• Journal of Trauma and Injury
• /
• v.37 no.2
• /
• pp.147-150
• /
• 2024

This case report describes the management of a 51-year-old female patient who arrived at the emergency room with a stab wound to the upper right chest. Immediate medical interventions were undertaken, including blood transfusions and endotracheal intubation. To prevent tension and control bleeding, gauze packing was applied directly through the large open wound. Further surgical exploration identified a laceration in the lung, necessitating a right upper lobe resection. Postoperatively, the patient's vital signs stabilized, and she was subsequently discharged without complications. This case highlights the decision-making process in selecting between an emergency department thoracotomy and an operating room thoracotomy for patients with penetrating chest trauma. It also illustrates the role of gauze packing in managing tension and hemorrhage. In summary, gauze packing can be an effective interim measure for stabilizing patients with traumatic injuries, unstable vital signs, and large open chest wounds, particularly when a chest tube is already in place, to prevent tension and facilitate bleeding control prior to surgical intervention.

• Clinical and Experimental Pediatrics
• /
• v.56 no.4
• /
• pp.186-190
• /
• 2013

Lung torsion is a very rare event that has been reported in only 9 cases in the pediatric literature but has not yet been reported in Korean infants. We present a case of lung torsion after tracheoesophageal fistula repair in an infant. Bloody secretion from the endotracheal tube and chest radiographs and computed tomographic scan results indicated lung torsion. Emergency exploration indicated $180^{\circ}$ torsion of the right upper lobe (RUL) and right middle lobe (RML). After detorsion of both lobes, some improvement in the RUL color was observed, but the color change in the RML could not be determined. Although viability of the RML could not be proven, pexy was performed for both the lobes. Despite reoperation, clinical signs and symptoms did not improve. The bronchoscopy revealed a patent airway in the RUL but not in the RML. Finally, the RML was surgically removed. The patient was discharged on the 42nd day after birth.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.17 no.4
• /
• pp.313-316
• /
• 2017

Mask ventilation, the first step in airway management, is a rescue technique when endotracheal intubation fails. Therefore, ordinary airway management for the induction of general anesthesia cannot be conducted in the situation of difficult mask ventilation (DMV). Here, we report a case of awake intubation in a patient with a huge orocutaneous fistula. A 58-year-old woman was scheduled to undergo a wide excision, reconstruction with a reconstruction plate, and supraomohyoid neck dissection on the left side and an anterolateral thigh flap due to a huge orocutaneous fistula that occurred after a previous mandibulectomy and flap surgery. During induction, DMV was predicted, and we planned an awake intubation. The patient was sedated with dexmedetomidine and remifentanil. She was intubated with a nasotracheal tube using a video laryngoscope, and spontaneous ventilation was maintained. This case demonstrates that awake intubation using a video laryngoscope can be as good as a fiberoptic scope.

• Korean Journal of Adult Nursing
• /
• v.21 no.5
• /
• pp.538-546
• /
• 2009

Purpose: The purpose of this study was to identify the effects of cuff pressure on postoperative sore throat. Methods: Data were collected from January 4 through May 15, 2008. Among the 60 patients, 30 patients were randomly assigned to the control group and the rest to the experimental group. Initial cuff pressure of both groups was set at 20 $cmH_2O$. The experimental group was maintained at 20 $cmH_2O$ throughout the anesthesia, while the control group was not regulated further. Sore throat was assessed at postoperative 1, 24 and 72 hours. Data were analyzed using Mann-Whitney test and Spearman's rho coefficients. Results: Cuff pressure in control group increased from 20 to 43 $cmH_2O$ within 3 hours after induction. However, the experimental group showed that there was apparently a reduced rate of sore throat at postoperative 24 hours (p = .048), and 72 hours (p = .002) than in the control group. However, no outstanding differences between both groups at postoperative 1 hour (p = .081) were detected. The correlation between cuff pressure and sore throat was statistically significant ($r_s$ = .590, p < .001). Conclusion: We conclude that maintaining cuff pressure at 20 $cmH_2O$ could be an effective means to reduce sore throat in surgical patients with inhalation anesthesia.

