응급의학 매뉴얼 제7판 > Emergency Medicine

응급실에 내원한 환자의 진료 및 각종처치에 필요한 표준 지침서가
필요하다고 생각되어 1991년 10월 10일 Manual of Emergency
Medicine 초판을 출간한 후 의사, 간호사 응급실에서 근무하는
의과대학생 및 응급현장에서 응급처치를 시행하는 응급구조사들의
참고서로 사용되어 왔다.
그 후 진전된 새로운 의학지식과 새로 개발된 약재등으로 치료에
변화가 있어왔고, 이에 호응하여 주기적으로 개정판을 출판하였고
2020년에 7판을 출간하였다.
근래에 심폐소생술에 약간의 개정이 있고 또한 다른 분야에도
보완이 필요하여, 제 7판의 개정판을 출간하게 되었다.
초판부터 7판까지 편집을 도와주신 응급의학과 주임교수 이원재,
박규남, 최승필 교수님들과 개정, 증보판을 출간하는데 도와주신
모든 응급의학과 교수님들께 감사드리고 특히 이번 제 7판을 출간
하는데 도움을 주신 김한준 교수님과 오상훈 교수님께 감사를
드립니다.
2020. 2. 25.
저자 김세경

머 리 말 / 출간사
제 1 부 심폐 정지와 심폐소생술
Ⅰ. 서론 ························································································· 3
Ⅱ. 성인, 소아, 영아의 심폐소생술(요약) ······································ 4
Ⅲ. 성인 심폐소생술(Standard CPR for adult) ···························· 8
Ⅳ. 소아·영아 심폐소생술(Standard CPR for Child/Infant) ······· 10
Ⅴ. 기도폐쇄(Relief of Foreign-Body Airway obstruction) ······ 11
(1) 영아의 기도폐쇄(0~1세) ······················································ 11
(2) 소아의 기도폐쇄(1~8세) ······················································ 12
(3) 성인의 기도폐쇄 ································································· 13
Ⅵ. CPR에 대한 몇 가지 중요사항 ············································· 14
Ⅶ. 무맥성 심정지(Pulseless Arrest) ··········································· 18
Ⅷ. 서맥(Bradycardia) ·································································· 20
Ⅸ. 빈맥(Tachycardia) ································································· 22
Ⅹ. 저혈압/쇼크/급성폐부종 알고리즘 ·········································· 30
ⅩⅠ. 의료제공자(healthcare provider)에 의한 소아 BLS ··········· 32
제 2 부 외상 환자의 응급처치
Ⅰ. Multiple injured patient ······················································· 45
Ⅱ. Head trauma ········································································· 52
Ⅲ. Spinal cord injury ································································ 60
Ⅳ. Neck trauma ········································································· 65
Ⅴ. Chest trauma ········································································· 70
Ⅵ. Abdominal trauma ································································ 73
Ⅶ. Genitourinary trauma ···························································· 80
제 3 부 각론(EMERGENCY MANAGEMENT)
Ⅰ. Shock ···················································································· 85
A. Hypovolemic shock ···························································· 85
B. Cardiogenic shock ······························································· 86
C. Septic shock ······································································· 87
D. Anaphylactic shock ····························································· 89
Ⅱ. CARDIOLOGY ····································································· 91
A. Ischemic chest pain algorithm ············································ 91
1. 일반적인 흉통 환자의 처치 ················································ 92
2. AMI(Acute ST-segment elevation) ···································· 93
3. Non-Q MI(Non-ST elevated MI) ······································ 98
4. Unstable angina ································································· 99
B. Hypertensive crisis ···························································· 100
C. Aortic aneurysm / Dissection ············································ 101
Ⅲ. NEUROLOGY & COMA ·················································· 104
1. Coma ··············································································· 104
2. Cerebral hemorrhage ······················································· 108
3. CVA / Stroke ·································································· 109
4. Syncope ········································································· 113
5. Dizziness & Vertigo ······················································ 114
6. Seizures ········································································· 117
7. Headache ········································································· 122
Ⅳ. GASTROINTESTINAL EMERGENCY(위장관계 응급질환) · · 124
A. Acute abdomen의 일반 치료원칙 ······································· 124
B. 각 론 ················································································· 129
1. Acute appendicitis ··························································· 129
2. Ulcer perforation ····························································· 130
3. Mechanical small bowel obstruction ································ 131
4. Strangulation obstruction ················································· 133
5. Paralytic ileus ·································································· 134
6. Upper G.I. Bleeding ························································ 135
7. Varix bleeding ································································· 136
8. Hepatic coma ·································································· 139
9. Acute viral hepatitis ························································ 139
10. Lower G.I. bleeding ······················································ 140
11. Acute cholecystitis ························································· 141
12. Acute pancreatitis ·························································· 141
13. Intussusception ······························································· 143
14. Diarrhea(Infectious colitis) ············································· 144
15. Urolithiasis(renal colic) ·················································· 144
Ⅴ. PULMONOLOGY(호흡기계 응급질환) ······························ 147
1. Dyspnea 환자의 일반처치 ·············································· 147
2. Bronchial asthma ····························································· 148
3. Pneumothorax ·································································· 149
4. Lung abscess ··································································· 151
5. Tuberculosis ···································································· 151
6. Pneumonia ······································································· 153
7. Hemoptysis ······································································ 155
8. Pulmonary embolism ····················································· 156
Ⅵ. ENDOCRINOLOGY ··························································· 158
