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대한응급의학회지 update

Journal of the Korean Society of Emergency Medicine

  • : 대한응급의학회
  • : 의약학분야  >  외과학
  • : KCI등재
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  • : 연속간행물
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  • : 1226-4334
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수록정보
수록범위 : 1권1호(1990)~28권5호(2017) |수록논문 수 : 2,340
대한응급의학회지
28권5호(2017년 10월) 수록논문
최근 권호 논문
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KCI등재

1응급진료센터에 내원한 기계적 장폐색 환자에서 델타 뉴트로필 지표를 이용한 30일 사망률 예측의 유용성

저자 : 한세희 ( Sehee Han ) , 유제성 ( Je Sung You ) , 정성필 ( Sung Phil Chung ) , 이혜선 ( Hye Su

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 28권 5호 발행 연도 : 2017 페이지 : pp. 403-412 (10 pages)

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Purpose: Mechanical bowel obstruction (MBO) is a common emergency problem resulting in high morbidity and mortality. The delta neutrophil index (DNI), reflecting the fraction of circulating immature granulocytes, is associated with increased mortality in patients with infection and/or systemic inflammation. This study was conducted to investigate the relationship between DNI and 30-day mortality in patients with MBO. Methods: We retrospectively identified consecutive patients (>18 years old) with MBO admitted to the emergency department from January 1, 2013 to April 30, 2015. The diagnosis of MBO was confirmed using clinical and radiological findings. The DNI was determined on each day of hospitalization. The outcome of interest was the 30-day mortality and the prognostic value of DNI for 30-day mortality was ascertained by Cox proportional hazards model analysis. Results: A total of 518 patients with MBO were included in this study. According to multivariate Cox proportional hazard models, higher DNI at admission (hazard ratio [HR], 1.080; 95% confidence interval [CI], 1.036-1.126; p< 0.001) was a strong independent predictor of short-term mortality. Among patients with MBO, a DNI >1.9% on admission (HR, 9.410; 95% CI, 2.671-33.145; p<0.001) was associated with increased 30-day mortality. Furthermore, the accuracy of DNI for predicting 30-day mortality was superior to that of other parameters. Conclusion: The DNI can be measured rapidly and simply on emergency department admission without additional cost or time burden. Increased DNI values are associated with 30-day mortality in patients with MBO.

KCI등재

2응급실에 내원한 급성 신우신염 환자에서 장기 입원 기간 예측에 있어서 델타뉴트로필의 유용성

저자 : 기동훈 ( Dong Hune Key ) , 유제성 ( Je Sung You ) , 이종욱 ( Jong Wook Lee ) , 이혜선 ( Hye

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 28권 5호 발행 연도 : 2017 페이지 : pp. 413-421 (9 pages)

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Purpose: The delta neutrophil index (DNI) corresponds to evaluated immature granulocyte counts and severity of sepsis. The aim of this study was to investigate the diagnostic value of DNI as a predictable laboratory marker for prolonged hospitalization in patients with acute pyelonephritis in the emergency department (ED). Methods: We retrospectively analyzed medical records in two EDs and screened eligible adult patients who were admitted to the ED with acute pyelonephritis from July 2012 to July 2014. The DNI was calculated for all patients as a part of routine complete blood analysis, and diagnostic performance of DNI for predicting prolonged hospitalization (over 14 days) in patients with acute pyelonephritis (APN) was evaluated. Results: A total of 308 patients with APN were enrolled in the study. Among them, 89 patients (29.9%) were hospitalized for more than 14 days. The initial DNI value was significantly higher in patients with more than 14 days of hospitalization than in those with less than 14 days of hospitalization (6% vs. 2%, p<0.001). The peak value of DNI was also significantly higher in patients discharged after 14 days of hospitalization than in those discharged before 14 days (8% vs. 2%, p<0.001). Multivariate Cox proportional hazard models showed that a DNI of more than 6.3 on ED admission day (hazard ratio [HR], 0.314; 95% confidence interval [CI], 0.191-0.515, p<0.001) and on peak day (HR, 0.37; 95% CI, 0.244-0.562, p=0.028) was an independent risk factor for hospitalization over 14 days. Conclusion: DNI is potentially useful as an independent factor for predicting hospitalization for more than 14 days.

