• Journal of Chest Surgery
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• 제28권12호
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• pp.1160-1166
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• 1995

From 1980 through 1993, sixty one patients having traumatic flail chest were analysised retrospectively at the Department of Thoracic and Cardivascular Surgery, Chonbuk National University Hospital. There were 47 men and 14 women, mean age, 49.3 years, age range 4 to 82 years. The most common mode of trauma was automobile accident, common combined other organ injuries were skeletal injury [ 36 patients and neurologic injury [ 20 patients . In the mode of treatment, ventilator therapy was done in 34 cases and operative stabilization was done in 18 cases [ Kirschner or steel wire: 9 cases, Judet`s strut: 9 cases . Sixteen patients died [26 % . The main factors associated with fatal outcome were shock [ p < 0.002 , head injury [ p < 0.005 , and more than 50 years of age [ p < 0.05 . In fatal cases, 14 patients died during in ventilator therapy [ 14/34, 41 % and 2 patients died following operative stabilization of chest wall [ 2/18, 11 % .The overall cause of death was septicemia, ARDS, ARF, hypovolemic shock and hypoxic brain damage.

• Journal of Chest Surgery
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• 제54권5호
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• pp.419-421
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• 2021

Fracture of prosthetic valve leaflets in the absence of traumatic injury is very rare. Leaflet fracture can cause acute pulmonary edema and cardiogenic shock and is potentially life-threatening, requiring emergency surgery. Thus, a leaflet fracture must be diagnosed quickly and accurately. We present the case of a 46-year-old man with CarboMedics prosthetic aortic and mitral valve replacements implanted 24 years previously. The patient presented at our emergency department with abrupt dyspnea and fever. We diagnosed severe mitral valve regurgitation with anterior leaflet fracture. The patient underwent venoarterial extracorporeal membrane oxygenation and delayed mitral valve replacement. The foreign body was removed step by step because the diagnosis was missed. Two pieces of broken leaflets were found in the left common iliac artery and left external iliac artery. The patient was treated successfully and remains asymptomatic 1 year following surgery.

• Journal of Chest Surgery
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• 제46권3호
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• pp.197-201
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• 2013

Background: Most traumatic tracheobronchial injuries are fatal and result in death. Some milder cases are not life threatening and are often missed at the initial presentation. Tracheobronchial rupture is difficult to diagnose in the evaluation of severe multiple trauma patients. We reviewed the traumatic tracheobronchial injuries at Konyang University and Eulji University Hospital and analyzed the clinical results. Materials and Methods: From January 2001 to December 2011, 23 consecutive cases of traumatic tracheobronchial injury after blunt trauma were reviewed retrospectively. We divided them into two groups by the time to diagnosis: group I was defined as the patients who were diagnosed within 48 hours from trauma and group II was the patients who diagnosed 48 hours after trauma. We compared the clinical parameters of the two groups. Results: There was no difference in the age and gender between the two groups. The most common cause was traffic accidents (56.5%). The Injury Severity Score (ISS) was 19.6 in group I and 27.5 in group II (p=0.06), respectively. Although the difference in the ISS was not statistically significant, group II tended toward more severe injuries than group I. Computed tomography was performed in 22 cases and tracheobronchial injury was diagnosed in 5 in group I and 6 in group II, respectively (p=0.09). Eighteen patients underwent surgical treatment and all four cases of lung resection were exclusively performed in group II (p=0.03). There were two mortality cases, and the cause of death was shock and sepsis. Conclusion: We believe that close clinical observation with suspicion and rigorous bronchoscopic evaluation are necessary to perform diagnosis earlier and preserve lung parenchyma in tracheobronchial injuries from blunt trauma.

