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대한응급의학회> 대한응급의학회지> 여성병원 화재 사고에서의 재난 의료 대응에 관한 고찰

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여성병원 화재 사고에서의 재난 의료 대응에 관한 고찰

A study on the disaster medical response in the fire accident at the women’s hospital

김민규 ( Mingyu Kim ) , 서주현 ( Joohyun Suh ) , 김용석 ( Yong Seok Kim ) , 배소현 ( Sohyun Bae )
  • : 대한응급의학회
  • : 대한응급의학회지 32권1호
  • : 연속간행물
  • : 2021년 02월
  • : 36-48(13pages)
대한응급의학회지

DOI


목차

서 론
방 법
결 과
고 찰
ORCID
CONFLICT OF INTEREST
ACKNOWLEDGMENTS
REFERENCES

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Objective: The purpose of this study is to report the activities of Disaster Medical Assistance Team and national emergency medical center in the fire at a women’s hospital on December 14, 2019, and to suggest an improvement plan for the special disastrous situation.
Methods: We reviewed the transfer records of national emergency medical center, medical records of regional emergency medical center, and records of each patient’s prognosis of the women’s hospital, retrospectively. Triage of casualties was conducted according to SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport) method.
Results: The fire was extinguished early and there was no victim with significant carbon monoxide intoxication. Among 228 casualties, there were 143 patients of the women’s hospital. Two patients were classified as immediate, 55 patients including pregnant women, newborns, and mothers were classified as delayed, and 171 casualties including newborns and mothers were classified as minimal. Among 66 newborns, 40 newborns were transferred to the regional Emergency Medical Center, and a second triage was conducted by doctors there.
Conclusion: Although there was no significant victim, physically and socially susceptible people such as pregnant women, newborns, and mothers were included in this accident. We recommend establishing a standard of disaster response for special population and improving our capability at a national level.

UCI(KEPA)

간행물정보

  • : 의약학분야  > 외과학
  • : KCI등재
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  • : 격월
  • : 1226-4334
  • : 2384-048x
  • : 학술지
  • : 연속간행물
  • : 1990-2021
  • : 2641


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32권4호(2021년 08월) 수록논문
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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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KCI등재

1응급실에서 자의 퇴원을 요구하는 환자에 대한 최선의 진료 지침

저자 : 안재윤 ( Jae Yun Ahn ) , 류현욱 ( Hyun Wook Ryoo ) , 최한주 ( Han Joo Choi ) , 김형일 ( Hyung Il Kim ) , 정진우 ( Jinwoo Jeong ) , 배현아 ( Hyun A Bae )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 1호 발행 연도 : 2021 페이지 : pp. 1-4 (4 pages)

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Discharge against medical advice remains a problematic issue worldwide because it may not only lead to adverse medical outcomes for the patients but also medicolegal problems for emergency physicians. Recently, there have been cases in Korea in which a patient in the emergency room, who had been discharged from hospital without following medical instructions, filed a lawsuit against the hospital and emergency medical staff for their responsibility for their worsening disease since discharge. The court acknowledged the responsibility of the medical staff. To minimize the legal risk and reach the optimal ethical standard for these patients, this paper suggests the best practice guideline for the emergency physicians for patients who request discharge against medical advice from the emergency department in Korea.

KCI등재

2다중검출컴퓨터단층촬영을 이용한 복부 팽만에 따른 적절한 흉부압박 위치 분석

저자 : 이진희 ( Jin Hee Lee ) , 고찬영 ( Chan Young Koh ) , 조현영 ( Hyun Young Cho )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 1호 발행 연도 : 2021 페이지 : pp. 5-10 (6 pages)

