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Background: Contrast-enhanced Abdominopelvic Computed Tomography(CT) is widely used for diagnosing abdominal injuries after blunt trauma. The purpose of this retrospective study is to classify the contrast-enhanced Abdominopelvic CT finding of mesenteric injuries after blunt abdominal trauma and assess of CT finding on clinical management. Methods: Between January 2000 and December 2003, 607 consecutive spiral abdomonopelvic CT examinations were performed in the ER of Gil medical center after blunt abdominal trauma. CT represented mesenteric injuries : bowel wall thickening or hematoma, mesenteric haziness or fatty infiltration, confined fluid or hematoma within mesenteric folds. We classified patients into 5 Grade by the hematoma size on CT scans : Grade I(None, 0 mm), II(Minimal, ≤10 mm), III(Small, 11~30mm), IV(Moderate, 31~60 mm), V(Large, ≥61 mm). Results: On the basis of the CT findings, 42 of the 607 patients were selected. 18 (42.9%) of 42 patients were classified as having grade I, II, III (≤30 mm) and 24 (57.1%) of 42 patients as having grade IV, V(≥31 mm). Of the 18 patients with grade I, II, III, 16(88.9%) were managed conservatively, while 2(11.1%) underwent surgery. of the 24 patients with grade IV, V injuries, 20(83.3%) were treated surgically and 4(16.7%) patients were managed conservatively. Conclusions: It is sufficient to treat of grade I, II, III mesenteric injuries by conservative management. It should be considered emergency operation to treatment of grade IV, V mesenteric injuries. (p<0.001) There were no relations between grading and initial systolic blood pressure, initial blood pressure and operation.
Purpose: Plasma neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker that shows correlation with the severity of acute infection and acute kidney injury (AKI). This study was conducted in order to determine the predictive value of NGAL in the emergency department for predicting the severity of acute pyelonephritis. Methods: A retrospective study was conducted between October 2012 and May 2013. A total of 46 patients diagnosed with acute pyelonephritis were enrolled in this study. Plasma NGAL was measured upon admission to the hospital and clinical and laboratory data, CT were collected. Based on these data, we classified our patients according to two groups (high NGAL group: NGAL ≥400 ng/mL vs low NGAL group: NGAL <400 ng/mL) and we evaluated the correlation between clinical data, laboratory data, and CT. Results: Among the 46 patients, there were 45 female patients and the mean age was 59.0±20.4 years. Statistically significant differences in CT grades, hospital stay, SIRS, and shock were observed between the NGAL groups. The area under the ROC curve for CT severity by NGAL was 0.890(95% CI, 0.796-0.985), which was better than CRP and MDRD GFR. NGAL levels showed correlation with CRP (r=0.508; p<0.001) and MDRD GFR (r=- 0.766, p<0.001). Conclusion: NGAL is a useful specific biomarker predicting severity of acute pyelonephritis.
Purpose: High voltage electrical injury mainly occurs in the industrial field. It can cause serious complications and sequelae that lead to high social and economic costs. We investigated the causes of this to try to help prevent these injuries. Methods: We reviewed 128 patients who incurred high voltage electrical injury during a 3-years period from Jan. 1, 2006 to Dec. 31, 2008. We performed a retrospective analysis of the medical records to review the epidemiology. We also performed a survey by telephone. The survey questions addressed the following: the duration of work, wearing safety equipment, the reason for working without safety equipment, did they receive safety education, was the safety education adequate, recognition of a high tension wire before working and did they understand the effect of high voltage on the human body. Results: The safety education was relatively carried out well. But most patients did not wear safety equipment even though they knew they had to wear it (92%). The major reason was discomfort of wear it (72%). The hand was the most common injury site (80%). Most injuries occurred with 22,900 volt or less (92%). In spite of safety education, many patients were unaware of the effects of electrical injury on their body. Conclusion: Strengthened safety education can play a significant role in preventing high voltage electrical injury. At this point, the doctors who are experienced in treating high voltage electrical injury must actively participate in this safety education. We suggest that handy safety equipment can lessen the incidence of high voltage electrical injury. It is essential to develop a handy safety glove for 22,900V with considering that the hand was the most common injury site and the most frequent voltage for injury was 22,900 volt or less.
