Blunt cardiac rupture is uncommon and is associated with significant mortality. Patients with blunt cardiac rupture usually have combined injury and do not always show signs of cardiac tamponade, which delays the diagnosis of cardiac rupture and increases mortality. We report a case of cardiac rupture diagnosed and treated by using only thoracic exploration based on clinical impression, with radiologic studies, including even echocardiography, showing negative results.
Atrial Appendage ; Cardiac Tamponade ; Echocardiography ; Heart Rupture ; Humans ; Rupture ; Thoracic Injuries

Blunt cardiac rupture is uncommon and is associated with significant mortality. Patients with blunt cardiac rupture usually have combined injury and do not always show signs of cardiac tamponade, which delays the diagnosis of cardiac rupture and increases mortality. We report a case of cardiac rupture diagnosed and treated by using only thoracic exploration based on clinical impression, with radiologic studies, including even echocardiography, showing negative results.
Atrial Appendage ; Cardiac Tamponade ; Echocardiography ; Heart Rupture ; Humans ; Rupture ; Thoracic Injuries

Accidental hypothermia is an uncommon health issue that can cause fatal problems. Mortality related to hypothermia has been reported to be up to 50%. Prognosis of hypothermia depends on the grade of hypothermia, interval of re-warming from the accident and the re-warming rate. Hypothermic patients with injury show worse prognosis. A 66 year-old man with history of cerebrovascular accident was rescued in the mountains. His Glasgow coma scale (GCS) was 3, core temperature was 25.2degrees C and he had a right lateral malleolar fracture. The second patient was a 45 year-old man whose GCS was 8 and core temperature 17.2degrees C. Blood pressure was unmeasurable with only palpable pulse and showed Osborn J wave on electrocardiography for both patients. Active re-warming was performed with forced warm air, warm saline infusion and bladder irrigation. Patient core temperature raised by 1.5degrees C/hour and 3.3degrees C/hour, respectively. The two patients were discharged without any other sequelae and disability.
Blood Pressure ; Electrocardiography ; Glasgow Coma Scale ; Humans ; Hypothermia ; Prognosis ; Stroke ; Urinary Bladder

PURPOSE: To compare the clinical results of hemodynamically unstable patients diagnosed with pelvic ring injury according to the presence of a trauma team. MATERIALS AND METHODS: Patients with hemodynamically unstable pelvic fracture were enrolled in the study and were divided into two groups: Group I, patients who were managed before March 2009, when there was no trauma team; and Group II, patients who were managed after March 2009, when emergent trauma team began to work. Data were collected regarding the time the trauma team began patient management, the treatment modality used to control bleeding, transfusion requirement, and patient mortality. RESULTS: The time when the trauma team began patient management was five hours and 48 minutes in Group I and 57 minutes in Group II. The time to definitive treatment in order to control bleeding in Group I and Group II was 14.4 hours and 4.2 hours, respectively. The amount of the transfusion was 41.1 unit in Group I and 13.2 unit in Group II patients. In Group I, four patients (57.1%) died, although only one of the seven patients in Group II (14.3%) died. CONCLUSION: Using a multidisciplinary approach, the trauma team has only a short amount of time to determine their treatment strategy and to achieve prompt management of bleeding, with the final objective to decrease the mortality rate in patients with hemodynamically unstable pelvic fractures.
Hemorrhage ; Humans

