• Journal of Trauma and Injury
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• v.24 no.1
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• pp.12-17
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• 2011

Purpose: A rib fracture secondary to blunt thoracic trauma continues to be an important injury with significant complications. Unfortunately, there are no definite treatment guidelines for severe multiple rib fractures. The purpose of this study was to evaluate the result of early operative stabilization and to find the risk factors of surgical fixation in patients with bilateral multiple rib fractures or flail segments. Methods: From December 2005 to December 2008, the medical records of all patients who underwent operative stabilization of ribs for severe multiple rib fractures were reviewed. We investigated patients' demographics, preoperative comorbidities, underlying lung disease, chest trauma, other associated injuries, number of surgical rib fixation, combined operations, perioperative ventilator support, and postoperative complications to find the factors affecting the mortality after surgical treatment. Results: The mean age of the 96 patients who underwent surgical stabilization for bilateral multiple rib fractures or flail segments was 56.7 years (range: 22 to 82 years), and the male-to-female ratio was 3.6:1. Among the 96 patients, 16 patients (16.7%) underwent reoperation under general or epidural anesthesia due to remaining fracture with severe displacement. The surgical mortality of severe multiple rib fractures was 8.3% (8/96), 7 of those 8 patients (87.5%) dying from acute respiratory distress syndrome or sepsis. And the other one patient expired from acute myocardial infarction. The risk factors affecting mortality were liver cirrhosis, chronic obstructive pulmonary disease, concomitant severe head or abdominal injuries, perioperative ventilator care, postoperative bleeding or pneumonia, and tracheostomy. However, age, number of fractured ribs, lung parenchymal injury, pulmonary contusion and combined operations were not significantly related to mortality. Conclusion: In the present study, surgical fixation of ribs could be carried out as a first-line therapeutic option for bilateral rib fractures or flail segments without significant complications if the risk factors associated with mortality were carefully considered. Furthermore, with a view of restoring pulmonary function, as well as chest wall configuration, early operative stabilization of the ribs is more helpful than conventional treatment for patients with severe multiple rib fractures.

• Journal of Yeungnam Medical Science
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• v.34 no.1
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• pp.123-127
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• 2017

Drug-induced immune hemolytic anemia (DIIHA) is a rare side effect of drugs. DIIHA may cause a systemic inflammatory response that results in acute multi-organ failure and death. Ceftizoxime belongs to the class of third generation cephalosporins, which are the most common drugs associated with DIIHA. Herein, we present a case of a 66-year-old man who developed fatal DIIHA after receiving a second dose of ceftizoxime. He was admitted to receive photodynamic therapy. He had a history of a single parenteral dose of ceftizoxime 3 months prior to admission. On the day of the procedure - shortly after the infusion of ceftizoxime - the patient's mental status was altered. The blood test results revealed hemolysis. Oliguric acute kidney injury developed, and continuous renal replacement therapy had to be applied. On the suspicion of DIIHA, the patient underwent plasmapheresis. Diagnosis was confirmed by a detection of drug-dependent antibody with immune complex formation. Although his hemolysis improved, his liver failure did not improve. He was eventually discharged to palliative care, and subsequently died.

• The Journal of the Korea Contents Association
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• v.16 no.5
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• pp.351-360
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• 2016

Purpose: The purpose of this study was to identify the nursing needs of elderly patients who got a surgical operation under regional anesthesia(spinal, epidural, nerve block). Methods: The participants were 126 elderly patients who completed a questionnaire. The data were collected October 1 and October 31, 2012, and analyzed using descriptive statistics, t-test and ANOVA, $Scheff{\acute{e}}$ test. Results: The mean score for the nursing needs of elderly patients administered regional anesthesia during surgery was $3.08{\pm}0.38$, The scores for specific nursing needs were as follows: educational needs ($3.47{\pm}0.50$), spiritual needs ($3.37{\pm}0.78$), physical needs ($3.31{\pm}0.46$), emotional needs ($2.72{\pm}0.50$), and environmental needs ($2.51{\pm}0.47$). There were significant differences in nursing needs relative to gender, religion, and spouse status. Additionally, there were significant differences in nursing needs according to surgery department, the length of time the surgery, and the ASA(American Society of Anesthesiologists) physical classification. of the operation-related characteristics. Conclusion: When caring for elderly patients during the surgery, nurses must provide adequate information about the surgery and anesthesia. Further studies are needed to develop and evaluate nursing interventions to provide quality surgical care for the elderly patients.

