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대한응급의학회> 대한응급의학회지> 원저 : 응급 협의진료 질 평가를 위한 기초 연구

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원저 : 응급 협의진료 질 평가를 위한 기초 연구

Original Articles : Evaluation of Emergency Consultation Skill: A Preliminary Study

전승훈 ( Seung Hoon Jeon ) , 한경화 ( Kyung Hwa Han ) , 김승환 ( Seung Hwan Kim ) , 김현종 ( Hyun Jong Kim ) , 이누가 ( Nu Ga Rhee ) , 유제성 ( Je Sung You ) , 박유석 ( Yoo Seok Park ) , 정성필 ( Sung Phil Chung ) , 박인철 ( In Cheol Park ) , 김민정 ( Min Joung Kim )
  • : 대한응급의학회
  • : 대한응급의학회지 24권1호
  • : 연속간행물
  • : 2013년 02월
  • : 89-94(6pages)
피인용수 : 21건

(자료제공: 네이버학술정보)

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Purpose: Emergency consultation is a common and important aspect in the emergency department (ED). Kessler et al. suggested the five Cs of the emergency medicine (EM) consulting checklist; contact, communication, core question, collaboration, and closing the loop as a tool for evaluation of consultation quality. The objective of this study was to evaluate the appropriateness of this checklist as a tool for assessment of the skill of requesting consultation in the ED. Methods: This study was conducted in the ED at an urban training hospital. Three emergency physicians recorded telephone conversations when they contacted consultant physicians for consultation regarding emergency patients. After recording files were collected, eight raters evaluated each conversation using the five Cs of the EM consulting checklist. Results: A total of 58 cases were gathered. The most frequent emergency acuity level of patients was 3, by 72.4%. The mean duration of conversation was 53±30 seconds. The mean total score was 41.9±3.1. When the scores for the five Cs` categories were evaluated, the score was lowest, at 2.9±1.0 for ``contact`` and highest, at 4.8±0.5, for ``communication``. Inter-rater agreement (95%confidence interval) of the total score was 0.819 (0.755-0.875). In the case of acuity level 3, the agreement was high, at 0.859(0.796-0.911), whereas it was 0.691 (0.491-0.874) and 0.426(0.115-0.922) in acuity levels 2 and 4, respectively. Conclusion: EM consultations were evaluated according to the five Cs of the EM consulting checklist showing high inter-rater agreement. This checklist could be used as a tool for monitoring and feedback in EM residency training.

UCI(KEPA)

I410-ECN-0102-2013-510-002263041

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  • : 의약학분야  > 외과학
  • : KCI등재
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  • : 1226-4334
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  • : 연속간행물
  • : 1990-2019
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1원저 : 인천대교 버스추락 사고로 평가한 지역 재난의료체계

저자 : 강수 ( Soo Kang ) , 윤성현 ( Sung Hyun Yun ) , 정현민 ( Hyun Min Jung ) , 김지혜 ( Ji Hye Kim ) , 한승백 ( Seung Baik Han ) , 김준식 ( Jun Sig Kim ) , 백진휘 ( Jin Hui Paik )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 1호 발행 연도 : 2013 페이지 : pp. 1-6 (6 pages)

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Purpose: Field triage, medical care, and transportation are important and life-saving medical tasks performed at the site of a mass-casualty incident (MCI). We experienced a mass-casualty incident when an express bus fell off the Incheon bridge and conducted an evaluation of problems. We are willing to provide information for equipping an local disaster planning. Methods: We surveyed the local emergency medical system response time, transportation time, and patients` clinical data using paramedics` records and medical records. We evaluated the adequacy of the order of priority of transportation by field triage used using the simple triage and rapid treatment (START) method. We evaluated field medical care, as well preponderance of transportation. Results: Twenty four people who were on the bus were evacuated, and 2 persons were dead on the scene. Two persons died within one week. There was a transport delay for patients who would benefit significantly from medical intervention because dead persons were transported early. Neither advanced airway nor fluid resuscitation was provided. Sixteen patients (66.7%) were transported to one hospital. Conclusion: When we reviewed this mass-casualty incident, there was no appropriate medical control, such as triage, field medical care, and transportation. In construction of the emergency medical service system for preparation for MCI or disasters, we suggest integration and unification of 119 rescue services and emergency medical information centers for effective medical control. Disaster drills should be performed according to guidelines for local emergency medical services.

