• 한국의료질향상학회지
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• 제10권2호
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• pp.216-231
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• 2003

Objectives: To develop a model that predicts a death probability of acute myocardial infarction(AMI) patient, and to evaluate a performance of hospital services using the developed model. Methods: Medical records of 861 AMI patients in 7 general hospitals during 1996 and 1997 were reviewed by two trained nurses. Variables studied were risk factors which were measured in terms of severity measures. A risk model was developed by using the logistic regression, and its performance was evaluated using cross-validation and bootstrap techniques. The statistical prediction capability of the model was assessed by using c-statistic, $R^2$ as well as Hosmer-Lemeshow statistic. The model performance was also evaluated using severity-adjusted mortalities of hospitals. Results: Variables included in the model building are age, sex, ejection fraction, systolic BP, congestive heart failure at admission, cardiac arrest, EKG ischemia, arrhythmia, left anterior descending artery occlusion, verbal response within 48 hours after admission, acute neurological change within 48 hours after admission, and 3 interaction terms. The c statistics and $R^2$ were 0.887 and 0.2676. The Hosmer-Lemeshow statistic was 6.3355 (p-value=0.6067). Among 7 hospitals evaluated by the model, two hospitals showed significantly higher mortality rates, while other two hospitals had significantly lower mortality rates, than the average mortality rate of all hospitals. The remaining hospitals did not show any significant difference. Conclusion: The comparison of the qualities of hospital service using risk-adjusted mortality rates indicated significant difference among them. We therefore conclude that risk-adjusted mortality rate of AMI patients can be used as an indicator for evaluating hospital performance in Korea.

• 한국임상수의학회지
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• 제34권5호
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• pp.356-358
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• 2017

A dog (neutered male Schnauzer, 11 years old, 8 kg) presented with recurrence of immune-mediated hemolytic anemia. Rapid whole blood transfusion was initiated, and then sudden tachycardia and dyspnea were observed. Invasive arterial blood pressure, arterial blood gas analysis, and thoracic radiograph indicated transfusion-associated circulatory overload (TACO). Persistent high blood pressure of 160-205 mmHg was observed; the thoracic radiograph revealed interstitial infiltration and a fissure line, which suggested pulmonary edema and pleural effusion. Despite furosemide administration and nasal oxygen supplementation, hypertension and respiratory distress were not completely controlled. Finally, cardiac arrest occurred and the patient expired due to TACO 24 hours after the transfusion.

• 한국응급구조학회지
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• 제14권1호
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• pp.5-18
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• 2010

Objective : This study compares Video laryngoscope and Direct laryngoscope in tracheal Intubation on rapidity and accuracy by paramedic and aims to improve efficiency of airway management and survival rate in pre-hospital treatment for the patients with severe trauma, cardiac arrest or dyspnea caused by acute diseases. Methods : 60 paramedics were recruited from 13 fire stations located in C province. With the consent of the paramedics, likelihood ratio test was carried out and they were divided into two different groups; DL group (30) and GVL group (30). Regarding intubation conditions, difficult airway grade I, grade II and grade III as well as sniffing position and neutral position were examined. This study also compared between ambulance in motion and in stand still. Frequency, average and standard deviation were analyzed with statistics program, SPSS WIN 17.0 and repeated measure design was introduced to examine inter-relations between position, grade and groups. Results : Intubation was performed more rapidly in neutral position and GVL than in sniffing position and DL(F = 15.260, p = .000). Rapidity value was better with grade I and grade II than grade III and better with GVL than DL(F = 32.629, p = .000). Accuracy value was higher with neutral position and GVL than sniffing position and DL(F = 5.008, p = .011). grade III was less accurate than grade I, grade II and GVL was more accurate than DL(F = 10.966, p = .000). Ambulance motion status did not show any statistically significant differences in accuracy and rapidity. Conclusion : Given this study results, neutral position is better for the patient with severe trauma. For a better survival, GVL intubation can be considered since GVL can enhance accuracy as well as rapidity regarding difficult airway. Since there is no significant differences in ambulance motion factors, intubation can be recommended even in moving ambulance for shortening traveling time to a hospital.

