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대한응급의학회> 대한응급의학회지> 병원간 전원에 대한 부산지역 응급실 의사들의 입장

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병원간 전원에 대한 부산지역 응급실 의사들의 입장

Survey of Emergency-Related Physicians on Inter-hospital Transfers via 1339 in Busan병원간 전원에 대한 부산지역 응급실 의사들의 입장

조석주 ( Suck Ju Cho ) , 황성연 ( Seong Youn Hwang ) , 이준호 ( Jun Ho Lee ) , 김형회 ( Hyung Hoi Kim ) , 이성화 ( Sung Hwa Lee ) , 박맹렬 ( Maeng Real Park ) , 박순창 ( Soon Chang Park )
  • : 대한응급의학회
  • : 대한응급의학회지 24권2호
  • : 연속간행물
  • : 2013년 04월
  • : 131-141(11pages)
대한응급의학회지

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Purpose: In most areas of the world, transfers between emergency centers are performed through direct communication between physicians of transferring and receiving hospitals. The emergency medical information center “1339” (or 1339, for short), which had mediated inter-hospital transfers for about 10 years, was recently discontinued. This study aimed to survey the stance of physicians at transferring and receiving hospitals on the importance of 1339 functions. Methods: In May 2012, before the discontinuation of 1339 as a mediator, a questionnaire was distributed to emergency- related physicians at several hospitals on the level of emergency care in Busan. Results: There were 202 answers. Physicians of high level emergency centers had a higher tendency to transfer patients without pre-contact for transfer (p=0.019). The physicians at each level of care thought that direct communication between physicians was more accurate (69.9%), but mediation through 1339 was more convenient (53.6%). Mediation through 1339 was the most frequent resource used for pre-contact of inter-hospital transfers (58.1%). Conclusion: Physicians at each level of care tended to find pre-contact between physicians more accurate for inter-hospital transfers; however, they also thought mediation through 1339 was more convenient and it was the most frequently used resource for pre-contact of inter-hospital transfers.

UCI(KEPA)

I410-ECN-0102-2013-510-002260924

간행물정보

  • : 의약학분야  > 외과학
  • : KCI등재
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  • : 격월
  • : 1226-4334
  • : 2384-048x
  • : 학술지
  • : 연속간행물
  • : 1990-2022
  • : 2760


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1진달래 꽃에서 liquid chromatography-tandem mass spectrometry를 이용한 grayanotoxin의 검출

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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2비외상성 병원 밖 심정지 환자에서 COVID-19 대유행 전후의 심정지 종결 사유 분석

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

3Multidetector computed tomography-based evaluation of gastric volumes in patients with out-of-hospital cardiac arrest

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

4Comparison of early warning scores for predicting deterioration in patients with respiratory distress in alert mentality presenting to the emergency department

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.

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5The difference of the HEART score for predicting cardiovascular disease according to obesity index in emergency department

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

6The association between the neutrophil-to-lymphocyte ratio and bacteremia in elderly patients admitted to the emergency department

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

7External validation of the STONE score and the modified STONE score for the patients with suspicious urinary stone in the emergency department

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

8수술을 시행 받은 노인 고관절 골절 환자에서 합병증 발생의 예측인자

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

9단일 고압산소치료센터에서의 감압병 환자에 대한 치료 경험

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.

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10Status of functional capacity of the emergency care system in Cambodia: a cross-sectional survey

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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1병원간 전원에 대한 부산지역 응급실 의사들의 입장

저자 : 조석주 ( Suck Ju Cho ) , 황성연 ( Seong Youn Hwang ) , 이준호 ( Jun Ho Lee ) , 김형회 ( Hyung Hoi Kim ) , 이성화 ( Sung Hwa Lee ) , 박맹렬 ( Maeng Real Park ) , 박순창 ( Soon Chang Park )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 131-141 (11 pages)

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Purpose: In most areas of the world, transfers between emergency centers are performed through direct communication between physicians of transferring and receiving hospitals. The emergency medical information center “1339” (or 1339, for short), which had mediated inter-hospital transfers for about 10 years, was recently discontinued. This study aimed to survey the stance of physicians at transferring and receiving hospitals on the importance of 1339 functions. Methods: In May 2012, before the discontinuation of 1339 as a mediator, a questionnaire was distributed to emergency- related physicians at several hospitals on the level of emergency care in Busan. Results: There were 202 answers. Physicians of high level emergency centers had a higher tendency to transfer patients without pre-contact for transfer (p=0.019). The physicians at each level of care thought that direct communication between physicians was more accurate (69.9%), but mediation through 1339 was more convenient (53.6%). Mediation through 1339 was the most frequent resource used for pre-contact of inter-hospital transfers (58.1%). Conclusion: Physicians at each level of care tended to find pre-contact between physicians more accurate for inter-hospital transfers; however, they also thought mediation through 1339 was more convenient and it was the most frequently used resource for pre-contact of inter-hospital transfers.

