• Journal of Trauma and Injury
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• 제33권1호
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• pp.23-30
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• 2020

Purpose: Hemorrhagic shock is the leading cause of death in trauma patients worldwide. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique used to improve the hemodynamic stability of patients with traumatic shock and to temporarily control arterial hemorrhage. However, further research is required to determine whether REBOA with cardiopulmonary resuscitation (CPR) in near-arrest or arrest trauma patients can help resuscitation. We analyzed trauma patients who underwent REBOA according to their CPR status and evaluated the effects of REBOA in arrest situations. Methods: This study was a retrospective single-regional trauma center study conducted at a tertiary medical institution from February 2017 to November 2019. We evaluated the mortality of severely injured patients who underwent REBOA and analyzed the factors that influenced the outcome. Patients were divided into CPR and non-CPR groups. Results: We reviewed 1,596 trauma patients with shock, of whom 23 patients underwent REBOA (1.4%). Two patients were excluded due to failure and a repeated attempt of REBOA. The Glasgow Coma Scale score was lower in the CPR group than in the non-CPR group (p=0.009). Blood pressure readings at the emergency room were lower in the CPR group than in the non-CPR group, including systolic blood pressure (p=0.012), diastolic blood pressure (p=0.002), and mean arterial pressure (p=0.008). In addition, the mortality rate was higher in the CPR group (100%) than in the non-CPR group (50%) (p=0.012). The overall mortality rate was 76.2%. Conclusions: Our study suggests that if REBOA is deemed necessary in a timely manner, it is better to perform REBOA before an arrest occurs. Therefore, appropriate protocols, including pre-hospital REBOA, should be constructed to demonstrate the effectiveness of REBOA in reducing mortality in arrest or impending arrest patients.

• 한국산학기술학회논문지
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• 제18권11호
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• pp.416-424
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• 2017

본 연구는 공공기관 종사자들의 자동제세동기에 대한 인식과 시행의도 및 교육경험을 조사하고 그를 통해 효율적인 교육과 응급상황 시 자동제세동기의 실제 시행률을 높이는데 그 목적이 있다. 이러한 목적을 달성하기 위하여 2016년 6월 13일부터 8월 21일까지 강원도 공공기관에 근무하는 성인 남녀 243명을 연구대상으로 조사하였다. 수집된 자료는 빈도분석과 ${\chi}^2$-test로 분석하였다. 연구결과는 다음과 같다. 첫째, 공공기관 종사자들의 일반적 특성에 따른 자동제세동기 사용방법에 대한 인식의 차이에 대한 결과, 성별($X^2=6.32$, p<.05), 최종학력($X^2=5.91$, p<.05)에서 유의미한 인식의 차이가 있었다. 둘째, 공공기관 종사자들의 일반적 특성에 따른 자동제세동기 시행의도 차이에 대한 결과, 최종학력($X^2=5.70$, p<.05)에서 시행의도에 유의미한 차이가 있는 것으로 나타났다. 셋째, 공공기관 종사자들의 자동제세동기 시행의도가 없는 경우의 원인은 '자동제세동기 사용법을 몰라서'가 31.5%로 가장 높게 나타났다. 넷째, 공공기관 종자사의 일반적 특성에 따른 자동제세동기 교육경험은 연령($X^2=6.15$, p<.05), 최종학력($X^2=11.56$, p<.01), 근무경력($X^2=11.92$, p<.01)에서 유의하게 나타났다. 다섯째, 공공기관 내 종사자들 자동제세동기 교육의 형태는 이론과 실습의 병행교육이 55.9%로 가장 높게 나타났다. 이러한 결과들로 보아 많이 사람들이 이용하는 공공기관의 종사자들은 표준화된 자동제세동기 교육을 필수적으로 이수하고 실제 응급상황시 심정지환자의 소생률을 높일 수 있도록 노력해야 할 것으로 사료된다.

