in the timing of vasopressin administration between death and survival patients was analyzed to determine the effect of the vasopressor on the survival rate using the receiver operating characteristic (ROC) curve.
Results: The general characteristics of the patients in the hospital and survivors were similar. Vasopressin infusion was faster in the surviving patients than in the death patients, but there was no significant difference (survival, 187.0 minutes; interquartile range [IQR], 95.0-548.0 minutes vs. death, 285.5 minutes; IQR, 92.7-739.2). To determine the effect of vasopressor injection on the survival rate, the ROC curve was drawn, and the area under curve was not affected significantly by norepinephrine (NE) 0.416 and vasopressin 0.529. In addition, the duration of the ventilator application was found to increase with increasing NE injection period in survivors (period of application of ventilator: NE injection time, r=0.460, P=0.048; vasopressin, r=0.369, P=0.120).
Conclusion: The prognosis was similar regardless of the timing of vasopressin in patients with septic shock.

KCI등재

4Delta neutrophil index가 응급센터를 통하여 중환자실로 입원한 환자들의 원내 사망률을 예측할 수 있는가?

저자 : 윤영탁 ( Young Tak Yoon ) , 김영식 ( Young Sik Kim ) , 하영록 ( Young Rock Ha ) , 신태용 ( Tae Yong Shin ) , 정루비 ( Ru Bi Jung ) , 이규현 ( Kyoo-hyun Lee ) , 유우성 ( Woo Sung Yu ) , 김동훈 ( Donghoon Kim )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 31권 2호 발행 연도 : 2020 페이지 : pp. 152-160 (9 pages)

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Objective: A retrospective study was performed to evaluate the usefulness of the delta neutrophil index as a prognostic factor for mortality in intensive care unit patients admitted via the emergency department.
Methods: Patients, who presented to the emergency department and were admitted to the intensive care unit from January 2018 to August 2018, were reviewed retrospectively. The clinical features, inflammatory marker levels, such as C-reactive protein, lactate, simplified acute physiology score 3, length of stay, and in-hospital mortality were obtained from the medical records. Patients, who visited the emergency department because of trauma or suicidal attempts, arrived after out-hospital cardiac arrest, or were diagnosed with cerebrovascular disease, were excluded.
Results: Of the 310 patients included, 65 died during their admission, and 245 patients were discharged after treatment. The receiver operating characteristic curve showed that the delta neutrophil index (area under curve [AUC], 0.72), Creactive protein (AUC, 0.70), lactate (AUC, 0.64), and simplified acute physiology score 3 (AUC, 0.79) indicated a low predictive power for in-hospital mortality. Whole patients were divided into four subgroups (infectious diseases, cardiovascular diseases, gastrointestinal bleeding diseases, and others). The receiver operating curve of delta neutrophil index revealed infectious diseases (AUC, 0.65), in cardiovascular diseases (AUC, 0.70), and gastrointestinal bleeding diseases (AUC, 0.79).
Conclusion: The role of the delta neutrophil index for predicting the prognosis of in-hospital mortality showed equally low predictive power for critically ill patients with the C-reactive protein and lactate.

KCI등재

5자전거와 비교한 개인용 이동장치 사고의 손상 심각성 및 사고 유발 요인

저자 : 전종복 ( Jong Bok Jeon ) , 장재호 ( Jae Ho Jang ) , 임용수 ( Yong Su Lim ) , 최재연 ( Jea Yeon Choi ) , 조진성 ( Jin Seong Cho ) , 우재혁 ( Jae-hyug Woo ) , 최우성 ( Woo Sung Choi ) , 양혁준 ( Hyuk Jun Yang ) , 현성열 ( Sung-youl Hyun )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 31권 2호 발행 연도 : 2020 페이지 : pp. 161-168 (8 pages)

