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종설 : 응급의료의 법과 윤리

Review Articles : Law and Ethics in Emergency Medicine

이석배 ( Seok Bae Lee ) , 배현아 ( Hyun A Bae ) , 정중식 ( Joong Sik Jeong ) , 김미란 ( Mi Ran Kim ) , 김지희 ( Jee Hee Kim )
  • : 대한응급의학회
  • : 대한응급의학회지 20권6호
  • : 연속간행물
  • : 2009년 12월
  • : 593-603(11pages)
피인용수 : 16건

(자료제공: 네이버학술정보)

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Ethical problems in an emergency department (ED) are much more common than is usually recognized. But these difficult ethical dilemmas have not been dealt with by general medical ethicists. Most medical ethics guidelines tend to concentrate on chronic or at least relatively stable situations rather than on the acute, episodic cases that are typical in the ED. most ethical problems such as abortion, euthanasia, and professionalism can be solved after reflection and deliberation, and after a process of communication that reveals the values and interests of the patient or the patient`s family. In contrast, when health care professionals in the ED recognize ethical problems, they often don`t have enough time for an ethical consultation such as a Hospital Ethics Committee. Ethical principles such as autonomy, beneficence, nonmaleficence, and justice need to be applied to the unique setting of emergency medicine. Hence, it is necessary to develop ethics guidelines in emergency medicine and ethics education for health care professionals in emergency departments. At first, we collected cases involving ethical problems and reviewed the ethical and legal aspects of those cases. In this article, we summarize the ethical issues in emergency medicine, deal with actions in emergency medical services, and also consider the relationships between ethical issues and act on emergency medical services. We want to present the important factors that should be considered in ethical decision making within an emergency medicine department including patient decision making capacity, legal custody, and ethical principles.

ECN

ECN-0102-2012-510-001088160


UCI

I410-ECN-0102-2012-510-001088160

간행물정보

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


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1종설 : 응급의료의 법과 윤리

저자 : 이석배 ( Seok Bae Lee ) , 배현아 ( Hyun A Bae ) , 정중식 ( Joong Sik Jeong ) , 김미란 ( Mi Ran Kim ) , 김지희 ( Jee Hee Kim )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 20권 6호 발행 연도 : 2009 페이지 : pp. 593-603 (11 pages)

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Ethical problems in an emergency department (ED) are much more common than is usually recognized. But these difficult ethical dilemmas have not been dealt with by general medical ethicists. Most medical ethics guidelines tend to concentrate on chronic or at least relatively stable situations rather than on the acute, episodic cases that are typical in the ED. most ethical problems such as abortion, euthanasia, and professionalism can be solved after reflection and deliberation, and after a process of communication that reveals the values and interests of the patient or the patient`s family. In contrast, when health care professionals in the ED recognize ethical problems, they often don`t have enough time for an ethical consultation such as a Hospital Ethics Committee. Ethical principles such as autonomy, beneficence, nonmaleficence, and justice need to be applied to the unique setting of emergency medicine. Hence, it is necessary to develop ethics guidelines in emergency medicine and ethics education for health care professionals in emergency departments. At first, we collected cases involving ethical problems and reviewed the ethical and legal aspects of those cases. In this article, we summarize the ethical issues in emergency medicine, deal with actions in emergency medical services, and also consider the relationships between ethical issues and act on emergency medical services. We want to present the important factors that should be considered in ethical decision making within an emergency medicine department including patient decision making capacity, legal custody, and ethical principles.

2원저 : 정상 기도와 시뮬레이션된 어려운 기도 시나리오에서 매킨토시 후두경과 GlideScope(R) 비디오 후두경의 비교 -마네킹 연구-

저자 : 시종원 ( Jong Won Si ) , 이삼범 ( Sam Beom Lee ) , 도병수 ( Byung Soo Do )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 20권 6호 발행 연도 : 2009 페이지 : pp. 604-608 (5 pages)

