• Journal of Trauma and Injury
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• 제37권3호
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• pp.224-227
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• 2024

In Korea, helicopter emergency medical services (HEMS) with a physician on board were introduced in September 2011, funded by both central and regional governments. HEMS was integrated into the Korean emergency medical system to address the need for EMS in remote rural areas. The present report describes 16-month-old twins who fell from the fifth floor of an apartment building, located approximately 100 km from the nearest level I trauma center. Utilizing HEMS along with initial emergency management by an emergency physician, the patients were transported to the level I trauma center within the critical "golden hour." The children had sustained multiorgan injuries. Without intervention at the scene by an emergency physician, a fatal outcome was anticipated for both children. With the use of HEMS, one patient died, but the other survived with a good prognosis. The use of HEMS flights with an emergency physician on board may improve outcomes for pediatric patients with severe trauma in medically underserved rural areas.

• Journal of Trauma and Injury
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• 제33권1호
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• pp.31-37
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• 2020

Purpose: We aimed to evaluate the trauma volume and performance indicators during the first 5-year period of operation in a single regional trauma center. Methods: We analyzed prospectively collected data from the Korean Trauma Data Bank for a single regional trauma center between January 2014 and December 2018. More than 250 variables were analyzed. We calculated the predicted survival rates using the trauma and injury severity score (TRISS) method. Results: In total, there were 16,103 trauma admissions during the first 5 years; trauma activation was performed in 5,105 of these cases. Over 70% of the patients were men, and most of the admitted patients were within the age groups of 55-59 years for men and 75-79 years for women. Analyses were performed considering two patient groups: the total patient group and the group of those with severe trauma (injury severity score [ISS] >15). The median ISS, revised trauma score, and TRISS of the two groups were 5 (interquartile range [IQR] 4-10), 22 (IQR 17-27), and 7.6±0.99 and 6.74±1.9, 0.95±0.13, 0.81±2.67, respectively. Of the total patient group, 801 patients (5%) died in the hospital, whereas of the group of patients with ISS >15, 526 (19.5%) died. The direct transportation of patients to the regional trauma center increased year by year. The emergency room stay time and time to entering the operating room showed a decrease until 2017; however, these parameters increased again in 2018. Conclusions: The trauma volume in the regional trauma center is appropriate, and some improvements could be observed after its establishment. However, performance indicators reveal the prematurity of the trauma center and its potential for further improvements. Moreover, the development of a national trauma system, beyond regional trauma centers, is required.

• 대한안과학회지
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• 제59권11호
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• pp.1062-1070
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• 2018

목적: 소아청소년 환자에서 발생한 개방안구손상의 임상 양상을 분석하여 최종시력을 예측할 수 있는 인자를 알아보고, 최종시력을 예측하는 방법으로 안외상 점수(ocular trauma score, OTS)와 소아 안외상 점수(penetrating ocular trauma score, POTS)를 평가해 보고자 한다. 대상과 방법: 1993년 5월부터 2014년 4월까지 개방안구손상으로 본원에 내원한 18세 이하 소아청소년 환자 77명을 대상으로 의무기록을 후향적으로 분석하였다. 최종시력에 영향을 미칠 수 있는 인자들을 조사하였고, 최종시력을 예측하는 방법으로 OTS와 POTS를 receiver operating characteristic 곡선을 이용하여 평가해 보았다. 결과: 단변량 분석에서 20/200 미만의 초기시력, 안구파열, 7.0 mm 이상의 손상 크기, 망막박리, 수정체이탈, 총 수술 횟수는 불량한 최종시력(<20/200)과 유의한 관련성이 있었다. 반면에 20/32 이상의 좋은 최종시력의 경우 각막중심 침범 유무, 외상백내장 유무, 7.0 mm 미만의 손상 크기, 20/200 이상의 초기시력과 관련성이 있었다. OTS와 POTS 모두 최종시력을 예측하는 방법으로 진단적 가치가 있었으며, 통계적으로 두 점수 체계에 유의한 차이는 없었다. 결론: 소아청소년에게 발생한 개방안구손상에서 초기시력과 안구손상 크기는 최종시력에 영향을 주는 중요한 예측인자이다. 소아청소년 개방안구손상 환자의 최종시력 예측에 있어 기존의 안외상 점수(OTS)뿐만 아니라 소아 안외상 점수(POTS) 또한 좋은 예측도를 보여주어 둘 모두 유용한 평가 방법으로 생각된다.