• Korean Journal of Adult Nursing
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• v.12 no.4
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• pp.741-757
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• 2000

This study was undertaken to develop an instrument to be used for measuring the concept of quality of life of Korean patients with cancer multidimensionary and correctly. It can contribute in holistic nursing care for Korean cancer patients and also provide and validate basic data to help oncology nurses measure the outcome of nursing intervention correctly. To develop this instrument, the researchers first estabilished a conceptual framework based on the results of qualitative data analysis and indepth interview method Development of the scale was conducted using a method in which 31 items were assessed by subjects' self report using linear analogue scales. The subjects were 79 D.M. patients, 103 patients with acute illness, and 91 cancer patients residing in Busan, Korea. Data were collected during the period from July, 24 to August 14, 2000. This instrument consisted of 31 items with a self report scale. This instrument covered 4 dimensions of cancer patients : 1) physical wellbeing 2) psychological wellbeing 3) social wellbeing and 4)spiritual wellbeing. Each item had a possible score of 10. The reliability of the scale was tested with Cronbach's alpha. Validity was evaluated by examining the relationships of this scale, Youn's Quality of Life Questionnare scores and the Simple Quality of Life scale. Two separate runs of multiple regression were used to predict scores on the Simple Quality of Life measurement. Further validation was obtained by examining the correlation between the instrument subscores and Youn's Quality of Life measurement subscore for convergence of this scale. Examination of the discriminant. power of the instrument was done using ANOVA test. The results are summarized as follows: 1. The reliability of the instrument for the quality of life was 0.8321(Cronbach's alpha.), physical wellbeing dimension 0.6343, psychological wellbeing dimension 0.6501, spiritual wellbeing dimension 0.5883. 2. This instrument had a high correlation with Youn's Quality of Life measurement(r= 0.636) in cancer patients, whereas it had a low correlation with Simple Quality of Life measurement(r=0.455) in cancer patients. In the D.M. patients, the instrument correlated with both the Youn's Quality of Life measurement and Simple Quality of life measurement(r=0.313, r= 0.407) and in the acute stage patients, the instrument had no correlation. 3. Multiple regression of individual items on the Simple Quality of Life scores accounted for 56.8% of the variance in the Simple Quality of Life measurement, whereas, Youn's Quality of Life measurement scores accounts for 31.7%. 4. The correlations collected from the three group had the same patterns of variations but especially the instrument developed in this study had higher disciminant power than that of Youn's Quality of Life Measurement.

• Journal of Physiology & Pathology in Korean Medicine
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• v.28 no.6
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• pp.689-694
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• 2014

We report a female small cell lung cancer patient in the extensive stage(T3N3Mx). After 6 cycles of chemotherapy combined radiation therapy, she received inpatient Korean medical care including herbal medicine, acupuncture therapy and concurrent western oral medications of opioid analgesics and anti-anxiety agent. The chief complaint was right side thoracic wall pain which had started after chemotherapy and was not effectively controlled by analgesics. For this condition, we treated her with 2Hz of constant electrical stimulation on Jiaji (Ex-B2) points T5-T7 laterally (right) using three needles for 20 minutes once a day for 9 days. With every session of electrical acupuncture treatment, thoracic pain decreased acutely. Korean medicine treatments including Jiaji (Ex-B2) point stimulation might be tried for lung cancer patients with uncontrolled thoracic pain at least for the acute analgesic effect.

• Journal of The Korean Society of Clinical Toxicology
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• v.13 no.1
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• pp.50-54
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• 2015

Podostroma cornu-damae is a rare species of fungus belonging to the Hyocreaceae family. Its fruit body is highly toxic, as it contains trichothecene mycotoxins. The morphology is similar to that of immature Ganoderma lucidum, making identification difficult for non-experts. We experienced such a case of a 56- year-old male who picked and consumed podostroma cornu-damae, and consumed. Later that day, he developed digestive system symptoms, including nausea, vomiting, and abdominal pain. He presented to the emergency room (ER), there were no abnormal physical findings, symptoms improved after gastric lavage, and the patient voluntarily discharged himself on the same day. The following day, as the symptoms gradually deteriorated, he was admitted via the ER. He was presented with severe pancytopenia, alopecia, desquamation of skin, and acute renal failure. He recovered without any complications after conservative care, antibiotics therapy, and granulocyte colony stimulating factor administration. The most commonly reported complications of podostroma cornu-damae intoxication were reported pancytopenia, infection, disseminated intravascular coagulation, acute renal failure, etc. since Prevention is especially important because its toxicity can be lethal and there is no particular treatment to date, prevention is especially important. Promotion and education for the public are needed.

• Journal of Digital Convergence
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• v.16 no.12
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• pp.489-503
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• 2018

The purpose of this study was to explore traumatic experiences and posttraumatic growth of nursing students who were in clinical training. The data were collected from 490 nursing students at four nursing colleges with clinical training experience more than 1 year, from November 20th 2017 to December 20th. Collected data were analyzed through t-test, ANOVA, and $Scheff{\acute{e}}$ test with the SPSS/WIN 25.0 program, and qualitative data were analyzed by content analysis. 26.5% of the subjects had traumatic experiences in their daily life, 61.2% in the clinical practice. Their posttraumatic growth was scored 2.63 out of 5 on average. The contents of traumatic experiences were 'Violence experienced by medical staff','Negative perception of nursing care','Non-Educational Practical Environment' Clinical practice in a harsh environment, Witness of a serious patient, et al. The findings can be used as important basic data for the development of nursing practice education program for encouraging the posttraumatic growth of nursing students.

