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대한응급의학회> 대한응급의학회지> 원저 : 119구급차 내부환경 및 안전도에 대한 만족도와 영향요인의 조사: 환자와 보호자대상의 예비연구

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원저 : 119구급차 내부환경 및 안전도에 대한 만족도와 영향요인의 조사: 환자와 보호자대상의 예비연구

Original Articles : EMS ; Satisfaction, and Factors Influencing Satisfaction, with Internal Environment and Safety of Emergency Medical Service Ambulances in Korea: Pilot Study of Patients and Guardians

전진우 ( Jin Woo Jeon ) , 임태호 ( Tae Ho Lim ) , 이상현 ( Sang Hyun Lee ) , 오재훈 ( Jae Hoon Oh ) , 강형구 ( Hyung Goo Kang ) , 안치원 ( Chi Won Ahn ) , 이준철 ( Jun Cheol Lee )
  • : 대한응급의학회
  • : 대한응급의학회지 26권6호
  • : 연속간행물
  • : 2015년 12월
  • : 598-604(7pages)
대한응급의학회지

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Purpose: This study was conducted to assess the satisfaction, and factors influencing the satisfaction, of patients and guardians with the internal environment and safety of ambulances in Korea. Methods: Participants were patients and guardians who were transported by public emergency medical service ambulance to an emergency medical center in June 2015. Data were collected using self-administered questionnaires. The degree of satisfaction with the ambulance was categorized as satisfaction (Likert scale 4 or 5) or dissatisfaction (Likert scale 1 or 2). The questionnaires comprised 3 categories: 1) demographics, 2) internal environment (space, light, temperature, humidity, soundproof, and odor), and 3) safety (vibration, leaning of body, and falling objects). Results: Among 84 cases, 80.5% of patients and 83.7% of guardians gave positive responses regarding general satisfaction with the internal environment of the ambulance, but these percentages were lower regarding adequacy of space and light. Four factors had a statistically significantly influence on the degree of satisfaction: 1) sex of guardian regarding adequacy of space, 2) number of guardians regarding general satisfaction, 3) severity of patient regarding guardian’s satisfaction with space, 4) diagnosis of patient (trauma vs non-trauma) regarding vibration during transport (all p<0.05). Conclusion: Overall, patients and guardians were satisfied with the internal environment and safety of ambulances except for adequacy of space and light.

UCI(KEPA)

I410-ECN-0102-2016-510-000652613

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  • : 의약학분야  > 외과학
  • : KCI등재
  • :
  • : 격월
  • : 1226-4334
  • : 2384-048x
  • : 학술지
  • : 연속간행물
  • : 1990-2022
  • : 2694


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1응급의학의 역사: 발전의 3요소와 해결해야 할 과제

저자 : 유인술 ( In Sool Yoo )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 1호 발행 연도 : 2022 페이지 : pp. 1-10 (10 pages)

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The year 2019 was the 30th anniversary of the Korean Society of Emergency Medicine (KSEM) and the 18th International Congress of Emergency Medicine (ICEM) was held in Seoul, Korea. During the last 30 years, Korean emergency medicine has developed and grown enormously, not only in quantity but also in quality. Thus, it is an appropriate occasion to review the history of the KSEM, the three elements of its development, and the challenges to be met. The three major factors contributing to the development of emergency medicine in Korea are the training of emergency medical personnel, the enactment of the emergency medical law, and the creation of an emergency medical fund. The interaction of these three factors has had a synergistic effect on the development of Korean emergency medicine. The challenges to be resolved include the fragmented emergency medical system divided between the fire department and emergency medical centers, the failure of the patient transport system according to the classification of roles for each type of emergency medical center, insufficient quality control in prehospital treatment, and the lack of clarity for the scope of work of emergency medical technicians in the prehospital phase.

KCI등재

2펼쳐진 상태의 구급차용 침대차에서 시행하는 한 손 가슴 압박의 효과 및 압박에 영향을 미치는 구조자의 특성 분석

저자 : 서용송 ( Yong Song Seo ) , 강지훈 ( Ji Hun Kang ) , 김양원 ( Yang Weon Kim ) , 윤유상 ( Yoo Sang Yoon ) , 박철호 ( Chul Ho Park ) , 지재구 ( Jae Gu Ji ) , 이시원 ( Si Won Lee )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 1호 발행 연도 : 2022 페이지 : pp. 11-18 (8 pages)

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Objective: When rescuers move from ambulance to resuscitation area, they press the chest with one-hand by the stretchers. The purpose of this study was to investigate the effect of one-hand chest compression on unfolded stretchers and analyze the characteristics of rescuers that affect compression.
Methods: A manikin simulation study was planned. A total of 28 participants performed one-hand chest compression for one minute to a manikin on the unfolded stretchers. The depth of compression, the extent of recoil and compression frequency were measured, and the results were analyzed. Correlation analysis was done between participant characteristics and depth and frequency of compression. Linear regression analysis was done for variables with significant correlation.
Results: Four participants were excluded due to wrist or shoulder pain. A total of 24 participants (13 male; 11 female) were enrolled. The mean depth of compression was 34.88±11.06 cm; the mean extent of recoil was 50.00±0 cm. The mean frequency of compression was 104.71±11.07 per minute. The extent of recoil and frequency of compression were satisfied with cardiopulmonary resuscitation (CPR) guidelines. The depth of compression was highly correlated with participants' sex (r=-0.88), height (r=0.86), and weight (r=0.78). When adjusted for sex, the depth of compression increased as height and weight increased.
Conclusion: Mechanical chest compression device should be used when CPR is required while moving a cardiac arrest patient by the stretchers. If CPR needs to be done manually, moving distance should be minimized. Finally, a new type of stretcher that fits the body shape of Koreans should be developed.