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Objective: Personal mobility vehicles (PMV) have been used widely as a means of replacing bicycles in recent years because of their convenience and high economic efficiency. On the other hand, accidents related to PMV are also increasing, but there have been few studies in this area. This study examined the factors that increase the severity of damage and determine the characteristics of the PMV compared to the accidents on a bicycle.
Methods: Retrospective observational studies were performed. The variables related to the accident were collected and analyzed for patients who visited the emergency room due to a PMV and bicycle accident. Multivariate logistic regression analysis was used to determine the factors affecting the severity of the patients. The odds ratios were calculated and compared between injuries related to PMV and bicycles.
Results: A total of 1,124 patients (bicycles 1,017, PMV 107) were enrolled in this study. In multivariate regression analysis, the severity of PMV was higher (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.06-2.83) than that of a bicycle. The factors affecting the severity of the patients were age (OR, 1.02, 95% CI, 1.01-1.03), alcohol use (OR, 1,70; 95% CI, 1.04-2.70), ambulance transport (OR, 2.46; 95% CI, 1.78-3.40), and wearing a helmet (OR, 2.06; 95% CI, 1.36-3.13).
Conclusion: PMV showed higher severity of damage than a bicycle. The PMV, which is a new transportation means, is insufficient for the prevention of safety compared to bicycles where driving regulations and wearing protective equipment are common. Additional studies on the precise mechanisms of injury and damage are expected to prevent accidents and reduce their severity.

KCI등재

6응급센터에 내원한 중증외상환자에서 평균혈소판용적의 연속 측정을 통한 다발성 장기부전 예측의 유용성

저자 : 양현영 ( Hyun Young Yang ) , 정성필 ( Sung Phil Chung ) , 좌민홍 ( Minhong Choa ) , 유제성 ( Je Sung You ) , 공태영 ( Taeyoung Kong ) , 고동률 ( Dong Ryul Ko ) , 황윤정 ( Yoon Jung Hwang ) , 이용희 ( Yong Hee Lee ) , 조영준 ( Young Joon Cho ) , 박인철 ( Incheol Park ) , 김시내 ( Sinae Kim

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 31권 2호 발행 연도 : 2020 페이지 : pp. 169-180 (12 pages)

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Objective: The early prediction of multiple organ dysfunction syndrome (MODS) in trauma patients and provision of prompt treatment may improve their outcomes. We investigated the efficacy of the mean platelet volume (MPV) for predicting MODS in cases of severe trauma.
Methods: This retrospective, observational cohort study was performed with patients prospectively integrated in a critical pathway of TRAUMA. We analyzed the severe trauma patients admitted to the emergency department (ED), based on the Advanced Trauma Life Support guideline, between January 1, 2011 and May 31, 2017. The outcomes were developed from MODS at least 48 hours after ED admission.
Results: A total of 348 patients were enrolled. An increase in the MPV at 12 hours (odds ratio [OR], 2.611; P< 0.001) was a strong independent predictor of MODS development. The increasing predictability of MODS was closely associated with an MPV at 12 hours >8.6 fL (OR, 4.831; P<0.001). The area under the receiver operating characteristic curve (AUROC) value of the MPV at 12 hours (0.751; 95% confidence interval [CI], 0.687-0.818; P<0.01) was not inferior than that of Acute Physiology and Chronic Health Evaluation II score, injury severity score, lactate, and total CO2 for predicting MODS.
Conclusion: MPV was an independent predictor of MODS development in severe trauma patients. Emergency physicians can use the MPV as an ancillary biomarker for predicting MODS.

KCI등재

7응급의료서비스 이용 유무에 따른 급성 심근경색증 환자의 1년간 주요 심뇌혈관사건 발생 비교

저자 : 김수진 ( Su Jin Kim ) , 이은숙 ( Eun Sook Lee ) , 정명호 ( Myung Ho Jeong ) , 김민철 ( Min Chul Kim ) , 심두선 ( Doo Sun Sim ) , 홍영준 ( Young Joon Hong ) , 김주한 ( Ju Han Kim ) , 안영근 ( Youngkeun Ahn ) , 조명찬 ( Myeong Chan Cho ) , 김종진 ( Chong Jin Kim ) , 김영조 ( Young Jo Kim )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 31권 2호 발행 연도 : 2020 페이지 : pp. 181-190 (10 pages)

