• Journal of Trauma and Injury
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• v.36 no.4
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• pp.354-361
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• 2023

Purpose: Ketamine has historically been contraindicated in traumatic brain injury (TBI) due to concern for raising intracranial pressure. However, it is increasingly being used in TBI due to the favorable respiratory and hemodynamic properties. To date, no studies have evaluated whether ketamine administered in subjects with TBI is associated with patient survival or disability. Methods: We performed a retrospective analysis of data from the multicenter Prehospital Tranexamic Acid Use for Traumatic Brain Injury trial, comparing ketamine-exposed and ketamine-unexposed TBI subjects to determine whether an association exists between ketamine administration and mortality, as well as secondary outcome measures. Results: We analyzed 841 eligible subjects from the original study, of which 131 (15.5%) received ketamine. Ketamine-exposed subjects were younger (37.3±16.9 years vs. 42.0±18.6 years, P=0.037), had a worse initial Glasgow Coma Scale score (7±3 vs. 8±4, P=0.003), and were more likely to be intubated than ketamine-unexposed subjects (88.5% vs. 44.2%, P<0.001). Overall, there was no difference in mortality (12.2% vs. 15.5%, P=0.391) or disability measures between groups. Ketamine-exposed subjects had significantly fewer instances of elevated intracranial pressure (ICP) compared to ketamine-unexposed subjects (56.3% vs. 82.3%, P=0.048). In the very rare outcomes of cardiac events and seizure activity, seizure activity was statistically more likely in ketamine-exposed subjects (3.1% vs. 1.0%, P=0.010). In the intracranial hemorrhage subgroup, cardiac events were more likely in ketamine-exposed subjects (2.3% vs. 0.2%, P=0.025). Ketamine exposure was associated with a smaller increase in TBI protein biomarker concentrations. Conclusions: Ketamine administration was not associated with worse survival or disability despite being administered to more severely injured subjects. Ketamine exposure was associated with reduced elevations of ICP, more instances of seizure activity, and lower concentrations of TBI protein biomarkers.

• Journal of Chest Surgery
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• v.13 no.3
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• pp.212-218
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• 1980

A severe crushing injury of the chest produce a very striking syndrome referred to as traumatic asphyxia. This syndrome is characterized by bluish-red discoloration of the skin which is limited to the distribution of the valveless veins of the head and neck. And also if it is characterized by bilateral subconjunctival hemorrhages and neurological manifestations. But these clinical entities faded away progressively in a few weeks. Apporximately 90% of the patients who live for more than a few hours will recover from traumatic asphyxia when it occurs as a single entity. And so, death results from either severe associated injuries of from subsequent infection, rather than from pulmonary or cardiac insufficiency in traumatic asphyxia. We have experienced 4 cases of traumatic asphyxia with severe crushing thoracic injuries at department of the chest surgery, Captial Armed forces General Hospital during about 3 years from April 1977 to Aug. 1980. The 1st 22 year-old male was struct 2$\frac{1}{2}$ ton truck on the road and was transferred to this hospital immediately. He had taken tracheostomy due to severe dyspnea with contusion pneumonia and for removal of a large amount of bronchial secretion. The 2nd case was 23 year-old male who was got buried in a chasm. In this case, the heavy metal post tumbled over him back while at work. The 3rd case was 39 year-old male who leapt out of a window in 5th story while fire broke out in living room by oil stove heating. He had multiple rib fracture with right hemothor x and right colle's fracture and pelvic bone fracture. The last 22 year-old male was run over by a gun carriage. The wheel of this gun carriage passed over his thorax and right chin. He was brought to this hospital by helicopter. when he was first examined at emergency room, he was in semicomatose state and has pneurmomediastinum with multiple rib fracture and severe subcutaneous emphysema. As soon as he arrived, bilateral closed thoracostomy was performed and cardiopulmonary resuscitation was done. In hospital 8th weeks, chest series showed fibrothorax in right side even if chest wall stabilized. All 4 cases had multiple petechiae over their facees and chest and bilateral subconjunctival hemorrhages referred to as traumatic asphyxia. 3 cases except one case who received splenectomy, had been suffered from contusion pneumonia and had been treated with respiratory care. In these 3 cases, they had warning of impending injury before accident, and took a deep breath hold it and braces himself. And also, even if he had not impending fear in remaining one case, he had taken a deep breath and had got valsalva maneuver for pulling off the heavy metal post. Intrathoracic pressure rose suddenly and resulted to traumatic asphyxia in this situation. All these cases were recovered completely without sequelae except one fibrothorax, right.

