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대한임상독성학회> 대한임상독성학회지> 원저 : 응급실 기반 자살 시도자 사후 관리사업의 등록률에 영향을 미치는 인자

KCI등재

원저 : 응급실 기반 자살 시도자 사후 관리사업의 등록률에 영향을 미치는 인자

The Factors Affecting the Registration Rates for Emergency Department Based Post-suicidal Care Program

이준철 ( Junchul Lee ) , 강형구 ( Hyung Goo Kang ) , 김창선 ( Changsun Kim ) , 오재훈 ( Jaehoon Oh ) , 임태호 ( Taeho Lim ) , 안동현 ( Dong Hyun Ahn ) , 이정임 ( Jung Im Lee ) , 박민희 ( Min Hee Park ) , 김경희 ( Kyung Hee Kim )
  • : 대한임상독성학회
  • : 대한임상독성학회지 13권1호
  • : 연속간행물
  • : 2015년 06월
  • : 25-32(8pages)
대한임상독성학회지

DOI


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대상과 방법
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Purpose: The aim of this study was to investigate the independent factors associated with the registration rate for the community-based post suicidal care program in the emergency department (ED). Methods: This prospective observational study was conducted between March and December 2013 at the academic ED at the tertiary urban hospital. During the study period, the pre-designed registry was recorded. The variables examined included the following: patients’ demographic data (Sex, age, address, type of insurance, marital status, level of education, and history of previous psychiatric disease), suicide-related data (suicidal methods, combined drink of alcohol and number of previous attempts), and management-related data (disposition at ED, physician’s training level, etc.). Univariated and multivariated logistic regression analyses were performed for identification of factors affecting the registration rate for the community-based post suicidal care program. Results: A total of 163 suicides were included during the study period. Of these, 33 (20.2%) patients were registered in the post-suicide care program. Factors including a patient’s address (OR: 14.92, 95% CI: 3.606-61.711), immediate intervention by psychiatric healthcare center (OR: 5.05, CI: 1.688-15.134), admissions in hospital (OR: 3.69, CI: 1.286-10.605), and history of previous psychiatric disease (OR: 3.52, CI: 1.216-10.201) showed significant association with registration for the program. Conclusion: The community-based post-suicidal care program, which is available 24 hours a day, should be operated in each district in order to increase the registration rate. Emergency physicians should actively consider the inpatient treatment program for suicidal patients and strongly recommend registration to the program, particularly for patients without previous history of psychiatric disease.

UCI(KEPA)

I410-ECN-0102-2016-510-000280935

간행물정보

  • : 의약학분야  > 기타(의약학)
  • : KCI등재
  • :
  • : 반년간
  • : 1738-1320
  • : 2508-6332
  • : 학술지
  • : 연속간행물
  • : 2003-2021
  • : 393


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1급성 중독으로 응급실에 내원하여 사망한 환자의 원인물질 및 시간 분포

저자 : 이현재 ( Hyeonjae Lee ) , 좌민홍 ( Minhong Choa ) , 한은아 ( Eunah Han ) , 고동률 ( Dong Ryul Ko ) , 고재욱 ( Jaiwoog Ko ) , 공태영 ( Taeyoung Kong ) , 조준호 ( Junho Cho ) , 정성필 ( Sung Phil Chung )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 19권 2호 발행 연도 : 2021 페이지 : pp. 65-71 (7 pages)

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Purpose: The purpose of this study was to investigate the cause of acute fatal poisoning and the time of death by analyzing the National Emergency Department Information System (NEDIS) of South Korea.
Methods: The NEDIS data from 2014 to 2018 excluding non-medical visits were used for this study. The patients with acute poisoning were extracted using diagnostic codes. The toxic substances were classified into pharmaceuticals, pesticides, gases, artificial poisonous substances, and natural toxic substances. Patients were classified according to the time of death, place of death, and region. In each case, the most causative substances of poisoning were identified.
Results: There were 380,531 patients including poisoning-related diagnoses, of which 4,148 (1.1%) died, and the WHO age-standardized mortality rate was 4.8 per 100,000. Analysis of 2,702 death patients whose primary diagnosis was acute poisoning, the most common cause of poisoning death was pesticides (62%), followed by therapeutic drugs, gas, and artificial toxic substances. Herbicides were the most common pesticides at 64.5%. The proportion of mortality by time, hyperacute (< 6 h) 27.9%, acute (6-24 h) 32.6%, subacute (1-7 d) 29.7%, and delayed period ( >7 d) were 9.8%.
Conclusion: This study suggests that the most common cause of poisoning death was pesticides, and 60% of deaths occurred within 24 hours. The 71% of mortality from pesticides occurred within 6-24 hours, but mortality from gas was mostly within 6 hours. According to the geographic region, the primary cause of poisoning death was varied to pesticides or pharmaceuticals.

