외상환자에 대한 손상 중증도 점수체계와 국내 외상성과 연구

정경원,이국종,김지영 대한외상중환자외과학회 2016 Journal of Acute Care Surgery Vol.6 No.1

To improve trauma outcomes, a solid logistic support system is obviously crucial. An impor-tant national trauma outcome indicator is preventable trauma death rate, 35% in Korea. The Korean government is aware of this figure and is making efforts to reduce the preventable trauma death rate by 20%. One of the main components was establishing regional trauma centers covering the Korean peninsula, and a trauma care system. Seventeen regional trauma centers will be verified by the year of 2020. To achieve this goal, trauma specialist medical staff’s role is essential. A trauma system is very complicated. It involves a broad range of health care fields from the prehospital setting to rehabilitation. In addition, a number of professionals, institutions and authorities are involved. Thus, very sophisticated systemic approaches are needed. An essential initial component is surveillance, which can start with collecting data and analyzing them thoroughly with a suitable trauma scoring system to describe the characteristics of injured patients in Korea. Several trauma scoring systems are available in Korea. However, these systems need validation to decide which is pertinent for a records- based Korean trauma system. Although the Korean Trauma Data Bank (KTDB) is recently established, it can be used for a predictive model in Korea. (J Acute Care Surg 2016;6:11-17)

Appendicitis – Is a Clinical Diagnosis Enough?

Caren D’Souza,Supriya Pinto,Midhun Kumar 대한외상중환자외과학회 2023 Journal of Acute Care Surgery Vol.13 No.1

Appendicitis has always been considered a clinical diagnosis wherein the surgeon’s clinical acumen and laboratory investigations take priority over the radiological imaging. However, an atypical presentation of appendicitis can occur due to the varying location of the appendix which may result in delayed diagnosis and complications. In such cases radiological imaging such as contrast enhanced computerized tomography helps in the diagnosis. We report two cases of subhepatic appendicitis with different clinical findings.

Uncommon Mechanism of Mangled Extremity; Three Cases of Rope Entanglement Injury of the Lower Leg

Minsu Noh,Kyu Hyouck Kyoung,Sungjeep Kim,Min-Ae Keum,Seong Ho Choi,Kyounghak Choi,Ji Hoon Kim 대한외상중환자외과학회 2023 Journal of Acute Care Surgery Vol.13 No.1

Rope entanglement injury is a rare entity. Previous reported studies mainly consisted of finger-related injuries. We describe three cases of rope entanglement injury of the lower leg. In the first patient, a belowthe- knee amputation was performed as the primary treatment for unilateral amputated lower limb. In the second patient, a below-the-knee amputation and perineal wound management were simultaneously performed. The third patient had vascular injury combined with internal soft tissue injury without related bone fracture. He suffered serious sequelae from a delay in transfer from a local hospital. Rope entanglement injuries of the lower leg do not present in a consistent manner, and the treatment of accompanying injuries should be considered from an early stage. Care should be taken to ensure that there are no internal injuries missed because the exterior appears to be stable.

Management of Adult Blunt Renal Injury: A 10-Year Retrospective Review at a Single Institution

Jin Soo Kim,Ki Hoon Kim,Se Hun Kim 대한외상중환자외과학회 2023 Journal of Acute Care Surgery Vol.13 No.1

Purpose: Renal injury occurs in up to 5% of trauma cases and the kidney is the third most wounded abdominal organ. The study objective was to analyze clinical characteristics of patients with blunt renal trauma and review the treatment of high-grade blunt renal injuries. Methods: The medical charts of trauma patients who visited Haeundae Paik Hospital between March 2010 and February 2020 were retrospectively analyzed. Data on demographics, injury patterns, clinical presentation, management, and outcomes were analyzed. Results: A total of 68 patients with renal trauma were included in this study. The most common renal injury was Grade III (n = 27, 39.7%). Falling was the predominant mechanism of injury (n = 33, 48.5%), and 23.5% (n = 16) of patients sustained isolated renal trauma. Organ damage related to kidney injury included chest injury (57.4%, n = 39) and abdominal or pelvic content injury (48.5%, n = 33). The overall mortality rate was 2.9% (n = 2). There were 45 cases of high-grade renal trauma (AAST Kidney injury scale Grade Ш-V). There was no statistical difference in the outcomes of high-grade (n = 44, 97.8%) and low-grade (n = 23, 100%) renal trauma patients who received nonoperative treatment (p = 0.511). Variables did not differ significantly, except for the injury severity score which was statistically significantly different between low-grade and high-grade renal trauma patients (p = 0.001). Conclusion: Most patients with traumatic renal injury, even those with high-grade injury, can be managed by nonoperative treatment, and have a good prognosis.