• 한국산학기술학회논문지
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• 제19권7호
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• pp.245-251
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• 2018

본 조사 연구는 일개 도내의 자동심장충격기 의무설치 기관의 자동심장충격기 설치현황 및 관리 점검 실태를 파악하기 위한 조사연구이다. 2017년 11월 20일부터 2017년 12월 20일까지 진행되었으며 총 169대의 자동심장충격기를 대상으로 조사하였다. 수집된 자료의 분석은 SPSS/WIN 20.0 프로그램을 이용하여 빈도분석과 백분율로 파악하였다. AED는 168대(99.41%)가 기관 실내에 설치되어 있는 것으로 조사되었으며, 24시간 항시 자동심장충격기가 운영되고 있는 경우는 47대(27.80%), 기관 운영시간 외에 자동심장충격기를 사용할 수 있는 경우는 44대(26.00%)으로 파악되었다. 책임관리자가 구조 및 응급처치 교육을 받은 경우가 87명(51.43%)이었으며, 자동심장충격기의 관리현황은 배터리 충전상태의 문제가 있는 경우는 2대(1.20%), 환자 부착용 AED패드의 유효기간이 지난 경우로 7대(4.10%)로 조사되었다. 향후 자동심장충격기 관리책임자를 위한 관리체계를 마련하고, 체계적 유지관리에 대한 정기적인 교육 프로그램을 개발하여 적용해야 한다. 또한 자동심장충격기 설치 관리에 대한 법률 강화 및 제도적 정비를 통한 지속적인 관리실태의 필요성에 대한 인식을 제고할 필요가 있다.

• 디지털융복합연구
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• 제10권10호
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• pp.415-421
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• 2012

최근 사회적으로 이슈인 폭력에 의한 손상의 양상을 파악하고 사회경제적 요인과의 관련성을 분석하여 정책개발 및 예방 사업의 기초자료로 제공하고자 하였다. 의료기관 기반 손상감시체계인 응급실 손상환자 표본심층조사자료를 활용하여, 폭력에 의한 손상과 그 외 손상의 양상을 비교하였고, 성, 연령, 교육수준, 직업을 상호 통제한 후 로지스틱 회귀분석 하였다. 여성이 남성보다 폭력에 의한 손상에 노출될 위험이 컸고, 나이는 적을수록 폭력에 의한 손상의 위험이 컸다. 고학력일수록 폭력에 노출될 확률이 적었고, 직업별로는 서비스 및 판매 종사자, 무직, 단순노무 종사자 순으로 위험이 컸다. 손상의 결과가 전원, 입원, 사망일 확률은 남성, 60대, 대학 이상의 교육수준, 농림어업 숙련 종사자에서 높았지만, 상관성은 없었다. 결론적으로 일부 사회경제적 요인(성, 연령, 교육수준, 직업)의 차이가 폭력으로 인한 손상 위험에 영향을 미치는 것으로 나타났다.

• Journal of Chest Surgery
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• 제49권6호
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• pp.435-442
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• 2016

Background: Blunt traumatic cardiac rupture is rare. However, such cardiac ruptures carry a high mortality rate. This study reviews our experience treating blunt traumatic cardiac rupture. Methods: This retrospective study included 21 patients who experienced blunt traumatic cardiac rupture from 1999 to 2015. Every patient underwent surgery. Several variables were compared between survivors and fatalities. Results: Sixteen of the 21 patients survived, and 5 (24%) died. No instances of intraoperative mortality occurred. The most common cause of injury was a traffic accident (81%). The right atrium was the most common location of injury (43%). Ten of the 21 patients were suspected to have cardiac tamponade. Significant differences were found in preoperative creatine kinase-myocardial band (CK-MB) levels (p=0.042) and platelet counts (p=0.004) between the survivors and fatalities. The patients who died had higher preoperative Glasgow Coma Scale scores (p=0.007), worse Trauma and Injury Severity Scores (p=0.007), and higher Injury Severity Scores (p=0.004) than those who survived. Conclusion: We found that elevated CK-MB levels, a low platelet count, and multi-organ traumatic injury were prognostic factors predicting poor outcomes of blunt cardiac rupture. If a patient with blunt traumatic cardiac rupture has these factors, clinicians should be especially attentive and respond promptly in order to save the patient's life.