KCI등재

2중증 급성 중독 환자에서 급성 신장 손상과 병원 내 사망률을 예측하기 위한 강이온차(Strong Ion Gap)의 중요성

저자 : 심태진 ( Tae Jin Sim ) , 조재완 ( Jae Wan Cho ) , 이미진 ( Mi Jin Lee ) , 정해원 ( Haewon Jung ) , 박정배 ( Jungbae Park ) , 서강석 ( Kang Suk Seo )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 19권 2호 발행 연도 : 2021 페이지 : pp. 72-82 (11 pages)

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Purpose: A high anion gap (AG) is known to be a significant risk factor for serious acid-base imbalances and death in acute poisoning cases. The strong ion difference (SID), or strong ion gap (SIG), has recently been used to predict in-hospital mortality or acute kidney injury (AKI) in patients with systemic inflammatory response syndrome. This study presents a comprehensive acidbase analysis in order to identify the predictive value of the SIG for disease severity in severe poisoning.
Methods: A cross-sectional observational study was conducted on acute poisoning patients treated in the emergency intensive care unit (ICU) between December 2015 and November 2020. Initial serum electrolytes, base deficit (BD), AG, SIG, and laboratory parameters were concurrently measured upon hospital arrival and were subsequently used along with Stewart's approach to acid-base analysis to predict AKI development and in-hospital death. The area under the receiver operating characteristic curve (AUC) and logistic regression analysis were used as statistical tests.
Results: Overall, 343 patients who were treated in the intensive care unit were enrolled. The initial levels of lactate, AG, and BD were significantly higher in the AKI group (n=62). Both effective SID [SIDe] (20.3 vs. 26.4 mEq/L, p<0.001) and SIG (20.2 vs. 16.5 mEq/L, p<0.001) were significantly higher in the AKI group; however, the AUC of serum SIDe was 0.842 (95% confidence interval [CI]=0.799-0.879). Serum SIDe had a higher predictive capacity for AKI than initial creatinine (AUC=0.796, 95% CI=0.749-0.837), BD (AUC=0.761, 95% CI=0.712-0.805), and AG (AUC=0.660, 95% CI=0.607-0.711). Multivariate logistic regression analyses revealed that diabetes, lactic acidosis, high SIG, and low SIDe were significant risk factors for in-hospital mortality.
Conclusion: Initial SIDe and SIG were identified as useful predictors of AKI and in-hospital mortality in intoxicated patients who were critically ill. Further research is necessary to evaluate the physiological nature of the toxicant or unmeasured anions in such patients.

KCI등재

3글라이포세이트 중독 환자에서 포함된 염의 종류에 따른 예후의 차이

저자 : 정민규 ( Jeong Min Gyu ) , 금경탁 ( Kyoung Tak Keum ) , 안성준 ( Seongjun Ahn ) , 김용환 ( Yong Hwan Kim ) , 이준호 ( Jun Ho Lee ) , 조광원 ( Kwang Won Cho ) , 황성연 ( Seong Youn Hwang ) , 이동우 ( Dong Woo Lee )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 19권 2호 발행 연도 : 2021 페이지 : pp. 83-92 (10 pages)

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Purpose: Glyphosate herbicide (GH) is a widely used herbicide and has been associated with significant mortality as poisoned cases increases. One of the reasons for high toxicity is thought to be toxic effect of its ingredient with glyphosate. This study was designed to determine differences in the clinical course with the salt-type contained in GH.
Methods: This was a retrospective study conducted at a single hospital between January 2013 and December 2017. We enrolled GH-poisoned patients visited the emergency department. According to salt-type, patients were divided into 4 groups: isopropylamine (IPA), ammonium (Am), potassium (Po), and mixed salts (Mi) groups. The demographics, laboratory variables, complications, and their mortality were analyzed to determine clinical differences associated with each salt-type. Addtionally, we subdivided patients into survivor and non-survivor groups for investigating predictive factors for the mortality.
Results: Total of 348 GH-poisoned patients were divided as follows: IPA 248, Am 41, Po 10, and Mi 49 patients. There was no difference in demographic or underlying disease history, but systolic blood pressure (SBP) was low in Po group. The ratio of intentional ingestion was higher in Po and Mi groups. Metabolic acidosis and relatively high lactate level were presented in Po group. As the primary outcome, the mortality rates were as follows: IPA, 26 (10.5%); Am, 2 (4.9%); Po, 1 (10%); and Mi, 1 (2%). There was no statistically significant difference in the mortality and the incidence of complications. Additionally, age, low SBP, low pH, corrected QT (QTc) prolongation, and respiratory failure requiring mechanical ventilation were analyzed as independent predictors for mortality in a regression analysis.
Conclusion: There was no statistical difference in their complications and the mortality across the GH-salt groups in this study.

