다발성 외상 환자에서 Emergency Room Transfusion Score (ETS)를 이용한 응급수혈의 예측인자

조현규 ( Hyeon Kyu Jo ),박용진 ( Yong Jin Park ),김선표 ( Sun Pyo Kim ),김성중 ( Seong Jung Kim ),조수형 ( Soo Hyung Cho ),조남수 ( Nam Soo Cho ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.1

Purpose: The purposes of this study are finding the elements for a fast determination of the need for a transfusion to a multiple trauma patient arriving at this clinic in the initial stage establishing objective bases for a doctor in an emergency department to determine the need for a transfusion immediately after a patient has arrived at the emergency department, and providing treatment by considering various factors based on the nine criteria suggested in the emergency room transfusion score (ETS). Methods: This study was conducted on 375 multiple-trauma patients who visited the Chosun University Hospital Emergency Medical Center and activated the Emergency Trauma Team from January 2010 to December 2013. The patients were divided into the transfused group and the non-transfused group by retrospectively analyzing their medical records. Subsequently, the medical records were examined using the nine items suggested by the ETS and the results were analyzed. Results: Three hundred seventy-five patients with multiple traumas visited the Chosun University Hospital Emergency Medical Center and activated the Emergency Trauma Team. Among them, 258 died and 117 recovered and left the hospital. The deceased patients consisted of 182 males and 76 females with an average age 45. Of the 375, 165 were transferred from other hospitals, and 245 were blunt trauma patients. One hundred sixty-nine patients were injured in traffic accidents, and 119 of those 169 who had systolic blood pressure less than 90 mm Hg died. Two hundred twenty-six (60.3%) out of the 375 patients with multiple traumas receivedan emergency blood transfusion and their average age was 48. The 375 patients consisted of 156 males, 151 who had been transferred from other hospitals, 218 who presented with blunt trauma, 134 who had been injured in traffic accidents, 156 who had a systolic blood pressure less than 90 mm Hg, 134 who scored higher than 9 points on the GCS, and 162 who had a stable pelvic fracture of these 143 died. Conclusion: During this study, 226 (60.3%) out of the patients with multiple traumas received an emergency blood transfusion. After analyzing the results related to emergency blood transfusion by using ETS, we found that an emergency blood transfusion had to be prepared quickly when patients were transferred from other hospitals when the systolic blood pressure was less than 90 mmHg. when abnormalities had been detected by ultrasonography and when the patient presented with a stable pelvic fracture. [ J Trauma Inj 2015; 28: 1-8 ]

다발성 외상시 응급 초음파검사의 의의

이강현,임경수,김선만,김영식,황성오,유수영,강성준 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

The Evaluation of blunt abdominal trauma is clinically challenging. Abdominal computed to-mography(CT) and diagnostic peritoneal lavage(DPL) has become primary diagnostic modali-ty in advanced trauma life support(ATLS). But DPL is invasive study with potential for the patients. Monitoring and resuscitation are usually suboptimal during there examinations. We examined the efficacy and role of emergency ultrasonographic(US) studies in the initial abdominal evaluation of blunt trauma patients. A prospective study was carried out on 101 blunt trauma patients from 1994, June to September. 101 patients underwent real-time US ex-amination of the chest and abdomen. Indication for emergency US included the cases of shock (systolic blood pressure<90mmHg) or tachycardia (pulse rate/min.>100) in blunt trauma pa-tients. US showed a sensitivity of 96.2%, specificity 98%, accuracy 97% in regard to indica-tion for surgery in case of blunt abdominal or thoracic trauma. US saves time, and it can be performed during the emergency care in the emergency department. US showes high sensitivity and specificty, and is the method of first choice in the evaluation of blunt trauma.