KCI등재

2병원 밖 심정지 환자에서 뇌출혈 유무에 따른 특징 및 예후 차이 분석: 후향적 분석

저자 : 장연식 ( Yeon Sik Jang ) , 임용수 ( Yong Su Lim ) , 조진성 ( Jin Seong Cho ) , 김진주 ( Jin Joo Kim ) , 현성열 ( Sung Youl Hyun ) , 양혁준 ( Hyuk Jun Yang ) , 이근 ( Gun Lee )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 142-148 (7 pages)

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Purpose: Spontaneous intracranial hemorrhage (ICH) is not an uncommon cause of cardiac arrest. The purpose of this study was to identify the prognosis of patients with ICH for Out-of-Hospital Cardiac arrest (OHCA). Methods: From January 2008 to December 2010, a total of 214 patients were checked brain computed tomography (CT) in OHCA. The majority of patients were male (136, 63.8%), and the median age was 55.0 (±16.7). We included all patients who were checked through brain CT for nontraumatic OHCA. Data were collected from electronic medical records and pre-hospital records. Demographic, clinical and laboratory data were compared between the ICH and non-ICH group. Results: The detection of ICH by clinical manifestations and laboratory data was difficult. Out of 214 patients, 21 (9.8%) patients were positive for ICH and 193(90.2%) patients had a normal brain CT. In demographic and clinical data, the neurological outcome (CPC score, p=0.009) and 30-day survival rate (p<0.001) were statistically different between the two groups. Using the Cox proportional hazards model, the ICH group had a 3.54 hazard ratio compared with non-ICH group. In addition, pH (p=0.033), lactate (p=0.023) in ABGA, potassium (p=0.008), glucose (p=0.026), and S-100 (p=0.047) showed significant results. Conclusion: The prognosis of ICH patients in OHCA is poor; further studies are needed to improve the prognosis of ICH patients after ROSC in OHCA.

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3A Comparison of Compression Rates on the Quality of Cardiopulmonary Resuscitation

저자 : Young Hoon Hong , Chong Kun Hong , Kyoung Yul Lee , Han Ho Jeong , Jung Hyun Kim , Yong Hwan Kim , Jun Ho Lee , Kwang Won Cho , Seong Youn Hwang

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 149-156 (8 pages)

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Purpose: In cardiopulmonary resuscitation (CPR) there are different opinions on the compression rate that should be applied. The aim of this study was to compare the total number of adequate compressions delivered during a fiveminute period among four groups of lay persons (≥139 min-1, 129-138, 114-128, and <114). Methods: This study represents a secondary data analysis from our previous research about the influence of age on fatigue during CPR. Participants were asked to perform chest compressions (without rescue breaths) at a rate of >100 times/minute and a depth of >5 cm for five minutes. A total of 86 participants were then divided into four groups based on their mean compression rate. Age, sex, and body mass index were analyzed as factors affecting the compression rates. Results: The group delivering a compression rate above 139 compressions min-1 performed better than those delivering below 114 compressions min-1 (p=0.03). There was no significant difference in the mean compression depth (p=0.13), percentage of incomplete chest recoil (p=0.277), or the percentage of incorrect hand positioning (p=0.091). All participants (except five) performed chest compressions at a rate above 100 compressions min-1. Conclusion: Our results suggest that a chest compression rate above 139 compressions min-1 does not deteriorate the quality of compressions compared to a lower chest compression rate (below 114 min-1) during a five-minute period. Most untrained lay people performed chest compressions well, within a range of 100~150 min-1.

