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

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.

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.

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.

Purpose: Tracheostomy is a procedure which requires careful selection of tracheostomy tube size, because it can significantly impact patient outcomes. However, in situations where radiological imaging is unavailable for measuring the tracheal inner diameter (ID), it can be estimated using the patient's height, weight, and sex. This study aimed to develop a method for estimating tracheal ID. Methods: A retrospective study was conducted on 468 adult patients who underwent chest computed tomography and chest X-ray at the National Medical Center from 2019 to 2021. Tracheal ID at the level of the jugular notch was measured and cross-checked. The correlation of the patient's body size and sex was then checked with tracheal ID and a regression equation was obtained to estimate tracheal ID. Results: Height showed the greatest correlation with tracheal ID, followed by either ideal body weight (IBW) or adjusted body weight (ABW). The regression equation to estimate tracheal ID was as follows: “Expected ID of the trachea (mm)” = [11.0781 + (1.9682 for Male or 1 for Female)] + [7.3767 × height (cm)] - {0.8022 × [√ IBW (kg) for healthy weight or ABW (kg) for obese]}. The equation was applied to determine appropriate tracheostomy tube sizes. Conclusion Tracheal ID can be estimated using patient sex, height, and either IBW or ABW. By providing a practical method for estimating tracheal ID, the derived regression equation can serve as a valuable tool for healthcare professionals in emergency situations, which may reduce tracheostomy complication rates and deliver better patient outcomes.

Purpose: Tracheostomy is a procedure which requires careful selection of tracheostomy tube size, because it can significantly impact patient outcomes. However, in situations where radiological imaging is unavailable for measuring the tracheal inner diameter (ID), it can be estimated using the patient's height, weight, and sex. This study aimed to develop a method for estimating tracheal ID. Methods: A retrospective study was conducted on 468 adult patients who underwent chest computed tomography and chest X-ray at the National Medical Center from 2019 to 2021. Tracheal ID at the level of the jugular notch was measured and cross-checked. The correlation of the patient's body size and sex was then checked with tracheal ID and a regression equation was obtained to estimate tracheal ID. Results: Height showed the greatest correlation with tracheal ID, followed by either ideal body weight (IBW) or adjusted body weight (ABW). The regression equation to estimate tracheal ID was as follows: “Expected ID of the trachea (mm)” = [11.0781 + (1.9682 for Male or 1 for Female)] + [7.3767 × height (cm)] - {0.8022 × [√ IBW (kg) for healthy weight or ABW (kg) for obese]}. The equation was applied to determine appropriate tracheostomy tube sizes. Conclusion Tracheal ID can be estimated using patient sex, height, and either IBW or ABW. By providing a practical method for estimating tracheal ID, the derived regression equation can serve as a valuable tool for healthcare professionals in emergency situations, which may reduce tracheostomy complication rates and deliver better patient outcomes.

Purpose: Tracheostomy is a procedure which requires careful selection of tracheostomy tube size, because it can significantly impact patient outcomes. However, in situations where radiological imaging is unavailable for measuring the tracheal inner diameter (ID), it can be estimated using the patient's height, weight, and sex. This study aimed to develop a method for estimating tracheal ID. Methods: A retrospective study was conducted on 468 adult patients who underwent chest computed tomography and chest X-ray at the National Medical Center from 2019 to 2021. Tracheal ID at the level of the jugular notch was measured and cross-checked. The correlation of the patient's body size and sex was then checked with tracheal ID and a regression equation was obtained to estimate tracheal ID. Results: Height showed the greatest correlation with tracheal ID, followed by either ideal body weight (IBW) or adjusted body weight (ABW). The regression equation to estimate tracheal ID was as follows: “Expected ID of the trachea (mm)” = [11.0781 + (1.9682 for Male or 1 for Female)] + [7.3767 × height (cm)] - {0.8022 × [√ IBW (kg) for healthy weight or ABW (kg) for obese]}. The equation was applied to determine appropriate tracheostomy tube sizes. Conclusion Tracheal ID can be estimated using patient sex, height, and either IBW or ABW. By providing a practical method for estimating tracheal ID, the derived regression equation can serve as a valuable tool for healthcare professionals in emergency situations, which may reduce tracheostomy complication rates and deliver better patient outcomes.

