• Journal of Trauma and Injury
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• 제23권2호
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• pp.68-74
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• 2010

Purpose: The purpose of this study is, first, to analyze the risk factors that influence the severity of injury in pediatric multiple trauma patients and, second, to present solutions for the problems related to the treatment of such patients. Our living situations are so complicated that the danger of accidents is truly open to children who are not prepared. We need to draw attention to the increased numbers of various accidents involving children. Methods: We studied patients who visited the Emergency Medical Center at Chosun University Hospital from January 1, 2006, to December 31, 2008. Using medical records, we evaluated the general characteristics: the mechanism of injury, the vital signs, the revised trauma score (RTS), the injury severity score (ISS), and the hemoglibin value, which was checked at the time of visit, and the presence or the absence of emergent on regular surgery. We divided the level of injury as follows: light level (1-8 points), mid level (9-15 points), and serious level (above 16 points). We analyzed the medical data by using SPSS 17.0 for windows. Results: The average age of the patients examined was 8.6 years. The number of 6- to 11-year-old patients was 96, which was the largest, but the degree of injury severity was the highest among infant (0-2 years), according to ISS 7.95(${\pm}6.85$). The frequency of accidents was highest on sunny days, and most accidents occurred from 16:00 to 20:00. The cause of multiple trauma for children was the greatest in the traffic accident, (95 patients, 49.0%). In addition, the trauma caused by traffic accidents showed the highest ISS value ($9.02{\pm}6.42$) and the most serious degree (P=0.004). The ISS level of injury ($8.40{\pm}6.64$) for patients moved from a secondary hospital was higher than that ($6.49{\pm}5.57$) for patients who visited the medical center directly. The severity of injury was highest for patients who used a 119 ambulance ($8.84{\pm}5.80$). According to the injured parts of body, Injuries to the arms and the feet most frequent (79 patients, 40.7%), but the level of injury was the highest for internal organs and chest, $16.42{\pm}8.56$ and $11.23{\pm}6.97$, respectively. Conclusion: We used Abbreviated Injury Scale (AIS) in order to examine the characteristics by injured body part for pediatric multiple trauma patients. Because the degree of injury was the highest for internal organs or the chest, we need to more seriously examine and provide for patients who are suspected of having injuries to the internal organs or the chest. We need to quickly determine the need for surgery in patients with serious injuries to the arms and the feet, which is the greatest in frequency. In particular, we need to consider the surgical care of patients who are not very high in the severity of injury to their brains.

• 대한한의학회지
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• 제17권1호
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• pp.374-406
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• 1996