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Objective: The emergency medical service (EMS) is expected to improve the prognosis of patients suffering from acute myocardial infarction (AMI). We investigated the impact of utilizing EMS on the clinical outcomes of AMI patients.
Methods: From November 2011 to November 2015, a total of 13,102 patients in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) registry were enrolled. Patients were divided into two groups: the EMS group, first medical contact (FMC) with 119; the non-EMS group, the FMC at local hospitals that were not available for percutaneous coronary intervention. The authors analyzed the mortality and major adverse cardiac and cerebrovascular events during one-year of clinical follow-up.
Results: A total of 8,863 patients were finally analyzed for this study, and a total of 1,999 patients (22.6%) utilized the EMS as FMC. The patients utilizing EMS were more frequently diagnosed with ST-segment elevation AMI. At presentation, the EMS group had a higher incidence of Killip class IV, and they had a shorter symptom-to-door time than non- EMS group. The patients utilizing EMS had higher incidence of peri-procedural complications and in-hospital mortality. The multivariate logistic regression analysis with backward elimination revealed that utilizing EMS is an independent factor for predicting lower one-year mortality.
Conclusion: This study has demonstrated that the high-risk AMI patients can utilize the EMS in Korea. The EMS group has more favorable clinical outcome during one-year follow-up after discharge than the non-EMS group, whereas it had a higher rate of death during hospitalization compared with that of the non-EMS group.

KCI등재

8Assessment of clinical and laboratory parameters for the severity of acute diverticulitis in a Korean emergency department

저자 : Stephen Gyung Won Lee , Hui Jai Lee , Jonghwan Shin , Kyoung Min You

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 31권 2호 발행 연도 : 2020 페이지 : pp. 191-199 (9 pages)

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Objective: Practice guidelines for diverticulitis have been developed in countries where left-colon diverticulitis is dominant, but there is limited information on right-colon diverticulitis. This study examined the clinical characteristics and risk factors of clinically severe right-colon diverticulitis.
Methods: A retrospective chart review of patients diagnosed with diverticulitis in an emergency department in Korea between 2013 and 2017 was performed. Clinically severe diverticulitis was defined as any cause of death, intensive care unit admission, surgery, or invasive intervention due to diverticulitis, and admission for seven or more hospital days. Multivariable logistic regression was used to identify the risk factors for clinically severe diverticulitis.
Results: This study analyzed 302 patients. Patients with older age (odds ratio [OR], 1.044; 95% confidence interval [CI], 1.009-1.080; P=0.013), complications observed on computed tomography (CT) (OR, 6.906; 95% CI, 2.514-18.968; P<0.001), rebound tenderness on a physical examination (OR, 2.542; 95% CI, 1.041-6.218; P=0.041), high alkaline phosphatase (ALP) levels (OR, 1.014; 95% CI, 1.002-1.026; P=0.026), and high C-reactive protein (CRP) levels (OR, 1.095; 95% CI, 1.017-1.178; P=0.013) were at higher risk of clinically severe diverticulitis.
Conclusion: Among patients diagnosed with right-colon diverticulitis in the emergency department, those of older age, distinct complications on CT, rebound tenderness on physical examination, high ALP, and high CRP levels are related to clinically severe disease.

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9응급실에 입원한 지역사회획득 폐렴 노인환자에서 lactate와 SMART-COP조합의 예후 예측 능력

저자 : 정아영 ( Ah Young Jeong ) , 오상희 ( Sanghee Oh ) , 박상현 ( Sanghyun Park ) , 윤준성 ( Chun Song Youn ) , 박정호 ( Jung Ho Park ) , 최승필 ( Seung Pill Choi ) , 오재훈 ( Jae Hun Oh ) , 박인아 ( In A Park )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 31권 2호 발행 연도 : 2020 페이지 : pp. 200-209 (10 pages)

