• Title/Summary/Keyword: Trauma Intensive Care Unit

검색결과 102건 처리시간 0.032초

Conservative treatment of corpus callosum hemorrhage due to a falling coconut in Indonesia: a case report

  • Hanan Anwar Rusidi;Ferry Wijanarko
    • Journal of Trauma and Injury
    • /
    • 제37권1호
    • /
    • pp.79-82
    • /
    • 2024
  • The potential for traumatic brain injury resulting from falling coconuts is frequently overlooked. These incidents can cause focal lesions in the form of brain hemorrhage. Corpus callosum hemorrhage due to blunt trauma from a falling object is rare and typically associated with poor prognosis. The purpose of this report is to detail a case of corpus callosum hemorrhage caused by a coconut fall and to discuss the conservative management approach employed. We report the case of a 54-year-old woman who was admitted to the hospital with symptoms of unconsciousness, headache, and expressive aphasia after being struck by a falling coconut. Notably, hemorrhage was detected within the body of the corpus callosum, as revealed by imaging findings. The patient received intensive monitoring and treatment in the intensive care unit, including oxygen therapy, saline infusion, an osmotic diuretic, analgesics, and medication to prevent stress ulcers. The patient demonstrated marked clinical improvement while undergoing conservative treatment. Despite the typically unfavorable prognosis of these rare injuries, our patient exhibited meaningful clinical improvement with conservative treatment. Timely diagnosis and appropriate interventions were crucial in managing the patient's condition. This report emphasizes the importance of considering traumatic brain injury caused by falling coconuts and highlights the need for further research and awareness in this area.

외상환자의 한국형 중증도 분류와 손상중증도 점수체계의 비교 (Comparison between Korean Triage and Acuity Scale and Injury Severity Scoring System in Emergency Trauma Patients)

  • 최윤희;김보화;신지은;장명진;이은자
    • 동서간호학연구지
    • /
    • 제28권1호
    • /
    • pp.10-20
    • /
    • 2022
  • Purpose: We compared the Korean Triage and Acuity Scale (KTAS), Injury Severity Score (ISS), and Revised Trauma Score (RTS) determined the validity of KTAS for classifying trauma patients. Methods: A retrospective chart review of 10,865 trauma patients (aged ≥15 years) who visited a single regional trauma and emergency medical center from January 1, 2016, to December 31, 2020, was conducted. Data were collected from the Korean Trauma Data Bank. Based on KTAS classification, the rates of intensive care unit admission, surgery and intervention, transfusion, emergency room (ER) and hospital mortality, and ER stay time were investigated. Data were analyzed using Chi-square test, Pearson's correlation coefficient, receiver operating characteristic curve, and area under the ROC curve. Results: In the KTAS, severe trauma patients (ISS ≥16) were classified as Level 1 (79.6%), 2 (44.8%), 3 (15.5%), 4 (4.0%) and 5 (7.6%). The following were the predictive powers of KTAS, ISS, and RTS for different parameters: surgery and intervention rate, KTAS (.71), ISS (.70), and RTS (.63); transfusion rate within 4h, KTAS (.82), ISS (.82), and RTS (.74); ER stay time within 90 min, KTAS (.72), ISS (.62), and RTS (.56); and ER mortality, KTAS (.84), ISS (.72), and RTS (.88). These findings were statistically significant (p<.001). The sensitivity and specificity of KTAS for trauma patients were .88 (.87~.90), and .38 (.37~.39), respectively. Conclusion: KTAS is a useful classification system that can predict the clinical outcomes of patients with trauma, and effectively triage acutely ill trauma patients, thus provide appropriate treatment.

