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PURPOSE: Ensuring the stability of central venous catheter placement for treating patients hospitalized in an intensive care unit is very important. Although PICC requires an ultrasound and fluoroscopy machine, it is difficult to use a fluoroscopy machine for PICC insertion in the intensive care unit. This study analyzed the cases of the insertion of a PICC under ultrasonic guidance at the bedsides in the intensive care unit to determine the usefulness of PICC in the intensive care unit. METHODS: A retrospective study was conducted on patients hospitalized in the surgical intensive care unit and received PICC using ultrasonography at their bedsides from October 2015 to January 2018. RESULTS: One hundred and twenty patients were collected. The number of successful PICCs stood at 105 patients, which was equal to 87.5%. Among them, 65 and 55 cases had left and right insertion, respectively; the corresponding success rate was 81.8%, and 92.3%. No statistically significant difference in success rates was observed between the left and right, as well as in the success rates depending on the presence of shock, sepsis, acute kidney injury, and mechanical ventilation. In the failed 15 cases, seven cases were due to the course of the procedure and eight cases were confirmed have been malpositioned after insertion. CONCLUSION: PICC at the bedside in an intensive care unit is a safe method for central venous catheterization without severe complications and death. The insertion sites, left or right, are equally acceptable. Further study of the cases of malposition will be necessary.
Acute Kidney Injury ; Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Critical Care ; Critical Illness ; Fluoroscopy ; Humans ; Intensive Care Units ; Methods ; Respiration, Artificial ; Retrospective Studies ; Sepsis ; Shock ; Ultrasonics ; Ultrasonography

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The Efficiency of Ground Transport and Efficacy of Mobile Trauma Unit on the Inter-Hospital Transfer of Severe Trauma Patients

Eunae BYUN ; Kyuhyouck KYOUNG ; Sungjeep KIM ; Minae KEUM ; Sungkyun PARK ; Jihoon T KIM

Journal of Acute Care Surgery.2019;9(1):12-17. doi:10.17479/jacs.2019.9.1.12

PURPOSE: The author's trauma center implemented Mobile Trauma Units (MTU), which are ground transportation automobiles constructed with advanced medical equipment, in an attempt to improve the survival rate of severe trauma patients. The purpose of this study was to examine the efficacy of MTU as a means of inter-hospital transfer of patients in urban environments. METHODS: Patients with an injury severity score (ISS) of 16 or more were enrolled in this study. The participants must also be patients who were transferred with the MTU in the 18 months between January 2017 and June 2018. To assess the survival probability, the revised trauma score (RTS), trauma and injury severity score (TRISS), and w-score were used as the outcome indices. RESULTS: Forty-four (86.3%) of the severe trauma patients with an ISS of 16 or more were male and 7 (13.7%) were female. The number of patients from the territory were 32 (62.7%), and patients from the others were 19 (37.3%). All the patients received their injury from blunt force trauma. The average time of from the scene of the accident to the trauma center was 176 minutes. In 13 deaths, 10 (76.9%) of the RTS values were below 4 points. Among the 51 patients, TRISS was more than 0.5 in 32 patients (62.7%). The w-score was 13.25 and the actual survival rate of a patient was 74.50%. CONCLUSION: Ground transportation automobiles that use MTU for severe trauma patients in urban areas are more economically beneficial and more efficient. The survival rate while using MTU was also shown to be higher than that of medical helicopter transfers.
Aircraft ; Automobiles ; Emergency Treatment ; Female ; Humans ; Injury Severity Score ; Male ; Survival Rate ; Transportation ; Transportation of Patients ; Trauma Centers ; Wounds and Injuries

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Review of the Clinical Characteristics of Adrenal Gland Injury Following Blunt Trauma in a Single Institution

