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논문검색은 역시 페이퍼서치

대한응급의학회지검색

Journal of the Korean Society of Emergency Medicine


  • - 주제 : 의약학분야 > 외과학
  • - 성격 : 학술지
  • - 간기: 격월
  • - 국내 등재 : KCI 등재
  • - 해외 등재 : -
  • - ISSN : 1226-4334
  • - 간행물명 변경 사항 :
논문제목
수록 범위 : 32권 2호 (2021)

노인 심정지의 초기 동맥혈가스분석에서 자발순환회복 예측 지표에 대한 연구

임현준 ( Hyun Joon Lim ) , 조준휘 ( Jun Hwi Cho ) , 문중범 ( Joong Bum Moon ) , 박찬우 ( Chan Woo Park ) , 신명철 ( Myoung Cheol Shin ) , 김가을 ( Ka Eul Kim ) , 박윤수 ( Yoon Soo Park ) , 양고은 ( Go Eun Yang ) , 옥택근 ( Taek Geun Ohk )
대한응급의학회|대한응급의학회지  32권 2호, 2021 pp. 103-111 ( 총 9 pages)
4,500
초록보기
Objective: The number of elderly patients in Korea has been on the rise recently, and hence the number of out-of-hospital cardiac arrest (OHCA) elderly patients is also rising. The causes of cardiac arrest for the elderly vary, and, it is difficult to predict the recovery of spontaneous circulation (ROSC) in OHCA patients. Therefore, the purpose of this study was to ascertain the predictive value of arterial blood gas analysis (ABGA) results in achieving ROSC in the elderly. Methods: A retrospective analysis of emergency department patients with OHCA was performed at the Kangwon National University Hospital, Korea from 1 January 2016 to 31 December 2019. The initial ABGA results were compared between two patient groups, those who had achieved a return of spontaneous circulation and those who had not. Univariate and multivariable analyses were performed to elucidate the factors associated with ROSC. Results: Overall, 229 OHCA patients were included in the final analysis. The lactate level was independently related to ROSC. A receiver operating characteristics (ROC) curve was plotted to obtain the best cutoff value. The lactate level <9.85 mmol/L showed the largest area under the ROC curve (AUC) to predict ROSC (AUC, 0.666; 95% confidence interval, 0.588-0.743). Multiple regression analysis was performed using the cutoff value, which was a lactate level of 9.85 (odds ratio, 2.907; 95% confidence interval, 1.432-5.902; P=0.003). Conclusion: The ABGA results during the cardiopulmonary resuscitation of OHCA patients, showed that the lactate level was an independent factor associated with ROSC. The lactate cutoff value was 9.85 mmol/L.

Injury patterns in cyclists with alcohol consumption

( Da Un Jeong ) , ( Won Cul Cha ) , ( Hee Yoon ) , ( Sung Yeon Hwang ) , ( Tae Gun Shin ) , ( Min Seob Sim ) , ( Ik Joon Jo ) , ( Taerim Kim )
대한응급의학회|대한응급의학회지  32권 2호, 2021 pp. 112-119 ( 총 8 pages)
4,500
초록보기
Objective: As the cycling population grows, the lack of public awareness about the dangers of cycling while under the influence of alcohol is a signifant problem. The purpose of this study was to investigate the association between alcohol consumption and bicycle-related injuries such as traumatic brain injuries (TBI) and excess mortality ratio-adjusted injury severity score (EMR-ISS). Methods: We conducted a retrospective analysis using data collected from the Korean Emergency Department-based Injury In-depth Surveillance (EDIIS) database from 20 emergency departments during the period 2011-2016. The study subjects who had sustained bicycle-related injuries were over 18 years of age. The covariates included the mechanism, place, and time of injury. The outcomes were TBI incidence and severe and critical injury of EMR-ISS≥25. The effects of alcohol consumption on these outcomes were analyzed, and the variations in effects were determined using logistic regression. Results: Of the 24,297 individuals studied, 1,912 had alcohol-related bicycle injuries, which led to a higher proportion of single-vehicle injury incidents (alcohol 63.7% vs. non-alcohol 46.4%, P<0.001). The alcohol group had a higher rate of TBI (alcohol 11.5% vs. non-alcohol 4.6%, P<0.001) and severe and critical injury of EMR-ISS (alcohol 23.1% vs. nonalcohol 11.7%, P<0.001). TBI (odds ratio [OR], 2.72; 95% confidence interval [CI], 2.33-3.16) and severe and critical injury of EMR-ISS (OR, 2.26; 95% CI, 2.01-2.53) showed a significant association with alcohol. Conclusion: Our study showed an association of alcohol consumption with a higher incidence of TBI and severe and critical EMR-ISS. Education should focus more on the association between cycling under alcohol influence and injury severity.