• Journal of Biosystems Engineering
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• v.35 no.5
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• pp.294-301
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• 2010

This study was performed to improve the utilization of the ROPS and seatbelt of tractors in Korea. We surveyed the ROPS and seatbelt use and the tractor related accidents through the personal interviews for 141 farmers. And comfort test for tractor seatbelts is done for 4 different subjects by measuring the body pressure distribution. The survey showed that 79.3% of the tractor accidents was overturning accidents. And, in case the tractor has ROPS and seatbelt, there was no serious injuries. With this results, we could confirm that ROPS and seatbelt is very effective devices for protecting drivers in overturning accidents. But, in case farmers didn't wear seatbelt, there was some fatal injuries. This shows the importance of the seatbelt use in working and driving tractors. Therefore, we tested the comfort of the tractor seatbelt for 4 different subjects operating the pedal in tractor seat simulator and in the tractor running on various roads. From the results of the static test in the Lab, it was shown that more the seatbelt anchorage point is far form SIP point, more the body pressure of the belly became higher, and more the subjects feel uncomfortable. Not only in the static test in the simulator, but also in the dynamic test in riding tractors, it was shown that non retractable seatbelt was more uncomfortable than retractable seatbelt. According to this study, we concluded that we need to promote the utilization of the ROPS and seatbelt use. And, the non retractable seatbelt need to be replaced by retractable seatbelt. Also, we recommend that the seatbelt anchorage position should to be in the seatbelt anchorage area of the ISO 3776 standard.

• Journal of rehabilitation welfare engineering & assistive technology
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• v.11 no.4
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• pp.323-330
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• 2017

Knee sleeve has been used for prevention of sport injuries as well as rehabilitation. To investigate prevention of sport injuries of knee sleeve, it is important to evaluate balance associated with proprioception. The aim of this study was to evaluate the effects of a knee sleeve with a pad that stimulate to golgi tendon organ (GTO_PAD) on proprioception and balance ability. Five healthy males were participated for the study. They were asked to reenact target angle with Biodex and perform one leg standing with knee sleeve and knee sleeve with GTO_PAD. There was no significant difference in %Target angle, but the value of %Target angle was higher in subjects wearing knee sleeve with GTO_PAD than only knee sleeve, except for one subject. During one leg standing, time duration was increased in subjects wearing knee sleeve with GTO_PAD. The length of center of pressure in x-axis (COPx) and COP in y-axis (COPy) were decreased when wearing knee sleeve with GTO_PAD (COPx : $162.06{\pm}58.99mm$ in knee sleeve vs. $149.03{\pm}45.30mm$ in knee sleeve with GTO_PAD, COPy : $310.79{\pm}115.89mm$ in knee sleeve, $291.57{\pm}76.53mm$ in knee sleeve with GTO_PAD). There was significant differences in INI_transition, steady, and LAT_transition phase (all, p < 0.05). These findings support that wearing knee sleeve with GTO_PAD might enhance proprioception and balance.

