• Journal of Trauma and Injury
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• 제33권3호
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• pp.162-169
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• 2020

Purpose: There is increasing evidence in the literature regarding resuscitative endovascular balloon occlusion of the aorta (REBOA) globally, but few cases have been reported in Korea. We aimed to describe our experience of successful Zone III REBOA and to discuss its algorithm, techniques, and related complications. Methods: We reviewed consecutive cases who survived from hypovolemic shock after Zone III REBOA placement for 4 years. We reviewed patients' baseline characteristics, physiological status, procedural data, and outcomes. Results: REBOA was performed in 44 patients during the study period, including 10 patients (22.7%) who underwent Zone III REBOA, of whom seven (70%) survived. Only one patient was injured by a penetrating mechanism and survived after cardiopulmonary resuscitation. All patients underwent interventions to stop bleeding immediately after REBOA placement. Conclusions: This case series suggests that Zone III REBOA is a safe and feasible procedure that could be applied to traumatic shock patients with normal FAST findings who receive a chest X-ray examination at the initial resuscitation.

• Journal of Chest Surgery
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• 제29권4호
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• pp.433-439
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• 1996

경북대 학교병원에서는 1980년 1월부터 1995년 7월까지 들상에 의한 횡격 막 손상 환자 32례와 관통상 에 의한 12례를수술 치료하였다. 평균연령은둔상의 경우)7.6세,관통상의 경우29.2세로,들상의 경우 가 평 균 8.4세가 높았다(p<0.05). 진단은 단순 흉부 X-선 사진으로 횡격막 손상을 진단한 경우가 둔상에서는 24례 (75%), 관통상에서는 4fl (33%)였다. 관통상에서는 횡격막 손상의 의심 없이 다른 장기손상으로 수술하여 횡격막 파열이 발견 된 경우가 7례 (58%)였다. 탈장은 둔상시 24례 (75%), 관통상시 5례 (42%)에서 발생 하였다. 탈장이 발생 한 29례의 횡격막 손상의 크기는 10.9 $\pm$ 4.3cm, 발생하지 않은 15례는 3.5 $\pm$ 2.9cm로 양군간의 크기 의 차 이가 있어 (p<0.05) 횡격막 손상의 크기와 탈장과는 밀접한 관계가 있었다. 수출은 진단 즉시 시 행하였으며, 수술시 절개방법은 들상의 경우 20례 (6)%)에서 개흥술, 9례 에서 개 복술, 2례 에서 개흥복술, 1례 에서 개흥술 및 개복술을 분리 시행하였으며, 관통상시에는 6례 (50%)에서 개복술, 4례에서 개흥술, 2례에서 개흥술 및 개복술을 분리 시행하였다. 수술 후 합병증은 둔상시 6례 (19%), 관통 澯\ulcorner3례 (25%)에서 발생하여 비교적 높았다. 수술 후 사망률은 들상의 경우 2례 에서 사망하 였고(6.3%), 관통상의 경우는 사망례가 없어 전체 사망률은 4.5%였다. 결론적으로흥복부 외상시 횡격막 손상의 가능성을 염두에 두어야하며, 둔상의 경우횡격막손상의 크기는 관통상에 의한 경우보다 더 크며, 탈장도 횡격막 손상의 길이 에 비례하여 더 많이 발생하였다.

• Journal of Chest Surgery
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• 제31권3호
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• pp.298-303
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• 1998

초기에 외상성 뇌병변의 진단에 국한되었던 단층 촬영은 전산화 단층 촬영기가 널리 보급됨에 따라 흉부, 복부 및 척추, 그리고 안면부나 골반부의 외상에 의한 병변의 진단에 널리 이용되고 있다. 본 연구는 1년간 응급실에 내원한 흉부외상 환자 중 흉부의 전산화 단층 촬영을 시행한 134명의 환자를 대 瓚막\ulcorner단순 흉부 엑스선 촬영의 결과와 단층 촬영 결과를 비교, 분석함으로 외상 환자에게 사용되고 있는 흉부 전산화 단층 촬영의 효용성을 알아보고자 하였다. 분석 결과 134명의 환자 중 45명은 단순 흉부 엑스선 촬영 소견이 정상인데 단층 촬영을 시행받은 환자였고, 이중 24명은 단층 촬영 결과 역시 정상 소견을 보였다. 단층 촬영의 기흉과, 혈흉을 포함한 늑막삼출에 대한 진단률을 100%라고 가정할 때 단순 흉부 엑스선 촬영의 기흉과 늑막 삼출의 진단률은 각각 46.2%, 62.9%로 낮은 진단율을 보였다. 전체 환자 중 흉관 삽관을 받은 환자는 63명이었는데 이중 45명(71.4%)이 단순 흉부 엑스선 촬영만으로 흉관 삽관을 결정한 환자여서 치료 방침의 결정에는 단순 촬영의 효용성이 다소 높았다. 따라서 본 연구에 흉부 외상에 대한 전산화 단층 촬영이 다소 남용되고 있음이 확인이 되었으나 단층 촬영은 소량의 기흉이나 종격동의 병변등, 임상적으로 중요하면서도 단순 촬영이 제공할 수 없는 병변의 진단에 결정적으로 유용하며 그 효용성 또한 높다고 할 수 있다.