코로나바이러스감염증-19 유행이 감염병 전담병원 근무자에게 미치는 영향: 감정 변화와 스트레스의 직종 간 비교

엽주용 ( Ju Yong Yeop ) , 박진형 ( Jin Hyung Park ) , 박현경 ( Hyun Kyung Park ) , 표창해 ( Chang Hae Pyo ) , 박근홍 ( Keun Hong Park ) , 김한범 ( Hahn Bom Kim ) , 함은미 ( Eun Mi Ham ) , 이유성 ( Yu Sung Lee )
대한응급의학회|대한응급의학회지  32권 2호, 2021 pp. 120-133 ( 총 14 pages)
5,400
초록보기
Objective: The coronavirus disease 2019 (COVID-19) outbreak is currently ravaging the world and is a major threat to public health. Healthcare workers (HCWs) are at a high risk of acquiring and transmitting COVID-19. Hence, HCWs are also experiencing emotional and behavioral changes. The purpose of this study was to compare emotional changes and stress between occupations and to investigate the impact of emotions of HCWs during the COVID-19 outbreak. Methods: An anonymous, self-administered, previously validated questionnaire was given to HCWs at a hospital dedicated to infectious diseases in Korea during the COVID-19 outbreak. The participants were asked to evaluate stress factors, depressive moods, trauma, reasons for continuing to work, things that helped them work, coping strategies to reduce stress, motivators that could help them work during future outbreaks, and what they would like to do after the outbreak was over. Results: The total number of participants was 400. The average age of participants was 34.69±9.44. Stress and depressive moods showed variations in the job-to-job comparisons. Ethical duty and the professionalism of the HCWs pushed them to continue with their jobs. The news of a decline in the number of patients was helpful to HCWs. The implementation of personal hygiene programs helped in reducing stress. The provision of adequate personal protective equipment was a factor that would encourage them to work during any future outbreak. The participants wanted to go on a trip after the outbreak was over. Conclusion: Our findings indicate that the COVID-19 outbreak had a significant emotional impact on HCWs. The concerns of HCWs may affect their work efficiency in an outbreak and should be addressed by incorporating appropriate management strategies while planning to combat an outbreak.

Risk factor leading to complicated appendicitis: pelvic position of the appendix

( Hyunseung Koh ) , ( Heebum Yang ) , ( Kwanghyun Cho ) , ( Yoon Young Jung ) , ( Yeon Soo Chang ) , ( Dong Hee Kim ) , ( Min Sung Kim )
대한응급의학회|대한응급의학회지  32권 2호, 2021 pp. 134-142 ( 총 9 pages)
4,500
초록보기
Objective: Several factors contribute to the progression of complicated appendicitis (CA) in patients diagnosed with acute appendicitis. The goal of this study was to investigate whether the pelvic location of an appendix may be a new prehospital risk factor associated with CA. Methods: The study retrospectively reviewed 375 patients who underwent surgery for appendicitis from January 2013 to December 2013. Patients were divided into two groups: patients diagnosed with uncomplicated appendicitis (UA) and patients with CA. Demographics, clinical and laboratory findings, duration of symptoms, and the location of the appendix were evaluated. Univariate and multivariate statistical analyses identified risk factors leading to CA. Results: Of the 375 patients, 46 (12.3%) had CA. The univariate analysis confirmed that the patients diagnosed with CA had a higher body temperature (BT), longer duration of symptoms (DOS), and complained of left lower quadrant abdominal (LLQ) pain more frequently. Furthermore, compared to the UA group, the appendix was more frequently located in the pelvic region in the CA group. Multivariate analysis confirmed that BT >37.5..C (odds ratio [OR], 3.29; 95% confidence interval [CI], 1.64-6.61; P<0.01), LLQ pain (OR, 2.78; 95% CI, 1.16-6.69; P=0.02), DOS ≥48 hours (OR, 3.87; 95% CI, 1.94-7.71; P<0.01), and the pelvic location of appendix (OR, 3.18; 95% CI, 1.49-6.75; P<0.01) were risk factors for CA. Conclusion: The pelvic location of an appendix may be a new prehospital risk factor associated with CA.

