• Journal of the Korean Burn Society
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• v.23 no.1
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• pp.1-6
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• 2020

Purpose: PL, creatinine and urine output are biomarkers of the suitability and prognosis of fluid therapy in severe burn patients. The purpose of this study is to evaluate the usefulness of predicting mortality by biomarkers and its change during initial fluid therapy for severe burn patients. Methods: A retrograde review was performed on 733 patients from January 2014 to December 2018 who were admitted as severe burn patients to our burn intensive care unit (BICU). Plasma lactate, serum creatinine and urine output were measured at the time of admission to the BICU and after 48 hours. ABSI score, Hangang score, APACHEII, revised Baux index and TBSA were collected after admission. Results: 733 patients were enrolled. PL was the most useful indicators for predicting mortality in burn patients at the time of admission (AUC: 0.813) and after 48 hours (AUC: 0.698). On the other hand, mortality prediction from initial fluid therapy for 48 hours showed different results. Only creatinine showed statistical differences (P<0.05) in mortality prediction. But there were no statistical differences in mortality prediction with PL and UO (P>0.05). Conclusion: In this study, PL was most useful predictor among biomarkers for predicting mortality. Improvement in creatinine levels during the first 48 hours is associated with improved mortality. Therefore, efforts are needed to improve creatinine levels.

• Journal of Chest Surgery
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• v.28 no.11
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• pp.1001-1006
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• 1995

From January, 1990 to December, 1994, we have operated 10 patients with cardiac rupture. The patients are divided into two groups according to their clinical manifestation ; five patients in each hemorrhage and tamponade group. The patients in both groups could maintain their vital signs with closed thoracostomy and fluid resuscitation. The effect of pericardiocentesis was especially dramatic in three patients of tamponade group. The average time from injury to admission was 101 minutes and that of the patients who came our hospital via one or two other hospitals was 170 minutes comparing 31 minutes of those who came directly. The average time from admission to operation was 211 minutes. Considering 98 minutes for the diagnosis and preoperative management and another 30 minutes for the preparation for operation, operations were delayed by 83 minutes to get permission. We conclude that this delaying time for transport and operation of heart-ruptured patients should be shortened in order to manage them more effectively.

• Journal of Yeungnam Medical Science
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• v.37 no.3
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• pp.236-241
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• 2020

The authors report a case of a 78-year-old female with a history of gastric surgery 35 years ago. She was initially misdiagnosed as gastric cancer bleeding and underwent an emergency laparotomy under the diagnosis of jejunogastric intussusception (JGI), 23 hours after the onset of symptoms. We also reviewed 116 JGI case reports and analyzed clinical features and outcomes. Compared to the past, diagnosis of JGI is easier with diagnostic examinations such as an endoscopy, computed tomography, and the upper gastrointestinal series. And a good prognosis can be expected with proper fluid resuscitation and surgical reduction, even if the symptoms persist more than 48 hours.

• Proceedings of the KAIS Fall Conference
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• 2011.12a
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• pp.326-329
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• 2011

Mortality associated with maxillofacial infection is relatively low due to the development of antibiotics, and improved oral care. However, inappropriate treatment, delayed treatment, old age, underlying systemic disease, and drug-resistant micro-organisms can potentially result in life threatening situations such as cavernous sinus thrombosis, mediastinitis, and sepsis. Sepsis is the most dangerous state with high mortality, ranging from 20~60%. The treatment of sepsis involves properly monitoring vital functions, fluid resuscitation, surgical drainage, and empirical use of high doses of antibiotics until culture results are available. Ventilatory support maybe be required as well. We encountered a 64-year-old patient who died from sepsis that developed as the result of an odontogenic infection. The initial diagnosis was right temporal, infraorbital, buccal, pterygomandibular space abscess. Despite surgical and medical supportive care, the condition progressed to sepsis and after four days the patient died due to multiple organ failure.

• The Korean Journal of Emergency Medical Services
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• v.9 no.1
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• pp.89-93
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• 2005

Penetrating chest trauma by stab injury may result in massive hemothorax from damage to single or multiple intrathoracic organs such as heart, aorta, internal mammary artery, intercostal artery or pulmonary parenchyme. Prognosis of massive hemothorax necessitating emergency thoracotomy is fatal especially so if there exists concomitant underlying compromise of cardiopulmonary function. A 56 year old man with destroyed left lung due to old pulmonary tuberculosis was stabbed in right parasternal lesion through third intercostal space. Intubation with cardiopulmonary resuscitation and closed thoracostomy were performed to resuscitate from cardiac asystole from hemorrhagic shock and acute respiratory distress. Midsternotomy was made to expose active bleeding foci in right mammary artery, subclavian vein, intercostal artery and anterior segment of right upper lung showing severe bullous change and pleural adhesion. Postoperative care included ventilator support, inotropic instillation and cautious, balance fluid therapy ; successful extubation was done on third postoperative day and patient was discharged on tenth postoperative day without any complication.

