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대한응급의학회> 대한응급의학회지> 원저 : 일개 응급의료센터에서 전문의에 의한 fast track 운영의 효과

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원저 : 일개 응급의료센터에서 전문의에 의한 fast track 운영의 효과

Original Articles : The Effectiveness of Operating Fast Track by Board Certified Emergency Physician in Emergency Medical Center of Teaching Hospital

정진희 ( Jin Hee Jung ) , 배현아 ( Hyun A Bae )
  • : 대한응급의학회
  • : 대한응급의학회지 19권4호
  • : 연속간행물
  • : 2008년 08월
  • : 372-377(6pages)
피인용수 : 11건

(자료제공: 네이버학술정보)

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Purpose: The main reasons for overcrowding of the Emergency Department (ED) in Korea were delay in the department`s decision making and entrance of non-emergency patients. The purpose of this study is to determine how primary care and in-hospital triage by board certified emergency physician can shorten the patients`s length of stay and relieve overcrowding in the ED. Methods: A prospective analysis of patients who visited the ED of a 700-bed tertiary care teaching hospital during holidays from April 2, 2006 to October 3, 2006 was done. We differentiated patients into a fast tract group and a non-fast tract group. Data compared were lengths of stay, decision time, number of unscheduled returns, and patient disposition. Results: The patients in the fast track group have significantly shorter decision time than the 1,159 patients in the non-fast track group (p<0.01). The disposition decision time of the fast track group was shorter than the non-fast track group by an average of 29 minutes. The total residence time of the fast tract group was shorter by an average of 26 minutes than the non-fast tract group. The difference in decision time (disposition decision time and residence time) was larger in the patients that were discharged from the ED. There was no unscheduled return. Conclusion: This study demonstrates that setting up a fast track system run by a board certified emergency physician could be one of the solutions in minimizing ED being crowding by patients with non-emergency problems. Fast track system could shorten total residence time about 26 minutes.

ECN

ECN-0102-2009-510-008723647


UCI

I410-ECN-0102-2009-510-008723647

간행물정보

  • : 의약학분야  > 외과학
  • : KCI 등재
  • : -
  • : 격월
  • : 1226-4334
  • :
  • : 학술지
  • : 연속간행물
  • : 1990-2018
  • : 2425


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1원저 : 일개 농어촌의 응급의료 현황 분석을 통한 농어촌형 응급의료체계 모델 개발

저자 : 김용산 ( Yong San Kim ) , 정경운 ( Kyung Woon Jeung ) , 허탁 ( Tag Heo )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 19권 4호 발행 연도 : 2008 페이지 : pp. 349-358 (10 pages)

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Purpose: Rural emergency medical service (EMS) is inferior to urban EMS. In creating and providing emergency patient care, in rural areas, it is important to consider resources, patient volumes, geography, technology challenges, volunteer and provider issues, medical oversight, polities, education, communications, and financial concerns. In the current environment in Korea, it is necessary to design tailored and self-supporting rural EMS systems. For the development of a self-supporting model for EMS systems in rural areas, we have studied the EMS system in one rural area, Goheung County. Methods: We obtained data from a health institute center, the Gwangju emergency medical information center, three emergency medical centers, and the fire station in Goheung county. In order to survey resident`s perceptions about the local EMS system, we provided a questionnaire to 324 residents in Goheung County in March 2005. The advisory council for the EMS system analyzed problems at each step or component of the EMS service delivery process and suggested a model for self-supporting EMS service in Goheung County. Results: The status of the EMS system in Goheung County is inferior to urban systems. A lack of appropriately trained emergency personnel at every level of care has been identified in this area. It is hard to find public education programs. There are few communication systems available for emergency medical care and there are extended transport times and distance, both for responding to and transporting patients. Resident`s perceptions of the EMS system is unfavorable. The advisory council suggested an optimized plan to address the problems of the EMS system in Goheung County. A self-supporting model is suggested by the council. It is necessary to consider residents` participation and to apply available resources in Goheung County. Conclusion: An ideal EMS system in Goheung County will be a self-supporting model requiring participation of residents and wise application of available sources. The first consideration in this model is institution of a public education program and recruitment and education of first responders in every village is suggested. The model recommends integration of the EMS communication system to provide quality emergency medical care.

