• Title/Summary/Keyword: pressure injury

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Emergency angioembolization performed in a hemodynamically unstable patient with grade V liver injury: The benefit of emergency angioembolization without computed tomography (혈역학적으로 불안정한 grade V 간손상에서 시행한 응급 혈관색전술: 전산화단층 촬영 없이 시행한 응급 혈관색전술의 이점)

  • Kang, Wu Seong;Park, Chan Yong
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.20 no.2
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    • pp.235-239
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    • 2019
  • High-grade liver injury is associated with high morbidity and mortality rates. We report successful emergency angioembolization and early interventional radiology support to manage a high-grade liver injury in a 29-year-old man who presented following a fall during parachute training. Upon arrival, his blood pressure was 80/40 mmHg, and emergency ultrasonography showed a liver injury with perihepatic fluid collection. The patient's blood pressure reduced to 60/40 mmHg, and emergency angiography was performed without computed tomography (CT) (door to puncture time 36 min). After angioembolization, his blood pressure returned to 120/77 mmHg. Subsequent CT revealed no additional bleeding or hollow viscus injury. He was admitted to the Intensive Care Unit and discharged without complications 30 days after admission. In this case, emergency angioembolization (without performing CT) could successfully and safely treat a hemodynamically unstable patient with a high-grade liver injury.

The Clinical Effects of Heating-Conduction Acupuncture Therapy for Anterior Talofibular and Calcaneofibular Ligament Injury Induced by Acute Ankle Sprain (전열침(傳熱鍼)이 급성 족관절 염좌로 인한 전거비·종비 인대 손상에 미치는 임상적 효과)

  • An, Soon-Sun;Heo, Dong-Seok
    • Journal of Korean Medicine Rehabilitation
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    • v.20 no.3
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    • pp.119-129
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    • 2010
  • Objectives : The purpose of this study is to investigate the clinical effects of heating-conduction acupuncture therapy on ligament injury induced by acute ankle sprain. Methods : From september 16, 2008 to April 17, 2010, the 28 outpatients who had admitted to department of oriental rehabilitation medicine, Dae-Jeon oriental Medical hospital, Dae-Jeon university with acute ankle sprain were performed heating-conduction acupuncture therapy on anterior talofibular and calcaneofibular ligament injury. To evaluate the efficiency of heating-conduction acupuncture therapy, pain threshold with pressure algometer and visual analogue scale(VAS) were applied before treatment and after 1st, 2nd treatment. Results : 1. The pain threshold and the VAS score showed statistical significant improvement after 1st treatment on calcaneofibular and anterior talofibular ligament injury. 2. The VAS score after 2nd treatment on calcaneofibular and anterior talofibular ligament injury showed statistical significant improvement compared with that after 1st treatment. 3. The pain threshold after 2nd treatment on calcaneofibular and anterior talofibular ligament injury did not show statistical significant improvement compared with that after 1st treatment. 4. The difference between anterior talofibular and calcaneofibular ligament injury was not statistical significant in pain threshold and VAS score. Conclusions : Heating-conduction acupuncture therapy has clinical effects of pain reduction on patient with calcaneofibular ligament injury as well as anterior talofibular ligament induced by acute ankle sprain.

Protective Roles of Ginseng Saponin in Cardiac Ischemia and Reperfusion Injury

  • Kim, Jong-Hoon
    • Journal of Ginseng Research
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    • v.33 no.4
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    • pp.283-293
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    • 2009
  • Ginsenosides, one of the most well-known traditional herbal medicines, are used frequently in Korea for the treatment of cardiovascular symptoms. The effects of ginseng saponin on ischemia-induced isolated rat heart were investigated through analyses of hemodynamic changes including perfusion pressure, aortic flow, coronary flow, and cardiac output. Isolated rat hearts were perfused and then subjected to 30 min of global ischemia followed by 60 min of reperfusion with modified Kreb's Henseleit solution. Myocardial contractile function was continuously recorded. Ginseng saponin administered before inducing ischemia significantly prevented decreases in perfusion pressure, aortic flow, coronary flow, and cardiac output. The ginseng saponin administered group significantly recovered all of the hemodynamic parameters, except heart rate, after ischemia-reperfusion (I/R) compared with ischemia control. The intracellular calcium ($[Ca^{2+}]_i$) content in rat neonatal cardiomyocytes was quantitatively determined. Administration of ginseng saponin significantly prevented $[Ca^{2+}]_i$ increase that had been induced by simulated I/R in vitro (p<0.01) in a dose-dependent manner, suggesting that the cardioprotection of ginseng saponin is mediated by the inhibition of $[Ca^{2+}]_i$ increase. Overall, we found that the administration of ginseng saponin has cardioprotective effects on the isolated rat heart after I/R injury. These results indicate that ginseng saponin has distinct cardioprotective effects in an I/R-induced rat heart.

