• The Korean Journal of Physiology
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• 제29권2호
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• pp.291-299
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• 1995

Lateral giant (LG)-mediated escape response of crayfish is sensitized by natural traumatic events. Such sensitization has previously been shown to be associated with increased transmission between primary afferents and sensory interneurons at the cholinergic synapse of LG escape reflex circuit. In the present study, it was firstly investigated as to whether transmission is also altered at other synapses of the LG-escape reflex circuit by traumatic shock-induced sensitization. Evidence that traumatic shock also directly affects the excitability of lateral giants is now provided by the finding that traumatic shock produces a significant reduction of the time needed for LG to recruit its contralateral homologue, which is defined as commissural delay. Octopamine, a naturally occurring neuromodulator in the crayfish nerve cord, has also been shown to enhance transmission at the cholinergic synapse between primary afferents and sensory interneurons, and has been conjectured to mediate sensitization. Like traumatic shock, $octopamine\;(10^{-5}-5{\times}10^{-4}\;M)$ also enhanced the efficacy of commissural transmission between lateral giants, as indicated by a significant reduction of commissural delay. This effect was blocked by an octopamine antagonist phentolamine, suggesting a specific action of octopamine on the octopamine receptor present on LGs. These observations suggest that both traumatic shocks and octopamine may cause a rather broad alteration in the excitability of the crayfish nervous system that contributes to the sensitization of the LG escape response.

• Journal of Chest Surgery
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• 제56권2호
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• pp.108-116
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• 2023

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has recently gained popularity as an adjunct to resuscitation of patients with traumatic shock. However, the effectiveness of REBOA is still debated because of inconsistent indications across centers and the lack of medical records. The purpose of this study was to investigate the effectiveness and feasibility of REBOA by analyzing clinical results from a single center. Methods: This study included 96 patients who underwent REBOA between August 2016 and September 2021 at a regional trauma center according to the center's treatment algorithm for traumatic shock. Medical records, including the time of the decision to conduct the REBOA procedure, time of operation, type of aortic occlusion, and clinical outcomes, were collected prospectively and analyzed retrospectively. Patients were classified by REBOA protocol (group 1, 2, or 3) and survival status (survivor or non-survivor) for analysis. Results: The overall success rate of the procedure was 97.9%, and the survival rate was 32.6%. In survivors, blood pressure was higher than in non-survivors both before the REBOA procedure (p=0.002) and after aortic occlusion (p=0.03). The total aortic occlusion time was significantly shorter (p=0.001) and the proportion of partial aortic occlusion was significantly higher (p=0.014) among the survivors. The non-survivors had more acidosis (p<0.001) and higher lactate concentrations (p<0.001) than the survivors. Conclusion: REBOA may be a feasible bridge therapy for resuscitation of patients with traumatic shock. Prompt and accurate decision-making to perform REBOA followed by damage control surgery could improve survival rates and clinical outcomes.

• Clinical Pain
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• 제19권1호
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• pp.28-31
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• 2020

The incidence of heterotopic ossification (HO) was reported to be higher in combat-injured patients than in civilian trauma patients. HO is often considered a possible cause of residual limbs pain in amputee. Here, we report the case of a 21-year-old male, who underwent a traumatic right transfemoral and left transtibial amputation with two segments of painful HO around his left amputation site. We report the effect of extracorporeal shock wave therapy (ESWT) on size and pain associated with HO. After ESWT, the visual analog scale score decreased from 5~6 to 0~1 and the size of two masses decreased from 13.1 × 6.7 mm and 12.5 mm to 11.9 × 4.7 mm and 12.2 mm, respectively. To the best of our knowledge, this is the first case that has reported on the treatment of HO using ESWT for a traumatic transtibial amputation patient. The case suggests that ESWT could serve as a complementary treatment for HO in traumatic amputation patient.