Characteristics and Clinical Outcomes of Elderly Patients with Trauma Treated in a Local Trauma Center

Kwanhoon Park,Geonjae Cho,Sungho Lee,Kang Yoon Lee,Ji Young Jang 대한외상중환자외과학회 2023 Journal of Acute Care Surgery Vol.13 No.1

Purpose: This study aimed to investigate the characteristics of elderly patients who visited a non-regional trauma center to examine the effects of old age on the clinical outcomes of patients. Methods: The medical charts of 159 patients with trauma who visited the National Health Insurance Service Ilsan Hospital between March 2020 and February 2022 were retrospectively analyzed. Results: Of the 159 patients, 41 were assigned to the elderly patient group (EPG) and 118 were assigned to the non-elderly patient group (NEPG). The average age of patients in each group was 75.5 and 38.2 years in the EPG and the NEPG, respectively. Comparing the injury mechanism between the two groups, pedestrian traffic accidents (TA) were the most common (24.4%), followed by slipping (19.5%), motorcycle TA, and bicycle TA (14.6%) in EPG. In the NEPG, motorcycle TA (28.0%) was the most common, followed by car TA (27.1%), and fall injury (16.9%), with a significant difference between the two groups (p < 0.001). The significant differences between the two groups were the injury severity score (ISS; p = 0.004), severe trauma (p = 0.045), intensive care unit admission (p = 0.028), emergency operation (p = 0.034), and mortality (p = 0.013). The statistically significant risk factors for mortality were old age (p = 0.024) and chest injury (p = 0.013). Conclusion: Patients in the EPG compared with the NEPG group showed different injury mechanisms. The EPG has a higher severity and mortality rate than the NEPG.

Submandibular Injury Caused by the Close-Range Firing of a Military Blank Cartridge Shot

Hyo Jin Kim,Donghyoun Lee,Kyungwon Lee 대한외상중환자외과학회 2023 Journal of Acute Care Surgery Vol.13 No.1

Few studies have reported injuries caused by a blank cartridge shot (BCS) into the head and neck. We experienced a case of minor injury resulting from BCS (despite the close proximity). The patient was a 20-year-old male soldier who attempted suicide by firing a BCS from a K2 rifle into his mouth. He suffered from skin and soft tissue defect in the submandibular area with burns and minimal bleeding. A computed tomography scan showed subcutaneous emphysema which was suspected to be related to the projectile gas released during the firing of the BCS, and a tiny fragment without hematoma or structure injuries. We closely observed the clinical features including the occurrence of infection and functional abnormalities. The subcutaneous emphysema faded away along with the soft tissue defect. After wound management was completed on the 13th hospital day, the patient was transferred to the Department of Psychiatry without any problems.

Rouviere’s Sulcus: A Guide to Safe Laparoscopic Cholecystectomy

Reetesh Pathak,Lakshya Mittal,Ghaus Mohd Chouhan,Apoorva Tripathi 대한외상중환자외과학회 2023 Journal of Acute Care Surgery Vol.13 No.1

Purpose: Rouviere’s sulcus (RS) serves as an important anatomical landmark to avoid bile duct injuries during a laparoscopic cholecystectomy. However, there is significant paucity in literature regarding its surgical importance during laparoscopic surgeries. The aim of this study was to identify cases where RS was identified before dissection of the Calot’s triangle. Methods: For this retrospective observational study, 500 patients who underwent a laparoscopic cholecystectomy at our hospital and who were operated on between September 2017 to August 2022 were reviewed. Identification of RS and its types were analyzed. Results: Among all 500 cases, RS was present in 465 (93%) cases whereas it was absent in only 35 (7%) cases. RS was present in different forms of cholelithiasis. Open, closed, slit like, and scar type of RS was found in 75.29%, 12.90%, 3.21%, and 8.20%, respectively. Identification of RS along with achieving a critical view of safety in antero-superior direction to RS resulted in no injury to the bile duct in all 465 cases. Conclusion: Identification of RS along with achieving a critical view of safety should be the aim in all laparoscopic cholecystectomy procedures. The RS is as an important landmark to reduce biliary tract injuries.