Exercise-induced rhabdomyolysis with acute kidney injury complicated by posterior reversible encephalopathy syndrome: a case report

  • Kim, Su Min;Lee, Yoo Jin;Heo, Chang Min;Park, Si Hyung;Park, Kang Min;Ko, Jung Hae;Park, Bong Soo;Kim, Yang Wook
    • Annals of Clinical Neurophysiology
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    • v.24 no.2
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    • pp.93-97
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    • 2022
  • Posterior reversible encephalopathy syndrome (PRES) is a rare condition manifested by inflammation in certain areas of the brain. Rhabdomyolysis with acute kidney injury (AKI) complicated by PRES is rarely reported. A 26-year-old female presented with neurological symptoms, high blood pressure, and AKI. Her symptoms improved with blood pressure control, anticonvulsant drug medications, and renal replacement therapy. This case demonstrates that PRES should be considered in the differential diagnosis of patients who have rhabdomyolysis with AKI accompanied by neurological symptoms, including headaches and convulsions.

Effects of Pyengpaetang Extracts on the Acute Pulmonary Edema induced by Oleic acid in dogs (평폐탕(平肺湯)이 Oleic acid로 유발(誘發)된 가견(家犬)의 급성폐수종(急性肺水腫)에 미치는 영향(影響))

  • Chung, Jae-Woo;Han, Sang-Whan;Choe, Sun-Ho
    • The Journal of Internal Korean Medicine
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    • v.11 no.2
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    • pp.1-15
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    • 1990
  • Certain oriental medication have been shown to be effective in decreasing pulmonary vascular resistance and increasing cardiac output in primary pulmonary artery pressure secondary to pulmonary edema. So oleic acid was administered in 14 dogs in order to induce acute lung injury. And we studied the hemodynamics and blood gas changes of Pyengpaetang(50mg, 100mg) with continuous postive pressure was ventilation in pulmonary edema. The pulmonary edema group, arterial oxygenation was improved after 5 and $10cmH_2O$ PEEP(positive end expiratory pressure), but cardiovascular system was depressed. Blood pressure and cardiac output were decreased, and CVP, MP AP, PCWP were increased. In Pyengpaetang(50mg) group, mean aortic pressure was decreased and PCWP(pulmonary capillary wedge pressure) was decreased remarkably, while there was a significant increase in cardiac output. And there was improvement in $PaO_2$ and $PaCO_2$ without hemodynamic changes after applying 5cm $H_2O$ PEEP, but arterial blood gases$(PaO_2,\;PaCO_2)$ were improved, while cardiovascular effects were depressed after cm $H_2O$ PEEP. In Pyengpaetang(100mg) treated group, there was no significant hemodynamic change. But mean pulmonary arterial pressure was significantly increased, and cardiac output was decreased significantly after applying the more degree of PEEP. And blood gases were not changed significantly after applying the more degree of PEEP. The above results suggest that the effects of Pyengpaetang(50mg) group is superior to those of Pyengpaetang(100mg) group on the effects of hemodynamics and gas exchanges in acute lung injury in dogs. So we can conclude that lower degree PEEP 5cm $H_2O$ is more beneficial in Pyengpaetang(50mg) treated group.

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Effect on Varying the Impact Velocity in the Controlled Cortical Impact Injury Model : Injury Severity and Impact Velocity

  • Ji, Yong-Cheol;Min, Byung-Kook;Park, Seung-Won;Hwang, Sung-Nam;Hong, Hyun-Jong;Suk, Jong-Sik
    • Journal of Korean Neurosurgical Society
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    • v.38 no.1
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    • pp.41-46
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    • 2005
  • Objective : A study of the histopathologic and neurobehavioral correlates of cortical impact injury produced by increasing impact velocity using the controlled cortical impact[CCI] injury model is studied. Methods : Twenty-four Sprague-Dawley rats [$200{\sim}250g$] were given CCI injury using a pneumatically driven piston. Effect of impact velocity on a 3mm deformation was assessed at 2.5m/sec [n=6], 3.0m/sec [n=6], 3.5m/sec [n=6], and no injury [n=6]. After postoperative 24hours the rats were evaluated using several neurobehavioral tests including the rotarod test, beam-balance performance, and postural reflex test. Contusion volume and histopathologic findings were evaluated for each of the impact velocities. Results : On the rota rod test, all the injured rats exhibited a significant difference compared to the sham-operated rats and increased velocity correlated with increased deficit [p<0.001]. Contusion volume increased with increasing impact velocity. For the 2.5, 3.0, and 3.5m/sec groups, injured volumes were $18.8{\pm}2.3mm^3$, $26.8{\pm}3.1mm^3$, and $32.5{\pm}3.5mm^3$, respectively. In addition, neuronal loss in the hippocampal sub-region increased with increasing impact velocity. In the TUNEL staining, all the injured groups exhibited definitely positive cells at pericontusional area. However, there were no significant differences in the number of positive cells among the injured groups. Conclusion : Cortical impact velocity is a critical parameter in producing cortical contusion. Severity of cortical injury is proportional to increasing impact velocity of cortical injury.