KCI등재

3응급의료센터를 방문한 급성담낭염 환자에서 나이쇼크인덱스를 이용한 중증도 예측의 유용성

저자 : 조진행 ( Jin Haeng Cho ) , 이종석 ( Jong Seok Lee ) , 정기영 ( Ki Young Jeong ) , 최한성 ( H

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 28권 5호 발행 연도 : 2017 페이지 : pp. 422-430 (9 pages)

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Purpose: This study examined the availability of the age shock index in an assessment of high risk patients with acute cholecystitis in an emergency department. Methods: Consecutive data of patients who presented to the emergency department with acute cholecystitis during the period, January 2012 and March 2017, were reviewed retrospectively. Univariate and multivariate analyses were performed to determine the relationship between the severity of acute cholecystitis and the clinical factors. Results: A total of 242 patients with acute cholecystitis were included in this study. From univariate analyses, age, Murphy's sign, symptom duration, heart rate, respiratory rate, age shock index, hypertension, diabetes, leukocytes, C-reactive protein and blood urea nitrogen were found to be related to the severity of acute cholecystitis. From multivariate analysis, the symptom duration (OR, 4.271; 95% CI, 2.672-6.827), respiratory rate (OR, 1.482; 95% CI, 1.189-1.847), age shock index (OR, 1.609; 95% CI, 1.060-2.442, 10-point interval), leukocytes (OR, 1.283; 95% CI, 1.156-1.424), and diabetes (OR, 4.590; 95% CI, 1.507-13.976) had a positive relationship with the severity of acute cholecystitis. Conclusion: The age shock index, which is calculated easily using the patient's age, heart rate, and systolic blood pressure, can be a predicting factor of severe acute cholecystitis in an emergency department.

KCI등재

4동맥혈 가스 검사 방법에 있어 헤파린 수동 코팅 방법과 헤파린 코팅 제품 사용 방법에 따른 전해질 및 혈색소 측정의 정확성 비교

저자 : 박정민 ( Jung Min Park ) , 박원빈 ( Won Bin Park ) , 김진주 ( Jin Joo Kim ) , 민경진 ( Kyung

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 28권 5호 발행 연도 : 2017 페이지 : pp. 431-440 (10 pages)

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Purpose: The results of arterial blood gas analysis using conventional liquid sodium heparin syringes are inaccurate due to the dilution effect, chelation of heparin and the electrolyte, and interference of the heparin electrolyte measurement. This study compared the accuracy of using heparin with a liquid sodium heparin syringe (LHs) and balanced lithium/zinc heparin syringe (BHs). Methods: This study evaluated 6,778 cases who underwent an arterial blood gas test, serum electrolytes test, and complete blood count test among patients aged 18 years or older who visited the emergency room from November 1, 2016 to March 3, 2017. Finally, there were 2,383 cases using LHs and 2,584 cases using BHs. The results were compared between the groups using the LHs and BHs for sodium, potassium, and hemoglobin, and the agreement was compared using the Bland-Altman plot. Results: Sodium difference value was the 5.714±5.696 mmol/L in the LHs group, -1.549±3.339 mmol/L in the BHs group. The potassium difference value was -0.650±0.494 mmol/L (LHs group) and -0.257±0.367 mmol/L (BHs group). The hemoglobin difference values were -0.556±1.116 g/dL (LHs group) and -0.170±1.062 g/dL (BHs group). The results showed that the BHs group was improved compared to the LHs group (p<0.001). Conclusion: The results of arterial blood gas analysis of sodium, potassium, and hemoglobin were more accurate for the BHs group than the LHs group based on the serum electrolytes and complete blood counts.

KCI등재

5심정지 환자의 예후 평가에서 자화율강조자기공명영상 소견의 유용성: 선행연구

저자 : 황진태 ( Jin Tae Hwang ) , 김용환 ( Yong Hwan Kim ) , 이준호 ( Jun Ho Lee ) , 조광원 ( Kwang

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 28권 5호 발행 연도 : 2017 페이지 : pp. 441-448 (8 pages)

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Purpose: This study was conducted to examine the efficacies of susceptibility weighted images (SWI) for predicting the clinical prognosis of comatose patients following cardiac arrest. Methods: Thirty-two patients who were resuscitated from cardiac arrest and underwent brain magnetic resonance imaging (MRI) were retrospectively investigated and compared to 32 subjects with normal brain MRI findings who served as controls. The SWI readings were divided into three categories: prominent, diminished, and normal. Comatose patients were divided into two groups: those with a Glasgow-Pittsburgh cerebral performance category (CPC) of 1-2 (good outcome group) and those with a CPC of 3-5 (poor outcome group). Results: Of the 32 patients, 17 (53.1%) showed good neurological outcomes upon hospital discharge. Normal patterns on SWI were mainly seen in the good outcome group (15 patients, 88.2%), while diminished patterns and prominent patterns were frequently found in the poor outcome group (13 patients, 88.7%). The combination of diminished pattern and prominent pattern predicted poor outcome with 86.7% sensitivity (95% confidence interval, 69.5%-100%) and 88.2% specificity (95% confidence interval, 72.9%-100%). Conclusion: The SWI findings correlate with the outcome of hypoxic-ischemic encephalopathy and may be a useful adjunct of vegetative state or death in comatose patients after cardiac arrest.