This study has been carried out to investigate the types of differential diagnosis of amnesia. The results are as follows; 1. Amnesia has various types of differential diagnosis(辨證分型) ; deficiency of both the heart and spleen(心脾兩虛型), deficiency of the heart(心虛型), deficiency of the kidney(腎虛型), breakdown of the coordination between the heart and the kidney(心腎不交型), mental confusion due to phlegm(痰迷心竅型), accumulation of stagnant blood(蓄血型), internal injury by seven emotion (七情所傷型). 2. The type of deficiency of both the heart and spleen(心脾兩虛型) occurs when the heart and spleen is injured by overthinking(思慮過度), The symptoms are heart palpitation(心悸), continuous palpitation(??), insomnia(少寐), hypochondric discomfort(心煩), dream disturbed sleep(多夢), being easy to be scared(易驚), dizziness(眩暈), these are caused by blood deficiency of the heart(心血不足), poor appetite(飮食不振), loss of appetite(納?), short breath(氣短), sense of turgid abdormen(腹部膨滿感), loose stool(泥狀便), these are caused by deficiency of the spleen(脾虛), lassitude and weakness (身倦乏力), lassitude of the extremities (四肢無力), dim complexion (面色少華), pale lips(舌質淡), thready and feeble(脈細弱無力), these are caused by deficiency of both qi and the blood(氣血虛損). The remedy is nourishing the heart-blood(養心血) and regulating the spleen(理脾土). I can prescribe the recipes such as Guibitang(歸脾湯), Gagambosimtang(加減補心湯), Seongbitang(醒脾湯), Insin-guisadan(引神歸舍丹), Insamyangyoungtang(人蔘養榮湯), Sojungjihwan(小定志丸), Yungjigo(寧志膏), Palmijungjihwan(八味定志丸), etc., 3. The type of deficiency of the heart(心虛型) occurs when the heart-blood is injured by the mental tiredness(神勞) and so blood cannot nourish the heart. The symptoms are amnesia(健忘), short breath(氣短), heart palpitation(心悸), perspire spontaneously(自汗), facial pallidness(顔面蒼白), pale lips (舌質淡白), feeble pulse and lassitude(脈虛無力), intermittent pulse(結代脈). The remedy is nourishing the hart and blood and allaying restlessness(補心益血安神). I can prescribe the recipes such as Chenwangbosimdan(天王補心丹), Jeongji-hwan(定志丸), Gaesimhwan(開心丸), Youngjigo(寧志膏), Chilseonghwan(七聖丸), Baegseogyoungtang(白石英湯), Oseohwan(烏犀丸), Yangsinhwan(養神丸), Guisindan(歸神丹), Bogsinsan(茯神散), Jinsamyohyangsan(辰砂妙香散), Cheongeumboksinsan(千金茯神散), Samjotang(蔘棗湯), jangwonhwan(壯元丸), Sa gunjatang(四君子湯) minus rhizoma atractylodis macrocephalae(白朮) plus rhizoma acori graminei(石菖蒲), radix polygalae(遠志), cinnabaris(朱砂), etc. 4. The type of deficiency of the kidney(腎虛型) occurs when the kidney-qi and kidney-essence is deficient(腎氣腎精不足) and so it cannot nourish the brain. The symptoms arc amnesia(健忘), ache at the waist and lassitude in the lower extremities(腰산腿軟), dizziness and tinnitus(頭暈耳嗚), emmission and premature ejaculation(遺精早泄), burning sensation of the five centres(五心煩熱), flushed tongue(舌紅), rapid and small palse(脈細數). The remedy is nourishing the kidney and strengthen the essence(補腎益精). I can prescribe the recipes such as Gagamgobonhwan(加減固本丸), Jeongjihwan(定志丸), Gongseongchlmjungdan(孔聖枕中丹), Yugmigihwanghwan(六味地黃丸) plus ra-dix polygalae(遠志), fructus schizandrae(五味子), Yugmigihwanghwan(六味地黃丸) plus radix polygalae(遠志), fructus schizandrae(五味子), rhizoma acori graminei(石菖蒲), semen zizyphi spinosae(酸棗仁), Palmihwan(八味丸) plus fructus schizandrae(五味子), semen zizyphi spinosae(酸棗仁). etc., 5. The type of breakdown of the coordination between the heart and the kidney (心腎不交型) occurs when the heart-fire(心火) and kidney-fluid(腎水) are imbalanced. The symptoms are amnesia(健忘), hypochondric discomfort(心煩), insomnia(失眠), dizziness and tinnitus(頭最耳嗚), feverish sensation m the palms and soles(手足心熱), emmision(遺精), ache at the waist and lassitude in the lower extremities(腰?腿軟), flushed tongue(舌紅), rapid pulse(脈數). The remedy is coordinating each other(交通心腎). I can prescribe the recipes such as Gangsimdan(降心丹), Jujaghwan(朱雀丸), Singyotang(神交湯), Simsinyang- gyotang(心腎兩交湯), Yugmihwan(六味丸) plus fructus schizandrae(五味子), radix polygalae(遠志), Yugmihwan(六味丸) plus fructus schizandrae(五味子), radix polygalae(遠志), rhizoma acari graminei(石菖蒲), semen zizyphi spinosae(酸棗仁), etc., 6. The type of mental confusion due to phlegm(痰迷心竅型) occurs when the depressed vital energy(氣鬱) create phlegm retention(痰飮) and phlegm stagnancy(痰濁) put the heart and sprit(心神) out of order. The symptoms arc amnesia(健忘), dizziness(頭暈), chest distress(胸悶), nausea(惡心), dull(神思欠敏), dull and slow facial expression(表情遲鈍), tongue with yellow and greasy fur(舌苔黃?), sliperry pulse(脈滑). The remedy is removing heat from the heart to restore consciousness and dispersing phlegm(淸心化痰開竅) I can prescribe the recipes such as Gamibogryeongtang(加味茯?湯), Goa-rujisiltang(瓜蔞枳實湯), Jusaansinhwan(朱砂安神丸), Dodamtang(導痰湯) plus radix saussurea(木香), Yijintang(二陳湯) plus succus phyllostachyos(竹瀝), rhizoma zingiberis(生薑) Ondamtang(溫膽湯) plus rhizoma acori graminei(石菖蒲), rhizoma curcumae aromaticae(鬱金), etc., 7. The type of accumulation of stagnant blood(蓄血型) occurs when the blood is accumulated in the lower part of body. The symptoms are amnesia(健忘), chest distress(胸悶), icteric skin(身黃), rinsing the mouth but don't wanting eat(漱水不欲燕), madness(發狂), black stool(屎黑), pain in the lower abdomen(小腹硬痛). The remedy is dispersing phlegm and absorb clots (化痰化瘀), I can prescribe the recipes such as Jeodangtang(抵當湯), Daejeodanghwan(代抵當丸), Hyeolbuchugeotang (血府逐瘀湯) plus rhizoma acori graminei (石菖蒲), rhizoma curcumae aromaticae(鬱金), Jusaansinhwan(朱砂安神丸) plus rhizoma curcumae aromaticae(鬱金), radix polygalae(遠志), semen persicae(桃仁), cortex moutan radicis(收丹皮), etc., 8. The type of internal injury by seven emotion(七情所傷型) occurs when the anger injures the will stored in the kidney(腎志). The symptoms are amnesia(健忘), heart palpitation(心悸). hot temper(易怒), being easy to be scared(善驚), panic(易恐). The remedy is relieving the depressed liver and regulating the circulation of qi(疏肝解鬱). I can prescribe the recipes such as Tongultang(通鬱湯), Sihosogantang(柴胡疏肝湯) plus rhizoma acari graminei(石菖蒲), rhizoma curcumae aromaticae(鬱金), etc.