• Journal of Yeungnam Medical Science
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• 제1권1호
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• pp.13-23
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• 1984

Acute renal failure refers to a rapid reduction in renal function that usually occurs in an individual with no known previous renal disease. Development of a complication of acue renal failure in critically ill surgical patients is not unusual, and it causes high morbidity and mortality. Acute renal failure can be divided as Pre-renal (functional), Renal (organic), and Post-renal (obstructive) azotemia according to their etiologies. Early recognition and proper correction of pre-renal conditions are utter most important to prevent an organic damage of kidney. These measures include correction of dehydration, treatment of sepsis, and institution of shock therapy. Prolonged exposure to ischemia or nephrotoxin may lead a kidney to permanent parenchymal damage. A differential diagnosis between functional and organic acute renal failure may not be simple in many clinical settings. Renal functional parameters, such as $FENa^+$ or renal failure index, are may be of help in these situations for the differential diagnosis. Provocative test utilyzing mannitol, loop diuretics and renovascular dilators after restoration of renal circulation will give further benefits for diagnosis or for prevention of functional failure from leading to organic renal failure. Converting enzyme blocker, dopamine, calcium channel blocker, and propranolol are also reported to have some degree of renal protection from bioenergetic renal insults. Once diagnosis of acute tubular necrosis has been made, all measures should be utilized to maintain the patient until renal tubular regeneration occurs. Careful regulation of fluid, electrolyte, and acid-base balance is primary goal. Hyperkalemia over 6.5 mEq/l is a medical emergency and it should be corrected immediately. Various dosing schedules for medicines excreting through kidney have been suggested but none was proved safe and accurate. Therefore blood level of specific medicines better be checked before each dose, especially digoxin and Aminoglycosides. Indication for application of ultrafiltration hemofilter or dialysis may be made by individual base.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제49권6호
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• pp.332-338
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• 2023

Objectives: This study aimed to compare the effectiveness of a hybrid arch bar (hAB) with the conventional Erich arch bar (EAB) for the management of jaw fractures, focusing on their use for temporary fixation in patients undergoing open reduction and internal fixation (ORIF). Materials and Methods: Patients presenting with maxillary and mandibular fractures at our institution were included in this prospective, comparative study. Placement time and ease of occlusal reproducibility were recorded intraoperatively for Group A (hAB patients) and Group B (EAB patients). The primary outcome was comparison of the postoperative stability of the two arch bars. Postoperative measurements also included mucosal overgrowth, screw loosening or wire retightening, and replacement rates. The data were tabulated and computed with a P<0.05 considered statistically significant. Results: The study included 41 patients. A statistically significant difference was observed in postoperative stability scores (3) between Group A and Group B (85.0% vs 9.5%, P=0.001). The mean placement time in Group A (23.3 minutes) significantly differed from that in Group B (86.4 minutes) (P<0.001). The ease of intraoperative occlusion was not different between the two groups (P=0.413). Mucosal overgrowth was observed in 75.0% of patients (15 of 20) in Group A. Conclusion: The hAB was superior to EAB in clinical efficiency, maxillomandibular fixation time reduction, stability, versatility, and safety. Despite temporary mucosal overgrowth, the benefits of hAB outweigh the disadvantages. The choice between hAB and EAB should be based on specific clinical requirements.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제26권6호
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• pp.291-300
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• 2023

Purpose: The impact of coronavirus 2019 (COVID-19) on gastrointestinal (GI) endoscopy procedures in adults has been reported, with a drastic reduction in the number of procedures. However, there are no sufficient data regarding the impact on pediatric GI endoscopy. Here, we aimed to report that impact in the Asia-Pacific region. Methods: A questionnaire-based internet survey was conducted from June to November 2021 among pediatric endoscopy institutions in the Asia-Pacific region, with each institution providing a single response. Overall, 25 questions focused on the impact of the number of procedures conducted, the usage of personal protective equipment (PPE), and endoscopy training programs during the pandemic. Results: A total of 162 institutions across 13 countries in the Asia-Pacific region participated in the study, and 133 (82.1%) institutions underwent procedure changes since the emergence of COVID-19. The number of esophagogastroduodenoscopy and ileocolonoscopy procedures decreased in 118/133 (88.7%) and 112/133 (84.2%) institutions, respectively. Endoscopy for patient with positive COVID-19 in an emergency or urgent cases still carried out in 102/162 (62.9%) institutions. Screening of COVID-19 for all patients before endoscopy was done across 110/162 (67.9%) institutions. PPE recommendations varied among institutions. Pediatric gastrointestinal endoscopy training programs were discontinued in 127/162 (78.4%) institutions. Conclusion: This study reports the impact of the COVID-19 pandemic on pediatric gastrointestinal endoscopy in the Asia-Pacific region. There has been a significant reduction in the number of endoscopic procedures and relevant training programs.