KCI등재

4중독 중환자에서의 초기 영양상태평가와 예후와의 관계

저자 : 고동완 ( Dong-wan Ko ) , 최상천 ( Sangcheon Choi ) , 민영기 ( Young-gi Min ) , 이혁진 ( Hyuk Jin Lee ) , 박은정 ( Eun Jung Park )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 19권 2호 발행 연도 : 2021 페이지 : pp. 93-99 (7 pages)

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Purpose: Nutritional status and support in critically ill patients are important factors in determining patient recovery and prognosis. The aim of this study was to analyze the early nutritional status and the methods of nutritional support in critically ill patients with acute poisoning and to evaluate the effect of nutritional status on prognosis.
Methods: A retrospective study was conducted in tertiary care teaching hospital from January 2018 to December 2020. in an emergency department of university hospital, 220 patients who were stayed more than 2 days of poisoning in intensive care unit were enrolled.
Results: 155 (70.5%) of patients with acute poisoning had low-risk in nutritional risk screening (NRS). Patients with malignancy had higher NRS (low risk 5.2%, moderate risk 18.5%, high risk 13.2%, p=0.024). Patients of 91.4% supplied nutrition via oral route or enteral route. Parenteral route for starting method of nutritional support were higher in patients with acute poisoning of herbicide or pesticide (medicine 3.2%, herbicide 13.8%, pesticide 22.2%, p=0.000). In multivariate logistic regression analysis, herbicide or pesticide intoxication, higher risk in NRS and sequential organ failure assessment over 4.5 were affecting factor on poor recovery at discharge.
Conclusion: NRS in patients intoxicated with herbicide or pesticide were higher than that in patients intoxicated with medicine intoxication. Enteral nutrition in patients intoxicated with herbicide or pesticide was less common. Initial NRS was correlated with recovery at discharge in patient with intoxication. It is expected to be helpful in finding patients with high-risk nutritional status in acute poisoning patients and establishing a treatment plan that can actively implement nutritional support.

KCI등재

5급성 일산화탄소 중독 후 해마에서 Parvalbumin 양성 중간뉴론의 변화에 대한 N-acetylcystein의 효과

저자 : 김선태 ( Seon Tae Kim ) , 유수진 ( Su Jin Yoo )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 19권 2호 발행 연도 : 2021 페이지 : pp. 100-109 (10 pages)

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Purpose: The purpose of this study was to investigate effect of N-acetylcysteine (NAC) on the injury of putative parvalbumin positive interneurons defined by molecular marker and hippocampal long-term potentiation (LTP), a marker of neural plasticity following acute carbon monoxide (CO) poisoning.
Methods: Adult Sprague-Dawley rats were exposed to 1100 ppm CO for 40 minutes followed by 3000 ppm CO for 20 minutes. Animals received daily intraperitoneal injection of NAC (150 mg/kg) for 5 days after CO exposure. Changes in learning and spatial memory were evaluated by Y-maze test 5 days after the poisoning. In vivo LTP in hippocampal CA1 area was evaluated by using extracellular electrophysiological technique. Immunohistochemical staining were adopted to observe expressional damages of parvalbumin (PV) immunoreactive interneurons in the hippocampus following the poisoning.
Results: Acute CO intoxication resulted in no changes in memory performance at Y-maze test but a significant reduction of LTP in the in hippocampal CA1 area. There was also a significant reduction of PV (+) interneurons in the hippocampal CA1 area 5 days after CO poisoning. Daily treatment of NAC significantly improved hippocampal LTP impairment and reduced immunoreactivity for PV in the hippocampus following the acute CO poisoning.
Conclusion: The results of this study suggest that reduction of hippocampal LTP and PV (+) interneurons in the hippocampus is sensitive indicator for brain injury and daily NAC injections can be the alternative therapeutics for the injury induced by acute CO poisoning.