• Journal of Chest Surgery
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• 제39권2호
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• pp.127-133
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• 2006

배경: 외상에 의한 사망의 시간적 분포에 대한 연구에 의하면 외상 후 수 시간 이내의 초기 사망이 높은 비율을 차지하고 있다. 외상체계의 발달로 전체적인 외상 사망은 감소하였으나 아직까지도 외상은 주요한 사망 원인 중 하나이다. 저자들은 외상 사망의 분포에서 과반수 이상을 차지하는 초기사망의 위험 요인을 알아보고자 하였다 대상 및 방법: 1994년 1월부터 2003년 12월까지 3차 의료기관 응급의료센터에 내원한 외상환자 중 사망한 환자 400예를 후향적으로 분석하여 사망의 시간적 분포와 손상의 부위에 따른 사망의 시간적 분포를 분석하였다. 외상 사망에 있어서 초기 6시간 이내에 사망한 환자와 6시간 이후에 사망한 환자를 비교하여 초기 사망의 위험요소를 분석하였다. 결과: 손상의 종류에 따른 외상 사망의 분포는 두부와 복부 손상은 2상 분포를 보였으나 흥부 손상의 경우는 초기 사망이 대부분을 차지하였다. 초기 사망군에서 GCS가 5.86$\pm$4.15로 후기 사망군 8.24$\pm$5.02로 유의한 차이를 보였으며(p<0.05), 흉부 AIS에서도 초기 사망군 2.66$\pm$1.87로 후기 사망군 1.55$\pm$1.76 으로 초기 사망군에서 손상이 더 심한 것을 나타났다(p<0.05). 초기 사망군의 위험요소 분석에서는 119 구급대에 의해 이송되지 않은 경우(교차비 3.474),높은 흉부 AIS (교차비 1.491), 낮은 GCS (교차비 0.859)가 각 주요 위험요소로 나타났다. 걸론. 외상에 의한 사망에서 지금까지 외상체계의 초점이 되었던 초기 사망의 원인 중 뇌신경계 손상과 출혈뿐만 아니라, 흥부 손상 역시 초기 외상사망의 중요한 요인이다. 따라서 외상환자의 초기 처치에서 흥부손상에 대한 적극적인 검사와 외과적 처치가 필요할 것이다.

• 한국환경보건학회지
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• 제40권6호
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• pp.454-468
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• 2014

Objectives: This study was conducted to investigate the actual condition of the farm work environment and personal protective equipment as part of the effort to improve livestock work for the safety and health of poultry farmers and provide basic data for establishing plans to improve and develop personal protective equipment. Methods: For this purpose, a questionnaire survey on general information about stables, the poultry work environment, accidents, the wearing of work clothes and personal protective equipment, and the level of awareness related to personal protective equipment was conducted among 148 poultry farmers. Results: As a result, it was found that poultry workplace environment was exposed to such risks as fine dusts; organic dusts; poisonous gases; odorous substances; chicken excrement; contact with chickens, bacteria or viruses; and accidents related to machine operation. Thirteen percent of respondents suffered severe respiratory diseases, and the most frequently injured sites due to accidents were the hands (25.7%), knees (23.8%), arms (17.3%), and head (10.9%). The most frequent type of accident was collisions between the body and obstacles or machinery during movement (36.4%), followed by erroneous machine operation such as feeders and electric shocks (8.5%). Regarding the wearing of work clothes and personal protective equipment, 51.7% of the respondents wore worn-out clothing or everyday clothes, whereas only 32.0% wore work clothes. The percentage of farmers who wore proper protective equipment for the work environment during poultry work was 48.4%. The most frequently used type of protective equipment was boots (38.9%), followed by mask (36.7%), gloves (36.3%), appropriate work clothes (22.6%), quarantine clothes (17.6%), helmets (13.4%), and goggles (12.6%). The rate of wearing goggles was low because they were considered inconvenient and lowered work efficiency. Furthermore, they purchased everyday products available on the market for their personal protective equipment which were not appropriate for maintaining safety in an actual harmful environment and its consequent risks. As a result of the survey of the awareness level related to personal protective equipment, their levels of awareness of accidents and attitude proved to be average or higher, but the practice of wearing protective equipment and the level of knowledge and management of personal protective equipment were lower. Conclusion: This survey found that the wearing status of personal protective equipment among poultry farmers was insufficient even though they were exposed to risks. Most respondents were aware of the necessity of wearing personal protective equipment and of the potential for accidents, but they did not wear proper protective equipment. Their wearing rate was low due to a lack of knowledge about protective equipment, as well as the inconvenience of wearing it. Therefore there is a need to improve and develop specialized personal protective equipment for respiration, hands, and eyes, as well as work clothes that can protect farmers from major harmful matter that is generated in the poultry workplace. Based on the results of this investigation, we will conduct further studies on the required performance and design directions of personal protective equipment while collecting more objective data through field-oriented assessments.