• Journal of Korean Critical Care Nursing
• /
• v.2 no.2
• /
• pp.42-55
• /
• 2009

Purpose: Despite numerous evidence based preventive strategies of ventilator associated pneumonia (VAP) have been introduced, the incidence rate of VAP continues in an unacceptable range. The purposes of this review were to identify risk factors and diagnosis of VAP and to introduce current evidence based preventive strategies of VAP. Methods: A comprehensive literature search using keywords, including ventilator associated pneumonia were entered into a search engine. A number of highly pertinent papers relevant to the purpose of the review were identified. The papers that discussed specific preventive strategies of VAP were selected for analysis and inclusion in this review. Results: A number of evidence based preventive strategies that nurses can implement in their clinical practice to prevent VAP were identified. Such strategies include hand washing, use of protective gloves and gowns, oral care, stress ulcer prophylaxis, avoidance of unnecessary intubation, weaning protocol, sedation vacation, use of non-invasive ventilation, semi-recumbent position, continuous aspiration of subglottic secretions, and maintenance of proper endotracheal tube cuff pressure. Staff education is essential in preventing VAP. Conclusion: Preventive strategies of VAP should be applied to daily nursing care and each critical nurse should play a functional role in preventing VAP.

• Journal of Veterinary Clinics
• /
• v.19 no.2
• /
• pp.199-203
• /
• 2002

Cardiovascular effects of propofol, were assessed after premedication with xylazine(1.0 mUkg, IM) under oxygen supply(200 ml/kg/min) via a endotracheal tube. Twelve adult mixed-breed dogs were divided into four groups; 0.2(Group 1), 0.4(Group 2), 0.6(Group 3) and 0.8 mg/kg/min(Group 4) of propofol respectively. Arterial blood pressure and electrocardiogram were monitored with a physiograph after an arterial catheter was inserted into the femoral artery. pH, arterial carbon dioxide tension($PaCO_2$and arterial oxygen tension($PaO_2$) were evaluated with arterial blood collected through the inserted catheter. Diastolic arterial pressure, systolic arterial pressure and mean arterial pressure were decreased slightly in Group I IIand III, but decreased significantly in Group IV. They were increased rapidly after stopping propofol infusion in Group IV pH was maintained in normal range in Group I, II and m, but was decreased in proportion to time passing in Group IV. $PaCO_2$ was increased significantly only in Group IV but $PaO_2$ was maintained in normal range in all groups Although heart rate was recorded in normal range for 90 minutes, arythmia was noted after stopping propofol infusion in all groups. It was concluded that propofol depressed the cardiovascular system in proportion to infusion dosage, and 0.8 mg/kg/min of propofol infusion rate was not appropriated in canine anesthesia with xylazine premedication.

• Journal of Chest Surgery
• /
• v.40 no.9
• /
• pp.651-654
• /
• 2007

Tracheoinnominate artery fistula (TIF) is a very rare complication that can happen after long standing tracheostomy or insertion of an endotracheal tube and its mortality is very high. This condition requires early diagnosis and urgent management because of the life threatening results from tracheal obstruction or hypovolemic shock that is caused by massive bleeding. We report here on a case of successful tracheoplasty with using the costal cartilage, including the perichondrium, in a patient with laryngeal stricture, and this was done to preserve the trachea for the following operation to relieve the laryngeal stricture.

• Korean Journal of Head & Neck Oncology
• /
• v.34 no.2
• /
• pp.77-80
• /
• 2018

Subglottic cysts have been reported as a relatively rare problem of pediatrics who have a history of premature birth and period of intubation. They may cause significant upper airway obstruction and many cases require tracheostomy to airway management. Endoscopic marsupialization by microinstruments or laser has been standard primary treatment but a high recurrence rate has been reported. A 19-month-old child presented with stridor who has history of ventilation via an endotracheal intubation in the newborn period for 7 days. Radiologic examinations were performed for aggravated dyspnea symptom and subglottic cystic mass was found, then it was marsupialized at operation room and tracheostomy was done at the same time. After decannulation of tracheostomy tube, there is no recurrence of cyst nor upper airway obstruction for 29 months. We report this case with a review of literature.