• Tuberculosis and Respiratory Diseases
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• v.63 no.5
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• pp.423-429
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• 2007

Background: Alveolar recruitment (RM) is one of the primary goals of respiratory care for an acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The purposes of alveolar recruitment are an improvement in pulmonary gas exchange and the protection of atelectrauma. This study examined the effect and safety of the alveolar RM using pressure control ventilation (PCV) in early ALI and ARDS patients. Methods: Sixteen patients with early ALI and ARDS who underwent alveolar RM using PCV were enrolled in this study. The patients data were recorded at the baseline, and 20 minutes, and 60 minutes after alveolar RM, and on the next day after the maneuver. Alveolar RM was performed with an inspiratory pressure of $30cmH_2O$ and a PEEP of $20cmH_2O$ in a 2-minute PCV mode. The venous $O_2$ saturation, central venous pressure, blood pressure, pulse rate, $PaO_2/FiO_2$ ratio, PEEP, and chest X-ray findings were obtained before and after alveolar RM. Results: Of the 16 patients, 3 had extra-pulmonary ALI/ARDS and the remaining 13 had pulmonary ALI/ARDS. The mean PEEP was 11.3 mmHg, and the mean $PaO_2/FiO_2$ ratio was 130.3 before RM. The $PaO_2/FiO_2$ ratio increased by 45% after alveolar RM. The $PaO_2/FiO_2$ ratio reached a peak 60 minutes after alveolar RM. The Pa$CO_2$ increased by 51.9 mmHg after alveolar RM. The mean blood pressure was not affected by alveolar RM. There were no complications due to pressure injuries such as a pneumothorax, pneumomediastinum, and subcutaneous emphysema. Conclusion: In this study, alveolar RM using PCV improved the level of oxygenation in patients with an acute lung injury and acute respiratory distress syndrome. Moreover, there were no significant complications due to hemodynamic changes and pressure injuries. Therefore, alveolar RM using PCV can be applied easily and safely in clinical practice with lung protective strategy in early ALI and ARDS patients.

• Physical Therapy Korea
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• v.20 no.2
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• pp.1-10
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• 2013

The purpose of this study was to determine the effect of the changes that occur in the leg muscle activity of unstable surface with different levels of air pressures. Three groups of college students have been placed randomly on unstable surfaces with different air pressures at group 1.0 psi ($n_1$=36), group 1.4 psi ($n_2$=40), and group 1.8 psi ($n_3$=40). Using surface electromyography, the recruitment of the tibialis anterior, peroneus longus, and the gastrocnemius was measured. Maximal voluntary isometric contraction was measured at the different air pressures based on the manual muscle test, then normalizing the value to %maximal voluntary isometric contraction (%MVIC). The tibialis anterior muscle activity was significant change from the unstable surface with difference levels of air pressures between group 1.0 psi and 1.8 psi and between group 1.4 psi and 1.8 psi. peroneus longus muscle activity was significant changes in muscle activity occurred between 1.0 psi and 1.4 psi group and between 1.0 psi and 1.8 psi group. Gastrocnemius muscle activity was significant change in muscle activity occurred between 1.0 psi and 1.4 psi group and between 1.0 psi and 1.8 psi group. In conclusion it identify that 1.0 psi group is most effective on muscle activity than the other groups. These suggest that the rehabilitation or strengthening of patients with ankle injuries, balance exercise with low air pressure like 1.0 psi can be more effective.

• Transactions of the Korean Society of Mechanical Engineers B
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• v.36 no.11
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• pp.1105-1110
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• 2012

The spine is one of the most important skeletal joints, and it strongly affects the health of the musculoskeletal system. A normal spine has an S-shape, and it is very important to maintain this shape. Recently, spinal diseases such as low back pain have increased rapidly, especially among the elderly. Some of these diseases are caused by congenital spinal disorders and sporting and accident injuries as well as by bad postures. Improper spinal postures could generate excessive disc pressure, which is related to degeneration and pain. Therefore, in this study, we investigated the three-dimensional kinematic parameters of the thoraco-lumbar joint in several bad postures using a motion capture analysis technique. Different bad postures created a significant amount of flexion/extension, side bending, and axial rotation angle compared with neutral postures. Further study is necessary to investigate the disc pressure and ligament force due to the increase in joint rotation from the bad postures.