2원저 : 우면산 재난에 대한 일개 응급의료센터의 대응 및 교훈에 대한 고찰

저자 : 문형기 ( Hyung Gi Moon ) , 김수현 ( Soo Hyun Kim ) , 오상훈 ( Sang Hoon Oh ) , 박규남 ( Kyu Nam Park ) , 김영민 ( Young Min Kim ) , 윤준성 ( Chun Song Youn )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 1호 발행 연도 : 2013 페이지 : pp. 7-13 (7 pages)

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Purpose: On July 27, 2011, landslides occurred on Woomyun Mountain, resulting in development of mass casualties. Seoul St. Mary  s Hospital was the primary recipient of patients. This experience prompted the drafting of a formal disaster plan. Therefore, we outline the Emergency Management External Disaster Plan of Seoul St. Mary`s Hospital and discuss the time course of presentation and medical characteristics of the patients. Methods: We conducted a retrospective review of medical records of patients who visited Seoul St. Mary`s Hospital from Woo-myun Mountain landslides. In addition, we reviewed the time course of hospital disaster response. Results: A total of 33 patients participated in this study. Mean age was 40.2 ( 21.8) years; eight patients died at the time of admission and cardiopulmonary resuscitation was performed in one patient. Mean Injury Severity Score (ISS) was 9.19 and four patients were ISS above 15. Six patients were admitted to our hospital and two patients underwent an emergency operation. Overall, the emergency disaster management was appropriate due to the formal disaster plan and experiences in conduct of disaster drills. However, there were also several problems. The major problems of our disaster response were as follows: delayed activation of external disaster, difficulties in securing a treatment section, and absence of a decontamination facility. Conclusion: We observed several problems from our experience with Woo-myun Mountain landslides. Reassessment of the disaster plan and additional planning for other possibilities are needed.

3원저 : 병원 밖 심정지 휴 자발순환이 회복되어 저체온 치료를 밭은 환자에 있어서 경력과 사마률 및 신경학적 예후와의 연관성

저자 : 이홍섭 ( Hong Sup Lee ) , 이근 ( Gun Lee ) , 김진주 ( Jin Joo Kim , , 박현미 ( Hyun Mi Park ) , 장재호 ( Jae Ho Jang ) , 황성연 ( Sung Youn Hwang ) , 현성열 ( Sung Youl Hyun ) , 양혁준 ( Hyuk Jun Yan )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 1호 발행 연도 : 2013 페이지 : pp. 14-21 (8 pages)

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Purpose: The purpose of this study is to evaluate relevance of postanoxic seizure with prognosis in cases of outof hospital cardiac arrest (OHCA) patients treated with TH and to research the prognostic role of portable electroencephalography (EEG). Methods: A total of 180 OHCA patients arrived during July of 2008 and June of 2011, and 144 patients who had beentreated with therapeutic hypothermia were included in thisstudy. Portable EEG was taken 24 hours after induction of TH and classified by the attending neurologist. As an outcome variable, overall mortality and neurological outcome after six months from discharge were evaluated (Good neurological outcome; Cerebral performance category (CPC) scale 1, 2, Poor neurological outcome; CPC scale 3~5). Results: Among 144 patients, 93 patients (63.9%) were male, and mean age was 51. Eighty two patients (56.9%) survived and almost 30% (43/144) of patients had a good neurological outcome. Sixty five patients (45.1%) had seizures, and, among this group, 19 patients (29.2%) were discharged with a good neurological outcome. No statistical difference was observed between the seizure group and the non-seizure group. Initial rhythm, APACHI II score, and time from basic life support to return of spontaneous circulation (OR, 2.169; 95% CI, 1.158~4.063, OR 1.107; 95% CI 1.064~1.152, OR 1.014; 95% CI 1.006~1.022, respectively) showed statistical importance, however, the seizure group (OR, 0.67, 95% CI, 0.356~1.032, p=0.065) had no statistical relevance with mortality. Grading of EEG by the neurologist showed a positive association with neurological outcomes (p<0.001). Factors associated with good neurological outcome were VF/VT initial rhythm (p=0.005), cardiac cause of arrest (p=0.001), high initial body temperature (p<0.001), low APACHI II score (p=0.010), and shorter time interval between arrest from basic life support (p=0.005). Conclusion: In our study, the seizure group showed no relevance with mortality and prognosis. In hope of achieving a better outcome, careful treatment should be provided in cases of OHCA patients with seizure. Conduct of larger, prospective studies is needed.