• Archives of Plastic Surgery
• /
• v.43 no.6
• /
• pp.506-511
• /
• 2016

Background The indications for surgical airway management in patients with Robin sequence (RS) and severe airway obstruction have not been well defined. While certain patients with RS clearly require surgical airway intervention and other patients just as clearly can be managed with conservative measures alone, a significant proportion of patients with RS present with a more confusing and ambiguous clinical course. The purpose of this study was to describe the clinical features and objective findings of patients with RS whose airways were successfully managed without surgical intervention. Methods The authors retrospectively reviewed the medical charts of infants with RS evaluated for potential surgical airway management between 1994 and 2014. Patients who were successfully managed without surgical intervention were included. Patient demographics, nutritional and respiratory status, laboratory values, and polysomnography (PSG) findings were recorded. Results Thirty-two infants met the inclusion criteria. The average hospital stay was 16.8 days (range, 5-70 days). Oxygen desaturation (<70% by pulse oximetry) occurred in the majority of patients and was managed with temporary oxygen supplementation by nasal cannula (59%) or endotracheal intubation (31%). Seventy-five percent of patients required a temporary nasogastric tube for nutritional support, and a gastrostomy tube placed was placed in 9%. All patients continued to gain weight following the implementation of these conservative measures. PSG data (n=26) demonstrated mild to moderate obstruction, a mean apneahypopnea index (AHI) of $19.2{\pm}5.3events/hour$, and an oxygen saturation level <90% during only 4% of the total sleep time. Conclusions Nonsurgical airway management was successful in patients who demonstrated consistent weight gain and mild to moderate obstruction on PSG, with a mean AHI of <20 events/hour.

• Journal of Chest Surgery
• /
• v.8 no.1
• /
• pp.37-44
• /
• 1975

Authors have reviewed the records of seven patients of multiple rib fractures with severe flail chest who were admitted to Hanyang University Hospital during the 3 years period from 1972 through 1975. Of the seven patients studied, automobile accidents led to the injuries in 4 cases, two patients were injured in fall from a tree and on the ox-heading. All who had a blunt trauma without any open wound on the chest. The numbers of the fractured ribs accounted for 6 to 9 of the ribs including double fractures from 3 to 5 ribs. The left side fractures occurred in the 6 patients and in the right only one patient. Thus the flail segment was more often located in the left antero-lateral position than in the right lateral position [the ratio was 6:1].. All cases had associated injuries. The injuries and multiple fractures were the most common associated injuries occurring in four and five of the patients respectively. The patients were classified as having associated head injuries when they were admitted in comatose or semicomatose state. When a major degree of instability of the thoracic cage exists, adequate respiratory change is not possible. For this reason the tracheostomy was performed in five patients in an acutely injured patient with flail chest only after an endotracheal tube has been inserted or after an endotracheal suction. All patients had secondary complications in the pleural cavity, such as hemothorax or hemopneumothorax with or without intrapulmonary hemorrhage and subcutaneous emphysema. Therefore, closed thoracostomy was performed in five patients in the emergency room. The thoracotomy was required in four patients: immediate operation without closed thoracostomy was performed in two patients and the thoracotomy was indicated in two patients after closed thoracostomy, because of increasing intrathoracic hemorrhage. As to the fixation of the flail segments, authors employed two techniques; one was towel clip traction of the flail segments and the other was intramedullary insertion of Kirschner`s wire in to the double fractured rib fragments for the fixation of the flail segments [Kirschner`s wire fixation]. Because` of an different results in the course of treatment between two techniques, data from patients with towel clip traction was compared with those from patients with thoracotomy and Kirschner`s wire fixation of the flail segments. Of the three patients with towel clip traction, two patients required bronchoscopic toilet due to lung atelectasis which developed because of inadequate motion of thoracic cage and poor expectoration. This was in contrast to the four patients with thoracotomy and Kirschner`s wire fixation, who didn`t these complication because of adequate motion of the thoracic cage and subsequent good expectoration.