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곽치환,이지한,최홍락,인용남,민진홍,박정수,김훈,이석우 대한응급의학회 2016 대한응급의학회지 Vol.27 No.6
Purpose: This study aimed to identify predictive factors for decreased blood pressure in patients prescribed with propacetamol in the emergency room using clinical and laboratory indicators of sepsis. Methods: Among patients aged 18 years or older with a fever, who visited Chungbuk National University hospital’s emergency room between July and December of 2014, 246 patients underwent intravenous infusion of propacetamol to control body temperature. Of these, 112 patients fulfilled all study requirements. Patients whose systolic or diastolic blood pressure dropped below 90 mmHg or 60 mmHg, respectively, were included in the blood pressure decline group. Additional inclusion criteria were a decline in systolic blood pressure of more than 30-mmHg and thereby treated with fluids or inotropics after intravenous infusion of propacetamol. Remaining patients were included in the blood pressure maintenance group. The relationship of each factor between the two groups was then investigated. Results: Twenty-nine patients (25.9%) showed a significant decrease in blood pressure, and among many factors, highsensitivity C-reactive protein (hs-CRP) (cut off value, 11.86; sensitivity, 72.4%; specificity, 69.9%; area under curve [AUC], 0.698) and procalcitonin (cut off value, 0.67; sensitivity, 75.9%; specificity, 60.2%; AUC, 0.667) levels showed a statistically significant effect. Of the 29 patients with a decrease in blood pressure, 10 patients received fluids and inotropics; procalcitonin in particular showed a significant effect. Conclusion: When propacetamol is administered to patients at the emergency room, and if hs-CRP or procalcitonin levels are high, there is an increased risk of a decrease in blood pressure. In particular, if procalcitonin levels are high, aggressive treatment is required, such as administration of inotropics in addition to fluids.
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하민석,곽치환,강준호,한규홍,민진홍,박정수,이석우,김훈 대한응급의학회 2015 大韓應急醫學會誌 Vol.26 No.1
Purpose: Stool exams are a useful tool for the early presumptive diagnosis of infectious bacterial diarrhea in the Emergency Department (ED). CT scans are often used to increase the physician’s level of certainty and to facilitate patient triage by identifying the source of pain in most patients with an acute abdomen in the ED. This study was designed to investigate the correlation between stool exams and abdominal CT in patients with acute diarrhea visiting the ED. Methods: We conducted a retrospective study in the emergency department of a national university hospital from January 1, 2012 to June 30, 2013. The subjects consisted of 156 patients with acute diarrhea and abdominal pain who had stool exam results and abdominal CT findings. We divided the patients into three groups according to the stool exam results. Simultaneously, we evaluated their CT findings of the bowel and adjacent structures. Results: A total of 156 patients were enrolled. Frequency of abnormal CT findings showed statistically significant correlation with stool exams (p-value <0.001). Abnormal CT findings increased as WBCs and RBCs in stool increased (pvalue <0.001). Conclusion: The stool exam was a statistically significant predictive variable in indirectly determining the severity of acute diarrhea and it showed correlation with the frequency of abnormal CT findings. It is suggested that stool exams can be used as a susceptible marker for predicting the probability of severe infectious colitis, and for making an early decision regarding close medical attention.
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