KCI등재

6응급실로 내원하는 급성중독환자의 원인물질 분석을 위한 중독 분석실 이용 현황 및 이용 만족도 조사: 전국 권역 및 지역응급의료센터 설문조사

저자 : 손동우 ( Dong Woo Son ) , 강지훈 ( Ji Hun Kang ) , 김양원 ( Yang Weon Kim ) , 박철호 ( Chul Ho Park ) , 윤유상 ( Yoo Sang Yoon ) , 지재구 ( Jae Gu Ji )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 19권 2호 발행 연도 : 2021 페이지 : pp. 110-126 (17 pages)

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Purpose: The purpose of this study is to find out the current status of toxicology laboratory operated by six locations nationwide and to investigate the satisfaction of emergency medical professionals who working at local and regional emergency medical centers.
Methods: This survey was conducted prospective. It was conducted on 665 emergency medical professionals working at regional and regional emergency medical centers across the South Korea. Among them, the analysis was conducted with data that 510 emergency medical professionals who respond to this survey. The questionnaire was conducted on an online basis for a month. To ensure statistical significance, consider a dropout rate of 10% based on a minimum response recovery rate of 70%. 506 people were selected for the survey.
Results: According to a survey on the status of addiction analysis room usage, the average monthly usage of addiction test rooms among respondents were 406 cases.71.0 cases (17.4%) of toxicology laboratory in Seoul and 71 cases (17.4%) in Gwangju. 32 cases (7.8%), 118 cases (29.0%) requested by toxicology laboratory in Busan, and the toxicology laboratory in Daegu. Eighty two cases (20.1%), Daejeon area 25 cases (6.1%), Wonju area toxicology laboratory was 78 (19.6%). According to a survey on the satisfaction of the addiction analysis room,Seoul (4.9±2.71) and Gwangju (4.8±2.52) showed high satisfaction.
Conclusion: Due to the limited operation time of the four addiction analysis rooms currently in operation, the satisfaction level of addiction analysis by emergency medical professionals in the area is low due to the delay until the result is notified.

KCI등재

7착화탄 연소에 의한 가스 중독 환자에서 혈중 중금속 농도의 영향에 대한 예비연구

저자 : 이상환 ( Sang Hwan Lee ) , 이준철 ( Juncheol Lee ) , 조용일 ( Yongil Cho ) , 고벽성 ( Byuk Sung Ko ) , 오재훈 ( Jaehoon Oh ) , 강형구 ( Hyunggoo Kang )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 19권 2호 발행 연도 : 2021 페이지 : pp. 127-132 (6 pages)

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Purpose: It is known that the most common cause of gas poisoning in Korea is suicide attempts by burning ignition coals. Ignition coals are made from waste wood, and studies have been reported that heavy metals are emitted when this coal is burned. However, there was no study on how much heavy metal poisoning occurs in the human body through this, so this study was planned to find out whether the concentration of heavy metals in the blood increased in patients exposed to ignition coal combustion.
Methods: From April 2020 to April 2021, blood lead, mercury, and cadmium concentrations were investigated in carbon monoxide poisoning patients who visited one regional emergency medical center in Seoul, and their association with exposure time, source of poisoning, and rhabdomyolysis were investigated.
Results: During the study period, a total of 136 carbon monoxide poisoning patients were tested for heavy metals, and 81 cases of poisoning by ignition coal were reported. When comparing poisoning caused by combustion of ignition coal and other substances, there was no difference in the concentrations of lead, mercury, and cadmium in the blood, and there was no difference in the number of patients above the reference range. However, the patients exposed to more than 5 hours of ignition coal gas exposure are more frequent than those in the group less than 5 hours in lead (51.4% vs. 23.9%, p=0.012).
Conclusion: Compared to poisoning with other combustible substances, the blood concentration of lead, mercury, and cadmium does not increase further in patients with gas poisoning by ignition coal. However, prolonged exposure may result in elevated levels of lead.

