양수색전증의 임상적 특징

최옥경 ( Ok Kyoung Choi ),이승한 ( Seung Han Lee ),정구영 ( Koo Young Jung ),김승철 ( Seung Cheol Kim ),강현욱 ( Hyun Wook Kang ) 대한주산의학회 1997 Perinatology Vol.8 No.3

복부 둔상 환자에서의 응급 초음파의 의의

유지영(Ji Young You),조석진(Suk Jin Cho),최옥경(Ok Kyoung Choi),정구영(Koo Young Jung) 대한외과학회 1999 Annals of Surgical Treatment and Research Vol.56 No.3

침술요법 후에 발생한 기흉 2례

신준섭,어은경,최옥경 대한응급의학회 1996 대한응급의학회지 Vol.7 No.3

Acupuncture is occasionally used in the treatment of intractable pain in the neck, shoulder, and any other site. Complications seem to be increasing by the frequency of acupuncture. Patients undergoing such therapy should be advised on its potential hazards. During the management of the patient with dyspnea, we experienced two cases of pneumothorax associated with acupuncture. A 53-year-old male and a 44-year-old female were carried into the emergency department in our hospital. They experienced shortness of breath and respiratory difficulty after multiple needle insertion in their back during acupuncture procedure. The chest X-ray was immediately taken and pneumothorax was found. The closed-chest thoracotomy with underwater seal drainage was performed in the emergency department. They were discharged after the chest tubes were removed, confirming the complete reexpansion of the lung.

장기간 심실세동상태의 돼지에서 고용량 epinephrine전처치의 효과

심호식,최옥경 대한응급의학회 1994 대한응급의학회지 Vol.5 No.2

There is a continual loss of high-energy phosphates in myocardium during prolonged ventricular fibrillation(VF), which cannot support myocardial contraction after defibrillation. Defibrillation should be attempted regardless of the duration of VF but the cumulative energy imparted to the fibrillating myocardium can induce structural myocardial injury. The myocardial blood flow requirements during VF are 50ml/min/100g, one third of blood flow, during normal sinus rhythm in swine. To attain this level of myocardial blood flow, epinephrine is required during CPR. The purpose of this study was to determine the effectiveness of epinephrine preceding defibrillation in a swine model of prolonged VF and comparing these results to intial defibrillation treatment only. Fourteen swine (20-25kg) were anesthezied and instrumented for hemodynamic monitoring. After eight minutes of VF, the control group(7) received defibrillation at 3J/kg. If unsuccessful, two additional defibrillation were attempted at 6J/kg. (AHA guideline) The other animals(7, experimental group) were given 0.025mg/kg epinephrine after eight minutes of VF. After two minutes of epinephrine injection, defibrillation was attempted in the same manner as the control group. If unsuccessful, the same dose of epinephrine was administered and external cardiac massage was begun. The mean weight of both group was 21±1kg. Systemic blood pressure was 110±15/68±12mmHg, 114±22/78±22mmHg in the control group, experimental group, respectively. There were no statistical differences in blood pressure and pulse rate between two groups. In the control group, 14% of the animals were resuscitated to a perfusing rhythm. In the experimental group, 71% of the animals were resuscitated to a perfusing rhythm. These results suggest that method of epinephrine pretreatment preceding defibrillation is more effective for restoration of spontaneous circulation than that of initial defibrillation in 8 minutes prolonged ventricular fibrillation in a swine model.

급성 충수돌기염의 조기 진단을 위한 초음파검사의 의의

오병연,임경수,이영주,김원,최옥경 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Background: In the most of emergency department, the diagnosis of appendicitis has been carried by clinical history, physical examination and plain X-ray. But the diagnostic accuracy by these methods was so low that unnecessary operation was common performed, and sometimes the operation was delayed till the physicians could confirm the acute appendicitis clinically. Although many kinds of diagnostic tools such as CT scan, laparoscope, and etc, we believe that ultrasonography(US) would be a quick and sensitive diagnostic method for the evaluation of acute appendicitis in the Emergency Department. Methods: Forty-seven patients who were clinically suspected as acute appendicitis were evaluated with the grayscaled US by emergency physician. The probe of US was placed on maximal tender point of abdomen, and the appendix image was evaluated while probe was pressed deeply and gently. When the blind loop was found at maximal tender point of abdomen, we evaluated the diameter of appendix, the presence of compressibility, peri-appendiceal fluid collection and other mass effect. As soon as the ultrasonographic evidences of the appendicitis were noticed, the operations were done and pathologic report were reviewed later. Results: Among the forty-seven patients, forty patients were diagnosed as a appendicitis by Us, and most common ultrasonic findings were as follows; 1) non-compressible blind loop larger than 5 mm in diameter, 2) wall thickening more than 3 mm, 3) peri-appendiceal fluid collection, 4) periappendiceal mass. Among remaining 7 patients in whom we could not get any positive findings of appendicitis, abdominal CT scan was carried in 2 cases who had direct and rebound tendemess on right lower abdomen, and CT scan showed the evidences of the appendicitis. The other 5 cases without rebound tendemess were observed for 2 hours, and abdominal pain was disappeared lately. Finally forty-two patients were operated and confirmed as acute appendicitis by pathologic reports; 24 were reported as suppurative appendicitis, and 12 cases of gangrenous appendicitis, 3 cases of perforated appendicitis, and 3 cases were peri-appendiceal abscess. The specificity of US in the diagnosis of acute appendicitis was 71.4%, and the sensitivity was 95.2%. Conclusions: In some patients suspected appendicitis, emergency physicians could diagnosis acute appendicitis accurately and rapidly by use of ultrasonography. Although the US was an accurate imaging modality to diagnosis acute appendicitis and evaluate its complications, we recommend a laparotomy or abdominal CT scan in the patients with negative US findings in spite of presence of peritoneal irritation signs such as rebound tenderness and/or muscle guarding on right lower abdomen.

