• Journal of Trauma and Injury
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• 제18권1호
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• pp.17-25
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• 2005

Background: Traumatic rupture of the aorta is a life-threatening injury that must be diagnosed as rapidly as possible and treated immediately. The chest X-ray is a valuable tool for screening traumatic rupture of the aorta in blunt chest trauma. And various chest radiologic parameters are being used as diagnostic tools for aortic injury. The purpose of this study is to identify chest radiographic parameters that may assist in the detection of traumatic rupture of the aorta and to compare these findings with those of other reports. Methods: This study involved 30 adult patients with traumatic rupture of the aorta seen at the emergency department of the Asan Medical Center from 1997 to 2004. The control subjects were 30 healthy patients with neither lung nor cardiovascular disease. We retrospectively assessed over 14 parameters on chest X-rays. Results: In 11 of the 14 parameters, there were significant differences between the study group and the control group. There was no significant difference in the M/C ratio (mediastinumto-chest width ratio) between the two groups, and neither the left nor the right paraspinal interface was statistically significant (p value>0.05). Our study indicates that new criteria for the MC ratio and for the paraspinal interfaces are needed for screening traumatic aorta injury. The other radiographic parameters for traumatic rupture of the aorta need to be further assessed through a prospective study.

• 대한영상의학회지
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• 제84권4호
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• pp.784-791
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• 2023

국내의 각종 통계에 따르면 외상센터는 외상 환자 치료에 중심적이며 확고한 역할을 담당하고 있는 것으로 나타났다. 외상센터에서 인터벤션 영상의학자의 역할은 출혈이 멈추도록 하는 것이다. 기본적인 색전술이 치료의 근간을 이루지만 스텐트 그래프트 설치술 등이 사용되기도 한다. 전통적인 응급인터벤션시술이 사용되어 왔으나 외상 환자에게는 짧은 시간 내에 효율적으로 출혈을 막는 것이 필수적이다. 따라서, 최근 부각되고 있는 손상통제인터벤션영상의학의 개념을 정확히 인지하고 실행하는 것이 예방 가능 외상 사망률을 낮추는데 매우 중요하다.

• 대한임상독성학회지
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• 제1권1호
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• pp.43-46
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• 2003

Phenypropanolamine (PPA) is a sympathetic amine used in over-the-counter cold remedies and weight-control preparations. The side effects are hypertension, dysrhythmias, stroke, etc. The Food and Drug Administration (FDA) is taking steps to remove PPA from all drug products and has requested that all drug companies discontinue marketing products containg PPA due to high risk of hemorrhage stroke. But, in Korea now, patinets take products containg PPA with over the counter. We report here the case of PPA induced myocardial injury in a young woman who takes overdose for suicide.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권4호
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• pp.303-308
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• 2010

Excessive oral and maxillofacial bleeding causes upper airway obstruction, bronchotracheal and gastric aspiration and hypovolemic shock. Therefore, the rapid and correct bleeding control is very important for saving lives in the emergency room. Despite the conventional bleeding control methods of wiring (jaw fracture, wound suture and direct pressure), continuous bleeding can occur due to the presence of various bleeding disorders. There are five main causes for excessive bleeding disorders in the clinical phase; (1) vascular wall alteration (infection, scurvy etc.), (2) disorders of platelet function (3) thrombocytopenic purpura (4) inherited disorders of coagulation, and (5) acquired disorders of coagulation (liver disease, anticoagulant drug etc.). In particular, infections can alter the structure and function of the vascular wall to a point at which the patient may have a clinical bleeding problem due to vessel engorgement and erosion. Wound infection is a frequent cause of postoperative active bleeding. To prevent postoperative bleeding, early infection control using a wound suture with proper drainage establishment is very important, particularly in the active bleeding sites in a contaminated emergency room. This is a case report of a rational bleeding control method by rapid wiring, wound suture with drainage of a rubber strip & iodoform gauze and wet gauze packing, in a 26-year-old male cerebral palsy patient with active oral and maxillofacial bleeding injuries caused by a traffic accident.