김용인 ( Yong In Kim ), 노기철 ( Ki Cheul Noh ), 강영준 ( Young Joon Kang ), 임용수 ( Yong Su Lim ), 양혁준 ( Hyuk Jun Yang ), 이근 ( Gun Lee ), 진욱 ( Wook Jin ), 황성연 ( Seong Youn Hwang ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2
Background: Simple cervical X-rays often miss cervical spine injuries. Magnetic resonance imaging is valuable in these cases. The aims of this study is to determine high-risk factors of the cervical injuries, and to contribute to make indications of cervical MRI in evaluation of blunt trauma patients. Methods: We retrospectively reviewed the patients who visited our ED due to nuchal pain and examed by simple cervical X-ray and cervical MRI after blunt trauma. We analyzed the incidence of abnormal MRI findings in various patients groups. We also compared the incidence of missed cervical spine injury by level of injured spine. We thought cervical MRI to be goldstandard of this analysis. Results: The incidence of abnormality on cervical MRI is higher in male patients than female patients (p<0.01). Old (age≥40) patients frequently shows abnormal cervical MRI findings than young patients (p<0.001). In patients who had neurologic abnormality, the incidence of abnormality on cervical MRI is higher than neurologically normal patients (p<0.001). But, mechanisms of injuries and associated injuries are not related to the incidence of abnormality on cervical MRI. Injuries of lower cervical spine (C7) are frequently missed than those of other cervical spines (p<0.01). Conclusion: When evaluate cervical injuries in male, old, and neurologically abnormal patients, we must consider cervical MRI although the simple cervical X-ray is normal. We must pay more attention to lower cervical spine injuries than other cervical spine injuries.
Purpose: High voltage electrical injuries can cause serious complications and sequelae, leading to social and economic costs. We reviewed patients with high voltage electrical injuries experienced over the last 8 years. Methods: We retrospectively reviewed the medical records of 645 consecutive patients admitted between January, 2000, and December, 2007. We noted demographics, burn type, fasciotomy time after burn injuries, distribution classified by voltage, entrance and exit of burn injuries, type of amputation and amputation rate, associated injuries and complications, death rate, electrocardiogram, and laboratory results. Results: Most injuries occurred in men (99.2%), with a mean age of 38.2±9.3 years. Direct contact burns were the most common (62.2%), and the mean burn extent was 14.8±15.9%. The right upper extremity was the most common entry point, with the left lower extremity the most common exit point. The amputation rate was 22.2%. Associated injuries and complications occurred in 62.0% of cases. Conclusion: This research may influence diagnosis and treatment of high-voltage injuries, reducing the associated injuries and complications. Furthermore, we should protect against high voltage electrical injuries.
장혜영 ( Hye Young Jang ), 정진희 ( Jin Hee Jung ), 경연영 ( Yeon Young Kyong ), 김강호 ( Kang Ho Kim ), 김도균 ( Do Kyun Kim ), 김미란 ( Mi Ran Kim ), 김진주 ( Jin Joo Kim ), 류일 ( Eell Ryoo ), 노기철 ( Ki Cheul Noh ), 서준석 ( Jun Seok) 대한응급의학회 2012 大韓應急醫學會誌 Vol.23 No.3
Procedural sedation and analgesia (below PSA), which is used for induction of appropriate sedation and elimination of pain during many procedures, is particularly essential for children. Many other countries have pediatric PSA guidelines. PSA guidelines are also needed in Korea. We have developed pediatric PSA guidelines for Korea by reference review of pediatric PSA for standard and safe PSA practice in Korea. Pharmacologic and non-pharmacologic methods could be used for performance of ideal pediatric PSA. Pre sedation phase included assessment of patients, with accompanying personnel who have adequate knowledge and experience, and informed consent. For sedation phase, the route of medication should be determined, along with monitoring of patients and evaluation of the depth of sedation. This phase also included writing all of the PSA process, adverse events, and intervention. Considering the pain of the procedures, the time of procedures, necessity for immobilization, and characteristics of PSA medication, we decided on the PSA method. Procedures were categorized into three types according to the level of pain, anxiety, and immobilization. The first type was radiologic imaging, which requires immobilization. The second type of procedure involves a high level of anxiety and a low level of pain, such as simple suturing and lumbar puncture. The third type of procedure involves a high level of anxiety and a high level of pain, such as reduction of fracture and dislocation. After performance of the procedure, patients must be observed and monitored at a location where oxygen and airway management can be applied until they reach full recovery. Discharge information should be provided to competent parents. The main characteristics of Korean guidelines for pediatric PSA were as follows: 1. We emphasized assessment and monitoring of patients during and after PSA. 2. We suggested selection of medication by categorization of procedures according to the level of pain and anxiety. 3. We suggest that PSA be performed by two healthcare personnel; one should have adequate knowledge and experience in performance of PSA. More equipment, locations, and specialized personnel are needed for conduct of safe pediatric PSA practice in Korea.