Objective: Immune reactions following traumatic brain injury (TBI) cause many complications, including intravascular dissemination. Antithrombin III (AT-III) plays an important role in suppressing abnormal clot formation and ensuring hemostasis. Therefore, we investigated the efficacy of serum AT-III in patients with severe TBI. Methods: This retrospective study included 224 patients with severe TBI who visited a single regional trauma center between 2018 and 2020. AT-III levels were measured immediately after the TBI diagnosis. AT-III deficiency was defined as an AT-III serum level <70%. Patient characteristics, injury severity, and procedures were also investigated. Patient outcomes included Glasgow Outcome Scale scores at discharge and mortality. Results: AT-III levels were significantly lower in the AT-III deficient group (n=89; 48.27% ± 1.91%) than in the AT-III sufficient group (n = 135, 78.90% ± 1.52%) (p < 0.001). Mortality occurred in 72 of the 224 patients (33.04%), indicating that there were significantly more patients in the AT-III-deficient group (45/89, 50.6%) than in the AT-III-sufficient group (27/135, 20%). Significant risk factors for mortality included the Glasgow Coma Scale score (P = 0.003), pupil dilatation (P = 0.031), disseminated intravascular coagulopathy (P = 0.012), serum AT-III level (P = 0.033), and procedures including barbiturate coma therapy (P = 0.010). Serum AT-III levels were significantly correlated with Glasgow Outcome Scale scores at discharge (correlation coefficient = 0.455, p < 0.001). Conclusion Patients with AT-III deficiency after severe TBI may require more intensive care during treatment, because AT-III levels reflect injury severity and correlate with mortality.

PURPOSE: Acute respiratory failure is a relatively common complication in surgical patients, especially after abdominal surgery. Non-invasive ventilation (NIV) is increasingly used in the treatment of acute respiratory failure. We have assessed the usefulness of NIV in surgical patients with acute respiratory failure. METHODS: We retrospectively reviewed the medical charts of patients who were admitted to a surgical intensive care unit between March 2007 and February 2008 with acute respiratory failure. The patients who have got respiratory care for secondary reason such as sepsis and encephalopathy were excluded from this study. RESULTS: Of the 74 patients who were treated with mechanical ventilation, 15 underwent NIV and 59 underwent invasive ventilation. The causes of acute respiratory failure in the NIV group were atelectasis in 5 patients, pneumonia in 5, acute lung injury in 4, and pulmonary edema in 1, this group included 3 patients with acute respiratory failure after extubation. Overall success rate of NIV was 66.7%. CONCLUSION: NIV may be an alternative to conventional ventilation in surgical patients with acute respiratory failure. Use of NIV may avoid re-intubation in patients who develop respiratory failure after intubation.
Acute Lung Injury ; Critical Care ; Humans ; Intubation ; Noninvasive Ventilation ; Pneumonia ; Pulmonary Atelectasis ; Pulmonary Edema ; Respiration, Artificial ; Respiratory Insufficiency ; Retrospective Studies ; Sepsis ; Ventilation

PURPOSE: Blunt pancreatic injury has a high mortality rate, especially if adequate management is delayed. Although many guidelines exist for diagnosis and treatment, there is no consensus to date. Therefore, we analyzed the role of endoscopic retrograde cholangiopancreatography (ERCP) as a diagnostic and therapeutic tool for the treatment of traumatic pancreatic injury. METHODS: We retrospectively reviewed the electronic medical records (EMR) database at Asan Medical Center (Seoul, South Korea) to identify all patients diagnosed with trauma to the pancreas between June 2003 and December 2010. Clinical and operative findings, CT (computed tomography) images, and ERCP findings were assessed. RESULTS: A total of 40 patients were evaluated in this study. Of these, 14 patients underwent diagnostic ERCP, and 26 did not. Of the 14 patients who underwent diagnostic ERCP, 5 were found to have normal pancreatic ducts, thereby preventing a needless laparotomy in these patients. Of the patients diagnosed with ductal injury, four were treated with endoscopic intervention, and four underwent an exploratory laparotomy. The remaining patient was treated with radiologic intervention (percutaneous drainage) to manage pancreatic pseudocyst formation. CONCLUSION: Our findings suggest that ERCP is a beneficial diagnostic and therapeutic modality for the treatment of traumatic pancreatic injury.
Cholangiopancreatography, Endoscopic Retrograde ; Consensus ; Electronic Health Records ; Humans ; Laparotomy ; Pancreas ; Pancreatic Ducts ; Pancreatic Pseudocyst ; Retrospective Studies

