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대한응급의학회지 update

Journal of the Korean Society of Emergency Medicine

  • : 대한응급의학회
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수록범위 : 1권1호(1990)~32권4호(2021) |수록논문 수 : 2,641
대한응급의학회지
32권4호(2021년 08월) 수록논문
최근 권호 논문
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KCI등재

1급성 호흡부전 환자에서 고유량 비강캐뉼라 적용 실패 시 기관삽관 및 기계호흡기 적용 예측 지표

저자 : 장진국 ( Jin-guk Jang ) , 박영숙 ( Young-sook Park ) , 박하영 ( Ha-young Park ) , 황태식 ( Tae-sik Hwang )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 4호 발행 연도 : 2021 페이지 : pp. 281-289 (9 pages)

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Objective: The use of a high flow nasal cannula (HFNC) might cover the gap between conventional oxygen therapy and mechanical ventilation in the management of acute respiratory failure patients and could be a significant factor in determining patient outcomes. Early predictors of HFNC failure may help a clinician decide whether to shift the patient to a mechanical ventilator. We aimed at identifying the predictors associated with HFNC failure and the application of a mechanical ventilator using arterial blood gas analysis (ABGA).
Methods: We retrospectively analyzed patients who were admitted to the emergency room at a single center with respiratory distress and a PaO2/FiO2 ratio (ratio of arterial partial pressure of oxygen to fraction of inspired oxygen) of less than 300. Comparing keeping and weaning HFNC groups with the escalation group, we sought to identify a few discriminating factors. Initial ABGA was done when the patients entered the emergency room and this was followed up within 2 hours after HFNC therapy.
Results: Two hundred and eighteen patients were enrolled and of these HFNC therapy succeeded in 153 and failed in 65. At baseline Glasgow Coma Scale, follow-up (F/U) pH, ΔpH, and F/U respiratory rate-oxygenation index were lower and pro-brain natriuretic peptide, initial lactate, F/U lactate, ΔPCO2, heart rate, acidosis, consciousness, oxygenation, respiratory rate score, Acute Physiology And Chronic Health Evaluation score, Simplified Acute Physiology Score, and Sequential Organ Failure Assessment score were significantly higher in the HFNC failure group. The results of the multivariate analysis indicated that initial lactate (odds ratio [OR], 1.215; 95% confidence interval [CI], 1.081-1.366; P=0.001) and ΔpH (OR, 0.000; 95% CI, 0.000-0.018; P<0.001) were independently associated with the prediction of application of the mechanical ventilator.
Conclusion: Patients who had higher initial lactate levels and insufficiently corrected pH after HFNC therapy may need to be monitored carefully and escalation of oxygen therapy may need to be considered.

KCI등재

2생애 주기에 따른 낙상 환자의 발생 특성과 사망 위험 요인

저자 : 유재영 ( Jai Young Yoo ) , 김동원 ( Dong Won Kim ) , 김상미 ( Sang Me Kim ) , 안무업 ( Moo Eob Ahn ) , 서정열 ( Jeong Yeol Seo ) , 이태헌 ( Tae Hun Lee ) , 박혜선 ( Hye Seon Park )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 4호 발행 연도 : 2021 페이지 : pp. 290-298 (9 pages)

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Objective: This study aimed at identifying the incidence rate and characteristics of patients who had suffered falls, classifying them by life cycle and factors that affect mortality.
Methods: The Korean National Hospital Discharge In-depth Injury Surveys (KNHDIS) from 2007 to 2016 were used to investigate the sex, age, place, season, payment method, underlying disease, and the death of hospitalized patients due to falls.
Results: The number of hospitalized patients increased with age. In all life cycles except old age, men were hospitalized more than women. The payment method for treatment was 66.1% through national health insurance, 6.6% through medical aid, and 27.3% through other sources. Falls were most common in winter and occurred frequently at home and on the road. In terms of the number of patients, the compound annual growth rate was 0.9% for men and 3.7% for women. In terms of the number of deaths in hospitals, the compound annual growth rate was -1.9% for men and -7.2% for women. Mortality risk was high in men in middle adulthood and old age, in patients with underlying diseases, and in patients who suffered a fall in their homes.
Conclusion: The number of patients from falls is increasing, but the deaths of hospitalized fall patients are decreasing. Mortality risk was high in men in middle adulthood and old age, in patients with underlying diseases, and in patients who suffered falls in their homes.

