• Journal of Trauma and Injury
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• 제29권4호
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• pp.139-145
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• 2016

Purpose: The major pelvic trauma results in high mortality with associated fatal other injuries. During early stage of resuscitation, multidisciplinary approach is essential to improve the survival and outcomes. This study aims to report the effect and positive outcome of the trauma team approach on the management of hemodynamically unstable pelvic bone fracture. Methods: This retrospective review included all patients with hemodynamically unstable pelvic bone fracture admitted between March 2007 and December 2015. Patients were divided into group A, which comprised those admitted before the trauma team approach was started, and group B, which comprised those admitted after the approach was started. The advanced trauma life support protocol was followed for all patient. The comparisons between the two groups were based on medical records. Study variables included demographics, initial vital sign, injury severity score, fracture type, and injury mechanism. We analyzed the outcomes in each group with respect to the time interval for doctors' arrival, total length of stay in the emergency department (ED), time interval for computed tomography evaluation, 24-hour mortality, time interval for definitive fixation, and definitive fixation in the time-window of opportunity. Results: Fifty-three patients met the inclusion criteria. No statistically significant differences in demographic data existed between the two groups. The time interval for doctors' arrival (min, $63.09{\pm}50.48$ vs $21.48{\pm}17.75$; p=0.038) and total length of stay in the ED (min, $269.33{\pm}105.96$ vs $115.49{\pm}56.24$; p=0.023) were significantly improved. The 24-hour mortality was not significantly different between the two groups.(%, 14.3 vs 12.0; p=1.000) However, the time interval for definitive fixation and definitive fixation in the time-window of opportunity showed better results. Conclusion: The trauma team approach has positive effects, which include initial resuscitation through multidisciplinary approach and shortening the time interval to definitive fixation, on the management of hemodynamically unstable pelvic bone fracture.

• Journal of Trauma and Injury
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• 제29권4호
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• pp.204-208
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• 2016

For an orthopaedic surgeon, the critical decisions to either amputate or salvage a limb with severe crushing injury with progressive ischemic change due to arterial rupture or occlusion can become a clinical dilemma at the Emergency Department (ED). And reperfusion injury is one of the fetal complications after vascular reconstruction. The authors present a case which was able to save patient's life by rapid vessel ligation at bedside to prevent severe reperfusion injury. A 43-year-old male patient with no pre-existing medical conditions was transported by helicopter to Level I trauma center from incident scene. Initial result of extended focused assessment with sonography for trauma (eFAST) was negative. The trauma series X-rays at the trauma bay of ED showed a multiple contiguous rib fractures with hemothorax and his pelvic radiograph revealed a complex pelvic trauma of an Anterior Posterior Compression (APC) Type II. Lower extremity computed tomography showed a discontinuity in common femoral artery at the fracture site and no distal run off. Surgical finding revealed a complete rupture of common femoral artery and vein around the fracture site. But due to the age aspect of the patient, the operating team decided a vascular repair rather than amputation even if the anticipated reperfusion time was 7 hours from the onset of trauma. Only two hours after the reperfusion, the patient was in a state of shock when his arterial blood gas analysis (ABGA) showed a drop of pH from 7.32 to 7.18. An imminent bedside procedure of aseptic opening the surgical site and clamping the anastomosis site was taken place rather than undergoing a surgery of amputation because of ultimately unstable vital sign. The authors would like to emphasize the importance of rapid decision making and prompt vessel ligation which supply blood flow to the ischemic limb to increase the survival rate in case of profound reperfusion injury.

• 간호행정학회지
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• 제12권1호
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• pp.63-75
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• 2006

Purpose: This study was aimed to specify roles of nurses from the anesthesia and recovery room by analyzing nursing activities as well as anesthesia nursing during surgery. Method: The objects were 12 RNs working in the recovery room of a university hospital located in Incheon. Self-report was performed by measuring stop-watch for five days from May 17th to May 21st in 2004. Research method was designed to record the time and frequency of the nursing activity from anesthesia and recovery room based on nurses' statement and other references for five days. The data were analyzed with descriptive statistics, ANOVA, and t-test via SPSS Win 10.0 program. Result: Nursing activities in anesthesia recovery room were classified into two different characteristics such as direct and indirect nursing activity. The activities consisted of 11 direct nursing areas and 39 nursing activities in anesthesia preparation room. The indirect nursing was classified into 8 nursing areas and 32 nursing activities. The direct nursing was classified into 12 nursing areas and 55 nursing activity. Also, the indirect nursing was classified into 7 nursing areas and 21 nursing activities in recovery room. In terms of prevalence of nursing activities in the anesthesia preparation room, observation and cooperation of anesthesia was the most prevalent activity, drug and eqipment management the second prevalent, and drug administration the third. On the other hand, in the recovery room, the most prevalent activity was vital sign checking and observation, the second most prevalent activity informative activity, and the third body temperature control. Nursing activity time was recorded according to the nursing characteristics. In the anesthesia preparation room, the direct nursing spent for 8092.20 minutes was larger than the indirect nursing spent for 7198.50 minutes. Also, in the recovery room, the direct nursing spent for 2361.16 minutes was larger than the indirect nursing spent for 1134.13 minutes. 4. Nursing activity time was compared to duty shifts. In the anesthesia preparation room, the direct nursing was more prevalent on day shift and the indirect nursing was prevalent on evening shift. However, in the recovery room, both direct and indirect nursing activities were prevalent on day shift. Conclusion: The role of anesthesia and recovery room nurses was analysed according to the time, frequency, and its characteristics.

