- The Significance of Clinical Examination for Brain Lesion Differentiation of Patients with Head Trauma after Alcohol Intoxication
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Yoon Hyun Jung, Dong Kil Jeong, Jung Won Lee, Hyung Jun Moon, Jae Hyung Choi, Jun Hwan Song
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J Trauma Inj. 2016;29(4):99-104. Published online December 31, 2016
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DOI: https://doi.org/10.20408/jti.2016.29.4.99
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 Abstract
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- PURPOSE
There are many patients visited to ED in an alcohol intoxicated state. For these patients, it is difficult to predict by only clinical examination whether he/she would have brain lesion. The purpose of this study is to research whether it is possible to predict brain lesion by only clinical examination findings, with comparing patients with/without actual brain lesions.
METHODS
A retrospective study was performed at a university hospital for the period 11 months with the medical records. As for the inclusion group, head trauma patients with objectively proved drunk, judging by their blood ethanol concentration, and performed the brain CT were selected. In terms of medical record, Glasgow coma scale (GCS), the presence of neurologic abnormalities, the presence of lesion on brain CT of the patients, were examined. From laboratory results, blood ethanol concentration, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT) and glucose concentration were identified.
RESULTS
For this study, there were total 80 patients of inclusion group. There was no statistically significant difference in terms of GCS score and neurological examination abnormalities, between the group with brain lesion and the group without brain lesion on brain CT.
CONCLUSION
Alcohol intoxicated patient with head trauma visits the ED, it is not possible to distinguish or determine whether brain lesion exists or not by only clinical findings. In order to check the lesion existence, the image examination, therefore, should be considered and performed.
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Summary
- Is Local Anesthesia Necessary in Ketamine Sedation for Pediatric Facial Laceration Repair?: A Double-Blind, Randomized, Controlled Study
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Min Jung Ko, Jae Hyung Choi, Young Soon Cho, Jung Won Lee, Hoon Lim, Hyung Jun Moon
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J Trauma Inj. 2014;27(4):178-185.
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Abstract
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- PURPOSE
The aim of this study was to assess the clinical efficacy of combined treatment with local anesthesia and ketamine procedural sedation for pediatric facial laceration repair in the Emergency Department (ED).
METHODS
Patients aged 1 to 5 years receiving ketamine for facial laceration repair were prospectively enrolled in a double-blind, randomized, and controlled study at an ED. All patients were to receive intravenous ketamine (2 mg/kg). The local anesthesia group (LA group) received a local anesthetic along with ketamine, whereas the no local anesthesia group (NLA group) received only ketamine. The total time of sedation, the patients' movements and groans, adverse events, and the satisfaction ratings of physicians, nurses, and parents were recorded.
RESULTS
A total of 186 patients were randomized (NLA group: 90, LA group: 96). The total time of sedation (30.5 minutes for the NLA group, 32.6 minutes for the LA group; p=0.660), patients' groans (26 (28.9%) versus 23 (24.0%); 0.446) and movements (27 (30%) versus 35 (36.5%); p=0.350) was not affected by the addition of local anesthesia. Other adverse events were similar between the two groups. Also, the satisfaction ratings of physicians (median 4 for the NLA group versus 4 for the LA group (p=0.796)), nurses (2 versus 2.5 (p=0.400)), and parents (4 versus 4 (p=0.199)) were equivalent between the two groups.
CONCLUSION
In this study, we found that local anesthesia was not required along with ketamine sedation for pediatric facial laceration repair.
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Summary
- Availability of the Optic Nerve Sheath Diameter Measured by Using Ultrasonography as a Secondary Survey for Patient with Head Injuries in the Emergency Department
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Dong Wook Lee, Jung Won Lee, Sae Hoon Park, Ihl Sung Park, Hyun Jung Lee, Byeong Dae Yoo, Hyung Jun Moon
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J Trauma Inj. 2013;26(3):104-110.
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Abstract
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- PURPOSE
Bedside ultrasonography is available in most emergency departments, and detecting the intracranial pressure is elevated is critical. Our objective is to evaluate the availability of bedside optic nerve ultrasound (ONUS) as a secondary survey for patients with head injuries in the emergency department (ED).
METHODS
From September, 2012, to March, 2013, we performed a prospective study of patients presenting to the ED after an accident. Patients with head injuries but without obvious ocular trauma or ocular disease were included. The ONUS was performed using a 3 to 12 MHz linear probe on closed eyelids after a primary survey. We analyzed the correlation between the brain computed tomography (CT) findings that suggested elevated intracranial pressure (ICP) and the Optic nerve sheath diameter (ONSD) measured by using ONUS.
RESULTS
A total of 81 patients were enrolled. Forty-seven had CT results consistent with elevated ICP, and their mean ONSD was 5.98+/-0.59 mm; the mean ONSD of patients who showed no signs of elevated ICP on CT was 4.63+/-0.21 mm. The sensitivity and the specificity for the ONSD, compared with elevated ICP, were 98.87% and 100%, respectively, when the cut-off value was set to 4.96 mm. The area under curve (AUC) was 0.997 in the receiver operating characteristic curve (ROC curve).
CONCLUSION
An evaluation using ONUS is a simple noninvasive procedure and is a potentially useful tool as a secondary survey to identify an elevated ICP.
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Summary
- Comparison of Compliance, Time Required for Diagnosis and Pain of Patients with Finger Tendon Injury Between Gross and Ultrasonographic Confirmation
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Seo Woo Lee, Hyun Jae Park, Jung Won Lee, Sae Hoon Park, Jae Woo Kim
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J Korean Soc Traumatol. 2010;23(2):83-88.
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Abstract
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- PURPOSE
It is not always easy to determine the existence of tendon injuries when it comes to patients with finger lacerations. Thus, we tried to find the difference in effectiveness and in compliance of patients when we employed two different types of diagnosis, conventional gross confirmation and ultrasonographic confirmation.
METHODS
From December 2009 to March 2010, we enrolled 14 patients with finger tendon injury at Soonchunhyang University Cheonan Hospital. The median age of the patients was 35.9+/-14.4, and the ratio of females to males was 1:2.5 We evaluated the compliance of each patient by measuring four different categories (level of cooperativeness in showing their wound and in following the instructions, level of movement of their fingers during the diagnosis and total number of attempts to diagnose) by using a score from 1 to 3 for each category, for a total possible score of 12 for each patient. We also measured the painfulness of each patient by using a score of 1 to 10 and the time required for each diagnosis.
RESULTS
The levels of patients' compliance was 8.9+/-2.1 when diagnosed with gross confirmation and 9.8+/-2.1 when diagnosed with ultrasonographic confirmation (p value=0.042). The pain score of the patients was 3.7+/-1.7 with gross confirmation and 2.9+/-1.2 with ultrasonographic confirmation (p value=0.020). The median duration of time in each test was 6.7+/-4.8 minutes with gross confirmation and 10.5+/-4.2 minutes with ultrasonography (p value=0.006).
CONCLUSION
Comparing gross confirmation and ultrasonographic confirmation, gross confirmation is a better method than ultrasonography because of time efficiency. However, ultrasonographic confirmation has advantages over gross confirmation in pain scale and better compliance of patients. Emergency physicians generally employ gross confirmation rather than ultrasonography in determining the existence of tendon injury in patients. In patients with finger lacerations without bone injury, ultrasonography can be considered as a secondary diagnostic tool, especially when patients have much pain.
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