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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)
Purpose: Current practice for patients who present to hospitals with acute sacrococcygeal pilonidal abscess is operative management. Wound swabs are routinely taken peri-operatively and antibiotics are initiated empirically pending culture and sensitivity results. The aim of our study was to evaluate whether the results of wound swabs change post-operative antibiotic therapy for these patients, and to identify the common microorganisms. Methods: This was a retrospective analysis which included patients who presented to the Northern Hospital, Victoria, with acute sacrococcygeal pilonidal abscess between 1st January 2013 to 30th June 2016. Data was collected using hospital electronic medical records. Patients who had wound swabs taken were identified and their post-operative management analyzed. Results: There were 297 presentations identified within the study period, of which, 224 cases (224/297, 75.4%) had wound swabs taken, out of which 130 (130/297, 43.8%) cases were followed up in outpatient clinic and 1 case (1/130, 0.8%) had a subsequent change in antibiotics based on the wound swab result. Common microorganisms grown were mixed anaerobes (138/224, 61.6%) and skin flora (45/224, 20.1%). Conclusion: Wound swabs could be omitted during peri-operative care for patients with acute sacrococcygeal pilonidal abscess. The because the results of wound swabs did not change the management of these patients. Additionally, omitting wound swabs could save money for the health care. Pre-operative antibiotic therapy should have anaerobic coverage as it is the most common type of micro-organism cultured from pilonidal abscesses.
Hohyun Kim,Sung Jin Park,Chang Ho Jeon,Jae Hoon Jang,Jae Hun Kim,Sun Hyun Kim,Chan Ik Park,Sang Bong Lee,Seon Hee Kim,Chan Yong Park,Seok Ran Yeom 대한외상중환자외과학회 2021 Journal of Acute Care Surgery Vol.11 No.1
Purpose: Management options for extraperitoneal bladder injury (EBI) associated with pelvicfracture are variable. Predictive factors of operative management (OM) in patients with EBIassociated pelvic fracture have not been previously addressed. This study assessed the currentepidemiology of blunt traumatic urinary bladder injury and evaluated relevant clinical findings ofpatients with EBI associated with pelvic fracture who received OM. Methods: Patients with urinary bladder injury with or without pelvic fracture from blunt traumafrom January 1, 2014 to December 31, 2019 were identified from the institute trauma registry(n = 12,891). Demographics, mechanism of injury, type of urinary bladder injury, pelvic fractureconfiguration, and management options were analysed in the study population (n = 9,894). Results: Of the 1,400 patients who had pelvic and/or acetabular fracture, 32 (2.3%) had urinarybladder injury. Of the 8,494 patients without pelvic and/or acetabular fracture, 12 (0.1%) had nonpelvicfracture urinary bladder injury. The total incidence of urinary bladder injuries in the studypopulation was 0.4% (44/9,894). Patients with EBI associated with pelvic fracture who underwentOM, had a higher frequency of high-grade pelvic injury (100% vs 0%, p = 0.015), concomitant pelvicsurgery (75.0% vs 0%, p = 0.001), and non-lateral compression type pelvic fracture (62.5% vs 10.0%,p = 0.043) compared with patients who underwent non-operative management of EBI. Conclusions: These data suggest that OM may be considered especially in patients with EBIassociated with pelvic fracture with high grade pelvic injury, concomitant pelvic surgery, and nonlateralcompression type pelvic fracture.