KCI등재

3기상 요소와 자살 시도 후 일개 응급의료센터로 내원한 환자 수 사이의 연관성

저자 : 명재영 ( Jae Yeong Myeong ) , 이준영 ( Juneyoung Lee ) , 박상현 ( Sang Hyun Park ) , 우선희 ( Seon Hee Woo ) , 김대희 ( Daehee Kim ) , 설승환 ( Seung Hwan Seol ) , 이운정 ( Woon Jeong Lee )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 4호 발행 연도 : 2021 페이지 : pp. 299-306 (8 pages)

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Objective: This study was conducted to investigate the association between meteorological factors and the number of patients who visited an emergency department after suicide attempts daily.
Methods: We conducted a retrospective analysis study of 359 patients who visited an emergency department after suicide attempts from January 1, 2016, to December 31, 2016. We used the Poisson regression model to analyze the association.
Results: Three hundred and fifty-nine patients were enrolled in this study. According to the Poisson regression analysis, the average temperature on the day of visit (adjusted odds ratio [aOR], 1.038; 95% confidence interval [CI], 1.018-1.058), relative humidity (aOR, 0.987; 95% CI, 0.976-0.997), and solar radiation (aOR, 0.965; 95% CI, 0.939-0.993) were meteorological factors associated with the daily number of patients in the non-violent suicidal attempt group.
Conclusion: This study showed that meteorological factors are associated with the number of patients who visited an emergency department after suicide attempts daily.

KCI등재

4Characteristics of alcohol-related non-traffic accident trauma patients

저자 : Seong Jun Eo , Suk Hee Lee , Young Woo Seo , Gyun Moo Kim , Tae Chang Jang , Seung Hyun Ko

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 4호 발행 연도 : 2021 페이지 : pp. 307-314 (8 pages)

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Objective: The purpose of this study was to analyze the characteristics of alcohol-related non-traffic accident trauma patients.
Methods: A total of 2,582 non-traffic accident patients, above 16 years old, who visited the emergency department (ED) from July 1, 2016, to June 30, 2017, were retrospectively analyzed. The patients were categorized as alcohol group (A group) and no alcohol group (NA group) after checking their electronic medical records. Their general characteristics, the severity of their injury, and their ED length of stay were compared.
Results: The A group included younger patients, a higher percentage of males, and a higher frequency of visits to the ED via the 119 ambulance route than the NA group. The A group had a higher proportion of patients being struck by a person or object in terms of the mechanism of injury, intentional violence, and head injuries, especially in the face as compared to the NA group. In terms of the severity of the injury, the Injury Severity Score was lower in the A group than in the NA group, and the ratio of bone fracture and/or cerebral hemorrhage was also lower. As per the survey, the A group tended to stay in the ED longer than the NA group.
Conclusion: The characteristics of alcohol-related non-traffic accident trauma patients show that they have a relatively long stay in the ED, a high ratio of facial injury with low trauma severity, and need professional treatment facilities with specialized personnel and equipment.

