This study was to investigate errors of death certificate (DC) issued for patients with trauma.
A retrospective review for DC issued after death related to trauma at a training hospital trauma center was conducted. Errors on DC were classified into major and minor errors depending on their influence on the process of selecting the cause of death (COD). All errors were compared depending on the place of issue of DC, medical doctors who wrote the DC, and the number of lines filled up for COD of DC.
Of a total 140 DCs, average numbers of major and minor errors per DC were 0.8 and 3.7, respectively. There were a total of 2.8 errors for DCs issued at the emergency department (ED) and 5.4 errors for DCs issued beyond ED. The most common major error was more than one COD on a single line for DCs issued at the ED and incompatible casual relation between CODs for DCs issued beyond ED. The number of major errors was 0.5 for emergency physician and 0.8 for trauma surgeon and neurosurgeon. Total errors by the number of lines filled up for COD were the smallest (3.1) for two lines and the largest (6.0) for four lines.
Numbers of total errors and major errors on DCs related to trauma only were 4 and 0.8, respectively. As more CODs were written, more errors were found.
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Near drowning refers to immediate survival after asphyxia due to submersion or immersion in water, which is a crucial public safety problem worldwide. Acute lung injury or acute respiratory distress syndrome (ARDS) is a common complication of near drowning. The purpose of this study was to investigate the feasibility and effectiveness of noninvasive nasal positive pressure ventilation (NINPPV).
This retrospective study was conducted at a tertiary emergency department. NINPPV was administered for moderate ARDS caused by submersion or immersion in patients who were older than 18 years, from January 2015 to December 2018. We collected the demographic (age, sex, length of hospital stay, and outcome), laboratory (arterial blood gas, lactate, oxygen saturation, partial pressure of oxygen divided by the fraction of inspired oxygen, complete blood count, blood urea nitrogen, and creatinine), and clinical data (acute lung injury index and ventilator failure) of the patients. A statistical analysis was performed using Statistical Package for the Social Sciences version 20.0 for Windows.
NINPPV treatment was provided to 57 patients for near drowning, 45 of whom (78.9%) were successfully treated without complications; in 12 (21.1%), treatment was changed to invasive mechanical ventilation within 48 hours due to ARDS or acute kidney injury. NINPPV treatment was successful in 31 (75.6%) out of 41 sea-water near drowning patients. They were more difficult to treat with NINPPV compared with the fresh-water near drowning patients (
NINPPV would be useful and feasible as the initial treatment of moderate ARDS caused by near drowning.
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No previous study has assessed elderly pedestrian traffic accidents based on a nationwide database. This study aimed to help primary physicians who examine patients in emergency departments to determine and make prompt and accurate treatment decisions.
This study used data from the Emergency Department-based Injury In-depth Surveillance from 2013 to 2017, managed by the Korea Centers for Disease Control and Prevention. Pedestrians aged ≥65 years were included, and using multivariate logistic regression multiple factors were analyzed to determine their relationship with injury severity.
Of 227,695 subjects, 6,498 were included, of whom 2,065 (31.8%) were severely injured. There were more female than male patients in all severity groups. Most accidents occurred in the afternoon and on general roads. In the multivariate analysis, the odds ratio (OR) of injury severity for male pedestrians was 1.165 (95% confidence interval: 1.034?1.313,
Injury severity was correlated with sex, age, transportation to the ED, TA onset time, and type of vehicle. The study results suggest that injury severity may be positively reflected in initial assessments and overall integrated treatments by physicians and in the related policies.
To determine whether a peripherally inserted central catheter (PICC) meets the goals of a low infection rate and long-term use in trauma patients.
From January 2016 to June 2018, the medical records of patients who underwent central venous catheterization at a level I trauma center were retrospectively reviewed. Data collected included age, sex, injury severity score, site of catheterization, place of catheterization (intensive care unit [ICU], emergency department, or general ward), type of catheter, length of hospital stay during catheterization, types of cultured bacteria, time to development of central line-associated bloodstream infection (CLABSI), and complications.
During the study period, 333 central vein catheters (CVC) were inserted with a total of 2,626 catheter-days and 97 PICCs were placed with a total of 2,227 catheter-days. The CLABSI rate was significantly lower in the PICC group when the analysis was limited to patients for whom the catheter was changed for the first time in the ICU after CVC insertion in the ER with similar indication and catheter insertion times (18.6 vs. 10.3/1,000 catheter-days, respectively,
The study results showed that the duration of catheter use was longer and the infection rate were lower in the PICC group than in the CVC group, suggesting that PICC is a safe and reliable alternative to conventional CVC.
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This study was conducted to status and needs for continuing education for trauma hospital nurses in Korea.
