1.Secondary Abdominal Compartment Syndrome Recognized in Operating Room in Severely Injured Patients.
Seok Hwa YOUN ; John Cook Jong LEE ; Kyoungwon JUNG ; Jonghwan MOON ; Yo HUH ; Younghwan KIM
Korean Journal of Critical Care Medicine 2016;31(1):58-62
For trauma patients with severe shock, massive fluid resuscitation is necessary. However, shock and a large amount of fluid can cause bowel and retroperitoneal edema, which sometimes leads to abdominal compartment syndrome in patients without abdomino-pelvic injury. If other emergent operations except intraabdomen are needed, a distended abdomen is likely to be recognized late, leading to multiple organ dysfunction. Herein, we report two cases of a 23-year-old woman who was in a car accident and a 53-year old man who was pressed on his leg by a pressing machine; severe brain swelling and popliteal vessel injury were diagnosed, respectively. They were both in severe shock and massive fluid resuscitation was required in the emergency department. Distended abdomen was recognized in both the female and male patients immediately after neurosurgical operation and immediately before orthopaedic operation in the operating room, respectively. Decompressive laparotomy revealed massive ascites with retroperitoneal edema.
Abdomen
;
Ascites
;
Brain Edema
;
Edema
;
Emergency Service, Hospital
;
Female
;
Humans
;
Intra-Abdominal Hypertension*
;
Laparotomy
;
Leg
;
Male
;
Operating Rooms*
;
Resuscitation
;
Shock
;
Young Adult
2.The Activities and Roles of Trauma Surgeons in the Treatment of COVID-19 Patients
Journal of Acute Care Surgery 2023;13(2):43-46
Trauma surgeons' roles in a national hospital in Korea changed during the COVID-19 pandemic. In this study, we report on their roles over a 15-month period (March 2020 to May 2021) including the eight months where the hospital was a COVID-19-only hospital. Despite shortages in medical resources including medical personnel, and intensive care unit (ICU) beds, the trauma surgeons helped to control the public health problem by assuming various roles including working in another COVID-19 ICU in Dae-gu, treating trauma patients with COVID-19 or those who needed self-quarantine, being in charge of care for some COVID-19 patients in the ICU (for two months), and performing the role of a rapid response team member for COVID-19 ICU patients. In this report, we emphasize how trauma surgeons, along with intensivists, played an active role in treatment of COVID-19 patients, and helped prevent the collapse of the healthcare system within the hospital during the pandemic.
3.A Case Series of Trauma Resuscitation in the Intensive Care Unit Bypassing the Emergency Room During the Conversion to a COVID-19 Only Hospital
Seok Hwa YOUN ; Hyemi KWON ; Sun Young BAEK ; Sung Soo HONG ; Younghwan KIM
Journal of Acute Care Surgery 2022;12(2):70-73
When a patient with severe trauma is admitted to the emergency room (ER), they are evaluated before transfer to either the intensive care unit (ICU) or operating room. To minimize the time until a definitive treatment can be provided, direct operating room resuscitation can be performed. In this hospital the ER was closed during the hospital’s transition to a coronavirus disease 2019-dedicated hospital, and direct ICU resuscitation for patients with trauma was performed for a short period. To perform effective trauma resuscitation, all ICU beds were reorganized to achieve a modified, experienced nurse: patient ratio (1:2-3) and 2 beds were assigned for trauma ICU resuscitation alone. The equipment for initial resuscitation was installed and ICU nurses received training. Consultations with the hospital administration, nursing, and pharmaceutical departments were completed in advance to avoid formal problems. Conversion of the ICU for direct resuscitation procedures was performed in 4 patients.
4.A Case Report of Tracheostomy for a Patient with COVID-19: How to Minimize Medical Staff and Patient Risks
Seok Hwa YOUN ; Sun Young BAEK ; Jiho YOON ; Sung Soo HONG ; Younghwan KIM
Journal of Korean Medical Science 2020;35(28):e263-
Coronavirus disease was first reported in December 2019, and the World Health Organization declared it as a pandemic on March 11, 2020. The virus is known to attack various vital organs, including the respiratory system. Patients sometimes require positive pressure ventilation and tracheostomy. Because tracheostomy is a droplet-spreading procedure, medical staff should protect themselves against the risk of transmission of this contagious viral disease. In our case, we performed tracheostomy for a 70-year-old man with coronavirus disease 2019 (COVID-19) who had required more oxygen with gradual weakness of respiratory muscle to maintain his arterial oxygen saturation. We focused on the risks of the medical staffs and patients, and minimized them at the same time using temporary balloon over-inflation, pre-operative adjustment of endotracheal tube position, and attachment of a transparent film dressing to the surgical field without stopping the ventilator while following routine safety measures. Fourteen days after the tracheostomy, all participating medical staff members were healthy and asymptomatic. The patient was discharged 105 days after the COVID-19 diagnosis.