• Journal of Chest Surgery
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• 제26권10호
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• pp.791-797
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• 1993

We evaluated forty cases of traumatic diaphragmatic ruptures that we have experienced from Mar. 1976 to Mar. 1992. Thirty patients were male and 10 were female[M:F=3:1]. The age distribution was ranged from 2 to 76 years with the mean age of 35 years. The traumatic diaphragmatic ruptures were due to blunt trauma in 26 cases[traffic accident 20, fall down 4, others 2] and penetrating trauma in 14 cases[stab wound 13, gun shot 1]. In the blunt trauma, 21 of 26 cases were diagnosed within 24 hours after injury and all cases except one in penetrating trauma were diagnosed within 24 hours. In the blunt trauma, the rupture site was located in the left in 20 cases and in the right in 6 cases. In the penetrating trauma, the rupture site was located in the left in 10 cases and in the right in 4 cases. The repair of 40 cases were performed with thoracic approach in 19 cases, thoracoabdominal approach in 17 cases and abdominal approach in 4 cases. The postoperative mortality was 7.5 %[3/40]. The causes of death were septic shock[1], acute renal failure[1] and hypovolemic shock[1].

• 한국산학기술학회논문지
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• 제14권8호
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• pp.3815-3823
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• 2013

본 연구는 소방공무원들의 지각한 현장출동 충격 경험과 외상 후 스트레스가 신체증상 및 대처방식에 미치는 영향을 규명하기 위하여 강원도 소재 소방안전센터에 근무하고 있는 소방공무원 남녀 362명을 대상으로 조사하였다. 수집된 자료는 Windows용 SPSS 19.0과 AMOS 19.0을 사용하여 빈도분석, 타당도와 신뢰도 분석을 위한 요인분석과 Cronbach's ${\alpha}$ 분석, 기술통계와 상관관계를 실시하였고, 가설 검정을 위해 구조방정식 모형을 이용한 분석을 실시하였다. 모든 통계분석은 유의수준은 p<.05로 설정하였다. 결과는 다음과 같다. 첫째, 지각한 현장출동 충격 경험은 외상 후 스트레스에 영향을 미치는 것으로 나타났다. 둘째, 지각한 현장출동 충격 경험이 신체증상에 영향을 미치는 것으로 나타났다. 셋째, 지각한 현장출동 충격 경험은 대처방식에 영향을 미치는 것으로 나타났다. 넷째, 외상 후 스트레스는 신체증상에 영향을 미치는 것으로 나타났다. 다섯째, 외상 후 스트레스는 대처방식에 영향을 미치는 것으로 나타났다. 여섯째, 신체증상은 대처방식에 영향을 미치는 것으로 나타났다. 이러한 결론으로 볼 때 충격적 스트레스를 해소하기 위한 제도적 방안으로 전 세계적으로 검증이 되어 실제 운영되고 있는 위기상항 스트레스 해소법(Critical Incident Stress Debriefing : CISD)을 소방서의 실정에 맞게 도입하여 운영하는 것이 필요할 것이다.

• Journal of Trauma and Injury
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• 제34권2호
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• pp.119-125
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• 2021

Purpose: The present study aimed to analyze the effect of trauma-related shock on myocardial function in the early stages of trauma through transthoracic echocardiography (TTE) findings. Methods: We performed a retrospective review and analysis of the medical records of patients aged ≥18 years who were evaluated by TTE within 2 days of admission for trauma-related shock (n=72). Patients were selected from a group of 739 patients admitted with trauma-related shock between January 2014 and December 2016. Results: The incidence rate of myocardial dysfunction in the left ventricle (LV) was 6.8% (5/72), with rates of 7.7% (4/52) in the thoracic injury group and 5.0% (1/20) in the non-thoracic injury group. In the diastolic function of LV, relaxation abnormality was present in 55.8% (29/52) of patients in the thoracic injury group and 50% (10/20) of patients in the non-thoracic injury group. Conclusions: This study may suggest that traumatic shock without thoracic injury may influence myocardial function in the early stages after trauma. Therefore, evaluation of myocardial function may be needed for patients experiencing shock after trauma, regardless of the presence of thoracic injury.