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4패혈증 환자의 급성 신손상 발생 예측에 있어 혈장 Neutrophil Gelatinase-Associated Lipocalin 측정의 유용성

저자 : 이제엽 ( Je Yeob Lee ) , 김진용 ( Jin Young Kim ) , 박상오 ( Sang O Park ) , 이경룡 ( Kyeong Ryong Lee ) , 백광제 ( Kwang Je Baek ) , 홍대영 ( Dae Young Hong )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 157-163 (7 pages)

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Purpose: Serum creatinine is a late marker of acute kidney injury (AKI). We assessed the diagnostic value of plasma neutrophil gelatinase-associated lipocalin (NGAL) for predicting acute kidney injury in emergency department patients with sepsis. Methods: This was a prospective observational study of adult sepsis patients. Plasma NGAL levels were measured upon admission to the hospital, and clinical data and serum creatinine were collected daily during the hospital stay. The primary outcome measure was the occurrence of AKI based on criteria from the Acute Kidney Injury Network (AKIN). Results: A total of 178 patients were included, with 13 patients (7.3%) that developed AKI during their hospital stay; 9 and 4 were classified as AKIN stage 1 and 2, respectively. Six patients out of the 13 with AKI died. Mean plasma NGAL levels were 277 ng/mL in patients without AKI and 852 ng/mL in patients with AKI. The area under the receiver operating characteristic curve was 0.883 (95% confidence interval 0.803 to 0.964), the sensitivity was 91.7%, and the specificity was 80.5% for the prediction of AKI (using a cut-off value of 353.5 ng/mL). Conclusion: Plasma NGAL is a useful early marker that predicts the development of AKI in adult sepsis patients.

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5일산화탄소 중독에서 지연성 합병증 예측에 대한 자기공명영상의 효과

저자 : 최익준 ( Ik Joon Choi ) , 오용해 ( Yong Hae Oh ) , 김갑득 ( Gab Teug Kim )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 164-173 (10 pages)

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Purpose: Delayed neuropsychiatric sequelae (DNS) encompass a broad spectrum of neurological deficits, cognitive impairments, and affective disorders which commonly occur after a recovery from acute carbon monoxide (CO) poisoning. The early identification of patients with a high risk of DNS might improve their quality of care. Thus, we studied the role of magnetic resonance imaging (MRI) for the prediction of DNS. Methods: This retrospective study included 41 patients with CO poisoning from January 2009 to June 2012. Magnetic resonance imaging (MRI) was performed within seven days after CO poisoning. Positive MRI findings were defined as focal or diffuse signals in fluid-attenuated inversion recovery (FLAIR), diffusion weighted imaging (DWI), and T2 weighted imaging (T2WI). DNS was considered present when patients had clinical symptoms and signs of DNS within 3 months after CO poisoning. Clinical and biohumoral data were collected; univariate and multivariate statistical analyses were performed to identify the predictive role of MRI for DNS. Results: DNS occurred at a rate of 58.5%, with abnormal MRI findings associated with the development of DNS in the multivariate analysis. The sensitivity of MRI to DNS was 82.6%. In contrast, a normal MRI was seen in eighteen patients (43.9%). MRI revealed abnormalities in the deep white matter (41.5%), globus pallidus (34.1%), cerebral cortex (12.2%), medial temporal lobe (MTL)/hippocampus (7.3%), and cerebellum (4.9%). Among the MRI abnormalities revealed, lesions in the deep white matter were significantly associated with DNS development. Abnormal findings of the globus pallidus, cerebral cortex, MTL/hippocampus, and cerebellum were not associated with DNS development. Conclusion: This study demonstrates the utility of early MRI for the prediction of DNS. Future studies will be required to ascertain the prevention of DNS with hyperbaric treatment in CO poisoning.

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6응급실 소아 손상 환자의 중증도 예측을 위한 PRISM III의 유용성

저자 : 이상훈 ( Sang Hun Lee ) , 박경혜 ( Kyung Hye Park ) , 박득현 ( Deuk Hyun Park ) , 조준호 ( Jun Ho Cho ) , 박하영 ( Ha Young Park ) , 권인호 ( In Ho Kwon ) , 여운형 ( Woon Hyung Yeo ) , 이준엽 ( Jun Yeob Lee ) , 김양원 ( Yang Weon Kim )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 174-180 (7 pages)

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Purpose: The primary prevention and proper initial treatment of childhood injuries is important, as it encompasses a bigger social and economic burden than cancer and ischemic heart disease. The Pediatric Risk of Mortality III (PRISM III) scoring system, used to evaluate the severity or mortality of pediatric patients in critical condition, was investigated for children with injuries in an emergency department (ED). Methods: A retrospective analysis included data on 293 injured children (age<16) who visited the ED in two hospitals from March 2010 to February 2012. Physiologic and laboratory data were collected to calculate the PRISM III score and the Injury Severity Score (ISS). The correlation was analyzed between PRISM III scores, the Revised Trauma Scale (RTS), and ISS. The PRISM III score and ISS were assessed for their ability to predict mortality by comparing their receiver operating characteristic (ROC) curves. Results: The median PRISM III score was 5.0 (Interquartile Range, 5.0-9.0) and correlated with RTS and ISS (the Spearman`s rho were -0.19 (p=0.001) and 0.20 (p=0.001), respectively. Five children did not survive after ED admission. The area under the ROC (AUC) was 1.00 for PRISM III (95% confidence interval [CI], 0.99-1.00), and the cutoff value was placed over 20 to predict mortality. The AUC of ISS and RTS was 0.99 (95% CI, 0.98-1.00) and 0.99 (95% CI, 0.98-1.00), respectively. Conclusion: The PRISM III score excellently predicts the mortality of injured children in the ED, and can be used to sort minor pediatric trauma patients in the ED. However, the PRISM III score had no great difference or advantage compared with RTS. The development of other tools for effective prognosis is needed to efficiently predict mortality and severity in the ED.