• Journal of Preventive Medicine and Public Health
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• 제17권1호
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• pp.65-73
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• 1984

산업재해의 원인을 규명하는 데에 일익이 될까하여 근로자 2,307명을 고용하고 있는 한 대기업 섬유업체를 대상으로 1981년 1월 1일부터 1982년 12월 31일까지 만 2년간에 걸쳐 발생된 재해를 분석해 본 결과는 다음과 같다. 전담안전부서를 설치한 결과 도수율은 81년도 9.70, 82년도 4.15였고 건수율은 근로자 1,000명당 81년도 27.11, 82년도 12.96이었다. 강도율은 81년도 0.33, 82년도 0.01이었고 평균손실 일수는 81년도 34.64, 82년도 3.34로서 전년에 비하여 매우 감소되었다. 산업재해 발생율은 연평균 2.3%로서 남자 2.7%, 여자 2.0%였다. 근속기간별 재해발생빈도는 근속 1년미만군이 3.6%로 가장 높았고 근속기간이 길어질수록 점차 감소하였다. 월별 산업재해건수율은 6월이 근로자 1,000명당 3.6으로서 제일 높게 나타났다. 계절별 재해건수율은 여름이 8.2로서 가장 높았다. 요일별 재해건수율은 각 요일간에 별차이를 발견할 수 없었으나 일요일이 1.8로 제일 낮았다. 산업재해 건수율을 시간별로 관찰해 보면 오전 $10{\sim}12$시가 14.7로 가장 높았으며 반별로는 오전반이 34.4로 가장 높았다. 상해부위는 손가락이 42.3%로 제일 높았고, 상지부 65.4%, 하지부 14.4%, 기타부위가 20.2%였다. 성별로 보면 남자는 상지 46.8%, 기타 53.2%로 상지와 기타부위가 비슷한 상해율을 보였으나 여자는 상지 80.7%, 기타 19.3%로서 주로 상지에 상해를 입고 있었다. 상해종류는 개방창이 46.1%로 가장 높았고 다음이 좌상 15.4%, 표재성손상 6.7% 순이었다. 성별로 보면 남자는 개방창 40.4%, 좌상 17.0%, 골절 10.6%, 화상 8.5%, 표재성손상 6.5% 순위였고 여자는 개방창 50.8%, 좌상 14.0%, 피부박리 8.8%, 표재성손상과 자상이 각각 7.0%순으로서 남여공히 개방창과 좌상이 높게 나타났다. 가해요인별 산업재해율은 기계에 의한 것이 47.1%로 제일 높았고 그 다음이 수공구 16.3%, 차량 및 운반기 9.6%, 유독 및 고열물 7.7%. 낙하물 6.7% 순이었다. 산업재해 발생원인은 환경요인이 13.5%, 인적요인 86.5%를 나타내었다. 인적요인중 심리적요인이 60.6%로 가장 많았다. 연도별로 산업재해 발생율을 보면 수공구, 차량 및 운반기, 전기 낙하물에 의한 것은 감소 경향을 나타내었으나 기계, 유독 및 고열물에 의한 것은 증가 하였고 추락과 전도는 81년도엔 발생되지 않았으나 82년도에 새로이 발생되었다. 이러한 것은 대상업체가 안전사고 재발방지에 주력한 탓으로 동질 재해 방지에는 어느정도 성공할 수 있었으나 기계안전공학에 대한 지식결여와 작업현장에 존재하는 모든 재해요인을 철저히 파악치 못했기 때문에 기계, 추락, 전도에 의한 안전사고는 예방할 수 없었을 것으로 생각된다.