2원저 : 원격 화상 진료가 무의도 주민의 의료 이용에 미치는 영향

저자 : 윤대흥 ( Dae Heung Yoon ) , 김선표 ( Sun Pyo Kim ) , 김성중 ( Seong Jung Kim ) , 조수형 ( Soo Hyung Cho ) , 조남수 ( Nam Soo Cho )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 19권 4호 발행 연도 : 2008 페이지 : pp. 359-365 (7 pages)

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Purpose: Video telemedicine system is efficient method of health care delivery that uses communication technologies via the internet and video-conferring to provide real-time video remote health provider, patient, or both. Video telemedicine system has the potential to improve access to the specialty of emergency medicine, particularly in rural and remote settings. Inadequate maintenance of ongoing health issues can result in high-cost care for both acute illness and long-term complications, whereas prevention of even a small percentage of these costs can pay for the cost of a video telemedicine system. Methods: We visited a doctorless island on September 8th, 2006 and studied the public health status of the citizens, making charts while giving a free medical examination and treatment. We maintained and analyzed the charts for one year and then surveyed citizens to evaluate the effectiveness of video telemedicine system and to query them regarding future remedies. Results: Out of 178 cases using video telemedicine system, 99 cases were the first medical examination and 12 cases were emergent, with 7 cases resulting in transfer to a mainland hospital. Of the patients transferred to the 3rd grade hospital, 41.4% had a heart problem. Thirty-eight cases were newly diagnosed via video telemedicine system, including 12 cases of vertebral disease (31.5%). 74.0% of citizens were satisfied with the video telemedicine system and among them 45.0% indicated satisfaction with the ease of seeing a doctor. After experiencing video telemedicine system, 100% of the citizens were agreed to continue video telemedicine system on the `doctorless island`, so more support and development is needed. Conclusion: Evidence suggests that a variety of video telemedicine system techniques can be applied effectively and safely to deliver emergency medicine across a variety of clinical settings. The utility and efficacy of telemedicine is discussed. Patient satisfaction is generally reported as high.

3원저 : 다중이용시설에서의 응급환자 보호에 관한 현행 법률의 연구

저자 : 안정환 ( Jung Hwan Ahn ) , 김호중 ( Ho Jung Kim ) , 김미선 ( Mi Seon Kim ) , 이종길 ( Jong Khil Lee ) , 이대욱 ( Dae Wook Lee ) , 조준필 ( Joon Pil Cho )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 19권 4호 발행 연도 : 2008 페이지 : pp. 366-371 (6 pages)

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Purpose: Our country has seen a rapid increase in economic growth, national land development and planning. As a consequence, cities were enlarged and became densely populated. Public facilities were also increased to adequately serve the increasing population. Within the past 10 years, a lot of accidents in public facilities have occurred but the legal foundations for emergency medical care and systems for these public facilities may be lacking. Methods: From the current domestic laws, we defined the public facilities and the enrolled laws that govern these facilities. Adequacy of the enrolled laws were then analyzed using 7 reference points: education for all employees, education for security employees, education for customers, arrangement of medical persons, arrangement of security person, equipment for emergency care and penalty. Results: There were 17 enrolled laws and only `Juvenile Activity Promotion Act` fulfilled most of the reference points except for 2; the arrangement of medical persons and penalty. Fifteen of the enrolled laws fulfilled less than 3 reference points. Conclusion: In the current domestic laws governing public facilities, almost all of them practically lacked policies addressing emergency care and systems.