• Journal of Trauma and Injury
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• v.28 no.4
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• pp.223-231
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• 2015

Purpose: Delayed, traumatic, intraparenchymal hemorrhage (DTIPH) is a well-known contributing factor to secondary brain damage that evokes severe brain edema and intracranial hypertension. Once it has occurred, it adversely affects the patient's outcome. The aim of this study was to evaluate the prognosis factors for DTIPH by comparing clinical, radiological and hematologic results between two groups of patients according to whether surgical treatment was given or not. Methods: The author investigated 26 patients who suffered DTIPH during the recent consecutive five-year period. The 26 patients were divided according to their having undergone either a decompressive craniectomy (n=20) or continuous conservative treatment (n=6). A retrospective investigation was done by reviewing their admission records and radiological findings. Results: This incidence of DTIPH was 6.6% among the total number of patients admitted with head injuries. The clinical outcome of DTIPH was favorable in 9 of the 26 patients (34.6%) whereas it was unfavorable in 17 patients (65.4%). The patients with coagulopathy had an unexceptionally high rate of mortality. Among the variables, whether the patient had undergone a decompressive craniectomy, the patient's preoperative clinical status, and the degree of midline shift had significant correlations with the ultimate outcome. Conclusion: In patients with DTIPH, proper evaluation of preoperative clinical grading and radiological findings can hamper deleterious secondary events because it can lead to a swift and proper decompressive craniectomy to reduce the intracranial pressure. Surgical decompression should be carefully selected, paying attention to the patient's accompanying injury and hematology results, especially thrombocytopenia, in order to improve the patient's neurologic outcomes.

• Journal of Chest Surgery
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• v.26 no.2
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• pp.75-79
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• 1993

Myocardial protection against ischemic and reperfusion injuries is still in troublesome eventhough couples of the way of myocardial protection have been applied since 1970's. One of the possibility in myocardial protection is adding Fructose-l,6-diphosphate(FDP) in cardioplegic solution. It is assumed that FDP can promote ATP production under anaerobic condition as well as inhibiting the supressing effect of lactate on phosphofructokinase. We compared the myocardial protecting effects of FDP in crystalloid cardioplegic solution (St. Thomas formula, 10$^{\circ}C$, pH = 7.4) and reperfusate using isolated rat hearts in modified Langendorf apparatus by the parameters of preischemic and post reperfusing heart rate, time to first beat, occurance of arrhythmia, time to stabilization, and the rate of left ventricular pressure developing. Group A (n = 10), containing no FDP in cardioplegic and reperfusing solutions was control. Group B (n = 5), containing FDP in cardioplegic solution, showed statistically significant superiority of postischemic left ventricular pressure development than the control group. Group C (n = 5), containing FDP in reperfusate, showed statistically significant myocardial depressing effect than the controls. Other parameters were unremarkable. The cause is uncertain, but it is assumed that the negative feedback inhibition of FDP in energy metabolism or unknown blocking effect of FDP on certain transmembrane ionic currents is present. In conclusion, 1) FDP in cardioplegic solution has beneficial effect on postischemic left ventricular preservation. 2) FDP is strong acid when is hydrolyzed, so precise acid titration is neccessary. 3) FDP in reperfusate has negative left ventricular preservation, otherwise the mechanism is still uncertain.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.12
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• pp.418-424
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• 2019

The present study investigated the effects of the moment arm length on balance and walking when carrying a backpack. In total, 30 normal adults without orthopedic and neurological injuries were assessed. For each subject, balance and gait were measured under three conditions: 1) the no backpack condition, 2) the general backpack condition, and 3) the decreased length of moment arm backpack condition. There were significant differences in the center of the pressure area and velocity between the three conditions, whereas there was no significant difference in the center of the pressure area and velocity according to the moment arm length. There were significant differences in double limb support time and walking velocity under the three conditions, and there was a significant difference only in double limb support time according to the moment arm length. The results of the present study showed that a change in the length of the moment arm can be helpful for walking when carrying a backpack.