KCI등재

8글루포시네이트 중독 후 심장독성의 다양한 임상경과를 보인 1례

저자 : 김선태 ( Seon Tae Kim )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 19권 2호 발행 연도 : 2021 페이지 : pp. 133-138 (6 pages)

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Glufosinate-containing herbicides is a non-selective herbicide commonly used worldwide. As the use of them increased gradually since paraquat was banned in 2012, the number of suicides by their ingestion is also increasing continuously. Complications of glufosinate-containing herbicide poisoning include various central nervous system (CNS) toxicities such as convulsions, loss of consciousness, memory impairment, and respiratory depression, which may be accompanied by hemodynamic changes such as bradycardia and hypotension. However, it is very rare that arrhythmias other than bradycardia occurred and Takotsubo cardiomyopathy was combined due to cardiotoxicity. A 71-year-old female patient was transferred to our hospital after ingesting 500 mL of glufosinate-containing herbicide and receiving 5 L of gastric lavage at a local hospital. A few hours later, she presented stuporous mentality, respiratory depression, and convulsions, and was accompanied by hypotension and bradycardia. On the second day of admission, electrocardiogram (ECG) showed bradycardia and QTc prolongation with hemodynamic Instability. Accordingly, we conducted the early treatment with continuous renal replacement therapy (CRRT) and the application of temporary cardiac pacemaker. An echocardiogram demonstrated decreased ejection fraction (EF) and Takotsubo cardiomyopathy on the third day of admission. Then, she was discharged safely with conservative treatment. At the follow-up after 1 year, Takotsubo cardiomyopathy, EF and QTc prolongation were recovered on echocardiogram and ECG. Because cardiac toxicity after glufosinate-containing herbicide poisoning may cause life-threatening consequences, caution is required while treating the patient. Therefore, if electrocardiogram changes are seen in the elderly with a large amount of glufosinate herbicide ingestion, additional cardiac function test through echocardiography should be concerned, and early treatment through CRRT or artificial cardiac pacing should be considered.

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KCI등재

1원저 : 급성 중독 환자에서 지질 유탁액 정맥투여의 효과: 체계적 고찰

저자 : 명진우 ( Jinwoo Myung ) , 고동률 ( Dong Ryul Ko ) , 공태영 ( Taeyoung Kong ) , 주영선 ( Young Seon Joo ) , 유제성 ( Je Sung You ) , 정성필 ( Sung Phil Chung )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 13권 1호 발행 연도 : 2015 페이지 : pp. 1-10 (10 pages)

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Purpose: The purpose of this study was to evaluate the usefulness of intravenous lipid emulsion as well as adverse events in acute poisoning patients. Methods: Literature was accessed through PubMed, EMBASE, Cochrane library, Web of science, and KoreaMed. All forms of literatures relevant to human use of intravenous lipid emulsion for acute poisoning were included. Cases reports or letters without description of clinical outcomes for each case were excluded. The literature search was conducted by two investigators in March, 2015, with publication language restricted to English and Korean. The effect, onset time, and adverse event of lipid emulsion and final outcome of each case were analyzed. Results: Eighty-one published articles were included, excluding articles whose title and abstract were not relevant to this study. No articles were classified as high level of evidence. Sixty-eight case reports were identified, consisting of 25 local anesthetics and 43 other drugs, such as tricyclic antidepressants and calcium channel blockers. Although most cases described significant clinical improvements, some of them showed no beneficial effect or worsening of clinical course. Several adverse events including hyperamylasemia and laboratory interference were reported. Conclusion: Although there were many case reports illustrating successful use of lipid for various drug poisonings, the effect cannot be estimated due to significant possibility of publication bias. Therefore, lipids might be considered in severe hemodynamic instability resulting from lipophilic drug poisoning, however further studies should follow to establish the use of lipid as the standard of care.

KCI등재

2원저 : 급성 약물중독 환자의 응급 기관내 삽관에서 임상적 특성

저자 : 한얼 ( Eol Han ) , 정현수 ( Hyun Soo Chung ) , 박유석 ( Yoo Seok Park ) , 유제성 ( Je Sung You ) , 주영선 ( Youngseon Joo ) , 공태영 ( Taeyoung Kong ) , 박인철 ( Incheol Park ) , 정성필 ( Sung Phil Chung )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 13권 1호 발행 연도 : 2015 페이지 : pp. 11-18 (8 pages)