4원저 : 일개 응급의료센터에서 전문의에 의한 fast track 운영의 효과

저자 : 정진희 ( Jin Hee Jung ) , 배현아 ( Hyun A Bae )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 19권 4호 발행 연도 : 2008 페이지 : pp. 372-377 (6 pages)

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Purpose: The main reasons for overcrowding of the Emergency Department (ED) in Korea were delay in the department`s decision making and entrance of non-emergency patients. The purpose of this study is to determine how primary care and in-hospital triage by board certified emergency physician can shorten the patients`s length of stay and relieve overcrowding in the ED. Methods: A prospective analysis of patients who visited the ED of a 700-bed tertiary care teaching hospital during holidays from April 2, 2006 to October 3, 2006 was done. We differentiated patients into a fast tract group and a non-fast tract group. Data compared were lengths of stay, decision time, number of unscheduled returns, and patient disposition. Results: The patients in the fast track group have significantly shorter decision time than the 1,159 patients in the non-fast track group (p<0.01). The disposition decision time of the fast track group was shorter than the non-fast track group by an average of 29 minutes. The total residence time of the fast tract group was shorter by an average of 26 minutes than the non-fast tract group. The difference in decision time (disposition decision time and residence time) was larger in the patients that were discharged from the ED. There was no unscheduled return. Conclusion: This study demonstrates that setting up a fast track system run by a board certified emergency physician could be one of the solutions in minimizing ED being crowding by patients with non-emergency problems. Fast track system could shorten total residence time about 26 minutes.

5원저 : 기관 삽관 후 기도내 튜브의 위치 확인에 있어 커프 촉지법의 유용성

저자 : 김현주 ( Hyun Ju Kim ) , 배현아 ( Hyun A Bae ) , 정구영 ( Koo Young Jung )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 19권 4호 발행 연도 : 2008 페이지 : pp. 378-383 (6 pages)

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Purpose: To confirm the utility of cuff palpation for the verification of the correct endotracheal tube position. Methods: One hundred and one intubated patients were selected randomly every three days among the 344 intubated patients in the emergency room of a tertiary care hospital between July 2006 and March 2007. After endotracheal intubation was confirmed, we recorded the probability of successful cuff palpation. We also measured the patient`s weight, height and neck length; the distance from ETT tip to the incisors, and distance from ETT tip to the carina of the patients. Sedatives or muscle relaxants that used were used were noted as well. Results: In the cuff palpated group (n=61), 40 patients` had the ETT tip at 3~5cm from the carina while in the nonpalpated group (n=40), 35 patients had the ETT tip placed at less than 3 cm or more than 5 cm from the carina (p value <0.001). The cuffs of the ETTs inserted in patients whose neck lengths were below 10 cm were less palpable than in patients whose neck lengths were more than 10 cm.(p=0.004) There was no relation between cuff palpability and height, BMI and use of muscle relaxant or sedatives. In addition, 9 of 10 cases whose cuffs were non-palpable, which were randomly chosen among the non-palpated group (n=40) with incorrectly positioned cuff became palpable after the repositioning of the ETT. Conclusion: We concluded that cuff palpation is a simple and reproducible way to verify the correct depth of endotracheal tubes.

6원저 : 무수축 또는 무맥성 전기활동 심정지에서 경도 저체온 요법의 의의

저자 : 이거성 ( Geo Sung Lee ) , 문정미 ( Jeong Mi Moon ) , 전병조 ( Byeong Jo Chun )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 19권 4호 발행 연도 : 2008 페이지 : pp. 384-391 (8 pages)

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Purpose: Therapeutic hypothermia has been recommended for postcardiac arrest coma due to ventricular fibrillation (Vf). However, although it is well known that the cardiac arrest due to non-Vf is associated with poorer neurologic outcome that Vf, there is no study that evaluates the effect of mild hypothermia on the cardiac arrests due to non-Vf. So, we intend whether mild hypothermia would improve the neurologic outcome of them saftly. Methods: We retrospectively analyzed the patients with cardiac arrest due to asystole or pulseless electrical activity who was presented at hopsital and successfully showed the return of spontaneous circulation. We divided the patients to two groups according to implementation of hypothermia and statistically compared the complication and neurologic outcome at discharge. Results: A total of sixty one patients were analyzed in this study. Baseline clinical and physiological characteristic were similar between patients treated with mild hypothermia or with conservative treatment. The complication rate did not differ significantly between the two groups. However, the good outcome at hospital discharge was observed in 13 of 41 patients treated with mild hypothermia compared with 0 of 27 patients treated with conservative treatment. Conclusion: Mild therapeutic hypothermia for the treatment of postcardiac arrest due to non-Vf can be saftly implemented with a major benefit on patient outcome.