• Tuberculosis and Respiratory Diseases
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• v.44 no.6
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• pp.1318-1325
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• 1997

Background : Since the late 1960s, mechanical ventilation has been accomplished primarily using volume controlled ventilation(VCV). While VCV allows a set tidal volume to be guaranteed, VCV could bring about excessive airway pressures that may be lead to barotrauma in the patients with acute lung injury. With the increment of knowledge related to ventilator-induced lung injury, pressure controlled ventilation(PCV) has been frequently applied to these patients. But, PCV has a disadvantage of variable tidal volume delivery as pulmonary impedance changes. Since the concept of combining the positive attributes of VCV and PCV(dual control ventilation, DCV) was described firstly in 1992, a few DCV modes were introduced. Pressure-regulated volume control(PRVC) mode, a kind of DCV, is pressure-limited, time-cycled ventilation that uses tidal volume as a feedback control for continuously adjusting the pressure limit However, no clinical studies were published on the efficacy of PRVC until now. 'This investigation studied the efficacy of PRVC in the patients with unstable respiratory mechanics. Methods : The subjects were 8 mechanically ventilated patients(M : F=6 : 2, $56{\pm}26$ years) who showed unstable respiratory mechanics, which was defined by the coefficients of variation of peak inspiratory pressure for 15 minutes greater than 10% under VCV, or the coefficients of variation of tidal volume greater than 10% under PCV. The study was consisited of 3 modes application with VCV, PCV and PRVC for 15 minutes by random order. To obtain same tidal volume, inspiratory pressure setting was adjusted in PCV. Respiratory parameters were measured by pulmonary monitor(CP-100 pulmonary monitor, Bicore, Irvine, CA, USA). Results : 1) Mean tidal volumes($V_T$) in each mode were not different(VCV, $431{\pm}102ml$ ; PCV, $417{\pm}99ml$ ; PRVC, $414{\pm}97ml$) 2) The coefficient of variation(CV) of $V_T$ were $5.2{\pm}3.9%$ in VCV, $15.2{\pm}7.5%$ in PCV and $19.3{\pm}10.0%$ in PRVC. The CV of $V_T$ in PCV and PRVC were significantly greater than that in VCV(p<0.01). 3) Mean peak inspiratory pressure(PIP) in VCV($31.0{\pm}6.9cm$ $H_2O$) was higher than PIP in PCV($26.0{\pm}6.5cm$ $H_2O$) or PRVC($27.0{\pm}6.4cm$ $H_2O$)(p<0.05). 4) The CV of PIP were $13.9{\pm}3.7%$ in VCV, $4.9{\pm}2.6%$ in PVC and $12.2{\pm}7.0%$ in PRVC. The CV of PIP in VCV and PRVC were greater than that in PCV(p<0.01). Conclusions : Because of wide fluctuations of VT and PIP, PRVC mode did not seem to have advantages compared to VCV or PCV in the patients with unstable respiratory mechanics.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.9 no.2
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• pp.247-252
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• 1998

Neuroleptic malignant syndrome(NMS) is an acute, potentially fatal, idiosyncratic reaction to neuroleptic medication. Early recognition and intensive care are crucial. An important issue is whether NMS will recur after initial recovery and subsequent use of neuroleptic medication. The authors presented with a male adolescent who had suffered a bipolar disorder manic episode and been taking clozapine after recovering from MNS. He had been admitted into a psychiatric ward once before and similarly diagnosed. On the second admission, he showed muscle rigidity, autonomic instability, mild fever, severe diaphoresis, and altered mental status on the fourth hospital day following a haloperidol injection. He was diagnosed with NMS, according to the clinical signs and laboratory data. After the use of antipsychotics was discontinued, he was moved to intensive care unit and given dantrolene. His condition began to improve about 48 hours after the onset of NMS. Due to manic behavior, he returned to the psychiatric ward. On the 21 st hospital day, clozapine was administered to counter the manic symptoms. The final dose was 350mg and showed good remission signs without further recurrence of NMS.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.17 no.7
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• pp.280-292
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• 2016

This descriptive survey assessed knowledge of intensive care unit (ICU) nurses regarding compliance with infection control for six kinds of multi-drug resistant organisms to assist in development of effective intervention strategies. Participants included 210 nurses working in the ICUs of general hospitals who completed a structured questionnaire. The results showed that the nurses' knowledge level and infection control compliance was 10.54 and 3.39 for MRSA; 11.25 and 3.69 for VRE; and 9.60 and 3.49 for CRGNB, respectively[ED highlight - consider providing additional information to describe what these values indicate.]. Knowledge regarding MRSA infection control differed significantly based on age, clinical experience, and experience as a trainee, while compliance with MRSA infection control differed based on age. Knowledge regarding VRE infection control was significantly different based on academic qualification level, experience as a trainee, and whether guidelines existed, while compliance with VRE infection control differed based on academic qualification level and the presence of an isolation environment. Knowledge regarding CRGNB infection control differed significantly based on academic qualification level and experience as a trainee, while compliance with CRGNB infection control differed based on the presence of an isolation environment. Thus, intervention strategies should include education programs for enhancing ICU nurse' knowledge regarding strategies for creating isolation environments.