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6Changes in Histopathology and Tumor Necrosis Factor-α Levels in the Hearts of Rats Following Asphyxial Cardiac Arrest

저자 : ( Jung Hoon Lee ) , ( Tae-kyeong Lee ) , ( In Hye Kim ) , ( Jae Chul Lee ) , ( M

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 28권 5호 발행 연도 : 2017 페이지 : pp. 449-456 (8 pages)

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Purpose: Post cardiac arrest (CA) syndrome is associated with a low survival rate in patients who initially have a return of spontaneous circulation (ROSC) after the CA. The aim of this study was to examine the histopathology and inflammatory response in the heart during post CA syndrome. Methods: Asphyxial CA was induced in male Sprague-Dawley rats and the survival rate of the rats was determined during the post resuscitation phase. Results: Survival of the rats decreased after CA: 66.7% at 6 hours, 36.7% at 1 day, and 6.7% at 2 days after the ROSC following CA. The rats were sacrificed at 6 hours, 12 hours, 1 day, and 2 days after the ROSC, and their heart tissues were examined. Histopathological scores increased at 12 hours post CA. Afterwards, the histopathological changes were not significant. In addition, the levels of tumor necrosis factor-α immunoreactivity increased gradually after CA. Conclusion: The survival rate of the rats 2 days post CA was very low, even though the histopathological and inflamma-tory changes in the heart were not pronounced in the early stages following the CA.

KCI등재

7C57BL/6 쥐 외상성 뇌손상 모델에서 뇌 손상 정도에 따른 조직병리학적 변화 및 신경행동학적 특징

저자 : 오기영 ( Ki Young Oh ) , 최동원 ( Dong Won Choi ) , 장문순 ( Moon Soon Jang ) , 이지한 ( Ji

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 28권 5호 발행 연도 : 2017 페이지 : pp. 457-466 (10 pages)

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Purpose: Traumatic brain injury (TBI) is a significant cause of morbidity and mortality worldwide. Severity of the initial insult is one of the most significant factors affecting outcome following TBI. In order to investigate the mechanisms of cellular injury and develop novel therapeutic strategies for TBI, we designed a standardized animal TBI model and evaluated histological and functional outcomes according to the degree of impact severity. Methods: Male adult C57Bl/6 mice underwent controlled cortical impact (CCI) at varying depths of deflection (1.0-2.0 mm). We performed hematoxylin and eosin staining at 7 days after recovery from TBI. Neurobehavioral characterization after TBI was analyzed by the Barnes maze test, passive avoidance test, open field test, rotarod test, tail suspension test, and light/dark test. Results: We observed a graded injury response according to the degree of deflection depths tested (diameter, 3 mm; velocity, 3 m/s; and duration, 500 ms) compared to sham controls. In the Barnes maze test, the severe TBI (2 mm depth) group showed reduced spatial memory as compared with the sham and mild TBI (1 mm depth) groups at 7 days after TBI. There was a significant difference in the results of the open field test and light/dark test among the three groups. Conclusion: Our findings demonstrate that the graded injury responses following TBI resulted in differential histopatho-logical and behavioral outcomes in a mouse experimental CCI model. Thus, a model of CCI with histologic/behavioral outcome analysis may offer a reliable and convenient design for preclinical TBI research involving mice.

KCI등재

8Prognosis of Acute Pancreatitis in Glyphosate Surfactant Herbicide-intoxicated Patients

저자 : ( Ingul Song ) , ( Seung Yong Cha ) , ( Mun Ju Kang ) , ( Yong Hwan Kim ) , ( Ju

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 28권 5호 발행 연도 : 2017 페이지 : pp. 467-474 (8 pages)

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Purpose: Glyphosate herbicides (GHs) are widely used and increasingly associated with poisoning cases. Acute pancreatitis (AP) is among the many complications associated with the toxicity of GHs. We investigated the relationship between incidence of AP and its prognosis in patients with GH poisoning. Methods: This was a retrospective cohort study conducted at a single tertiary hospital between January 2004 and December 2014. We enrolled all patients presented to the emergency department with GH poisoning. The Clinical and laboratory variables were analyzed to investigate the relationship between GH intoxication and AP. Results: We studied 245 patients. Incidence of AP after GH poisoning was 6.5%. Patients with AP (mean 66 years) were older than the non-AP group (56 years). Systolic blood pressure, Glasgow Coma Scale, and amount of ingested poison differed significantly between the two groups. In the blood tests, white blood cell count, alanine aminotransferase, glucose, potassium, amylase, and lipase showed significant differences. The pH, bicarbonate, and lactate levels also differed significantly. Patients with AP demonstrated higher incidence of respiratory failure, pneumonia, acute kidney injury, rhabdomyolysis, and intensive care unit stay time. Additionally, 30-day mortality (n=11, 68.8%) was significantly higher in the AP group. On multivariate analysis, adjusted age, amount of ingestion, and lactate correlated with occurrence of AP. Conclusion: The incidence of GH-induced AP was 6.5% with a 30-day mortality of 68.8%. The patient's age, ingested dosage, and lactate levels were associated with GH-induced AP.

