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김세경,나병호,이기중,박규남,오동렬,박승현,임근우 대한응급의학회 1994 대한응급의학회지 Vol.5 No.2
Dissecting aortic aneurysm is the most fatal disease involving the aorta that can be resulted in a life-threatening outcome unless a prompt diagnosis and an appropriate treatment is done. A retrospective clinical study was done on 51 cases of dissecting aortic aneurysm who had been admitted to department of Emergency Medicine, St. Mary's hospital, Kangnam, CUMC. from Jan, 1990 to Sep. 1994, in aspects of locations of pain, ECGs, and chest X-rays. The mean age at admission was 61.4 years old (range ; 31-88). It was seen more frequently in male than female with M : F ratio of 2 : 1. Hypertension was the most frequent predisposing factor(70.6%). According to the DeBakey classification, type Ⅰ was found in 29.4%, type Ⅱ in 11.4%, type Ⅲ in 58.8%. The most frequent symptom was a pain in 44 cases(86.3%), no pain in 7 cases(13.7%). Painful symptoms were back pain in 25 cases(73%), chest pain in 19 cases(55.9%), epigastric pain in 12 cases(35.3%), abdominal pain in 3 cases(8.8%). Painless symptoms were 5 cases in type Ⅰ, Ⅱ, 2 cases in type Ⅲ. ECG showed normal in 29 cases(56.9%), LVH(Left Vontricular Hypertrophy) in 13 cases(25.5%), BBB(Bundle Branch Block) in 5 cases(9.8%), ST segment depression in 3 cases(5.9%), Atrial fibrillation in 1 cases(1.9%). Mediastinal widenings on chest PA, erect or sitting position, were found in 63%, in comparison with control group.(p<.05). The average mediastinal length was 10.39cm in type Ⅰ, 10.82cm in type Ⅱ, 8.89cm in type Ⅲ. The definitive diagnosis was made by CT, aortography, echocardiography, MRI. Among them 36 cases(70.6%) were treated by medically, in which 3 patients were died. 15 cases(29.4%) were treated by surgically, in which 10 patients were died. Conclusion : Among 51 cases, no ST segment elevation in all cases was found and mediastinal widening on chest PA was found in 63%. It is thought that ECG and chest PA is very important screening method to differentiate acute myocardial infarction from dissecting aortic aneurysm, when patients suffered from acute chest pain visit emergency room.
박승현,최승필,나병호,황주일,나석주,전해명,김세경 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1
Traumatic asphyxia has often been described as a rare clinical syndrome characterized by cervicofacial cyanosis and edema, multiple petechiae, and subconjunctival hemorrhage after a severe crush injury of the thorax or upper part of the abdomen. The pathogenesis of traumatic asphyxia is that after compression of the chest or upper abdomen, intrathoracic pressure increased suddenly. Blood is forced out of the right atrium through the valveless innominate and jugular veins into the head and neck. This sudden increased thoracic pressure in small venules and capillaries causes rapid dilation and minute hemorrhages producing the petechiae often seen. Treatment is supportive and should be focused on the associated injuries. The prognosis for traumatic asphyxia is very good despite the alarming initial physical appearance. If the patient survives the initial insult, the prognosis is excellent. Neurologic sequale may be permernant. We experienced five case of the traumatic asphyxia, and its clinical and pathophysiologic features are discussed. Increased awareness of this syndrome by emergency physicians will result in better reporting ad understanding of its clinical implications.