삽입된 비위관 위치 확인을 위한 응급실 내 capnography와 초음파의 유용성

방효진 ( Hyo Jin Bang ) , 김형민 ( Hyung Min Kim ) , 소병학 ( Byung Hak So ) , 정원중 ( Won Jung Jeong )
대한응급의학회|대한응급의학회지  32권 2호, 2021 pp. 143-150 ( 총 8 pages)
4,500
초록보기
Objective: This study was designed to verify the effectiveness of capnography and ultrasound for confirmation of the location of the nasogastric tube (NGT) in the emergency room (ER). Methods: In this prospective single-blinded study, carried out on 137 patients over 19 years of age, the NGT location was confirmed by capnography in 63 patients and by ultrasound in 74 patients. The capnography and ultrasound scans were performed in random order, while auscultation was performed and chest X-rays were taken for all patients. Capnography was performed by checking the end-tidal carbon dioxide (ETCO2) level and the wave form after inserting the NGT. An ultrasound scan was conducted on the neck, gastroesophageal junction and stomach. The X-ray results were interpreted by a doctor who had not inserted the NGT. Results: The sensitivity and specificity of auscultation were 98.43% and 10%, respectively. After 30 cm of NGT was inserted ETCO2 was measured through the capnography, and was found to be ranging from 0-23. When the capnography showed an ETCO2 value of less than 4, the tube was considered to be inserted in the stomach. In such a case, the specificity was 100%, but the sensitivity was only 46.43%. The sensitivity and specificity of the ultrasound were 92.96% and 66.67%, respectively. In addition, the positive predictive value was confirmed to be 100% and 98.51% when using capnography and ultrasound, respectively. Conclusion: When the NGT is inserted in the ER, it is possible to use ultrasound and capnography for confirmation of its location. However, in some patients, when neither method can confirm the location, a chest X-ray will still be needed.

재난의료지원팀과 보건소 신속대응반의 다수사상자 발생 사고 대응에 대한 분석: 응급의료취약지 여부에 따른 비교

마진실 ( Jin Sil Ma ) , 우재혁 ( Jae-hyug Woo ) , 최우성 ( Woo-sung Choi ) , 양혁준 ( Hyuk Jun Yang ) , 현성열 ( Sung Youl Hyun )
대한응급의학회|대한응급의학회지  32권 2호, 2021 pp. 151-161 ( 총 11 pages)
5,100
초록보기
Objective: When mass casualty incidents occur in Korea, disaster medical assistance teams (DMATs) and public health disaster response teams (PHDRTs) treat casualties at the scene. However, the appropriateness of their on-site responses has not been assessed so far. In this study, we evaluated their response and the variations in their response according to the accessibility of medical care. Methods: We analyzed mass casualty incidents that were reported to the Disaster Emergency Medical Service Situation Room of the National Emergency Medical Center from July 2014 to December 2018. We divided the accident locations into medically underserved areas (MUAs) and adequately served areas (ASAs) and compared the responses of the two teams in each area. Results: Of the 61 incidents, 20 occurred in MUAs, and 41 occurred in ASAs. In MUAs compared to ASAs, time from DMATs' dispatch to arrival was longer (48 [40-58.5] vs. 23 [18-32], P<0.001) but the time taken by the PHDRTs did not vary between two areas (19 [14-35] vs. 15.5 [9-24.5], P=0.263). In MUAs, the time elapsed from the PHDRTs' dispatch to arrival was less than that of the DMATs (48 [40-58.5] vs. 20 [15-35], P<0.001). In MUAs, the distance of the PHDRTs from the scene was lower (31.4 [25-50.95] vs. 13.6 [5.3-19.7], P=0.001) and more members were dispatched to the scene than the DMAT (5 [4-6] vs. 9 [5-10.5], P=0.013). Conclusion: Because of the low accessibility to the scene in MUAs, DMATs took a long time to initiate medical support. To provide adequate disaster medical support, the PHDRTs must be specialized and trained.