KCI등재

5뇌동맥류 파열에 의한 뇌지주막하 출혈 환자의 신경학적 예후 예측 인자로서 델타 뉴트로필 인덱스의 유용성

저자 : 이용희 ( Yonghee Lee ) , 유제성 ( Je Sung You ) , 공태영 ( Taeyoung Kong ) , 이혜선 ( Hye Sun Lee ) , 전소영 ( Soyoung Jeon ) , 이종욱 ( Jong Wook Lee ) , 황현아 ( Hyuna Hwang ) , 이혁민 ( Hyukmin Lee ) , 정현수 ( Hyun Soo Chung ) , 박인철 ( Incheol Park ) , 정성필 ( Sung Phil Chung )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 4호 발행 연도 : 2021 페이지 : pp. 315-327 (13 pages)

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Objective: Aneurysmal subarachnoid hemorrhage (SAH) is a common emergency condition, resulting in high morbidity and mortality. The delta neutrophil index (DNI), which reflects the fraction of circulating immature granulocytes, is significantly associated with systemic inflammation after infection or sterile injury. Aneurysmal SAH also leads to systemic inflammation after a brain injury. This study aimed to evaluate the relationship between the DNI and poor neurologic outcomes in patients with aneurysmal SAH.
Methods: We retrospectively identified patients (>18 years old) with aneurysmal SAH consecutively admitted to the emergency department (ED) between January 1, 2011, and November 30, 2018. The diagnosis of aneurysmal SAH was confirmed using clinical and radiological findings. DNI was determined at 0, 24, 48, and 72 hours after ED admission. The primary result was a poor neurologic outcome using the modified Rankin scale.
Results: A total of 352 patients with aneurysmal SAH were included in this study. A multivariable logistic regression model revealed that a high value of DNI at 24 hours after ED admission was a strong independent predictor of poor neurologic outcome upon discharge (odds ratio [OR], 1.471; 95% confidence interval [CI], 1.081-2.001; P=0.014). Among patients with aneurysmal SAH, DNI >1.0% at 24 hours was significantly associated with poor neurologic outcomes upon discharge (OR, 5.037; 95% CI, 3.153-8.044; P<0.001).
Conclusion: DNI can be determined easily and rapidly after ED admission without any additional cost or time burden. A high DNI value at 24 hours after ED admission is significantly associated with a poor neurologic outcome upon discharge among patients with aneurysmal SAH.

KCI등재

6노인 발열 환자에 있어 전산화단층촬영 진행과 응급실 재내원과의 상관 관계

저자 : 노민형 ( Minhyung Noh ) , 조준호 ( Junho Cho ) , 범진호 ( Jinho Beom ) , 한은아 ( Eunah Han )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 4호 발행 연도 : 2021 페이지 : pp. 328-336 (9 pages)

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Objective: The number of elderly people visiting emergency rooms is rapidly increasing. Fever is one of the common complaints of patients who come to the emergency room, and it is often difficult to determine its cause in elderly patients only through basic examinations and tests. This study sought to verify the relationship between computed tomography and emergency department revisits of febrile elderly patients.
Methods: This study is a retrospective medical record analysis study. Patients who came to our emergency room between September 2016 and September 2019, aged 65 years or more, and with body temperature higher than 37.8℃ at the time of presentation or during their stay in the emergency room were enrolled. Patient age, sex, vital signs at triage, laboratory tests, whether computed tomography (CT) was conducted or not were analyzed. The primary outcome was set as revisits to the emergency department within 72 hours after discharge, due to any reason.
Results: Three thousand two hundred and forty patients were enrolled and of these 289 patients revisited the emergency department (ED). In the revisit (-) group, CT was performed on 44.09% of patients and 54.67% of patients in the revisit (+) group thus showing a statically significant difference.
Conclusion: This study showed that in elderly patients with fever presenting to the ED, patients who underwent a CT had 1.558 higher odds of revisit to the ED compared to patients who did not undergo a CT. From this result, it should be considered that the decision to discharge the febrile elderly patients based on the results of CT examination may not be appropriate.