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9가스 흡입으로 응급실로 내원한 환자의 초기 중증도 예측 인자

저자 : 황정성 ( Jung Sung Hwang ) , 최욱진 ( Wook Jin Choi ) , 김선휴 ( Sun Hyu Kim ) , 최병호 ( By

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 28권 5호 발행 연도 : 2017 페이지 : pp. 475-483 (9 pages)

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Purpose: To define early predictors of critical cases involving patients who visited the emergency department (ED) due to gas inhalation, with the goal of identifying patients who require intensive monitoring and treatment. Methods: The retrospective study was carried out for patients who visited the ED at Ulsan University Hospital due to gas inhalation from March 2014 to February 2016. General demographics, mechanism of accident, critical symptoms, vital signs, blood lab test results, severity, and clinical manifestation were investigated. Patients were divided into a critical group and non-critical group, and predictors of critical cases were investigated by comparing both groups. Results: Of the 180 patients, 26 patients were in the critical group. In this group, more patients displayed altered mentality and cardiac arrest (both p<0.001). The critical group also showed significantly higher fractions for low-blood pressure (systolic blood pressure<90 mmHg; p<0.001), number of critical symptoms (p<0.001), transport by emergency medical services (p=0.003), and consultation involving other departments (p<0.001). Patients in the critical group showed higher Korean Triage and Acuity Scale (KTAS) level (p<0.001), lactate value (p=0.001), and carboxy-hemoglobin value (p=0.017) as well as older age (p=0.001), lower pH (p=0.001), and HCO3 - value (p<0.001). Multiple regression analysis revealed that predictors of critical cases were older age and higher KTAS level (both p<0.001). Conclusion: Patients admitted to the ED for treatment of gas inhalation, who were older and had a higher KTAS level, require intensive monitoring and treatment.

KCI등재

10일산화탄소 중독에서 초기 젖산의 측정은 카복시헤모글로빈 측정과 비교하여 어떤 임상적 의의를 가지는가?

저자 : 황순곤 ( Soon-gon Hwang ) , 진상찬 ( Sang-chan Jin ) , 최우익 ( Woo-ik Choi ) , 전재천 ( Jae

발행기관 : 대한응급의학회 간행물 : 대한응급의학회지 28권 5호 발행 연도 : 2017 페이지 : pp. 484-492 (9 pages)

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Purpose: This study was performed to compare clinical significance between lactate and carboxyhemoglobin (COHb) in a patient with carbon monoxide (CO) poisoning. Methods: We conducted a 13-year retrospective study on CO poisoning patients who visited the emergency departments of the Medical Center between October 2004 and January 2016. The patients were divided into two groups according to initial lactate levels. Patients with serum lactate levels of ≤2 mmol/L were classified as the normolactatemia group (n=14), and patients with serum lactate levels of >2 mmol/L were classified as the hyperlactatemia group (n=34). General characteristics, clinical features, and laboratory findings of the two groups were compared. In addition, we compared initial lactate levels with COHb levels according to complications, neurological disorder, myocardial enzyme elevation, and abnormal Glasgow Coma Scale (GCS) score in patients with CO poisoning. We also analyzed the correlation between laboratory parameters and lactate levels. Results: Forty-eight patients were enrolled in this study. The hyperlactatemia group had significantly more neurological disorders and consciousness disorders than the normolactatemia group (p<0.001), and COHb, creatine phosphokinase MB, and troponin I levels were also significantly higher in the hyperlactatemia group (p<0.001, p=0.017, and p=0.007). Lactate levels were significantly elevated in patients with elevated cardiac enzymes (p=0.001), neurological disorders (p<0.001), complications (p=0.001), and abnormal GCS score (p<0.001), whereas COHb levels were not significantly increased in all subjects. The correlation between COHb and lactate levels was weak (r=0.313, p=0.030), and a positive correlation was found between lactate and bicarbonate (HCO3), white blood cell, and troponin I (p<0.001). The diagnostic value of lactate for severe CO poisoning was analyzed using a receiver operating characteristic curve. The optimal cut-off value of lactate was 2.2 mmol/L with 83.3% sensitivity and 91.7% specificity (p<0.001). Conclusion: Lactate has significant diagnostic efficacy in patients with CO poisoning. It is recommended that lactate level be measured for appropriate treatment and prognostic evaluation of CO poisoning.

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1연안해역에서 석유오염물질의 세균학적 분해에 관한 연구

(2006)홍길동 외 1명심리학41회 피인용

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(2006)홍길동심리학41회 피인용

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(2006)홍길동41회 피인용

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