• Journal of Trauma and Injury
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• v.26 no.4
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• pp.255-260
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• 2013

Purpose: For the treat hypothermia patients, active warming might be needed. In most emergency departments, IV warm saline infusion is used for treatments. However, during IV warm saline infusion, heat loss from the warm saline may occur and aggravate hypothermia. Thus, in this study, we conducted an experiment on conserving heat loss from warm saline by using a simple method. Methods: Four insulation methods were used for this study. 1) wrapping the set tube for the administration of the IV fluid with a cotton bandage, 2) wrapping the set tube for the administration of the IV fluid with a cotton bandage with aluminum foil, 3) wrapping the warm saline bag and tube with a cotton bandage, and 4) wrapping the warm saline bag and tube with a cotton bandage with aluminum foil. Intravenous fluid was preheated to a temperature between $38-40^{\circ}C$. The temperatures of the saline bag temperature and the distal end of the IV administration set were measured every ten minutes for an hour. The infusion rate was 1000 cc/hr, and to obtain an accurate infusion rate, we used an infusion pump. Results: The mean initial temperature of the saline bag was $39.11^{\circ}C$. An hour later, the fluid temperature at the distal end of the fluid temperature ranged from $39.11^{\circ}C$ to $34.3^{\circ}C$. Without any insulation, the initial temperature of the pre-heated warm saline, $39^{\circ}$ had decreased to $34.8^{\circ}C$ after having been run through the 170-cm-long IV administration tube, and after 1-hour, the temperature was $29.63^{\circ}C$. As we expected, heat loss was prevented most by wrapping both the saline bag and the IV administration set with a cotton bandage and aluminum foil. Conclusion: Wrapping both the saline bag and the IV administration set with a cotton bandage and aluminum foil can prevent heat loss during IV infusion in Emergency departments.

• Archives of Craniofacial Surgery
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• v.17 no.1
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• pp.28-30
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• 2016

Major maxillofacial bone injury itself can be life threatening from both cardiovascular point of view, as well as airway obstruction. Significant hemorrhage from facial fracture is an uncommon occurrence, and there is little in the literature to guide the management of these patients. We report a 73-year-old male driver who was transported to our hospital after a motor vehicle collision. The patient was hypotensive and tachycardic at presentation and required active fluid resuscitation and transfusion. The patient was intubated to protect the airway. All external attempts to control the bleeding, from packing to fracture reduction, were unsuccessful. Emergency angiogram revealed the bleeding to originate from terminal branches of the sphenopalatine artery, which were embolized. This was associated with cessation of bleeding and stabilization of vital signs. Despite the age and severity of injury, the patient recovered well and was discharged home at 3 months with full employment. In facial trauma patients with intractable bleeding, transcatheter arterial embolization should be considered early in the course of management to decrease mortality rate.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.249-252
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• 2001

Total spinal anesthesia is a serious life threatening complication of spinal and epidural anesthesia. We report an accidental total spinal anesthesia developed during a thoracic epidural block in a practitioner's pain clinic. A 69-year-old female with post-herpetic neuralgia was treated by a thoracic epidural block. A thoracic tapping for the epidural block was performed in the right lateral position at a level between $T_{5-6}$, using a 23 gauge Tuohy needle. After the epidural space was identified, a mixed solution of 10 ml of 0.3% lidocaine and 20 mg of triamcinolone was injected into the epidural space. After removal of the syringe, fluid was dripping through the needle. The patient subsequently complained of dyspnea and dizziness, and she became unconscious. She was intubated immediately and cardiopulmonary resuscitation was performed because there was no pulse palpable. The patient recovered an hour after transfer to a general hospital and was discharged without any further complication 19 days later.

• Proceedings of the Korean Society of Applied Pharmacology
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• 2001.11a
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• pp.109-109
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• 2001

The present study was done to investigate the relationship between Kupffer cells and alteration of cytochrome P-450 (CYP)-dependent drug metabolizing enzyme activities during polymicrobial sepsis. Male rats were subjected to polymicrobial sepsis by cecal ligation and puncture (CLP) followed by fluid resuscitation. The gadolinium chloride (GdC1$_3$, 10 mg/kg), blocker of Kupffer cells, was pretreated intravenously at 48 h and 24 h prior to the induction of CLP. All assay parameters were determined at 24 h after CLP or sham operation. In CLP-treated rats, the mortality rate of animals increased to 50% and serum alanine (ALT) and aspartate aminotransferase (AST) levels also significantly elevated. However, this increase was not suppressed by GdC1$_3$ pretreatment. Microsomal lipid peroxidation markedly increased after CLP operation. This increase was significantly attenuated by pretreatment. Total cytochrome P-450 content and NADPH-cytochrome P-450 reductase activity were not changed after CLP operation, but GdC1$_3$pretreatment reduced total cytochrome P-450 content, The hepatic microsomal CYP 1A1, 1A2, 2Bl and 2El activities in CLP-induced rats were also not significantly different from sham-operated rats. However, GdC1$_3$pretreatment showed a moderate increase in CYP1A1 and 1A2 activities. Our findings suggest that Kupffer cells may be partly responsible for producing hepatocellular dysfunction during sepsis.

• Journal of Trauma and Injury
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• v.26 no.3
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• pp.252-254
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• 2013

A hepatic hemangioma is the most frequent benign liver tumor. Once rupture occurs, the bleeding can barely be controlled by using conservative management or endovascular treatment. We report a case of traumatic hepatic hemangioma rupture. A 60-year-old man was referred to our hospital under cardiopulmonary cerebral resuscitation (CPCR). CPCR was continued for 16 minutes after his admission to the emergency room (ER). Computed tomography (CT) showed fluid accumulation in the peritoneal cavity with active contrast extravasation in the left lateral segment of the liver. Percutaneous transarterial embolization and massive transfusion were carried out. Embolization did not stop the bleeding, we decided on an exploration and then resected the lateral segment of the liver to control the bleeding. The specimen showed a ruptured hemangioma in the liver segment.