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.

Purpose: This study aimed to update the previously published nursing practice guideline for oral care. Methods: The guideline were updated according to the manuals developed by National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN), and a Handbook for Clinical Practice Guideline Developer Version 1.0. Results: Updated nursing practice guideline for oral care was consisted of 10 domains and 79 recommendations. The number of recommendations in each domain were: 5 general issues, 2 oral care indications, 9 oral assessment, 16 general oral care, 12 oral care for critically ill patients, 16 oral care for cancer patients, 12 oral care for cancer patients with oral complications, 5 oral care education, 1 oral care referral, and 1 documentation and report. In terms of grades for recommendations, 11.4% was grade A, 17.0% was grade B, and 68.2% was grade C. Twelve new recommendations were developed and 7 previous recommendations were deleted. Conclusion Updated nursing practice guideline for oral care is expected to serve as an evidence-based practice guideline for oral care in South Korea. It is recommended that this guideline be spread to clinical nursing settings nationwide to improve the effectiveness of oral care practice.

PURPOSE: A task force appointed by the Korean Society of Acute Care Surgery reviewed previously published guidelines on antibiotic use in patients with abdominal injuries and adapted guidelines for Korea. METHODS: Four guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II instrument. Five topics were considered: indication for antibiotics, time until first antibiotic use, antibiotic therapy duration, appropriate antibiotics, and antibiotic use in abdominal trauma patients with hemorrhagic shock. RESULTS: Patients requiring surgery need preoperative prophylactic antibiotics. Patients who do not require surgery do not need antibiotics. Antibiotics should be administered as soon as possible after injury. In the absence of hollow viscus injury, no additional antibiotic doses are needed. If hollow viscus injury is repaired within 12 hours, antibiotics should be continued for ≤ 24 hours. If hollow viscus injury is repaired after 12 hours, antibiotics should be limited to 7 days. Antibiotics can be administered for ≥7 days if hollow viscus injury is incompletely repaired or clinical signs persist. Broad-spectrum aerobic and anaerobic coverage antibiotics are preferred as the initial antibiotics. Second-generation cephalosporins are the recommended initial antibiotics. Third-generation cephalosporins are alternative choices. For hemorrhagic shock, the antibiotic dose may be increased twofold or threefold and repeated after transfusion of every 10 units of blood until there is no further blood loss. CONCLUSION: Although this guideline was drafted through adaptation of other guidelines, it may be meaningful in that it provides a consensus on the use of antibiotics in abdominal trauma patients in Korea.
Abdominal Injuries* ; Advisory Committees ; Anti-Bacterial Agents ; Antibiotic Prophylaxis ; Cephalosporins ; Consensus ; Humans ; Korea ; Shock, Hemorrhagic

PURPOSE: Several published policy statements have warned against the risks associated with trampoline use and recommended safety guidelines. However, few studies have focused on trampoline-related injuries in Korea. This study aimed to assess the incidence and characteristics of pediatric trampoline-related injuries presented to Ulsan University Hospital. METHODS: We retrospectively reviewed the medical records of children aged <16 years with trampoline-related injuries who visited our Emergency Department between 2008 and 2017. RESULTS: Over the 10-year period, 178 trampoline-related injuries were reported, which represented a significant increase (P=0.016). Most (87.6%) of the injuries occurred during the last 5 study years, and a rapid increase in injuries was observed in children aged <6 years. Lower extremity injuries (62.4%) were the most common, followed by injuries of the upper extremities, head and face, and trunk, including injuries to the neck and spine. Sixty-seven children (37.6%) had fractures, and proximal tibia fractures were the most common. Fractures were significantly more common in younger children (<6 years old) than in older children (P=0.026). CONCLUSION: In Korea, the mechanism of trampoline injury is similar to that of injuries incurred in indoor trampoline parks but is characterized by smaller spaces and multiple users. Trampoline use and the incidence of trampoline-related injuries in children aged <6 years are increasing rapidly. Prohibiting the use of trampolines for children aged <6 years, restricting simultaneous use by multiple children, and ensuring adult supervision should be strictly emphasized. Public awareness and policy guidelines are needed to reduce the incidence of trampoline-related injuries.
Adult ; Child ; Emergency Service, Hospital ; Head ; Humans ; Incidence ; Korea ; Lower Extremity ; Medical Records ; Neck ; Organization and Administration ; Retrospective Studies ; Spine ; Tibia ; Ulsan ; Upper Extremity

