No abstract available.
Humans ; Vena Cava, Inferior* ; Wounds, Stab*

No abstract available.
Hemorrhage*

No abstract available.
Diospyros* ; Intussusception*

The traditional drug for anticoagulation in those with a high risk of thrombosis is a vitamin K antagonist, such as warfarin. On the other hand, this drug has several limitations and hemorrhagic complications. Recently, novel or non-vitamin K-dependent antagonist oral anticoagulants (NOACs) have been developed to solve these problems. This paper presents a case of adaptation of NOAC for a warfarin anticoagulated patient with traumatic ongoing hemorrhages with a discussion of the clinical implications of NOAC.
Anticoagulants* ; Hand ; Hemorrhage* ; Humans ; Thrombosis ; Vitamin K ; Warfarin*

Takotsubo syndrome, also known as stress-induced cardiomyopathy, is a transient cardiac syndrome that mimics acute coronary syndrome. This condition should be suspected if the patient presents with chest pain after intense emotional stress, accompanied by an abnormal electrocardiogram, elevated levels of myocardial enzymes, and left ventricular apical akinesia on echocardiography. Coronary angiography should be performed for prompt differentiation from ischemic heart disease. A 77-year-old female presented with traumatic multiple fractures of the left sixth and seventh ribs resulting from a violent strike. Clinical findings of physical examination, laboratory tests, electrocardiogram, and coronary angiography provided the diagnosis of Takotsubo syndrome. We performed conservative management including pain control, and the patient was uneventfully discharged seven days after admission.
Acute Coronary Syndrome ; Aged ; Cardiomyopathies ; Chest Pain ; Coronary Angiography ; Diagnosis ; Echocardiography ; Electrocardiography ; Female ; Fractures, Multiple ; Humans ; Myocardial Ischemia ; Physical Examination ; Rib Fractures* ; Ribs* ; Stress, Psychological ; Strikes, Employee ; Takotsubo Cardiomyopathy*

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.
Analgesics, Opioid ; Anesthesia ; Anesthesia and Analgesia ; Anesthesia, Conduction ; Anesthesia, General ; Carbon Dioxide* ; Carbon* ; Critical Care ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary ; Lung Diseases ; Pulmonary Heart Disease*

PURPOSE: The aim of this study is to evaluate treatment outcomes and mortality risks associated with hemodynamic instability caused by severe pelvic fracture in a regional trauma center. METHODS: The medical charts of 44 patients with hemodynamic instability due to pelvic fractures who were admitted to a regional trauma center from January 2014 to May 2017 were analyzed retrospectively. RESULTS: The mean age was 61.8 years, and the mean injury severity score was 39.1. Twenty-six patients (59.1%) were transferred from other hospitals, and the median time from injury to emergency room arrival was 115.5 minutes. Preperitoneal pelvic packing, pelvic angiography, and external pelvic fixation were performed in 38 patients (86.4%) for hemostasis. The mortality rate was 52.3%, and 15 patients (34.1%) died from hemorrhage. Logistic regression analysis showed that initial low systolic blood pressure and packed red blood cell (PRBC) requirement were independent risk factors associated with mortality. PRBC requirement for four hours and application of emergent hemostatic procedures were independent factors associated with hemorrhage-induced mortality. CONCLUSION: Emergency procedures for hemostasis should be performed immediately for patients with hemodynamic instability due to pelvic fracture, and they should be transferred to a regional trauma center as soon as possible.
Angiography ; Blood Pressure ; Emergencies ; Emergency Service, Hospital ; Erythrocytes ; Hemodynamics* ; Hemorrhage ; Hemostasis ; Humans ; Injury Severity Score ; Logistic Models ; Mortality* ; Pelvis ; Retrospective Studies ; Risk Factors* ; Shock ; Trauma Centers*

PURPOSE: Creatine kinase (CK) elevation is caused by rhabdomyolysis, intense exercise, muscle damage, and several drugs. This study evaluated the clinical significance of elevated serum CK levels in patients with an intensive care unit (ICU) and their effects on muscle strength. METHODS: The database of 179 patients, who were examined with CK a t least once among patients in the Samsung Medical Center ICU database, was reviewed retrospectively. Forty-eight patients with a myocardial infarction were excluded and 131 patients were analyzed. The clinical features of patients with an elevated CK of more than 2,000 IU/L (more than 10 times the normal value) and those who did not were compared. RESULTS: The ICU stay days were longer in the high elevation group than the other group (8.6 days vs. 21.7 days, p=0.002). The high elevation group was more likely to go to other treatment centers than home after discharge (14.6% vs. 60.0%, p=0.007). When the Medical Research Council scale was measured, the score of the high elevation group was lower than that of the other group (17.2 vs. 13.3, p=0.006). CONCLUSION: Patients with high CK levels were more likely to receive invasive treatment in the ICU, so their muscle strength may decrease with increasing ICU stay and were less likely to be discharged home because of difficulties in living alone. Therefore, in patients with high CK, anticipating long-term treatment in an ICU, minimizing muscle loss, and maintaining functional muscle strength through active rehabilitation will be helpful for the prognosis of the patient.
Creatine Kinase* ; Creatine* ; Critical Illness* ; Humans ; Intensive Care Units ; Muscle Strength ; Myocardial Infarction ; Prognosis ; Rehabilitation ; Retrospective Studies ; Rhabdomyolysis

PURPOSE: Trauma is a leading cause of death, even in previously healthy and disease-free individuals, and the mortality rate is very high in neck trauma patients. On the other hand, there have been few studies related to neck injuries. This study examined the characteristics and treatment results of trauma-related neck injuries using the data from Korean National Emergency Department Information System. METHODS: Neck trauma patients were classified using the 6th Korean Standard Disease Classification system. The patients' demographic factors, number of surgeries, and clinical results were investigated. Statistical analysis was conducted using SPSS to evaluate the annual differences in the demographic factors; mortality according to the site of injury and type of surgery; and mechanisms of injury. RESULTS: From 2011 to 2014, 2,458 neck trauma patients were treated in hospitals in South Korea. The number of patients admitted to regional and local emergency medical centers was 883 (35.9%) and 1,502 (61.1%), respectively. No significant annual differences were observed in age, sex ratio, location of treatment center, mortality, and injury site (vascular, tracheal, or esophageal). In addition, no significant differences in the cause of injury, performed surgery (%), and mortality according to the injured organ were observed. CONCLUSION: This study revealed no annual changes in neck injury patients or differences in mortality according to injured organs. This study can be used as a basis for national research on organ-specific injuries, and may help predict the demand for future support projects for the establishment of regional trauma centers.
Cause of Death ; Classification ; Demography ; Emergencies* ; Emergency Service, Hospital* ; Hand ; Humans ; Information Systems* ; Korea ; Mortality ; Neck Injuries ; Neck* ; Sex Ratio ; Trauma Centers ; Wounds and Injuries

In the past, critically ill patients in intensive care units have often been managed with bed rest and sedation. On the other hand, prolonged bed rest results in deconditioning and many survivors from the intensive care unit suffer from physical and mental sequelae. Therefore, rehabilitation in intensive care units has been started to prevent them. Recently, many positive results about the effectiveness and safety of rehabilitation in intensive care units were published. In this review, the evidence and the practical point of rehabilitation in intensive care units are discussed.
Bed Rest ; Critical Care* ; Critical Illness ; Early Ambulation ; Hand ; Humans ; Intensive Care Units* ; Rehabilitation* ; Survivors