Thirty nurses from the seven level I trauma center hospitals or trauma treatment systems were randomly selected and surveyed. The survey was conducted from March 1 to May 31, 2017. Categorical data were analyzed with Pearson chi-square tests and Continuous variables were analyzed with ANOVA.
Only 86 out of 204 nurses had received continuing education (42.1%). The current status of continuing education programs, delivering institution (
It is necessary to consider differences between the hospitals to develop continuing education programs that reflect the needs of nurses, in order to improve the efficiency of and satisfaction with the educational programs.
The treatment outcome remains poor of severe facial injuries because of the high risk of compromised airway or massive bleeding. We experienced two successful treatment cases of severe facial injury by the chainsaw. A 52-year-male had his face injured by the chainsaw during his work. He was transferred to the Level I trauma center using the Doctor-Helicopter. During his flight, bleeding control was tried and the information was given to the trauma surgeons before his arrival. His consciousness was alert and the vital signs were stable. The crushing wound, mandible open fracture, deep laceration of tongue, lip, neck and arterial bleeding were noted around his mandible. Nasotracheal intubation was performed under the bronchoscope-guided. Emergency operation (open reduction & internal fixation, primary repair with neurorrhaphy) was performed. At 30 hospital days, he was discharged with facial palsy on left mandibular area. A 30-year-male had his face injured by the chainsaw. He was transferred to our Level I trauma center from the local hospital. The deep-mutiple lacerations on right upper eyelid and forehead with the bony exposure were noted. The vital signs were stable and emergency operation was performed. He was discharged at 20 hospital days. Bone loss or tissue loss were not devastating than we expected even though the injury was occurred by the chainsaw. Aggressive treatment including airway manipulation or bleeding control and maximal opportunity of therapy are absolutely needed.
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Although thoracic endovascular aortic repair (TEVAR) has grown to become the standard of care to treat blunt thoracic aortic injury (BTAI), the long-term effects of TEVAR are still unclear. We here present a 72-year-old man with BTAI due to a traffic accident. He successfully underwent TEVAR and was transferred to another rehabilitation hospital 2 months after the accident. However, 1 month later, he underwent gastroscopy with fever and hematemesis and was diagnosed with aorto-esophageal fistula (AEF). After being re-transferred to Niigata University Medical and Dental Hospital, we tried to convince him to undergo surgical treatment, but he strongly refused. He received palliative care and died due to rupture of the aortic pseudoaneurysm 3 days after the hospital transfer. Fatal complications like AEF may occur after TEVAR, so clinicians need to carefully follow patients who underwent TEVAR.
The growing use of laparoscopy in elective surgery has led to its increase utilization in emergency surgery. However, the employment of laparoscopy in abdominal trauma is still unusual. Here in we report a case of a patient with blunt abdominal trauma that resulted in a combination of exceptional traumatic lesions, diaphragmatic and bladder lacerations. Both injuries were diagnosed and successfully resolved by laparoscopy. The report of this type of lesions and resolution is extremely rare, being this the second case described in the international literature. This article intends to show that laparoscopy may not only be used as a diagnostic tool, but also as a therapeutic instrument in selected cases of blunt abdominal trauma.
Finger reconstruction involves paramount significance of both functional and aesthetic aspects, due to its great impact on quality of life. The options range from primary closure, skin grafts, local flaps, pedicled flaps, and free flaps. The optimal method should consider various circumstances of the patient and surgeon. We would like to report a case of a young woman who initially presented with cellulitis and necrosis of the left second finger-tip who underwent reconstruction with bilateral toe pulp free flap. The patient could successfully return to her job that involves keyboard typing and playing the piano, with acceptable donor site morbidity.
Many techniques have been developed for reconstruction of the hand; however, less attention has been paid to foot reconstruction techniques. In particular, reconstruction of the forefoot and big toe has been considered a minor procedure despite the importance of these body parts for standing and walking. Most of the weight load on the foot is concentrated on the forefoot and big toe, whereas the other toes have a minor role in weight bearing. Moreover, the forefoot and big toe are important for maintaining balance and supporting the body when changing directions. Recently, attention has been focused on the aesthetic appearance and functional aspects of the body, which are important considerations in the field of reconstructive surgery. In patients for whom flap reconstruction in the forefoot and big toe is planned, clinicians should pay close attention to flap survival as well as functional and cosmetic outcomes of surgery. In particular, it is important to assess the ability of the flap to withstand functional weight bearing and maintain sufficient durability under shearing force. Recovery of protective sensation in the forefoot area can reduce the risk of flap loss and promote rapid rehabilitation and functional recovery. Here, we report our experience with two cases of successful reconstruction of the forefoot and big toe with a sensate anterolateral thigh flap, with a review of the relevant literature.
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