Monitoring and Interpretation of Mechanical Ventilator Waveform in the Neuro-Intensive Care Unit (신경계 중환자실에서 기계호흡 그래프 파형 감시와 분석)

  • Park, Jin
    • Journal of Neurocritical Care
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    • v.11 no.2
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    • pp.63-70
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    • 2018
  • Management of mechanical ventilation is essential for patients with neuro-critical illnesses who may also have impairment of airways, lungs, respiratory muscles, and respiratory drive. However, balancing the approach to mechanical ventilation in the intensive care unit (ICU) with the need to prevent additional lung and brain injury, is challenging to intensivists. Lung protective ventilation strategies should be modified and applied to neuro-critically ill patients to maintain normocapnia and proper positive end expiratory pressure in the setting of neurological closed monitoring. Understanding the various parameters and graphic waveforms of the mechanical ventilator can provide information about the respiratory target, including appropriate tidal volume, airway pressure, and synchrony between patient and ventilator, especially in patients with neurological dysfunction due to irregularity of spontaneous respiration. Several types of asynchrony occur during mechanical ventilation, including trigger, flow, and termination asynchrony. This review aims to present the basic interpretation of mechanical ventilator waveforms and utilization of waveforms in various clinical situations in the neuro-ICU.

Characteristics and Outcomes of Trauma Patients via Emergency Medical Services

  • Cho, Dae Hyun;Lee, Jae Gil
    • Journal of Trauma and Injury
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    • v.30 no.4
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    • pp.120-125
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    • 2017
  • Purpose: The aim of this study was to identify clinical outcome and characteristics of trauma patients via emergency medical services (EMS). Methods: Medical records of the trauma patients visiting the emergency department were retrospectively collected and analyzed from January 2015 to June 2016 in the single institution. Of 529 registered patients, 371 patients were transported by - were enrolled. The parameters including age, gender, injury mechanism, Glasgow coma scale on arrival, presence of shock (systemic blood pressure <90 mmHg) on arrival, time to arrival from accident to emergency room (ER), need for emergency procedures such as operation or angioembolization, need for intensive care unit (ICU) admission, injury severity score (ISS), the trauma and injury severity score, revised trauma score (RTS), length of stay, and mortality rate were collected. The SAS version 9.4 (SAS Institute, Cary, NC, USA) was used for the data analysis. Results: Arrival time from the field to the ER was significantly shorter in EMS group. However, overall outcomes including mortalities, length of stay in the ICU and hospital were same between both groups. Age, ISS, RTS, and injury mechanisms were significantly different in both groups. ISS, RTS, and age showed significant influence on mortality statistically (p<0.05). Conclusions: The time to arrival of EMS was fast but had no effect on length of hospital stay, mortality rate. Further research that incorporates pre-hospital factors influence clinical outcomes should be conducted to evaluate the effectiveness of such a system in trauma care of Korea.

Successful TAE after DCS for Active Arterial Bleeding from Blunt Hepatic Injury in a Child: A Case Report

  • Park, Chan Ik;Lee, Sang Bong;Yeo, Kwang Hee;Lee, Seungchan;Park, Sung Jin;Kim, Ho Hyun;Kim, Jae Hun;Kim, Chang Won;Park, Chan Yong
    • Journal of Trauma and Injury
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    • v.29 no.2
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    • pp.47-50
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    • 2016
  • Transcatheter arterial embolization (TAE) for blunt hepatic injury in children is not common and is especially rare after damage control surgery (DCS). We report a successful TAE after DCS on a child for massive bleeding from the left hepatic artery due to a motor vehicle accident. The car (a sport utility vehicle) ran over the chest and abdomen of a 4-year-old boy. On arrival, initial vital signs were as follows: blood pressure, 70/40 mmHg; heart rate, 149/min; temperature, $36.7^{\circ}C$; respiratory rate, 38/min. After resuscitation, computed tomography was done, and a suspicious contrast leakage from a branch of the left hepatic artery and a spleen injury (grade V) were found. TAE was performed successfully after DCS for a liver injury.