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Purpose: The aim of this study was to compare the clinical characteristics in emergency endotracheal intubation between patients with acute drug intoxication and medical disease. Methods: Data for airway registry collected in two emergency departments (ED) between April 2006 and March 2010 were reviewed retrospectively. The airway registry data included patient's demographic information and variables such as Cormack-Lehane grade, 3-3-2 finger analysis, success rate, the number of attempts at intubation, complications of intubation, and clinical outcomes after intubation. Results: A total of 1480 patients were enrolled; 62 patients were classified as belonging to the intubation group after the drug intoxication group. No significant differences in Cormack-Lehane grade, 3-3-2 finger analysis, success rate, the number of attempts at intubation, and complications after intubation were observed between patients with acute drug intoxication and medical disease. However, significant difference was observed for indication of emergency endotracheal intubation. While emergency endotracheal intubations were usually performed in medical patients because of failure of airway patency, they were performed in intoxicated patients with the goal of preventing serious complications. Conclusion: Anatomical structures related to endotracheal intubation, the process and clinical outcome of intoxicated patients are not significantly different from those for medical patients.

KCI등재

3원저 : 유기인계 중독 환자에서 알코올이 사망률에 미치는 효과

저자 : 민용훈 ( Yong Hun Min ) , 박승민 ( Seung Min Park ) , 이귀자 ( Kui Ja Lee ) , 오영택 ( Young Taeck Oh ) , 안희철 ( Hee Cheol Ahn ) , 손유동 ( You Dong Sohn ) , 안지윤 ( Ji Yun Ahn ) , 이영환 ( Young Hwan Lee ) , 하상욱 ( Sang Ook Ha ) , 김유정 ( Yu Jung Kim )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 13권 1호 발행 연도 : 2015 페이지 : pp. 19-24 (6 pages)

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Purpose: Many patients who are acutely poisoned with organophosphorus pesticides have co-ingested alcohol. The purpose of this study was to identify the factors that influence mortality in organophosphate intoxication and the differences between alcohol coingested patients and non-coingested patients, looking at vital signs, length of admission, cholinesterase activity, complications, and mortality. Methods: All patients visiting one Emergency Department (ED) with organophosphate intoxication between January 2000 and December 2012 were reviewed retrospectively. The patients were divided into two groups, alcohol coingested group and non-coingested group. Results: During the study period, 136 patients (alcohol coingested group, 95 patients; non-coingested group, 41 patients) presented to the ED with organophosphate intoxication. Seventy-one alcohol coingested patients (74.1%) vs. 16 non-coingested patients (39.0%) received endotracheal intubation, with results of the analysis showing a clear distinction between the two groups (p=0.001). Twenty-three alcohol coingested patients (24.2%) vs. 1 non-coingested patient (2.4%) required inotropics, indicating a significant gap (p=0.002). Twenty-eight alcohol coingested patients (29.5%) vs. 2 non-coingested patients (4.9%) died, with results of the analysis showing a clear distinction between the two groups (p=0.002). Conclusion: In cases of organophosphate intoxication, alcohol coingested patients tended to receive endotracheal intubation, went into shock, developed central nervous system complications, and more died.

KCI등재

4원저 : 응급실 기반 자살 시도자 사후 관리사업의 등록률에 영향을 미치는 인자

저자 : 이준철 ( Junchul Lee ) , 강형구 ( Hyung Goo Kang ) , 김창선 ( Changsun Kim ) , 오재훈 ( Jaehoon Oh ) , 임태호 ( Taeho Lim ) , 안동현 ( Dong Hyun Ahn ) , 이정임 ( Jung Im Lee ) , 박민희 ( Min Hee Park ) , 김경희 ( Kyung Hee Kim )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 13권 1호 발행 연도 : 2015 페이지 : pp. 25-32 (8 pages)

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Purpose: The aim of this study was to investigate the independent factors associated with the registration rate for the community-based post suicidal care program in the emergency department (ED). Methods: This prospective observational study was conducted between March and December 2013 at the academic ED at the tertiary urban hospital. During the study period, the pre-designed registry was recorded. The variables examined included the following: patients' demographic data (Sex, age, address, type of insurance, marital status, level of education, and history of previous psychiatric disease), suicide-related data (suicidal methods, combined drink of alcohol and number of previous attempts), and management-related data (disposition at ED, physician's training level, etc.). Univariated and multivariated logistic regression analyses were performed for identification of factors affecting the registration rate for the community-based post suicidal care program. Results: A total of 163 suicides were included during the study period. Of these, 33 (20.2%) patients were registered in the post-suicide care program. Factors including a patient's address (OR: 14.92, 95% CI: 3.606-61.711), immediate intervention by psychiatric healthcare center (OR: 5.05, CI: 1.688-15.134), admissions in hospital (OR: 3.69, CI: 1.286-10.605), and history of previous psychiatric disease (OR: 3.52, CI: 1.216-10.201) showed significant association with registration for the program. Conclusion: The community-based post-suicidal care program, which is available 24 hours a day, should be operated in each district in order to increase the registration rate. Emergency physicians should actively consider the inpatient treatment program for suicidal patients and strongly recommend registration to the program, particularly for patients without previous history of psychiatric disease.