5.Erratum: Correction of Author Order: Reduced Mortality by Physician-Staffed HEMS Dispatch for Adult Blunt Trauma Patients in Korea.
Yo HUH ; John CJ LEE ; Younghwan KIM ; Jonghwan MOON ; Seok Hwa YOUN ; Jiyoung KIM ; Tea Youn KIM ; Juryang KIM ; Hyoju KIM ; Kyoungwon JUNG
Journal of Korean Medical Science 2018;33(14):e118-
The correction of author order.
Adult*
;
Humans
;
Korea*
;
Mortality*
6.Heated wire humidification circuit attenuates the decrease of core temperature during general anesthesia in patients undergoing arthroscopic hip surgery.
Sooyong PARK ; Seok Hwa YOON ; Ann Misun YOUN ; Seung Hyun SONG ; Ja Gyung HWANG
Korean Journal of Anesthesiology 2017;70(6):619-625
BACKGROUND: Intraoperative hypothermia is common in patients undergoing general anesthesia during arthroscopic hip surgery. In the present study, we assessed the effect of heating and humidifying the airway with a heated wire humidification circuit (HHC) to attenuate the decrease of core temperature and prevent hypothermia in patients undergoing arthroscopic hip surgery under general anesthesia. METHODS: Fifty-six patients scheduled for arthroscopic hip surgery were randomly assigned to either a control group using a breathing circuit connected with a heat and moisture exchanger (HME) (n = 28) or an HHC group using a heated wire humidification circuit (n = 28). The decrease in core temperature was measured from anesthetic induction and every 15 minutes thereafter using an esophageal stethoscope. RESULTS: Decrease in core temperature from anesthetic induction to 120 minutes after induction was lower in the HHC group (–0.60 ± 0.27℃) compared to the control group (–0.86 ± 0.29℃) (P = 0.001). However, there was no statistically significant difference in the incidence of intraoperative hypothermia or the incidence of shivering in the postanesthetic care unit. CONCLUSIONS: The use of HHC may be considered as a method to attenuate intraoperative decrease in core temperature during arthroscopic hip surgery performed under general anesthesia and exceeding 2 hours in duration.
Anesthesia, General*
;
Arthroscopy
;
Body Temperature
;
Heating
;
Hip*
;
Hot Temperature*
;
Humans
;
Hypothermia
;
Incidence
;
Methods
;
Respiration
;
Shivering
;
Stethoscopes
7.Traumatic Liver Injury: Factors Associated with Mortality.
Youn Suk CHAI ; Jae Kwang LEE ; Seok Jin HEO ; Yeong Ki LEE ; Yong Woo LEE ; Young Hwa JO ; Seong Soo PARK ; Hyun Jin KIM ; In Gu KANG
Korean Journal of Critical Care Medicine 2014;29(4):320-327
BACKGROUND: We postulate that a delay in the implementation of hepatic arterial embolization for traumatic liver injury patients will negatively affect patient prognosis. Our work also seeks to identify factors related to the mortality rate among traumatic liver injury patients. METHODS: From January 2008 to April 2014, patients who had been admitted to the emergency room, were subsequently diagnosed with traumatic liver injury, and later underwent hepatic arterial embolization were included in this retrospective study. RESULTS: Of the 149 patients that underwent hepatic arterial embolization, 86 had the procedure due to traumatic liver injury. Excluding the 3 patients that were admitted to the hospital before procedure, the remaining 83 patients were used as subjects for the study. The average time between emergency room arrival and incidence of procedure was 164 min for the survival group and 132 min for the non-survival group; this was not statistically significant (p = 0.170). The average time to intervention was 182 min for the hemodynamically stable group, and 149 min for the hemodynamically unstable group, the latter having a significantly shorter wait time (p = 0.047). Of the factors related to the mortality rate, the odds ratio of the Glasgow Coma Score (GCS) was 18.48 (p < 0.001), and that of albumin level was 0.368 (p = 0.006). CONCLUSIONS: In analyzing the correlation between mortality rate and the time from patient admission to arrival for hepatic arterial embolization, there was no statistical significance observed. Of the factors related to the mortality rate, GCS and albumin level may be used as prognostic factors in traumatic liver injury.
