• 의료법학
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• 제25권1호
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• pp.87-115
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• 2024

우리나라는 급격한 발전과 더불어 많은 성장을 이루는 과정에서 스트레스에 노출이 정신적 고통을 수반하게 되었고 다양한 사회문제로 나타나며, 응급입원의 빈도가 높아지고 있다. 정신질환자의 경우 '비자의 입원'이 문제가 되며, 경찰, 119구급대원이 정신질환자의 신체억제를 시도하며, 많은 문제점이 노출되고 있다. 이는 정신건강복지법 상 응급입원의 조항의 구성요건이 현실을 반영하지 못해 하나의 정신질환자를 두고 각 기관이 다른 입장을 내며, 응급입원이 원활하게 진행되지 않거나, 관계기관의 마찰로 이어지며 정신질환자의 안전이나, 타인의 안전이 확보되지 못하는 경우가 발생하고 있다. 응급입원은 주체가 '정신질환자로 추정되는 사람으로 자신의 건강 또는 안전이나 다른 사람에게 해를 끼칠 위험이 큰 사람을 발견한 사람'으로 정하고 있으며, 그 상황이 매우 급박하여 스스로 입원을 결정하는 입원절차를 거칠 시간적 여유가 없는 경우 의사와 경찰관의 동의를 얻어 응급입원을 의뢰할 수 있다고 규정하고, 이 경우 119구급대원이 정신의료기관까지의 호송하도록 하고 있다. 이러한 응급입원의 조항은 정신의료기관까지 이송하는 과정에 많은 문제를 내포하고 있다. 실무를 담당하는 경찰관이나 119구급대원이 응급입원과정 중 '물리력'을 사용하게 되면, 필연적으로 부작용이 발생하게 되는데, 업무상과실이 문제가 될 수 있으며, 구체적으로는 물리력을 행사할 때 법령에 근거하고 비례원칙에 따른 필요최소한도의 신체억제가 필요하게 되는데, 법령상 119구급대원이나 경찰관의 주의의무의 부재가 결국 다른 법령을 적용하여 해결하게 된다는 것이다. 이에 정신건강복지법 상 응급입원 조항의 주체를 경찰, 소방기관의 장점을 살려 주체를 변경하고, 정신보건법의 시행규칙으로 신체보호대 사용을 정의하고, 규정함으로써 119구급대원과 경찰관의 주의의무를 설정하고 정신질환자가 안전하게 치료받을 수 있도록 이송에 대한 환경을 조성함으로써 자기 또는 타인의 위험을 내포하고 있는 정신질환자 또한 안전한 환경에서 정신의료기관으로 이송될 수 있는 계기가 될 것이다.

• 대한임상독성학회지
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• 제20권1호
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• pp.8-14
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• 2022

Purpose: This study was undertaken to investigate how sedative-hypnotics affect the occurrence and severity of the patient's symptoms. In addition, we conducted a study to determine the type of patients who reacted severely and required hospitalization; patients were accordingly classified as hospitalized patients and patients discharged from the emergency room. Methods: From January 2017 to December 2019, we investigated the demographics, drug information, history, laboratory tests, and severity of patients who visited our emergency department and were diagnosed with benzodiazepine, zolpidem, and doxylamine succinate overdose. We further compared details of hospitalized patients and discharged patients. Results: Subjects who had overdosed and visited the ED included 120 for benzodiazepine, 147 for zolpidem, and 27 for doxylamine succinate. Comparisons between the three groups revealed differences in their early diagnosis, psychiatric history, and sleep disturbance. Differences between groups were also determined for mental state, poisoning history, treatment received in the intensive care unit, and intubation and ventilator support. In cases of benzodiazepine overdose, we obtained a high hospitalization rate (40.0%), admission to the intensive care unit (24.2%), and intubation rate (18.3%). Comparisons between hospitalized patients and discharged groups showed differences in transferred patients, early diagnosis, and mental state. Conclusion: Patients poisoned by sedative-hypnotics are increasing every year. In cases of benzodiazepine and zolpidem, the hospitalization rates were high, and benzodiazepine overdose resulted in hospitalization, intensive care unit admission, and pneumonia in a majority of cases. Therefore, active treatment and quick decisions in the emergency room are greatly required.