• 한국산학기술학회논문지
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• 제21권9호
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• pp.498-508
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• 2020

본 연구는 제2형 당뇨병 환자의 자기관리지식, 스트레스, 당뇨관리 자기효능감의 정도와 상관관계를 파악하고, 당뇨관리 자기효능감의 영향을 미치는 요인을 설명하는 서술적 조사연구이다. 본 연구의 참가자는 2015년 9월 17일부터 10월 15일까지 국내 K시 소재 1차 의료기관을 방문한 당뇨병 환자 150명으로 구성되었다. 데이터는 기술 통계량, t-검정, 분산 분석, Pearson 상관 계수 및 SPSS 18.0의 다중 회귀 분석을 사용하여 분석되었다. 일반적 특성에 따른 당뇨관리 자기효능감에서는 연령과 교육에서 유의한 차이가 나타났다. 자기관리지식과 당뇨관리 자기효능감은 양의 상관관계가 있는 것으로 나타났다. 당뇨관리 자기효능감과 스트레스, 자기관리지식과 스트레스는 음의 상관관계가 있는 것으로 나타났다. 당뇨관리 자기효능감에 영향을 미치는 중요한 요인은 스트레스와 자기관리지식이었다. 본 연구결과 자기관리지식을 향상시키고 제2형 당뇨병 환자의 스트레스를 줄이기 위한 적절한 당뇨관리 자기효능감 프로그램이 제공되어야 한다는 것을 시사한다. 이를 통해 당뇨관리 자기효능감 증진을 위한 효과적인 교육과 중재 개발의 기초자료를 제공하기 위함이다.

• Journal of Korean Neurosurgical Society
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• 제62권1호
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• pp.96-105
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• 2019

Objective : The aims in the management of thoracolumbar spinal fractures are not only to restore vertebral column stability, but also to obtain acceptable alignment of the thoracolumbar junction (T-L junction) to prevent complications. However, insufficient surgical correction of the thoracolumbar spine would be likely to cause late progression of abnormal kyphosis. Therefore, we identified the surgical factors that affected unfavorable radiologic outcomes of the thoracolumbar spine after surgery. Methods : This study was conducted in a single institution from January 2007 to December 2013. A total of 98 patients with unstable thoracolumbar spine fracture were included. In these patients, fixation was done through transpedicular screws with rods by three surgical patterns. We reviewed digital radiographs and analyzed the images preoperatively and postoperatively during follow-up visits to compare the change of the thoracolumbar Cobb angle with radiologic parameters and clinical outcomes. The unfavorable radiologic group was defined as the patients who were measured as having greater than 20 degrees of thoracolumbar Cobb angle on the last follow-up, or who underwent kyphotic progression of thoracolumbar Cobb angle greater than 10 degrees from the immediate postoperative state to final follow-up, or who had overt instrument failure with/without additional surgery. We assessed the risk factors that affected the unfavorable radiologic outcomes. Results : We had 43 patients with unfavorable radiologic outcomes, including 35 abnormal thoracolumbar alignments and 14 instrumental failures with/without additional surgery. The multivariate logistic regression test showed that immediate postoperative T-L junction Cobb angle less than 10.5 degrees was a statistically significant risk factor, as well as the presence of osteoporosis (p=0.017 and 0.049, respectively). Conclusion : Insufficient correction of thoracolumbar kyphosis was considered to be a major factor of an unfavorable radiological outcome. The spinal surgeon should consider that having a T-L junction Cobb angle larger than 10.5 degrees immediately after surgery could result in an unfavorable radiological outcome, which is related to a poor clinical outcome.