• Journal of Chest Surgery
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• 제38권6호
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• pp.441-444
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• 2005

복강내 종양이 혈관을 통해 전이될 수는 있으나 우심장까지 침범되는 경우는 드물다. 자궁에서 기원하는 정맥내 평활근종증은 매우 드물며 조직학적으로는 양성이지만 임상적으로는 하대 정맥, 우심장 또는 폐동맥의 폐쇄를 동반함으로써 치명적인 결과를 초래할 수 있는 질환이다. 치료 방법은 심폐 순환기를 통한 완전 순환정지하에 종괴를 완전절제하는 것이다. 자궁에서 기원한 정맥내 평활근종증을 개복술과 개심술을 이용해 일차 수술로 성공적으로 치유하였기에 문헌고찰과 함께 보고하는 바이다.

• 한국컴퓨터정보학회논문지
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• 제24권10호
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• pp.175-182
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• 2019

이 연구는 경찰관에게 실시한 기본인명소생술 훈련의 효과를 증명하기 위해 실시되었고, 연구대상자는 K 경찰관 중 10명의 실험군과 10명의 대조군으로, 교육프로그램은 60분 이론과 30분 실습을 포함하였다. 기본인명소생술 술기 측정은 미국심장협회에서 제시한 응급 심혈관 치료의 가이드라인을 따랐다. 결과는 다음과 같다. 실험군에서 현장확인기술, 1차 평가수행기술 및 기본인명소생술 능력(심장압박, 인공호흡, 의학적 평가)이 대조군에 비하여 높게 나타났다. 결론적으로, 이 연구결과는 시뮬레이션 교육프로그램이 전통적인 이론실습강의보다 경찰관의 임상술기능력을 향상시키는데 효과적이라는 것을 증명하였다. 그러므로 시뮬레이션 교육프로그램을 심정지 응급치료에 대한 교육프로그램으로 적용하는 것을 제안한다.

• 대한임상독성학회지
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• 제8권2호
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• pp.122-124
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• 2010

$Basagran^{(R)}$ is a herbicide that is widely used in the field and it acts by interfering with photosynthesis in plants. It consists of bentazone, 2-methyl-4-chlorophenoxyacetic acid (MCPA) and surfactants. Bentazone is commonly used, but poisoning due to Bentazone has not been previously reported in Korea. The patients with toxic effects of bentazone show mild to severe symptoms and various complications. We report here on a case of a woman who intentionally ingested 500 ml of $Basagran^{(R)}$ and she was discharged without complication. As soon as the patient visited the emergency department, we started to treat her as if she had organophosphate intoxication because of the cholinergic symptoms. We could not detect the bentazone in her serum and urine, and we could confirm $Basagran^{(R)}$ ingestion only after getting information from her husband. Bentazone poisoning may induce harmful complications like muscle rigidity, rhabdomyolysis, respiratory failure and cardiac arrest. A detailed history taking, an accurate analysis method and early conservative management will be helpful for patients with acute bentazone poisoning.

• International Journal of Advanced Culture Technology
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• 제10권1호
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• pp.187-195
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• 2022

Since most of the first witnesses of cardiac arrest in clinical settings are nurses, the ability to perform CPR is important. The purpose of this study is to provide basic data for developing education that strengthens CPR performance in the future by examining inactive nurses' CPR knowledge, attitude, performance confidence, device discomfort, continued use intention, and educational achievement. The final subjects of this study were 88 inactive nurses residing in B city. The study period was from June 23, 2020 to December 24, 2020. The collected data were analyzed by descriptive statistics and Pearson correlation using SPSS WIN 24.0 program. After obtaining the subject's consent for the study, an inactive nurse who understood the purpose of the study and voluntarily consented to the study participated. To investigate the perception of experience, the subjects watched 360-degree virtual reality contents about CPR in the hospital using HMD. The data of this study were analyzed using SPSS WIN 22.0.program. As a result of this 360-degree study on CPR in the hospital, the average score for the inactive nurses on CPR knowledge was 12.70±3.43, the average score for performance confidence was 6.04±2.45, and the average score for attitude was 4.63±0.80. As a result of experience recognition of 360-degree virtual reality contents for CPR in hospitals, the average score for device discomfort was 4.01±0.94, the average score for continued use intention was 2.07±0.85, and the average score for educational achievement was 2.11±0.79. As a result of correlation analysis, educational achievement and continued use intention were significantly positively correlated (r=.77, p<.001). Based on the results of this study, in order to strengthen the CPR performance capability of inactive nurses in emergency situations, it is necessary to increase CPR knowledge and confidence in performing CPR, and to cultivate a positive attitude toward performing CPR. In addition, it is necessary to implement CPR simulation education based on patient cases by applying content that considers educational achievement and continuous use intention.