중증외상팀의 운영 전후 손상환자의 응급실체류시간과 치료결과 비교 (A Comparison of the Effectiveness of Before and After the Trauma Team's Establishment: Treatment Outcomes and Lengths of Stay in the Emergency Department)

  • 권정훈;박창민;박영태
    • Journal of Trauma and Injury
    • /
    • 제24권2호
    • /
    • pp.75-81
    • /
    • 2011
  • Purpose: The aim of this study was to analyze the influence of a trauma team's management. Methods: A total of 181 patients with severe trauma were retrospectively divided into two groups. Of these 181 patients, 81 patients without a trauma team admitted between April and October 2008 were assigned to Group 1, and 100 patients with a Trauma team admitted between April and October 2009 were assigned to Group II. We compared general characteristics, the length of stay in the emergency department (ED) and treatment outcomes (24-h packed RBC transfusion, length of intensive care unit (ICU) stay, length of hospital stay, in-hospital mortality, 24-h mortality) between these two groups. Results: The length of stay in the ED was significantly reduced in Group II compared to Group I ($p$=0.025). No significant differences were found in mean arterial pressure, Glasgow Coma Scale, Revised Trauma Score, Injury Severity Score, in-hospital mortality and 24-h mortality between the two groups. However, Group II had a lower amount of 24-h packed RBC transfusion and a shorter length of ICU and hospital stay than Group I, although these differences were not statistically significant. Conclusion: Through the establishment of a trauma team, the length of stay in the ED can be reduced remarkably. Furthermore, the need for 24-h packed RBC transfusions and the length of stay in the ICU and hospital were found to be decreased in patients managed by a trauma team.

둔상성 간 손상환자의 비수술적 치료 (Nonoperative Management of Blunt Liver Trauma)

  • 백정주;김정일;최승호;최영철;전시열;이준호;황성연
    • Journal of Trauma and Injury
    • /
    • 제18권2호
    • /
    • pp.161-171
    • /
    • 2005
  • Background: The management of hepatic injuries has changed dramatically during the past two decade after the technologic breakthroughs in radiologic imaging techniques. Recently, the non-operative management of blunt hepatic trauma has become the standard of care in hemodynamically stable patients. We reviewed our experience of the non-operative management of blunt hepatic trauma. And the purpose of this study was to examine the prognostic factors and indicators affecting the decision for treatment modality of emergent hepatic trauma. Methods: The medical records of 84 patients who were treated for blunt hepatic injury at Masan Samsung Hospital from January 2002 to December 2003. The patients were divided two groups, non-operative(Non-OP) and operative(OP), according to the treatment modality. The two groups were compares for age, sex, mechanism of injury, grade of liver injury scale, combined injury, systolic blood pressure, pulse rate, hemoglobin, hematocrit, WBC count, S-GOT, S-GPT, ALP, transfusion amount during initial 24 hours, amount of infused crystalloid fluid, length of ICU stay, length of ward care, morbidity and mortality. The grade of the liver injury were determined by using the organ injury scale(OSI). Results: Among the 84 patients, 46 cases(54.8%) were managed non-surgically, and 3 cases of Non-OP group were treated by transarterial embolization. Between the two groups, there were significant difference in age, injury grade, combined injury, hemoglobin, hematocrit, initial systolic blood pressure, amount of infused crystalloid fluid, amount of transfusion during the first 24 hours, and length of ICU care, morbidity and mortality.(p<0.05) The overall mortality rate was 8.3%, but 2.2% mortality in the non-operative group. Conclusion: Non-operative management may be considered as a first choice in hemodynamic stable patients with blunt liver trauma. The reliable indicators affecting the treatment modality of blunt hepatic trauma were systolic BP, Hb, Hct, amount of infused crystalloid fluid, amount of transfusion during the first 24 hours, liver injury grade and combined injury. Strict selection of treatment madality and aggresive monitoring with intensive care unit were more important.