4Original Articles : Neurologic Outcomes and Factors Related to Outcomes in Patients Transferred for Specialized Post-cardiac Arrest care after Successful Resuscitation at other Facilities: One-year Experience in a Regional Emergency Center in Seoul, Repub

저자 : Suk Jae Ryu , Kyu Nam Park , Sang Hoon Oh , Young Min Kim , Han Joon Kim , Chun Song Youn , Seung Pill Choi , Soo Hyun Kim

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 1호 발행 연도 : 2013 페이지 : pp. 22-30 (9 pages)

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Purpose: We report on neurologic outcomes and experience with specialized post-cardiac arrest (PCA) care of transferred patients at a regional emergency center in Seoul over a one-year period, and we evaluate factors related to neurologic outcomes by analyzing the characteristics of the patients, transport processes, and therapeutic interventions. Methods: We conducted a retrospective review of patients who were transferred to our facility after successful resuscitation at another hospital. The variables evaluated included clinical variables, whether there was the presence of any critical event on arrival, the transport time, the transport distance, the PCA care delay, and whether or not specialized PCA care was administered. Results: A total of 31 cardiac arrest patients were included in this study. Of these, 27 patients (87.1%) were treated with therapeutic hypothermia. Thirteen patients (41.9%) were ultimately included in the good outcome group (discharge CPC 1, 2), and 18 were included in the poor outcome group (discharge CPC 3-5). During transport, occurrence of re-arrest was uncommon (n=1, 3.2%). Conversely, other critical events were common (11 patients, 35.5%). Transport time, distance, and PCA care delay were not statistically relevant to occurrence of critical events during inter-facility transport. A critical event was more likely to occur in patients who were on vasopressors (p=0.045), and it was an independent risk factor of poor outcome (odds ratio 12.28 [95% confidence interval, 1.44-104.83]). Conclusion: The transfer of resuscitated patients is reasonable for specialized PCA care. Because critical events were common during transport and showed correlation with poor neurologic outcomes, a critical care transport team must be used with these patients.

5원저 : 경도 외상성뇌손상에서 뇌진탕후증후군을 예측할 수 있는 임상소견

저자 : 김갑득 ( Gab Teug Kim )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 1호 발행 연도 : 2013 페이지 : pp. 31-38 (8 pages)

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Purpose: Mild traumatic brain injury (mTBI) is defined as head injury resulting from blunt trauma with one or more of the following conditions: 1) any period of transient confusion, disorientation, or impaired consciousness; 2) any period of dysfunction of memory (amnesia) around the time of injury; 3) observed signs of other neurological or neuropsychological dysfunction; 4) any period of loss of consciousness lasting 30 minutes or less. As a result of its subtle computed tomography (CT) findings, patients with mTBI were almost ordered discharged in the emergency setting. However, postconcussion syndrome (PCS) could develop in approximately 10 to 20% of these patients. This study was conducted in order to investigate the prognostic factors of PCS, and the role of magnetic resonance imaging (MRI) for diagnosis of PCS in mTBI patients. Methods: This retrospective study was conducted in 397 patients who were admitted with mTBI (GCS=15, age≥6 years old) for analysis of the prognostic factors of PCS, and 187 patients who underwent both CT scan and MRI for comparison of the sensitivity of CT to that of MRI from January 2009 to December 2010. PCS was defined as a disorder with somatic, cognitive, or affective symptoms. Results: Of the mTBI patients, 44.2% had PCS. The independent prognostic factors were loss of consciousness (LOC)/posttraumatic amnesia (PTA), headache, and intracranial hemorrhage on CT scans. Strong suggestive CT findings of PCS were lesions located in intra-axial and white matter, subdural hematoma, and intraprenchymal contusion of the frontal or temporal lobe. A decision model for prediction of PCS in mTBI consisted of three risk factors: LOC/PTA, headache, facial fracture, and intracranial hemorrhage on CT scans. The sensitivity of MRI was superior to that of CT in detection of PCS (72.4.4% vs 60.9%, p=0.021). Conclusion: The possibility of developing PCS was high in mTBI patients with LOC/PTA, headache, and abnormal CT findings. These patients may require MRI evaluation.

