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대한응급의학회지 update

Journal of the Korean Society of Emergency Medicine

  • : 대한응급의학회
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수록정보
수록범위 : 1권1호(1990)~33권6호(2022) |수록논문 수 : 2,760
대한응급의학회지
33권6호(2022년 12월) 수록논문
최근 권호 논문
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KCI등재

저자 : 김선춘 ( Sun Cheun Kim ) , 김희중 ( Heejung Kim ) , 심주현 ( Juhyun Sim ) , 장혜진 ( Hye Jin Chang ) , 장문희 ( Moonhee Jang ) , 권은채 ( Eunchae Kwon ) , 정종민 ( Chong Min Choung ) , 정성필 ( Sung Phil Chung )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 6호 발행 연도 : 2022 페이지 : pp. 521-523 (3 pages)

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KCI등재

저자 : 목동엽 ( Dongyeob Mok ) , 조규종 ( Gyu Chong Cho ) , 조영석 ( Youngsuk Cho )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 6호 발행 연도 : 2022 페이지 : pp. 524-531 (8 pages)

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Objective: The coronavirus disease 2019 (COVID-19) pandemic saw rising cases of out-of-hospital cardiac arrests. In addition, there was an increase in the number of cardiac arrest terminations. This study analyzes the 3-year status (2018 to 2020) of out-of-hospital cardiac arrest resuscitation terminations.
Methods: This study is a retrospective observational study based on the diary of 119 first aid activities in the Seoul area. Factors analyzed included patient demographics, history, location of occurrence, witness status, cause of cardiac arrest, electrocardiogram rhythm, reasons for cardiac arrest termination, and hospital transfer. Data obtained from the periods January 1, 2018, to December 31, 2019 (defined as the pre_COVID-19 period) and from January 1, 2020, to December 31, 2020 (defined as the COVID-19 period) were compared and analyzed.
Results: There was an increase in the number of terminated resuscitation cases during the study period. Most cases were elderly men with chronic disease who underwent asystole arrest at home. The reasons for the termination of resuscitation were obvious evidence of death, refusal of cardiopulmonary resuscitation (CPR) by the guardian, medical guidance, and cessation of prior life-sustaining treatment. During the COVID-19 pandemic, clear evidence of death and refusal of CPR by caregivers were statistically and significantly increased.
Conclusion: The results of this study indicate a rise in the number of cases subjected to termination of resuscitation during the COVID-19 period. It is, therefore, necessary to find a way to improve this situation.

KCI등재

저자 : Jung-ju Lee , Hyun-jeong Park , Gyeong-gyu Yu , Young-min Kim , Sang-chul Kim , Jee-han Lee , Hyun-seok Chai , Gwan-jin Park , Suk-woo Lee , Hoon Kim

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 6호 발행 연도 : 2022 페이지 : pp. 532-542 (11 pages)

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Objective: Resuscitation-related gastric inflation is associated with inadequate ventilation and the risk of gastric regurgitation in out-of-hospital cardiac arrest (OHCA) patients. This study aims to estimate resuscitation-related gastric inflation values by using multi-detector computed tomography (MDCT) scanning.
Methods: MDCT imaging data were obtained from OHCA patients undergoing resuscitation from January 2014 to December 2020. Thirty age- and sex-matched healthy controls that underwent an MDCT scan were included. Gastric air volume (GAV), total gastric volume (TGV), and GAV/gastric content volume (GCV) ratio values were estimated.
Results: In healthy controls (n=30), GAV and TGV values were in the range 5.0-35.0 mL, and 202.0-1,002.0 mL, respectively. The mean GAV and TGV values of OHCA patients (n=97) were 251.0 mL (range, 55.5-896.0) and 878.0 mL (range, 430.5-1,696.0), respectively. Significant between-group differences were determined in the mean GCV, GAV, and GAV/GCV ratio values. In OHCA patients, the cut-off value for abnormal GAV was defined as 56.5 mL (mean value plus two times standard deviation). Patients with abnormal GAV findings on MDCT scans had a longer duration from arrest to the return of spontaneous circulation, low body mass index, and increased rates of lactic acidosis.
Conclusion: Our results indicate an association between gastric air accumulation after resuscitation with longer recovery from arrest to return of spontaneous circulation, low body mass index, and increased lactic acidosis.

