No abstract available.
Acute Kidney Injury* ; Critical Care* ; Humans ; Intensive Care Units*

No abstract available.
Cardiopulmonary Resuscitation*

Traumatic carotid-cavernous fistula (TCCF) is a pathologic communication between the internal carotid artery and cavernous sinus, and is associated with craniomaxillofacial trauma. TCCF are very rare, occurring in 0.17~0.27% of craniomaxillofacial trauma cases. We describe a 76-year-old woman treated for multiple fractures including the skull base, left temporal bone, right tibia and fibula, left clavicle, and fifth and seventh rib fractures. She developed symptoms of TCCF two weeks after the initial trauma. We successfully treated her by endovascular occlusion of the internal carotid artery.
Aged ; Carotid Artery, Internal ; Carotid-Cavernous Sinus Fistula* ; Cavernous Sinus ; Clavicle ; Endovascular Procedures ; Female ; Fibula ; Fistula ; Fractures, Multiple ; Humans ; Intracranial Hemorrhages* ; Radiology, Interventional ; Rib Fractures ; Skull Base ; Temporal Bone ; Tibia

PURPOSE: To assess the effects of whole-body computed tomography (WBCT) on severely injured trauma patients. METHODS: After the installation of a WBCT scanner, we compared 48 patients who underwent the WBCT (WBCT cohort) with 40 patients prior to the WBCT (pre-WBCT cohort). We evaluated the number of CT, radiation exposure, time interval to decision and clinical outcomes such as length of intensive care unit stay, ventilation period, and acute kidney injury rates. RESULTS: In the WBCT cohort, the number of CT scans was significantly less (3.5 times) than in the pre-WBCT cohort (5.5 times; p<0.001). The radiation exposure was significantly lower in the WBCT cohort (24.5 mSv) than in the pre-WBCT cohort (31.3 mSv; p=0.040). The amount of radio-contrast used differed between the groups, but not significantly. Although there were fewer acute kidney injuries in the WBCT cohort (27.1%) than in pre-WBCT cohort (37.5%; p=0.296), especially severe injuries (stage 3 Acute Kidney Injury [AKI] Network: 17.5% in pre-WBCT vs. 6.3% in WBCT; p=0.059), the difference did not reach statistical significance. The hospital length of stay was significantly shorter in the WBCT cohort (21.42 days) than in the pre-WBCT cohort (32.38 days, p=0.019). However, there were no significant differences in the time interval to decision, intensive care unit stay, ventilation days, and mortality. CONCLUSION: The WBCT decreased the number of CT scans and subsequent less use of radio-contrast amount. It also tended to reduce severe AKI.
Acute Kidney Injury ; Cohort Studies* ; Humans ; Intensive Care Units ; Length of Stay ; Mortality ; Radiation Exposure ; Retrospective Studies* ; Tomography, X-Ray Computed ; Ventilation

No abstract available.

The mortality of patients with hemodynamic instability due to severe pelvic fracture is high despite multidisciplinary management. Current management algorithms for these patients emphasize pelvic angioembolization (AE) for hemorrhage control. However, a surgical procedure is often needed because AE is time-consuming and approximately only 15% of patients have arterial bleeding. Most hemorrhages from severe pelvic fracture originate from venous or bone injury. Current research demonstrates the effectiveness of preperitoneal pelvic packing (PPP) in hemorrhage control. However, there are no reports of its use in Korea. Accordingly, we present our early experiences of PPP for control of hemorrhage due to severe pelvic fracture in a trauma center in Korea.
Angiography* ; Hemodynamics* ; Hemorrhage ; Humans ; Korea ; Mortality ; Pelvis ; Trauma Centers