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Objective: The purpose of this study was to analyze the effect of abdominal distension on proper chest compression position selection during the use of multi-detector computed tomography (MDCT).
Methods: Fifty-eight patients who underwent thoraco-abdominal MDCT for the diagnosis of aortic dissection from January 2013 to August 2018 were included in the study. Abdominal distension was defined as a condition in which the area around the navel in the supine position was higher than the lower half of the sternum. The left ventricle maximal diameter (LVMD) level was scored based on the vertebral body using MDCT. The distance from the end of the sternum (Se), the middle of the lower half of the sternum (Sm), and the upper edge of the liver (Lu) to the LVMD were measured and analyzed.
Results: The LVMD level was significantly higher in the abdominal distension group than in the non-abdominal distension group (1.74±1.39 vs. 2.77±1.33, P=0.007). The difference was about 1/2 of the height of a vertebral body, i.e. 1.2 cm. In the abdominal distension group, Lu was higher (19.6±18.0 vs. 29.2±13.1, P=0.034) and the distance from LVMD to Sm was shorter than in the non-abdominal distension group (36.3±17.5 vs. 45.8±11.5, P=0.027).
Conclusion: Abdominal distension alters the position of the heart through the elevation of the diaphragm. Therefore, when performing chest compressions in patients with cardiac arrest, it is necessary to select a chest compression location based on the presence or absence of abdominal distension.

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3응급의료센터 내 비디오 후두경과 직접 후두경의 첫 번째 시도에서의 기관내삽관 성공률과 부작용 발생률 비교 연구

저자 : 박준완 ( Jun Wan Park ) , 김신영 ( Sin Young Kim ) , 김종원 ( Jong Won Kim ) , 홍대영 ( Dae Young Hong ) , 이경룡 ( Kyeong Ryong Lee ) , 백광제 ( Kwang Je Baek ) , 박상오 ( Sang O Park )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 1호 발행 연도 : 2021 페이지 : pp. 11-18 (8 pages)

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Objective: The study compared the first-attempt success and complication rates of endotracheal intubation (ETI) using video laryngoscopy (VL; GlideScope) with those of direct laryngoscopy (DL) in the emergency department (ED).
Methods: This was a retrospectively clinical study of adult patients who underwent intubation using from 2010 to 2014 in the ED. All data were collected from the electronic medical records. The primary outcome was the first-attempt intubation success of ETI. The secondary outcomes were occurrences of desaturation, hypotension, oesophageal intubation, dental injuries, and cardiac arrest. The between-device differences in outcome risks were examined.
Results: A total of 431 emergency ETIs were included. The first-attempt intubation success rate was higher in the VL than DL (93.8% vs. 74.8%, P<0.001). The non-expert emergency physicians (first and second-year residents) showed a higher first-attempt intubation success rate in VL than DL, but there was no difference in the first-attempt intubation success rate between the two devices between experts (third and fourth-year residents). The use of VL was associated with a lower rate of desaturation (0.0% vs. 5.0%) and tooth injuries (0.0% vs. 2.7%) compared to the DL.
Conclusion: The use of VL was associated with a higher first-attempt success rate compared to DL, particularly in inexperienced intubators. For complications related to ETI, VL showed a lower rate of desaturation and dental injuries in the ED than the DL.

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4증상 발현 후 6시간 이내 응급실 도착한 급성심근경색증에서 hs-CRP 및 CRP velocity와 재원 기간 내 단기 예후와의 상관 관계

저자 : 박진원 ( Jin Won Park ) , 조태진 ( Tae Jin Cho ) , 곽세정 ( Sae Jeung Kwak ) , 윤성현 ( Sung Hyun Yun )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 1호 발행 연도 : 2021 페이지 : pp. 19-26 (8 pages)

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Objective: This study is to measure the high sensitivity C-reactive protein (hs-CRP) value in acute myocardial infarction (AMI) patients who arrive within 6 hours of the symptom manifestation and see how the resulting value affects the short term prognosis in AMI patients.
Methods: This study was conducted on 118 patients who had less than 6 hours of onset-to-door time among 149 patients who were diagnosed with myocardial infarction in emergency room and undergo percutaneous coronary intervention (PCI) for 2 years from September 2017. The group including main adverse cardiovascular outcomes were compared in the patients according to the blood test figures (hs-CRP on admission [CRP1], CRP velocity [CRPv], post-PCI hs-CRP [CRP2], and CRP difference values [CRP2-1]).
Results: In this study, the average of the hs-CRP values of AMI patients arriving within 6 hours of the symptom manifestation was 2.2±2.3 mg/L. CRP velocity that corrected the CRP value to the elapsed time after the onset of symptoms and N-terminal probrain natriuretic peptide (NT-proBNP) appeared to be significantly correlated with the occurrence of main adverse cardiovascular outcomes (P=0.03).
Conclusion: The hs-CRP values of AMI patients arrived within 6 hours of the symptom manifestation showed the mean risk group. CRPv and NT-proBNP showed a significant casual relationship with main adverse cardiovascular outcomes.

