• Journal of Trauma and Injury
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• v.22 no.2
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• pp.218-226
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• 2009

Purpose: In multiple blunt trauma patients, transfusion may be a significant therapeutic adjunct to non-operative management. The blood products must be expedited and efficiently to patients in impending shock caused by hemorrhage or traumatic coagulopathy, but the decision to perform blood transfusion has been made empirically, based on the clinician' and has not been guided by objective parameters, but own opinion, that may result in an underestimate of or a failure to detect bleeding, in delayed transfusion, and in a reduced outcome. This article presents quickly assessable predictive factors for determining if a blood transfusion is required to improve outcomes in multiple blunt trauma patients admitted to the emergency room. Methods: In a retrospective review of 282 multiple blunt trauma patients who visited our emergency center by emergency rescuer during a 1-year period, possible factors predictive of the need for a blood transfusion were subjected to univariate and multivariate logistic regression analysis. Results: Of blunt trauma patients, 9.2% (26/282), received red blood cells in the first 24 hours of care. Univariate analysis revealed significant associations between blood transfused and heart rate (HR) > 100 beats/min, respiratory rate (RR) > 20 breaths/min, Glasgow Coma Scale (GCS) < 14, Revised Trauma Score (RTS) < 11, white blood cell count (WBC) < 4000 or > 10000, and initial abnormal portable trauma series (Cspine lateral, chest AP, pelvis AP). A multiple regression analysis, with a correction for diagnosis, identified HR > 100 beats/min (EXP 3.2), GCS < 14 (EXP 4.1), and abnormal trauma series (EXP 2.9), as independent predictors. Conclusion: In our study, systolic blood pressure (SBP) < 90 mmHg, old age > 65 years, hemoglobin < 13g/dL, mechanism of injury were poor predictors of early blood transfusion. Initial abnormal portable trauma series, HR > 100 beats/min, and GCS < 14 were quickly assessable useful factors for predicting a need for early blood transfusion in blunt trauma patients visiting the emergency room.

• Journal of Chest Surgery
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• v.48 no.3
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• pp.164-173
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• 2015

Background: Hypertrophied myocardium is especially vulnerable to ischemic injury. This study aimed to compare the early and late clinical outcomes of three different methods of myocardial protection in patients with aortic stenosis. Methods: This retrospective study included 225 consecutive patients (mean age, 65{\pm}10 years; 123 males) with severe aortic stenosis who underwent aortic valve replacement. Patients were excluded if they had coronary artery disease, an ejection fraction <50%, more than mild aortic regurgitation, or endocarditis. The patients were divided into three groups: group A, which was treated with antegrade and retrograde cold blood cardioplegia; group B, which was treated with antegrade crystalloid cardioplegia using histidine-tryptophan-ketoglutarate (HTK) solution; and group C, treated with retrograde cold blood cardioplegia. Results: Group A contained 70 patients (31.1%), group B contained 74 patients (32.9%), and group C contained 81 patients (36%). The three groups showed significant differences with regard to the proportion of patients with a New York Heart Association functional classification ${\geq}III$ (p=0.035), N-terminal pro-brain natriuretic peptide levels (p=0.042), ejection fraction (p=0.035), left ventricular dimensions (p<0.001), left ventricular mass index (p<0.001), and right ventricular systolic pressure (p <0.001). Differences in cardiopulmonary bypass time (p=0.532) and aortic cross-clamp time (p=0.48) among the three groups were not statistically significant. During postoperative recovery, no significant differences were found regarding the use of inotropes (p=0.328), mechanical support (n=0), arrhythmias (atrial fibrillation, p=0.347; non-sustained ventricular tachycardia, p=0.1), and ventilator support time (p=0.162). No operative mortality occurred. Similarly, no significant differences were found in long-term outcomes. Conclusion: Although the three groups showed some significant differences with regard to patient characteristics, both antegrade crystalloid cardioplegia with HTK solution and retrograde cold blood cardioplegia led to early and late clinical results similar to those achieved with combined antegrade and retrograde cold blood cardioplegia.