• Journal of Trauma and Injury
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• 제21권2호
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• pp.100-107
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• 2008

Purpose: A traumatic lung cyst (TLC) is a rare complication and is usually detected with a pulmonary contusion. This study attempted to identify the prognostic factors and the clinical characteristics for pulmonary contusion with TLCs. Methods: We retrospectively reviewed the medical records and chest CT findings of 71 TLC patients who visited our hospital from January 2006 to December 2007. Patients were assessed for any clinical characteristics. We evaluated significant differences between the survival and the death groups for patients with a traumatic lung cyst. Results: The male-to-female ratio of patients with TLCs was 54:17, and the mean age of the patients was $37.70{\pm}19.78years$ with 36.6% of the patients being under 30 years fo age. The cause of blunt thoracic trauma was mainly pedestrian traffic accidents (26.8%) and falls (25.4%). Associated conditions included pulmonary contusion in 68 patients (95.7%), hemopneumothorax in 63 patients (88.7%), and rib fracture in 52 patitents (73.2%). There was no consistent relationship between the number of TLCs and the pulmonary contusion score. The overall mortality rate of TLC patients was 26.8%. Death correlated with a need for ventilatory assistance, mean arterial pressure, worst mean arterial pressure in 24 hours, initial pH and base excess, worst pH and base excess in 24 hours, refractory shock, initial GCS score, and pulmonary contusion score. Conclusion: The presence of the aforementioned predictors indicate serious injury, which is the main determinant of the outcome for thoracic injuries with TLCs.

• 문화기술의 융합
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• 제9권5호
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• pp.385-390
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• 2023

본 연구는 소방공무원의 스트레스에 대한 심리적 응급처치 필요성을 연구하는데 목적이 있다. 연구 문제를 해결하기 위해 10명의 구급대원을 대상으로 1:1 심층 인터뷰를 통해 구급대원의 근무환경, 외상 후 스트레스 경험, 심리적 응급처치 경험 등을 분석하여 소방관의 정신건강 향상을 위한 심리적 응급처치의 필요성에 대한 정책을 다음과 같이 제안하였다. 첫째, 소방공무원을 현장에 배치해 외상 후 스트레스와 그로 인한 신체 증상을 미리 교육한 뒤 외상 사건에 노출될 필요가 있다. 둘째, 소방공무원은 외상환자에 노출된 후 적절한 시기에 심리적 응급처치를 해야 한다. 셋째, 정신건강 업무를 전문적으로 수행할 인력과 제도적 장치의 보완이 필요하다. 넷째, 소방공무원에 적합한 맞춤형 전문의료서비스와 심리지원을 위해서는 소방복합치유센터와 국립 소방병원의 연계가 필요하다.

• Journal of Trauma and Injury
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• 제33권1호
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• pp.23-30
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• 2020

Purpose: Hemorrhagic shock is the leading cause of death in trauma patients worldwide. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique used to improve the hemodynamic stability of patients with traumatic shock and to temporarily control arterial hemorrhage. However, further research is required to determine whether REBOA with cardiopulmonary resuscitation (CPR) in near-arrest or arrest trauma patients can help resuscitation. We analyzed trauma patients who underwent REBOA according to their CPR status and evaluated the effects of REBOA in arrest situations. Methods: This study was a retrospective single-regional trauma center study conducted at a tertiary medical institution from February 2017 to November 2019. We evaluated the mortality of severely injured patients who underwent REBOA and analyzed the factors that influenced the outcome. Patients were divided into CPR and non-CPR groups. Results: We reviewed 1,596 trauma patients with shock, of whom 23 patients underwent REBOA (1.4%). Two patients were excluded due to failure and a repeated attempt of REBOA. The Glasgow Coma Scale score was lower in the CPR group than in the non-CPR group (p=0.009). Blood pressure readings at the emergency room were lower in the CPR group than in the non-CPR group, including systolic blood pressure (p=0.012), diastolic blood pressure (p=0.002), and mean arterial pressure (p=0.008). In addition, the mortality rate was higher in the CPR group (100%) than in the non-CPR group (50%) (p=0.012). The overall mortality rate was 76.2%. Conclusions: Our study suggests that if REBOA is deemed necessary in a timely manner, it is better to perform REBOA before an arrest occurs. Therefore, appropriate protocols, including pre-hospital REBOA, should be constructed to demonstrate the effectiveness of REBOA in reducing mortality in arrest or impending arrest patients.