• 대한임상독성학회지
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• 제18권2호
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• pp.102-109
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• 2020

Purpose: This study examined factors associated with the hospitalization of patients who visited the emergency department (ED) after deliberate self-poisoning. Methods: The medical records of the patients, who visited the ED at a tertiary teaching hospital after deliberate self-poisoning between March 2017 and December 2019, were reviewed retrospectively. Results: Fifty-seven in the hospitalization and 236 in the discharge group patients were included. The mean age in the hospitalization and discharge group was 48.8±20.4 and 41.8±19.1, respectively (p=0.020). Univariate analysis revealed statistically significant differences in age (p=0.020), mental status (p<0.001), request for help (p=0.046), chronic disease (p=0.036), substance ingested (p<0.001), and risk rescue-rating scale (p<0.001) between the two groups (hospitalization group and discharge group). In multiple logistic regression analysis for predicting the hospitalization of patients after deliberate self-poisoning, the Risk-Rescue Rating Scale (RRRS) was identified (OR=1.493, 95% confidential interval=1.330-1.675, p<0.001). Receiver operating characteristics analysis of RRRS for the decision to hospitalize showed a cut-off value of 38.9, with a sensitivity, specificity, and area under the curve of 96.4%, 77.0%, and 0.949, respectively. Conclusion: The RRRS can be used to determine the hospitalization for patients who visited the ED after deliberate self-poisoning. Nevertheless, multicenter prospective studies will be needed to determine the generalisability of these results.

• 생물정신의학
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• 제8권1호
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• pp.167-174
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• 2001

A 54-year old male patient who was suffering from bipolar I disorder for 19 years and was admitted to the National Bugok Mental Hospital due to a depressive episode, was referred to the Kosin University Gospel Hospital. On arrival at the emergency room, he had confused mentality with disorientation, memory impairment, hypomania, marked anxiety and hyperirritability. The change of neuromuscular activity such as ataxia, gait disturbance, tremor, shivering, myoclonus and epileptic seizures was also shown. In addition, the symptoms and signs of autonomic instability including diaphoresis, tachycardia, hypotension, fever and facial flushing were noticed. The above symptoms developed after the administration of sertraline successive to the discontinuation of fluoxetine without any washout period. The degree of severity seemed to be severe because he had epileptic seizures, fever and hypotension. He was recovered from the severe serotonin syndrome by the supportive symptomatic treatment with sodium valproate, clonazepam, lorazepam and cyproheptadine after cessation of the selective serotonin reuptake inhibitors during hospitalization. Therefore, this rare case of severe serotonin syndrome was reported and related literatures were also reviewed.

• 생물정신의학
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• 제28권1호
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• pp.13-22
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• 2021

Objectives Despite growing attention to anxiety in bipolar disorder (BD), little research has assessed anxiety symptoms in the course of BD. The current prospective follow-up study examines the influence of subjectively and objectively measured anxiety symptoms on the course of BD. Methods A total of 49 patients with BD were followed-up prospectively for average of one year at an average of four months interval. The Korean version of the Beck Anxiety Inventory (K-BAI), the Hamilton Anxiety Rating Scale, heart rate variability (HRV) were used to measure anxiety subjectively, objectively and physiologically. Participants were divided into high and low anxiety groups based on their K-BAI scores. Kaplan-Meier survival analysis was performed to compare the recurrence of mood episode, suicide attempt, emergency room visit, and psychiatric hospitalization between two groups. Mediators were investigated with Cox proportional hazards models. Results Compared to the low anxiety group, the high anxiety group reported significantly higher impulsiveness (p = 0.016) and lower high frequency component on HRV (p = 0.007) after controlling for severity of BD. Regarding survival analysis, the high anxiety group showed hastened depressive episode recurrence (p = 0.048) and suicidal ideation was the mediator of the hazard ratio (HR) 1.089 (p = 0.029) in the Cox model. Moreover, the high anxiety group showed a tendency of accelerated suicide attempt (p = 0.12) and impulsivity was the risk factor of suicide attempt (HR = 1.089, p = 0.036). Conclusions This interim analysis of prospective study suggests that high anxiety level in BD may anticipate unfavorable course. Further studies are needed to understand the multifactorial mechanism of anxious bipolar patients.

