• 대한간호학회지
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• 제53권3호
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• pp.275-294
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• 2023

Purpose: This study aimed to develop an evidence-based extracorporeal membrane oxygenation (ECMO) nursing protocol for critically ill patients receiving ECMO treatment by using an adaptation process, and to verify the effects of the protocol. Methods: The protocol was developed according to the adaptation guidelines. A non-randomized controlled trial was conducted to test the protocol's effects. Data were collected between April 2019 and March 2021. The differences in physiological indicators and complication rates between the two groups were investigated using a chart review to evaluate patient outcomes. The nurses' outcome variables were evaluated using a questionnaire. Results: First, after reviewing 11 guidelines by appraisal of the guidelines for research and evaluation collaboration II, 5 guidelines with a standardization grade of over 50 points were selected. An ECMO nursing protocol was developed based on these guidelines. Second, there were no statistically significant differences in physiological indicators between the two groups of patients. However, the experimental group showed a statistically significant decrease in the infection rate (p = .026) and pressure injury rates (p = .041). The levels of satisfaction with ECMO nursing care, and empowerment and performance of the nurses who used the ECMO nursing protocol were higher than those of nurses who did not (p < .001). Conclusion: This protocol may help prevent infections and pressure injuries in patients, and improve nurses' satisfaction and empowerment. The nursing protocol developed for critically ill patients receiving ECMO treatment can be utilized in evidence-based nursing practice.

• 임상간호연구
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• 제30권2호
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• pp.114-124
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• 2024

Purpose: Incontinence-associated dermatitis (IAD) is widespread and a common problem in healthcare settings, It is defined as irritation of the perineal skin due to contact with urine, feces, or both. It is one of the major risk factors for the development of pressure injuries are regarded as a quality indicator of nursing care. It is important to understand the knowledge and attitudes of nurses who are primarily responsible for providing appropriate nursing care that includes differentiation of IAD from other skin breakdowns, and appropriate management. Therefore, the purpose of this study was to determine the knowledge, attitudes, and performance of IAD among clinical nurses in Korea. Methods: Data about IAD knowledge, attitudes, and performance were collected from August to November 2022. 656 nurses from six hospitals participated in the study. Results: The mean scores of nurses' knowledge, attitudes, and performance were 17.98±2.91, 76.34±7.85, and 91.53±16.18, respectively. Nurses' knowledge showed a positive correlation in both attitudes (r=0.27, p<.001) and performance (r=0.09, p=.02), and attitudes and performance (r=0.34, p<.001) also showed a positive correlation. Conclusion: To improve the knowledge and performance of nurses, an educational program consisting only of incontinence-related dermatitis is needed, and case-based education and clinical skills education are needed to enhance the ability to differentiate from pressure injury.

• 한국터널지하공간학회 논문집
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• 제23권6호
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• pp.517-534
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• 2021

수소연료는 환경오염문제를 해소하고 에너지 불균형 및 비용을 절감할 수 있다는 점에서는 화석연료를 대체하는 에너지원으로 부각되고 있다. 수소는 친환경적이나 폭발성이 강하기 때문에 수소연료차의 화재, 폭발 사고에 대한 우려가 매우 높은 실정이다. 연구결과에서 수소사고는 일반적인 화재의 경우 비교적 안전하나, 폭발이 발생하면 매우 위험한 것으로 인식되고 있다. 특히, 터널과 같은 반밀폐공간에서는 위험도가 보다 증가할 것으로 예측되기에 이에 대한 예측방법 및 대책을 마련하기 위한 연구가 수행되고 있다. 이에 본 연구에서는 터널에서 수소폭발시 안전성을 평가하기 위해서 등가 TNT모델의 적용성과 수치해석 방법에 대한 검토를 수행하였다. 6개의 등가 TNT모델과 Weyandt의 실험결과의 폭발압력을 비교·검토하여 모델의 적용성을 평가한 결과, Henrych식이 13.6%의 편차로 가장 근접하는 것으로 나타났다. 수치해석을 이용하여 수소탱크 용량(52, 72, 156 L)과 터널 단면적(40.5, 54, 72, 95 m²)이 폭발압력에 미치는 영향에 대한 검토한 결과, 터널에서 폭발 압력파는 초기에는 대기중에서와 마찬가지로 반구형 형태로 전파되나 벽체에 도달하면 반사파가 형성되며, 일정 거리 이상에서는 평면파로 변형되어 아주 완만한 감쇄율로 전파하는 것으로 나타났다. 등가 TNT모델인 Henrych식은 폭발압력이 급격하게 감소하는 구간에서는 수치해석 결과와 잘 일치하나 폭발압력파가 변형된 이후에는 큰 폭으로 과소평가하는 것으로 나타났다. 수소탱크용량이 동일한 경우에는 터널 단면적이 증가할수록 폭발압력이 감소하며, 단면적이 동일한 경우에는 수소탱크 용량이 52 L에서 156 L로 증가하면 폭발압력은 약 2.5배 정도 증가하는 것으로 나타났다. 인체에 영향을 미치는 한계거리에 대한 평가결과, 수소탱크용량이 52 L인 경우 사망에 이르는 한계거리는 약 3 m, 중상에 이르는 거리는 단면적별로 차이가 있으나 28.5~35.8 m로 나타났다.

• 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.