Sung Yong HONG ; Ki Hoon KIM

Journal of Acute Care Surgery.2019;9(1):7-11. doi:10.17479/jacs.2019.9.1.7

PURPOSE: Adrenal gland injuries in trauma are rare and usually misdiagnosed or underestimated in an emergency setting because they are asymptomatic and associated with severe abdominal injuries. This paper reviews the clinical characteristics of adrenal injuries. METHODS: A retrospective analysis of trauma patients who visited the authors' emergency center was performed from March, 2010 to December, 2017. The patient demographic data, injury mechanism & associated injuries, injury severity score, hospital stay, and mortality were retrieved and analyzed. RESULTS: Adrenal gland injuries were found in 52 patients: 73.1% (n=38) were males and the mean age was 43.6 years. Of the patients, 84.6% (n=44) had ISS ≥15. Right adrenal gland injuries occurred in 82.7% (n=43). The mechanism of injury was falls in 30.8% (n=16), motor vehicle accidents in 25.0% (n=13), and pedestrian accidents in 23.1% (n=12). Associated injures were liver injury (58.5%), rib fracture (52.8%), kidney injury (24.5%), pelvic bone fracture (20.8%), spine fracture (28.3%), and spleen injury (13.2%). The mean hospital stay was 34.2 days, and the intensive care unit stay was 9 days. The mortality rate was 3.8% (n=2). CONCLUSION: Adrenal gland injuries are common in males and frequent in the right side. Falls are the leading cause of injury. Most injuries have an associated injury at the abdominal or thoracic region. Adrenal injury is accompanied by high injury severity but showed a good prognosis.
Abdominal Injuries ; Accidental Falls ; Adrenal Glands ; Emergencies ; Humans ; Injury Severity Score ; Intensive Care Units ; Kidney ; Length of Stay ; Liver ; Male ; Mortality ; Motor Vehicles ; Pelvic Bones ; Prognosis ; Retrospective Studies ; Rib Fractures ; Spine ; Spleen

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Comparison of Quality of Life among Patients with Mangled Trauma

Joon Young KIM ; Yooun Joong JUNG ; Min Ae KEUM ; Su Kyung KWON ; Suk Kyung HONG

Journal of Acute Care Surgery.2019;9(1):1-6. doi:10.17479/jacs.2019.9.1.1

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

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Veno-Veno Extracorporeal Membrane Oxygenation in Post-Traumatic Acute Lung Injury

Se Heon KIM ; Young Hoon SUL ; Jin Young LEE ; Jin Bong YE ; Jin Suk LEE ; Soo Young YOON ; Joong Suck KIM

Journal of Acute Care Surgery.2020;10(2):68-71. doi:10.17479/jacs.2020.10.2.68

Patients with severe lung injury and hemorrhagic shock, may develop acute respiratory failure syndrome during resuscitation, and may require extracorporeal membrane oxygenation (ECMO) support to ensure adequate oxygenation to sustain life. In this case study, a 69 year-old female was hit by a motor vehicle whilst riding her bicycle. She was in a state of hemorrhagic shock due to polytrauma and was resuscitated with massive fluid transfusion during the initial management. After admission to the intensive care unit, she suffered from hypoxia which required mechanical ventilation using 100% oxygen. However, hypoxia did not improve, so she was placed on venoveno ECMO support after 4 days of intensive care treatment. Although trauma and bleeding are considered as relative contraindications for ECMO support, veno-veno ECMO allows for lung rest, and improvement of pulmonary function.

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Retroperitoneal Hepatocellular Carcinoma Rupture Mimicking an Adrenal Hematoma

Chang Yeon JUNG ; Jung Min BAE

Journal of Acute Care Surgery.2020;10(2):65-67. doi:10.17479/jacs.2020.10.2.65

The retroperitoneum is a posterior space of the peritoneum, which has many visceral and vascular structures. Spontaneous retroperitoneal hemorrhages have variable causes, the most common of which are diseases of retroperitoneal organs. However, retroperitoneal hemorrhages may be caused by bare area injury. In this case study, a bare area was observed in the right upper quadrant (RUQ) of the retroperitoneum, the posterosuperior region of Couinaud liver segment 7 (bare area) is directly connected to the anterior pararenal space. The rupture or exophyte of the hepatocellular carcinoma on the bare area could invade the retroperitoneum, which may lead to inaccurate diagnosis of the condition. When the mass or the hemorrhage in the RUQ of the retroperitoneum is observed in computed tomography images, it is possible that ruptured hepatocellular carcinoma or a mass on the bare area of the liver, looks like a spontaneous retroperitoneal hemorrhage in the RUQ area for example a right adrenal hemorrhage.

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Pneumoperitoneum Caused by the Spontaneous Perforation of a Pyometra in an 80-Year-Old Woman: A Case Report

Ki Hoon KIM

Journal of Acute Care Surgery.2020;10(2):62-64. doi:10.17479/jacs.2020.10.2.62

Pyometra is a rare condition that is defined as the accumulation of purulent material in the uterine cavity caused by an occlusion to the natural drainage of the uterus. Pyometra cases are seldom reported. The symptoms of pyometra may be non-specific, resulting in a delay or misdiagnosis that may subsequently increase the risk of perforation of the pyometra. Once a pyometra ruptures, the patient develops acute abdominal and generalized peritonitis. This case report describes diffuse peritonitis caused by the spontaneous perforation of a pyometra in a woman who was diagnosed preoperatively and treated successfully by emergency laparotomy.

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