• Journal of Chest Surgery
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• 제13권1호
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• pp.60-65
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• 1980

We have experienced 2 cases of the hunshot wound sof the chest involving cardiac injuries at department of the thoracic surgery, Capital Armed Forces General Hospital during I year from April I 1979 to Jan. 1980. In one case of two patients , he was a 22 years old man who was transported to this emergency room 4 hour 10 minutes after having gunshot wound of the left chest by helicopter. Physical examination showed small inlet in left 3rd ICS and left parasternal border, large outlet in left 8th ICS and left scapular line, no breath sound on left side and distant heart sound. chest roentgenography demonstrated marked pleural effusion in left side and mediastinum shifted to right. As soon as chest X-ray was taken, the bleeding through penetrating wound became profuse and cardiac arrest ensued. Closed chest cardiac massage was started and vigorous transfusion continued, but no effective cardiac activity could not be obtained. The patient was pronounced dead due to exsanguinating hemorrhage from wuwpected cardiac wounds. In this critically injured patient with evidence of intrathoracic hemorrhage and suspected cardiac penetration, only emergency thoracic exploration and immediate surgical control of bleeding points might offer the maximum possibility of survival. The other case was a 23 years old man who was transferred to the emergency room 4 hours 50 minutes after having kmultiple communicated fractures of sternum and linear fracture of right mandible by a missile. Examination revealed about 30% skin loss of the anterior chest wall, weak pulse of 96 beats/min., distant heart sound and decreased breath sounds bilaterally. finding on the chest X-ray films showed multiple sternal fractures, marked pericardial effusion indicating hemopericardium. So, the patient was moved immediately to the operation room where, after endotracheal tube inserted, a median sternotomy was performced. A hemorrhagic congestion of the right upper lobe and marked bulging pericardium were disclosed. The pericardium was opened anterior to right phrenic nerve and exsanguinating hemorrhage ensued from the 0.5cm lacerated wound in the auricle of right atrium. The rupture site of right atrium was occluded with non-crushing vascular clamps and then was over sewn with interrupted sutures. It was thought to be highly possible that he was alive long enough to have cardiorrhaphy because of cardiac tamponade, which prevented exsanguinating hemorrhage. He was taken closed reduction for linear fracture of right mandible 2 weeks after repair of ruptured right auricle in dental clinic. This patient's post-operative course was not eventful.

• 한국응급구조학회지
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• 제24권1호
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• pp.67-76
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• 2020

Purpose: Effective time management, as well as life-saving care, are important in maximizing the prognosis of patients who have sustained major traumas. This study evaluated the appropriateness of emergency medical system (EMS) provider's essential care and how this care impacted on-scene time in patients with major traumas. Methods: This retrospective observational study analyzed the EMS major trauma documents, classified according to the physiological criteria (Glasgow coma scale <14, systolic blood pressure <90mmHg, Respiration rate <10 or >29) in Daejeon, from January, 2015 to December, 2018. Results: Of the 707 major trauma cases, the mean on-scene time was 7.75±4.64 minutes. According to EMS guidelines, essential care accuracy was 67.5% for basic airway, 36.4% for advanced airway, 91.2% for cervical collar, 81.5% for supplemental oxygen, 47.0% for positive pressure ventilation, 19.9% for intravenous access and fluid administration, and 96.0% for external hemorrhage control. Factors affecting on-scene time were positive pressure ventilation (p<.004), and intravenous access and fluid administration (p<.002). Conclusion: Adherence to guidelines was low during advanced airway procedures, positive pressure ventilation, intravenous access, and fluid administration. In addition, the on-scene time was prolonged when the practitioner provided positive pressure ventilation, intravenous access, and fluid administration; however, these durations did not exceed the recommended 10 minutes.