KCI등재

3코로나바이러스감염증-19 확산에 따른 응급실 기반 선별진료소 현황 분석: 단일 기관 후향적 연구

저자 : 한준호 ( Jun Ho Han ) , 이성민 ( Sung Min Lee ) , 이동훈 ( Dong Hun Lee ) , 허탁 ( Tag Heo )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 1호 발행 연도 : 2022 페이지 : pp. 19-27 (9 pages)

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Objective: Emergency department-based screening clinic (ED-BSC) is a new concept. It is a multifunctional clinic at the entrance of the emergency department (ED) that serves as a screening center for suspected coronavirus disease 2019 (COVID-19) patients and triaging patients and provides basic emergency treatment. We aimed to analyze the current status of the COVID-19 ED-BSC and determine the factors when assigning suspected COVID-19 patients to the negative pressure isolation rooms (NPIRs) at the ED.
Methods: Data of patients who visited the ED-BSC between February 7, 2020, and April 30, 2020, were obtained retrospectively. The data of the patients who underwent the COVID-19 screening test per the standards of the Korea Disease Control and Prevention Agency were analyzed.
Results: A total of 1,378 patients who visited the ED-BSC were included in the study. Of these, 1,226 patients were allowed to go home after the COVID-19 screening test, and 152 patients were assigned to the NPIRs. In univariate analysis, factors influencing the allocation of NPIRs were old age, history of overseas travel within the last 14 days, fever and peripheral oxygen saturation. The multivariate regression analysis confirmed that older adults, history of overseas travel within the last 14 days and fever influenced the allocation of patients to NPIRs.
Conclusion: This study elucidates the current status of suspected COVID-19 patient visits to an ED-BSC. This study may serve as a basis for the establishment and revision of clinical guidelines for ED-BSC.

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4일중 시간에 따른 병원 밖 심정지 예후: 도시전체 다기관 후향적 관찰연구

저자 : 류종화 ( Jong Hwa Ryu ) , 김정호 ( Jung Ho Kim ) , 류현욱 ( Hyun Wook Ryoo ) , 김종연 ( Jong-yeon Kim ) , 안재윤 ( Jae Yun Ahn ) , 문성배 ( Sungbae Moon ) , 이동언 ( Dong Eun Lee ) , 장태창 ( Tae Chang Jang ) , 진상찬 ( Sang Chan Jin ) , 문유호 ( You Ho Mun )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 1호 발행 연도 : 2022 페이지 : pp. 28-36 (9 pages)

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Objective: The characteristics and prognosis of out-of-hospital cardiac arrest (OHCA) patients can vary due to a variety of factors, including the time of the day. We tried to identify the characteristics and prognosis of OHCA in a Korean metro city based on the time of the day.
Methods: This citywide retrospective observational study was conducted from January 1, 2015, to November 31, 2020, in Daegu, Korea on patients over 18 years of age who were suspected of having a medical etiology of OHCA. We evaluated the characteristics and outcomes of OHCA, according to the time of day, divided into dawn (00:00-05:59), morning (06:00-11:59), afternoon (12:00-17:59), and night (18:00-23:59). The outcome variables were survival to hospital discharge and favorable neurological outcomes.
Results: The median age of the total of 4,783 OHCA patients in the study was 72.0 years of which 3,096 (64.7%) were males. The number of patients who survived was 317 (7.8%) and 301 (6.3%) were discharged with favorable neurological outcomes. There were 672 (14.0%) patients admitted at dawn, 1,607 (33.6%) in the morning, 1,379 (28.8%) in the afternoon, and 1,125 (23.5%) at night. After adjusting for the possible confounding variables, compared with the morning group, the survival to hospital discharge was low in the afternoon and the night (adjusted odds ratio [aOR], 0.69; 95% confidence interval [CI], 0.48-0.98 and aOR, 0.48; 95% CI, 0.32-0.74). In addition, favorable neurological outcomes were also low in the afternoon and the night compared with the morning (aOR, 0.59; 95% CI, 0.40-0.85 and aOR, 0.62; 95% CI, 0.41-0.93).
Conclusion: Diurnal differences in OHCA outcomes were observed. Identification of the diurnal OHCA characteristics will be necessary to devise an appropriate regional emergency medical services strategy.

