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J Trauma Inj : Journal of Trauma and Injury

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Volume 3(2); December 1990
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The Need for Trauma Team and Trauma Center
Kyoung Soo Lim, Moo Eob Ahn, Sung Oh Hwang, Yoon Kyu Chung, Soo Young Yoo, Sung Joon Kang, Hun Joo Kim
J Korean Soc Traumatol. 1990;3(2):71-152.
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AbstractAbstract PDF
With development of economic and social state, the traffic accident and industrial injury is increasing progressively. Especially, the most patients injured by traffic accident or falling-down have multiple injuries. We studied the injured patients who visited emergency center of Wonju Christian Hospital from January 1991 to June 1991 prospectively. Over a 6-month period, 2,669 patients admitted and multiple injured patients occupy 39.2%(1,045/2,669). The severe injured patients who were defined as Injury Severity Score(ISS) was above 16 point occupy 14.2%(378/2,669) and mortality of injured patients was 3.2%(86/2,669). Among expired patients, the D.O.A was 35(40.7%) and the patients expired at E.R was 29(33.7%). And the more multiple injured, the more stay time at emergency center was spent. So we need well-organized trauma team and trauma triage system in recent time. But there are many problems in organizing trauma system, and the most serious problem is financial one in builting trauma center and managing of trauma team. We conclude that trauma triage system and trauma center should be organized in a short time and governmental support in economics must be considered.
Summary
The Role of Computed Tomography and Diagnostic Peritoneal Lavage in Blunt Abdominal Trauma
Myung Soo Kim, Joon Pil Cho, Hoon Sang Chi
J Korean Soc Traumatol. 1990;3(2):83-172.
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AbstractAbstract PDF
We reviewed retrospectively medical records and films of 83 patients who underwent abdominal computed tomogram and/or diagnostic peritoneal lavage following abdominal blunt trauma between January 1986 and december 1990. Thirty eight among 83 patients were operated because of positive findings of abdominal computed tomogram and/or diagnostic peritoneal lavage. Only one patient of thirty eight revealed no definite intraaabdominal organ injuries except non significant retroperitoneal hematoma due to pelvic bone fracture. The interval time from initial evaluation at emergency room to laparotomy was average 8.4 hours. Positive findings of diagnostic peritoneal lavage provided fastest discision of laparotomy, of which time interval was average 6.4 hours. Diagnostic peritoneal lavage showed that sensitivity was 95.8%, specificity 85.7%, and accuracy 93.5%. Abdominal computed tomogram showed that sensitivity was 75.0%, specificity 100%, and accuracy 73.9%. False negative findings were more frequent in patients who was taken abdominal computed tomogram than diagnostic peritoneal lavage. We conclude that in order to facilitate the early and precise recognition of intraab-dominal organ injuries following blunt abdominal trauma, diagnostic peritoneal lav-age is more superior method to abdominal computed tomogram. Nevertheles abdo-minal computed tomogram is non invasive procedures and provides intraabdominal or retroperitoneal organ specific findings. So abdominal computed tomogram helps us to manage hemodynamically stable patients conservatively dependent upon degree of solid organ injuries or retroperitoneal hematoma under close observation.
Summary
Predictors of Injury Severity in the Pediatric Trauma Patients
Soo Young Yoo, Ik Yong Kim, Byung Wook Kang, Kyung Soo Lim, Seong Joon Kang
J Korean Soc Traumatol. 1990;3(2):91-189.
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AbstractAbstract PDF
Trauma is the leading cause of death in the Korean pediatric population. Initial correct assessment of injury severity is necessary to reduce preventable traumatic deaths and it can help the appropriate patient to be referred to the appropriate facility. Injury Severity Score(ISS) system widly used for categorizing the severity of injury requires many clinical datas including radiologic modalities, therefore, it does not provide a quick assessment. Five hundreds and eighty-four injury patients less than sixteen years of age were prospectively assessed for 6 month from May 1, 1990 to October 31, 1990. All patients were initially assessed for mechanism of injury, age, direct or referred admission, time from injury, anatomical site of injury, blood cell count and pediatric trauma score(PTS). After diagnostic procedure or operation, the patients were reevaluated with ISS. Motor vehicle related injuries accounted for 42.9% of all deaths and pedestrian injuries of them caused the greatest number of deaths. The patients referred from local hospitals had the prolonged time interval from injury to arrival and higher mortality rate. We have observed a significantly higher death rate among trauma patients younger than 8 year-old. Anatomically, thoracic or abdominal injury presented higher mortality rate than the other site did. All mortality cases had PTS 4 or below, and ISS above 20. A decreasing PTS was directly associated with an increasing ISS. Count of leucocyte, band-form neutrophil or lymphocyte presented linear relationship with ISS and the parients with total leucocyte count more than 20,000/mm3, lymphocyte more than 4,000/mm3, band-form neutrophil more than 500/mm3 disclosed far more death rate (p< 0.0001). We have concluded that quick assessment of injury patients with evaluation of anatomical injury site, severity scoring with PTS, and blood cell count are readily available means of identifying the high risk patients.
Summary
A Clinical Study of Snake Bite in West Kyungnan
Beong Kwon Hwang, Jung In Je, Sang Bum Kim, Soon Tae Park, Woo Song Ha, Sang Kyung Choi, Soon Chan Hong, Ho Seong Han
J Korean Soc Traumatol. 1990;3(2):100-205.