A. 내분비계 응급질환 ····························································· 158
1. DKA(Diabetic ketoacidosis) ············································· 158
2. HHNS(Hyperglycemic hyperosm. nonketotic syndrome) ·· 160
3. Hypoglycemia ·································································· 161
4. Hyperthyroioism(Thyroid storm) ······································ 162
B. ELECTROLYTES IMBALANCE ······································ 164
1. Hypernatremia ································································· 164
2. Hyponatremia ·································································· 165
3. Hyperkalemia ··································································· 165
4. Hypokalemia ···································································· 167
5. Hypercalcemia ································································· 169
6. Hypocalcemia ·································································· 170
7. Hypermagnesemia ···························································· 171
8. Hypomagnesemia ····························································· 171
Ⅶ. INFECTION(감염계 응급질환) ··········································· 173
1. FUO(Fever of unknown origin) ······································· 173
2. Needle stick injury(주사침 자상) ····································· 173
3. Meningitis ······································································· 174
4. Acute pyelonephritis ························································ 176
5. Salmonelosis ···································································· 177
Ⅷ. PEDIATRIC EMERGENCIES ··········································· 179
A. 중증도 환아의 일반처치 ····················································· 179
B. Rapid cardiopulmonary assessment ··································· 179
C. FEVER ············································································· 181
1. 일반적인 발열환아의 치료원칙 ········································· 181
2. Croup(Laryngotracheobronchitis) ······································ 182
3. Epiglottitis ······································································· 183
4. URI, Tonsilitis ································································· 184
5. Otalgia ············································································· 185
6. Bronchiolitis ···································································· 185
7. Pneumonia ······································································· 186
D. 기타 소아 질환의 치료 ······················································ 186
1. Asthma ············································································ 186
2. Intussusception ································································· 187
3. Enterocolitis, Gastroenteritis ············································ 188
4. Seizure ············································································ 189
5. Lethargy ·········································································· 190
6. Skin rash/Urticaria ··························································· 191
7. Drug intoxication ····························································· 192
8. Foreign body in the airway ············································ 192
E. DISCHARGE OR COMMON MEDICATION ·················· 193
Ⅸ. 산부인과 질환 ······································································ 196
1. 기본 OBGY Hx. taking ··················································· 196
2. 일반적인 Vaginal bleeding 치료지침 ································ 196
3. 임산부 환자의 약물 사용시 유의사항 ······························· 197
4. Uterine atony bleeding의 치료지침 ·································· 198
5. Childbirth ········································································ 198
6. Preeclampsia ·································································· 199
7. Eclampsia(산모의 seizure 시 한번 의심!) ························· 201
8. Ectopic pregnancy ··························································· 202
9. Ovarian cystic torsion ····················································· 203
10. Pelvic Inflammatory Disease(PID) ································· 204
11. Rape ·············································································· 205
Ⅹ. OTHER EMERGENCY CONDITION ······························ 209
A. 정형외과적 응급질환 ·························································· 209
1. Amputations ··································································· 210
2. Fractures(GENERAL) ···················································· 210
3. Fractures(FEMUR) ························································· 211
4. Fractures(PELVIS) ························································· 214
5. Pulled elbow(Radial head subluxation) ···························· 215
B. 성형외과적 응급질환 ·························································· 216
1. Facial trauma ·································································· 216
2. Blow-out fracture ···························································· 217
3. Laceration ········································································ 217
C. 기타 응급질환 ···································································· 227
1. Ophthalmology(안과질환) ················································· 227
2. Herpes zoster(대상포진) ··················································· 228
3. Anaphylaxis/Urticaria ······················································· 228
4. Epistaxis - 비출혈 처치방법 ············································· 229
5. 정신과 환자의 일반적인 행동조절과 restrain ···················· 233
6. Conversion disorder(전환장애) ········································· 233
7. 자살시도 환자의 일반처치(Evaluation of Suicide Attempt) ·· 234
8. Sexual assault 환자의 일반처치(Rape 포함) ····················· 235
9. 사망환자의 검안(사체검안서의 기술) ································· 235
ⅩⅠ. 환경 응급의학 (Enviromental emergency) ························ 237
1. Snake bite(뱀에 물린 경우) ·············································· 237
2. Dog bite(개에 물린 경우)/광견병 ····································· 239
3. Bee sting(벌 쏘임) ··························································· 242
4. 일반적인 Burn(화상)의 치료 ············································· 244
5. 잠수병(Decompression sickness) ····································· 252
6. Frostbite(동상) ································································· 253