KCI등재

5Factors predicting injury severity in driver traffic accidents

저자 : Chul-hwan Park , Sung-wook Park , Seok-ran Yeom , Soon Chang Park , Youngmo Cho , Byung Kwan Bae , Sang Kyoon Han

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 1호 발행 연도 : 2022 페이지 : pp. 37-44 (8 pages)

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Objective: The factors related to injury severity in accidents in Korea are unclear. This study helps primary physicians treat victims of traffic accidents with a high probability of severe injury during the initial evaluation in the emergency department (ED).
Methods: This study was conducted on patients who visited Pusan National University Hospital regional trauma center, Korea, between January 2017 and December 2019 due to involvement in automobile accidents as a driver. Multivariate logistic regression analysis was used to determine the relationship of factors with injury severity.
Results: A total of 973 patients were included. Of them, 316 (32.5%) were severely injured. In the multivariate logistic regression analysis, older age was significantly associated with more severe injury (odds ratio [OR], 1.030; 95% confidence interval [CI], 1.017-1.043; P<0.001). A significant difference was noted in injury severity according to the mode of transportation to the ED. Transportation via private ambulance was associated with more severe injury than via public ambulance (OR, 5.853; 95% CI, 3.986-8.594; P<0.001). The severe injury was more likely when the collision involved a large-sized vehicle (OR, 2.369; 95% CI, 1.466-3.826; P<0.001), or a fixed object (OR, 2.077; 95% CI, 1.326-3.254; P<0.001) compared to a small-sized vehicle. The group that did not wear a seat belt had more severe injuries than those who wore a seat belt (OR, 2.218; 95% CI, 1.421-3.463; P<0.001).
Conclusion: Injury severity was correlated with age, mode of transportation to the ED, type of collision and seat belt use. These results will help primary physicians assess critically ill patients.

KCI등재

6중증 외상 환자에서의 다발성 장기부전 발생 예측에 있어 젖산/알부민값의 유용성

저자 : 한상우 ( Sangwoo Han ) , 정성필 ( Sung Phil Chung ) , 좌민홍 ( Minhong Choa ) , 유제성 ( Je Sung You ) , 공태영 ( Taeyoung Kong ) , 박정민 ( Jungmin Park ) , 박인철 ( Incheol Park )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 1호 발행 연도 : 2022 페이지 : pp. 45-60 (16 pages)

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Objective: Early prediction of the multiple organ dysfunction syndrome (MODS) and providing early innovative treatment may improve outcomes in patients with severe trauma. Lactate and serum albumin levels, which are widely used markers predicting the severity of critically ill patients, tend to diverge during clinical deterioration. This study aimed to evaluate the clinical utility of the lactate/albumin ratio (LAR) as a predictive factor for MODS and 30-day mortality in patients with severe trauma.
Methods: This retrospective, observational cohort study was performed with patients prospectively integrated into a critical pathway for trauma. We analyzed severe trauma patients (Injury Severity Score≥16) admitted to the emergency department (ED), between January 1, 2011, and May 31, 2017. The outcomes were the development of MODS and 30- day mortality.
Results: In total, 348 patients were enrolled, of which 18 (5.2%) died within 96 hours of ED admission, and the remaining 330 patients (94.8%) were evaluated for the development of MODS. An increase in the LAR at admission (odds ratio, 1.618; P=0.028) was an independent predictor of MODS development. The area under the receiver operating characteristic curve (0.755) and Harrell's C-index (0.783) showed that LAR could predict MODS and 30-day mortality.
Conclusion: Initial LAR is an independent predictor of MODS development in patients with severe trauma. Our study results suggest that an elevated LAR can be a useful prognostic marker in patients with severe trauma.

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7코로나19 대유행 시기 전후 일개 지역 응급의료센터를 방문한 환자의 임상적 특성 분석

저자 : 최진국 ( Jingook Choi ) , 정해원 ( Haewon Jung ) , 안재윤 ( Jae Yun Ahn ) , 류현욱 ( Hyun Wook Ryoo ) , 문성배 ( Sungbae Moon ) , 조재완 ( Jae Wan Cho ) , 서강석 ( Kang Suk Seo ) , 박정배 ( Jungbae Park )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 1호 발행 연도 : 2022 페이지 : pp. 60-68 (9 pages)

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Objective: This study aimed at analyzing the clinical characteristics of patients visiting the emergency department (ED) and pre-triage clinic during the coronavirus disease 2019 (COVID-19) pandemic era in Daegu, South Korea.
Methods: We conducted a retrospective observational study by using the medical records of patients who visited the ED and pre-triage clinic from February 22 to March 31, 2020 and comparing them with the corresponding period in 2019.
Results: The number of patients visiting the ED per day decreased from 122 (115-138) to 77 (66-93). The percentage of patients with respiratory infection increased from 6.6% to 15.4% (P<0.001). The length of the ED stay increased from 269 (150-562) to 559 (293-941) minutes, especially in patients with fever (P<0.001). The rate of injured and less urgent patients decreased from 24.7 to 13.2 and 53.4% to 50.2%, respectively (P<0.001). Sixty-one-point nine percent of patients visiting the ED were triaged and discharged at the pre-triage clinic without entering the ED.
Conclusion: In the COVID-19 pandemic era, there was an increase in the proportion of patients with fever and respiratory symptoms and a decrease in the proportion of injured patients. At the pre-triage clinic, a significant number of patients with suspected COVID-19 or less urgent conditions were treated and discharged without their having to enter the ED.