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Purpose: To compare the usefulness of Macintosh laryngoscope with GlideScope(R) video laryngoscope in five airway scenarios on Simman(R) manikin. Methods: Forty medical students, 20 males and 20 females, were enrolled and performed endotracheal intubation with Macintosh laryngoscope and GlideScope(R) video laryngoscope in five airway scenarios: normal airway, cervical rigidity, tongue edema, pharyngeal obstruction and combined tongue edema with pharyngeal obstruction. We studied the laryngeal view, ease of intubation, time for intubation, success rate and number of attempts in the five airway scenarios. Results: VAS for the ease of intubation showed that intubation with GlideScope(R) video laryngoscope was easier than intubation with Macintosh laryngoscope in each scenario except the cervical rigidity scenario (p<0.05). The laryngeal view with GlideScope(R) video laryngoscope was better than that with Macintosh laryngoscope in each scenario except the pharyngeal obstruction scenario (p<0.05). The time for visualizing epiglottis with Macintosh laryngoscope was shorter than with GlideScope(R) video laryngoscope except the tongue edema and pharyngeal obstruction scenario (p<0.05). The time from visualizing epiglottis to insertion of endotracheal tube with Macintosh laryngoscope was shorter than with GlideScope(R) video laryngoscope except the tongue edema and combined scenario (p<0.05). The total time for endotracheal intubation with Macintosh laryngoscope was shorter than with GlideScope(R) video laryngoscope except the tongue edema scenario (p<0.05). The success rate with GlideScope(R) video laryngoscope was higher than with Macintosh laryngoscope in the tongue edema and combined scenario (p<0.05). There was no statistical significance for the number of attempts between GlideScope(R) video laryngoscope and Macintosh laryngoscope. Conclusion: Endotracheal intubation with GlideScope(R) video laryngoscope had better results than with Macintosh laryngoscope in most scenarios. Endotracheal intubation with GlideScope(R) video laryngoscope promises to be a useful device for non-skilled personnel.

3원저 : 미국심폐소생협회의 기본심폐소생술 교육을 받은 간호대학생의 술기수행능력 유지 정도

저자 : 홍정석 ( Jung Seok Hong ) , 안력 ( Ryeok Ahn ) , 김선휴 ( Sun Hyu Kim ) , 김우연 ( Woo Youn Kim ) , 김수옥 ( Soo Ok Kim ) , 홍은석 ( Eun Seog Hong )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 20권 6호 발행 연도 : 2009 페이지 : pp. 609-614 (6 pages)

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Purpose: After initial cardiopulmonary resuscitation (CPR) training, CPR performance declines substantially over time. We undertook this study to evaluate the retention of CPR skills by nursing students who received training in the American Heart Association (AHA) basic life support (BLS) course for healthcare providers. Methods: Third-year nursing students at Ulsan College received training in an 8-hour AHA BLS course. The sequence of CPR actions follows those of the AHA 2005 guidelines. Six months later, skill retention was tested in some of the students without previous notice. Performance in fifteen discrete skills was tested in a scenario format. Resuscitation skills were measured using skill-reporting manikin connected to a PC using Ambu(R) MegaCode Simulation Software and Philips` AED Trainer-2(R). Each of the tests was recorded in video-tapes and the results were analysed by two emergency physicians. Results: Sixty participants were trained and 22 of them were chosen for testing after 6 months. Although not statistically significant, assessing responsiveness (n=17, 77.3%), correct hand placements for compressions (n=17, 77.3%), delivering adequate compression (n=15, 68.2%), turning on the AED (n=18, 81.8%), and placing pads correctly (n=17, 77.3%) tended to be better than the performance of the other discrete skills. The chest compression rate and depth were 105.6±26.4/min and 45.5±11.3mm, respectively. These two skills were performed correctly 59.1% and 59.1% in all the participants, respectively. Conclusion: This study confirmed the generally poor 6-month retention of CPR skills and demonstrated the need for reeducation in nursing students. Further studies are needed to identify the appropriate re-training interval for different occupations.

4원저 : DVD 시청 또는 강사 주도 학습에 이은 자가 실습 직후 획득된 심폐소생술 수행능력에 강사 추가 개입이 미치는 영향

저자 : 이원석 ( Won Suk Lee ) , 박대성 ( Dae Sung Park ) , 하원선 ( Won Sun Ha ) , 최용준 ( Yong Jun Choi ) , 정준영 ( Jun Young Chung ) , 윤영현 ( Young Hyun Yun )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 20권 6호 발행 연도 : 2009 페이지 : pp. 615-619 (5 pages)

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Purpose: Effective training in CPR is important for medical personnel and the public and a variety of educational methods have been used. We compared the results of the two most common CPR teaching methods, video-based and Instructor-led teaching, with particular emphasis on the effects of supervised practice by an instructor. Methods: Sixty college students who had never been taught CPR were divided into 2 groups of 30. One group was given a 30-minute lecture using slides and the other watched the 30-minute CPR Anytime DVD. Afterwards, all participants were tested on the Mini Anne manikin. All students were re-tested after 30 minutes of practice under the supervision of an instructor. Results: The only statistically significant difference between the two groups was an increased accuracy in breath delivery in the DVD group before the instructor supervised practice. There were no statistically significant differences between the 2 groups after the instructor supervised practice. Conclusion: Self practice via DVD was relatively more effective than the theory lecture. However, the effect of the education significantly increased with instructor`s participation and the difference between teaching methods was insignificant.