• Journal of Trauma and Injury
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• 제33권1호
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• pp.1-12
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• 2020

Purpose: Despite recent developments in the management of trauma patients in South Korea, a standardized system and guideline for trauma treatment are absent. Methods: Five guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II instrument. Results: Restrictive volume replacement must be used for patients experiencing shock from trauma until hemostasis is achieved (1B). The target systolic pressure for fluid resuscitation should be 80-90 mmHg in hypovolemic shock patients (1C). For patients with head trauma, the target pressure for fluid resuscitation should be 100-110 mmHg (2C). Isotonic crystalloid fluid is recommended for initially treating traumatic hypovolemic shock patients (1A). Hypothermia should be prevented in patients with severe trauma, and if hypothermia occurs, the body temperature should be increased without delay (1B). Acidemia must be corrected with an appropriate means of treatment for hypovolemic trauma patients (1B). When a large amount of transfusion is required for trauma patients in hypovolemic shock, a massive transfusion protocol (MTP) should be used (1B). The decision to implement MTP should be made based on hemodynamic status and initial responses to fluid resuscitation, not only the patient's initial condition (1B). The ratio of plasma to red blood cell concentration should be at least 1:2 for trauma patients requiring massive transfusion (1B). When a trauma patient is in life-threatening hypovolemic shock, vasopressors can be administered in addition to fluids and blood products (1B). Early administration of tranexamic acid is recommended in trauma patients who are actively bleeding or at high risk of hemorrhage (1B). For hypovolemic patients with coagulopathy non-responsive to primary therapy, the use of fibrinogen concentrate, cryoprecipitate, or recombinant factor VIIa can be considered (2C). Conclusions: This research presents Korea's first clinical practice guideline for patients with traumatic shock. This guideline will be revised with updated research every 5 years.

• 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.

• 한국산학기술학회논문지
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• 제14권5호
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• pp.2225-2233
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• 2013

본 연구는 외상후스트레스 고위험군이 많이 분포된 구조대원에 대한 사건충격정도를 파악하고, 사건충격정도에 영향을 미치는 관련 요인을 분석하였다. 연구대상은 화재 및 구조출동 빈도가 높은 서울소방재난본부 소속 구조대원 415명을 통계분석 자료로 활용하였으며, 사건충격정도에 대한 신뢰도는 .975로 높게 나타났다. 분석결과 첫째, 사건충격정도의 하위요인으로 침습이 가장 높았고, 회피, 수면장애 및 정서적마비, 해리증상, 과각성 순으로 사건충격정도가 높게 나타났다. 둘째, 기혼자와 연령이 높을수록 사건충격정도가 높았으며, 셋째, 소방공무원으로서 근무연수와 구조대원 직무를 수행한 기간이 길고, 출동횟수와 사고현장 경험빈도가 높을수록 충격정도가 높게 나타났다. 특히 스트레스 해소 방법 중 음주로 해소하는 구조대원의 사건충격정도가 높게 나타나, 고위험군에 대한 체계적인 관리와 사건충격을 경험하였을 때 즉시 대처할 수 있는 예방케어프로그램 도입이 시급한 것으로 나타났다.

• The Journal of Korean Physical Therapy
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• 제16권2호
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• pp.90-98
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• 2004

Traumatic brain injury is an insult to the brain caused by an external physical force, that may product a diminished or altered state of consciousness, which results in impairment of cognitive abilities or physical function. The purposes of this study were to overview injury mechanism and neural plasticity of traumatic brain injury. Injury mecanism includes exitotoxicity, production free radical, inflammation and apoptosis. Furthermore traumatic brain injury has protective mechanisms includes production of neural growth factor, heat shock protein, anti-inflammatory cytokines.