KCI등재

8중증응급환자의 응급의료센터 재실시간에 따른 중증도 표준화 생존 분석

저자 : 강사율 ( Sayul Kang ) , 최유리 ( Yuri Choi ) , 이성우 ( Sung Woo Lee ) , 한갑수 ( Kap Su Han ) , 김수진 ( Su Jin Kim ) , 김원영 ( Won Young Kim ) , 강형구 ( Hyunggoo Kang ) , 홍은석 ( Eun Seog Hong ) , 정진우 ( Jinwoo Jeong )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 1호 발행 연도 : 2022 페이지 : pp. 69-83 (15 pages)

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Objective: The length of stay in the emergency department (ED) is a major contributor to ED overcrowding, which in turn negatively affects the quality of emergency care. Several efforts have been made to reduce the ED length of stay (EDLOS), including a mandatory target to limit ED-LOS within certain parameters. However, the association between EDLOS and treatment results is yet to be clarified. The authors investigated the influence of ED-LOS on patient survival by comparing severity-adjusted survival.
Methods: This study was a retrospective analysis of data registered in 2018 in the National Emergency Department Information System (NEDIS). Cases registered by the regional and local emergency centers were included for analysis. The standardized W scores (Ws) based on the Emergency Department Initial Evaluation Score were used to assess treatment outcomes represented by severity-standardized survival, and the correlation between the Ws and the ED-LOS was analyzed.
Results: A total of 2,281,526 cases were included for analysis. The overall mortality comprised 52,284 cases (2.3%) and the median ED-LOS was 165 minutes (interquartile range, 96-301). Although a longer ED-LOS was associated with poorer outcomes overall, the association was not apparent when an analysis of cases eligible for ED-LOS evaluation in the national evaluation program was carried out. Moreover, in the analysis of severe cases with a predicted survival probability of less than 0.9, an ED-LOS shorter than 6 hours was associated with significantly poorer severity-adjusted survival.
Conclusion: The study revealed that the current ED-LOS criteria used in the national evaluation program were not associated with better survival.

KCI등재

9코로나19 대유행 이후 폐렴 환자의 응급실 체류시간과 예후 변화

저자 : 하지성 ( Ji Sung Ha ) , 서상원 ( Sang Won Seo ) , 이장영 ( Jang Young Lee ) , 이원석 ( Won Suk Lee ) , 성원영 ( Won Young Sung ) , 이근택 ( Keun Taek Lee )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 1호 발행 연도 : 2022 페이지 : pp. 84-93 (10 pages)

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Objective: This study aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) outbreak on the emergency department length of stay (ED-LOS) and outcomes of patients admitted with pneumonia.
Methods: This was a retrospective observational study that included adult pneumonia patients admitted to the emergency department during the period from February to July 2019 and the corresponding period in 2020. After the COVID- 19 outbreak, many changes occurred in medical systems, causing prolonged ED-LOS. We divided ED-LOS into pre-, mid-, and post-ED-LOS and compared ED-LOS, hospital LOS and in-hospital mortality rates of pneumonia patients during the above-mentioned periods. In addition, a multivariable logistic regression analysis was performed to identify the risk factors leading to in-hospital mortality in 2020.
Results: A total of 365 patients were included in the study. Pre-ED-LOS, mid-ED-LOS, post-ED-LOS, and in-hospital mortality in the 2020 group were significantly higher than those of the 2019 group (P<0.05). Mid-ED-LOS (odds ratio [OR], 1.474; P=0.001) and post-ED-LOS (OR, 1.098; P=0.024) were identified as being independently associated with an increased risk of in-hospital mortality in 2020.
Conclusion: Our study shows that ED-LOS and in-hospital mortality increased after the COVID-19 pandemic. Mid-EDLOS and post-ED-LOS were independently associated with an increased risk of in-hospital mortality in patients with pneumonia in 2020.

KCI등재

10Mortality prognostic factors of COVID-19 in the emergency department during outbreak in Daegu, Korea: a multicenter retrospective study

저자 : Jong-yeon Kim , Jung Ho Kim , Hyun Wook Ryoo , Jae Yun Ahn , Sungbae Moon , Dong Eun Lee , Sang Hun Lee , You Ho Mun , Tae Chang Jang

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 33권 1호 발행 연도 : 2022 페이지 : pp. 94-105 (12 pages)