• The Korean Journal of Pain
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• 제28권2호
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• pp.144-147
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• 2015

Recently, percutaneous epidural neuroplasty has become widely used to treat radicular pain caused by spinal stenosis or a herniated intervertebral disc. A 19-year-old female patient suffering from left radicular pain caused by an L4-L5 intervertebral disc herniation underwent percutaneous epidural neuroplasty of the left L5 nerve root using a Racz catheter. After the procedure, the patient complained of acute motor weakness in the right lower leg, on the opposite site to where the neuroplasty was conducted. Emergency surgery was performed, and swelling of the right L5 nerve root was discovered. The patient recovered her motor and sensory functions immediately after the surgery. Theoretically, the injection of a large volume of fluid in a patient with severe spinal stenosis during epidural neuroplasty can increase the pressure on the opposite side of the epidural space, which may cause injury of the opposite nerve by barotrauma from a closed compartment. Practitioners should be aware of this potential complication.

• Archives of Reconstructive Microsurgery
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• 제9권2호
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• pp.110-113
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• 2000

The reconstruction of soft tissue defects of the sole requires to stand the force of weight bearing, provide sensation and adequacy for normal foot-wear. Although certain local flaps have been described and used for resurfacing the foot, extensive injury requires distant or free flaps for coverage. There is no doubt that the ideal tissue for resurfacing the sole is the plantar tissue itself. The specialized dermal-epidermal histology and fibrous septa of the subcutaneous layer gives its unique property to stand the pressure and to absorb the shock upon gait. This paper presents a case of reconstructing the sole that involves about 70% of the weight bearing portion. The combined medial plantar and dorsalis pedis chimeric free flap based on the medial plantar artery and medial plantar nerve adds another dimension in resurfacing the weight bearing sole of moderate to large sized defects.

• Journal of Trauma and Injury
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• 제24권2호
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• pp.159-163
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• 2011

Massive bleeding due to traumatic pelvic bone fracture is a leading cause of death. Thus, several methods to control bleeding have been attempted, but none of these has yet been clearly established. After an automobile accident, a 34-year-old motorist was admitted to the Emergency Department for right hip,leg and abdominal pain. Because the patient's pressure remained consistently low and pelvic bone fracture and abdominal bleeding were found on radiologic examination, an explorative laparotomy was performed. After pelvic packing and bleeding control, bleeding still continued, so Angiography was performed, and arterial embolization for bleeding was performed.

• Journal of Chest Surgery
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• 제20권1호
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• pp.106-111
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• 1987

Twenty eight patients with atrial septal defect operated on from May, 1983, to July, 1986 at the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, were analyzed retrospectively. Among the 28 patients of atrial septal defect, 8 were male and 20 were female. Their ages ranged from 4.6 years to 52.5 years old with the mean of 15.3 years. The main clinical symptoms on admission were exertional dyspnea [82%], frequent respiratory infection [75%], palpitation [54%] and easy fatigability [25%]. Electrocardiographic findings were as follows: Regular sinus rhythm [100%], RVH [54%], RBBB [25%] and first degree of A-V block [4%]. Hemodynamic studies were performed in all cases and mean pulmonary systolic arterial pressure was 34.1*11.8mmHg. and mean Qp/Qs was 2.6*0.9. All 28 patients were operated under direct vision using extracorporeal circulation. 23 cases were secundum type defect and a single hole was found in 22 cases. The associated cardiovascular anomalies were found in 11 patients: ventricular septal defect in 3, patent ductus arteriosus in 1, partial anomalous pulmonary venous drainage in 2, mitral regurgitation in 2, tricuspid regurgitation in 1, anomalous left atrial septation in 1 and valvular pulmonary stenosis in 1. The defect closed directly in 22 cases and with patches in 6 cases. Postoperative complications were wound infection, arrhythmia bleeding, intracardiac patch detachment, pneumothorax and urethral injury. But there was no operative mortality.

• Journal of Korean Neurosurgical Society
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• 제30권1호
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• pp.81-84
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• 2001

Pneumocephalus is exceedingly rare in the absence of trauma or recent surgery. It is most commonly seen after severe head injury, with disruption of the dura and subsequent cerebrospinal fluid leakage. Intracranial air has also been reported as a complication of shunting. This may be secondary to intermittent shunt failure or a persistent communication between the extracranial and intracranial space that permits the entrance of air. In the present case, air appeared to enter the ventricular system through the fistula that connected the frontal sinus. This air replaced the CSF being drained into the peritoneal cavity by the shunt. The decrease of intracranial pressure after a shunt might play a role in causing pneumocephalus. We report a case of tension pneumocephalus after shunting for hydrocephalus as a life-threatning complication.

• 한국생산제조학회지
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• 제22권6호
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• pp.957-962
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• 2013

This paper presents a performance testing device for safety fences of domestic professional baseball stadiums. Safety fences of professional stadiums have been fabricated and installed without adhering to any safety regulations, safety fences demonstrate critically low safety performances and many outfielders are severely injured every season. In this study, we designed and fabricated a performance testing device for safety fences and investigated its validity and reproducibility. A HIC (head injury criterion) was used for the statistical analysis of colliding data. We found that the optimal expulsion pressure and eliminated the accelerometer by replacing it with a velocity sensor using an estimation of the correlation between the momentum data obtained from velocity sensor and the impulse data from the accelerometer.