도시지역 응급센터를 내원한 약물중독 환자

유지영,최옥경,김무수,정구영 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

Acute drug intoxication is a important part of emergency medicine. The outcome of intoxicated patients depends upon a kind of drug, a dose of drug, the time of initial management and the knowledge of variable drugs. Our study was made on 249cases of acute drug intoxication, who visited to emergency department of Ehwa Wonams University Mokdong Hospital during 15months from June 1994 to August 1995. The patients of early 10 months period were treated in department in IM and patients of late 5 months period treated in department of EM. The results were as follows : 1) Total nember of patients was 249 which is 0.59% fo total ED patients. The male to female ratio was 1:2 (81pts : 168 pts) The age distribution showed the highest incidences in 2nd (35%) and 3rd (23%) decades. 2) The most patients (78%) were visited to ED within 4 hour after drug ingestion. 3) The most common drug which activated charcoal was indicated was sedatives and hynotics (63%) The most common drug which activated charcoal was contraindicated was strong acid-alkali (4%) 4) The total mortality of intoxicated patients was 8%. 5) The outcomes of the patients( early 10 months vs. late 5 months) : the percentage of admission was 20% vs 24%, discharge against admission was 36% vs 46% discharge was 21% vs 22%, transfer to other hospital was 22% vs 9%

피하기종,기종격을 동반한 제초제 중독 1례

신준섭,최옥경,정구영 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Paraquat(1,1-dimethyl-4,4-bipyridium dichloride) is lethal herbicide and it is thought to act by turning into superoxide and peroxide free radical in the presence of reducing agents. Among the multiple organ failure, the pulmonary complication is always fatal. We present the case of a patient with subcutaneous emphysema and pneumomediastinum without pneumothorax on 6days later after acute paraquat ingestion. A 28 years old female patient was admitted ED at 10:40 on September 8, 1995(Day 1) after ingestion of 10cc-15cc of paraquat (20% solution) at 20:00 on yesterday. By the sodium dithionite test, the presence of paraquat was negative in the urine. She was alert without oropharyngeal ulceration and had stable vital signs. Her hepatic function was moderately deteriorated (SGOT/SGPT 389/867, ALP 233, TB 5.7) and the others laboratory findings were normal limits. She was transferred to ICU and treatment was according to a our protocole(Table 1). On day 6, she complainted numbness on the right lateral neck and respiratory difficulty. The chest X-ray showed subcutaneous emphysema, pneumomediastinum and pneumomediastinum without pneumothorax. Day after day, the size of subcutaneous emphysema and pneumomediastinum were decreased on chest x-ray and it was not found inflammatory signs. The chest CT showed pulmonary fibrosis on the both lower lung field(onday 10) and the esophagography showed no specific findings without dye leakage(on day 14). On day 16, The high resolution chest CT was showed diffuse pulmonary opacity with cystic lesions and peribronchovascular air densities were found with pericardial emphysema and pneumomediastinum. At 4:30 a.m. on day 18, the respiratory arrest was developed and she was expired at 4:35 a.m. under DNR.