KCI등재

7Magnetic resonance imaging as the first diagnostic imaging modality for pregnant women with suspected acute appendicitis

저자 : Jae Hwan Kim , Jonghwan Shin , Hui Jai Lee , Kyoung Min You , Jin Hee Jung

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 4호 발행 연도 : 2021 페이지 : pp. 337-343 (7 pages)

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Objective: The sensitivity of ultrasonography is poor in pregnant women with suspected appendicitis. Additional magnetic resonance imaging (MRI) is usually required, which can delay the diagnosis and surgical intervention. We hypothesized that the use of MRI as the first diagnostic tool could increase the detection rate and reduce the time for diagnosis. Therefore, we sought to investigate the diagnostic yield of ultrasonography vs. MRI and the emergency department length of stay (ED-LOS) of pregnant women with suspected appendicitis.
Methods: This was a retrospective, observational study in the ED of a single tertiary teaching hospital from January 2010 to December 2017. Patients who underwent ultrasonography or MRI or both were enrolled. The primary outcome was the diagnostic yield of acute appendicitis and the ED-LOS. The secondary outcome was the proportion of complicated appendicitis cases.
Results: A total of 145 pregnant women were enrolled (ultrasonography only, n=73; MRI only, n=26; both ultrasonography and MRI, n=46). The diagnostic yield was 23.5% (28/119) by ultrasonography and 79.2% (57/72) by MRI. The diagnostic yield of ultrasonography was significantly lower than that of MRI, especially in the second and third trimesters. The ED-LOS was significantly longer in the ultrasonography plus MRI group than that in the MRI-only group (9 hours vs. 6 hours, P=0.002).
Conclusion: In this study, MRI had a higher diagnostic yield than ultrasonography and can reduce the time to diagnosis. Thus, MRI should be considered as the first diagnostic tool for suspected acute appendicitis in pregnant women.

KCI등재

8흉통 노인 환자에게 침상 옆 현장 초음파 검사는 충분히 시행되고 있나?: 응급센터에 내원한 비외상 환자를 중심으로

저자 : 주지상 ( Jeesang Ju ) , 강보승 ( Bossng Kang ) , 김창선 ( Changsun Kim ) , 신현구 ( Hyungoo Shin ) , 조용일 ( Yongil Cho ) , 이준기 ( Joonkee Lee )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 4호 발행 연도 : 2021 페이지 : pp. 344-352 (9 pages)

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Objective: The bedside on-site ultrasound examination is a very useful diagnostic test for medically ill elderly emergency patients. However, it is not known whether it is being sufficiently used in the real world scenario. We investigated this aspect in patients with chest pain in two emergency departments in the Seoul metropolitan area.
Methods: Elderly patients with chest pain who visited the two emergency departments from January 2019 to December 2019 were recruited using the 'cardiogenic pain' code, which is the third step classification of the Korean Triage and Acuity Scale, and their medical records were reviewed to confirm whether an emergency physician-performed ultrasound prescription code was entered.
Results: Of the 744 elderly patients with chest pain, 66 were given bedside on-site ultrasound examinations. The rate of examination was 8.8%. Among the emergency departments, the local emergency departments accounted for 33 out of 389 patients (8.5%), and the regional emergency department accounted for 33 out of 355 (9.3%).
Conclusion: These results raise the need to check the extent of bedside on-site ultrasound examinations that are conducted in the initial care of medically ill emergency elderly patients nationwide.

KCI등재

9급성 자리공 중독 환자의 임상 양상과 중증 중독과 관련된 인자

저자 : 심동오 ( Dong O Sim ) , 이재백 ( Jae Baek Lee ) , 진영호 ( Young Ho Jin ) , 정태오 ( Tae Oh Jeong ) , 김소은 ( So Eun Kim ) , 오태환 ( Tae Hwan Oh ) , 이정문 ( Jeong Moon Lee ) , 윤재철 ( Jae Chol Yoon )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 4호 발행 연도 : 2021 페이지 : pp. 353-361 (9 pages)