• 대한지역사회영양학회지
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• 제3권3호
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• pp.430-439
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• 1998

This study was performed to investigate the nutritional status of neurosurgical tube-fed patients. The objective of this study was to improve the nutrition management of tube-fed patients. The current practices of tube feeding and enteral nutrition formula as for 95 patients in the hospital were examined by reviewing patients charts, and interviewing patients, nurses and their family members. The results are summarized as follows ; 57.9% of patients that received the formula showed a decrease in mental status. Among the subjects, 55.7% had nervous system diseases due to old age. Most of the tube-fed patients were hospitalized in the emergency room and while hospitalized, the status of their respiratory organ was abnormal. The method of tube-feeding was by Bolus injection and the type of the tube was a 16Fr size silicone tube. The amount of the injection per day while tube-feeding was on average 1424kcal for men and 1322kcal for women and the calories per day ranged from 1000-1500kcal(50.5%). The injection volume averaged 332.7ml and 45% of patients received more than 300ml per injection. The tube feeding intake rate was 127.9ml/min with 50% of subjects in the range of 50-100ml/min and 10% at 20ml/min. The longer the hospitalization, the older age, coma status, and the higher tube feeding rate, the more decreased were the biochemical parameters.

• 대한임상독성학회지
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• 제6권1호
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• pp.9-15
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• 2008

Purpose: Dichlorvos has been in widespread use as an organophosphate (OP) insecticide compound. The purpose of this study was to access the epidemiology and clinical features of dichlorvos in Korea. Methods: This was a 38 multi-center prospective study of dichlorvos poisoning using surveys, a structural reporting system and review of hospital records from August 2005 to July 2006. A total of 54 patients with acute dichlorvos poisoning on a national basis were enrolled. We analyzed the epidemiologic characteristics and clinical manifestations of dichlorvos poisoning. In addition, the clinical features of dichlorvos poisoning were compared with others OP compounds. Results: During the study period, compounds involving pure OP poisoning were dichlorvos (22.7%), methidathion (8.4%), and phosphamidon (6.7%). In acute dichlorvos poisoning, all ingestion routes were oral. Intentional poisoning involved 74.1% of cases. The common initial complaints involved gastrointestinal (64.8%), systemic (61.1%), central or peripheral nervous system (53.7%), and respiratory symptoms (50.0%). The median arrival time to hospital after dichlorvos poisoning was 2.6 hours and mean hospitalization duration was 7.1 days. 2-PAM was administered in 35 patients in mean doses of 6.3 g/day intravenously. Atropine was administered in 30 patients with a mean dose of 62.8 mg/day (maximal 240 mg/day). Overall mortality rate for dichlorvos poisonings were 14.8% (8/54). Immediate causes for death included sudden cardiac arrest or ventricular dysrhythmias (50%), multi-organ failure (25%), acute renal failure (12.5%), and unknown causes (12.5%). Conclusion: When compared to previous reports, dichlorvos poisoning displayed relatively moderate severity. The presence of a lower GCS score, altered mental status, serious dysrhythmias, systemic shock, acute renal failure, and respiratory complications upon presentation were associated with a more serious and fatal poisoning.

• Pediatric Infection and Vaccine
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• 제30권2호
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• pp.91-96
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• 2023