Case Report : Anesthetic management of the emergency Laparotomy for a patient With multiple sclerosis -A case report-

( Ki Hwa Lee ),( Jang Su Park ),( Sang Il Lee ),( Ji Yeon Kim ),( Kyeong Tae Kim ),( Won Ju Choi ),( Jeong Won Kim ) 대한마취과학회 2010 Korean Journal of Anesthesiology Vol.59 No.5

A 33-year-old male patient with multiple sclerosis (MS) received an emergency laparotomy because of perforated appendicitis. He had been suffering from MS for 2 years and the symptoms of MS were paraplegia and urinary incontinence. Anesthesia was induced with propofol and remifentanil and maintained with nitrous oxide, sevoflurane and remifentanil. Rocuronium was used for tracheal intubation. Train of four ratio and bispectral index scale were also monitored for adequate muscle relaxation and anesthetic depth. The patient emerged from general anesthesia smoothly and was extubated without any complication. Postoperative exacerbation of MS symptoms did not appear. However, he was rehospitalized because deep vein thrombosis (DVT) occurred after discharge and he received heparinization immediately. Eventually, he was discharged after a full recovery from DVT. We report a safe anesthetic management of the patient with MS, with the use of sevoflurane and with no the aggravation of MS during postoperative period. (Korean J Anesthesiol 2010; 59: 359-362)

다발성 중증 외상 환자들의 치료에 대한 응급 외상팀 운영의 효과

이성화 ( Seong Hwa Lee ),조석주 ( Suck Joo Cho ),염석란 ( Seok Ran Yeom ),류지호 ( Ji Ho Ryu ),정진우 ( Jin Woo Jung ),한상균 ( Sang Kyun Han ),김용인 ( Yong In Kim ),박맹렬 ( Maeng Real Park ),김영대 ( Young Dae Kim ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.2

Purpose: We performed this study to determine how the emergency trauma team affects the treatment of patients with multiple severe trauma and to discuss the effect and the direction of the emergency trauma team`s management. Methods: We performed a retrospective analysis of 518 patients who visited our emergency department with severe trauma from August 2006 to July 2008. We divided the severe trauma patients into 2 groups: patients before and after trauma team management (Group 1 and Group 2). Then, we compared demographic characteristics, mechanisms of injury, and treatment outcomes (lengths of stay in the ED, admission ratio, and in-hospital mortality) between the 2 groups. In the same way, patients with multiple severe trauma were divided into 2 groups, that are patients before and after trauma team management (Group 3 and Group 4) and analyzed. Results: There was no significant difference, except mean age, between groups 1 and 2. In group 4 patients, compared to group 3 patients, the lengths of stay in the ED were lower (p value<0.001), and the admission ratio were higher (p value=0.017), but there was no significant difference in the in-hospital mortality between the groups 3 and 4. Conclusion: When patients with multiple severe trauma visit the ED, the emergency trauma team`s management can decrease the lengths of stay in the ED and increase the admission ratio, but does not produce a decrease in the in-hospital mortality rate. Further investigations of emergency trauma team management are needed to improve treatment outcomes for patients with multiple severe trauma. (J Korean Soc Traumatol 2009;22:172-78)