• Journal of Chest Surgery
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• 제48권4호
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• pp.281-284
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• 2015

We present the case of a 38-year-old woman admitted to our outpatient clinic with accelerating back pain and fatigue following a kick to her back by her husband. Upon arrival, we detected ST segment elevation in the D1, aVL, and V2 leads and accelerated idioventricular rhythm. She had pallor and hypotension consistent with cardiogenic shock. We immediately performed coronary angiography and found a long dissection starting from the mid-left main coronary artery and progressing into the mid-left anterior descending (LAD) and circumflex arteries. She was then transferred to the operating room for surgery. A saphenous vein was grafted to the distal LAD. Since the patient was hypotensive under noradrenaline and dopamine infusions, she was transferred to the cardiovascular surgery intensive care unit on an extracorporeal membrane oxygenator and intra-aortic balloon pump. During follow-up, her blood pressure remained low, at approximately 60/40 mmHg, despite aggressive inotropic and mechanical support. On the second postoperative day, asystole and cardiovascular arrest quickly developed, and despite aggressive cardiopulmonary resuscitation, she died.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.281-285
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• 2023

Traumatic uterine rupture is uncommon but can be fatal and life-threatening for both the mother and infant. In addition to complications caused by trauma itself, such as pelvic fracture, gestational complications such as placental abruption, abortion, premature labor, rupture of membranes, maternal death, and stillbirth can occur. In particular, fetuses have been reported to have a high mortality rate in cases of traumatic uterine rupture. A 35-year-old pregnant female patient fell from the fourth floor and was admitted to our trauma center. We observed large hemoperitoneum, pelvic fractures, and spleen laceration, and the fetus was presumed to be located outside the uterus. The pregnant woman was hemodynamically unstable. Although the fetus was stillborn, angioembolization and surgical treatment were properly performed through collaboration with an interventional radiologist, obstetrician, and trauma surgeons. After two orthopedic operations, the patient was discharged after 34 days. This case report suggests the importance of a multidisciplinary approach in the treatment of pregnant trauma patients.

• 디지털콘텐츠학회 논문지
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• 제19권4호
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• pp.673-683
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• 2018

세월호 사건은 재난의 일반적인 피해 수준을 넘어 온 국민들에게 정신적 충격을 준 참사이다. 이 연구는 세월호 사건과 관련한 미디어 이용으로 대리된(vicarious) 재난 경험과 이용자의 외상 후 스트레스 장애(post-traumatic stress disorder: PTSD) 간의 연관성을 탐색하는 데 목적이 있다. 이를 위해 세월호 사건 발생 직후인 2014년 4월 28일부터 12일 동안 수도권 소재 종합대학과 중고등학교 학생 417명을 대상으로 수집한 답변 자료를 분석한 결과, 세월호 사태 기간 중에 주요 재난 사건 뉴스정보를 접하는 채널이 소셜 미디어인 경우 신문이나 TV방송보다 더 높은 수준의 외상을 나타냈다. 또한 재난 사건 뉴스정보와 소셜 미디어 이용량이 많을수록 PTSD와 정적인 인과관계를 나타냈다. 본 연구 결과는 재난 사건에 대한 미디어 매개 심리적 외상 문제의 작동기제와 경험적 결과를 제시하며 후속 연구를 촉발한다는 데 의의가 있다.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.207-213
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• 2013

Purpose: Traumatic pancreas injuries are rare conditions that result in high morbidity and mortality. Thus, early diagnosis and intervention are very important to manage pancreatic injuries. The purpose of this study is to review the management and outcomes of the pancreatic injuries in the Korean population. Methods: Original articles published from January 2001 to December 2012 and addressing the Korean population were selected by using indices such as 'pancreas injury', 'traumatic pancreas injury', and 'pancreatic trauma' to search KoreaMed and PubMed. Nine reports were selected to review the management options for surgery or endoscopic retrograde cholangio-pancreatography. We assessed the injury mechanisms, injury severities, associated injuries, types of operation, and outcomes. Results: Two hundred fifty of the 332 patients included in the 9 selected reports were men, and the mean age of all patients was 36.4 years. The main injury mechanism was traffic accidents(65.6%). Most patients had grade II or III injuries(68.9%). The most common extra-pancreatic injury site was the liver, followed by the chest and spleen. Operative management, including distal pancreatectomies(129), drainage procedures(64), pancreaticoduodenectomies(23), and others(60), was used for 276 patients. The reported mortality rate was 10.2%, and the morbidity rate ranged from 38% to 76.9%. The average length of hospital stay was 39.5 days. Risk factors for mortality were amount of transfusion, injury severity, base deficit, age, and presence of shock. Conclusion: In this study, we found neither significant data nor a consensus. If national guidelines are to be developed and established, a national data bank or registry, and nationwide data collection are required.