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2급 응급구조사의 성인외상환자에 대한 처치의 적절성 평가
장문수,어은경,김상현,김창섭,송근정,박한규,유지영,최동섭 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2
In Korea, EMT have two classified subgroup of first and second degree : EMT-P, and EMT. For the beginning, authorization of the first EMT was made in this year through the EMT educational program. There are 8 items which EMT can perform the treatment without the supervision by a physician. But there was no previous report of pertinent assesment of treatment performed by the EMT. There upon authors have conducted review of assessment done by the EMT in EC setting, and proposed the following treatment application can be used by EMT at the field of accident. The study materials include adult trauma patient older than 15 years, and sustained trauma within 48 hours before visiting Ewha University DongDaeMoon Hospital Emergency Deparment. The duration of study was from Apr. 1 1995 to Aug. 31 1995. the study was conducted by 5 certified EMT. The EMT's performance was evaluated by the attending Emergency Medicine physician. The result were as followings ; 1. Among the total 5532 ED visiting patients during the study period, 1267 were adult trauma patients who recieved treatment within 48 hours of injury. 2. Among 1222 out of 1267 patients have completed performed survey. 3. Male to female ratio was 2.6 : 1, age distribution was from 15 to 87 years old and mean age was 34.6 years old. 4. The MOI showed : MVA (33.1%), blunt trauma (29.9%), slip down (16.8%), penetrating injury(15.4%), and miscellaneous (5.7 %), burn (3.1%), falling down injury(2.9 %), bite injury(1.1%) in order. 5. There were 437 cases of survey completed by the EMT. For assessment of mental status of 3 different method : AVPU, 5 scale mental status and GCS, were correlated with EM physician with 99.1%, 98.6%, 97.7 %, respectively. 6. For 320 out of 437 cases of survey completed, 319 patients recieved treatment by the EMT within 30 minute and 1 patient between 30 to 60 minute of an ED arrival. 7. For those 437 cases of survey completed, 266 patient (60.9%) had adequate treatment and 54 patients (12.4%) had inadequate treatment. 67 patient (15.3%) did not received treatment but it was adequate inway, and 50 patients (11.9%) did not received treatment even though patient required treatment. In cases of adult trauma patients, EMT's mental status assessment was correlated with EM physician's assessment. But treatment done by EMT without the supervision of EM physician was adequate only in 76.2 %. Therefore, continuous education and assessment of treatment performed by EMT in needed to improve field treatment by EMT future.
교합성 골수강내 금속정술후 발생한 대퇴골 간부 골절의 불유합의 치료
이근배,문은선,송은규,최진,정성택 대한골절학회 2002 대한골절학회지 Vol.15 No.4
목적 : 교합성 골수강내 금속정술 후 발생한 대퇴골 간부 골절의 불유합의 치료 결과를 알아 보고자 하였다. 대상 및 방법 : 1990년 5월부터 2000년 7월까지 대퇴골 간부 골절에 대한 교합성 골수강내 금속정술후 발생한 불유합에 대해 치료받은 환자중 1년 이상 추시 가능하였던 33명을 대상으로 후향적으로 조사하였다. 수술 당시 평균 연령은 40세(19~68)였으며, 남자가 27례, 여자가 6례였다. 불유합의 형태는 Weber와 Brunner와 분류 방법에 따르면 과혈관형 10예(30%), 무혈관형 21예(64%), 혼합형이 2예(6%), 무혈관형중에서 감염성이 5예(23%)였다. 결과는 수술 방법에 따른 골 유합 기간 및 불유합, 부정 유합, 감염 등의 합병증의 유무로 평가하였다. 결과 : 수술 방법은 불유합의 원인과 형태에 따라 결정하였으며, 5가지 방법으로 시행하였다. 골수강내 금속정 교환술을 시행한 경우가 7예, 골수강내 금속정 교환술 및 골 이식술을 함께 시행한 경우가 11예, 외고정술 5예, 금속판 고정 및 골 이식술 3예, 해면골 이식술만을 시행한 경우가 7예였다. 골유합 기간은 각각 평균 19주, 17주, 20주, 16주, 15주로서 치료 방법 간에 통꼐학적인 의의는 없었다. 전례에서 술 후 감염이나 불유합, 부정 유합 등은 관찰되지 않았다. 결론 : 교합성 골수강내 금속정술후 발생한 대퇴골 간부 골절의 불유합의 치료에 있어서는 불유합의 원인과 형태를 잘 분석하여 그 원인에 맞는 적절한 치료 방법을 선택하는 것이 골유합을 얻는데 매우 중요하다고 생각된다. Purpose : We analyzed the results of treatment for the nonunion of femur shaft fractures after interlocking intramedullary(IM) nail fixation. Materials and Methods : Thirty-three patients who underwent interlocking IM nailing due to femur shaft fractures from May, 1990 to July, 2000 and followed up for more than one year were evaluated retrospectively. Mean age at the time of operation was 40 year(Range, 19-68). 27 cases were men and 6 cases were women. By Weber and Brunner classification of the nonunion, hypervascular type were 10 cases(30%), avascular type 21cases(64%), mixed type 2 cases(6%). Infected type among the avascular type of noumion were 5 cases(23%). Results were evaluated with bone union by treatment methods and complications. Results : According to the causes and types of nonunion, we performed IM nail exchange in seven cases, IM nail exchange and bone grafting in eleven cases, external fixation in five cases, compression plating and bone grafting in three cases, and only cancellous bone grafting in seven cases. Radiographical union was achieved in 19weeks, 17 weeks, 20 weeks, 16 weeks and 15 weeks respectively. There’s no statistically significant difference between treatment methods. There are no cases of nonunion, malunion and infection. Conclusion : The selection of appropriate treatment method by the cause and type of each nonunion is very important to achieve the bony union in the treatment for the nonunion of femur shaft fractures after interlocking intramedullary nailing.