• Journal of Trauma and Injury
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• v.27 no.4
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• pp.133-138
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• 2014

Purpose: If the survival of patients suffering from severe blunt trauma is to be improved, appropriate interventions should be taken immediately. The purpose of this study is to evaluate the clinical utility of end-tidal carbon dioxide ($ETCO_2$) as a surrogate marker for predicting both the need for intervention and the prognosis. Methods: This is a prospective observational study. Nasal cannula was applied to measure $ETCO_2$, and the following parameters, which are known to be related to the prognosis for a patient, were recorded: injury severity score (ISS), revised trauma score (RTS), arterial blood gas (ABG), lactate, and hemoglobin (Hb). To evaluate the outcome, we investigated the details of emergent interventions and expired patients. Results: A total of 93 patients were enrolled in this study. Emergent intervention was significantly associated with systolic blood pressure (sBP, p-value=0.001), $ETCO_2$ (p-value<0.001), serum lactate level (p-value<0.001), pH (p-value< 0.003), $HCO_3$ (p-value=0.004), base excess (p-value<0.002), ISS (p-value<0.001) and RTS (p-value=0.005). In the multivariate logistic regression, only $ETCO_2$ (odds ratio (OR): 0.897, 95% confidence interval (CI): 0.792-0.975, p-value= 0.048) and ISS (OR: 1.132, 95% CI: 1.053-1.233, p-value=0.002) were associated with emergent intervention whereas $ETCO_2$ (p-value=0.973) and ISS (p-value=0.511) were not statistically significant in predicting the survival of patients in the univariate analysis. An optimal ETCO cut-off of 29 mmHg on the ROC curve was determined, with the area under the ROC curve (AUC) being 0.824 (0.732-0.917)]. Conclusion: This study has revealed that $ETCO_2$, which can be rapid and easily measured through a nasal cannula, and the ISS may be prognostic indicators of emergent interventions in Emergency Departments.

• Journal of Home Health Care Nursing
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• v.5
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• pp.47-60
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• 1998

This study was done to identify basic information in classifying nursing diagnoses and nursing interventions needed for the further development of computerized nursing care plans. Data were collected by reviewing charts of 123 home care clients who had active disease, for whom at least one nursing diagnosis was on the chart, and who had been discharged. Data included demographics, medical orders, nursing diagnoses and nursing interventions. The results of the study, which found the most frequent medical diagnoses to be cancer (40.7%) and brain injury (26.8%), showed that 'Impaired Skin Integrity'(18.3%), 'Risk for Infection'(15.0%), 'Altered Nutrition, Less than Body Requirements'(13.8%), and 'Risk for Impaired Skin Integ rity'(9.9%) were the most frequent nursing diagnoses. 'Pressure Ulcer Care'(28.4%) was the most frequent intervention for 'Impaired Skin Integrity', 'Infection Protection'(16.0%) for 'Risk of Infection', 'Nutrition Counseling'(26.8%) for 'Altered Nutrition' and 'Positioning'(22.0%) for 'Risk for Skin Integrity Impairment', Comparison of interventions with the Nursing Intervention Classification(NIC) showed that the most frequent interventions were in the domain 'Basic Physiological' (33.94%), followed by 'Behavioral'(27.8%), and 'Complex Physiological' (22.6%). Interventions related to teaching family to give care at home could not be classified in the NIC scheme. Examination of the frequency of NIC interventions showed that for the domain 'Activity & Exercise Management', 75% of the interventions were used, but for seven domains, none were used. For the domain 'Immobility Management', 93% of the times that an intervention was used, it was 'Positioning', for the domain 'Tissue Perfusion Management', 'IV Therapy' (59.1%) and for the domain 'Elimination Management', 'Tube Care: Urinary'(54.0%). The nursing diagnoses 'Altered Urinary Elimination' and 'Im paired Physical Mobility' were both used with these clients, but neither 'Fluid Volume Deficit' nor 'Risk of Fluid Volume Deficit' were used rather 'IV Therapy' was an intervention for 'Altered Nutrition, Less than Body Requirements', A comparison of clients with cancer and those with brain injury showed that interventions for the nursing diagnosis 'Impaired Skin Integrity' were more frequent for the clients with cancer, interventions for 'Risk of Infection' were similar for the two groups but for clients with cancer there were more interventions for' Altered Nutrition'. Examination of the nursing diagnoses leading to the intervention 'Positioning' showed that for both groups, it was either 'Impaired Skin Integrity' or 'Risk for Skin Integrity Impairment'. This study identified a need for further refinement in the classification of nursing interventions to include those unique to home care and that for the purposes of computerization identification of the nursing activities to be included in each intervention needs to be done.