• Journal of Chest Surgery
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• 제47권4호
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• pp.402-405
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• 2014

Myocardial infarction (MI) secondary to coronary artery fistula and the subsequent occlusion of the distal right coronary artery (RCA) after blunt chest trauma is a rare entity. Here, we describe a case of coronary artery fistula and occlusion with an inferior MI that occurred following blunt chest trauma. At the initial visit to the emergency room after a car accident, this patient had been undiagnosed with acute myocardial infarction, readmitted five months after ischemic insult, and revealed to have experienced MI due to RCA-right atrial fistula and occlusion of the distal RCA. He underwent coronary surgery and recovered without complications.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.261-264
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• 2023

Pancreatic trauma occurs in 0.2% of patients with blunt trauma and 5% of severe abdominal injuries, which are associated with high mortality rates (up to 60%). Traumatic pancreatoduodenectomy (PD) has significant morbidity and appreciable mortality owing to complicating factors, associated injuries, and shock. The initial reconstruction in patients with severe pancreatic injuries aggravates their status by causing hypothermia, coagulopathy, and acidosis, which increase the risk for early mortality. A staging operation in which PD follows damage control surgery is a good option for hemodynamically unstable patients. We report the case of a patient who was treated by staging PD for an injured pancreatic head.

• Journal of Trauma and Injury
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• 제30권1호
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• pp.12-15
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• 2017

A 58-year-old male visited our emergency room for multiple traumas from explosion. On initial evaluation, hemopneumoperitoneum with liver laceration (grade 4) and colon perforation was identified. Hemopericardium with cardiac tamponade was also identified. Shrapnel was detected in the right ventricle. Damage control surgery was planned due to condition of hypotension. In operation room, control over bleeding was achieved after sternotomy, pericardiotomy, and laparotomy. Massive transfusion was done during operation. After gauze packing, operation was terminated with temporary closure (TC). Sanguineous fluid was drained profusely. Disseminated intravascular coagulopathy was confirmed through laboratory findings. No extravasation was discovered at hepatic angiogram. On re-operation, there was no active bleeding but oozing from sternotomy site was identified. Bone bleeding was impossible to control. Finally, reoperation was ended after gauze packing and TC all over again. The patient could survive for only a day after re-operation.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.125-130
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• 2013

Purpose: This study was undertaken in order to identify the characteristics of patients diagnosed with occult an hip fracture after hip trauma. Methods: We retrospectively reviewed the medical records and radiology reports of all patients who underwent hip skeletal computed tomography (CT) for suspected hip fractures but had normal initial X-rays after hip trauma between August 2006 and January 2012. The variables evaluated included age, gender, body mass index (BMI), accident mechanism, previous fracture, independence, late presentation, ability to bear weight, pain on passive rotation, tenderness of the groin area, diagnosis and treatment. Patients were divided into two groups, with hip fracture (occult hip fracture group) and without hip fracture (no fracture group) to evaluate the characteristics associated with an occult hip fracture. Results: The patients, a total of 139, had a mean age of 58.3 years and included 72 male patients(51.8%). The occult hip fracture group included 43 patients(30.9%). Of those 43, 21 patients(48.8%) had intertrochanteric or trochanteric fractures, 8 patients(18.6%) had femur neck fractures and 14 patients(32.6%) had acetabular fractures. Of the 43, 15 patients(34.9%) needed operative treatment. Age was higher in the occult hip fracture group than it was in the no fracture group($64.4{\pm}19.1$ years vs. $55.5{\pm}23.6$ years, p=0.021). A previous fracture was associated with the presence of a new fracture (p=0.014; OR=3.971, 95% CI=1.314-11.997). Conclusion: Further evaluation of patients who are older or have history of fractures is prudent, even though the initial X-rays are normal.