Enterovirus (EV) 71은 무균성 뇌수막염 환자로부터 처음 분리된 이후로 주로 수족구병으로 나타났으며 소아에서 전형적인 피부 발진, 구강 병변 및 발열을 동반한다. 피부 발진은 수포성으로 손과 발에 영향을 미치고 수포가 없는 반구진 양상일 수도 있으며 특히 어린 소아 및 유아에서는 팔꿈치, 무릎 그리고 엉덩이를 침범할 수도 있다. EV 71 감염으로 인한 신경학적 합병증은 매우 드물지만 주로 뇌간 뇌염으로 나타난다. 대근육 운동 발달 지연 이외에 건강했던 30개월 된 남아가 발열, 혼수 증상으로 내원하였고 입원 후 무호흡 및 호흡 정지 증상이 동반되어 뇌척수액 검사 및 뇌 MRI, 뇌파검사를 하였다. 검사 결과 뇌간 뇌염 및 미만성 대뇌 기능 장애가 확인되었고 비인두도말 및 대변 검체에서 EV 71이 검출되었으며 유전자 검사에서 myoclonic epilepsy with ragged red fiber syndrome이 확인되었다. 저자들은 기저미토콘드리아 질환으로 인해 인후 및 피부 발진의 증상 없이 발열 하루 만에 빠르게 진행되는 EV 71 감염으로 인한 뇌간 뇌염 1예를 보고하는 바이다.

• Journal of Preventive Medicine and Public Health
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• 제33권3호
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• pp.334-342
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• 2000

이 연구는 당일수술을 실시하고 있지 않은 병원에서 당일수술이 가능한 질병으로 입원하고 있는 환자를 대상으로 당일수술에 대한 인지도와 선호도를 조사하고, 당일수술 가능 질병의 평균 재원일수를 분석하며, 마취 후 퇴원점수체계를 이용한 시간대별 퇴원 가능한 환자의 비율을 분석하여 당일수술 가능여부를 판단하기 위하여 실시되었다. 자료수집은 1999년 2월 1일부터 동년 3월 31일까지 $\bigcirc\bigcirc$대학교 의과대학 부속병원에 입원하여 백내장, 편도선 비대, 탈장, 사시, 안검하수, 담석증, 질, 치루로 수술 받은 환자 353명을 대상으로 하였다. 자료 수집 방법은 설문지를 이용하여 설문과 면담을 하였고, 간호사용 마취 후 퇴원점수체계(PADS)를 이용하여 환자의 수술 후 활력징후, 활동력과 정신상태, 통증, 오심 구토, 출혈, 식이 및 배뇨 등의 환자상태를 조사하였다. 당일수술에 대한 인지도는 52.7%이었으며, 당일수술 의향이 있는 환자는 52.1%이었다. 당일수술을 받고 싶은 이유로는 "질병이 경미하고 수술이 간단하여"가 43.1%, "집에서 안정을 취해도 충분하므로"가 30.4%이었고, 당일수술을 받고 싶지 않는 이유는 "집에 있기 불안해서"가 56.5%로 가장 높았다. 당일수술 후 가장 염려되는 것은 응급 상황발생에 대한 것이었다. 당일수술의 가장 큰 장점은 입원기간 절약(39.1%)이었으며 단점은 응급상황 시 불안하다는 것이 53.9%로 가장 많았다. 환자의 주관적 판단에 의한 퇴원시기는 수술 후 1-2일이라고 생각하는 사람이 47.6%로 가장 많았다. 수술명에 따른 평균 재원일수는 백내장적출술 2.9일, 사시 교정술 2.2일, 편도선제거술 3일, 탈장교정술 3.8일, 안검복원술 2.2일, 담석증복강경술 4.9일, 치질제거술 4.1일, 치루제거술 4.6일로, 이들 전체의 평균 재원일수는 3.1일이었다. 수술 후 나타난 증상으로는 통증이 45.6%로 가장 많았고, 다음으로 오심 구토(10.5%) 및 두통(7.9%)의 순이었다. 시간대별 퇴원 가능 환자 수는 3시간대에 95.2%, 12시간대에 99.2%, 24시간대에는 100%로 나타나 이 연구에서 선정된 모든 수술이 마취 후 퇴원점수체계에 의한 24시간 이내 퇴원 기준을 충족시켰고, 통상적으로 당일수술 3시간 뒤에 환자가 퇴원하는 것을 고려하면 의학적인 측면에서 당일수술이 가능한 수술은 백내장적출술과 사시교정술로 판단되었다. 당일수술의 경과에 대한 설명과 수술 시행 후에 환자들에게 발생할지도 모르는 응급상황에 대한 대처 방안이 잘 강구 된다면 당일수술의 수요가 증가할 것이며, 그 서비스에 대한 만족도도 높아져 당일수술이 활성화될 것이다.