• Journal of Trauma and Injury
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• v.21 no.1
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• pp.46-52
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• 2008

Purpose: This study was to evaluate the effect of arterial embolization on survival in patients with pelvic bone fractures and arterial bleeding. Methods: From January 2001 to December 2007, in all, 18 patients with pelvic bone fractures that had been treated with interventional arterial embolization were included in this retrospective study. The Injury Severity Score (ISS), the Revised Trauma Score (RTS), the initial hemodynamic status, the blood gas analysis, blood transfusion data, and mortality were the main outcome measurements. Results: Pelvic bone fractures were classified into lateral compression (LC), antero-posterior compression (APC), vertical shear (VS), and combined (CM) type according to the Young-Burgess classification. The Survivor group included 11 patients (61.1%), and the non-survivor group included 7 patients (38.9%). The mean ages for the survivor and the non-survivor groups were 40.0 and 45.6 years (p=0.517). The types of pelvic bone fractures were LC 11 (61.1%), APC 6 (33.3%), and VS 1 (5.6%): LC 7 (63.6%), and APC 4 (36.4%) in the survivor group and LC 4 (57.1%), APC 2 (28.6%), and VS 1 (14.3%) in the non-survivor group. The internal iliac artery was the predominant injured vessel among both the survivors (n = 5, 45.5%) and the non-survivors (n = 4, 57.1%). No differences in initial blood pressures, ISS, and RTS existed between the two groups, but the arterial pH was lower in the non-survivor group (pH 7.09 (${\pm}0.20$) vs 7.30 (${\pm}0.08$), p=0.018). The number of transfused 24-hour units of packed RBC was greater in the non-survivor group ($24.1{\pm}12.5$ vs $14.4{\pm}6.8$, p=0.046). Conclusion: No differences in initial blood pressure and trauma scores existed between survivors and non-survivors with pelvic bone fractures, who had been treated with arterial embolization, but arterial pH was lower the in non-survivors.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.3
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• pp.35-42
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• 2019

Risk assessment and analysis for a medium-to-small sized chemical plant that manufactures a polyester resin by the process of batch-type condensation reaction was conducted using K-PSR technique which is one of the risk assessment methods used to implement the Process Safety Management System (PSM). K-PSR is a risk assessment technique developed by KOSHA to compensate for difficulties caused by the lack of infrastructure of medium-to-small sized chemical plants in the re-evaluation. To apply the K-PSR technique, the entire process of a selected chemical palnt was classified in two review sections, i.e., the condensation reaction process and the dilution/filtration process, and the potential risks of the process about these review sections were identified and classified based on the four guide-words (release, fire.explosion, process trouble, and injury). As the results of the research, refer to recommend of risk rating has been confirmed that non-destructive testing of old facilities and the preparation of LOTO procedures for the electrical equipments are necessary as specific measures to prevent the risk of release and fire.explosion. It was also shown that pressure gauges and thermometers should be installed on the hot-oil supply piping to minimize the process trouble, and exhausting hood should be installed to prevent potential injury.

• Journal of Trauma and Injury
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• v.37 no.1
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• pp.13-19
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• 2024

Purpose: Trauma is an important public health concern, and it is important to increase the survival rate of patients with trauma and enable them to return to society in a better condition. Initial treatment in the emergency department (ED) is closely associated with the prognosis of patients with trauma. However, studies regarding laboratory biomarker tests that can help predict the prognosis of trauma patients are limited. Presepsin is a novel biomarker of inflammation that can predict a poor prognosis in patients with sepsis. This study aimed to determine whether presepsin could be used as a prognostic indicator in patients with polytrauma. Methods: The study included patients with trauma who had visited a single regional ED from November 2021 to January 2023. Patients who had laboratory tests in the ED were included and analyzed retrospectively through chart review. Age, sex, injury mechanism, vital signs, surgery, the outcome of ED treatment (admission, discharge, transfer, or death), and trauma scores were analyzed. Results: Overall, 550 trauma patients were enrolled; 59.1% were men, and the median age was 64 years (interquartile range, 48.8-79.0 years). Patients in a hypotensive state (systolic blood pressure, <90 mmHg; n=39) had higher presepsin levels (1,061.5±2,522.7 pg/mL) than those in a nonhypotensive state (n=511, 545.7±688.4 pg/mL, P<0.001). Patients hospitalized after ED treatment had the highest presepsin levels (660.9 pg/mL), followed by those who died (652.0 pg/ mL), were transferred to other hospitals (514.9 pg/mL), and returned home (448.0 pg/mL, P=0.041). Conclusions: Serum presepsin levels were significantly higher in trauma patients in a hypotensive state than in those in a nonhypotensive state. Additionally, serum presepsin levels were the highest in hospitalized patients with trauma, followed by those who died, were transferred to other hospitals, and returned home.

