• 한국임상약학회지
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• 제32권3호
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• pp.251-259
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• 2022

Background: Intravenous fluid therapy is one of the most common interventions in critically ill patients. Normal saline is frequently used, but there have been some concerns about hyperchloremia. Due to closer to plasma composition, crystalloids have been used as alternatives to normal saline. However, the optimal choice of resuscitative fluids remains controversial. Methods: MEDLINE, EMBASE, and CENTRAL were comprehensively searched until July 2021 to compare balanced crystalloids with normal saline in critically ill patients with the risk factors for multiple organ dysfunction syndromes (MODS).The primary endpoint was composite mortality. Secondary outcomes were acute kidney injury (AKI)/acute renal failure (ARF), and new receipt of renal replacement therapy (RRT). Results: A total of 1,240 studies were searched, and finally, 8 randomized controlled trials and 5 cohort studies were included. In the meta-analysis of composite mortality of 30,710 patients, balanced crystalloids compared to normal saline were significantly associated with reduced mortality (OR 0.80, 95% CI 0.68-0.95). In AKI/ARF, balanced crystalloids had a lower risk than normal saline (OR 0.91, 95% CI 0.84-0.99). There was no difference between balanced crystalloids and normal saline in risk of new receipt of RRT (OR 0.91, 95% CI 0.80-1.04). Conclusion: In fluid resuscitation for patients at high risk of MODS, the use of balanced crystalloids showed a significantly lower incidence of mortality compared to normal saline.

• Journal of Trauma and Injury
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• 제19권2호
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• pp.178-182
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• 2006

Compartment syndrome has a wide spectrum from muscle pain to a life- threatening condition, such as acute renal failure and disseminated intravascular coagulation (DIC). Intracerebral hemorrhage (ICH) due to compartment syndrome has not been reported. We report a patient who presented with ICH leading to death. A 25-year-old female with no significant past history developed extensive compartment syndrome followed by rhabdomyolysis, acute renal failure, DIC, and ICH. Although the patient underwent a fasciotomy and hemodialysis and received aggressive resuscitation with massive transfusions of blood and intravenous fluids, she died. This case stresses the importance of early diagnosis and prompt treatment of compartment syndrome to prevent devastating complications.

• 한국임상약학회지
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• 제26권3호
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• pp.264-266
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• 2016

A 21-year-old healthy Korean man worked on a building construction site every day for almost 2 months and exercised every day for 1 or 2 hours after working hard. He felt dizziness, nausea, and experienced vomiting and body aches immediately after exercise and immediately took cold medicines including acetaminophen, cimetidine, bepotastine, and Codenal? complex for the common cold symptoms for 2 days because he was scheduled to participate in navy training at that time. He complained of severe trapezius pain and aches in his left calf 3 days after joining the Navy training. Testing revealed creatine phosphokinase (CPK) 6260 U/L, myogloblin 176 mcg/L in the urine, liver enzymes increased, and oliguria, suggesting rhabdomyolysis. He recovered with intravenous fluids without any complications.

• 대한수의학회지
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• 제50권3호
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• pp.253-257
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• 2010

A 3-year-old female Thoroughbred racehorse was presented following the accidental oral and skin administration of amitraz. This case report describes the clinical signs and the treatment of this horse. Clinical signs of amitraz toxicosis are associated with the stimulation of alpha2-adrenergic receptors. Amitraz is seldom fatal because the effects can be reversed by alpha2-adrenergic antagonists. The horse displayed typical clinical signs of colic, including pawing, small hard drops, tranquillisation, depression, ataxia, muscular incoordination and impaction colic lasting up to 7 days. The syndrome was accompanied by mild dehydration. The horse survived after persistent symptomatic treatment, including the giving of intravenous fluids, antibiotics, multiple doses of mineral oil per os, nonsteroidal anti-inflammatory drugs and dexamethasone intramuscularly and intravenously.