7. Hyperthermia ································································· 254
8. Hypothermia ··································································· 255
9. Near-drowning(익수환자의 치료) ······································ 256
10. CO poisoning(일산화탄소 중독의 치료) ·························· 257
11. 버섯중독(Mushroom poisoning) ······································ 259
제 4 부 Toxicology
Ⅰ. Toxicology ·········································································· 265
A. 약물 중독 환자의 일반적인 처치 ······································· 265
B. 각 론 ················································································· 273
1. Acetaminophen(AAP,타이레놀,게보린,펜잘) ······················ 273
2. Aspirin, Salicylate(아스피린) ············································ 275
3. NSAIDS(부루펜,낙센) ······················································· 278
4. Opioids/Narcotics(데메롤,몰핀,코데인) ······························ 278
5. Neuroleptics(일반 항정신성 약물들) ································· 279
6. Lithium(조울증 치료제) ···················································· 280
7. Benzodiazepine(BZP,아티반,발리움,할시온) ······················· 281
8. Barbiturate(페노바비탈,치오펜탈) ······································ 282
9. Doxylamine succinate
(일반 수면제, 아졸, 자메로, 슐라폰, 스라민) ···················· 284
10. Tricyclic antidepressants ················································ 285
11. SSRI ·············································································· 288
12. Amphetamines, 코카인, CNS 흥분제 ···························· 288
13. Hallucinogen ·································································· 290
14. Sympathomimetics ························································· 292
15. Beta-blockers ································································· 293
16. Calcium channel blockers ·············································· 295
17. Digitalis glycosides ························································ 296
18. Theophylline(아미오필린) ··············································· 299
19. Phenytoin ······································································· 300
20. Carbamazepine ······························································· 301
21. Ethanol ·········································································· 302
22. Methanol ······································································· 305
23. Isopropanol, Ethylene glycol(부동액) ····························· 307
24. Caustics(산, 알칼리 손상) ················································ 309
25. Hydrocarbons(벤젠,휘발유,등유,좀약 등) ························· 313
26. Cyanide ········································································· 315
27. Isoniazide(항결핵제) ······················································· 317
28. Organophosphate ···························································· 317
29. Carbamate ······································································ 319
30. Pyrethroids(피레스로이드계 농약) ··································· 320
31. Paraquat(1,1'-dimethyl-4,4'-bipyridinium) ························· 320
32. Superwarfarin(쥐약;일명 쥐톨) ········································ 323
33. Iron ··············································································· 324
34. Methemoglobinemia 유발 약제(댑손,나병약) ··················· 326
제 5 부 부록
Ⅰ. 응급실 기본술기 및 처치 ···················································· 331
A. 기본적인 수액요법 ····························································· 331
1. First Fluid Selection(at ER) ············································ 331
2. Daily Requirement of Water, Electrolyte & Protein ······· 332
3. Fluid 공급시 Drop수 계산 방법 ······································· 332
B. 기본적인 응급수혈(Transfusion) ········································· 335
C. ABGA & Mechanical Ventilation ····································· 336
D. EKG Recording ································································ 339
E. Endotracheal Intubation ····················································· 341
F. Cricothyroidotomy ····························································· 344
G. RSI (Rapid sequence Intubation) ······································ 346
H. ABGA Technique ····························································· 348
I. 심낭천자술(Pericardiocentesis) ············································ 351
J. 심폐성 흉강 삽관술(CTD) ··················································· 352
K. Lumbar Puncture ······························································ 354
L. L-tube Insertion ································································· 356
M. S-B TUBE INSERTION ·················································· 357
N. Central venous cannulation ··············································· 360
O. Physical signs ··································································· 365
Ⅱ. Radiology ············································································ 368
A. PA film에서 관찰해야 할 사항들 ······································ 368
B. Lateral film ······································································· 372
C. Chest X-rays에 의한 Lung Segments ································ 373
D. Normal anatomy of abdomen CT ····································· 374
E. Normal anatomy of abdomen aonogram ··························· 376
Ⅲ. COMMONLY USED DRUGS ·········································· 378
A. Care and comfort drugs ··················································· 378
B. Cardiovascular drugs ························································· 384
C. Respiratory drugs ······························································ 395
D. Gastrointestinal drugs ························································ 397
E. Infectious disease drugs ··················································· 404
F. Endocrine drugs ································································ 413
Ⅳ. Cardiac emergency drug(2015년 개정 ACLS guideline) · · 417
Ⅴ. 치료 후 귀가조치시 치료지침서 ·········································· 424
Ⅵ. Normal Laboratory Findings ·············································· 428
Ⅶ. Ascites fluid examination ·················································· 430
Ⅷ. 소아의 심폐소생술 Table(약제포함) ···································· 431
찾아보기 ··········································································· 433

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