6원저 : 급성충수염의 진단점수체계에 대한 전향적 비교평가

저자 : 김정운 ( Jeong Woon Kim ) , 정시경 ( Sik Yung Jeong ) , 이운정 ( Woon Jeong Lee ) , 최승필 ( Seung Pill Choi ) , 우선희 ( Seon Hee Woo ) , 박규남 ( Kyu Nam Park ) , 홍성엽 ( Sung Youp Hong )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 1호 발행 연도 : 2013 페이지 : pp. 39-45 (7 pages)

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Purpose: Scoring systems such as the Modified Alvarado Score (MAS), Eskelinen score (ES), Lintula score (LS), and Ohmann score (OS) can be helpful in the early diagnosis of acute appendicitis (AA). We analyze and compare the diagnostic value of each scoring system and investigate the optimal cut off point. Methods: A total of 62 adult patients admitted for suspicion of acute appendicitis in a tertiary hospital emergency department were analyzed prospectively. Each scoring system was calculated at admission and compared to the final diagnosis. Receiver operating characteristic (ROC) curves were used to determine the appropriate cutoff scores of scoring systems. The sensitivity and specificity, and area under the ROC curve were calculated. Results: The area under curve of the Ohmann score was higher than those of the other scoring systems (OS: 0.79, MAS: 0.73, ES: 0.65, LS: 0.67). In pairwise comparison of the ROC curve of two scoring systems, OS was found to have significantly higher predictive power than ES and LS. However, no difference was observed between MAS and OS. Conclusion: No single score may be used alone to dictate or decline surgery. However, the scoring system may provide helpful information for primary or emergency physicians to determine whether the patient should undergo surgical consultation may provide helpful information for use by primary or emergency physicians in determination of whether the patient should undergo surgical consultation.

7Original Articles : A 45°set Square Method for Accurate Needle Insertion in Ultrasound-guided Internal Jugular Venous Catheterization

저자 : Ji Hoon Kim , Dong Woo Lee , Sung Phil Chung , Je Sung You , Yoo Seok Park , In Cheol Park , Seung Ho Kim , Hahn Shick Lee

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 1호 발행 연도 : 2013 페이지 : pp. 46-54 (9 pages)

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Purpose: Until now, there has been no standardized method for insertion of the introducer needle in ultrasoundguided internal jugular venous catheterization (IJVC). The needle insertion site and angle have been determined by the performer`s experiences. In an effort to improve first attempt success rates and reduce complications, we designed a new standardized approach (called the 45°set square method) for determination of the site and angle of needle insertion during ultrasound-guided IJVC. This study investigated that the clinical usefulness of the novel 45°set square method for ultrasound-guided IJVC in the emergency department. Methods: We conducted a prospective study in the emergency department (ED) of a tertiary teaching hospital. Forty one patients requiring central venous catheterization were enrolled in the study. They were randomized to either the conventional ultrasound guidance group or the 45°set square group. The primary outcome measure was success rate within three attempts and secondary measures were the number of trials, first-attempt success, puncture time, complications, and technical difficulty score. Results: All 41 participants completed this study successfully. Twenty one consecutive patients were enrolled in the 45°set square group and 20 were enrolled in the conventional group. The 45°set square group (100%) was superior to the conventional group (60%) in overall success rate within three attempts (p=0.001) and the number of attempts (p<0.001). Significant differences in puncture time (p=0.004), hematoma (p=0.048), and technical difficulty score (p<0.001) were observed between the groups. Conclusion: The 45°set square method is an effective and safe method for ultrasound-guided internal jugular venous catheterization.