• 대한장애인치과학회지
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• 제12권1호
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• pp.20-26
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• 2016

저자 들은 뺑소니 차량에 다발성 손상을 입고 응급실로 내원된 정신지체 장애환자에서, 초기 평가와 관리의 단계에서부터 다발성 외상환자 진료우선 순위에 따라 먼저 경척수를 안정시키고, 구강출혈부 지혈위한 구개횡단 강선결찰술과 비강출혈부 바셀린 거즈 전색 압박술 및 구강주위 개방 창상내 습윤거즈 전색 압박술 등을 신속하게 시행하여 기도폐쇄를 방지하고서, 임상 병리검사와 방사선 사진검사를 시행한 다음에, 기관내 삽관술, 비위장관 삽입술, 전신상태 모니터링 장비 활용, 수액 약물요법 등을 시행하였고, 보호자와 뒤늦게 연락이 되어서 체계적인 관련의학과적 관리를 장기간 시행해서, 비교적 양호한 예후를 관찰할 수 있었다.

• 한국응급구조학회지
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• 제2권1호
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• pp.26-35
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• 1998

This study was to exhibit the effective emergency care method for the drowning and non-drowning who are reached two-thousand peoples every year in our country. For investigate the effective emergency care, this study was discussed as follows ; Pathophysiology of the water submersion, Fresh-water & sea-water drowning, Factors affecting survival, and Prehospital management. The conclusions from this study were summarized as follows; 1. Remove the patient from the water. If you suspect neck or spinal injuries, Always support the head and neck level with the back and, begin rescue breathing. 2. Maintain the airway and support ventilation in the water use the jaw-thrust technique to avoid farther injury to the neck or spine. We might encounter more resistance to ventilations than you expect because of water in the airway. Once you have determined that there are no foreign objects in the airway, apply ventilations with more force; adjust ventilations until you see the patient's chest rise and fall but not until you see gastric distention. Do not attempt to remove water from the patient's lungs or stomach. 3. If there is no pulse, begin CPR. 4. Administer high-flow supplemental oxygen; suction as needed. 5. Once the patient is breathing and has a pulse, assess for hemorrhage; control any serious bleeding that you find. 6. Cover the patient to conserve body heat, Handle the patient very gently, and, Transport the patient as quickly as possible to Emergency Department, Continuing resuscitative measures during transport. If the patient have the hypothermia, follow hypothermia management.

• Journal of Trauma and Injury
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• 제37권2호
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• pp.147-150
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• 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.

• Journal of Korean Neurosurgical Society
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• 제62권5호
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• pp.526-535
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• 2019

Objective : While the risk of aneurysmal rebleeding induced by catheter cerebral angiography is a serious concern and can delay angiography for a few hours after a subarachnoid hemorrhage (SAH), current angiographic technology and techniques have been much improved. Therefore, this study investigated the risk of aneurysmal rebleeding when using a recent angiographic technique immediately after SAH. Methods : Patients with acute SAH underwent immediate catheter angiography on admission. A four-vessel examination was conducted using a biplane digital subtraction angiography (DSA) system that applied a low injection rate and small volume of a diluted contrast, along with appropriate control of hypertension. Intra-angiographic aneurysmal rebleeding was diagnosed in cases of extravasation of the contrast medium during angiography or increased intracranial bleeding evident in flat-panel detector computed tomography scans. Results : In-hospital recurrent hemorrhages before definitive treatment to obliterate the ruptured aneurysm occurred in 11 of 266 patients (4.1%). Following a univariate analysis, a multivariate analysis using a logistic regression analysis revealed that modified Fisher grade 4 was a statistically significant risk factor for an in-hospital recurrent hemorrhage (p=0.032). Cerebral angiography after SAH was performed on 88 patients ${\leq}3$ hours, 74 patients between 3-6 hours, and 104 patients >6 hours. None of the time intervals showed any cases of intra-angiographic rebleeding. Moreover, even though the DSA ${\leq}3$ hours group included more patients with a poor clinical grade and modified Fisher grade 4, no case of aneurysmal rebleeding occurred during erebral angiography. Conclusion : Despite the high risk of aneurysmal rebleeding within a few hours after SAH, emergency cerebral angiography after SAH can be acceptable without increasing the risk of intra-angiographic rebleeding when using current angiographic techniques and equipment.