KCI등재

5증례 : 시너(Thinner) 정주로 발생한 급성 폐질환 1례

저자 : 이혜지 ( Hae Ji Lee ) , 최병호 ( Byung Ho Choi ) , 김미진 ( Mi Jin Kim ) , 홍정석 ( Jung Seok Hong )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 13권 1호 발행 연도 : 2015 페이지 : pp. 33-35 (3 pages)

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A 24 year-old man attempted suicide by injection of 1 cc of thinner into his left antecubital vein; 3 hours later, he visited our emergency room because of left chest pain. We suspected a chemical pneumonitis based on the abnormal findings of his chest X-ray and computed tomography. On the 3rd day after admission, a cellulitis also occurred at the injection area. His symptoms were relieved after supportive care for 2 weeks. There is significant experience with intoxication of thinner inhalation, whereas intoxication of intravenous thinner is rare.

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6증례 : 급성 호흡부전으로 사망한 황산구리 중독 1례

저자 : 김건배 ( Gun Bea Kim )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 13권 1호 발행 연도 : 2015 페이지 : pp. 36-39 (4 pages)

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Copper sulfate is a copper compound used widely in the chemical and agriculture industries. Most intoxication occurs in developing countries of Southeast Asia particularly India, but rarely occurs in Western countries. The early symptoms of intoxication are nausea, vomiting, diarrhea, and abdominal cramps, and the most distinguishable clue is bluish vomiting. The clinical signs of copper sulfate intoxication can vary according to the amount ingested. A 75-year old man came to our emergency room because he had taken approximately 250 ml copper sulfate per oral. His Glasgow Coma Scale (GCS) score was 14 and vital signs were blood pressure 173/111 mmHg, pulse rate 24 bpm, respiration rate 24 bpm, and body temperature 36.1°.... Arterial blood gas analysis (ABGa) showed mild hypoxemia and just improved after 2 L/min oxygen supply via nasal cannula. Other laboratory tests and chest CT scan showed no clinical significance. Three hours later, the patient's mental status showed sudden deterioration (GCS 11), and ABGa showed hypercarbia. He was arrested and his spontaneous circulation returned after 8 minutes CPR. However, 22 minutes later, he was arrested again and returned after 3 minutes CPR. The family did not want additional resuscitation, so that he died 5 hours after ED visit. In my knowledge, early deaths are the consequence of shock, while late mortality is related to renal and hepatic failure. However, as this case shows, consideration of early definite airway preservation is reasonable in a case of supposed copper sulfate intoxication, because the patients can show rapid deterioration even when serious clinical manifestation are not presented initially.

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7증례 : 클로르플루아주론 살충제 음독 후 발생한 의식변화 1례

저자 : 박은석 ( Eun Suk Park ) , 강수 ( Soo Kang ) , 김아진 ( Ah Jin Kim ) , 백진휘 ( Jin Hue Baek ) , 정현민 ( Hyun Min Jung )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 13권 1호 발행 연도 : 2015 페이지 : pp. 40-42 (3 pages)

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Benzoylureas are chemical compounds best known for their use as insecticides. Diflubenzuron is one of the more commonly used benzoylurea pesticides. Others include chlorfluazuron, flufenoxuron, hexaflumuron, and triflumuron. They act as insect growth regulators by inhibiting synthesis of chitin in the body of the insect. They have low toxicity in mammals because mammals have no chitin. Chlorfluazuron insecticides, which are mixed with solvent naphatha, are commonly used. Thus we assume that in the presented case mental change outcome of poisoning was connected with toxic effects of solvent naphtha rather than with chlorfluazuron action. Components of solvent naphtha, particularly trimethylbenzenes, exert strong irritant action on the gastric mucosa and are very well absorbed from the gastrointestinal tract. We report on a 67-year-old man with stuporous mentality after intentional ingestion of approximately 200 ml of liquid chlorfluazuron in a suicide attempt. He was discharged after conservative treatments including gastric irrigation, charcoal, mechanical ventilation, hydration, and antibiotics for aspiration pneumonia without complications.