5Original Articles : Feasibility of Extracorporeal Life Support for Out-of-Hospital Cardiac Arrest Patients who are Unresponsive to Conventional Cardiopulmonary Resuscitation

저자 : Sung Woo Moon , Sung Woo Lee , Jae Seung Shin , Jae Ho Jung , Won Jae Jung , Kwang Ja Kim , Yun Sik Hong , Jan Kurt Horn

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 20권 6호 발행 연도 : 2009 페이지 : pp. 620-628 (9 pages)

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Purpose: To determine the feasibility of using extracorporeal life support (ECLS) for out-of-hospital cardiac arrest (OHCA) patients who are unresponsive to conventional cardiopulmonary resuscitation (CPR) techniques. Methods: This study was a case series of consecutive non-traumatic OHCA patients aged 18~75 years who received ECLS in the emergency department (ED) of a university teaching hospital. We analyzed outcomes, physiologic effects, and complications associated with ECLS. To compare outcomes of ECLS and conventional CPR, we selected a conventional CPR subgroup, those who were aged 18 to 75 years, who experienced cardiac arrest with pre-hospital CPR, who had no terminal illness, and who had CPR for more than 40 minutes. Results: Of 14 attempts to initiate ECLS, 13 patients received ECLS and one patient failed catheterization. Nine patients achieved return of spontaneous circulation (ROSC) more than 20 minutes later; 4 of the 9? patients survived more than 24 hours; 2 patients were successfully weaned off ECLS; 1 patient was discharged alive without neurologic complications. Median (minimum-maximum) duration of CPR before ECLS (pre-hospital and in-hospital) was 84(41 to 167) minutes. Blood gas parameters obtained 3 hours after the start of ECLS were significantly improved compared with those obtained pre-ECLS. Four patients who arrested from acute myocardial infarction received intervention as during ECLS support to correct the causes of the arrest. Serious complications of ECLS causing mortality were catheterization failure, intracranial hemorrhage, and massive hemothorax. The ECLS group showed a higher ROSC rate than patients who received conventional CPR without ECLS (64.3% vs. 7.1%, p=0.002). Conclusion: ECLS in the ED is feasible for OHCA patients who are unresponsive to prolonged CPR. ECLS provides a bridge to evaluation and definitive care in refractory OHCA by improving early hemodynamic and physiologic status. Earlier application of ECLS and reduction of complications associated with ECLS may improve the survival of OHCA patients.

6원저 : 마네킹 모델을 이용한 가슴압박 질 평가 감시장비의 타당도 평가

저자 : 이수열 ( Sue Yeol Lee ) , 조규종 ( Gyu Chong Cho ) , 최기훈 ( Ki Hoon Choi ) , 안지윤 ( Ji Yun Ahn ) , 서정열 ( Jung Yeol Seo ) , 손유동 ( You Dong Shon ) , 안희철 ( Hee Cheol Ahn )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 20권 6호 발행 연도 : 2009 페이지 : pp. 629-634 (6 pages)

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Purpose: The 2005 resuscitation guidelines stipulate the need for monitoring CPR (cardiopulmonary resuscitation) quality. Recently, several clinical investigations have shown that a real time monitoring and feedback system is effective for improving the quality of chest compressions during resuscitation. However little data exists regarding the accuracy of the monitoring system using an accelerometer sensor and a pressure sensor for the measuring of compression rate and depth. Our goal for this study was to investigate how well chest compression rate and depth can be estimated using the monitoring system. Methods: Thirty seconds of continuous chest compressions were delivered on a standard skillmeter manikin lying on the floor with the monitoring system. The chest compressions were delivered with variations in compression rate (67~142 /min) and with variations in compression depth (22~61 mm). A total of 120 sets of compressions were delivered for validation of rate and depth. Results: The correlation coefficient for compression rate between the monitoring system and the standard method was 0.999 (p<0.001), and Bland-Altman analysis showed a mean bias of -0.10±0.77/min, with limits of agreement ranging from -1.60 to 1.40/min. The correlation coefficient for compression depth between two methods was 0.983 (p<0.001), and Bland-Altman analysis showed a mean bias of 4.2±2.0 mm, with limits of agreement ranging from 0.24 to 8.10 mm. Conclusion: Compared with a skillmeter manikin, a monitoring system for the quality of CPR estimates chest compression rate precisely, but overestimates chest compression depth by an average of 10.3%.