8원저 : 응급실에 내원한 진단이 불명확한 흉통 환자에서 급성관상동맥증후군 예측 인자로 서의 조기 위험 예측 점수체계의 유용성

저자 : 박규태 ( Kyu Tae Park ) , 조규종 ( Gyu Chong Cho ) , 유지영 ( Ji Yeong Ryu ) , 최준혁 ( Jun Hyeok Choi ) , 안정환 ( Jung Hwan Ahn )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 1호 발행 연도 : 2013 페이지 : pp. 55-62 (8 pages)

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Purpose: The aim of this study was to investigate the usefulness of several risk scoring systems, such as TIMI, GRACE, HEART, and PERSUIT as predictors for acute coronary syndrome (ACS) in chest pain with an unclear diagnosis. Methods: This study was conducted as a retrospective and observational study. Enrolled patients were classified into two groups depending on the cause of chest pain: ACS group (CG; N=80) and non-ACS group (NCG; N=42). Clinical variables, including age, gender, past history, characteristics of chest pain, final diagnosis, and risk score were analyzed according to each group. Risk scoring systems for prediction of acute coronary syndrome were compared using receiver operating characteristic curve (ROC) analysis and area under the curve (AUC). Results: Significant differences in age (p<0.001), diabetes mellitus (p=0.049), prior ischemic heart disease (p<0.001), continuous chest pain (p=0.035), and severe chest pain (p=0.001) were observed between the two groups. Results of ROC analysis for each scoring system for prediction of ACS were as follows: HEART (AUC; 0.878, 95% Confidence Interval, CI; 0.806~0.930, cut-off value; 4 points, sensitivity; 90.48%, specificity; 71.25%), TIMI (AUC; 0.839, 95% CI; 0.762~0.899, cut-off value; 1 point, sensitivity 83.33%, specificity 77.50%), PERSUIT (AUC; 0.748, 95% CI; 0.661~0.822, cut-off value; 11 points, sensitivity 61.90%, specificity 77.50%), and GRACE (AUC; 0.698, 95% CI, 0.608~0.778, cut off value 102 points, sensitivity 83.33, specificity 53.75%). Conclusion: In comparative analysis of each scoring system, the HEART scoring system was found to be a strong predictor of ACS in chest pain with an unclear diagnosis, followed by the TIMI, PURSUIT, and GRACE scoring systems.

9원저 : 동맥혈가스검사 시 발생하는 통증을 감소시키기 위한 냉각 알코올 솜의 효과

저자 : 공태영 ( Tae Young Kong ) , 이혜선 ( Hye Sun Lee ) , 김승환 ( Seung Hwan Kim ) , 김민정 ( Min Joung Kim ) , 박유석 ( Yoo Seok Park ) , 정성필 ( Sung Phil Chung ) , 박인철 ( In Cheol Park )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 1호 발행 연도 : 2013 페이지 : pp. 63-69 (7 pages)

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Purpose: Patients undergoing arterial puncture experience significant pain and discomfort. Cryoanalgesic pretreatment using vapocoolant spray and a cold alcohol swap stick can be easily and rapidly applied before arterial puncture. The purpose of this study was to compare the efficacy of vapocoolant spray and a cold alcohol swab stick for control of pain associated with arterial blood gas analysis. Methods: We conducted a non-blinded, randomized controlled trial in which adult patients underwent an arterial puncture after pretreatment with different analgesics. Enrolled patients were randomized to one of three treatment groups: 1) vapocoolant spray; 2) cold alcohol swap stick; or 3) alcohol swap stick stored at room temperature (control). We assessed the patient`s pain after the arterial puncture using a 100-mm visual analogue scale. The difficulty associated with the arterial puncture and the likelihood of successful puncture was assessed using time to successful sampling and the number of attempts required for successful sampling. Time to successful sampling and the number of attempts required for successful sampling were used for assessment of the difficulty associated with the arterial puncture and the likelihood of successful puncture. Results: A total of 101 patients were enrolled in this study. The mean scores for pain after the arterial puncture were 41.2±11.7 mm for patients treated with vapocoolant spray, 35.9±8.6 mm for patients treated with a cold alcohol swap stick, and 66.2±8.5 mm for the control group (p<0.001). The time to successful sampling was less consumed and the number of attempts was significantly lower in the treatment groups, compared with the control group (p=0.002 and p=0.008, respectively). Conclusion: We conclude that pretreatment using a cold alcohol swap stick as well as vapocoolant spray resulted in a decrease in patients`perception of pain associated with arterial puncture and facilitated the arterial puncture.