PURPOSE: Blunt pancreatic injury has a high mortality rate, especially if adequate management is delayed. Although many guidelines exist for diagnosis and treatment, there is no consensus to date. Therefore, we analyzed the role of endoscopic retrograde cholangiopancreatography (ERCP) as a diagnostic and therapeutic tool for the treatment of traumatic pancreatic injury. METHODS: We retrospectively reviewed the electronic medical records (EMR) database at Asan Medical Center (Seoul, South Korea) to identify all patients diagnosed with trauma to the pancreas between June 2003 and December 2010. Clinical and operative findings, CT (computed tomography) images, and ERCP findings were assessed. RESULTS: A total of 40 patients were evaluated in this study. Of these, 14 patients underwent diagnostic ERCP, and 26 did not. Of the 14 patients who underwent diagnostic ERCP, 5 were found to have normal pancreatic ducts, thereby preventing a needless laparotomy in these patients. Of the patients diagnosed with ductal injury, four were treated with endoscopic intervention, and four underwent an exploratory laparotomy. The remaining patient was treated with radiologic intervention (percutaneous drainage) to manage pancreatic pseudocyst formation. CONCLUSION: Our findings suggest that ERCP is a beneficial diagnostic and therapeutic modality for the treatment of traumatic pancreatic injury.
Cholangiopancreatography, Endoscopic Retrograde ; Consensus ; Electronic Health Records ; Humans ; Laparotomy ; Pancreas ; Pancreatic Ducts ; Pancreatic Pseudocyst ; Retrospective Studies

Hemodynamics of a brain-dead donor can change rapidly during management. It frequently leads to loss of the donor or deterioration of organ functions. Various efforts have been made not to lose potential donors. Extracorporeal membrane oxygenation (ECMO) and non-heart-beating donation (NHBD) are good examples of such efforts. A 47 year-old woman with a history of hypertension, diabetes mellitus and atrial fibrillation was diagnosed with cerebral infarction and hemorrhage. Cardiopulmonary resuscitation was performed three times before transfer to our hospital. Her family agreed to organ donation. ECMO was applied due to her unstable vital signs, which made the first declaration of brain death possible. However, considering the deteriorating vital signs and expected cardiac arrest, it was decided to switch to NHBD under the family's consent. All life-support devices including ECMO were turned off in the operation room. After cardiac death was declared, the harvesting of liver and kidneys was performed with perfusion through an ECMO catheter. The liver and kidneys were successfully transplanted to three recipients.
Atrial Fibrillation ; Brain Death ; Cardiopulmonary Resuscitation ; Catheters ; Cerebral Infarction ; Death ; Diabetes Mellitus ; Extracorporeal Membrane Oxygenation ; Female ; Heart Arrest ; Hemodynamics ; Hemorrhage ; Humans ; Hypertension ; Kidney ; Liver ; Membranes ; Perfusion ; Tissue and Organ Procurement ; Tissue Donors ; Transplants ; Vital Signs

We describe two patients, with no previous history of vascular problems but poor lung function, who experienced septic shock due to bowel ischemia. Both were fed an enteral formula rich in fiber using a feeding tube and experienced septic shock with regular enteral feeding. Surgical finding showed hemorrhagic ischemia in the bowel. The pathologic finding suggests these changes may have been due to inspissations of bowel contents, which may put direct pressure on the mucosa of the bowel wall, leading to local impairment of mucosal and submucosal blood flow with subsequent bowel necrosis. Bowel ischemia may have been precipitated by an increased mesenteric blood flow requirement in combination with a metabolically stressed bowel. Patients in the intensive care unit fed a fiber-rich enteral formula may have inspissated bowel contents, leading to bowel ischemia, suggesting that the use of fiber-rich formula should be limited in patients at high-risk of bowel ischemia.
Enteral Nutrition ; Humans ; Intensive Care Units ; Ischemia ; Lung ; Mucous Membrane ; Necrosis ; Sepsis ; Shock, Septic ; Vascular Diseases