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8증례 : 설폭사플로르 살충제 중독 이후 발생한 저독성 보고 1례

저자 : 오재훈 ( Jaehoon Oh ) , 강형구 ( Hyunggoo Kang ) , 임태호 ( Tae Ho Lim ) , 이상현 ( Sanghyun Lee ) , 안치원 ( Chiwon Ahn )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 13권 1호 발행 연도 : 2015 페이지 : pp. 43-45 (3 pages)

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Sulfoxaflor is the first insecticide belonging to the sulfoximine class and is efficient against sap-feeding insects that are resistant to other insecticides. Sulfoxaflor acts as a neurotoxin to the central nervous system of insects compared with very low toxicity to mammalian. We report on a case of a 67-year-old male who ingested insecticide and received conservative treatment for mild metabolic acidosis and gastrointestinal symptoms.

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9증례 : 급성 일산화탄소 중독 환자에서 발생한 양하지 말초 운동신경병증 1례

저자 : 최재형 ( Jae Hyung Choi ) , 임훈 ( Hoon Lim )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 13권 1호 발행 연도 : 2015 페이지 : pp. 46-49 (4 pages)

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Carbon monoxide (CO) intoxication is a leading cause of severe neuropsychological impairments. Peripheral nerve injury has rarely been reported. Following are brief statements describing the motor peripheral neuropathy involved bilateral lower extremities of a patient who recovered following acute carbon monoxide poisoning. After inhalation of smoke from a fire, a 60-year-old woman experienced bilateral leg weakness without edema or injury. Neurological examination showed diplegia and deep tendon areflexia in lower limbs. There was no sensory deficit in lower extremities, and no cognitive disturbances were detected. Creatine kinase was normal. Electroneuromyogram patterns were compatible with the diagnosis of bilateral axonal injury. Clinical course after normobaric oxygen and rehabilitation therapy was marked by complete recovery of neurological disorders. Peripheral neuropathy is an unusual complication of CO intoxication. Motor peripheral neuropathy involvement of bilateral lower extremities is exceptional. Various mechanisms have been implicated, including nerve compression secondary to rhabdomyolysis, nerve ischemia due to hypoxia, and direct nerve toxicity of carbon monoxide. Prognosis is commonly excellent without sequelae. Emergency physicians should understand the possible-neurologic presentations of CO intoxication and make a proper decision regarding treatment.

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10증례 : 과립구집락자극인자 투여로 치료한 범혈구감소증과 피부 박리를 보인 붉은사슴뿔버섯 중독 1례

저자 : 김중석 ( Jung Seok Kim ) , 김규원 ( Gyu Won Kim ) , 정재일 ( Jae Il Chung ) , 심명기 ( Myoung Ki Sim ) , 윤기철 ( Ki Chul Yoon ) , 최용훈 ( Yong Hoon Choi ) , 이하람 ( Ha Ram Yi ) , 최인주 ( In Zoo Choi ) , 심찬섭 ( Chan Sup Shim ) , 한정호 ( Joung Ho Han )

발행기관 : 대한임상독성학회 간행물 : 대한임상독성학회지 13권 1호 발행 연도 : 2015 페이지 : pp. 50-54 (5 pages)

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Podostroma cornu-damae is a rare species of fungus belonging to the Hyocreaceae family. Its fruit body is highly toxic, as it contains trichothecene mycotoxins. The morphology is similar to that of immature Ganoderma lucidum, making identification difficult for non-experts. We experienced such a case of a 56- year-old male who picked and consumed podostroma cornu-damae, and consumed. Later that day, he developed digestive system symptoms, including nausea, vomiting, and abdominal pain. He presented to the emergency room (ER), there were no abnormal physical findings, symptoms improved after gastric lavage, and the patient voluntarily discharged himself on the same day. The following day, as the symptoms gradually deteriorated, he was admitted via the ER. He was presented with severe pancytopenia, alopecia, desquamation of skin, and acute renal failure. He recovered without any complications after conservative care, antibiotics therapy, and granulocyte colony stimulating factor administration. The most commonly reported complications of podostroma cornu-damae intoxication were reported pancytopenia, infection, disseminated intravascular coagulation, acute renal failure, etc. since Prevention is especially important because its toxicity can be lethal and there is no particular treatment to date, prevention is especially important. Promotion and education for the public are needed.

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