The correction of author order.
Adult* ; Humans ; Korea* ; Mortality*

BACKGROUND: This study was conducted to investigate risk factors for perioperative periods between general anesthesia (GA group) and thoracic epidural blockade combined with general anesthesia (CEA group) for consecutive hepatic resections. METHODS: A retrospective chart review was carried out regarding 85 patients who had undergone hepatic resections. We compared the effects of postoperative pain control in the two groups, including pulmonary complications and durations of hospital stay. RESULTS: There was no significant difference in demographic data between the two groups. The perioperative fluid requirement and transfusions were lower in the CEA group. Supplemental analgesics requirement was significantly lower in the CEA group than the GA group in the 3 days postoperatively. There were no statistical difference between the two groups in nausea, vomiting, urticaria, constipation or urinary retention, but hypotension was more pronounced in the CEA group than the GA group. Postoperative pulmonary and surgical complications were similar between the two groups, but the duration of hospital stay was longer in the GA group than the CEA group. CONCLUSIONS: We conclude that the thoracic epidural blockade combined with general anesthesia provided lower surgical blood loss and better postoperative analgesia and hospital stay than general anesthesia for hepatic resections.
Analgesia ; Analgesics ; Anesthesia, General* ; Blood Loss, Surgical ; Constipation ; Hepatectomy* ; Humans ; Hypotension ; Length of Stay ; Nausea ; Pain, Postoperative ; Perioperative Period ; Retrospective Studies ; Risk Factors ; Urinary Retention ; Urticaria ; Vomiting

BACKGROUND: Hemophiliacs are known to have higher risk of exposure of hepatitis virus and immunosuppression. The aim of this study is to investigate the positive rate of viral markers for hepatitis and anti-HIV and the changes of lymphocyte subpopulations in Hemophiliacs in Chonnam GwangJu area. METHODS: One hundred four patients who had visited to the Hemophilic Clinic, Chonnam University Hospital from 1999 to 2001 were enrolled. They were checked for type A, B, C hepatitis viral markers, anti-HIV and lymphocyte subpopulations. The prevalence of hepatitis and lymphocyte subpopulation were compared according to severity and age of hemophiliacs. RESULTS: Anti-HAV IgM, anti-HAV IgG, HBsAg, anti-HBs, anti-HCV were positive in 40%(22/55), 65.5%(66/101), 42.3%(42/97) of cases tested. Positivity of anti-HCV showed trends of increase according to the severity of hemophiliacs (P<0.01) and age(P<0.001). Previous infection of hepatitis B were increased according to age (P=0.01) but not to the severity (P=0.194). Positive rate of anti-HCV and previous infection of hepatitis B were significantly lower in young age group (10 years old) than in older age group (>11 years old) (P=0.003, P<0.001, respectively). Although all enrolled patients were negative for anti-HIV, absolute T and B cells counts were decreased in 71.6% and 14.9% of patients, respectively and inversion of CD4/CD8 ratio were found in 65.7%. But there were no statistical difference in not only decrease of T and B cells but also inversions of CD4/CD8 ratio according to age and severity. CONCLUSION: The number of hemophiliacs with previous history of hepatitis B virus infection and seropositivity of anti-HCV were increased according to the age and severity of hemophilia. Active vaccinations of hepatitis B may be required in hemophiliacs. The greater part of hemophiliacs showed decrease in T cell count and inverted CD4/CD8 ratio. The hemophiliacs need a cautiion for infection and follow up tests for immunologic function.
B-Lymphocytes ; Biomarkers ; Cell Count ; Follow-Up Studies ; Gwangju* ; Hemophilia A ; Hepatitis A Antibodies ; Hepatitis B ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis Viruses ; Hepatitis* ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Immunosuppression ; Jeollanam-do* ; Lymphocyte Subsets* ; Lymphocytes* ; Prevalence ; Vaccination