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Objective: We aimed to investigate the characteristics and prognostic factors of coronavirus disease 2019 (COVID-19) patients in the emergency departments (EDs) in Daegu, Korea, the region with the second regional outbreak worldwide.
Methods: We conducted a retrospective observational multicenter study using a population-based COVID-19 registry of EDs. We included the demographic, clinical and laboratory data. Cox proportional hazard regression analysis was performed to identify the prognostic factors of mortality.
Results: A total of 241 patients were included in this study. In the Cox hazard regression model (hazard ratio [95% confidence interval]), age (65-79 years: 3.531 [1.529-8.156], ≥80 years: 5.335 [2.229-12.770]), respiratory rate (RR) (>20 breaths/min: 2.025 [1.205-3.403], ≤11 breaths/min: 111.292 [30.845-401.555]), lymphocyte counts < 1.0×109/L (2.611 [1.494-4.739]), blood urea nitrogen (BUN) levels >23 mg/dL (2.047 [1.233-3.399]), aspartate aminotransferase (AST) levels> 40 IU/L (1.785 [1.009-3.158]) and neutrophil counts>6.3×109/L (1.638 [1.014-2.644]) were associated with mortality.
Conclusion: Age, RR, lymphocyte counts, BUN levels, AST levels and neutrophil counts were prognostic factors in COVID-19 patients in the ED. These factors can help effectively treat and reduce mortality through optimized management of COVID-19 patients, in places with limited emergency medical resources such as massive regional outbreaks.

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1원저 : 응급진료센터에 내원한 급성 담관염 환자에서 혈액요소질소/알부민 비를 이용한 28일 사망률 예측의 유용성

저자 : 강현솔 ( Hyun Sol Kang ) , 정성필 ( Sung Phil Chung ) , 유제성 ( Je Sung You ) , 주영선 ( Young Seon Joo ) , 공태영 ( Tae Young Kong ) , 고동률 ( Dong Ryul Ko ) , 홍정화 ( Jung Hwa Hong ) , 박유석 ( Yoo Seok Park ) , 정현수 ( Hyun Soo Chung ) , 박인철 ( In Cheol Park )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 26권 6호 발행 연도 : 2015 페이지 : pp. 491-499 (9 pages)

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Purpose: We evaluated the blood urea nitrogen (BUN)/albumin (B/A) ratio in patients with acute cholangitis to determine the prognostic significance of the B/A ratio as a marker of early mortality in critically ill patients with acute cholangitis. Methods: We retrospectively analyzed medical records in two emergency departments (ED) and screened eligible adult patients who were admitted to the ED with acute cholangitis. The B/A ratio was evaluated as the BUN value divided by albumin level on each hospital day. The clinical outcome was mortality after 28 days. Results: A total of 461 patients with acute cholangitis were included in this study. Multivariate Cox proportional hazard models showed that higher B/A ratio on ED admission (day 1) (Hazard Ratio (HR): 1.182; 95% Confidence Interval (CI): 1.076-1.298, p<0.001) and day 4 (HR: 1.192; 95% CI: 1.019-1.395, p=0.028) were independent risk factors for mortality at 28 days. Our study showed that the increased 28-day mortality was associated with a B/A ratio >6.83 on day 1 (HR: 4.065; 95% CI: 4.123-43.737, p<0.001) and a higher B/A ratio (>6.26) on day 4 (HR: 7.16; 95% CI: 1.412-36.333, p=0.018) in patients with acute cholangitis. Conclusion: The ratio of BUN to albumin on ED admission is a promising prognostic marker of 28-day mortality in patients with acute cholangitis.

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2원저 : 급성 신우신염 환자의 중증도 예측에 CRP velocity의 유용성

저자 : 김재진 ( Jae Jin Kim ) , 강수 ( Su Kang ) , 한승백 ( Seung Baek Han ) , 이형민 ( Hyung Min Lee ) , 이재성 ( Jae Sung Lee ) , 정광율 ( Kwang Yul Jung ) , 김성진 ( Seong Jin Kim ) , 백진휘 ( Jin Hui Paik )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 26권 6호 발행 연도 : 2015 페이지 : pp. 500-508 (9 pages)

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Purpose: C-reactive protein (CRP) velocity is value of the CRP level divided by the time after fever start. The aim of this study was to attempt to determine the usefulness of CRP velocity to predict the severity of acute pyelonephritis (APN). Methods: We retrospectively reviewed medical records of patients who visited the emergency department (ED) and were diagnosed with APN for five years. The patients underwent computed tomography (CT) in the ED. The characteristics and laboratory findings compared with the CT group were classified from group I to group V as severity of APN. The patients were grouped according to mild and severe based on the CT groups for comparison of area under the curve. Patients who had fever within 24 hours were extracted and the same analysis was performed. Results: A total of 199 patients were enrolled in our study. The CT groups were classified as follows: group 1 (N=24); group 2 (N=25); group 3 (N=80); group 4 (N=58); group 5 (N=12). Statistically significant differences in laboratory results including CRP, CRP velocity, age, and past history of hypertension were found between mild and severe group. The area under ROC curve of CRP and CRP veloci-ty was 0.888 and 0.841 (p<0.05). For APN patients within 24 hours, AUROC of CRP and CRP velocity were 0.871 and 0.949 (p<0.05). However, AUROC comparison did not show statistically significant differences within CRP and CRP velocity (p=0.1410). Conclusion: In APN patients who had fever within 24 hours, CRP and CRP velocity had predictive value for severity of APN.