Prognosis of Pulmonary Function in Patients with Multiple Rib Fractures

  • Park, Hee Beom;Hyun, Sung Youl;Kim, Jin Joo;Jang, Yeon Sik
    • Journal of Trauma and Injury
    • /
    • 제30권4호
    • /
    • pp.179-185
    • /
    • 2017
  • Purpose: Rib fracture is the most common complication of blunt thoracic trauma. We investigated the effect of rib fracture on pulmonary function in the conservatively treated patients. Methods: From January 2000 to February 2017, we reviewed the records of 72 patients with rib fracture and pulmonary function tests were performed. According to the number of rib fractures, patients were classified into two groups: less than six fractured ribs (group A) and more than six fractured ribs (group B). The groups were compared concerning demographics, underlying diseases, associated thoracic injuries, surgery, mechanical ventilator times, days spent in the intensive care unit and pulmonary function test. Results: There were no statistically significant differences in the demographic data between the two groups. Mean hospitalization was 13.5 days in group A and 27.0 days in group B (p<0.001). There was no statistically significant difference between the two groups in the pulmonary function test. Conclusions: We conclude that pulmonary function is restored by conservative treatment in patients with rib fractures even if the number of rib fractures increases. In patients with multiple rib fractures, studies comparing open rib fixation and conservative treatment of long term pulmonary function are required.

Usefulness of Shock Index to Predict Outcomes of Trauma Patient: A Retrospective Cohort Study

  • Kim, Myoung Jun;Park, Jung Yun;Kim, Mi Kyoung;Lee, Jae Gil
    • Journal of Trauma and Injury
    • /
    • 제32권1호
    • /
    • pp.17-25
    • /
    • 2019
  • Purpose: We investigated how prehospital, emergency room (ER), and delta shock indices (SI) correlate with outcomes including mortality in patients with polytrauma. Methods: We retrospectively reviewed the medical records of 1,275 patients who visited the emergency department from January 2015 to April 2018. A total of 628 patients were enrolled in the study. Patients were divided into survivor and non-survivor groups, and logistic regression analysis was used to investigate independent risk factors for death. Pearson coefficient analysis and chi-square test were used to examine the significant relationship between SI and clinical progression markers. Results: Of 628 enrolled patients, 608 survived and 27 died. Multivariate logistic regression analysis reveals "age" (p<0.001; OR, 1.068), "pre-hospital SI >0.9" (p<0.001; OR, 11.629), and "delta SI ${\geq}0.3$" (p<0.001; OR, 12.869) as independent risk factors for mortality. Prehospital and ER SIs showed a significant correlation with hospital and intensive care unit length of stay and transfusion amount. Higher prehospital and ER SIs (>0.9) were associated with poor clinical progression. Conclusions: SI and delta SI are significant predictors of mortality in patients with polytrauma. Moreover, both prehospital and ER SIs can be used as predictive markers of clinical progression in these patients.

Blush on Computed Tomography and Transcatheter Arterial Embolization in Pelvic Fracture

  • Gwak, Jihun;Yoon, Yong-Cheol;Lee, Min A;Yu, Byungchul;Jang, Myung Jin;Choi, Kang Kook
    • Journal of Trauma and Injury
    • /
    • 제29권4호
    • /
    • pp.161-166
    • /
    • 2016
  • Purpose: Bleeding is the primary cause of death after severe pelvic fracture. Transcatheter arterial embolization (TAE) is the mainstay of treatment for arterial bleeding. This study aimed to determine the frequency of bleeding by angiography of blush-positive pelvic fractures on computed tomography (CT) images. The bleeding arteries that were involved were investigated by pelvic angiography. Methods: This retrospective cohort study evaluated 83 pelvic fracture patients who were treated in the intensive care unit of the author's trauma center between January 01, 2013 and April 30, 2015. Results: Overall mortality was 9 of 83 patients (10.8%). Blush was observed in 37 patients; blush-positive patients had significantly higher mortality (24.3%) than blush-negative patients (0%). Twenty-four of the 83 patients (28.9%) underwent pelvic angiography. Bleeding was showed in 22 of 24 patients in pelvic angiography. TAE was successfully performed in 21 (95.5%) of the bleeding 22 patients. Angiography was performed in 23 of 37 blush-positive patients, and arterial bleeding was identified in 21 (91.3%). A total 33 bleeding arteries were identified in 22 angiography-positive patients. The most frequent origin of bleeding was internal iliac artery (69.7%) followed by the external iliac artery (18.2%) and lumbar arteries (12.1%). Conclusion: The vascular blush observed in CT scans indicates sites of ongoing bleeding in pelvic angiography. TAE is an excellent therapeutic option for arterial bleeding and has a high success rate with few complications.

