- Traumatic Tricuspid Regurgitation Cause by Chordal Rupture: A Case Report
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Min Ae Keum, Hyo Keun No, Byung Joo Sun, Suk Kyung Hong
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J Trauma Inj. 2015;28(2):67-70. Published online June 30, 2015
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DOI: https://doi.org/10.20408/jti.2015.28.2.67
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 Abstract
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- Traumatic tricuspid regurgitation is a rare complication of blunt chest trauma caused by chordal rupture, anterior papillary muscle rupture and anterior leaflet tear. Since clinical symptoms are vague, early diagnosis is difficult and some patient exhibit symptoms of right heart failure. Right heart failure has been the traditional indication for surgical treatment, such as tricuspid valve replacement. Recently, early detection using transthoracic echocardiography and surgical treatment, like valve repair, prior to overt right heart failure have been shown to better prognosis. We report a case of traumatic tricuspid regurgitation with chordal rupture in patient due to traffic accident.
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Summary
- Outcomes for Employment of a Trauma Clinical Nurse Specialist in the Treatment of Trauma Patients
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Yooun Joong Jung, Young Hwan Kim, Tae Hyun Kim, Min Ae Keum, Dae Sung Ma, Kyu Hyouck Kyoung, Jung Jae Kim, Suk Kyung Hong
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J Trauma Inj. 2012;25(4):254-260.
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Abstract
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Ongoing treatment and care, as well as initial stabilization, are required for trauma patients. With increasing number of sickest trauma patients and shortage of surgeons, the need for advanced practice nurse to provide and coordinate trauma care has been greater. The purpose of this study is to analyze the effect of hiring a trauma clinical nurse specialist and its influence on the treatment of trauma patients.
METHODS
Based on the employment of the clinical nurse specialist in December 2010, the patients were divided into two groups: patients admitted from January 1, 2010 to November 30, 2010 and patients admitted from December 1, 2010 to December 31, 2011. Retrospectively, data were collected using electronic medical records. The general characteristics, clinical courses, and ICU re-admission rates, collaboration (transfers to other departments and collaborative surgery) were compared.
RESULTS
To have a clinical nurse specialist on the trauma team resulted in a statistically significant reductions in the length of general ward hospital stay (p<0.05), the ICU re-admission rate, (p<0.03), the lead-time before transfer to other departments (p<0.05).
CONCLUSION
The clinical nurse specialist, as a professional practitioner, improved the quality of treatment through early detection and management of problems. In addition, as a coordinator, the clinical nurse specialist maintained a cooperative relationship with multi-disciplinary medical personnel. The trauma clinical nurse specialist contributed to the treatment of trauma patients positively through a decrease in ICU re-admission rate and length of hospital stay.
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Summary
- Medical Expenses for Trauma According to the Type of Medical Insurance
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Heeseung Park, Yooun Joong Jung, Young Hwan Kim, Tae Hyun Kim, Min Ae Km, Kyu Hyouck Kyoung, Jung Jae Kim, Suk Kyung Hong
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J Trauma Inj. 2012;25(4):178-187.
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Abstract
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In Korea, the nation's medical expenses were 12 billion won in 2010. The medical costs for individuals can also be overwhelming. If a patient has sustained severe trauma, his/her insurance company responsible may pay only part of the medical bills. In Korean, there are diverse types of medical insurance, such as health insurance, automobile insurance, and industrial accident compensation insurance. And each insurance system has a different type of payment system. Our study will be essential for establishing the optimal medical expense payment system.
METHODS
From January to December 2011, we retrospectively reviewed the medical charts of 161 patients who were admitted to our hospital's emergency room after having undergone severe trauma. Of those 161 patients, 125 were retrospectively reviewed. Written permission was obtained from all of the patients. We analysed the demographic characteristics, clinical outcomes, data of the trauma, type of the patient's insurance, and the entire bill when the patient was discharged.
RESULTS
Seventy-one patients had health insurance, 48 automobile insurance, and six industrial accident compensation insurance. High-deductible insurance included health insurance and industrial accident compensation insurance, with the deductibles up to 20.6% and 19.1%, respectively. We attempted to analyze the cause of the high deductible rate. In patients with health insurance, medicines, primarily sedatives, pain killers, antibiotics, and fluids. comprised a large proportion. On the other hand, industrial accident compensation insurance deducted for a high-grade hospital room charge.
CONCLUSION
We found that medical expenses were diverse according to the type of insurance. In particular, health insurance forced patients to pay too much of the medical expenses. Therefore, in Korea we should try to identify the insurance problems and improve the wage system.
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Summary
- Abdominal Organ Injuries with Chyloperitoneum after Blunt Tauma: A Case Report
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Young Hwan Kim, Yooun Joong Jung, Suk Kyung Hong
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J Korean Soc Traumatol. 2012;25(3):105-108.
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- Chyloperitoneum or chylous ascite after trauma is a rare condition. It can develop after direct injuries of lymphatic vessels or cisterna chyli. Though isolated chyle duct injury has sometimes been reported, chyloperitoneum is generally accompanied by various kinds of damage to other intraabdominal organs. There's still no established therapeutic protocol regarding the treatment of chyloperitoneum when it is accompanied by the serious injuries of intraabdominal organs. We describe a 66-year-old male with serious intraabdominal organ injuries after blunt trauma. In our case, chyloperitoneum developed due to the injuries to the mesenteric lymph vessels and compression of cisterna chyli by hematoma around aorta.
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Summary
- Successful Treatment of Blunt Traumatic Rupture of the Left Atrial Appendage and Pericardium: A Case Report
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Kyu Hyouck Kyoung, Sung Ho Jung, Suk Kyung Hong
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J Korean Soc Traumatol. 2011;24(2):168-170.