응급실에서 succinylcholine을 이용한 기관내 삽관시 혈청 칼륨의 변화

김무수,최옥경,어은경,정구영 大韓應急醫學會 1997 대한응급의학회지 Vol.8 No.1

Succinylcholine is a depolarizing neuromuscular blocking agent(NMB) and is used in induction of anesthesia. Succinylcholine-assisted endotracheal intubation has been routinely used in the operating room and rapid sequence intubation with NMB agent has been the method for airway management in emergency department(ED). Adverse effects of succinylcholine are hyperkalemia, malignant hyperthermia, transient hypotension, arrhythmia, and increased intracranial, intraocular and gastric pressure, etc. This study carried out the change of serum potassium as an adverse effects of succinylcholine during endotracheal intubation in ED. A prospective, noncontrolled design was used to study serial serum potassium levels in pre-and postendotracheal intubation(5min) from February 1996 to August 1996. Succinycholine was selectively used in patient with a ploblem of difficult endotracheal intubation (alert to drowsy mental status with intact gag reflex). The dose of succinylcholine was 1.5 mg/kg and injected into intravenous line during preoxygenation with bag-valve-mask device. Student's two-tailed t-test was used and p-value was<0.05. Among the total of 48 patients(male 27, female 21), the postintubation level of the serum potassium of 25 patients were increased and those of 21 persons were decreased compared with preintubation level. Two patient showed no change in amount. The average serum potassium indicated 3.7±0.8 mEq/L before the injection of the succinylcholine and 3.8±0.9 mEq/L 5 minutes after its injection. P-value showed more than 0.05 and as the result statistically there was no noteworthy difference. All patients were intubated within 30 sec and no patients were failed. We concluded that succinylcholine-assisted endotracheal intubation is a rapid and safe method as an endotracheal intubation practiced in ED and succinylcholin-induced hyperkalemia is miniimal and no adverse effect.

병원전 응급처치의 시행정도와 정확도

이승한,최옥경,정구영 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

The Emergency Medical Technitian(EMT) is the main personnel of Emergency Medical Service Systems, requiring a whole set of special rescue skills and the knowledges for emergent patients in prehospital area. The most important aspects of the EMT system is the medical direction, which is education, protocol, and quality assurance especially in implementing phase. The EMT system just has been started in Korea with legislative effort of Emergency Medical Act since 1994. There has been no data about the frequencies of prehospital emergency care and it`s medical evaluation. Therefore, we investigated the volume of the prehospital emergency care performed by 119 rescue personnel, and assessed the accuracy of cardiopulmonary resuscitation(CPR) skills. We also analyzed which personal factors influence the accuracy of CPR skills by using the multiple regression test in SAS program. One hundred sixty four(64.5%) of the 259 rescuer graduated highschool, and 66.4% had less than 4 years career as a rescuer. Sixty one percentage has less than four times of CPR training. The interval from the last CPR training was less than 6 months in 59.1%, and less then 1 year in 71.4%. While over 75% of 119 rescuers had the experiences of primary emergency cares, about 50% had of CPR and of vital sign check. The accuracy of chest compression were 48.3%, 50.2%, and 52.2% in the rate, depth, and the site, but the accuracy of ventilation, and the ratio of inspiration and expiration. The accuracy of CPR was influenced only by times of CPR training(p=0.0083), not by the education level, the professional career, nor interval after the last training. From the above results, we could have conclusion that EMT training program should be focused to the initial patient assessment, and CPR training should be shared more time in ventilation than in chest compression. Also we could reach to a conclusion that it is important to increase the times of CPR training for improving the accuracy of CPR and that the proper interval of the training might be less than 3 months in early phase.

한국인에게 적절한 기관삽관 위치

이승한,최옥경,정구영,정성필 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Endotracheal intubation is one of the important procedures in ED and various fields. Endobronchial intubation can lead to hypoxemia secondary to tension pneumothorax of intubated side and atelectasis of contralateral side. The placement of tube beyond the vocal cords may results in inadvertent extubation, larygeal spasm and aspiration pneumonia. The conformation methods of endotracheal intubation are auscultation of the chest, observation of a vapor trail, oximetry and capnography, and radiologic evaluation. Owen and associates recommended that oral intubation tubes at the upper incisor teeth at the 23cm in men and the 21cm in women of average adult size would have led to proper placement. We studied that whether the proper depth of endotracheal tube in American is appropriate to Korean. We studied adult patients admitted to ED (of both hospitals during March in 1995. Endotracheal tubes in men were positioned at the 23cm and women had positioned at the 21cm at the upper incisor teeth. The distance of the tip of the endotracheal tube to the tracheal carina on the postintubation chest X-ray then determined. Correct placement of intubation was defined with the tip of the tube≥3cm above the carina and below the level of the larynx. Fifty adult patients were enrolled in the study ; 29 men (58%) and 31 women (42%). Mean height and weight were 170±5.2cm, 68±9kg in men and 158±6.5cm, 56±10kg in women. Reasons for intubation were ; respiratory failure(38%), trauma(16%), increased intracramial pressare(16%), drug intoxication(12%), shock(8%), cardiac arrest(7%)and others(3%). The mean distance from the tip to carina on chest X-ray was 4.13±1.5cm in men and 3.45±2.1cm in women. Proper position was 27/29(93%) in men, 14/21(67%) in women or 41/50(82%). this means the placement of endotracheal tube of our patients was positioned deeper than prion study group(97.6%).(p<.05) We recommend that the 22cm tube mark for men and 20cm tube mard for women at upper incisor teeth would have led to proper placement in Korean adult patient.