Effect of Early Tracheostomy on Clinical Outcomes in Patients with Prolonged Acute Mechanical Ventilation: A Single-Center Study

  • Kang, Yewon;Yoo, Wanho;Kim, Youngwoong;Ahn, Hyo Yeong;Lee, Sang Hee;Lee, Kwangha
    • Tuberculosis and Respiratory Diseases
    • /
    • 제83권2호
    • /
    • pp.167-174
    • /
    • 2020
  • Background: The purpose of this study was to investigate the effect of early tracheostomy on clinical outcomes in patients requiring prolonged acute mechanical ventilation (≥96 hours). Methods: Data from 575 patients (69.4% male; median age, 68 years), hospitalized in the medical intensive care unit (ICU) of a university-affiliated tertiary care hospital March 2008-February 2017, were retrospectively evaluated. Early and late tracheostomy were designated as 2-10 days and >10 days after translaryngeal intubation, respectively. Results: The 90-day cumulative mortality rate was 47.5% (n=273) and 258 patients (44.9%) underwent tracheostomy. In comparison with the late group (n=115), the early group (n=125) had lower 90-day mortality (31.2% vs. 47.8%, p=0.012), shorter stays in hospital and ICU, shorter ventilator length of stay (median, 43 vs. 54; 24 vs. 33; 23 vs. 28 days; all p<0.001), and a higher rate of transfer to secondary care hospitals with post-intensive care settings (67.2% vs. 43.5% p<0.001). Also, the total medical costs of the early group were lower during hospital stays than those of the late group (26,609 vs. 36,973 USD, p<0.001). Conclusion: Early tracheostomy was associated with lower 90-day mortality, shorter ventilator length of stay and shorter lengths of stays in hospital and ICU, as well as lower hospital costs than late tracheostomy.

Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

  • Park, Hyun Oh;Kang, Dong Hoon;Moon, Seong Ho;Yang, Jun Ho;Kim, Sung Hwan;Byun, Joung Hun
    • Journal of Chest Surgery
    • /
    • 제50권5호
    • /
    • pp.346-354
    • /
    • 2017
  • Background: Ventilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. Methods: We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score. Results: Forty-six patients (45.5%) had at least 1 episode of VAP, 10 (21.7%) of whom died in the ICU. Of the 55 (54.5%) patients who did not have pneumonia, 9 (16.4%) died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029). Conclusion: Severe pulmonary contusion (pulmonary lung contusion score 6-12) is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.

소아에서의 흉부외상 (Thoracic Trauma in Children)

  • 구본원;김성완
    • Journal of Chest Surgery
    • /
    • 제30권1호
    • /
    • pp.77-82
    • /
    • 1997
  • 경북대학교병원 흉븐외과엔서는 1995년 8월까지 약 10년간 본과에 입원하여 치료한 60명의 15세이하 소아연령의 흉부외상 환아 60울을 대상으로, 외상의 원인과 양상 및 치료결과 등을 분석하여, 국내에서 발표됐던 전체 연령군에 대한 결과와 비교하여 소아 연령층의 특수성을 파악하는데 중점을 두어 분석해 보았다. 남아가 46명으로 77%를 차지하였고, 평균연령은 9세였다. 50명의 환아가 들상에 기인하였으며, 둔상환아의 60%이상이 교통사고와 관련되어 있었다. 들상의 경우 늑골골절이 52%로 가장 흔하였고, 그 다음이 기흉, 혈흉 등의 순이었다. 특히 둔상환아의 32%가 늑골골절없이 기흉 등 흉곽내 장기 손상이 있었다. 관통상의 경우 10명 모두 남아였으며, 기흉, 혈흉이 가장 흔하였다. 42%의 환아에서 흉 부이외의 동반손상이 있었다. 치료를 위해 가장 흔히 시행한 외과적 처치는흉강삽관술이었으며(45%), 10례에서 개흉술이 필요하였다. 동반손상아 있었던 경우 MISS score와 중환자실 입실기간 사이에는 유의한 상관관계가 있었다(p<0.05). 9명의 환아에서 합병증이 있었으며 폐혈증으로 1명(1.7%)이 사망하였다.

  • PDF