7원저 : 중심정맥도관 삽입 시 도관의 우심방 내 위치 확인을 위한 단순흉부촬영 영상 지표로서 기관용골-중심정맥도관 끝 거리의 유용성

저자 : 박준민 ( Joon Min Park ) , 정태녕 ( Tae Nyoung Chung ) , 김민정 ( Min Joung Kim ) , 김선욱 ( Sun Wook Kim ) , 박유석 ( Yoo Seok Park ) , 정성필 ( Sung Pil Chung ) , 김승호 ( Seung Ho Kim )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 20권 6호 발행 연도 : 2009 페이지 : pp. 635-641 (7 pages)

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Purpose: Our goal was to check the effect of physique on tip-to-carina (TC) distance for detecting the right atrium (RA) position of a central venous catheter tip, and to determine the optimal cut-off value for TC distance. Methods: We did a retrospective review of patients who were given chest computed tomography within 12 hours after central venous catheterization (CVC) between September 2005 and February 2009. We used electronic medical records (EMR) and a picture archiving communication system (PACS). TC/height ratio and TC/thoracic width ratio were used as height and thoracic width corrected TC distances. We developed receiver operating characteristic (ROC) curves for TC distance, TC/height and TC/thoracic width, and compared the area under curves (AUCs) of each. An optimal cut-off value for TC distance was obtained using ROC curves. Results: A total of 88 patients were enrolled in our study to determine the optimal cut-off value for TC distance. Of the 88, records for 64 included height, which was required for comparing TC with height and thoracic width corrected TC. AUCs of TC, TC/height, and TC/thoracic width were, respectively, 0.966, 0.962, 0.970. There was no statistically significant differences between them. The cut-off value for TC distance for detecting RA positioning of a CVC is 30 mm (Sensitivity=100%, Specificity=85.1%). Conclusion: TC distance is a useful marker for detecting RA positioning of a CVC regardless of the patient`s height and thoracic width. We suggest 30 mm as the optimal cutoff value for TC distance.

8원저 : 패혈증 환자에서 장기 부전의 예측 인자로서 초기 젖산 제거율의 의의

저자 : 이선범 ( Sun Beom Lee ) , 홍윤식 ( Yun Sik Hong ) , 김정윤 ( Jung Youn Kim ) , 김도현 ( Do Hyun Kim ) , 문성우 ( Sung Woo Moon ) , 최성혁 ( Sung Hyuk Choi ) , 이성우 ( Sung Woo Lee )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 20권 6호 발행 연도 : 2009 페이지 : pp. 642-648 (7 pages)

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Purpose: To understand the prognostic value of initial lactate level and initial lactate clearance rate in severe sepsis and septic shock patients. We analyzed the Sequential Organ Failure Assessment (SOFA) score to determine the relationship with organ failure. Methods: This was a prospective observational study on severe sepsis and septic patients. We calculated the SOFA score on admission (0), and at 4, 24, 48, and 72 hours. We divided the patients into four groups by lactate level of 4 mmol/L and initial lactate clearance rate of 10%. We compared the 28-day mortality rate and the SOFA score. Results: Initial lactate level and initial lactate clearance rate on admission showed significant difference in the SOFA score, 28-day survival rate and survival curves (p<0.05). The initial serum lactate level according to the SOFA score of the renal system showed no significant difference at any time period. However, the lactate clearance rate was correlated with the renal system at 24, 48, and 72 hours. In addition, the group with high initial lactate level and low lactate clearance rate showed a significantly low 28-day survival rate (p<0.05) and the SOFA score was also high. Conclusion: We confirmed that the initial lactate level and the initial lactate clearance rate were closely related with the prognosis and SOFA score of severe sepsis and septic shock patients. According to each organ, the renal system was not significantly correlated with the initial lactate level but did show a significant relationship with the initial lactate clearance rate.