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AbstractAbstract PDF
We analysed 24 cases of snake bite who were managed at the GNUH from Mar. 1987 to Dec. 1990. The results were as follows; The sex ratio of male to female was 1 : 2 and peak age was 4th decade. August was the most prevalent season of snake bite. The most common predilection site in body was the foot (29.1 %). The time interval from the onset of snake bite to the time when patients arrived for the first aid treatment were 4 hours and 24 hours in 11 cases(45.8%)., The duration of tourniquet application was 2 and 5 hours in 2 cases(8.3%), but in the rest of cases(91.6%) we did not apply tourniquet. The most frequent general symptoms and signs were dyspnea (45.8%) and headache (45.8%) Most common local symptoms and signs were pain (83.3%) and swelling (83.3%). The severe complications were 2 cases of ARF and 1 case of hepatic subcapsular hematoma rupture due to DIC, but there was no case of death.
Summary
Coverage of Open Elbow Joint Using Island Flap
Youn Kyu Chung, Moon Bang Sohn
J Korean Soc Traumatol. 1990;3(2):107-218.
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AbstractAbstract PDF
The management of soft tissue defects of the elbow is a difficult problem. Open elbow joint can inevitably result in leakage of synovial fluid and subsequent joint infection. Soft tissue defect in this area can cause a severe functional disability due to continuous erosion of supporting structures of the joint, and it can further cause the reduction of dislocation or fracture difficult. There fore, an adequate coverage of the lesion and early excercise are important to salvage the elbow joint with good function. Recently I have experienced two parients with exposed elbow joint due to traumatic injury. One has open wound in the posterior aspect of elbow joint and the other in the lateral aspect. I successfully treated the patients using the proximally-based radial forearm island flap and latissimus dorsi muscular island flap with split thickness skin graft. And I also found that two procedures are very useful.
Summary
Abdomiinal Injuries Associated with Pelvic Fracture
Hoon Sang Chi, Tae Wan Ahn, Kang Sup Shim, Joon Pil Cho, Byung Ro Kim
J Korean Soc Traumatol. 1990;3(2):113-232.
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AbstractAbstract PDF
Pelvic fracture due to high energy forces such as motor vehicle accidents, fall from height, and industrial crush injuries-has become one of the most serious injuries. In addition to life threatening hemorrhage itself and post-hemorrhagic complications (post-traumatic respiratory distress syndrome, sepsis, multiple organ failures), local and distant associated injuries, deformities and disabilities are all potential problems for a patient with pelvic fracture. So it is not enough to emphasize the need for an accurate and a rapid diagnosis of associated injuries of hemodynamically stable or unstable patient with pelvic fracture. We retrospectively reviewed medical records of 100 cases of abdominal or perineal injuries associated with pelvic fracture, which had been admitted to departement of General surgery, Yonsei University College of Medicine. During recent 5 years from Jan. 1984 to Dec. 1988. Laparatomy was performed in half of 100 cases. The most common type associated with abdominal injury was retroperitoneal hematoma in 33%. Twenty one patients received transfusion more than 10 units. The overall mortality rate was 6%. The causes of death were sepsis with multiple organ falilures in 3 patients and irreversible hypovolemic shock in 3 patients. In order to manage appropriately hemodynamically stable or unstable patients of pelvic fracture associated with surgical problems we present a management protocol.
Summary
Surgical Evaluation of Splenic Injury & Comparative Analysis of Operative Method
Hee Yeol Bae, Bong Wha Chung, Ki Chu Lee, Soo Tong Pai
J Korean Soc Traumatol. 1990;3(2):121-251.
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AbstractAbstract PDF
Injuries to the speen are commonly encountered by surgeons treating the patients with abdominal trauma. With documentation that overwhelming postsplenectomy infection can occur after splenectomy for trauma, splenic salvage procedure rather than splenectomy have been considered the preferred treatment for traumatic splenic injuries. Splenic salvage has been most often accomplished by splenorrhaphy and more recently by a controversial non-operative approach. This report delineated results with splencetomy, splenorrhaphy and non-operative approach based on 7 years (1984-1990) inwhich 150 consecutive patients with splenic injuries were treated. Results were as follow: 1) The ratio of male to female patients was 2.75: 1 and peak incidence of age was the 3rd decade. 2) The most common cause of splenic injury(52%)was the traffic accident. 3) The most common site of associated trauma is liver(45%)in intraperitoneum and is rib fractures(98%)in extraperitoneum. 4) Of these, 95 patients were treated by splenectomy, 42 patients by splenorrhaphy and 13 patients by non-operative management. 5) Comparative studies of main complication were evaluated by analyzing the values of two groups dividing on each preoperative status concerning to the multiplicity of associated injury, grade of splenic injury and arrival time with X2-test to find higher significance in group of multiple injuries than the opposite group(p< 0.0005). 6) Comparative studies of operative methods were evaluated by analyzing value of two group dividing on duration of operation, amount of transfusion and complica-tion rate with t-test. On result, it was not found any evidence that splenectomy was superior to splenorrhaphy. 7) The overall motality rate was 9.3%.
Summary
Pancreatico-duodenostomy for Iatrogenic Pancreatic Injury during Gastrectomy
Ki Boong Kim, Sung Tae Oh, Yong Wha Moon
J Korean Soc Traumatol. 1990;3(2):132-266.
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AbstractAbstract PDF
Iatrogenic injury of the pancreas may occur in assosiation with a variety of operations or diagnostic studies. We experienced the iatrogenic pancreatic injury during the subtotal gastrectomy and successfully treated with pancreaticoduodenos-tomy without complication. Reviewing the literature and from our experience in this regard, the pancreaticoduodenostomy is not an inappropriate procedure in pancreatic duct injury.
Summary

J Trauma Inj : Journal of Trauma and Injury