KCI등재

저자 : Jae Hwa Kwon , Yo Sep Shin , Se Hyun Oh , Hui Dong Kang , Sang Ku Jung , You Jin Lee

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 6호 발행 연도 : 2022 페이지 : pp. 543-551 (9 pages)

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Objective: Early identification of patients at risk for deterioration is crucial to reduce in-hospital mortality. Various early warning scores have been widely applied in the emergency department (ED) of hospitals. This study evaluates and compares the effectiveness of three early warning scores_Modified Early Warning Score, Rapid Acute Physiology Score (RAPS), Worthing Physiological Scoring System (WPS), and Rapid Emergency Medicine Score. These scores help predict the need for critical care and 24- and 72-hour mortalities among alert patients presenting to the ED with dyspnea.
Methods: This retrospective cohort study used data from electronic medical records of patients admitted between 2018 and 2020 and included all consecutive alert patients who presented with dyspnea in the ED. The primary outcome was to evaluate the performance of early warning scores regarding the need for critical care. The secondary outcomes were the prediction of 24- and 72-hour in-hospital mortalities.
Results: Among 4,322 patients evaluated, 255 received critical care, and 17 and 84 died within 24 and 72 hours, respectively. The WPS had the overall highest performance for predicting the need for critical care (area under the curve [AUC], 0.781; 95% confidence interval [CI], 0.751-0.810) and 24-hour (AUC, 0.816; 95% CI, 0.738-0.894) and 72-hour mortalities (AUC, 0.794; 95% CI, 0.750-0.838), but differed significantly only from the RAPS.
Conclusion: The WPS might better predict the need for critical care and short-term mortality in alert patients with dyspnea in the ED. However, owing to a lack of its superiority in statistics, further studies are warranted to conclude the optimal tools applicable for these patients.

KCI등재

저자 : Songhyun Kim , Heajin Chung , Youngjoo Lee , Hye Young Jang , Young Shin Cho , Joon Bum Park , Sang-il Kim , Beom Sok Seo , Youngwha Sohn

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 6호 발행 연도 : 2022 페이지 : pp. 552-564 (13 pages)

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Objective: The HEART score is a fast and simple cardiovascular disease (CVD) prediction tool useful in the emergency department (ED). This study evaluates the predictive value of the HEART score when applying other obesity indices such as waist circumference (WC) or waist-to-height ratio (WHtR) instead of body mass index (BMI).
Methods: Data were prospectively collected from the pre-made registry of patients who had visited the ED with chest pain. Based on their final diagnoses and coronary imaging study results, patients were classified as acute coronary syndrome (ACS), non-ACS, significant coronary arterial stenosis (SCS), and non-SCS. We compared the HEART score for each group and modified it with variable obesity indices. Multivariable logistic regression and the area under the curve were calculated to determine the most suitable obesity index for the HEART score in predicting ACS or SCS. In addition, we compared the gender-dependent relationship between obesity and ACS or SCS.
Results: Of the total 689 patients examined, 281 were diagnosed with ACS. The odds ratio (OR) of the HEART score for ACS was 12.1. The ORs were 13.2 and 11.2 when the HEART score was modified with WC or WHtR, respectively. Obesity was determined as the meaningful factor to predict ACS (OR: BMI, 2.38; WC, 3.39) and SCS (OR: BMI, 3.07; WC, 4.03) in women but not men.
Conclusion: The HEART score showed good predictive value regardless of obesity index modification. Furthermore, obesity is associated with CVD in women with chest pain, but not in men.