10원저 : 헬멧 미착용자의 이륜자동차 사고에서 사고기전에 관한 분석

저자 : 김상철 ( Sang Chul Kim ) , 이재완 ( Jae Wan Lee ) , 고덕환 ( Duk Hwan Ko ) , 백광제 ( Kwang Je Baek ) , 정호성 ( Ho Sung Jung ) , 박상오 ( Sang O Park ) , 홍대영 ( Dae Young Hong ) , 이경룡 ( Kyeong Ryong Lee )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 1호 발행 연도 : 2013 페이지 : pp. 70-76 (7 pages)

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Purpose: Due to their vulnerability and relatively high driving speed, motorcycles have been associated with a high risk of sustaining multiple severe injuries after traffic accidents. We sought to investigate sustained injuries and the association of accident mechanisms with injury severity for unhelmeted motorcycle accident victims. Methods: This study was conducted as an observational retrospective study. Unhelmeted motorcycle accident victims who visited the study hospital from January 2010 to December 2011 were included. Data were obtained from medical records, ambulance run-sheets, and telephone interviews. Accident mechanisms were divided into collision with an obstacle, single vehicle accident, collision with another vehicle, collision by another vehicle, and falling accident from the viewpoint of energy. Glasgow coma scale (GCS), Revised trauma score (RTS), and Injury Severity Score (ISS) were analyzed for comparison of injury severity according to the accident mechanisms. Results: Of 404 patients who visited the study hospital, 165 patients were included; 87.3%(144/165) were male, and 78.8%(130/165) were drivers. The incidence of motor cycle accident showed the highest in the teenager and in time during 18:00~24:00 o`clock. Lower extremity was the most common site of injury, followed by upper extremity, head, and face etc. Injury due to falling was the most severe injury mechanism, followed by collision with another vehicle, collision by another vehicle, and a single vehicle and an obstacle (p=0.013). Conclusion: Lower extremity injury was the most common injury site in unhelmeted motorcycle accidents, and motorcycle accidents by fall and collision with another vehicle should be considered as a severe mechanism of injury.

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32권 3호 ~ 32권 3호

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대한응급의학회지
30권 4호 ~ 30권 4호

KCI등재

대한응급의학회지
30권 3호 ~ 30권 3호

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32권 2호 ~ 32권 2호

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30권 2호 ~ 30권 2호

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32권 1호 ~ 32권 1호

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대한응급의학회지
30권 1호 ~ 30권 1호

KCI등재

대한응급의학회지
29권 6호 ~ 29권 6호

KCI후보

대한외상학회지
31권 3호 ~ 31권 3호

대한응급의학회 학술대회초록집
2018권 2호 ~ 2018권 2호

KCI등재

대한응급의학회지
29권 5호 ~ 29권 5호

KCI등재

대한응급의학회지
29권 4호 ~ 29권 4호

KCI후보

대한외상학회지
31권 2호 ~ 31권 2호

KCI후보

대한외상학회지
31권 2호 ~ 31권 2호

대한응급의학회 학술대회초록집
2017권 2호 ~ 2018권 1호

KCI등재

대한응급의학회지
29권 3호 ~ 29권 3호

KCI등재

대한응급의학회지
29권 2호 ~ 29권 2호

KCI후보

대한외상학회지
31권 1호 ~ 31권 1호

KCI등재

대한응급의학회지
29권 1호 ~ 29권 1호

KCI등재

대한응급의학회지
28권 6호 ~ 28권 6호
발행기관 최신논문
자료제공: 네이버학술정보
발행기관 최신논문
자료제공: 네이버학술정보

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