교통사고 예방 및 대책에 대한 워크샵

대한외상학회 대한외상학회 1989 大韓外傷學會誌 Vol.2 No.1

노인 외상 환자에 대한 분석 및 외상성 혈기흉의 임상양상

김정태 ( Jung Tae Kim ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.2

Purpose: This study was conducted to analyze chest-trauma patients and the old-aged patients with a traumatic hemopneumothorax. Methods: We reviewed the medical records of 101 chest-trauma patients admitted to the department of cardiovascular and thoracic surgery from June 1999 to November 2008. We evaluated the general characteristics of the chest-trauma patient, especially those of old-aged patients with a traumatic hemopneumothorax. Results: Rib fracture was observed in 99 of the cases, the location distribution was right: left =261: 255, with right being dominant. Rib fractures commonly involved the 4th and the 7th rib. The average number of rib fractures was 5.1, and the average number of rib fractures in the old-aged patients was significantly higher than that in the non-old-aged patients (p=0.04). There were 17 cases of a hemopnuemothorax in old-aged patients, 52 cases in non-old-aged patients. The blood loss through the chest tube for old-aged patients was significantly more than that for the non-old-aged patients, and the initial hemoglobin level was lower in the old-aged patients. Conclusion: Elderly trauma patients are more likely to die after trauma than other age groups. Even with relatively stable vital signs, invasive hemodynamic monitoring and intensive treatment are recommended. (J Korean Soc Traumatol 2009;22:161-66)

응급수술을 시행한 응급의료센터 내원 외상 환자 분석; 응급의학과 진료는 외상환자에 대한 외과의 수술과 같은 전문적인 진료를 오히려 지연시키는가?

이경원 ( Kyung Won Lee ) 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.1

Purpose: Trauma surgery is not an official medical specialty in the Republic of Korea (South Korea). Thus, a trauma victim transported to an emergency room (ER) is resuscitated and surveyed by an intern, a resident, or an emergency physician (EP) at first. Currently an operative management is decreasing because of multiple factors. Nevertheless, trauma surgery is the key for some patients. Does the EP`s treatment in the ER delay the surgeon`s emergency operation? Methods: A retrospective study was performed for trauma victims who underwent trauma surgery from March 2004 to February 2005 in a local emergency center of Daegu-city. We reviewed the medical records and analyzed the trauma victim`s age, sex, cause of injury, method of transport, time from the trauma to the operation, EP`s treatment, surgical department, mortality, and injury severity score (ISS). Results: Of the 223 trauma victims included in this study, males were predominant (83.4%). The mean age was 37.98 years of age. The main Causes of trauma were trauma NOS (not otherwise specified) and motor vehicle accidents (MVA). The main methods of transport was privately owned automobile. The mean time from trauma to operation was 617.46 min. The mean ISS was 7.67. Trauma surgery with the EP`s treatment group included 40 trauma victims with higher ISS, and the time from trauma to operation was shorter than it was for the 183 trauma victims not in that group. Conclusion: The EP`s treatment of high-ISS multiple-injury trauma victims can shorten the time from trauma to trauma surgery and will help the surgical department treatment. In the trauma care system of the Republic of Korea, and increased role should be encouraged for emergency physician. (J Korean Soc Traumatol 2007;20:19-25)

2차와 3차 병원에서 외상 치료의 적정성 비교

홍석현 ( Suk Hyun Hong ),한갑수 ( Gap Su Han ),정상헌 ( Sang Hun Jung ),전정민 ( Chung Min Chun ),최성혁 ( Sung Hyuk Choi ),이성우 ( Sung Woo Lee ),홍윤식 ( Yun Sik Hong ) 대한외상학회 2005 大韓外傷學會誌 Vol.18 No.1

