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RISS 인기검색어
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- 저자 : 박득현 ( Deuk Hyun Park ) (검색결과 4 건)
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응급센터에 내원한 외상환자에서 간과된 골절의 요인 분석
박득현 ( Deuk Hyun Park ),이성실 ( Sung Sil Lee ),김동언 ( Dong Un Kim ),조현영 ( Hyun Young Cho ),이영근 ( Young Geun Lee ),김준수 ( Jun Su Kim ),전진 ( Jin Jun ),김영식 ( Young Sik Kim ),하영록 ( Young Rock Ha ),신태용 ( Tae Yo 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.1
Purpose: A missed fracture is a very common occurrence in the Emergency Department (ED) and can have serious results because of delays in treatment, resulting in long-term disability. It is also one of the most common causes leading to medical legal issues. We analyzed the causes of missed fractures by using a bone scan which is known to be an effective tool for diagnosing bony lesions. Methods: We reviewed the medical records of trauma patients who underwent a bone scan after being discharged the ED from September 2006 to March 2008. Cases of missed fractures were identified by using electronic medical records to review each diagnosis. Definition of missed fracture was read after bone scan by radiologist. We decided that there was no fracture if we read `trauma-related lesion` or `cannot rule out fracture` on a bone scan read by a radiologist. Enrolled patients were analyzed by age, sex, time until bone scan and Injury Severity Score (ISS). Patients were divided into two groups, alert mentality and not-alert mentality, so there were split between a diagnosis group and a missed fracture group. ISS was also used in determining the severity of the patient`s injury upon discharge from the ED. Results: A total of 532 patients were enrolled in this study. Of those, 487 patients were in the diagnosis group, and 45 patients (8.4%) were discovered to have had a fracture. Of the 45 missed fracture patients, 34 patients (6.4%) had one-site fractures, 8 patients (1.5%) had two-site fractures, and 3 patients (0.6%) had threesite fractures. The most commonly missed fracture was multiple rib fractures (18 patients, 30.5%), followed by lumbosacral (LS) spine fractures (10 patients, 16.9%), thoracic spine fractures (8 patients, 13.6%), and clavicle fractures (6 patients, 10.2%). Mean age was 50.12±18.54 years in the diagnosis group and 57.38±16.88 years in the missed fracture group. For the diagnosis group, the mean ISS was 9.03±8.26, but in the missed fracture group it was17.53±9.69. Missed fractures were much more frequent in the not-alert mentality (p<0.01) and in the high ISS (ISS≥16) group (p<0.01). Conclusion: Missed fractures occur most frequent in patients of old age, not-alert mentality, and high ISS. Multiple rib and spine fractures were found to be the most frequent missed fractures, regardless of trauma severity. This study also shows a high possibility of clavicle and scapula fractures in patients with severe trauma. (J Korean Soc Traumatol 2009;22:37-43)
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택시 운전자의 응급처치 시행의지에 대한 응급처치 교육 효과
성화용 ( Hwa Yong Seong ),박득현 ( Deuk Hyun Park ),윤유상 ( Yoo Sang Yoon ),박경혜 ( Kyung Hye Park ),김양원 ( Yang Weon Kim ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3
Purpose: After a traffic accident, first-aid performed within the first few minutes is important for the injured in terms of survival, future health, and quality of life. Taxi drivers have more possibility of witnessing traffic accidents because they spend much time on the road. If taxi drivers are well trained and can perform first-aid in a correct manner, they will play an important role in pre-hospital emergency medical services. We investigated the effect of first-aid training on taxi drivers` willingness to perform emergency care. Methods: We provided first-aid training for 600 deluxe taxi drivers in Busan in 2012. The subjects were given a questionnaire to answer at the beginning and at the end of first-aid training. Results: 427 out of 600 deluxe taxi drivers answer our questionnaire completely. 93 out of 427 deluxe taxi drivers answered that they had first-aid training within past 3 years(21.8%). 323 taxi drivers have witnessed a traffic accident(76%). 45 out of 323 deluxe taxi drivers who witnessed a traffic accident answered that they provided first-aid to victims(14.0%). After first-aid training, taxi drivers` willingness to perform emergency care was increased compared to that before training. The failed group of taxi drivers that had same or decreased willingness after first-aid training had a low level of education than the successful group that had increased willingness after first-aid training. Conclusion: First-aid training increased taxi drivers` willingness to perform emergency care. So Taxi drivers should be encouraged more to undertake and maintain first-aid training. For more volunteering of first-aid training and improvement in the effect of first-aid training, a graded education program for taxi drivers with a low level of education should be developed, and a policy on giving credit for completing first-aid training course and for carrying out first-aid needs to be formulated.
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손목 관절과 발목 관절 손상 환자의 진단에 있어 응급 초음파의 유용성
이성실 ( Sung Sil Lee ),김동언 ( Dong Un Kim ),박득현 ( Deuk Hyun Park ),조현영 ( Hyun Young Cho ),안성준 ( Seung Jun Ahn ),고찬영 ( Chan Young Kho ),신태용 ( Tae Yong Shin ),김영식 ( Young Sik Kim ),하영록 ( Young Rock Ha ) 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.2
Purpose: Ultrasound is of proven accuracy in abdominal and thoracic trauma and may be useful for diagnosing extremity injury in situations where radiography is not available, such as disasters and military and space applications. However, the diagnosis of fractures is suggested by history and physical examination and is typically confirmed with radiography. As a alternative to radiography, we prospectively evaluated the utility of extremity ultrasound performed by trained residents of emergency medicine (EM) one patient with wrist and ankle extremity injuries. Methods: Initially, residents of EM performed physical examinations for fractures. The emergency ultrasound (EM US) was performed by trained residents, who used a portable ultrasound device with a 10- to 5-MHz linear transducer, on suspected patients before radiography examination. The results of emergency ultrasound and radiography and the final diagnosis were recorded, and correlations among them were determined by using Kappa`s test. Results: Thirty-nine patients were enrolled in our study. The average age was 36.6±19.3 years. There were radius Fx. (n=21), radius-ulna Fx. (n=1), ulna Fx. (n=1), and contusion (n=2) injuries among the wrist injury and lat.-med. malleolar Fx. (n=13), lat. malleolar Fx. (n=6), and med. malleolar Fx. (n=3) injuries among the ankle injury. Comparing EM US with radiography, we found the sensitivity, specificity, positive predictive value, and negative predictive value of EM US for Fx. diagnosis to be 100%, 66.7%, 97.3%, 100% and those of radiography to be 97.2%, 100%, 100%, and 75%, respectively. Kappa`s test for a correlation between the Fx. diagnosis of EM US and the final diagnosis of Fx was performed, and Kappa`s value was 0.787 (P = 0.004). Conclusion: EM US for Fx. can be performed quickly and accurately by EM residents with excellent accuracy in remote locations such as disaster areas and in military and aerospace applications. EM US was as useful as radiography in our study and had a high correlation to the final diagnosis of Fx. Therefore, ultrasound should performed on patients with extremity injury to determine whether extremity evaluation should be added to the FAST (focused abdominal sonography trauma) examination. (J Korean Soc Traumatol 2007;20:130-137)
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