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Objective: Community-acquired pneumonia (CAP) in older patients is a potentially life-threatening infection with a poor prognosis. Therefore, is important to predict the mortality rate of CAP for older patients. This study examined the effects of predictive increases on CAP mortality by adding a biomarker to known CAP severity prediction tools.
Methods: A retrospective analysis of information was conducted on patients older than 65 years, who were treated with CAP in five emergency departments from October 2016 to February 2017. The primary outcome was the 28-day mortality. The following were calculated for each patient: qSOFA (quick Sequential Organ Failure Assessment), A-DROP (Age, Dehydration, Respiratory failure, Orientation, blood Pressure), CURB-65 (Confusion, Urea level, Respiratory rate, Blood pressure, age≥65 years), SMART-COP (Systolic blood pressure, Multilobar infiltrates, Albumin, Respiratory rate, Tachycardia, Confusion, Oxygen and pH), NLR (neutrophil:lymphocyte ratio), PLR (platelet:lymphocyte ratio), and CAR (high-sensitivity C-reactive protein:albumin ratio). The prognostic value for the 28-day mortality was determined by multivariate logistic regression analysis.
Results: The 28-day mortality was 12.0% of 693 CAP patients. Multivariate logistic regression analysis showed that lactate (odds ratio [OR], 1.589; P<0.001) and CAR (OR, 1.208; P=0.006) were correlated with the 28-day mortality. NLR (OR, 1.00; P=0.983) and PLR (OR, 1.00; P=0.784) were not correlated. The area under curve (AUC) was significant as CAR 0.649, lactate 0.737, and SMART-COP 0.735 (P<0.001), and the AUC of lactate+SMART-COP increased significantly to 0.784 compared to SMART-COP (P=0.014).
Conclusion: A combination of lactate and SMART-COP can be used as a tool to assess the severity of older hospitalized CAP patients who visited emergency departments.

KCI등재

10요양병원에서 전원 온 폐렴환자의 특성: 일개 권역응급의료센터의 후향적 연구

저자 : 김호일 ( Ho-il Kim ) , 유승 ( Seung Ryu ) , 정원준 ( Won-joon Jeong ) , 조용철 ( Yong-chul Cho ) , 안홍준 ( Hong-joon Ahn ) , 조성욱 ( Seong-wook Cho ) , 오세광 ( Se-kwang Oh ) , 박정수 ( Jung-soo Park ) , 유연호 ( Yeon-ho You )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 31권 2호 발행 연도 : 2020 페이지 : pp. 210-220 (11 pages)

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Objective: This study investigated the characteristics of elderly pneumonia patients transferred from long-term care hospitals (LTCH).
Methods: The initial emergency department (ED) data of patients, who were transferred from other hospitals and over 65 years old and hospitalized from 2014 to 2018 for pneumonia management through the ED, were extracted from the electronic medical records. The differences in the initial status and prognosis between the LTCH group and non-LTCH group were compared, and the initial ED variables that affect the in-hospital mortality of the LTCH group were investigated.
Results: The total number of patients was 1,032; 423 (41.0 %) were included in the LTCH group. Compared to the non- LTCH group, the following severity indices, some laboratory data, and mortality were worse in the LTCH group: systemic inflammatory reaction syndrome (SIRS) criteria ≥2 (65.0% vs. 56.7%, P=0.008), quick Sequential Organ Failure Assessment score ≥2 (48.2% vs. 20.4%, P<0.001), CURB-65 (Confusion, Urea nitrogen, Respiration rate, Blood pressure, Age≥65 years) criteria ≥3 (51.8% vs. 29.2%, P<0.001), pneumonia severity index (PSI) class ≥4 (86.5% vs. 61.2%, P<0.001), modified early warning score ≥5 (38.8% vs. 18.4%, P<0.001), serum albumin (median [IQR], 2.6 [2.2- 2.9] g/dL vs. 2.8 [2.4-3.2] g/dL; P<0.001), blood urea nitrogen/albumin (B/A) ratio (median [IQR], 8.0 [5.0-12.8] vs. 6.6 [4.4-10.4]; P<0.001), and in-hospital mortality (26.0% vs. 15.9%, P<0.001). Multivariate regression analysis revealed the albumin grade, B/A ratio grade, PSI class, and SIRS criteria to independently affect the in-hospital mortality of the LTCH group.
Conclusion: The LTCH group had poorer initial severity indices and higher in-hospital mortality than the non-LTCH group. In addition, the albumin grade, B/A ratio grade, could be used for the severity index of pneumonia patients transferred from the LTCH.

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