본 연구에서는 응급처치 및 중환자 처치 능력의 확충이 중증 외상환자 치료에 미치는 영향을 알아보고자 두 기간 동안 대도시의 3차 병원과 중소도시의 2차 병원에서 외상치료의 적정성을 비교하였다. 응급 및 중환자 처치 능력의 확충 이후, 2차 병원은 타 병원으로의 전원 없이도 중증 외상 환자를 치료할 수 있게 되었으며, 생리학적 외상 치료 능력이 향상되어 보다 정확한 외상 치료가 가능해 졌다. 비록 특별하게 고안된 외상 센터가 아니라 하더라도, 잘 구축된 응급 의료 체계하에서 지역별로 응급 및 중 환자 처치 능력을 강화하면 외상 환자 치료 성적을 향상 시킬 수 있을 것이다. Background: This study compared the performance of trauma care in an urban and a suburban hospital before and after the enhancement of emergency and intensive care. Method: The medical records of patients who were admitted to the intensive care unit following trauma from 1994 to 1995 and from 2002 to 2003 were examined. The standardized W (Ws), the 95% confidence interval (CI) of the Ws, and the predicted survival rate (Ps) were calculated. During each period, each hospital`s actual survival rate was compared with the 95% CI of the Ps according to the revised trauma score (RTS) and injury severity score (ISS). Spell out RTS and ISS. Result: From 1994 to 1995, 225 and 121 records from the urban and the suburban hospitals were reviewed, respectively. The 95% CI`s of the Ws were -2.30 to 2.73 and -11.40 to -5.90, respectively. The actual survival rate of the suburban hospital was significantly lower than the predicted survival rate at all RTS. From 2002 to 2003, 315 and 268 records from the urban and the suburban hospitals were reviewed, respectively. The 95% CI`s of the Ws was -3.56 to 0.24 and -3.73 to 0.26, respectively. There was no difference between the actual survival rate and the predicted survival rate. Conclusion: An enlargement of the capacities of emergency and intensive care may improve the performance of trauma care at a small suburban hospital.

다발성 중증 외상 환자들의 치료에 대한 응급 외상팀 운영의 효과

이성화 ( Seong Hwa Lee ),조석주 ( Suck Joo Cho ),염석란 ( Seok Ran Yeom ),류지호 ( Ji Ho Ryu ),정진우 ( Jin Woo Jung ),한상균 ( Sang Kyun Han ),김용인 ( Yong In Kim ),박맹렬 ( Maeng Real Park ),김영대 ( Young Dae Kim ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.2

Purpose: We performed this study to determine how the emergency trauma team affects the treatment of patients with multiple severe trauma and to discuss the effect and the direction of the emergency trauma team`s management. Methods: We performed a retrospective analysis of 518 patients who visited our emergency department with severe trauma from August 2006 to July 2008. We divided the severe trauma patients into 2 groups: patients before and after trauma team management (Group 1 and Group 2). Then, we compared demographic characteristics, mechanisms of injury, and treatment outcomes (lengths of stay in the ED, admission ratio, and in-hospital mortality) between the 2 groups. In the same way, patients with multiple severe trauma were divided into 2 groups, that are patients before and after trauma team management (Group 3 and Group 4) and analyzed. Results: There was no significant difference, except mean age, between groups 1 and 2. In group 4 patients, compared to group 3 patients, the lengths of stay in the ED were lower (p value<0.001), and the admission ratio were higher (p value=0.017), but there was no significant difference in the in-hospital mortality between the groups 3 and 4. Conclusion: When patients with multiple severe trauma visit the ED, the emergency trauma team`s management can decrease the lengths of stay in the ED and increase the admission ratio, but does not produce a decrease in the in-hospital mortality rate. Further investigations of emergency trauma team management are needed to improve treatment outcomes for patients with multiple severe trauma. (J Korean Soc Traumatol 2009;22:172-78)

호흡기 보조를 받는 환자에서 발생한 하인두 천공

박권재 ( Kwon Jae Park ),박창민 ( Chang Min Park ),정상석 ( Sang Seok Jung ),방정희 ( Jung Hee Bang ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.3

Hypopharyngeal perforation is a rare, but fatal, complication. Clinical signs and symptoms of this condition are neck pain, odynophagia, dysphagia, fever, vomiting, cervical swelling and subcutaneous emphysema. However, these signs are obscured in patient suffering from severe trauma who has had an endotracheal tube inserted, which delay proper evaluation and treatment. Here, we report a case of hypopharyngeal perforation in a trauma patient who had an endotracheal tube inserted for mechanical ventilation. [ J Trauma Inj 2014;27:75-78 ]

다발성 손상 환자에서의 복부 손상에 대한 비수술적 치료: 권역 외상 센터가 아닌 3차 병원의 치료 경험(2009~2014)

오승영 ( Seung Young Oh ),서길준 ( Gil Joon Suh ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.4