KCI등재

저자 : Ji Sun Yu , Hwan Song , Chun Song Youn , Sang Hoon Oh , Jeeyong Lim , Soo Hyun Kim , Hyo Jin Bang , Hyo Joon Kim

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 6호 발행 연도 : 2022 페이지 : pp. 565-572 (8 pages)

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Objective: Bacteremia is a common cause of increased morbidity and mortality in elderly patients, but early diagnosis and identification are complex. The neutrophil-to-lymphocyte count ratio (NLR) is suggested as a useful indicator for diagnosing bloodstream infections. This study evaluated whether the NLR at admission is associated with bloodstream infections in older patients admitted to the emergency department.
Methods: A retrospective, multicenter analysis was performed on patients admitted to the emergency department from November 2016 to February 2017. We included patients aged 65 years and older who visited the emergency department with medical problems. Baseline NLR values were measured upon admission to the emergency department. The primary outcome was a positive blood culture.
Results: A total of 1,815 patients were included in this study. The median age was 77.25±7.38 years, and bacteremia was identified in 290 older patients (15.9%). The NLR was significantly higher in the bacteremia group (15.95±22.03) than in the non-bacteremia group (8.76±8.74, P<0.001). In the multivariate logistic regression analysis, the NLR was associated with bacteremia after adjusting for confounding factors as continuous variables (odds ratio [OR], 1.033; 95% confidence interval [CI], 1.009-1.057) and categorical variables (NLR ≥10; OR, 2.018; 95% CI, 1.246-3.268). The area under the curve of the NLR was determined to be 0.667 (95% CI, 0.639-0.694).
Conclusion: These results indicate that the NLR at admission to the emergency department is associated with bloodstream infections. Early suspicion of bacteremia, by determining the initial NLR value, will help treat bacteremia in elderly patients.

KCI등재

저자 : Chanyi Song , Jeeyong Lim , Sang Hoon Oh , Hyo Joon Kim

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 6호 발행 연도 : 2022 페이지 : pp. 573-580 (8 pages)

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Objective: We aimed to investigate diagnostic accuracy of the STONE score and the modified STONE score by external validation in a large-scale cohort.
Methods: We retrospectively reviewed the medical records of patients with suspected urinary stones who underwent computed tomography in the emergency center of a single tertiary hospital from 2014 to 2015. We compared and analyzed our cohort and two original studies with each other. Patients were categorized into three risk groups (low, moderate, and high) according to both scoring systems. The prevalence of urinary stones and alternative diagnoses was evaluated in each group. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with our data for each score performance.
Results: Eight hundred fifty-six patients out of a total of 1,013 were diagnosed with urinary stones. The prevalence of urinary stones in the high-risk group of the STONE and the modified STONE scores were 91.1% and 91.2%, respectively. The areas under the receiver operating characteristic curve of both scores were 0.71 and 0.73, respectively. The optimal cutoff value for predicting urinary stones using the STONE score was 9, with 87.9% sensitivity, 45.9% specificity, 89.8% PPV, and 40.9% NPV. In the case of the modified STONE score, the optimal cutoff value was 10, which was the same as that of the original study with 85.9% sensitivity, 54.8% specificity, 91.2% PPV, and 41.6% NPV.
Conclusion: The STONE and the modified STONE scores showed good diagnostic accuracy in high-risk groups of patients with suspected urinary stones. These scoring systems would be helpful to physicians in their diagnoses and in reducing radiation exposure.

KCI등재

저자 : 장경덕 ( Kyoung Deok Jang ) , 이재백 ( Jae Baek Lee ) , 진영호 ( Young Ho Jin ) , 정태오 ( Tae Oh Jeong ) , 윤재철 ( Jae Chol Yoon ) , 오태환 ( Tae Hwan Oh ) , 김소은 ( So Eun Kim )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 6호 발행 연도 : 2022 페이지 : pp. 581-588 (8 pages)

