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: Proper use of antibiotics during emergency abdominal surgery is essential in reducing the incidence of surgical site infection. However, no studies have investigated the type of antibiotics and duration of therapy in individuals with abdominal trauma in Korea. We aimed to investigate the status of initial antibiotic therapy in patients with solitary abdominal trauma. Methods: From January 2015 to December 2015, we retrospectively analyzed the medical records of patients with solitary abdominal trauma from 17 institutions including regional trauma centers in South Korea. Both blunt and penetrating abdominal injuries were included. Time from arrival to initial antibiotic therapy, rate of antibiotic use upon injury mechanism, injured organ, type, and duration of antibiotic use, and postoperative infection were investigated. Results: Data of the 311 patients were collected. The use of antibiotic was initiated in 96.4% of patients with penetrating injury and 79.7% with blunt injury. Initial antibiotics therapy was provided to 78.2% of patients with solid organ injury and 97.5% with hollow viscus injury. The mean day of using antibiotics was 6 days in solid organ injuries, 6.2 days in hollow viscus. Infection within 2 weeks of admission occurred in 36 cases. Infection was related to injury severity (Abbreviated Injury Scale of >3), hollow viscus injury, operation, open abdomen, colon perforation, and RBC transfusion. There was no infection in cases with laparoscopic operation. Duration of antibiotics did not affect the infection rate. Conclusion Antibiotics are used extensively (84.2%) and for long duration (6.2 days) in patients with abdominal injury in Korea.

A case of a 30-year-old man who was admitted following a penetrating neck injury is presented. A clinical examination and operative findings identified semi-comatose mentality, neck muscle laceration, and transection of the left common carotid and vertebral arteries and the internal jugular vein. During the operation, the carotid arteries were repaired by interposition grafting, and the internal jugular vein was ligated. The vertebral artery was managed by interventional embolization. Although the patient had some neurological deficit, he was discharged on postoperative Day 52. This surgical case prompted a discussion regarding neurological outcomes, and surgical and endovascular treatment following vascular neck injury.

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

OBJECTIVE: To investigate the effects of trauma center establishment on the clinical characteristics and outcomes of trauma patients with traumatic brain injury (TBI).METHODS: We enrolled 322 patients with severe trauma and TBI from January 2015 to December 2016. Clinical factors, indexes, and outcomes were compared before and after trauma center establishment (September 2015). The outcome was the Glasgow outcome scale classification at 3 months post-trauma.RESULTS: Of the 322 patients, 120 (37.3%) and 202 (62.7%) were admitted before and after trauma center establishment, respectively. The two groups were significantly different in age (p=0.038), the trauma location within the city (p=0.010), the proportion of intensive care unit (ICU) admissions (p=0.001), and the emergency room stay time (p < ;0.001). Mortality occurred in 37 patients (11.5%). Although the preventable death rate decreased from before to after center establishment (23.1% vs. 12.5%), the difference was not significant. None of the clinical factors, indexes, or outcomes were different from before to after center establishment for patients with severe TBI (Glasgow coma scale score ≤8). However, the proportion of inter-hospital transfers increased and the time to emergency room arrival was longer in both the entire cohort and patients with severe TBI after versus before trauma center establishment.CONCLUSION: We confirmed that for patients with severe trauma and TBI, establishing a trauma center increased the proportion of ICU admissions and decreased the emergency room stay time and preventable death rate. However, management strategies for handling the high proportion of inter-hospital transfers and long times to emergency room arrival will be necessary.
Brain Injuries ; Classification ; Cohort Studies ; Coma ; Emergency Service, Hospital ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Humans ; Intensive Care Units ; Korea ; Mortality ; Retrospective Studies ; Trauma Centers

PURPOSE: Mechanical ventilation (MV) is an essential life-saving modality for severely injured patients. However, the long-term use of MV is a major risk factor for late mortality. The surgical correction of long bone fractures plays a critical role not only in improving functional outcomes, but also in reducing physiological derangements, including MV duration. This study investigated the factors affecting prolonged MV (PMV) in severely injured patients with femur fractures. METHODS: We retrospectively evaluated all severely injured patients (injury severity score >15) with femur fractures who were taken to the emergency department within 12 hours of the causative accidents between January 2016 and December 2018. PMV was defined as MV lasting for ≥7 days. We analyzed the factors affecting PMV. RESULTS: In total, 35 patients were enrolled and 21 (33.3%) were included in the PMV group. The PMV group required more red blood cell (RBC) transfusions within 7 days RBC (7dRBC) (12.8 vs. 6.8 units; p=0.03) and the time to femur fracture fixation (TFFF) was longer (7.9 vs. 2.7 days; p=0.018). The area under the curve (AUC) for TFFF was 0.740 (95% confidence interval [CI]: 0.572–0.908; p=0.018) and the AUC for 7dRBC was 0.718 (95% CI: 0.546–0.889; p=0.031). CONCLUSIONS This study indicates that TFFF is an independent risk factor for PMV. Early fixation of femur fractures might prevent PMV and its associated complications.

Intra-abdominal hypertension (IAH) is defined as steady state pressure in the abdominal cavity. Intra-abdominal pressure (IAP) acts as resistance against blood flow. IAH decreases abdominal perfusion pressure, aggravates hemodynamics and organ dysfunction and raises serious risks of morbidity and mortality. IAP should be a goal of resuscitation, and aggressive treatment should be performed to relieve IAH, including therapeutic open abdomen.
Abdomen ; Abdominal Cavity ; Hemodynamics ; Intra-Abdominal Hypertension* ; Mortality ; Perfusion ; Resuscitation

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

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

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