The aim of this study is to present a nonoperative treatment for abdominal injuries in patients with multiple traumas and to discuss the role of metropolitan tertiary hospital, non-regional trauma centers. We collected data from patients with multiple traumas including abdominal injuries from 2009 to 2014. Patient characteristics, associated injuries, short-term outcomes and departments that managed the patients overall were analyzed. Based on treatment modalities for abdominal injury, patients were divided into two groups: the operative treatment group and the nonoperative treatment group. We compared differences in patient characteristics, injury mechanisms, initial vital signs, detailed injury types, lengths of hospital and ICU stays. Of the 167 patients with multiple traumas, abdominal injuries were found in 57 patients. The injury mechanism for 44 patients (77.2%) was traffic accidents, and associated extra-abdominal injuries were shown in 45 patients (78.9%). The mean lengths of hospital and ICU stays for the 57 patients were 36.4 days and 8.3 days, respectively. The in-hospital mortality rate was 8.8%. Ten patients (17.5%) were treated operatively, and 47 patients (82.5%) were treated nonoperatively. Among the 47 patients in the nonoperative treatment group, 17 patients received embolization, and 3 patients underwent a percutaneous drainage procedure. Operative treatments were used more in patients with injuries to the pancreas and bowel. No patient required additional surgery or died due to the failure of nonoperative treatment. No differences in the clinical characteristics except for the detailed injury type were observed between the two groups. In appropriately selected patients with multiple traumas including abdominal injuries, nonoperative treatment is a safe and feasible. For rapid and accurate managements of these patients, well-trained trauma surgeons who can manage problems with the various systems in the human body and who can decide whether nonoperative treatment is appro-priate or not are required. [ J Trauma Inj 2015; 28: 284-291 ]

외상 후 단독 상장간막동맥박리 후에 국소적으로 진행된 박리성 동맥류와 심한 진강의 압박이 있는 환자에서 혈관내 스텐트설치술 1례

김영규 ( Young Kyu Kim ),허규희 ( Kyu Hee Her ),김승형 ( Seung Hyoung Kim ),김광식 ( Kwangsik Kim ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.4

Reports on a posttraumatic isolated superior mesenteric artery (SMA) dissection are rare. Recently, endovascular stent placement via percutaneous access, instead of vascular surgery, has been widely accepted as the initial treatment for a patient with an isolated SMA dissection or its complications. A 60-year-old female patient was transferred to our hospital due to an isolated SMA dissection after a car accident. The SMA dissection was 8.5 cm in length, and it involved the true lumen, which was severely compressed by the thrombosed false lumen. The patient was closely observed because she did not complain of any specific visceral pain. On the seventh hospital day, she underwent computed tomography (CT) to decide on a further treatment plan, irrespective of the presence of the abdominal symptom. The findings of the follow-up CT showed no difference compared to those of the previous CT. She was discharged with anticoagulants. One month later, the follow-up CT revealed focally progressing dissecting aneurysms in the false lumen of the dissected SMA and a more severely compressed true lumen. Two self-expandable metallic stents were successfully placed in the true lumen of the dissected SMA, covering two aneurysmal lesions. Herein, we report a successful endovascular treatment with stent placement for treating focally progressing dissecting aneurysms and a severely compressed true lumen in a patient with a posttraumatic isolated SMA dissection. [ J Trauma Inj 2015; 28: 266-271 ]

중심정맥관의 동맥 내 거치: 증례보고

오승영 ( Seung Young Oh ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.4

Central venous catheterization is one of the most important procedures for initial resuscitation of hemodynamically unstable patients including multiple trauma patients. Inadvertent arterial placement of the large caliber central venous catheter can results in resuscitation failure as well as unnecessary invasive treatment. Here, we report an arterial puncture during central venous catheterization which may lead to inadvertent arterial catheterization. We recommend that arterial catheterization should be evaluated before dilator insertion during Seldinger’s method. Ultrasound can help in preventing the inadvertent arterial catheterization of central venous catheter. [ J Trauma Inj 2015; 28: 292-294 ]

족관절 삼과 골절과 동반된 청소년기 Tillaux 골절

박석균 ( Seok Kyun Park ),채수욱 ( Soo Uk Chae ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.4

The adolescent Tillaux fracture is an avulsion fracture of the anterolateral corner of the distal tibial epiphysis caused by external rotation of the foot. This type of fracture occurs during epiphyseal fusion in adolescence. A difficult to detect Tillaux fracture was discovered on a preoperative radiograph, such fractures have rarely been reported to accompany a predominantly adult-type ankle fracture. Especially, to the best of our knowledge, no case of a trimalleolar ankle fracture in an adolescent with a Tillaux fracture has been reported. Thus, we present a case of a trimalleolar ankle fracture in a 15-year-old adolescent with a Tillaux fracture who was successfully treated surgically. [ J Trauma Inj 2015; 28: 280-283 ]