Neostigmine Treatment of Paralytic Ileus in Critically Ill Patients

최낙준,김태현,홍석경 대한외상중환자외과학회 2017 Journal of Acute Care Surgery Vol.7 No.2

Paralytic ileus is a common complication in critically ill patients, and can affect all parts of the gastrointestinal tract. We report a case of paralytic ileus that improved after neostigmine administration. An 80-year-old man was transferred to the intensive care unit after a diagnosis of severe colitis due to Clostridium difficile infection while under conservative treatment for paralytic ileus . The patient ’s colitis resolved but the ileus did not. This promp ted neostigmine administration, resulting in remarkable improvements in the abdominal physical examination and radiographic images. Bowel movements recovered, oral feeding was restarted, and the patient was transferred back to the general ward. (J Acute Care Surg 2017;7:78-82)

중환자실에서 말초 정맥 삽입형 중심정맥관을 시행한 환자의 임상양상

김형주,정창연,배정민 대한외상중환자외과학회 2019 Journal of Acute Care Surgery Vol.9 No.1

Purpose: Ensuring the stability of central venous catheter placement for treating patients hospitalized in an intensive care unit is very important. Although PICC requires an ultrasound and fluoroscopy machine, it is difficult to use a fluoroscopy machine for PICC insertion in the intensive care unit. This study analyzed the cases of the insertion of a PICC under ultrasonic guidance at the bedsides in the intensive care unit to determine the usefulness of PICC in the intensive care unit. Methods: A retrospective study was conducted on patients hospitalized in the surgical intensive care unit and received PICC using ultrasonography at their bedsides from October 2015 to January 2018.Results: One hundred and twenty patients were collected. The number of successful PICCs stood at 105 patients, which was equal to 87.5%. Among them, 65 and 55 cases had left and right insertion, respectively; the corresponding success rate was 81.8%, and 92.3%. No statistically significant difference in success rates was observed between the left and right, as well as in the success rates depending on the presence of shock, sepsis, acute kidney injury, and mechanical ventilation. In the failed 15 cases, seven cases were due to the course of the procedure and eight cases were confirmed have been malpositioned after insertion. Conclusion: PICC at the bedside in an intensive care unit is a safe method for central venous catheterization without severe complications and death. The insertion sites, left or right, are equally acceptable. Further study of the cases of malposition will be necessary.

외상 환자에서 말초삽입 중심정맥관의 유용성: 단일기관의 초기경험

김길환,이상봉,김재훈,이찬규 대한외상중환자외과학회 2017 Journal of Acute Care Surgery Vol.7 No.2

Purpose: A peripherally inserted central catheter (PICC) provides effective, reliable intravenous access in patients who require long term therapy such as intravenous antibiotics, total parenteral nutrition, transfusion or inotropic agents. This retrospective study evaluated the usefulness of PICC in trauma patients by examining patient characteristics and common complications, including PICC related bloodstream infection. Methods: We reviewed the trauma patients who underwent PICC at Pusan National University Hospital Trauma Center from January 2016 to February 2017. Results: From January 2016 to February 2017, 32 patients underwent PICC. Total catheter insertion days were 875 days, and the average catheter indwelling time was 27.3±25.02 days. The most common indication for PICC was total parenteral nutrition (n=20, 62.5%), while the remainder was to ensure a long-term fluid administration route (n=12, 37.5%). Catheter related complications included infection (n=3, 9.4%; 3.42 per 1,000 catheter-days), catheter tip malposition (n=2, 6.3%), catheter dislodgement (n=1, 3.1%), insertion site leakage (n=1, 3.1%) and arm swelling (n=1, 3.1%). No statistically significant differences were found between those who developed bloodstream infection and those who did not. Conclusion: If the PICC is performed by correcting adjustable factors that increase the risk of infection, effective and reliable intravenous access can be maintained in patients who require long-term therapy without bleeding, pneumothorax, or other complications of central venous catheter insertion. (J Acute Care Surg 2017;7:69-74)