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5응급실 일산화탄소 중독 환자 추이 분석: 국가응급의료정보체계

저자 : 이순형 ( Soonhyung Lee ) , 이지숙 ( Jisook Lee ) , 김경환 ( Kyung Hwan Kim ) , 박준석 ( Junseok Park ) , 신동운 ( Dong Wun Shin ) , 김현종 ( Hyunjong Kim ) , 박준민 ( Joon Min Park ) , 김훈 ( Hoon Kim ) , 전우찬 ( Woochan Jeon ) , 김정언 ( Jungeon Kim )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 1호 발행 연도 : 2021 페이지 : pp. 27-35 (9 pages)

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Objective: We aimed to investigate the epidemiological characteristics and trends of carbon monoxide (CO) poisoning in the National Emergency Department Information System (NEDIS).
Methods: Using the NEDIS data from 2014 to 2018, we included patients who had visited the emergency department (ED) with CO poisoning (T58.0 in 7th Korean Standard Classification of Diseases [KCD-7]). We excluded patients with an uncertain time of onset, uncertain intentionality of poisoning, mental state, and unknown clinical outcome. We surveyed age, sex, time of onset, the intentionality of poisoning, mental state, results of emergency treatment, the proportion of admissions to intensive care units (ICU), the outcome of hospitalization, and the regional distribution. We analyzed the rate of incidence and trends of CO poisoning in patients using time series analysis.
Results: A total of 18,533 patients, including 10,671 (57.6%) males and 7,862 (42.4%) females, with a mean age of 40.38±18.41 years, were included in this study. Gyeonggi Province (n=6,354, 34.3%) had the highest distribution of patients, followed by Seoul (n=3,357, 18.1%). The incidence of unintentional CO poisoning was more frequent in January and December, and less frequent in August and September. However, the incidence of intentional CO poisoning showed no seasonal variation. The severity, ICU hospitalization rate, and mortality rate for intentional CO poisoning were higher than unintentional CO poisoning (4.1% vs. 0.8%, 29.9% vs. 16.7%, and 2.0% vs. 0.8% respectively) (P<0.001). Applying Winter's additive method, we could predict that the rate of unintentional CO poisoning would continue to increase and the seasonal fluctuation, such as cases increasing in January-December and decreasing in August-September, would also increase.
Conclusion: Intentional CO poisoning showed higher severity than unintentional CO poisoning. In the time series analysis, the rate of unintentional CO poisoning and seasonal fluctuation is predicted to increase.

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6여성병원 화재 사고에서의 재난 의료 대응에 관한 고찰

저자 : 김민규 ( Mingyu Kim ) , 서주현 ( Joohyun Suh ) , 김용석 ( Yong Seok Kim ) , 배소현 ( Sohyun Bae )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 1호 발행 연도 : 2021 페이지 : pp. 36-48 (13 pages)

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Objective: The purpose of this study is to report the activities of Disaster Medical Assistance Team and national emergency medical center in the fire at a women's hospital on December 14, 2019, and to suggest an improvement plan for the special disastrous situation.
Methods: We reviewed the transfer records of national emergency medical center, medical records of regional emergency medical center, and records of each patient's prognosis of the women's hospital, retrospectively. Triage of casualties was conducted according to SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport) method.
Results: The fire was extinguished early and there was no victim with significant carbon monoxide intoxication. Among 228 casualties, there were 143 patients of the women's hospital. Two patients were classified as immediate, 55 patients including pregnant women, newborns, and mothers were classified as delayed, and 171 casualties including newborns and mothers were classified as minimal. Among 66 newborns, 40 newborns were transferred to the regional Emergency Medical Center, and a second triage was conducted by doctors there.
Conclusion: Although there was no significant victim, physically and socially susceptible people such as pregnant women, newborns, and mothers were included in this accident. We recommend establishing a standard of disaster response for special population and improving our capability at a national level.