• 한국사회복지학
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• 제69권2호
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• pp.219-246
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• 2017

본 연구는 트라우마 센터에 근무한 사회복지사들의 소진과 이차적 외상 스트레스 경험을 이해하기 위한 실체 이론 개발을 목적으로 한다. 근거이론을 통해 자료를 분석한 결과, 초기코딩을 통해서 159개의 의미단위, 47개의 하위범주, 그리고 12개의 범주를 구성하였다. 초점 코딩에서 중심현상을 '상처받은 존재성'으로 보고 '사회복지사로서의 자리 찾기'를 핵심범주로 정하였으며 이를 중심으로 연관된 범주들을 연결하였다. 이론적 코딩 결과 트라우마 센터에서 근무한 사회복지사의 소진과 이차적 외상 스트레스 경험 과정은 사명기, 갈등기, 침체기, 해체기로 나타났다. 이러한 연구 결과를 바탕으로 재난복지실천에 대한 준비, 트라우마 치유 관점에 대한 논의 및 합의, 그리고 소진과 이차적 외상 스트레스 예방과 대처를 위한 프로그램의 필요성을 제시하였다.

• Journal of Trauma and Injury
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• 제25권3호
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• pp.79-86
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• 2012

Purpose: The most common cuase of transfusion for trauma victims in an emergency department is hypovolemic shock due to injury. After an injury to an internal organ of the chest or the abdomen, transfusion is needed to supply blood products and to compensate tissue oxygen transport and bleeding. From the 1990's, there have been some reports that transfusion is one of the major factors causing multiple-organ failure. Thus, as much as possible, tranfusion has been minimized in the clinical setting. This study aims to analyze the prognostic factors for mortality among trauma victims transfused with blood products in an emergency department. Methods: We conducted this study for the year of 2010 retrospectively. The study group included adult trauma victims tranfused with blood products in our ED. The exclusion criteria were discharge against medical advice, and missing follow-up due to transfer to another facility. During the study period, 34 adult trauma victims were enrolled. We compared the clinical variables between survivors and non-survivors. Results: the mean age of the 34 victims was 58.06 years, and males account for 58.5% of the study group. The most-frequently used form transportation was ambulance(119, 55.9%), and the most common injury mechanism was mobile vehicle accidents(67.6%). The mean revised trauma score (RTS) was 5.9, and the mean injury severity score (ISS) was 47.76. The mortality rate in the ED was 58.5%, Comparison of survivors with non-survivors showed statistical differences in injury mechanism, initial SBP, DBP, RTS, ISS, and some laboratory data such as AST, ALT, pH, PO2, HCO3, glucose (p<0.05). Regression analyses showed that mortality among adult trauma victims transfused in the ED correlated with RTS. Conclusion: When an adult trauma victim is transported to the ED and needs a tranfusion, the emergency physician carefully assess the victim by using physiologic data.

• Journal of Korean Biological Nursing Science
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• 제23권2호
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• pp.138-150
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• 2021

Purpose: This retrospective study aimed to investigate nursing interventions in patients with severe thoracic injury in trauma bay of a regional trauma center. Methods: Of the 1,780 patients admitted to the trauma bay of a regional trauma center in a university hospital in the Gyeonggi Province between January 1, 2019 and December 31, 2019, 120 adult patients with severe thoracic injury who met the inclusion criteria were enrolled. Participants' clinical characteristics and nursing interventions were collected from electronic medical records after receiving ethical approval. Nursing interventions were classified using the terminology in the Nursing Intervention Classification. Results: The mean age of participants was 52.25 years and 72.5% of participants were male. The main areas of thoracic injury included lung parenchyma and pleura (95.8%). The mean Abbreviated Injury Scale (AIS) for thoracic injury was 3.13 and the mean Injury Severity Score (ISS) was 17.81. Fluid resuscitation, invasive hemodynamic monitoring, chest tube care, respiratory monitoring, artificial airway management, gastrointestinal tube care, mechanical ventilation management: airway insertion and stabilization, blood product administration, allergy management, and surgical preparation were performed significantly more frequently in thoracic injury patients with unstable vital signs or a higher AIS score. Conclusion: This study is significant as it investigated the types of nursing interventions given to patients with severe thoracic injury in the trauma bay. These results would contribute to developing more detailed educational materials for initial nursing interventions in trauma bay.