7원저 : 중증 뇌손상 환자에게 비침습적 과호흡 감시로서 호기말 이산화탄소의 이용

저자 : 한철 ( Chul Han ) , 이성우 ( Sung Woo Lee ) , 홍윤식 ( Yun Sik Hong ) , 정동민 ( Dong Min Jeong ) , 이선범 ( Sun Bum Lee ) , 최성혁 ( Sung Hyuk Choi ) , 문성우 ( Sung Woo Moon )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 19권 4호 발행 연도 : 2008 페이지 : pp. 392-397 (6 pages)

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Purpose: Hyperventilation is no longer recommended as a prophylactic intervention during the first 24 hours after severe head injury. The vasoconstriction caused by reducing carbon dioxide (CO2) levels leads to cerebral ischemia, and multiple arterial punctures may be required in order to monitor hyperventilation in severe brain injury. However, end-tidal CO2 (Petco2) reflects arterial CO2 (Paco2) noninvasively. The aim of this study was to determine whether Petco2 can be successfully used instead of Paco2 to monitor hyperventilation in brain injury patients. Methods: From July 1, 2006 to June 30, 2007, 71 patients who visited the emergency department of a hospital after severe brain injury (trauma or acute cerebral disorder) were enrolled. Ten patients with chest trauma, 6 patients who received CPR in the emergency department (ED), and 1 patient who had COPD were excluded. Hemodynamic variables (Glasgow coma scale, mean arterial pressure, heart rate, respiration rate, body temperature, emergency operation, serum lactate concentration) under mechanical ventilation support were measured. The concordance between Petco2 and Paco2 was analyzed by employing a Bland-Altman plot. We defined the normal range for Paco2 and Petco2 [P(a-et)co2] is -5~5 mmHg. We compared the normal and high P(a-et)co2 groups to identify factors affecting the P(a-et)co2. Results: Excepting 17 patients under exclusion criteria, we analyzed 54 of the total of 71 patients. Thirteen patients (24.1%) were seen to be below 30 mmHg for Paco2. The Pearson correlation coefficient between Paco2 and Petco2 is 0.834 (p < 0.001), and the concordance between Paco2 and Petco2 was similarly high. The patients with high P(a-et) co2 showed significantly lower mean arterial pressure and lower arterial pH than patients with normal P(a-et)co2. Conclusion: Petco2 shows high concordance with Paco2 in severe brain injury. However, patients with high P(a-et)co2 showed evidence of poor tissue perfusion. Therefore, the hemodynamic and tissue perfusion state should be considered when attempting to monitor hyperventilation in severe brain injury patients using Petco2.

8원저 : 응급실을 통해 입원한 패혈증 혹은 패혈성 쇼크 환자에서 생존에 영향을 미치는 인자

저자 : 변재민 ( Jae Min Byun ) , 조한진 ( Han Jin Cho ) , 홍훈표 ( Hoon Pyo Hong ) , 최한성 ( Han Sung Choi ) , 고영관 ( Young Gwan Ko )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 19권 4호 발행 연도 : 2008 페이지 : pp. 398-404 (7 pages)

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Purpose: We sought to determine the impact of the factors that affect the mortality of critically ill patients with sepsis or septic shock. Methods: We performed a retrospective cohort study of adult patients admitted with sepsis or septic shock from April 1, 2006, to December 31, 2007, at a single, urban academic emergency department (ED). The primary outcome was patients` death. Predictor variables were the EDLOS, the time from registration to order for antibiotics administration, number of hospital days, initial systolic blood pressure, systolic blood pressure after hydration, heart rate, respiration rate, body temperature, serum white blood cell count, and serum lactic acid level. Cox`s proportional hazard model was used to elucidate the relationship of predictor variables to patients` death. Data were analyzed with SPSS version 12.0. Results: The overall mortality rate was 56.2%. Average length of stay was 204.5±90.6 minutes in the survival group and 166.6±81.8 minutes in the death group (p=0.041). The mortality was not shown to be significantly different between patients spending less than 4 hours and patients spending over 4 hours. The relative risk (RR) for patients` death was significantly higher in patients with hypotension persisting despite adequate fluid resuscitation. Conclusion: EDLOS did not affect mortality for the patients admitted with sepsis or septic shock. The patients` prognoses were mainly related to the systolic blood pressure after hydration.