PURPOSE: Mangled injury is defined as severe injury, including three or more tissues such as bones, nerves, vessels, muscles, and tendons in the upper or lower extremities. The choice of treatment results in different cosmetic and functional outcomes for mangled injury. In this study, we estimated patients' quality of life after treatment with the future intention of having patients make proper decisions at the time of injury. METHODS: Twenty patients were treated at Asan Medical Center from January, 2009 to November, 2011, and 11 patients were included who agreed with the questionnaire. We used 36-item short form health survey (SF-36) for estimating quality of life after treatments. RESULTS: Subjective satisfaction of cosmetic and functional aspects was higher in the reconstruction group than in the amputation group. However, in the estimation of specified satisfaction using SF-36, the amputation group was more satisfied than the reconstruction group. CONCLUSION: Among the many treatment considerations at the time of injury, expected cosmetic and functional outcomes were important parts determining the decision. In our study, the amputation group showed a better satisfaction level. This result could help patients make more appropriate decisions in the case of mangled injury.
Amputation ; Chungcheongnam-do ; Health Surveys ; Humans ; Intention ; Limb Salvage ; Lower Extremity ; Muscles ; Quality of Life ; Tendons

PURPOSE: Patients in the intensive care unit (ICU) are more susceptible to nosocomial infections, including central line-associated bloodstream infection (CLABSI), surgical site infection, urinary tract infection or ventilator-associated pneumonia. This study is a comparative analysis of how central venous catheter (CVC) management staff affects CLABSI. METHODS: We performed a two-phase review of all patients transferred to the surgical ICU (SICU) from January 2013 to June 2014. CVC management staff was introduced in October 2013. Electronic medical records provided the data for a comparative analysis of incidence rates and risks of CLABSI, as well as the subjects' general characteristics. RESULTS: This study included 248 patients before the introduction of a CVC management staff member and 196 patients after the introduction. General patient characteristics before and after the CVC management staff was in place did not differ significantly. The CLABSI rate decreased by 4.61 cases/1,000 device days after the introduction (6.26 vs. 1.65; odds ratio, 4.47; 95% confidence interval, 1.39~14.37; p=0.009). However, the mortality rate and length of ICU stay did not change after CVC management staff was in place (12.9% vs. 10.7%, p=0.480; 16.00±24.89 vs. 15.87±18.80, p=0.954; respectively). CONCLUSION: In this study, the introduction of CVC management staff effectively reduced CLABSI rates in current ICU system.
Central Venous Catheters* ; Critical Care* ; Cross Infection ; Electronic Health Records ; Humans ; Incidence ; Intensive Care Units ; Mortality ; Odds Ratio ; Pneumonia, Ventilator-Associated ; Surgical Wound Infection ; Urinary Tract Infections

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

Posterior reversible encephalopathy syndrome (PRES) is a transient condition characterized by altered mental status, seizure, headache, and visual disturbance with typical neuro-imaging findings in the bilateral parieto-occipital regions. Clinicians should be aware of this syndrome because delayed diagnosis and treatment result in irreversible neurologic deficits. We present the case of a 77-year-old male diagnosed with PRES in the setting of postoperative critical illness caused by small-bowel strangulation.
Aged ; Critical Illness* ; Delayed Diagnosis ; Headache ; Humans ; Intensive Care Units ; Male ; Neurologic Manifestations ; Posterior Leukoencephalopathy Syndrome* ; Postoperative Period ; Seizures

Anaphylactic reaction during the perioperative period typically exhibits rapid onset, varying clinical manifestations, and an expected mortality rate of 1.5-9%. Neuromuscular blocking agents are the leading cause of perioperative anaphylaxis. Here, we report a severe case of anaphylaxis that developed in a 66-year-old man due to cisatracurium administration. And he was successfully managed by extracorporeal membrane oxygenation. Cardiopulmonary resuscitation was performed by extracorporeal membrane oxygenation, and the patient was successfully weaned off 24 hours later.
Aged ; Anaphylaxis* ; Cardiopulmonary Resuscitation ; Extracorporeal Membrane Oxygenation* ; Heart Arrest* ; Humans ; Mortality ; Neuromuscular Blocking Agents ; Perioperative Period

Posterior reversible encephalopathy syndrome (PRES) is a transient condition characterized by altered mental status, seizure, headache, and visual disturbance with typical neuro-imaging findings in the bilateral parieto-occipital regions. Clinicians should be aware of this syndrome because delayed diagnosis and treatment result in irreversible neurologic deficits. We present the case of a 77-year-old male diagnosed with PRES in the setting of postoperative critical illness caused by small-bowel strangulation.
Aged ; Critical Illness ; Delayed Diagnosis ; Headache ; Humans ; Intensive Care Units ; Male ; Neurologic Manifestations ; Posterior Leukoencephalopathy Syndrome ; Postoperative Period ; Seizures