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7국지적 재난 개념의 관점에서 본 과거 우리나라 재난의 역학적 특성

저자 : 김주현 ( Chu Hyun Kim )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 1호 발행 연도 : 2021 페이지 : pp. 49-60 (12 pages)

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Objective: The aim of this study was to investigate the epidemiological characteristics of disasters to analyze typical disasters in Korea based on the concept of mass casualty incidents (MCIs).
Methods: We reviewed literature from data sources including the National Emergency Management Agency, the National Police Agency, and other agencies. We analyzed cases of MCIs to investigate their epidemiological characteristics such as natural disasters, types of man-made disasters, incidence, casualties, and mortalities by descriptive methods.
Results: From 1985 to 2012, the incidence of man-made MCIs (4,827,893 cases) with the number of the deceased at 160,908 was higher than that of natural disasters (532 cases) with the number of deceased at 4,129. These included 219 cases (41.0%) of heavy rains with the number of deceased at 2,067 (50.1%), 161 cases (30.1%) of gales with the deceased numbering 64 (1.6%), 58 cases (10.9%) of heavy snowfall with the number of deceased at 673 people (16.3%), 51 cases (9.6%) of typhoon with 1,290 people deceased (31.2%), and 43 other cases (8.1%). Man-made disasters from 1999 to 2011 included 3,055,487 cases (85.7%) of traffic accidents with 89,967 (92.5%) deceased, 496,631 cases (13.9%) of fire with the deceased victims numbering 6,130 (6.3%), and 12,924 cases (0.4%) of maritime disasters with the deceased at 1,150 people (1.2%).
Conclusion: The concept of disasters has to be changed to reflect the contemporary situation in Korea. The epidemiological characteristics of MCIs as conventional disasters revealed that man-made disasters such as traffic accidents, fires, and natural disasters such as heavy rain, snowfall, and gales occur most frequently and result in the most casualties.

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8응급의학과 전공의 총조사 자료를 이용한 전공의의 교육 요구도 분석

저자 : 권태현 ( Tae Hyun Gwon ) , 박경혜 ( Kyung Hye Park ) , 기동훈 ( Donghune Key ) , 김인병 ( In Byung Kim ) , 김호중 ( Ho Jung Kim ) , 박송이 ( Song Yi Park ) , 서범석 ( Bum Suk Seo ) , 윤유상 ( Yoo Sang Yoon ) , 이의선 ( Eu Sun Lee ) , 이형민 ( Hyung Min Lee ) , 조광현 ( Kwang Hyun Cho ) ,

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 1호 발행 연도 : 2021 페이지 : pp. 61-68 (8 pages)

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Objective: This study was conducted to identify the needs assessment for education and training of emergency medicine (EM) residents.
Methods: The results of a national survey of EM residents of the Korean Society of Emergency Medicine in 2019 were used. Education was one of the five categories in the survey. The preferred learning methods and their perceived importance and ability to perform in nine competencies were assessed. The Borich's needs assessment model was used to analyze their needs.
Results: Among 591 EM residents, 382 responded, and 371 responses were finally analyzed. Regarding the learning methods, junior residents preferred in-hospital conferences, staff lectures, internet resources, and textbooks. Overall, medical knowledge and procedural skills were the most important, and research was less important to recognize. Medical knowledge showed the highest rank in the needs assessment in all years, and ethics and professionalism showed the lowest ranks. The needs for procedural skills were higher in junior years but lower in senior years.
Conclusion: These results will form the basis for the design of training programs to meet the educational needs of EM residents for each grade. Furthermore, an analysis of the educational needs should be done periodically according to the changes and demands of the times.