• Journal of Trauma and Injury
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• 제26권4호
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• pp.291-296
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• 2013

Purpose: Prolonged ventilation leads to a higher incidence of ventilator-associated pneumonia (VAP), resulting in weaning failure and increased medical costs. The aim of this study was to analyze clinical results and prognostic factors of VAP in patients with blunt chest trauma. Methods: From 2007 to 2011, one hundred patients undergoing mechanical ventilation for more than 48 hours were divided into two groups: a VAP-negative group, (32 patients, mean age; 53 years, M:F=25:7) and a VAP- positive group, (68 patients, mean age; 60 years, M:F=56:12). VAP was diagnosed using clinical symptoms, radiologic findings and microorganisms. The injury severity score (ISS), shock, combined injuries, computerized tomographic pulmonary findings, transfusion, chronic obstructive lung disease (COPD), ventilation time, stay in intensive care unit (ICU) and hospital stays, complications such as sepsis or disseminated intravascular coagulation (DIC) and microorganisms were analyzed. Chi square, t-test, Mann-Whitney U test and logistic regression analysies were used with SPSS 18 software. Results: Age, sex, ISS, shock and combined injuries showed no differences between the VAP - negative group and - positive group (p>0.05), but ventilation time, ICU and hospital stays, blood transfusion and complications such as sepsis or DIC showed significant differencies (p<0.05). Four patients(13%) showed no clinical symptoms eventhough blood cultures were positive. Regardless of VAP, mortality-related factors were shock (p=0.036), transfusion (p=0.042), COPD (p=0.029), mechanical ventilation time (p=0.011), ICU stay (p=0.032), and sepsis (p=0.000). Microorgnisms were MRSA(43%), pseudomonas(24%), acinetobacter(16%), streptococcus(9%), klebsiela(4%), staphillococus aureus(4%). However there was no difference in mortality between the two groups. Conclusion: VAP itself was not related with mortality. Consideration of mortality-related factors for VAP and its aggressive treatment play important roles in improving patient outcomes.

• Journal of Chest Surgery
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• 제47권6호
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• pp.523-528
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• 2014

Background: Numerous statistical models have been developed to accurately predict outcomes in multiple trauma patients. However, such trauma scoring systems reflect the patient's physiological condition, which can only be determined to a limited extent, and are difficult to use when performing a rapid initial assessment. We studied the predictive ability of the systemic inflammatory response syndrome (SIRS) score compared to other scoring systems. Methods: We retrospectively reviewed 229 patients with multiple trauma combined with chest injury from January 2006 to June 2011. A SIRS score was calculated for patients based on their presentation to the emergency room. The patients were divided into two groups: those with an SIRS score of two points or above and those with an SIRS score of one or zero. Then, the outcomes between the two groups were compared. Furthermore, the ability of the SIRS score and other injury severity scoring systems to predict mortality was compared. Results: Hospital death occurred in 12 patients (5.2%). There were no significant differences in the general characteristics of patients, but the trauma severity scores were significantly different between the two groups. The SIRS scores, number of complications, and mortality rate were significantly higher in those with a SIRS score of two or above (p<0.001). In the multivariant analysis, the SIRS score was the only independent factor related to mortality. Conclusion: The SIRS score is easily calculated on admission and may accurately predict mortality in patients with multiple traumas.

• Journal of Trauma and Injury
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• 제23권2호
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• pp.175-179
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• 2010

Purpose: Sternal fractures after blunt thoracic trauma can cause significant pain and disability. They are relatively uncommon as a result of direct trauma to the sternum and open reduction is reserved for those with debilitating pain and fracture displacement. We reviewed consecutive 11 cases of open reduction and fixation of sternum and tried to find standard approach to the traumatic sternal fractures with severe displacement. Methods: From December 2008 to August 2010, the medical records of 11 patients who underwent surgical reduction and fixation of sternum for sternal fractures with severe displacement were reviewed. We investigated patients' characteristics, chest trauma, associated other injuries, type of open reduction and fixation, combined operations, preoerative ventilator support and postoperative complications. Results: The mean patient age was 59.3years (range, 41~79). The group comprised 6 male and 5 female subjects. Among 11 patients who underwent open reduction and fixation for sternal fracture with severe displacement, 6 cases had isolated sternal fractures and the other 5 patients had associated other injuries. Sternal fractures were caused by car accidents (9/11, 81.8%), falling down (1/11, 9.1%) and direct blunt trauma to the sternum (1/11, 9.1%), respectively. 3 of the 7 patients (42.9%) who underwent sternal plating with longitudinal plates showed loosening of fixation. Otherwise, none of the 4 patients who underwent surgical fixation using T-shaped plate had stable alignment of the fracture. Conclusion: Sternal fractures with severe displacement need to be repaired to prevent chronic pain, instability of the anterior chest wall, deformity of the sternum, and even kyphosis. In the present study, a T-shaped plate with a compression-tension mechanism constitutes the treatment of choice for displaced sternal fractures.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.224-230
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• 2023