• 대한소아치과학회지
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• 제26권3호
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• pp.513-519
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• 1999

진정요법을 위한 경구 투여 약물에는 비교적 안전하고 부작용이 적은 것으로 알려진 chloral hydrate가 있으나, 체내에 흡수되는 용량이 환자에 따라 다양하여 이것에 대한 정확한 측정이 어렵고, 환자의 불안 정도와 주변환경 등의 영향을 받아 약효발현이 충분히 이루어지지 않는 경우가 적지 않다. 이런 경우 환자와 보호자 모두에게 고통과 불편함을 줄 수 있으며, 재내원시의 치료도 더욱 어려워지는 고충을 흔히 겪게 된다. 이런 문제점을 해결하기 위해 chloral hydrate와 midazolam의 추가 투여, chloral hydrate와 hydroxyzine, 또는 아산화질소-산소와 함께 사용하는 등 소아환자의 행동조절을 위한 많은 연구와 노력이 시행되어지고 있다. 본 증례에서는 Chloral hydrate 경구 투여 후 진정효과가 나타나지 않은 37명의 소아환자에게 아산화질소-산소와 함께 Enflurane을 사용하여 초기 수면을 유도하여 다음과 같은 결과를 얻었다. 1. Enflurane 투여 및 국소마취 시행시 말초동맥혈 산소 포화도와 이완기 혈압의 변화는 관찰되지 않았으며 정상범위 내에서 안정된 양상을 보였다(p<0.05). 2. Enflurane 투여 및 국소마취 시행시 심박수와 수축기 혈압의 일시적인 변화가 관찰되었지만 곧 정상범위 내로 회복되었으며 안정되었다(p<0.05). 3. Enflurane 투여 후 바람직한 행동양상(Q:Quiet)의 증가를 관찰할 수 있었다. 4. 안정된 생징후와 바람직한 행동양상으로 재 내원의 약속을 하지 않고 97%이상이 치료를 성공적으로 마칠 수 있게 되어 환자, 보호자, 술자 모두에게 만족할 만한 결과를 준 것으로 평가되었다.

• 재활간호학회지
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• 제5권1호
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• pp.18-26
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• 2002

The purpose of this study was to elucidate the effects of inhalation method using essential oils on the preoperative anxiety of hystrectomy patients, and to provide effective and holistic nursing care to them. The research design was a nonequivalent control group non synchronized design. The data were collected from February 1 to March 31, 2002 at D Medical Center in Busan. The subjects were forty one patients that were operated on under general anesthesia for hystrectomy. They were assigned to two groups, twenty one subjects in the experimental group and twenty subjects in the control group. The tool of the Visual Analogue Scale(VAS) was used to anxiety on all patients the day before surgery and the preoperative period. Then systolic and diastolic blood pressure, pulse rate levels were measured the day before surgery and the preoperative period. The experimental group received two treatments of inhalation method using essential oils of with lavender, ylang ylang, and bergamot oil. The data were analyzed by the $X^2$ test and the independent t-test. The results of this study were summarized as follows: 1. Hypothesis 1: It has been supported that the experimental group received inhalation method using essential oils might cause lower level of the preoperative VAS anxiety than that of the control group(t=-2.93, p=.006). 2. Hypothesis 2: It has been rejected that the experimental group received inhalation method using essential oils might cause lower level in the preoperative systolic blood pressure than the control group(t=-.120, p=.905). It has been rejected that the experimental group received inhalation method using essential oils might cause lower level in the preoperative diastolic blood pressure than the control group.(t=1.766, p=.085). 3. Hypothesis 3: It has been supported that the experimental group received inhalation method using essential oils might cause lower level in preoperative pulse rate than the control group(t=5.853, p=.000). According to these results, inhalation method using essential oils can be considered an effective nursing intervention that relieves the preoperative anxiety of hysterectomy patients and stabilizes vital sign partially.