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7응급진료센터에 내원한 지역획득 폐렴 환자에서 델타뉴트로필을 이용한 패혈성 쇼크 발생 예측의 유용성

저자 : 주영선 ( Young Seon Joo ) , 이누가 ( Nu Ga Rhee ) , 김현종 ( Hyun Jong Kim ) , 유제성 ( Je Sung You ) , 정현수 ( Hyun Soo Chung ) , 정성필 ( Sung Phil Chung ) , 이한식 ( Hahn Shick Lee ) , 이종욱 ( Jong Wook Lee )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 181-187 (7 pages)

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Purpose: The delta neutrophil index (DNI) corresponds to the calculated immature granulocyte counts and the severity of sepsis. The aim of this study was to investigate the diagnostic value of DNI as a predictable laboratory marker for septic shock in patients with severe community-acquired pneumonia in emergency department. Methods: The present study was a retrospective analysis of patients with pathologically confirmed communityacquired pneumonia from December 2011 to February 2012 at a hospital. The DNI was automatically calculated as a subset of routine complete blood count test. The diagnostic performance of DNI for septic shock in patients with community-acquired pneumonia was evaluated. Results: During the study period, 105 patients were enrolled. Among them, 27 patients (25.7%) were confirmed as having septic shock according to predetermined criteria. The initial value of DNI was significantly higher in septic shock group than in non-shock group (8.7% vs 2.3%, p=0.008). The peak value of DNI was also significantly higher in septic shock group (18.6% vs 4%, p<0.001). The sensitivity and specificity of the initial and peak DNI values for predicting septic shock in patients with communityacquired pneumonia were 48.2%, 96.2%, 74.1%, and 87.2%, respectively, at initial and peak cutoff levels of 11.2% and 8.7% with an area under the curve (AUC) of 0.72 and 0.81 on the Receiver Operating Characteristic (ROC) curve. The AUC to predict septic shock was 0.74 for the CURB-65 scale. The AUC was significantly increased when peak DNI was added to CURB-65 scale (p=0.007). Conclusion: This study suggested that the DNI is associated with septic shock in patients with community-acquired pneumonia. Clinically, the peak value of DNI added to CURB-65 scale could improve predictable performance of septic shock in patients with community-acquired pneumonia.

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8Indoxacarb 살충제 중독 환자의 임상양상

저자 : 정상민 ( Sang Min Jung ) , 이경우 ( Kyung Woo Lee ) , 강태신 ( Tae Shin Kang )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 188-198 (11 pages)

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Purpose: Indoxacarb insecticide poisoning causes methemoglobinemia, which is occasionally life-threatening. However, there is limited data on indoxacarb effects after human ingestion. The purpose of this study was to examine the clinical features, complications, management, and medical outcome of patients with indoxacarb insecticide poisoning. Methods: We retrospectively reviewed the medical records of 10 patients with indoxacarb insecticide poisoning who had visited our emergency centers from January 2008 to December 2011. We collected data on the general characteristics of the patients, their clinical symptoms and signs, laboratory data, management of their condition, and clinical results. Results: Among the 10 patients, 8 were diagnosed with methemoglobinemia. The clinical manifestations of indoxacarb insecticide poisoning were hypotension (3 patients), altered mentality (5 patients), cyanosis (5 patients), dyspnea (2 patients), seizure (3 patients), and cardiac arrest (2 patients). Four patients had a poisoning severity score of 3 and 2 patients had a poisoning severity score of 2. Four patients were treated with methylene blue for methemoglobinemia and one patient was treated with a high dose (150 mg/kg) of ascorbic acid. The serum methemoglobin saturation of five patients who were treated with methylene blue or a high dose of ascorbic acid was nearly normalized. Four patients experienced rhabdomyolysis, pneumonia, hemolytic anemia, acute pancreatitis, and heart failure as a complication of indoxacarb insecticide poisoning. Conclusion: We observed a variety of clinical features, complications, management, medical outcome, and clinical course of patients with indoxacarb insecticide poisoning. We could also ascertain the efficacy of methylene blue and high dose ascorbic acid for indoxacarb-induced metheglo-binemia.