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3Original Articles : The Application of a Dried Balanced Heparin Syringe Can Attenuate the Dilution Effect in Rapid Point-of-care Potassium Testing for the Early Identification of Hyperkalemia in the Emergency Department

저자 : Min Kyung Seung , Sung Phil Chung , Yoo Seok Park , Hyun Soo Chung , Hye Sun Lee , Young Seon Joo , Je Sung You , In Cheol Park

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 26권 6호 발행 연도 : 2015 페이지 : pp. 509-516 (8 pages)

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Purpose: Current methods to evaluate the blood concentration of potassium (K) on point-of-care (POC) are influenced by the relative volumes of heparin and arterial blood. Blood potassium concentration may be underestimated with a high volume of heparin or low volume of blood. This dilution effect can produce false negative results that negatively affect decision-making of clinicians and throw critical patients into crisis. We hypothesized that the application of a dried balanced heparin syringe in rapid POC-K+ could attenuate the dilution effect and would more accurately and consistently measure the concentration of potassium compared with reference testing in emergency situations. Methods: This retrospective study was conducted between January, 1, 2008 and September, 30, 2013 at an urban hospital affiliated with our institution. To attenuate the dilution effect, dried balanced heparin syringes (HS) were also used between October, 1, 2011 and September, 30, 2013. Concentrations of potassium were compared between the dried balanced HS group and the liquid HS group. The reliability of each of these outcome measures was assessed using intra-class correlation coefficient analysis. Results: Application of dried balanced HS improved the degree of concordance for potassium using two different assays. The false negative rate was significantly improved from 9.1% (95% CI 7.3-11.0) to 5.7% (95% CI 3.5-8.0) in the dried balanced HS group compared with the liquid HS liquid group (p=0.037). Conclusion: This study suggests that the usage of dried balanced HS could attenuate the dilution effect in rapid POC-K+ and predict potassium levels more accurately for identification of patients at risk of hyperkalemia in emergency situations.

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4원저 : 상부위장관 출혈 환자에서의 조기 고위험군 예측인자 및 사망예측 인자로서의 초기적혈구 크기 분포 폭의 유용성: 예비 임상연구

저자 : 김신영 ( Sin Young Kim ) , 김진용 ( Jin Yong Kim ) , 이정훈 ( Jung Hoon Lee ) , 이경룡 ( Kyeong Ryong Lee ) , 홍대영 ( Dae Young Hong ) , 백광제 ( Kwang Je Baek ) , 박상오 ( Sang O Park )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 26권 6호 발행 연도 : 2015 페이지 : pp. 517-525 (9 pages)

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Purpose: The aim of the study is to evaluate the efficacy of initial red cell distribution width (RDW) levels in the emergency department (ED) in predicting early 28-day mortality and high risk patients for early intervention in patients with upper gastrointestinal hemorrhage (UGIB). Methods: This is a retrospective clinical study including UGIB patients in the ED. All data were collected through electronic medical records. The two major endpoints were early 28-day mortality and high risk patients. We assessed the relationship between initial RDW level and high risk patients and 28-day mortality. Results: A total of 198 patients were analyzed. There were 160 high risk patients (81.8%) and 12 non-survival patients (6.1%). The mean RDW value in high risk patients was higher than in non-risk patients (15.4±2.8 vs. 13.6±1.8%; p<0.0001). Area under curve (AUC) in Receiver-operatory characteristic (ROC) curve for RDW in high risk patients was 0.735 (95% Confidence Interval: 0.649-0.821; p<0.001) with an optimal cutoff value of 13.45% with sensitivity of 69.4% and specificity of 73.7%. The mean value of RDW in non-survivals was higher than in survivals (18.0±3.3 vs. 14.9±2.6 %; p<0.0001). AUC for RDW in predicting 28-day mortality was 0.793 (95% CI: 0.684-0.902; p<0.001) with an optimal cutoff value of 15.95% with sensitivity of 83.3% and specificity of 71.5%. Conclusion: RDW level in initial state might be helpful in predicting high risk patients for early intervention and 28- day mortality in UGIB in the ED.

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5원저 : 병원 전 심정지 후 자발순환이 회복된 환자에서 치료적 저체온 요법을 시행하는데 있어 치료온도까지 도달하는데 영향을 주는 인자 분석

저자 : 유재진 ( Jae Jin Ryou ) , 김진주 ( Jin Joo Kim ) , 황인철 ( In Cheol Hwang ) , 조진성 ( Jin Seong Cho ) , 임용수 ( Yong Su Lim ) , 양혁준 ( Hyuk Jun Yang ) , 이근 ( Keun Lee )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 26권 6호 발행 연도 : 2015 페이지 : pp. 526-533 (8 pages)

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Purpose: The relationship between prognostic factors and outcomes of post-cardiac arrest patients treated with therapeutic hypothermia was analyzed. Methods: We conducted a tertiary center retrospective study of post-cardiac arrest patients treated with therapeutic hypothermia between January 2008 and December 2012. We investigated the association of the following factors with outcomes: BMI, time to ROSC, number of vasoactive drugs, smoking, alcohol, and short time to therapeutic range in hypothermia. Results: A total of 251 patients were enrolled in this study. Large number of vasoactive drugs was a prognostic factor of 3-month mortality (adjusted OR 1.96, 95% CI:1.41-2.71, p<0.001). Obesity (BMI≥25 kg/m2) was not associated with delayed time to therapeutic range in hypothermia. Both univariate and multivariate analysis showed that high initial BT (β(SE)=63.64 (11.53), p<0.001) and a small number of vasoactive drugs (β(SE)=18.66(8.74), p=0.034) were independent predictors of delayed time to therapeutic range in hypothermia. Conclusion: In this study, a small number of vasoactive drugs showed a significant influence on delayed time to therapeutic range in patients receiving therapeutic hypothermia after return of spontaneous circulation after out-of-hospital cardiac arrest.

