Journal of Trauma and Injury

Volume 30(1); March 2017

Original Articles

Efficacy of Nefopam Analgesia for Trauma Patients in the Emergency Department: Tae Youn Lim, Jung Youn Kim, Sung Hyuk Choi, Young Hoon Yoon; J Trauma Inj. 2017;30(1):1-5. Published online March 31, 2017; DOI: https://doi.org/10.20408/jti.2017.30.1.1

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Abstract PDF: PURPOSE
Nefopam is a centrally acting non-narcotic analgesic that has mostly been used for postoperative pain. We examined the efficacy of nefopam analgesia (alone and in combination with ketorolac) for trauma patients in the emergency department.
METHODS
We performed a retrospective chart review to select trauma patients who received nefopam at the emergency department of Korea University Medical Center Guro Hospital between January 2012 and December 2012. Patients younger than 15 years were excluded. The primary outcome measure was change of pain score (numeric rating scale) from baseline (before medication) to 30 min after medication. The secondary outcome measure was requirement for additional analgesia (pethidine).
RESULTS
Records of 1465 trauma patients who received analgesics in the emergency department from January 2012 to December 2012 were examined. Patients were classified into five groups according to initial analgesic: nefopam (n=112), ketorolac (n=867), pethidine (n=365), nefopam+ketorolac (92), and nefopam+pethidine (22). There were no significant differences in pain score reductions among the five groups. Twenty-two patients in the nefopam group, 141 in the ketorolac group, and 29 in the nefopam+ketorolac group required rescue analgesia with pethidine; these rates were not significantly different.
CONCLUSION
The efficacy of nefopam analgesia for trauma patients in the emergency department is comparable to that of more commonly used agents, including ketorolac and pethidine.; Summary

The Impact of Trauma Center Establishment on Laparotomy Patterns and Outcomes in Severe Hemoperitoneum Patients: Min A Lee, Jungnam Lee, Min Chung, Giljae Lee, Jaejeong Park, Kangkook Choi, Byung Chul Yoo; J Trauma Inj. 2017;30(1):6-11. Published online March 31, 2017; DOI: https://doi.org/10.20408/jti.2017.30.1.6

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Abstract PDF: PURPOSE
The establishment of the trauma system has changed the quality of trauma care in many countries. As one of the first designated level I trauma centers in Korea, we hypothesized that there were changes in laparotomy patterns and subsequent survival rates after the center was established.
METHODS
This was a 5-year retrospective study of all severe hemoperitoneum patients who were transfused with more than 10 units of packed red blood cells (RBCs) within 24 h of hospitalization. Variables related to trauma were collected throughout the study period, and the patients admitted before (period 1) and after (period 2) the establishment of a trauma center were compared.
RESULTS
Forty-five patients were managed from January 2009 to March 2015. The baseline patient characteristics of the two groups, including age, Injury Severity Score, blood pressure, and hemoglobin levels, were similar. The time to the operating room (OR) was 144.3±51.5 min (period 1) and 79.9±44.1 min (period 2) (p<0.0001). Damage control surgery (DCS) was performed in 17% of patients during period 1 and in 73% during period 2. The number of actual survivors (n=10) was higher than expected (n=8) in period 2.
CONCLUSION
This is the first study analyzing the impact of a trauma center on the management of specific injuries, such as severe hemoperitoneum, in patients in Korea. During the study, the time to OR was shortened and DCS was used to a greater extent as a surgical procedure.; Summary

Case Reports

Temporary Closure for Sternotomy in Patient with Massive Transfusion Might Be Lethal: Maru Kim, Joongsuck Kim, Sung Jeep Kim, Hang Joo Cho; J Trauma Inj. 2017;30(1):12-15. Published online March 31, 2017; DOI: https://doi.org/10.20408/jti.2017.30.1.12

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Abstract PDF: A 58-year-old male visited our emergency room for multiple traumas from explosion. On initial evaluation, hemopneumoperitoneum with liver laceration (grade 4) and colon perforation was identified. Hemopericardium with cardiac tamponade was also identified. Shrapnel was detected in the right ventricle. Damage control surgery was planned due to condition of hypotension. In operation room, control over bleeding was achieved after sternotomy, pericardiotomy, and laparotomy. Massive transfusion was done during operation. After gauze packing, operation was terminated with temporary closure (TC). Sanguineous fluid was drained profusely. Disseminated intravascular coagulopathy was confirmed through laboratory findings. No extravasation was discovered at hepatic angiogram. On re-operation, there was no active bleeding but oozing from sternotomy site was identified. Bone bleeding was impossible to control. Finally, reoperation was ended after gauze packing and TC all over again. The patient could survive for only a day after re-operation.; Summary

Missed Traumatic Rupture of the Diaphragm: Sang Woo Ryu, Jaykey Chekar, In Ho Yi, Bo Ra Seo, Seong Huek Park, Seong Ju Go; J Trauma Inj. 2017;30(1):16-20. Published online March 31, 2017; DOI: https://doi.org/10.20408/jti.2017.30.1.16

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Abstract PDF

A 48-year-old man came to the emergency department with altered consciousness and hemoperitoneum following a pedestrian traffic accident. He underwent immediate emergency laparotomy, and on the second day, he required craniectomy because of increase of intracranial hemorrhage. A chest radiograph taken 7 days after admission, showed elevation of the right hemi-diaphragm, and follow-up chest CT showed a right-sided rupture of the diaphragm, which was surgically repaired. Rupture of the diaphragm can be easily overlooked and the diagnosis delayed, especially in unstable patients with multiple trauma or altered level of consciousness, as in the case reported here.

Summary

Citations

Citations to this article as recorded by

Identification of Delayed Traumatic Diaphragmatic Injury: A Concise Review
Patricia J. Bartzak
Journal of Trauma Nursing.2022; 29(1): 47. CrossRef

Penetrating Cardiac Injury and Traumatic Pericardial Effusion Caused by a Nail Gun: Willem Guillermo Calderon Miranda, Edgardo Jim?nez Fuentes, Nidia Escobar Hern?ndez, Luis Rafael Moscote Salazar, Paul M Parizel; J Trauma Inj. 2017;30(1):21-23. Published online March 31, 2017; DOI: https://doi.org/10.20408/jti.2017.30.1.21

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Abstract PDF: Penetrating cardiac injury caused by nail gun is an uncommon life-threatening condition characterized by a rapidly severe hemodynamic status compromise. We report non-contrast-enhanced CT findings of a right ventricle myocardium injury leading to a fluid collection in the pericardial space with the same attenuation as blood. The CT findings well depicted the pathological feature of a significant cardiac injury and may be helpful for the surgical management.; Summary

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