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- Blunt cardiac rupture is uncommon and is associated with significant mortality. Patients with blunt cardiac rupture usually have combined injury and do not always show signs of cardiac tamponade, which delays the diagnosis of cardiac rupture and increases mortality. We report a case of cardiac rupture diagnosed and treated by using only thoracic exploration based on clinical impression, with radiologic studies, including even echocardiography, showing negative results.
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Summary
- The Role of Endoscopic Retrograde Cholangiopancreatography (ERCP) in the Treatment of Traumatic Pancreas Injury
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Min young Jeong, Young hwan Kim, Kyu hyouck Kyoung, Sung Koo Lee, Suk kyung Hong
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J Korean Soc Traumatol. 2011;24(2):136-142.
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Abstract
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Blunt pancreatic injury has a high mortality rate, especially if adequate management is delayed. Although many guidelines exist for diagnosis and treatment, there is no consensus to date. Therefore, we analyzed the role of endoscopic retrograde cholangiopancreatography (ERCP) as a diagnostic and therapeutic tool for the treatment of traumatic pancreatic injury.
METHODS
We retrospectively reviewed the electronic medical records (EMR) database at Asan Medical Center (Seoul, South Korea) to identify all patients diagnosed with trauma to the pancreas between June 2003 and December 2010. Clinical and operative findings, CT (computed tomography) images, and ERCP findings were assessed.
RESULTS
A total of 40 patients were evaluated in this study. Of these, 14 patients underwent diagnostic ERCP, and 26 did not. Of the 14 patients who underwent diagnostic ERCP, 5 were found to have normal pancreatic ducts, thereby preventing a needless laparotomy in these patients. Of the patients diagnosed with ductal injury, four were treated with endoscopic intervention, and four underwent an exploratory laparotomy. The remaining patient was treated with radiologic intervention (percutaneous drainage) to manage pancreatic pseudocyst formation.
CONCLUSION
Our findings suggest that ERCP is a beneficial diagnostic and therapeutic modality for the treatment of traumatic pancreatic injury.
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Summary
- The Importance of the Trauma Surgeon: A Reflection on the Management of Hemodynamically Unstable Pelvic Trauma Patients
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Sung Shin, Kyu Hyuk Kyung, Ji Wan Kim, Jung Jae Kim, Suk Kyung Hong
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J Korean Soc Traumatol. 2009;22(2):254-259.
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Abstract
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Pelvic trauma is a serious skeletal injury with high mortality. Especially in cases of severe injury trauma, treatment outcomes depend on early diagnosis and intervention. We expect trauma surgeon to play an important role in the management of severe multiple trauma patients.
METHODS
A retrospective study was performed on pelvic trauma patients with hemodynamic instability between March 2005 and September 2009. We divided the time period into period I (March 2005~Feburary 2009) and period II (March 2009~September 2009). The trauma surgeon and team started to work from period II. Data were collected regarding demographic characteristics, mechanism of injury, type of pelvic fracture, ISS (injury severity score), treatment modality, transfusion requirement, time to definitive treatment, and mortality.
RESULTS
During period I, among 7 hemodynamically unstable patients, 4(57.1%) patients died. However during Period II, only one of 6(16.6%) patients died. The demographic data and injury scores showed no differences between the two time periods, but the time to definitive treatment was very short with trauma team intervention( 14.4 hrs vs. 3.9 hrs). Also, the amount of transfusion was less(41.1 U vs. 13.9 U). With arterial embolization, early pelvic external fixation led to less transfusion and made patients more stable.
CONCLUSION
This study demonstrated the importance of the trauma surgeon and the trauma team in cases of hemodynamically unstable pelvic trauma. Even with the same facility and resources, an active trauma team approach can increase the survival of severely injured multiple trauma patients.
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Summary
- Supraventricular Arrhythmias in the Surgical Intensive Care Unit
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Song Soo Yang, Suk Kyung Hong
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J Korean Soc Traumatol. 2008;21(2):85-90.
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Abstract
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Supraventricular arrhythmia is a well-known complication of cardiothoracic surgery, and is common in patients wirth underlying cardiovascular disease. Also, it's treatment and prognosis are well known. However the incidence, the contributing factors, and the prognosis for supraventricular arrhythmias in noncardiothoracic surgical patients are less well known. This study was undertaken to investigate the incidence, the clinical presentation, the prognosis, and the factors comtributing to the prognosis for supraventricular arrhythmia in the surgical intensive care unit.
METHODS
We performed a retrospective study of 34 patients with newly developed or aggravated supraventricular arrhythmias in the surgical intensive care unit between March 2004 and February 2005. The incidence, the risk factors, and the prognosis of supraventricular arrhythmias were analyzed.
RESULTS
During a 12month period, the incidence of supraventricular arrhythmia was 1.79% (34/1896). Most patients had pre-existing cardiovascular disease and sepsis. The mortality rate was 29.4%, and the most common cause of death was multiple organ failure due to septic shock. The mean value of the APACHE II score was 20.9, and the surgical intensive care unit and the hospital lengths of stay were 9.9 days and 25.8 days, respectively. The APACHE II score measured when the arrhythmia developed was a significant factor in predicting mortality, CONCLUSION: Supraventricular arrhythmias result in increased mortality and increased length of stay in both the surgical intensive care unit and the hospital. The arrhythmia itself did not cause death, but a high APACHE II score incicated a poor prognosis. This may reflect the severity of the illness rather than an independent contributor to mortality.
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