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9신경학적 증상이 없는 어지럼증에 대한 한국형 중증도 분류체계의 적절성

저자 : 손승우 ( Seung Woo Son ) , 민문기 ( Mun Ki Min ) , 류지호 ( Ji Ho Ryu ) , 이대섭 ( Daesup Lee ) , 이민지 ( Min Jee Lee ) , 천모세 ( Mose Chun ) , 현태규 ( Tae Gyu Hyun ) , 왕일재 ( Il Jae Wang ) , 한상균 ( Sang Kyun Han )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 1호 발행 연도 : 2021 페이지 : pp. 69-76 (8 pages)

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Objective: This study aimed to identify the appropriateness of the Korean Triage and Acuity Scale (KTAS) for dizziness without neurological symptoms, which was level 3.
Methods: Using the registry of the National Emergency Department Information System (NEDIS), data regarding consecutive emergency patients from January 2016 to July 2018, who were aged 15 years and older, were reviewed retrospectively. The data were classified using KTAS and Dizziness KTAS level 3 were compared with non-dizziness KTAS level 3 including age, total admission rate, intensive care unit (ICU) admission rate, discharge rate, hospital cost, and length of stay in the emergency department (length of stay [LOS]).
Results: Of the 76,153 emergency patients, 345 (0.5%) had a KTAS level 1, 4,593 (6.0%) had a KTAS level 2, 21,561 (28.3%) had a KTAS level 3, 45,390 (59.6%) had a KTAS level 4, and 4,264 (5.6%) had a KTAS level 5. As the patient's triage score decreased, the total admission rate, ICU admission rate, hospital cost, and LOS decreased. Patients discharged to home also had the same result. Dizziness KTAS level 3 had a significantly lower rate of total admission (23% vs. 56.2%, P<0.001) and ICU admission (0.9% vs. 6.2%, P<0.001) compared with non-dizziness KTAS level 3. On the other hand, the hospital cost and LOS were higher when patients were discharged to their home. The predictors of the admission rate of dizziness KTAS level 3 were the transportation method using a private ambulance service and older age, but older age was only slightly associated.
Conclusion: This study showed that KTAS level 3 for dizziness needs to be adjusted because of lower severity than other level 3. Old age and the transportation method should be considered factors.

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1028개 중증상병 진단군에 따른 재실 시간과 입원 후 사망과의 연관성 분석

저자 : 한갑수 ( Kap Su Han ) , 정진우 ( Jinwoo Jeong ) , 강형구 ( Hyunggoo Kang ) , 김원영 ( Won Young Kim ) , 김수진 ( Su Jin Kim ) , 이성우 ( Sung Woo Lee )

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 32권 1호 발행 연도 : 2021 페이지 : pp. 77-88 (12 pages)

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Objective: The purpose of this study was to analyze the effects of emergency department length of stay (ED LOS) on the prognosis of patients classified in 28 severe illness diagnosis code groups.
Methods: We used data from the National Emergency Department Information System (NEDIS) from 2016 to 2017. Patients with severe illness diagnosis codes as per the discharge diagnosis reports of the emergency department were included and classified into 28 diagnosis code groups. We used multiple logistic regression analysis on the various diagnosis groups to determine whether 6 hours of ED LOS was a factor influencing mortality.
Results: Of the 18,217,034 patients in the NEDIS data, 553,918 patients were hospitalized with a severe illness code at regional or local emergency medical centers. The average ED LOS was 389 minutes in the non-survivor group and 420 minutes in the survivor group. After adjusting for confounders, ED LOS >6 hours was associated with lower mortality (odds ratio, 0.737; 95% confidence interval, 0.715-0.759). The association of ED LOS >6 hours with lower mortality was found in the diagnosis groups for acute myocardial infarction, intracranial hemorrhage, major trauma, aortic dissection, gastrointestinal bleeding/foreign bodies, intoxication, acute kidney injury, and post-resuscitation status.
Conclusion: In the analysis for the 28 severe disease illness code groups, ED LOS of more than 6 hours was not a factor that adversely affects the in-hospital mortality.

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