Purpose: Patients with penetrating injuries are at a high risk of mortality, and many of them require emergency surgery. Proper triage and transfer of the patient to the emergency department (ED), where immediate definitive treatment is available, is key to improving survival. This study aimed to evaluate the epidemiology and outcomes of patients with penetrating torso injuries in Incheon Metropolitan City. Methods: Data from trauma patients between 2014 and 2018 (5 years) were extracted from the National Emergency Department Information System. In this study, patients with penetrating injuries to the torso (chest and abdomen) were selected, while those with superficial injuries were excluded. Results: Of 66,285 patients with penetrating trauma, 752 with injuries to the torso were enrolled in this study. In the study population, 345 patients (45.9%) were admitted to the ward or intensive care unit (ICU), 20 (2.7%) were transferred to other hospitals, and 10 (1.3%) died in the ED. Among the admitted patients, 173 (50.1%) underwent nonoperative management and 172 (49.9%) underwent operative management. There were no deaths in the nonoperative management group, but 10 patients (5.8%) died after operative management. The transferred patients showed a significantly longer time from injury to ED arrival, percentage of ICU admissions, and mortality. There were also significant differences in the percentage of operative management, ICU admissions, ED stay time, and mortality between hospitals. Conclusions: Proper triage guidelines need to be implemented so that patients with torso penetrating trauma in Incheon can be transferred directly to the regional trauma center for definitive treatment.

• Journal of Chest Surgery
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• 제40권12호
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• pp.871-873
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• 2007

무명동맥은 길이가 짧고 가슴 골격에 의해 보호되기 때문에 외상에 의한 무명동맥의 파열은 드문 질환으로 알려져 있다. 본 증례는 자동차 사고로 내원한 25세 남자로 흉부 전산화 단층촬영 및 혈관 조영술로 무명동맥 파열이 진단되어 우측 쇄골하 절개를 동반한 정중 흉골 절개술을 이용하여 응급 수술을 시행하였다. 다른 동반 손상이 많아 인공 심폐기를 사용하지 않고 수술을 하였으며, 손상은 무명동맥의 중위부부터 우측 쇄골하 동맥 및 총경동맥의 기시부까지 약 3 cm 정도로 동맥 내막까지 완전히 찢어져 있었다. 복제정맥을 이용하여 첩포 혈관 성형술을 시행하였으며, 수술 후 환자는 별 다른 이상 없이 외래 추적 관찰 중이다.

• Tuberculosis and Respiratory Diseases
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• 제67권5호
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• pp.467-470
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• 2009

A traumatic pulmonary pseudocyst is a rare complication of blunt thoracic trauma. The clinical symptoms and signs are similar to other respiratory diseases, such as pulmonary tuberculosis. Therefore, a trauma history with the resulting radiologic and clinical findings is important for making a diagnosis. A 26-year-old male was admitted to our hospital due to cough for 3 days. The chest x-ray revealed diffuse infiltrations and a cavitary lesion at the left lung. His left chest had hit a tree as a result of motorcycle accident one day before admission. Initially, it was assumed that his symptoms and chest X-ray might be due to a tuberculosis infection. However, bronchoscopy revealed old blood clots at both lungs, particularly in the left lower lobe bronchus. A transbronchial lung biopsy showed alveolar hemorrhage. A traumatic pulmonary pseudocyst was diagnosed from his trauma history and these findings. Computed tomography of the chest performed 4 months later showed regression of the cavitary lesion.

• Journal of Chest Surgery
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• 제41권1호
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• pp.128-132
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• 2008

경부 1구역은 주요혈관과 식도, 기관 등 생명 유지 기관들이 조그만 구역 속에 밀집되어 있고 접근하기도 힘들어서 경부 1구역 관통상 시에 위중할 수 있는데 특히 혈관 손상이 발생할 경우 생명이 위협받을 수 있다. 따라서 정확한 손상 정도의 평가 후 적극적이고 신속한 외과적인 조치를 취해야 한다. 경부 1구역의 관통상에 의한 혈관 손상을 치험 하였기에 보고한다.