9원저 : 응급의료 센터를 바탕으로 한 취학전 어린이 손상 환자의 심층적 손상감시 체계 시범적 적용

저자 : 송해달 ( Hae Dal Song ) , 김경환 ( Kyung Hwan Kim ) , 김아진 ( Ah Jin Kim ) , 박준석 ( Jun Seok Park ) , 신동운 ( Dong Wun Shin ) , 노준영 ( Jun Young Roh ) , 이경미 ( Kyoung Mi Lee )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 20권 6호 발행 연도 : 2009 페이지 : pp. 649-657 (9 pages)

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Purpose: To describe the use of an emergency department (ED)-based, in-depth injury surveillance system to determine the incidence and mechanism of preschool children injury. Methods: We prospectively studied and registered injured children under 7 years old, (n=5,921) whose injuries resulted in ED treatment from August 2006 to July 2008. We upgraded the checklist surveillance items, included place, accident mechanism, and agent factors. The ED physicians recorded the injury data on checklists in real time as they gave the ED orders. The recorded data were stored in computer networks and automatically coded, which enabled access to the raw data sources. The statistical data were calculated in detail by using relative frequency distribution from the raw data. Results: A total of 29,548 injured patients visited the ED from August 2006 to July 2008. Preschool children injuries, except those from traffic accidents, were 5,921(20.0%). The most common sources of injuries were from blunt trauma (37%), slips(17%), and falls(16%). Among those admitted to our hospital, fall injuries and inhalation of foreign body accidents accounted for 7.6% and 7.5%, respectively. The larger proportion of fall injuries occurred from a height of less than 1 meter(82.2%). The frequency of injury mechanism differed according to age: fall(35%), blunt(19%), and burn(14%) were noted under 1 year old, compared to blunt(34%), fall(14%), and slip(13%) from between 1 to under 3 years of age, and blunt(37%), slip(19%), and fall (11%) between 3 to under 7 years of age. Conclusion: The ED-based preschool children injury surveillance system could provide a useful and efficient method to determine injury incidence and injury-related factors.

10Original Articles : Lipid Peroxidation and Antioxidant Defenses According to Severity of PQ Poisoning

저자 : Hyung Hoon Kim , Jeong Mi Moon , Byeong Jo Chun , Byung Kook Lee

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 20권 6호 발행 연도 : 2009 페이지 : pp. 658-665 (8 pages)

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Purpose: Paraquat (PQ) increases the level of toxic reactive oxygen species in humans. Various endogenous antioxidant mechanisms against PQ exist in humans. The aim of the present study was to assess lipid peroxidation and antioxidative defenses of humans exposed to acute PQ poisoning over time. Methods: The medical records of patients who presented to the emergency department (ED) within 6 hours after PQ poisoning were reviewed. Patients were classified into three groups based on the severity index of paraquat poisoning (SIPP) using the serum level of PQ and time interval from exposure to ED arrival. The serum level of malondialdehyde (MDA) and the activities of antioxidative enzymes were compared between groups at baseline, 12 hours, 24 hours and 48 hours after presentation. Results: The mean age of enrolled patients was 51.0±15.9 years and they ingested 143.3±144.4 ml of 24.5% liquid PQ accidently or as an attempted suicide. The baseline MDA level, and the activities of superoxide dismutase (SOD) and glutathione peroxidase (GPx) in the three groups were similar. In the SIPP >50 group, the serum MDA level and the SOD activity significantly increased from baseline, peaking at 24 hours. In the 10≤SIPP≤50 group, serum MDA level and SOD activity displayed a smooth and steady increase. In the SIPP <10 group, serum MDA level steadily decreased but SOD activity increased. GPx activity did not show any changes. Conclusion: PQ changes serum levels of MDA and SOD activity depending on the severity of PQ intoxication, but serum GPx activity does not significantly change.

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KCI후보

대한외상학회지
30권 2호 ~ 30권 2호

KCI등재

대한응급의학회지
28권 4호 ~ 28권 4호

KCI후보

대한외상학회지
30권 1호 ~ 30권 1호

KCI등재

대한응급의학회지
28권 3호 ~ 28권 3호

KCI후보

대한외상학회지
29권 4호 ~ 29권 4호

대한응급의학회 학술대회초록집
2017권 1호 ~ 2017권 1호
발행기관 최신논문
자료제공: 네이버학술정보
발행기관 최신논문
자료제공: 네이버학술정보

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최근 열람 자료

맞춤 논문

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