다수사상자 발생사고 사례분석을 통한 재난응급의료 대응체계 확립에 관한 연구

김무현 ( Kim Moo-hyun ) 한국융합과학회 2021 한국융합과학회지 Vol.10 No.4

연구목적: 본 연구는 다수사상자 발생사고 사례분석을 통해 재난응급의료 대응체계 확립을 위한 함의점을 제시하기 위해 수행되었다. 연구방법: 본 연구의 방법은 초점사건(focusing event)의 개념을 적용한 분석틀을 정립하여 다수사상자 발생사고를 초점사건으로 간주하고 김포시 요양병원 화재사고, 고양시 허유재병원 화재사고, 이천시 물류센터 공사장 화재사고 사례에 대한 분석을 진행하였다. 결과: 분석결과, 재난 사고 초기 대응 시의 문제점, 보건소의 응급의료 기능 미비, 응급의료 연관 기관 간 연계성이 다소 미흡한 부분 등으로 인한 문제점이 공통적으로 나타났다. 결론: 분석결과를 통해 본 연구는 공중보건의의 적절한 활용, 다수사상자 발생 시 효과적인 환자 분산 정책 마련, 유관기관과 유기적인 다수사상자 훈련 및 협력체계 구축 등과 같은 개선방안을 도출하였다는 점에서 의의가 있으며, 초점사건 개념이 다수사상자 사고에 적용되고 개념을 활용한 분석틀을 통해 보다 효과적으로 재난 사고의 문제점 파악, 개선방안 도출이 가능함을 시사한다. Purpose: The purpose of study intends to present implications for establishing a disaster emergency medical response system through the analysis of cases of multiple casualties. Methods: This study of the analysis framework applied with the concept of focusing events was established to consider multiple casualties as a focal event and analyze the fire accidents at the Gimpo nursing hospital, the fire accident at Heo Yu-jae Hospital in Goyang City, and the fire accident at the Icheon Logistics Center. Result: As a result of the analysis, there were common problems due to problems in early response to disasters, lack of emergency medical functions at health centers, and lack of connectivity between emergency medical institutions. Conclusion: this study is meaningful in that it has derived improvements such as proper use of public health, effective patient dispersion policy in the event of multiple casualties accident, and established a cooperative system with related agencies.

자동주행차량의 안전성 향상을 위한 원격비상정지시스템

유영재(Young-Jae Ryoo) 제어로봇시스템학회 2015 제어·로봇·시스템학회 논문지 Vol.21 No.3

In this paper, a remote emergency stop system to improve the safety of an automated driving vehicle is proposed. One of the most serious problems of the previous wireless remote emergency system is that it does not work when the wireless channel is damaged in case of an emergency because it is composed of a single communication channel. Therefore, the proposed remote emergency stop system composed of a portable wireless remote system and a stationary wireless remote system is designed and the remote emergency stop system for automated driving vehicles is developed. By applying it to an automated driving vehicle to check it"s performance, the wireless remote system is tested. Emergency stops using the portable wireless remote system is tested when the stationary wireless remote system is disconnected. Also, emergency stops using the stationary wireless remote system are tested when the portable wireless remote system is disconnected. The results of the emergency stop test show a satisfactory performance.

충남지역 중증응급질환 환자들의 응급의료이용에 대한 코로나-19 팬데믹의 영향

최일국,노을희,최한주 대한응급의학회 2023 대한응급의학회지 Vol.34 No.6

Objective: This study analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic on emergency care utilization in Chungnam Province by examining the status of emergency care utilization during this period. Methods: This study retrospectively analyzed 154,946 patients who visited emergency medical institutions in Chungnam Province for a major emergency between January 2015 and December 2021, using the National Emergency Department Information System data. Results: The incidence of the The three major emergency diseases are acute myocardial infarction (AMI), acute stroke, severe trauma decreased. Primary visits to the regional and local emergency medical centers increased, except for local emergency medical institutions. The utilization rate of the 119 ambulance service in 2020 decreased significantly for AMI compared to the previous year and was the lowest among the three major emergency diseases. Air transportation by helicopter decreased during the COVID-19 pandemic. The rate of emergency room arrivals within the golden hour decreased during the COVID-19 pandemic. The transfer and retransfer rates also decreased for all three major emergency diseases. Despite the decreased number of patients during the pandemic, the ratio of primary visits to the local emergency medical centers for the three major emergency diseases increased, and the lengths of stay in the emergency room increased. Conclusion: The COVID-19 pandemic significantly impacted the occurrence, transportation, and therapeutic response to the three major emergency diseases in Chungnam Province. The vulnerability of patients with AMI in the pre-pandemic era was further exacerbated during the pandemic.