• 동의생리병리학회지
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• 제27권6호
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• pp.832-841
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• 2013

This research, as a basic preliminary study for development of functional health food, is aimed at assessing the body fat reduction effect and for application to human body for such reduction in actual clinical settings by preliminary extraction of 2 types of wild edible greens, Lythrum salicaria L. and Aceriphyllum rossii. Subjects over the age of 19 and less than 60 years old with BMI value range of $23.0kg/m^2{\sim}29.9kg/m^2$ were recruited through screening were divided into experimental group and control group, each with 25 subjects, through randomized allocation. With both patients and evaluators wearing blindfold, the experimental group was orally administered with 4 capsules of 500mg of composite preparation containing the extracts of Lythrum salicaria L. and Aceriphyllum rossii 3 times a day for a period of 8 weeks while the control group was orally administered with 4 capsules of 500mg of placebo (fake food) with the same appearance as the preparation administered to the experimental group 3 times a day for a period of 8 weeks. After having carried out evaluation on physical examinations (body weight, BMI and body fat ratio, etc.), laboratory tests (general blood test, biochemical test of blood and urine test), lipid test, the changes were analyzed. There was no significant change between the 2 groups and within the groups in BMI and body fat ratio, which are the primary effectiveness evaluation at each time. There was no significant difference between the 2 groups in serum lipid and WHR, obesity related KOQOL, KEAT-26 which are the secondary effectiveness evaluations. There was no change between the 2 groups and within the groups in vital sign, CBC, BC and urin test. These results suggest that Lythrum salicaria L. and Aceriphyllum rossii ext. showed no significant reduction in BMI, body fat ratio and serum lipid. Additional confirmative clinical application test is needed in the future.

• Journal of Trauma and Injury
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• 제18권1호
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• pp.47-52
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• 2005

Background: This study was undertaken to evaluate the clinical pattern of the patients with penetrating torso injury. We retrospectively analyzed the clinical symptoms, mechanism of injury, injury type including injured organ, and ultimate outcome of treatment. Our purpose of the study was to establish guideline of management in penetrating torso injury. Methods: This study consists of an analysis of a consecutive series of 94 patients with penetrating injury of trunk treated at one general hospital during 7year period (from January 1995 to April 2003) who was admitted through in our emergency department. All data were collected from the medical records and entered in a database for analysis on the following: age, sex, mechanism of injury, vital sign at admission, clinical outcome including hospital mortality, length of hospital stay, length of intensive care unit stay, requirement of crystalloid fluid and blood product. Results: Among 94 patients, there were 68 men and 26 women, with ages ranging from 19 to 82 years (average 38.2 years). The most frequent mechanism of injury was violence by others including rob (n=54, 57.4%) followed by suicidal attempt (n=24, 25.5%) and accidental injury (n=16, 17.0%). No injury was inflicted from gun. In 37 patients, systolic blood pressure at admission was under 90mmHg. The time interval from injury to admission, and from admission to operation was 57.8minutes and 4hour 12minutes each. Laparotomy was required in 70 patients, thoracotomy in 5 patients, and 3 patients required thoracotomy and laparotomy. Among 94 patients, an average of 1.7 organs were injured. The small bowel and colon were the organs most commonly wounded followed by liver, mesentery, pleura. Of the 94 patients, 6 died for an overall mortality rate of 6.4%, and two of them were not related with hemorrhage. The average length of hospital stay was 18.1 days, and 40 patients required ICU care. Conclusion: Of the 94 patients who were admitted from penetrating torso injury, no patient was injured from firearm. Overall mortality rate was 6.4%. In our hospital, firearm injury was relative rare.

• 한국의료질향상학회지
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• 제1권1호
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• pp.44-54
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• 1994

약물사용검토는 약물을 적합하고, 안전하며, 효과적으로 사용하기 위해 고안된 권위 있는 질 보장 제도로 정의된다. Ceftazidime에 대한 약물사용검토는 이를 시행함으로써 ceftazidime사용의 합리성을 찾고자 하였으며, ceftazidime의 약물사용검토는 미국병원 약사회에 의해 설정된 ceftazidime에 대한 약물사용검토 criteria를 근간으로 변화시켜 사용하였고, 1993년 1월1일부터 1993년 7월31일까지 서울대학교 병원에 입원하여 ceftazidime으로 약물치료를 받은 환자 60명의 의무기록을 후향적으로 검토하는 방법을 사용하였다. 연구결과, 사용의 정당성에 관한 항목에서는 73%, 사용시 지켜 주거나 시행되어야 할 사항에 관한 항목중 배양과 감수성 시험, 간 기능 검사, 첫 약물투여전 과민반응 약물검사등은 80%이상의 적합율을 받았다. 치료효과 판정 및 사용결과에 대한 검토항목에서는 약물사용 중지후 감염의 완전한 퇴치여부를 확인하는 항목에서는 46%의 적합율을 보이고 있다. 결과적으로 Pseudomonas aeruginosa에 ceftazidime사용은 유용하게 쓸 수 있는 다른 약물을 먼저 사용한 후 ceftazidime은 좀 더 신중하게 선택하고, 또한 심각한 부작용을 막기 위해 더욱 적극적인 검사 및 모니터링이 요구된다.