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Objective: Hip fractures in elderly populations are a major public concern worldwide. This study aims to demonstrate the emergency department (ED)-related factors associated with medical complications in older patients with hip fractures who underwent surgery.
Methods: This was a retrospective observational study of 150 elderly patients (≥65 years) presenting with hip fractures in 2020. The data collected were analyzed to investigate medical complications and determine the predictors of complications after a hip fracture surgery by comparing the complication and non-complication group patients. Logistic regression analysis was applied to determine the independent predictors of postoperative medical complications.
Results: The overall complication rate was determined to be 39.3%, and delirium (40.7%) was observed to be the most common affliction. Independent walking (adjusted odds ratio [AOR], 0.459; 95% confidence interval [CI], 0.214-0.985), pre-operative medical conditions (AOR, 4.823; 95% CI, 1.735-13.408), and estimated glomerular filtration rate (eGFR; 3rd quartile [AOR, 3.224; 95% CI, 1.086-9.576], 4th quartile [AOR, 5.584; 95% CI, 1.861-16.756]) were independently associated with the development of medical complications post-surgery.
Conclusion: The overall incidence of complications following hip fracture surgery is relatively high. Independent walking, preoperative medical condition, and decreased eGFR are independent predictors of postoperative complications that can be screened in the ED in elderly hip fracture patients.

KCI등재

저자 : 이정현 ( Joyng Hyun Lee ) , 정상구 ( Sang Ku Jung ) , 이유진 ( You Jin Lee ) , 오세현 ( Se Hyun Oh ) , 강희동 ( Hui Dong Kang )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 6호 발행 연도 : 2022 페이지 : pp. 589-598 (10 pages)

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Objective: Hyperbaric oxygen therapy (HBOT) is the most crucial treatment for decompression sickness (DCS), which needs to be administered as swiftly as possible. This study evaluates the therapeutic responses of DCS patients and analyzes the major factors for clinical outcomes.
Methods: This is a retrospective cohort single-center study on patients who arrived at our hospital's emergency department for diving-related symptoms and were diagnosed with DCS and administered HBOT.
Results: Totally, 337 patients were enrolled from June 2015 to May 2020. The proportion of SCUBA diving, rapid ascent, and inter-facility transport cases was higher in the recreational group, with a longer lag time from symptom onset to HBOT. The professional group had a higher proportion of cases with previous DCS history, total diving time, bottom time, in-water decompression, and repetitive diving. Examination of treatment outcomes revealed more type I cases and a shorter lag time from symptom onset to HBOT in the complete recovery group. Conversely, the incomplete recovery group had a higher proportion of type II cases and aggravation of symptoms before HBOT was administered.
Conclusion: DCS can occur regardless of professional or recreational divers. Both groups showed a similar level of severity. It is recommended that recreational divers should be cautious of accidents related to safety (such as rapid ascent) and receive swift treatment in case of the onset of symptoms. Occupational divers need more active efforts to get HBOT rather than just performing in-water recompression or home O2 therapy.

KCI등재

저자 : Duk Hwan Ko , Kyung Hwan Kim , Junseok Park , Dong Wun Shin , Hyunjong Kim , Joon Min Park , Hoon Kim , Woochan Jeon , Jung Eon Kim

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 6호 발행 연도 : 2022 페이지 : pp. 599-615 (17 pages)

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Objective: The establishment of a proper emergency care system can significantly decrease the number of deaths and disabilities. However, this is neglected in many low- and middle-income countries, including Cambodia. At present, many Cambodian hospitals lack designated emergency departments, formal triage systems, and staff trained in emergency medicine. This study sought to measure the functional capacity of the Cambodian emergency care system corresponding to each hospital level using the Emergency Care Assessment Tool (ECAT).
Methods: We conducted a survey from April 19, 2021, to April 27, 2021, by distributing survey sheets to a total of eight Cambodian medical staff who were invited to a hospital in South Korea for an educational program. The ECAT comprises items evaluating the capability of hospitals to perform signal functions for each of the six emergent sentinel conditions that could occur prior to death. We analyzed the data by categorizing the hospitals into basic, intermediate, and advanced levels.
Results: Basic-level hospitals had weaknesses in signal functions related to altered mental status and trauma care. The intermediate-level hospital showed weaknesses in signal functions related to respiratory failure, altered mental status, shock, and trauma care. Advanced-level hospitals had weaknesses in signal functions related to respiratory failure, trauma, and shock.
Conclusion: Our survey shows that most Cambodian hospitals lack the capability to perform the emergency signal functions expected at each level. We believe that this gap can be bridged with proper customized education targeting medical staff based on the level of their hospital and ensuring a proper supply of medical devices.

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