응급실 다방문 결정 요인: 종합병원급 이상 권역응급의료센터를 중심으로

이정찬 ( Jungchan Lee ),안병기 ( Byeungki Ahn ) 대한보건협회 2018 대한보건연구 Vol.44 No.3

연구목적: 부적절하게 권역응급의료센터를 다이용하고 있는 환자들의 이용요인들을 찾아 병원이용 전단계에서 환자들의 이용을 사전에 조정함으로써 권역응급의료센터를 부적절하게 다이용하지 않도록 하고자 하였다. 연구방법: 2011년 전국 종합병원급 이상 권역응급료센터의 응급실 이용 현황 자료를 사용하였다. Dutton(1986)의 의료이용 모형을 활용하여 응급실 다방문에 영향을 미치는 요인을 분석하였으며 이를 위해 일반화추정방정식(GEE) 방법을 사용하였다. 연구결과: 2011년 총 605,604명의 환자가 733,184번 권역응급의료센터 응급실을 이용하였다. 응급실 다방문 결정요인을 분석한 결과, 남자가 여자보다 응급실 이용횟수가 높았고, 30대, 50대, 40대, 9세 이하, 10대 순으로 응급실 이용횟수가 높았다. 사고 보다 질병으로 내원한 환자가 응급실 이용횟수가 더 높았다. 암이나 정신질환을 보유한 환자가 그렇지 않은 환자보다 응급실 이용횟수가 더 높았다. 의료급여 환자, 자동차보험 환자, 건강보험 환자, 일반 환자 순으로 응급실 이용횟수가 높았다. 응급실 직접 방문 환자, 외래 경유 환자, 타 병원으로부터 전원 온 환자 순으로 응급실 이용횟수가 높았다. 개인 차량, 119서비스, 사설 앰뷸런스, 도보 순으로 응급실 이용횟수가 높았다. 응급실 체류시간이 60분 미만인 경우 응급실 이용횟수가 높았다. 응급실 방문일이 화-금요일, 월요일, 토요일, 일요일 순으로 응급실 이용횟수가 높았다. 퇴실 후 귀가 환자, 입원 환자, 타 병원으로 전원 된 환자 순으로 응급실 이용횟수가 높았다. 트리아지가 9점(중증)인 환자보다 9점미만(경증)인 환자의 응급실 이용횟수가 더 높았다. 결론: 본 연구결과 권역응급의료센터 다이용 환자를 감소시키기 위해서는 권역응급의료센터를 우회하여 이용할 수 있는 의료기관들에 대한 정보를 지역 주민들에게 제공함으로써 주민들 스스로가 권역응급의료센터를 이용하지 않도록 하여야 할 것이다. 또한 비응급환자의 의료이용을 병원이용 전단계에서부터 원할히 조정해주고, 1차 의료제공체계를 구축하여 지역사회 중심의 완화의료를 포함한 통합의료서비스를 제공해야 한다. Objectives: The purpose of this study was to find out the utilization factors of the patients who are inadequately using the regional emergency medical center(REMC) so that the patients do not use the REMC improperly. Methods: We used nationwide general hospital level REMC visit data of 2011. Dutton(1986)'s medical use model was applied and the generalized estimation equation(GEE) method was used to analyze the factors affecting the multiple ED visit. Results: In 2011, a total of 605,604 patients visited 733,184 times ED of REMC. We analyzed the determinants of frequent ED visit. The number of ED visit higher in males than females. By age, 30s, 50s, 40s, 9 or younger, and 10s were the most frequent users in the ED. Patients who visited the hospital with an illness rather than an accident were more likely to visit the ED. Patients with cancer or mental illness were more likely to visit the ED than those who did not. The number of ED visit was higher in the order of medical aid, auto insurance, NHI, and general patients. The number of ED visit was higher in the order of direct ED visit, referred from outpatient department, transferred from other hospitals. The number of ED visit was high in the order of personal vehicles, 119 services, private ambulances, and by walking. The number of ED visit was higher when the stay time in the ED was shorter than 60 minutes than when it was more than 60 minutes. The number of ED visit was higher in the order of Tuesday-Friday, Monday, Saturday, and Sunday. The number of ED visit was higher in the order of return home, inpatients, and transferred to other hospitals. Patients with less than triage score 9(mild) were more likely visit ED than patients with 9(severe). Conclusion: As a result, in order to reduce the number of patients in the ED of REMC, it is necessary to continuously promote the alternative medical institutions that can be used in the local community in case of an emergency, so that the residents themselves do not use the emergency medical center. In addition, medical use of non-emergent patients should be adjusted prior to use of the hospital, and a primary health care delivery system should be established to provide community-based integrated health care services.