9원저 : 국내 상지손상의 발생현황에 대한 분석

저자 : 오재훈 ( Jae Hoon Oh ) , 김재용 ( Jai Yong Kim ) , 신상도 ( Sang Do Shin ) , 고상백 ( Sang Baek Koh ) , 이국종 ( Kug Jong Lee ) , 최혁중 ( Hyuk Joong Choi ) , 임태호 ( Tai Ho Im )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 19권 4호 발행 연도 : 2008 페이지 : pp. 405-413 (9 pages)

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Purpose: This study was conducted to assess the frequency and severity of upper extremity injuries in Korea through a retrospective epidemiological study. Methods: For this study, we retrospectively reviewed nation-wide upper extremity injury data compiled from 2001 to 2003 from the National Injury Database, which includes the National Health Insurance Corporation (NHIC), Car Insurance, and Industry Insurance. NHIC consists of the medical aid population, the self-employed insured population and the employer-insured population. Data was standardized in terms of demographic characteristics, region and socioeconomic status by NHIC. To assess the degree of the injuries, we used the International Classification of Disease-10 (ICD-10) code and the Modified Abbreviated Injury Scale (MoAIS). Afterwards, we classified the degree of the severity into 4-four categories-mild, moderate, severe and critical- using the Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS). Results: Frequency of cases of upper extremity injuries per 1,000,000 persons was 58,663, and the incidence rate is 26.9% of total injuries. In fact, the incidence rate remained stable. Yet, there was a steady increase in total injuries from 2001 to 2003. Injuries in men outnumbered women regardless of the severity. In terms of severity, mortality was higher for the elderly aged 60 and over. The Seoul and Kyeonggi-areas showed the highest incidence rate while Jeju was the lowest. Furthermore, injuries were more frequent among the medical aid population. The daily incidence rate for non-critical cases was higher in the months of June, September and October. Conclusion: The data indicated that upper extremity injuries comprised a major portion of all injuries. Moreover, the result were affected by differences in gender, location and socioeconomic status. All in all, it is critical that sophisticated research and clinical data be compiled in order to develop more effective prevention strategies.

10원저 : 응급의료센터에 내원한 외상환자의 알코올 사용 장애에 대한 선별검사의 유용성

저자 : 최윤희 ( Yoon Hee Choi ) , 이동훈 ( Dong Hoon Lee ) , 노현 ( Hyun Noh ) , 어은경 ( Eun Kyung Eo ) , 정구영 ( Koo Young Jung )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 19권 4호 발행 연도 : 2008 페이지 : pp. 414-420 (7 pages)

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Purpose: Early identification of alcohol use disorder (AUD) among patients coming to the emergency department (ED) for treatment is important in order to facilitate timely intervention and further evaluation. A number of brief screening tools have been developed for identifying patients with AUD. This study compared three brief screening tools for detecting DSM-Ⅳ-defined AUD. Methods: A prospective study was performed from 20th of July 2004 to 20th of October 2004 at a university hospital emergency department (ED). We studied trauma patients including trauma patients who needed administration. Patients were screened by AUDIT, CAGE and RAPS test. Receiver operator characteristic analysis were used to evaluate the performance of the brief screens against the criterion of a DSM-IV AUD. Results: One hundred and thirty-five patients were enrolled in this study. Of the existing screening tools, AUDIT had the best overall performance in identifying AUD (sensitivity 98%. specificity 84%) Conclusion: Of the existing screening tools used to identify AUD, AUDIT had the best overall performance in identifying AUD in the ED.

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