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6원저 : 일반인 심폐소생술 교육에의 현황 및 성향 분석

저자 : 김성훈 ( Seong Hun Kim ) , 노우영 ( Woo Young Nho ) , 이미진 ( Mi Jin Lee ) , 황성오 ( Sung Oh Hwang ) , 차경철 ( Kyoung Chul Cha ) , 조규종 ( Gyu Chong Cho ) , 최마이클승필 ( Michael Sung Pil Choe )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 26권 6호 발행 연도 : 2015 페이지 : pp. 534-542 (9 pages)

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Purpose: The purpose of this study was to perform a comparative analysis of training methodology between accessibility and needs for cardiopulmonary resuscitation (CPR) in the community. Methods: This population-based nationwide study used a structured questionnaire via telephone survey in 2011- 2012. The study was conducted by stratified cluster sampling to assess the impact of age, gender, and geographic regions (n=1,000). The contents of the questionnaire consisted of awareness, prior training status, and willing methodology of public CPR training. Results: Thirty-eighty percent of respondents (n=381) had previously been taught CPR. Military service, education facility/ school, and workplace were 3 major resources of public CPR training among previously educated subjects (45%, 23%, and 9%, respectively). Seventy-two percent of trainees had been taught less than an hour and only 60% were trained using an individual manikin for CPR practice. Fiftynine percent (n=593) had willingness to participate in CPR education and 40% of subjects wished to learn in a hospital or health care facility. Place of CPR training showed a major difference between previous experiences and willing groups in the community. Women and elders were more likely to learn CPR. Almost all respondents wanted short-duration learning (<1 hour), however, it was similar in the groups. Conclusion: In the scope of the public, training site showed a significant discrepancy between previous accessibility and needs of layperson. They prefer a highly accessible location and method with relatively short-practice programs.

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7원저 : 녹화 영상 분석을 통한 일개 권역 응급의료센터에서 시행된 심폐소생술의 질에 관한 고찰

저자 : 양의석 ( Eui Seok Yang ) , 정원준 ( Won Joon Jeong ) , 조성욱 ( Sung Uk Cho ) , 조용철 ( Yong Chul Cho ) , 유연호 ( Yeon Ho You ) , 이준완 ( Jun Wan Lee ) , 유승 ( Seung Ryu )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 26권 6호 발행 연도 : 2015 페이지 : pp. 543-550 (8 pages)

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Purpose: Maintaining the quality of CPR is connected with improvement in survival rates, but CPR performance in the field does not always fulfill the guidelines. Therefore, many ways to obtain the quality of CPR have been studied and tried, including CPR education, manikin training, mechanical CPR, audio-visible feedback system, and video-recording system, et cetera. The aim of our study is to determine how CPR procedures are actually performed on the scene by real-time video recording. Methods: Digital video of CPR cases was obtained from April 2014 to March 2015 in a wide regional emergency medical center. The video was analyzed by two physicians in the emergency department. We evaluated quality of major CPR variables including compression rate, hands-off time, chest compression fraction, ventilation rate, et cetera. Results: A total of 52 cases were analyzed. Mean chest compression rate was 122.43±10.74/min, and mean ventilation rate was 7.47±2.58/min. Performance of adequate compression-to-ventilation ratio before insertion of advanced airway was 37%. Mean recognition to compression time was 31.31±27.32 seconds, and proportion of chest compression interruption time exceeding 10 seconds was 7.6%. Mean chest compression fraction was 91.12± 0.4%. In five out of 25 cases of defibrillation, chest compression was interrupted during charging, resulting in prolongation of chest compression interruption time. Conclusion: In this study, overall performance met the qualification of AHA guidelines. However, poor compliance was observed for some parameters. Continuous education and feedback are required in order to make an improvement in these areas.