• Journal of Chest Surgery
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• 제39권1호
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• pp.60-63
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• 2006

혈관 확장성 쇼크는 심장 수술 후 발생할 수 있는 치명적인 합병증이다. 이러한 혈관 확장성 쇼크는 체외 순환 후 바소프레신의 결핍으로 발생하며, 수액 공급이나 심근 수축제에 잘 반응하지 않는 경우가 많다. 저자들은 체외 순환 중지 후 혈관 확장성 쇼크가 발생한 환자들에서 바소프레신을 사용하여 성공적으로 치료하였기에 문헌 고찰과 함께 보고하는 바이다.

• Clinical and Experimental Pediatrics
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• 제60권10호
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• pp.333-336
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• 2017

Coxsackievirus A16 (CA16), which primarily causes hand, foot, and mouth disease (HFMD), is associated with complications, such as encephalitis, acute flaccid paralysis, myocarditis, pericarditis, and shock. However, no case of pancreatitis associated with CA16 has been reported in children. We report a case of CA16-associated acute pancreatitis in a 3-year-old girl with HFMD. She was admitted because of poor oral intake and high fever for 1 day. Maculopapular rashes on both hands and feet and multiple vesicles on the soft palate were observed on physical examination. She was treated conservatively with intravenous fluids. On the fourth hospital day, she had severe abdominal pain and vomiting. The serum levels of amylase and lipase were remarkably elevated (amylase, 1,902 IU/L; reference range, 28-100 IU/L; lipase, >1,500 IU/L; reference range, 13-60 IU/L), and ultrasonography showed diffuse swelling of the pancreas with a small amount of ascites. The real-time reverse transcription polymerase chain reaction result from a stool sample was positive for CA16. CA16 can cause acute pancreatitis, and should be considered in the differential diagnosis of abdominal pain in children with HFMD.

• 대한치과마취과학회지
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• 제6권2호
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• pp.121-126
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• 2006

Generalized anaphylaxis is a most dramatic and acutely life-threatening allergic reaction. Most fatalities from anaphylaxis occur within the first 30 minutes postantigenic exposure. The mechanism of generalized anaphylaxis is the reaction of IgE antibodies to an allergen that causes the release of histamine, bradykinin, and others. These chemical mediators cause the contraction of smooth muscles of the respiratory and intestinal tracts, as well as increased vascular permeability. Four major clinical symptoms are recognized: skin reactions, smooth muscle spasm (gastrointestinal and genitourinary tracts and respiratory smooth muscle), respiratory distress, and cardiovascular collapse. Epinephrine is the drug of choice for the management. Its syrnpathomimetic effects directly counteract most aspects of the attack. Respiration must be immediately supported by the establishment of a patent airway along with artificial ventilation. The circulation should be supported and the existing hypotension overcome by placing the victim in a position to allow gravity to aid venous return and by administering intravenous fluids, vasopressors, and corticosteroids. When an imperceptible pulse is evident, external cardiac compression must also be instituted. This is a case report of anaphylactic shock care during general anesthesia, possibly due to penicillin, pancuronium and others.

• Tuberculosis and Respiratory Diseases
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• 제82권1호
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• pp.6-14
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• 2019

Sepsis is a life-threatening condition caused by infection and represents a substantial global health burden. Recent epidemiological studies showed that sepsis mortality rates have decreased, but that the incidence has continued to increase. Although a mortality benefit from early-goal directed therapy (EGDT) in patients with severe sepsis or septic shock was reported in 2001, three subsequent multicenter randomized studies showed no benefits of EGDT versus usual care. Nonetheless, the early administration of antibiotics and intravenous fluids is considered crucial for the treatment of sepsis. In 2016, new sepsis definitions (Sepsis-3) were issued, in which organ failure was emphasized and use of the terms "systemic inflammatory response syndrome" and "severe sepsis" was discouraged. However, early detection of sepsis with timely, appropriate interventions increases the likelihood of survival for patients with sepsis. Also, performance improvement programs have been associated with a significant increase in compliance with the sepsis bundles and a reduction in mortality. To improve sepsis management and reduce its burden, in 2017, the World Health Assembly and World Health Organization adopted a resolution that urged governments and healthcare workers to implement appropriate measures to address sepsis. Sepsis should be considered a medical emergency, and increasing the level of awareness of sepsis is essential.