Coma
;
Embolization, Therapeutic
;
Emergency Service, Hospital
;
Humans
;
Incidence
;
Liver*
;
Mortality*
;
Odds Ratio
;
Patient Admission
;
Prognosis
;
Retrospective Studies
;
Time Factors
8.Thoracic interfascial nerve block for breast surgery in a pregnant woman: a case report.
Boohwi HONG ; Seok Hwa YOON ; Ann Misun YOUN ; Bum June KIM ; Seunghyun SONG ; Yeomyung YOON
Korean Journal of Anesthesiology 2017;70(2):209-212
Regional anesthesia for non-obstetric surgery in parturients is a method to decrease patient and fetal risk during general anesthesia. Thoracic interfascial nerve block can be used as an analgesic technique for surgical procedures of the thorax. The Pecs II block is an interfascial block that targets not only the medial and lateral pectoral nerves, but also the lateral cutaneous branch of the intercostal nerve. Pecto-intercostal fascial block (PIFB) targets the anterior cutaneous branch of the intercostal nerve. The authors successfully performed a modified Pecs II block and PIFB without complications in a parturient who refused general anesthesia for breast surgery.
Anesthesia, Conduction
;
Anesthesia, General
;
Breast*
;
Female
;
Humans
;
Intercostal Nerves
;
Methods
;
Nerve Block*
;
Pregnant Women*
;
Thoracic Nerves
;
Thorax
9.Thoracic interfascial nerve block for breast surgery in a pregnant woman: a case report.
Boohwi HONG ; Seok Hwa YOON ; Ann Misun YOUN ; Bum June KIM ; Seunghyun SONG ; Yeomyung YOON
Korean Journal of Anesthesiology 2017;70(2):209-212
Regional anesthesia for non-obstetric surgery in parturients is a method to decrease patient and fetal risk during general anesthesia. Thoracic interfascial nerve block can be used as an analgesic technique for surgical procedures of the thorax. The Pecs II block is an interfascial block that targets not only the medial and lateral pectoral nerves, but also the lateral cutaneous branch of the intercostal nerve. Pecto-intercostal fascial block (PIFB) targets the anterior cutaneous branch of the intercostal nerve. The authors successfully performed a modified Pecs II block and PIFB without complications in a parturient who refused general anesthesia for breast surgery.
Anesthesia, Conduction
;
Anesthesia, General
;
Breast*
;
Female
;
Humans
;
Intercostal Nerves
;
Methods
;
Nerve Block*
;
Pregnant Women*
;
Thoracic Nerves
;
Thorax
10.18F-2-Deoxy-2-Fluoro-D-Glucose Positron Emission Tomography: Computed Tomography for Preoperative Staging in Gastric Cancer Patients.
Seok Hwa YOUN ; Kyung Won SEO ; Sang Ho LEE ; Yeon Myung SHIN ; Ki Young YOON
Journal of Gastric Cancer 2012;12(3):179-186
PURPOSE: The use of 18F-2-deoxy-2-fluoro-D-glucose positron emission tomography-computed tomography as a routine preoperative modality is increasing for gastric cancer despite controversy with its usefulness in preoperative staging. In this study we aimed to determine the usefulness of preoperative positron emission tomography-computed tomography scans for staging of gastric cancer. MATERIALS AND METHODS: We retrospectively analyzed 396 patients' positron emission tomography-computed tomography scans acquired for preoperative staging from January to December 2009. RESULTS: The sensitivity of positron emission tomography-computed tomography for detecting early gastric cancer was 20.7% and it was 74.2% for advanced gastric cancer. The size of the primary tumor was correlated with sensitivity, and there was a positive correlation between T stage and sensitivity. For regional lymph node metastasis, the sensitivity and specificity of the positron emission tomography-computed tomography were 30.7% and 94.7%, respectively. There was no correlation between T stage and maximum standardized uptake value or between tumor markers and maximum standardized uptake value. Fluorodeoxyglucose uptake was detected by positron emission tomography-computed tomography in 24 lesions other than the primary tumors. Among them, nine cases were found to be malignant, including double primary cancers and metastatic cancers. Only two cases were detected purely by positron emission tomography-computed tomography. CONCLUSIONS: Positron emission tomography-computed tomography could be useful in detecting metastasis or another primary cancer for preoperative staging in gastric cancer patients, but not for T or N staging. More prospective studies are needed to determine whether positron emission tomography-computed tomography scans should be considered a routine preoperative imaging modality.
Electrons
;
Humans
;
Lymph Nodes
;
Neoplasm Metastasis
;
Neoplasm Staging
;
Positron-Emission Tomography and Computed Tomography
;
Retrospective Studies
;
Sensitivity and Specificity
;
Stomach Neoplasms
;
Biomarkers, Tumor