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8원저 : 요양병원과 비요양병원에 입원한 노인환자에게 시행된 심폐소생술의 역학적 특징과 결과의 비교: 건강보험심사평가원 자료기반

저자 : 이중호 ( Jung Ho Lee ) , 제상모 ( Sang Mo Je ) , 정운혁 ( Woon Hyuk Jung ) , 이수형 ( Soo Hyung Lee ) , 김철수 ( Cheol Su Kim ) , 배진건 ( Jin Kun Bae ) , 정태녕 ( Tae Nyoung Chung ) , 김의중 ( Eui Chung Kim ) , 최성욱 ( Sung Wook Choi ) , 김옥준 ( Ok Jun Kim )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 26권 6호 발행 연도 : 2015 페이지 : pp. 551-556 (6 pages)

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Purpose: The aim of this study was to investigate the epidemiological characteristics and outcomes for in-hospital cardiac arrest (IHCA) patients who were 65 years and older between nursing care hospitals versus non-nursing care hospitals in Korea. Methods: This is a population study enumerating 24,203 IHCA patients registered in Korean Health Insurance Review and Assessment Service in 2013. The Cardiopulmonary resuscitation (CPR) outcomes including survival discharge and 30 day survival rate were analyzed. The main diagnoses of IHCA patients were categorized according to the Korean Standard classification of Disease version 6 (KCD-6). All data of patients who were CPR recipients in nursing care hospitals were compared with those of CPR recipients in non-nursing care hospitals. Results: The overall survival discharge and 30 day survival rate were 29.5% and 28.1%, respectively. However, the survival discharge rate of IHCA patients was significantly low in nursing care hospitals compared to non-nursing care hospitals (20.0% vs. 30.0%, p<0.001). The 30 day survival rate was similarly low in nursing care hospitals (20.1% vs. 28.4%, p<0.001). The most common diagnosis of IHCA patients was respiratory disease in nursing care hospitals and cardiovascular disease in non-nursing care hospitals. The most common respiratory disease leading to IHCA in nursing care hospitals was acute respiratory infections. Conclusion: The survival rate after IHCA was lower in nursing care hospitals, and the major diagnosis leading to CPR was acute respiratory infections rather than chronic underlying diseases. Therefore, it is crucial to set higher standards in performing CPR and controlling infections innursing care hospitals nationwide.

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9원저 : 2인 구조자 심폐소생술에서 인공호흡 횟수를 세는 것이 가슴압박 중단시간과 가슴압박분율에 미치는 영향: 마네킹 선행 연구

저자 : 여현철 ( Hyun Chul Yeo ) , 이현정 ( Hyun Jung Lee ) , 나지웅 ( Ji Ung Na ) , 신동혁 ( Dong Hyuk Shin ) , 한상국 ( Sang Kuk Han ) , 최필조 ( Pil Cho Choi ) , 이정훈 ( Jeong Hun Lee ) , 서준석 ( Jun Seok Seo )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 26권 6호 발행 연도 : 2015 페이지 : pp. 557-562 (6 pages)

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Purpose: The aim of this study was to estimate the effect of counting numbers out for giving breaths on the interruption time (IT) of chest compressions (CCs) and chest compression fraction (CCF) in the 2-rescuer cardiopulmonary resuscitation (CPR). Methods: Thirty medical students were enrolled in this randomized control simulation study, and were randomly divided into the control group and the study group. Both groups performed 2-rescuer CPR for 5-cycles with giving breaths using a bag-mask. Only participants in the study group were instructed to count numbers out for each breath verbally (“one, two”) at the end point of each inspiration period and immediately perform CCs at the point of counting “two”. Results: However, no differences in terms of depth, rate, incorrect location, and duty cycle of CCs, as well as ventilation volume of each breath, time to delivery of two breaths, and counts of breathing during 1 minute were observed between the two groups. Conclusion: The study group had significantly shorter IT and higher CCF compared with the control group. And no significant differences in the other measured parameters of CPR quality were observed between the two groups.

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10원저 : 비숙련자에서 매킨토시 후두경과 일회용 후두경을 이용한 기관 삽관의 비교: 마네킹연구

저자 : 이은형 ( Eun Hyeong Lee ) , 최재형 ( Jae Hyung Choi ) , 임훈 ( Hoon Lim ) , 조영순 ( Young Soon Cho ) , 이정원 ( Jung Won Lee ) , 이보라 ( Bo Ra Lee )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 26권 6호 발행 연도 : 2015 페이지 : pp. 563-570 (8 pages)

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Purpose: Disposable one piece laryngoscope (DOL), which probably carries a lower risk of infection than conventional reusable ones, is the only device which has received approval by the Korean Ministry of Food and Drug safety. In the current study, we evaluated the effectiveness and usefulness of the conventional Macintosh laryngoscope (MAC) and DOL in inexperienced personnel. Methods: A randomized crossover trial was designed. Ninety seven participants (Medical students, Paramedic students) were enrolled and performed endotracheal intubation with MAC and DOL in Manikin (SimMan.. Laedal Medical Corporation, Stravanger; Norway). Cormack- Lehane grade, the number of attempts, time required for intubation, and dental compression were measured to evaluate the effectiveness. The participants were given a questionnaire survey on the usefulness of laryngoscopes (easier to use, lightness, brightness, manageable to use, delivering power, safer for patients, intense to use). Results: Regarding the aspect of effectiveness, a significant difference in dental compression was observed between DOL and MAC (p=0.011). Others showed no sig-nificant differences. Regarding the aspect of usefulness, DOL was superior to MAC except in delivering power. Conclusion: The DOL appears to be a reasonable device for use in emergency airway management. It should be verified for effectiveness and usefulness of newly developed equipment in emergency airway management because it is directly related to life.

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