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Objective: This study evaluated the clinical features of acute Phytolacca poisoning and investigated the prognostic factors associated with severe poisoning.
Methods: This is a retrospective observational study using the data of patients presenting with acute Phytolacca poisoning. Demographic data, toxicological data, vital signs, laboratory data, and electrocardiographic data were collected. Study patients were divided into mild and severe poisoning patients. After a univariate analysis, binary logistic regression analysis, which used 'severe poisoning' as a dependent variable, was performed to figure out the independent variables. In addition, the area under the curve and the cut-off value of independent variables were suggested by using receiver operating characteristics analysis.
Results: Most poisonings (80.5%) occurred in winter and spring. Most patients (98.4%) ingested the root of Phytolacca. It took 2 hours from ingestion to the beginning of the symptoms (interquartile range, 1.0-3.0) which included nausea/vomiting (98.4%), abdominal pain (58.6%), or diarrhea (53.1%). Severe poisoning developed in 21 patients (16.4%). For prediction of severe poisoning, the adjusted odds ratio of time from ingestion to the onset of symptoms was 0.18 (95% confidence interval [CI], 0.05-0.61) and that of the amount of ingestion was 1.42 (95% CI, 0.99-2.03). The area under the curve of time from ingestion to the onset of symptoms (≤1 hour) was 0.81 (95% CI, 0.73-0.88) and that of the amount of ingestion (>1.5 knuckles) was 0.75 (95% CI, 0.65-0.83).
Conclusion: Acute Phytolacca poisoning has clinical features of acute enterocolitis. Severe poisoning could develop especially in patients with a rapid onset of symptoms (≤1 hour) and ingesting over 1.5 knuckles.

KCI등재

10119 대원에 의하여 지면 위 자세에서 이루어지는 기관내 삽관에서 비디오 후두경과 부지의 사용이 가지는 효과: 무작위 시뮬레이션 연구

저자 : 송형우 ( Hyung Woo Song ) , 강구현 ( Gu Hyun Kang ) , 장용수 ( Yong Soo Jang ) , 김원희 ( Wonhee Kim ) , 최현영 ( Hyun Young Choi ) , 김재국 ( Jae Guk Kim ) , 이윤재 ( Yoonje Lee ) , 김태용 ( Tae Yong Kim ) , 방성환 ( Sung Hwan Bang )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 4호 발행 연도 : 2021 페이지 : pp. 362-370 (9 pages)

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Objective: This study aimed to evaluate the efficacy of a bougie and glidescope video laryngoscope (GVL) for ground intubation by novice prehospital caregivers. We hypothesized that the intubation outcome using a bougie or GVL was superior to that using the Macintosh laryngoscope (MCL) with a stylet (MCLS) in ground intubation.
Methods: A randomized crossover manikin study was conducted. Studied groups were categorized into 4 according to the intubation devices used; MCLS, Macintosh laryngoscope with bougie (MCLB), glidescope video laryngoscope with a stylet (GVLS), and glidescope video laryngoscope with bougie (GVLB). The primary outcome was the total endotracheal intubation time and the secondary outcome was the success rate for endotracheal intubation.
Results: The use of a bougie did not cause a significant difference in the intubation time (MCLS vs. MCLB, P=0.213; GVLS vs. GVLB, P=0.633) and the success rate of endotracheal intubation (MCLS vs. MCLB, P>0.990; GVLS vs. GVLB, P=0.077) was compared with the use of a stylet in MCL and GVL. The use of GVL showed a longer endotracheal intubation time compared with MCLS (MCLS vs. GVLS, P<0.001; MCLS vs. GVLB, P<0.001). GVLB showed a decreased success rate of endotracheal intubation compared with the use of MCL (MCLS vs. GVLB, P=0.004; MCLB vs. GVLB, P<0.001).
Conclusion: The use of the GVL and a bougie could not affect the performance of endotracheal intubation on the ground. The use of MCL and a stylet for ground intubation could increase the intubation success rate and shorten intubation time compared with the use of a bougie or the use of GVL.

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