Regional anesthesia is generally recommended over general anesthesia for non-cardiac surgeries in patients with severe pulmonary hypertension (PH) caused by pulmonary disease. However, pre-, and intra-, postoperative management are critical for patients with severe PH even when regional anesthesia is performed. This is the first reported case of carbon dioxide retention and administration of the appropriate treatment during non-cardiac surgery performed under spinal/epidural anesthesia and analgesia in a patient diagnosed with chronic cor pulmonale accompanied by severe PH. (J Acute Care Surg 2018;8:25-29)
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)
Purpose: This retrospective study evaluated the clinical utility of the delta neutrophil index (DNI) as a predictor of mortality in critically ill surgical patients with Acinetobacter baumannii (AB) pneumonia. Methods: The medical records of 104 surgical patients with AB pneumonia treated from March 2011 to October 2014 were reviewed and analyzed. Results: The mean patient age was 60.8±18.8 years, and the mean Acute Physiology and Chronic Health Evaluation II score was 15.8±5.3. At the time of culture, 16 patients (15.4%) had renal failure, and the median DNI was 2.7% (0∼39.4%). Twenty-four patients (23.1%) died from infection during intensive care unit admission. Bivariate analysis indicated that several factors were associated with mortality, namely age, occurrence of shock, renal failure, low platelet count and elevated DNI at the time of culture. Logistic regression analysis revealed that elevated DNI (odds ratio [OR], 1.136; 95% confidence interval [CI], 1.001∼1.288), acute renal failure (OR, 3.811; 95% CI, 1.025∼14.176) and decreased platelet count (OR, 0.994; 95% CI, 0.989∼1.000) at the time of culture are associated with mortality. When a receiver-operating characteristics curve was constructed to determine the optimal cut-off value to predict mortality within seven days of the bacterial culture, the area under the curve was 0.839 (95% CI, 0.694∼ 0.985) and the cut-off DNI value was 6.85%. Conclusion: DNI may be an effective predictor of mortality in critically ill surgical patients with AB pneumonia. (J Acute Care Surg 2017;7:61-68)
Purpose: Acute care surgery (ACS) has been shown to improve patient outcome and treatmentefficiency in the U.S. ACS was introduced to the Department of Surgery, Yonsei University College ofMedicine, Seoul to solve the problems associated with delays in surgical evaluation of non-traumapatients who needed emergency surgery, and to offer exposure to a wide variety of surgical casesto general surgical fellows and residents. The objective of this study was to describe the 10-yearexperience of the ACS department in a single center. Methods: A retrospective chart review was conducted at the Department of Surgery, YonseiUniversity College of Medicine, Seoul, for all patients admitted from March 2008 to February 2018. Patients were grouped into either the trauma or non-trauma group, and were further classifiedaccording to their diagnosis, and the type of operations they had undergone. Results: There was a total of 2,805 patients, including 1,001 trauma patients and 1,804 non-traumapatients. The average hospital length of stay was 14 days and the total in-hospital mortality rate was3.6%. Trauma mechanisms included blunt (92.6%), penetrating (7.0%) and burn (0.4%) trauma. Themajority of non-trauma patients were admitted for appendicitis (37.1%), followed by cholecystitis(21.7%). There was a total of 1,561 operations conducted. The most frequent operations wereappendectomy (38.3%) and cholecystectomy (19.5%), followed by adhesiolysis (7.8%). Conclusion: A working ACS department has been implemented in a Korean medical center.
Bariatric patients are at risk of diverse complications, such as bowel obstruction, internal hernia,and mesenteric thrombosis, which can result in massive small bowel resection with short bowelsyndrome (SBS) as a consequence. In this study a case of an internal hernia after childbirth in a36-year-old patient with a history of laparoscopic Roux-en-Y gastric bypass surgery is reported. An emergency laparotomy revealed an internal hernia in Petersen’s space with volvulus, causingextensive small bowel infarction and necrosis. SBS is a complicated multifaceted syndrome whichrequires a multidisciplinary approach, such as medical, nutritional, and pharmaceutical therapies,to optimize fluid and nutrient absorption over long-term monitoring and with revisions of thecare plan. To reduce the morbidity and mortality associated with an internal hernia and volvulus,clinicians must be acutely aware of a potential SBS diagnosis and not delay surgical exploration, evenif the vital signs, laboratory results, and imaging studies are normal.
A 51-year-old female underwent recurrent open incisional hernia repair with retrorectus meshplacement. Early in the post-operative course, she developed a hernia reoccurrence secondary tobreakdown of the staple line, at the level of the posterior rectus sheath, resulting in a small bowelobstruction. This hernia could not be felt upon physical examination but was detected by imaging. The patient was promptly taken to the operating room for laparoscopic reduction of the incarceratedloop of small intestine, along with laparoscopic repair of the posterior rectus sheath defect. It iscritical for surgeons to recognize the possibility of a staple line breakdown at the level of posteriorrectus sheath early on in the diagnosis which would prompt urgent surgical intervention in thesetting of a bowel obstruction.