PURPOSE: Open adhesiolysis has been the favored approach regarding surgical management of intestinal obstruction. Following the development of laparoscopic devices and necessary surgical techniques, laparoscopic treatment of intestinal obstruction and adhesion has been tried in highly selected cases. Our study was designed to investigate laparoscopic adhesiolysis to treat intestinal obstruction. METHODS: The clinicopathologic data and surgical outcomes of 14 patients who underwent emergency laparoscopy between January 2007 and April 2015 were retrospectively reviewed. RESULTS: Five patients had a history of abdominal surgery, and twelve patients had adhesive intestinal obstruction. The causes of adhesive intestinal obstruction included tuberculous peritonitis, periappendiceal abscess, serosal fibrosis and chronic inflammation of intestine, gastric volvulus by fibrotic band. Two patients had non-adhesive intestinal obstruction, caused by intussusception and small bowel ulcer with stricture. The mean surgical time was 98.5 minutes, with mean blood loss of 35 ml. One case was converted to open surgery (7.1%). The mean postoperative hospital stay was 6.5 days. The mean time to oral intake was 3.4 days. There were no postoperative complications or deaths. CONCLUSION: When the patients are selected carefully in accordance with the guidelines, in our experience laparoscopic adhesiolysis is safe and feasible.
Abscess ; Adhesives ; Constriction, Pathologic ; Emergencies ; Fibrosis ; Humans ; Inflammation ; Intestinal Obstruction* ; Intestines ; Intussusception ; Laparoscopy ; Length of Stay ; Operative Time ; Peritonitis, Tuberculous ; Postoperative Complications ; Retrospective Studies ; Stomach Volvulus ; Ulcer

To improve trauma outcomes, a solid logistic support system is obviously crucial. An important 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.
Delivery of Health Care ; Humans ; Injury Severity Score ; Korea* ; Mortality ; Outcome Assessment (Health Care)* ; Rehabilitation ; Specialization ; Trauma Centers

Timing of surgery is important for prognosis. In patients with acute abdomen, the urgency means timing of surgery is even more important. However early emergency surgery is often logistically daunting because of constraints on resources such as operating room, supporting anesthesiologist, and nurses. Therefore it is worthwhile reviewing the timing of surgery in the patient with acute abdomen. The authors discuss the ideal time to surgery based on their experience and a review of the literature. For appendicitis and for peptic ulcer perforation, the authors recommend surgery within 24 hours from symptom onset. However, for other acute abdomen disease, evidence for a consensus is not as strong. If a surgeon faces a large number of emergent patients, if resources are limited, the surgeon must decide priorities for surgery. Therefore, an emergency triage system is needed, based on expert opinion and evidence. Although several triage systems are described in the literature, there is some controversy. If we follow a triage system, utilization of resources will be more efficient and acute care surgery might be performed within the ideal time.
Abdomen, Acute* ; Appendicitis ; Consensus ; Emergencies ; Expert Testimony ; Humans ; Operating Rooms ; Peptic Ulcer Perforation ; Prognosis ; Time Management ; Time-to-Treatment ; Triage

Hemorrhage is a major cause of death in trauma patients. The medical definition of hemorrhagic shock is tissue hypoperfusion resulting from a reduction of blood volume. Decreased blood pressure resulting from acute blood loss induces cardiac stimulation, systemic vasoconstriction, and volume redistribution. These effects are due to the baroreceptor reflex, the humoral compensatory mechanisms including the renin angiotensin system, and the release of catecholamine and vasopressin. Hemorrhagic shock causes acidosis, hypothermia, and coagulopathy, known as ‘the lethal triad.’ Tissue hypoxia induces metabolic acidosis by producing lactic acid. The three components of the lethal triad amplify each other and form a vicious cycle, eventually causing the death of the patient. To reduce the risk of mortality in severely bleeding patients, we need to understand the pathophysiology of hemorrhagic shock and the related complications.
Acidosis ; Anoxia ; Baroreflex ; Blood Pressure ; Blood Volume ; Cause of Death ; Disseminated Intravascular Coagulation ; Hemorrhage ; Humans ; Hypothermia ; Lactic Acid ; Mortality ; Renin-Angiotensin System ; Shock, Hemorrhagic* ; Vasoconstriction ; Vasopressins