• 임상간호연구
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• 제27권1호
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• pp.109-119
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• 2021

Purpose: The purpose of this study was to identify and analyze the characteristics of nurses' medication errors during three years. Methods: Retrospective survey study design was used to analyze medication errors by nurses among patient safety accidents. Data were collected for three years from January, 2017 to December, 2019. Data were analyzed using frequency, percentage, 𝑥²-test, and logistic regression with SPSS 26.0 program. Results: Of a total 677 medication errors, 40.6% were caused by nurses. Among the medication errors, near miss (n=154, 56.0%), intravenous bolus injection (n=170, 61.8%), wrong dose (n=102, 37.1%) and carelessness for repetitive work (n=98, 35.6%) were the most common. Medication errors differed by department, and nurses' career, and patient safety accident type. The results of the logistic regression analysis showed that the risk factors of adverse events were medication of fluids (OR=3.93, 95% CI: 1.26~12.27), insulin subcutaneous injection (OR=39.06, 95% CI: 4.58~333.18), and occurrence of extravasation/infiltration (OR=7.26, 95% CI: 1.85~28.53). Conclusion: The simplest and most effective way to prevent medication errors is to keep 5 right, and a differentiated education program according to department and nurse career is needed rather than general education programs. Hospital-level integrated interventions such as a medication barcode system or a team nursing method are also necessary.

• 대한의용생체공학회:의공학회지
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• 제24권4호
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• pp.293-299
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• 2003

본 연구에서는 혈관 내 폐 보조장치(Vibrating Intravascular Lung Assist Device. VIVLAD)에서의 뉴우튼 유체와 비뉴우튼 유체의 압력손실관계에 대한 관계를 고찰하고자 하였으며, VIVLAD를 선계하기 위한 압력 강하를 예측할 수 있는 관계식을 결정하고자 하였다. 혈관 내 폐 보조장치를 정맥에 삽입하기 전, 모듈 설계를 위하여 압력손실을 예측하기 위한 설계조건을 실험적 모델을 통하여 연구하고자 하였다. 뉴우튼 유체로 증류수와 글리세롤/증류수 혼합용액을 이용하였으며, 비뉴우튼 유체는 혈액을 이용하여 실험을 수행하였다. 액체의 흐름은 중공사의 외부로 평행하게 흐르도록 하였다. 내경의 직경을 3cm로 고정한 관에 삽입되는 중공사 개수의 변화에 파른 압력손실을 측정하였으며 실험에 의하여 얻어진 압력손실과 중공사의 전면면적과의 상관관계를 curve fitting을 통하여 유도하였고 유도되어진 관계식을 이용하여 관내에 삽입되는 중공사 개수의 변화에 따른 압력손실을 예측하였다 그리고 실험을 통하여 예측되어진 값과 비교 검토하여 유사성을 찾고자 하였다. 실험결과 40%글리세롤 용액에서의 압력손실과 혈액에서의 압력손실과 마찰계수는 유사한 결과를 보였다. 이 실험에서 VIVLAD의 압력손실을 측정하는데 40%글리세롤 용액이 이용될 수 있음을 보였다 또한 장치 내에서의 압력손실과 마찰계수에 대한 관계식을 중공사 충진율의 함수로 관계식을 유도할 수 있었으며. 관계식에 의하여 압력손실을 예측할 수 있었다. 또한. 실험에 의한 압력손실과 비교하였을 때 유사한 경향성을 보여 줌으로써 압력손실 예측의 신뢰성을 얻을 수 있었다. 이와 같은 연구결과는 VIVLAD를 설계하는데 유용한 자료가 될 것이다.