• Journal of Chest Surgery
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• v.37 no.3
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• pp.201-209
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• 2004

Extracorporeal life support (ECLS) system is a device for respiratory and/or heart failure treatment, and there have been many trials for development and clinical application in the world. Currently, a non-pulsatile blood pump is a standard for ECLS system. Although a pulsatile blood pump is advantageous in physiologic aspects, high pressure generated in the circuits and resultant blood cell trauma remain major concerns which make one reluctant to use a pulsatile blood pump in artificial lung circuits containing a membrane oxygenator. The study was designed to evaluate the hypothesis that placement of a pressure-relieving compliance chamber between a pulsatile pump and a membrane oxygenator might reduce the above mentioned side effects while providing physiologic pulsatile blood flow. The study was performed in a canine model of oleic acid induced acute lung injury (N=16). The animals were divided into three groups according to the type of pump used and the presence of the compliance chamber, In group 1, a non-pulsatile centrifugal pump was used as a control (n=6). In group 2 (n=4), a single-pulsatile pump was used. In group 3 (n=6), a single-pulsatile pump equipped with a compliance chamber was used. The experimental model was a partial bypass between the right atrium and the aorta at a pump flow of 1.8∼2 L/min for 2 hours. The observed parameters were focused on hemodynamic changes, intra-circuit pressure, laboratory studies for blood profile, and the effect on blood cell trauma. In hemodynamics, the pulsatile group II & III generated higher arterial pulse pressure (47$\pm$ 10 and 41 $\pm$ 9 mmHg) than the nonpulsatile group 1 (17 $\pm$ 7 mmHg, p<0.001). The intra-circuit pressure at membrane oxygenator were 222 $\pm$ 8 mmHg in group 1, 739 $\pm$ 35 mmHg in group 2, and 470 $\pm$ 17 mmHg in group 3 (p<0.001). At 2 hour bypass, arterial oxygen partial pressures were significantly higher in the pulsatile group 2 & 3 than in the non-pulsatile group 1 (77 $\pm$ 41 mmHg in group 1, 96 $\pm$ 48 mmHg in group 2, and 97 $\pm$ 25 mmHg in group 3: p<0.05). The levels of plasma free hemoglobin which was an indicator of blood cell trauma were lowest in group 1, highest in group 2, and significantly decreased in group 3 (55.7 $\pm$ 43.3, 162.8 $\pm$ 113.6, 82.5 $\pm$ 25.1 mg%, respectively; p<0.05). Other laboratory findings for blood profile were not different. The above results imply that the pulsatile blood pump is beneficial in oxygenation while deleterious in the aspects to high pressure generation in the circuits and blood cell trauma. However, when a pressure-relieving compliance chamber is applied between the pulsatile pump and a membrane oxygenator, it can significantly reduce the high circuit pressure and result in low blood cell trauma.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.2
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• pp.189-195
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• 2010

Excessive oral and maxillofacial bleeding causes upper airway obstruction, bronchotracheal & gastric aspiration and hypovolemic shock. Therefore, the rapid & correct bleeding control is very important for life-saving in the medical emergency room. In spite of the bleeding control methods of the wound suture & direct pressure, the postoperative bleeding can be occurred, because of the presence of various bleeding disorders & postoperative delayed wound infections. The proper care of bleeding disorders & wound infections are very important for the control of the delayed postoperative rebleeding. In spite of these methods, active oral bleeding can be presented by the other causes of head injury. A rare but particularly dangerous sort of bleeding that may have an especial importance to the patient with severe basal skull fracture that damage large vessels and even the cavernous sinus. The occurrence of profuse nasal or oropharyngeal bleeding may arise from damage to the anterior and posterior ethmoidal vessels, but when mixed with brain tissue it is evidence of mortal damage. In this condition, rapid entire oropharyngeal packing is essential for the control of active oral bleeding. This is a case report of rapid rational bleeding control method by much amount of wet gauze packings, in a 44-years-old male patient with active oropharyngeal bleeding by basal skull fractures.

• Journal of Chest Surgery
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• v.50 no.6
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• pp.424-429
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• 2017

Background: The surgical treatment of secondary spontaneous pneumothorax (SSP) can be complicated by fragile lung parenchyma. The preoperative prediction of air leakage could help prevent intraoperative lung injury during manipulation of the lung. Common sites of bulla development and ruptured bullae were investigated based on computed tomography (CT) and intraoperative findings. Methods: The study enrolled 208 patients with SSP who underwent air leak control through video-assisted thoracoscopic surgery (VATS). We retrospectively reviewed the sites of bulla development on preoperative CT and the rupture sites during VATS. Results: Of the 135 cases of right-sided SSP, the most common rupture site was the apical segment (31.9%), followed by the azygoesophageal recess (27.4%). Of the 75 cases on the left side, the most common rupture site was the apical segment (24.0%), followed by the anterior basal segment (17.3%). Conclusion: The azygoesophageal recess and parenchyma along the cardiac border were common sites of bulla development and rupture. Studies of respiratory lung motion to measure the pleural pressure at the lung surface could help to determine the relationship between cardiogenic and diaphragmatic movement and bulla formation or rupture.