요골동맥 천자 보조 도구의 초기 경험

이규하 ( Gyu Ha Lee ) , 김양원 ( Yang Weon Kim ) , 강지훈 ( Ji Hun Kang ) , 박철호 ( Chul Ho Park ) , 지재구 ( Jae Gu Ji ) , 이시원 ( Si Won Lee ) , 윤유상 ( Yoo Sang Yoon )
대한응급의학회|대한응급의학회지  32권 2호, 2021 pp. 162-169 ( 총 8 pages)
4,500
초록보기
Objective: Although several studies have been conducted on the use of ultrasound to assist in arterial punctures, its utility is controversial and it is also inconvenient to use the equipment in the emergency room. Therefore, we developed a radial artery puncture assistive device for use in the emergency room and evaluated its utility. Methods: The operator attempted the procedure on a mannequin, both with and without the device. We recorded the first-attempt success rate, the number of punctures, the time to success, and the failure rate. We conducted a survey to assess pre-experiment expectation and post-experiment satisfaction. Results: The first-attempt success rate was 78% with no device and 66% with the device (P=0.105). The failure rate was 5% both when the device was not worn and worn (P>0.99). The number of attempts was 2.18 with no device and 2.10 with the device (P=0.765). The time to success was 40.81 seconds without the device and 54.08 seconds with the device (P=0.307). The responses to the pre-experiment survey were 5% for ‘Not wearing the device seems to be more helpful’, 75% for ‘Wearing the device seems to be more helpful’, and 20% for ‘There seems to be no difference’. In the postexperiment survey, the responses were 30% for ‘Not wearing the device was more helpful’, 55% for ‘Wearing the device was more helpful’, and 15% for ‘There was no difference’. Conclusion: There were no significant results from the experiments. But respondents felt that wearing the device was better in both the pre-experiment and post-experiment survey.

중환자실 병상 감소가 중환자의 응급센터 체류시간과 임상 결과에 미치는 영향

임대황 ( Dae Whang Lim ) , 성원영 ( Won Young Sung ) , 이장영 ( Jang Young Lee ) , 이원석 ( Won Suk Lee ) , 서상원 ( Sang Won Seo ) , 이근택 ( Keun Taek Lee )
대한응급의학회|대한응급의학회지  32권 2호, 2021 pp. 170-178 ( 총 9 pages)
4,500
초록보기
Objective: This study aimed to investigate the impact of reduced bed capacity in the intensive care unit (ICU) on emergency department (ED) length of stay (LOS) and prognosis of critically ill patients. Methods: This retrospective observational study included patients who presented to a university hospital ED and were admitted to the ICU between August 2017 and July 2019. In our center, the number of beds in the traumatic ICU was maintained, while the number of beds in the non-traumatic ICU was reduced. We comparatively assessed ED LOS and the mortality rate between traumatic and non-traumatic patients over 2 years (1 year before and after the reduced number of beds in the non-traumatic ICU) to determine the impact of reduced ICU bed capacity. Also, a multivariate logistic regression analysis was performed to identify the risk factors related to in-hospital mortality. Results: A total of 2,945 patients were included in this study. In the traumatic ICU patient group, the ED LOS did not change (2.62 [1.95-3.72] hours vs. 2.78 [2.01-3.92] hours, P=0.079) after reducing the number of ICU beds; and no significant difference in mortality rate was noted (19.5% vs. 17.6%, P=0.417). In the non-traumatic ICU patient group, both ED LOS (prolonged by 1.69 hours, 3.46 [2.17-5.66] hours vs. 5.15 [3.43-8.37] hours, P<0.001) and mortality rate (21.6% vs. 25.8%, P=0.003) were significantly increased after reducing the number of ICU beds. In the multivariate logistic regression analysis, ED LOS was identified as a risk factor for in-hospital mortality (odds ratio, 1.035; P<0.001). Conclusion: In this study, the reduced ICU bed capacity resulted in prolonged ED LOS of critically ill patients, which consequently contributed to increased in-hospital mortality.