• 대한영상의학회지
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• 제82권6호
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• pp.1594-1599
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• 2021

64세 남성이 2미터 높이에서 낙상한 이후 심한 우측 옆구리 통증으로 내원하였다. 시행한 조영증강 전산화단층촬영에서 우측 혈흉과 다수의 우측 갈비뼈 골절 및 우측 장골의 골절 소견이 있었다. 또한 간 주변에 혈종이 있었으나, 간실질 외상 소견은 보이지 않았다. 먼저 시행된 수술 중, 간문에서 지혈되지 않는 지속적인 출혈이 관찰되었다. 이에 대한 진단을 위해 인터벤션 시술이 시행되었고, 최초 간동맥조영술에서는 출혈 소견이 보이지 않았다. 이어서 시행한 조영증강 전산화단층촬영에서 좌측 복부의 조영제혈관바깥유출이 보였는데, 이는, 경피경간문맥조영술에서 좌측 문맥의 출혈로 확인되었다. 이 지점에 접착제 색전술을 시행했으나, 환자는 끝내 사망하였다. 이 증례를 통해 복부 외상환자 평가에서 간동맥조영술이 정상이라도 간문맥 손상의 가능성을 고려해야 한다는 것과 복부에서도 반충손상기전에 의한 손상이 가능하다는 것을 확인하였다.

• Journal of Chest Surgery
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• 제31권10호
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• pp.945-951
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• 1998

개심술시 총순환정지는 매우 유용한 방법이나 뇌손상등 부작용으로 그 사용이 제한되고 있다. 이러한 뇌손상의 분석에 유용한 지표로서 뇌 허혈성 손상의 특이한 효소인 크레아티닌 카이네이즈 BB(CK-BB)의 유용성을 재고하고 뇌손상에 영향을 미치는 인자들의 분석을 시도하였다. 총순환정지를 이용하여 개심술을 시행한 18명의 환자를 대상으로 하였다. 이들은 다시 비청색증형 심기 형군과 청색증형 심기형군으로 나누어 각각 6명과 12명으로 하였다. 각 환자에서 총순환정지전 및 후 15, 30, 60, 120, 240, 480, 720분에 동맥혈을 채취하여 CK-BB분획을 측정하였고 이와 동시에 혈색소농도, 이 온화 칼슘농도, 혈당량 등을 측정하였다. 총순환정지시간과 CK-BB와 통계적으로 유의한 관계를 보이는 채혈시간은 찾을 수 없었다. 또 총순환 정지전의 문제로 인한 영향을 줄이기 위하여 각각의 측정치에서 총순환정지전의 측정치를 뺀 값을 구하 여 각기 CKBBD15, CKBBD30....등으로 표시하고 상관관계를 구하였으나 역시 유의한 상관관계를 보이 지 않았다. CKBB30과 CKBBD30값은 비청색증형 군과 청색증형 군 사이에 유의한 차이를 보이지 않았 다. CK-BB농도와 혈색소 농도는 유의한 상관관계를 보였다. 단일 채혈에 의한 CK-BB농도의 지표는 순환정지시간과 유의한 관계가 없음이 확인되었다. 또한 청색 증형 심질환군이 총순환정지에 의한 뇌손상에 비청색증형 심질환군에 비해 더 취약하지는 않은 것으로 생각된다.

• Journal of Chest Surgery
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• 제38권10호
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• pp.717-720
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• 2005

심실중격파열 및 좌심실자유벽파열은 급성 심근경색의 주요 합병증들 중의 하나이나 이 치명적인 합병증 둘이 모두 동일 환지에서 발생한 소위 심실이중파열에 대한 외과적 치험예는 거의 보고되고 있지 않고 있다. 저자들은 급성심근경색의 합병증으로 발생한 심실중격파열에 이어 좌심실자유벽이 파열된 환자에서 시행된 외과 치험 1예를 보고하고자 한다. 58세 남자가 급성심근경색으로 전원되었다. 심초음파로 후심실중격파열을 진단 후 대동맥내풍선점프를 넣고 응급수술을 계획하였다. 마취 유도 중 갑자기 환자는 순환허탈에 빠져 심장마사지를 하며 개흉하여 혈심낭에 의한 급성 심장압전과 좌심실 후벽 중간 부위에서 혈액을 분출하고 있는 약 2cm 길이의 세로 방향의 파열을 관찰할 수 있었다. 심폐바이패스를 설치, 혈역학을 안정시킨 후 좌심실 재건술을 시행하였다. 환자의 수술 후 경과는 술 전 심장마비로부터 비롯된 것으로 생각되는 뇌손상으로 지연되었다.