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9Cardiopulmonary Resuscitation Training for a Layperson Through Conventional Instructor-led Training and a Self-learning Program Using the CPR Anytime Kit

저자 : Soo Hoon Lee , Kyu Seok Kim , Jae Hyuk Lee , Tae Yun Kim , Chang Woo Kang , Chan Jong Park , Joong Hee Kim , You Hwan Jo , Joong Eui Rhee , Dong Hoon Kim

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 199-208 (10 pages)

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Purpose: We aimed to investigate whether a trained layperson could perform high quality Cardiopulmonary Resuscitation (CPR) after conventional training and a selflearning program using the “CPR Anytime” kit. Methods: Traditional CPR training for a lay rescuer was conducted two weeks before a CPR contest for high school students. “CPR Anytime” training kits were distributed to the students for their practical training at home or in school. The students were tested in pairs for two-person CPR with rescuer breaths and an automated external defibrillator. The quantitative and qualitative data regarding the quality of CPR, including chest compression and rescuer breaths, were collected using a standardized checklist and a skill reporter. Results: A total of 161 teams with 322 students, including 116 males and 206 females, participated in the CPR contest in pairs. The mean depth and rate for the chest compression were 49.0±8.2 mm and 110.2±10.2 /min, respectively. The mean tidal volume for the rescue breaths was 604.8±208.7 ml. The percentage of participants satisfying the correct chest compression rate of 100/min and depth of 50 mm was 87.3% and 52.2%, respectively. Only 25.2% of the participants satisfied an optimal tidal volume (between 500 ml and 600 ml). Shallow compression (57.5%) and under-ventilation (44.4%) were the major causes of incorrect compression and ventilation, respectively. Conclusion: The quality of CPR with rescuer breaths in the trained lay rescuer was not adequate, especially for mouthto- mouth rescue breathing. Therefore, the development of teaching methods to improve rescue breathing or omit mouth-to-mouth ventilation in training should be considered.

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10일차반응자의 기본 소생술 교육에 따른 질 측정 변수의 분석

저자 : 문준동 ( Jun Dong Moon ) , 최성혁 ( Sung Hyuk Choi )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 24권 2호 발행 연도 : 2013 페이지 : pp. 209-215 (7 pages)

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Purpose: As an emergency medical system provider, cardiopulmonary resuscitation (CPR) quality for first responder is an important determinant of cardiac arrest outcome. However, feedback on their CPR performance is often lacking. In this simulation study, we analyzed their CPR variables after CPR training based on high-quality CPR requirements highlighted by the 2010 American Heart Association updated guidelines. Furthermore, we aimed to compare the CPR quality between first responders and emergency medical technicians. Methods: Firefighters employed at Seoul metropolitan fire and disaster headquarters in 2011 and 2012 were included in the study. The data were collected from a PC Skill reporting System? (Laerdal, Norway) 5 hours after CPR training. Outcomes included compression variables (depth, rate, hand position, full release, delivered per minute, duty cycle), ventilation variables (volume, flow rate) and hands-off time variables (hands-off fraction, time for airway and breathing, automated external defibrillator (AED)). Results: Sixty-one members to the emergency medical technician group and 66 members to the first responder group were recruited and were tested after CPR training. Results of the first responder group were as follows: for average compression variables, depth 57.6 mm, rate 108.3 numbers/ min, correct hand position 90.0%, full release 100.0%, and duty cycle 40.8%. For average ventilation variables, volume 526.2 ml and flow rate 316.8 ml/sec. These values were same for both groups and showed no statistical significance. The number of compressions performed per minute was better in the emergency medical technician group (74.4 versus 70.6, p<0.002), as was total hands-off time (65.5 sec versus 73.2 sec, p<0.000) and hand-off fraction (32.0% versus 35.2%, p<0.000). Time for operating AED was found to be same for both groups but time for airway and breathing management was shorter in the emergency medical technician group (41.0 sec versus 48.0 sec, p<0.000) Conclusion: The first responder group showed that through short-term CPR training, overall measured quality of CPR was in compliance with international consensus guidelines. But total hands-off time was longer in the first responder group and the time spent for airway and breathing management rather than operating AED was significantly different between the two groups. Appropriate training programs for first responder`s airway and breathing skills are required to minimize interruption time.

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