• 대한간호
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• 제32권1호
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• pp.61-76
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• 1993

This study was done in order La provide basic data to a Fee System for hospital based Home Health Care services in Korea in the future. It was done by investigating activities provided to possible Home Health Care clients who could be discharged early from genera] hospitals and then estimating the nursing care fee according to each nursing activity based upon the time used for activity. The subjects of the study were selected by convenience sampling and consisted of 35 clients who might be clients for Home Nursing Care and were presently admitted to a medical- surgical ward of Y University Medical Center located in Seoul, Korea. The data collection period was from September 1, 1991 to September 30, 1991. The research in strum nets utilized for the study were a client selection criterial for Home Health Care developed by Choo(l991) and a check-list of nursing activity developed by researcher. The results of the study were as follows : 1. There were 44 different nursing activities provided in the seven days but the time was calculated for only 25 of the nursing activities. 2. Fees for the 25 different nursing activities were calculated by multipling the median of the average wage of a staff nurse having five years experience in an A grade general hospital to the Lime of the nursing activity. The results were compared with the insurance fee which the government recognized as an appropriate fee for that activity. The nursing activities with a lower calculated fee than the insurance fee were suction, catheterization, exercise education and dressing change. The nursing activities with a higher calculated fee than the government recognized fee were 1M injection and vital sign check. 3. There was a range of 1-15 nursing activities provided daily to the client. For the average number of nursing activities per day of 6.26 events the nursing care fee was calaulated at W 6136 per day. 4. Based upon the results of the study, a recommentdation for a Home Health Care fee per visit based on the nursing activities provided could be formulated for a Home Health Care fee system. It could be formulated as following: 1) Home health Care fee per visit $=[(direct{\;} nursing{\;}fee(direct{\;}nursing{\;}care{\;}time{\;}per{\;}activity{\;}{\times}{\;}average{\;}nursing{\;}wage)+indirect fee]{\times}average$ nursing activity per visit]+management fee+ materials fee+a travel fee In this way a nursing fee could be calculated based upon the result of the study of the nursing fees per visit. 2) Nursing activity fees per visit. = $([direct nursing{\;}care{\;}fee+indirect{\;}nursing{\;}fee]{\times}average$ number of nursing activities provided per visit] (W 6, 136) + travel fee(\ 5, 542) +management fee material $fee({\alpha})\{\;}16, 436+{\alpha}$ The nursing fee per visit as calculated in this research of $\{\;}15, 0000+{\alpha}$ could be adjusted according to the patient's condition or the use of high technology nursing care or according to the amount of time spent for travel. The nursing care fee per visit presented in this study can be validated through a Home Health Care demonstration project.

• Elastomers and Composites
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• 제49권1호
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• pp.1-12
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• 2014

전투기 연료필터의 막힘은 조종사 생명과 전투기의 손실에 큰 영향을 줄 수 있다. 따라서 결함 연구는 사고를 미연에 방지하는데 매우 중요하다. 전투기 연료필터는 제트 연료에 포함된 다양한 불순물을 여과하는 중요한 기능을 수행한다. 연료 필터는 시간당 1,330 파운드의 유속으로 공급되는 제트 연료에 함유된 10 ${\mu}m$ 크기 이하의 불순물을 여과한다. 필터는 운영시간 기준 500 시간마다 교체되어야 한다. 그러나 500 시간이 도달하기 훨씬 전에 연료 필터의 막힘 현상으로 경고등이 켜지고 있다. 이와 같은 유사한 결함이 최근에 반복적으로 발생하고 있다. 그러므로, 이 연구에서는 전투기의 연료 필터 막힘에 대한 원인을 FT-IR microcopy, FE-SEM/EDS, 총 황함량 분석기와 같은 다양한 분석기술을 이용하여 조사하였다. 결론적으로, 연료 필터를 막히게 한 물질은 내부 연료 탱크용 실란트에서 기인한 가류 촉진제로 확인되었다. 그리고 연료 탱크내에서 가류 촉진제 블루밍 현상에 의해 연료필터를 막히게 하는 물질의 형성에 대한 메커니즘을 제시하였다.