응급실 과밀화 해결을 위한 데이터 분석 기반 응급실 혼잡도 예측 모형 연구

김벼울(Byeo Wool Kim),윤용익(Yong Ik Yoon) 한국데이터정보과학회 2018 한국데이터정보과학회지 Vol.29 No.5

본 연구는 전국에 있는 414개 응급의료센터의 2017년 자료를 토대로 응급실의 특성 및 지역적 특성을 반영하여 응급실 혼잡도를 실시간으로 예측하는 모형을 개발했다. 예측모형 개발에는 데이터마이닝 기법 중 다중선형회귀분석, 부분집합선택, 능형회귀, Lasso, 주성분회귀분석 방법을 적용하였으며, 주성분회귀분석이 가장 높은 예측력을 보였다. 또한, 예측모형을 개발하는데 있어 전체 응급의료 기관을 기준으로 한 예측모형(92.73%) 보다 응급의료기관 유형에 따라 세분화한 예측모형의 예측력이 더 높게 나타났다. 특히, 가장 혼잡한 유형인 권역의료센터의 예측정도는 97.37%로 나타났다. 본 연구에서 개발된 응급실 혼잡도 예측모형은 응급실 간의 지역네트워크를 형성하고, 응급실 과밀화 문제를 해결하기 위한 기초자료가 될 수 있을 것이다. This research developed a model that predicts the congestion of the emergency room in real time based on the 2017 data of 414 emergency medical institutions nationwide. In the development of the predictive model, data mining techniques such as multiple linear regression analysis, subset selection, ridge regression, Lasso and principal component regression were applied, and principal component regression method showed high prediction power. The predictive power of the subdivided prediction models (especially regional emergency medical center (97.37%)) according to the types of emergency medical institution was higher than that of the predictive model based on the entire emergency medical institutions (92.73%). The emergency room congestion predictive model developed in this research can be used as basic data to solve the problem of overcrowding of emergency room and form a regional network between the emergency rooms.

무인차량용 다중채널 무선원격 제어시스템의 설계

김진관(Jin-Kwan Kim),유영재(Young-Jae Ryoo) 한국지능시스템학회 2014 한국지능시스템학회논문지 Vol.24 No.5

본 논문에서는 무인차량용 다중채널 무선원격 제어시스템의 설계방안을 제안한다. 기존의 무선원격 제어시스템은 단일 제어채널로 구성되어 제어채널에 고장이 발생하였을 때 응급대처가 불가능한 문제점이 있다. 따라서 휴대용 무선원격 제어기와 스테이션용 무선원격 제어로 구성되는 다중채널 무선원격시스템을 제안한다. 무인차량용 다중채널 무선원격 제어시스템을 개발하기 위하여 휴대용 무선원격 제어기와 휴대용 무선원격 제어기를 설계 및 개발하였다. 개발한 무선원격 제어시스템의 성능을 확인하기 위하여 무인차량에 적용하여 주행 실험을 실시하였다. 무선원격제어기의 고장 시 휴대용 무선원격 제어기를 이용한 비상정지 실험과 휴대용 무선원격제어기의 고장 시 스테이션용 원격제어시스템을 이용한 비상정지 실험을 실시한 결과 모두 만족하는 비상정지 성능을 발휘함을 검증하였다. In this paper, a design of multiple channel wireless remote control system for unmanned vehicle is proposed. One of serious problems of the previous wireless remote control system is that it does not work when a control channel is damaged in case of emergency because it`s composed of single control channel. Therefore, we propose the multiple channel wireless remote system which is composed of a portable wireless remote controller and a stationary wireless remote controller. The portable wireless remote controller and stationary wireless remote controller are designed and the multiple channel wireless remote control system for unmanned vehicles in developed. By applying to the unmanned vehicle to check its performance. The wireless remote control system is tested. Emergency stop using the portable wireless remote controller is tested when the stationary wireless remote controller is damaged. Also, emergency stop using the stationary wireless remote controller is tested when the portable wireless remote controller is damaged. The result of emergency stop test shows satisfied performance.