한국형 응급환자 분류도구(Korean Triage and Acuity Scale) 재평가 특성 분석: 응급실 과밀화와 재평가와의 관계

이은실 ( Eun Sil Lee ) , 오현진 ( Hyunjin Oh )
대한응급의학회|대한응급의학회지  32권 2호, 2021 pp. 179-188 ( 총 10 pages)
4,500
초록보기
Objective: The purpose of the study was to analyze triage re-evaluation characteristics of the Korean Triage and Acuity Scale (KTAS). In particular, the relationship between overcrowding and KTAS re-evaluation at the emergency department (ED) was analyzed. Methods: In this study, a retrospective chart review of 3,158 KTAS re-evaluation cases was performed. The sample included patients visiting a regional ED from January 1 to December 31 in 2018. Crowding was measured using the ED occupancy rate. Any cases assigned to a higher level on initial rather than the final evaluation were defined as overtriage, while any cases assigned to a lower level on initial rather than the final evaluation were defined as under-triage. Results: The ED occupancy rate, which represents the level of ED overcrowding, scored 1.24±0.45 in case of undertriage, and 1.36±0.51 in case of over-triage. KTAS re-evaluation did not vary significantly based on the ED occupancy rate. The treatment results were analyzed according to the different KTAS grades of the KTAS re-evaluation group. The treatment results were different depending on the degree of under-triage. In the under-triage group, patients with a KTAS 2 or 3-grade difference had higher rates of ED hospitalization, mortality, and inter-hospital transfer than the patients with a KTAS 1 grade difference, and this variation was significant. Conclusion: KTAS re-evaluation was not related to overcrowding in the ED. Among the KTAS re-evaluation cases, under-triage patients had higher rates of ED hospitalization, mortality, and hospital transfer. The triage provider, therefore, needs to be more careful at the time of initial classification.

내과적 질병으로 진단된 환자에서 응급의학과 입원 결정권이 응급실 재실시간과 환자 예후에 미치는 영향

김태용 ( Tae Yong Kim ) , 강구현 ( Gu Hyun Kang ) , 장용수 ( Yong Soo Jang ) , 김원희 ( Wonhee Kim ) , 최현영 ( Hyun Young Choi ) , 김재국 ( Jae Guk Kim ) , 이윤재 ( Yoonje Lee ) , 송형우 ( Hyung Woo Song )
대한응급의학회|대한응급의학회지  32권 2호, 2021 pp. 189-197 ( 총 9 pages)
4,500
초록보기
Objective: Overcrowded emergency departments (ED) are a worldwide problem, which could cause treatment delays and increased mortality of patients. This study aimed at evaluating the effect of admission decisions by emergency physicians without consultation of an internal medicine doctor on the emergency department length of stay (ED LOS) and survival rate of patients diagnosed with medical disease. Methods: The study was a retrospective observational study comparing the ED LOS of patients admitted to the internal medicine (IM) department before and after the policy change regarding admission decisions, implemented in July 2017. During and after the policy change, emergency physicians took decisions on the arrangements and treatment for patients by processing their admission and providing follow-up care without further specialist consultations. The ED LOS and rate of admission to the IM department were compared between the study period (October 2017 to October 2018) and the control period (June 2016 to June 2017). Results: The median ED LOS of patients admitted to the IM department decreased from 164.0 minutes (interquartile range [IQR], 118.0-234.0) in the control period to 114.0 minutes (IQR, 104.0-208.0) in the study period. After propensity score matching, the median ED LOS of patients admitted to the IM department decreased from 187.0 minutes (IQR, 136.0-253.0) in the control period to 144.0 minutes (IQR, 104.0-208.0) in the study period. Conclusion: The admission decisions made by emergency physicians reduced the ED and hospital LOS of patients visiting the ED and diagnosed with medical disease.
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